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Seat No.:______________
Republic of the Philippines
PROFESSIONAL REGULATION COMMISSION
Manila

BOARD OF NURSING

PHILIPPINE NURSE, Licensure Examination

Thursday, February 11, 2021 1:00 p.m – 3:00 p.m
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NURSING PRACTICE II- CARE OF CLIENTS (PART B) SET B

INSTRUCTION: Select the correct answer for each of the following questions.
Mark only one answer for each item by shading the box corresponding to the
letter of your choice on the answer sheet provided. STRICTLY NO ERASURES
ALLOWED.

SITUATIONAL

Situation 1 – The following questions refer to nurse’s efforts to do

collaboration and teamwork. Select the best answer.

1. The most important role of the nurse as a member of the team is to:
A. carry out medical orders
B. meet the needs for the physical well-being of patients
C. coordinate the psychological care and management of clients
D. keep a 24 hour watch for the patients

2. A biological/medical approach to patient care utilizes which of the

following?

A. Million therapy C. Behavioral therapy

B. Somatic therapy D. Psychotherapy
3. Which of these nursing actions belong to the secondary level of preventive
intervention?

A. Providing mental health consultation to health care providers

B. Providing emergency psychiatric services
C. Being politically active in relation to mental health issues
D. Providing mental health education to members of the community

4. When the nurse identifies a client who has attempt to commit suicide the
nurse should:

A. call a priest
B. counsel the client
C. refer the client to the psychiatrist
D. refer the matter to the police

5. The community health nurse was invited by the principal of an elementary

school and wasasked to give a talk to parents. An appropriate topic would be:

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A. the legal aspects of drug abuse

B. disciplining children at home and school
C. marital crises
D. the problems of out of school youth

Situation 2 – The nurse visited the Reyes family to check on their two growing
children, aged 7 and 4 years. Upon her visit she observed that common areas of
arguments between Mr. and Mrs. Reyes are about conflicting ways of bringing up
their children. Mrs. Reyes is lax and tolerant while Mr. Reyes often insists
strict ways to a point of protectiveness from what he perceives as unsafe i.e.
community and neighbour that cannot be trusted.

6. Mr. Reyes remarked “I am wary about people visiting- with all the media
news about child kidnapping and robberies. “The nurse’s BEST response would
be:
A. “Would you rather wish that I don’t come and visit you may regard
me as a stranger?”
B. “I get that.” The nurse diverts the attention to talk about non-
threatening topics.
C. “It must be distressing to think and feel the way you do.”
D. “I acknowledge what you are saying. My concern is the health care
of your family and information are strictly confidential.”

7. Mrs. Reyes expressed that her socializing with neighbors is limited because
her husband thinks she is getting overly friendly with a guy next door. Which
of the following would the nurse emphasize as basic?

A. Keeping trust in the relationship

B. Avoid relating with neighbours to minimize conflict
C. Be assertive to express to express her individuality
D. Ignore the husband and just be supportive

8. For the nurse to be effective in developing rapport with the family it is

essential that she keeps her appointment on time and stick to a care plan. She
is applying the principle of:
A. responsibility and accountability
B. consistency and predictability
C. honesty and integrity
D. empathy and compassion

9. Which of these symptoms if demonstrated by Mr. Reyes would necessitate

referral to a doctor?

A. Hypervigilance C. hypersensitive
B. Suspicious affect D. loss of reality contact

10. The paranoid client utilizes which of the following defense mechanisms?

A. Sublimation C. Rationalization
B. Projection D. Reaction formation

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Situation 3 – Mr. Sison has been diagnosed as having early chronic glaucoma.
He has been admitted to the hospital for treatment.

