Instructions: Get a pen/pencil and a piece of paper for your answers.

FOUNDATION OF PROFESSIONAL NURSING PRACTICE

Situation 1: Mr. Martin, 71 years old was suddenly rushed to the hospital because of severe chest pain. On admission, he was diagnosed to have acute myocardial infarction and was placed in the ICU.

1. While in the ICU, he executes the document tat list the medical treatment he chooses to refuse in case his condition becomes severe to a point that he will be unable to make decisions for himself. This document is:

A. living will
B. informed consent
C. last will and testament
D. power of attorney

2. After one day, the patient’s condition worsened and feeling hopeless. He requested the nurse to remove the oxygen. The nurse should:

A. follow the patient because it is his right to die gracefully
B. follow the patient as it is his right to determine the medical regimen he needs
C. refuse the patient and encourage him to verbalize hid feelings
D. refuse the patient since euthanasia is not accepted in the Philippines

3. Euthanasia is an ethical dilemma which confronts nurses in the ICU because:

A. the choices involved do not appear to be clearly right or wrong
B. a clients legal right co-exist with the nurse’s professional obligation
C. decisions has to be made based on societal norms.
D. decisions has to be mad quickly, often under stressful conditions

4. A nurse who supports a patient and family’s need to make decisions that is right for them is practicing which of the following ethical principles?

A. Autonomy
B. confidentiality
C. privacy
D. truthfulness

5. Mr. Martin felt better after 5 days but recognizing the severity of his illness, he executes a document authorizing the wife to transact any form of business in his behalf in addition to all decisions relative to his confinement his document is referred to as:

A. power of attorney
B. living will
C. informed consent
D. medical records

Situation 2: Miss Castro was recently appointed chief nurse of a 50-bed government hospital in Valenzuela. On her first day of duty, she tried to remember the elements of administration she learned from her basic nursing education.

6. One of the first things Ms. Castro did was to engage her until in objective writing, formulating goals and philosophy of nursing service. Which activities are MOST appropriately described to which elements of administration?

A. planning
B. controlling
C. directing
d. organizing

7. In recognizing the Department of Nursing, she comes up with the organizational structure defining the role and function of the different nursing positions and line-up the position with qualified people. This is included in which element of administration:

A. monitoring
B. evaluation
C. organizing
D. planning

8. After one month, she and her management committee assess the regulatory measures taken and correct whatever discrepancies are found. This is part of which element of administration:

A. monitoring
B. organizing
C. evaluation
D. planning

9. Revaluation and administrative process is BEST described as:

A. a continuing process of seeing that performance meets goals and targets
B. obtaining commitment of members to do better
C. informing personnel how well and how much improvement has been made
D. follow-up of activities that have been studied

10. In all of the various administrative functions, which of the following management skill is demanded efficiently and effectively of Ms. Castro?

1. Decision making skills
2. Forecasting skills
3. Auditing skills
4. Communications skills

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

Situation 3: Meldy. 40 years old. is waiting for her doctor’s appointment at the clinic where you work.

11. You are to interview her as an initial nursing action so that you can.

A. Document important data in her client records for health team to read.
B. Gather data about her lifestyle, health needs, lifestyle, health needs and problems to develop
plan of care
C. provide solutions to her immediate health concern
D. identify the most appropriate nurse diagnosis for her heath problem

12. During the interview, Meldy experiences a sharp abdominal pain on the right side of her abdomen. She further tells you that an hour ago, she ate fatty food and this had happened many times before. You will record this as:

A. Client complains of intermittent abdominal pain an hour alter eating fatty foods
B. After eating fatty food the client experienced severe abdominal pain
C. Client claims to have sharp abdominal pains after eating fatty food unrelieved by pain medication
D. Client reported sharp abdominal pain on the right upper quadrant of abdomen an hour after
ingestion of fatty foods.

13. Meldy tells you that she has been on a high protein / high fat / low carbohydrate diet order to lose weight and that she has successfully lost 8 lbs during the past two weeks. In planning a healthy balanced diet for her, you will:

A. Encourage her to eat well-balanced diet with a variety of food from the major food groups and
take plenty of fluids.
B. Ask her to shift to a macrobiotic diet rich in complex carbohydrates.
C. Encourage her to cleanse her body toxins by changing a vegetarian diet with regular exercise.
D. Encourage her to eat a high carbohydrate, low protein diet and low fat diet.

14. You learn that Meldy drinks 5-8 cups o coffee a day plus cola drinks. Because she is in her pre-menopausal years, the nurse instructs her to decrease consumption of coffee and cola preparation because:

A. these products increase calcium loss from the bones
B. These products have stimulant effect n the body
C. these products encourage increase in sugar consumption
D. these products are addicting

15. Health education plan for Meldy stresses prevention of NCD or Non-communicable diseases that are influenced by lifestyle. These include the following EXCEPT:

A. Cancer
B. DM
C. Osteoporosis
D. Cardiovascular diseases

Situation 4: Changes in technology, the nation’s economy and the increasing number of population have brought about changes in the Health Care System.

