College of Nursing

FINAL COMPREHENSIVE INTEGRATED EXAMINATION

LEVEL 4
“If your actions inspire others to dream more, learn more, do more and become
more, you are a leader.”
- John Quincy Adams

Instruction: CHOOSE THE BEST ANSWER. Shade your choice of answer on the answer
sheet provided. Strictly NO ERASURES or SUPERIMPOSITIONS!

PSYCHIATRIC NURSING:
1. A 17-year-old client has a record of being absent in the class without permission, and
“borrowing” other people’s things without asking permission. The client denies stealing;
rationalizing instead that as long as no one was using the items, there is no problem to use it
by other people. It is important for the nurse to understand that psychodynamically, the
behavior of the client may be largely attributed to a development defect related to the:

A) Oedipal complex C) Id
B) Superego D) Ego
2. A client tells the nurse, “Yesterday, I was planning to kill myself.” What is the best nursing
response to this client?
A) “What are you going to do this time?”
B) Say nothing. Wait for the client’s next comment
C) “You seem upset. I am going to be here with you; perhaps you will want to talk about it”
D) “Have you felt this way before?”
3. In crisis intervention therapy, which of the following principle that the nurse will use to plan
her/his goals?
A) Crises are related to deep, underlying problems
B) Crises seldom occur in normal people’s lives
C) Crises may go on indefinitely.
D) Crises usually resolved in 4-6 weeks.
4. The nurse enters the room of the male client and found out that the client urinates on the
floor. The client hides when the nurse is about to talk to him. Which of the following is the
best nursing intervention?
A) Place restriction on the client’s activities when his behavior occurs.
B) Ask the client to clean the soiled floor.
C) Take the client to the bathroom at regular intervals.
D) Limit fluid intake.
5. A young lady with a diagnosis of schizophrenic reaction is admitted to the psychiatric unit. In
the past two months, the client has poor appetite, experienced difficulty in sleeping, was mute
for long periods of time, just stayed in her room, grinning and pointing at things. What would
be the initial nursing action on admitting the client to the unit?
A) Assure the client that “ You will be well cared for.”
B) Introduce the client to some of the other clients.
C) Ask “Do you know where you are?”
D) Take the client to the assigned room.
6. A 16-year-old girl was diagnosed with anorexia. What would be the first assessment of the
nurse?

A) What food she likes. C) Her body image.

B) Her desired weight. D) What causes her behavior.
7. On an adolescent unit, a nurse caring to a client was informed that her client’s closest
roommate dies at night. What would be the most appropriate nursing action?
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 A) Do not bring it up unless the client asks.
B) Tell the client that her roommate went home.
C) Tell the client, if asked, “You should ask the doctor.”
D) Tell the client that her closest roommate died.
8. A woman gave birth to an unhealthy infant, and with somebody defects. The nurse should
expect the woman’s initial reactions to include:

A) Depression C) Apathy
B) Withdrawal D) Anger
9. A client in the psychiatric unit is shouting out loud and tells the nurse, “Please, help me. They
are coming to get me.” What would be the appropriate nursing response?

A) “ I won’t let anyone get you.” C) “I don’t see anyone coming.”

B) “Who are they?” D) “You look frightened.”
10. A client who is severely obese tells the nurse, “My therapist told me that I eat a lot because I
didn’t get any attention and love from my mother. What does the therapist mean?” What is
the best nursing response?
A) “What do you think is the connection between your not getting enough love and
overeating?”
B) “Tell me what you think the therapist means.”
C) “You need to ask your therapist.”
D) “We are here to deal with your diet, not with your psychological problems.”
11. After the discussion about the procedure the physician scheduled the client for mastectomy.
The client tells the nurse, “If my breasts will be removed, I’m afraid my husband will not love
me anymore and maybe he will never touch me.” What should the nurse’s response?
A) “I doubt that he feels that way.”
B) “What makes you feel that way?”
C) “Have you discussed your feelings with your husband?”
D) Ask the husband, in front of the wife, how he feels about this.
12. The child is brought to the hospital by the parents. During assessment of the nurse, what
parental behavior toward a child should alert the nurse to suspect child abuse?

