Care of Clients with Physiologic and Psychosocial Alterations (Part A)

Situation 1 – Concerted work efforts among members of the surgical team is essential to the success of the surgical procedure.

1. The sterile nurse or sterile personnel touch only sterile supplies and instruments. When there is a need for sterile supply which is not
in the sterile field, who hands out these items by opening its outer cover?
A. Circulating Nurse
B. Anaesthesiologist
C. Surgeon
D. Nursing Aide

2. The OR team performs distinct roles for one surgical procedure to be accomplished within a prescribed time frame and deliver a
standard patient outcome. While the surgeon performs the surgical procedure, who monitors the status of the client like urine output,
blood loss?
A. Scrub Nurse
B. Surgeon
C. Anesthesiologist
D. Circulating Nurse

3. Surgery schedules are communicated to the OR usually a day prior to the procedure by the nurse of the floor or ward where the
patient is confined. For orthopedic cases, what department is usually informed to be present in the OR?
A. Rehabilitation department
B. Laboratory department
C. Maintenance department
D. Radiology department

4. Minimally invasive surgery is very much into technology. Aside from the usual surgical team, who else has to be present when a client
undergoes laparoscopic surgery?
A. Information technician
B. Biomedical technician
C. Electrician
D. Laboratory technician

5. In massive blood loss, prompt replacement of compatible blood is crucial. What department needs to be alerted to coordinate closely
with the patient’s family for immediate blood component therapy?
A. Security Division
B. Chaiplaincy
C. Social Service Section
D. Pathology department

Situation 2 – You are assigned in the Orthopedic Ward where clients are complaining of pain in varying degrees upon movement of body
parts.

6. Troy is a one day post open reduction and internal fixation (ORIF) of the left hip and is in pain. Which of the following observation
would prompt you to call the doctor?
A. Dressing is intact but partially soiled
B. Left foot is cold to touch and pedal pulse is absent
C. Left leg in limited functional anatomic position
D. BP 114/78, pulse of 82 beats/minute

7. There is an order of Demerol 50 mg I.M. now and every 6 hours p r n. You injected Demerol at 5 pm. The next dose of Demerol 50 mg
I.M. is given:
A. When the client asks for the next dose
B. When the patient is in severe pain
C. At 11 pm
D. At 12 pm

8. You continuously evaluate the client’s adaptation to pain. Which of the following behaviors indicate appropriate adaptation?
A. The client reports pain reduction and decreased activity
B. The client denies existence of pain
C. The client can distract himself during pain episodes
D. The client reports independence from watchers

9. Pain in ortho cases may not be mainly due to the surgery. There might be other factors such as cultural or psychological that influence
pain. How can you alter these factors as the nurse?
A. Explain all the possible interventions that may cause the client to worry
B. Establish trusting relationship by giving his medication on time
C. Stay with the client during pain episodes
D. Promote client’s sense of control and participation in control by listening to his concerns

10. In some hip surgeries, an epidural catheter for Fentanyl epidural analgesia is given. What is your nursing priority care in such a case?

A. Instruct client to observe strict bed rest

B. Check for epidural catheter drainage
C. Administer analgesia through epidural catheter as prescribed
D. Assess respiratory rate carefully

Situation 3 – Records are vital tools in any institution and should be properly maintained for specific use and time.

11. The patient’s medical record can work as a double edged sword. When can the medical record become the doctor’s/nurse’s worst
enemy?
A. When the record is voluminous
B. When a medical record is subpoenaed in court
C. When it is missing
D. When the medical record is inaccurate, incomplete, and inadequate

12. Disposal of medical records in government hospitals/institutions must be done in close coordination with what agency?
A. Department of Interior and Local Government (DILG)
B. Metro Manila Development Authority (MMDA)
C. Records Management Archives Office (RMAO)
D. Department of Health (DOH)

13. In the hospital, when you need the medical record of a discharged patient for research you will request permission through:
A. Doctor in charge
B. The hospital director
C. The nursing service
D. Medical records section

