Dennis N.

Muoz

Concepts of Health & Illness

CONCEPTS OF HEALTH & ILLNESS

WHO (World Health Organization) Health is a state of complete physical, mental & social well-being, and not merely the absence of disease/infirmity

CLAUDE BERNARD
Health is the ability to maintain the internal milieu. Illness is the result of failure to maintain the internal environment.

WALTER CANNON

Health is the ability to maintain homeostasis or dynamic equilibrium.

NIGHTINGALE Health is being well & using ones power to the fullest extent. Health is maintained through prevention of disease via environmental health factors. HENDERSON Health is maintained through the individuals ability to perform 14 components of nursing care unaided.

ROGERS Positive health symbolizes wellness. ROY Health is a state & process of being & becoming an integrated & whole person.

OREM: Health is a state characterized by soundness or wholeness of developed human structures & of bodily & mental functioning

KING Health is a dynamic state in the life cycle, illness is an interference in the life cycle. NEUMAN Wellness is the condition in which all parts & subparts of an individual are in harmony with the whole system

JOHNSON Health is reflected by the organization, interaction, interdependence & integration of the subsystems of the behavioral system.

1. Defines health as the ability to maintain internal milieu. Illness according to him/her/them is the failure to maintain internal environment. A. Cannon B. Bernard C. Leddy and Pepper D. Roy

2. Postulated that health is a state and process of being and becoming an integrated and whole person. A. Cannon B. Bernard C. Dunn D. Roy

3. What regulates HOMEOSTASIS according to the theory of Walter Cannon?

A. Positive feedback B. Negative feedback C. Buffer system D. Various mechanisms

Negative feedback
occurs when the output of a system acts to oppose changes to the input of the system, with the result that the changes are attenuated. If the overall feedback of the system is negative, then the system will tend to be stable.

4. Stated that health is WELLNESS. A termed define by the culture or an individual.

A. Roy B. Henderson C. Rogers D. King

5. Defined health as a dynamic state in the life cycle, and Illness as interference in the life cycle.
A. Roy B. Henderson C. Rogers D. King

6. She defined health as the soundness and wholness of developed human structure and bodily mental functioning. A. Orem B. Henderson C. Neuman D. Clark

7. According to her, Wellness is a condition in which all parts and subparts of an individual are in harmony with the whole system. A. Orem B. Henderson C. Neuman D. Johnson

SELF CARE THEORY

EFICIT

OROTHEA OREM

SELF CARE

EFICIT THEORY

OROTHEA OREM

SELF CARE
SELF CARE AGENCY
SELF CARE DEMANDS

DEFICI T

SELF CARE AGENT

DEPENDENT CARE AGENT

NURSIN G AGENCY

3 TYPES OF NURSING SYSTEMS:

Wholly Compensatory
NURSE accomplish ALL the patients needs

Partially Compensatory
BOTH Nurse and Patient engage in self care

Supportive - Educative
Requires ASSISTANCE

Goal Attainment Theory

Imogene

ing

BETTY Neuman
LEVELS OF PREVENTION

Health Care System

PRIMARY SECONDARY TERTIARY

MODEL

SISTER Callista Roy ADAPTATION

Model
RESPONSE NEEDS: P-I-R-S

P Physiologic Mode I Interdependence Mode R Role Function Mode S Self Concept Mode PERSON is a BIOPSYCHOSOCIAL

Madeleine

Leininger

AYAS CULTURE

TRANSCULTURAL NURSING MODEL

CARING varies among cultures, in its expression, processes and patterns.
CARE is the essence of nursing

Jean

WATSON
NURSING is the application of the ART and HUMAN SCIENCE through transpersonal caring transactions to help person achieve mind-body-soul harmony.

HUMAN CARING THEORY

Rosemarie Rizzo Parse

THEORY OF HUMAN

BECOMING

FAYE ABDELLAH
Dorothy

21 Nursing Problems

JOHNSON Behavioral

System Model

M-Y-R-A Levine
4 Conservation Principles

LYDIA

HALL
COR E CAR E CUR E

DA JEAN ORLANDO
BACH
Clinical Nursing A HELPING ART Model

YNAMIC Nurse Patient Relationship Model

ERNESTINE WEIDEN

Patricia Benner and Judith

Wrubel Primacy of CARING Model

Anne BOYKIN and Savina Schoenhofer

GRAND Theory of Nursing as

Benners Stages of Nursing Expertise

OVICE

NO experience Limited performance Inflexible Governed by rules and regulations

DVANCED EGINNER

Marginally Acceptable Performance

EXPERIENCED real situations judgments

OMPETENT

ROFECIENT

XPERT

Benners Stages of Nursing Expertise

N C

OVICE

DVANCED EGINNER

B E
XPERT

OMPETENT

ROFECIENT

3 to 5 years

2 to 3 years experience Organizational and Planning Abilities Differentiates IMPORATANT from LESS important

Flexible WHOLE rather rules, NO than in partsguidelines Maxims as It felt right Highly guide Long Term Proficient

Goal

Joyce TRAVELBEE
INTERPERSONAL ASPECTS OF NURSING MODEL

8. Postulated that health is reflected by the organization, interaction, interdependence and integration of the subsystem of the behavioral system.
A. Orem B. Henderson C. Neuman D. Johnson

 According to Leddy and Pepper, Wellness is

subjective and depends on an individuals perception of balance, harmony and vitality. Leavell and Clark postulared the ecologic model of health and illness or the AGENT-HOSTENVIRONMENT model. Peterson and Zderad developed the HUMANISTIC NURSING PRACTICE theory while Benner and Wruber postulate the PRIMACY OF CARING MODEL.

9. According to them, Well being is a subjective perception of BALANCE, HARMONY and VITALITY
A. Leavell and Clark B. Peterson and Zderad C. Benner and Wruber D. Leddy and Pepper

MODELS OF HEALTH & ILLNESS

1. Health Illness Continuum 2. Health Belief Model (HBM) 3. Smiths Models of Health 4. Leavell & Clarks Agent-HostEnvironment Model (Ecologic Model) 5. Health Promotion Model

F. HEALTH-ILLNESS CONTINUUM (McCann/Flynn & Heffron, 1984)

Wellness Model
Premature Death

Disability

Symptoms

Signs

Awareness

Education Growth

High-Level Wellness

Treatment Model

THE HEALTH ILLNESS CONTINUUM (DUNNS THEORY)

Protected poor health in favorable environment HLW in favorable environment

ILLNESS

HEALTH

Good Health Precursor of Illness

High Level Wellness

Poor health in unfavorable environment

Emergent HLW in unfavorable environment

** HLW- High Level Wellness

HEALTH BELIEF MODEL (HBM)

Describes relationship between persons belief & behavior Individual perceptions & modifying factors influence health belief Individual Perceptions include: 1. - perceived susceptibility to an illness 2. - perceived seriousness of an illness 3. - perceived threat of an illness

 Modifying Factors include: - demographic , sociopsychologic, structural variables & cues to action Interventions depend on: - perceived benefit - perceived barriers

SMITHS MODEL OF HEALTH

1. Clinical Model man is a physiologic system & health is absence of signs & symptoms of disease 2. Role Performance Model health is individuals ability to fulfill societal roles 3. Adaptive Model focus on adaptation 4. Eudaemonistic Model health is a condition of actualization or realization of a persons potential

 Three interactive factors affecting health & illness: 1. AGENT any factor/stressor that can lead to illness / disease

LEAVELL & CLARKS AGENTHOST-ENVIRONMENT MODEL (ECOLOGIC MODEL)

2. HOST persons who may or may not be affected by a disease

3. ENVIRONMENT - any factor external to the host that may or may not predispose a person to a disease.

HEALTH PROMOTION MODEL

-Describes the multi-dimensional nature of persons as they interact with the environment -Advocates that health promotion involves activities directed toward increasing level of well-being and self-actualization. Focus on: individual perception, modifying factors & participation in healthpromoting behaviors

10. He describes the WELLNESS-ILLNESS Continuum as interaction of the environment with well being and illness. A. Cannon B. Bernard C. Dunn D. Clark

11. An integrated method of functioning that is oriented towards maximizing ones potential within the limitation of the environment. A. Well being B. Health C. Low level Wellness D. High level Wellness

12. What kind of illness precursor, according to DUNN is cigarette smoking?

A. Heredity B. Social C. Behavioral D. Environmental

13. According to DUNN, Overcrowding is what type of illness precursor?

A. Heredity B. Social C. Behavioral D. Environmental

14. Health belief model was formulated in 1975 by who?

A. Becker B. Smith C. Dunn D. Leavell and Clark

15. In health belief model, Individual perception matters. Which of the following is highly UNLIKELY to influence preventive behavior? A. Perceived susceptibility to an illness B. Perceived seriousness of an illness C. Perceived threat of an illness D. Perceived curability of an illness

16
Which of the following is not a PERCEIVED

BARRIER in preventive action? A. Difficulty adhering to the lifestyle B. Economic factors C. Accessibility of health care facilities D. Increase adherence to medical therapies

17.Conceptualizes that health is a condition of actualization or realization of persons potential. Avers that the highest aspiration of people is fulfillment and complete development actualization.
A. Clinical Model B. Role performance Model C. Adaptive Model D. Eudaemonistic Model

Smith formulated 5 models of health

Clinical model simply states that when people experience sign

and symptoms, they would think that they are unhealthy therefore, Health is the absence of clinical sign and symptoms of a disease. Role performance model states that when a person does his role and activities without deficits, he is healthy and the inability to perform usual roles means that the person is ill. Adaptive Model states that if a person adapts well with his environment, he is healthy and maladaptation equates illness. Eudaemonistic Model of health according to smith is the actualization of a person's fullest potential. If a person functions optimally and develop self actualization, then, no doubt that person is healthy.

 18.Views people as physiologic system and Absence

of sign and symptoms equates health. A. Clinical Model B. Role performance Model C. Adaptive Model D. Eudaemonistic Model

* Modifying variables in Becker's health belief model includes

DEMOGRAPHIC : Age, sex, race etc.
SOCIOPSYCHOLOGIC : Social and Peer influence.

STRUCTURAL : Knowledge about the disease and prior

contact with it and

CUES TO ACTION : Which are the sign and symptoms

of the disease or advice from friends, mass media and others that forces or makes the individual seek help.

 19. Knowledge about the disease and prior contact

with it is what type of VARIABLE according to the health belief model?

A. Demographic B. Sociopsychologic C. Structural D. Cues to action

 20. It includes internal and external factors that leads

the individual to seek help A. Demographic B. Sociopsychologic C. Structural D. Cues to action

 21.Influence from peers and social pressure is

included in what variable of HBM? A. Demographic B. Sociopsychologic C. Structural D. Cues to action

 22. Age, Sex, Race etc. is included in what variable

of HBM? A. Demographic B. Sociopsychologic C. Structural D. Cues to action

* According to L&C's Ecologic model, there are 3 factors that affect health and illness. These are the:
AGENT or the factor the leads to illness, either a

bacteria or an event in life.

HOST are persons that may or may not be affected

by these agents.
ENVIRONMENT are factors external to the host that

may or may not predispose him to the AGENT.

 23. According to Leavell and Clarks ecologic model,

All of this are factors that affects health and illness except

A. Reservoir B. Agent C. Environment D. Host

 24. Is a multi dimensional model developed by

PENDER that describes the nature of persons as they interact within the environment to pursue health

A. Ecologic Model B. Health Belief Model C. Health Promotion Model D. Health Prevention Model

Pender developed the concept of:

HEALTH PROMOTION MODEL which postulated that an

individual engages in health promotion activities to increase well being and attain self actualization. These includes :
1.
2. 3. 4. 5. 6.

exercise, immunization, healthy lifestyle, good food, self responsibility and all other factors that minimize if not totally eradicate risks and threats of health

 25. Defined by Pender as all activities directed

toward increasing the level of well being and self actualization.