A) Ignoring the child. C) Expressions of guilt.

B) Flat affect. D) Acting overly solicitous toward the child
13. A nurse is caring to a client with manic disorder in the psychiatric ward. On the morning
shift, the nurse is talking with the client who is now exhibiting a manic episode with flight of
ideas. The nurse primarily needs to:
A) Focus on the feelings conveyed rather than the thoughts expressed.
B) Speak loudly and rapidly to keep the client’s attention, because the client is easily
distracted.
C) Allow the client to talk freely.
D) Encourage the client to complete one thought at a time.
14. The nurse is caring to an autistic child. Which of the following play behavior would the nurse
expect to see in a child?

A) competitive play C) cooperative play

B) nonverbal play D) solitary play
15. The client is telling the nurse in the psychiatric ward, “I hate them.” Which of the following is
the most appropriate nursing response to the client?
A) “Tell me about your hate.”
B) “I will stay with you as long as you feel this way.”
C) “For whom do you have these feelings?”
D) “I understand how you can feel this way.”
16. The mother visits her son with major depression in the psychiatric unit. After the
conversation of the client and the mother, the nurse asks the mother how it is talking to her
son. The mother tells the nurse that it was a stressful time. During an interview with the
client, the client says, “we had a marvelous visit.” Which of the following coping mechanism

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 can be described to the statement of the client?

A) Identification. C) Denial.
B) Rationalization. D) Compensation.
17. A male client is quiet when the physician told him that he has stage IV cancer and has 4
months to live. The nurse determines that this reaction may be an example of:

A) Indifference C) Resignation
B) Denial D) Anger
18. A nurse is caring to a female client with five young children. The family member told the
client that her ex-husband has died 2 days ago. The reaction of the client is stunned
silence, followed by anger that the ex-husband left no insurance money for their young
children. The nurse should understand that:
A) The children and the injustice done to them by their father’s death are the woman’s main
concern.
B) To explain the woman’s reaction, the nurse needs more information about the relationship
and breakup.
C) The woman is not reacting normally to the news.
D) The woman is experiencing a normal bereavement reaction.
19. A client who is manic comes to the outpatient department. The nurse is assigning an activity
for the client. What activity is best for the nurse to encourage for a client in a manic phase?
A) Solitary activity, such as walking with the nurse, to decrease stimulation.
B) Competitive activity, such as bingo, to increase the client’s self-esteem.
C) Group activity, such as basketball, to decrease isolation.
D) Intellectual activity, such as scrabble, to increase concentration.
20. The nurse is about to administer Imipramine HCI (Tofranil) to the client, the client says, “Why
should I take this?” The doctor started me on this 10days ago; it didn’t help me at all.”
Which of the following is the best nursing response:
A) “What were you expecting to happen?”
B) “It usually takes 2-3 weeks to be effective.”
C) “Do you want to refuse this medication? You have the right.”
D) “That’s a long time wait when you feel so depressed.”
21. Which of the following drugs the nurse should choose to administer to a client to prevent
pseudoparkinsonism?

A) Isocarboxazid (Marplan) C) Trihexyphenidyl HCI (Artane)

B) Chlorpromazine HCI (Thorazine) D) Trifluoperazine HCI (Stelazine)
22. The nurse is caring to an 80-year-old client with dementia? What is the most important
psychosocial need for this client?
A) Focus on the there-and-then rather the here-and-now.
B) Limit in the number of visitors, to minimize confusion.
C) Variety in their daily life, to decrease depression.
D) A structured environment, to minimize regressive behaviors.
23. A client tells the nurse, “I don’t want to eat any meals offered in this hospital because the
food is poisoned.” The nurse is aware that the client is expressing an example of:

A) Delusion. C) Negativism.
B) Hallucination. D) Illusion.
24. A client is admitted in the hospital. On assessment, the nurse found out that the client had
several suicidal attempts. Which of the following is the most important nursing action?
A) Ignore the client as long as he or she is talking about suicide, because suicide attempt is
unlikely.
B) Administer medication.
C) Relax vigilance when the client seems to be recovering from depression.
D) Maintain constant awareness of the client’s whereabouts.
25. The nurse suspects that the client is suffering from depression. During assessment, what
are the most characteristic signs and symptoms of depression the nurse would note?

