PATHOPHYSIOLOGY

1. Which of the following classes of medications maximizes cardiac performance in clients with heart failure by
increasing ventricular contractility?
a. Beta-adrenergic blockers c. iuretics
b. !alcium channel blockers d. "notropic agents

#. $timulation of the sympathetic nervous system produces which of the following responses?
a. Bradycardia c. %ypotension
b. &achycardia d. ecreased myocardial contractility
'. Which of the following conditions is most closely associated with weight gain( nausea( and a decrease in urine output?
a. )ngina pectoris c. *eft-sided heart failure
b. !ardiomyopathy d. +ight-sided heart failure
,. What is the most common cause of an abdominal aortic aneurysm?
a. )therosclerosis c. %ypertension
b. iabetes mellitus d. $yphilis
-. "n which of the following areas is an abdominal aortic aneurysm most commonly located?
a. istal to the iliac arteries c. )d.acent to the aortic arch
b. istal to the renal arteries d. /roximal to the renal arteries
0. ) pulsating abdominal mass usually indicates which of the following conditions?
a. )bdominal aortic aneurysm c. 1astric distention
b. 2nlarged spleen d. 1astritis
3. What is the most common symptom in a client with abdominal aortic aneurysm?
a. )bdominal pain c. %eadache
b. iaphoresis d. 4pper back pain
5. Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic
aneurysm?
a. )bdominal pain c. )ngina
b. )bsent pedal pulses d. *ower back pain
6. What is the definitive test used to diagnose an abdominal aortic aneurysm?
a. )bdominal 7-ray c. !omputed tomography 8!&9scan
b. )rteriogram d. 4ltrasound
1:. Which of the following complications is of greatest concern when caring for a preoperative abdominal aortic aneurysm
client?
a. %ypertension c. !ardiac arrhythmias
b. )neurysm rupture d. iminished pedal pulses
11. Which of the following blood vessel layers may be damaged in a client with an aneurysm?
a. 2xterna c. ;edia
b. "nterna d. "nternal and media
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1#. When assessing a client for an abdominal aortic aneurysm( which area of the abdomen is most commonly palpated?
a. +ight upper <uadrant
b. irectly over the umbilicus
c. ;iddle lower abdomen to the left of the midline
d. ;iddle lower abdomen to the right of the midline
1'. Which of the following conditions is linked to more than -:= of clients with abdominal aortic aneurysms?
a. iabetes mellitus c. /eripheral vascular disease
b. %ypertension d. $yphilis
1,. Which of the following sound sis distinctly heard on auscultation over the abdominal region of an abdominal aortic
aneurysm client?
a. Bruit c. ullness
b. !rackles d. >riction rubs
1-. Which of the following groups of symptoms indicates a ruptured abdominal aortic aneurysm?
a. *ower back pain( increased blood pressure( decreased red blood cell 8+B!9
b. $evere lower back pain( decreased blood pressure( decreased +B! count( increased WB! count
c. $evere lower back pain( decreased blood pressure( decreased +B! count( decreased WB! count
d. "ntermittent lower back pain( decrease blood pressure( decreased +B! count( increase WB! count
10. Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the
perineal area?
a. %ernia
b. $tage 1 pressure ulcer
c. +etroperitoneal rupture at the repair site
d. +apid expansion of the aneurysm
13. Which hereditary disease is most closely linked to aneurysm?
a. !ystic fibrosis c. ;arfan?s syndrome
b. *upus erythematosus d. ;yocardial infarction
15. Which of the following treatments is the definitive one for a ruptured aneurysm?
a. )ntihypertensive medication administration
b. )ortogram
c. Beta-adrenergic blocker administration
d. $urgical intervention
16. Which of the following heart muscle diseases is unrelated to other cardiovascular disease?
a. !ardiomyopathy c. ;yocardial infarction
b. !oronary artery disease d. /ericardial effusion
#:. Which of the following types of cardiomyopathy can be associated with childbirth?
a. ilated c. ;yocarditis
b. %ypertrophic d. +estrictive
#1. Which of the following symptoms are considered signs of a fracture?
a. &ingling( coolness( loss of pulses
b. *oss of sensation( redness( coolness
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c. !oolness( redness( new site of pain
d. +edness( warmth( pain at the site of in.ury
##. Which of the following areas would be included in a neurovascular assessment?
a. @rientation( movement( pulses( warmth
b. !apillary refill( movement( pulses( warmth
c. @rientation( papillary response( temperature( pulses
d. +espiratory pattern( orientation( pulses( temperature
#'. Which of the following methods is the correct way to assess limb circumference?
a. 4se a measuring tape
b. Aisually compare limbs bilaterally
c. !heck the client?s medical history
d. >ollow the standardized chart for limb circumference
#,. "f pulses aren?t palpable which of the following interventions should be performed first?
a. !heck again in 1 hour
b. )lert the nurse in charge immediately
c. Aerify the findings with opler ultrasonography
d. )lert the physician immediately
#-. ) client describes a foul from this cast. Which of the following responses or interventions would be the most
appropriately?
a. )ssess further because this may be a sign of infection
b. &each him proper cast care( including hygiene measures
c. &his is normal( especially when a cast is in place for a few weeks
d. )ssess further because this may be a sign of neurovascular compromise.
#0. &o reduce the roughness of a cast( which of the following measures should be used?
a. /etal the edges c. Break off the rough area
b. 2levate the limb d. istribute pressure evenly
#3. 2levating a limb with a cast will prevent swelling. Which of the following actions best describes how this is done?
a. /lace the limb with the cast close to the body
b. /lace the limb with the cast at the level of the heart
c. /lace the limb with the cast below the level of the heart
d. /lace the limb with the cast above the level of the heart
#5. ) client asks why a cast can?t get wet. Which of the following responses would be the most appropriate?
a. ) wet cast can cause a foul odor
b. ) wet cat will weaken or be destroyed
c. ) wet cast is heavy and difficult to maneuver
d. "t?s all right to get the cast wet( .ust use a hair dryer to dry it off
#6. ) client comes to the emergency department complaining of dull( deep bone pain unrelated to movement. Which of
the following statements is correct to help decide if the bone pain is caused by a fracture?
a. &hese are classic symptoms of a fracture
b. >racture pain is sharp and related to movement
c. >racture pain is sharp and unrelated to movement
d. >racture pain is dull and deep related to movement
':. Which of the following fractures is classic for occurring from trauma?
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a. Brachial and clavicle c. %emerus and clavicle
b. Brachial and humerus d. @ccipital and humerus
'1. Which of the following characteristics applies to a closed fracture?
a. 2xtensive tissue damage c. $ame as for a compound fracture
b. "ncreased risk of infection d. "ntact skin over the fracture site
'#. ) client is put in traction before surgery. Which of the following reasons for the traction is correct?
a. /revents skin breakdown c. %elps the client become active
b. )ids in turning the client d. /revents trauma and overcomes muscle spasms
''. When the fracture line is straight across the bone( the fracture is known as which of the following types?
a. *inear c. @bli<ue
b. *ongtitudinal d. &ransverse
',. Which of the following fractures commonly occurs with such bone diseases as osteomalacia and /aget?s disease?
a. *inear c. @bli<ue
b. *ongtitudinal d. &ransverse
'-. Which of the following fractures is commonly seen in the upper extremities and is related to physical abuse?
a. *ongtitudinal c. $piral
b. @bli<ue d. &ransverse
'0. Which of the following mechanisms or conditions causes healing of a fracture?
a. $car tissue c. Becrotic tissue formation
b. isplacement d. >ormation of new bone tissue
'3. Which of the following conditions is a serious complication of a femoral shaft fracture?
a. !onstipation c. %emorrhage
b. ecreased urine output d. /ain
'5. Which of the following serious complications can occur with long bone fractures?
a. Bone emboli c. /latelet emboli
b. >at emboli d. $erous emboli
'6. Which of the following signs and symptoms can occur with fat emboli?
a. &achypnea( tachycardia( shortness of breath( paresthesia
b. /aresthesia( bradypnea( bradycardia( petechial rash on chest and neck
c. Bradypnea( bradycardia( shortness of breath( petechial rah on chest and neck
d. &ahypnea( tachycardia( shortness of breath( petechial rash on chest and neck
,:. &reatment of a fat embolus may include which of the following therapies?
a. )lbuterol( oxygen( ".A. fluids steroids
b. @xygen( ".A. fluids( steroids( antibiotics
c. ;orphine( oxygen( ".A. fluids antibiotics
d. &heophylline( morphine( oxygen( ".A. fluids
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,1. Which of the following terms describes involuntary( .erking( rhythmic movements of the eyes?
a. iplopia c. Bystagmus
b. 2xophthalmos d. "ncreased protein levels
,#. Which of the following nursing interventions takes priority for the client having a tonic-clonic seizure?
a. ;aintaining a patent airway
b. &iming the duration of the seizure
c. "nserting the origin of seizure activity
d. "nserting a padded tongue blade to prevent the client from biting his tongue
,'. ) client recalls smelling an unpleasant odor before his seizure. Which of the following terms describes to this?
a. )tonic seizure c. "cterus
b. )ura d. /ostictal experience
,,. ) client with new-onset seizures of unknown cause is started on phenytoin 8ilantin9( 3-: mg ".A. now and 1:: mg
/.@. t.i.d. Which of the following statements best describes the purpose of the loading dose?
a. &o ensure that the drug reaches the cerebrospinal fluid
b. &o prevent the need for surgical excision of the epileptic focus
c. &o reduce secretions in case another seizure occurs
d. &o more <uickly attain therapeutic levels
,-. Which of the following adverse effects may occur during phenytoin 8ilantin9 therapy?
a. ry mouth c. $omnolence
b. >urry tongue d. &achycardia
,0. Which of the following symptoms may occur with a phenytoin level of '# mgCdl?
a. )taxia and confusion c. tonic-clonic seizure
b. $odium depletion d. 4rinary incontinence
,3. Which of the following precautions must be taken when giving phenytoin 8ilantin9 to a client with a nasogastric 8B19
tube for feeding?
a. !heck the phenytoin level after giving the drug to check for toxicity
b. 2levate the head of the bed before giving phenytoin through the B1 tube
c. 1ive phenytoin 1 hour before or # hours after B1 tube feedings to ensure absorption
d. Aerify proper placement of the B1 tube by placing the end of the tube in a glass of water and observing for
bubbles
,5. What?s the most important concern for clients who drink alcohol while taking phenytoin?
a. )lcohol increases phenytoin activity
b. )lcohol raises the seizure threshold
c. )lcohol impairs .udgment and coordination
d. )lcohol decreases the effectives of phenytoin
,6. When assessing vital signs in a client with a seizure disorder( which of the following measures is used?
a. !hecking for a pulse deficit
b. !hecking for pulse paradoxus
c. &aking an axillary instead of oral temperature
d. !hecking the blood pressure for an auscultatory gap
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-:. ) client in status epilepticus arrives at the emergency department. &he family is interviewed to determine the cause of
this problem. Which of the following events may have predisposed the client to this condition?
a. )bruptly stopping anticonvulsant therapy
b. )irplane travel
c. 2xposure to sunlight
d. +ecent upper respiratory infection
-1. ) client comes to the emergency department after hitting head in a motor vehicle accident. %e?s alert and oriented.
Which of the following nursing interventions should be done first?
a. )ssess full range of motion 8+@;9 to determine the extent of in.uries
b. !all for an immediate chest 7-ray
c. "mmobilize the client?s head and neck
d. @pen the airway with the head-tilt- chin-lift maneuver
-#. ) client with a !0 spinal in.ury would most likely have which of the following symptoms?
a. )phasia c. /araplegia
b. %emiparesis d. &etraplegia
-'. ) client with damage to the hippocampus( amygdale( and fornix would have dysfunction in which of the following
areas?
a. 2motions c. ;uscle synergy
b. %igher thought levels d. Aital functions
-,. ) ':-year-old client is admitted to the progressive care unit with a !- fracture from a motorcycle accident. Which of
the following assessments would take priority?
a. Bladder distention c. /ulse oximetry readings
b. Beurologic deficit d. &he client?s feelings about the in.ury
--. While in the emergency department( a client with !5 <uadriplegia develops a blood pressure of 5:C,, mm %g( pulse
of ,5 beatsC minute and respiratory rate of 15 breathsCminute. &he nurse suspects which of the following conditions?
a. )utonomic dysreflexia c. Beurogenic shock
b. %emorrhagic shock d. /ulmonary embolism
-0. ) client is admitted with a spinal cord in.ury at the level of &1#. %e has limited movement of his upper extremities.
Which of the following medications would be used to control edema of the spinal cord?
a. )cetazolamide 8iamox9 c. ;ethylprednisolone 8$olu-;edrol9
b. >urosemide 8*asix9 d. $odium bicarbonate
-3. ) ##-year-old client with <uadriplegia is apprehensive and flushed( with a blood pressure of #1:C1:: mm %g and heart
rate of -: beatsCminute. Which of the following nursing interventions should be done first?
a. /lace the client flat in bed
b. )ssess patency of the indwelling urinary catheter
c. 1ive one sublingual nitroglycerin tablet
d. +aise the head of the bed immediately to 6: degrees
-5. ) client with paraplegia from a &1: in.ury is getting ready to transfer to a rehabilitation hospital. When a nurse offers to
assist him( the client throws his suitcase on the floor and says( DEou don?t want to help meF Which of the following
responses would be the most appropriate for the nurse to give?
a. DEou know " want to help you( " offeredF
b. D"?ll pick these things up for you and come back laterF
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c. DEou seem angry today. 1oing to rehab may be scaryF
d. DWhen you get to rehab( they won?t let you behave like a spoiled bratF
-6. ) client with a cervical spine in.ury has 1arnder-Wells tongs inserted for hwihc of the following reasons?
a. &o hasten wound healing
b. &o immobilize the surgical spine
c. &o prevent autonomic dysreflexia
d. &o hold bony fragments of the skull together
0:. When a client with a halo vest is discharged from the hospital( which of the following instructions should the nurse
give the client and family?
a. Don?t use the wheelchair while the halo vest in placeF
b. D!lean the pin sites with povidone-iodine and apply water-soluble lubricantF
c. DGeep the wrench that opens the vest attached to the client at all timesF
d. D/erform range-of-motion exercises to the neck and shoulders four times dailyF
01. Which of the following factors may place a surgical client at risk for urinary retention?
a. ehydration c. uration of surgery
b. %istory of smoking d. )nticholinergic medication before surgery
0#. Which type of catheter is generally used for the client with urine retention?
a. !oude c. $traight
b. "ndwelling urinary d. &hree-way
0'. )n 5:-year old reports urine retention. Which of the following factors may contribute to this client?s problems?
a. Benign prostatic hyperplasia 8B/%9 c. iet
b. iabetes d. %ypertension
0,. $erum creatinine levels provide the most accurate picture of renal function for which of the following reasons?
a. $erum creatinine is rapidly reabsorbed by the renal tubules
b. ) slow urine flow through the kidneys increases creatinine level
c. $erum creatinine levels indicate a decrease in glomerular filtration
d. $erum creatinine levels are related to the rate of urine flow through the kidneys
0-. ) urologic client undergoes excretory urography to evaluate which of the following areas?
a. Gidney function c. )bnormalities of the lower urinary tract
b. Gidneys( ureters( and bladder d. )bnormalities of the upper urinary tract
00. ) client is in.ected with radiographic contrast medium and immediately shows signs of dyspnea( flushing( and pruritus.
