NCM 104 (CMO No.

30)
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Pasig Online Assessment Section 1 - Attempt 1

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Question 1
Marks: 1
A patient asks the nurse, “What is the difference between rheumatoid arthritis and osteoarthritis?” Which of the following
responses by the nurse is best?
Choose one answer.
a. “Rheumatoid arthritis is a systemic disease and osteoarthritis is not.”

b. “There is very little clinical difference between rheumatoid arthritis and osteoarthritis.”

c. “Rheumatoid arthritis is often treated surgically and osteoarthritis is not.”

d. “Rheumatoid arthritis is progressive and osteoarthritis is not.”

Question 2
Marks: 1
When a nurse develops feelings towards a client that are based on the nurse’s past experience, it is called:
Choose one answer.
a. Countertransference

b. Transference

c. Role reversal

d. Unconditional regard
Question 3
Marks: 1
Upon returning home from work, a young man discovers that his mother has been in a serious automobile accident. Initially, he
responds to the news by stating, "No, I don't believe it. It can't be true." Which defense mechanism is he using?
Choose one answer.
a. Suppression

b. Introjection

c. Repression

d. Denial
Question 4
Marks: 1
The nurse is assessing the neurovascular status of a client's newly casted right arm. Which of the following assessment findings
should be reported to the physician?
Choose one answer.
a. Nail bed capillary refill time of 10 seconds

b. No pain on passive movement of fingers

c. Slight swelling of the fingers

d. Localized pain in the right arm

Question 5
Marks: 1
The nurse suspected a neck injury in a patient hurried to the emergency room. The nurse has knowledge that she must open the
airway of the victim by using which most appropriate method?
Choose one answer.
a. A head tilt-chin lift

b. Flexed position

c. Jaw thrust maneuver

d. Placing the head in lateral position

Question 6
Marks: 1
Under certain circumstances the virus that causes chicken pox can also cause:
Choose one answer.
a. Shingles

b. Poliomyelitis
 c. Measles

d. Herpes simplex
Question 7
Marks: 1
The normal intraocular pressure is:
Choose one answer.
a. 10-21 mmHg

b. 21-30 mmHg

c. 5-10 mmHg

d. 1-5 mmHg
Question 8
Marks: 1
The essential feature of mental retardation is below-average intellectual functioning accompanied by significant limitations in
areas of adaptive functioning. If the child’s IQ is 20, the child is classified to have:
Choose one answer.
a. Mild retardation

b. Moderate retardation

c. Profound retardation

d. Severe retardation
Question 9
Marks: 1
The hallmark of a beginning and mild dementia is:
Choose one answer.
a. Apraxia

b. Forgetfulness

c. Agnosia

d. Wandering
Question 10
Marks: 1
After cataract removal surgery, the nurse teaches the client about activities that she can do at home. Which of the following
activities would be contraindicated?
Choose one answer.
a. Performing isometric exercises

b. Lying in bed on the non-operative side

c. Walking down the hall unassisted

d. Bending over the sink to wash her hair

Question 11
Marks: 1
The nurse is instructing a patient about the potential side effects of pilocarpine hydrochloride. The nurse determines that teaching
has been effective if the patient’s makes which of the following statements?
Choose one answer.
a. “This medication may cause me to develop blindness.”

b. “Due to this medication, I will have difficulty seeing distances.”

c. “This medication may cause me to have blurred vision and periorbital pain.”

d. “This medication is going to cause me to be color blind.”

Question 12
Marks: 1
A client is diagnosed as having phobia. The nurse can expect that the client’s treatment plan will include:
Choose one answer.
a. Group therapy

b. Lithium

c. Desensitization therapy

d. Anti psychotics
Question 13
Marks: 1
Gab, a past PBB housemate is a known car racer. During her engine testing a day before her actual race, she unfortunately met an
accident. Her car tripped over and she has suffered from spinal cord injury along her lumbar spine. You are the nurse in ICU unit
taking care of her. Which vital sign would indicate the need to notify the physician as the patient may be suffering from
neurogenic shock?
Choose one answer.
a. Temperature 38.1 C

b. Pulse 50 bpm
 c. BP 160/100 mmHg

d. Perspiration rate (RR) 16 bpm

Question 14
Marks: 1
An elderly patient asks the nurse what caused his cataract. The nurse’s response should be based on the knowledge that:
Choose one answer.
a. Any type of chronic systemic disease can cause cataracts

b. Cataracts are most common in the elderly

c. All cataracts result from eye injuries

d. The usual cause of cataracts in elderly people is congenital

Question 15
Marks: 1
A client with major depression states, "Everything is my fault, and I'd be better off dead." What
is the priority nursing intervention?

