COMPREHENSIVE EXAM REVIEWER

THEORETICAL FOUNDATIONS
IN NURSING

Florence Nightingale Emphasis will be placed on theories environment of the patient to assist
related to the development of him in his recovery.
Began the history of professional
therapeutic relationships, modes of
nursing 1950s
effective communication and nursing
Envisioned nurses as a body of therapeutics. There is a consensus among nursing
educated women at a time when scholars that nursing needed to
Nursing theories
women where neither educated nor validate itself through the production
employed in a public service Are organized body of knowledge to of its own scientifically tested body of
define what nursing is, what nurses knowledge.
Curriculum era: questions of content
do, and why do they do it.
nurses should study to learn how to be 1952 Hildegard Peplau
a nurse Provide a way to define nursing as a
Introduced her theory of interpersonal
unique discipline that is separate from
The idea or moving nursing education relations that puts emphasis on the
other discipline (e.g. medicine)
from hospital based diploma programs nurse client relationship as the
into colleges and universities began to Nursing theories: It is a framework foundation of nursing practice.
emerge. of concepts and purposes intended to
1955 Virginia Henderson
guide the practice of nursing at a more
Theory era
concrete and specific level. Conceptualized the nurse's role as
The natural outgrowth of the research assisting sick or healthy individuals to
Nursing Theory
and graduate education gain independence in meeting 14
Is an organized, coherent and fundamentals of needs thus, her
The significance of theory for the
systematic articulation of set of Nursing Need Theory was developed.
discipline of nursing is that the
statements related to significant
discipline is dependent on theory for 1960 Faye Abdellah
questions in a discipline and
its continued existence
communicated as meaningful whole Published her work "typology of 21
Nursing nursing problems" that shifted the
Is an inductively and or deductively
focus of nursing from a disease
- Can be a vocation; can be a derived collage of coherent, creative,
centered approach to a patient-
discipline with a professional and focused nursing phenomenon that
centered approach
style of theory based practice frame, give meaning to and help
- As a profession is committed to explain specific and selective aspects 1962 Ida Jean Orlando
recognizing its own unparalleled of nursing research and practice
Nursing Process Theory, emphasized
body of knowledge parallel to Identify, develop and understand the reciprocal relationship between
nursing practice. patient and nurse and viewed the
- Is a unique discipline and is To distinguish this foundation of
professional function of nursing as
separate from medicine. It has its knowledge nursing needed to __, __,
finding out and meeting the patient's
own body of knowledge on which and __ concept theories in line with
immediate need for help.
delivery care is based. nursing.
1968 Dorothy Johnson
Commitment to theory-based evidence 1800s
for practice is Beneficial to patients Pioneered the Behavioral System
The first nursing theories appeared in
in that it guides systematic, Model and upheld the fostering of
the late ________ when a strong
knowledgeable care. efficient and effective behavioral
emphasis was placed on nursing
functioning in the patient to prevent
Theoretical Foundations of Nursing education.
illness
A central concept of health, person, 1860 Florence Nightingale
1970 Martha Rogers
environment, nursing, and caring will Defined nursing in her environmental
be explored. Viewed nursing as both a science and
theory as the act of utilizing the
an art as it provides a way to view the
Theoretical

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unitary human being, who is integral known and understood by a group with its own special features, its own
with the universe. or discipline theoretical perspective spelled out as
- is dynamic, it evolves and it is 'good nursing' and its own scientific
1971 Dorothea Orem
subtle while simultaneously being ideal: a wish "being better able to meet
States in her theory that nursing care is overt the requirements of persons who seek
required if the client is unable to fulfill - encompasses more than rhetoric; nursing through the mapping out of
biological, psychological, it is a guide by which situation are nursing actions which result in good
developmental, or social needs. approached, the viewpoint used to nursing"
see what is before one, and the
When did Orem put her theory into Epistemology
method by which one searches for
words? 2001
truth as well as understanding of Is described generally as the doctrine
What does Orem’s theory focus on? what truth is. of the sources, reliability and
Patient’s self-care needs - Capture the essence of human boundaries of human knowledge
being, such as the essence of what
What is the goal of Orem's theory? Epistemology
is means to be a provider in
For the patient to manage his or caring profession. Described generally as the doctrine of
Orem's self-care deficit theory - is more than a belief - it is the the sources, reliability and boundaries
Increase the ability of the client to application of threat belief to of human knowledge.
meet and perform self-care needs her situation known or unknown
- Defined as "belief of a person or History and philosophy of science
health problems
group of persons" and reveals Important as a foundation for
1971 Imogene King underlying values and attitudes exploring whether scientific results are
Theory of Goal attainment states that regarding an area actually truth.
the nurse is considered part of the - Beliefs and values that define a
way of thinking and are generally Truth
patient's environment and the nurse-
patient relationship is for meeting known and understood by a group As nurses our practice should be based
goals towards good health. or discipline. upon ________ and we need the
Caring: indicates philosophical belief. ability to interpret the results of
1972 Betty Neuman science.
Based on stress and the client's Empiricist
Nursing science
reaction to stressors Truth is based on experience and
relating to one's experience - Provides us with knowledge to
In her theory states that many needs describe, explain and predict
exist, and each may disrupt client Positivist outcomes. The legitimacy of any
balance or stability. Stress reduction is profession is built on its ability to
the goal of the system When was Is science and facts that science
discover generate and apply theory."
Neuman's theory created? 2010 - Explain phenomenon and that
What is Neuman's based on? Based on Positivism scientist create theories for the
stress and the patient's stressor purpose of explanation.
A term first used by Comte, emerged
- Theories are developed for
In Neuman's theory what is the role of as the dominant view of modern
explaining different type of data
nursing? To stabilize the patient or science
both objective and subjective
situation model of nursing practice. Philosophy of science exists as the which are considered relevant to
1979 Sr. Callista Roy interaction of philosophy and the development of knowledge
science within nursing.
Viewed the individual as a set of
interrelated systems who strives to Where the two meet to form a new 1960s
maintain the balance between these perspective that aims to examine the
The development of nursing science
various stimuli. body of knowledge and the
has evolved since the ____ as a pursuit
approaches to the study of body of
1979 Jean Watson to be understood as a scientific
knowledge.
discipline
Developed the philosophy of caring Philosophy of science in nursing
highlighted humanistic aspects of The Rationalist
nursing as they intertwine with An examination of nursing concepts,
Consider that logical-conceptual
scientific knowledge and nursing theories, laws and aims as they relate
thinking is based on theoretical
practice. to nursing practice.
analysis is most source of knowledge
Philosophy Philosophy of nursing science and method form ideal of deductive
reasoning from cause and effect from
- Beliefs and Values that define a includes the basic research, the
generalization to a particular instance
way of thinking and are generally standpoints for this particular science

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Priori principles about nature of knowledge that explain a phenomenon. It should
and truth (epistemology) and about the also explain how these components
The source of knowledge comes from
nature of entities- nursing practice and relate to each other.
___________
human healing processes?
Phenomenon
Knowledge is independent of one's
Define how one finds the truth
experience. A term given to describe an idea or
Overall purpose of personal responses about an event, a situation, a
Posteriori
philosophy process, a group of events, or a group
Knowledge is dependent on the of situations; may be temporary or
Theory
experience permanent.
Notion or an idea that explains
Deductive reasoning Phenomena of Nursing
experience, interprets observation,
Derived from one or more statements. describes relationship and suggest Nursing theories focus on the
It starts form general statement and outcomes
Concepts
examine possibilities to reach a logical
Nursing theorist
conclusion. Mental representations of categories
Wrote that theories help us know what of items or ideas, based on experience.
The Empiricist
we know and decide what we need to
Are used to help describe or label a
Person who believes that knowledge know.
phenomenon. They are words or
comes from experience with the
Theories phrases that identify, define, and
environment; argue that knowledge is
establish structure and boundaries for
based on human experience and that Are mental patterns of frameworks
ideas generated about a particular
concepts, the meaning of words is created to help understand and create
phenomenon; may be abstract or
reflection of observation. The central meaning form our experience,
concrete.
idea that scientific knowledge can be organize and articulate our knowing,
derived only form sensory ask questions leading to new insights? Abstract Concepts
experiences. Utilizing inductive
Are part of knowledge structure of any Defined as mentally constructed
method of reasoning which is based
discipline independent of a specific time or place
on the idea that the collection of facts
precede attempts to formulate Theories: help describe, explain, Concrete Concepts
generalization predict, and/or prescribe nursing care
Are directly experienced and related to
measures.
Early 20th Century a particular time or place.
Purpose of theory in a Professional
During the first half of this century, Definition
Discipline
Philosophers focused on the analyses
Definitions are used to convey the
of theory structure. Scientist focused They organize knowledge, guide
general meaning of the concepts of the
on Empirical research. inquiry to advance science, guide
theory. C1an be theoretical or
practice and enhance the care of
Modern logical positivists operational.
patients.
Believed that empirical research and Theoretical Definitions
Purpose of theory in a Professional
logical analysis (deductive and
Discipline Define a particular concept based on
inductive) were two approaches that
the theorist's perspective.
would produce scientific knowledge Nursing Theory addresses the
phenomena of interest to nursing: Operational Definitions.
Theory in the late twentieth century
human beings, health and caring in the
States how concepts are measured.
In 1977, Brown argued an intellectual context of the nurse person
revolution in philosophy that relationship. Relational Statement
emphasized the history of science was
replacing formal logic as the major Define the relationships between two
analytical tool in the philosophy of or more concepts. They are the chains
Purpose of theory in a Professional
science. One of the major perspectives that link concepts to one another.
Discipline
in the new philosophy emphasized Assumptions "Taken for granted"
Theories are patterns that guide the
science as a process of continuing
thinking about being, and doing of (in) Are accepted as truths and are based
research rather than a product focused
nursing. on values and beliefs. These are
on findings.
statements that explain the nature of
Components of Nursing Theories
Nursing philosophy concepts, definitions, purpose,
Theory to be a theory it has to contain relationships, and structure of a
Is a statement of foundational and
a set of concepts, definitions, theory.
universal assumptions, beliefs, and
relational statements, and assumptions