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 A) Constipation, increased appetite. C) Diarrhea, anger.
B) Anorexia, insomnia. D) Verbosity, increased social interaction.
26. The client in the psychiatric unit states that, “The goodas are coming! I must be ready.” In
response to this neologism, the nurse’s initial response is to:
A) Acknowledge that the word has some special meaning for the client.
B) Try to interpret what the client means.
C) Divert the client’s attention to an aspect of reality.
D) State that what the client is saying has not been understood and then divert attention to
something that is really bound.
27. A male client diagnosed with depression tells the nurse, “I don’t want to look weak and I
don’t even cry because my wife and my kids can’t bear it.” The nurse understands that this
is an example of:

A) Repression. C) Undoing.
B) Suppression. D) Rationalization.
28. A female client tells the nurse that she is afraid to go out from her room because she thinks
that the other client might kill her. The nurse is aware that this behavior is related :
A) Hallucination. C) Delusion of persecution.
B) Ideas of reference. D) Illusion.
29. A female client is taking Imipramine HCI (Tofranil) for almost 1 week and shows less
awareness of the physical body. What problem would the nurse be most concerned?

A) Nausea. C) Bowel movements.

B) Gait disturbances. D) Voiding.
30. A 6-year-old client dies in the nursing unit. The parents want to see the child. What is the
most appropriate nursing action?
A) Give the parents time alone with the body.
B) Ask the physician for permission.
C) Complete the postmortem care and quietly accompany the family to the child’s room.
D) Suggest the parents to wait until the funeral service to say “good-bye.”
31. A 20-year-old female client is diagnosed with anxiety disorder. The physician prescribed
Flouxetine (Prozac). What is the most important side effects should a nurse be concerned?

A) Tremor, drowsiness. C) Visual disturbance, headache.

B) Seizures, suicidal tendencies. D) Excessive diaphoresis, diarrhea.
32. A nurse is assigned to activate a client who is withdrawn, hears voices and negativistic.
What would be the best nursing approach?
A) Mention that the “voices” would want the client to participate.
B) Demand that the client must join a group activity.
C) Give the client a long explanation of the benefits of activity.
D) Tell the client that the nurse needs a partner for an activity.
33. A nurse is going to give a rectal suppository as a preoperative medication to a 4-year-old
boy. The boy is very anxious and frightened. Which of the following statement by the
nurse would be most appropriate to gain the child’s cooperation?
A) “Be a big kid! Everyone’s waiting for you.”
B) “Lie still now and I’ll let you have one of your presents before you even have your
operation.”
C) “Take a nice, big, deep breath and then let me hear you count to five.”
D) “You look so scared. Want to know a secret? This won’t hurt a bit!”
34. A depressed client is on an MAO inhibitor? What should the nurse watch out for?

A) Hypertensive crisis. C) Taking medication with meals.