16. At present, government hospitals are expected to offer comprehensive health services to include illness prevention
and health promotion. In which of the following unit of services are these services integrated?

A. Wellness center
B. Intensive Care unit
C. Rehabilitation Center
D. newborn screening unit

17. Which of the following is the MOST recent government initiative to help subsidize the cost of health services for both the employed and the unemployed?

A. National Health Insurance Act
B. Worker’s Compensation Act
C. Medicare Act
D. Magna Carta for Public Health Workers

18. The top ten morbidity cases in the Phil. Include TB, diarrhea among children to name a few. Many of these conditions are preventable and have implications are preventable and have implications in the development of which nursing competencies?

A. Execution of nsg. procedure and technique
B. Therapeutic use of self
C. Administration of treatment and medication
D. Health education

19. The cost of hospitalization is getting more expensive and unaffordable to many of our people. These facts will MOST LIKELY bring about development in which of the following?

A. acute services
B. managed care services
C. home care services
D. advance practice nursing

20. Which of the following latest trend has expanded health services based on prepaid fees with emphasis on health promotion and illness prevention?

A. Government Insurance Plan
B. Preferred Provider Organization
C. Health Maintenance Organization
D. Private Insurance Plan

Situation 5: It is Safety Awareness Week in the Community and the nurse checks on the presence of hazards at home. The nurse plan is to have the residents themselves identify the physical hazards in their own homes.

21. Which of the following is NOT a physical hazard in the home?

A. unstable and slippery stairway
B. large windows that allow good ventilation
C. obstacle people cam trip over like door mats, rugs, electric cords
D. inadequate lighting in and out of the house

22. Risk factors exist for each of the different developmental levels. From infancy to preschool age, the most common cause of death is injury rather than disease. To protect children from harm, that parents should be aware that MOST injuries for this age group are due to:

A. Accidents at home caused by the swallowed poisonous materials, small objects, exploring
electrical sockets
B. Accidents from self inflicted wounds
C. accidents from sports related activities at school or the neighborhood
D. accidents in the Playground Park, school and presence of strangers who may abduct of molest the child.

23. To promote safety at home, the nurse identifies ways and means of “child proofing” the house. Which of the following is NOT safe?

A. apply child proof caps and medicine bottles and chemicals
B. covering electrical outlets, tying up long and loose electrical and telephone cords, securing cabinets or doors within reach o the child
C. giving colorful grocery bags to play with or to store toys and materials
D. removing objects that the child could easily dismantle and swallow like small parts of a mechanical toy, buttons, materials inside, stuffed animals, liquid chemicals.

24. The nurse knows that a person’s hygienic practices are influenced family customs and traditions. Which of the following is NOT part of Basic Hygienic Practices?

A. bathing practices, frequency and time, care of eyes, ear and nose
B. oral hygiene practices such as brushing and flossing teeth, gum care
C. care of skin with lesions, cuts with infection
D. hair and skin such as washing hair and face, feet, hand and nail care

25. Falls are the common home accident among elderly and these are due to physical limitations imposed by aging and some hazards in the home setting. The nurse reduces the risk of falling through the following EXCEPT:

A. rearranging furniture frequently
B. having the bed or mattress close to the floor
C. providing a nonskid and well fitted shoes or slippers
D. having a call bell within the persons reach and answering call bells immediately

Situation 6: Eileen, 45 years old is admitted to the hospital with a diagnosis of renal calculi. She is experiencing severe flank pain, nauseated and with a temperature of 39 0C.

26. Given the above assessment data, the most immediate goal of the nurse would be which of the following?

A. Prevent urinary complication
B. maintains fluid and electrolytes
C. Alleviate pain
D. Alleviating nausea

27. After IVP a renal stone was confirmed, a left nephrectomy was done. Her post operative order includes “daily urine specimen to be sent to the laboratory” . Eileen has a foley catheter attached to a urinary drainage system. How will you collect the urine specimen?

A. remove urine from drainage tube with sterile needle and syringe and empty urine from the
syringe into the specimen container
B. empty a sample urine from the collecting bag into the specimen container
C. disconnect the drainage tube from the indwelling catheter and allow urine to flow from catheter into the specimen container.
D. disconnect the drainage the from the collecting bag and allow the urine to flow from the catheter into the specimen container.

28. Where would the nurse tape Eileen’s indwelling catheter in order to reduce urethral irritation?

A. to the patient’s inner thigh
B. to the patient’s lower thigh
C. to the patient’
D. to the patient lower abdomen

29. Which of the following menu is appropriate for one with low sodium diet?

A. instant noodles, fresh fruits and ice tea
B. ham and cheese sandwich, fresh fruits and vegetables
C. white chicken sandwich, vegetable salad and tea
D. canned soup, potato salad, and diet soda

30. Howe will you prevent ascending infection to Eileen who has an indwelling catheter?

A. see to it that the drainage tubing touches the level of the urine
B. change he catheter every eight hours
C. see to it that the drainage tubing does not touch the level of the urine
D. clean catheter may be used since urethral meatus is not a sterile area

Situation 7: Miss Tingson is assigned to Mang Carlos, a 60 year old newly diagnosed diabetic patient. She is beginning to write objectives of her teaching plan.