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Domain of inquiry Focus on the phenomena of concern to Is defined as the degree of wellness or
the discipline such as persons as well-being that the client experiences.
(Also called metaparadigm or focus of
adaptive systems, self-care deficit, It may have different meanings for
discipline) is the foundation of the
unitary human being, human each patient, the clinical setting, and
structure.
becoming or health expanding the health care provider.
Nursing domain consciousness.
A state of complete physical, mental,
Described as the disciplinary focus The grand theories or conceptual and social well-being and not merely
statement or metaparadigm. models the absence of disease or infirmity
Domain Are composed of concepts and Nursing
relational statements, organizational
The view/ perspective of a profession. The attributes, characteristics, and
and societal belief and values.
Contains: Subject; concepts, values, actions of the nurse providing care on
beliefs, problems Grand nursing theories behalf of or in conjunction with, the
client. There are numerous definitions
metaparadigm. Do not provide guidance for specific
of nursing, though nursing scholars
nursing interventions but rather
Disciplinary focus statement may have difficulty agreeing on its
provide a general framework and ideas
exact definition, the ultimate goal of
Knowledge structure about nursing.
nursing theories is to improve patient
Includes paradigm, conceptual models Grand nursing theorists care.
or grand theories, middle range Middle Range Theories
Develop their works based on their
theories, practice theories, research
own experiences and the time they
and practice traditions - Are the next level in the structure
were living explaining why there is so
of discipline? Nursing scholars
Paradigm much variation among theories.
proposed using this level of
Is the next level of the disciplinary Examples of Grand Theory theory because of the difficulty in
structure of nursing that is useful in testing grand theory
Johnson's Behavioral System's model,
understanding nursing knowledge? - Are narrower in scope and offer
Roy's Adaptation model, Rogers'
an effective bridge between grand
Paradigm Science of Unitary Beings, Orem's
theories and the description and
Self-Care Deficit Nursing theory,
A global, general framework explanation of specific nursing
Watson's Theory of Human Caring
composed of assumptions about the phenomenon.
nature of phenomenon of concern to Conceptual models - More limited in scope (as
the discipline. compared to grand theories) and
Also called conceptual framework or present concepts and propositions
It offers particular perspective on the conceptual systems which are sets of at a lower level of abstraction.
metaparadigm or disciplinary domain. general concepts and prepositions that They address a specific
provide perspective on the major phenomenon in nursing.
Totality paradigm concepts of the metaparadigm to - Due to the difficulty of testing
Reflects a worldview that humans are include, person, environment, health grand theories, nursing scholars
integrated beings with biological, and nursing proposed using this level of
psychological, sociocultural and Person theory.
spiritual dimensions. Humans adapt to - Most _______________ are
their environments, and health and (Also referred to as Client or Human based on the works of a grand
illness are on a state of continuum Beings) is the recipient of nursing care theorist but they can be conceived
and may include individuals, patients, from research, nursing practice, or
Grand Theories groups, families, and communities. the theories of other disciplines.
Next in structure level of discipline. Environment - Address specific phenomena and
They are less abstract than the focus of reflect practice.
the discipline and paradigms but more (Or situation) is defined as the internal - Theories limited in scope that
abstract than middle range theories. and external surrounds that affect the address specific phenomena and
client. It includes all positive or reflects practice
Theories broad in scope and complex; negative conditions that affect the
require further specification through patient, the physical environment, Practice Level theories
research such as families, friends, and Have the most limited scope and level
Are abstract, broad in scope, and significant others, and the setting for of abstraction and are developed for
complex, therefore requiring further where they go for their healthcare. the use within specific range of
research for clarification Health nursing situations
Conceptual models and grand Practice nursing theories
theories

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Are situation specific theories that are (Philosophy, conceptual model, Theory of Interpersonal Relations
narrow in scope and focuses on a theory, or middle range theory).
Has been described as the mother of
specific patient population at a
Simplicity psychiatric nursing because her
specific time?
theoretical and clinical work led to the
It is highly valued in nursing theory
Practice-level nursing theories development of the distinct specialty
development.
field of psychiatric nursing. Her scope
Provide frameworks for nursing
It discuss the degrees of simplicity and of influence in nursing includes her
interventions and suggest outcomes or
call for simple forms of theory, such contributions as a psychiatric nursing
the effect of nursing practice.
as middle range, to guide practice. expert, educator, author, and nursing
Practice-level nursing theories leader and theorist.
Complex practice situation may call
Theories developed at this level have a for more complex theory. Hildegard Peplau's Interpersonal
more direct effect on nursing practice Relations Theory
A theory should be sufficient,
as compared to more abstract theories.
comprehensive, presented at a level of Emphasized the nurse-client
These theories are interrelated with abstraction to provide guidance, and relationship as the foundation of
concepts from middle-range theories have as few concepts possible with a nursing practice
or grand theories. simplistic relation as possible to aid
Peplau
clarity.
Theory.
Form an interpersonal model
Generality
A belief, policy, or procedure emphasizing the need for a partnership
proposed or followed as the basis of It speaks to the scope of application between nurse and client as opposed
action. It refers to a logical group of and the purpose within the theory to the client passively receiving
general propositions used as principles (Chinn & Kramer, 2015). treatment and the nurse passively
of explanation. are also used to acting out doctor's orders.
Understanding the levels of
describe, predict, or control
abstraction by doctor’s students and Phase in Nurse Patient Interaction
phenomena.
nurse scientist has facilitated the use
- Orientation Phase.
Concept. of abstract frameworks and the
- Identification Phase
development of middle-range theories.
are often called the building blocks of - Exploitation Phase.
theories. They are primarily the Accessibility - Resolution Phase.
vehicles of thought that involve
“Accessible addresses the extent to Peplau Metaparadigm
images.
which empiric indicators for the
Person, which is a developing
Conceptual framework. concepts can be identified and to what
organism that tries to reduce anxiety
extent the purposes of the theory can
is a group of related ideas, statements, caused by needs
be attained"
or concepts. It is often used
Orientation Phase.
interchangeably with the conceptual It is vital to developing nursing
model and with grand theories. research to test theory. It facilitate Is directed by the nurse and involves
testing, because the empirical engaging the client in treatment,
Paradigm.
indicators provide linkage too practice providing explanations and
Refers to a pattern of shared for test ability and ultimate use of information, and answering questions.
understanding and assumptions about theory to describe and test aspects of
Identification Phase
reality and the world; worldview or practice (Chinn&Krammer, 2015).
widely accepted value system. Begins when the client works
Importance
interdependently with the nurse,
Structure Level (Analysis of theory,
"Does this theory create understanding expresses feelings, and begins to feel
clarity, simplicity, generality,
that is important to nursing?". Because stronger.
accessibility, importance).
research, theory, and practice are
Exploitation Phase.
Clarity closely related, nursing theory lends
itself to research testing and research The client makes full use of the
It speaks to the meaning of term used,
testing leads itself to knowledge of services offered.
and definitional consistency and
practice.
structure speak to the consistent Resolution Phase.
structural form of terms in the theory. Hildegard Peplau
The client no longer needs
Words have multiple meanings within was born on September 1, 1909. She professional services and gives up
and across disciplines; therefore a was raised in Reading, Pennsylvania dependent behavior. The relationship
word should be defined specifically by her parents of German descent, ends.
according to the framework Gustav and Otyllie Peplau.
Peplau Metaparadigm

