FUNDAMENTALS OF NURSING
Final Coaching Exam – Dr. Aleni Iray
SITUATION: Mr. Andrae Go is assigned to the triage c. Pull skin of patient down to administer the
area and while on duty, he assesses the condition of drug in a Z track – Z track is for deep IM
Mrs. David who came in with asthma. She has d. Spread skin or pinch at the injection site
difficulty breathing and her respiratory rate is 40 and inject needle at a 45-90 degree angle
beats per minute. Mr. Go is asked to inject the client
epinephrine 0.3mg subcutaneously. The following
Subcutaneous – to facilitate the slow
questions refer to this situation.
release
1. The indication for epinephrine injection for 4. When preparing for a subcutaneous injection,
Mrs. David is to: the proper size of syringe and needle would be:
a. Reduce anaphylaxis a. Syringe 3-5ml and needle gauge 21 to 23 –
b. Relieve hypersensitivity to allergen IM
c. Relieve respiratory distress due to b. Tuberculin syringe 1 ml with needle gauge 26
bronchial spasm or 27
d. Restore client’s cardiac rhythm c. Syringe 2ml and needle gauge 22
d. Syringe 1-3ml and needle gauge 25 to
2. When preparing the epinephrine injection 27
from an ampule, Nurse Andrae initially:
SITUATION. Frank has a nursing diagnosis of
a. Taps the ampule at the top to allow fluid to
ineffective airway clearance related to excessive
flow to the base of the ampule
secretions and is at risk for infection because of
b. Checks expiration date of the
retained secretions. Part of Nurse Mario's nursing
medication ampule
care plan is to loosen and remove excessive
c. Removes needle cap of syringe and pulls
secretions in the airway.
plunger to expel air
d. Breaks the neck of the ampule with a gauze
wrapped around it 5. Nurse Mario knows he can perform chest
physiotherapy:
3. Mrs. David is obese. When administering a
subcutaneous injection to an obese patient, it is a. Immediately before meals – we do this before
best for Nurse Andrae to: meals but not immediately
a Inject needle at a 15 degree angle' over the b. One hour after meals
stretched skin of the client c. During meals
b. Pinch skin at the Injection site and use airlock d. Before bedtime – para maginhawa ang
technique tulog
, 6. When assessing Frank for chest percussion or c. From the tip of the nose to the tip of the
chest vibration and postural drainage Mario ear lobe to the xiphoid process
would focus on the following, EXCEPT: d. Eight to ten inches from the tip of the nose to
the sternum
a. Amount of food and fluid taken during the last
meal before treatment SITUATION. Mrs. Sales, 49 years old, asks you
b. Respiratory rate, breath sounds and location about possible problems regarding her elimination
of congestion now that she is in the menopausal stage.
c. Teaching the client's relatives to
perform the procedure
9. Instruction on health promotion regarding
d. Doctor's order regarding position restriction
urinary elimination is important. Which would
and client's tolerance for lying flat
you include?
SITUATION. Using Maslow's need theory, Airway, a. Hold urine, as long as she can before
Breathing and Circulation are the physiological emptying the bladder to strengthen her
needs vital to life. The nurse's knowledge and sphincters muscles
ability to identify and immediately intervene to meet b. If burning sensation is experienced while
these needs is important to save lives. voiding, drink cola
c. After urination, wipe from anal area up
Physiologic needs: towards the pubis
Air/ Oxygen d. Tell client to empty the bladder at each
water voiding
food
Make sure that there is no residual urine
7. Which of these clients has a problem with the
transport of oxygen from the lungs to the 10. Mrs. Sales asked for instructions for skin
tissues: care for her mother who has urinary
incontinence and is almost always in bed. Your
a. Carol with a tumor in the brain instruction would focus on prevention of skin
b. Theresa with anemia - capacity to carry irritation and breakdown by:
oxygen
c. Sonny Boy with a fracture in the femur a. Using thick diapers to absorb urine well
d. Brigette with diarrhea b. Drying the skin with baby powder to prevent
or mask the smell of ammonia
8. To determine how long the nasogastric tube c. Thorough washing, rinsing and drying of
must be to reach the stomach of the patient, the skin area that gets wet with urine
nurse should hold the end of the tube: d. Making sure that linen are smooth and dry at
all times
a. From the tip of the nose to the base of the
neck
b. From the tip of the nose to the middle of the
cheek to the xiphoid process
, 11. Mrs. Sales also tells the nurse that she is a. The nurse must look for another registered
often constipated. Because she is aging, what nurse to double check the bag
physical changes predispose her to constipation? b. The nurse must add 10ml of normal saline to
the bag to remove the bubbles
a. Inhibition of the parasympathetic reflex c. The nurse must return the bag to the
b. Esophageal emptying hastens blood bank for replacement
c. Loss of tone of the smooth muscles of d. The nurse must add 100 units of Heparin to
the colon the bag
d. Decreased ability to absorb fluids in the lower
intestines Bubbling – sign of bacterial growth
12. Chronic Obstructive Pulmonary Disease 15. A physician orders 1L of normal saline
(COPD) is one of the leading causes of death solution to infuse over 8 hours. The drop factor
worldwide and is a preventable disease. The is 15 drops per 1 ml. Nurse Corazon prepares to
primary cause of COPD is: set the flow rate at how many drops per minute?