Choose one answer.

a. Leave the patient

b. Do nothing

c. Assess the seriousness of the client's comment

d. Assign staff member who will scold the patient

Question 16
Marks: 1
Which clinical manifestations would lead the nurse to suspect that the client with a fracture of
the left femur is experiencing fat embolism?

Choose one answer.

a. Complaints of shortness of breath, restlessness, and petechiae over the chest

b. Joint swelling, pruritus, and low back pain

c. Diminished breathing, back pain, headache

 d. Purulent discharge, low back pain, and death
Question 17
Marks: 1
Which of the following interventions is most appropriate in helping a client with dementia complete activities of daily living
(ADL’s)?
Choose one answer.
a. Tell the client to complete the ADL’s at a certain time

b. Perform ADL’s for the client

c. Give the client ample time to perform the ADL’s as independently as possible

d. Provide a written list of activities to be completed

Question 18
Marks: 1
A patient is admitted to the emergency room following a sexual assault. Which of the following statements should the nurse
recognize as the most pertinent cue in determining whether or not an individual experiences a crisis?
Choose one answer.
a. The patient’s perception of the event

b. The patient’s past history

c. The patient’s understanding of STD’s

d. The patient’s behavior prior to the assault

Question 19
Marks: 1
Diptheria is an acute bacterial disease can infect the body in which of the following areas?
Choose one answer.
a. Conjunctivae and skin

b. Throat and ears

c. Skin and throat

d. GI and urinary tracts

Question 20
Marks: 1
An essential aspect of the plan of care for a client after cataract removal surgery is to:
Choose one answer.
 a. Prevent fluid volume excess

b. Increase cardiac output

c. Promote safety at home

d. Maintain a darkened environment

Question 21
Marks: 1
When working with a client suspected of having Alzheimer’s, the nurse needs to be alert for increasing agitation that worsens at
night. This is known as:
Choose one answer.
a. Pseudodementia

b. Pseudodelirium

c. Sundowning

d. Catastrophic reaction
Question 22
Marks: 1
A client is admitted in the unit for an acute anxiety reaction. The nurse approaches the client,
who is mute, immobile, sitting rigidly on his chair, and staring at a fixed point. Given these
behaviors, the client is said to be in which level of anxiety?

Choose one answer.

a. Mild

b. Superb

c. Severe

d. Panic
Question 23
Marks: 1
A client complains of vertigo. The nurse anticipates that the client may have a problem with which portion of the ear?
Choose one answer.
a. Tympanic membrane

b. Middle ear
 c. External ear

d. Inner ear
Question 24
Marks: 1
Initial interventions for a client with acute anxiety would not include:

Choose one answer.

a. Approaching the client in a calm, confident manner

b. Touching the client in an attempt to comfort him

c. Providing the client with a safe, quiet, and private place

d. Encouraging the client to verbalize feelings and concerns

Question 25
Marks: 1
After being bitten by a rapid dog, a child is to receive a series of anti-rabies inoculations. The nurse understands that rabies is:
Choose one answer.
a. A viral infection, characterized by seizures and difficulty in swallowing that affects the
nervous system.
b. An acute bacterial infection characterized by meningeal irritation

c. A viral infection manifested by meningeal irritation

d. An acute bacterial septicemia causing morbid fear of water

Question 26
Marks: 1
Which of these children at the site of a disaster at a child day care center would the triage nurse put in the "treat last" category?
Choose one answer.
a. A school-age child with singed eyebrows and hair on the arms

b. An infant with intermittent bulging anterior fontanel between crying episodes

c. A preschooler with a lower leg fracture on one side and an upper leg fracture on the other

d. A toddler with severe deep abrasions over 98% of the body

Question 27
Marks: 1
All except one are the nursing measures are supportive and symptomatic treatment in Dengue:
Choose one answer.
a. Give aspirin for fever

b. Give analgesic for headache

c. Give oresol to replace fluid

d. Give paracetamol for muscle pains

Question 28
Marks: 1
After seeking help at an outpatient mental health clinic, a client who is raped is diagnosed with posttraumatic stress disorder
(PTSD). Three months later, the client returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which
nursing intervention is most appropriate for this client?
Choose one answer.
a. Exploring the meaning of the traumatic event with the client

b. Encouraging the client to attend a rape therapy group

c. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle

d. Allowing the client time to heal

Question 29
Marks: 1
What is the nurse's most important role in caring for a client with a mental health disorder?
Choose one answer.
a. To establish trust and rapport

b. To offer advice

c. To set limits with the client

d. To know how to solve the client's problems

Question 30
Marks: 1
Petechial spots may occur on the soft palate or uvula. This assessment finding is called:

