FUNDAMENTAL OF NURSING: Situation 1: Nursing is a profession.

The nurse should have a background on the theories and foundation of nursing as it influenced what is nursing today. 1. Nursing is the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response and advocacy in the care of the individuals, families, communities and population. This is the most accepted definition of nursing as defined by the: A. PNA B. ANA C. Nightingale D. Henderson 2. Advancement in Nursing leads to the development of the Expanded Career Roles. Which of the following is NOT expanded career role for nurse? A. Nurse practitioner B. Clinical Nurse Specialist C. Nurse Researcher D. Nurse anaesthesiologist 3. The Board of Nursing regulated the Nursing profession in the Philippines and is responsible for the maintenance of the quality of nursing in the country. Powers and duties of the board of nursing are the following EXCEPT: A. Issue, suspend revoke certificates of registration B. Issue subpoena duces tecum, ad testificandum C. Open and close colleges of nursing D. Supervise and regulate the practice 4. A nursing student or a beginning staff nurse who has not yet experienced enough in a situation to make judgments about them is in what stage of Nursing Expertise? A. Novice B. Newbie C. Advanced Beginner D. Competent

5. Benners Proficient nurse level is different from the other levels in nursing expertise in the context of having: A. The ability to organize and plan activities B. Having attained an advanced level of education C. A holistic understanding and perception of the client D. Intuitive and analytic ability in new situations Situation 2: The nurse has been asked to administer an injection via Z TRACK technique. Questions 6 to 10 refer this. 6. The nurse prepares an IM injection for an adult client using the Z track techniques, 4 ml of medication is to be administered to the client. Which of the following site will you choose? A. Deltoid B. Rectus Femoris C. Ventrogluteal D. Vastus lateralis 7. In infants 1 year old and below, which of the following is the site of choice in intramuscular injection? A. Deltoid B. Rectus Femoris C. Ventrogluteal D. Vastus lateralis 8. In order to decrease discomfort in Z track administration, which of the following should be done? A. Pierce the skin quickly and smoothly at 90 degree angle B. Inject the medication at around 10 minutes per millilitre C. Pull back the plunger and aspirate for 1 minute t make sure that the needle did not hit a blood vessel D. Pierce the skin slowly and carefully at a 90 degree angle 9. After injection using the Z track technique, the nurse should know that she needs to wait for few second before withdrawing the needle and this is to allow the medication to disperse into the muscle tissue thus decreasing the clients discomfort. How many seconds should the nurse wait before withdrawing the needle? A. 2 second B. 5 seconds

C. 10 seconds D. 15 seconds 10. The rationale in using the Z track technique in an intramuscular injection is: A. It decreases the leakage of discolouring and irritating medication into the subcutaneous tissue. B. It will allow a faster absorption of the medication C. The Z track technique prevent irritation of the muscle D. It is much more convenient for the nurse Situation 3: A client was rushed to the emergency room and you are his attending nurse. You are performing a vital sign assessment: 11. All of the following are correct methods in assessment of the blood pressure EXCEPT: A. Take the blood pressure reading on both arms for comparison B. Listen to and identify the phases of Korotkoff sound C. Pump the cuff to around 50mmHg above the point where the pulse is obliterated D. Observe procedures for infection control 12. You attached a pulse oximeter to the client. You know that the purpose id to: A. Determine if the clients hemoglobin level is low and if he needs blood transfusion B. Check level of clients tissue perfusion C. Measure the efficacy of the clients anti-hypertension medications D. Detect oxygen saturation of arterial blood before symptoms of hypoxemia develops 13. After a few hours in the Emergency Room, the client is admitted to the ward with an order of hourly monitoring of blood pressure. The nurse finds that the cuff is too narrow and this will cause the blood pressure reading to be: A. Inconsistent B. Low systolic and high diastolic C. Higher than what the reading should be D. Lower than what the reading should be 14. Through the clients health history, you gather that the patient smokes and drinks coffee. When taking the blood pressure of a client who recently smoked or drank coffee, how long should the nurse wait before taking the clients blood pressure for accurate reading?