a. High cholesterol diet a. 20 gtts/minute
b. Bronchitis b. 28 drops per minute
c. Asthma c. 31 gtts/minute
d. Cigarette smoking d. 22 drops per minute
13. Lifestyle-related diseases in general share Total Vol x gtts factor
common risk factors. These are the following Time (60)
except:
1,000 ml x 15 gtts = 31.25
a. Physical activity 8 = 60
b. Smoking
c. Genetics 16. A physician tells Nurse Corazon that the
d. Nutrition client’s intravenous line will be discontinued. She
should obtain which of the following supplies
SITUATION: Nurse Corazon is assigned in the from the unit supply area for use in applying
Manila Toprank Hospital. She is administering pressure to the IV site after removing the
various medications and intravenous therapies to intravenous (IV) catheter?
her patients.
a. Sterile gauze
b. Adhesive bandage
14. Nurse Corazon has just received a unit of
c. Betadine swab
packed red blood cells from the blood bank to
d. Alcohol swab
transfuse into a client as ordered. Before
preparing the blood for transfusion, Nurse
17. A physician’s order reads Potassium chloride
Corazon noticed the presence of bubbles in the
(KCl) 30mEq to be added to 1L ml normal saline
bag. She should take which of the following
and to be given over 10-hour period. The
actions?
Final Coaching Exam – Dr. Aleni Iray
SITUATION: Mr. Andrae Go is assigned to the triage c. Pull skin of patient down to administer the
area and while on duty, he assesses the condition of drug in a Z track – Z track is for deep IM
Mrs. David who came in with asthma. She has d. Spread skin or pinch at the injection site
difficulty breathing and her respiratory rate is 40 and inject needle at a 45-90 degree angle
beats per minute. Mr. Go is asked to inject the client
epinephrine 0.3mg subcutaneously. The following
Subcutaneous – to facilitate the slow
questions refer to this situation.
release
1. The indication for epinephrine injection for 4. When preparing for a subcutaneous injection,
Mrs. David is to: the proper size of syringe and needle would be:
a. Reduce anaphylaxis a. Syringe 3-5ml and needle gauge 21 to 23 –
b. Relieve hypersensitivity to allergen IM
c. Relieve respiratory distress due to b. Tuberculin syringe 1 ml with needle gauge 26
bronchial spasm or 27
d. Restore client’s cardiac rhythm c. Syringe 2ml and needle gauge 22
d. Syringe 1-3ml and needle gauge 25 to
2. When preparing the epinephrine injection 27
from an ampule, Nurse Andrae initially:
SITUATION. Frank has a nursing diagnosis of
a. Taps the ampule at the top to allow fluid to
ineffective airway clearance related to excessive
flow to the base of the ampule
secretions and is at risk for infection because of
b. Checks expiration date of the
retained secretions. Part of Nurse Mario's nursing
medication ampule
care plan is to loosen and remove excessive
c. Removes needle cap of syringe and pulls
secretions in the airway.
plunger to expel air
d. Breaks the neck of the ampule with a gauze
wrapped around it 5. Nurse Mario knows he can perform chest
physiotherapy:
3. Mrs. David is obese. When administering a
subcutaneous injection to an obese patient, it is a. Immediately before meals – we do this before
best for Nurse Andrae to: meals but not immediately
a Inject needle at a 15 degree angle' over the b. One hour after meals
stretched skin of the client c. During meals
b. Pinch skin at the Injection site and use airlock d. Before bedtime – para maginhawa ang
technique tulog
, 6. When assessing Frank for chest percussion or c. From the tip of the nose to the tip of the
chest vibration and postural drainage Mario ear lobe to the xiphoid process
would focus on the following, EXCEPT: d. Eight to ten inches from the tip of the nose to
the sternum
a. Amount of food and fluid taken during the last
meal before treatment SITUATION. Mrs. Sales, 49 years old, asks you
b. Respiratory rate, breath sounds and location about possible problems regarding her elimination
of congestion now that she is in the menopausal stage.
