DMC-College Foundation Inc.Sta. Filomena, Dipolog CityCOLLEGE OF NURSING

HIGHER EDUCATION DEPARTMENT NCM 103 SEMI-FINAL EXAMINATION Joseph B. Lagod, MN

Name: ____________________________ Course: ________________________Year/Section: _______________________ Date: __________________________

Multiple-Choice TestDirection: ENCIRCLE the LETTER of CHOICE. Neither ERASURES nor SUPERIMPOSITIONS are allowed.

1. Mang Ronald is being treated in the clinic for hypertension. His blood pressure is 170/92 and he is complaining of fatigue and lassitude. He has been taking propanolol (Inderal) 80 mg bid. The BEST indication that previous teaching about this drug has been SUCCESSFUL is that he

A. checks his pulse for bradycardiaB. makes an appointment as soon as he notices fatigueC. stops the drug when he experiences chest painD. takes the drug with breakfast and dinner

2. Mang Helton is recovering from a bowel resection surgery and is on his third post-op day. He is complaining that the area around the calf of his leg is warm and tender. Suspecting he may have developed a thrombus, the nurse will observe Mang Helton for common manifestations of deep vein thrombosis which is

A. absence of pulse distal to the clotB. cyanosis distal to the clotC. pain on dorsiflexionD. reddened area around the clot

3. Mr. Domingo has been treated over the years for chronic venous insufficiency. The nurse caring for Mr. Domingo reminds him that the underlying cause of his venous insufficiency is

A. congestive heart failureB. hypertrophied leg musclesC. decreased hemoglobin levelsD. poor blood return to the heart

4. A goal of care for Mr. Domingo with venous insufficiency is the control of swelling. The primary mechanism for achieving this is to

A. exercise vigorouslyB. restrict fluid intakeC. promote gravity drainageD. eat a high-protein, low-salt diet

5. Prolonged bedrest after surgery appears to promote hemostasis, particularly in the deep veins of the calves. The most likely pathologic result of such hemostasis may be thrombus formation and A. cerebral embolism C. pulmonary embolism B. coronary occlusion D. dry gangrene of a limb

6. A client is being instructed on the use of antiembolic stockings. The nurse should teach the client that the stockings should be A. alternately kept on 2 hours and off 2 hours B. worn only at night when activity is lessened C. put on before getting out of bed in the morning D. left in place until the physician advised otherwise

7. A pulsating abdominal mass usually indicates which of the following conditions? A. Abdominal aortic aneurysm B. Enlarged spleen

C. Gastic distentionD. Gastritis

8. Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal aortic aneurysm client?

A. Bruit B. Crackles C. Dullness D. Thrill

9. Which hereditary disease is MOST closely linked to aneurysm?

A. Cystic fibrosisB. Lupus erythematosusC. Marfan's syndromeD. Myocardial infarction

10. Which of the following treatments is the definitive for a ruptured aneurysm? A. Antihypertensive medication administration B. Aortogram C. Beta-adrenergic blocker administration D. Surgical intervention

Situation: As a nurse you have to be prepared to care for patients receiving blood transfusion. The physician has ordered 3 units of whole blood to be transfused to Diego following a repair of a dissecting aneurysm of the aorta.

11. You are preparing a unit of whole blood for transfusion. From the time you obtain it from the blood bank how long should you infuse it?

A. 4 hours C. 2 hoursB. 1 hour D. 6 hours

12. What should you do FIRST before you administer blood transfusion? A. Check IV site and use appropriate BT set and needle B. Verify physician’s order C. Verify client identity and blood product blood product, serial number, blood type, cross matching results, expiration

date with another nurse D. Verify client identity and blood product, serial number, blood type, cross matching results, expiration date

13. As Diego's nurse what will you do after the transfusion has been started? A. Discontinue the primary IV of Dextrose 5% water B. Stay with Diego for 15 minutes to note for any possible BT reaction C. Check his vital signs every 15 minutes D. Add the total amount of the blood to be transfused to the intake and output

14. In case Diego will experience an acute hemolytic reaction, what will be your PRIORITY intervention? A. Immediately stop the blood transfusion, infuse Dextrose 5% in water and call the physician B. Slow the blood transfusion and monitor the patient closely C. Immediately stop the blood transfusion, notify the blood bank and administer antihistamines D. Immediately stop the blood transfusion, infuse normal saline solution, call the physician, notify the blood bank

Situation: You are assigned as a nurse to a group of patients with peripheral vascular diseases.

