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MERGE LIVE ONLINE REVIEWDIAGNOSTIC EXAMINATION PART 1Situation - The coronavirus disease 2019 (COVID-19) pandemic may be stressful for people. Fear and anxiety about a new disease and what could happen can be overwhelming and cause strong emotions in adults and children. -CDC Stress during an infect...

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MERGE LIVE ONLINE REVIEW DIAGNOSTIC EXAMINATION PART 1 Situation - The coronavirus disease 2019 (COVID-19) pandemic may be stressful for people. Fear and anxiety about a new disease and what could happen can be overwhelming and cause strong emotions in adults and children. -CDC

1.

Stress during an infectious disease outbreak can sometimes cause the following: 1 Fear and worry about your own health and the health of your loved ones, your financial situation or job, or loss of support services you rely on. 2 3 4 5 6

A. B. C. D.

2.

Changes in sleep or eating patterns. Difficulty sleeping or concentrating. Improving of chronic health problems. Worsening of mental health conditions. Decreased use of tobacco, and/or alcohol and other substances.

123456 235 456 1235

People who may respond more strongly to the stress of a crisis include: A.

People who are at higher risk for severe illness from COVID-19 (for

example, older people, and people of any age with certain underlying medical conditions). B. Frontline workers such as health care providers and first responders, C. People who are socially isolated from others, including people who

live

alone, and people in rural or frontier areas.

D. People who have lost their jobs, had their work hours reduced, or had other major changes to their employment. E. All of them

3.

4.

5.

6

Mr. Duque has just been informed that he has to be included in the mass separation program of his company. He developed anxiety and now feeling stressed. The MOST physical evidence to Nurse Bona indicative of Mr. Duque feeling stressed is A.

Decreased heart rate

B.

Hyperventilation

C.

Constricted pupil

D.

Dilated peripheral blood vessels

One resident in Barangay Ususan, Jayson is having muscle tension, complaining of “Ayuda” problems and becoming apprehensive. Nurse Bona asks the client if something upsetting happened and Jayson shows agitated movement with a shaky voice. Nurse Bona assesses Jayson’s level of anxiety as a.

Mild

b.

Panic

c.

Severe

d.

Moderate.

Another old resident in same Barangay complained of fever, cough, diarrhea, excessively and unduly worried about having serious illness. This condition is known as A. B.

Conversion disorder Somatic Disorder

C. D.

Body dismorphic disorder Hypochondriasis

Which of the following question is NOT related to contact tracing for COVID-19?

A B C D

7

8

Do you have close contact with someone who has been diagnosed with COVID-19, within the past 14 days? YES OR NO Are you experiencing fever, dry cough, difficulty of breathing, chest pain or shortness of breath? YES OR NO Have you travelled, or had close contact with a person who has recently travelled internationally within the past 14 days? YES OR NO Are you sexually active for the past 14 days? YES OR NO

Infection with the virus causing COVID-19 is confirmed by the presence of viral RNA detected by molecular testing, usually

A

RAT

B

RBC-HG-HC

C

CD4

D

RT-PCR

The causative agent of COVID-19 is:

A

Corona Virus

B

SARS-CoV-20

C

SARS-CoV-2

D

SARS-CoV-19

9

10

Hydroxychloroquine, sold under the brand name Plaquenil is an experimental drug for COVID19. Which of the following are the adverse effects?

A

it can treat malaria

B

it can reduce inflammation

C

it can modify the disease process

D

it can damage the retina and can cause blood clots

The Second-Tier precaution for COVID-19 is droplet. During direct contact with splashes to occur, universal precaution must be utilized. In chronological order, arranged the DOFFING of the PPE? A. B. C. D.

Mask, goggles, gown, gloves, handwashing Handwashing, gloves, gown, goggles, mask Handwashing, mask, goggles, gown, gloves Gloves, gown, goggles, mask, handwashing

Situation - Public health actions, such as social distancing, can make people feel isolated and lonely and can increase stress and anxiety. However, these actions are necessary to reduce the spread of COVID-19. Coping with stress in a healthy way will make you, the people you care about, and your community stronger – CDC

11. Harrya, your neighbor is transported by an ambulance to NCMH. She is alone in her home, becomes depressed and attempts to commit suicide. What are the signs of suicide?