31. Which of the following objectives is written in behavioral terms?

A. Mang Carlos will know about diabetes related to foot care and the techniques and equipments necessary to carry it out
B. Mang Carlos daughter should learn about DM within the week
C. Mang Carlos wife needs to understand the side effects of insulin
D. Mang Carlos sister will be able to determine in two days his insulin requirement based on blood glucose levels obtained from glucometer

32. Which of the following is the BEST rationale for written objectives?
A. ensure communication among staff members
B. facilitate evaluation of the nurse’s performance
C. ensure learning on the part of the nurse
D. document the quality of care

33. Which of the following behavior BEST contribute to the learning of Mang Carlos regarding his disease condition?
A. frequent use of technical terms for familiarization
B. drawing him into discussion about diabetes
C. detailed lengthy explanation about his condition
D. loosely structured teaching session

34. Miss Tingson should encourage exercise in the management of diabetes, because it:

A. decrease total triglyceride levels
B. improves insulin utilization
C. lowers blood glucose
D. accomplishes all of the above

35. The chief life-threatening hazard for surgical patient with uncontrolled diabetes is:

A. dehydration
B. hypertension
C. hypoglycemia
D. glucosuria

Situation 8: Caring for the perioperative patient.

36. An appendectomy during a hysterectomy would be classified as:

A. Major, emergency, diagnosis
B. major, urgent, palliative
C. Minor, elective, ablative
D. minor, urgent, reconstructive

37. An informed consent is required for:

A. closed reduction of a fracture
B. insertion of intravenous catheter
C. irrigation of the external ear canal
D. urethral catheterization

38. The circulating nurse’s responsibilities, in contrast to the scrub nurse’s responsibilities, include:

A. assisting the surgeon
B. monitoring aseptic practices
C. setting up the sterile tables
D. all of the above functions

39. The primary nursing goal in the immediate postoperative period is maintenance of pulmonary function and prevention of:

A. Laryngospasm
B. hyperventilation
C. hypoxemia and hypercapnea
D. pulmonary edema ad embolism

40. Unless contraindicated, any unconscious patient should be positioned:

A. flat on his of her back, without elevation of the head, to facilitate frequent turning and minimize pulmonary complications
B. in semi-fowlers position, to promote respiratory function and reduce the incidence of orthostatic hypotension when the patient can eventually stand.
C. in fowler’s position, which most closely stimulates a sitting position, thus facilitating reparatory as well as gastrointestinal functioning.
D. on his or her side without a pillow at the patient’s back and his or her chin extended to minimize
the danger of aspirations

Situation 9: To prevent further injury to patients with problems of immobility / mobility, the nurse should observe certain principles of body mechanics for herself and her patients.

41. Which of the following are appropriate goals for client with positioning and mobility needs?

A. developing of contractures
B. proper body alignment
C. sensory alterations
D. decrease in activity tolerance

42. Which for the following would MOST likely cause injury to the nurse when moving the patient from bed to the wheelchair?

A. bending at the knees
B. standing with feet together
C. using body weight to assist with the movement
D. standing with feet apart

43. Which of the following is the CORRECT guideline when positioning patients?

A. put pillows above a joint to immobilize it
B. position of the joint should be slightly extended
C. joints of patient to be supported with pillow
D. patient’s position should be changed at least three or four times a day

44. Which of the following can be used by clients with problem of immobility to enable them raise their body from bed to wheelchair or perform some bed exercises?

A. sandbag
B. side-rail
C. trochanter roll
D. trapeze bar

45. The importance of forcing fluids with an immobilized patient is to:

A. prevent pneumonia
B. prevent urinary stasis
C. prevent skin breakdown
D. maintain peristalsis

46. Which of the following is the least nursing activity in performing assessment of the patient?

A. laboratory test
B. physical examination
C. Health history
D. systemic review

47. One of the responsibilities of Mr. Lata, RN, an industrial nurse, is to conduct physical head-to-toe assessment of a newly hired factory worker. As part of the assessment, he took the vital signs. Which of the four assessment techniques did he utilize?

1. auscultation
2. percussion
3. palpation
4. inspection

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

48. Which of the following are the purpose of performing a physical assessment?

1. gather baseline data about the client’s health
2. confirm and identify nursing diagnosis
3. evaluate physiological outcome of care
4. make clinical judgment of patients’ diagnosis

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

49. Which of the following should be given the HIGHEST PRIORITY before physical examination is done to a patient?

A. preparation of the equipment
B. psychological preparation of the client
C. preparation of the environment
D. physical preparation of the client

50. During the assessment phase of the nursing process, the nurse is concerned with:

A. interpreting data
B. designing nursing strategies
C. establishing a data base
D. comparing client responses with the anticipated outcome

Situation 11: The nurse is responsible to accurately records and reports patient’s progress. She is able to communicate to the other member of the team by documenting the nursing care plan and the appropriate nursing intervention.