A. 15 minutes B. 30 minutes C. 1 hour D. 5 minutes 15. While the client has pulse oximeter on his fingertip, you notice that the sunlight is shining on the area where the oximeter is. Your action will be to: A. Set and turn on the alarm of the oximeter B. Do nothing since there is no identified problem C. Cover the fingertip sensor with a towel or bedsheet D. Change the location of the sensor every four hours 16. The nurse finds it necessary to recheck the blood pressure reading. In case of such reassessment, the nurse should wait for a period of: A. 15 seconds B. 1 to 2 minutes C. 30 minutes D. 15 minutes 17. If the arm is said to be elevated when taking the blood pressure. It will create a: A. False high reading B. False low reading C. True False reading D. Indeterminate 18. You are to assessed the temperature of the client the next morning and found out that he ate ice cream. How many minutes should you wait before assessing the clients oral temperature? A. 10 minutes B. 20 minutes C. 30 minutes D. 15 minutes 19. When auscultating the clients blood pressure the nurse hears the following: From 150 mmHg to 130 mmHg: Silence, Then: a thumping sound continuing down to 100 mmHg: muffled sound continuing down to 80 mmHg and then silence. What is the clients pressure?

A. 130/80 B. 150/100 C. 100/80 D. 150/100 20. In a client with a previous blood pressure of 130/80 4 hours ago, how long will it take to release the blood pressure cuff to obtain an accurate reading? A. 10 20 seconds B. 30 45 seconds C. 1 1.5 minutes D. 3 3.5 minutes Situation 4 Oral care is an important part of hygienic practices and promoting client comfort. 21. An elderly client, 84 years old, is unconscious. Assessment of the mouth reveals excessive dryness and presence of sores. Which of the following is BEST to use for oral care? A. lemon glycerine B. hydrogen peroxide C. Mineral oil D. Normal saline solution 22. When performing oral care to an unconscious client, which of the following is a special consideration to prevent aspiration of fluids into the lungs? A. Put the client on a side lying position with head of bed lowered B. Keep the client dry by placing towel under the chin C. Wash hands and observe appropriate infection control D. Clean mouth with oral swabs in a careful and an orderly progression 23. The advantages of oral care for a client include all of the following, EXCEPT: A. decreases bacteria in the mouth and teeth B. reduces need to use commercial mouthwash which irritate the buccal mucosa C. improves clients appearance and self-confidence D. improves appetite and taste of food 24. A possible problem while providing oral care to unconscious clients is the risk of fluid aspiration to lungs. This can be avoided by:

A. Cleaning teeth and mouth with cotton swabs soaked with mouthwash to avoid rinsing the buccal cavity B. swabbing the inside of the cheeks and lips, tongue and gums with dry cotton swabs C. use fingers wrapped with wet cotton washcloth to rub inside the cheeks, tongue, lips and ums D. suctioning as needed while cleaning the buccal cavity 25. Your client has difficulty of breathing and is mouth breathing most of the time. This causes dryness of the mouth with unpleasant odor. Oral hygiene is recommended for the client and in addition, you will keep the mouth moistened by using: A. salt solution B. water C. petroleum jelly D. mentholated ointment Situation 5: Ensuring safety before, during and after a diagnostic procedure is an important responsibility of the nurse. 26. To help Fernan better tolerate the bronchoscopy, you should instruct him to practice which of the following prior to the procedure: A. Clenching his fist every 2 minutes B. Breathing in and out through the nose with his mouth open C. Tensing the shoulder muscles while lying on his back D. Holding his breath periodically for 30 seconds 27. Following a bronchoscopy, which of the following complains to Fernan should be noted as a possible complication: A. Nausea and vomiting B. Shortness of breath and laryngeal stridor C. Blood tinged sputum and coughing D. Sore throat and hoarseness 28. Immediately after bronchoscopy, you instructed Fernan to: A. Exercise the neck muscles B. Breathe deeply C. Refrain from coughing and talking D. Clear his throat