11. The nurse identified a nursing problem of disturbed sensory perception:

visual impairment characterized by:

A. sudden loss of eyesight

B. loss of night vision
C. loss of peripheral vision
D. loss of central vision

12. In order to understand the rationale for drug therapy, it is important for
the nurse to know that glaucoma is usually caused by:

A. opacity in the lens

B. gradual diminution of the retina
C. damage to the proteins in the lens
D. increase production of aqueous fluid

13. Diamox is a drug used in the treatment of glaucoma. Which of these is the
effect of this drug?

A. Constricts the pupil

B. Acts as osmotic diuretic
C. Reduces the production of aqueous humor
D. Facilitates outflow of aqueous humor

14. Public health nurses should identify which of these patients as a risk
group for development of glaucoma, hence the need for annual eye examinations:

A. Patient with Parkinson’s disease

B. Cancer patients
C. Diabetic and hypertensive patients
D. Patient with COPD

15. The appropriate method of instilling eye drops is: Instilling into an
opened eye, with the head held back and with the eye looking:

A. Upward C. aggressiveness
B. downward D. suspiciousness

Situation 4 – SEXUAL DISORDER

16. A hospitalized male adolescent flirts with and is sexually provocative

toward a female nurse. The nurse can respond MOST therapeutically by doing
which of the following?

A. Telling him she is married and too old for him

B. Introducing him to female clients his own age
C. Encouraging him to watch TV in his room
D. Ignoring his flirtatious and provocative behaviors

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17. The premorbid personality of a person with a non-psychotic maladaptive

response to anxiety may most accurately be described as:

A. unpredictable, impulsive and aggressive

B. rigid, insecure and conforming
C. dependent, pessimistic and moody
D. anxious, insensitive and self-absorbed

18. An oral-dependent personality is characterized by which of the following?

A. Helplessness C. Aggressiveness
B. Hopelessness D. Suspiciousness

19. The pedophile’s choice of a sex object is primarily based on:

A. difficulty relating with adults

B. feelings of tenderness toward children
C. fears of incestuous impulses
D. preferred for a passive sexual role

20. A young adult male unable to stay put in one job and has no commitment in
his relationship is having difficulty achieving a sense of:

A. Autonomy C. industry
B. Trust D. intimacy

Situation 5 – Anita is experiencing rape-trauma syndrome in an acute phase.

She had been invited to a fraternity party. She had too much drink and she has
feelings of anger, humiliation, helplessness, nausea, vomiting, nightmare and
muscle tension.

21. When the nurse approached Anita, initially she was just crying, felt she
was in a nightmare and she was at a loss. The appropriate nursing diagnosis is

A. Situational low self-esteem

B. Sexual violence
C. Ineffective coping
D. Sexual dysfunction

22. Anita expressed to the nurse that she douched, showered for an hour and
still did not feel clean. Anita is experiencing:

A. guilt C. denial
B. anger D. frustration

23. Which of these communicate unconditional acceptance of Anita and hr

situation?

A. “You are here and I am ready to listen.”

B. Why did you date a guy you hardly knew?”
C. Tell me when you are ready and I’ll come back to you.”
D. I would be best of help if you stop crying.”

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24. Anita is experiencing:

A. maturational crisis C. Social crisis

B. developmental crisis D. frustration

25. Which of these behaviors of Anita signal her readiness to proceed to the
working phase of the nurse-patient relationship?

A. She states she trusted the nurse

B. She wants to talk to a lawyer
C. She inquires about personal information about the nurse
D. She wants to be told what her rights are

Situation 6 – The psychiatric mental health nurse adheres to standards that

ensure quality improvement. The following situations and behaviors are means
to achieve this goal.

26. This is a process wherein the client’s chart is reviewed to compare

criteria for quality care with actual practice:

A. Psychiatric Audit
B. Nursing Care Process
C. Interaction Process Analysis
D. Algorithms

27. In order to assess “Reliability” as a behavioral characteristic, the

nurse would ask herself which of the following questions regarding her
recording:

A. Did the history of the present problem correlate with the review of
growth and development?
B. How long did it take to complete the nursing data base?
C. Is the nursing data base complete?
D. Are the nursing history and psychosocial assessment accurate?

28. All of these are the advantages of peer review EXCEPT:

A. Demands accountability for nursing actions

B. Has the possibility of enhancing intra professional respect
C. It requires the development of standards for quality care
D. Provide an evaluation of the nurse’s abilities

29. The nursing team leader wants to involve all the nurses in participating
in their own personal and professional growth through a brainstorming session.
One of the most important ground rules is:

A. Follow the problem solving approach

B. Do not pass judgment on the ideas presented
C. Ideas must be feasible
D. Suggestions must be cost effective

30. “Did the nurse perform in the best possible manner without waste?” aims
to describe the nurse’s:

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A. thoroughness C. efficiency
B. reliability D. analytic sense

Situation 7 – A nurse was interested to study the research question: “What

are the differences and similarities between aggressive and non-aggressive
cognitively impaired, elderly, institutionalized people?”