Which of the following interventions should take priority?
a. !heck vital signs c. )pply a cold pack to the ".A. site
b. ;ake sure the airway is patent d. !all the physician
03. Which of the following instructions is given to clients with chronic pyelonephritis?
a. $tay on bed rest for up to # weeks
b. 4se analgesia on a regular basis for up to 0 months
c. %ave a urine culture every # weeks for up to 0 months
d. Eou may antibiotic treatment for several weeks or months
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05. Which of the following factors causes the nausea associated with renal failure?
a. @liguria c. 2lectrolyte imbalance
b. 1astric ulcers d. )ccumulation of metabolic wastes
06. Which of the following clients is at greatest risk for developing acute renal failure?
a. ) dialysis client who gets influenza
b. ) teenager who has an appendectomy
c. ) pregnant woman who has a fractured femur
d. ) client with diabetes who has a heart catheterization
3:. Which of the following interventions would be done for a client with urinary calculus?
a. $ave any calculi larger than :.#- cm
b. $train the urine( limit oral fluids( give pain medications
c. 2ncourage fluid intake( strain the urine( give pain medications
d. "nsert an indwelling urinary catheter( check intake and output( give pain medications
31. ) client has passed a renal calculus. &he nurse sends the specimen to the laboratory so it can be analyzed for which
of the following factors?
a. )ntibodies c. !omposition of calculus
b. &ype of infection d. $ize and number of calculi
3#. Which of the following symptoms indicate acute re.ection of a transplanted kidney?
a. 2dema( nausea c. Weight gain( pain at graft site
b. >ever( anorexia d. "ncreased white blood cell count( pain with voiding
3'. )dverse reactions of prednisone therapy include which of the following conditions?
a. )cne and bleeding gums
b. $odium retention and constipation
c. ;ood swings and increased temperature
d. "ncreased blood glucose levels and decreased wound healing
3,. &he nurse suspects that a client with polyuria is experiencing water diuresis. Which laboratory value suggests water
diuresis?
a. %igh urine specific gravity c. Bormal to low urine specific gravity
b. %igh urine osmolarity d. 2levated urine p%
3-. ) client is diagnosed with prostate cancer. Which test is used to monitor progression of this disease?
a. $erum creatinine c. /rostate specific antigen 8/$)9
b. !omplete blood count 8!B!9 d. $erum potassium
30. ) client presents with a possible urinary tract infection. Which of the following should the nurse assess first?
a. 4rine clarity c. 4rine acetone
b. 4rine specific gravity d. 4rine odor
33. Which medication is most likely to be prescribed for a client with gonorrhea?
a. /enicillin 8/enicillin 19 c. !iprofloxacin 8!ipro9
b. )zithromycin 8Hithromax9 d. &richloroacetic acid
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35. "n a client with renal failure( which assessment findings may indicate hypocalcemia?
a. %eadache c. "ncreased blood coagulation
b. $erum calcium level of - m2<C* d. iarrhea
36. When teaching a client how to prevent recurrences of acute glomerulonephritis( which instruction should the nurse
include?
a. D)void physical activityF c. D$eek early treatment for respiratory infectionF
b. D$train all urineF d. D;onitor urine specific gravity every dayF
5:. When providing discharge teaching for a client with uric acid calculi( the nurse should include an instruction to avoid
which type of diet?
a. *ow- calcium c. %igh - oxalate
b. *ow- oxalate d. %igh I purine
51. &he thyroid gland produces which of the following groups of hormones?
). )mylase( lipase and trypsin
B. &riiodothyronine 8&'9( thyroxine 8&,9 and calcitoninc
!. 1lucocorticoids( mineralocorticoids( and androgens
. Aasopressin( oxytocin and thyroid stimulating hormone 8&$%9
5#. $ecretion of thyroid stimulating hormone 8&$%9 by which of the following glands controls the rate at which thyroid
hormone is released?
). )drenal gland !. /ituitary gland
B. /arathyroid gland . &hyroid gland
5'. Which of the following treatments can be used for hyperthyroidism?
). !holelithotomy
B. "rradiation of the thyroid
!. )dministration of oral thyroid hormones
. Whipple procedure
5,. Which of the following groups of symptoms of hyperthyroidism is most commonly found in elderly clients?
). epression( apathy and weight loss
B. /alpitations( irritability and heat intolerance
!. !old intolerance( weight gain( and thinning hair
. Bumbness( tingling( and cramping of extremities
5-. Which of the following forms of severe hyperthyroidism is life threatening and produces high fever extreme
tachycardia and altered mental status?
). %epatic coma
B. &hyroid storm
!. ;yxedema coma
. %yperosmolar hyperglycemic nonketotic syndrome 8%%B$9
50. %yperthyroidism is commonly known as which of the following disorders?
). )ddison?s disease !. !ushing?s syndrome
B. Buerger?s disease . 1raves? disease
53. 2xcessive output of thyroid hormone from abnormal stimulation of the thyroid gland is the etiology of which condition?
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). %yperparathyroidism !. %yperthyroidism
B. %ypoparathyroidism . %ypothyroidism
55. ) client presents with flushes skin( bulging eyes( and perspiration( and states that he has been DirritableF and having
palpitations. &his client is presenting with symptoms of which disorder?
). %yperthyroidism !. /ancreatitis
B. ;yocardial infarction 8";9 . &ype 1 diabetes mellitus
56. Which of the following hormones is secreted by the anterior pituitary gland?
). !orticotrophin !. !ortisol
B. )ntiduretic hormone . @xytocin
6:. ) client is brought into the emergency department with a brain stem contusion. &wo days after admission( the client
has a large amount of urine and a serum sodium level of 1-- m2<Cdl. Which of the following conditions may be
developing?
). ;yxedema coma !. &ype 1 diabetes mellitus
B. iabetes insipidus . $yndrome of inappropriate antidiuretic hormone secretion
61. Which of the following conditions could be diagnosed in a client with serum ketones and a serum glucose level above
':: mgCdl?
). iabetes insipidus !. %ypoglycemia
B. iabetic ketoacidosis . $omogyi phenomenon
6#. @b.ectives for treating diabetic ketoacidosis 8G)9 include administration of which of the following treatments?
). 1lucagon !. 1lucocorticoids
B. Blood products . "nsulin and ".A. fluids
6'. Which of the following methods of insulin administration would be used in the initial treatment of hyperglycemia in a
client with diabetic ketoacidosis?
). $ubcutaneous !. ".A. bolus only
B. "ntramuscular . ".A. bolus( followed by continuous infusion

6,. Which of the following causes of hyperosmolar hyperglycemia nonketotic syndrome 8%%B$9 is most common?
). "nsulin overdose
B. +emoval of the adrenal gland
!. 4ndiagnosed( untreated hyperpituitarism
. 4ndiagnosed( untreated diabetes mellitus
6-. What would be the diagnosis for a client presenting with a temperature of 1:'J> 8'6.,J!9( hypotension( dry mucous
membranes and a body glucose level of -6: mgCdl?
). iabetes mellitus !. iabetic ketoacidosis
B. iabetes insipidus . %yperosmolar hyperglycemic nonketotic syndrome
60. Which of the following conditions is characterized by osteopenia and renal calculi?
). %yperparathyroidism !. %ypopituitarism
B. %ypoparathyroidism . %ypothyroidism
63. +enal calculus formation in clients with hyperparathyroidism is caused by an excess of which of the following
electrolytes?
). !alcium and magnesium !. /otassium and magnesium
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B. !alcium and phosphorus . /otassium and phosphorus
65. Which of the following laboratory results supports a diagnosis of primary hyperparathyroidism?
). %igh parathyroidism hormone and high calcium levels
B. %igh magnesium and high thyroid hormone levels
!. *ow parathyroid hormone and low potassium levels
. *ow thyroid-stimulating hormone 8&$%9 and high phosphorus levels
66. Which of the following types of medications is contraindicated in the treatment of clients with hyperparathyroidism?
). )cetaminophen !. /otassium wasting diuretics
B. )spirin . &hiazine diurectics
1::. "n a client with hyperparathyroidism which of the following calcium levels would be considered an acute
hypercalcemic crisis?
). # mgCdl !. 1:.- mgCdl
B. , mgCdl . 1- mgCdl
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BATTERY EXAM REVIEW IN CHN
Situation: &he following <uestions pertain to nursing interventions for a child with diarrhea.
1. "t is utilized in the extensive case management of diarrhea to reduce mortality rate in children?
a @ral dehydration solution c. /roper waste disposal
b @ral rehydration therapy d. "mproved wearing practices
#. What is the primary ob.ective of the ! advocated by @%?
a &o reduce mortality from diarrhea
b 2nvironmental sanitation
c ;aternal and child health
d /romote breastfeeding
'. What is the primary prevention for ! advocated by @% that is effective and affordable?
a >luid replacement c. @ral dehydration therapy
b Breastfeeding d. ;easles immunization
,. %ome made @resol is composed ofK
a Water( sugar and salt c. Water and little sugar
b 2lectrolyte d. 2lectrolytes and sugar
-. What type of immunoglobulin is passed to the baby during breastfeeding?
a "g 1 c. "g )
b "g ; d. "g 2
0. &he lifespan of vaccine in a regional hospital usually lasts for how many months?
a 0 months c. 1 month
b ' months d. - days
3. !ity hospitals and istrict hospitals is in what level of the health care delivery system?
a &ertiary c. /rimary
b $econdary d. B@&)
5. +ural %ealth units is in what level of the health care delivery system?
a &ertiary c. /rimary
b $econdary d. B@&)
6. What is the legal basis of primary health care in the /hilippines?
a *@" 6,6 c. *@" 6-6
b *@" 0,0 d. *@" 0,6
1:. &he following are some diarrhea-preventive interventions found to be both effective and affordable exceptK
a Breast feeding c. ;inimizing use of water
b %and washing d. ;easles immunization
11. &he nurse is assigned in a certain barrio where there is no Botika. What will you give to a dehydrated infant who is
having diarrhea to prevent further dehydration?
a 1ive DamF every hour c. /ounded guava leaves < 1hr
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b 1ive cola to drink d. 1ive milk as usual
1#. "t is the tool making use of public health bag to which the nurse can performed in her home visit with simplicity and
skill K
a %ome visit c. /ublic %ealth Bag
b Bag techni<ue d. B@&)
Situation: &here are other important basic knowledge in the performance of our task as !ommunity %ealth Burse in
relation to ";;4B"H)&"@B( these includeK
1'. &o ensure universal( ade<uate and regular supply of potent vaccines for implementing units the @% has
institutionalized a Aaccine "ndependence "nitiative with the assistance of which international agency?
a W%@ c. 4B"!2>
b World Bank d. +esearch "nstitute for &ropical ;edicine 8+"&;9
1,. &he /hilippines was declared polio free in what year?
a #::: c. #::,
b #::# d. #::0
1-. &he greatest protection of individuals from ac<uiring %epatitis B infection that may develop into a chronic liver disease
isK
a $ave sex practice c. %epatitis B immunization
b )voidance of alcohol d. /roper nutrition
10. ;rs. e Aera is due to bring her baby back to the health center for the third dose of immunization three weeks from
now but she came today with her baby and re<uested that her baby be immunized because they are going abroad
and will return only to the country after , weeks. &he nurse tells ;rs. e Aera thatK
a "t is alright for the third immunization to be delayed for a week anyway lengthening the interval between
doses of vaccines leads to higher antibody levels
b "t is good that she brought her baby for immunization because delaying the last dose will reduce its effectivity
c "t is alright not to immunize her child today anyway they can always restart immunization to ensure complete
protection from diphtheria( tetanus and pertusis once they are back
d &he health center cannot give immunization that is not scheduled but they can always go to a private
practitioner for immunization anytime
13. )ll of the following are phases of !@/)+ except
a /re entry phase c. @rganization and Building phase
b 2ntry phase d. 1round work
15. &his vaccine content is derived from +B) recombinantsK
a &etanus toxoids c. /&
b %epatitis B vaccines d. ;easles
16. )ll of the following are principles of %ome visits except
a $hould have a purpose
b $hould have acceptance of service
c $hould have a thorough plan
d $hould use available resources
#:. &his is the vaccine needed before a child reaches one 819 year in order form himCher to <ualify as a Dfully immunized
childF.