14. You readmitted a client who was in another department a month ago. Since you will need the previous chart, from whom do you
request the old chart?
A. Central supply section
B. Previous doctor’s clinic
C. Department where the patient was previously admitted
D. Medical records section

15. Records Management and Archives Office of the DOH is responsible for implementing its policies on record disposal. You know that
your institution is covered by this policy if:
A. Your hospital is considered tertiary
B. Your hospital is in Metro Manila
C. It obtained permit to operate from DOH
D. Your hospital is PhilHealth accredited

Situation 4 – In the OR, there are safety protocols that should be followed. The OR nurse should be well versed with all these to
safeguard the safety and quality of patient delivery outcome.

16. Which of the following should be given highest priority when receiving patient in the OR?
A. Assess level of consciousness
B. Verify patient identification and informed consent
C. Assess vital signs
D. Check for jewelry, gown, manicure, and dentures

17. Surgeries like I and D (incision and drainage) and debridement are relatively short procedures but considered ‘dirty cases’. When are
these procedures best scheduled?
A. Last case
B. In between cases
C. According to availability of anaesthesiologist
D. According to the surgeon’s preference

18. OR nurses should be aware that maintaining the client’s safety is the overall goal of nursing care during the intraoperative phase. As
the circulating nurse, you make certain that throughout the procedure…
A. the surgeon greets his client before induction of anesthesia
B. the surgeon and anesthesiologist are in tandem
C. strap made of strong non-abrasive materials are fastened securely around the joints of the knees and ankles and around the 2 hands
around an arm board.
D. Client is monitored throughout the surgery by the assistant anesthesiologist

19. Another nursing check that should not be missed before the induction of general anesthesia is:
A. check for presence underwear
B. check for presence dentures
C. check patient’s ID
D. check baseline vital signs

20. Some lifetime habits and hobbies affect postoperative respiratory function. If your client smokes 3 packs of cigarettes a day for the
past 10 years, you will anticipate increased risk for:

A. perioperative anxiety and stress

B. delayed coagulation time
C. delayed wound healing
D. postoperative respiratory function

Situation 5 – Nurses hold a variety of roles when providing care to a perioperative patient.

21. Which of the following role would be the responsibility of the scrub nurse?
A. Assess the readiness of the client prior to surgery
B. Ensure that the airway is adequate
C. Account for the number of sponges, needles, supplies, used during the surgical procedure.
D. Evaluate the type of anesthesia appropriate for the surgical client

22. As a perioperative nurse, how can you best meet the safety need of the client after administering preoperative narcotic?
A. Put side rails up and ask the client not to get out of bed
B. Send the client to OR with the family
C. Allow client to get up to go to the comfort room
D. Obtain consent form
23. It is the responsibility of the pre-op nurse to do skin prep for patients undergoing surgery. If hair at the operative site is not shaved,
what should be done to make suturing easy and lessen chance of incision infection?
A. Draped
B. Pulled
C. Clipped
D. Shampooed

24. It is also the nurse’s function to determine when infection is developing in the surgical incision. The perioperative nurse should
observe for what signs of impending infection?
A. Localized heat and redness
B. Serosanguinous exudates and skin blanching
C. Separation of the incision
D. Blood clots and scar tissue are visible

25. Which of the following nursing interventions is done when examining the incision wound and changing the dressing?
A. Observe the dressing and type and odor of drainage if any
B. Get patient’s consent
C. Wash hands
D. Request the client to expose the incision wound

Situation 6 – Carlo, 16 years old, comes to the ER with acute asthmatic attack. RR is 46/min and he appears to be in acute respiratory
distress.