Choose one answer.

a. Blood vessels

b. Forscheimer spots
 c. Differential spots

d. Spotting
Question 31
Marks: 1
A client is admitted to an acute care facility with osteomyelitis. Which organism usually causes
this infection?

Choose one answer.

a. Escherichia coli

b. Pseudomonas

c. Klebsiella

d. Staphylococcus aureus
Question 32
Marks: 1
The release of histamine in the antigen-antibody reaction during anaphylactic shock results in:

Choose one answer.

a. Increased myocardial contractility

b. Vasoconstriction

c. Vasodilation

d. Decreased vascular permeability

Question 33
Marks: 1
A nurse is caring for a client with a dysfunctional thyroid gland who is at risk for the development of thyroid storm. To detect
this complication, the nurse would assess for:
Choose one answer.
a. High Fever

b. Bradypnea

c. Bradycardia
 d. Constipation
Question 34
Marks: 1
The cause of symptoms of a brain attack that resolves quickly is known as:
Choose one answer.
a. Cerebrovascular accident (CVA)

b. Peripheral neuropathy

c. Transient ischemic attack (TIA)

d. Brain herniation
Question 35
Marks: 1
Leprosy is a chronic skin and peripheral nerve disease caused by Mycobacterium Leprae. The mode of transmission of this
disease, aside from skin to skin contact, is by:
Choose one answer.
a. Sexual contact

b. Sharing food

c. Droplet infection

d. Borrowing utensils
Question 36
Marks: 1
A client with anorexia nervosa who is on bed rest stares at her dinner tray. She has made little effort to eat. Which statement by
the nurse would be most therapeutic?
Choose one answer.
a. “Don't worry. You can eat more tomorrow”

b. “Hurry up with your tray. I have several more clients to see”

c. “You should be ashamed of yourself. There are starving people who would love that
food”
d. “I'll stay with you while you eat and help you fill out tomorrow's menu.”
Question 37
Marks: 1
The nurse is caring for a client in the Emergency Department of an acute care facility. Four clients have been admitted in the last
10 minutes. Which of the following admissions should the nurse see FIRST?
Choose one answer.
 a. A client with a fractured hip

b. A client with third-degree burns to the face

c. A client complaining of epigastric pain

d. A client complaining of chest pain that is unrelieved by nitroglycerine

Question 38
Marks: 1
Which of the following conditions most commonly causes cardiogenic shock?
Choose one answer.
a. Hypotension

b. Decreased hemoglobin level

c. Acute myocardial infarction

d. Coronary artery disease

Question 39
Marks: 1
The nurse plans care for a 72-year-old patient after removal of a cataract. The nurse should:
Choose one answer.
a. Instruct the patient to lie flat in bed without turning the head.

b. Provide the patient with a pen and paper to communicate with the family.

c. Have the patient exercise both eyes every four hours.

d. Advise the patient to wear an eye shield at bedtime.

Question 40
Marks: 1
Which of the following behaviors is seen in a child with autism?
Choose one answer.
a. Has difficulty sustaining attention

b. Fidgets

c. Talks excessively

d. Head banging
Question 41
Marks: 1
A nurse started performing a cardiopulmonary resuscitation (CPR) on the victim. When performing chest compressions, the nurse
understands that the correct hand placement is located over the:
Choose one answer.
a. Lower third of the sternum

b. Upper half of the sternum

c. Lower half of the sternum

d. Upper third of the sternum

Question 42
Marks: 1
First aid management in a rattle snake bite is:
Choose one answer.
a. Elevate the legs above the level of the heart to increase blood supply to the brain and
preventing neurotoxicity.
b. Placing the area of the bite below level of the heart and keep the snake bite victim calm.
c. Ask the client to move affected bite and immediately suck the bite part to remove the
venom.
d. Agitate the snake immediately then cute the bite part and let the blood drain on that part.
Question 43
Marks: 1
During an assessment of a client, the nurse finds that he is trembling, restless, blood pressure and pulse are elevated, has dry
mouth, shortness of breath, inability to relax, loss of appetite, and an upset stomach. What is the client’s level of anxiety?
Choose one answer.
a. Moderate