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Environment, which consists of Was born in Kansas City, Missouri, in Contributed to nursing knowledge by
existing forces outside of the person, 1897. providing direction for the discipline,
and put in the context of culture forming a basis for professional
Nursing Need Theory was developed
scholarship and leading to new
Health, which is a word symbol that by her to define the unique focus of
theoretical understandings
implies forward movement of nursing practice.
personality Nursing philosophies
The theory focuses on the importance
Nursing, which is a significant of increasing the patient's Represent early works predating the
therapeutic interpersonal process that independence to hasten their progress theory era, as well as contemporary
functions cooperatively with other in the hospital. works of a philosophical nature
human process that make health
Virginia Henderson's Philosophies
possible for individuals in
Metaparadigm
communities. are works that provide broad
Individual, Environment, Health, understanding that advances the
Nursing discipline and its professional
Faye Glenn Abdellah application
Individual. Henderson
(March 13, 1919 - present) is a Florence Nightingale
States that have basic needs that are
pioneer in nursing research who
component of health and require The founder of modern nursing, was
developed the "Twenty-One Nursing
assistance to achieve health and born on May 12, 1820, in Florence,
Problems."
independence or a peaceful death. Italy.
Her model of nursing was progressive According to her, a _________
She was called The Lady of the Lamp,
for the time in that it refers to a achieves wholeness by maintaining
as immortalized in the poem "Santa
nursing diagnosis during a time in physiological and emotional balance.
Filomena" (Longfellow, 1857)
which nurses were taught that
Environment. Henderson
diagnoses were not part of their role in She used to establish schools or
health care. Mean implementing Theory supports the tasks of the nursing training at St. Thomas's
skilled nursing interventions and private and the public health sector or Hospital and King's College Hospital
clinical judgment skills in actual agencies in keeping the people in London
clinical situations healthy. She believes that society
Theory focused on environment
wants and expects the nurse's service
Major Concepts of 21 Nursing
of acting for individuals who are She defined and described the
Problems Theory
unable to function independently. concepts of ventilation, warmth, light,
Individual, Health, Society, diet, cleanliness, and noise—
Health. Henderson
components of surroundings usually
Individual, Abdellah
Was taken to mean balance in all referred to as environment
She describes the recipients of nursing realms of human life. It is equated
Proper ventilation is her major
as individuals (and families), although with the independence or ability to
concern, she indicates that the
she does not delineate her beliefs or perform activities without any aid in
surroundings as a source of disease
assumptions about the nature of the 14 components or basic human
and recovery
human beings. needs.
Major Assumptions, Nightingale
Health, Abdellah Nursing. Henderson
Nursing, Health, Environment, Person
is "total health needs" and "a healthy She defined nursing as "the unique
state of mind and body." _________ function of the nurse is to assist the Nursing. Major Assumption
may be defined as the dynamic pattern individual, sick or well, in the
Nightingale believed that every
of functioning whereby there is a performance of those activities
woman, at one time in her life, would
continued interaction with internal and contributing to health or its recovery
be a nurse in the sense that _______ is
external forces that results in the that he would perform unaided if he
being responsible for someone else's
optimal use of necessary resources to had the necessary strength, will or
health
minimize vulnerabilities. knowledge
Health. Major Assumption
Society, Abdellah Nursing philosophy
Nightingale defined _______ as being
is included in "planning for optimum Sets forth the meaning of nursing
well and using every power (resource)
health on local, state, and international phenomena through analysis,
to the fullest extent in living life.
levels." reasoning, and logical argument.
Environment. Major Assumption
Virginia Henderson Philosophies
The Need Theory

6
Nightingale's concept of ________ elements: (1) a high level of overall Medical-Surgical Nursing from the
emphasized that nursing was "to assist physical, mental, and social University of California, Berkeley
nature in healing the patient. functioning; (2) a general adaptive-
From Novice to Expert
maintenance level of daily
Person. Major Assumption
functioning; (3) the absence of illness This nursing theory proposes that
as a patient. Nurses performed tasks to (or the presence of efforts that lead to expert nurses develop skills and
and for the patient and controlled the its absence)" understanding of patient care over
patient's environment to enhance time through a proper educational
Watsons Major Assumptions,
recovery. background as well as a multitude of
Nursing
experiences.
Environmental aspects of her theory
Consists of "knowledge, thought,
(i.e., ventilation, warmth, quiet, diet, Is not focused on how to be a nurse,
values, philosophy, commitment, and
and cleanliness) rather on how nurses acquire nursing
action, with some degree of passion"
knowledge - one could gain
The __ remain integral components of
Watsons Major Assumptions, knowledge and skills ("knowing
nursing care and the relevance of
Environment how"), without ever learning the
concepts continues in the twenty-first
theory ("knowing that").
century. As "attending to supportive,
protective, and or corrective mental, Stages of Clinical Competence
Notes in Nursing
physical, societal, and spiritual
Novice, advanced beginner,
Nightingale's philosophy and theory of environments
competent, proficient, expert
nursing are stated clearly and
Watsons Major Assumptions,
concisely in _____________________ Novice
Human
Philosophy of nursing. Nurses lack the speed and flexibility
Being, person, life, personhood, and
of proficient nurses, but they have
Nightingale's work has come to be self. She views the person as "a unity
some mastery and can rely on advance
recognized as a _______________ of mind/body/spirit/nature" (1996, p.
planning and organizational skills.
some formulations have been tested, 147), and she says that "personhood is
most often principles are derived from tied to notions that one's soul possess a Advanced Beginner.
anecdotal situations to illustrate their body that is not confined by objective
Those are the new grads in their first
meaning and support their claims time and space
jobs; they have the knowledge and the
Jean Watson Philosophy and Theory of know-how but not enough in-depth
Transpersonal Caring (Nursing experience.
Philosophy and Theory of
model)
Transpersonal Caring Competent
The nursing model states that "nursing
(June 10, 1940 - present) is an These nurses lack the speed and
is concerned with promoting health,
American nurse theorist and nursing flexibility of proficient nurses, but
preventing illness, caring for the sick,
professor who is well known for her they have some mastery and can rely
and restoring health."
"Philosophy and Theory of on advance planning and
Transpersonal Caring." Her study on Caring organizational skills
caring has been integrated into
It focuses on health promotion, as well Proficient:
education and patient care to various
as the treatment of diseases.
nursing schools and healthcare At this level, nurses are capable to see
According to Watson. Is also central
facilities all over the world. situations as "wholes" rather than
to nursing practice, and promotes
parts. Proficient nurses learn from
10 carative factors health better than a simple medical
experience what events typically occur
cure
Watson's main concepts include __ and are able to modify plans in
and transpersonal healing and Watson response to different events.
transpersonal caring relationship,
She believes that a holistic approach Expert:
caring moment, caring occasion,
to health care is central to the
caring healing modalities, caring Nurses who are able to recognize
practice of caring in nursing.
consciousness, caring consciousness demands and resources in situations
energy, and phenomenal file/unitary Patricia Benner and attain their goals. These nurses
know what needs to be done. They no
Watsons Major Assumptions, From Novice to Expert
longer rely solely on rules to guide
Health
Was born in Hampton, Virginia, and their actions under certain situations.
Was derived from the World Health received her bachelor's degree in
Metaparadigm Concepts as Defined
Organization as, "The positive state of Nursing from Pasadena College in
by Benner, Person
physical, mental, and social well- 1964, and later a master's degree in
being with the inclusion of three

7
Embodied _________ living in the nursing specialty education at the Explains a systematic view of a
world who is self-interpreting being, same institution. She graduated in phenomenon specific to the discipline
that is _________ who does not come 1970 from the nursing teacher of inquiry. Includes: basic human
into the world into the world. (Benner education program at Helsinki Finnish
needs, developmental, psychological,
& Wrubel 1989.) School of Nursing. She continued her
academic studies at University of systems
Metaparadigm Concepts as Defined
Helsinki, where she received her MA Nursing paradigm
by Benner, Environment
degree in philosophy in 1974 and her
A social environment with social licentiate degree in 1976; she Direct the activity of the nursing
definition and meaningfulness defended her doctoral dissertation in profession, including knowledge
pedagogy (The Patient Care Process— development, philosophy, theory,
Metaparadigm Concepts as Defined educational experience, research, and
An Approach to C
by Benner, Health practice.
Caritas
The human experience of health or 4 links include: Person, Health,
wholeness Means love and charity. In_________, Environment, and Nursing
eros and agapé are united, and caritas
Metaparadigm Concepts as Defined Nursing theory
is by nature unconditional love. it is
by Benner, Nursing.
the fundamental motive of caring
The conceptualization of some aspect
A caring relationship that includes the science, also constitutes the motive for
of nursing that describes, explains,
care and study of the live experience, all caring. It means that caring is an
predicts, or prescribes nursing care.
of health, illness and disease. endeavor to mediate faith, hope, and
love through tend
Theory of Human Caring Descriptive theories
Caring communion
"Nursing is concerned with promoting
health, preventing illness, caring for Constitutes the context of the meaning Theories that describe phenomena,
the sick, and restoring health." of caring and is the structure that why they occur and the consequences;
determines caring reality has ability to explain, relate and
Nurse - Patient Relationship
The act of caring predict
not a uniform, professionalized
blueprint but rather a kaleidoscope of Contains the caring elements (faith, Descriptive theory
intimacy and distance in some of the hope, love, tending, playing, and Describe phenomena, speculate on
most dramatic, poignant, and mundane learning), involves the categories of why phenomena occur, and describe
moments of life." • infinity and eternity, and invites to the consequences of phenomena.
deep communion. It is the art of
Carative Caring making something very special out of
Prescriptive theories
- The ultimate goal of caring is to something less special.
lighten suffering and serve life and Content Theories address nursing interventions
health.
The information about the nursing and predicts consequences of the
Katie Erikson interventions for patients with specific interventions; action oriented and tests
Carative Caring health care problems. validity and predictability of a nursing
Environment/situation intervention
is one of the pioneers of caring science
in the Nordic countries. When she Includes all possible conditions A closed system
started her career 30 years ago, she affecting patients and the settings in
had to open the way for a new science. which their health care needs occur. Does not interact with the
We who followed her work and environment
progress in Finland have noticed her Feedback
ability from the beginning to design An open system
The outcomes reflect the patient's
caring science as a discipline, while
responses to nursing interventions.
bringing to life the abstract substance Interacts with the environment
of caring. Input
Nightingale's theory
Was born on November 18, 1943, in The data or information that comes
Jakobstad, Finland. She belongs to the from a patient's assessment Manipulate the environment to heal,
Finland-Swedish minority in Finland, pioneered nursing education,
Output
and her native language is Swedish.
observation and data collection
She is a 1965 graduate of the Helsinki Patient’s health status for returning to
Swedish School of Nursing, and in the environment Peplau's theory
1967, she completed her public health
Interdisciplinary theory