51. A main function of the patient’s records is to:

A. prepare the nurse for the shift worked
B. serve as a record of financial charges
C. serve as a vehicle for communication
D. ensure that the message is received

52. When the nurse writes in the chart and discovers an error has been made, which is the BEST approach?

A. erase the erroneous material
B. carefully ink out the erroneous material
C. place as asterisk next to the statement, then footnote it
D. draw a straight line through the error and initial it.

53. Which of the following persons cannot have the access to the patient record?

A. physical therapist
B. lawyer of the family
C. the patient
D. speech therapist

54. POMR charting is different from traditional method because of which of the following practices?

1. SOAP charting
2. use of flow sheet
3. narrative charting
4. use of checklist

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

55. Which of the following qualities are relevant in documenting patients care?

1. Accuracy and consciousness
2. thoroughness and currentness
3. systematic and orderly
4. legibly, properly dated and signed
5. use of locally accepted abbreviation

A. 1,3,4 & 5
B. 2,3,4 & 5
C. 1,2,3 & 5
D. 1,2,3 & 4

Situation 12: The practice of primary nurse in primary nursing is preferred by many nurses because it supports professional autonomy and accountability of the nurses.

56. What is the function of the primary nurse in primary nursing?

A. acts as patient advocate and coordinate the health care team for specific group of patients
B. act as the charge nurse, organizing staff assignments and help in solving problem in the unit
C. plans and coordinate the patient care assigned to her from admission to discharge
D. coordinates the care given to a group of patients by support staff

57. Primary nursing is MOST advantageous and satisfying to the patient and nurse because of which of the following
principles?

A. autonomy and authority for planning care are best delegated to a nurse
B. accountability is clearest since our nurse is responsible for the overall plan and implementation of care
C. the holistic approach provides fro a therapeutic relationship continuity of care and efficient
nursing care
D. continuity of patients care promotes efficient nursing care.

58. Which is the role of the associate nurse in primary nursing?

A. over-all manager of the unit
B. responsible for the over-all care of the patient during off days of primary nurse
C. patient advocate in the health care team
D. coordinator of comprehensive, holistic patient care

59. In primary nursing, the nurse is responsible for which of the following group of patient?

A. the whole ward
B. small group of patient like 3-5 patients
C. big group of patients like 10-15 patients
D. the whole unit

60. In primary nursing who among the following is needed to her leadership and quality control in the ward?

A. the chief nurse
B. the head nurse
C. the nurse supervisor
D. the service director

Situation 13: Your nursing unit plans to conduct a study on the use of structured preoperative preparation in lessening the demand for post-operative pain medications.

61. Which of the following research activities should you initially do?

A. find out from interview how many patients are willing to participate
B. get the permission from the hospital director
C. review literature on the topic
D. prepare the tool for collecting data

62. Which of the following statements do NOT contribute to the researchabilty of your proposed problem?

A. potential use of findings
B. readability of findings
C. well-defined problem statement
D. measurability of variables

63. A study /research table should NOT contain which of the following ?

A. categories of data collected
B. relevant rows and columns
C. specific title of table
D. names and sample of the selected

64. Which of the following actions will facilitate analysis of research data?

A. consult a physician
B. consult an adviser
C. consult a complete expert
D. categorize data collected

65. The research methodology that is appropriate for the above problem would be:

A. descriptive
B. normative
C. experimental
D. quasi experimental

Situation 14: The nurse meets a new client, Mr. Principe, 50 years old. During the initial interview, the nurse begins to feel irritated towards the client. Shortly after, he becomes uncomfortable and politely leaves the room. The nurse realizes the behavior and mannerism of Mr. Principe reminds him of his strict disciplinarian father who abused him physically.

66. The recognize that his feeling for the client is known as:

A. denial
B. counter transference
C. revenge
D. transference

67. Seeing that his negative feelings for Mr. Principe could affect his nursing care, the nurse applies the concept of therapeutic use of self when:

A. the nurse talks about his personal feelings towards the client
B. the nurse suppresses his feelings and continue to take care of the client
C. the nurse uses his awareness and asks to be reassigned to another client
D. the nurse uses self-awareness to manage his feelings and thoughts towards the client

68. Mr. Principe is terminally ill and his family is coping with his impending death. The nurse has to deal with his own thoughts and personal feelings about death and grieving in order to:

A. avoid sharing personal thought about their impending loss and feeling of grief since this is very subjective
B. get self out of the way while he assists the client and his family express their feelings of impending loss
C. prevent self from being affected by the family’s grief and remain objective
D. help the family plan for the funeral arrangement and burial services

69. One morning when the nurse enters the client’s room. Mr. Principe asks the nurse to “leave me alone and stop bothering me and I don’t want your pity”. The following response by the nurse would be MOST appropriate?

A. “You seem upset this morning” and remains with the client
B. “You are probably upset because you don’t feel well”
C. “Why you are angry with me? What did I do anything to upset you?
D. “I understand and will leave you for a while”

70. The nurse understands that the nurse-client relationship is a therapeutic alliance when:

A. the nurse is a role model for a client
B. this is an essential part of the nursing process
C. the nurse has to be therapeutic at all times
D. how the nurse thinks and feels affects her actions and behavior towards her client and her work

Situation 15: Mr. Ong is for admission to the medical unit and you are his nurse.