13
a ;easles c. %epatitis B
b /& d. B!1
#1. ;rs. )revalo brought her 0 month old baby Gyle to the clinic for immunization. $he told the nurse that Gyle has
already received B!1 and a first dose of /& when she was 5 weeks old. ;rs. )revalo was not able to bring Gyle to
the clinic for her next /& immunization because they went to the province. $he is asking the nurse if Gyle can still
receive her /& immunization. &he nurse?s reply is thatK
a &hey will have to start her /& immunization all over again because the interval is more than # months
already.
b Gyle will be given her #
nd
dose of /& and ;rs. )revalo should bring her back to the clinic after four weeks to
complete her /& immunization
c Gyle will receive two in.ections of /& today to make sure that the vaccine will take effect on her
d Gyle can no longer receive /& immunization because she is more than five months
##. Which is not true of measles vaccine?
a "t can be given at the same time as /&
b "t should be given at nine months because it provides higher protection than if it is given at 1# months
c "t is given subcutaneously
d "ts is alright to give ;easles vaccine to a child with diarrhea and low grade fever
#'. Which of the following dose of tetanus toxoid is given to the mother to protect her infant from neonatal tetanus and
likewise provide 1: years protection for the mother?
a &etanus toxoid ' c. &etanus toxoid -
b &etanus toxoid # d. &etanus toxoid ,
#,. &he goal of the government?s 2/" program is to eliminate which diseases by year #::5K
a /oliomyelitis and tetanus c. /oliomyelitis and rabies
b &etanus and measles d. %epatitis B and poliomyelitis
#-. %epatitis vaccine is given subcutaneously a dose of :.- ml. "t can be given as early asK
a Bine months c. )t birth
b $ix months d. $chool entrance
#0. B!1 provides protection from the following infections exceptK
a *eprosy c. ;eningitis
b &uberculosis d. /neumonia
#3. &he vaccines most sensitive to heat areK
a /& and %epa B c. @/A and measles
b B!1 and && d. B!1 and measles
#5. &he temperature of the refrigerator where vaccines are stored should be checked how many times a day?
a &wo times a day( in the morning and afternoon before going home
b &hree time a day( in the morning at 1# nn and at - pm
c @nce a day as long as the refrigerator is not fre<uently opened to keep temperature inside it stable
d "t is not needed to monitor to temperature because the refrigerator?s thermostat is maintained at the desired
temperature
#6. "n Biostatistics in indicates the east by which a communicable disease can be transmitted from one host to another
a 4rban +ural index
b !rowding index
14
c /opulation density
d $waroops index
':. "f the child spits the @/A vaccine administered( the nurseK
a $hould ask the mother to return the child after two days to be given another dose
b $hould give the child another dose immediately
c $hould not give another dose because @/A Aaccine is absorbed by the glands in the tongue immediately
after giving it
d $hould ask the child if he swallowed the medication before giving another dose
'1. &he following two vaccines are easily damaged by heat but not destroyed by freezingK
a /& and B!1 c. &etanus toxoid and B!1
b B!1 and %epatitis B d. /olio and measles vaccine
'#. Gochs phenomenon is a side effect of
a /& c. @/A
b %epa A d. B!1
''. &he correct temperature to store vaccines in a refrigerator isK
a Between # deg ! and L5 deg ! c. Between -5 deg ! and : deg !
b Between -, deg ! and L5 deg ! d. Between -5 deg ! and L, deg !
',. Eou should see to it that measles vaccine is administered as followsK
a. :.1 ml intradermally c. :.- ml subcutaneously
b. :.- ml intramuscularly d. two drops orally
'-. What age group is targeted by the @% health teams during immunization days?
a. :-#, months c. :-1# months
b. :--6 months d. 1-- year olds
'0. "n order for a children to be classified as >ully "mmunized !hild 8>"!9( he should have received the following
immunizations before he reaches the age of oneK
a. ' doses /&( single dose ;easles( - doses &&( single dose B!1( ' doses @/A( ' doses %epa B
b. $ingle dose B!1M ' doses each of /&( @/A( ;easles Aaccine and %epa B
c. $ingle dose B!1( ' doses @/A( one dose ;easles Aaccine( three doses %epa B( ' doses /&
d. &hree doses @/A( one dose B!1( ' doses ;easles Aaccine( three doses /&( single dose %epa B
'3. ;easles is given subcutaneously on a dose of :.- ml. )t what age is this done?
a. Bine months c. , weeks to 0 weeksK /& and @/A
b. )t birthK B!1 d. 0 months
'5. *erie took of sister at $an *azaro %ospital. $he was exposed to viral %epatitis. %ence she was given an in.ection of
gamma globulin by her physician. &his isK
1. Batural immunity
#. )ctive immunity
'. )rtificial immunity
,. /assive immunity
a 1 and , c. 1 and #
b # and ' d. ' and ,
15
Situation: Eou are in-charge of the +ural %ealth 4nit. >or your immunization activities( you see to it that you have
ade<uate supply of vaccines. &his year( ':: infants are due for /& and measles immunization.
'6. ;rs. $evilla asked the rural health midwife about the immunization schedule. &he correct response of the midwife is
that immunization isK
a !onducted once a month in the barangay health station usually at Wednesdays
b !onducted everyday in the barangay health center
c !onducted only when there are more than 1:: children to be immunized
d )ll immunization is to be conducted at the health center and hospitals @/ starting #::5
,:. &he correct techni<ue of preparing the measles vaccine isK
a )spirate # ml of saline solution and empty the saline from the syringe into the vial containing the measles
vaccine
b )lways use - ml sterile syringe to withdraw diluent to be mixed with measles vaccine
c &horoughly mix the diluent and vaccine by shaking it gently until the mixture is clear
d Wrap vials of reconstituted measles vaccine with aluminum foil
,1. Which of the following is sensitive to freezing
a /& and %epa- B c. );A and @/A
b );A and /& d. @/A and %epa - B
,#. "f measles is given at nine months( what is the percentage that measles can be prevented?
a 3-= b. 5-= c. 6-= d. 1::=
,'. %ow many doses should /& be given with a interval of four weeks?
a , b. ' c. - d. 0
,,. "f the woman has completed the ' /& when she was a child( she will .ust receive
a # && c. , &&
b ' && d. - &&
,-. What is the causative agent of schistosomiasis?
a %ansens bacillus c. $. .aponicum
b &- pallidum d. /. falcifarum
,0. What is the vector for sleeping sickness?
a !rabs c. ) poecilus
b &setse fly d. ) egypti
,3. Which / provided the legal basis for the compulsory basic immunization for infants and children below eight 859
years of age?
a /resident proclamation no 0 c. / Bo 660
b +) 35,0 d. /residential proclamation no 33'
,5. What is the 2/" based on?
a +esearch studies on communicable diseases
b $cenario of the community affected
c 2pidemiological situation
d +eport of basic health service

16
,6. &he grandmother of a ' year old asks to give immunization on another day because they are going on a vacation.
What will you do?
a 1ive immunization anyway and tell her it is not possible to delay
b &ell her to bring the card to the center of the place where they are going to
c "nstruct the grandmother to return the next day for immunization
d &ell her that it is alright if immunization is given after vacation
-:. What is the immunization that they should have before reaching one year?
a ;easles c. @/A
b /& d. B!1
17
MICROBIOLOGY
1. What do you call the outside coat of protein possessed by viruses?
a. !ytopsid c. 1uaneri layer
b. !apsid d. ;osaic bodies
#. )ll of the ff. are kinds of $hapes of viruses exceptK
a. %elical c. !ylinder
b. $phere d. iamond
'. Which of the following is the causative agent of rabies?
a. >ormido "nexorabilis c. Borrioleta
b. *egio ebilitans d. *egio 2rebea
,. +icketsia +icketsii causesK
a. Nail fever c. Bine-mile fever
b. &ick fever d. 2uropean typhus
-. Which of the following causes( psittacosis( lymphogranuloma venerum and trachoma?
a. !hlamydiae c. ;arbili
b. +icketsiae d. !oryne bacterium
0. Who is known as the D>ather of BacteriologyF?
a. *eeuwenhoek c. 2dward Nenner
b. /asteur d. 2hrlich
3. Which bacteriologist discovered an antitoxin against diphtheria organism?
a. Walter +eed c. %oward >lorey
b. 2lie ;etchnikoff d. 2mil Aon Behring
5. "n pasteurization( milk is heated at exactlyK
a. 1::J c. 11:J
b. 1,-J d. #::J
6. Who is known as the father of Bacteriological &echni<ues?
a. Noseph *ister c. +obert Goch
b. Walter +eed d. 2dward Nenner
1:. Which of the ff. discovered DsulfanilamideF?
a. omagk c. 2hrlich
b. Waksman d. +eed
11. Which of the ff. is Dnon-filterableF?
a. /rotozoan c. Bacteria
b. >ungi d. Airus
1#. /rotococcus( Bostoc and )nabaena are all types ofK
a. )lgae c. Airus
18
b. +icketsiae d. /rotozoan
1'. "t is an association of algae and fungi that is a primary source of food for reindeers and caribou?
Aolvox c. *ichens
!hlorophytes d. !hlorella
1,. What is the term for membrane bound organelles that hold the pigments in algae?
a. /lastids c. !hlorosomes
b. ;esosomes d. !entrioles
1-. "t is the tem used for the thread or filaments of the mycelium composed of cylindric shaped cells arranged end to end.
a. %yphae c. Blastomycerium
b. !hitin d. ;ucor
10. "t is a plant parasite that attacks rye and other grains and produces the toxic substance ergot?
a. !laviceps purpura c. +yzophus
b. $aprolegnia d. ;ucor
13. Which of the ff. is employed by brewers in the production of malt( beverages( beer and ale?
a. $accharomyces cerevisiae c. $accharomyces )lternaria
b. $accharomyces ellipsaides d. $accharomyces Begrensis
15. Which of the ff. is used in the ripening process of Dblue cheesesF?
a. /enicillium Botatum c. /enicillium !amemberti
b. /enicillium !heddarii d. /enicillium 2damii
16. Which of the ff. is used in the fermentive action in sugar and fruit .uices resulting to a far better tasting wine?
a. $. !erevisiae c. $. )lternaria
b. $. 2llipsoides d. $. Begrensis
#:. )ll of the ff. causes ;alarai exceptK
a. /. >alcifarum c. /. )nophelii
b. /. Aivax d. /. @vale
#1. "t is the technical term for acid-fast stain?
a. B"1+@$"B $&)"B c. H"2%*-B2"*$2B $&)"B
b. >24*12B $&)"B d. 1+)E ;2&%@
##. Which of the following retains it crystal violent dye color when a decolorizer is applied?
a. 1ram Begative c. )ll of the above
b. 1ram /ositive d. Bone of the above
#'. Which of the ff. exhibits a red color when a counter stain 8$afranin9 is applied?
a. 1ram negative c. )ll of the above
b. 1ram positive d. B@&)
#,. Which of the ff. serves as a ;ordant 8a chemical that forms an insoluble complex with dyes 8!A-1 !omplex9
19
a. "odine c. )lcohol
b. !rystal violet d. $afranin
#-. "t is a sterilization method which uses a cylindrical chamber which is closed during sterilization?
a. )utoclave c. @b.ect sterilization
b. ry air oven d. $teradian sterilization
#0. Which of the ff. is not involved in the process of inoculation?
a. /ressing the bateria to the medium c. 4se of sterile inoculating needle
b. )dding a small <uantity of li<uid d. Bon-exposure of culture to air
#3. >ractional sterilization 8used for materials that cannot be sub.ected to temp. above 1::J!9 is the other term forK
a. /asteurization c. )utoclaving
b. &yndallization d. )rnold sterilization
#5. "t is the term for Dslow dryingF that kills more bacteria than <uick drying?
a. /asteurization c. essication
b. &yndallization d. )utoclaving
#6. Which of the ff. is described as DellipsoidalF in shape?
a. !occi c. $pirilli
b. Bacilli d. B@&)
':. )ll of the ff. are rod-shaped 8bacilli9 in form exceptK
a. iptheriae c. Beisseria
b. )nthracis d. >. >usoforme
'1. "t is the type of flagellation 8bacteria9 in which several flagella are on one pole?
a. ;onotrichous c. )mphitrichous
b. *ophotrichous d. /seudotrichous
'#. &he stracture called DpiliF or DfimbriaeF is found only in what type of bacteria?
a. 1ram positive c. 1ram Beutral
b. 1ram negative d. B@&)
''. &ylers method in staining bacterial capsule usesK
a. "odine c. "ndia ink
b. $afronine d. !rystal Aiolet
',. Which membrane is the one responsible for high fevers during 1ram 8-9 infections?
a. &eichoic *ayer c. >lagellates *ayer
b. $lime *ayer d. 2ndotoxin *ayer
'-. What type of parasites grow only on living matter and completely dependent on the host?
a. @bligate c. issimilative
b. >acultative d. B@&)
'0. What type of parasites can live on either living or dead organic matter?
20
a. @bligate c. issimilative
b. >acultative d. B@&)
'3. "t is the time re<uired for one organism to divide into # or double?
a. *oyarithmic time c. 1eneration time
b. >ragmentation time d. Binary time
'5. What type of bacteria obtains food from non living or decaying organic matter like dead leaves( trees or animals?
a. >acultative c. /arasites
b. @bligate d. $aprophytes
'6. What type of bacteria grows at lower temperature 8below #:J!9 and involved in spoilage of refrigerated food?
a. Beutrophiles c. ;esophiles
b. /sychrophiles d. &hermophiles
,:. What type of bacteria grows best at very high temperature between #-J! and ,:J ! and is considered as the largest
group?
a. Beutrophiles c. ;esophiles
b. /sychrophiles d. &hermophiles
,1. "n the stages of bacterial growth( it is the initial phase characterized by increase in size but not in number.
a. *og phase c. *ag phase
b. $tationary phase d. ecline phase
,#. "n the stages of bacterial growth( it is the exponential logarithmic multiplication phase?
