Вы находитесь на странице: 1из 8


Health Care Services and Preparation Final Exam

Name: 5. A client had oral surgery following a motor vehicle accident.

Year and Section: Cielo is assessing the client, and finds the skin flushed and
Score: Date: warm. Which of the following would be the best method to

take the clients body temperature?

Direction: Strictly NO ERASURE IN ANY FORM, Encircle the letter of the
a. Oral
b. Axillary

1. Using the principles of standard precautions, Joan would c. Arterial line

wear gloves in what interventions? d. Rectal

a. Providing a back massage 6. A client who is unconscious needs frequent mouth care.

b. Feeding a client When performing a mouth care, the best position of a client

c. Providing hair care is:

d. Providing oral hygiene a. Fowlers position

2. Grace is preparing to take vital sign in an alert client admitted b. Side lying

to the hospital with dehydration secondary to vomiting and c. Supine

diarrhea. What is the best method used to assess the clients d. Trendelenburg

temperature? 7. A client is hospitalized for the first time, which of the following

a. Oral actions ensure the safety of the client?

b. Axillary a. Keep unnecessary furniture out of the way

c. Radial b. Keep the lights on at all time

d. Heat sensitive tape c. Keep side rails up at all time

3. Angel obtained a clients pulse and found the rate to be above d. Keep all equipment out of view

normal. The nurse document this findings as: 8. A walk-in client enters into the clinic with a chief complaint of

a. Tachypnea abdominal pain and diarrhea. Lulu takes the clients vital sign

b. Hyperpyrexia hereafter. What phrase of nursing process is being

c. Arrhythmia implemented here by the nurse?

d. Tachycardia a. Assessment

4. Which of the following actions should Menchie take to use a b. Diagnosis

wide base support when assisting a client to get up in a c. Planning

chair? d. Implementation

a. Bend at the waist and place arms under the 9. Exchange of gases takes place in which of the following

clients arms and lift organ?

b. Face the client, bend knees and place hands on a. Kidney

clients forearm and lift b. Lungs

c. Spread his or her feet apart c. Liver

d. Tighten his or her pelvic muscles d. Heart

Page 1|8
Health Care Services and Preparation Final Exam

10. The chamber of the heart that receives oxygenated blood d. Embrace soiled linen

from the lungs is the: 16. The most important purpose of cleansing bed bath is:

a. Left atrium a. To cleanse, refresh and give comfort to the client

b. Right atrium who must remain in bed

c. Left ventricle b. To expose the necessary parts of the body

d. Right ventricle c. To develop skills in bed bath

11. The ability of the body to defend itself against scientific d. To check the body temperature of the client in

invading agent such as baceria, toxin, viruses and foreign bed

body 17. It refers to the manner of walking

a. Hormones a. Gait

b. Secretion b. Range of motion

c. Immunity c. Flexion and extension

d. Glands d. Hopping

12. This is characterized by severe symptoms relatively of short 18. Which element in the circular chain of infection can be

duration. eliminated by preserving skin integrity?

a. Chronic Illness a. Host

b. Acute Illness b. Reservoir

c. Pain c. Mode of transmission

d. Syndrome d. Portal of entry

13. It refers to the preparation of the bed with a new set of linens 19. Which of the following will probably result in a break in sterile

a. Bed bath technique for respiratory isolation?

b. Bed making a. Opening the patients window to the outside

c. Bed shampoo environment

d. Bed lining b. Turning on the patients room ventilator

14. Which of the following is the most important purpose of c. Opening the door of the patients room leading

handwashing into the hospital corridor

a. To promote hand circulation d. Failing to wear gloves when administering a bed

b. To prevent the transfer of microorganism bath

c. To avoid touching the client with a dirty hand 20. Which of the following patients is at greater risk for

d. To provide comfort contracting an infection?

15. What should be done in order to prevent contaminating of the a. A patient with leukopenia

environment in bed making? b. A patient receiving broad-spectrum antibiotics

a. Avoid fanning soiled linens c. A postoperative patient who has undergone

b. Strip all linens at the same time orthopedic surgery

c. Finished both sides at the time d. A newly diagnosed diabetic patient

Page 2|8
Health Care Services and Preparation Final Exam

21. Effective hand washing requires the use of: c. 80 140 breaths/min

a. Soap or detergent to promote emulsification d. 60 100 breaths/min

b. Hot water to destroy bacteria 26. Rectal temperature taking is the most accurate method of

c. A disinfectant to increase surface tension measurement. To reduce friction and prevent trauma to the

d. All of the above mucous membranes, Catlleya must do which of the following?