b. Severe

c. Mild

d. Panic
Question 44
Marks: 1
A client in group therapy is restless. His face is flushed and he makes sarcastic remarks to group members. The nurse responds by
saying, "You look angry." The nurse is using which technique?
Choose one answer.
a. Giving a broad opening
 b. Making observations

c. Reassuring

d. Clarifying
Question 45
Marks: 1
The nurse is preparing a client who sustained a hip fracture for discharge. The nurse should teach the client to avoid which of the
following groups of activities to prevent dislocation of the hip?
Choose one answer.
a. Using reachers for applying shoes and socks, and sitting in chairs with arms

b. All exercises, bed rest, and using raised toilet seats

c. Taking leisurely walks, low chair seats, and bending at hips

d. Crossing the legs, bending at hips, and sitting on low toilet seats
Question 46
Marks: 1
A 42-year-old man is admitted to the hospital for surgical repair of a detached retina in the right eye. In planning care for this
patient postoperatively, the nurse should:
Choose one answer.
a. Encourage the patient to perform self-care activities

b. Caution the patient against excessive talking

c. Limit movements of the patient’s eyes

d. Position the patient on his left side

Question 47
Marks: 1
Common adverse effects of electroconvulsive therapy (ECT) include:
Choose one answer.
a. Seizure

b. Cardiac arrhythmias

c. Brain damage

d. Short-term memory loss

Question 48
Marks: 1
To prevent further exacerbations in a client recently diagnosed with gout, which dietary modification would be implemented?
Choose one answer.
a. Restricted fluid intake

b. Reduced salt intake

c. Avoidance of excessive caffeine

d. Decreased purine intake

Question 49
Marks: 1
Which of the following is a risk factor for hypovolemic shock?
Choose one answer.
a. Antigen-antibody reaction

b. Hemorrhage

c. Vasodilation

d. Gram-negative bacteria
Question 50
Marks: 1
After sustaining a closed head injury, numerous lacerations and abrasions to the face and neck, a five-year-old child is admitted
to the emergency room. The client is unconscious and has minimal response to noxious stimuli. Which of the following
assessments, if observed by the nurse three hours after admission, should be reported to the physician?
Choose one answer.
a. The client withdraws in response to painful stimuli.

b. There is some bleeding from the child's lacerations.

c. The client has slight edema of the eyelids.

d. There is clear fluid draining from the client's right ear.

Question 51
Marks: 1
What is the treatment for the client who has inhaled cyanide?
Choose one answer.
a. Administration of syrup of ipecac to perform gastric emptying

b. Administration of naloxone (Narcan)

 c. Administration of activated charcoal

d. Administration of amyl nitrate

Question 52
Marks: 1
Which drug should be administered to the client who has taken an overdose of fentanyl (Sublimaze)?
Choose one answer.
a. Atropine

b. Naloxone (Narcan)

c. Physostigmine (Antilirium)

d. Flumazenil (Romazicon)
Question 53
Marks: 1
The client was telling the nurse about her parents’ impending divorce. She said, “I couldn’t believe that he was going to leave us
for someone else.” Which would be best for the nurse to reply?
Choose one answer.
a. “I can understand how you must feel.”

b. “Did you cry?”

c. “Yes, go on.”

d. “Was your mother expecting this to happen?”

Question 54
Marks: 1
One effective way to start an interaction with a client is to:
Choose one answer.
a. Introduce a neutral topic, giving the client a broad opening

b. Bring up a controversial topic to elicit the client’s response

c. Tell the client something about yourself and hope that the client does the same

d. Remain silent, waiting for the client to bring up a topic

Question 55
Marks: 1
It is MOST important for the nurse’s preoperative teaching for a patient scheduled for extracapsular cataract removal to include:
Choose one answer.
 a. Postoperative activities and restriction

b. The proper use of dark glasses

c. Signs and symptoms of a detached retina

d. Symptoms of eye hemorrhage

Question 56
Marks: 1
During a crisis intervention lecture of a professor in psychiatric nursing, he mentions that crisis does not last indefinitely but
usually exists for:
Choose one answer.
a. 6 months

b. One year

c. 2 weeks

d. 4-6 weeks
Question 57
Marks: 1
Which type of hepatitis is also known as post-transfusion hepatitis?