*og phase c. *ag phase
$tationary phase d. ecline phase
,'. &he protein portion of an enzyme is calledK
)poenzyme c. %oloenzyme
!oenzyme d. B@&)
,,. "t is a microbial interaction wherein two organisms produce a substance which neither can produce alone.
a. )ntibiosis c. !ommensalism
b. $ymbiosis d. $ynergism
,-. "t is a microbial interaction where one organism benefits while the other remains unaffected by the relationship.
a. )ntibiotics c. !ommensalism
b. $ymbiosis d. $ynergism
,0. "t is an antibody type characterized by attachment to bacteria 8combine with certain substances in bacterial cells9( thus
paralyzing it and prepares it for ingestion by phagocytic cells.
a. )ntitoxins c. @psonins
b. )gglutinins d. /recipitins
,3. "t is an antibody type that causes bacteria to settle so that it can be easily filtered out in lymph nodes( spleen and
other organs.
a. )ntitoxins c. @psonins
21
b. )gglutinins d. /recipitins
,5. What disease is also known as Dgalloping consumptionF?
a. &uverculosis c. iphtheria
b. "nfluenza d. /neumonia
,6. )ll of the ff. are causative agent of schistosomiasis exceptK
a. $. ;ansoni c. $. haematobium
b. $. .aponicum d. $. nilodini
-:. "n $chistosomiasis( eggs are carried to the exterior through the feces and hatch into ciliated larvae calledK
a. ;erozoites c. !ercaria
b. ;iracidium d. B@&)
22
ANATOMY
1. Which of the following cell structure is capable of self-generated movement?
a. 2ndoplasmic c. !ilia
b. ;itochondria d. 1olgi apparatus
#. $lender extension of the plasma membrane that increased the surface area for absorption
a. ;itochondria c. ;icrofilaments
b. ;icrotubules d. ;icrovili
'. &he random movement of molecules from an area of high concentration to an area of lower concentration is called
a. iffusion c. >acilitated
b. 2xocytosis d. )ctive transport
,. &he centrosome contains
a. 2ndoplasmic reticulum c. !entrioles
b. !ilia d. >lagella
-. Within a cell( the flexible lattice supports organelles and is involved in movement is called the
a. 2ndoplasmic reticulum c. 1olgi appratus
b. !ytoskeleton d. $pindle
0. &he ma.or bone at the posterior part of the base of the skull is the
a. $phenoid c. &emporal
b. @ccipital d. *acrimal
3. Which of the following is not a component of the axial skeleton?
a. $acrum c. $ternum
b. /atella d. Aertebra
5. ) prominent ridge or border on the surface of a bone is a
a. !ondyle c. %ead
b. !rest d. *ine
6. 4nlike other vertebrae( thoracic vertebrae have
a. >acets for rib attachment c. &uberosity
b. /edicles d. &ransverse processes
1:. &he hard palate is made up of the
a. *acrimal bone c. Hygomatic bone
b. 2thmoid bone d. ;axillae and palatine bones
11. &he period after a contraction when a muscle fiber cannot respond to a stimulus
a. epolarization period c. +efractory period
b. "sotonic period d. +elaxation phase
1#. 2nergy to move myosin heads during muscle contraction comes directly from
a. )&/ c. 1lucose
23
b. B) d. *actic
1'. &he ions that bind to the troponin complex during muscle contraction areK
a. $odium ions c. ;agnesium ions
b. /otassium ions d. )&/ase
1,. uring muscle contraction( the
a. ) bands shorten c. H lines shortens
b. " bands lengthen d. ) bands lengthen
1-. &he type of muscle contraction in which the muscle develops tension but does not change length
a. &repan c. "sotonic contraction
b. "sometric contraction d. &itanic contraction
10. Which of the following isC are not part of the peripheral nervous system?
a. !ranial nerves c. 1anglia
b. $pinal nerves d. $pinal cord
13. ) progressive degeneration of myelin sheaths in neutrons of the brain and spinal cord is called
a. ;yasthenia gravis c. /arkinson?s disease
b. ;ultiple sclerosis d. %untington?s disease
15. &he simplest neuronal circuit is the
a. >eedback circuit c. &wo-neuron circuit
b. /arallel circuit d. &hree-neuron circuit
16. &he ma.or functions of the spinal cord include
a. *inking the brain with most of the body
b. "ts involvement in spinal reflex actions
c. "ts autonomic motor functions
d. ) and B
#:. &he spinal cord and the roots of its nerves are protected by
a. &he flexible body vertebral column
b. &he ligamentum flavum and the posterior longitudinal ligament
c. &he spinal meninges
d. )ll of the above
#1. Which of the following body parts have Bo pain receptors?
a. *ungs c. "ntestines
b. Brain d. B and !
##. Which of the following help the body deal with changes in position and acceleration?
a. 4tricle c. $emicircular ducts
b. $accute d. )ll of the above
#'. Which of the following is B@& a skeletal muscle of the eye?
a. !iliary muscle c. *alteral rectus
b. ;edial rectus d. $uperior obli<ue
24
#,. 1ustatory cells are
a. Bipolar neurons c. 4nipolar neurons
b. ;ultipolar neurons d. 2pithelial cells
#-. )lkaloids excite gustatory hairs at the
a. &ip of the tongue c. !ircumvallate papillae
b. Back of the tongue d. >ungiform papillae
#0. &he kidney?s function in all of the following ways except
a. )cid base balance c. By removing metabolic wastes
b. )s endocrine organs d. By removing excess carbon dioxide
#3. ) glomerulus is
a. &he same as the renal corpuscle
b. &he same as the uriniferous tubule
c. &he same as the nephron
d. !apillaries
#5. )pproximately what percentage of the cardiac output goes to the kidneys?
a. - percent c. #: percent
b. 1: percent d. ': percent
#6. +enin is a 8n9
a. 2nzyme c. /olypeptide
b. %ormone d. ) and B
':. &he rate of glomerular filtration depends on
a. &he effective filtration pressure
b. &he total surface area available for filtration
c. &he capillary permeability
d. ) and B
'1. Which of the following is B@& a type of granulocyte?
a. Basophile c. Beutrophil
b. 2osinophil d. /olymorph
'#. 2rythrocytes are derived form bone marrow stem cells called
a. %emocytoblasts c. /romyelocytes
b. ;egakaryoblasts d. 1ranulocytes
''. ) person with blood type ) can safely receive
a. &ype ) blood c. &ype )B blood
b. &ype @ blood d. ) and B
',. &he short life span of erythrocytes is due to their
a. $hape
b. *arge surface area for gas diffusion
c. *ack of nucleus and many organelles such as mitochondria
d. )bility to divide by mitosis
25
'-. Which would lead to increased erythropoiesis?
a. !hronic bleeding ulcer
b. +eduction in respiratory ventilation
c. ecreased level of physical activity
d. +educed blood flow to the kidneys
'0. &he outermost layer of the heart is called the
a. 2ndocardium c. ;yocardium
b. 2picardium d. Aisceral pericardium
'3. &he part of the serous pericardium that lines the outer portion of the pericardial sac is called the
a. 2ndocardium c. ;yocardium
b. 2picardium d. Aisceral pericardium
'5. >reshly oxygenated blood is first received by the
a. +ight ventricle c. +ight atrium
b. *eft ventricle d. *eft atrium
'6. Which of the following valves allows deoxygenated blood to enter the pulmonary artery?
a. )trioventricular c. /ulmonary semilunar valve
b. )ortic semilunar d. &ricuspid valve
,:. Which of the following depolarizes next after the )A node?
a. )trial myocardium c. Bundle branches
b. Aentricular myocardium d. )A bundle
,1. "n comparing a parallel artery and vein( you would find that
a. &he artery wall is thicker c. &he artery lumen is smaller
b. &he artery diameter is greater d. &he artery endothelium is thicker
,#. &he great arteries that emerge from the heart are often called
a. ;a.or arteries c. &runks
b. )ortas d. )rterioles
,'. Which of the following tunicas contain connective tissue and smooth muscle cells?
a. &unica intima c. &unica adventitia
b. &unica media d. ) and B
,,. Which type of capillary has walls made up of one continuous endothelial cells?
a. $inusoids c. >enestrated
b. !ontinuous d. )rteriole
,-. Aeins that do B@& carry deoxynated blood are
a. /ulmonary veins c. %ypophyseal veins
b. %epatic veins d. ) and B
,0. &he ma.or hormone affecting the metabolic rate is
a. &hyroxine c. !alcitonin
26
b. /arathormone d. &$%
,3. &he release of hormones from the adenohypophysis is controlled by secretions of the
a. )drenal medulla c. %ypothalamus
b. Gidneys d. /osterior pituitary
,5. &he part of the pituitary that contains secretory cells is the
a. )nterior lobe c. /osterior lobe
b. "nfundibulum d. %ypothalamic-hypophyseal portal system
,6. 2pinephrine and norepinephrine are secreted by the
a. )drenal cortex c. )drenal medulla
b. /ancreatic islets d. )nterior pituitary
-:. Which of the following is not secreted by the adenohypophysis?
a. )!&% c. ;$%
b. )% d. >$%
27
BASIC CONCEPTS IN NURSING
1. uring a neurosensory assessment( the nurse observes that a patient has a slightly dilated pupil in his right eye. &he
nurse understands that this can be explained by noncon:duction of theK
a. $econd cranial nerve 8optic9 c. >ourth cranial nerve 8trochlear9
b. &hird cranial nerve 8oculomotor9 d. $eventh cranial nerve 8facial9
#. "mmediately following a motor vehicle accident( a teenager is diagnosed as a <uadriplegic. $he?s placed on a tilt table
for half an hour while the head of the table is elevated to a ':-degree angle. 2ach day the angle is increased( and the
time spent on the table is also increased. &he nurse explains to the patient that this procedure is intended toK
a. "mprove circulation to the extremities
b. /revent hypotension
c. /revent loss of calcium from the bones
d. /revent pressure sores
'. ) '--year-old male patient complaining of chronic progressive chorea and mental deterioration is admitted to the unit.
&he nurse recognizes that these characteristics indicate a disease that results in degeneration of the basal ganglia
and cerebral cortex. &he disease is calledK
a. 1uillain-Barre? syndrome c. ;ultiple sclerosis 8;$9
b. %untington?s disease d. ;yasthenia gravis
,. "n caring for a patient recovering from an acute head in.ury( the nurse understands that the onset of seizures most
likely will occurK
a. 0 months to # years after the head in.ury
b. ' to - years after the head in.ury
c. Within the first 0 months after the head in.ury
d. Within the first weeks posttrauma
-. ) patient is admitted to the rehabilitation unit with a diagnosis of <uadriplegia. /lanning nursing care for a <uadriplegic
patient is based on the nurse?s knowledge that <uadriplegia results from in.uries to what level of the spinal cord?
a. !ervical spine levels !1 to !, c. !ervicothoracic spine levels !' to +,
b. !ervical spine levels !1 to !- d. &horacolumbar spine levels &1 to &,
0. ) patient is diagnosed with an upper motor neuron lesion. &he nurse expects that the patient will experience which of
the following conditions?
a. 2xcessive parasympathetic stimulation
b. >laccid paralysid
c. $pastic paralysis
d. &emporary paralysis
3. &he nurse understands that normal physiological changes in the eye associated with aging includeK
a. ecrease elasticity of the lens and a slower papillary light reflex
b. ecreased strabismus and decreased tearing
c. "ncreased elasticity of the lens and slower papillary light reflex
d. "ncreased strabismus and decreased tearing
5. &he nurse understands that physical changes associated with aging includeK
a. ecreased physical strength and endurance
b. "ncreased muscular coordination
c. "ncreased tolerance to cold
d. ) tendency to gain weight
28
6. /sychogenic pain is best defined as painK
a. ue to a lesion in the central nervous system
b. ue to emotional factors without anatomic or physiologic explanation
c. @riginating in the internal organs
d. ue to an amputation
1:. When preparing a nursing plan of care for an elderly patient( the nurse understands that ma.or fears of elderly people
includeK
a. >ear of acute illness c. >ear of physical and economic dependency
b. >ear of economic dependency d fear of physical dependency
Situation: Mike Hilario has suffered a cerebrovascular accident in the left hemisphere of his brain.
Questions 11 to 14 refer to this situation.
11. &he nurse anticipates that ;r. %ilario will have paresis on theK
a. >our extremities of his body c. +ight side of his body
b. *eft side of his body d. +ight-side of his body and the left side of his
>ace
1#. ;r. %ilario has difficulty speaking( but he can communicate through gestures. &he term that best describes this
condition isK
a. )cephalia c. )kathisia
b. )ccoucheur d. )phasia
1'. )s part of the long-term planning for ;r. %ilario( the nurse shouldK
a. Begin associating words with physical ob.ects
b. )sk the patient <uestions and wait as long as it takes for him to verbally respond
c. !onsult with the patient?s doctor concerning a speech therapy program
d. %elp the patient accept this disability as permanent
1,. &he action most helpful in communicating with ;r. %ilario isK
a. !onversing in a rapid manner
b. 1iving directions on a two-at-a-time basis
c. $peaking in a louder-than-usual tone of voice
d. 4sing gestures to accompany the spoken word
Situation: Richard Clipton is admitted to the hospital with a disease characteried b! the rapid development of
s!mmetrical weakness and lower motor neuron flaccid paral!sis that ascends to the upper e"tremities.
Questions 1# to 1$ refer to this situation.
1-. &he nurse recognizes that ;r. !lipton?s symptoms are characteristics of which of the following diseases?
a. 1uillain-Barre? syndrome c. ;ultiple sclerosis 8;$9
b. %untington?s disease d. ;yasthenia gravis
10. &he nurse anticipates that the doctor will order which of the following treatments for ;r. !liptons?
a. %igh-dose steroid therapy
b. ".A. wide-spectrum antibiotic therapy
c. &he monitoring of respiratory vital capacity every # hours
d. /yridostigmine bromide 8;estinon9
29
13. ;r. !lipton deteriorates( suffering respiratory failure and re<uiring transfer to the intensive care unit for continuing
care. Based on her knowledge of the disease( the nurse knows which of the following facts about ;r. !lipton?s
prognosis?
a. eath usually occurs in 1 to # months
b. /rognosis is poor or variable and may progress rapidly or slowly
c. +ecovery is complete and spontaneous in about 6-= of all patients
d. &he patient will most likely have severe residual lower extremity weakness re<uiring long-term supportive
care
Situation: %unior &ntonio is a '$ !ear old man who(s admitted with a dia)nosis of a brain aneur!sm.
Questions 1* to +, refer to this situation.
15. Based on the diagnosis of a brain aneurysm( the nurse anticipates which of the following orders from the doctor?
a. )mbulate the patient the length of the hallway three times a day.
b. )dminister hydralazine( prednisone( and diazepam around the clock
c. )dminister ".A. phenytoin and phenobarbitol
d. )dminister subcutaneous terbutaline alternating with beta-agonist inhalers every # hours
16. &he nurse understands that brain aneurysms are the result ofK
a. )n autoimmune process
b. amage to the seventh cranial nerve 8facial9
c. ilation of a cerebral artery
d. @titis media or tooth abscess
#:. ) diagnosis of a brain aneurysm was based on which of the following symptoms demonstrated by ;r. )ntonio?
a. ) headache( nuchal rigidity and a stiff back and legs
b. "nsidious mental deterioration
c. $evere hypertension( bradycardia( and a pounding headache
d. 4nilateral weakness or paralysis
Situation: -elson .a/era is a 1' !ear old hi)h school student admitted to the pediatric unit with a dia)nosis of
epileps!.
Questions +1 to +4 refer to this situation.
#1. &he nurse anticipates immediate implementation of which intervention if Belson experiences a seizure?
a. )dministration of phenytoin 8ilantin9 and diazepam 8Aalium9 by mouth
b. 2mergency intubation and mechanical ventilation
c. 2nsuring side-lying positioning with padded side rails
d. /lacement of a bite block and physical restraints
##. )lmond is ordered to receive ':: mg of phenytoin 8ilantin9 by mouth every evening. &he nurse?s teaching plan for
)lmond includes meticulous oral hygiene because phenytoinK
a. ;ay cause needing of the gums
b. ;ay cause hypertrophy of the gums
c. ;ay increase bacterial growth
d. ;ay increase pla<ue( which increases cavities.
#'. )lmond tells the nurse that he?s experiencing a generalized tingling sensation and is Dsmelling rosesF. &he nurse
understands that )lmond is probably experiencingK
a. )cute alcohol withdrawal
b. )n acute cerebrovascular accident 8!A)9
30
c. )n aura
d. )n olfactory hallucination.
