NURSING.CRIMINOLOGY.LET.CSE.NAPOLCOM.

FOE REVIEW
4th Floor Insular Life Bldg, Rizal St., Camia Corner, Legazpi City, Albay 4500
Tel. No: 09175002996 / 09171141434
NOVEMBER 2024 NLE SEASON - ENHANCEMENT REVIEW PHASE
ENHANCEMENT EVALUATION EXAM
Instructions:
1. Choose the best answer and shade the corresponding letter on the answer sheet.
2. Avoid erasures or any form of alteration.
3. Use a pencil to shade your answers.
4. You may write, encircle, or underline words on your questionnaire.
1. The goal of medical asepsis is to: 13. Priority medical and nursing concern when managing a patient with
A. Prevent progress of the disease cholera is
B. Treat existing disease condition A. Control episodes of diarrhea and vomiting
C. Control occurrence of a disease B. Replace fluids and electrolytes lost
D. Prevent transmission of infectious microorganisms C. Monitor I and O including vital signs
2. Universal precautions are practiced by health care personnel to D. Monitor and report possible hypovolemic shock
protect:
A. Himself 14. Which of the following characterizes the stool of a patient with
B. The patient cholera?
C. The patient & his family A. Acholic
D. All B. Rice-watery
3. Which organism usually causes self-limiting diseases and C. Mucoid, blood-streaked
administration of antibiotics do not alter the course of the disease. D. Greenish, mushy to watery
A. Bacteria 15. A client who is to receive MMR must first be checked for which of
B. Fungus the following?
C. Virus A. Allergy to antibiotics
D. Protozoan B. Allergy to eggs
4. It is possible that several hours after immunization with DPT. Baby C. History of chicken pox infection
Bean will develop fever, the Nurse will explain that: D. (+) for PPD test
A. Fever is an expected outcome after DPT. 16. Which of the following is the most common cause of bacterial
B. The newborn is allergic to DPT. meningitis among young children ?
C. Infection developed as a result of vaccination. A. Haemophilus influenzae
D. Refer to doctor for possible assessment. B. Streptococcus pneumoniae
5. As Baby Bean reaches 9 months, he was brought to the clinic for his C. Neisseria meningitidis
due immunization, which is D. Listeria monocytogenes
A. BCG 17. A client with meningitis will be placed in which type of isolation
B. DPT technique?
C. OPV A. Airborne precaution
D. Measles B. Droplet precaution
6. What is the dose and route of administration of Measles Vaccine? C. Blood and body fluid precaution
A. Given 0.5 ml, deltoid muscle D. Reverse isolation
B. Given 0.5 ml, SQ, upper arm 18. What is the pathophysiological basis of hydrophobia in Rabies?
C. Given 0.5 ml, vastus lateralis A. Fear of water
D. Given 0.05 ml, ID right deltoid area B. Respiratory spasm
7. Which of the following is not a synonym of Leptospirosis? C. Increase intracranial pressure
A. Swineherd's disease D. Pharyngeal spasm
B. Ictero-hemorrhagica 19. Which of the following is the vehicle of transmission of Rabies?
C. Catarrhal jaundice A. Dog bite
D. Trench fever B. Brain
8. The causative organism of tetanus, Clostridium tetani, will best C. Saliva
thrive in which of the following environment? D. Lick of a dog or scratch of a cat
A. Decaying organic materials like vegetables and fruits 20. Blackwater fever may occur in some clients infected with malaria.
B. Bloody secretions and purulent exudates The Nurse will expect the client with this condition to manifest:
C. Untreated puncture wounds A. Dark urine
D. Post-surgical wound B. Melena
9. Young children can easily acquire tetanus thru which of the C. Low-grade fever
following means? D. Severe chills and fever
A. Getting infected with otitis media 21. What type of immunity is provided with the administration of anti-
B. Decaying temporary teeth diphtheria serum?
C. Any untreated lacerations or wounds A. Artificial active immunity
D. Scratches B. Artificial passive immunity
10. Microorganisms are transmitted to a client when a contaminated C. Natural active immunity
stethoscope touches his skin. The stethoscope is a D. Natural passive immunity
A. Vehicle of transmission 22. Koplik’s spots is to measles as which of the following characterizes
B. Portal of exit Rubella?
C. Portal of entry A. Forscheimer’s spots
D. Route of transmission B. Waterhouse-Friedrichsen
11. Serum hepatitis cannot be clinically distinguished from infectious C. Herman sign
hepatitis, but which laboratory result will distinguish serum D. Ghon complex
hepatitis from infectious hepatitis? 23. What is the important instruction to the client after lumbar
A. HBsAg puncture?
B. Anti-HAV A. Maintain supine position with one pillow support
C. SGPT B. Instruct watcher to observe and report any unusual
D. Anti-HCV manifestations such as headacheand vomiting
12. Which of the following measures can be applied to prevent cholera? C. Lie flat on bed for 6-8 hours
A. Control of flies and proper disposal of feces D. Observe for respiratory difficulty
B. Ensure drinking water is safe for consumption 24. An important nursing consideration prior to administration of
C. Screening of blood donors Mannitol will be to
D. Maintain environmental sanitation A. Check the drug that will be administered for right dose, right
route, right patient

COMMITMENT.EXCELLENCE.QUALITY 1
 B. Check whether the patient is vomiting, with unbearable D. Anti anxiety
headache and restless 39. Known as mood elevators:
C. Check for doctor’s order A. Anti depressants
D. Check for hypotension B. Antipsychotics
C. Anti manic
25. A client with TB meningitis is receiving phenytoin. What nursing D. Anti anxiety
instruction will be emphasized regarding this drug? 40. The priority of care for a client with Alzheimer’s disease is
A. Observe aspiration precaution A. Help client develop coping mechanism
B. Place client in fowler’s position B. Encourage to learn new hobbies and interest
C. Provide oral care regularly C. Provide him stimulating environment
D. Encourage small frequent feedings D. Simplify the environment to eliminate the need to make chores
26. In caring for a dying client, you should perform which of the 41. Autism is diagnosed at:
following activities A. Infancy
A. Do not resuscitate B. 3 years old
B. Assist client to perform ADL C. 5 years old
C. Encourage to exercise D. School age
D. Assist client towards a peaceful death 42. The common characteristic of autism child is:
27. The Nurse is aware that the ability to enter into the life of another A. Impulsitivity
person and perceive his current feelings and their meaning is B. Self destructiveness
known: C. Hostility
A. Belongingness D. Withdrawal
B. Genuineness 43. The nurse is aware that the most common indication in using ECT is:
C. Empathy A. Schizophrenia
D. Respect B. Bipolar
28. The termination phase of the NPR is best described one of the C. Anorexia Nervosa
following: D. Depression
A. Review progress of therapy and attainment of goals 44. A therapy that focuses on here and now principle to promote self-