15. George is admitted to the hospital and has edematous ankles. The BEST way to limit the ankle edema is by A. restricting fluids C. applying elastic bandages B. elevating the legs D. initiating range-of-motion exercises

16. Shane, a client with arterial insufficiency and Raynaud’s disease is prepared for discharge. Your teaching instructions to Shane should include

A. walking several times each day as part of an exercise routine B. keeping the heat up so that the environment is warm C. wearing elastic stockings during the day D. using hydrotherapy for increasing oxygenation

17. Bart is admitted with venous stasis leg ulcer. You assesses the ulcer, expecting to note that the ulcer A. has a pale-colored base C. has little granulation tissue B. is deep, with even edges D. has brown pigmentation surrounding it

18. Ben, 26 years old, seeks medical attention for complaints of claudication in the arch of the foot. You, as his nurse notes superficial thrombophlebitis of the lower leg. You would next assess for

A. familial tendency toward peripheral vascular disease B. smoking history C. recent exposure to allergens D. history of recent insect bites

19. You have given instructions to Thelma with Raynaud’s disease about self management of the disease process. You would evaluate that Thelma needs further reinforcement if she states that

A. smoking cessation is very important B. sources of caffeine should be eliminated from the diet C. taking nifedipine (Procardia) a calcium channel blocker as prescribed will decrease vessel spasm D. moving to a warmer climate is needed

Situation: Continue answering questions related to hematologic conditions.

20. A clinic nurse reminds a mother of a child with sickle cell disease regarding precipitating factors related to PAIN crisis. Which of the following, if identified by the mother as a PRECIPITATING factor is INCORRECT?

A. Infection C. Fluid overload B. Trauma D. Stress

21. A client with upper gastrointestinal bleeding develops anemia. The nurse should EXPECT the client to be treated with A. Dextran C. Iron Salts B. Epogen D. Vitamin B12

22. In general, the higher the red blood cell count, the A. higher the blood pH C. greater the blood viscosity B. lower the hematocrit D. less it contributes to immunity

23. Antibodies are produced by A. eosinophils C. erythrocytes B. plasma cells D. lymphocytes

24. A female client has a low hemoglobin level, which is attributed to nutritional deficiency. What food in the client’s diet should the nurse recommend to increase?

A. Cereals C. Oranges B. Liver D. Cabbage

25. The nurse is caring for an adolescent with sickle cell anemia. To prevent thrombus formation in capillaries, as well as other problems from stasis and clotting of blood in the sickling process, the nurse should

A. administer oxygen C. encourage to maintain bed rest B. administer prescribed anticoagulants D. increase fluids by mouth

26. Which of the following is HIGHEST priority concern in a client with neutropenia? A. Risk for bleeding C. Risk for infection B. Risk for injury D. Risk for body image disturbance

27. A child with B-thalassemia is receiving long term blood transfusion therapy for treatment of this disorder. Which of the following should be of importance to be considered by the nurse?

A. The child needs additional iron supplements to prevent further anemia B. The child should be allowed to eat red meats and green leafy vegetables C. The child need not receive iron supplements, instead a chelation therapy D. The iron stores should be replenished by giving Epogen SQ

28. Intravenous heparin is ordered for a client. While implementing this order, a nurse ensures that which of the following medications is available in the nursing unit?