22. After routine patient contact, hand washing should last at a. Lubricate thermometer with soap

least: b. Insert thermometer 4 inches above the sphincter

a. 30 seconds c. Lubricate thermometer with water soluble jelly

b. 1 minute d. Instruct the client to breathe out then insert

c. 2 minute thermometer

d. 3 minutes 27. A type of heat loss that occurs when the heat is dissipated by

23. A natural body defense that plays an active role in preventing air current

infection is: a. Convection

a. Yawning b. Conduction

b. Body hair c. Radiation

c. Hiccupping d. Evaporation

d. Rapid eye movements 28. Which of the following is TRUE about temperature?

a. The highest temperature usually occurs later in a

Situation: The accuracy of VS taking is an important indicator of the day, around 8 P.M to 12 M.N

clients condition and is used extensively as a basis for nursing b. The lowest temperature is usually in the

interventions. Afternoon, Around 12 P.M

c. Thyroxin decreases body temperature

24. The use of appropriate size of the BP cuff is an important d. Elderly people are risk for hyperthermia due to

factor to get an accurate reading. Nurse Lindsay knows that a the absence of fats, Decreased thermoregulatory

cuff that is too narrow or tight can cause which findings? control and sedentary lifestyle.

a. Hypertension 29. Hyperpyrexia is a condition in which the temperature is

b. False low reading . greater than

c. False high reading a. 40 degree Celsius

d. Ecchymosis b. 39 degree Celsius

25. Henmar is the student nurse assigned at the neonatal c. 100 degree Fahrenheit

intensive care unit. Dr. Besonia requested him to take the d. 105.8 degree Fahrenheit

heart rate of Baby Shane. After doing so, Henmar knows that 30. Tympanic temperature is taken from John, A client who was

the normal heart rate of a newborn is: brought recently into the ER due to frequent barking cough.

a. 80 180 beats/min The temperature reads 37.9 Degrees Celsius. As a Health

b. 75 120 beats/min Care Provider, you conclude that this temperature is

Page 3|8
Health Care Services and Preparation Final Exam

a. High a. Delirium

b. Low b. Goose flesh

c. At the low end of the normal range c. Cyanotic nail beds

d. At the high end of the normal range d. Sweating

31. Marlown has a fever of 38.5 Deg. Celsius. It surges at around 36. Considered as the most accessible and convenient method

40 Degrees and go back to 38.5 degrees 6 times today in a for temperature taking

typical pattern. What kind of fever is John having? a. Oral

a. Relapsing b. Rectal

b. Intermittent c. Tympanic

c. Remittent d. Axillary

d. Constant 37. Considered as Safest and most non invasive method of

32. Jarev has a fever of 39.5 degrees 2 days ago, But yesterday, temperature taking

he has a normal temperature of 36.5 degrees. Today, his a. Oral

temperature surges to 40 degrees. What type of fever is John b. Rectal

having? c. Tympanic

a. Relapsing d. Axillary

b. Intermittent 38. Which of the following is a contraindication in taking RECTAL

c. Remittent temperature?

d. Constant a. Unconscious

33. Johns temperature 10 hours ago is a normal 36.5 degrees. 4 b. Neutropenic

hours ago, He has a fever with a temperature of 38.9 c. NPO

Degrees. Right now, his temperature is back to normal. d. Very young children

Which of the following best describe the fever john is having? 39. How long should the Rectal Thermometer be inserted to the

a. Relapsing clients anus?

b. Intermittent a. 1 to 2 inches

c. Remittent b. .5 to 1.5 inches

d. Constant c. 3 to 5 inches

34. What can you expect from rhea, who is currently at the d. 2 to 3 inches

ONSET stage of fever? 40. In cleaning the thermometer after use, The direction of the

a. Hot, flushed skin cleaning to follow Medical Asepsis is :

b. Increase thirst a. From bulb to stem

c. Convulsion b. From stem to bulb

d. Pale,cold skin c. From stem to stem

35. Restituto is now at the Defervescence stage of the fever, d. From bulb to bulb

which of the following is expected? 41. How long should the thermometer stay in the Clients Axilla?

Page 4|8
Health Care Services and Preparation Final Exam

a. 3 minutes d. Low BP leads to Metabolic acidosis

b. 4 minutes 47. All of the following factors correctly influence respiration

c. 7 minutes except one. Which of the following is incorrect?

d. 10 minutes a. Hydrocodone decreases RR

42. Which of the following statement is TRUE about pulse? b. Stress increases RR

a. Young person have higher pulse than older c. Increase temperature of the environment,

persons Increase RR

b. Males have higher pulse rate than females after d. Increase altitude, Increase RR

puberty 48. When does the heart receives blood from the coronary

c. Digitalis has a positive chronotropic effect artery?

d. In lying position, Pulse rate is higher a. Systole

43. The following are correct actions when taking radial pulse b. Diastole

except: c. When the valves opens

a. Put the palms downward d. When the valves closes

b. Use the thumb to palpate the artery 49. Which of the following is more life threatening?

c. Use two or three fingers to palpate the pulse at a. BP = 180/100

the inner wrist b. BP = 160/120

d. Assess the pulse rate, rhythm, volume and c. BP = 90/60

bilateral quality d. BP = 80/50

44. The difference between the systolic and diastolic pressure is 50. Refers to the pressure when the ventricles are at rest

termed as a. Diastole

a. Apical rate b. Systole

b. Cardiac rate c. Preload

c. Pulse deficit d. Pulse pressure

d. Pulse pressure 51. Which of the following is TRUE about the blood pressure

45. The primary respiratory center determinants?

a. Medulla oblongata a. Hypervolemia lowers BP

b. Pons b. Hypervolemia increases GFR

c. Carotid bodies c. HCT of 70% might decrease or increase BP

d. Aortic bodies d. Epinephrine decreases BP

46. Which of the following is TRUE about the mechanism of 52. Which of the following do not correctly correlates the increase

action of the Aortic and Carotid bodies? BP of Ms. Aida, a 70 year old diabetic?