#,. &he nurse sees that Belson has glassy eyes( is starting( and is performing a chewing motion with his mouth. &he
nurse correctly assumes that he?s experiencing aK
a. 1eneralized tonic-clonic seizure c. $imple focal seizure
b. /artial complex seizure d. &emporal lobe seizure
Situation: 0heresa 1elismino is a 1$2!ear2old female who(s admitted to the intensive care unit 34C56 with an acute
spinal cord in/ur!.
Questions +# to +* refer to this situation.
#-. &he nurse understands that the most common causes of spinal cord in.ury in patients of this age areK
a. "llnesses such as ankylosing spondylitis and rheumatoid arthritis
b. ;otor vehicle accidents( falls( and diving accidents
c. /enetrating in.uries such as gunshot wounds
d. $ports in.uries
#0. uring the first #, to ,5 hours after the in.ury( the nurse anticipates orders from the doctor to administerK
a. )ntihypertensive medications and diuretics
b. ".A. fluids and blood products
c. ".A. fluids and corticosteroids
d. ".A. mannitol
#3. &heresa has been diagnosed with paraplegia. &he nurse recognizes that one early problem of paraplegia isK
a. iarrhea c. /atient education
b. *earning to use mechanical aids d. +elearning how to control one?s bladder
#5. &heresa develops spinal shock( which is manifested by which of the following signs and symptoms?
a. %ypertension and bradycardia c. Aentricular arrhythmias and hypotension
b. %ypotension and tachycardia d. Aentricular arrhythmias and tachypnea
Situation: Rod 7ilbert is a 8+ !ear old construction worker admitted to the emer)enc! department with complete
transaction of the spinal cord at the fifth thoracic level 30S6.
Questions +9 to 88 refer to this situation.
#6. &he nurse anticipates which of the following assessment findings regarding ;r. 1ilbert?s voluntary motor activity and
sensation?
a. !omplete loss of voluntary motor activity and sensation below the level of in.ury
b. !omplete loss of voluntary motor activity below the level of in.ury( with variable sensory loss below the level of
in.ury
c. !omplete loss of voluntary motor activity on one side below the level of in.ury
d. Aariable loss of voluntary motor activity and sensation below the level of in.ury.

':. ;r. 1ilbert complains of a severe headache and is extremely anxious. &he nurse checks his vital signs and finds him
to have a heart rate of -- beatsCminute and a blood pressure of #-:C1:5 mm %g. &he nurse should also assess forK
a. >ecal incontinence c. /resence of bowel sounds
b. /resence of a Babinski?s reflex d. 4rinary catheter patency
'1. &hree days later( ;r. 1ilbert is informed that he will be a paraplegic. %e asks the nurse if he will be able to have
sexual intercourse. &he most knowledgeable response to this <uestion would beK
31
a. D"t?s too early to make this assumptionF
b. DBo( " really don?t think will ever have sexual intercourse againF
c. D&his shouldn?t be discussed this early in your recoveryF
d. DEou are a paraplegic and have lost motor control below your waistF
'#. ;r. 1ilbert may develop the complication of urinary calculi. &he ma.or factor that contributes to this condition in
paraplegia patients isK
a. %ypoparathyroidism c. "ncreased intake of calcium
b. "nade<uate renal function d. "ncreased loss of calcium from the skeletal system
''. When planning long-term care for ;r. 1ilbert( the nurse should understand that rehabilitationK
a. $hould begin as soon as the patient is admitted to the hospital
b. $hould begin as soon as the patient is stabilized
c. $hould be left up to the patient
d. $hould not begin until the patient is transferred to a rehabilitation facility
Situation: &nnette Mendador is a $+2!ear2old )randmother with a histor! of mild obesit!: osteoporosis; and
cataracts.
Questions 84 to 89 refer to this situation.
',. &he nurse performs an assessment on ;rs. ;endador. &he nurse should understand that which of the following
symptoms is most characteristic of cataracts?
a. ecreased discrimination between green and blue
b. Bone I most patients are asymptomatic
c. /ainful( sudden bilateral vision loss
d. /ainless( progressive vision loss in one eye or both eyes
'-. Which of the following statements is true regarding the visual changes associated with cataracts?
a. Both eyes typically develop cataracts at the same rate
b. &he loss of vision is experienced as a painless( gradual blurring
c. &he patient is suddenly blind
d. &he patient typically experiences a painful( sudden blurring of vision
'0. &reatment of cataracts generally involvesK
a. )pplication of lubricants to eyes four time a day
b. )pplication of miotic eyedrops twice a day
c. Bo treatment I cataracts are a normal part of aging
d. $urgical removal of cataracts.
'3. ;rs. ;endador is schedualed for outpatient surgical correction of her cataracts. ischarge teaching on this patient
should be based on the nurse knowledge thatK
a. !ataracts are usually removed with the patient receiving general anesthesia
b. !ataract surgery typically involves a #-to '-day hospital stay
c. $urgery can restore about 3-= of vision loss by removing the cataract.
d. $urgery can restore about 6-= of vision loss by removing the cataract.
'5. &he nurse should include which of the following instructions in ;rs. ;endador?s discharge teaching?
a. Bed rest for 1 week
b. *imited alcohol and nicotine consumption
c. Bo behavior modifications are necessary
d. Bo bleeding( straining( lifting( or coughing.
32
'6. Which of the following choices are complications of cataract surgery?
a. "ntraocular infarction and uveitis c. Aitreous collapse and intraocular infection
b. "ntraocular infection and uveitis d. Aitreous prolapse and intraocular infarction
Situation: &nthon! <alesteros is a $*2!ear2old retired mechanic who(s admitted from home with severe verti)o
and tinnitus. He has a histor! of prostatic h!pertroph! and hard of hearin) in his left ear.
Questions 4, to 4+ refer to this situation.
,:. &he nurse expects which of the following characteristics to be true regarding normal physiologic changes to ;r.
Ballesteros hearing?
a. )symmetrical sensorineural hearing loss
b. ifficulty hearing high-fre<uency sounds symmetrically
c. /rogressive hearing loss in the middle ear
d. *ess distortion of sounds symmetrically
,1. ;r. Ballesteros is displaying symptoms ofK
a. 1laucoma c. ;endel?s disease
b. elirium d. ;eniere?s disease
,#. Bursing interventions of ;r. Ballesteros should includeK
a. )dministration of narcotic agents during severe attacks
b. 2ncouragement of fre<uent independent activity
c. 2ncouragement of a high-sodium diet and intake of fluids
d. >re<uent rest periods( with nursing assistance with activity
Situation: Mar)arita Saldom is a $#2!ear2old active female e"periencin) bout of urinar! incontinence.
Questions 48 to 4# refer to this situation.
,'. ;rs. $aldom may be increased risk of urinary incontinence because ofK
a. ecreased bladder capacity c. iuretic use
b. ) dilated urethra d. "ncreased glomerular filtration rate
,,. ;rs. $aldom is diagnosed with stress incontinence. "nitial treatment of this bladder condition involvesK
a. )bdominal wall exercises c. /elvic floor exercises 8Gegel exercises9
b. Beta-adrenergic agonists d. &emporary urinary catheter placement
,-. ;rs. $aldom?s incontinence places her at risk for which of the following problems?
a. ecreased mobility c. >ecal incontinence
b. >alls d. $ocial "solation
Situation: Harold =spiritu is an *,2!ear2old man who(s admitted with a dia)nosis of dementia and malnutrition.
Questions 4' to #, refer to this situation.
,0. &he doctor orders a series of laboratory tests to determine whether ;r. 2spiritu?s dementia is treatable. &he nurse
understands that the most common cause of dementia in this patient population isK
a. )c<uired immunodeficiency syndrome 8)"$9
b. )lzheimer?s disease
33
c. Brain tumors
d. Aascular disease
,3. ;r. 2spiritu is in the middle stage of dementia. @bservable behaviors of this stage includeK
a. ifficulty concentrating and learning new material
b. 2asy distraction re<uiring constant supervision of patient
c. 1etting lost easily in unfamiliar places
d. )n inability to feed oneself and dependence on nonverbal communication.
,5. &he most likely treatment for ;r. 2spiritu will includeK
a. &he implementation of specific diets and exercises
b. &he treatment of symptoms as well as patient and family support
c. &reatment with lecithin and physostigmine
d. &he use of physical restraints when the patient is left unsupervised
,6. Bursing measures aimed at correcting ;r. 2spiritu?s nutritional status includeK
a. /roviding excessive stimulation at mealtimes to stimulate hunger
b. /roviding meals in calm surrounding without distractions
c. /roviding meals with many choices
d. $trictly enforcing mealtimes
-:. ;easures to support ;r. 2spiritu?s family should includeK
a. iscouraging planning for the future because outcomes in this patient population are unpredictable
b. 2ncouraging planning for the future( including financial planning and nursing home application
c. 2ncouraging isolation and minimal patient activities
d. 2ncouraging as much patient stimulation and as many activities as possible
34
MATERNAL & CHILD NURSING
1. 4sually individual twins will grow appropriately and at the same rate as singletons until how many weeks?
gestation?
a. 10 to 15 weeks c. ': to '# weeks
b. 15 to ## weeks d. '5 to ,: weeks
#. Which of the following classification applies to monozygotic twins for whom the cleavage of the fertilized ovum
occurs more than 1' days after fertilization?
a. !on.oined twins c. iamniotic monochorionic twins
b. iamniotic dichorionic twins d. ;onoamniotic monochorionic twins
'. "n twin-to-twin transfusion syndrome( the arterial circulation of one twin is in communication with the venous
circulation of the other twin. @ne fetus is considered the DdonorF twin and one becomes the DrecipientF twin.
)ssessment of the recipient twin would most likely show which of the following conditions?
a. )nemia c. /olycythemia
b. @ligohydramnios d. $mall fetus
,. ) pregnant client who reports painless vaginal bleeding at #5 weeks? gestation is diagnosed with placenta previa.
&he placental edge reaches the internal os. &his type of placenta previa is known as which of the following types?
a. *ow-lying placenta previa c. /artial placenta previa
b. ;arginal placenta previa d. &otal placenta previa
-. 2xpectant management of the client with a placenta previa includes which of the following procedures or
treatments?
a. $tat culture and sensitivity
b. )ntenatal steroids after ', weeks? gestation
c. 4ltrasound examination every # to ' weeks
d. $cheduled delivery of the fetus before fetal maturity in a hemodynamically stable mother
0. ) client with painless vaginal bleeding has .ust been diagnosed as having a placenta previa. Which of the
following procedures is usually performed to diagnose placenta previa?
a. )mniocentesis
b. igital or speculum examination
c. 2xternal fetal monitoring
d. 4ltrasound
3. !lient with placenta previa are at increased risk for the placenta to form an abnormally firm attachment to the
uterine wall( known as placenta accrete. Which of the following statements best describes this abnormal
attachment?
a. &he placenta invades the myometrium
b. &he placenta covers the cervical os
c. &he placenta penetrates the myometrium
d. &he placenta attaches to the myometrium
5. Which of the following symptoms occurs with a hydatidiform mole?
a. %eavy-bright red bleeding every #1 days
b. >etal cardiac motion after 0 weeks? gestation
c. Benign tumors found in the smooth muscle of the uterus
d. D$nowstormF pattern on ultrasound with no fetus or gestational sac
35
6. ) #1-year-old client has .ust been diagnosed with having a hydatidiform mole. Which of the following factors is
considered a risk factor for developing a hydatidiform mole?
a. )ge in #:s or ':s c. /rimigravida
b. %igh socioeconomic status d. /rior molar gestation
1:. ) #1-year-old client arrives at the emergency department with complaints of cramping abdominal pain and mild
vaginal bleeding. /elvic examination shows a left adnexal mass that is tender when palpated. !uldocentesis
shows blood in the cul-de-sac. &his client probably has which of the following conditions?
a. )bruption placentae c. %ydatidiform mole
b. 2ctopic pregnancy d. /elvic inflammatory disease
11. ) client( ', weeks? pregnant( arrives at the emergency department with severe abdominal pain( uterine
tenderness( and an increased uterine tone. &he client denies vaginal bleeding. &he external fetal monitor shows
fetal distress with severe( variable decelerations. &he client most likely has which of the following conditions?
a. )bruption placentae c. ;olar pregnancy
b. 2ctopic pregnancy d. /lacenta previa
1#. Before the placenta functions( the corpus luteum is the primary source for synthesis of which of the following
hormonses?
a. !ortisol and thyroxine
b. 2strogen and progesterone
c. *uteinizing hormone 8*%9 and follicle stimulating hormone
d. &hyroxine 8&,9 and triiodothyronine 8&'9
1'. Which of the following changes in respiratory functioning during pregnancy is considered normal?
a. "ncreased tidal volume c. ecreased inspiratory capacity
b. "ncreased expiratory volume d. ecreased oxygen consumption
1,. Which of the following terms applies to the tiny( blanched( slightly raised end arterioles found on the face( neck(
arms( and chest during pregnancy?
a. 2pulis c. $triae gravidarum
b. *inea nigra d. &elangiectasias
1-. Which of the following statement is true about dizygotic twins?
a. &hey occur most fre<uently in )sian women
b. &here?s a decreased risk with increased parity
c. &here?s an increased risk with increased maternal age
d. &here?s no increased risk with the use of fertility drugs
10. Which of the following conditions is common in pregnant clients in the second trimester of pregnancy?
a. ;astitis c. /hysiologic anemia
b. ;etabolic alkalosis d. +espiratory acidosis
13. ) #1-year-old client0 weeks? pregnant( is diagnosed with hyperemesis gravidarum. &his excessive vomiting during
pregnancy will often result in which of the following conditions?
a. Bowel perforation c. ;iscarriage
b. 2lectrolyte imbalance d. /regnancy-induced hypertension
15. ) client is being admitted to the antepartum unit for hypovolemia secondary to hyperemesis gravidarum. Which of
the following factors predisposes a client to the development of this condition?