A. Vitamin K C. Potassium chloride B. Aminocaproic acid D. Protamine sulfate

29. What is the classic sign of pernicious anemia? A. Neuromuscular deficits C. Severe bleeding B. Red, beefy tongue D. Immunosuppression

30. Which of the following individuals will be considered prone to Pernicious Anemia related to deficiency in Vitamin B12? A. Strict vegetarians C. Those who eat more meats than vegetables B. Alcoholics D. Women

31. Which condition is unrelated to the causation of Pernicious Anemia? A. Post-gastrectomy C. Ileostomy B. Deficiency in Vitamin B12 D. Microcytic and hypochromic RBC

32. When assessing the client with iron deficiency anemia, the nurse should expect to findA. bradycardia C. hungerB. jaundice D. fatigue

33. After a few hours in the Emergency Room, Mr. Dizon is admitted to the ward with an order of hourly monitoring of blood pressure. The nurse finds that the cuff is too narrow and this will cause the blood pressure reading to beA. lower than what the reading should beB. inconsistent

C. low systolic and high diastolic pressureD. higher than what the reading should be

34. Through the client’s health history, you gather that Mr. Dizon smokes and drinks coffee. When taking the blood pressure of a client who recently smoked or drank coffee, how long should the nurse wait before taking the client’s blood pressure for accurate reading?A. 1 hourB. 30 minutes

C. 15 minutesD. 5 minutes

35. Which of the following indicates shock?A. BP of 110/70 mmHgB. CVP < 4 cm water

C. Urine Sp gravity of 1.010D. Hematocrit at 48%

Situation : Nurse Dorina is going to perform an abdominal examination to Mr. Lim who was admitted due to on and off pain since yesterday.

36. How will you position Mr. Lim prior to the procedure? A. supine with knees flexed B. prone

C. lying on back D. sim’s

37. The nurse is preparing an abdominal assessment. The nurse performs which assessment technique FIRST?A. Auscultation B. Palpation

C. Inspection D. Percussion

38. Mr. Lim verbalized pain on the right iliac region. Nurse Dorina knows that the organ affected would be the A. liver B. sigmoid colon

C. appendixD. duodenum

39. Mr. Lim felt pain upon release of Nurse Dorina’s hand. This can be referred as A. referred pain B. rebound tenderness

C. direct tendernessD. indirect tenderness

Situation : Mrs. Cruz was admitted in the Medical Floor due to pyrosis, dyspepsia and difficulty of swallowing.

40. Based from the symptoms presented, Nurse Yoshi might suspect A. Esophagitis B. Hiatal hernia

C. GERDD. Gastric Ulcer

41. What diagnostic test would confirm the type of problem Mrs. Cruz have? A. barium enema B. barium swallow

C. colonoscopyD. lower GI series

42. Mrs. Cruz complained of difficulty in swallowing. This term is referred as A. Odynophagia B. Dysphagia

C. PyrosisD. Dyspepsia

43. To avoid acid reflux, Nurse Yoshi should advice Mrs. Cruz to AVOID which type of diet? A. cola, coffee and tea B. high fat, carbonated and caffeinated beverages

C. beer and green tea D. lechon paksiw and bicol express

Situation : Nurse Gloria is the staff nurse assigned at the Emergency Department. During her shift, a patient was rushed – in the ED complaining of severe heartburn, vomiting and pain that radiates to the flank. The doctor suspects gastric ulcer.

44. What other symptoms will validate the diagnosis of gastric ulcer? A. right epigastric pain B. pain occurs when stomach is empty

C. pain occurs immediately after mealD. pain not relieved by vomiting

45. What diagnostic test would yield good visualization of the ulcer crater? A. Endoscopy B. Gastroscopy

C. Barium SwallowD. Histology

46. Peptic ulcer disease particularly gastric ulcer is thought to be cause by which of the following microorgamisms? A. E. coli B. H. pylori

C. S. aureusD. K. pnuemoniae

47. She is for occult blood test, what specimen will you collect? A. Blood B. Urine

C. StoolD. Gastric Juice

48. Preparation of the client for occult blood examination is A. Fluid intake limited only to 1 liter/day B. NPO for 12 hours prior to obtaining of specimen C. Increase fluid intake D. Meatless diet for 48-72 hours prior to obtaining of specimen

Situation : Mr. Sean is admitted to the hospital with a bowel obstruction. He complained of colicky pain and inability to pass stool.