Choose one answer.

a. Hepatitis F

b. Hepatitis A

c. Hepatitis E

d. Hepatitis C
Question 58
Marks: 1
A 22-year-old client is diagnosed with dependent personality disorder. Which behavior is evident of ineffective individual
coping?
Choose one answer.
a. Inability to make choices and decisions without advice

b. Recurrent self-destructive behavior with history of depression

 c. Showing interest only in solitary activities

d. Avoiding developing relationships

Question 59
Marks: 1
The nurse is caring for a patient in Buck’s traction. It is MOST important for the nurse to take which of the following actions?
Choose one answer.
a. Encourage the patient to limit body movements.

b. Remove weights immediately when patient complains of discomfort.

c. Give pain mediation regularly.

d. Allow weights to hang freely at all times.

Question 60
Marks: 1
The nurse is teaching a new group of mental nursing staff. The nurse should teach them that
setting limits is most important for a:

Choose one answer.

a. Creative client

b. Silent client

c. Manic client

d. Phobic client
Question 61
Marks: 1
The nurse is caring for a client who has an above-the-knee amputation. The client refuses to look at the stump. When the nurse
attempts to speak with the client about his surgery, he tells the nurse that he does not wish to discuss it. The client also refuses to
have his family visit. The nursing diagnosis that best describes the client's problem is:
Choose one answer.
a. Disturbed body image

b. Fear

c. Hopelessness

d. Powerlessness
Question 62
Marks: 1
To determine if the snake is venomous or not, these are the following characteristics of the venomous snake except:
Choose one answer.
a. Has rough skin

b. Constrictor

c. Non-constrictor

d. Has vertical pupil

Question 63
Marks: 1
A client with quadriplegia is in spinal shock. What should the nurse expect?
Choose one answer.
a. Absence of reflexes along with flaccid extremities

b. Hyperreflexia along with spastic extremities

c. Positive Babinski's reflex along with spastic extremities

d. Spasticity of all four extremities

Question 64
Marks: 1
The emergency department nurse should expect a client with severe burn injuries to have which electrolyte abnormalities in the
immediate postburn phase?
Choose one answer.
a. Decreased potassium, increased sodium

b. Increased potassium, increased sodium

c. Decreased potassium, decreased sodium

d. Increased potassium, decreased sodium

Question 65
Marks: 1
What is the most fatal type of diptheria?
Choose one answer.
a. Nasal

b. Tonsilar
 c. Laryngeal

d. Cutaneous
Question 66
Marks: 1
The goal of crisis intervention is:
Choose one answer.
a. To provide a means for admission to an acute care facility

b. Psychological resolution of the immediate crisis

c. To solve the client's problems for him

d. To establish a means for long-term therapy

Question 67
Marks: 1
To care for a newly applied plaster cast, the nurse should:

Choose one answer.

a. Cover the cast lightly with a sheet and remove it frequently

b. Set-up a fan to blow on the cast and turn the patient frequently using the fingertips
c. Rest the casted leg on the mattress, avoid handling it until it has dried and turn the patient
every shift
d. Elevate the leg on pillow and leave the cast open to air.
Question 68
Marks: 1
Before cataract surgery, the nurse is to instill several types of eye drops into a client's right eye.
The accepted abbreviation for the right eye is:

Choose one answer.

a. OD

b. OU

c. RE

d. OS
Question 69
Marks: 1
In caring for a patient with a detached retina preoperatively, which of the following actions
should the nurse take?

Choose one answer.

a. Have the patient stand all the time

b. Irrigate the eye with alcohol

c. Do nothing

d. Maintain the patient on bed rest

Question 70
Marks: 1
A 42-year-old woman with a diagnosis of Meniere’s disease is seen in the clinic. The nurse would expect the client to complain
of:
Choose one answer.
a. Vertigo, tinnitus, and neurosensory hearing loss

b. Severe headache, enlarged lymph nodes, and fever

c. Fever, ear noises, and headache

d. Discharge from the ear, pain, and conductive deafness

Question 71
Marks: 1
A client on the behavioral health unit spends several hours a day organizing and reorganizing his
closet. He repeatedly checks to see if his clothing is arranged in the proper order. What term is
commonly used to describe this behavior?