A. Health prevention B. Health promotion C. Health teaching D. Self actualization

WELLNESS Definition:
The condition in which an individual functions at optimal

levels.(Delmar, 2004) an active process by which an individual progresses towards maximum potential possible, regardless of current state of health:
1.

2.

State of well-being Basic aspects include:

Self-responsibility An ultimate goal A dynamic, growing process Daily decision-making in areas related to health (nutrition and proper body fat, avoid abusing drugs, tobacco and alcohol, avoidance of sedentary lifestyle, stress management, physical fitness, preventive health care, emotional health, etc.) Whole being of the individual

WELL-BEING
Definition:

Subjective perception of vitality and feeling well Described objectively, experienced, measured Can be plotted on a continuum

ILLNESS
Define:
Illness is the inability of an individuals adaptive responses to maintain

physical and emotional balance that subsequently results in an impairment of functional abilities. Illness is the result of a disease (either physiological or psychological) or injury that affects functioning, and occurs when there is an inability to meet ones needs.
Illness is a

personal state in which the person feels

unhealthy; Only person can say he or she is ill Illness is a state in which a persons physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired compared with previous experience. Illness is not synonymous with disease. the response a person to a disease; it is an abnormal process in which the person's level of functioning is changed compared with a previous level influenced by the following:
1. 2. 3. 4. 5.

self-perceptions others perceptions the effects of changes in body structure and function the effects of those changes on roles and relationships cultural and spiritual values and beliefs

 Disease - alteration in body function resulting in

reduction of capacity or shortening of normal life span. Theories of disease - "forces", evil spirits. Later this belief was replaced by the single causation theory. Today, many factors are recognized as causing disease (multiple causation)

Causation of disease = etiology

Common Causes of Disease

1. Biologic agent e.g. microorganism 2. Inherited genetic defects e.g. cleft palate 3. Developmental defects e.g. imperforate anus 4. Physical agents e.g. radiation, hot and cold substances, ultraviolet rays 5. Chemical agents e.g. lead, asbestos, carbon monoxide 6. Tissue response to irritations/injury e.g. inflammation, fever 7. Faulty chemical/metabolic process e.g. inadequate insulin in diabetes 8. Emotional/physical reaction to stress e.g. fear, anxiety

TYPES OF ILLNESS
acute illness
has a rapid onset of symptoms that lasts for a limited and relatively short period of time (severe symptoms, short duration, sx appear suddenly & subside quickly, may/may not
require intervention by health care professionals, may possibly be treated with OTC meds, after acute illness, most return to a normal level of wellness) e.g., typically less than six months

chronic illness
has a gradual onset of symptoms that lasts for an extended and relatively long period of time e.g., typically six months or longer
characterized by periods of remission and exacerbation 1. remission

symptoms disappear 2. exacerbation symptoms reappear

26.
Defined as an alteration in normal function resulting

in reduction of capacities and shortening of life span. A. Illness B. Disease C. Health D. Wellness

27
68. Personal state in which a person feels unhealthy

A. Illness B. Disease C. Health D. Wellness

28.
69. According to her, Caring is defined as a nurturant

way of responding to a valued client towards whom the nurse feels a sense of commitment and responsibility. A. Benner B. Watson C. Leininger D. Swanson

 or nervous system is the bodys communication network it coordinates and organizes the functions of all other body systems
NERVOUS SYSTEM

Central Nervous System

Peripheral Nervous System

Brain

Spinal Cord

Motor (Efferent) Neurons

Sensory (Afferent ) Neuron

Somatic Nervous System

Autonomic Nervous System

Sympathetic Nervous System

Parasympathetic Nervous System

Autonomic Division: Homeostasis

Antagonistic branches Parasympathetic

Rest and digest Restore body function Fight or flight Energetic action

Sympathetic

Autonomic Division: Homeostasis

Figure 11-1

Autonomic Control Centers

Hypothalamus Water balance, temperature, and hunger Pons Respiration, cardiac, and urinary Medulla Respiration

Figure 11-3

Sympathetic versus Parasympathetic

Sympathetic versus Parasympathetic

Somatic and Autonomic Divisions

Antagonistic Control

Autonomic sympathetic and parasympathetic pathways Notice the mention of antagonistic responses & receptors involved

Figure 11-5

29.
78. When the General adaptation syndrome is

activated, FLIGHT OR FIGHT response sets in. Sympathetic nervous system releases norepinephrine while the adrenal medulla secretes epinephrine. Which of the following is true with regards to that statement? A. Pupils will constrict B. Client will be lethargic C. Lungs will bronchodilate D. Gastric motility will increase

Adaptation
- the adjustments that a person make in different

situations. Types: 1. General Adaptation Syndrome (GAS)

a. Stage of Alarm b. Stage of Resistance c. Stage of Exhaustion
2. Local Adaptation Syndrome (LAS)

-man may respond to stress through a particular body part or organ. -examples: inflammation, backache, headache, diarrhea

Homeostasis -homeodynamic, because of

constant change -a state of stability or equilibrium Sympatho-Adreno-Medullary Responses (SAMR)
Stressors: Physical injury, dehydration etc. Hypothalamus

Adrenal Medullla (Norepinephrine and epinephrine)

30.
71. Which of the following response is not expected

to a person whose GAS is activated and the FIGHT OR FLIGHT response sets in?

A. The client will not urinate due to relaxation of the detrusor muscle B. The client will be restless and alert C. Clients BP will increase, there will be vasodilation D. There will be increase glycogenolysis, Pancrease will decrease insulin secretion

31.
82. State in which a persons physical, emotional,

intellectual and social development or spiritual functioning is diminished or impaired compared with a previous experience. A. Illness B. Disease C. Health D. Wellness

STAGES OF ILLNESS

1. SYMPTOM EXPERIENCE
- Transition stage

- 3 aspects: physical, cognitive, emotional

2. ASSUMPTION OF SICK ROLE

- Acceptance of the illness

- Seeks advice, support, decision

3. MEDICAL CARE CONTACT

- Seeks advice of health professionals: validation, explanation, reassurance

4. DEPENDENT PATIENT ROLE -Person becomes client dependent on health professional -Accepts / rejects HPs suggestions -Becomes more passive and accepting -May regress to an earlier behavioral stage

5. RECOVERY / REHABILITATION

-Gives up sick role & returns to former roles/functions

RISK FACTORS

-Any situation, habit, condition or other variable that increases the vulnerability of one individual to an illness / accident RISK FACTORS OF A DISEASE 1. Genetic and Physiological Factors 2. Age 3. Environment 4. Lifestyle

32.
86. This is the first stage of illness wherein, the

person starts to believe that something is wrong. Also known as the transition phase from wellness to illness. A. Symptom Experience B. Assumption of sick role C. Medical care contact D. Dependent patient role

33.
87. In this stage of illness, the person accepts or

rejects a professionals suggestion. The person also becomes passive and may regress to an earlier stage. A. Symptom Experience B. Assumption of sick role C. Medical care contact D. Dependent patient role

34.
88. In this stage of illness, The person learns to

accept the illness. A. Symptom Experience B. Assumption of sick role C. Medical care contact D. Dependent patient role

35.
89. In this stage, the person tries to find answers for

his illness. He wants his illness to be validated, his symptoms explained and the outcome reassured or predicted A. Symptom Experience B. Assumption of sick role C. Medical care contact D. Dependent patient role

36.
90. The following are true with regards to aspect of

the sick role except A. One should be held responsible for his condition B. One is excused from his societal role C. One is obliged to get well as soon as possible D. One is obliged to seek competent help

37.
91. Refers to conditions that increases vulnerability

of individual or group to illness or accident A. Predisposing factor B. Etiology C. Risk factor D. Modifiable Risks

IMPORTANT TERMINOLOGIES:

Disease disturbance of structure / function of the body or its constituent parts

Morbidity condition of being diseased

Morbidity Rate proportion of disease to health in a community

Mortality condition or quality of being subject to death Ecology deals with relationship between disease & geographical environment

Epidemiology study of patterns of health & disease, its occurrence & distribution

Susceptibility degree of resistance the potential host has against the pathogen Etiologic Agent one that possesses the potential for producing injury or disease Virulence relative power or degree of pathogenicity of invading microorganism, the ability to produce poisons that repel or destroy phagocytes Symptomatology study of symptoms Syndrome set of symptoms, sum of which constitutes a disease - commonly occurs together

Sign objective symptom or evidence or physical manifestation made apparent by special methods of examination or use of senses

Symptom any disorder of appearance, sensation or function experienced by the patient indicative of a certain phase of a disease

Pathology branch of medicine which deals with the cause, nature, treatment & resultant structural & functional changes of disease Pathogenesis- method of origin & development of a disease

Diagnosis art or act of determining the nature of a disease

Sequela consequence that follows the normal course of an illness

Complication condition that occurs during or after the course of an illness

Prognosis prediction of the course & end of a disease Recovery person has no observable or known after effects from an illness, apparent restoration to a pre-illness state

CLASSIFICATION OF DISEASES
I. ACCORDING TO ETIOLOGIC FACTORS 1. Hereditary defect in genes of 1 or both parent transmitted to offspring 2. Congenital present at birth; defect in development, hereditary factors, prenatal infection 3. Metabolic disturbance in the process of metabolism 4. Deficiency from inadequate intake or absorption of essential dietary factors

5. Traumatic due to injury

6. Allergic abnormal response of body to chemical or protein subs or physical stimuli

7. Neoplastic abnormal or uncontrolled growth of cells

8. Idiopathic unknown cause, self-originated, spontaneous origin 9. Degenerative from degenerative changes that occur in tissues or organs 10. Iatrogenic from treatment of a disease

II. ACCORDING TO DURATION OR ONSET 1. Acute Illness has short duration & severe

- S/S occurs abruptly , are intense & subsides after a relatively short period of time
2. Chronic Illness persists, longer than 6 months and can affect functioning & may fluctuate between maximal functioning & serious relapses that may be life threatening & characterized by remission & exacerbation

REMISSION- period where the disease is controlled & symptoms are not obvious EXACERBATION- disease becomes active again with pronounced symptoms 3. Sub- Acute symptoms are pronounced but more prolonged than in acute disease

III. OTHERS
1. Organic from changes in the normal structure, from anatomical changes in an organ or tissue

2. Functional no anatomical changes observed, may be due to abnormal responses to stimuli

3. Occupational from factors associated with the occupation of the patient 4. Familial occurs in several individuals of the same family

5. Venereal usually acquired through sexual relations 6. Epidemic attacks a large number of individuals in the community at the same time 7. Endemic present more or less continuously or recurs in a community 8. Pandemic an epidemic disease which is extremely widespread involving an entire country or continent 9. Sporadic occurs on occasional cases

38.
Refers to the degree of resistance the potential host

has against a certain pathogen A. Susceptibility B. Immunity C. Virulence D. Etiology

39.
A group of symptoms that sums up or constitute a

disease A. Syndrome B. Symptoms C. Signs D. Etiology

40.
A woman undergoing radiation therapy developed

redness and burning of the skin around the best. This is best classified as what type of disease?

A. Neoplastic B. Traumatic C. Nosocomial D. Iatrogenic

 41.The classification of CANCER according to its etiology Is

best described as 1. Nosocomial 2. Idiopathic 3. Neoplastic 4. Traumatic 5. Congenital 6. Degenrative A. 5 and 2 B. 2 and 3 C. 3 and 4 D. 3 and 5

 42. Term to describe the reactiviation and recurrence

of pronounced symptoms of a disease A. Remission B. Emission C. Exacerbation D. Sub acute

 43. A type of illness characterized by periods of

remission and exacerbation A. Chronic B. Acute C. Sub acute D. Sub chronic

 44. Diseases that results from changes in the normal

structure, from recognizable anatomical changes in an organ or body tissue is termed as

A. Functional B. Occupational C. Inorganic D. Organic

 45. It is the science of organism as affected by

factors in their environment. It deals with the relationship between disease and geographical environment. A. Epidemiology B. Ecology C. Statistics D. Geography

 46. This is the study of the patterns of health and

disease. Its occurrence and distribution in man, for the purpose of control and prevention of disease.