36
a. &rophoblastic disease
b. ;aternal age older than '- years
c. ;alnourished or underweight clients
d. *ow levels of human chorionic gonadotrophin 8%!19
16. !lients with gestational diabetes are usually managed by which of the following therapies?
a. iet c. @ral hypoglycemic drugs
b. *ong-acting insulin d. @ral hypoglycemic drugs and insulin
#:. ;agnesium sulfate is given to pregnant clients with preeclampsia to prevent which of the following conditions?
a. %emorrhage c. %ypomagnesemia
b. %ypertension d. $eizures
#1. ) pregnant client has a negative contraction stress test 8!$&9. Which of the following statements describes
negative !$& results?
a. /ersistent late decelarations in fetal heartbeat occurred( with at least three contractions in a 1:-minute
window
b. )ccelerations of fetal heartbeat occurred( with at least 1- beatsCminute( lasting 1- to ': seconds in a #:-
minute period
c. )ccelerationss of fetal heartbeat were absent or didn?t increase by 1- beatsCminute for 1- to ': seconds
in a #: minute period
d. &here was good fetal heart rate variability and no decelerations from contraction in a 1: minute period in
which there were three contractions.

##. ) pregnant client with sickle cell anemia is at an increased risk for having a sickle cell crisis during pregnancy.
)ggressive management of a sickle cell crisis includes which of the following measures?
a. )ntihypertensive agents c. ".A. fluids
b. iuretic agents d. )cetaminophen 8&ylenol9 for pain
#'. Which of the following cardiac conditions is normal during pregnancy?
a. !ardiac tamponade c. 2ndocarditis
b. %eart failure d. $ystolic murmur
#,. "n a complete hydatidiform mole( which of the following karyotypes is typically found?
a. ,077 c. 06777
b. 0677E d. 067EE
#-. ;agnesium sulfate is given to clients with pregnancy induced hypertension to prevent seizure activity. Which of
the following magnesium levels is therapeutic for clients with preeclampsia?
a. , to 3 m2<C* c. 1: to 1# m2<C*
b. 5 to 1: m2<C* d. 1reater than 1- m2<C*
#0. ) client is receiving ".A. magnesium sulfate for severe preeclampsia. Which of the following adverse effects is
associated with magnesium sulfate?
a. )nemia c. %yperreflexia
b. ecreased urine output d. "ncreased respiratory rate
#3. &he antagonist for magnesium sulfate should be readily available to any client receiving ".A. magnesium. Which of
the following drugs is the antidote for magnesium toxicity?
a. !alcium gluconate 8Galcinate9
b. %ydralazine 8)presoline9
c. Baloxone 8Barcan9
37
d. +h: 89 immune globulin 8+ho1);9
#5. ) pregnant client is screened for tuberculosis during her first prenatal visit. )n intradermal in.ection of purified
protein derivative 8//9 of the tuberculin bacilli is given. &he client is considered to have a positive test for which
of the following results?
a. )n indurated wheal under 1: mm in diameter appears in 0 to 1# hours
b. )n indurated wheal over 1: mm in diameter appears in ,5 to 3# hours
c. ) flat circumcised are under 1: mm in diameter appears in 0 to 1# hours.
d. ) flat circumcised area over 1: mm in diameter appears in ,5 to 3# hours
#6. ) #'-year-old client who is #3 week?s pregnant arrives at her physician?s office with complaints of fever( nausea(
vomiting( malaise( unilateral flank pain and costovertebral angle tenderness. Which of the following diagnoses is
the most likely?
a. )symptomatic bacteriuria c. /yelonephritis
b. Bacterial vaginosis d. 4rinary tract infection 84&"9
':. !lients with which of the following conditions would be appropriate for a trial of labor after a prior cesarean
delivery?
a. !omplete placenta previa c. /remature rupture of membranes
b. "nvasive cervical cancer d. /rior classical cesarean delivery
'1. +h isoimmunization in a pregnant client develops during which of the following conditions?
a. +h-positive maternal blood crosses into fetal blood( stimulating fetal antibodies.
b. +h-positive fetal blood crosses into maternal blood( stimulating maternal antibodies
c. +h-negative fetal blood crosses into maternal blood( stimulating maternal antibodies.
d. +h-negative maternal blood crosses into fetal blood( stimulating fetal antibodies
'#. Which of the following doses of +ho 89 immune globulin 8+ho1);9 is appropriate for a pregnant client at #5
weeks? gestation?
a. -: mcg in a sensitized client
b. -: mcg in an unsensitized client
c. ':: mcg in a sensitized cleint
d. ':: mcg in an unsensitized client
''. ) client hospitalized for premature labor tells the nurse she?s having occasional contractions. Which of the
following nursing interventions would be the most appropriate?
a. &each the client the possible complications of premature birth
b. &ell the client to walk to see if she can get rid of the contractions
c. 2ncourage her to empty her bladder and drink plenty of fluids( and give ".A. fluids
d. Botify anesthesia for immediate epidural placement to relieve the pain associated with contractions
',. &he phrase gravida 4, para 2 indicates which of the following prenatal histories?
a. ) client has been pregnant four times and had two miscarriages
b. ) client has been pregnant four times and had two live-born children
c. ) client has been pregnant four times and had two cesarean deliveries
d. ) client has been pregnant four times and had two spontaneous abortions
'-. Which of the following factors would contribute to a high-risk pregnancy?
a. Blood type @ positive
b. >irst pregnancy at age '' years
c. %istory of allergy to honey bee pollen
d. %istory of insulin-dependent diabetes mellitus
38
'0. Which of the following complications can be potentially life-threatening and can occur in a client receiving a
tocolytic agent?
a. iabetic ketoacidosis c. /ulmonary edema
b. %yperremesis gravidarum d. $ickle cell anemia
'3. Which of the following hormones would be administered for the stimulation of uterine contractions?
a. 2strogen c. @xytocin
b. >etal cortisol d. /rogesterone
'5. Which of the following answers best describes the stage of pregnancy in which maternal and fetal blood are
exchanged?
a. !onception
b. 6 weeks? gestation( when the fetal heart is well developed
c. '# to ', weeks? gestation 8third trimester9
d. ;aternal and fetal blood are never exchanged
'6. Which of the following rationales best explains why a pregnant client should lie on her left side when resting or
sleeping in the later stages of pregnancy?
a. &o facilitate digestion
b. &o facilitate bladder emptying
c. &o prevent compression of the vena cava
d. &o avoid the development of fetal anomalies
,:. ) pregnant client is concerned about lack of fetal movement. What instructions would the nurse give the might
offer reassurance?
a. $tart taking two prenatal vitamins
b. &ake a warm bath to facilitate fetal movement
c. 2at foods that contain a high sugar content to enhance fetal movement
d. *ie down once a day and count to number of fetal movements for 1- to ': minutes
,1. What would be the most appropriate recommendation to a pregnant client who complains of swelling in her feet
and ankles?
a. *imit fluid intake c. $it and elevate the feet twice daily
b. Buy walking shoes d. $tart taking a diuretic as needed daily
,#. Which of the following interventions would the nurse recommend to a client having severe heartburn during her
pregnancy?
a. 2at several small meals daily
b. 2at crackers on waking every a.m.
c. rink a preparation of salt and vinegar
d. rink orange .uice fre<uently during the day
,'. Which of the following maternal complications is associated with obesity in pregnancy?
a. ;astitis c. /reeclampsia
b. /lacenta previa d. +h isoimmunization
,,. Because uteroplacental circulation is compromised in clients with preeclampsia( a non stress test 8B$&9 is
performed to detect which of the following conditions?
a. )nemia
b. >etal well-being
c. "ntrauterine growth retardation 8"41+9
39
d. @ligohydramnios
,-. ) client is '' weeks? pregnant and has had diabetes since she was #1. when checking her fasting blood sugar
level( which of the following values would indicate the client?s disease was controlled?
a. ,- mgCdl c. 1#: mgCdl
b. 5- mgCdl d. 1'0 mgCdl
,0. Which of the following techni<ues is best to monitor the fetus of a client with diabetes in her third trimester?
a. 4ltrasound examination weekly
b. Bonstress test 8B$&9 twice weekly
c. aily contraction stress test 8!$&9 at '# week?s gestation
d. ;onitoring of fetal activity by client weekly
,3. ) client is diagnosed with preterm labor at #5 weeks? gestation. *ater( she comes to the emergency department
saying( D" think "?m in laborF. &he nurse would expect her physical examination to show which of the following
conditions?
a. /ainful contraction with no cervical dilation
b. +egular uterine contractions with cervical dilation
c. "rregular uterine contraction with no cervical dilation
d. "rregular uterine contractions with cervical effacement
,5. Which of the following conditions is the most common cause of anemia in pregnancy?
a. )lpha thalassemia c. "ron deficiency anemia
b. Beta thalassemia d. $ickle cell anemia
,6. Which of the following test should be ordered to confirm a diagnosis of beta thalassemia?
a. !omplete blood count 8!B!9 c. %emoglobin electrophoresis
b. %emoglobin )1c d. "ron level
-:. ) pregnant adolescent client is at risk for which of the following complications?
a. 1estational diabetes c. ;acrosomic infant
b. *ow-birth-weight infant d. /lacenta previa
40
ANSWERS IN PATHOPHYSIOLOGY
1. I "notropic agents are administered to increase the force of the heart?s contractions( thereby increasing ventricular
contractility and ultimately increasing cardiac output.
#. B I $timulation of the sympathetic nervous system causes tachycardia and increased contractility.
'. I Weight gain( nausea and a decrease in urine output are secondary effects of right sided heart failure.
,. ) I )therosclerosis accounts for 3-= of all abdominal aortic aneurysm. /la<ues build up on the wall of the vessel and
weaken it( causing an aneurysm.
-. B I &he portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isn?t
surrounded by stable structures( unlike the proximal portion of the aorta.
0. ) I &he presence of a pulsating mass in the abdomen is an abnormal finding( usually indicating an outpouching in a
weakened vessel as in abdominal aortic aneurysm.
3. ) I )bdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in
the abdominal region.
5. I *ower back pain results from expansion of the aneurysm. &he expansion applies pressure in the abdominal
cavity( and the pain is referred to the lower back.
6. B I )n arteriogram accurately and directly depicts the vasculatureM therefore( it clearly delineates the vessels and any
abnormalities.
1:. B I +upture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for
this type of client.
11. ! I &he factor common to all types of aneurysms is a damaged media. &he media has more smooth muscle and less
elastic fibers( so it?s more capable of vasoconstriction and vasodilation.
1#. ! I &he aorta lies directly left of the umbilicusM therefore( any other region is inappropriate for palpation.
1'. B I !ontinuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to
occur.
1,. ) I ) bruit( a vascular sound resembling heart murmur( suggests partial arterial occlusion.
1-. B I $evere lower back pain indicates an aneurysm rupture( secondary to pressure being applied within the abdominal
cavity.
10. ! I Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area.
13. ! I ;arfan?s syndrome results in the degeneration of the elastic fibers of the aortic media. &herefore( clients with the
syndrome are more likely to develop an aneurysm.
15. I When the vessel ruptures( surgery is the only intervention that can repair it. )dministration of antihypertensive
medications and beta-adrenergic blockers can help control hypertension( reducing the risk of rupture.
16. ) I !ardiomyopathy isn?t usually related to an underlying heart disease such as arthrosclerosis.
#:. ) I )lthough the cause isn?t entirely known( cardiac dilation and heart failure may develop during the last month of
pregnancy or the first few months after birth.
#1. I $igns of a fracture may include redness warmth( numbness or loss of sensation and new site of pain( coolness(
tingling and loss of pulses are signs of a vascular problem.
##. B I ) correct neurovascular assessment should include capillary refill( movement( pulses( and warmth. Beurovascular
assessment involves nerve and blood supply to an area.
#'. ) I &he right way to assess limb circumference is to use a measuring tape.
#,. ! I "f pulses aren?t palpable( verify the assessment with oppler ultrasonography. "f pulses can?t be found with
oppler ultrasonography( immediately notify the physician.
#-. ) I ) foul odor from a cast may be a sign of infection. &he nurse needs to assess for fever( malaise and possibly and
elevation in white blood cells.
#0. ) -&o reduce the roughness of the cast( petal the edges.
#3. I &o reduce swelling( place the limb the cast above the level of the heart. &o elevate a cast( the limb may need to be
extended from the body.
#5. B I ) wet cast will weaken or be destroyed. ) foul odor is a sign of infection. "t?s never all right to get a cast wet.
#6. B I >racture pain is sharp and related to movement. /ain that?s dull and deep and unrelated to movement isn?t typical
of a fracture.
':. ! -!lassic fractures that occur with trauma are those of the humerus and clavicle.
'1. -) closed fracture maintains intact skin over the fracture site. )n open fracture has extensive tissue damage( an
increased risk of infection and is also known as a compound fracture.
'#. -&raction prevents trauma and overcomes muscle spasms. &raction doesn?t prevent skin breakdown help in turning
the client( or help the client become active.
''. -) fracture lien straight across the bone is called a transverse fracture.
',. -) transverse fracture commonly occurs with such bone diseases as osteomalacia and /aget?s disease.
'-. ! -$piral fractures are commonly seen in the upper extremities and are related to physical abuse.
41
'0. -%ealing of a fracture occurs by the formation of new bone tissue. Bone doesn?t heal by forming scar tissue or
necrotic tissue or by displacement.
'3. ! - >emoral shaft fractures may cause hemorrhage( with as much as 1(::: to 1(-:: ml of blood loss.
'5. B -) serious complication of long bone fractures is the development of fat emboli.
'6. I $igns and symptoms of fat emboli include tachypnea( tachycardia( shortness of breath( and petechial rash on the
chest and neck.
,:. B I &reatment of a fat embolus may include oxygen. ".A.( fluids( steroids to counteract inflammation in the lungs and
correct cerebral edema and antibiotics to prevent infection.
,1. ! I Bystagmus refers to .erking movements of the eye.
,#. ) I &he priority during and after a seizures is to maintain a patent airway.
,'. B I )n aura occurs in some clients as a warning before a seizure. &he client may experience a certain smell( a vision
such as flashing lights( or a sensation.
,,. I ) loading dose of phenytoin and other drug is given to reach therapeutic levels more <uicklyM maintenance dosing
follows.
,-. ! I )dverse effects of phenytoin include sedation( drowsiness( gingival hyperplasia( blood dyscrasia and toxicity.
,0. ) I ) therapeutic phenytoin level is 1: to #: mgCdl. ) level of '# mgCdl indicates phenytoin toxicity. $ymptoms of
toxicity include confusion and ataxia.
,3. ! I Butritional supplements and milk interfere with the absorption of phenytoin( decreasing its effectiveness.
,5. I )lcohol decreases phenytoin activity( diminishing its effectiveness. )lthough alcohol also reduces the seizure
threshold and impairs .udgment and coordination( these effects aren?t the primary concern.
,6. ! I &o reduce the risk of in.ury( the nurse should take an axillary temperature or use a metal thermometer when taking
an oral temperature to prevent in.ury if a seizure occurs.