Choose one answer.

a. Compulsion

b. Exhibitionism

c. Obsession

d. Transference
Question 72
Marks: 1
Which of the following clinical manifestations commonly occur in retinal detachment?
Choose one answer.
a. A tearing sensation and increased lacrimation

b. Sudden severe eye pain and colored halos around lights

c. Sensation of a shade or curtain coming from across the vision of the eye

d. Inability to move the eye and loss of light accommodation

Question 73
Marks: 1
In dengue, the characteristic blood disorder is:
Choose one answer.
a. Leukopenia

b. Leukocytosis

c. Thrombocytopenia

d. Anemia
Question 74
Marks: 1
The nurse is caring for a client who had open reduction and internal fixation (ORIF) of the right femur four days ago. The client
complains of intense pain, swelling, tenderness and warmth at the site, chills, malaise, and has a temperature of 102.2ºF (39º).
These data indicate which of the following?
Choose one answer.
a. Compartment syndrome

b. Osteomyelitis

c. Malunion of the bone

d. Fat embolism
Question 75
Marks: 1
The long-term goal, “The client will learn new ways of coping with anxiety,” is most appropriate
at which level of anxiety?

Choose one answer.

a. Mild
 b. Superb

c. Extensive

d. Moderate
Question 76
Marks: 1
The nurse is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan?
Choose one answer.
a. Provide privacy during meals

b. Restrict visits with the family until the client begins to eat

c. Encourage the client to exercise, which will reduce her anxiety

d. Establish a consistent eating plan

Question 77
Marks: 1
An anticipated outcome for the client after cataract removal surgery would include which of the following?
Choose one answer.
a. The client states her vision is clear.

b. The client states her infection is under control.

c. The client describes methods to prevent an increase in intraocular pressure.

d. The client states she is able to administer parenteral pain medication.

Question 78
Marks: 1
The client reports that she has difficulty focusing and he is seeing halos around lights. The likely diagnosis for this client is:
Choose one answer.
a. Retinal Detachment

b. Macular degeneration

c. Cataract

d. Glaucoma
Question 79
Marks: 1
A client whose husband recently left her is admitted to the hospital with severe depression. The nurse suspects that the client is at
risk for suicide. Which of the following questions would be most appropriate and helpful for the nurse to ask during an
assessment for suicide risk?
Choose one answer.
a. “How do you think you would kill yourself?”

b. “Are you sure you want to kill yourself?”

c. “I know if my husband left me, I'd want to kill myself. Is that what you think?”

d. “Why don't you just look at the positives in your life?”

Question 80
Marks: 1
The nurse should seek clarification of which order for a child who has ingested a large amount of gasoline?
Choose one answer.
a. Activated charcoal

b. Gastric lavage

c. Syrup of ipecac

d. Oxygen delivered at 2L/min

Question 81
Marks: 1
The nurse should recognize that a patient who is unable to remember being raped is using which of the following ego defense
mechanisms?
Choose one answer.
a. Compensation

b. Undoing

c. Repression

d. Regression
Question 82
Marks: 1
The nurse is documenting a care plan for a client who has undergone electroconvulsive therapy (ECT). Which intervention
should the nurse include?
Choose one answer.
a. Placing the client in Trendelenburg's position

b. Monitoring the client's vital signs every hour for 4 hours

 c. Reorienting the client to time and place

d. Encouraging early ambulation

Question 83
Marks: 1
Postoperative orders for a patient after cataract surgery state, “Apply pressure dressing, O.S.” Which of the following nursing
actions would be MOST appropriate?
Choose one answer.
a. Ask another nurse to read the order and carry it out.

b. Carry out the order by applying four eye pads and covering them tightly with tape.
c. Call the doctor to verify the order because pressure dressings are usually contraindicated
after eye surgery.
d. Call the doctor to verify the order because dressings are usually applied bilaterally after
eye surgery.
Question 84
Marks: 1
The most common type of circulatory shock and is caused by widespread infection is:
Choose one answer.
a. Cardiogenic shock

b. Anaphylactic shock

c. Septic shock

d. Neurogenic shock
Question 85
Marks: 1
A 60-year-old client complains of headaches, restlessness, and insomnia. During an interview, the nurse learns that the symptoms
began 3 months ago after the client was forced into early retirement. The nurse recognizes that the client is probably
experiencing:
Choose one answer.
a. A situational crisis

b. A developmental crisis

c. A social crisis

d. An adventitious crisis
Question 86
Marks: 1
Abrupt withdrawal of corticosteroid therapy puts a client at risk for:
Choose one answer.
a. Psychiatric disturbances