A. Epidemiology B. Ecology C. Statistics D. Geography

 47. Refers to diseases that produced no anatomic

changes but as a result from abnormal response to a stimuli.

A. Functional B. Occupational C. Inorganic D. Organic

Three Levels of Prevention

1. 2. 3.

Primaryhealth promotion and protection Secondary- early detection, diagnosis, screening Tertiaryrehabilitation and adaptation

THREE LEVELS OF PREVENTION 1. PRIMARY PREVENTION encourage optimal health & increase persons resistance to illness - seeks to prevent disease or condition at a prepathologic state - Health Promotion, Specific Protection
- ACTIVITIES:

quit smoking avoid alcohol regular exercise well-balanced diet reduce fat increase fiber adequate fluids maintain ideal body weight complete immunization program

2. SECONDARY PREVENTION known as health maintenance - seeks to identify specific illness/condition at an early stage with prompt intervention to prevent or limit disability - Early Diagnosis, Detection, Screening, Prompt Treatment - ACTIVITIES:
annual physical exam regular PAP smear monthly BSE sputum exam for TB

3. TERTIARY PREVENTION support clients achievement of successful adaptation to known risks, optimal reconstitution or establishment of high-level wellness - occurs after a disease or disability has occurred & recovery process has begun - seeks to halt the disease or injury process & obtain optimal health status - ACTIVITIES: self monitoring of CBG among diabetics, PT after CVA, cardiac rehab, attending self-management education, speech therapy after laryngectomy

TYPES OF HEALTH PROMOTION PROGRAMS

1. Information Dissemination
2. Health Appraisal and Wellness Assessment Programs

3. Lifestyle & Behavior Change Programs

4. Worksite wellness Programs 5. Environment Control Programs

Activities to Promote Health and Prevent Illness

1. Have regular (yearly) PE -Papsmear and BSE 2. Men: regular testicular examination 3. Annual dental examination 4. Exercise regularly at least 3x per week for 30 mins. 5. Do not smoke. 6. Avoid alcohol 7. Reduce fat and increase fiber in the diet. 8. Sleep regularly 7 to 8 hours/ night 9. Eat breakfast 10. Maintain an ideal body weight

 48. In what level of prevention according to Leavell

and Clark does the nurse support the client in obtaining OPTIMAL HEALTH STATUS after a disease or injury? A. Primary B. Secondary C. Tertiary D. None of the above

 49. In what level of prevention does the nurse

encourage optimal health and increases persons susceptibility to illness?

A. Primary B. Secondary C. Tertiary D. None of the above

 50. Also known as HEALTH MAINTENANCE

prevention. A. Primary B. Secondary C. Tertiary D. None of the above

 51. PPD In occupational health nursing is what type

of prevention? A. Primary B. Secondary C. Tertiary D. None of the above

 52. BCG in community health nursing is what type of

prevention? A. Primary B. Secondary C. Tertiary D. None of the above

53. A regular pap smear for woman every 3 years after establishing normal pap smear for 3 consecutive years Is advocated. What level of prevention does this belongs? A. Primary B. Secondary C. Tertiary D. None of the above

 54. Self monitoring of blood glucose for diabetic

clients is on what level of prevention? A. Primary B. Secondary C. Tertiary D. None of the above

 55. Which is the best way to disseminate information

to the public? A. Newspaper B. School bulletins C. Community bill boards D. Radio and Television

 56. Who conceptualized health as integration of

parts and subparts of an individual? A. Newman B. Neuman C. Watson D. Rogers

 57. The following are concept of health:

1. Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity. 2. Health is the ability to maintain balance 3. Health is the ability to maintain internal milieu 4. Health is integration of all parts and subparts of an individual A. 1,2,3 B. 1,3,4 C. 2,3,4 D. 1,2,3,4

 58. The theorist the advocated that health is the

ability to maintain dynamic equilibrium is A. Bernard B. Selye C. Cannon D. Rogers

 59. Excessive alcohol intake is what type of risk

factor? A. Genetics B. Age C. Environment D. Lifestyle

 60. Osteoporosis and degenerative diseases like

Osteoarthritis belongs to what type of risk factor? A. Genetics B. Age C. Environment D. Lifestyle

ETIOLOGIC AGENT may be bacteria, virus, fungi or parasites RESERVOIR humans, animals, plants, environment

PORTAL OF EXIT (from reservoir)

-Respiratory Tract- droplet,sputum

-GIT- vomitus, feces, saliva, drainage tubes

-Urinary Tract urine, urethral catheter

-Reproductive Tract- semen, vaginal discharge

-Blood needle puncture, open wound

MODES OF TRANSMISSION

CONTACT TRANSMISSION direct/indirect

DROPLET TRANSMISSION when MM are exposed to secretions of an infected personwho is coughing, sneezing, laughing within 3 feet VEHICLE TRANSMISSION transfer by way of vehicles or contaminated items (food, water, milk, utensils, pillows, mattress) AIRBORNE TRANSMISSION when fine particles are suspended in the air for a long time & dispersed by air current then inhaled/deposited to a host

VECTOBORNE TRANSMISSION vectors can be biologic or mechanical Biologic animals (rats, snails, mosquitoes)

Mechanical infected inanimate objects (contaminated needles/syringes)

PORTAL OF ENTRY permits organism to enter host - Through body orifice such as mouth, nose, vagina, rectum OR breaks in the skin or MM

SUSCEPTIBLE HOST host is a person who is at risk for infection, whose body defense mechanism are unable to withstand the invasion of the pathogen

TYPES OF IMMUNIZATION

ACTIVE IMMUNIZATION- antibodies are produced by the body in response to infection

1. NATURAL antibodies formed in presence of active infection in the body. It is lifelong. 2. ARTIFICIAL antigens (vaccines/toxoid) are administered to stimulate Ab production PASSIVE IMMUNIZATION antibodies are produced by another source (animal/human)

1. NATURAL Ab from mother to baby

2. ARTIFICIAL Immune serum (antibody) from an animal or another human is injected

ASEPTIC PRACTICES

1. HANDWASHING Handwashing is the single most important infection control practice. Handwashing for medical asepsis is done by holding hands lower than the elbows

Use running water, soap & friction for 15-30 seconds each hand
Wash hands before and after client contact

2. CLEANING, DISINFECTION & STERILIZATION

-Cleaning physical removal of dirt & debris by washing, dusting or mopping -Disinfection chemical or physical process to reduce number of potential pathogens on a surface but not necessarily the spores

-Sterilization complete destruction of all microorganisms including spores

METHODS OF STERILIZATION

STEAM STERILIZATION autoclaving uses supersaturated steam under pressure -non-toxic , inexpensive, sporicidal & penetrates fabric -Color indicator strips change color to indicate sterilization GAS STERILIZATION ethylene oxide is colorless gas that can penetrate plastic, rubber, cotton or other subs. Used for oxygen, suction gauges, BP apparatus, stethoscope, catheter

-Expensive & requires 2-5 hours

-Ethylene oxide is toxic to humans

RADIATION ionizing radiation penetrates deeply to objects -Used for drugs, food & other heat-sensitive items CHEMICALS are effective disinfectants -Attacks all types of microorganisms rapidly, inexpensive & stable in light & heat. Chlorine is used. BOILING WATER least expensive, at least 15 minutes

TYPES OF DISINFECTION Concurrent during Terminal - after

3. USE OF BARRIERS

CATEGORIES OF WASTES: Infectious Injurious

a. Masks b. Gowns

c. Caps & shoe covers

d. Gloves

Hazardous

e. Private rooms

* Most agencies use color coding

f. Equipment & refuse handling

4. ISOLATION SYSTEMS

CLASSIFICATIONS:
A. Standard Precautions - Universal Precaution & Body-Substance Isolation - Prevent transmission of bloodborne & moist body substance pathogens

1. Wear clean gloves

2. Perform handwashing 3. Wear masks, goggles, face shield if sprays/splashes are expected

4. Wear gown if soiling & splashes are expected 5. Remove soiled protective items immediately

6. Clean & reprocess all equipment

7. Discard all single-used items

8. Prevent injuries
9. Use private room or consult with Infection Control Department

B. Transmission-Based Precautions 1. AIRBORNE PREC for small-particle droplet that may remain suspended in the air & dispersed by air current (varicella, TB, measles - Private room, negative airflow, wear masks 2. DROPLET PREC for large-particle droplet & dispersed by air current (H. influenza, diphtheria, rubella, mycoplasma pneumoniae) - Private room, wear masks within 3 ft.

3. CONTACT PREC for those transferred by handor skin-to-skin contact (clostridium difficile, shigella, impetigo) - Private room, use gloves, gowns & other protective barriers when exposure to infected material is likely C. Protective Isolation prevent infection for people with compromised resistance (leukopenia, undergoing chemoRx, extensive burns) - Private room, restrict visitors, no fresh fruits/flowers, raw foods, potted plants allowed, only cooked/canned foods allowed

5. SURGICAL ASEPSIS

PRINCIPLES:
a. Moisture causes contamination.

b. Never assume that an object is sterile.

c. Always face the sterile field.

d. Sterile articles may touch only sterile surface/articles to maintain sterility. e. Sterile equipment/areas must be kept above the waist & on top of the sterile field.

f. Prevent unnecessary traffic & air currents around sterile area g. open, unused sterile articles are no longer sterile after the procedure h. A person who is considered sterile who becomes contaminated must reestablish sterility i. Surgical technique is team effort.

Medical Asepsis CLEAN TECHNIQUE: Involves procedures and practices that reduce the number and transfer of pathogens Will exclude pathogens ONLY
Attained by: Frequent and thorough hand washing Personal grooming Proper cleaning of supplies and equipment Disinfection Proper disposal of needles, contaminated materials and infectious waste Sterilization

Surgical Asepsis STERILE TECHNIQUE : Practices used to render and keep objects and areas sterile Exclude ALL microorganism
Attained by: Use strict aseptic precautions for invasive procedures Scrub hands and fingernails before entering O.R. Use sterile gloves, masks, gowns and shoe covers Use sterile solutions and dressings Use sterile drapes and create an sterile field Heat sterilized surgical instruments

 61. Also known as STERILE TECHNIQUE

A. Surgical Asepsis B. Medical Asepsis C. Sepsis D. Asepsis

 62. This is a person or animal, who is without signs

of illness but harbors pathogen within his body and can be transferred to another

A. Host B. Agent C. Environment D. Carrier

 63. Refers to a person or animal, known or believed

to have been exposed to a disease. A. Carrier B. Contact C. Agent D. Host

 64. A substance usually intended for use on

inanimate objects, that destroys pathogens but not the spores.