B) Diet restrictions. D) Exposure to sunlight.
35. A 16-year-old girl is admitted for treatment of a fracture. The client shares to the
nurse caring to her that her step-father has made sexual advances to her. She got the
chance to tell it to her mother but refuses to believe. What is the most therapeutic action
of the nurse would be:
A) Tell the client to work it out with her father.
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 B) Tell the client to discuss it with her mother.
C) Ask the father about it.
D) Ask the mother what she thinks.
36. A client with a diagnosis of paranoid disorder is admitted in the psychiatric hospital. The
client tells the nurse, “the FBI is following me. These people are plotting against me.” With
this statement the nurse will need to:
A) Acknowledge that this is the client’s belief but not the nurse’s belief.
B) Ask how that makes the client feel.
C) Show the client that no one is behind.
D) Use logic to help the client doubt this belief.
37. A nurse is completing the routine physical examination to a healthy 16-year-old male client.
The client shares to the nurse that he feels like killing his girlfriend because he found out
that her girlfriend had another boyfriend. He then laughs, and asks the nurse to keep this a
secret just between the two of them. The nurse reviews his chart and notes that there is no
previously history of violence or psychiatric illness. Which of the following would be the best
action of the nurse to take at this time?
A) Suggest the teen meet with a counselor to discuss his feelings about his girlfriend.
B) Tell the teen that his feelings are normal, and recommend that he find another girlfriend to
take his mind off the problem.
C) Recall the teenage boys often say things they really do not mean and ignore the
comment.
D) Regard the comment seriously and notify the teen’s primary health care provider and
parents.
38. Which of the following person will be at highest risk for suicide?
A) A student at exam time
B) A married woman, age 40, with 6 children.
C) A person who is an alcoholic.
D) A person who made a previous suicide attempt.
39. A male client is repetitively doing the handwashing every time he touches things. It is
important for a nurse to understand that the client’s behavior is probably an attempt to:
A) Seek attention from the staff.
B) Control unacceptable impulses or feelings.
C) Do what the voices the patient hears tell him or her to do.
D) Punish himself or herself for guilt feeling.
40. In a mental health settings, the basic goal of nursing is to:
A) Advance the science of psychiatry by initiating research and gathering data for current
statistics on emotional illness.
B) Plan activity programs for clients.
C) Understand various types of family therapy and psychological tests and how to interpret
them.
D) Maintain a therapeutic environment.
41. A 3-year-old boy is brought to the emergency department. After an hour, the boy dies of
respiratory failure. The mother of the boy becomes upset, shouting and abusive, saying to
the nurse, “If it had been your son, they would have done more to save it. “What should the
nurse say or do?
A) Touch her and tell her exactly what was done for her baby.
B) Allow the mother to continue her present behavior while sitting quietly with her.
C) “No, all clients are given the same good care.”
D) “Yes, you’re probably right. Your son did not get better care.”
42. The nurse is interacting to a client with an antisocial personality disorder. What would be
the most therapeutic approach of the nurse to an antisocial behavior?
A) Gratify the client’s inner needs.
B) Give the client opportunities to test reality.
C) Provide external controls.
D) Reinforce the client’s self-concept.
43. A 55-year-old male client tells the nurse that he needs his glasses and hearing aid with him
in the recovery room after the surgery, or he will be upset for not granting his request. What
is the appropriate nursing response?
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 A) “Do you get upset and confused often?”
B) “You won’t need your glasses or hearing aid. The nurses will take care of you.”
C) “I understand. You will be able to cooperate best if you know what is going on, so I will find
out how I can arrange to have your glasses and hearing aid available to you in the recovery
room.”
D) I understand you might be more cooperative if you have your aid and glasses, but that is
just not possible. Rules, you know.”
44. The male client had fight with his roommates in the psychiatric unit. The client agitated
client is placed in isolation for seclusion. The nurse knows it is essential that:
A) A staff member has frequent contacts with the client.
B) Restraints are applied.
C) The client is allowed to come out after 4 hours.
D) All the furniture is removed from the isolation room.
45. A medical representative comes to the hospital unit for the promotion of a new product. A
female client, admitted for hysterical behavior, is found embracing him. What should the
nurse say?
A) “Have you considered birth control?”
B) “This isn’t the purpose of either of you being here.”
C) “I see you’ve made a new friend.”
D) “Think about what you are doing.”
46. A client with dementia is for discharge. The nurse is providing a discharge instruction to the
family member regarding safety measures at home. What suggestion can the nurse make to
the family members?
A) Avoid stairs without banisters.
B) Use restraints while the client is in bed to keep him or her from wandering off during the
night.
C) Use restraints while the client is sitting in a chair to keep him or her from wandering off
during the day.
D) Provide a night-light and a big clock.
47. A 30-year-old married woman comes to the hospital for treatment of fractures. The woman
tells the nurse that she was physically abused by her husband. The woman receives a call
from her husband telling her to get home and things will be different. He felt sorry of what he
did. What can the nurse advise her?