8
Nurse-client interactions, interpersonal What interactions does the input 4. Orem- 2001
relationships include? 5. Leininger- 2010
 Psychological
Henderson's theory  Physiological When was Roy's theory created? 1989
 Developmental What does Roy's view the patient as?
Move client toward independence as  Sociocultural An adaptive system
quickly as possible, based on 14 basic  Environmental
needs of the whole person  Spiritual When is nursing needed according to
Roy's theory? When the patient
Leininger's theory System nursing process: cannot adapt to stressors
Cultural diversity - goal of nursing is  assessment When was Watson's theory created?
 Nursing diagnosis 1996
to provide culturally specific nursing
 Planning
care What does Watson's theory define?
 Implementation
 Evaluation The outcome of nursing activity
Roy's theory
** All revolving around content with regard to the humanistic
Client is an adaptive system, nurse activities of life
assists clients to adapt to changes in Mid 1800s
What is the purpose of Watson's
illness Nightingale live and do research theory? To understand the
interrelationships among health,
Watson's theory Focus of nursing care: the illness, and human behavior
environment- air, light, temperature,
Transpersonal caring; based on human diet of people, whether or not the Watson
behavior and response environment was quiet and how all
Hospice care- if we can’t provide
these played into the wellness of
Benner andn Wrubel's theory wellness then help them be
patients
comfortable and die peacefully
Caring as a means of coping with What kind of theory was
When was Benner and Wrubel
stressors of illness Nightingales? Descriptive
created? 1989
Chinn and Kramer described the When did Peplau put her theory into
What does Benner and Wrubel say?
relationship between research and words? 1952
Caring is central. (Central provides
theory as a Spiral What did Peplau's theory focus on? aspects of coping????)
Interpersonal relations between
What is the goal of nursing Bill reads about the concept of
nurse, patient, and patient’s family
people's responses and adaptation to
knowledge? change. The theory that views the
* The development of the nurse-
patient relationship patient as an adaptive system is Roy
To explain the practice of nursing as
different and distinct from the practice When did Henderson put her theory Nursing is both theoretical and
of medicine, psychology, and other into words? 1955, 1966 practical
health care disciplines Henderson's theory What are the goals of theoretical
knowledge?
Basic human needs There are 14 basic needs of humans. If
one of these needs isn't met then To stimulate thinking and create a
1. Physiological- we need a heart beat threats where nursing is needed. broad understand of the "science" and
2. Safety and security- a female the practices of the nursing discipline
emergency room who has just been When did Leininger put her theory
into words? 2010 Experiential Knowledge
beaten up by her bf and she is in fear
that he will come find her. Or the "art" of nursing, based on
Cultural care diversity and
3. Loving and belonging nurses' experiences in providing care
universality -it considers social
4. Esteem and self-esteem to patients
structure factors
5. Self-actualization
Chronological Order of Nursing
Nursing theories provide nurses with theorists:
perspectives from which to predict Is theory the "law"?
phenomena 1. Nightingale- mid 1800s
2. Peplau- 1952
3. Henderson- 1955, 1966

9
NO, it changes. We pull out aspects of theory. Benner and Wrubel's theory is Builds the knowledge base for
all the different theories and make based on the premise that persons, nursing, which is then applied to
them our own theory. events, projects, and things matter to practice
people. (true)
Nursing process is central to nursing Theory-generating or theory testing
practice. Nursing practice is derived Theories provide: direction for research
from a theory nursing theory
Refines the knowledge base of nursing
Susan quizzes Bill about the core Nursing theory and nursing
concept of Benner and Wrubel's research

HEALTH ASSESSMENT

Assessment 4. Evaluating each hypothesis with Second-level priority problems

the new data collected, which
Assessment is the collection of leads to a final diagnosis. Second-level priority problems are
subjective and objective data about a next in urgency. They require prompt
patient's health. The nursing process includes which intervention to prevent deterioration,
six phases? and may include a mental status
Subjective data change or acute pain.
(1) Assessment,
Subjective data consist of information (2) Diagnosis, Third-level priority problems
provided by the affected individual. (3) Outcome identification,
(4) Planning, Third-level priority problems are
Objective data important to the patient's health, but
(5) Implementation, and
Objective data include information (6) Evaluation. can be addressed after more urgent
obtained by the health care provider problems. Examples include lack of
through physical assessment, the It is a dynamic, interactive process in knowledge or family coping.
patient's record, and laboratory which practitioners move back and
forth within the steps. Evidence-based practice
studies.
The novice nurse Evidence-based practice is a
The database systematic approach to practice that
The database is the totality of The novice nurse has no experience uses the best evidence, the clinician's
information available about the with specific patient populations and experience, and the patient's
patient. The purpose of assessment is uses rules to guide performance. preferences and values to make
to make a judgment or diagnosis. decisions about care and treatment.
The experienced nurse
Diagnostic reasoning Every examiner needs to collect four
The experienced nurse understands a kinds of databases based on the
Diagnostic reasoning is the process of patient situation as a whole rather than situation. What are the four kinds of
analyzing health data and drawing as a list of tasks, attends to an databases?
conclusions to identify diagnoses. assessment data pattern, and acts
without consciously labeling it. (1) A complete (or total health)
Diagnostic reasoning has which four database includes a complete
major components? Critical thinking health history and a full physical
Critical thinking is the examination.
1. Attending to initially available (2) A focused (or problem-centered)
cues, which are pieces of multidimensional thinking process
needed for sound diagnostic reasoning database is used for a limited or
information, signs, symptoms, or short-term problem. It is smaller
laboratory data; and clinical judgment. Seventeen
critical thinking skills have been in scope and more targeted than
2. Formulating diagnostic the complete database.
hypotheses, which are tentative identified, including setting priorities.
(3) A follow-up database evaluates
explanations for a cue or a set of First-level priority problems the status of any identified
cues and can serve as a basis for problem at regular intervals to
further investigation; First-level priority problems are follow up on short-term or
3. Gathering data relative to the emergent, life-threatening, and chronic health problems.
tentative hypotheses; immediate, such as establishing an (4) An emergency database calls for
airway or supporting breathing. rapid collection of data, which

10
 commonly occurs while Emergency: An emergency database The second largest population
performing lifesaving measures. is rapid collection of the data often is Asians followed by Blacks,
obtained concurrently with lifesaving American Indians, Alaska natives,
The biomedical model measures. Native Hawaiians, and other Pacific
The biomedical model of Western islanders.
A medical diagnosis is used to
medicine views health as the absence evaluate: Many new immigrants have little
of disease. It focuses on collecting understanding of the modern health
data on biophysical signs and The cause of disease: Medical care system and medical and nursing
symptoms and on curing disease. diagnoses are used to evaluate the practices and interventions. Many also
etiology (cause) of disease. speak and understand little or no
The holistic health model
An example of subjective data is: English
The holistic health model assesses the
whole person because it views the Left knee has been swollen and hot for The National Standards for
mind, body, and spirit as the past 3 days: Subjective data is Culturally and Linguistically
interdependent and functioning as a what the person says about himself or Appropriate Services in Health
whole within the environment. Health herself during history taking. Care state that health care
depends on all these factors working organizations should ensure that
together. A complete data base is: patients receive effective,
understandable, and respectful
The concept of health also includes Used to perform a thorough or care in a manner compatible with
health promotion and disease comprehensive health history and their cultural health beliefs and
prevention. physical examination: A complete practices and their preferred
database includes a complete health language.
Health assessment also should history and a full physical
consider what two other factors? examination; it describes the current When people with limited English
and past health state and forms a proficiency seek health care,
(1) The usual and expected baseline against which all future services cannot be denied to them.
developmental tasks for each age changes can be measured.
group What type of database is most
(2) The cultural beliefs and practices A patient admitted to the hospital appropriate for an individual who is
of different people. Obtaining a with asthma has the following admitted to a long-term care
heritage assessment helps gather problems identified based on an facility?
data that are accurate and admission health history and
meaningful and can guide physical assessment. Which Complete: A complete database
culturally sensitive and problem is a first-level priority? includes a complete health history and
appropriate care. a full physical examination; it
Impaired gas exchange: First-level describes the current and past health
According to the biomedical model, priority problems are those that are state and forms a baseline against
a narrow definition of health is: emergent, life threatening, and which all future changes can be
immediate. Impaired gas exchange is measured.
The absence of disease: From a an emergent and immediate problem.
biomedical perspective, health is Which of the following is considered
defined as the absence of disease or In the United States, an example of objective data?
elimination of symptoms and signs of about one in eight people
disease. are immigrants. Alert and oriented: Objective data is
what the health professional observes;
What type of data base is most One in every three residents belongs level of consciousness and orientation
appropriate when a rapid collection to a group other than single-race, are observations.
of data is required and often non-Hispanic White.
compiled concurrently with life- An example of objective data
saving measures? Of the emerging majority in the
US, Hispanics are the largest
population.
Crepitation in the left knee joint: A nursing diagnosis is best response to an actual or potential
Objective data is what the health described as: health state.
professional observes by inspecting,
percussing, palpating, and auscultating A concise statement of actual or The most common non-English
during the physical examination. potential health concerns or level of languages spoken at home are
Crepitation is assessed by palpation. wellness: Nursing diagnoses are Spanish, Chinese, French, German,
clinical judgments about a person's and Tagalog.