A. Sterilization B. Disinfectant C. Antiseptic D. Autoclave

 65. This is a process of removing pathogens but not

their spores A. Sterilization B. Auto claving C. Disinfection D. Medical asepsis

 66. The third period of infectious processes

characterized by development of specific signs and symptoms

A. Incubation period B. Prodromal period C. Illness period D. Convalescent period

 67. A child with measles developed fever and

general weakness after being exposed to another child with rubella. In what stage of infectious process does this child belongs? A. Incubation period B. Prodromal period C. Illness period D. Convalescent period

 68. A 50 year old mailman carried a mail with anthrax

powder in it. A minute after exposure, he still hasnt developed any signs and symptoms of anthrax. In what stage of infectious process does this man belongs? A. Incubation period B. Prodromal period C. Illness period D. Convalescent period

 69. Considered as the WEAKEST LINK in the chain

of infection that nurses can manipulate to prevent spread of infection and diseases

A. Etiologic/Infectious agent B. Portal of Entry C. Susceptible host D. Mode of transmission

 70. Which of the following is the exact order of the

infection chain? 1. Susceptible host 2. Portal of entry 3. Portal of exit 4. Etiologic agent 5. Reservoir 6. Mode of transmission

A. 1,2,3,4,5,6 B. 5,4,2,3,6,1 C. 4,5,3,6,2,1 D. 6,5,4,3,2,1

 71. Markee, A 15 year old high school student asked

you. What is the mode of transmission of Lyme disease. You correctly answered him that Lyme disease is transmitted via A. Direct contact transmission B. Vehicle borne transmission C. Air borne transmission D. Vector borne transmission

 72. The ability of the infectious agent to cause a

disease primarily depends on all of the following except

A. Pathogenicity B. Virulence C. Invasiveness D. Non Specificity

 73. Contact transmission of infectious organism in

the hospital is usually cause by A. Urinary catheterization B. Spread from patient to patient C. Spread by cross contamination via hands of caregiver D. Cause by unclean instruments used by doctors and nurses

 74. Transmission occurs when an infected person

sneezes, coughs or laugh that is usually projected at a distance of 3 feet.

A. Droplet transmission B. Airborne transmission C. Vehicle transmission D. Vector borne transmission

 75. Considered as the first line of defense of the

body against infection A. Skin B. WBC C. Leukocytes D. Immunization

 76. All of the following contributes to host

susceptibility except A. Creed B. Immunization C. Current medication being taken D. Color of the skin

TYPES OF IMMUNITY
NATURAL =innate; within the HOST;

Immune System
ACQUIRED = outside the HOST

Natural = active or passive Artificial = active or passive

Types of Immunity
A. NATURAL : 1. Natural active through exposure or diseases; had the disease & recovered 2. Natural Passive maternal antibodies; acquired through placental transfer

B. ARTIFICIAL ( Laboratory )

1. Artificial active introduction of antigen Ex. Vaccines ; toxoids ( No exposure yet; preventive measure) = gives long immunity months to years 2. Artificial passive- introduction of antibodies Ex. Antitoxins; immunoglobulin ( gammaglobulin), antiserum, convalescent serum Ex. TAT ( tetanus antitoxin) ( w/ exposure to the causative agent) = gives short immunity 3-4 weeks

Immunity

NATURAL - INHERENT BODY TISSUES

ACQUIRED

Outside the host

1. NATURAL

2. ARTIFICIAL

( HUMAN)

( LABORATORY)

A. ACTIVE -HAD THE DISEASE & -RECOVERED

B. PASSIVE - MATERNAL ANTIBODIES

A. ACTIVE - VACCINES - TOXOIDS

B. PASSIVE - ANTITOXINS - IGS

 77. Graciel has been injected TT5, her last dosed for

tetanus toxoid immunization. Graciel asked you, what type of immunity is TT Injections? You correctly answer her by saying Tetanus toxoid immunization is a/an A. Natural active immunity B. Natural passive immunity C. Artificial active immunity D. Artificial passive immunity

 78. Agatha, was hacked and slashed by a psychotic

man while she was crossing the railway. She suffered multiple injuries and was injected Tetanus toxoid Immunoglobulin. Agatha asked you, What immunity does TTIg provides? You best answered her by saying TTIg provides A. Natural active immunity B. Natural passive immunity C. Artificial active immunity D. Artificial passive immunity

 79. This is the single most important procedure that

prevents cross contamination and infection A. Cleaning B. Disinfecting C. Sterilizing D. Handwashing

 80. This is considered as the most important aspect

of handwashing A. Time B. Friction C. Water D. Soap

 81. In handwashing by medical asepsis, Hands are

held .

A. Above the elbow, The hands must always be above the waist B. Above the elbow, The hands are cleaner than the elbow C. Below the elbow, Medical asepsis do not require hands to be above the waist D. Below the elbow, Hands are dirtier than the lower arms

 82. The suggested time per hand on handwashing

using the time method is A. 5 to 10 seconds each hand B. 10 to 15 seconds each hand C. 15 to 30 seconds each hand D. 30 to 60 seconds each hand

 83. The minimum time in washing each hand should

never be below A. 5 seconds B. 10 seconds C. 15 seconds D. 30 seconds

 84. How many ml of liquid soap is recommended for

handwashing procedure? A. 1-2 ml B. 2-3 ml C. 2-4 ml D. 5-10 ml

 85. Which of the following is not true about

sterilization, cleaning and disinfection? A. Equipment with small lumen are easier to clean B. Sterilization is the complete destruction of all viable microorganism including spores C. Some organism are easily destroyed, while other, with coagulated protein requires longer time D. The number of organism is directly proportional to the length of time required for sterilization

 86. Karlita asked you, How long should she boil her

glass baby bottle in water? You correctly answered her by saying

A. The minimum time for boiling articles is 5 minutes B. Boil the glass baby bottler and other articles for atleast 10 minutes C. For boiling to be effective, a minimum of 15 minutes is required D. It doesnt matter how long you boil the articles, as long as the water reached 100 degree Celsius

 87. This type of disinfection is best done in sterilizing

drugs, foods and other things that are required to be sterilized before taken in by the human body

A. Boiling Water B. Gas sterilization C. Steam under pressure D. Radiation

 * Terminal disinfection refers to practices to remove

pathogens that stayed in the belongings or immediate environemnt of an infected client who has been discharged. An example would be Killing airborne TB Bacilli using UV Light. Concurrent disinfection refers to ongoing efforts implented during the client's stay to remove or limit pathogens in his supplies, belongings, immediate environment in order to control the spread of the disease. An example is cleaning the bedside commode of a client with radium implant on her cervix with a bleach disinfectant after each voiding.

 88.A TB patient was discharged in the hospital. A UV

Lamp was placed in the room where he stayed for a week. What type of disinfection is this?

A. Concurrent disinfection B. Terminal disinfection C. Regular disinfection D. Routine disinfection

 89. Which of the following is not true in implementing

medical asepsis A. Wash hand before and after patient contact B. Keep soiled linens from touching the clothings C. Shake the linens to remove dust D. Practice good hygiene

 90. Which of the following is true about autoclaving

or steam under pressure? A. All kinds of microorganism and their spores are destroyed by autoclave machine B. The autoclaved instruments can be used for 1 month considering the bags are still intact C. The instruments are put into unlocked position, on their hinge, during the autoclave D. Autoclaving different kinds of metals at one time is advisable

 91. Which of the following is true about masks?

A. Mask should only cover the nose B. Mask functions better if they are wet with alcohol C. Masks can provide durable protection even when worn for a long time and after each and every patient care D. N95 Mask or particulate masks can filter organism as mall as 1 micromillimeter

Philippines set-up
Black plastic bags are for non-biodegradable
and noninfectious
wastes such as cans, bottles, tetrabrick

containers, styropor, straw, plastic, boxes, wrappers, newspapers.

Green plastic bags are biodegradable wastes

such as fruits and vegetables' peelings, leftover food flowers, leaves, and twigs.

Philippines set-up

Yellow plastic bags are for infectious waste

such as disposable materials used for collection

of blood and body fluids like diapers, sanitary pads, incontinent pads; materials (like tissue paper) with blood secretions and other exudates; dressings, bandages, used cotton balls, gauze; IV tubings, used syringes; Foleys catheter/ tubings; gloves and drains.

 92. Where should you put a wet adult diaper?

A. Green trashcan B. Black trashcan C. Orange trashcan D. Yellow trashcan

 93. Needles, scalpels, broken glass and lancets are

considered as injurious wastes. As a nurse, it is correct to put them at disposal via a/an

A. Puncture proof container B. Reused PET Bottles C. Black trashcan D. Yellow trashcan with a tag INJURIOUS WASTES

 94. Miranda Priestly, An executive of RAMP magazine,

was diagnosed with cancer of the cervix. You noticed that the radioactive internal implant protrudes to her vagina where supposedly, it should be in her cervix. What should be your initial action? A. Using a long forceps, Push it back towards the cervix then call the physician B. Wear gloves, remove it gently and place it on a lead container C. Using a long forceps, Remove it and place it on a lead container D. Call the physician, You are not allowed to touch, re insert or remove it

 95. After leech therapy, Where should you put the

leeches? A. In specially marked BIO HAZARD Containers B. Yellow trashcan C. Black trashcan D. Leeches are brought back to the culture room, they are not thrown away for they are reusable

Environmental Control

Routine care, cleaning and disinfection of

environmental surfaces

PRECAUTIONS FOR INVASIVE PROCEDURES:

wear gloves during all invasive procedure +

goggles + mask

Work Practice Precaution

Prevent injuries caused by needles, scalpels and

other sharps instrument or devices when cleaning used instrument, when disposing of used needles
Do not recap used needles, bend , break nor remove

them from disposable syringes or manipulate them. Place sharps in puncture resistant containers If gloves tears or a needle-stick or other injury occurs, REMOVE the gloves, wash hands, and wash sites of the needle stick thoroughly then put new gloves

Report injuries and mucous membrane exposure to appropriate infection control officer.

Waste management
is the collection, transport, processing,

recycling or disposal of waste materials. Involves:

1. sharps

2.Solid infectious cotton swab, dressing

3. Anatomic Infectious placenta / organ 4.Solid non-infectious used IV / bottle IV 5.General waste scrap paper / food material

 96. Which of the following should the nurse AVOID

doing in preventing spread of infection? A. Recapping the needle before disposal to prevent injuries B. Never pointing a needle towards a body part C. Using only Standard precaution to AIDS Patients D. Do not give fresh and uncooked fruits and vegetables to Mr. Gatchie, with Neutropenia

 97. Where should you put Mr. Alejar, with Category II

TB? A. In a room with positive air pressure and atleast 3 air exchanges an hour B. In a room with positive air pressure and atleast 6 air exchanges an hour C. In a room with negative air pressure and atleast 3 air exchanges an hour D. In a room with negative air pressure and atleast 6 air exchanges an hour

 * TB patients should have a private room with

negative air pressure and atleast 6 to 12 air exhanges per hour. Negative pressure room will prevent air inside the room from escaping. Air exchanges are necessary since the client's room do not allow air to get out of the room.

Revised C.D.C. Isolation Precaution

( centers for disease control)

2. Transmission-Based Precautions The second tier of precaution Precaution are instituted for patients who are known to be or suspected of being infected with highly transmissible infection.
THREE TYPES OF TRANSMISSION-BASED PRECAUTIONS:

1. Airborne precautions 2.Droplet precautions 3.Contact precautions

Infection Control Signage

Infection Control Signage

Infection Control Signage

Personal Protective Equipment ( PPE)

( Barrier Technique)
mask gloves

gown
shoe cover goggles

Transmission based precautions for Hospitalized patient :

Category Precaution Single Room Masks Gowns Gloves

Airborne

Yes, with (-) air pressure ventilation Yes

Yes

No

No

Droplet

Yes, mask for persons close to patient yes

No

No

Contact

Yes

yes

yes

 98. A client has been diagnosed with RUBELLA.

What precaution is used for this patient? A. Standard precaution B. Airborne precaution C. Droplet precaution D. Contact precaution

 99. A client has been diagnosed with MEASLES.

What precaution is used for this patient? A. Standard precaution B. Airborne precaution C. Droplet precaution D. Contact precaution

 100. A client has been diagnosed with IMPETIGO.

What precaution is used for this patient? A. Standard precaution B. Airborne precaution C. Droplet precaution D. Contact precaution

 101. The nurse is to insert an NG Tube when

suddenly, she accidentally dip the end of the tube in the clients glass containing distilled drinking water which is definitely not sterile. As a nurse, what should you do? A. Dont mind the incident, continue to insert the NG Tube B. Obtain a new NG Tube for the client C. Disinfect the NG Tube before reinserting it again D. Ask your senior nurse what to do

 102. All of the following are principle of SURGICAL

ASEPSIS except A. Microorganism travels to moist surfaces faster than with dry surfaces B. When in doubt about the sterility of an object, consider it not sterile C. Once the skin has been sterilized, considered it sterile D. If you can reach the object by overreaching, just move around the sterile field to pick it rather than reaching for it

 103. Which of the following is true in SURGICAL

ASEPSIS? A. Autoclaved linens and gowns are considered sterile for about 4 months as long as the bagging is intact B. Surgical technique is a sole effort of each nurse C. Sterile conscience, is the best method to enhance sterile technique D. If a scrubbed person leaves the area of the sterile field, He/she must do handwashing and gloving again, but the gown need not be changed.