26. Which of the following nursing actions should be initiated first?

A. Promote emotional support
B. Administer oxygen at 6L/min
C. Suction the client every 30 min
D. Administer bronchodilator by nebulizer

27. Aminophylline was ordered for acute asthmatic attack. The mother asked the nurse, what is its indication, the nurse will say:
A. Relax smooth muscles of the bronchial airway
B. Promote expectoration
C. Prevent thickening of secretions
D. Suppress cough

28. You will give health instructions to Carlo, a case of bronchial asthma. The health instruction will include the following, EXCEPT:
A. Avoid emotional stress and extreme temperature
B. Avoid pollution like smoking
C. Avoid pollens, dust, seafood
D. Practice respiratory isolation

29. The asthmatic client asked you what breathing techniques he can best practice when asthmatic attack starts. What will be the best
position?
A. Sit in high-Fowler’s position with extended legs
B. Sit-up with shoulders back
C. Push on abdomen during exhalation
D. Lean forward 30-40 degrees with each exhalation

30. As a nurse, you are always alerted to monitor status asthmaticus who will likely and initially manifest symptoms of:
A. metabolic alkalosis
B. respiratory acidosis
C. respiratory alkalosis
D. metabolic acidosis

Situation 7 – Joint Commission on Accreditation of Hospital Organization (JCAHO) patient safety goals and requirements include the care
and efficient use of technology in the OR and elsewhere in the healthcare facility.

31. As the head nurse in the OR, how can you improve the effectiveness of clinical alarm systems?
A. Limit suppliers to a few so that quality is maintained
B. Implement a regular inventory of supplies and equipment
C. Adherence to manufacturer’s recommendation
D. Implement a regular maintenance and testing of alarm systems

32. Overdosage of medication or anesthetic can happen even with the aid of technology like infusion pumps, sphygmomanometer and
similar devices/machines. As a staff, how can you improve the safety of using infusion pumps?
A. Check the functionality of the pump before use
B. Select your brand of infusion pump like you do with your cellphone
C. Allow the technician to set the infusion pump before use
D. Verify the flow rate against your computation

33. JCAHOs universal protocol for surgical and invasive procedures to prevent wrong site, wrong person, and wrong procedure/surgery
includes the following, EXCEPT:
A. Mark the operative site if possible
B. Conduct pre-procedure verification process
C. Take a video of the entire intra-operative procedure
D. Conduct ‘time out’ immediately before starting the procedure

34. You identified a potential risk of pre-and postoperative clients. To reduce the risk of patient harm resulting from fall, you can
implement the following, EXCEPT:
A. Assess potential risk of fall associated with the patient’s medication regimen
B. Take action to address any identified risks through Incident Report (IR)
C. Allow client to walk with relative to the OR
D. Assess and periodically reassess individual client’s risk for falling

35. As a nurse, you know you can improve on accuracy of patient’s identification by 2 patient identifiers, EXCEPT:
A. identify the client by his/her wrist tag and verify with family members
B. identify client by his/her wrist tag and call his/her by name
C. call the client by his/her case and bed number
D. call the patient by his/her name and bed number

Situation 8 – Team efforts is best demonstrated in the OR.

36. If you are the nurse in charge for scheduling surgical cases, what important information do you need to ask the surgeon?
A. Who is your internist
B. Who is your assistant and anesthesiologist, and what is your preferred time and type of surgery?
C. Who are your anesthesiologist, internist, and assistant
D. Who is your anesthesiologist

37. In the OR, the nursing tandem for every surgery is:
A. Instrument technician and circulating nurse
B. Nurse anesthetist, nurse assistant, and instrument technician
C. Scrub nurse and nurse anesthetist
D. Scrub and circulating nurses

38. While team effort is needed in the OR for efficient and quality patient care delivery, we should limit the number of people in the
room for infection control. Who comprise this team?
A. Surgeon, anesthesiologist, scrub nurse, radiologist, orderly
B. Surgeon, assistants, scrub nurse, circulating nurse, anesthesiologist
C. Surgeon, assistant surgeon, anesthesiologist, scrub nurse, pathologist
D. Surgeon, assistant surgeon, anesthesiologist, intern, scrub nurse

39. When surgery is on-going, who coordinates the activities outside, including the family?
A. Orderly/clerk
B. Nurse Supervisor
C. Circulating Nurse
D. Anesthesiologist

40. The breakdown in teamwork is often times a failure in:

A. Electricity
B. Inadequate supply
C. Leg work
D. Communication

Situation 9 – Colostomy is a surgically created anus. It can be temporary or permanent, depending on the disease condition.