31. Investigation of cognitively impaired individual presented some ethical

dilemmas. Which of the following protocol would be considered unethical?

A. Recording interaction with the elderly with their permission

B. Verbal permission from the subject is unnecessary
C. Data coded and recorded solely by the investigation
D. A written consent from the institution and a significant other

32. A semi-structured interview was conducted. This means that:

A. Interview is conducted precisely in the same manner

B. Interviewer is not held to any specific question
C. Subject is allowed to express without any suggestion from
interviewer
D. Interviewer is free to probe beyond a number of specific major
questions

33. The type of study conducted is:

A. Descriptive C. experimental
B. Quasi-experimental D. case study

34. The review of literature included reference to retrospective studies. Such

studies have the advantages EXCEPT:

A. Data are inexpensive to obtain

B. Possibility of memory bias and distortion of fact
C. There is much material available
D. It is easy to get data
35. The average age of the respondents was 86, this represents:

A. the sum ages divided by total number of participants

B. the youngest participant is 86 years old
C. the oldest participant is 86 years old
D. most of the number participant is 86 years old

Situation 8 – Mr. David is brought to the hospital due to pain radiating to

the hip and leg. He is diagnosed with a herniated lumbar disk. H is scheduled
for myelogram.

36. After the procedure, the nurse must include which of the following nursing
action in his care?

A. Assess for movement and sensation of the lower extremity

B. Place the client in most comfortable position
C. Lying supine with heels flexed

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D. Bed rest with bed elevated at 45 degrees

37. Mr. David is scheduled for lumbar laminectomy. Post operatively the nurse
should:

A. Logroll the client with the help of another nurse

B. Inform the client that he should be in supine position
C. Assess the sensory loss in his legs
D. Instruct the patient to move from side to side

38. Trimethobenzamine Hydrochloride (Tigan) was administered postoperatively.

The action of this drug is effective when it:

A. Controls nausea C. controls muscle spasm

B. Controls pain D. controls edema

39. Mr. David is to ambulate for the first time following surgery. What
nursing action should be BEST when the client begins to faint?

A. Get another nurse for help

B. Maneuver the client to a sitting position
C. Get back to his bed and place in side lying position
D. Assist the client to form a wide base of support and lean against
the nurse

40. Mr. David has to wear back brace. Which position is recommended when the
brace is applied?

A. Sitting position C. lying on his side in bed

B. Standing position D. supine position in bed

Situation 9 – Through the nurse-patient relationship, the nurse intervenes

utilizing effective communication techniques. The following are varied
situations in a psychiatry ward.

41. The patient verbalizes, “Masama and pakiramdam ko. Hindi ako nakatulog
kagabi.”A therapeutic response of the nurse would be:

A. “Baka ini-istorbo ka na naman ng mga boses.”

B. “Sinabi mo sana sa nars nabigyan ka ng sedative mo”
C. “Relax lang! Huwag ka masyadong mag-iisip ng mga problema mo”
D. “Maari mo bang sabihin sa akin and mga naiisip at nararamdaman
mo?”

42. Soledad is terminally ill of cancer. Looking sad, she expresses, “Wala na
yata akong pagasang mabuhay pa,” A response which fosters hope is:

A. “Mukhang napakabigat ang dinaramdam ninyo. Andito po ako at puwede

tayong mag-usap.“
B. “Huwag po ninyong isipin ang sakit ninyo. Bale wala yon.
Andito naman ako para
makausap ninyo.”

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C. “Lakasan ang loob ninyo. Lahat naman po tayo ay doon ang

patutunguhan.”
D. “Gagaling din po kayo. Huwag po kayong mag-aalala.”

43. Camilia verbalizes, “Pinag-uusapan nila ako. Ayaw nila ako.”

A therapeutic response is:

A. “Nalulungkot ba ang pakiramdam mo?”

B. “Hayaan mo sila. Ang mahalaga ay ang palagay mo sa
sarili mo.”
C. “Sino ang ‘nila’ na tinutukoy mo?”
D. “Huwag mong isipin yan. Hindi tama yan.”