 104. In putting sterile gloves, Which should be

gloved first? A. The dominant hand B. The non dominant hand C. The left hand D. No specific order, Its up to the nurse for her own convenience

 105. As the scrubbed nurse, when should you apply

the goggles, shoe cap and mask prior to the operation?

A. Immediately after entering the sterile field B. After surgical hand scrub C. Before surgical hand scrub D. Before entering the sterile field

 106. Which of the following should the nurse do

when applying gloves prior to a surgical procedure? A. Slipping gloved hand with all fingers when picking up the second glove B. Grasping the first glove by inserting four fingers, with thumbs up underneath the cuff C. Putting the gloves into the dominant hand first D. Adjust only the fitting of the gloves after both gloves are on

 107. Which gloves should you remove first?

A. The glove of the non dominant hand B. The glove of the dominant hand C. The glove of the left hand D. Order in removing the gloves Is unnecessary

 use CaMEy Hand and Body Lotion in

moisturizing his hand before surgical procedure and after handwashing. Ca stands for CAP, M stands for MASK, Ey stands for eye goggles. The nurse will do handwashing and then [HAND], Don the gloves first and wear the Gown [BODY].

 108. Before a surgical procedure, Give the sequence on

applying the protective items listed below 1. Eye wear or goggles 2. Cap 3. Mask 4. Gloves 5. Gown A. 3,2,1,5,4 B. 3,2,1,4,5 C. 2,3,1,5,4 D. 2,3,1,4,5

 109. In removing protective devices, which should be the

exact sequence? 1. Eye wear or goggles 2. Cap 3. Mask 4. Gloves 5. Gown A. 4,3,5,1,2 B. 2,3,1,5,4 C. 5,4,3,2,1 D. 1,2,3,4,5

 110. In pouring a plain NSS into a receptacle located

in a sterile field, how high should the nurse hold the bottle above the receptacle?

A. 1 inch B. 3 inches C. 6 inches D. 10 inches

 111. The tip of the sterile forceps is considered

sterile. It is used to manipulate the objects in the sterile field using the non sterile hands. How should the nurse hold a sterile forceps? A. The tip should always be lower than the handle B. The tip should always be above the handle C. The handle and the tip should be at the same level D. The handle should point downward and the tip, always upward

 112. The nurse enters the room of the client on airborne precaution

due to tuberculosis. Which of the following are appropriate actions by the nurse? 1. She wears mask, covering the nose and mouth 2. She washes her hands before and after removing gloves, after suctioning the clients secretion 3. She removes gloves and hands before leaving the clients room 4. She discards contaminated suction catheter tip in trashcan found in the clients room A. 1,2 B. 1,2,3 C. 1,2,3,4 D. 1,3

 113. When performing surgical hand scrub, which of the

following nursing action is required to prevent contamination? 1. Keep fingernail short, clean and with nail polish 2. Open faucet with knee or foot control 3. Keep hands above the elbow when washing and rinsing 4. Wear cap, mask, shoe cover after you scrubbed A. 1,2 B. 2,3 C. 1,2,3 D. 2,3,4

 114. When removing gloves, which of the following is

an inappropriate nursing action? A. Wash gloved hand first B. Peel off gloves inside out C. Use glove to glove skin to skin technique D. Remove mask and gown before removing gloves

General Adaptation Syndrome

A diagram of the General

Adaptation Syndrome model. Physiologists define stress as how the body reacts to a stressor, real or imagined, a stimulus that causes stress. 1. Acute stressors affect an organism in the short term; 2. chronic stressors over the longer term.

Alarm is the first

stage.

When the threat or stressor is

identified or realized, the body's stress response is a state of alarm. During this stage, adrenaline will be produced in order to bring about the fight-or-flight response. There is also some activation of the HPA axis, producing cortisol.

Resistance is the

second stage

If the stressor persists, it becomes necessary to attempt

some means of coping with the stress. Although the body begins to try to adapt to the strains or demands of the environment, the body cannot keep this up indefinitely, so its resources are gradually depleted.

Exhaustion is the third

and final stage in the GAS model.

At this point, all of the body's resources are eventually

depleted and the body is unable to maintain normal function. The initial autonomic nervous system symptoms may reappear (sweating, raised heart rate, etc.). If stage three is extended, long-term damage may result, as the body's immune system becomes exhausted, and bodily functions become impaired, resulting in decompensation.

 115. Which of the following is TRUE in the concept of

stress? A. Stress is not always present in diseases and illnesses B. Stress are only psychological and manifests psychological symptoms C. All stressors evoke common adaptive response D. Hemostasis refers to the dynamic state of equilibrium

 116. According to this theorist, in his modern stress

theory, Stress is the non specific response of the body to any demand made upon it.

A. Hans Selye B. Walter Cannon C. Claude Bernard D. Martha Rogers

117.
Which of the following is NOT TRUE with regards to

the concept of Modern Stress Theory? A. Stress is not a nervous energy B. Man, whenever he encounters stresses, always adapts to it C. Stress is not always something to be avoided D. Stress does not always lead to distress

118.
Which of the following is TRUE with regards to the

concept of Modern Stress Theory? A. Stress is essential B. Man does not encounter stress if he is asleep C. A single stress can cause a disease D. Stress always leads to distress

119.
Which of the following is TRUE in the stage of alarm

of general adaptation syndrome? A. Results from the prolonged exposure to stress B. Levels or resistance is increased C. Characterized by adaptation D. Death can ensue

120.
The stage of GAS where the adaptation mechanism

begins A. Stage of Alarm B. Stage of Resistance C. Stage of Homeostasis D. Stage of Exhaustion

121.
Stage of GAS Characterized by adaptation

A. Stage of Alarm B. Stage of Resistance C. Stage of Homeostasis D. Stage of Exhaustion

122.
Stage of GAS wherein, the Level of resistance are

decreased A. Stage of Alarm B. Stage of Resistance C. Stage of Homeostasis D. Stage of Exhaustion

123.
Where in stages of GAS does a person moves back

into HOMEOSTASIS? A. Stage of Alarm B. Stage of Resistance C. Stage of Homeostasis D. Stage of Exhaustion

124.
Stage of GAS that results from prolonged exposure

to stress. Here, death will ensue unless extra adaptive mechanisms are utilized

A. Stage of Alarm B. Stage of Resistance C. Stage of Homeostasis D. Stage of Exhaustion

125.
All but one is a characteristic of adaptive response

A. This is an attempt to maintain homeostasis B. There is a totality of response C. Adaptive response is immediately mobilized, doesnt require time D. Response varies from person to person

126.
Andy, a newly hired nurse, starts to learn the new

technology and electronic devices at the hospital. Which of the following mode of adaptation is Andy experiencing? A. Biologic/Physiologic adaptive mode B. Psychologic adaptive mode C. Sociocultural adaptive mode D. Technological adaptive mode

127.
Andy is not yet fluent in French, but he works in

Quebec where majority speaks French. He is starting to learn the language of the people. What type of adaptation is Andy experiencing? A. Biologic/Physiologic adaptive mode B. Psychologic adaptive mode C. Sociocultural adaptive mode D. Technological adaptive mode

128.
Andy made an error and his senior nurse issued a

written warning. Andy arrived in his house mad and kicked the door hard to shut it off. What adaptation mode is this? A. Biologic/Physiologic adaptive mode B. Psychologic adaptive mode C. Sociocultural adaptive mode D. Technological adaptive mode

129
1. The coronary vessels, unlike any other blood

vessels in the body, respond to sympathetic stimulation by

A. Vasoconstriction B. Vasodilatation C. Decreases force of contractility D. Decreases cardiac output

130.
2. What stress response can you expect from a

patient with blood sugar of 50 mg / dl? A. Body will try to decrease the glucose level B. There will be a halt in release of sex hormones C. Client will appear restless D. Blood pressure will increase

131.
All of the following are purpose of inflammation

except A. Increase heat, thereby produce abatement of phagocytosis B. Localized tissue injury by increasing capillary permeability C. Protect the issue from injury by producing pain D. Prepare for tissue repair

132.
The initial response of tissue after injury is

A. Immediate Vasodilation B. Transient Vasoconstriction C. Immediate Vasoconstriction D. Transient Vasodilation

133.
The last expected process in the stages of

inflammation is characterized by A. There will be sudden redness of the affected part B. Heat will increase on the affected part C. The affected part will loss its normal function D. Exudates will flow from the injured site

134.
What kind of exudates is expected when there is an

antibody-antigen reaction as a result of microorganism infection?

A. Serous B. Serosanguinous C. Purulent D. Sanguinous

135.
The first manifestation of inflammation is

A. Redness on the affected area B. Swelling of the affected area C. Pain, which causes guarding of the area D. Increase heat due to transient vasodilation

136.
The client has a chronic tissue injury. Upon

examining the clients antibody for a particular cellular response, Which of the following WBC component is responsible for phagocytosis in chronic tissue injury? A. Neutrophils B. Basophils C. Eosinophils D. Monocytes

137.
Which of the following WBC component proliferates

in cases of Anaphylaxis? A. Neutrophils B. Basophils C. Eosinophils D. Monocytes

137.
Icheanne, ask you, about WBC Components. She

got an injury yesterday after she twisted her ankle accidentally at her gymnastic class. She asked you, which WBC Component is responsible for proliferation at the injured site immediately following an injury. You answer: A. Neutrophils B. Basophils C. Eosinophils D. Monocytes

139.
Icheanne then asked you, what is the first process

that occurs in the inflammatory response after injury, You tell her:

A. Phagocytosis B. Emigration C. Pavementation D. Chemotaxis

140.
Icheanne asked you again, What is that term that

describes the magnetic attraction of injured tissue to bring phagocytes to the site of injury?

A. Icheanne, you better sleep now, you asked a lot of questions B. It is Diapedesis C. We call that Emigration D. I dont know the answer, perhaps I can tell you after I find it out later

141.
. This type of healing occurs when there is a delayed

surgical closure of infected wound A. First intention B. Second intention C. Third intention D. Fourth intention

142.
Type of healing when scars are minimal due to

careful surgical incision and good healing A. First intention B. Second intention C. Third intention D. Fourth intention

143.
Imelda, was slashed and hacked by an unknown

suspects. She suffered massive tissue loss and laceration on her arms and elbow in an attempt to evade the criminal. As a nurse, you know that the type of healing that will most likely occur to Miss Imelda is A. First intention B. Second intention C. Third intention D. Fourth intention

144.
Imelda is in the recovery stage after the incident. As

a nurse, you know that the diet that will be prescribed to Miss Imelda is

A. Low calorie, High protein with Vitamin A and C rich foods B. High protein, High calorie with Vitamin A and C rich foods C. High calorie, Low protein with Vitamin A and C rich foods D. Low calorie, Low protein with Vitamin A and C rich foods

145.
. Miss Imelda asked you, What is WET TO DRY Dressing

method? Your best response is A. It is a type of mechanical debridement using Wet dressing that is applied and left to dry to remove dead tissues B. It is a type of surgical debridement with the use of Wet dressing to remove the necrotic tissues C. It is a type of dressing where in, The wound is covered with Wet or Dry dressing to prevent contamination D. It is a type of dressing where in, A cellophane or plastic is placed on the wound over a wet dressing to stimulate healing of the wound in a wet medium

146.
The primary cause of pain in inflammation is

A. Release of pain mediators B. Injury to the nerve endings C. Compression of the local nerve endings by the edema fluids D. Circulation is lessen, Supply of oxygen is insufficient

147.
The client is in stress because he was told by the

physician he needs to undergo surgery for removal of tumor in his bladder. Which of the following are effects of sympatho-adreno-medullary response by the client?