-:. ) I $tatus epilepticus 8seizures not responsive to usual therapies9 occurs with the abrupt cessation of anticonvulsant
drugs or ethanol intake.
-1. ! I )ll clients with a head in.ury are treated as if a cervical spine in.ury is present until 7-rays confirm their absence.
-#. I &etraplegia 8<uadriplegia9 occurs as a result of cervical spinal in.uries
-'. ) I &he hippocampus( amygdale( and fornix make up the limbic system( which regulates emotions.
-,. ! I )fter a spinal cord in.ury ascending cord edema may cause a higher level of in.ury.
--. ! I $ymptoms of neurogenic shock include hypotension( bradycardia( and warm( dry skin due to loss of adrenergic
stimulation below the level of the lesion.
-0. ! I %igh doses of methylprednisolone are sued within #, hours of spinal cord in.ury to reduce cord swelling and limit
neurological deficit.
-3. I )nxiety( flushing above the level of the lesion( piloerection( hypertension and bradycardia are symptoms of
autonomic dysreflexia( typically caused by such noxious stimuli as a full bladder( fecal impaction or decubitus ulcer.
-5. ! I &he nurse should always focus on the feelings underlying a particularly action.
-6. B I 1ardner-Wells( Ainke( and !rutchfield tongs immobilize the spine until surgical stabilization is accomplished.
0:. ! I &he wrench must be attached at all times to remove the vest in case the client needs cardiopulmonary
resuscitation.
01. I )nticholinergic medication( such as atropine and scopolamine( may cause urinary retention( particularly for the
client who has surgery in the pelvic area.
0#. ! I 4rine retention is usually a temporary problem that re<uires insertion of a straight catheter.
0'. ) I B/% is common among elderly men and often results in urine retention( fre<uency( dribbling( and difficulty starting
the urine stream.
0,. ! I !reatinine is filtered by the glomeruli and isn?t reabsorbed by the renal tubules.
0-. B I 2xcretory urography identifies calculi or masses and helps diagnose other anomalies of the upper and lower
urinary tract 8kidney( ureters( urethra( bladder9
00. B I &he client is showing symptoms of an allergy to the iodine in the contrast medium. &he first action is to make sure
the client?s airway is patent.
03. I !hronic pyelonephritis can be a long term condition and re<uires close monitoring to prevent permanent damage
to the kidneys.
05. I )lthough clients with renal failure can develop stress ulcers( the nausea is usually related to the poisons of
metabolic wastes that accumulate when the kidneys are unable to eliminate them.
06. I !lients with diabetes are prone to renal insufficiency and renal failure. &he contrast used for heart catheterization
must be eliminated by the kidneys( which further stresses them and may produce acute renal failure.
3:. ! I 2ncourage fluid intake and strain all urine( saving all calculi( including DflecksF 1ive pain medications because
renal calculi are painful.
31. ! I &he calculus should be analyzed for composition to determine appropriate interventions such as dietary
restrictions.
3#. ! I /ain at the graft site and weight gain indicates the transplanted kidney isn?t functioning and possibly is being
re.ected.
42
3'. I $teroids use tends to increase blood glucose levels( particularly in clients with diabetes and borderline diabetes.
$teroids also contribute to poor wound healing and may cause acne( mood swings and sodium and water retention.
3,. ! I Water diuresis causes low urine specific gravity( low urine osmolarity and a normal to elevated serum sodium
level.
3-. ! I &he /$) test is used to monitor prostate cancer progressionM higher /$) levels indicate a greater tumor burden.
30. ) I >irst( the nurse should assess urine clarityM cloudy urine usually indicates drainage( which may reflect infection.
33. ! I !iprofloxacin( ceftrizoxime 8!efizox9( cefixime 8$uprax9( ofloxacin 8>loxin9 and doxycline 8Aibramycin9 are the
drugs of choice for treating gonorrhea.
35. I "n renal failure( calcium absorption from the intestine declines( leading to increased smooth muscle contractions(
causing diarrhea.
36. ! I %emolytic streptococci are common in throat infections and can cause an immune reaction that causes
glomerular damage.
5:. I &o control uric acid calculi( the client should follow a low-purine diet( which excludes high-purine foods such as
organ meats.
51. B I &'( &, and calcitonin are all secreted by the thyroid gland.
5#. ! I By secretion of &$%( the pituitary gland controls the rate of thyroid hormone released.
5'. B I "rradiation( involving administration of the 1'1"( destroys the thyroid gland and thereby treats hyperthyroidism.
5,. ) I ;ost elderly clients present with depression( apathy and weight loss( which are typical signs and symptoms of
hyperthyroidism.
5-. B I &hyroid storm is a form of severe hyperthyroidism that can be precipitated by stress( in.ury or infection.
50. I %yperthyroidism is known as 1raves? disease.
53. ! I 2xcessive output of thyroid hormone is the etiology of hyperthyroidism.
55. ) I $igns and symptoms of hyperthyroidism include nervousness( palpitations( irritabilityM bulging eyes heat
intolerance( weight loss and weakness.
56. ) I !orticotropin is secreted by the anterior pituitary gland.
6:. B I &wo leading causes of diabetes insipidus are hypothalamic or pituitary tumors and closed head in.uries.
61. B I !lients with serum ketones and serum glucose levels above ':: mgCdl could be diagnosed with diabetic
ketoacidosis.
6#. I ) client with G) would receive insulin to lower glucose and ".A. fluids to correct hypotension.
6'. I )n ".A. bolus of insulin is given initially to control the hyperglycemiaM followed by a continuous infusion( titrated to
control blood glucose.
6,. I 4ndiagnosed( untreated diabetes mellitus is one of the most common causes of %%B$.
6-. I %%B$ usually present with hypotension( dehydration( fever( and tachycardia.
60. ) I %yperparathyroidism is characterized by osteopenia and renal calculi( secondary to overproduction of parathyroid
hormone.
63. B I +enal calculi usually consist of calcium and phosphorus.
65. ) I ) diagnosis of primary hyperparathyroidism is established based on increased serum calcium levels and elevated
parathyroid hormone levels.
66. I &hiazide diuretic shouldn?t be used because they decrease renal excretion of calcium( thereby raising serum
calcium levels even higher.
1::. I Bormal calcium levels are 5.- to 1:.- mgCdl( so a level of 1- mgCdl is dangerously high.
ANSWERS: CHN
1. B I !hildren given @+& gained more weight compared to children who were not given @+&
#. ) I &he primary ob.ective of ! is D&o reduce mortality from diarrhea particularly among children under five through
extensive case management utilizing oral dehydration therapy 8@+&9( environmental sanitation( maternal and child
health( nutrition and health education activitiesF
'. B I Breastfeeding-2arliest and most practical preventive measure that the mother can institute from the choices
above
,. ) I @+$ should not taste more salty than tears.
-. ! I &he antibodies passed through breast milk are "g).
0. )
3. B
5. !
6. )
1:. !
43
11. I &o prevent further dehydration to an infant who is having diarrhea( the nurse must advice the mother to continue
milk feeding. "f the infant is bottle feeding( the mother should be instructed to give the infant a diluted formula which
means that if the usual milk formula is one scoop to one ounce of water( she must change it to two scoops of milk for
three ounces of water.
1#. B
1'. !
1,. ) I "n @ctober #:::( the /hilippines was declared polio-free. /oliomyelitis is considered eradicated if zero wild
poliovirus is reported for at least three consecutive years with good <uality surveillance for acute flaccid paralysis
8)>/9.
1-. ! I %epatitis B virus is a ma.or cause of the development of liver malignancy. "mmunization upon birth ensures the
greatest protection of individuals from ac<uiring %epatitis B infection that may develop into a chronic liver disease.
10. ) I 1iving the "mmunization at less than the recommended four week interval may lessen antibody response( thus the
effectivity of the immunization and lengthening the interval between doses of vaccines leads to higher antibody.
13.
15. B I %epatitis B vaccine is an immunoglobulin derived from +B) recombinants. "t provides passive immunity.
16. B
#:. ) I &he last vaccine administered to an infant is the measles vaccine. "t is given at 6 months of age.
#1. B I &he vaccination schedule should not be restarted even if the interval exceeded , weeks or it is more than months
or years. Bo extra doses should be given to a child who missed a dose of /&C%BC@/AC&&. Aaccination should be
continued even if the interval is more than the recommended period of time.
##. B I ;easles if given at 6 months provides 5-= protection and if given at 1 year( it provides 6-= protection. ;easles
should be given as soon as the child is 6 months old regardless if the child will be receiving other vaccines on the
same day.
#'. I &he fourth dose of tetanus toxoid provides 1: years protection to the mother. &he third dose of tetanus toxoid
provides - years protection( the third dose of tetanus toxoid provides ' years protection and the fifth dose gives
lifetime protection.
#,. B I &he goal is to eradicate neonatal tetanus and measles by year #::5. &he effort to eliminate measles started in
1665. >or hepatitis B( the goal is to eliminate this disease by #:1#.
#-. ! I %epatitis can be given as early as after birth. &he second dose is given after six weeks and the third dose is given
5 weeks after the second dose. When given early( this vaccine provides protection against hepatitis B( liver cirrhosis
and liver cancer.
#0. I When B!1 vaccine is given immediately after birth( it provides protection against tuberculosis( &B meningitis and
leprosy.
#3. ! I &he vaccines most sensitive to heath are @/A and measles. &hese vaccines should be kept in the freezer at
temperature 1-J! to #-J!.
#5. )
#6. B
':. B I "f the child spits out @/A after giving it( the nurse should give the child another dose. &he nurse should open the
child?s mouth by s<ueezing the cheeks gently and let the vaccine drop on the tongue of the child. &he dropper should
not touch the tongue to prevent contamination.
'1.
'#. B
''. ) I &he temperature in the refrigerator should be between #J! to 5J!. &he temperature in the freezer should be 1-J!
to #-J. &he vaccine stored in the body of the refrigeratorare /&( %epa B( B!1 and tetanus toxoid. &he vaccines
stored in the freezer are oral polio vaccine and measles vaccine.
',. ! I When administering measles vaccine( it is given art a dose of .- ml subcutaneously at the outer part of the upper
arm.
'-. B I &he target age groups for immunization are children between :--6 months old.
'0. ! - ) fully immunized child is one who received single dose B!1( ' doses @/A( one dose ;easles Aaccine( three
doses %epa B( and ' doses /& before reaching age one.
'3. ) I ;easles is routinely given at nine months.
'5. I 1amma globulins are performed antibodies in.ected to individuals in order to provide immediate protection against
infection or lessen the severity of an on going infection.
'6. ) I 2very Wednesday is designated as immunization day. "mmunization is usually conducted once a month in
barangay health stations.
,:. I &he reconstituted vaccine should be protected from sunlight by wrapping the vital with aluminum foil before
placing it in the slit of the foam provided in the vaccine carrier.
,1. )
,#. B I When measles is given at 6 months( it provides 5-= protection. When given at 1 year( it provides 6-= protection.
44
,'. B I &he infant should receive three doses of /&( three doses of @/A( one dose of B!1( one dose of measles and
three doses of hepatitis B vaccine.
,,. B
,-. !
,0. B
,3. ! I /residential ecree Bo. 660 which was signed into law on $eptember 10( 1630 provides for compulsory basic
immunization for infants and children below 5 years old.
,5. ! I &he 2/" is based on epidemiological situation( which is the rising mortality and morbidity from tuberculosis(
diphtheria( measles( pertusis( tetanus and poliomyelitis.
,6. B I &he 1rowth ;onitoring !ard contains the treatment and immunization given to the child. &hus( it is important to
bring it to the health center every immunization and check-up of the child.
-:. ) I &he last immunization given to the infant before heCshe reaches 1 year of age is measles vaccine.
ANSWERS: MICROBIOLOGY
1 B 10. A '1. B ,0. C
! D 13. A '# B ,3. D
" A 15. C ''. D ,5. A
# B 16. B ',. D ,6. D
$ A #:. C '-. A -:. B
% B #1. C '0. B
& D ##. B '3. C
' B #'. A '5. D
( C #,. A '6. B
1) A #-. A ,:. C
11 D #0. D ,1. C
1! A #3. B ,#. A
1" C #5. C ,' A
1# A #6. A ,,. D
1$ A ':. C ,-. C
ANSWERS: ANATOMY
1 C !% D
! D !& A
" A !' D
# C !( A
$ A ") D
% B "1 D
& B "! A
' B "" D
( A "# C
1) D "$ D
11 C "% B
1! A "& D
1" A "' D
1# D "( C
1$ B #) D
1% C #1 A
1& B #! C
1' A #" B
1( D ## B
!) D #$ A
!1 D #% A
!! D #& C
!" D #' B
!# C #( C
!$ D $) B
45
ANSWER AND RATIONALE : BASIC CONCEPTS IN NURSING
1. B - amage to the third cranial nerve 8oculomotor9 may cause dilation of the pupil.
#. ! - >or the body to absorb calcium( pressure must be placed on the long bones. &he tilt table places the patient in a
standing position( which puts pressure on the long bones.
'. B - %untington?s disease is a hereditary in which degeneration of the basal ganglia and cerebral cortex causes
chronic progressive chorea 8muscle twitching9 and mental deterioration( ending in dementia.
,. ) - $eizures may occur at any time following a head in.ury( but the onset of seizures specifically tends to occur 0
months to # years posttrauma.
-. B - Ouadriplegia results from an in.ury to the spinal cord anywhere between levels !1 to !5. "n.uries to the spinal
cord at levels below !5 can cause lower level paralysis such as paraplegia.
0. ! - &he upper motor neuron originates in the cerebral cortex and terminates in the anterior horn cell in the spinal
cord. +eflexes return following an in.ury( resulting in spastic paralysis.
3. ) - &he elasticity of the eye?s lens and the papillary light-reflex decline with age. ecreased tearing of the eyes also
in normal in the elderly. $trabismus is an abnormal finding.
5. ) - /hysical changes associated with aging include decreased physical strength and endurance( decreased
muscular coordination( decreased tolerance to cold( and a tendency to lose weight.
6. B - /sychogenic pain is related to emotional factors and has no anatomic or physiological explanation. /ain due to
an amputation is called phantom pain( pain originating in the internal organs is visceral pain and originating in the
central nervous system is central pain.
1:. ! - ;a.or fears of elderly people include fear of physical and economic dependency as well as fear of chronic illness
and fear of loneliness.