49. Which of these findings by Nurse Leonard, would indicate that the obstruction is in the early stages? A. high pitched tinkling or rumbling bowel sounds B. hypoactive bowel sounds C. no bowel sounds auscultated D. normal bowel sounds heard in all four quadrants

50. Nasogastric tube was inserted to Mr. Sean. The NGT’s primary purpose is A. nutrition B. decompression of bowel

C. passage for medication D. aspiration of gastric contents

51. Mr. Sean has undergone surgery. Post – operatively, which of the following findings is normal? A. absent bowel sounds B. bleeding

C. hemorrhage D. bowel movement

52. After how many hours should you anticipate that the surgeon will order Mr. Sean to ambulate? A. 48 hours until stool is formed B. 24 hours

C. 72 hours when the wound is healed D. 36 hours

53. What is the rationale in the timing of ambulation? A. To prevent skin ulcerations B. To promote lung expansion

C. To prevent intestinal adhesionsD. To prevent blood stasis in the lower extremities

55. Client education should be given in order to prevent constipation. Nurse Leonard’s health teaching should include which of the following? A. use of natural laxatives B. fluid intake of 6 glasses per day

C. use of OTC laxativesD. complete bed rest

56. Four hours post – operatively, Mr. Sean complains of guarding and rigidity of the abdomen. Nurse Leonard’s initial intervention is A. assess for signs of peritonitis B. call the physician

C. administer pain medicationD. ignore the client

57. Physical assessment of the client who is experiencing diarrhea should focus on all of the following EXCEPTA. the abdomenB. muscle weakness/signs of fatigue

C. mucous membranesD. the skin (especially in perineal area)

58. Jaundice is caused byA. excessive accumulation of bile pigments in the bloodB. large amounts of ketonesC. intake of cellular hepatic cellsD. breakdown of carbohydrates in the cells

59. Portal vein hypertension develops in severe cirrhosis due toA. a retrograde increase in pressure resistanceB. ascites due to osmotic or hydrostatic shiftsC. incomplete clearing of protein metabolic wastesD. increase in ammonia levels

60. After administering an antacid, the nurse encourages a client with GERD to lie A. supine with the head of bed flatB. on the stomach with the head flatC. on the left side with the head of bed elevated 30 degreesD. on the right side with the head of bed elevated 30 degrees

61. Kuya Kim has undergone esophagogastroduodenoscopy. You place HIGHEST PRIORITY on which of the following items as part of Kuya Kim’s care plan?A. Assessing for the return of gag reflexB. Giving warm gargles for a sore throat

C. Monitoring the temperatureD. Monitoring complains of heartburn

62. Charice has been scheduled for a barium swallow. Which of the following instructions for Charice should you write down BEFORE the test?A. Fast for 8 hours before the testB. Eat a regular supper and breakfastC. Continue to take all oral medications as scheduledD. Monitor own bowel movement pattern for constipation

63. You should monitor a client with chronic gastritis for which of the following vitamin deficiencies?A. Vitamin AB. Vitamin B12

C. Vitamin CD. Vitamin E

64. You should question which physician’s medication order for a client with heart failure and acute gastritis?A. Digoxin (Lanoxin)B. Indomethacin (Indocin)

C. Furosemide (Lasix)D. Propanolol hydrochloride (Inderal)

65. The basic goal underlying the unique dietary management of gastritis is toA. provide optimal amounts of all important nutrientsB. increase the amount of bulk and roughage in the dietC. eliminate chemical, mechanical and thermal irritationD. promote psychologic support by offering a wide variety of foods

