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Saturday, September 02, 2006

PRC: No retake of nursing exams

PRC: No retake of nursing exams

Adjusted grades add 499 to list of passers

By Michael Lim Ubac, Christine Avendaño
Last updated 01:03am (Mla time) 08/31/2006

Published on Page A1 of the August 31, 2006 issue of the Philippine Daily Inquirer

THE PROFESSIONAL Regulation Commission has come up with a formula that it believes will put to rest the cheating controversy surrounding the June nursing board exams -- maintaining that “passers” will not retake the exams, and nullifying 90 of the 100 questions under Test V.

The formula would even increase the number of passers by 499, PRC Chair Leonor Tripon Rosero yesterday told the House committees on civil service and good government.

Rosero said the formula was a “fair and impartial way” of putting closure to the controversy.

“Oh yes, it’s fair to all. So we released the (recomputed) results of the board exam. That’s already fair to everyone even to those who failed,” Rosero told reporters shortly after the hearing.

In another controversial move, the PRC gave a 2-percent bonus to those who got 73 percent, raising their scores to 75 percent. The bonus is aimed at providing those who might be hurt by the downgrading of Test V (psychiatric nursing) with a “cushion.”

To pass the nursing board exams, examinees should correctly answer at least 75 percent of 500 test questions equally distributed among five subject matters.

Test V was one of the two tests whose questions were leaked by two review centers to their students days before the nursing board exams were administered on June 11-12. The other was Test III (medical-surgical nursing).

The leakage led the Court of Appeals to order the PRC to put on hold the oath-taking of those who passed the tainted exams. Hundreds were able to take their oath before the CA issued the restraining order to the PRC. But a group of nurses and students wants the court to nullify the oath-taking.

Because of the controversy, a number of hospitals are reluctant to hire the June passers.


The new PRC formula did not mollify those calling for a retake of the nursing board exams to restore public confidence in new nursing graduates.

Dante Ang, who heads an inter-agency task force looking into the leakage, said the recomputation violated Republic Act No. 9173, or the Nursing Act of 2002.

He said even Test III was recomputed.

“The law says that your passing average should be 75 percent, provided you don’t get a grade below 60 percent in any subject. When the Board of Nursing recomputed Test III corresponding to the questions from one percent to 1.25 percent, the effect of that would be to get the 60 percent minimum passing average for Test III,” Ang said at the hearing.

Thus, examinees only have to answer 48 correct questions.

“By revising, or by recomputing Test III, and by assigning 1.25 percent to every questions left, in effect, you’re passing average was reduced from 60 to 48 questions. This is not acceptable if you follow the original intention and the spirit of the law ... and therefore putting in doubt the competence of the examinees,” he said.

Here’s how the PRC formula works:

The PRC nullifies 90 of the 100 questions under Test V and incorporates the scores of examinees in the remaining 10 questions into the final score, which is computed by combining the average of Tests I-IV and Tests I-V.

The result: The number of passers went up from 17,322 to 17,821, or from 41.24 to 42.42 percent passing rate. A total of 42,006 nursing graduates took the exams on June 11 to 12 in 11 test centers across the country.

Bar exams precedent

PRC Commissioner Avelina de la Rea explained to the joint committee that reducing the weight of Test V “actually resulted in 78 percent of questions being graded.”

De la Rea said the PRC move was not without precedent.

In 2002, she said the Supreme Court invalidated one subject, commercial law, in the bar exams because of a leakage, and distributed the weight to the other seven subjects.

“So, one of the eight subjects was removed. What we did is not an unusual response from testing institutions that cannot find all the actual beneficiaries of the leakage. We can find some of the beneficiaries but not all,” De la Rea said.

Some of the examinees might have been “hurt” because Test V was downgraded, but it “would only be true for those who have only high grades in Test V,” she said.

De la Rea said those who passed Tests I-IV, even with a low grade, would not really be disadvantaged.

Advantage of leakage removed

She said the PRC did the recomputation “blindly” because the names in the examination papers had not been determined until after all the subjects had been corrected and graded.

“We don’t know who they are. But we know that people like the witness this morning (George Cordero, owner of a review center), (since) the advantage of the leakage was removed, did not pass,” she said.

The chair of the civil service committee, Pampanga Rep. Francis Nepomuceno, said the joint committee could not yet comment on the PRC decision because it was still on its preliminary hearing.

Nepomuceno said the Court of Appeals could eventually settle the controversy. “We want to finish this investigation as soon as possible but there’s a pending injunction from the court,” he said.

Malacañang favors the retake of the nursing board exams but only for those passers found to have benefited from the leakage.

Executive Secretary Eduardo Ermita said it was the position of President Gloria Macapagal-Arroyo that those who passed should not retake (the exams), except those who took advantage of the leakage.

NBI probe

Ermita said the National Bureau of Investigation (NBI) was set to submit to him today the results of its investigation, which included those to be criminally charged and the identification of the testing places where the leakage happened.

Asked who will make the final decision to give a retake of the exams, the executive secretary said the Palace “will give it to the PRC.”

Responding to the challenge of Cavite Rep. Jesus Crispin Remulla for the PRC board to resign en masse, Rosero said: “We will wait until the investigation is finished. Until found guilty and unqualified, we won’t resign.”

Remulla said resignation was the best option to give way to an “impartial and fair investigation” by the NBI and Congress which are separately conducting a probe.

“No one is invincible. This will haunt them forever,” he said.


In Baguio City, the examinees, who exposed the cheating, said many of them were on the brink of giving up the fight after the PRC rejected the proposal for the examinees to retake the exams.

On Aug. 24, the whistle-blowers and the nursing school deans sympathetic to their cause issued a manifesto saying they were supporting a reexamination.

“Painful as it may be, retaking the spoiled portions [of the examinations, Tests III and V] is the less unjust course to adopt. This gives the examinees the opportunity to shake off the stigma caused by the leakage, assures them that employers will not turn them away because of the conviction that they are incompetent, and regains the integrity of the nursing profession,” the manifesto read.


But Lilian Yangot, one of the complainants, said they were frustrated about the way things were going.

Yangot was the complainant who first obtained a copy of the 18-page test leakage that was circulated by clients of a review center during the examinations in Baguio.

She said the group decided to stay away from the retake debate because they all felt that taking another examination would be tiresome.

“Mahirap mag-retake (It’s hard to take a new examination). Had they told us we could retake the test earlier, we would have bitten the bullet,” she said.

“But if they ask us to do so today, we would beg off for a December test instead so we can prepare all over again. Now that PRC is again saying no to a retake, we will just go with the flow unless the government shows that it means to convict the people who leaked the test.”

The complainants had asked the PRC to hold the test results and to suspend members of the Board of Nursing. The PRC did not heed their request.

“We want to move on, but by releasing the test results, the PRC managed to shift the debate from the culprits who should be convicted to a debate between people who passed and failed,” said Yangot.

“This is unfair because we are all victims,” she added. With a report from Vincent Cabreza, Inquirer Northern Luzon

100 Item Exam On Fundamentals Of Nursing : Nursing Process, Physical and Health Assessment and Routine Procedures

100 Item Exam On Fundamentals Of Nursing : Nursing Process, Physical and Health Assessment and Routine Procedures


By : Budek

Content Outline

1. The nursing process
2. Physical Assessment
3. Health Assessment
3.a Temperature
3.b Pulse
3.c Respiration
3.d Blood pressure
4. Routine Procedures
4.a Urinalysis specimen collection
4.b Sputum specimen collection
4.c Urine examination
4.d Positioning pre-procedure
4.e Stool specimen collection

1. She is the first one to coin the term “NURSING PROCESS” She introduced 3 steps of nursing process which are Observation, Ministration and Validation.

A. Nightingale
B. Johnson
C. Rogers
D. Hall

2. The American Nurses association formulated an innovation of the Nursing process. Today, how many distinct steps are there in the nursing process?

A. APIE – 4
B. ADPIE – 5

3. They are the first one to suggest a 4 step nursing process which are : APIE , or assessment, planning, implementation and evaluation.

1. Yura
2. Walsh
3. Roy
4. Knowles

A. 1,2
B. 1,3
C. 3,4
D. 2,3

4. Which characteristic of nursing process is responsible for proper utilization of human resources, time and cost resources?

A. Organized and Systematic
B. Humanistic
C. Efficient
D. Effective

5. Which characteristic of nursing process addresses the INDIVIDUALIZED care a client must receive?

A. Organized and Systematic
B. Humanistic
C. Efficient
D. Effective

6. A characteristic of the nursing process that is essential to promote client satisfaction and progress. The care should also be relevant with the client’s needs.

A. Organized and Systematic
B. Humanistic
C. Efficient
D. Effective

7. Rhina, who has Menieres disease, said that her environment is moving. Which of the following is a valid assessment?

1. Rhina is giving an objective data
2. Rhina is giving a subjective data
3. The source of the data is primary
4. The source of the data is secondary

A. 1,3
B. 2,3
C. 2.4
D. 1,4

8. Nurse Angela, observe Joel who is very apprehensive over the impending operation. The client is experiencing dyspnea, diaphoresis and asks lots of questions. Angela made a diagnosis of ANXIETY R/T INTRUSIVE PROCEDURE. This is what type of Nursing Diagnosis?

A. Actual
B. Probable
C. Possible
D. Risk

9. Nurse Angela diagnosed Mrs. Delgado, who have undergone a BKA. Her diagnosis is SELF ESTEEM DISTURBANCE R/T CHANGE IN BODY IMAGE. Although the client has not yet seen her lost leg, Angela already anticipated the diagnosis. This is what type of Diagnosis?

A. Actual
B. Probable
C. Possible
D. Risk

10. Nurse Angela is about to make a diagnosis but very unsure because the S/S the client is experiencing is not specific with her diagnosis of POWERLESSNESS R/T DIFFICULTY ACCEPTING LOSS OF LOVED ONE. She then focus on gathering data to refute or prove her diagnosis but her plans and interventions are already ongoing for the diagnosis. Which type of Diagnosis is this?

A. Actual
B. Probable
C. Possible
D. Risk
11. Nurse Angela knew that Stephen Lee Mu Chin, has just undergone an operation with an incision near the diaphragm. She knew that this will contribute to some complications later on. She then should develop what type of Nursing diagnosis?