71. The MOST important initial nursing approach when admitting client is to:

A. introduce the client to the ward staff
B. orient the client to the physical set up of the unit
C. identify the most immediate needs of the client and implement the necessary intervention
D. take V/S fro baseline assessment

72. When gathering baseline data, the BEST way for you to check if the client has pedal edema is to:

A. talk to the relatives
B. interview the client
C. do auscultation
D. do a physical assessment

73. You want to know the sleeping pattern of Mr. Ong You will:

A. interview the clients and relatives
B. take his BP before sleeping and upon waking up
C. observe his sleeping pattern over a period of time
D. perform physical assessment

74. Mr. Ong has severe pedal edema. Which accessory device would be appropriate for his condition?

A. footboard
B. cradle
C. bed board
D. rolled pillows

75. A student nurse is observed putting a standard size cuff on an obese client. The action would probably result in BP reading that is:

A. false high
B. false low
C. normal
D. undetectable

Situation 16: Health is wealth specifically in this time of the century. The nurse is trained to promote well being of the people.

76. How does a nurse promote one’s well being?

A. periodic travels for rest and recreation
B. faithful and observance of healthy simple lifestyle
C. run away from polluted, stressful areas
D. avoid sleepless, over fatigue nights

77. The nurse can be involved with health promotion as a significant person in helping the family:

A. become a better family
B. prevent disease
C. control their symptoms
D. modify health promotive behaviors

78. The nurse should NOT leave medication at the bedside because:

a. the bedside table is not sterile
b. it is convenient for the nurse
c. the nurse will not be able to accurately document that the patient actually took the
medication
d. the patient may forget to take it.

79. Non-pharmacologic pain management includes all the following EXCEPT:

a. relaxation techniques
b. massage
c. use of herbal medicines
d. body movement

80. When assessing a client’s blood pressure, the nurse finds it necessary to recheck the reading. How many seconds after deflating the cuff should the nurse wait before rechecking the pressure?

a. 10
b. 30
c. 45
d. 60

Situation 17: Safe nursing practice involves an understanding of the law.

81. In the Philippines, this law is :

a. The Philippine Nursing Act of 2002 or R.A. 9173
b. the Philippine Nursing Act of 1991 or R.A. 7164
c. IRR or Resolution 425 of 2003
d. Republic Act No. 8981

82. The Philippine Nursing Act delineates the scope of nursing. It specifies that independent practicing nurse is responsible for:

a. health promotion and prevention of illness
b. administration of written prescription for treatment and therapies
c. rehabilitative aspect of care
d. Collaborating with other healthcare providers for health restoration and alleviation of suffering

83. Standards of care provide the legal basis for evaluation of nursing practice or malpractice. Its functions include all EXCEPT:

a. used by nurse experts to define what appropriate nursing practice is in a given situation
b. used to measure or evaluate nursing conduct to determine if the nurse acted reasonably as any prudent nurse would under similar circumstances
c. used to delineate the scope, function and role of the nurse
d. use to measure or evaluate the conduct of nurse specialists who are certified in their own
specialty fields

84. As a standard in ethics, this represents an understanding and agreement to respect another person’s right to decide a course his or her own destiny:

a. Autonomy
b. justice
c. Beneficence
d. nonmalifecence

85. The Code of Ethics refers to standards of behavior or ideals of conduct. The ability to answer for and stand by one’s action refers to:

a. accountability
b. veracity
c. advocacy
d. responsibility

Situation 18: An understanding of the factors influencing the health care delivery system will enable nurses to adjust to change, create better ways of providing nursing care and develop new nursing roles.

86. Wellness clinics and health education activities have been integrated in government hospitals to render appropriate services. Which of the following purposes LEAST helps clients in cases of these health promotion activities?

A. maintain maximum functions
B. reduce the costs of health care
C. promote health habits
D. identify disease symptoms

87. With regards to illness prevention activities as part of nursing care, which of the following will help clients MOST?

A. maintain maximum function
B. reduce risk factor
C. promote habits related to health care
D. manage stress

88. By experience, which of the following nursing goals are MOST often overlooked by nurses and other members of the hospital team in the care of their clients in the hospital?

A. illness prevention
B. health promotion
C. diagnosis and treatment
D. rehabilitation of patients

89. Which of the following health care agencies is usually family-centered, relatively recent in popularity and oftentimes focuses on maintenance of comfort and satisfactory lifestyle of clients in the terminal phase of illness?

A. non-government organization
B. hospice
C. community health center
D. support group

90. Which of the following is NOT a legally binding document but nonetheless very important in the care of all patients in any setting?