A. Excessive worry and prolonged hand washing B. Having multiple personality C. Statements of despair, hopelessness and nothing to live for. D. Hyperactive and elated E. Hallucination, delusion, disorganized speech and bizarre behavior

12. You prepare a care plan for Harrya. Which of the following nursing care objectives is given HIGHEST PRIORITY?

a.

Use measures to protect Harrya from harming herself

b.

Provide for contact between Harrya and her family

c.

Reassure Harrya of her worthiness in a gentle manner

d.

Ask a relative to watch the whereabouts of Harrya

13. The priority nursing diagnosis for Harrya is: A. B. C. D.

Risk for violence: Directed unto others Potential for self-directed violence Self-esteem disturbance Ineffective individual coping

14. What would be your FIRST nursing action to No. 13?

A. Render close patient supervision by sustaining observation or awareness of the patient at all times. B.

Remove all potentially harmful objects from the environment

C. Present opportunities for the patient to express thoughts, and feelings in a nonjudgmental environment. D. Create a verbal or written contract stating that the patient will not act on impulse to do self-harm. E.

Stay with the patient more often.

15. Harrya says, "No one cares about me. I'm not worth anything." Which response would be the most helpful? a. "Things will look brighter soon. Everyone feels down once in a while." b. "Our staff members care about you and want to try to help you get better." c. "It is difficult for others to care about you when you repeatedly say the same negative things." d. "I'll sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you."

SITUATION - Several Clients for TB-DOTS program are listening to Nurse Ruel’s discussion.

16.

Which of the following responses by Nurse Ruel is considered incorrect when it comes to Sputum Collection? A. B. C. D.

Around 8 ml of sputum is sufficient for the test. Drinking water right before the test will help those with tenacious sputum. Eating is prohibited before expectorating the sputum for specimen collection None.

17. Strains of MDR-TB are most resistant to which drugs? A. B. C. D.

Rifampicin Isoniazid Pyrazinamide Both A and B

18. The following notions about Tuberculosis are true except all but one: Isolation is necessary for the first 18 days of continuous therapy B. TB patients are not contagious as long as they wear masks. C. Use of all TB drugs is imperative throughout the course of treatment D. Sputum microscopy is crucial to determine communicability. A.

19. Foundation of TB prevention can be attained through: A. B. C. D.

Proper documentation of ongoing and treated DOTS cases. Monitoring of cases in terms of frequency and occurrence. Organized referral systems for confirmed cases. Collaboration among health care personnel to ensure resolution of confirmed cases.

20. Which of the following people exposed to TB would be at highest risk for contracting the disease? A. B. C. D.

A person undergoing routine dialysis. A person taking Amiodarone A client taking Adriamycin A client who recently underwent CT Scan.

SITUATION – You are assigned to care for patients with HIV. 21.

Which of the following concepts about HIV is true?

A. B. C. D. 22.

Which of the following drugs for HIV is considered as NNRTI? A. B. C. D.

23.

HIV is defined by the presence of opportunistic infections in clients. HIV is curable as long as proper compliance with medications is observed. HIV can be transmitted via any bodily secretions None of the above

Lamivudine Eltegravir Saquinavir None

A nurse is conducting a health teaching regarding STD prevention. Which of the following is the most important concept that should be up for discussion? A.

Consider that all abstinence should be enforced to ensure nontransmission B. Reinforce condom use for people with multiple sex partners. C. Reinforce the fact that strict compliance to medications will prevent drug resistance of STD strains. D. All of the above E. B and C only

24.

A client with HIV is suffering from a decreased appetite. Among the following interventions, which would be the most ideal to stimulate more food intake?

A. B. C. D. 25.

Serve meals which are nutritious and fresh. Small frequent feedings. Avoid serving foods which the client dislikes. All of the above

Which of the following changes in the client’s physiology would guarantee discontinuation or adjustment in the dosage of the client’s medication? A. B. C. D.