B. Exploring the client’s thoughts, feelings and concerns acceptance?
C. Identifying and solving patients problem A. Gestalt therapy
D. Establishing rapport B. Cognitive therapy
29. During the process of cocaine withdrawal, the physician orders C. Behavior therapy
which of the following: D. Personality therapy
A. Haloperidol (Haldol) 45. A client has many irrational thoughts. The goal of therapy is to
B. Imipramine (Tofranil) change her:
C. Benztropine (Cogentin) A. Personality
D. Diazepam (Valium) B. Communication
30. The nurse is aware that cocaine is classified as: C. Behavior
A. Hallucinogen D. Cognition
B. Psycho stimulant 46. The appropriate nutrition for Bipolar I disorder, in manic phase is:
C. Anxiolytic A. Low fat, low sodium
D. Narcotic B. Low calorie, high fat
31. In community health nursing, it is the most important risk factor in C. Finger foods, high in calorie
the development of mental illness? D. Small frequent feedings
A. Separation of parents 47. Which of the following activity would be best for a depressed client?
B. Political problems A. Chess
C. Poverty B. Basketball
D. Sexual abuse C. Swimming
32. All of the following are characteristics of crisis except D. Finger painting
A. The client may become resistive and active in stopping the 48. The nurse is aware that clients with severe depression, possess
crisis which defense mechanism:
B. It is self-limiting for 4-6 weeks A. Introjection
C. It is unique in every individual B. Suppression
D. It may also affect the family of the client C. Repression
33. Freud states that temper tantrums is observed in which of the D. Projection
following: 49. Nurse John is aware that self mutilation among Bipolar disorder
A. Oral patients is a means of:
B. Anal A. Overcoming fear of failure
C. Phallic B. Overcoming feeling of insecurity
D. Latency C. Relieving depression
34. The nurse is aware that ego development begins during: D. Relieving anxiety
A. Toddler period 50. Which of the following may cause an increase in the cystitis
B. Preschool age symptoms?
C. School age A. Water
D. Infancy B. Orange juice
35. A 19 year old nursing student has lost 36 lbs for 4 weeks. Her C. Coffee
parents brought her to the hospital for medical evaluation. The D. Mango juice
diagnosis was ANOREXIA NERVOSA. The Primary gain of a client 51. In caring for clients with renal calculi, which is the priority nursing
with anorexia nervosa is: intervention?
A. Weight loss A. Record vital signs
B. Weight gain B. Strain urine
C. Reduce anxiety C. Limit fluids
D. Attractive appearance D. Administer analgesics as prescribed
36. The nurse is aware that the primary nursing diagnosis for the client 52. In patient with renal failure, the diet should be:
is: A. Low protein, low sodium, low potassium
A. Altered nutrition : less than body requirement B. Low protein, high potassium
B. Altered nutrition : more than body requirement C. High carbohydrate, low protein
C. Impaired tissue integrity D. High calcium, high protein
D. Risk for malnutrition 53. Which of the following cannot be corrected by dialysis?
37. After 14 days in the hospital, which finding indicates that her A. Hypernatremia
condition in improving? B. Hyperkalemia
A. She tells the nurse that she had no idea that she is thin C. Elevated creatinine
B. She arrives earlier than scheduled time of group therapy D. Decreased hemoglobin
C. She tells the nurse that she eat 3 times or more in a day 54. Tony with infection is receiving antibiotic therapy. Later the client
D. She gained 4 lbs in two weeks complaints of ringing in the ears. This ototoxicity is damage to:
38. The nurse is aware that ataractics or psychic energizers are also A. 4th CN
known as: B. 8th CN
A. Anti manic C. 7th CN
B. Anti depressant D. 9th CN
C. Antipsychotics

COMMITMENT.EXCELLENCE.QUALITY 2
55. Nurse Emma provides teaching to a patient with recurrent urinary 70. A male client is hospitalized with Guillain-Barre Syndrome. Which
tract infection includes the following: assessment finding is the most significant?
A. Increase intake of tea, coffee and colas A. Even, unlabored respirations
B. Void every 6 hours per day B. Soft, non distended abdomen
C. Void immediately after intercourse C. Urine output of 50 ml/hr
D. Take tub bath everyday D. Warm skin
56. Which assessment finding indicates circulatory constriction in a 71. For a female client with suspected intracranial pressure (ICP), a
male client with a newly applied long leg cast? most appropriate respiratory goal is:
A. Blanching or cyanosis of legs A. Maintain partial pressure of arterial oxygen (Pa O2) above
B. Complaints of pressure or tightness 80mmHg
C. Inability to move toes B. Promote elimination of carbon dioxide
D. Numbness of toes C. Lower the PH
57. During acute gout attack, the nurse administer which of the D. Prevent respiratory alkalosis
following drug: 72. Which nursing assessment would identify the earliest sign of ICP?
A. Prednisone (Deltasone) A. Change in level of consciousness
B. Colchicines B. Temperature of over 103°F
C. Aspirin C. Widening pulse pressure
D. Allopurinol (Zyloprim) D. Unequal pupils
58. Information in the patients chart is inadmissible in court as evidence 73. The greatest danger of an uncorrected atrial fibrillation for a male
when: patient will be which of the following:
A. The client objects to its use A. Pulmonary embolism
B. Handwriting is not legible B. Cardiac arrest
C. It has too many unofficial abbreviations C. Thrombus formation
D. The clients parents refuses to use it D. Myocardial infarction
59. Nurse Karen is revising a client plan of care. During which step of 74. Linda, A 30 year old post hysterectomy client has visited the health
the nursing process does such revision take place? center. She inquired about BSE and asked the nurse when BSE
A. Planning should be performed. You answered that the BSE is best performed:
B. Implementation A. 7 days after menstruation
C. Diagnosing B. At the same day each month
D. Evaluation C. During menstruation
60. When examining a client with abdominal pain, Nurse Hazel should D. Before menstruation
assess: 75. An infant is ordered to recive 500 ml of D5NSS for 24 hours. The
A. Symptomatic quadrant either second or first Intravenous drip is running at 60 gtts/min. How many drops per
B. The symptomatic quadrant last minute should the flow rate be?
C. The symptomatic quadrant first A. 60 gtts/min.
D. Any quadrant B. 21 gtts/min
61. How long will nurse John obtain an accurate reading of temperature C. 30 gtts/min
via oral route? D. 15 gtts/min
A. 3 minutes 76. A client’s nursing diagnosis is Deficient Fluid Volume related to
B. 1 minute excessive fluid loss. Which action related to the fluid management
C. 8 minutes should be delegated to a nursing assistant?
D. 15 minutes a. Administer IV fluids as prescribed by the physician.
62. The one filing the criminal care against an accused party is said to be b. Provide straws and offer fluids between meals.