A. Actual
B. Probable
C. Possible
D. Risk

12. Which of the following Nursing diagnosis is INCORRECT?

A. Fluid volume deficit R/T Diarrhea
B. High risk for injury R/T Absence of side rails
C. Possible ineffective coping R/T Loss of loved one
D. Self esteem disturbance R/T Effects of surgical removal of the leg

13. Among the following statements, which should be given the HIGHEST priority?

A. Client is in extreme pain
B. Client’s blood pressure is 60/40
C. Client’s temperature is 40 deg. Centigrade
D. Client is cyanotic

14. Which of the following need is given a higher priority among others?

A. The client has attempted suicide and safety precaution is needed
B. The client has disturbance in his body image because of the recent operation
C. The client is depressed because her boyfriend left her all alone
D. The client is thirsty and dehydrated

15. Which of the following is TRUE with regards to Client Goals?

A. They are specific, measurable, attainable and time bounded
B. They are general and broadly stated
D. Example is : After discharge planning, Client demonstrated the proper psychomotor skills for insulin injection.

16. Which of the following is a NOT a correct statement of an Outcome criteria?

A. Ambulates 30 feet with a cane before discharge
B. Discusses fears and concerns regarding the surgical procedure
C. Demonstrates proper coughing and breathing technique after a teaching session
D. Reestablishes a normal pattern of elimination

17. Which of the following is a OBJECTIVE data?

A. Dizziness
B. Chest pain
C. Anxiety
D. Blue nails

18. A patient’s chart is what type of data source?

A. Primary
B. Secondary
C. Tertiary
D. Can be A and B

19. All of the following are characteristic of the Nursing process except

A. Dynamic
B. Cyclical
C. Universal
D. Intrapersonal

20. Which of the following is true about the NURSING CARE PLAN?

A. It is nursing centered
B. Rationales are supported by interventions
C. Verbal
D. Atleast 2 goals are needed for every nursing diagnosis

21. A framework for health assessment that evaluates the effects of stressors to the mind, body and environment in relation with the ability of the client to perform ADL.

A. Functional health framework
B. Head to toe framework
C. Body system framework
D. Cephalocaudal framework

22. Client has undergone Upper GI and Lower GI series. Which type of health assessment framework is used in this situation?

A. Functional health framework
B. Head to toe framework
C. Body system framework
D. Cephalocaudal framework

23. Which of the following statement is true regarding temperature?

A. Oral temperature is more accurate than rectal temperature
B. The bulb used in Rectal temperature reading is pear shaped or round
C. The older the person, the higher his BMR
D. When the client is swimming, BMR Decreases

24. A type of heat loss that occurs when the heat is dissipated by air current

A. Convection
B. Conduction
C. Radiation
D. Evaporation

25. Which of the following is TRUE about temperature?

A. The highest temperature usually occurs later in a day, around 8 P.M to 12 M.N
B. The lowest temperature is usually in the Afternoon, Around 12 P.M
C. Thyroxin decreases body temperature
D. Elderly people are risk for hyperthermia due to the absence of fats, Decreased thermoregulatory control and sedentary lifestyle.

26. Hyperpyrexia is a condition in which the temperature is greater than

A. 40 degree Celsius
B. 39 degree Celsius
C. 100 degree Fahrenheit
D. 105.8 degree Fahrenheit

27. Tympanic temperature is taken from John, A client who was brought recently into the ER due to frequent barking cough. The temperature reads 37.9 Degrees Celsius. As a nurse, you conclude that this temperature is

A. High
B. Low
C. At the low end of the normal range
D. At the high end of the normal range

28. John has a fever of 38.5 Deg. Celsius. It surges at around 40 Degrees and go back to 38.5 degrees 6 times today in a typical pattern. What kind of fever is John having?

A. Relapsing
B. Intermittent
C. Remittent
D. Constant

29. John has a fever of 39.5 degrees 2 days ago, But yesterday, he has a normal temperature of 36.5 degrees. Today, his temperature surges to 40 degrees. What type of fever is John having?

A. Relapsing
B. Intermittent
C. Remittent
D. Constant

30. John’s temperature 10 hours ago is a normal 36.5 degrees. 4 hours ago, He has a fever with a temperature of 38.9 Degrees. Right now, his temperature is back to normal. Which of the following best describe the fever john is having?

A. Relapsing
B. Intermittent
C. Remittent
D. Constant

31. The characteristic fever in Dengue Virus is characterized as:

A. Tricyclic
B. Bicyclic
C. Biphasic
D. Triphasic

32. When John has been given paracetamol, his fever was brought down dramatically from 40 degrees Celsius to 36.7 degrees in a matter of 10 minutes. The nurse would assess this event as:

A. The goal of reducing john’s fever has been met with full satisfaction of the outcome criteria
B. The desired goal has been partially met
C. The goal is not completely met
D. The goal has been met but not with the desired outcome criteria

33. What can you expect from Marianne, who is currently at the ONSET stage of fever?

A. Hot, flushed skin
B. Increase thirst
C. Convulsion
D. Pale,cold skin

34. Marianne is now at the Defervescence stage of the fever, which of the following is expected?

A. Delirium
B. Goose flesh
C. Cyanotic nail beds
D. Sweating

35. Considered as the most accessible and convenient method for temperature taking

A. Oral
B. Rectal
C. Tympanic
D. Axillary

36. Considered as Safest and most non invasive method of temperature taking

A. Oral
B. Rectal
C. Tympanic
D. Axillary

37. Which of the following is NOT a contraindication in taking ORAL temperature?

A. Quadriplegic
B. Presence of NGT
C. Dyspnea
D. Nausea and Vomitting

38. Which of the following is a contraindication in taking RECTAL temperature?

A. Unconscious
B. Neutropenic
D. Very young children

39. How long should the Rectal Thermometer be inserted to the clients anus?

A. 1 to 2 inches
B. .5 to 1.5 inches
C. 3 to 5 inches
D. 2 to 3 inches

40. In cleaning the thermometer after use, The direction of the cleaning to follow Medical Asepsis is :

A. From bulb to stem
B. From stem to bulb
C. From stem to stem
D. From bulb to bulb

41. How long should the thermometer stay in the Client’s Axilla?

A. 3 minutes
B. 4 minutes
C. 7 minutes
D. 10 minutes

42. Which of the following statement is TRUE about pulse?

A. Young person have higher pulse than older persons
B. Males have higher pulse rate than females after puberty
C. Digitalis has a positive chronotropic effect
D. In lying position, Pulse rate is higher

43. The following are correct actions when taking radial pulse except:

A. Put the palms downward
B. Use the thumb to palpate the artery
C. Use two or three fingers to palpate the pulse at the inner wrist
D. Assess the pulse rate, rhythm, volume and bilateral quality

44. The difference between the systolic and diastolic pressure is termed as

A. Apical rate
B. Cardiac rate
C. Pulse deficit
D. Pulse pressure

45. Which of the following completely describes PULSUS PARADOXICUS?

A. A greater-than-normal increase in systolic blood pressure with inspiration
B. A greater-than-normal decrease in systolic blood pressure with inspiration
C. Pulse is paradoxically low when client is in standing position and high when supine.
D. Pulse is paradoxically high when client is in standing position and low when supine.

46. Which of the following is TRUE about respiration?

A. I:E 2:1
B. I:E : 4:3
C I:E 1:1
D. I:E 1:2

47. Contains the pneumotaxic and the apneutic centers

A. Medulla oblongata
B. Pons
C. Carotid bodies
D. Aortic bodies

48. Which of the following is responsible for deep and prolonged inspiration

A. Medulla oblongata
B. Pons
C. Carotid bodies
D. Aortic bodies

49. Which of the following is responsible for the rhythm and quality of breathing?

A. Medulla oblongata
B. Pons
C. Carotid bodies
D. Aortic bodies

50. The primary respiratory center

A. Medulla oblongata
B. Pons
C. Carotid bodies
D. Aortic bodies

51. Which of the following is TRUE about the mechanism of action of the Aortic and Carotid bodies?

A. If the BP is elevated, the RR increases
B. If the BP is elevated, the RR decreases
C. Elevated BP leads to Metabolic alkalosis
D. Low BP leads to Metabolic acidosis

52. All of the following factors correctly influence respiration except one. Which of the following is incorrect?

A. Hydrocodone decreases RR
B. Stress increases RR
C. Increase temperature of the environment, Increase RR
D. Increase altitude, Increase RR

53. When does the heart receives blood from the coronary artery?

A. Systole
B. Diastole
C. When the valves opens
D. When the valves closes

54. Which of the following is more life threatening?

A. BP = 180/100
B. BP = 160/120
C. BP = 90/60
D. BP = 80/50

55. Refers to the pressure when the ventricles are at rest

A. Diastole
B. Systole
C. Preload
D. Pulse pressure

56. Which of the following is TRUE about the blood pressure determinants?

A. Hypervolemia lowers BP
B. Hypervolemia increases GFR
C. HCT of 70% might decrease or increase BP
D. Epinephrine decreases BP

57. Which of the following do not correctly correlates the increase BP of Ms. Aida, a 70 year old diabetic?

A. Females, after the age 65 tends to have lower BP than males
B. Disease process like Diabetes increase BP
C. BP is highest in the morning, and lowest during the night
D. Africans, have a greater risk of hypertension than Caucasian and Asians.

58. How many minutes are allowed to pass if the client had engaged in strenuous activities, smoked or ingested caffeine before taking his/her BP?

A. 5
B. 10
C. 15
D. 30

59. Too narrow cuff will cause what change in the Client’s BP?

A. True high reading
B. True low reading
C. False high reading
D. False low reading

60. Which is a preferable arm for BP taking?

A. An arm with the most contraptions
B. The left arm of the client with a CVA affecting the right brain
C. The right arm
D. The left arm

61. Which of the following is INCORRECT in assessing client’s BP?

A. Read the mercury at the upper meniscus, preferably at the eye level to prevent error of parallax
B. Inflate and deflate slowly, 2-3 mmHg at a time
C. The sound heard during taking BP is known as KOROTKOFF sound
D. If the BP is taken on the left leg using the popliteal artery pressure, a BP of 160/80 is normal.