29. Thoracentesis may be performed for cytologic study of pleural fluid. As a nurse your most important function during the procedure is to: A. Keep the sterile equipment from contamination B. Assist the physician C. Open and close the three-way stopcock D. Observe the patients vital signs 30. Right after thoracentesis, which of the following is most appropriate intervention? A. Instruct the patient not to cough or deep breathe for two hours B. Observe for symptoms of tightness of chest or bleeding C. Place an ice pack to the puncture site D. Remove the dressing to check for bleeding Situation 6: Knowledge of the acid base disturbance and the functions of the electrolytes is necessary to determine appropriate intervention and nursing actions. 31. A client with diabetes mellitus has glucose level of 644 mg/dL. The nurse interprets that this client is at most risk for the involvement at which type of acid base imbalance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis 32. In a client in the health care clinic, arterial blood gas analysis gives the following results: pH 7.48, PCO2 32mmHg, PO2 94 mmHg, HCO3 24 mEq/L. The nurse interprets that the client has which acid base disturbance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis 33. A client has an order for ABG analysis on radial artery specimens. The nurse ensures that which of the following has been performed or tested before the ABG specimen are drawn? A. Guthing test B. Allens test

C. Rombergs test D. Webers test 34. A nurse is reviewing the arterial blood gas values of a client and notes that the pH is 7.31, Pco2 is 500 mmHg, and the bicarbonate is 27 mEq/L. The nurse concludes that which acid base disturbance is present in this client? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis 35. Allens test checks the patency of the: A. Ulnar artery B. Radial artery C. Carotid artery D. Brachial artery 36. (skip) (Pretend Im not here.) 37. 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. 38. Where would the nurse tape Eileens indwelling catheter in order to reduce urethral irritation? A. to the patients inner thigh B. to the patients lower thigh C. to the patients buttocks D. to the patient lower abdomen 39. 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 40. How 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: Hormones are secreted by the various glands in the body. Basic knowledge of the endocrine system is necessary. 41. Somatotropin or the Growth Hormone releasing hormone is secreted by the anterior pituitary gland: A. Hypothalamus B. Anterior pituitary gland C. Posterior pituitary gland D. Thyroid gland 42. All of the following are secreted by the anterior pituitary gland except: A. Somatotropin/Growth hormone B. Follicle stimulating hormone C. Thyroid stimulating hormone D. Gonadotropin hormone releasing hormone 43. All of the following hormones are hormones secreted by the Posterior pituitary gland except: A. Vasopressin B. Oxytocin C. Anti-diuretic hormone D. Growth hormone 44. Calcitonin, a hormone necessary for calcium regulation is secreted in the: A. Thyroid gland B. Hypothalamus

C. Parathyroid gland D. Anterior pituitary gland 45. While Parathormone, a hormone that regulates the effect of calcitonin is secreted by the: A. Thyroid gland B. Hypothalamus C. Parathyroid gland D. Anterior pituitary gland Situation 8 The staff nurse supervisor requests all the staff nurses to brainstorm and learn ways to instruct diabetic clients on self-administration of insulin. She wants to ensure that there are nurses available daily to do health education classes. 46. The plan of the nurse supervisor is an example of A. in service education process B. efficient management of human resources C. increasing human resources D. primary prevention 47. When Mrs. Guevarra, a nurse, delegates aspects of the clients care to the nurse-aide who is an unlicensed staff, Mrs. Guevarra A. makes the assignment to teach the staff member B. is assigning the responsibility to the aide but not the accountability for those tasks C. does not have to supervise or evaluate the aide D. most know how to perform task delegated 48. Connie, the new nurse, appears tired and sluggish and lacks the enthusiasm she had six weeks ago when she started the job. The nurse supervisor should A. empathize with the nurse and listen to her B. tell her to take the day off C. discuss how she is adjusting to her new job D. ask about her family life 49. Process of formal negotiations of working conditions between a group of registered nurses and employer is

A. grievance B. arbitration C. collective bargaining D. strike 50. You are attending a certification on cardiopulmonary resuscitation (CPR) offered and required by the hospital employing you. This is A. professional course towards credits B. inservice education C. advance training D. continuing education Situation 9: As a nurse, you are aware that proper documentation in the patient chart is your responsibility. 51. 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. Board of Nursing resolution adopting the Code of Ethics D. Patients Bill of Rights 52. A nurse gives a wrong medication to the client. Another nurse employed by the same hospital as a risk manager will expect to receive which of the following communication? A. Incident Report B. Oral report C. Nursing kardex D. Complain report 53. Performing a procedure on a client in the absence of an informed consent can lead to which of the following charges? A. Fraud B. Assault and Battery C. Harassment D. Breach of confidentiality 54. Which of the following is the essence of informed consent?