the? c. Develop plan for added fluid intake over 24 hours
A. Guilty d. Teach family members to assist client with fluid intake
B. Accused 77. The client also has the nursing diagnosis Decreased Cardiac Output
C. Plaintiff related to decrease plasma volume. Which finding on assessment
D. Witness supports this nursing diagnosis?
63. A male client has a standing DNR order. He then suddenly stopped a. Flattened neck veins when client is in supine position
breathing and you are at his bedside. You would: b. Full and bounding pedal and post-tibial pulses
A. Call the physician c. Pitting edema located in feet, ankles, and calves
B. Stay with the client and do nothing d. Shallow respirations with crackles on auscultation
C. Call another nurse 78. The physician has written the following orders for the client with
D. Call the family Excess Fluid volume. The client’s morning assessment includes
64. The ANA recognized nursing informatics heralding its establishment bounding peripheral pulses, weight gain of 2 pounds, pitting ankle
as a new field in nursing during what year? edema, and moist crackles bilaterally. Which order takes priority at
A. 1994 this time?
B. 1992 a. Weight client every morning.
C. 2000 b. Maintain accurate intake and output.
D. 2001 c. Restrict fluid to 1500 mL per day
65. When is the first certification of nursing informatics given? d. Administer furosemide (Lasix) 40 mg IV push
A. 1990-1993 79. You have been pulled to the telemetry unit for the day. The monitor
B. 2001-2002 informs you that the client has developed prominent U waves.
C. 1994-1996 Which laboratory value should you check immediately?
D. 2005-2008 a. Sodium
66. The nurse is assessing a female client with possible diagnosis of b. Potassium
osteoarthritis. The most significant risk factor for osteoarthritis is: c. Magnesium
A. Obesity d. Calcium
B. Race 80. The client’s potassium level is 6.7 mEq/L. Which intervention should
C. Job you delegate to the student nurse under your supervision?
D. Age a. Administer Kayexalate 15 g orally
67. A male client complains of vertigo. Nurse Bea anticipates that the b. Administer spironolactone 25 mg orally
client may have a problem with which portion of the ear? c. Assess WCG strip for tall T waves
A. Tymphanic membranes d. Administer potassium 10 mEq orally
B. Inner ear 81. A client is admitted to the unit with a diagnosis of syndrome of
C. Auricle inappropriate antidiuretic hormone secretion (SIADH). For which
D. External ear electrolyte abnormality will you be sure to monitor?
68. When performing Weber’s test, Nurse Rosean expects that this client a. Hypokalemia
will hear b. Hyperkalemia
A. On unaffected side c. Hyponatremia
B. Longer through bone than air conduction d. Hypernatremia
C. On affected side by bone conduction 82. The charge nurse assigned in the care for a client with acute renal
D. By neither bone or air conduction failure and hypernatremia to you, a newly graduated RN. Which
69. Toy with a tentative diagnosis of myasthenia gravis is admitted for actions can you delegate to the nursing assistant?
diagnostic make up. Myasthenia gravis can confirmed by: a. Provide oral care every 3-4 hours
A. Kernigs sign b. Monitor for indications of dehydration
B. Brudzinski’s sign c. Administer 0.45% saline by IV line
C. A positive sweat chloride test d. Assess daily weights for trends
D. A positive edrophonium (Tensilon) test

COMMITMENT.EXCELLENCE.QUALITY 3
83. You are preparing to discharge a client whose calcium level was low A. Increased urine output, decreased urine specific gravity,
but is now just slightly within the normal range (9-10.5 mg/dL). decreased serum sodium
Which statement by the client indicates the need for additional B. Increased urine output, increased urine specific gravity,
teaching? increased serum sodium
a. “I will call my doctor if I experience muscle twitching or C. Decreased urine output, decreased urine specific gravity,
seizures.” decreased serum sodium
b. “I will make sure to take my vitamin D with my calcium each D. Decreased urine output, increased urine specific gravity,
day.” decreased serum sodium
c. “I will take my calcium pill every morning before breakfast.” 94. Samson is taking hydrochlorothiazide, a potassium-wasting diuretic,
d. “I will avoid dairy products, broccoli, and spinach when I eat.” for treatment of hypertension. As a nurse, you will teach him to
84. A nursing assistant asks why the client with a chronically low report symptoms of adverse effects such as:
phosphorus level needs so much assistance with activities of daily A. Facial muscle spasms
living. What is your best response? B. Frequent loose stools
a. “The client’s low phosphorus is probably due to malnutrition.” C. Mood changes
b. “The client is just worn out form not getting enough rest.” D. Generalized weakness
c. “The client’s skeletal muscles are weak because of the low 95. Spironolactone (Aldactone), an aldosterone antagonist, is prescribed
phosphorus.” for Hermin as a diuretic. Which statement by Hermin indicates that
d. “The client will do more for herself when her phosphorus is the teaching about this medication has been EFFECTIVE?
normal” A. “I can use a salt substitute.”
85. You are reviewing a client’s morning laboratory results. Which of B. “I will have apple juice instead of orange juice.”
these results is of most concern? C. “I can have low-fat cheese.”
a. Serum potassium 5.7 mEq/L D. “I will drink at least 6 glasses of water every day.”
b. Serum sodium 134 mEq/L 96. Joseph, who has been receiving diuretic therapy is admitted to
c. Serum calcium 10.6 mg/dL hospital with a serum potassium level of 3.1 mEq/L. Of the following
d. Serum magnesium 0.8 mEq/L medications that he has been taking at home, which will you be
86. You are the charge nurse. Which client is most appropriate to assign MOST concerned about?
to the step-down unit nurse pulled to the intensive care unit for the A. Oral digoxin (Lanoxin) 0.25 mg daily
day? B. Lantus insulin 24 u subcutaneously every evening
a. A 68-year-old client on ventilator with acute respiratory failure C. Ibuprofen (Motrin) 400 mg every 6 hours
and respiratory acidosis D. Metoprolol (Lopressor) 12.5 mg orally daily
b. A 72-year-old client with COPD and normal arterial blood gases 97. You administered 3% saline to Wanda who has hyponatremia. As
(ABGs) who is ventilator-dependent Wanda’s nurse, which one of your assessment findings will require
c. A 56-year-old new admission client with diabetic ketoacidosis your MOST rapid response?