62. Which of the following is the correct interpretation of the ERROR OF PARALLAX

A. If the eye level is higher than the level of the meniscus, it will cause a false high reading
B. If the eye level is higher than the level of the meniscus, it will cause a false low reading
C. If the eye level is lower than the level of the meniscus, it will cause a false low reading
D. If the eye level is equal to that of the level of the upper meniscus, the reading is accurate

63. How many minute/s is/are allowed to pass before making a re-reading after the first one?

A. 1
B. 5
C. 15
D. 30

64. Which of the following is TRUE about the auscultation of blood pressure?

A. Pulse + 4 is considered as FULL
B. The bell of the stethoscope is use in auscultating BP
C. Sound produced by BP is considered as HIGH frequency sound
D. Pulse +1 is considered as NORMAL

65. In assessing the abdomen, Which of the following is the correct sequence of the physical assessment?

A. Inspection, Auscultation, Percussion, Palpation
B. Palpation, Auscultation, Percussion, Inspection
C. Inspection, Palpation, Auscultation, Percussion
D. Inspection, Auscultation, Palpation, Percussion

66. The sequence in examining the quadrants of the abdomen is:


67. In inspecting the abdomen, which of the following is NOT DONE?

A. Ask the client to void first
B. Knees and legs are straighten to relax the abdomen
C. The best position in assessing the abdomen is Dorsal recumbent
D. The knees and legs are externally rotated

68. Dr. Fabian De Las Santas, is about to conduct an ophthalmoscope examination. Which of the following, if done by a nurse, is a Correct preparation before the procedure?

A. Provide the necessary draping to ensure privacy
B. Open the windows, curtains and light to allow better illumination
C. Pour warm water over the ophthalmoscope to ensure comfort
D. Darken the room to provide better illumination

69. If the client is female, and the doctor is a male and the patient is about to undergo a vaginal and cervical examination, why is it necessary to have a female nurse in attendance?

A. To ensure that the doctor performs the procedure safely
B. To assist the doctor
C. To assess the client’s response to examination
D. To ensure that the procedure is done in an ethical manner

70. In palpating the client’s breast, Which of the following position is necessary for the patient to assume before the start of the procedure?

A. Supine
B. Dorsal recumbent
C. Sitting
D. Lithotomy

71. When is the best time to collect urine specimen for routine urinalysis and C/S?

A. Early morning
B. Later afternoon
C. Midnight
D. Before breakfast

72. Which of the following is among an ideal way of collecting a urine specimen for culture and sensitivity?

A. Use a clean container
B. Discard the first flow of urine to ensure that the urine is not contaminated
C. Collect around 30-50 ml of urine
D. Add preservatives, refrigerate the specimen or add ice according to the agency’s protocol

73. In a 24 hour urine specimen started Friday, 9:00 A.M, which of the following if done by a Nurse indicate a NEED for further procedural debriefing?

A. The nurse ask the client to urinate at 9:00 A.M, Friday and she included the urine in the 24 hour urine specimen
B. The nurse discards the Friday 9:00 A M urine of the client
C. The nurse included the Saturday 9:00 A.M urine of the client to the specimen collection
D. The nurse added preservatives as per protocol and refrigerates the specimen

74. This specimen is required to assess glucose levels and for the presence of albumin the the urine

A. Midstream clean catch urine
B. 24 hours urine collection
C. Postprandial urine collection
D. Second voided urine

75. When should the client test his blood sugar levels for greater accuracy?

A. During meals
B. In between meals
C. Before meals
D. 2 Hours after meals

76. In collecting a urine from a catheterized patient, Which of the following statement indicates an accurate performance of the procedure?

A. Clamp above the port for 30 to 60 minutes before drawing the urine from the port
B. Clamp below the port for 30 to 60 minutes before drawing the urine from the port
C. Clamp above the port for 5 to 10 minutes before drawing the urine from the port
D. Clamp below the port for 5 to 10 minutes before drawing the urine from the port

77. A community health nurse should be resourceful and meet the needs of the client. A villager ask him, Can you test my urine for glucose? Which of the following technique allows the nurse to test a client’s urine for glucose without the need for intricate instruments.

A. Acetic Acid test
B. Nitrazine paper test
C. Benedict’s test
D. Litmus paper test

78. A community health nurse is assessing client’s urine using the Acetic Acid solution. Which of the following, if done by a nurse, indicates lack of correct knowledge with the procedure?

A. The nurse added the Urine as the 2/3 part of the solution
B. The nurse heats the test tube after adding 1/3 part acetic acid
C. The nurse heats the test tube after adding 2/3 part of Urine
D. The nurse determines abnormal result if she noticed that the test tube becomes cloudy

79. Which of the following is incorrect with regards to proper urine testing using Benedict’s Solution?

A. Heat around 5ml of Benedict’s solution together with the urine in a test tube
B. Add 8 to 10 drops of urine
C. Heat the Benedict’s solution without the urine to check if the solution is contaminated
D. If the color remains BLUE, the result is POSITIVE

80. +++ Positive result after Benedicts test is depicted by what color?

A. Blue
B. Green
C. Yellow
D. Orange

81. Clinitest is used in testing the urine of a client for glucose. Which of the following, If committed by a nurse indicates error?

A. Specimen is collected after meals
B. The nurse puts 1 clinitest tablet into a test tube
C. She added 5 drops of urine and 10 drops of water
D. If the color becomes orange or red, It is considered postitive

82. Which of the following nursing intervention is important for a client scheduled to have a Guaiac Test?

A. Avoid turnips, radish and horseradish 3 days before procedure
B. Continue iron preparation to prevent further loss of Iron
C. Do not eat read meat 12 hours before procedure
D. Encourage caffeine and dark colored foods to produce accurate results

83. In collecting a routine specimen for fecalysis, Which of the following, if done by a nurse, indicates inadequate knowledge and skills about the procedure?

A. The nurse scoop the specimen specifically at the site with blood and mucus
B. She took around 1 inch of specimen or a teaspoonful
C. Ask the client to call her for the specimen after the client wiped off his anus with a tissue
D. Ask the client to defecate in a bedpan, Secure a sterile container

84. In a routine sputum analysis, Which of the following indicates proper nursing action before sputum collection?

A. Secure a clean container
B. Discard the container if the outside becomes contaminated with the sputum
C. Rinse the client’s mouth with Listerine after collection
D. Tell the client that 4 tablespoon of sputum is needed for each specimen for a routine sputum analysis

85. Who collects Blood specimen?

A. The nurse
B. Medical technologist
C. Physician
D. Physical therapist

86. David, 68 year old male client is scheduled for Serum Lipid analysis. Which of the following health teaching is important to ensure accurate reading?

A. Tell the patient to eat fatty meals 3 days prior to the procedure
B. NPO for 12 hours pre procedure
C. Ask the client to drink 1 glass of water 1 hour prior to the procedure
D. Tell the client that the normal serum lipase level is 50 to 140 U/L

87. The primary factor responsible for body heat production is the

A. Metabolism
B. Release of thyroxin
C. Muscle activity
D. Stress

88. The heat regulating center is found in the

A. Medulla oblongata
B. Thalamus
C. Hypothalamus
D. Pons

89. A process of heat loss which involves the transfer of heat from one surface to another is

A. Radiation
B. Conduction
C. Convection
D. Evaporation

90. Which of the following is a primary factor that affects the BP?

A. Obesity
B. Age
C. Stress
D. Gender

91. The following are social data about the client except

A. Patient’s lifestyle
B. Religious practices
C. Family home situation
D. Usual health status

92. The best position for any procedure that involves vaginal and cervical examination is

A. Dorsal recumbent
B. Side lying
C. Supine
D. Lithotomy

93. Measure the leg circumference of a client with bipedal edema is best done in what position?

A. Dorsal recumbent
B. Sitting
C. Standing
D. Supine

94. In palpating the client’s abdomen, Which of the following is the best position for the client to assume?

A. Dorsal recumbent
B. Side lying
C. Supine
D. Lithotomy

95. Rectal examination is done with a client in what position?

A. Dorsal recumbent
B. Sims position
C. Supine
D. Lithotomy

96. Which of the following is a correct nursing action when collecting urine specimen from a client with an Indwelling catheter?

A. Collect urine specimen from the drainage bag
B. Detach catheter from the connecting tube and draw the specimen from the port
C. Use sterile syringe to aspirate urine specimen from the drainage port
D. Insert the syringe straight to the port to allow self sealing of the port

97. Which of the following is inappropriate in collecting mid stream clean catch urine specimen for urine analysis?

A. Collect early in the morning, First voided specimen
B. Do perineal care before specimen collection
C. Collect 5 to 10 ml for urine
D. Discard the first flow of the urine

98. When palpating the client’s neck for lymphadenopathy, where should the nurse position himself?

A. At the client’s back
B. At the client’s right side
C. At the client’s left side
D. In front of a sitting client

99. Which of the following is the best position for the client to assume if the back is to be examined by the nurse?

A. Standing
B. Sitting
C. Side lying
D. Prone

100. In assessing the client’s chest, which position best show chest expansion as well as its movements?

A. Sitting
B. Prone
C. Sidelying
D. Supine


Don't hire new grads, dean tells U.S. nurses

Don't hire new grads, dean tells U.S. nurses



NURSES in the United States involved directly in the recruitment of nurses from the Philippines should consider only candidates with a minimum two- to three-year work experience and completely desist from hiring fresh graduates.

By doing so, the Filipino nursing community in the United States would help ensure the continued flow of only qualified and well-trained professionals into the American healthcare system.

This is the gist of the e-mail Dean Josefina Tuazon of the University of the Philippines College of Nursing, dated August 25 sent primarily to the president-elect of the Philippine Nurses Association of Southern California, Brenda Cohen. More than 50 other healthcare professionals here and in the Philippines were listed as secondary addresses of the letter.

A copy of the letter was provided Philippine News by the president of the Philippine Nurses Association of America, New York-based May Mayor.

The head of the Philippines' premier nursing school apparently wrote the letter in order to rally her colleagues in the Philippines and in the United States into helping redeem the tainted image and reputation of Filipino nurses, as a result of the alleged nursing board exams leakage last June.

"Spread the word around that we need to do something in each of our own world," Tuazon said in her letter.