11
Cultural care and meaning in life. Spirituality may population was younger than 18 years
be used to find meaning and purpose old.
Cultural care is professional health for illnesses.
care that is culturally sensitive, Spirituality is defined as:
appropriate, and competent. To Socialization
develop cultural care, you must have A personal effort to find meaning and
knowledge of your personal heritage Socialization is the process of being purpose in life.
and the heritage of the nursing raised within a culture and acquiring
the characteristics of the group. Which of the following is true
profession, the health care system, and regarding language barriers and
the patient. Education is a form of socialization
health care?
Heritage consistency Religious beliefs may influence the
person's: There are laws addressing language
Heritage consistency is the degree to barriers and health care. Title VI of
which a person's lifestyle reflects his (1) Explanation of the cause of the Civil Rights Act of 1964 provides
or her traditional heritage. A person illness people with limited English
can possess values that are consistent (2) Perception of its severity proficiency access to health care; these
with the norms of the traditional (3) And choice of healers. individuals cannot be denied health
culture or that are modern (or care services.
Each person responds differently to
acculturated to the norms of the the same stimuli, regardless of the What is the yin/yang theory of
dominant society). Heritage primary culture and value system. You health?
consistency includes determination of should guard against stereotyping
a person's cultural, ethnic, and individuals. You should also Health exists when all aspects of the
religious background and socialization understand culture-bound syndromes, person are in perfect balance.
experiences. which may have no equivalent from a Which theory has been expanded in
Culture has the following four biomedical perspective. an attempt to study the degree to
characteristics: Each culture has its own healers which a person's lifestyle reflects his
who usually: or her traditional heritage?
(1) it is learned from birth through
language acquisition and Cost less than traditional or Heritage consistency: Heritage
socialization. biomedical providers. Most healers consistency theory has been expanded
(2) it is shared by all members of the cost significantly less than healers in an attempt to study the degree to
same cultural group. practicing in the biomedical or which a person's lifestyle reflects his
(3) it is adapted to specific conditions scientific health care system. or her traditional heritage.
related to environmental and
technical factors. While evaluating the health history, What symptom is greatly influenced
(4) it is dynamic and ever changing. the nurse determines that the by a person's cultural heritage? The
patient subscribes to the hot/cold interview has three phases:
Ethnicity theory of health. Which of the (1) Introduction,
Ethnicity pertains to membership in a following will most likely describe
social group that claims to possess a this patient's view of wellness? (2) Working phase,
common geographic origin, migratory The humors must be balanced: The (3) Closing.
status, religion, race, language, shared hot/cold theory of health is based on
values, traditions or symbols, and food humoral theory; the treatment of During the first phase of an
preferences. One's cultural disease is based on the balance of the interview
background is a fundamental humors.
component of one's ethnic During the first phase, introduce the
background. Before determining whether interview.
cultural practices are helpful,
Religion During the working phase of an
harmful, or neutral, nurses must
interview
Religion is the belief in a divine or first understand:
superhuman power or powers to be During the working phase, gather data.
The logic of the traditional belief
obeyed and worshipped as the creator Start with open-ended questions,
systems.
or ruler of the universe. which ask for narrative information.
On the basis of median age: Then use closed questions, which ask
Spirituality for specific information in short, one-
The Asian population tends to be or two-word answers.
Spirituality is borne out of each younger: The Asian population was
person's unique life experience and his younger with a median age of 35.4 During the closing phase of an
or her personal effort to find purpose years, and about 26% of the Asian interview

12
During the closing, signal that the Nonverbal communications convey Reflection. This response echoes the
interview is ending, which gives the messages from the sender to the patient's words. Reflection is repeating
patient one last chance to share receiver. Work to develop the part of what the person has just said.
concerns or express himself or herself. ability to read patients' nonverbal
Also briefly summarize what you behaviors and to monitor your own Clarification
learned during the interview. nonverbal communication. Clarification. Use this when the
You can use different types of Modify communication techniques person's word choice is ambiguous or
verbal responses to assist the based on each patient's confusing (e.g., "Tell me what you
narrative and help gather data. developmental stage, including mean by 'tired blood.' "). Clarification
Each response plays a role in the parents, infants, young children, also is used to summarize the person's
interview process, but practice is adolescents, and older adults. words, simplify the words to make
needed to use them effectively and them clearer, and then ask if you are
move among them smoothly. Learn to communicate effectively on the right track. You are asking for
with patients who have special agreement, and the person can then
Through facilitation, silence, needs, such as those with a hearing confirm or deny your understanding.
reflection, empathy, and impairment, acute illness, or
clarification, you react to the facts intoxication and those who are Confrontation
or feelings the patient has sexually aggressive, angry, anxious, Confrontation. These responses now
communicated. Your response violent, or in tears. include your own thoughts and
focuses on the patient's frame of feelings. Use this only when merited
reference. When a patient comes from a
different culture, modify your by the situation. If you use it too often,
Through confrontation, approach as needed. Behaviors that you take over at the patient's expense.
interpretation, explanation, and one culture views positively may In the case of confrontation, you have
summary, your response focuses on have different, possibly negative, observed a certain action, feeling, or
your own frame of reference, connotations in another culture. statement and you now focus the
thoughts, and feelings. person's attention on it. You give your
For a patient with limited English honest feedback about what you see or
10 traps of interviewing. These proficiency, use a bilingual team feel.
nonproductive verbal messages member or a trained medical
include: interpreter whenever possible. Interpretation
Avoid using a family member or Interpretation. This statement is not
(1) Providing false assurance or close friend as an interpreter
reassurance, based on direct observation as with
because this violates the patient's confrontation, but it is based on your
(2) Giving unwanted advice, confidentiality.
(3) Using authority, inference or conclusion. It links
(4) Using avoidance language, Facilitation events, makes associations, or implies
(5) Engaging in distancing, cause: "It seems that every time you
(6) Using professional jargon, These responses encourage the patient feel the stomach pain, you have had
(7) Using leading or biased questions, to say more, to continue with the story some kind of stress in your life."
(8) Talking too much, ("mm-hmm, go on, continue, uh- Interpretation also ascribes feelings
(9) Interrupting, huh"). Also called general leads, these and helps the person understand his or
(10) And using "why" questions. responses show the person you are her own feelings in relation to the
interested and will listen further. verbal message.
Nonverbal modes of communication Simply maintaining eye contact,
include: shifting forward in your seat with Explanation
increased attention, nodding "Yes," or Explanation. With these statements,
- Physical appearance, using your hand to gesture, "Yes, go
- Posture, you inform the person. You share
on, I'm with you," encourage the factual and objective information. This
- Gestures, person to continue talking.
- Facial expression, may be for orientation to the agency
- Eye contact, Silence setting: "Your dinner comes at 5:30
- Voice, and PM." Or, it may be to explain cause:
- Touch. Silence is golden after open-ended "The reason you cannot eat or drink
questions. Your silent attentiveness before your blood test is that the food
communicates that the patient has time will change the test results."
to think, to organize what he or she
wishes to say without interruption When preparing the physical setting
from you. for an interview, the interviewer
should:
Reflection