41. Skin care around the stoma is critical. Which of the following is not indicated as a skin care barriers?
A. Apply liberal amount of mineral oil to the area
B. Use karaya paste and rings around the stoma
C. Clean the area daily with soap and water before applying bag
D. Apply talcum powder twice a day
 42. What health instruction will enhance regulation of a colostomy (defecation) of clients?
A. Irrigate after lunch everyday
B. Eat fruits and vegetables in all three meals
C. Eat balanced meals at regular intervals
D. Restrict exercise to walking only

43. After ileostomy, which of the following condition is NOT expected?

A. Increased weight
B. Irritation of skin around the stoma
C. Liquid stool
D. Establishment of regular bowel movement

44. The following are appropriate nursing interventions during colostomy irrigation, EXCEPT:
A. Increase the irrigating solution flow rate when abdominal cramps is felt
B. Insert 2-4 inches of an adequately lubricated catheter to the stoma
C. Position client in semi-Fowler
D. Hang the solution 18 inches above the stoma

45. What sensation is used as a gauge so that patients with ileostomy can determine how often their pouch should be drained?
A. Sensation of taste
B. Sensation of pressure
C. Sensation of smell
D. Urge to defecate

Situation 10 – As a beginner in research, you are aware that sampling is an essential elements of the research process.

46. What does a sample group represent?

A. Control group
B. Study subjects
C. General population
D. Universe

47. What is the most important characteristic of a sample?

A. Randomization
B. Appropriate location
C. Appropriate number
D. Representativeness

48. Random sampling ensures that each subject has:

A. Been selected systematically
B. An equal chance of selection
C. Been selected based on set criteria
D. Characteristics that match other samples

49. Which of the following methods allows the use of any group of research subject?
A. Purposive
B. Convenience
C. Snow-ball
D. Quota

50. You decided to include 5 barangays in your municipality and chose a sampling method that would get representative samples from
each barangay. What should be the appropriate method ofor you to use in this care?
A. Cluster sampling
B. Random sampling
C. Stratified sampling
D. Systematic sampling

Situation 11 – After an abdominal surgery, the circulating and scrub nurses have critical responsibility about sponge and instrument
count.

51. When is the first sponge/instrument count reported?

A. Before closing the subcutaneous layer
B. Before peritoneum is closed
C. Before closing the skin
D. Before the fascia is sutured

52. What major supportive layer of the abdominal wall must be sutured with long tensile strength such as cotton or nylon or silk suture?
A. Fascia
B. Muscle
C. Peritoneum
D. Skin

53. Like sutures, needles also vary in shape and uses. If you are the scrub nurse for a patient who is prone to keloid formation and has
low threshold of pain, what needle would you prepare?
A. Round needle
B. Atraumatic needle
C. Reverse cutting needle
D. Tapered needle

54. Another alternative “suture” for skin closure is the use of ____________
A. Staple
B. Therapeutic glue
C. Absorbent dressing
D. Invisible suture

55. Like any nursing interventions, counts should be documented. To whom does the scrub nurse report any discrepancy of counts so
that immediate and appropriate action is instituted?
A. Anesthesiologist
B. Surgeon
C. OR nurse supervisor
D. Circulating nurse

Situation 12 – As a nurse, you should be aware and prepared of the different roles you play.

56. What role do you play when you hold all client’s information entrusted to you in the strictest confidence?
A. Patient’s advocate
B. Educator
C. Patient’s Liaison
D. Patient’s arbiter

57. As a nurse, you can help improve the effectiveness of communication among healthcare givers by:
A. Use of reminders of ‘what to do’
B. Using standardized list of abbreviations, acronyms, and symbols
C. One-on-one oral endorsement
D. Text messaging and e-mail

58. As a nurse, your primary focus in the workplace is the client’s safety. However, personal safety is also a concern. You can
communicate hazards to your co-workers through the use of the following EXCEPT:
A. Formal training
B. Posters
C. Posting IR in the bulletin board
D. Use of labels and signs