She continued: "For some of you involved directly or indirectly in the recruitment of Filipino nurses, please be selective and choose only graduates from reputable schools. Do not recruit new graduates."

Tuazon further explained that recruiting only the experienced nurses for overseas employment would also help stabilize the turnover rate of nurses in the Philippines and alleviate the brain-drain syndrome that has been increasingly affecting the nursing profession there.

On the quality of nursing education in the Philippines, Tuazon deplored the practice of many, if not most, nursing schools of increasing their enrollment beyond what their capacities and resources can handle. Thus, she said, these so-called diploma mills resort to hiring new and raw graduates as teachers, effectively removing the clinical experience requirement so essential to nursing instructorship.

"For Filipinos based abroad, we hope you will tell your relatives and friends in the Philippines who intend to take up nursing to enroll only in reputable schools," she urged. "And if you have connections to your alma mater, pressure them into doing what is right towards quality nursing education."

Along this line, Tuazon insisted that nursing schools ought to have a set of criteria for selecting and keeping students. While she appreciates that most nursing students eagerly look forward to working abroad, the least nursing schools could do is to conduct pre-admission screening and then work hard to make good nurses out of the students.

"Let's pressure schools into adopting a selection criteria," she said. "Not just anybody and certainly not everybody can be nurses. Nursing cannot and should not be merely used as a stepping stone to go abroad."

As investigation into the alleged test leak continued alongside government efforts to start fixing the breached licensure testing system, some "players" are shrewdly, if not inappropriately, positioning themselves to gain from the scandal. Tuazon specifically referred to how several review centers are jostling with one another in order to win over the lost customer base of Gapuz and Inress, two review institutions implicated in the scam.

The scramble seems a pitiful reminder of the gallant and almost successful bid put up by the Philippines for accreditation as a testing center of the U.S. National Commission on Licensure Examination (NCLEX) for nurses. The (U.S.) National Council of State Boards of Nursing last week shelved that application as a direct repercussion of the scandal.

Manila newspapers also reported last week that according to Dante Ang, chair of the Commission on Filipinos Overseas, he has received information that the state of Arkansas will not hire nurses who took the June 2006 board exams.

In the meantime, PNAA's Mayor expressed her disappointment over the results of the controversial nursing board exams. Whether or not there was a leak, she noted, the passing rate of 42 percent (17,000 out of the 42,000 examinees) is still alarmingly low.

"It is an embarrassing percentage and tends to mirror the deteriorating quality of nursing education in the Philippines because of the proliferation of diploma mills," Mayor told Philippine News.

"Many schools do not even have hospital affiliations," she lamented, citing the case of an information technology school chain that now offers an undergraduate nursing program.

Both Tuazon and Mayor, as well as the institutions they represent, however, see a silver lining amid the scandal. "It had to take a scandal like this to call the attention of media and the public to the fact that there is something very wrong in the nursing profession today," Tuazon said in her letter.

The PNAA, on the other hand, has issued a position statement condemning the alleged test leakage.

Philippine News, California

Mabagal na usad ng imbestigasyon sa leakage binira

Mabagal na usad ng imbestigasyon sa leakage binira

Binira ng mga petitioners at ilang sektor ang National Bureau of Investigation sa mabagal na pagusad ng isinagawa nitong imbestigasyon hinggil sa kontrobersiyal na 2006 nursing licensure examination leakage.

“Masyadong mabagal and there is nothing new. They just repeated the results of the fact-finding (committee). What about the Gapuz Review Center? What about INRESS? Marami na ang mga ebidensiya na tumutukoy sa kanila,” ayon kay Rene Tadle, pangulo ng University of Sto. Tomas Faculty

Hindi pa rin kumpiyansa ang mga petitioners sa pagsisiyasat ng NBI kahit pa inirekomenda na ng ahensiya ang pagsasampa ng kaso sa dalawang board examiners na sina Anesia Dionisio at Virginia Madeja

Sa report ng Bandila, naninindigan pa rin ang mga petitioners na dapat na managot ang lahat ng mga nakinabang sa leakage

Napag-alaman na hawak na ng Malacañan ang rekomendasyon ng NBI na patuloy pa rin pinagaaralan ng legal department ng ahensiya.

“Ang mga tao kapag ayaw magbigay ng written statements hindi naman namin mapilit,” sinabi ni Atty. Vergel Meneses, ang hepe ng anti-fraud and computer crimes division ng NBI

Nakatakda namang siyasatin ng NBI sa susunod na Linggo ang posibleng kinalaman ng Gapuz Review Center at INRESS Review Center sa naturang leakage. Ang INRESS Review Center ay pagmamay-ari ni Dr. George Cordero, ang nagbitiw na pangulo ng Philippine Nurses Association.

Friday, 01 September, 2006

Nursing exam results should be voided

By Rasheed Abou-Alsamh
Last updated 01:52am (Mla time) 09/02/2006

THE ONGOING controversy about the leaked answers to two parts of the five-part nursing board exams given last June is threatening the reputation of Filipino nurses both at home and abroad. Both the government and the Professional Regulation Commission (PRC) therefore should exert the utmost effort at restoring the tarnished reputation of the nursing profession.

The PRC has been resolute in refusing to validate the exam results and ask those who took it to sit again for new exams. Instead, it has decided to cancel the grades from the exams’ tests III and V, answers to which were leaked by two review centers in Manila, and to recalibrate the rest of the grading to take this leak into account. Not only do I fail to see the logic in doing this, but it is still unfair to all the examinees that did not cheat.

To say that it is too daunting to have new exams, or that nursing students are too tired and stressed to sit through the whole thing again, is ridiculous. If I were a nursing student in this batch of tainted-exam takers I would want to secure my reputation by taking new exams.

Under the new formula of the PRC, even more students (499 to be exact) will pass the examination, whether they cheated or not, which to my mind is ridiculous.

Why should cheaters be rewarded in the end for something immoral that they have done? It just doesn’t make sense.

Dante Ang, the head of the government’s inter-agency task force investigating the cheating, has said a recomputation of the nursing board exam results would be a violation of the Nursing Act of 2002.

The National Bureau of Investigation (NBI) has finished its preliminary investigation of this fiasco and recommended that two Nursing Board officials be charged with leaking the answers to the two tests. It has also furnished Malacañang with the names of the testing centers that leaked the test questions, but asked the Palace not to release the names to the public until next week, after it has completed its probe.

Representative Jesus Crispin Remulla has called for the whole PRC board to resign in order to help the investigation. The board has refused to do so, and created more confusion when it went ahead and released the results of the nursing board exams despite requests from Congress and the government to hold off until the investigation into the cheating was finished.

This was an act of bad faith, designed to create a fait accompli situation that the government would find hard to reverse once examinees have found out their scores.

The PRC should be punished for this attempt at short-circuiting the whole process.

The Department of Justice needs to file criminal charges against those guilty of leaking the results and also against those who benefited from them. After that, the PRC should at the very least cancel the results of tests III and V and ask that all students retake those two tests. That is the only fair solution to a situation that can be described only as foul and stinky.

Since nurses are one of the main exports of the Philippines, it behooves everyone involved in this noble profession to keep the highest standards of integrity and respectability. Overseas Filipino nurses send home millions of dollars ever year, and jeopardizing this hard-earned revenue because a few nursing students are too “stressed” to retake part of the exam is, frankly, idiotic.

Retake of nursing exam likely confined in leakage areas determined by NBI — Malacañang

Retake of nursing exam likely confined in leakage areas determined by NBI — Malacañang


Malacañang yesterday said a retake of the nursing licensure examinations last June, if any, would likely be confined in areas in Luzon identified by the National Bureau of Investigation (NBI) as places where contents of the nursing board exams were leaked.

Executive Secretary Eduardo Ermita said the NBI has submitted an initial report to Malacañang on its investigation on the exam leakage.

Ermita said the NBI has already pinpointed several areas in Luzon where the leakage took place, but the bureau had requested for another week to finish its investigation on the controversy and submit a final report on the culpability of officials and other private individuals.

The NBI had initially set a deadline of Aug. 31 for it to conclude its investigations on the cheating that marred the nursing licensure examinations last June. But the bureau later requested for the deadline to be extended up to next week, which was accepted by Malacañang.

Press Secretary and Presidential Spokesman Ignacio Bunye said the NBI needs the additional time to compile evidence and file criminal charges before the Department of Justice against those suspected of involvement in the case.

Meanwhile, Bunye said the Professional Regulation Commission (PRC), which is conducting another investigation on the cheating in the nursing board exams, is preparing administrative charges against nursing board examiners for alleged negligence.

"The PRC’s preliminary findings show that examiners Virginia Madeja and Anesia Dionisio can be administratively sanctioned for violation of Section 15 A and B of RA 8981, the Act for the Modernization of the PRC. Their violation consists of negligence," Bunye said.

PRC vows to continue probe of nursing test scandal


The Professional Regulation Commission (PRC) yesterday reiterated its commitment to continue its investigation on the leakage in the June 2006 nursing board examinations. The body likewise assured that it is implementing strategies to ensure the integrity of future exams.

In an update, the PRC said its preliminary investigation did not found sufficient evidence of a leakage.

PRC officials assured, however, that they will continue to investigate the issue until they get to the heart of the controversy.

Based on the initial results of the probe, only the manuscripts containing 300 or so questions in Test III and 500 questions in Test V were leaked to the examinees before the examination, contrary to the complaint that a PRC staff in Baguio leaked actual questions consisting of 100 randomly selected items during the printing of the test questions.

This came after a careful scrutiny of evidence presented by the reviewees and complainants to the investigating body.

"The actual test questions that were alleged to come from the Baguio Office were submitted to the PRC Central office after the examination. This is in violation of PRC internal procedures requiring the shredding of papers after each test but not enough evidence to conclude a leakage," the statement said.

It further stated that in the inquiries among PRC staff in the confidential room where the printing was done, there were no indications that the printed tests were brought out when a staff member, who has been pinpointed as the source of the leak, went out of the office.

The staff member cited the need for funding requirements as the reason for leaving the office, which was in deviation of standard procedures. The staff member is now being investigated.

The body is also calling on additional witnesses to corroborate the allegations made during the hearings at the House of Representatives to further shed light on the issue.

"The PRC is expecting the NBI investigation to yield other persons in addition to the board members implicated in the leakage," the statement said.

