SCFHS MCQs 3.3
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A. Grieving
B. Acute pain
C. Hyperthermia
D. Knowledge deficit
A. Plasma
B. Whole blood
C. packed red cell
D. Serum albumin
3. A new community nurse in the rural clinics has to have good background about the health status of the community in order to assess their needs What is the appropriate way to assess the health status of the community?
A. Home visit
B. Community assembly
C. Mass information campaign
D. Community health assessments
4. A 75 year-old bedridden patient is hosp Medical ward for the treatment of her in Area. Her wound is infected with multiple Longer than normal time to treat. She Crying spells and is talking about death Which of the following nursing diagnosis must be
A. Health and wellness
B. Coping mechanism
C. Self-perception
D. Belief system
5. a nurse is caring for a child with traction of fractured bone. In the chart, a doctor has placed a reminder to maintain even and constant traction What would be the most likely understanding of the nurse for this order?
A. Add or remove weights every other day
B. Allow weights to hang free continuously
C. Elevate head and foot of the bed alternatively when in pain
D. Allow weights to hang free every 12 hours to achieve good circulation
6. A patient complains of pain when standing upright hump on the upper back. In the past year slightly shorter. The doctor has suggested tests to What is the best appropriate intervention?
A. Instruct the patient in the use of prescribed magnesium supplements
B. Have the patient sleep propped on two pain
C. Prepare the patient for a CT scan of both hip
D. Instruct the patient in the use of vitamins
7. A 56-year-old patient was diagnosed with instructions about administration of insulin Regular Insulin and Neutral Protamine Hagedo subcutaneously every morning? Which of the following is right period for(in minutes) after administration?
A. 10-15
B. 30-60
C. 60-90
D. 240-360
8. In a post-operative patient in the Surgical Unit most indicative of a developing complication? ,
A. Increasing alertness
B. Weak and rapid pulse
C. Negative Homans' sign
D. Minimal bowel sounds in four quadrants
9. A child was admitted to the hospital three hours ago with a injury. The child responds appropriately, but sluggishly to drifts in and out of sleep Which of the following best describes this patient's level of?
A. Lethargic
B. Obtunded
C. Comatose
D. Semi comatose
10. A nurse is planning to discharge a known HIV, a the Isolation Unit after the recovery from upper, Which of the following nursing problem requires?
A. Risk of infection due to altered immune
B. Fluid volume deficit due to frequent diarrhoea
C. Anxiety due to disease, fear and social
D. Weight loss due to higher metabolism rate
11. An elderly patient who has an aortic aneurysm Intensive Care Unit to a Medical Surgical Unit on day. While assessing the client, a nurse notes extremities and is unable to palpate the pedal pulse Which intervention should the nurse implement?
A. Wrap the lower extremities with warm
B. Use a Doppler ultrasound to reassess the
C. Elevate the extremities above heart level
D. Place a bed cradle over the bed to levitate
12. A 60-year-old man client had a permanent complains of chest pain and dyspnea with rapid feels suffocated and appears restless
100/70 mmHg Blood pressure 96 /min Heart rate
32 /min Respiratory rate
37.2C Temperature
What is the immediate nursing intervention?
A. Monitor and report findings of chest
B. Chest X-ray to identify dislocation of
C. Manage pain with medication as ordered
D. Administer oxygen as ordered
13. A 28-year-old man and his wife involved in which his wife was killed. The client is being Care Unit for multiple rib fractures and a broken which room his wife is located. Which of the following is the most appropriate?
A. "Your wife is not in the hospital"
B. " I'm sorry, but your wife did not survive the
C. "I need to get your family so that you can wife”
D. " The doctor will be talking to you about located”
14. A nurse is preparing a sterile field prior the Which of the following procedures illustrates the nurse to the principles of aseptic technique?
A. Touch the outer 2-inch border of the sterile gloves
B. Place the sterile linen-wrapped package on waist level
C. Hold the bottle lip 1-2 inches above sterile pouring the solution
D. Open sterile item while holding outside hand then throw object onto sterile field
15. Which of the following is the appropriate nursing advice to mother complaining of epigastric burning sensation and do use of drugs?
A. Chewing gums
B. Increase fluids at bedtime
C. Drink orange juice on getting up
D. Eat small meals every 2 to 3 hours
16. A nurse is caring for a 72-year-old man patient , is unsteady. The patient requests the nurse to help nurse asked the patient to wait few minutes device to transfer him. Which of the following transfer devices is the nurse to use?
A. Belt
B. Board
C. Handle
D. Mechanical lift
17. 62 year-old female patient is admitted for her left eye cataract removal. She has cataract in both eyes with no visibility in her left sys. She is scheduled for the surgery .What essential safety precautions must be assessed preoperatively?