1. Constipation 2. Urinary frequency 3. Hyperglycemia 4. Increased blood pressure A. 3,4 B. 1,3,4 C.1,2,4 D.1,4

148.
The client is on NPO post midnight. Which of the

following, if done by the client, is sufficient to cancel the operation in the morning?

A. Eat a full meal at 10:00 P.M B. Drink fluids at 11:50 P.M C. Brush his teeth the morning before operation D. Smoke cigarette around 3:00 A.M

149.
The client place on NPO for preparation of the blood

test. Adreno-cortical response is activated and which of the following below is an expected response?

A. Low BP B. Decrease Urine output C. Warm, flushed, dry skin D. Low serum sodium levels

150.
Which of the following is true about therapeutic

relationship? A. Directed towards helping an individual both physically and emotionally B. Bases on friendship and mutual trust C. Goals are set by the solely nurse D. Maintained even after the client doesnt need anymore of the Nurses help

151.
According to her, A nurse patient relationship is

composed of 4 stages : Orientation, Identification, Exploitation and Resolution

A. Roy B. Peplau C. Rogers D. Travelbee

152.
In what phase of Nurse patient relationship does a

nurse review the clients medical records thereby learning as much as possible about the client?

A. Pre Orientation B. Orientation C. Working D. Termination

153.
Nurse Aida has seen her patient, Roger for the first

time. She establish a contract about the frequency of meeting and introduce to Roger the expected termination. She started taking baseline assessment and set interventions and outcomes. On what phase of NPR Does Nurse Aida and Roger belong? A. Pre Orientation B. Orientation C. Working D. Termination

154.
Roger has been seen agitated, shouting and

running. As Nurse Aida approaches, he shouts and swear, calling Aida names. Nurse Aida told Roger That is an unacceptable behavior Roger, Stop and go to your room now. The situation is most likely in what phase of NPR? A. Pre Orientation B. Orientation C. Working D. Termination

155.
Nurse Aida, in spite of the incident, still consider

Roger as worthwhile simply because he is a human being. What major ingredient of a therapeutic communication is Nurse Aida using? A. Empathy B. Positive regard C. Comfortable sense of self D. Self awareness

156.
Nurse Irma saw Roger and told Nurse Aida Oh look

at that psychotic patient Nurse Aida should intervene and correct Nurse Irma because her statement shows that she is lacking? A. Empathy B. Positive regard C. Comfortable sense of self D. Self awareness

157.
Which of the following statement is not true about

stress? A. It is a nervous energy B. It is an essential aspect of existence C. It has been always a part of human experience D. It is something each person has to cope

158.
Martina, a Tennis champ was devastated after many

new competitors outpaced her in the Wimbledon event. She became depressed and always seen crying. Martina is clearly on what kind of situation? A. Martina is just stressed out B. Martina is Anxious C. Martina is in the exhaustion stage of GAS D. Martina is in Crisis

159.
Which of the following statement is not true with

regards to anxiety? A. It has physiologic component B. It has psychologic component C. The source of dread or uneasiness is from an unrecognized entity D. The source of dread or uneasiness is from a recognized entity

160.
Lorraine, a 27 year old executive was brought to the

ER for an unknown reason. She is starting to speak but her speech is disorganized and cannot be understood. On what level of anxiety does this features belongs? A. Mild B. Moderate C. Sever D. Panic

161.
Elton, 21 year old nursing student is taking the board

examination. She is sweating profusely, has decreased awareness of his environment and is purely focused on the exam questions characterized by his selective attentiveness. What anxiety level is Elton exemplifying? A. Mild B. Moderate C. Sever D. Panic

162.
You noticed the patient chart : ANXIETY +3 What will

you expect to see in this client? A. An optimal time for learning, Hearing and perception is greatly increased B. Dilated pupils C. Unable to communicate D. Uses palliative coping mechanism

163.
When should the nurse starts giving XANAX?

A. When anxiety is +1 B. When the client starts to have a narrow perceptual field and selective inattentiveness C. When problem solving is not possible D. When the client is immobile and disorganized

164.
Which of the following behavior is not a sign or a

symptom of Anxiety? A. Frequent hand movement B. Somatization C. The client asks a question D. The client is acting out

165.
Which of the following intervention is inappropriate

for clients with anxiety? A. Offer choices B. Provide a quiet and calm environment C. Provide detailed explanation on each and every procedures and equipments D. Bring anxiety down to a controllable level

166.
Which of the following statement, if made by the

nurse, is considered not therapeutic? A. How did you deal with your anxiety before? B. It must be awful to feel anxious. C. How does it feel to be anxious? D. What makes you feel anxious?

167.
Marissa Salva, Uses Bensons relaxation. How is it

done? A. Systematically tensing muscle groups from top to bottom for 5 seconds, and then releasing them B. Concentrating on breathing without tensing the muscle, Letting go and repeating a word or sound after each exhalation C. Using a strong positive, feeling-rich statement about a desired change D. Exercise combined with meditation to foster relaxation and mental alacrity

168.
What type of relaxation technique does Lyza uses if

a machine is showing her pulse rate, temperature and muscle tension which she can visualize and assess? A. Biofeedback B. Massage C. Autogenic training D. Visualization and Imagery

169.
This is also known as Self-suggestion or Self-

hypnosis A. Biofeedback B. Meditation C. Autogenic training D. Visualization and Imagery

170.
Which among these drugs is NOT an anxiolytic?

A. Valium B. Ativan C. Milltown D. Luvox

171.
Kenneth, 25 year old diagnosed with HIV felt that he had not

lived up with Gods expectation. He fears that in the course of his illness, God will be punitive and not be supportive. What kind of spiritual crisis is Kenneth experiencing?

1. Spiritual Pain 2. Spiritual Anxiety 3. Spiritual Guilt 4. Spiritual Despair A. 1,2 B. 2,3 C. 3,4 D. 1,4

172.
Grace, believes that her relationship with God is

broken. She tried to go to church to ask forgiveness everyday to remedy her feelings. What kind of spiritual distress is Grace experiencing? A. Spiritual Pan B. Spiritual Alienation C. Spiritual Guilt D. Spiritual Despair

173.
Remedios felt EMPTY She felt that she has already

lost Gods favor and love because of her sins. This is a type of what spiritual crisis?

A. Spiritual Anger B. Spiritual Loss C. Spiritual Despair D. Spiritual Anxiety

174.
Budek is working with a schizophrenic patient. He

noticed that the client is agitated, pacing back and forth, restless and experiencing Anxiety +3. Budek said You appear restless What therapeutic technique did Budek used? A. Offering general leads B. Seeking clarification C. Making observation D. Encouraging description of perception

175.
Rommel told Budek I SEE DEAD PEOPLE Budek

responded You see dead people? This Is an example of therapeutic communication technique?

A. Reflecting B. Restating C. Exploring D. Seeking clarification

176.
Rommel told Budek, Do you think Im crazy? Budek

responded, Do you think your crazy? Budek uses what example of therapeutic communication?

A. Reflecting B. Restating C. Exploring D. Seeking clarification

177.
Myra, 21 year old nursing student has difficulty

sleeping. She told Nurse Budek I really think a lot about my x boyfriend recently Budek told Myra And that causes you difficulty sleeping? Which therapeutic technique is used in this situation? A. Reflecting B. Restating C. Exploring D. Seeking clarification

178.
Myra told Budek I cannot sleep, I stay away all

night Budek told her You have difficulty sleeping This is what type of therapeutic communication technique? A. Reflecting B. Restating C. Exploring D. Seeking clarification

179.
Myra said I saw my dead grandmother here at my

bedside a while ago Budek responded Really? That is hard to believe, How do you feel about it? What technique did Budek used? A. Disproving B. Disagreeing C. Voicing Doubt D. Presenting Reality

180.
Which of the following is a therapeutic communication in

response to I am a GOD, bow before me Or ill summon the dreaded thunder to burn you and purge you to pieces!

A. You are not a GOD, you are Professor Tadle and you are a PE Teacher, not a Nurse. I am Glen, Your nurse. B. Oh hail GOD Tadle, everyone bow or face his wrath! C. Hello Mr. Tadle, You are here in the hospital, I am your nurse and you are a patient here D. How can you be a GOD Mr. Tadle? Can you tell me more about it?

181.
Erik John Senna, Told Nurse Budek I dont want to

that, I dont want that thing.. thats too painful! Which of the following response is NON THERAPEUTIC

A. This must be difficult for you, But I need to inject you this for your own good B. You sound afraid C. Are you telling me you dont want this injection? D. Why are you so anxious? Please tell me more about your feelings Erik

182.
Legrande De Salvaje Y Cobrador La Jueteng, was

caught by the bacolod police because of his illegal activities. When he got home after paying for the bail, He shouted at his son. What defense mechanism did Mr. La Jueteng used? A. Restitution B. Projection C. Displacement D. Undoing

183.
Later that day, he bought his son ice cream and

food. What defense mechanism is Legrande unconsciously doing?

A. Restitution B. Conversion C. Redoing D. Reaction formation

184.
Crisis is a sudden event in ones life that disturbs a

persons homeostasis. Which of the following is NOT TRUE in crisis?

A. The person experiences heightened feeling of stress B. Inability to function in the usual organized manner C. Lasts for 4 months D. Indicates unpleasant emotional feelings

185.
Which of the following is a characteristic of crisis?

A. Lasts for an unlimited period of time B. There is a triggering event C. Situation is not dangerous to the person D. Person totality is not involved

186.
Levito Devin, The Italian prime minister, is due to

retire next week. He feels depressed due to the enormous loss of influence, power, fame and fortune. What type of crisis is Devin experiencing? A. Situational B. Maturational C. Social D. Phenomenal

187.
Estrada, The Philippine president, has been

unexpectedly impeached and was out of office before the end of his term. He is in what type of crisis? A. Situational B. Maturational C. Social D. Phenomenal

188.
The tsunami in Thailand and Indonesia took

thousands of people and change million lives. The people affected by the Tsunami are saddened and do not know how to start all over again. What type of crisis is this? A. Situational B. Maturational C. Social D. Phenomenal

189.
Which of the following is the BEST goal for crisis

intervention? A. Bring back the client in the pre crisis state B. Make sure that the client becomes better C. Achieve independence D. Provide alternate coping mechanism

190.
What is the best intervention when the client has just

experienced the crisis and still at the first phase of the crisis?

A. Behavior therapy B. Gestalt therapy C. Cognitive therapy D. Milieu Therapy

191.
Therapeutic nurse client relationship is describes as follows

1. Based on friendship and mutual interest 2. It is a professional relationship 3. It is focused on helping the patient solve problems and achieve health-related goals 4. Maintained only as long as the patient requires professional help A. 1,2,3 B. 1,2,4 C. 2,3,4 D. 1,3,4

192.
The client is scheduled to have surgical removal of

the tumor on her left breast. Which of the following manifestation indicates that she is experiencing Mild Anxiety? A. She has increased awareness of her environmental details B. She focused on selected aspect of her illness C. She experiences incongruence of action, thoughts and feelings D. She experiences random motor activities

193.
Which of the following nursing intervention would

least likely be effective when dealing with a client with aggressive behavior?

A. Approach him in a calm manner B. Provide opportunities to express feelings C. Maintain eye contact with the client D. Isolate the client from others

194.
Whitney, a patient of nurse Budek, verbalizes I

have nothing, nothing nothing! Don't make me close one more door, I don't wanna hurt anymore! Which of the following is the most appropriate response by Budek? A. Why are you singing? B. What makes you say that? C. Ofcourse you are everything! D. What is that you said?