The PRC report was issued by chairman Eufemia Octaviano, members Remedios Fernandez and Esterlita Gatura, together with chairperson Leonor T. Rosero and Commissioner Avelina dela Rea.

The Board of Nursing also aired its appeal for understanding on its move to downgrade Test V and remove the leaked questions, saying that it was a necessary move to restore the integrity of the examination.

"The test framework still contained the same subjects in different tests," the Board assured.


NBI wrapping up report on nursing test leakage

NBI wrapping up report on nursing test leakage
Friday, September 01 2006 @ 11:38 AM BST


Malacañang said Thursday the National Bureau of Investigation (NBI) is now in the "final stages of preparing the final report" on the leakage-marred 2006 nursing licensure examinations in order to file the necessary charges before the Prosecutor’s office.

Press Secretary and Presidential Spokesperson Ignacio R. Bunye said the move is in line with President Gloria Macapagal-Arroyo’s directive to apply the full force of the law to those responsible for the leakage that cast doubt on the integrity of the country’s nursing graduates.

"The NBI asked for additional time up to next week," Bunye said in a statement this afternoon.

He bared that preliminary findings of the Professional Regulation Commission (PRC) tasked to probe deeply into the anomaly showed that examiners Virginia Madeja and Anesia Dionisio can be administratively sanctioned for violation of Section 15A and B of Republic Act 8981, otherwise known as the PRC Modernization Act.

It is the government’s stand that the case is an isolated one but President Arroyo, determined to get into the bottom of the test leakage, wanted to charge and try those found guilty and punished to the full extent of the law.

The government had earlier maintained that the test leakage "should not be cause for any stigma" on Filipino nurses and other professionals who are among the best in the world.

Citing honesty and professional integrity as eminent traits of the Filipino workers, Bunye expressed confidence that the controversy will not affect the deployment of Filipino nurses overseas, including the United States and Japan. (PNA)


Oathtaking fees wind up in BON members' bank account

Oathtaking fees wind up in BON members' bank account

Oathtaking fees collected from nursing graduates have wound up in the personal bank account of two Board of Nursing members, ABS-CBN's Bandila reported Friday.

The report by Ces Oreña-Drilon said a P105,000 check issued by BON member Remedios Fernandez was deposited to Banco de Oro account no. 01053005-2 on Februay 5.

BON chairwoman Eufemia Octaviano said the check is the nursing graduates' payment for the printing of souvenir programs for the oathtaking ceremonies.

"[Fernandez and I] are the signatories as BON chairman and treasurer. [The account is] in our names. The money collected is for the souvenir programs because the region asks us to prepare souvenir programs and (the oathtakers) have to pay for the printing," Octaviano told Bandila.

She added that each souvenir program costs P100.

Octaviano admitted that the BON had already printed the programs before the Court of Appeals issued a temporary restraining order barring oathtaking ceremonies for 60 days due to the allege test leakage in the 2006 nursing board exams.

A Bandila report earlier said the BON would have collected P2 million-P2.4 million from nursing graduates had a national oathtaking ceremony at the Araneta Coliseum pushed through as scheduled on August 22.

The report added, however, that BON would have paid only P392,000 for the venue and P15,000 for the food.

Octaviano admitted that the bank account does not undergo a government audit. She added, however, that BON members abide by Professional Regulation Commission guidelines on how to spend the money collected from nursing graduates.

"All the boards under PRC do this," she said.

She added that BON members use the excess money to visit nursing schools inside and outside the country.

Octaviano did not give Bandila a complete accounting of its collections. She added that the Philippine Nurses Association is helping the board collect the fees.

"Since it is a joint venture or activity, the PNA would collect for us at the same time the PNA would collect [its] membership fee," she said.

PNA president Marilyn Yap, however, denied Octaviano's claim.

"What usually happens is that they ask us (to collect) because they don't have the manpower. They also ask us to help distribute the tickets for the oathtaking," Yap said.

"To my mind there are moral and legal issues [so] I opposed it," she added.


Nursing exam results should be voided

Most cheating occurred in Luzon, Ermita says
By Joyce Pangco Pañares

MOST of the nursing graduates who must retake their licensing exams come from Luzon because investigators believe that is where most of the cheating happened, Executive Secretary Eduardo Ermita said yesterday.

“The NBI [National Bureau of Investigation] has informed us that most of the review centers that had obtained copies of the leaked exam were based in Luzon,” Ermita said without identifying specific areas.

He echoed the Philippine Regulation Commission’s view that a new law must be passed to regulate the operation of review centers.

President Gloria Macapagal Arroyo earlier announced that she would sign an executive order that would put review centers under the direct supervision of the Commission on Higher Education and spell out possible penalties for leaks.

As this developed, the commission recommended administrative sanctions against examiners Virginia Madeja and Anesia Dionisio for gross negligence that resulted in the leak.

But the NBI asked for a one-week extension of the deadline set by the President to give it time to determine the criminal liability of some officials of the Board of Nursing.

Senator Richard Gordon said Madeja and Dionisio were sacrificial lambs given up to hide the real culprits. He pressed the Senate to issue a subpoena to PRC commissioners and bureau officials who snubbed two hearings of the Senate committee on civil service and government reorganization.

Earlier, the President rejected the recommendation of Dante Ang, chairman of the Commission on Overseas Filipinos, for all examinees who took the nursing board exams to retake the test.

Ang made the recommendation after certain foreign employers, including those from the American state Arizona, imposed a ban on the hiring of Filipino nurses who passed the June 2006 board exams.

Mrs. Arroyo instead made a public appeal for the ban to be lifted and ordered the exam readministered in areas where the leaks were confirmed.

“We are earnestly appealing to all public and private hospitals to reconsider their decision to freeze the hiring of the 2006 nursing licensure test passers, for we believe that those who passed this board exam fairly should not suffer from the dishonest acts of an erring few,” Presidential Spokesman Ignacio Bunye said. With Roy Pelovello

Velasco: Nursing the wounds

Velasco: Nursing the wounds
By Diana B. Velasco
Grain of Salt

THERE'S a piece of news that has hit close to home--the controversial alleged leakage and proposed retaking of the 2006 Nursing Licensure Examination.

The issue has a particularly personal impact on me because I have taken two licensure examinations for two different professions and with some partners, operate a review center here in the city.

As anybody who has ever tried to become a recognized professional in the country knows, taking the PRC exam is no mean feat; it requires intellectual, psychological, emotional, physical and spiritual conditioning. The suspense on the questions that will actually be asked is so intense that the exam itself sometimes becomes anti-climactic after months and months of nerve-wracking and sometimes debilitating tension.

Preparing oneself for a board exam is a major event for a professional wannabe, and finding your name in the list of passers never fails to elicit a tidal wave of relief and the affirmation that you are good enough to practice your chosen field. The roller coaster ride of emotions it brings is not a joke and I can only begin to imagine the distress that this batch of nursing board passers is going through because their competence has yet to be formally recognized.

Assuming that the allegations are true and that test questions were leaked days before the exam, I cannot find one molecule in my body that empathizes with the administrators of the accused review center. Yes, I know for a fact that the review center competition is tough, and more so with nursing review schools. But that does not excuse anyone who wants to stay on top of the game to resort to old-school underhanded tactics just so it could generate some psychic pressure on future enrollees who would like to have every possible advantage on their side.

People should enroll in a review center based on the innovation and effectiveness of their methodology and the quality of their materials and instructors, not on their access to leakage!

The re-computation of the scores by PRC, nullifying the contestable questions, resulted in an increase in the number of passers by almost 500. This was based on a similar approach to a controversial bar examination and is a good basis for us to conclude that even while some portions of the test was leaked, it actually gave, at best, a negligible advantage to the people who had access to it in the first place.

What truly riles me about the issue is that there seems to be very little being done in addressing the root cause of the problem: the leakage. How did it happen? Did the review center in question have access to one of the examiners, or the people who printed the exam, or an insider from the PRC? Whatever made them think they could actually get away with something like that? These are the questions that need to be answered, and fast, if we want to build on whatever is left of the credibility of that board exam. All parties privy to the controversy should be put behind bars and never have the chance to work in a credible organization ever again.

We are a democracy. But that does not give anybody the chance to lie, cheat steal and defraud intellectually honest and competent nurses to practice their profession. Professionalism is something that cannot be defined by one examination. It is also something that can never be bought.

Ms. Velasco is a licensed geologist and environmental planner, and owns the Foresight Cram School in Matina, which offers review classes and tutorial services. You may call 296-1654 or email for more information and for your comments and reactions

Answers and Rationales: Practice Test on Hepatobiliary and Pancreatic Health Disorders by brewed

Disclaimer: Care has been taken to ensure that all answers and rationales are correct and accurate.

Feel free to post comments or suggestions for any misleading statements, typographical or grammatical errors.

Thank you.

- brewed

Situation 1: Nurse Craig works as a probationary staff nurse at the Bicol Medical Center. During his shift, he was tasked by his head nurse to conduct a health education session about the functions of the hepatobiliary and pancreatic system.

1. Nurse Craig knows that the liver is located at the __________________ of the abdomen.
a. Right Upper Quadrant
b. Left Lower Quadrant
c. Right Lower Quadrant
d. Left Upper Quadrant

Answer: A. Right Upper Quadrant
Rationale: The liver is located in the right upper quadrant of the abdomen, beneath the diaphragm and weighing 1200 to 1600 grams; covered with a fibroelastic capsule called Glisson capsule that contains blood vessels, lymphatics and nerves.

2. Bile is synthesized in the liver and transported to the bile ducts via the bile canaliculi. What controls the flow of bile in the duodenum?
a. Cystic duct
b. Sphincter of Oddi
c. Common bile duct
d. Common hepatic duct

Answer: B. Sphincter of Oddi
Rationale: The sphincter of oddi is at the distal end of the common hepatic duct and controls the flow of bile into the duodenum. Cystic duct connects the gallbladder to the hepatic duct and they merge to form the common bile duct – where it opens into the duodenum allowing secretion of bile necessary for digestion. Bile canaliculi drain into the right or left hepatic ducts which come together to form the common hepatic duct.