A. Assess and document visual acuity of both eyes
B. Knowledge to prevent eye injury after Surgery
C. Cleanliness of eye and removal of eyeglasses
18. A nurse is providing postpartum care for a GSP4 mother who had a rapid labor of an infant weighing 4000 gm. Assessment revealed a boggy uterus, heavy lochia and stable vital signs. After fundal massage and bladder evacuation. the fundus remains soft. which of the following is the most appropriate next nursing action?
A. Inform the physician ..
B. Reassess the vital signs
C. Continue fundal massage
D. Take venous blood sample
19. A 46-year-old man is presented to Emergency Room with severe chest and unstable angina. The ECG of the patient shows ST segment pression on his 12-lead. e rhythm strip example of specific ECG changes (see image). Which of the following cases the nurse determines ST segment depression?
A. Injury
B. Necrosis
C. Ischemia
D. Nothing significant
20. A 35 year-old man with pulmonary edema is admitted to the Intensive re unit. He is on a Mechanical Ventilator(MV) without sedation. After the client is placed on the MV, the nurse diagnosed the case as impaired
communication related to intubation and MV. What is the best method for the nurse to communicate with the patient?
A. Use normal verbal communication
B. Communicate with the patient after MV removal
C. Use non-verbal communication, such as head-nodding and writing
21. The nurse observes the client csf ,Which of the following of csf color indication for patient with bacterial meningitis?
A. Cloudy
B. Clear
C. Red
D. Brown
22. Elsa Santos is a 18 year old student admitted to the ward with a diagnosis of epilepsy. She tells the nurse that
she is experiencing a generalized tingling sensation and “smells roses”. The nurse understands that Esla is probably experiencing:
A. An olfactory hallucination
B. An acute CVA
C. An aura
D. An acute alcohol withdrawal
23. Child has a third- degree burns of the hand, chest, face, which nursing diagnosing takes priority?
A. Ineffective airway clearance
B. disturbed body image
C. impaired urinary eliminations
D. risk for infection
24. A woman has polycystic ovary syndrome which is 3cm in size what should the nurse do?
A. A repeat the ultrasound after menstruation
B. Remove it by laparoscopy.
C. Give the medication
D. None
A. Shake the patient’s hand
B. Place the nursing supply bagon a clean, dry surface.
C. Obtain the patient’s written consent for home health care
D. Perform hand hygiene per the agency protocol
26. Which of the following patient is the most appropriate to delegate to a new nurse?
A. Patient on a strict bed rest
B. Patient for discharge teaching
C. Patient scheduled for an operation
D. Patient who is hooked to mechanical ventilation
27. An 8-year-old girl is seen in the Emergency Department because of a fracture in the right fibula and she has a fiberglass cast on her leg instead of a plaster cast. Which of the following is an advantage to use a fiberglass cast?
A. Cheaper
B. Dries rapidly
C. Smooth external
D. Shape closely to body parts
28. 62 year-old female patient is admitted for her left eye cataract removal. She has cataract in both eyes with no visibility in her left sys. She is scheduled for the surgery .What essential safety precautions must be assessed preoperatively?
A. Assess and document visual acuity of both eyes
B. Knowledge to prevent eye injury after Surgery
C. Cleanliness of eye and removal of eyeglasses
29. A newly graduated nurse is inserting an intravenous cannula into the mid-cephalic vein of a patient who is being admitted to the unit. As she withdraws the needle, a nurse calls out for help from another patient’s room. The new nurse rushes to help. She secured the intravenous catheter and threw the needle into the waste basket instead of
the sharp’s container. When asked who had thrown the needle into the bin, the new nurse admits that she had made that mistake. Which professional act best describes the newly graduated nurse’s response?
A. Responsibility
B. Accountability
C. Assertiveness
D. Leadership
30. A 50-year-old man presents to the Emergency Department after having suffered a fall while practicing mountain biking. He appears confused and disoriented. His friend reports that he had been thrown over the handle bars and hit his head against a rock
Blood pressure 108/66 mmHg
Heart rate 102 /min
Respiratory rate 22 /min
Temperature 37.2 C
Oxygen saturation 99% room air Which initial intervention is the most important?
A. Intravenous infusion
B. Oxygen administration
C. cervical immobilization
D. Trendelenburg position
A. Bright red and moist stoma
B. Dark red and purple skin
C. Bloody liquid in pouch
D. Ulcerations with a rash
32. A 45-year-old man is admitted to the Surgical Ward for stoma care. The stoma appears a dark red to purple colour, is slightly swollen and leaks a scant amount blood. There is no presence of stool around or on the site. Which observation requires immediate attention?