195.
Whitney verbalizes that she is anxious that the

diagnostic test might reveal laryngeal cancer. Which of the following is the most appropriate nursing intervention? A. Tell the client not to worry until the results are in B. Ask the client to express feelings and concern C. Reassure the client everything will be alright D. Advice the client to divert his attention by watching television and reading newspapers

196.
Considered as the most accurate expression of

persons thought and feelings A. Verbal communication B. Non verbal communication C. Written communication D. Oral communication

197.
Represents inner feeling that a person do not like

talking about. A. Overt communication B. Covert communication C. Verbal communication D. Non verbal communication

198.
Which of the following is NOT a characteristic of an

effective Nurse-Client relationship? A. Focused on the patient B. Based on mutual trust C. Conveys acceptance D. Discourages emotional bond

199.
A type of record wherein , each person or

department makes notation in separate records. A nurse will use the nursing notes, The doctor will use the Physicians order sheet etc. Data is arranged according to information source. A. POMR B. POR C. Traditional D. Resource oriented

200.
Type of recording that integrates all data about the

problem, gathered by members of the health team. A. POMR B. Traditional C. Resource oriented D. Source oriented

201.
These are data that are monitored by using graphic

charts or graphs that indicated the progression or fluctuation of clients Temperature and Blood pressure. A. Progress notes B. Kardex C. Flow chart D. Flow sheet

202.
Provides a concise method of organizing and

recording data about the client. It is a series of flip cards kept in portable file used in change of shift reports. A. Kardex B. Progress Notes C. SOAPIE D. Change of shift report

203.
You are about to write an information on the Kardex.

There are 4 available writing instruments to use. Which of the following should you use?

A. Mongol #2 B. Permanent Ink C. A felt or fountain pen D. Pilot Pentel Pen marker

204.
The client has an allergy to Iodine based dye. Where

should you put this vital information in the clients chart?

A. In the first page of the clients chart B. At the last page of the clients chart C. At the front metal plate of the chart D. In the Kardex

205.
Which of the following is NOT TRUE about the

Kardex A. It provides readily available information B. It is a tool of end of shift reports C. The primary basis of endorsement D. Where Allergies information are written

206.
Which of the following, if seen on the Nurses notes,

violates characteristic of good recording? A. The client has a blood pressure of 120/80, Temperature of 36.6 C Pulse rate of 120 and Respiratory rate of 22 B. Ate 50% of food served C. Refused administration of betaxolol D. Visited and seen By Dr. Santiago

207.
The physician ordered : Mannerix a.c , what does a.c

means? A. As desired B. Before meals C. After meals D. Before bed time

208.
The physician ordered, Maalox, 2 hours p.c, what

does p.c means? A. As desired B. Before meals C. After meals D. Before bed time

209.
The physician ordered, Maxitrol, Od. What does Od

means? A. Left eye B. Right eye C. Both eye D. Once a day

210.
The physician orderd, Magnesium Hydroxide cc

Aluminum Hydroxide. What does cc means? A. without B. with C. one half D. With one half dose

211
Physician ordered, Paracetamol tablet ss. What

does ss means? A. without B. with C. one half D. With one half dose

212.
Which of the following indicates that learning has

been achieved? A. Matuts starts exercising every morning and eating a balance diet after you taught her mag HL tayo program B. Donya Delilah has been able to repeat the steps of insulin administration after you taught it to her C. Marsha said I understand after you a health teaching about family planning D. John rated 100% on your given quiz about smoking and alcoholism

213.
In his theory of learning as a BEHAVIORISM, he

stated that transfer of knowledge occurs if a new situation closely resembles an old one.

A. Bloom B. Lewin C. Thorndike D. Skinner

214.
Which of the following is TRUE with regards to

learning? A. Start from complex to simple B. Goals should be hard to achieve so patient can strive to attain unrealistic goals C. Visual learning is the best for every individual D. Do not teach a client when he is in pain

215.
According to Bloom, there are 3 domains in learning.

Which of these domains is responsible for the ability of Donya Delilah to inject insulin?

A. Cognitive B. Affective C. Psychomotor D. Motivative

216.
Which domains of learning is responsible for making

John and Marsha understand the different kinds of family planning methods?

A. Cognitive B. Affective C. Psychomotor D. Motivative

217.
Which of the following statement clearly defines

therapeutic communication? A. Therapeutic communication is an interaction process which is primarily directed by the nurse B. It conveys feeling of warmth, acceptance and empathy from the nurse to a patient in relaxed atmosphere C. Therapeutic communication is a reciprocal interaction based on trust and aimed at identifying patient needs and developing mutual goals D. Therapeutic communication is an assessment component of the nursing process

218.
Which of the following concept is most important in

establishing a therapeutic nurse patient relationship? A. The nurse must fully understand the patients feelings, perception and reactions before goals can be established B. The nurse must be a role model for health fostering behavior C. The nurse must recognize that the patient may manifest maladaptive behavior after illness D. The nurse should understand that patients might test her before trust is established

219.
Which of the following communication skill is most

effective in dealing with covert communication? A. Validation B. Listening C. Evaluation D. Clarification

220.
Which of the following are qualities of a good recording?

1. Brevity 2. Completeness and chronology 3. Appropriateness 4. Accuracy A. 1,2 B. 3,4 C. 1,2,3 D. 1,2,3,4

221.
All of the following chart entries are correct except

A. V/S 36.8 C,80,16,120/80 B. Complained of chest pain C. Seems agitated D. Able to ambulate without assistance

222.
Which of the following teaching method is effective in

client who needs to be educated about self injection of insulin?

A. Detailed explanation B. Demonstration C. Use of pamphlets D. Film showing

223.
What is the most important characteristic of a nurse

patient relationship? A. It is growth facilitating B. Based on mutual understanding C. Fosters hope and confidence D. Involves primarily emotional bond

224.
Which of the following nursing intervention is needed

before teaching a client post spleenectomy deep breathing and coughing exercises? A. Tell the patient that deep breathing and coughing exercises is needed to promote good breathing, circulation and prevent complication B. Tell the client that deep breathing and coughing exercises is needed to prevent Thrombophlebitis, hydrostatic pneumonia and atelectasis C. Medicate client for pain D. Tell client that cooperation is vital to improve recovery

225.
The client has an allergy with penicillin. What is the

best way to communicate this information? A. Place an allergy alert in the Kardex B. Notify the attending physician C. Write it on the patients chart D. Take note when giving medications

226.
An adult client is on extreme pain. He is moaning

and grimacing. What is the best way to assess the clients pain?

A. Perform physical assessment B. Have the client rate his pain on the smiley pain rating scale C. Active listening on what the patient says D. Observe the clients behavior

227.
The PCS gave new guidelines including leaflets to

educate cancer patients. As a nurse, When using materials like this, what is your responsibility?

A. Read it for the patient B. Give it for the patient to read himself C. Let the family member read the material for the patient D. Read it yourself then, Have the client read the material

228.
Which of the following is the shape of posterior fontanelle?
Diamond Triangular

c. round d. oblong

229.
During an otoscopic examination on an infant, in which direction is the pinna pulled?
Down and back Down and forward

c. Up and forward d. Up and back

230.
On auscultation of 8 year old Carlas lung fields, the midwife hears inspiratory sounds that are louder, longer, and higher pitched then on expiration. These sounds are heard over the chest, except over the scapula and sternum. These sounds are:
a. Bronchovesicular breath sounds

Vesicular breath sounds c. Bronchial breath sounds d. Adventitious breath sounds

b.

231.
Vibrations caused by the flow of blood from one chamber to another through a narrowed opening. b. Best felt with the dorsal surface of the hands. c. Found at the point of maximum intensity. d. Louder on inspiration than expiration.

232.
Which of the following organs is located in the lower

right quadrant of the abdomen? a. Bladder c. ovaries b. liver d. appendix

233.
An example of secondary prevention activity is a(n): a. cardiac rehabilitation program b. immunization program c. mammography screening program d. nutrition education program

234.
The site of copulation:
a. b.

Uterus Fundus

c. Cervix d. Vigina

235.
It is a uterine structure that houses the fetus during

pregnancy: a. Corpus b. Fundus

c. Isthmus d. Vagina

236.
When assessing a pregnant clients physical

condition, the midwife is aware that a normal adaptation of pregnancy is an increased blood supply to the pelvic region that results in purplish discoloration of the vaginal mucosa and known as: a. Ladins sign c. Goodels Sign b. Hegars Sign d. Chadwicks Sign

237.
It is the sleeping hormone of the body:
a. b.

Melatonin Diencephalons

c. vasopressin d. ADH

238.
A blood cell affected by plasmodium falciparum:
a. b.

Erythrocyte Thrombocyte

c. Leukocyte d. macrophage

239.
A specific blood cell affected by HIV:
a. b.

Helper T Cell Suppressor T Cell

c. CD8 T Cell d. Cytotoxic T Cell

240.
It is the control system of the body:
a. b.

c.
d.

Nervous System Endocrine System Cardiovascular System Renal System

241.
Isoimmunization results from:
a. b.

c.
d.

Rh - mother and Rh + fetus Rh + mother and Rh + fetus RH mother and Rh fetus RH + mother and Rh fetus

242.
An abruption placenta in which more than 2/3 of the

placenta is separated from the uterus: a. central c. overt b. moderate d. severe

243.
The diagnostic tool of choice for hydramnios:
a. b.

Sonogram Amniocentesis

c. Guthrie test d. Salk test

244.
A confirmatory test for HIV infection:
a. b.

ELISA Western Blot

c. HIV antigen test d. All of the above

245.
An immediate diet given to a client with hyperemesis

gravidarum right after vomiting has subsided: a. clear liquid diet b. full liquid diet c. small frequent feedings d. intravenous fluids

246.
A full liquid diet is one that contains :
a. b.

c.
d.

clear liquid at body temperature any liquid at body temperature only liquid have residue only liquid have no residue

247.
A low cholesterol diet includes foods that are primary

low in : a. animal protein and carbohydrates b. sodium c. saturated fats d. vitamins and minerals

248.
Vitamin B 12 is found naturally in :
a. b.

meat breads

c. fruits d. sugars

249.
Nutrients are substances needed by the body for

maintaining life and growth. Essential nutrition group includes: a. meats, bread and cereals, milk, citrus fruits b. fats, carbohydrates, meats, calcium, sodium and water c. protein, minerals, starches, vitamins and fats d. Protein, fats, carbohydrates, vitamins, minerals and water

250.
A client relates that the first day of her last menstrual

period was July 22. The estimated date of birth would be: a. May 5 c. April 5 b. May 15 d. April 29

251.
A client visits her gynecologist to confirm a

suspected pregnancy. During the history taking the client states that her last menstrual period began on April 11. The client states that some spotting occurred on May 8. The midwife calculates that the clients due date is: a. January 10 c. February 12 b. January 18 d. February 15

252.
What is the LMP of the mother is her latest

menstruation took place last June 14 18, 2010? a. June 14, 2010 c. June 14 18, 2010 b. June 18, 2001 d. June 16, 2010

253.
A pregnant woman comes to the clinic for an initial

check-up. Her LMP was December 16, 2009. Present day is February 14, 2010. Compute the Age of gestodian. a. 8 weeks and 4 days c. 8 weeks b. 7 weeks and 5 days d. 7 weeks

254.
What is the EDC if the LMP is January 15, 2010?
a. b.

September 22, 2010 c. September 23, 2010 October 22, 2010 d. October 23, 2010

255.
Where is the anatomical landmark of a pregnant

client with 36 weeks AoG? a. Level of the umbilicus b. Slightly above the xiphoidprocen c. Below the xiphoid process d. Slightly above the symphysis pubis

256.
The main purpose of Leopolds 3rd maneuver is to

determine: a. Fetal engagement c. Fetal presentation b. Fetal position d. Fetal attitude

257.
What is the Fahrenheit value of 39.3 C?
a. b.

100.74 101.74

c. 101.7 d. 102.7

258.
What is the Celsius value of 112.8 F?
a. b.

44 44.9

c. 45 d. 44.8

259.
Refer to these data: Systolic pressure 160mm.Hg;

Diastolic pressure75mm.Hg; Apical pulse100 beats per minute; Radial pulse65 beats per minute; stroke volume50cc per beat; Respiration16 breaths per minutes.