3. Gallbladder is a sac like organ located on the inferior surface of the liver. Nurse Craig is aware that the gallbladder’s primary purpose is to:
a. metabolize bilirubin
b. store fat soluble vitamins
c. store and concentrate bile
d. produce bile

Answer: C. Store and concentrate bile
Rationale: To store and concentrate bile about 90 ml is the primary purpose of the gallbladder. The mucosa of the gallbladder wall absorbs water and electrolytes resulting in a high concentration of bile salts, bile pigments and cholesterol. Options A, B, and D are all functions of the liver.

4. What hormone promotes the storage and utilization of food primarily glucose and fats?
a. Glucagon
b. Thyroxine
c. Secretin
d. Insulin

Answer: D. Insulin
Rationale: The endocrine pancreas secretes insulin and glucagon from islets of Langerhans; where insulin is a protein hormone that promotes the storage of food primarily glucose and fats while glucagon stimulates glycogenolysis in the liver. Secretin is secreted from the small intestine that stimulates the acinar and duct cells to secrete the alkaline – rich fluid that neutralizes chyme. Thyroxine is a thyroid hormone that increases the rate of ATP production.

5. During the session, a client asks Nurse Craig if she can live without her gallbladder. In order to respond to this client, Nurse Craig must have which understanding of the hepatobiliary system?
a. The liver produces about 1000 ml of bile/day
b. The liver concentrates bile more than 10 times
c. The gallbladder makes about 90 ml bile/day
d. The gallbladder dilutes and releases bile

Answer: A. The liver produces about 1000 ml of bile/day
Rationale: The liver produces between 700 and 1000 ml of bile a day. The gallbladder stores and concentrates bile and then releases it when stimulated, but is not an essential structure.

Situation 2: Nurse Nelly is assessing Mr. Shick who is in the early stages of cirrhosis of the liver.

6. Which early sign would Nurse Nelly anticipates finding?
a. Peripheral edema
b. Ascites
c. Anorexia
d. Jaundice

Answer: C. Anorexia
Rationale: Early clinical manifestations of cirrhosis are subtle and usually include GI symptoms such as anorexia, nausea, vomiting and changes in bowel patterns. These changes are caused by the liver’s altered ability to metabolize carbohydrates, proteins and fats. Options A, B and D are later signs of liver failure and portal hypertension.

7. What diet should be implemented for Mr. Shick who is in the early stages of cirrhosis? a. High calorie, high carbohydrate
b. High protein, low fat
c. Low fat, low protein
d. High carbohydrate, low sodium

Answer: A. High calorie, high carbohydrate
Rationale: For clients who have cirrhosis without complications, a high calorie, high CHO diet is preferred to provide an adequate supply of nutrients. In the early stages of cirrhosis, there is no need to restrict fat, protein or sodium.

8. Mr. Shick complains that his skin always feel itchy and that he “scratches himself raw” while he sleeps. Nurse Nelly should recognize that the itching is the result of which abnormality associated with cirrhosis?
a. Folic acid deficiency
b. Prolonged prothrombin time
c. Increased bilirubin level
d. Hypokalemia

Answer: C. Increased bilirubin level
Rationale: Excess retained bilirubin produces an irritating effect on the peripheral nerves, causing intense itching. Folic acid deficiency causes varied symptoms, but not itching. Itching is not a symptom of a prolonged PT or hypokalemia.

9. Few days after, Mr. Shick is developing ascites. Nurse Nelly should recognize that the pathologic basis for the development of ascites in clients with cirrhosis is portal hypertension and:
a. an excess serum Na level
b. an increased metabolism of aldosterone
c. a decreased flow of hepatic lymph
d. a decreased serum albumin level

Answer: D. A decreased serum albumin level
Rationale: Acites results from increased pressure in the venous system caused by a low level of serum albumin (which contributes to decreased colloid osmotic pressure) and sodium retention. The serum sodium level is not increased. There is a decreased aldosterone clearance and an increased flow of hepatic lymph.

10. Which of the following health promotion activities would be appropriate for Nurse Nelly to suggest to his client add to the daily routine at home?
a. Supplement the diet with multivitamins
b. Limit daily alcohol intake
c. Take a sleeping pill at bedtime
d. Limit contacts with other people

Answer: A. Supplement the diet with multivitamins
Rationale: General health promotion measures include maintaining good nutrition, avoiding infection, and abstaining from alcohol. Rest and sleep are essential, but an impaired liver may not be able to detoxify sedatives and barbiturates. Such drugs must be used cautiously, if at all, by clients with cirrhosis. The client does not need to limit contact with others but should exercise caution to stay away from ill people.

Situation 3: Nurse Rihanna together with her colleagues at San Lazaro Hospital is conducting a community education on how to prevent the transmission of hepatitis.

11. Which of the following types of hepatitis is considered to be primarily a sexually transmitted disease?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Hepatitis D

Answer: B. Hepatitis B
Rationale: Hepatitis B is considered to be a STD. It can also be transmitted by a percutaneous exposure to infected blood. Hepatitis A is transmitted vial the fecal-oral route. Hepatitis C is primarily transmitted percutaneoulsy and less frequently, sexually. Hepatitis D is transmitted percutaneously too.

12. Nurse Rihanna knows that during the icteric phase of viral hepatitis, the client will exhibit which of the following symptoms?
a. Tarry stools
b. Yellowed sclera
c. Shortness of breath
d. Light, frothy urine

Answer: B. Yellow sclera
Rationale: Icteric phase is marked by the onset of jaundice after the prodromal phase. Liver inflammation and obstruction block the normal flow of bile. Excess bilirubin turns the skin and sclera yellow and the urine dark and frothy. Profound anorexia is also common. Tarry stools are indicative of GI bleeding and would not be expected in hepatitis. Light or clay colored stools may occur in hepatitis owing to bile duct obstruction. Shortness of breath is unexpected.

13. Which of the following precautions would Nurse Rihanna and her colleagues indicate as essential when caring for clients with Hepatitis A?
a. Gowning when entering a client’s room
b. Wearing a mask when providing care
c. Assigning the client in a private room
d. Wearing gloves when giving direct care

Answer: D. Wearing gloves when giving direct care
14. Nurse Rihanna is developing a teaching plan for a client with Hepatitis A. Which of the following instructions is appropriate?
a. Spray the house to eliminate infected insects
b. Tell family members to try to stay away from the client
c. Tell the family members to wash their hands frequently
d. Disinfect clothing and eating utensils

Answer: C. Tell the family members to wash their hands frequently
Rationale: Contact precautions are recommended for clients with Hepatitis A. This includes wearing gloves for direct care. A gown is not required unless substantial contact with the client is anticipated. It is not necessary to wear a mask. The client does not nned a private room unless incontinent of stool.

15. After the community education, a client approached Nurse Rihanna and expressed feelings of isolation as a result of having hepatitis. What would be Nurse Rihanna’s best response?
a. “Don’t Worry. It’s normal to feel that way.”
b. “Your friends are probably afraid of contracting hepatitis from you.”
c. “I’m sure you’re imagining that!”
d. “Tell me more about your feelings of isolation.”

Answer: D. “Tell me more about your feelings of isolation.”
Rationale: A nurse should encourage the client to further verbalize feelings of isolation. Instead of dismissing these feelings or making assumptions about the cause of isolation, the nurse should allow clients to verbalize their fears and provide education on how to prevent infection transmission. Option A is giving a false reassurance. Options B and C are non-therapeutic and employ threat.

Situation 4: Mrs. Smith, 44 years old is admitted to the hospital complaining of severe abdominal pain and extreme nausea and has vomited several times. A diagnosis of cholecystitis from cholelithiasis was made.

16. Based on the data, which nursing diagnosis would have the highest priority intervention at this time?
a. Anxiety r/t severe abdominal discomfort
b. Fluid Volume Deficit r/t vomiting
c. Pain r/t gallbladder inflammation
d. Imbalanced Nutrition: Less than body requirement r/t vomiting

Answer: C. Pain r/t gallbladder inflammation
Rationale: The priority for nursing care at this time is to decrease the client’s severe abdominal pain. The pain, which is frequently accompanied by nausea and vomiting, is caused by biliary spasm. Narcotic analgesics are given to relieve the severe pain and spasm of cholecystitis. Relief of pain may decrease nausea and vomiting and thereby decrease the likelihood of developing further complications, such as deficient fluid volume and imbalanced nutrition.

17. The group of characteristics that would alert Nurse Pharrel that his client has increased risk of developing gall bladder disease would be female:
a. over the age of 40, obese
b. over the age of 40, low cholesterol level
c. under the age of 40, history of high fat intake
d. under the age of 40, family history of gallstone

Answer: A. Over the age of 40, obese
Rationale: Factors that placed client a greater risk for developing gall bladder disease are female, forty years old and above, fat/obesity and fertile. Options B, C, and D are incorrect. (Just remember the 4 F’s)

18. When common bile duct is obstructed, Nurse Pharrel should evaluate her client for signs of which of the following complications?
a. Respiratory distress
b. Circulatory overload
c. Urinary tract infection
d. Prolonged bleeding time

Answer: D. Prolonged bleeding time
Rationale: A client with an obstructed common bile duct should be monitored for prolonged bleeding time. Such an obstruction prevents bile from entering the intestinal tract, thus decreasing the absorption of fat soluble vitamins (ADEK). Vit. K is necessary for prothrombin formation. Prothrombin deficiency causes delayed blood clotting, which results in prolonged bleeding time. An obstructed bile duct does not cause respiratory distress, circulatory overload or UTI.

19. Mrs. Smith complained of severe right upper quadrant pain. Which of the following medication would Nurse Pharrel anticipates administering to relieve the client’s pain?
a. Meperidine (Demerol)
b. Acetaminophen with codeine
c. Promethazine (Phernergan)
d. Morphine sulfate

Answer: A. Meperidine (Demerol)
Rarionale: This would be the narcotic analgesic of choice for a client with cholecystitis. Acetaminophen would not be appropriate to administer, because the codeine could cause biliary duct spasm and increase pain, as could opiates such as morphine sulfate. Promethazine (Phenergan) is an antiemetic.