A) “Do you think so?” C) “What will be different?”

B) “It’s not likely.” D) “I hope so, for your sake.”
48. A female client was diagnosed with breast cancer. It is found to be stage IV, and a modified
mastectomy is performed. After the procedure, what behaviors could the nurse expects the
client to display?

A) Denial of the possibility of carcinoma. C) Relief that the operation is over.

B) Signs of grief reaction. D) Signs of deep depression.
49. A client is withdrawn and does not want to interact to anybody even to the nurse. What is
the best initial nursing approach to encourage communication with this client?
A) Use simple questions that call for a response.
B) Encourage discussion of feelings.
C) Look through a photo album together.
D) Bring up neutral topics.
50. Which of the following nursing approach is most important in a client with depression?
A) Deemphasizing preoccupation with elimination, nourishment, and sleep.
B) Protecting against harm to others.
C) Providing motor outlets for aggressive, hostile feelings.
D) Reducing interpersonal contacts.
MATERNAL AND CHILD HEALTH NURSING:
Situation: Mrs. Reyes, a gravida III, para II, has an uneventful labor and delivery. After a 7 hours
labor she delivers a 3.69kgs.a baby boy spontaneously.
51. Two hours after delivery, the nurse finds that Mrs. Reyes’s fundus is firm, shifted to the
right, and two fingers above the umbilicus, this would indicate:
A. A normal process C. Retained secundines
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 B. A full bladder D. Impending bleeding
52. After delivery, when checking Mrs. Reyes’s vital signs, the nurse should normally find:
A. An elevated basal temperature with a decrease in respirations
B. Bradycardia with no change in respirations
C. A decided tachycardia with decrease in respirations
D. A slight lowering of basal temperature with an increase in respiration
53. 8 hrs after delivery the nurse notices that Mrs. Reyes is voiding frequently in small amounts.
Intake and output are important in the early postpartum period, since small amounts of output:
A. Are commonly voided and should cause no alarm.
B. May be indicative of beginning glomerulonephritis
C. May indicate retention of urine with overflow
D. Are common because less fluid is excreted following delivery
54. In helping Mrs. Reyes develop her parenting role, the nurse should:
A. Do things for the baby in the mother’s presence
B. Find out what she knows about babies and proceed from there
C. Demonstrate baby bathing and care before discharge
D. Provide enough time for her and the baby together
55. Mrs. Reyes’s infant develops a cephalhematoma. The nurse should plan to explain to Mrs.
Reyes that:
A. This condition is unusual with vaginal delivery
B. It will resolve spontaneously in 3-6 weeks
C. The swelling may cross a suture line
D. The soft sac will bulge when the infant cries
56. Nursing care of baby Reyes is directed primarily toward:
A. Supporting the parents C. Recording neurologic signs
B. Applying ice packs to the hematoma D. Protecting the infant’s head
Mrs. Gordon, 24 y/o is 6 months pregnant with her second child and is being visited at home by a
community health nurse as part of her prenatal care. The nurse knows that her lunch includes salami,
cheese, and cola drink. During the assessment the notes edema in her ankle:
57. Besides advising rest with legs elevated, the nurse discussed the foods Mrs. Gordon has
been eating and gives instructions concerning her diet. In this instance:
A. Dietary preferences must influence the food that is eaten
B. The food selected should have moderate salt content
C. The nutritionist should be brought in to plan a diet
D. The client should be advised to attend the prenatal clinic to see the physician.
58. Mrs. Gordon complains of constipation. The nurse should explain constipation frequently
occurs during pregnancy because of:
A. Pressure of the growing uterus on the anus
B. Increased intake of milk as recommended during pregnancy
C. The slowing of peristalsis in the GIT
D. Changes in the metabolic rate.
59. Mrs. Gordon begins labor close to her expected date of delivery and is admitted to the
hospital. The nurse notices a gush of fluid from the client’s vagina. After checking the FHR the
nurse should:
A. Notify the physician immediately about the gush of fluid from the vagina