44. During socialization, Nicanor was provoked, became furious

and started shouting “Walang hiya kayo! Ako ang bida dito!” The
nurse’s action is:

A. Take him away from the group until he manages to have

control of himself.
B. Immediately restrain him and put him on isolation to
protect other patients.
C. Prevent him from becoming more furious by giving an
extra PRN dose of sedative.
D. Respond with, “Nicanor, pare-pareho lang kayo ng mga
ibang pasyente dito.”

45. Nicanor becomes verbally assaultive to the nurse. He says,

“Ikaw, nurse, wala kanga lam! Marunong pa ako sa iyo e. Ano ba
ang ipinagmamalaki mo!” The nurse responds therapeutically by:

A. admonishing him with, “Ako ang nurse dito. Dapat sumunod

ka sa akin.”
B. Acknowledging his behavior, however, put him in his
right senses, respond with, “Oo nga, galit ka sa nurse pero
hindi tama na naninigaw ka.”
C. Acknowledging his behavior and respond, “Nagagalit ka sa
nurse at
nawawala ka ng control sa sarili mo.”
D. Ignoring the behavior of the patient

Situation 10 – Nicanor was discharged from the hospital and

recovered from a manic episode of Bipolar Disorder. Nicanor was
readmitted with an entirely different behaviour, he was very
depressed.
46. The defense mechanism utilized by manic patients to cover up
depression is:

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A. reaction formation C. displacement

B. compensation D. denial

47. The psychodymanics of depression is:

A. lax super-ego
B. weak super-ego
C. internalized hostility feelings
D. narcissistic personality

48. Which of these drugs is likely to indicated to Nicanor?

A. Serenace (Haloperidol)
B. Valium (Diazepam)
C. Tofranil (Imipramine HCl)
D. Trilaton (Pherpenazine)

49. Therapeutic use of self is essential in relating with

psychiatric patients. This is BEST demonstrated in:

A. sympathizing with the miserable feelings of Nicanor

B. engaging Nicanor in productive activity
C. engaging Nicanor in introspective thinking
D. suppressing her own feelings toward Nicanor

50. After three days of antidepressant medication, Nicanor still

manifests depression. The nurse evaluates this as:

A. unusual because action of antidepressant drug is

immediate
B. expected because it takes about two weeks for the
medication to be effective
C. unexpected because it takes within one week for the
medication to be effective
D. ineffective because perhaps the drug’s dose is
inadequate

Situation 11 - Ninety year old Purita is confined at the medical

unit for respiratory ailment for which a breathing apparatus is
prescribed for her to use while she sleeps. She refuses to wear
it continuously though she fully understands the medical
indication for it.

51. Which of these ethical principles can guide the nurse in her
action?

A. Beneficence C. Autonomy

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B. Fidelity D. Non maleficence

52. Purita has six children who are already adults. They differ
in their opinion whether or not to allow their mother to decide
for herself. The nurse would encourage family conference for:

A. the eldest child’s opinion to be given priority

B. majority of the children to decide
C. allowing the medical staff to decide in their behalf
D. consensus building

53. Breathing treatments are to be given to Purita. In

anticipation that Purita might refuse, Dinio, one of the children
requests that he be the one to sign the consent in behalf of
their mother. The nurse explains that Purita is rational in her
thinking and which of these client’s right must be regarded?

A. Right to refuse treatment

B. Right to privacy
C. Right to informed consent
D. Right of habeas consent

54. Which of these would be the nurse’s priority following the

treatment principle of least restrictive alternative?

A. One of one staffing C. Physical restraint

B. Use of onsite guard/watcher D. Seclusion

55. Purita talks about her joy in having responsible and

accomplished children and recalls challenging career as a lawyer.
She is demonstrating a sense of:

A. ego integrity C. generativity

B. industry D. autonomy

Situation 12 – Marina, 26 years old, is aloof in relating with

other patients and members of the staff. She claims that the
medications being given her are meant to poison her. She is also
suspicious about the food being served for her.

56. Basically, Marina is suspicious because of her inability to

develop a sense of:

A. Intimacy C. Trust
B. Generativity D. Intiative

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57. Marina utilizes projection by being suspicious. This means

that she:
A. unconsciously refuses to accept a feeling, thought or
impulse and attributes it to someone else
B. justifies behavior, attitudes and feelings with excuses
C. involuntarily refuses to acknowledge reality
D. involuntarily excludes wishes, impulses, memories and
feelings from awareness
58. Which of these nursing approaches is MOST appropriate for the
nurse to begin with?