20. A laparoscopic cholecystectomy is scheduled. Which of the following instructions should Nurse Pharrel include in his discharge plan?
a. Avoid showering for 48 hours after surgery
b. Return to work within one week
c. Change the dressing daily until the incision heals
d. Use acetaminophen (Tylenol) to control fever

Answer: B. Return to work within one week
Rationale: After a laparoscopic cholecystectomy, clients can return to work within 1 week. The client can remove dressings from the puncture site and shower the day after the surgery. The site does not need to be rebandaged but should be left open to air. The client should report any fever, which could be an indication of a complication.

Situation 5: Capt. Jack Sparrow was admitted in the Medical Floor of The Medical City. The admission history shows an alcohol abuse of excessive intake of liquor for more than 10 years. Laboratory findings result shows high trygyceride levels and hypercalcemia.

21. The initial diagnosis of pancreatitis is confirmed if Capt. Sparrow’s blood work shows a significant elevation in which of the following serum values?
a. Amylase
b. Glucose
c. Potassium
d. Trypsin

Answer: A. Amylase
Rationale: The primary diagnostic tests for pancreatitis are serum amylase, serum lipase, and urine amylase. All 3 lab results are typically elevated. Serum amylase is the most common tests; the result is usually higher than 200 units/dL. Serum glucose may be elevated in pancreatitis because of beta – cell damage, but this is not used to diagnose pancreatitis. Serum K and trypsin levels are not affected in pancreatitis.

22. Which of the following actions of pancreatic enzymes can cause pancreatic damage?
a. Utilization by the intestine
b. Autodigestion of the pancreas
c. Reflux into the pancreas
d. Clogging of the pancreatic duct

Answer: B. Autodigestion of the pancreas
Rationale: When the pancreas is injured and/or has an impaired or disrupted function, the pancreatic enzymes (phospolipase A, lipase, and elastase) leak into the pancreatic tissue and initiate autodigestion. Options C and D can be causes of pancreatitis. Option A is incorrect to this situation.

23. The initial treatment plan for Capt. Sparrow most likely would focus on which of the following as a priority?
a. Resting the GIT
b. Ensuring adequate nutrition
c. Maintaining fluid and electrolyte balance
d. Preventing the development of an infection

Answer: Resting the GIT
Rationale: There is a little definitive treatment for pancreatitis. It is crucial to decrease pancreatic enzymes to reduce stimulation of the pancreas. This is done by keeping the client NPO to rest the gastrointestinal tract and thereby suppress pancreatic enzymes secretion. Ensuring adequate nutrition, maintaining fluid and electrolyte balance, and preventing the development of an infection are issues for the client with pancreatitis but are not the primary focus of treatment.

24. Capt. Sparrow may exhibit Cullen’s sign on physical examination. Nurse Shakira knows that Cullen’s sign can be best described as:
a. Distended tortuous veins in the esophagus
b. Yellow-orange discoloration of the skin
c. Bluish discoloration of the left flank area
d. Bluish discoloration of the periumbilical area

Answer: D. Bluish discoloration of the periumbilical area
Rationale: Clinical manifestations vary with severity of attack. Cullen’s sign and Grey Turner’s sign may be present in clients with pancreatitis. Cullen’s sign is the bluish discoloration of the periumbilical area while Grey Turner’s sign is the bluish discoloration of the left flank area. Option A is a complication of cirrhosis which is esophageal varices. Option B is jaundice or icterus.

25. In alcohol related pancreatitis, which of the following interventions is the best way to reduce the exacerbation of pain?
a. Lying supine
b. Taking aspirin
c. Eating a low – fat diet
d. Abstaining from alcohol

Answer: D. Abstaining from alcohol
Rationale: Abstaining from alcohol is the best way to reduce the exacerbation of pain. Encourage position of comfort, which is elevation of the head at 45 degrees side lying with knees flexed rather lying supine. Taking aspirin may cause bleeding. An Opiod narcotic analgesic such as Demerol is given. Maintain NPO status (7 – 3 days) in order to reduce gastric secretions and aggravation of pancreatic pain and once feeding resumes provide several small meals.

Situation 6: Nurse Cassie is caring to clients who had undergone surgeries and diagnostic procedures.

26. Nurse Cassie understands that after a cholecystectomy and common bile duct exploration, the client will:
a. need to take oral bile salts
b. be incapable of producing bile
c. be unable to concentrate bile
d. not be able to digest fatty foods

Answer: C. Be unable to concentrate bile
Rationale: In cholecystectomy, the gallbladder is surgically removed. Gallbladder functions primarily to store and concentrate bile. The inability to concentrate bile results from the removal of gallbladder. Option A is a medical treatment for cholecystitis. Options B and D may result if there is liver failure.

27. Because of prolonged bile drainage from a T – tube, a client may develop symptoms related to a lack of fat soluble vitamins such as:
a. easy bruising
c. excessive jaundice
c. muscle twitching
d. tingling of the fingers

Answer: A. Easy bruising
Rationale: Easy bruising signifies a lack of fat soluble Vitamin K related to prolonged bile drainage from a T – tube. Excessive jaundice may result to clients with hepatitis or cirrhosis because of a disturbance of bilirubin metabolism. Options C and D are signs of hypocalcemia which in severe cases result in clients with acute pancreatitis.

28. Considering both the endocrine and exocrine functions of the pancreas, the client’s postoperative regimen would primarily include managing intake of:
a. alcohol and caffeine
b. fluids and electrolytes
c. vitamins and minerals
d. fats and carbohydrates

Answer: D. Fats and carbohydrates
Rationale: The pancreas produces enzymes (exocrine) and hormones (endocrine) that assist in the digestive process. The endocrine pancreas secretes insulin that stores and utilized fats. The pancreatic enzymes lipase and amylase aids in the digestion of fats and carbohydrates respectively. These should be managed to avoid exacerbation of pain postoperatively.

29. Nurse Cassie knows that several hours after liver biopsy, the client will remain in what position?
a. Left side lying with head of bed elevated
b. Right side lying with pillows placed under the costal margin
c. High fowler’s with both arms supported on pillows
d. Any comfortable recumbent position as long as the client remains immobile

Answer: B. Right side lying with pillows under the costal margin
Rationale: Positioning on the right side lying with pillows under the costal margin will provide compression over the biopsy site thus preventing bleeding. Options A, C and D are incorrect nursing care after a liver biopsy.

30. An obese client with a history of gallstone has an abdominal cholecystectomy. After surgery, Nurse Cassie plans to alleviate tension on the surgical wound by:
a. limiting deep breathing
b. maintaining T – tube patency
c. maintaining nasogastric tube patency
d. encouraging the right side lying position

Answer: C. Maintaining NGT patency
Rationale: Maintaining NGT patency will promote gastric decompression thus alleviates tension in the surgical wound. Encouraging deep breathing rather limiting is advised to decrease pain. Maintaining T- tube patency promotes gravity drainage of bile. Option D is incorrect for this situation for it is a nursing care done after a liver biopsy.

Situation 7: Mr. Gibson, 60 – year old, is admitted to the hospital with cirrhosis. He has history of alcoholism and hepatitis B.

31. What should Nurse Ashanti expect to find on his initial laboratory results?
a. hypernatremia
b. elevated ALT
c. elevated serum albumin
d. leukocytosis

Answer: B. Elevated ALT
Rationale: Elevation of Alanine aminotransferase (5 – 35 IU/L) indicates damage of liver cells and decreased liver function. Other lab values result a low serum albumin, hyponatremia, leucopenia, thrombocytopenia, prolonged PT, anemia and possible elevated serum ammonia.

32. Mr. Gibson is scheduled for a liver biopsy. What is your priority of care for this patient? a. monitor for bleeding
b. encouraging increased activity
c. controlling blood pressure
d. providing nutritional support

Answer: A. Monitor for bleeding
Rationale: Since the liver is a vascular organ, the priority of care is to monitor bleeding. The dressing should be monitored for oozing of blood and should be positioned on the right side, which helps apply pressure on the biopsy site. The client is usually maintained on bed rest for 24 hours to reduce the risk of bleeding so increased activity is contraindicated. Providing nutritional support is not the utmost priority at this time. Option C is to prevent the occurrence of portal hypertension as a complication from cirrhosis.

33. What life threatening complication will result when the liver is destroyed due to hepatitis B and up to the development of chronic hepatitis?
a. portal hypertension
b. esophageal varices .
c. liver failure
d. hepatic encephalopathy

Answer: C. Liver Failure
Rationale: All are complications of cirrhosis but option C is the most life threatening. Complications of hepatitis B include the development of chronic hepatitis, which destroys the liver and leads to cirrhosis and liver failure causing death. The complications of cirrhosis are portal hypertension leading to esophageal varices, right sided heart failure and varicose veins. Ascites, hepatic encephalopathy are also complications.

34. What instruction about diet modification should Nurse Ashanti give to Mr. Gibson?
a. increase fluid intake
b. avoid canned and processed food
c. eat food reach in protein
d. encourage to eat dairy products and poultry

Answer: B. Avoid canned and processed foods
Rationale: The client with late stage of cirrhosis is usually on a protein, sodium and fluid restricted diet. Foods to avoid would be canned and processed foods (high in sodium), chicken, meat, eggs and dairy products (high in CHON), and fluids are usually limited.

35. Mr. Gibson asks Nurse Ashanti why he has edema. Nurse Ashanti would use which of the following statements to explain how edema results from pathophysiologic changes in cirrhosis?
a. “The edema occurs because your liver produces fewer proteins that help draw fluid into the bloodstream”
b. “The high osmotic pressure of proteins in your blood pushes fluid into the body tissues”
c. “The kidneys are able to filter less fluid, so the body cannot excrete it as urine very easily”
d. “Your body is metabolizing sex hormones more quickly, leading to fluid retention.

Answer: A. The edema occurs because your liver produces fewer proteins that help draw fluid into the bloodstream”
Rationale: The liver is responsible for the production of albumin, which in turn is responsible for maintaining colloidal osmotic pressure. With less production of albumin, osmotic pressure decreases and edema develops. Options B, C and D are false statements that do not explain the relationship between cirrhosis and edema.

Situation 8: Mrs. Carey, 49-year-old female was rushed in the emergency department because of severe and steady right upper quadrant pain that radiates to the scapula lasting for 2 hours. She has vomited frequently and experiencing chills.