B. Place the client in a modified lithotomy position and inspect the perineum
C. Keep the client flat in bed and elevate her legs
D. Place the client on her side and obtain her BP.
60. After several hours of labor the physician orders oxytocin. When a client in labor is being
infused with oxcytocin, it is the nurse’s responsibility to:
A. Obtain a physician’s order to slow the IV in the presence of hypertonic contraction s
B. Flush the IV tubing if the flow slows
C. Shut off the IV in the presence of hypertonic contractions
D. Monitor FHT q2h
61. The nurse knows that Mrs. Gordon has begun the transitional phase of labor when she:
A. Complains of severe pains at the back C. Perspires and her face flashes
B. States that the pain has lessened D. Assumes the lithotomy position
62. Shortly following delivery, Mrs. Gordon says she feels like she is bleeding. On checking the
fundus the nurse finds a steady trickling of blood from the vagina. The fist action should be to:
A. Call the physician immediately
B. Check client’s BP
C. Hold the fundus firmly and massage it gently
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 D. Take no action since this a common occurrence
Juanita has been married for 1-1/2 years. She stopped taking oral contraceptives several months ago
and now suspects she is pregnant. She is being seen by her physician for the first time.
63. Juanita has numerous common signs and symptoms associated with pregnancy. Which of the
following signs suggests she is probably pregnant?
A. Amenorrhea C. Enlarged and tender abdomen
B. Frequent micturition D. Goodell’s sign
64. Which of the following is true of pregnancy test done on urine samples?
A. A positive test is based on increased estrogen excretion in the urine
B. 100% accurate if done 10-14 days after fertilization
C. A positive test is based on the excretion of chorionic gonadotropin in the urine
D. Home pregnancy test are not accurate, and client should be cautioned not to use them
65. Juanita is concerned about eating the proper foods during her pregnancy. Which of the
following nursing actions is the most appropriate?
A. Give her list of foods to refer to in planning her meals
B. Emphasize the importance of limiting highly seasoned and salty foods
C. Ask Juanita to list her food intake for the last 3 days
D. Instruct her to continue her usual diet, as she appears to be nutritionally fit.
66. Juanita has low hemoglobin. When counseling her to increase her iron intake, which of the
following meals should the nurse recommend to her?
A. Ham sandwich, corn pudding, tossed salad C. Hamburger, green beans, fruit cup
B. Chicken livers, sliced tomatoes, dried apricot D. Omelet with mushrooms,
spinach salad
67. The nurse should instruct Juanita to notify the physician immediately if which of the following
symptoms occur?
A. Swelling of the face C. Frequent micturition
B. Increased vaginal discharge D. the presence of chloasma
68. Which of the following changes is a pregnant woman most likely to notice in her breast?
A. Darkening of the areola, tingling sensation, engorgement
B. Lightening of the areola, colostrums, increased size
C. Colostrums, tingling sensations, darkening of the areola
D. Increased nipple size, tenderness, flattening of the nipples.
69. Which of the following symptoms would be considered normal if found while assessing
Juanita?
A. Vaginal bleeding and 1+ albuminuria
B. Oliguria and glycosuria
C. 1+ sugar in the urine and urinary frequency
D. Swelling of the face and increased vaginal discharge
70. Constipation in pregnancy is best treated by:
A. Regular use of mild laxative suppositories C. Limiting excessive weight pain
B. Increased bulk and fluid in the diet D. Regular use of Bisacodyl
PEDIATRIC NURSING:
Mrs. Lopez brings her 3 y/o Tony to the ER indicating he has had a fever for several days, has held
his neck rigid, and is now vomiting. While being examined he has a convulsion and is admitted to the
pediatric unit.
71. While instituting nursing measures to reduce Tony’s fever, the nurse recognizes that an
important consideration is to:
A. Monitor vital signs every 10 min. C. Measure output every hour
B. Force fluids D. Limit exposure to prevent shivering
72. One morning while Tony is in his crib, the nurse notes that his jaws are clamped and he is