c. Teaching the client's relatives to
perform the procedure
9. Instruction on health promotion regarding
d. Doctor's order regarding position restriction
urinary elimination is important. Which would
and client's tolerance for lying flat
you include?
SITUATION. Using Maslow's need theory, Airway, a. Hold urine, as long as she can before
Breathing and Circulation are the physiological emptying the bladder to strengthen her
needs vital to life. The nurse's knowledge and sphincters muscles
ability to identify and immediately intervene to meet b. If burning sensation is experienced while
these needs is important to save lives. voiding, drink cola
c. After urination, wipe from anal area up
Physiologic needs: towards the pubis
Air/ Oxygen d. Tell client to empty the bladder at each
water voiding
food
Make sure that there is no residual urine
7. Which of these clients has a problem with the
transport of oxygen from the lungs to the 10. Mrs. Sales asked for instructions for skin
tissues: care for her mother who has urinary
incontinence and is almost always in bed. Your
a. Carol with a tumor in the brain instruction would focus on prevention of skin
b. Theresa with anemia - capacity to carry irritation and breakdown by:
oxygen
c. Sonny Boy with a fracture in the femur a. Using thick diapers to absorb urine well
d. Brigette with diarrhea b. Drying the skin with baby powder to prevent
or mask the smell of ammonia
8. To determine how long the nasogastric tube c. Thorough washing, rinsing and drying of
must be to reach the stomach of the patient, the skin area that gets wet with urine
nurse should hold the end of the tube: d. Making sure that linen are smooth and dry at
all times
a. From the tip of the nose to the base of the
neck
b. From the tip of the nose to the middle of the
cheek to the xiphoid process
, 11. Mrs. Sales also tells the nurse that she is a. The nurse must look for another registered
often constipated. Because she is aging, what nurse to double check the bag
physical changes predispose her to constipation? b. The nurse must add 10ml of normal saline to
the bag to remove the bubbles
a. Inhibition of the parasympathetic reflex c. The nurse must return the bag to the
b. Esophageal emptying hastens blood bank for replacement
c. Loss of tone of the smooth muscles of d. The nurse must add 100 units of Heparin to
the colon the bag
d. Decreased ability to absorb fluids in the lower
intestines Bubbling – sign of bacterial growth
12. Chronic Obstructive Pulmonary Disease 15. A physician orders 1L of normal saline
(COPD) is one of the leading causes of death solution to infuse over 8 hours. The drop factor
worldwide and is a preventable disease. The is 15 drops per 1 ml. Nurse Corazon prepares to
primary cause of COPD is: set the flow rate at how many drops per minute?
a. High cholesterol diet a. 20 gtts/minute
b. Bronchitis b. 28 drops per minute
c. Asthma c. 31 gtts/minute
d. Cigarette smoking d. 22 drops per minute
13. Lifestyle-related diseases in general share Total Vol x gtts factor
common risk factors. These are the following Time (60)
except:
1,000 ml x 15 gtts = 31.25
a. Physical activity 8 = 60
b. Smoking
c. Genetics 16. A physician tells Nurse Corazon that the
d. Nutrition client’s intravenous line will be discontinued. She
should obtain which of the following supplies
SITUATION: Nurse Corazon is assigned in the from the unit supply area for use in applying
Manila Toprank Hospital. She is administering pressure to the IV site after removing the
various medications and intravenous therapies to intravenous (IV) catheter?
her patients.
a. Sterile gauze
b. Adhesive bandage
14. Nurse Corazon has just received a unit of
c. Betadine swab
packed red blood cells from the blood bank to
d. Alcohol swab
transfuse into a client as ordered. Before
preparing the blood for transfusion, Nurse
17. A physician’s order reads Potassium chloride
Corazon noticed the presence of bubbles in the
(KCl) 30mEq to be added to 1L ml normal saline
bag. She should take which of the following
and to be given over 10-hour period. The
actions?