Urticaria Peripheral neuritis Arthralgia Icteric Sclera

SITUATION - Inflammation refers to your body's process of fighting against things that harm it, such as infections, injuries, and toxins, in an attempt to heal itself. When something damages your cells, your body releases chemicals that trigger a response from your immune system.

26.

Which of the following clinical manifestations would the Nurse QL expect to find in the client with rhinitis? a.

Nasal congestion, headache and sore throat

b.

Nasal congestion, rhinorrhea and sneezing

c.

Headache, sore throat and sneezing

d.

Nasal congestion, pyrexic and rhinorrhea

Definition: inflammation of the mucous membrane of the nose marked especially by rhinorrhea, nasal congestion and itching, and sneezing

27.

A nurse is planning care for a patient who takes fexofenadine (Allegra) for allergic rhinitis. Which outcome should the nurse anticipate? A. No complaints of dry mouth B. Relief of sneezing and itching

C. D. 28.

A nurse is teaching a patient who is to start taking an expectorant. The nurse provides the patient with which of these instructions?

A. B. C. D.

29.

Use limited to allergy season Absence of rebound congestion

"Restrict cold fluids to promote reduced mucus production." "Take the medication once a day only, usually at bedtime." "Increase your fluid intake to reduce the viscosity of secretions." "Increase your fiber and fluid intake to prevent constipation."

Which statement by a patient indicates understanding of a nurse's teaching about fluticasone nasal spray (Flonase)? A.

"I'll gradually stop taking this so I don't have any problems with withdrawal." B. "This drug will help prevent the inflammation and irritation from my allergies." C. "I'll have to be more careful about not falling, because my bones may break more easily." D. "I realize that I only need to take this when my symptoms are really bad." 30.

A nurse should monitor more frequently the blood pressure of a patient with a history of hypertension who takes which medication for allergic rhinitis? A. B. C. D.

Pseudoephedrine (Sudafed) Montelukast (Singulair) Mometasone (Nasonex spray) Oxymetazoline (Afrin spray)

SITUATION – You are working in the ED. Patients are wheeled for admission.

31.

32.

Nurse Lacharity is triaging the patients. Which one is the PRIORITY? a.

Ecchymosis in the flank area

b.

A deviated trachea

c.

Unequal pupils

d.

Irregular apical pulse

A client with heart attack is brought to the ER. He is unresponsive not breathing and no palpable pulse. Which of the following emergency measures will Nurse Lacharity anticipates to do?

33.

34.

a.

Starting bag valve mask ventilation.

b.

Aiding with oral intubation

c.

Placing the defibrillator pads

d.

Performing chest compressions

Nurse Lacharity conducts primary assessment on a trauma patient. Which of the following is considered one of the priority elements? a.

Initiation of pulse oximetry

b.

Brief neurologic assessment

c.

Client’s allergy history

d.

Complete vital signs

Reverse triage is to a.

Save scarce resources for future use

b.

The first responders on the triage classification category

c.

Save those persons who are in the most critical condition.

d.

Do the greatest good for the greatest number with limited resources Reverse Triage- variant of the usual triage system where the

sorting is based on the lack of manpower and equipment to

properly address the standard prioritization of clients or in cases of emergency.

PRIORITY Ambulatory Bedridden/Immobile Critically ill- last to be rescued due to life support and connections that can hinder transport and evacuation

35.

The nurse is the first responder after a tornado has destroyed many homes in the community. Which victim should the nurse attend to first? A.

A pregnant woman who exclaims, "My baby is not moving."

B.

A child who is complaining, "My leg is bleeding so bad, I am afraid it is going to fall off!"

C.

A young child standing next to an adult family member who is screaming, "I want my mommy!"

D.

An older victim who is sitting next to her husband sobbing, "My husband is dead. My husband is dead."

SITUATION – You are caring for client with heart and respiratory diseases. 36.

Which of the following is the manifestation of MI?

a.

Crushing chest pain

b.

Severe, chest pain characterized as heaviness in the early morning

c.

Fever and murmur

d.

Dyspnea and crackles

37.

The physician orders laboratory tests on the patient. Which of the following finding would MOST concern Nurse QL? a.