13
(1) Conduct the interview at eye level Avoidance language. Euphemisms are data from the physical examination
and at a distance of 4 to 5 feet. used to avoid reality or to hide and diagnostic tests, you create a
(2) Both the interviewer and the feelings. Using direct language is the database to make a judgment about
patient should be at eye level at a best way to deal with frightening the person's health status.
distance of 4 to 5 feet. topics instead of using avoidance
(3) The interviewer and patient language. For sick patients, the health history
should be comfortably seated; includes a detailed, chronologic
standing communicates haste and When addressing a toddler during record of the health problem.
assumes superiority. the interview, the health care
provider should: For all patients, it is a screening tool
Parents or caretakers accompany for abnormal symptoms, health
children to the health care setting. Use short, simple, concrete sentences. problems, and concerns. It also
Starting at ___ years of age, the A toddler's communication is direct, records the patient's responses to
interviewer asks the child directly concrete, literal, and set in the present. health problems.
about his or her presenting The health care provider should use
short, simple sentences with concrete No matter what form is used to
symptoms. record the health history, plan to
explanations.
7: School-age children (starting at age gather data in eight categories.
7) have the verbal ability to add Nonverbal communication is the
primary form of communication for Complete health history data
important data to the history. The category 1.
nurse should interview the parent and which group of individuals?
child together, but when a presenting Infants: Nonverbal communication is First, collect biographic data, such as
symptom or sign exists, the nurse the primary form of communication the patient's name, address, and date
should ask the child about it first, then method for infants. of birth as well as language and
gather data from the parent. communication needs.
Viewing the world from another
Which of the following statements, person's inner frame of reference is Complete health history data
if made by the interviewer, would be called: category 2.
an appropriate response?
Empathy. Empathy means viewing the Second, note the source of the history,
"Tell me what you mean by 'bad world from the other person's inner which is usually the patient, but may
blood'." frame of reference. be someone else, such as a relative or
interpreter.
This response is an appropriate An example of an open-ended
communication technique referred to question or statement is: Complete health history data
as seeking further clarification. category 3.
"Tell me about your pain." Open-
While discussing the treatment plan, ended questions and statements ask for Third, obtain the reason for seeking
the nurse infers that the patient is narrative information; they state the care, formerly known as the chief
uncomfortable asking the physician topic to be discussed, but only in complaint. In the patient's own words,
for a different treatment because of general terms. This type of question briefly describe the reason for the
fear of the physician's reaction. In encourages the person to respond in visit.
this situation, the nurse's verbal paragraphs and to give a spontaneous
interpretation: Complete health history data
account in any order chosen. category 4.
Helps the patient understand personal The most appropriate introduction
feelings in relation to his or her verbal Fourth, record the present health or
to use to start an interview with an history of present illness. For a well
message. Patients may experience older adult patient is:
barriers to communication with a person, briefly note the general state
health care provider seen as an "Mr. Jones, I want to ask you some of health. For a sick person,
authority figure. The patient may not questions about your health so that we chronologically record the reason for
share personal feelings if fear is can plan your care." An older adult seeking care. When a patient reports a
experienced. In this situation, the should be addressed by the last name; symptom, perform a symptom
nurse identified the patient's personal older adults may be offended by a analysis. If you find it helpful, use the
feelings in relation to the patient's younger person using their first mnemonic PQRSTU to do this.
verbal message. names. PQRSTU
The use of euphemisms to avoid The purpose of the complete health PQRSTU stands for Provocative or
reality or to hide feelings is known history is to collect subjective data, palliative, Quality or quantity, Region
as: which is what the person says about or radiation, Severity scale, Timing,
himself or herself. By combining and Understanding the patient's
this subjective data with objective perception of the problem.

14
Complete health history data When taking an older adult's health Aggravating factors. Aggravating
category 5. history, also ask additional factors are determined by asking the
questions. For example, explore patient what makes the pain worse.
Fifth, investigate past health events, changes in activities of daily living
such as illnesses, injuries, that may result from the aging Excessive or uncontrollable drinking.
hospitalizations, and allergies as well process or chronic illness. CAGE is a screening questionnaire to
as current medications. identify excessive or uncontrolled
Remember that the impact or drinking (e.g., C = Cut down; A =
Complete health history data burden of a disease may be more Annoyed; G = Guilty; E = Eye
category 6. important to an older adult than the opener).
Sixth, gather a family history to help actual disease diagnosis or
pathology. So be sure to record the The "review of systems" in the
detect health risks for the patient. To health history is:
aid in this process, draw a pedigree or person's reason for seeking care, not
genogram. your assumption about the problem. A documentation of the problem as
The Comprehensive Older Person's perceived by the patient. The reason
Complete health history data for seeking care is a statement in the
category 7. Evaluation is particularly useful
because it addresses: person's own words that describes the
Seventh, perform a review of systems reason for the visit.
to evaluate the past and present health Basic and instrumental activities of
daily living, Functional assessments, When recording information for the
of each body system, double-check for review of systems, the interviewer
significant data, and assess health and physical, social, psychologic,
demographic, financial, and legal must document:
promotion practices. For each body
system, assess for symptoms and issues. The presence or absence of all
health-promoting behaviors. CAGE test identify what? symptoms under the system heading.
When recording information for the
Complete health history data CAGE test is a screening review of systems, the interviewer
category 8. questionnaire to identify excessive or should record the presence or absence
Finally, perform a functional uncontrolled drinking, such as: of all symptoms, otherwise it is
assessment, including activities of unknown which factors were asked.
- C Cut down - Have you ever
daily living, such as bathing dressing, thought you should cut down your Assessment of self-esteem and self-
toileting, eating, walking, drinking? concept is part of the functional
housekeeping, and shopping, cooking, - A Annoyed - Have you ever been assessment. Areas covered under
and other factors. annoyed by criticism of your self-esteem and self-concept include:
The depth of information obtained drinking?
- G Guilty - Have you ever felt Education, financial status, and value-
for each health history category belief system. Functional assessment
may vary from one setting to guilty about your drinking?
- E Eye-opener - Do you drink in measures a person's self-care ability.
another. However, you should The areas assessed under the self-
address all categories before making the morning (i.e. an eye-opener?)
esteem and self-concept section of the
a diagnosis or judgment about the Which of the following is included functional assessment include
patient's health status. in documenting a history source? education, financial status, and value-
When obtaining a child's health belief system.
Reliability of informant. The source of
history, use the same structure you history is a record of who furnishes PQRSTU is a mnemonic that helps
would use for an adult, but make the information, how reliable the the clinician to remember to address
pertinent modifications or informant seems, and how willing he characteristics specific to:
additions. Additions include: or she is to communicate. In addition,
there should be a note of any special Symptoms. The eight critical
- A prenatal and perinatal history, characteristics of any symptom
- The parents' description of the circumstances, such as the use of an
interpreter. reported in the history of the present
present problem, illness are: P = provocative or
- Any childhood illnesses or A patient seeks care for palliative; Q = quality or quantity; R =
accidents, Immunization data, "debilitating headaches that cause region or radiation; S = severity scale;
- A developmental overview, excessive absences at work." On T = timing; and U = understand
- And a nutritional history. further exploration, the nurse asks, patient's perception.
When assessing functional abilities, "What makes the headaches
worse?" With this question, the The nurse questions the reliability
consider the child's environment of the history provided by the
and his or her function or role in the nurse is seeking information about:
patient. One method to verify
environment.

15
information within the context of discrete areas include A two-person interaction usually
the interview is to: understanding of: has two roles: sender and receiver.
When exchanging information, both
Rephrase the same questions later in A) his or her own heritage. individuals engage in verbal and
the interview.: A reliable person B) the heritage of the nursing nonverbal communication. Internal
always gives the same answers, even profession. and external factors can affect
when questions are rephrased or are C) the heritage of the patient. communication.
repeated later in the interview. D) the heritage of the health care
system. Internal factors
When taking a health history from
an adolescent, the interviewer Empathy Internal factors are what you bring to
should: the interview.
Empathy means viewing the world
Interview the youth alone with a from the other person's inner frame of Three internal factors promote good
parent in the waiting area. The reference while remaining yourself. communication:
adolescent interview during the health
history should be with the youth A health interview (1) liking others,
alone; the parent(s) may wait in the (2) expressing empathy, and
A health interview is a structured (3) having the ability to listen.
waiting area and complete other past interaction between you and the
health questionnaire forms. patient. The rules governing this
What information is included in interaction should be clearly outlined
and agreed on by you and the patient External factors
greater detail when taking a health
history on an infant? at the start of the interview. Your External factors relate mainly to the
mutual goal is the patient's optimal physical setting.
Nutritional data. The amount of health.
nutritional information needed You can foster good communication
depends on the child's age; the Communication with which external factors?
younger the child is the more detailed Communication carries you and the
and specific the data should be. You can foster good communication
patient through the interview. with certain external factors, such as
When considering cultural Communication is the exchange of by ensuring privacy, preventing
competence, there are discrete areas information so that each person clearly interruptions, creating a conducive
that the nurse must develop understands the other. environment, and documenting
knowledge of to understand the responses without interfering with the
health care needs of others. These conversation

NCM – 100 (FUNDAMENTALS OF

NURSING

16
 EMILIO AGUINALDO COLLEGE
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SCHOOL OF NURSING QUALITY MANAGEMENT
SYSTEMS