b. Glaucoma

c. Tardive dyskinesia

d. Adrenal crisis
Question 87
Marks: 1
The nurse would expect a patient with a cataract to complain of:
Choose one answer.
a. Double vision

b. Halos around lights

c. Blurred vision

d. Eye pain when doing close work

Question 88
Marks: 1
A pregnant client with sickle cell anemia is at an increased risk for having a sickle cell crisis. Aggressive management of a sickle
cell crisis includes which of the following measures?
Choose one answer.
a. Antihypertensive agents

b. Acetaminophen (Tylenol) for pain

c. IV fluids

d. Diuretic agents
Question 89
Marks: 1
A child is brought to the health center with a cold clammy skin having a history of high fever for 3 days. Tourniquet Test is
performed by the PHN. A test is positive when:
Choose one answer.
a. 20 or more petechiae per 1 square inch just below the cuff

b. 20 or more petechiae per 2.5 cm near the wrist

 c. 15 to 20 petechiae per 1 square inch

d. Less than 20 petechiae per 2.5 cm

Question 90
Marks: 1
You admitted a patient bitten by a dog. In which phase a patient becomes sensitive to light, sound and temperature?
Choose one answer.
a. Prodromal phase

b. Terminal Phase

c. Excitement or Neurological phase

d. Paralytic Phase
Question 91
Marks: 1
The nurse understands that pilocarpine eye drops are given to a patient with closed-angle glaucoma to:
Choose one answer.
a. Produce ciliary muscle relaxation, thereby enhancing vitreous humor production.

b. Induce pupil dilation, thereby promoting aqueous humor absorption.

c. Produce ciliary muscle contraction, thereby inhibiting aqueous humor production.

d. Induce pupil constriction, thereby improving aqueous humor outflow.

Question 92
Marks: 1
A nurse is caring for a client in an acute manic state. What is the most effective nursing action
for this client?

Choose one answer.

a. Helping him find his peace

b. Assisting him to go out the house

c. Allowing him to shout

d. Reducing his stimulation

Question 93
Marks: 1
An X-ray of the left femur shows a fracture that extends through the midshaft of the bone and multiple splintering fragments.
What is this type of fracture called?
Choose one answer.
a. Greenstick fracture

b. Comminuted fracture

c. Compression fracture

d. Impacted fracture
Question 94
Marks: 1
Which of the following findings is the best indicator that fluid replacement for the client in hypovolemic shock is adequate?
Choose one answer.
a. Respiratory rate of 20 breaths/minute

b. Systolic blood pressure greater than 100 mmHg

c. Urine output greater than 30 mL/hour

d. Diastolic blood pressure greater than 90 mmHg

Question 95
Marks: 1
The nurse is giving home care instructions to a client who just had a cataract removed and an intraocular lens implanted. What
should the nurse tell the client?
Choose one answer.
a. Aspirin may be taken for mild pain.

b. Wear the eye shield continuously for 2 weeks.

c. Don't sleep on the operated side.

d. Straining during bowel movements is allowed.

Question 96
Marks: 1
A nurse role in the prevention of spread of leprosy is through:

Choose one answer.

a. Proper feeding
 b. Health education

c. BCG vaccination

d. Personal hygiene
Question 97
Marks: 1
Which of the following statements, if made by a patient who has terminal cancer, demonstrates the stage of bargaining as
described in the theory of death and dying?
Choose one answer.
a. I know I am going to get better

b. I do not understand why this is happening to me

c. I have to put my financial affairs in order

d. Please let me live until the graduation of my grand daughter

Question 98
Marks: 1
After surgical repair of a detached retina, a nurse advises a patient to avoid strenuous exercise
and activity for:

Choose one answer.

a. Six years

b. Twelve weeks

c. One day

d. Four years
Question 99
Marks: 1
The symptom of vertigo in a client with Meniere's disease is a subjective experience. Which of
the following is the most accurate description of vertigo?

Choose one answer.

a. Lightheadedness

b. An episode of blackout
 c. Narrowed vision preceding fainting

d. A feeling that the environment is in motion

Question 100
Marks: 1
The goal of a psychotherapy group is for members to learn about their behavior and to make positive changes in their behavior by
interacting and communicating with others in the group. A type of group which is organized to help members share a common
problem in order to cope with it is called:
Choose one answer.
a. Support group

b. Self-help group

c. Education group

d. Family therapy

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