11. ! - When a patient has had a cerebrovascular accident 8!A)9 in the left hemisphere of the brain( the paresis will be
on the right side of the body. Because the pyramidal motor tracts cross over at the medulla oblongata( the right side of
the body and the right side of the face will have paresis with left-hemisphere damage.
1#. - )phasia describes the absence or impairment of speech when the patient can still communicate through
gestures.
1'. ! - *ong-term planning for a patient with aphasia would include consulting with the patient?s doctor concerning a
speech therapy program. "n ;r. %ilario?s case( it?s too soon to know whether his disability will be permanent.
1,. - 4sing gestures to accompany the spoken word will help the patient better understand the message being
communicated. !onversing slowly and giving directions one at a time will allow the patient time to understand what is
being said.
1-. ) - 1uillain( Barre? syndrome is an acute( rapidly progressive( and potentially fatal form of poly neuritis that causes
muscle weakness and mild distal sensory loss.
10. ! - /atients with 1uillain-Barre? syndrome may suffer from progressive paralysis that includes the respiratory
muscles and may re<uires intubation and mechanical ventilation during the acute phase of their disease.
13. ! - &reatment of 1uillain-Barre? syndrome is supportive and includes intubation with mechanical ventilation(
nutritional supplementation( and rigorous attention to hygiene and skin care.
15. B - %ypotensive agents( steroids( and sedatives are utilized to prevent rupture of the aneurysm or to reduce
bleeding if a cerebrovascular accident has occurred. /atients are typically kept on bed rest with a <uiet room and no
stimulants.
16. ! - ) brain aneurysm is a dilation of a cerebral artery( which is caused secondary to weakness in the vessel wall.
&he vessel may rupture and cause a subarachnoid bleed.
#:. ) - $igns of a brain aneurysm may include a headache( nuchal rigidity( and a stiff back and legs( progressing to
altered consciousness and coma in severe cases.
#1. ! - uring a seizure( the patient should be positioned on his side to prevent aspiration if he vomits. /adding the side
rails prevents in.ury during generalized tonic-clonic seizures.
##. B - Because phenytoin 8ilantin9 may cause hypertrophy of the gums( meticulous oral hygiene is re<uired to reduce
inflammation and prevent infection of the gums. /henytoin doesn?t cause an increase in bacterial growth or pla<ue
formation( nor does it cause bleeding of the gums.
#'. ! - )n aura fre<uently precedes an epileptic seizure and may manifest as vague psychic discomfort or specific
aromas. /atients experiencing auras aren?t having a !A) experiencing substance withdrawal( or hallucinating.
#,. ! - ) simple focal seizure begins in one part of the cerebral cortex and remains localized( resulting in specific
isolated behaviors and brief lapses of attention.
#-. B - &he most common causes of spinal cord in.ury in teenagers and young adults are motor vehicle accidents( falls(
and diving accidents. )rthritis conditions may occasionally cause spinal cord in.ury secondary to narrowing of the
spinal canal in the elderly population.
#0. ! - "n the early stages of spinal cord in.ury( patients experience a relative hypovolemi( with inflammation contributing
to secondary in.ury to the damaged spinal cord region. /atients are treated with ".A. fluids and corticosteroids.
46
#3. B - *earning to use mechanical aids is an early problem for a paraplegic. ;ost paraplegics are young adults and are
accustomed to leading active( independent lives.
#5. B - $pinal shock occurs in patients with complete transaction of the spinal cord. "mpairment of the vasomotor
mechanism 8nerves having muscular control of the blood vessels walls9 causes a drop in blood pressure and an
increased heart rate.
#6. ) - >ollowing a complete spinal cord transaction( all voluntary motor activity and sensation below the level of in.ury
is lost. Aariable loss of voluntary motor activity and sensation occurs following partial transaction of the spinal cord.
':. - &he patient is complaining of symptoms of autonomic dysreflexia( which consists of the triad of hypertension(
bradycardia( and a headache. ;a.or causes of autonomic dysreflexia include urinary bladder distention and fecal
impaction.
'1. ) -&he short span of ' days after a spinal cord in.ury is too early to determine a male patient?s ability to have sexual
intercourse.
'#. - /araplegic patients can?t put pressure I which is necessary for calcium absorption I on their long bones. &his
causes the skeletal system to lose calcium( a situation that causes an increase in serum calcium levels and can cause
renal calculi.
''. B - +ehabilitation should begin as soon as the patient is stabilized after a spinal cord in.ury. "t can?t be left up to the
patient( particularly because he may be depressed and uninterested in rehabilitation early recovery.
',. - !ataracts are caused by clouding or opacity of the lens that leads to eventual loss of sight. ;ost patients have
painless progressive vision loss( sometimes with increased glare from bright lights. !ataracts may occur in one eye or
both eyes.
'-. B - &ypically( a patient with cataracts experiences a painless( gradual loss of vision. )lthough both eyes may
develop cataracts( the cataracts usually develop at different rates.
'0. - $urgical removal of cataracts is performed when vision loss interferes with the patient?s functional status.
*ubricants and miotic eyedrops don?t improve cataracts. !ataracts occur in many older adults but aren?t part of normal
aging.
'3. - $urgery can restore about 6-= of vision loss by removing the cataract. &he procedure is generally performed
under local anesthesia in an ambulatory surgical center( with patients returning hoe # to ' hours postoperatively.
'5. - /atients must be careful to not increase intraocular pressure by bending( straining( lifting( or coughing. Bed rest
isn?t necessary. )lcohol and nicotine don?t directly affect recovery.
'6. B - "ntraocular infection and uveitis I together with vitreous prolapse and hyphema I are ma.or complications of
cataract surgery.
,:. B - ue to presbycusis 8sensorineural hearing loss9( the ability to hear high-fre<uency sounds is lost first.
,1. - ;eniere?s disease is a labyrinthine dysfunction. ;anifestations include severe vertigo( tinnitus( and
sensorineural hearing loss.
,#. - uring severe attack?s of ;eniere?s disease( patients should rest in a position that minimizes their vertigo.
/atients also should re<uest assistance with activities to prevent in.ury from falls.
,'. ) - Bladder capacity decreases to #:: ml or less in postmenopausal women( causing urinary fre<uency.
,,. ! - /elvic floor exercises 8Gegel exercises9 are the first appropriate intervention for stress incontinence. &hese
exercises are used to strengthen perianal and sphincter muscle control.
,-. - Because of the fre<uent need to urinate( the patient may limit social activities and suffer from isolation and
lowered self-image.
,0. B - )lzheimer?s disease is the most common cause of dementia in the elderly population. )"$( brain tumors and
vascular disease are all less common causes of progressive loss of mental function in elderly patients
,3. B - uring the middle stage of dementia( patients re<uire constant supervision to ensure safety and are easily
distracted during activities. ifficulties with concentration and learning are common in early dementia.
,5. B - !are of the patient with )lzheimer?s disease is symptomatic and supportive including patient and family
counseling and education. &reatment with lecithin and physostigmine hasn?t proven useful( and the use of physical
restraints is ethically unacceptable.
,6. B - ;eals provides in a <uite environment with minimal distractions are most helpful. @ffering too many food
choices( providing excessive stimulation at mealtimes( and strictly enforcing mealtimes can lead to anger and lack of
cooperation in this patient population.
-:. B - >amilies of patients with )lzheimer?s disease should be encouraged to plan ahead for progressive patient
decline in functioning. &his includes financial planning and nursing home or hospice applications.
47
ANSWER AND RATIONALE: MCN
1. C I "ndividual twins usually grow at the same rate as singletons until ': to '# weeks? gestation( then twins don?t
gain weight as rapidly as singletons of the same gestational age.
#. A I &he type of placenta that develops in monozygotic twins depends on the time at which cleavage of the ovum
occurs. !leavage in con.oined twins occurs more than 1' days after fertilization.
'. C I &he recipient twin in twin-twin transfusion syndrome is transfused by the other twin. &he recipient twin then
becomes polycythemic and often has heart failure due to circulatory overload.
,. B I ) marginal placenta previa is characterized by implantation of the placenta in the margin of the cervical os(
not covering the os.
-. C I >etal surveillance through ultrasound examination ever y# to ' weeks is indicated to evaluate fetal growth(
amnionic fluid( and placental location in clients with placenta previa being expectantly managed.
0. D I @nce the mother and fetus are stabilized ultrasound evaluation of the placenta should be done to determine
the cause of the bleeding.
3. D I /lacenta accrete is the abnormal attachment of the placenta to the myometrium of the uterus. When the
placenta invades the myometrium( it?s called placenta increta.
5. D I 4ltrasound is the techni<ue of choice in diagnosing a hydatidiform mole. &he chorionic villi of a molar
pregnancy resemble a snowstorm pattern on ultrasound.
6. D I ) previous molar gestation increases a woman?s risk for developing a subse<uent molar gestation by , to -
times.
1:. B I ;ost ectopic pregnancies don?t appear as obvious life-threatening medical emergencies. 2ctopic pregnancies
must be considered in any sexually active woman of childbearing age who complains of menstrual irregularity(
cramping abdominal pain and mild vaginal bleeding.
11. A I ) client with severe abruption placentae will often have severe abdominal pain. &he uterus will have increased
tone with little to no return to resting tone between contractions.
1#. B I &he corpus luteum produces progesterone and estrogen for the first 5 to 1: weeks pf pregnancy until the
placenta takes over this function.
1'. A I ) pregnant client breathes deeper( which increases the tidal volume of gas moved in and out of the respiratory
tract with each breath.
1,. D I &he dilated arterioles that occur during pregnancy are due to the elevated level of circulating estrogen.
1-. C I izygotic twinning is influenced by race 8most fre<uent in Black women and least fre<uent in )sian women9(
age 8increased risk with increased maternal age9( parity 8increased risk with increased parity9( and fertility drugs
8increased risk with the use of fertility drugs( especially ovulation-inducing drugs9.
10. C I %emoglobin and hematocrit values decrease during pregnancy as the increase in plasma volume exceeds
the increase in red blood cell production.
13. B I 2xcessive vomiting in clients with hyperemesis gravidarum often causes weight loss and fluid( electrolyte( and
acid-base imbalances.
15. A I &rophoblastic disease is associated with hyperremesis gravidarum.
16. A I !lients with gestational diabetes are usually managed by diet alone to control their glucose intolerance.
#:. D I &he anticonvulsant mechanism of magnesium is believed to depress seizure foci in the brain and peripheral
neuromuscular blockade.
#1. D I ) !$& measures the fetal response to uterine contractions. ) client must have three contractions in a 1:
minute period. ) negative !$& shows good fetal heart rate variability with no decelerations from the uterine
contractions.
##. C I ) sickle cell crisis during pregnancy is usually managed by exchange transfusion( oxygen( and ".A. fluids.
#'. D I $ystolic murmurs are heard in up to 6:= of pregnant clients( and the murmur disappears soon after the
delivery.
#,. A I ) complete hydatidiform mole results from the fertilization of an egg in which the nucleus is lost or inactivated.
&his causes the nucleus of the sperm 8#'79 to duplicate itself 8,0779.
#-. A I &he therapeutic level of magnesium for clients with pregnancy-induced hypertension is , to 3 m2<C*.
#0. B I ecreased urine output may occur in clients receiving ".A. magnesium and should be monitored closely to
keep urine output at greater than ': mlChour( because magnesium is excreted through the kidneys and can easily
accumulate to toxic levels.
#3. A I !alcium gluconate is the antidote for magnesium toxicity. &en milliliters of 1:= calcium gluconate is given ".A.
push over ' to - minutes.
#5. B I ) positive // result would be an indurated wheal over 1: mm in diameter that appears in ,5 to 3# hours.
&he area must be a raised wheal( not a flat circumcised area to be considered positive.
#6. C I &he symptoms indicate acute pyelonephritis( a serious condition in a pregnant client.
':. C I !lients with premature rupture of membranes are permitted a trial of labor after a previous cesarean delivery.
48
'1. B I +h isoimmunization occurs when +h positive fetal blood cells cross into the maternal circulation and stimulate
maternal antibody production.
'#. D I )n +h negative unsensitized woman should be given ':: mcg of +ho1); at #5 weeks? after an indirect.
''. C I )n empty bladder and ade<uate hydration may help decrease or stop labor contractions.
',. B I Gravida refers to the number of times a client has been pregnantM para refers to the number of viable children
born. &herefore( the client who is gravida 4 para 2 has been pregnant four times and had two live-born children.
'-. D I ) woman with a history of diabetes has an increased risk for perinatal complications( including hypertension(
preeclampsia( and neonatal hypoglycemia.
'0. C I &ocolytics are used to stop labor contractions. &he most common adverse effect associated with the use of
these drugs is pulmonary edema.
'3. C I @xytocin is the hormone responsible for stimulating uterine contractions.
'5. D I @nly nutrients and waste products are transferred across the placenta. Blood exchange never occurs.
!omplications and some medical procedures can cause an exchange to occur accidentally.
'6. C I &he weight of the pregnant uterus is sufficiently heavy to compress the vena cava( which could impair blood
flow to the uterus( possibly decreasing oxygen to the fetus.
,:. D I %aving the client lie down once during the day will allow her to concentrate on detecting fetal movement(
which can be reassuring. )dditionally( when the mother is up and actively walking around( it tends to be soothing
to the fetus( resulting in sleep promotion.
,1. C I $itting down and putting up her feet at least once daily will promote venous return and therefore decrease
edema.
,#. A I 2ating small fre<uent meals will place less pressure on the esophageal sphincter( reducing the likelihood of
the regurgitation of stomach contents into the lower esophagus.
,'. C I &he incidence of preeclampsia in obese clients is about seven times more than that in pregnant nonobese
clients.
,,. B I )n B$& is based on the theory that a healthy fetus will have transient fetal heart rate accelerations with fetal
movement.
,-. B I +ecommended fasting blood sugar levels in pregnant clients with diabetes are 0: to 6: mgCdl.
,0. B I @f the techni<ues listed( the B$& is the preferred antepartum heart rate screening test for pregnant clients
with diabetes. B$&s should be done at least twice weekly( starting at '# weeks? gestation( as fetal deaths in clients
with diabetes have been noted within 1 week of a reactive B$&.
,3. B I +egular uterine contractions 8every 1: minutes or more9 along with cervical dilation change before '0 weeks
is considered preterm labor.
,5. C I "ron-deficiency anemia accounts for approximately 6-= of anemia in pregnancy.
,6. C I iagnosis of the specific type of thalassemia is achieved by hemoglobin electrophoresis. &his test detects
high levels of hemoglobin )# or >.
-:. B I )dolescent clients are at risk for delivering low-birth-weight neonates not macrosomic neonates.
49