59. As a nurse, what is one of the best way to reconcile medications across the continuum
of care?
A. Endorse on a case-to-case basis
B. Communicate a complete list of the patient’s medication to the next provider of service
C. Endorse in writing
D. Endorse the routine and ‘stat’ medications every shift

60. As a nurse, you protect yourself and co-workers from misinformation and misrepresentations through the following EXCEPT:
A. Provide information to clients about a variety of services that can help alleviate the client’s pain and other conditions
B. Advising the client, by virtue of your expertise, that which can contribute to the client’s well-being
C. Health education among clients and significant others regarding the use of chemical disinfectant
D. Endorsement thru trimedia to advertise your favorite disinfectant solution

Situation 13 – You are assigned at the surgical ward and clients have been complaining of post pain at varying degrees. Pain as you
know, is very subjective.

61. A one-day postoperative abdominal surgery client has been complaining of severe throbbing abdominal pain described as 9 in a 1-10
pain rating. Your assessment revelas bowel sounds on all quadrants and the dressing is dry and intact. What nursing intervention would
you take
A. Medicate client as prescribed
B. Encourage client to do imagery
C. Encourage deep breathing and turning
D. Call surgeon stat

62. Pentoxidone 5 mg IV every 8 hours was prescribed for post abdominal pain. Which will be your priority nursing action?
A. Check abdominal dressing for possible swelling
B. Explain the proper use of PCA to alleviate anxiety
C. Avoid overdosing to prevent dependence/tolerance
D. Monitor VS, more importantly RR

63. The client complained of abdominal distention and pain. Your nursing intervention that can alleviate pain is:
A. Instruct client to go to sleep and relax
B. Advice the client to close the lips and avoid deep breathing and talking
C. Offer hot and clear soup
D. Turn to sides frequently and avoid too much talking
64. Surgical pain might be minimized by which nursing action in the O.R.
A. Skill of surgical team and lesser manipulation
B. Appropriate preparation for the scheduled procedure
C. Use of modern technology in closing the wound
D. Proper positioning and draping of clients

65. One very common cause of postoperative pain is:

A. Forceful traction during surgery
B. Prolonged surgery
C. Break in aseptic technique
D. Inadequate anesthetic

Situation 14 – You were on duty at the medical ward when Zeny came in for admission for tiredness, cold intolerance, constipation, and
weight gain. Upon examination, the doctor’s diagnosis was hypothyroidism.

66. Your independent nursing care for hypothyroidism includes:

A. administer sedative round the clock
B. administer thyroid hormone replacement
C. providing a cool, quiet, and comfortable environment
D. encourage to drink 6-8 glasses of water

67. As the nurse, you should anticipate to administer which of the following medications to Zeny who is diagnosed to be suffering from
hypothyroidism?
A. Levothyroxine
B. Lidocaine
C. Lipitor
D. Levophed

68. Your appropriate nursing diagnosis for Zeny who is suffering from hypothyroidism would probably include which of the following?
A. Activity intolerance related to tiredness associated with disorder
B. Risk to injury related to incomplete eyelid closure
C. Imbalance nutrition to hypermetabolism
D. Deficient fluid volume related to diarrhea

69. Myxedema coma is a life threatening complication of long standing and untreated hypothyroidism with one of the following
characteristics.
A. Hyperglycemia
B. Hypothermia
C. Hyperthermia
D. Hypoglycemia

70. As a nurse, you know that the most common type of goiter is related to a deficiency of:
A. thyroxine
B. thyrotropin
C. iron
D. iodine

Situation 15 – Mrs. Pichay is admitted to your ward. The MD ordered “Prepare for thoracentesis this pm to remove excess air from the
pleural cavity.”