having seizure. The most important nursing responsibility at this time is to:
A. Insert a padded tongue blade C. Protect from harm from the environment
B. Start oxygen at 10L per mask D. Restrain to prevent injury to soft tissue
73. Febrile convulsions are common in children and:
A. Usually occur after the first year of life C. May occur in minor illness
B. The cause is usually readily identified D. Occur more frequently in female
than male
74. Tony is being diagnosed as having meningococcal meningitis. The nurse observes Tony for
the:
A. Identifying purpuric skin rash C. Low-grade nature of the fever
B. Continual tremors of the extremities D. Palatal paralysis and glossitis
75. The most serious complication of meningitis in young children is:
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 A. Hydrocephalus C. Peripheral circulatory collapse
B. Blindness D. Epilepsy
Two year old, John is brought to the clinic. Her mother states that he has been irritable and noticed
swollen glands on the neck. After examination a diagnosis of otitis media is made and analgesic
eardrops ordered.
76. To teach the correct way of administering eardrops to a small child, the nurse should instruct
the parent to position the child on the right side and instill the drop while pulling the auricle:
A. Straight back C. Forward
B. Up and back D. Down and back
77. Physiologically the middle ear ( containing the 3 ossicles ) serves primarily to:
A. Communicate with the throat via the Eustachian tube
B. Amplify the energy of sound waves entering the ear
C. Translate sound wave into nerve impulses
D. Maintain balance
Baby boy, 8 days old, is diagnosed to have Down’s syndrome
78. In caring for the Boy, the nurse recognizes that he will have:
A. A developmental lag after 1-2 years of age C. Proneness of URTI
B. High incidence of circulatory problems D. Difficulty in hearing
79. The symptom of Down syndrome that is most evident to the nurse during the initial
assessment of the newborn would be:
A. Asymmetric glueteal folds C. A rounded occiput
B. Hypertonicity of the skeletal muscles D. A simian crease
80. Special nursing care for baby boy should include:
A. Frequent handling and rocking to keep him from crying
B. Helping the parent learn about their child
C. Teaching the infant to nipple-feed
D. Preventing aspirations of formula by frequent bubbling
81. When observing a newborn with Down’s syndrome, the nurse should be aware that a common
defect associated with the condition is:
A. Deafness C. Hydrocephaly
B. Congenital heart defect D. Muscular hypertonicity
82. The factor that would be probably significant for the nurse working with in the family is then:
A. Response to their family and friends reaction to their infant
B. Ability to give physical care to their infant
C. Ability to talk about changing plans they had made for their infant.
D. Understanding of the factors causing Down’s Syndrome
83. As Boy grows, his development lag is assessed and it is found that he is moderately retarded.
The suggestion that would be most helpful to his parents:
A. Offer challenging, competitive situation
B. Offer simple, repetitive tasks
C. Concentrate on teaching detailed task
D. Offer complete directions at the beginning of the task to be accomplished
84. The handicapped child has the same needs as the normal child, although his means of
satisfying these needs are limited. This limitation frequently causes:
A. Emotional disability C. Frustration
B. Overcompensation D. Rejection
MEDICAL AND SURGICAL NURSING:
Nine- month old Anna has been admitted in the pedia ward with vomiting, colicky abdominal pain, and
abdominal distension. A tentative diagnosis of intussusceptions is made.
85. When assessing Anna, which type of stool indicates a worsening of Anna’s condition?
A. Fatty, bulky, foul smelling stool C. Ribbon-like, dark green
B. Dark red, jelly-like D. Clay colored
86. Anna is scheduled for surgery. Her parents are anxious and ask what will be done in surgery.
Which explanation should be given?
A. The sigmoid colon will be resected with a pull-through anastomosis
B. The obstruction will be corrected by manual reduction
C. The affected portion of the intestine will be resected with an end-to-end anastomosis
D. The ileum will be resected and a permanent ileostomy created
87. Anna’s parents ask what is wrong with her intestines. Which statements best describes Anna’s