A. Bill of rights as provided in the Philippine Constitution
B. Scope of nursing practice as defined in R.A. 9173
C. Patient’s Bill of Rights ( as adopted by American Nurses Association )
D. Board of Nursing resolution adopting the Code of Ethics

Situation 19: One of the professional competencies that nurse must always demonstrate is in the area of communication:

91. Which communication technique would be MOST effective in eliciting detailed information from the client?

A. open-ended questioning
B. verbalizing observations
C. active listening
D. summarizing clients views

92. Which of the following terms refer to the sender’s attitude towards the self, the message and the listener?

A. verbal communication
B. double-bind communication
C. non-verbal communication
D. meta communication

93. In interacting with patients, the nurses should remember that a client’s personal space is:

A. that which revolves around the client
B. highly mobile depending upon certain situation
C. clearly visible to others
D. the same as that of the nurse

94. In interpersonal communication is LEAST threatening during what type of relationship?

A. social
B. intimate
C. personal
D. professional

95. In demonstrating the method for deep breathing exercises, the nurse places the hands on the client’s abdomen to explain diaphragmatic movement. This technique involves the use of which element of communication?

A. appropriateness
B. feedback
C. channel
D. message

Situation 20: Roy, an adolescent, was diagnosed to have pneumonia. He constantly complains of chest pain and has a standing order of Morphine SO4.

96. Which of the following MOST appropriately describe pain sensation that has periods of remission and exacerbation?

A. chronic
B. intractable
C. acute
D. Psychosomatic

97. Roy is constantly asking to be relieved from pain. Since morphine is an addicting drug, which of the following is BEST for the patient?

A. administer morphine SO4 PRN
B. administer morphine on a routine schedule as ordered
C. give instructions on relaxation technique to reduce frequency of pain sensation
D. divert the attention by not limiting visitors

98. To get accurate information about the quality of pain the patient is experiencing, which of the following statements would be MOST APPROPRIATE?

A. “What cause you the pain?”
B. “ Tell me what your pain feels like”
C. “Have you taken something to relieve the pain?”
D. “Is it stubbing or radiating pain?”

99. As the nurse assigned to Ray, which of the following can decrease his chest pain?

A. supporting his rib cage when he coughs
B. advising him
C. teaching him
D. encouraging him to breathe deeply

100. Which of the following is the nurse’s primary goal in caring for clients with chronic pain?

A. change the clients perception of pain
B. reduce the clients perception of pain
C. change the clients reaction to pain
D. enumerate the source of pain

NLE Nov08 Room Assignments

FROM  YOUR PUB FAMILY: HAPPY BIRTHDAY CHINO ANGELO


imikimi - Customize Your World

65 Tips for Foreign Born Nurses Working in American Hospitals

By: Geri-Ann Galanti, PhD

Physician/Nurse Relationships

1. Ask for clarification if you don’t understand a doctor’s orders in order to avoid making a costly or dangerous mistake.

2. Question a doctor’s order if you think it’s in the best interests of the patient; it is not considered disrespectful. Be sure to talk to the doctor privately, and definitely not in front of the patients.

3. You can refuse to carry out a physician’s order if you think they are dangerous or inappropriate. In that case, document the incident for your supervisor.

4. You are not expected to accept verbal abuse from doctors. If it continues after you have politely asked the doctor to stop, report it immediately to your supervisor.

5. Nurses and doctors are members of a medical team; it is not your job to simply be a “helper” to the doctor. Everyone on the team has roles and responsibilities related to delivering patient care.

6. Even though you regularly work with the physicians, you are not expected to take the blame for a physician’s mistakes.

Nurse/Nurse Relationships

7. You are member of a medical team; therefore, if you finish your own work, offer to assist another nurse. If another nurse finishes his or her work, expect that he/she will offer to help you.

8. If a supervisor offers to help you, it does not imply that he/she thinks you are incompetent; he/she is simply acting as a helpful team member.

9. If you have a problem with a member of the team, speak directly to him/her about it, rather than go someone else or keep it to yourself. Going to someone else is referred to as “going behind their back,” and that will reduce the level of trust among team members.

10. If you feel a supervisor has treated you unfairly, it is best to discuss the problem directly with the supervisor and find a resolution. Do not feel that you are acting improperly by doing so. If all good faith efforts to resolve the problem fail, as a last resort, you may choose to file a grievance against the supervisor. Employee issues are usually addressed through the human resources department in the hospital.

11. If a problem or conflict arises, and you aren’t able to resolve it with the person or department involved, go to the person directly above you in rank, rather than to someone at the “top.” This is referred to as “going through the chain of command.”

12. If you do not understand how to do a procedure or use a piece of equipment, admit it and ask for assistance. There is no shame in not knowing. People will expect it to take you a while to get adjusted to your new job. The problem occurs when pretending to know something that you do not know.

13. The hospital has many resources available. You will be expected To learn how to use these resources for when you need information or when a problem or need arises related to patient care. You can find out about these resources by asking other nurses and your supervisor.

14. If you are new to American culture, it is useful to observe the actions of other nurses; through observation, you will learn a great deal, build your confidence and be more effective in your interactions with the patients and team members.

15. Most nurses will call each other by their first name. It is a sign of friendliness and shows no lack of respect, even to someone older than you or in a position of authority over you.

16. You are not required to give gifts to your supervisor, even for special occasions, such as holidays, birthdays, anniversaries, etc. Gift giving is completely voluntary.