66. Which assessment finding would MOST likely indicate perforation of a peptic ulcer?A. Numbness in the legsB. Bradycardia

C. Nausea and vomitingD. A rigid, board-like abdomen

67. Mr. Alfonso, a client with a peptic ulcer disease is prescribed by his physician with cimetidine (Tagamet). You recognizes that the primary reason Mr. Alfonso is taking Tagamet is that itA. blocks the secretion of gastric HClB. coats the gastric mucosa with a protective membraneC. increase the sensitivity of H2 receptorsD. releases gastric acids

68. Mr. K has a Billroth II procedure and does well postoperatively. You instructed Mr. K. that symptoms of dizziness, palpitations, sweating and weakness in the weeks following the surgery are usually associated withA. afferent loop syndromeB. dumping syndrome

C. pernicious anemiaD. marginal ulcers

69. Don Quijote having peptic ulcer asks you the purpose of a vagotomy procedure. You should tell him that the procedureA. decreases food absorption in the stomachB. heals the gastric mucosa

C. halts stress reactionsD. reduces the stimulus to acid secretions

70. Which measure will you instruct the client to follow to assist in preventing dumping syndrome?A. Eat high carbohydrate foodsB. Limit the fluids taken with meals

C. Ambulate following a mealD. Sit in a high-fowler’s position during meals

71. After a Billroth II procedure, which of the following, if prescribed, would you question and verify?A. Irrigating the nasogastric tubeB. Coughing and deep breathing exercises

C. Leg exercisesD. Early ambulation

72. After a subtotal gastrectomy for cancer of the stomach, a client develops dumping syndrome. The nurse understands that dumping syndrome refers toA. nausea due to a full stomachB. reflux of intestinal contents into the esophagusC. rapid passage of osmotic fluid into the jejunumD. buildup of feces and gas within the large intestine

73. To determine whether there is an active DUODENAL ULCER in a client, the nurse would assess the client for which of the following frequent symptom(s)?A. Weight lossB. Nausea and vomiting

C. Pain that is relieved by foodD. Pain that radiates down the right arm

74. The nurse tells the client that which of the following items is BEST given as dietary management for epigastric pain in peptic ulcers?A. Fresh fruitsB. Wine

C. CoffeeD. Congee (Am)

75. A man is admitted with bleeding esophageal varices. A Sengstaken-Blakemore tube is inserted in an effort to stop the bleeding. After the Sengstaken-Blakemore tube is inserted, the client has difficulty breathing. The FIRST action the nurse should take is toA. deflate the esophageal balloonB. encourage him to take deep breaths

C. monitor his vital signsD. notify the physician

76. Anticipating the scenario in the previous question (# 75 ), the nurse should prepare at bedside which of the following equipments before inserting the Sengstaken-Blakemore tube?A. A tracheostomy setB. An NGT tube

C. Nasal cannula for O2 inhalationD. Pair of scissors

77. The nurse understands that the ejection of bile into the alimentary tract is initiated by the hormoneA. GastrinB. Secretin

C. EnterocrininD. Cholecystokinin

Situation: Manny, was admitted at Cardinal Santos Hospital due to increasing frequency of bowel movements, abdominal cramps and distension.

78. Diarrhea is said to be the leading cause of morbidity in the Philippines. Nurse Harry knows that diarrhea is present if passage of stool is A. more than 3 bowel movements per week B. less than 3 bowel movements per day

C. more than 3 bowel movements per day D. less than 3 bowel movements per week

79. Diarrhea is believed to be caused by all of the following EXCEPT A. increase intestinal secretions B. altered immunity

C. decrease mucosal absorption D. altered motility

80. Voluminous, watery stools can deplete fluids and electrolytes. The acid base imbalance that can occur is Metabolic Acidosis. This is due to

A. loss of HCl in the stomachB. loss of high amounts of bicarbonates through the kidneysC. a compensation of the lungs; increases the carbonic acid content of the bloodD. a massive GI losses of bicarbonates

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Good Luck