A. Engage Marina for at least one hour in a one-to-one

interaction daily
B. Invite her to socialize with other patients
C. Make self-available while maintaining distance until
patient shows readiness to interact
D. Refer her for activity therapy

59. When she resists to take her medication, it is best to:

A. let her read the drug literature to convince her that

it is therapeutic
B. force her to take the drug to maintain therapeutic
effectiveness of the drug
C. have the same nurse, who she interacts with regularly,
administer the drug
D. request the doctor to give her medication

60. Another reason why she refuses to take Thorazine is because

she complains of robot like movement and slurred speech. The
nurse’s action is:

A. decrease the dosage of thorazine

B. explain the extrapyramidal side effects and administer
Benadryl
C. avoid giving foods that are rich in tyramine
D. withhold medication until referral is made to the
doctor

Situation 13 – The supervising nurse received report that a staff

nurse is displaying frequent irritation, anger, and even
indifference toward clients and co-workers.

61. The initial action of the supervisor would be to:

A. post guidelines on proper decorum of nurses in the

bulletin board

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B. write a memo of warning to the nurse

C. request anecdotal report form nurse’s co-workers
D. call the nurse for a one on one conference
62. The nurse expressed increasing feelings of dissatisfaction.
The supervising nurse intervenes therapeutically by taking the
role of:

A. administrator by relieving her of responsibilities

B. therapist by delving into the nurse’s internal
conflicts
C. counselor by actively listening
D. educator by reorienting her of her role as a nurse

63. Coupled with poor work performance, mental and physical

fatigue and actual withdrawal from client contact and nursing
duties, the nurse can be said to be suffering from:

A. psychotic anxiety
B. staff burnout
C. personality maladjustment
D. neurotic depression

64. A priority in the nurse’s personal development would be to:

A. address her physical well-being

B. boost her self-confidence
C. provide social support
D. help her find value and meaning in her work

65. The most relevant professional program for her would be:

A. assertiveness training
B. stress management
C. group dynamics and team building
D. behavior modification

Situation 14 – The purpose of the nursing care plan is to

identify the care for an individual patient based on his
problems. The nurse writes a nursing care plan for a patient
based on nursing care standards.

66. Given this example of a problem, “Anxiety due to a job

interview”. The “due to” or the reason for the problem should be
included if it is known. The initial step in identifying problems
is:

A. gather data about the patient

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B. determine if the problems are usual or unusual

C. analyze the data
D. analyze the problems as concisely as possible
67. Given this example of an expected outcome: “Openly verbalize
anxiety about job interview. Identify how he can prepare for the
job interview.” Which of these is not a criterion of expected
outcomes?

A. An expected outcome is stated in terms of what the

patient will do
B. An expected outcome is stated in terms of what the
nurse will do
C. Every outcome must be measurable
D. Every outcome answers the question “How will you know
when the problem is resolved?”

68. The following are reasons for setting deadlines within which
to achieve outcomes of care
EXCEPT:

A. Indicate specific times to review progress or lack of

progress
B. Does not allow plans to be changed
C. Allow plans the need to be changed
D. Set the time by which the expected outcome should be
reached

69. Which of these is not a relevant nursing order?

A. Ask the patient any untoward side effects of

medications he is taking
B. Have patient role play interview situation
C. Discuss with a patient with specific means he might
prepare for the job interview
D. Ask the patient what he is feeling about the job
interview

70. Which of these practices on evaluation support nursing care?

Review of care plan is:

A. a nursing team responsibility

B. the sole responsibility of the primary nurse
C. the responsibility of peers
D. the sole responsibility of the supervisor

Situation 15 – A nurse assigned in the neurologic unit is taking

care of clients with varying degrees of degenerative disorders.

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71. Ma. A with myasthenia gravis is having difficulty speaking.

What communication strategies should the nurse avoid when
interacting with Mr. A?

A. Repeating what the client says for better understanding

B. Using paper and pencil in communicating with the client
C. Encouraging the client to speak slowly
D. Encouraging the client to speak quickly

72. When planning for nursing care for Mr. B who has Parkinson’s
disease, which of the following goals would be MOST appropriate?