(DKA) on an insulin drip A. Her blood pressure increased from 120/80 to 142/94 mmHg
d. A 38-year-old client on a ventilator with narcotic overdose and B. There is sediment and blood in Wanda’s urine
respiratory alkalosis C. Wanda’s radial pulse is 105 beats/minute
87. A client with respiratory failure is receiving mechanical ventilation D. There are crackles audible throughout both lungs fields
and continues to produce ABG results indicating respiratory 98. A client has a sodium level of 153. The nurse consults the physician
acidosis. Which action should you expect to correct this problem? and is given orders for dietary restrictions. The nurse should
a. Increase the ventilator rate from 6 to 10 per minute instruct the client to avoid which foods?
b. Decrease the ventilator rate from 10 to 6 per minute A. Cheese
c. Increase the oxygen concentration fro 30% to 40% B. Tomatoes
d. Decrease the oxygen concentration fro 40% to 30% C. Squash
88. You are admitting an elderly client to the medical unit. Which factor D. Apples
indicates that this client has a risk for acid-base imbalances? 99. Which of the following should be reported to the physician
a. Myocardial infarction 1 year ago immediately?
b. Occasional use of antacids A. Monitor showing a sinus rhythm with a premature ventricular
c. Shortness of breath with minimal exertion contractions (PVC) occurring every 10th beat.
d. Chronic renal insufficiency B. Sodium level 130 mEq/L.
89. The nursing assistant reports to you that a client seems very anxious C. Potassium level of 5.9 mEq/L.
and that vital signs included a respiratory rate of 38 per minute. D. Oxygen saturation level of 90% on room air.
Which acid-base imbalance should you suspect? 100. A nurse is reviewing a client’s chart and notices the potassium level
a. Respiratory acidosis is 6.0; the nurse plans on administering which drug from protocol?
b. Respiratory alkalosis A. Sodium polystyrene sulfonate (Kayexalate) 30 grams retention
c. Metabolic acidosis enema _ 1 dose.
d. Metabolic alkalosis B. 1 L normal saline with 20 mEq potassium chloride IV over 2
90. A client is admitted to the unit for chemotherapy. To prevent an hours.
acid-base problem, which of the following would you instruct the C. Normal saline 1 L IV over 10 hours.
nursing assistant to report? D. phosphate/biphosphate (Phospho-Soda) 48 grams by mouth _
a. Repeated episodes of nausea and vomiting 1 dose.
b. Complaints of pain associated with exertion 101. If a male client experienced a cerebrovascular accident (CVA) that
c. Failure to eat all food on breakfast tray damaged the hypothalamus, the nurse would anticipate that the
d. Client hair loss during morning bath client has problems with:
91. A client has a nasogastric tube connected to intermittent wall a. body temperature control.
suction. The student nurse asks why the client’s respiratory rate has b. balance and equilibrium.
decreased. What your best response? c. visual acuity.
a. “It’s common for clients with uncomfortable procedures such d. thinking and reasoning.
as nasogastric tubes to have a higher rate to breathing.” 102. A female client admitted to an acute care facility after a car accident
b. “The client may have a metabolic alkalosis due to the NG develops signs and symptoms of increased intracranial pressure
suctioning and the decreased respiratory rate is a (ICP). The client is intubated and placed on mechanical ventilation
compensatory mechanism.” to help reduce ICP. To prevent a further rise in ICP caused by
c. “Whenever a client develops a respiratory acid-base problem, suctioning, the nurse anticipates administering which drug
increasing the respiratory rate helps correct the problem.” endotracheally before suctioning?
d. “The client is hyperventilating because of anxiety and we will a. phenytoin (Dilantin)
have to stay alert for development of a respiratory acidosis b. mannitol (Osmitrol)
92. A client has blood drawn for an electrolyte profile. The venipuncture c. lidocaine (Xylocaine)
was difficult and the blood aspiration was slow. The findings d. furosemide (Lasix)
included the following: sodium 150 mEq/L, potassium 6.1 mEq/L, 103. After striking his head on a tree while falling from a ladder, a young
chloride 101 mEq/L, and CO2 25 mEq/L. Which conclusion could man age 18 is admitted to the emergency department. He’s
the nurse draw from this information? unconscious and his pupils are nonreactive. Which intervention
A. The client is doing well as all values are normal. would be the most dangerous for the client?
B. The sodium is low so the client may have heat stroke. a. Give him a barbiturate.
C. The CO2 is elevated so there may be a respiratory problem. b. Place him on mechanical ventilation.
D. The potassium is high, the specimen may have been c. Perform a lumbar puncture.
hemolyzed. d. Elevate the head of his bed.
93. Due to hypothalamus dysfunction, a syndrome of inappropriate 104. When obtaining the health history from a male client with retinal
antidiuretic hormone develops. Which of the following detachment, the nurse expects the client to report:
manifestations will Helen watch CLOSELY? a. light flashes and floaters in front of the eye.
b. a recent driving accident while changing lanes.

COMMITMENT.EXCELLENCE.QUALITY 4
 c. headaches, nausea, and redness of the eyes. Which behavior indicates that the client accurately understands
d. frequent episodes of double vision. safety measures related to paralysis?
105. Which nursing diagnosis takes highest priority for a client with a. The client leaves the side rails down.
Parkinson’s crisis? b. The client uses a mirror to inspect the skin.
a. Imbalanced nutrition: Less than body requirements c. The client repositions only after being reminded to do so.
b. Ineffective airway clearance d. The client hangs the left arm over the side of the wheelchair.
c. Impaired urinary elimination 115. A male client in the emergency department has a suspected
d. Risk for injury neurologic disorder. To assess gait, the nurse asks the client to take
106. To encourage adequate nutritional intake for a female client with a few steps; with each step, the client’s feet make a half circle. To
Alzheimer’s disease, the nurse should: document the client’s gait, the nurse should use which term?
a. stay with the client and encourage him to eat. a. Ataxic
b. help the client fill out his menu. b. Dystrophic
c. give the client privacy during meals. c. Helicopod
d. fill out the menu for the client. d. Steppage
107. The nurse is performing a mental status examination on a male 116. A client, age 22, is admitted with bacterial meningitis. Which
client diagnosed with subdural hematoma. This test assesses which hospital room would be the best choice for this client?