A. It should have a durable power of attorney B. It should have coverage from an insurance company C. It should respect the clients freedom from coercion D. It should discloses previous diagnosis, prognosis and alternative treatments available for the client. 55. Delegation is the process of assigning tasks that can be performed by a subordinate. The RN should always be accountable and should not lose his accountability. Which of the following is a role included in delegation? A. The RN must supervise all delegated tasks B. After a task has been delegated. It is no longer a responsibility of the RN. C. The RN is responsible and accountable for the delegated task in a adjunct with the delegate. D. Follow up with a delegated task necessary only if the assistive personnel is not trustworthy. Situation 10 When creating your lesson plan for cerebrovascular disease or STROKE. It is important to include the risk factors of stroke. 56. The most important risk factor is: A. Cigarette smoking B. Hypertension C. binge drinking D. heredity 57. Part of your lesson plan is to talk about etiology or cause of stroke. The types of stroke based on cause are the following EXCEPT: A. Embolic stroke B. Hemorrhagic stroke C. diabetic stroke D. thrombotic stroke 58. Hemmorhagic stroke occurs suddenly usually when the person is active. All are causes of hemorrhage, EXCEPT: A. phlebitis B. trauma C. damage to blood vessel D. aneurysm

59. The nurse emphasizes that intravenous drug abuse carries a high risk of stroke. Which drug is closely linked to this? A. Amphetamines B. Cocaine C. shabu D. Demerol 60. A participant in the STROKE class asks what is a risk factor of stroke. Your best response is: A. More red blood cells thicken blood and make clots more possible. B. Increased RBC count is linked to high cholesterol. C. More red blood cell increases hemoglobin content. D. High RBC count increases blood pressure. Situation 11: Recognition of normal values is vital in assessment of clients with various disorders. 61. A nurse is reviewing the laboratory test results for a client with a diagnosis of severe dehydration. The nurse would expect the hematocrit level for this client to be which of the following? A. 60% B. 47% C. 45% D. 32% 62. A nurse is reviewing the electrolyte results of an assigned client and notes that the potassium level is 5.6 mEq/L. Which of the following would the nurse expect to note on the ECG as a result of this laboratory value? A. ST depression B. Inverted t wave C. Prominent U wave D. Tall peaked T waves 63. A nurse is reviewing the electrolyte results of an assigned client and notes that the potassium level is 3.2 mEq/L. Which of the following would the nurse expect to note on the ECG as a result of this laboratory value? A. U waves B. Absent P waves

C. Elevated T waves D. Elevated ST segment 64. Dorothy underwent diagnostic test and the result of the blood examination are back. On reviewing the result the nurse notices which of the following as abnormal finding? A. Neutrophils 60% B. White blood cells (WBC) 9000/mm C. Erythrocyte sedimentation rate (ESR) is 39 mm/hr D. Iron 75 mg/100 ml 65. Which of the following laboratory test result indicate presence of an infectious process? A. Erythrocyte sedimentation rate (ESR) 12 mm/hr B. White blood cells (WBC) 18,000/mm3 C. Iron 90 g/100ml D. Neutrophils 67% Situation 12: Pleural effusion is the accumulation of fluid in the pleural space. 66. Which of the following is a finding that the nurse will be able to assess in a client with pleural effusion? A. Reduced or absent breath sound at the base of the lungs, dyspnea, tachypnea and shortness of breath. B. Hypoxemia C. Noisy respiration, crackles, stridor and wheezing D. Tracheal deviation towards the affected side, increased fremitus and loud breath sounds 67. Thoracentesis is performed to the client with effusion. The nurse knows that he removal of fluid should be slow. Rapid removal of fluid in thoracentesis might cause: A. Pneumothorax B. Pleurisy or Pleuritis C. Cardiovascular collapse D. Hypertension 68. Three days after thoracentesis, the client again exhibited respiratory distress. The nurse will know that the pleural effusion has reoccurred when she noticed a sharp stabbing pain during inspiration. The physician ordered a closed tube thoracotomy for the client. The nurse knows that the primary function of the chest tube is to:

A. Restore positive intrathoracic pressure B. Restore negative intrathoracic pressure C. To visualize the intrathoracic content D. As a method of air administration 69. The chest tube is functioning properly if: A. There is an oscillation B. There is no bubbling in the drainage bottle C. There is a continuous bubbling in the water seal. D. The suction control bottle has a continuous bubbling 70. In a client with pleural effusion, the nurse is instructing a appropriate breathing technique. Which of the following is included in the teaching? A. Breath normally B. Hold the breath after each inspiration for 1 full minute C. Practice abdominal breathing D. Inhale slowly and hold the breath for 3-5 seconds after each inhalation. Situation 13: Health care delivery system affects the health status of every Filipino. As a Nurse, Knowledge of this system is expected to ensure quality of life. 71. When should rehabilitation commence? A. The day before discharge B. When the patient desires C. Upon admission D. 24hours after discharge 72. What exemplified the preventive and promotive programs in the hospital? A. Hospitals as a center to prevent and control infection B. Program for smokers C. Program for alcoholics and drug addicts D. Wellness Center 73. Which makes nursing dynamic? A. Every patient is a unique physical, emotional, social and spiritual being B. The patient participate in the over all nursing care plan

C. Nursing practice is expanding in the light of modern development that takes place D. The health status of the patient is constantly changing and the nurse must be cognizant and responsive to these changes. 74. Prevention is an important responsibility of the nurse in: A. Hospitals B. Community C. Workplace D. All of the above 75. This form of Health Insurance provides comprehensive prepaid health services to enrollees for a periodic payment. A. Health Maintenance Organization B. Medicare C. Philippine Health Insurance Act D. Hospital Maintenance Organization 76. Health care reports have different purposes. The availability of patients record to all health ream members demonstrates which of the following purposes: A. Legal documentation B. Education C. Research D. Vehicle for communication 77. When a nurse commits medication error she should accurately document clients response and her corresponding action. This is very important for which of the following purposes: A. Research B. Nursing Audit C. Legal documentation D. Vehicle for communication 78. POMR has been widely used in many teaching hospitals. One of its unique features is SOAPIE charting. The P in SOAPIE charting should include: A. Prescription of the doctor to the patients illness B. Plan of care for patient

C. Patients perception of ones illness D. Nursing Problem and Nursing Diagnosis 79. The medical records that are organized into separate section from doctors or nurses has more disadvantages than advantages. This is classified as what type of recording? A. POMR B. SOAPIE C. Modified POMR D. SOMR 80. Which of the following is the advantage of SOMR or Traditional Recording? A. Increase efficiency of Data gathering B. Reinforces the use of the nursing process C. The caregiver can easily locate proper section for making charting entries D. Enhances effective communication among health care team members Situation 17: June is 24 year old client with symptoms of dyspnea, absent breath sounds on the right lung and chest X-ray revealed pleural effusion. The physician will perform thoracentesis 81. Thoracentesis is useful in treating which of the following pulmonary disorders except: A. Hemothorax B. Tuberculosis C. Hydrothorax D. Empyema 82. Which of the following psychological preparation is not relevant for him? A. Telling him that the gauge of the needle and anesthesia to be used B. Telling him to keep still during the procedure to facilitate the insertion of the needle in the correct place. C. Allow June to express his feeling and concerns D. Physicians explanation on the purpose of the procedure and how it will be done. 83. Before thoracentesis, the legal consideration you must check is: A. Consent is signed by the client B. Medicine preparation is correct C. Position of the client is correct D. Consent is signed by relative and physician