260.
What is the cardiac output?
a. b.

3250 cc per minute 3250 cc per beat

c. 5000 cc per minute d. 5,000 cc per beat

261.
What is the pulse deficit?
a. b.

35 40

c. 85 d. 50

262.
What is pulse pressure?
a. b.

85 35

c. 50 d. 40

263.
When a hypotonic crystalloid solution is infused into

the bloodstream it causes the cells to: a. Shrink c. Release Chloride b. Swell d. release potassium

264.
The main extra cellular cation is:
a. b.

Calcium Potassium

c. Bicarbonate d. Sodium

265.
IF your patient is breathing rapidly, his body is

attempting to: a. retain carbon dioxide b. get rid of excess carbon dioxide c. improve the buffering ability of bicarbonate d. produce more cabonic acid.

266.
If your pregnant patient has a higher than normal pH,

you would also expect to see: a. High PaCo2 and high HC03b. Low PaCo2 and high HC03c. High PaCo2 and low HC03d. Low PaCo2 and low HC03-

267.
The laboratory reports the following ABG results for

your patient: pH 7.33; PaCO2 40mmHg; and HC03 meglL. You interpret these results as: a. Respiratory acidosis b. Metabolic acidosis c. Respiratory Alkalosis d. Metabolic Alkalosis

268.
AB+ blood type means:
a. b.

c.
d.

has antigens A, B and D has antibodies A, B and D has antigens A and B has antigen O

269.
O blood type means:
a. b.

c.
d.

has antigens A and B has anti A antibody only has an antigen O has no antigens A, B and D

270.
During childbirth preparation classes for a group of

adolescent primigravid clients, one client asks, How does the baby breathe inside of me? The midwife responds by explaining Fetal circulation, stating that circulation of oxygenated blood from the placenta begins which of the following? a. Umbilical artery c. Ductus arteriosus b. Foramen Ovale d. Umbilical vein

271.
A primigravid client at 34 weeks gestation is

experiencing contractions every 3 to 4 minutes lasting for 35 seconds. Her cervix is 2cm dilated and 50% effaced. While the midwife is assessing the clients vital signs, the client says, I think my bag of water just broke which of the following would the midwife do first? a. Check the status of her right side b. Turn the client to her right side c. Test the leaking fluid with Nitrazine paper. d. Perform a sterile vaginal examination.

272.
A midwife on the day swifts walks into a clients room

and finds the client unresponsive. The client is not breathing and does not have a pulse. The midwife immediately calls out for help. The next action of the midwife is which of the following? a. Ventilate with a mouth-to-mouth device b. Start chest compression c. Give the client oxygen d. Open the airway

273.
A midwife is performing CPR on an adult client.

When performing chest compressions, the midwife understands that correct hand placement is located over the: a. Lower third of the sternum b. Upper half of the sternum c. Upper third of the sternum d. Lower half of the sternum

274.
A midwife witnesses a neighbors husband sustain a

fall from the roof of the house.The client has no spinal injury. The midwife rushes the victim and determines the need to open the airway. The midwife opens the airway in this victim by using which most of appropriate period? a. Head tilt chin lift b. Flexed position c. Jaw thrust maneuver d. Any of the above

275.
A midwife is performing a basic life support (BLS) on

a 7 year old. The midwife delivers how many breath per minute to the child? a. 12 c. 18 b. 16 d. 20

276.
A midwife is performing CPR on an infant. When

performing chest compression, the midwife understands that the compression rate is at least: a. 60 times per minute b. 80 times per minute c. 100 times per minute d. 160 times per minute

277.
A midwife instructor teaches a group of student

about BLS. The instructor asks the student to identify the most appropriate location to assess the pulse of an infant under 1 year of age. Which of the following, if stated by the student, would indicate that the student understands the appropriate assessment procedure? a. Brachial c. Popliteal b. Carotid d. Radial

278.
A midwife is performing CPR on an adult client. The

midwife understands that when chest compressions are performed, the sternum should be depressed: a. to inch c. 1 to 2 inches b. to 1 inch d. 2 to 3 inches

279.
The following are the functions of Sitz bath except:
a. b.

c.
d.

to provide comfort to aid perineal healing to reduce edema to provide comfort with cool water

280.
A type of joint movements defined as an outward

rotation: a. Eversion b. Inversion

c. Pronation d. Supination

281.
A type of joint movement in which the palm of the

hand faces upward. a. Eversion c. Pronation b. Inversion d. Supination

282.
A therapeutic exercise carried out by the midwife

without the assistance from the patient: a. Passive c. Active b. Active Assistive d. Resistive

283.
A therapeutic exercise carried out by the client alone:
a. b.

Passive Active assistance

c. Active d. Isometric

284.
The following DOH programs are celebrated on the

6th month of the year, except: a. Kidney month b. No smoking month c. Dengue awareness month d. Bright child week

285.
DOH anniversary is celebrated on:
a. b.

June 24 June 23

c. September 12 d. March 24

286.
The month of National Newborn screening week:
a. b.

August July

c. September d. October

287.
The breastfeeding position best used for small

babies: a. cradle hold b. cross cradle hold

c. clutch hold d. reclining position

288.
The breastfeeding position best for mothers who

have undergone Cesarean section. a. cradle hold c. clutch hold b. cross cradle hold d. reclining position

289.
Which microorganism most commonly causes

mastitis? a. staphylococcus aureus b. staphylococcus epidermis c. beta hemolytic streptococcus d. mumps virus

290.
Where would you expect to assess the uterine

fundus in a patient whos 2 days post partum? a. 2cm above the level of the umbilicus b. At the level of the symphysis pubis c. Approximately 2cm below the umbilicus d. 2cm above the symphysis pubis

291.
Which measure would the woman who is not

breastfeeding use to minimize engorgement? a. Cold compresses c. Warm Showers b. Manual expression d. Nipple stimulation

292.
A type of bed with the top sheet fan folded, ready for

a newly admitted client: a. Closed bed b. Open bed

c. post-op bed d. Occupied bed

293.
The following are purposes of bed making except:
a.

the promote comfort of the client b. to provide clean, neat environment c. to provide a smooth , wrinkle free bed foundation d. none of the above.

294.
A back rub technique that uses a smooth, long

stroke, moving the hands up and down: a. Effleurage c. Petrissage b. Tapotement d. all of the above

295.
A type of pain felt @the source and extends to

surrounding tissues: a. Radiating b. Intermittent

c. Intractable d. Referred

296.
QRS complex in an ECG result reflects :
a. b.

atrial contraction atrial relaxation

c. ventricular contraction d. ventricular relaxation

297.
The most life threatening causative agent of malaria

is known: a. Plasmodium falciparum b. Plasmodium ovale c. Plasmodium malariae d. Anopheles mosquito

298.
The causative agent of Hansenosis is known as :
a. b.

c.
d.

Mycobacterium tuberculosis Mycobacterium leprae Hansen bacteria none of the above

299.
The best preventive measure for hansenosis is :
a. b.

c.
d.

BCG vaccine handwashing stay away from infected people all of the above

300.
Rabies is also known as:
a. b.

rhabdovirus lyssa virus

c. hydrophobia d. Rabbie

301.
The drug of choice for malaria is :
a. b.

chloramphenicol chloroquine

c. ascorbic acid d. acetylcysteine

302.
Malarial parasites attack:
a. b.

RBC WBC

b. platelets d. all of the above

303.
The following are antileprosy drugs except:
a. b.

minocycline rifampicin

b. dapsone d. ethambutol

304.
The color of gauge 16 IV cannula is :
a. b.

blue gray

c. pink d. green

305.
What is the color of the bottle label of D5W?
a. b.

red blue

c. green d. orange

306.
What is the color of the bottle label of D5LR?
a. b.

red blue

c. green d. pink

307.
Refers to the strength of the uterine contraction:
a. b.

frequency duration

c. intensity d. interval

308.
It is measured from the beginning of a contraction to

the beginning of the next contraction: a. frequency c. intensity b. duration d. interval

309.
Babinskis sign is assessed by:
a.

Touching the lips or cheek with a nipple or a finger b. Stroking the heel upward along the lateral aspect of the sole and along the balls of the foot c. Placing a fingers in the palm of the newborns hand d. Making a loud noise or clap hands to elicit response

310.
The stage of cognitive development wherein the

child is able to solve abstract and concrete problems a. sensorimotor stage b. preoperational stage c. concrete operational d. formal operations

311.
An infants birth weight is 6 lbs at birth. At 6 months,

the nurse would anticipate that he would weigh: a. 16 lbs c. 18 lbs b. 12 lbs d. 21 lbs

312.
The first solid food that should be introduced to an

infant is: a. rice cereal b. fruits and vegetables

c. meats d. egg yolks

313.
The first solid food can be introduced at age:
a. b.

2 months 5 months

c. 9 months d. 1 year

314.
Vitamin K is given to neonata in order to prevent
a. b.

infection anemia

c. jaundice d. bleeding

315.

The midwife dries the infant after birth in order

to: a. b. c. d. Stimulate the circulating system Avoid excess heat less Remove organisms acquired during delivery Remove the skins white substance

316.
Shortly after the delivery, the baby is given vitamin K,

primarily to help; a. stimulate bilirubin b. start peristalsis movement c. improve blood coagulation d. increase sodium absorption

317.
The purpose of placing the baby in the crib with the

head lower than trunk is to: a. prevent hiccups b. facilitate the drainage of section c. improve respiration d. avoid tympanism

318.
A discussion starts among several mother

concerning whether to use reusable or dispensable diapers for their babies. Most mother are of the opinion that: a. Reusable and disposable diapers have both been found satisfactory and the choice is a personal. b. Reusable diapers are better since they are most absorbent c. Disposable diapers are better since they are less irritating to an infants skin. d. Reusable diapers are better for night time use

319.
Before the infant takes its first breath after birth the

midwife concern is to: a. perform APGAR score b. stimulate to cry c. clamp and cup the umbilical cord d. clear the airway

320.
Failure to administer Vit. K most often leds to:
a. b.

c.
d.

Prolong prothrombin time Bleeding within 24 hours of delivery Anemia Early blood clotting

321.
The goal of the initial assessment for the newborn is

to: determine a. Determine b. deformities and handicaps c. the state of oxygenation and ventilation d. the heart rate

322.
Which of the following injury at birth the midwife

need not to refer immediately? a. hemorrhage c. brain damage b. facial palsy d. cephalhematoma

323.
Crede prophylaxis is given to newborn in order to

prevent which of the following neonatorum? a. opthalmia c. interus b. tetanus d. jaundice

224.
The safest and most economical way for the mother

to prevent anemia in the 0-6 months old infant is by: a. giving iron preparation b. breast feeding c. giving early supplementation d. artificial feeding

325.
The correct technique of applying an ointment on the

eye of a neonate to prevent infection is: a. to apply the ointment on the conjuctive starting from the inner canthus b. to do it from the outer towards the inner canthus c. to place the tip of the tube as close possible to the childs eyes d. none of the above

326.
A type of heat loss that occurs when the heat is

dissipated by air current a. Convection c. Radiation b. Conduction d. Evaporation

327.
Which of the following is considered to be the most

important immediate care given to newborn: a. prevention of infection b. establishment and maintenance of respiration c. provision of clean environment d. stabilization of temperature