36. Based from the data presented, Mrs. Carey is experiencing which of the following problems?
a. acute pancreatitis
b. cholelithiasis
c. acute cholecystitis
d. hepatic encephalopathy

Answer: C. Acute cholecystitis
Rationale: In acute cholecystitis, the lodging of a gallstone in the duct causes inflammation of the cystic duct. The lodged gallstone in the cystic duct causes pressure against the wall of the gall bladder, decreasing blood flow. Cholelithiasis can cause cholecystitis because of the distention of the gallbladder thus, severe, steady RUQ pain that radiates to the scapula occurs. Other GI symptoms also occur but when patient experiences chill, an inflammation and infection are happening resulting to acute cholecystitis.

37. Physical exam findings revealed a severe pain in the RUQ with inspiratory arrest. Nurse Beyonce knows, that her client is positive for which of the following signs?
a. Grey Turner’s sign
b. McBurney’s sign
c. Cullen’s sign
d. Murphy’s sign

Answer: D. Murphy’s sign
Rationale: A positive Murphy's sign is seen in acute cholecystitis. It is elicited by firmly placing a hand at the costal margin in the right upper abdominal quadrant and asking the patient to breathe deeply. If the gallbladder is inflamed, the patient will experience pain and catch their breath as the gallbladder descends and contacts the palpating hand. Options A and C are signs of pancreatitis. Option D is a sign for appendicitis.

38. Which of the following tests is most commonly used to diagnose Mrs. Carey’s problem?
a. Abdominal computed tomography scan
b. Abdominal ultrasound
c. Barium swallow
d. Endoscopy

Answer: A. Abdominal computed tomography scan
Rationale: This is a definitive diagnostic test for acute cholecytitis. This provides a cross sectional images of the abdomen to differentiate subtle changes in the tissue in the selected structure particularly it will visualize where the gallstone has been lodged in the cystic duct.

39. Frequent vomiting puts Mrs. Carey at risk of which of the following acid-base imbalance?
a. metabolic acidosis and hyperkalemia
b. metabolic alkalosis and hyperkalemia
c. metabololic acidosis and hypokalemia
d. metabolic alkalosis and hypokalemia

Answer: D. Metabolic alkalosis and hypokalemia
Rationale: If frequent vomiting happens, the client is at risk for metabolic alkalosis and hypokalemia. Option C could happen in patient experiencing persistent diarrhea. Options A and B are incorrect.

40. When counseling Mrs. Carey in the ways to prevent the exacerbation of the problem, which of the following guidelines is most important?
a. Eat a low protein diet
b. Limit exercise to 10 minutes a day
c. Eat a low – fat diet, cholesterol diet
d. Keep weight proportional to height

Answer: D. Keep weight proportional to height
Rationale: Keeping weight proportional to height is the best indicator of being healthy. This is your Body Mass Index. Client should be taught to avoid high fat foods (cholesterol diet), whole milk products, fried foods, nuts, gravies, cooking oils, hot dogs, chocolate and cheese. Not all protein rich foods are restricted. Exercise should be encouraged to promote OLOF.

Situation 9: Nursing process is a systematic problem solving approach to the collaborative identification of client health needs and the application of nursing care to effectively meet those needs.

41. A client was admitted in the emergency department with exacerbation of cholelithiasis. When does discharge planning begins?
a. after physical examination c. upon admission
b. after initial assessment d. before discharge

Answer: C. Upon admission
Rationale: Discharge planning begins upon admission so to have a continuous/ongoing assessment to provide appropriate nursing intervention throughout the course of disease.

42. How will you assess a client with hepatic encephalopathy having asterixis?
a. On deep inspiration, pain is elicited and breathing stops
b. On deep palpation and released, pain is elicited
c. Ask client to hold his arms straight in front and flappy hand tremors occur
d. Place hand over the patient's right knee while the patient flexes their right hip against the resistance

Answer: C. Ask client to hold his arms straight in front and flappy hand tremors occur
Rationale: Asterixis/liver flap describes a motor disturbance characterized by intermittent lapses of an assumed posture. It is commonly associated with liver failure where it produces the flapping tremor of hepatic encephalopathy characterized by jerky, irregular flexion-extension movements at the wrist and metacarpophalangeal joints, often accompanied by lateral movements of the fingers. The motor disturbance may rarely involve the arms, neck, tongue, jaw and eyelids. It is usually bilateral, absent at rest, and asynchronous on each side. Option A is Murphy’s sign. Option B is rebound tenderness. Option D is Psoa’s sign.

43. The client who has acute pancreatitis tells Nurse Juris, “I Just want my gall bladder taken out now.” Nurse Juris best response should be which of the following?
a. “I don’t blame you but they want your pain under control first”
b. “Would you like to ask if your physician will schedule surgery today?”
c. “The symptoms are distressing, but the surgeon must wait until your gallbladder is less infected”
d. “They will try to dissolve the stones before they do the surgery”

Answer: C. “The symptoms are distressing, but the surgeon must wait until your gallbladder is less infected”
Rationale: With the advent of laparoscopic surgical technique, the only absolute contraindication for surgery is acute infection. The other options do not address this concern.

44. Mr. Prefix with cirrhosis was admitted to the hospital. Which of the following assessments made by Nurse Juris would indicate the development of portal hypertension?
a. Hematemesis
b. Elevated blood pressure
c. Asterixis
d. Confusion

Answer: A. Hematemesis
Rationale: In cirrhosis, the liver becomes fibrotic, which obstructs the venous blood flow through the liver. This increases the vascular pressure in the portal system, and causes congestion in the spleen and development of varicosities in the esophagus. Bleeding esophageal varices are a complication of portal hypertension and result in vomiting of blood (hematemesis) and possible hemorrhage and death.

45. Ms. Suffix with hepatitis is experiencing fatigue, weakness, and a general feeling of malaise. She tires rapidly during morning care. Based on this information, which of the following would be an appropriate nursing diagnosis?
a. Impaired physical mobility r/t malaise
b. Ineffective individual coping r/t long term illness
c. Self care deficit r/t fatigue
d. Activity intolerance r/t fatigue

Answer: D. Activity intolerance r/t fatigue
Rationale: This is the most appropriate diagnosis for this client. The major goal of care for the client with hepatitis is to increase activity gradually as tolerated. Periods of alternating rest and activity should be included in the plan of care. There is no evidence that the client is physically immobile, unable to provide self care, or coping ineffectively.

Situation 10: Nurse Shaggy is the staff nurse on duty in the Medical Floor. He is caring to clients with hepatobiliary and pancreatic disorders. Health teaching is his primary role for the quick recovery of his clients.

46. Ms. Demeanor has jaundice. Nurse Shaggy’s most appropriate comfort measure to implement is:
a. Offer hot beverages frequently
b. Encourage taking a hot bath or shower
c. Keep the air temperature at approximately 68O to 70O F
d. Suggest the use of alcohol based skin lotion

Answer: C. Keep the air temperature at approximately 68O to 70O F
Rationale: Jaundice frequently causes pruritus. Comfort measures include keeping the air temperature cool (68O to 70O F) and the humidity at 30 to 40 percent. Tepid baths (not hot) with colloidal agents decrease itching. Use of an emollient lotion is also helpful, but anything drying should be avoided. Hot beverages are of no benefit as a comfort measure for pruritus due to jaundice.

47. When teaching Mr. Gabrielle with hepatitis A about infection control, Nurse Shaggy explains that he is most infectious to others at which of these times?
a. 7 days exposure
b. 2 months after exposure
c. 10 days before the onset of symptoms
d. 14 days after symptoms begin

Answer: B. 2 months after exposure
Rationale: The incubation period for hepatitis A is 4 – 6 weeks in length with viral shedding highest 10 – 14 days before the onset of symptoms and during the first week of symptoms. The other options do not fall within this time frame.

48. Which of the following dietary instructions would be appropriate for Nurse Shaggy to give a client who is recovering from acute pancreatitis?
a. Avoid crash dieting
b. Eat six small meals day
c. Restrict carbohydrate intake
d. Decrease sodium in diet

Answer: A. Avoid crash dieting
Rationale: Crash dieting or bingeing may cause an acute attack of pancreatitis and should be voided. CHO intake should be increased, because CHO are less stimulating to the pancreas. There is no need to maintain a dietary pattern of six small meals a day; the client can eat whenever desired. There is no need to place the client on a sodium – restricted diet, because pancreatitis does not promote fluid retention.

49. Mr. Foxx who has ascites and peripheral edema is at risk for impaired skin integrity. Which of the following intervention would be implemented to prevent skin breakdown?
a. ROM exercises every 4 hours
b. Use of alternating air pressure mattress
c. Massage of the abdomen once a shift
d. Elevation of the lower extremities

Answer: B. Use of alternating air pressure mattress
Rationale: Edematous tissue is easily traumatized and must receive meticulous care. An alternating air pressure mattress will help decrease pressure on the edematous tissue. Range-of-motion exercises are important to maintain joint function, but they do not necessarily prevent skin breakdown. When abdominal skin is stretched taut (tightly) due to ascites, it must be cleaned very carefully. The abdomen should not be massaged. Elevation of the lower extremities promotes venous return and decrease swelling.

50. A male client with liver dysfunction reports that his gums bleed spontaneously. In addition, Nurse Shaggy notes small hemorrhagic lesions on his face. Nurse Shaggy recognizes that the client needs nutritional vitamin:
a. D
b. E
c. A
d. K

Answer: D. Vitamin K
Rationale: All options are fat soluble vitamins stored in the liver. Vitamin K (Aquamephyton) is necessary for the proper clotting of blood and helps promote bone health. Without sufficient amounts of vitamin K, hemorrhaging can occur. Vitamin D (Calciferol) is required for growth, especially bone growth or "calcification". Vitamin D plays a critical role in the body’s use of calcium and phosphorous. It increases the amount of calcium absorbed from the small intestine and helps form and maintain bones. Vitamin E (Tocopherol) is the most effective, fat-soluble antioxidant known to occur in the human body. It makes the specialized membranes that enclose the body cells much more stable and helps to protect the structures inside the cells, such as DNA, from damage by free radicals and other harmful chemicals. Vitamin A (Retinol) is an antioxidant chemical that is essential for normal vision (particularly night vision), a healthy immune system, healthy reproductive organ function and normal fetal development.

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