Theory (Kristen Swanson) Explanatory Theories (Factor- measured by the person who came
Relating Theories) cause and effect up with that perception
describes, explains, predicts and relationship are well explained
prescribes. Conceptual Model or Frameworks
Prescriptive Theories (Situation-
American Nursing Association Producing Theories) deal with researcher's perception of a particular
nursing action phenomenon
nursing is the diagnosis and
treatment of human responses to Descriptive Theories (Example) Theoretical Model or Frameworks
actual or potential health problems
determining the percentage of ready-made map for the study
International Council of Nurses patients receiving intravenous (IV) Science
nursing is autonomous and therapy who experience IV
collaborative care infiltration It came from the Latin word,
scientia, which means knowledge. It
Association of Deans of Philippine Explanatory Theories (Example) is systematic of the body of
Colleges of Nursing a research study about the factors knowledge used in a discipline of
affecting the quality of life of study.
nursing is a dynamic discipline and
art & science of caring pregnant women Knowledge
Philippine Nurses Act of 2002 Predictive Theories (Example) considered as facts of information
a theoretical model based on the gained from experiences
nursing is initiation and performance
of nursing services observation of the effects of Phenomenon
unsanitary environmental condition
Virginia Henderson on the recovery of post-operative compose empirical data and
patients perceived as physically tangible
nursing is to assist clients in the experiences
performance of activities Prescriptive Theories (Example)
contributing to health Hypothesis
Kolcaba's Theory of Comfort
Metaparadigm Concepts validates and explains the different educated guess that is a testable
nursing interventions in an acute care relationship statement
patterns to show a relationship hospital in relieving anxiety among
between the existing theoretical patients Research
works in nursing
Philosophy of Nursing studying a phenomenon that creates
Ferson and enhances a body of knowledge
it sets forth the meaning of
recipient of nursing care phenomena Proposition
Health Concepts refers to the relationship between
various concepts
patient's level of wellness building blocks of theories
Assumptions
Environment Abstract
something a researcher believes that
external and internal social factors non-observable (care, respect, is true, but there is no universal
that has an impact on patient's health collaboration, equilibrium, proof.
adaptation, stress, and
Nursing Metaparadigm Concepts
powerlessness)
nursing actions or nursing are the most general basis in the
Concrete
interventions practice of nursing
readily observable (fever, pain,
Descriptive Theories (Factor- Four Nursing Phenomena
fatigue, thermometer, rash, and
Isolating Theories)
lesion)
Person, Environment, Health, and
identify and describe the central Nursing.
Conceptual definition
concepts of phenomena
how relevant literature perceives it Empirical Knowing
Predictive Theories (Situation
Relating Theories) describe future Operational definition relating factual and descriptive
outcomes consistently knowing aimed at the expansion of
abstract and theoretical explanations

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Ethical Knowing research era this analysis is used to critique and

evaluate nursing theoretical works.
requires knowledge of different - era known as the scientific age
philosophical positions regarding - the era where nursing research metaparadigm, philosophy,
what is good and right in making integrated into the nursing conceptual models, grand theory,
moral actions and decisions, curriculum nursing theory, middle range
particularly in the theoretical and - the era of enrich theory theory
clinical components of nursing development
the structural level of nursing
Personal Knowing graduate era knowledge
encompasses knowledge of the self - era where a Master's degree metaparadigm
in relation to others and to self. It program is established
involves the entirety of the Nurse- - ere where there is progression in the broad conceptual boundaries of
Patient Relationship. the theory development process nursing knowledge (human beings,
- the era of evolution of a health, nursing and environment)
Aesthetics or Esthetics Knowing specialized body of knowledge philosophy
is related to understanding what is of theory era 1980-1990s
significance to particular patients it sets forth the meaning of nursing
such as feelings, attitudes, points of - the natural development of the phenomena
view (Carper, 1978). It is also the combination of research and conceptual model
manifestation of the creative and graduate era
expressive styles of the nurse - the era where research and set of concepts that address
(Kenney, 1996). theory produce nursing science phenomena central to nursing
- the era of classifying
Theory metaparadigm concepts interdependence of theory and
research
concepts, prepositions, assumptions J. Fawcett
and definitions. it is said that the relationship of
the one who established the theory, practice, and research are
Florence Nightingale metaparadigm concepts cyclical and reciprocal
Founder of modern nursing Theory Utilization Era Maslow's Hierarchy of Needs
Lady with the Lamp 21st century era physiological, safety, love and
Florence Nightingale is also known belonging, esteem, self-actualization
Theory Utilization Era
as? Abraham Maslow
the era that focuses on theory
establishing nursing schools and application in the areas of education, he proposed the hierarchy of needs in
hospitals practice, and research and his work "A Theory of Human
Nightingale's pioneering activities administration (MIDDLE RANGE Motivation"
and profound writings became the THEORY)
higher, lower
basis of what? Theory Utilization Era
A person will not feel a ___ need,
Curriculum Era this shift in focus of vital for the until the needs of ___ levels are
The era that standardized curriculum development of theory-based nursing satisfied
as to what content the nurses should and evidence-based practice that
would serve as a basis for critical Maslow's Hierarchy of Needs
study.
judgment and decision making.
this theory is used in nursing to guide
Curriculum Era nursing care prioritization.
discipline
The era where nursing programs Five, 5
integrated into colleges and this refers to academia; the branch of
univeristies education
The hierarchy of needs is represented
profession by a pyramid with ___ level of needs
Research era and Graduate era
a specialized field of practice Self-fulfillment needs
1950-1970's era
firmly establishes with the
self-actualization represents?
Curriculum Era theoretical structure of science
psychological needs
1900-1940's era analysis of theory

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esteem, love and belongingness the infant is experiencing the world psychological regression or growth
represents? through mouth, eyes, ears, and sense in initiative vs. guilt
of touch
basic needs Industry vs. Inferiority
Sense of hope
Safety needs and physiological needs School age 5-12 yrs.
pertain to? inherent strength (virtue) in Trust vs.
Mistrust industry vs. inferiority
physiological needs
psychosis, addiction, depression also known as the stage of latency
the most basic human needs to be wherein the child is in school age
satisfied- water, food, shelter, psychological regression in trust vs.
clothing, reproduction, sleep mistrust industry vs. inferiority

safety needs Mother the stage where the child discovers

their talents
personal security, employment, the role of ___ is the key to the
resources, health, property psychosocial development of infant teacher, peers

love and belonging Autonomy vs. Shame and Doubt recognition received from ___ or ___
helps in the stage of initiative vs.
friendship, family, intimacy, sense of early childhood 2-4 years old inferiority
connection
Autonomy vs. Shame and Doubt competence
esteem
this stage becomes decisive for the inherent strength (value) in initiative
respect, self-esteem, status, ratio between loving goodwill and vs. inferiority
recognition, strength, freedom hateful self-insistence, cooperation
and willfulness, and between self- creative inhibition, inertia
self-actualization expression and compulsive self- psychological regression or growth
desire to become the most that one restraint or meek compliance in initiative and inferiority
can be will schools, community
Erik Erikson inherent strength (value) in ___ and ___ influences the child the
a psychoanalyst who proposed the autonomy vs. shame and doubt most in initiative and inferiority
theory of psychosocial development paranoia, obsessions, compulsions, identity vs. role confusion
Theory of Psychosocial impulsivity
Development adolescence 13-19 years old
psychological regression in
it is said in this theory that the autonomy vs. shame and doubt identity vs. role confusion
achievements and failures of earlier parents this is the puberty stage, wherein
stages will affect later stages of teenager explores their identity crisis
development, whereas later stages both ___ have a significant role in and struggles within a degree of role
transform the earlier ones. the stage of autonomy vs. shame and confusion
doubt
eight, 8 fidelity
Initiative vs. Guilt
Erikson's __ stages of psychosocial inherent strength (value) in identity
development preschool 4-5 years old vs. role confusion
Psychological regression, inherent Initiative vs. Guilt delinquent behavior, gender-
strength related identity disorder,
a child in this stage of growth is to
expected results of the stages of develop a sense of initiative. the last borderline psychotic disorder
psychosocial development phase of this development is a sense psychological regression or growth
of purpose in identity vs. role confusion
Trust vs. Mistrust
purpose role models, peers
infancy 0-2 years
inherent strength (value) in initiative key to the learning in identity vs. role
Trust vs. Mistrust vs. guilt confusion are ___ and ___
conversion disorder, phobia Intimacy vs. Isolation
psychosomatic disorder, inhibition

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early adulthood 20-40 years old you compare ___ with ___ in ego Kurt Lewin
integrity vs. despair
Intimacy vs. Isolation he is known for his writings in group
Ludwig von Bertalanffy dynamics, group therapy, and social
capacity for love is the achievement psychology
of this growth. the major conflict is a professor of Biology and author of
forming intimate, loving "Science and Philosophy of unfreezing, changing, refreezing
relationships with other people Synthesis" and proposed the general
systems theory The three stage models of change
love theory
Systems Theory
inherent strength (value) in intimacy freezing
vs. isolation the specialization of systems
thinking and a generalization of process of which involves finding a
schizoid personality disorder, system science way for people to let go of patterns
distintiation that are not productive
wholeness
psychological regression or growth moving
in intimacy vs. isolation the general science of ___ is the
systems theory a process of change in thoughts,
Generativity vs. Stagnation feelings, and behavior, leading to a
system more significant change
adulthood 40-65 years old
any set of distinct parts that form a refreezing
generativity vs. stagnation relationship between them to create a
whole complex establishing change as 'a new habit',
the concern for establishing and without going back to old ways
guiding the next generation cell
care an excellent sample of a system
driving force
inherent strength (value) in Open system, closed system
generativity vs. stagnation forces that are pushed in a direction
two types of system in which change is to occur
middle crisis, premature
invalidism open system equilibrium
psychological regression or growth contains inputs that are influenced by driving forces are eqaul, and no
in generativity vs. stagnation the environment being transformed change occurs
through a process to create services
work, homes or products known as outputs Restraining forces
people at ___ and in our ___ feedback opposes the driving force, hinder
influence us the most in generativity change and push the person towards
vs. stagnation Open system contains ___ the opposite direction
throughout the process to make sure
Ego Integrity vs. Despair the improvements of the outputs Hildegard Peplau
maturity 65 to death closed system Who proposed the 'Interpersonal
Relations Theory'?
Ego Integrity vs. Despair it is not influenced by the
environmental factors and focuses known as the 'Psychiatric Nurse of
this stage reflects one's life and either the Century'
experience a feeling of satisfaction or only on the internal functions and
regret/despair. provides no feedback she described the therapeutic nurse-
Change Theory client relationship with its phases and
wisdom tasks
inherent strength (value) in ego it is expanding the theoretical
discipline of nursing as its goal She used her experiences with
integrity vs. despair professionals in the areas of
extreme alienation Kurt Lewin psychiatry, medication, education,
and sociology as her theoretical
psychological regression or growth he proposed the Change theory source.
in ego integrity vs. despair Father of social psychology Influenced by Maslow, Freud, and
yourself, humankind Kurt Lewin is also known as? Sullivan's interpersonal relationship