a. If the BP is elevated, the RR increases a. Females, after the age 65 tends to have lower

b. If the BP is elevated, the RR decreases BP than males

c. Elevated BP leads to Metabolic alkalosis b. Disease process like Diabetes increase BP

Page 5|8
Health Care Services and Preparation Final Exam

c. BP is highest in the morning, and lowest during a. If the eye level is higher than the level of the

the night meniscus, it will cause a false high reading

d. Africans, have a greater risk of hypertension than b. If the eye level is higher than the level of the

Caucasian and Asians. meniscus, it will cause a false low reading

53. How many minutes are allowed to pass if the client had c. If the eye level is lower than the level of the

engaged in strenuous activities, smoked or ingested caffeine meniscus, it will cause a false low reading

before taking his/her BP? d. If the eye level is equal to that of the level of the

a. 5 upper meniscus, the reading is accurate

b. 10 58. How many minute/s is/are allowed to pass before making a

c. 15 re-reading after the first one?

d. 30 a. 1

54. Too narrow cuff will cause what change in the Clients BP? b. 5

a. True high reading c. 15

b. True low reading d. 30

c. False high reading 59. Which of the following is TRUE about the auscultation of

d. False low reading blood pressure?

55. Which is a preferable arm for BP taking? a. Pulse + 4 is considered as FULL

a. An arm with the most contraptions b. The bell of the stethoscope is use in auscultating

b. The left arm of the client with a CVA affecting the BP

right brain c. Sound produced by BP is considered as HIGH

c. The right arm frequency sound

d. The left arm d. Pulse +1 is considered as NORMAL

56. Which of the following is INCORRECT in assessing clients 60. The primary factor responsible for body heat production is the

BP? a. Metabolism

a. Read the mercury at the upper meniscus, b. Release of thyroxin

preferably at the eye level to prevent error of c. Muscle activity

parallax d. Stress

b. Inflate and deflate slowly, 2-3 mmHg at a time 61. The heat regulating center is found in the

c. The sound heard during taking BP is known as a. Medulla oblongata

KOROTKOFF sound b. Thalamus

d. If the BP is taken on the left leg using the c. Hypothalamus

popliteal artery pressure, a BP of 160/80 is d. Pons

normal. 62. A process of heat loss which involves the transfer of heat

57. Which of the following is the correct interpretation of the from one surface to another is


Page 6|8
Health Care Services and Preparation Final Exam

b. Conduction c. one side of the body is flexing the top hip and

c. Convection knee and placing his leg in front

d. Evaporation d. the client sits on bed with an overbed table

63. Which of the following is a primary factor that affects the BP? across the lap

a. Obesity 67. How will you position Mr. Seoul to a Semi-Fowlers position?

b. Age a. Elevate head of bed to an angle of 35 degrees

c. Stress b. Place arms at the sides, pronated and elevate

d. Gender with pillow

c. Place patient in supine position

Situation: Nursing procedures are directed toward restoring optimal d. Elevate head of bed to an angle of 50 degree

mobility and preventing some of the effects of immobility. When 68. To promote the use of herbal medicines, which of the

performing these procedures, a nurse must be efficient and competent in following projects would you encourage the people in the

rendering nursing care. community to do?

a. Backyard herbal gardening

64. In assisting client to an erect or standing position, Marvin b. Plant a tree today

must observe all of the following EXCEPT: c. Save Mother Earth

a. Assist patient to stand d. Clean and Green

b. Place a chair near one side where he can rest 69. Which of the following herbal plants is used for respiratory

hand for support problems such as asthma, cough and fever?

c. Drape with a double folded sheet around the a. Lagundi

body from the breast to legs b. Sambong

d. Elevate one foot on a foot stool if needed c. Niyog-niyogan

65. Zamira complains of difficulty of breathing while lying on bed. d. Yerba Buena

Joem can assist her in an orthopneic position by: 70. Which of the following aromatic herbs for body pain,

a. Elevating head of bed to 45 degrees rheumatism and arthritis is used by older persons?

b. Assisting patient to sit up on bed with overbed a. Sambong

table across the lap b. Yerba Buena

c. Assisting patient to lie on his back c. Carmona-rosa

d. Raising knees and separate legs, with soles of d. ulasimang Bato

feet resting on bed

66. Dr. Lopez ordered a cleansing enema for Mr. Rusty. Kim

knows that his client assumes Sims position when:

a. the lower arm is positioned behind the client and 71-76: 6 Vital Signs

upper arm is flexed

b. the client lies on his back, with the knees raised 71.

Page 7|8
Health Care Services and Preparation Final Exam

72. 97.

73. 98.

74. 99.

75. 100.


77-87 Body Systems












88-91 assistive devices











Page 8|8