84. As a nurse, you know that the position for June before thoracentesis is: A. Orthopneic B. Knee-chest C. Low fowlers D. Sidelying position on the affected side 85. Which of the following anesthetic drug is used for thoracentesis? A. Procaine 2 % B. Valium 250 mg C. Demerol 75 mg D. Phenobarbital

Answers
Here are the answers for the exam. Unfortunately, rationales are not given. If you need clarifications or disputes, please direct them to the comments section and well be glad to give you an explanation. 1. B. ANA 2. D. Nurse anaesthesiologist 3. C. Open and close colleges of nursing 4. A. Novice 5. C. A holistic understanding and perception of the client 6. C. Ventrogluteal 7. D. Vastus lateralis 8. A. Pierce the skin quickly and smoothly at 90 degree angle 9. C. 10 seconds 10. A. It decreases the leakage of discolouring and irritating medication into the subcutaneous tissue. 11. C. Pump the cuff to around 50 mmHg above the point where the pulse is obliterated 12. D. Detect oxygen saturation of arterial blood before symptoms of hypoxemia develops 13. C. Higher than what the reading should be 14. B. 30 minutes 15. C. Cover the fingertip sensor with a towel or bed sheet 16. B. 1 to 2 minutes 17. B. False low reading 18. C. 30 minutes 19. A. 130/80 20. C. 1 1.5 minutes

21. D. Normal saline solution 22. A. Put the client on a side lying position with head of bed lowered 23. B. reduces need to use commercial mouthwash which irritate the buccal mucosa 24. D. suctioning as needed while cleaning the buccal cavity 25. C. petroleum jelly 26. B. Breathing in and out through the nose with his mouth open 27. B. Shortness of breath and laryngeal stridor 28. B. Breathe deeply 29. D. Observe the patients vital signs 30. B. Observe for symptoms of tightness of chest or bleeding 31. A. Respiratory acidosis 32. B. Respiratory alkalosis 33. B. Allens test 34. A. Respiratory acidosis 35. B. Radial artery 36. (skip) 37. A. remove urine from drainage tube with sterile needle and syringe and empty urine from the syringe into the specimen container 38. A. to the patients inner thigh 39. C. white chicken sandwich, vegetable salad and tea 40. C. see to it that the drainage tubing does not touch the level of the urine 41. A. Hypothalamus 42. D. Gonadotropin hormone releasing hormone 43. D. Growth hormone 44. A. Thyroid gland 45. C. Parathyroid gland 46. B. efficient management of human resources 47. B. is assigning the responsibility to the aide but not the accountability for those tasks 48. C. discuss how she is adjusting to her new job 49. C. collective bargaining 50. B. in-service education 51. D. Patients Bill of Rights 52. A. Incident Report 53. B. Assault and Battery 54. D. It should discloses previous diagnosis, prognosis and alternative treatments available for the client. 55. C. The RN is responsible and accountable for the delegated task in a adjunct with the delegate.

56. B. Hypertension 57. C. diabetic stroke 58. A. phlebitis 59. B. Cocaine 60. A. More red blood cells thicken blood and make clots more possible. 61. A. 60% 62. D. Tall peaked T waves 63. A. U waves 64. C. Erythrocyte sedimentation rate (ESR) is 39 mm/hr 65. B. White blood cells (WBC) 18,000/mm3 66. A. Reduced or absent breath sound at the base of the lungs, dyspnea, tachypnea and shortness of breath. 67. C. Cardiovascular collapse 68. B. Restore negative intrathoracic pressure 69. A. There is an oscillation 70. D. Inhale slowly and hold the breath for 3-5 seconds after each inhalation. 71. C. Upon admission 72. D. Wellness Center 73. D. The health status of the patient is constantly changing and the nurse must be cognizant and responsive to these changes. 74. D. All of the above 75. A. Health Maintenance Organization 76. D. Vehicle for communication 77. C. Legal documentation 78. B. Plan of care for patient 79. D. SOMR 80. C. The caregiver can easily locate proper section for making charting entries 81. B. Tuberculosis 82. A. Telling him that the gauge of the needle and anesthesia to be used 83. A. Consent is signed by the client 84. A. Orthopneic 85. A. Procaine 2 %