of the following? a. A private room down the hall from the nurses’ station
a. Cerebellar function b. An isolation room three doors from the nurses’ station
b. Intellectual function c. A semiprivate room with a 32-year-old client who has viral
c. Cerebral function meningitis
d. Sensory function d. A two-bed room with a client who previously had bacterial
108. Shortly after admission to an acute care facility, a male client with a meningitis
seizure disorder develops status epilepticus. The physician orders 117. A physician diagnoses a client with myasthenia gravis, prescribing
diazepam (Valium) 10 mg I.V. stat. How soon can the nurse pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before
administer a second dose of diazepam, if needed and prescribed? administering this anticholinesterase agent, the nurse reviews the
a. In 30 to 45 seconds client’s history. Which preexisting condition would contraindicate
b. In 10 to 15 minutes the use of pyridostigmine?
c. In 30 to 45 minutes a. Ulcerative colitis
d. In 1 to 2 hours b. Blood dyscrasia
109. A female client complains of periorbital aching, tearing, blurred c. Intestinal obstruction
vision, and photophobia in her right eye. Ophthalmologic d. Spinal cord injury
examination reveals a small, irregular, nonreactive pupil — a 118. A female client is admitted to the facility for investigation of balance
condition resulting from acute iris inflammation (iritis). As part of and coordination problems, including possible Ménière’s disease.
the client’s therapeutic regimen, the physician prescribes atropine When assessing this client, the nurse expects to note:
sulfate (Atropisol), two drops of 0.5% solution in the right eye twice a. vertigo, tinnitus, and hearing loss.
daily. Atropine sulfate belongs to which drug classification? b. vertigo, vomiting, and nystagmus
a. Parasympathomimetic agent c. vertigo, pain, and hearing impairment.
b. Sympatholytic agent d. vertigo, blurred vision, and fever.
c. Adrenergic blocker 119. A male client with a conductive hearing disorder caused by
d. Cholinergic blocker ankylosis of the stapes in the oval window undergoes a
110. Emergency medical technicians transport a 27-year-old iron worker stapedectomy to remove the stapes and replace the impaired bone
to the emergency department. They tell the nurse, “He fell from a with a prosthesis. After the stapedectomy, the nurse should provide
two-story building. He has a large contusion on his left chest and a which client instruction?
hematoma in the left parietal area. He has a compound fracture of a. “Lie in bed with your head elevated, and refrain from blowing
his left femur and he’s comatose. We intubated him and he’s your nose for 24 hours.”
maintaining an arterial oxygen saturation of 92% by pulse oximeter b. “Try to ambulate independently after about 24 hours.”
with a manual-resuscitation bag.” Which intervention by the nurse c. “Shampoo your hair every day for 10 days to help prevent ear
has the highest priority? infection.”
a. Assessing the left leg d. “Don’t fly in an airplane, climb to high altitudes, make sudden
b. Assessing the pupils movements, or expose yourself to loud sounds for 30 days.”
c. Placing the client in Trendelenburg’s position 120. Nurse Oliver is monitoring a client for adverse reactions to
d. Assessing level of consciousness dantrolene (Dantrium). Which adverse reaction is most common?
111. An auto mechanic accidentally has battery acid splashed in his eyes. a. Excessive tearing
His coworkers irrigate his eyes with water for 20 minutes, and then b. Urine retention
take him to the emergency department of a nearby hospital, where c. Muscle weakness
he receives emergency care for corneal injury. The physician d. Slurred speech
prescribes dexamethasone (Maxidex Ophthalmic Suspension), two 121. The nurse is monitoring a male client for adverse reactions to
drops of 0.1% solution to be instilled initially into the conjunctival atropine sulfate (Atropine Care) eyedrops. Systemic absorption of
sacs of both eyes every hour; and polymyxin B sulfate (Neosporin atropine sulfate through the conjunctiva can cause which adverse
Ophthalmic), 0.5% ointment to be placed in the conjunctival sacs of reaction?
both eyes every 3 hours. Dexamethasone exerts its therapeutic a. Tachycardia
effect by: b. Increased salivation
a. increasing the exudative reaction of ocular tissue. c. Hypotension
b. decreasing leukocyte infiltration at the site of ocular d. Apnea
inflammation. 122. A male client is admitted with a cervical spine injury sustained
c. inhibiting the action of carbonic anhydrase. during a diving accident. When planning this client’s care, the nurse
d. producing a miotic reaction by stimulating and contracting the should assign highest priority to which nursing diagnosis?
sphincter muscles of the iris. a. Impaired physical mobility
112. Nurse April is caring for a client who underwent a lumbar b. Ineffective breathing pattern
laminectomy 2 days ago. Which of the following findings should the c. Disturbed sensory perception (tactile)
nurse consider abnormal? d. Self-care deficient: Dressing/grooming
a. More back pain than the first postoperative day 123. A male client has a history of painful, continuous muscle spasms. He
b. Paresthesia in the dermatomes near the wounds has taken several skeletal muscle relaxants without experiencing
c. Urine retention or incontinence relief. His physician prescribes diazepam (Valium), 2 mg P.O. twice
d. Temperature of 99.2° F (37.3° C) daily. In addition to being used to relieve painful muscle spasms,
113. After an eye examination, a male client is diagnosed with open-angle diazepam also is recommended for:
glaucoma. The physician prescribes pilocarpine ophthalmic solution a. long-term treatment of epilepsy.
(Pilocar), 0.25% gtt i, OU q.i.d. Based on this prescription, the nurse b. postoperative pain management of laminectomy clients.
should teach the client or a family member to administer the drug c. postoperative pain management of diskectomy clients
by: d. treatment of spasticity associated with spinal cord lesions.
a. instilling one drop of pilocarpine 0.25% into both eyes daily. 124. A female client who was found unconscious at home is brought to
b. instilling one drop of pilocarpine 0.25% into both eyes four the hospital by a rescue squad. In the intensive care unit, the nurse
times daily. checks the client’s oculocephalic (doll’s eye) response by:
c. instilling one drop of pilocarpine 0.25% into the right eye daily. a. introducing ice water into the external auditory canal.
d. instilling one drop of pilocarpine 0.25% into the left eye four b. touching the cornea with a wisp of cotton.
times daily. c. turning the client’s head suddenly while holding the eyelids
114. A female client who’s paralyzed on the left side has been receiving open.
physical therapy and attending teaching sessions about safety. d. shining a bright light into the pupil.