Elevated CK and Troponin

b.

Serum glucose: 90mg/dL

c.

RBC 4 million mm3

d.

Hematocrit (HCT) : 42% D Hematocrit- measures degree of concentration of blood. Used to monitor degree of fluid/ blood loss Normal Values: Male-----42% to 52% Female--- 35% to 47% C RBC------- 4 to 6 million units/mm3 B. Blood Glucose-- 70 to 110mg/DL

38.

Nurse QL reviews the arterial blood gas results of the patient with COPD. The laboratory report indicates a pH of 7.30, PC02 of 56 mmHg, P02 of 82 mmHg, and a HC03 of 28mEq/L. which acid-base disturbance is the patient experiencing?

7.30 acidosis PCO2 is elevated a.

Metabolic alkalosis

b.

Metabolic acidosis

c.

Respiratory acidosis

d.

Respiratory alkalosis

Normal pH 7.35 to 7.45 PaCO2

35 to 45 mmHg

HCO3 22 to 26mEq/L PaO2 80 to 100mm/Hg 39.

A client has the following lab values: a pH of 7.55, an HCO3- of 22 , and a PCO2 of 30 mm Hg. What should Nurse QL do? 7.55, alkalosis PaCO2 is 30mmHg(LOW) A. Perform Allen's test B. Prepare the client for dialysis C. Administer insulin as ordered D. Encourage the client to slow down breathing

40.

A client is scheduled for blood to be drawn from the radial artery for an ABG determination. Nurse QL assists with performing Allen's test before drawing the blood to determine the adequacy of the: A. Ulnar circulation B. Carotid circulation C. Femoral circulation D. Brachial circulation

SITUATION - Emergency and Disaster 41.

Which of the following is NOT applicable in disaster priority? a.

“Hostage crisis in Luneta last June 23, 2010.”

b.

“My son has not come home from school”.

c.

“I cannot find my mobile phone”.

d.

“A plane is about to crash”.

42. Nurse BONA arrives at the scene as the first responder. Which is the first step?

43.

A.

Clear the walking wounded using verbal instructions. “If you can walk, move over there

B.

Give priority to dead bodies

C.

Tag patients.

D.

Stop at each victim and quickly assess their respiration.

Many clients were rescued from a bombing area and some has possible smoke inhalation What is the PRIORITY action of the ER nurse? A.

Check vital signs and auscultate lung sounds

B.

Readily transfer patients and visitors from the area

C.

Check carbon monoxide level

D.

Give O2

44. A patient is admitted to the emergency department after sustaining abdominal injuries and a broken femur from a motor vehicle accident. The patient is pale, diaphoretic, and is not talking coherently. Vital signs upon admission are temperature 98, heart rate 130 beats/minute, respiratory rate 34 breaths/minute, blood pressure 50/40. The healthcare provider suspects which type of shock? TACHYCARDIA/ TACHYPNEA, HYPOTENSION(HEMORRHAGE/SEVERE DEHYDRATION)

A.

Cardiogenic

associated with decreased Cardiac

output/congestion(CHF) Hypovolemic B. C. Neurogenic---BP decreased/ Bradypnea/ Both legs are paralyzed(SCI) D. Distributive 45. A patient who is in hypovolemic shock has the following clinical signs: Heart rate 120 beats/minute, blood pressure 80/55 and urine output 20ml/hr. After administering an IV fluid bolus, which of these signs if noted by the healthcare provider is the best indication of improved perfusion?-look for the cue that signifies improved blood flow to tissues A. B.

C.

Right atrial pressure increases Systolic blood pressure increases to 85

Urine output increases to 30ml/hr-- improved blood flow to the kidneys means higher Glomerular Filtration Rate(amount of blood that passes through the kidneys on a per minute basis)--normal is 125ml/hr---

**higher GFR correlates with a higher Urine Output D.

Heart rate drops to 100 beats/minute

SITUATION – You are caring for clients with Cellular Aberration

46. A 32-year-old patient who is employed as a hairdresser and has a 15 pack-year history of cigarette smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient about the increased risk for a.

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