A. to improve muscle tone

B. to start rehabilitation as much as possible
C. to treat the disease
D. to maintain optimal body function

73. For the past 10 years, Alma, 42 years old, has had multiple
sclerosis. Clients with multiple sclerosis experience many
different symptoms. As part of the rehabilitation planned for
Alma, the nurse suggested therapy and hobbies to help her:

A. strengthen muscle coordination

B. establish routine
C. develop perseverance and motivation
D. establish good health habits

74. On his second day of hospitalization, Mr. Santos was unable

to stand and is having difficulty swallowing and talking. Which
of the following is the priority of the nurse in assisting Mr.
Santos?

A. To prevent bladder distention

B. To prevent decubitus ulcer
C. To prevent contracture
D. To prevent aspiration pneumonia

75. The wife of a seventy two (72) year old male with a diagnosis
of Alzheimer’s disease begins to cry and tells the nurse, “I
could not understand my husband anymore. He has changed
drastically.” Which of the following responses of the nurse is
MOST appropriate?

A. “The physician and the staff will make sure that your
husband will be comfortable and safe here.”

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B. “This has been a difficult time for you. Let us walk

and find a quiet place where we can talk.”
C. “He will soon recover in his condition.”
D. “You need not worry, we are doing the best we could.”
Situation 16 – Annie has a morbid fear of heights. She asks the
nurse what desensitization therapy is:

76. The accurate information of the nurse of the goal of

desensitization is:

A. to help the clients relax and progressively work up a

list of anxiety provoking situations through imagery.
B. To provide corrective emotional experiences through a
one-to-one intensive relationship.
C. To help clients in a group therapy setting to take on
specific roles and reenact in front of an audience,
situations in which interpersonal conflict is involved.
D. To help clients cope with their problems by learning
behaviors that are more functional and be better equipped
to face reality and make decisions.

77. It is essential in desensitization for the patient to:

A. have rapport with the therapist

B. use deep breathing or another relaxation technique
C. assess one’s self for the need of an anxiolytic drug
D. work through unresolved unconscious conflicts

78. In this level of anxiety, cognitive capacity diminishes.

Focus becomes limited and client experiences tunnel vision.
Physical signs of anxiety become more pronounced.

A. severe anxiety C. mild anxiety

B. panic D. moderate anxiety

79. Antianxiety medications should be used with extreme caution

because long term use can lead to:

A. Parkinsonian like syndrome

B. Hypertensive crisis
C. Hepatic failure
D. Risk of addiction

80. The nursing management of anxiety related with post-traumatic

stress disorder includes all of the following EXCEPT:

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A. encourage participation in recreation or sports

activities
B. reassure client’s safety while touching client
C. speak in a calm soothing voice
D. remain with the client while fear level is high
Situation 17 – For personal and professional development, the
nursing staff decided to hold a staff development program, “Self-
enhancement through Assertiveness”.

81. An appropriate assessment tool to maximize gathering of needs

of nurses is through:

A. interview of nurses C. observation

B. survey D. brainstorming session

82. A priority objective of the program is:

A. develop the art of public speaking

B. project a positive image of the nursing profession
C. develop art and skills of therapeutic use of self
D. earn continuing education units

83. The most effective way to practice assertiveness skills is

through:

A. written evaluation form C. descriptive

report
B. process recording D. role play

84. The least satisfactory method to evaluate the effectiveness

of the program is through:

A. group discussion and report

B. return demonstration
C. attendance
D. individual interviews

85. Which of these feedback from individual participants indicate

maximum gain from the staff development program?

A. “I will write a plan for personal development program.”

B. “I feel very good. The program inspired me a lot.”
C. “I learned a lot. I hope to have more seminars of its
kind.”
D. “I have a “Do it Now” project for myself i.e. to
approach my clinical supervisor regularly to discuss
nursing care of our clients.”

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Situation 18 – A vehicle hit some pedestrians while waiting for a

bus ride. Some of the victims suffered injuries in the different
part of their bodies. The victims were brought to the nearby
hospital. One of the victims, Josephine was confirmed to have a
fractured left arm. While waiting for the plaster cast to be
applied, Josephine appears to be anxious.

86. To reduce anxiety, the nurse teaches the procedure to the

client. Which of the following topics should NOT be included in
the teaching plan?