71. Which of the following nursing responsibilities is essential in Mrs. Pichay who will undergo thoracentesis?
A. Support and reassure client during the procedure
B. Ensure that informed consent has been signed
C. Determine if client has allergic reaction to local anesthesia
D. Ascertain if chest x-rays and other tests have been prescribed and
completed

72. Mrs. Pichay who is for thoracentesis is assigned by the nurse to which of the following positions?
A. Trendelenburg position
B. Supine position
C. Dorsal Recumbent position
D. Orthopneic position

73. During thoracentesis, which of the following nursing intervention will be most crucial?
A. Place patient in a quiet and cool room
B. Maintain strict aseptic technique
C. Advice patient to sit perfectly still during needle insertion until it has
been withdrawn from the chest
D. Apply pressure over the puncture site as soon as the needle is withdrawn

74. To prevent leakage of fluid in the thoracic cavity, how will you position the client after thoracentesis?
A. Place flat in bed
B. Turn on the unaffected side
C. Turn on the affected side
D. On bed rest

75. Chest x-ray was ordered after thoracentesis. When your client asks what is the reason for another chest x-ray, you will explain:
A. to rule out pneumothorax
B. to rule out any possible perforation
C. to decongest
D. to rule out any foreign body

Situation 16 – In the hospital, you are aware that we are helped by the use of a variety of equipment / devices to enhance quality
patient care delivery.

76. You are to initiate an IV line to your patient, Kyle, 5, who is febrile. What IV administration set will you prepare?
A. Blood transfusion set
B. Macroset
C. Volumetric chamber
D. Microset

77. Kyle is diagnosed to have measles. What will your protective personal attire include?
A. Gown
B. Eyewear
C. Face mask
D. Gloves

78. What will you do to ensure that Kyle, who is febrile, will have a liberal oral fluid intake?
A. Provide a glass of fruit juice every meal
B. Regulate his IV to 30 drops per minute
C. Provide a calibrated pitcher of drinking water and juice at the bedside and monitor intake and output
D. Provide a writing pad to record his intake

79. Before bedtime, you went to ensure Kyle’s safety in bed. You will do which of the following:
A. Put the lights on
B. Put the side rails up
C. Test the call system
D. Lock the doors

80. Kyle’s room is fully mechanized. What do you teach the watcher and Kyle to alert the nurses for help?
A. How to lock side rails
B. Number of the telephone operator
C. Call system
D. Remote control

Situation 17 – Tony, 11 years old, has ‘kissing tonsils’ and is scheduled for tonsillectomy and adenoidectomy or T and A.

81. You are the nurse of Tony who will undergo T and A in the morning. His mother asked you if Tony will be put to sleep. Your teaching
will focus on:
A. spinal anesthesia
B. anesthesiologist’s preference
C. local anesthesia
D. general anesthesia

82. Mothers of children undergoing tonsillectomy and adenoidectomy usually ask what food to prepare and give their children after
surgery. You as the nurse will say:
A. balanced diet when fully awake
B. hot soup when awake
C. ice cream when fully awake
D. soft diet when fully awake

83. The RR nurse should monitor for the most common postoperative complication of:
A. hemorrhage
B. endotracheal tube perforation
C. osopharyngeal edema
D. epiglottis

84. The PACU nurse will maintain postoperative T and A client in what position?
A. Supine with neck hyperextended and supported with pillow
B. Prone with the head on pillow and turned to the side
C. Semi-fowler’s with neck flexed
D. Reverse trendelenburg with extended neck

85. Tony is to be discharged in the afternoon of the same day after tonsillectomy and adenoidectomy. You as the RN will make sure that
the family knows to:
A. offer osterized feeding
B. offer soft foods for a week to minimize discomfort while swallowing
C. supplement his diet with Vitamin C rich juices to enhance healing
D. offer clear liquid for 3 days to prevent irritation

Situation 18 – Rudy was diagnosed to have chronic renal failure. Hemodialysis is ordered so that an A-V shunt was surgically created.