condition:
A. A telescoping of one part of the bowel into amore distal part
B. Malrotation of the intestine
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 C. Atresia of the intestine tract
D. Absence of parasympathetic ganglion cells
88. Preoperatively, the priority- nursing goal for Anna is to :
A. Maintain Anna’s attachment to her parents
B. Meet Anna’s need for sucking and comfort while she is NPO
C. Maintain adequate hydration
D. Promote adequate rest and sleep
89. Following surgery, Anna returns to the unit. She is fussy and seems to be in discomfort. The
nurse palpates her abdomen and notes some distention. Which action should be implemented
first:
A. Call the surgeon to report this observation C. Sit Anna upright and pat her back
B. Insert a rectal tube D. Check the NGT for patency
90. What is the potentially greatest threat to Anna’s continued development while she is
hospitalized?
A. Developing mistrust of nursing staff C. Restricted mobility
B. Disruption in her sleeping and eating routine D. Separation from parents
Mrs. Santos, age 40 was admitted to the hospital after complaining of right- sided weakness, slurring
of speech, dysphagia, and some visual disturbances. She has a history of hypertension. The
admitting diagnosis is CVA.
91. What is the most probable cause of the admitting symptom?
A. Transient ischemic attack C. Cerebral aneurysm
B. Cerebral hemorrhage D. Meningitis
92. Mrs. Santos is incontinent during the first few hours of her hospitalization. What would be the
most satisfactory means of handing this problem?
A. Restrict oral fluid intake C. Insert indwelling catheter
B. Offer the bedpan q4h D. Apply disposable diapers
93. While you are bathing the client, she begins to matter something unintelligible about the
“plant”, while pointing excitedly at a glass of water at the bedside stand. She indicates in
pantomime that she wants a drink of water. This behavioral observation is most characteristic
of which of the following type of aphasia?
A. Visual aphasia C. Receptive aphasia
B. Hysterical aphasia D. Expressive aphasia
94. This type of aphasia occurs when the injury is in the speech center. Where in the brain is the
speech center located?
A. Medulla oblongata C. Occipital lobe
B. Around the center fissure (Broca’s area) D. Parietal lobe
95. What would be the most therapeutic approach when Mrs. Santos’s aphasia is severe?
A. Anticipate her wishes so that she will not need to speak
B. Communicate by means of questions that can be answered by shaking her head
C. Keep up steady flow of talk to minimize her silence
D. Encourage her to speak at every possible opportunity
96. When Mrs. Santos is attempting to talk she becomes frustrated. Her family asks you how to
deal with this problem. What is your best advice?
A. They should continue to encourage her
B. It may be their frustration rather than Mrs. Santos’s
C. It will help if they anticipate her needs more
D. Be patient and do not expect too much progress at this time
97. Mrs. Santos has still dysphagia, but she is beginning to eat solid foods. What is the most
important aspect when assisting her to eat?
A. Use a bulb syringe when giving her food
B. Praise her consistently if she can feed herself
C. Keep her position in a semi-Fowler’s position.
D. Allow her to attempt to feed herself
98. Mrs. Santos asks if her right arm and leg will always be paralyzed. The nurse’s answer is
primarily based on the knowledge that:
A. Much of the initial paralysis due to the edema of the brain tissue.
B. Stroke are characterized by function, rather than organic changes
C. Neurons will be regenerated to replace the damage ones
D. Her neurologic status cannot be predicted this early
99. When is the best time to begin the rehabilitation plan for Mrs. Santos?
A. When the physician orders it
B. 24 hours after the critical phase of the illness
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 C. Upon admission to the hospital
D. When the entire health team can meet and decide on a comprehensive program.
100. Which of the following will be considered as the most vital to success or failure of the
rehabilitation program?
A. Physicians C. Significant others or family members
B. Nursing staff D. Physical therapist.

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