17. Nursing leadership positions. Many nurses like to be in positions of leadership, such as “charge nurse.” These positions generally pay more money. However, they involve additional responsibilities and skills including: a.) Counseling and reprimanding staff members when appropriate. b.) Advocating for your department’s needs with administration. c.) The ability to deal comfortably with conflict.

Nurse & Patient

18. Patients expect nurses to treat them in a warm and friendly manner. It is customary to smile and ask patients how they are doing. Avoid being too gruff and “no nonsense” when doing patient rounds. It will perceived as rude and unfriendly, rather than professional.

19. Part of your job is to provide psychosocial care for patients (emotional and psychological assessment and support), even if they have family members nearby. Ask patients about their emotional needs in order to provide them with needed resources that will support their recovery.

20. Independence is highly valued in the U.S. If a patient wants to practice “self-care” – bathing and feeding themselves, etc., and has an appropriate level of mobility to do so, it should be encouraged.

21. Bonding between a mother and her newborn is highly valued; therefore, new mothers are encouraged to take care of their own infants following a normal delivery.

22. While it is often helpful to include family members in patient teaching, do not automatically expect that Anglo American families will want to participate. Ask the patient is he/she wants any family members to be included.

23. In many cultures, patients are not given their diagnosis and prognosis, especially if they are dying. Many Americans, however, do want to know this information. It is good practice to always ask the patient whether they want information about their condition to be given to them or to a designated family member. Check with your hospital regarding HIPPA regulations and confidentiality.

24. Many patients will want the most aggressive approach and the latest treatments, for they will perceive these to be better. Expect that in some cases, patients may choose to do their own research and advocate for a particular treatment that may not be approved or widely available.

25. Many patients may also use complementary and alternative medicine. Be sure to inquire in a nonjudgmental way about any herbal medications and other healers the patient may have used or may wish to access for care. It is important to know about any home remedies or herbs that may interact with prescribed medication.

26. Domestic Violence: In some cultures, it is common for a husband to answer questions put to his wife. This is not customary in American culture and may sometimes be a sign of domestic violence. (Domestic violence is against the law in America). If you are treating a woman for injuries you suspect were caused by a husband/partner, you must document your suspicions and report it to the proper authorities within the hospital. Find out from your supervisor or Human Resources whom that is.

27. Lawsuits are common in America; therefore, document everything in writing in case a patient sues the hospital. Include the patient’s behaviors and responses to treatment as well as everything that is pertinent to the patient’s condition, such as a description of the patient’s symptoms, actions taken to increase patient comfort, and discharge instructions when applicable.

28. Avoid using family members as interpreters when speaking to a patient who does not speak English; It is very important that you use a professional interpreter whenever possible. If one is not available, call the AT&T Language Line at (800) 628-8486. It offers 24-hour-a-day access to interpretations of over 140 languages, over the phone.

The Role of the Nurse

29. In the United States, the job of the nurse extends into areas normally taken care of by family members in other countries.

30. The nurse’s job in the U.S. is five-fold:

- To provide professional technical care

- To provide non-specialized care (e.g. bathing patients, bedpans, vital signs). For example, although emptying bedpans may not have been part of your job in your home country, if you avoid it here, it will cause resentment on the part of the other nurses.

- To serve as patient advocates. If you think a physician is not providing an appropriate level of care for the patient, and the patient is not able to advocate for him/herself, it is your job to question the physician and even suggest what should be done differently.

- To provide psychosocial care. Talk to the patients about their feelings and emotional needs in order to provide the necessary care and offer resources to support their recovery.

- To educate the patients about self care. Patient education, prior to discharge, helps patients to competently care for themselves when they leave the hospital.

31. Nurses are expected to use critical thinking skills effectively manage their workload: These skills include organization, prioritization, and problem solving.

American Culture and Values

Unlike many other cultures which value the family and interdependence, American culture values independenceindividualism. Therefore, and

32. Patients may want to know the plan of care for their illness, and expect to be part of the decision making process. They may ask a lot of questions; it is important to remain patient and willing to answer their questions when possible. Refer questions that you are unable to answer a physician.

33. Patients may refuse to do what a physician or nurse tells them to do. If a patient is a non-compliant ( not taking their medications, etc.), inquire what the problem is and try to accommodate their concerns. However, do not coerce them if they remain resistant. Document and discuss patient non-compliance with a physician.

34. Self-care is emphasized. Patient teaching supports this concept and is usually done as part of patient’s care plan.

35. Elderly parents may prefer to live on their own, rather than with their adult children even when their mobility is limited and their health is fragile. It is best not to assume otherwise.

Privacy and confidentiality are other important American values. Therefore,

36. You should knock before entering a patient’s room.

37. Do not discuss a patient’s condition with family members without the patient’s permission.

Emotional control is valued by many Americans of northern Europe descent, but not by many of those of southern European descent. Therefore,

38. It may be inaccurate to judge a patient’s pain level based on their expressiveness. Be sure to ask about their pain level. Use the “1-10” pain scale: (1, not much pain, 10, sever pain), as a way to accurately assess their level of pain. Explain the importance of pain medication if they seem reluctant to use it. [See also pain management, tip 65.]