COMMITMENT.EXCELLENCE.QUALITY 5
125. While reviewing a client’s chart, the nurse notices that the female a. Sugar
client has myasthenia gravis. Which of the following statements b. Bread
about neuromuscular blocking agents is true for a client with this c. Margarine
condition? d. Filled milk
a. The client may be less sensitive to the effects of a 137. Which of the following clients should be classified as a case of
neuromuscular blocking agent. multibacillary leprosy?
b. Succinylcholine shouldn’t be used; pancuronium may be used a. 3 skin lesions, negative slit skin smear
in a lower dosage. b. 3 skin lesions, positive slit skin smear
c. Pancuronium shouldn’t be used; succinylcholine may be used c. 5 skin lesions, negative slit skin smear
in a lower dosage. d. 5 skin lesions, positive slit skin smear
d. Pancuronium and succinylcholine both require cautious 138. To improve compliance to treatment, what innovation is being
administration. implemented in DOTS?
126. Which is the primary goal of community health nursing? a. Having the health worker follow up the client at home
a. To support and supplement the efforts of the medical b. Having the health worker or a responsible family member
profession in the promotion of health and prevention of illness monitor drug intake
b. To enhance the capacity of individuals, families and c. Having the patient come to the health center every month to
communities to cope with their health needs get his medications
c. To increase the productivity of the people by providing them d. Having a target list to check on whether the patient has
with services that will increase their level of health collected his monthly supply of drugs
139. A 1-year-old child was classified as having 3rd degree protein
d. To contribute to national development through promotion of
energy malnutrition, Kwashiorkor. Which of the following signs will
family welfare, focusing particularly on mothers and children.
be most apparent in this child?
127. R.A. 1054 is also known as the Occupational Health Act. Aside from a. Voracious appetite
number of employees, what other factor must be considered in b. Wasting
determining the occupational health privileges to which the workers c. Apathy
will be entitled? d. Edema
a. Type of occupation: agricultural, commercial, industrial 140. Based on assessment, you classified a 3-month-old infant with the
b. Location of the workplace in relation to health facilities chief complaint of diarrhea in the category of SOME DEHYDRATION.
c. Classification of the business enterprise based on net profit Based on IMCI management guidelines, which of the following will
d. Sex and age composition of employees you do?
128. “Public health services are given free of charge.” Is this statement a. Bring the infant to the nearest facility where IV fluids can be
true or false? given.
a. The statement is true; it is the responsibility of government to b. Supervise the mother in giving 200 to 400 ml. of Oresol in
provide basic services. 4 hours.
b. The statement is false; people pay indirectly for public c. Give the infant’s mother instructions on home management.
health services. d. Keep the infant in your health center for close observation.
c. The statement may be true or false, depending on the specific 141. PrimeWater provides water Sorsogon City and several others in
service required. Sorsogon Province. This is an example of which level of water
d. The statement may be true or false, depending on policies of facility?
the government concerned. a. I
129. Region IV Hospital is classified as what level of facility? b. II
a. Primary c. III
b. Secondary d. IV
c. Intermediate 142. You are the PHN in the city health center. A client underwent
d. Tertiary screening for AIDS using ELISA. His result was positive. What is the
130. One of the participants in a hilot training class asked you to whom best course of action that you may take?
she should refer a patient in labor who develops a complication. You a. Get a thorough history of the client, focusing on the practice of
will answer, to the: high-risk behaviors.
a. Public Health Nurse b. Ask the client to be accompanied by a significant person before
b. Rural Health Midwife revealing the result.
c. Municipal Health Officer c. Refer the client to the physician since he is the best person to
d. Any of these health professionals reveal the result to the client.
131. The public health nurse is responsible for presenting the municipal d. Refer the client for a supplementary test, such as Western
health statistics using graphs and tables. To compare the frequency blot, since the ELISA result may be false.
of the leading causes of mortality in the municipality, which graph 143. Using IMCI guidelines, you classify a child as having severe
will you prepare? pneumonia. What is the best management for the child?
a. Line a. Prescribe an antibiotic.
b. Bar b. Refer him urgently to the hospital.
c. Pie c. Instruct the mother to increase fluid intake.
d. Scatter diagram d. Instruct the mother to continue breastfeeding.
132. Which is CONTRARY to the principles in planning a home visit? 144. The number of cases of Leptospirosis usually increases towards the
a. A home visit should have a purpose or objective. end of the rainy season. This pattern of occurrence of Leptospirosis
b. The plan should revolve around family health needs. is best described as;
c. A home visit should be conducted in the manner a. Epidemic occurrence
prescribed by the RHU. b. Cyclical variation
d. Planning of continuing care should involve a responsible family c. Sporadic occurrence
member. d. Secular occurrence
133. Which is a characteristic of person-to-person propagated 145. Which biological used in Expanded Program on Immunization (EPI)
epidemics? should NOT be stored in the freezer?
a. There are more cases of the disease than expected. a. DPT
b. The disease must necessarily be transmitted through a vector. b. Oral polio vaccine
c. The spread of the disease can be attributed to a common c. Measles vaccine
vehicle. d. MMR
d. There is a gradual build-up of cases before the epidemic 146. When residents obtain water from an artesian well in the
becomes easily noticeable. neighborhood, the level of this approved type of water facility is
134. To describe the sex composition of the population, which a. I
demographic tool may be used? b. II
a. Sex ratio c. III
b. Sex proportion d. IV
c. Population pyramid 147. Sputum examination is the major screening tool for pulmonary
d. Any of these may be used. tuberculosis. Clients would sometimes get false negative results in
135. Which of the following professionals can sign the birth certificate? this exam. This means that the test is not perfect in terms of which
a. Public health nurse characteristic of a diagnostic examination?
b. Rural health midwife a. Effectiveness
c. Municipal health officer b. Efficacy
d. Any of these health professionals c. Specificity
136. Food fortification is one of the strategies to prevent micronutrient d. Sensitivity
deficiency conditions. R.A. 8976 mandates fortification of certain 148. Which of the following is NOT a primary role of a community health
food items. Which of the following is among these food items? nurse in epidemiology?