A. Colour
B. Edema
C. Absence of stool
33. A nurse is taking care of a patient who underwent abdominal surgery three days ago. The patient has not been able to breathe deeply and uses to get out of bed since the surgery due to pain. Also, the patient nplains of shortness of breath, and the lung sounds are diminished on auscultation.
Blood pressure 120/70 mmHg
Heart rate 75 /min
Respiratory rate 22 /min
Temperature 36.4 ℃
Oxygen saturation 89%
Which of the following conditions should the nurse suspect?
A. Sepsis
B. Atelectasis
C. Congestive heart failure
D. Emphysema
34. What do the standards of pain management dictate nurse do?
A. Avoid the use of the word "pain"
B. Screen for pain at each encounter
C. Discourage around-the-clock dosage of analgesics
D. Administer analgesics via injection whenever possible
35. A nurse is planning post-operative teaching for a patient undergone left partial mastectomy. On the third post- operative day, the nurse teaches the patient to elevate the arm above the heart several times per day. What does this exercise reduce?
A. Pain
B. Infection
C. Hematoma
D. Lymphedema
36. Conscious victim of a motor vehicle accident arrives at the emergency department. The patient is Gasping for air, is extremely anxious, and has a deviated trachea. What diagnosis should the nurse Anticipate?
A. pleural effusion.
B. tension pneumothorax
C. pneumothorax
D. cardiac tamponed
37. A nurse calls together an interdisciplinary team with members from medicine, social service, the clergy, and nutritional services to care for a patient with a terminal illness. Which of the following types of care would the team most likely be providing?
A. Palliative
B. curative
C. respite
D. preventive
38. A 46-year-old patient is admitted in the Female back pain which is graded 6 on the scale of10 with the slight elevation in her blood pressure. The eat lunch which is a low sodium diet documented that patient is uncooperative and lunch. What can be assessed by the nursing document patient?
A. Subjective judgement of patient's statement
B. Misunderstanding of patient's attitude
C. Understatement of communication
D. Unethical evaluation of reality
39. The nurse is assigned to care for several patients, who should be assessed first by the nurse?
A. A diabetic patient who will be discharged
B. A patient with rheumatoid arthritis who has
C. An asthmatic patient who is due for
D. A patient with surgical incision who require
40. 9-year-old child is admitted to paediatric word diagnosed with Glomerulonephritis (AGN). The mother ask the nurse why you the blood pressure frequently which of the following the nurse should be respond based on knowledge.
A. Acute hypertension must be anticipated and identified
B. Hypotension leading to sudden shock
C. Blood pressure fluctuations are a common side effect of therapy
D. Blood pressure fluctuation are a sign that the condition has become chronic
41. Which of the following terms applis to the tiny. blanched. slightly raised end arterioles found on the face. neck. arms. and chest during pregnancy?
A. Epulis
B. Linea nigra
C. Striae gravidarum
D. Telangiectasias
A. daily care activity
B. medication chart
43. Doctor during new born assessment he toush the bed by the sterile gloves the nurse shoud:-
A. let him complet the cvl then take to him
B. stop him and tell him remove the gloves and give new gloves
44. During skin assessment of a patient the nurse observed a skin described as roundsolid mass beneath the skin (see image).
Which of the following terms is best to describe the lesion?
A. Cyst
B. Papule
C. Pastule
D. Blister
45. A patient who has pain localized in the chest, now down the left arm. What is this type of pain called?
A. Phantom
B. Regimented
C. Shooting
D. Radiating
46. The nurse is preparing a patient for an insertion of a central venous pressure line into a neck vein .The nurse should place the patient into which position?
A. Side-lying position
B. Fowler's position
C. Trendelenburg position
D. Semi-Fowler's position
47. Neonate is admitted to the neonatal intensive care unit for observation with a diagnosis of probable meconium aspiration syndrome (MAS) the neonate weight 4.650 grams and is at 40 weeks gestation which of the following would be the priority problem
A. Impaired skin integrity
B. Hyperglycaemia
C. Risk for impaired parent infant child attachment
D. Impaired gas exchange
A. Expose all surfaces
B. Prevent stimulation
C. Cover the eyes with shield
D. Change position every four hourly
49. Patient with ongoing potassium infusion he has burning sensation ant the site of infusion what should the nurse do first
A. Stop infusion
B. Document as normal finding
C. Slow rate and call the doctor
D. Inform the doctor
50. Treating pregnant women diagnosed with syphilis is considered
A. Primary level of prevention
B. Secondary level of prevention
C. Tertiary level of prevention
D. Primary and secondary
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