86. Which of the following action would be of highest priority with regards to the external
shunt?
A. Avoid taking BP or blood sample from the arm with the shunt
B. Instruct the client not to exercise the arm with the shunt
C. Heparinize the shunt daily
D. Change dressing of the shunt daily

87. Diet therapy for Rudy, who has acute renal failure is low-protein, low potassium and low sodium. The nutrition instructions should
include:
A. Recommend protein of high biologic value like eggs, poultry and lean
meats
B. Encourage client to include raw cucumbers, carrot, cabbage, and tomatoes
C. Allowing the client cheese, canned foods and other processed food
D. Bananas, cantaloupe, orange and other fresh fruits can be included in the diet

88. Rudy undergoes hemodialysis for the first time and was scared of disequilibrium syndrome. He asked you how this can be
prevented. Your response is:
A. maintain a conducive comfortable and cool environment
B. maintain fluid and electrolyte balance
C. initial hemodialysis shall be done 30 minutes only so as not to rapidly
remove the waste from the blood than from the brain
D. maintain aseptic technique throughout the hemodialysis

89. You are assisted by a nursing aide with the care of the client with renal failure. Which delegated function to the aide would you
particularly check?
A. Monitoring and recording I and O
B. Checking bowel movement
C. Obtaining vital signs
D. Monitoring diet

90. A renal failure patient was ordered for creatinine clearance. As the nurse you will collect…
A. 48 hour urine specimen
B. first morning urine
C. 24 hour urine specimen
D. random urine specimen

Situation 19 – Fe is experiencing left sharp pain and occasional hematuria. She was advised to undergo IVP by her physician.

91. Fe was so anxious about the procedure and particularly expressed her low pain threshold. Nursing health instruction will include:
A. assure the client that the pain is associated with the warm sensation
during the administration of the Hypaque by IV
B. assure the client that the procedure painless
C. assure the client that contrast medium will be given orally
D. assure the client that x-ray procedure like IVP is only done by experts

92. What will the nurse monitor and instruct the client and significant others post IVP?
A. Report signs and symptoms for delayed allergic reaction
B. Observe NPO for 6 hours
C. Increased fluid intake
D. Monitor intake and output

93. Post IVP, Fe should excrete the contrast medium. You instructed the family to include more vegetables in the diet and:
A. increase fluid intake
B. barium enema
C. cleansing enema
D. gastric lavage

94. The IVP reveals that Fe has small renal calculus that can be passed out spontaneously. To increase the chance of passing the stones,
you instructed her to force fluids and do which of the following?
A. Balanced diet
B. Ambulate more
C. Strain all urine
D. Bed rest

95. The presence of calculi in the urinary tract is called

A. Colelithiasis
B. Nephrolithiasis
C. Ureterolithiasis
D. Urolithiasis
Situation 20 – At the medical-surgical ward, the nurse must also be concerned about drug interactions.

96. You have a client with TPN. You know that in TPN like blood transfusion, these should be no drug incorporation. However the MD’s
order read; incorporate insulin to present TPN. Will you follow the order?
A. No, because insulin will induce hyperglycemia in patients with TPN
B. Yes, because insulin is chemically stable with TPN and can enhance
blood glucose level
C. No, because insulin is not compatible with TPN
D. Yes, because it was ordered by the MD

97. The RN should also know that some drugs have increased adsorption when infused in the PVC container. How will you administer
drugs such as insulin, nitroglycerine hydralazine to promote better therapeutic drug effects?
A. Administer by fast drip
B. Inject the drugs as close to the IV injection site
C. Incorporate to the IV solutions
D. Use volumetric chamber

98. One patient had a ‘runaway’ IV of 50% dextrose. To prevent temporary excess of insulin or transient hyperinsulin reaction what
solution you prepare in anticipation of the doctor’s order?
A. Any IV solution available to KVO
B. Isotonic solution
C. Hypertonic solution
D. Hypotonic solution

99. How can nurses prevent drug interaction including adsorption?

A. Always flush with NSS after IV administration
B. Administering drugs with more diluents
C. Improving on preparation techniques
D. Referring to manufacturer’s guidelines

100. In insulin administration, it should be understood that our body normally releases insulin according to our blood glucose level.
When is insulin and glucose level highest?
A. After excitement
B. After a good night’s rest
C. After an exercise
D. After ingestion of food