COMMITMENT.EXCELLENCE.QUALITY 6
 a. Collecting and analyzing data on health trends 162. Among children aged 2 months to 3 years, the most prevalent form
b. Educating the community about disease prevention of meningitis is caused by which microorganism?
c. Administering vaccines to prevent outbreaks a. Hemophilus influenzae
d. Providing treatment for individuals with chronic diseases b. Morbillivirus
149. What is the term used to describe the spread of a disease across c. Steptococcus pneumoniae
multiple countries or continents? d. Neisseria meningitidis
a. Pandemic 163. Human beings are the major reservoir of malaria. Which of the
b. Epidemic following strategies in malaria control is based on this fact?
c. Outbreak a. Stream seeding
d. Endemic b. Stream clearing
150. Which of the following interventions is an example of secondary c. Destruction of breeding places
prevention in epidemiology? d. Zooprophylaxis
a. Implementing smoking cessation programs 164. The use of larvivorous fish in malaria control is the basis for which
b. Screening for breast cancer strategy of malaria control?
c. Providing insulin therapy for diabetes a. Stream seeding
d. Promoting healthy eating habits b. Stream clearing
151. In the Philippines, which condition is the most frequent cause of c. Destruction of breeding places
death associated with schistosomiasis? d. Zooprophylaxis
a. Liver cancer 165. Mosquito-borne diseases are prevented mostly with the use of
b. Liver cirrhosis mosquito control measures. Which of the following is NOT
c. Bladder cancer appropriate for malaria control?
d. Intestinal perforation a. Use of chemically treated mosquito nets
152. What is the most effective way of controlling schistosomiasis in an b. Seeding of breeding places with larva-eating fish
endemic area? c. Destruction of breeding places of the mosquito vector
a. Use of molluscicides d. Use of mosquito-repelling soaps, such as those with basil or
b. Building of foot bridges citronella
c. Proper use of sanitary toilets 166. A 4-year old client was brought to the health center with the chief
d. Use of protective footwear, such as rubber boots complaint of severe diarrhea and the passage of “rice water” stools.
153. When residents obtain water from an artesian well in the The client is most probably suffering from which condition?
neighborhood, the level of this approved type of water facility is a. Giardiasis
a. I b. Cholera
b. II c. Amebiasis
c. III d. Dysentery
d. IV 167. In the Philippines, which specie of schistosoma is endemic in certain
154. For prevention of hepatitis A, you decided to conduct health regions?
education activities. Which of the following is IRRELEVANT? a. S. mansoni
a. Use of sterile syringes and needles b. S. japonicum
b. Safe food preparation and food handling by vendors c. S. malayensis
c. Proper disposal of human excreta and personal hygiene d. S. haematobium
d. Immediate reporting of water pipe leaks and illegal water 168. A 32-year old client came for consultation at the health center with
connections the chief complaint of fever for a week. Accompanying symptoms
155. Which biological used in Expanded Program on Immunization (EPI) were muscle pains and body malaise. A week after the start of fever,
should NOT be stored in the freezer? the client noted yellowish discoloration of his sclera. History showed
a. DPT that he waded in flood waters about 2 weeks before the onset of
b. Oral polio vaccine symptoms. Based on his history, which disease condition will you
c. Measles vaccine suspect?
d. MMR a. Hepatitis A
156. You will conduct outreach immunization in a barangay with a b. Hepatitis B
population of about 1500. Estimate the number of infants in the c. Tetanus
barangay. d. Leptospirosis
a. 45 169. MWSS provides water to Manila and other cities in Metro Manila.
b. 50 This is an example of which level of water facility?
c. 55 a. I
d. 60 b. II
157. In Integrated Management of Childhood Illness, severe conditions c. III
generally require urgent referral to a hospital. Which of the d. IV
following severe conditions DOES NOT always require urgent 170. You are the PHN in the city health center. A client underwent
referral to a hospital? screening for AIDS using ELISA. His result was positive. What is the
a. Mastoiditis best course of action that you may take?
b. Severe dehydration a. Get a thorough history of the client, focusing on the practice of
c. Severe pneumonia high risk behaviors.
d. Severe febrile disease b. Ask the client to be accompanied by a significant person before
158. A client was diagnosed as having Dengue fever. You will say that revealing the result.
there is slow capillary refill when the color of the nailbed that you c. Refer the client to the physician since he is the best person to
pressed does not return within how many seconds? reveal the result to the client.
a. 3 d. Refer the client for a supplementary test, such as Western blot,
b. 5 since the ELISA result may be false.
c. 8 171. Which is the BEST control measure for AIDS?
d. 10 a. Being faithful to a single sexual partner
159. A 3-year old child was brought by his mother to the health center b. Using a condom during each sexual contact
because of fever of 4-day duration. The child had a positive c. Avoiding sexual contact with commercial sex workers
tourniquet test result. In the absence of other signs, which is the d. Making sure that one’s sexual partner does not have signs of
most appropriate measure that the PHN may carry out to prevent AIDS
Dengue shock syndrome? 172. The most frequent causes of death among clients with AIDS are
a. Insert an NGT and give fluids per NGT. opportunistic diseases. Which of the following opportunistic
b. Instruct the mother to give the child Oresol. infections is characterized by tonsillopharyngitis?
c. Start the patient on intravenous fluids STAT. a. Respiratory candidiasis
d. Refer the client to the physician for appropriate management. b. Infectious mononucleosis
160. The pathognomonic sign of measles is Koplik’s spot. You may see c. Cytomegalovirus disease
Koplik’s spot by inspecting the _____. d. Pneumocystis carinii pneumonia
a. Nasal mucosa 173. To determine possible sources of sexually transmitted infections,
b. Buccal mucosa which is the BEST method that may be undertaken by the public
c. Skin on the abdomen health nurse?
d. Skin on the antecubital surface a. Contact tracing
161. Among the following diseases, which is airborne? b. Community survey
a. Viral conjunctivitis c. Mass screening tests
b. Acute poliomyelitis d. Interview of suspects
c. Diphtheria
d. Measles

COMMITMENT.EXCELLENCE.QUALITY 7
174. Antiretroviral agents, such as AZT, are used in the management of 186. Nina, an oncology nurse educator is speaking to a women’s group
AIDS. Which of the following is NOT an action expected of these about breast cancer. Questions and comments from the audience
drugs. reveal a misunderstanding of some aspects of the disease. Various
a. They prolong the life of the client with AIDS. members of the audience have made all of the following statements.
b. They reduce the risk of opportunistic infections Which one is accurate?
c. They shorten the period of communicability of the disease. a. Mammography is the most reliable method for detecting breast
d. They are able to bring about a cure of the disease condition. cancer.
175. A barangay had an outbreak of German measles. To prevent b. Breast cancer is the leading killer of women of childbearing
congenital rubella, what is the BEST advice that you can give to age.
women in the first trimester of pregnancy in the barangay? c. Breast cancer requires a mastectomy.
a. Advice them on the signs of German measles. d. Men can develop breast cancer.
b. Avoid crowded places, such as markets and moviehouses. 187. In caring for a patient with neutropenia, what tasks can be delegated
c. Consult at the health center where rubella vaccine may be to the nursing assistant? (Choose all that apply).
given. i. Take vital signs every 4 hours
d. Consult a physician who may give them rubella ii. Report temperature elevation >100.4o F
immunoglobulin. iii. Assess for sore throat, cough, or burning with urination.