American culture is based on egalitarian system, where everyone is theoretically (even if not actually) equal. This is in contrast to the Asian system, which is hierarchical, in which peoples’ status depends on their age, sex, profession, etc. Within the hospital, there is a hierarchical system, but it is influenced by the egalitarian nature of the culture. Therefore,

39. Those in positions of authority are responsible for making the final decisions, but those “below” them may make recommendations and refuse to carry out orders that they believe can potentially do harm to a patient.

40. Disagreements or conflicts need to be discussed openly and honestly. This kind of “conflict” is seen as normal and healthy, rather than something to be avoided.

41. Negotiation is often used to resolve problems or conflicts between two people. Successful negotiation is often referred to as “win-win” since the solution usually benefits both parties.

42. Men have no authority over women simply because they are men. They have authority only if they are in a position of authority. Thus, for example, a male LVN is expected to take orders from a female RN.

43. You are not expected to behave more formally with people who are older than you or in positions of authority over you.

Understanding (Anglo) American Families

44. American families are often small, with an average of two children. Some couples choose not to have any children.

45. American families are often spread around the country, therefore family members may not be able to be with a sick loved one.

46. Patients may make decisions about their own health without consulting other family members. Either parent may make decisions for a child.

47. Many Americans believe that patients must rest quietly in order to get well. Therefore, patients may become irritable when there are many interruptions and the noise level is high.

48. The individual, not the family, is considered the primary unit. Information about the patient is not be given to the family without the patient’s permission and decisions may be made by a patient without consulting other family members.

49. Due to frequent divorce and remarriage, there may be several “mothers” and “fathers” for a child.

50. Americans often form “fictive” families – families created by their own choosing, rather than by marriage or blood. This is due in part to the fact that many families are spread around the country.

51. If a patient is a gay or lesbian, friends may be closer to the patient than blood relatives and should be considered “immediate family” is so identified by the patient.

52. Maintaining a non judgmental attitude toward different types of families – including gay and lesbian families – is expected.

53. The husband will usually be the preferred labor coach, unless the woman is lesbian, in which case, it will be her partner. Single mothers may choose a friend or hire a labor coach to assist them.

American Communication Patterns

54. Make direct eye contact, even with those who are in a position of authority over you. Lack of eye contact may be seen as a sign of discomfort or dishonesty. People may think you are hiding something from them if you do not make direct eye contact.

55. Assertive communication, clearly (and respectfully) asking others for what you need and honestly expressing your feelings, is encouraged when working on a busy unit in a hospital.

56. While in many Asian cultures giggling is a sign of discomfort , in American culture it is seen as a sign of amusement, or that you are not taking something seriously. If this is your custom, you may need to explain that to others so they do not misinterpret your giggling as a sign of disrespect.

57. A common gesture to call someone over to you is to move the index finger back and forth towards you. Although this gesture is used to call dogs in some parts of the world and is thus seen as rude when used with a person, in the United States, it usually has no negative meaning. The preferred way of getting someone’s attention, whenever possible, is to say, “Can you please come over here?”

58. Speaking in your own language is often a source of conflict in hospitals. While you may feel more comfortable speaking in your native language, others may perceive you as talking about them. The best rules to follow in this regard are:

- Never speak any language other than English around patients.

- The only time it is acceptable to speak in your native language is if you are in break room and everyone in the room speaks your language. But as soon as someone walks in who does not speak your language, you should switch to English. It is considered good manners to invite them to join in your conversation. Say something along the lines of “Hi. We were just talking about [x]. Why don’t you join us.” Otherwise, they may think you were talking about them.

59. It is expected that your tone of voice will convey the seriousness of a situation. If the situation is critical, make sure this is expressed in your tone of voice. People may not respond appropriately if your tone does not match your words.

60. Although it may be seen as friendly and respectful in other cultures to call older people by terms of “Auntie” or “Mama,” it is seen as rude in American culture. Call elderly patients by their last name and title…e.g., Mr. Jones, Mrs. White, Miss/Ms. Roberts, unless they tell you to call them by their first name.

61. Using good manners builds respect and credibility in relationships. It is customary to say, “I’m sorry”, when you make a mistake. When asking for something, say “Please,” and “Thank you.” These words are very important and are seen as a sign of respect, even when talking to someone in a position lower than yours.

62. Verbal appreciation or praise of another person’s positive actions is considered a valuable thing to do. Using the phrase, “good job” or “well-done” helps build the confidence of others and promotes good will among team members.

63. If someone says to you, “that’s crazy,” do not be offended. The word “crazy” is used similarly to “silly”. It does not imply mental illness and is not meant to be insulting.

64. If someone asks “Do you mind if I….” and you do not mind, the correct polite response is “No” as in “No, I do not mind if you…” If you say yes, they will think you do not want them to do it.

Pain Management

65. It is considered very important to aggressively manage a patient’s pain in order for the patient to recover. Addiction is unlikely under most circumstances for which pain medication will be prescribed. Addiction is most likely to occur when the patient is under medicated, rather than over-medicated.

Contributed by: NC