A. Leave the cast uncovered to promote drying.

B. Bear weight on the plaster cast for one hour. A
stockinet will be placed over the left arm to be placed in
cast.
C. Handle hardening cast with palm of hands
D. Trim and reshape finish cast with knife or cutter.

87. Cast was applied on Josephine’s left arm. In assessing the

neurovascular status of the client, which of the following
assessment findings should be reported to the physician?

A. Pain on the left arm

B. Swelling of the fingers
C. Skin abrasions on the edges of the plaster cast
D. Nail bed capillary refill time of 10 seconds

88. One of the victims, a sixty year old woman sustained hip
fracture. Prior to surgery, a Buck’s extension traction is to be
applied. The rationale of traction is primarily based on the
understanding that Buck’s extension traction:

A. reduces muscle spasms and helps to immobilize the

fracture
B. allows reduction of the fracture site for bone healing.
C. Secures the fracture site to prevent damage to the
muscle tissues
D. Secures the fracture site for rigid immobilization

89. Phillip was placed in skeletal leg traction with an over bed
frame. He is not allowed move from side to side. Which of the
following nursing interventions is useful in maintaining
effective traction?

A. Assist the client by holding the trapeze and raising

the hips off the bed.

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B. Check the apparatus that weights hang free and knots in

the rope are tied securely
C. Suspend the trapeze within easy reach of the client
D. Support the affected extremity while the weights are
removed.
90. To prevent complications when a child is in Buck’s traction,
the nurse should”

A. clean the extremity and keep the skin dry

B. assess any skin and circulatory disturbances
C. clean the pin sites as necessary
D. provide high fiber small meals

91. All of the following concepts are true EXCEPT:

A. Hostility is destructive
B. Frustration develops in response to unmet needs, wants
and desire
C. Anger is incompatible with love
D. Aggression can be expressed in a constructive as well
as a destructive manner.

92. Carlo is acting out hostile and aggressive feeling by kicking

the chairs in the room. The MOST effective way to deal with
Carlo’s behavior is initially to:

A. set limits on the behavior by verbal command

B. administer PRN tranquilizer
C. remove the chairs from the room
D. restrain the patient and place him in the “Isolation
Room”

93. Mrs. Dizon was visiting her son at the Psychiatry Ward. Which
of the following items will the nurse not allow to be brought
inside the ward?

A. string rosary bracelet C. bottle of coke

B. box of cake D. rubber shoes

94. Which of the following will probably be most therapeutic for

a patient on a behavioural modification ward?

A. if the client is agitated, discuss the feelings

especially anger
B. insist to stop obscene language by verbal reprimand
C. give client support and positive feedback for
controlling use of obscene language

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D. Provide a punching bag as an alternative to express

upset emotions

95. Which of the following must be considered while planning

activities for the depressed patient?
A. activities which require exertion of energy
B. challenging activities to get him out of his depression
C. variety of structured activities
D. variety of unstructured activities

Situation 20 - Jim, age 25, recalled that his problem began

around age 15-16. He would count pencils in a mug over and over
with the thought that stopping could result in something bad
happening.

96. There are many things Jim seems he has to do to keep himself
from feeling:

A. confused C. excited
B. suspicious D. anxious

97. He has change clothes 20 times before work, chew each bite he
east 24 times and go up and down the stairs four to five times
before it feels right. He is demonstrating:

A. ideas of reference
B. denial and projection
C. obsession and compulsion
D. rationalization and over reaction

98. The objective of nursing care for Jim is to develop or

increase feelings of:
A. self-mastery C. self-actualization
B. self-worth D. self-determination

99. All of these are therapeutic interventions EXCEPT:

A. impose limits every time the behavior becomes

repetitive
B. establish a routine for him
C. assign task that can be done repetitively
D. facilitate self-expression

100. Jim is aware of his behavior yet realizes that it is very

disturbing to him. This is a pattern of:
A. personality disorder C. neurosis
B. psychosis D. habitual disorder

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SUBMIT THIS TEST BOOKLET TOGETHER WITH THE ANSWER SHEET TO YOUR WATCHERS.
BRINGING THE TEST BOOKLET OUT OF THE ROOM WILL BE A GROUND FOR CANCELLATION OF
YOUR EXAMINATION.

***END***

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