176. Nurse Farah is caring for a client following a mastectomy. Which iv. Gather the supplies to prepare the room for protective
assessment finding indicates that the client is experiencing a isolation.
complication related to the surgery? v. Report superinfections, such as candidiasis
a. Pain at the incisional site vi. Practice good handwashing technique.
b. Arm edema on the operative side A. 1, 2, 4, 6
c. Sanguineous drainage in the Jackson-Pratt drain B. 1, 4, 5, 3
d. Complaints of decreased sensation near the operative site C. 1, 2, 5, 6
177. Sarah, a hospice nurse visits a client dying of ovarian cancer. During D. 1, 3, 5, 2
the visit, the client expresses that “If I can just live long enough to 188. Materials used in radiation Therapy should be disposed in a garbage
attend my daughter’s graduation, I’ll be ready to die.” Which phrase bin that is colored:
of coping is this client experiencing? a. Yellow
a. Anger b. Orange
b. Denial c. Green
c. Bargaining d. Black
d. Depression 189. When assigning staff to patients who are receiving chemotherapy,
178. Mr. Miller has been diagnosed with bone cancer. You know this type what is the major consideration about chemotherapeutic drugs?
of cancer is classified as: a. During preparation, drugs may be absorbed through the skin
a. sarcoma. or inhaled.
b. lymphoma b. Many chemotherapeutics are vesicants.
c. carcinoma c. Chemotherapeutics are frequently given through central
d. melanoma nervous access devices.
179. During the admission assessment of a 35-year-old client with d. Oral and venous routes are the most common.
advanced ovarian cancer, the nurse recognizes which symptom as 190. For a patient who is experiencing side effects of radiation therapy,
typical of the disease? which task would be the most appropriate to delegate to the nursing
a. Diarrhea assistant?
b. Hypermenorrhea a. Assist the patient to identify patterns of fatigue.
c. Abdominal bleeding b. Recommend participation in a walking program.
d. Abdominal distention c. Report the amount and type of food consumed from the
180. The home health care nurse is caring for a male client with cancer tray.
and the client is complaining of acute pain. The appropriate nursing d. Check the skin for redness and irritation after the treatment.
assessment of the client’s pain would include which of the 191. Which patient is at greatest risk for pancreatic cancer?
following? a. An elderly black male with a history of smoking and
a. The client’s pain rating alcohol use
b. Nonverbal cues from the client b. A young, white obese female with no known health issues
c. The nurse’s impression of the client’s pain c. A young black male with juvenile onset diabetes
d. Pain relief after appropriate nursing intervention d. An elderly white female with a history of pancreatitis
181. A cervical radiation implant is placed in the client for treatment of 192. A 56-year-old patient comes to the walk-in clinic for scant rectal
cervical cancer. The nurse initiates what most appropriate activity bleeding and intermittent diarrhea and constipation for the past
order for this client? several months. There is a history of polyps and a family history for
a. Bed rest colorectal cancer. While you are trying to teach about colonoscopy,
b. Out of bed ad-lib the patient becomes angry and threatens to leave. What is the
c. Out of bed in a chair only priority diagnosis?
d. Ambulation to the bathroom only a. Diarrhea/Constipation related to altered bowel patterns
182. The male client is receiving external radiation to the neck for cancer b. Knowledge Deficit related to disease process and diagnostic
of the larynx. The most likely side effect to be expected is: procedure
a. Dyspnea c. Risk for Fluid Volume Deficit related to rectal bleeding and
b. Diarrhea diarrhea
c. Sore throat d. Anxiety related to unknown outcomes and perceive threat
d. Constipation to body integrity
183. Vanessa, a community health nurse conducts a health promotion 193. In assigning patients with alterations related to gastrointestinal (GI)
program regarding testicular cancer to community members. The cancer, which would be the most appropriate nursing care tasks to
nurse determines that further information needs to be provided if a assign to the LPN/LVN, under supervision of the team leader RN?
community member states that which of the following is a sign of a. A patient with severe anemia secondary to GI bleeding
testicular cancer? b. A patient who needs enemas and antibiotics to control GI
a. Alopecia bacteria
b. Back pain c. A patient who needs pre-op teaching for bowel resection
c. Painless testicular swelling surgery
d. Heavy sensation in the scrotum d. A patient who needs central line insertion for chemotherapy
184. Nurse Bea is reviewing the laboratory results of a client diagnosed 194. For a patient who is receiving chemotherapy, which laboratory
with multiple myeloma. Which of the following would the nurse result is of particular importance?
expect to note specifically in this disorder? a. WBC
a. Increased calcium b. PT and PTT
b. Increased white blood cells c. Electrolytes
c. Decreased blood urea nitrogen level d. BUN
d. Decreased number of plasma cells in the bone marrow 195. Materials used in radiation Therapy should be disposed in a garbage
185. Mina, who is suspected of an ovarian tumor is scheduled for a pelvic bin that is colored:
ultrasound. The nurse provides which pre-procedure instruction to a. Yellow
the client? b. Orange
a. Eat a light breakfast only c. Green
b. Maintain an NPO status before the procedure d. Black
c. Wear comfortable clothing and shoes for the procedure 196. Following chemotherapy, a patient is being closely monitored for
d. Drink six to eight glasses of water without voiding before tumor lysis syndrome. Which laboratory value requires particular
the test attention?

COMMITMENT.EXCELLENCE.QUALITY 8
 a. Platelet count
b. Electrolytes
c. Hemoglobin
d. Hematocrit
197. Nurse Meredith is instructing a premenopausal woman about breast
self-examination. The nurse should tell the client to do her self-
examination:
a. at the end of her menstrual cycle.
b. on the same day each month.
c. on the 1st day of the menstrual cycle.
d. immediately after her menstrual period.
198. A female client with cancer is receiving chemotherapy and develops
thrombocytopenia. The nurse identifies which intervention as the
highest priority in the nursing plan of care?
a. Monitoring temperature
b. Ambulation three times daily
c. Monitoring the platelet count
d. Monitoring for pathological fractures
199. 199.A male client is diagnosed as having a bowel tumor and several
diagnostic tests are prescribed. The nurse understands that which
test will confirm the diagnosis of malignancy?
a. Biopsy of the tumor
b. Abdominal ultrasound
c. Magnetic resonance imaging
d. Computerized tomography scan
200. The male client is receiving external radiation to the neck for cancer
of the larynx. The most likely side effect to be expected is:
a. Dyspnea
b. Diarrhea
c. Sore throat
d. Constipation

COMMITMENT.EXCELLENCE.QUALITY 9