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theories and other psychoanalytical lasting impression on the patient as it • This role strengthens nurse-patients
models values the unique human experience relationships. • The very core of the
of the nurse-patient relationship interpersonal technique is to value
Defined 'Person' as a being who is an the nurse-patient relationship and
organism that thrives in an unstable Hildegard Peplau apply it in his life
balance of a given system.
She determined the Roles of a nurse Virginia Henderson
Refers the 'environment' as the
external forces that influence a being Stranger proposed the 14 Basic Human Need
and socially define a way of living in Role of the nurse where they attempt Theory
which human social processes are to know the patient better.
achieved, such as norms, customs, Known as the "First Lady of
and beliefs. Treat him with utmost courtesy Nursing" and the "First Truly
(acceptance of the patient as a person International Nurse."
Defined 'Health' as something that and due respect into his
reflects the flow of the personality 20th, 19th
individuality)
and other human processes that leads "Henderson was to the ___ century
a human being in a way that is Thus, roles coincidence with the as Nightingale was to the ___
creative, constructive, productive Identification Phase century."
community, and society
Resource Person Virginia Henderson
Defined 'Nursing' as an essential,
therapeutic nurse-patient relationship • Patient assumes a dependent role. Identified the 14 proposed basic
• Nurse provision specific answers to human needs on which nursing care
Defined the Four Phases of Nurse- is based
Patient Relationship his queries.
• It is the responsibility of the nurse Her vision, "practice of nursing as
orientation, identification, independent from the practice of
exploitation, resolution to appropriately change her
responses to the patient's level of physicians"
What are the 4 phases of Nurse- understanding. Nursing
Patient relationship?
Teacher Henderson defined ___ as "The
Orientation unique function of the nurse is to
• Teaching self-care and helping the
This phase is about the initial patient to understand the therapeutic assist the individual, sick or well, in
interaction of the nurse and the plan. the performance of those activities
patient; the patient expresses a need contributing to health or its recovery
for assistance from the nurse. • The nurse must develop a plan (or to peaceful death) that he would
according to the patient's interest and perform unaided if he had the
his ability to use such information necessary strength, will, knowledge;
needed for the plan. and to do this in such a way as to
Identification help him gain independence as
Leader rapidly as possible."
The phase by which a feeling of
relatedness takes place as the patient • The patient is still able to decide 14 Basic Human Needs
and the nurse explores the experience regarding his plan of care.
and the needs of the patient 1. Breathe Normally
• A nurse, as a ___, must act on
Exploitation behalf of the patient's best interest 2. Eat and Drink Adequately
and allow the patient to decide for
The phase wherein the patient values his own care. 3. Eliminate Body Wastes
the relationship and moves on from a
dependent role to an independent Surrogate 4. Move and maintain desirable
role. New goals are planned by the postures
nurse, but these goals would be • The patient's dependency regarding
his care gives the nurse a surrogate 5. Sleep and rest
achieved through the patient's effort
as an independent being role, which means a temporary care 6. Select suitable clothes - dress and
only. undress
Resolution
• The nurse must assist the patient to 7. Maintain body temperature within
This is the phase where the patient make sure that her surrogate role is normal range by adjusting clothing
learns to be independent, and it is different and only and modifying environment
where the relationship ends between
the patient and the nurse. It leaves a counselor

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8. Keep the body clean and well- One of her major concepts is about Her concept of 'Nursing' is generally
groomed and protect the integument the Three Levels of Nurse-Patient grouped into 21 problem areas for
Relationship nurses to work out their judgment
9. Avoid dangers in the environment and appropriate care
and avoid injuring others Substitute for a patient
Overt
10. Communicate with others in the level of nurse-patient relationship
expressing emotions, needs, fears or that talks about doing everything for Health needs can be seen as ___
opinions. the client which is obvious or can-be-seen
condition
11. Worship according to one's faith Helper to the patient
Covert
12. Work in such a way that there is the level of nurse-patient relationship
a sense of accomplishment where the nurse helps the client Health needs can be seen as ___
which is an unseen or masked one
13. Play or participate in various Partner with the patient
forms of recreation These are the steps in The problem
The level of nurse-patient - solving process
14. Learn, discover, and satisfy the relationship where the nurse works
curiosity that leads to normal with the client. 1. Identifying the problem
development and health and use the
available health facilities Faye G. Abdellah 2. Selecting relevant data

Virginia Henderson She determined the problem-solving 3. Devising hypothesis

process
Her theoretical sources are based on; 4. Testing hypothesis through the
Proposed the 21 Nursing Problems assortment of data
1. Thorndike, an American
Psychologist. A leader in the development of 5. Revising hypothesis when
nursing research and nursing as a necessary on the basis of conclusion
2. Her student experiences with profession obtained from the data
Henry House Visiting nurse Agency
She believed that nursing care should 21 Nursing Problems
3. Her experience in rehabilitation be based on research, not hours of
nursing care. 1. To maintain good hygiene and
physical comfort
4. Orlando's conceptualization of She is named "Living Legend" by the 2. To promote optimal activity:
deliberative nursing action American Academy of Nursing in exercise, rest, sleep
1994 3. To promote safety through
In her definition of 'Environment' she prevention of accident, injury, or
emphasized the importance of the Her theory adapted Henderson's 14 other trauma and through
patient's controlling his/her basic human needs and nursing prevention of the spread of
environment. However, as illness research for the classification of infection
occurs, this ability is diminished. It is nursing problems. 4. To maintain good body
also the responsibility of the nurse to mechanics and prevent and
manage the surroundings by Defined 'Environment' as "Planning
for optimum health on local, state, correct deformity
protecting the safety of the patient 5. To facilitate the maintenance of
national and International levels."
She referred to a person as a patient. However, she `elaborates her ideas, a supply of oxygen to all body
An individual who requires the apex (core) of Nursing service is cells
assistance to achieve health and the individual. 6. To facilitate the maintenance of
independence or, in some cases, a nutrition for all body cells
peaceful death. Must maintain Defined 'Person' as beneficiary of 7. To facilitate the maintenance of
physiological and emotional balance care as individuals. the 21 nursing elimination
to be able to function problems related with biological, 8. To facilitate the maintenance of
psychological, and social aspects of fluid and electrolyte balance
She asserted that the nurse works in individuals 9. To recognize the physiologic
interdependence with other health responses of the body to disease
professionals and with the patients. In her theory, her concept of 'Health' conditions— pathologic,
is defined as the center and purpose physiologic, and compensatory
According to ___, health is of nursing services. No definition of 10. To facilitate the maintenance
considered as a quality of life and is health, but she speaks of the totality of regulatory mechanisms and
a fundamental need of a person to of health needs and indicative of a functions
function. She added that it requires healthy state of mind and body. 10. To facilitate the maintenance of
independence and interdependence. sensory function

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11. To identify and accept positive she developed more fully in Meeting Weidenbach defined ___ as a
and negative expressions, the Realities in Clinical teaching. functioning individual who helps the
feelings, and reactions patient who has a need-for-help.
12. To identify and accept Ernestine Wiedenbach
interrelatedness of emotions and They not only acts but also uses her
Defined that each 'person' is or his thinking and feelings as well.
organic illness endowed with a endowed with a
13. To facilitate the maintenance of unique potential to develop self- Knowledge
effective verbal and nonverbal sustaining resources. Persons
communication generally tend towards independence Weidenbach defined ___ as
14. To promote the development of and fulfillment of responsibilities "encompassing all that has been
productive interpersonal perceived and understood by the
relationships 'Health' is not defined her model mind of a human."
15. To facilitate progress toward
achievement and personal She did not discuss the concept of Judgement
spiritual goals the 'environment'; however, she
recognized the potential effects of Weidenbach defined ___ as
16. To create or maintain a
the environment. something that represents a nurse's
therapeutic environment
ability to make a good clinical
17. To facilitate awareness of self as
Her philosophy in nursing are the judgment, that is a good sound
an individual with varying
following; decision.
physical, emotional, and
developmental needs 1. Reverence for the gift of life Nursing Skills
18. To accept the optimum possible
goals in the light of limitations, 2. Respect for the dignity, worth, Weidenbach defined ___ as skills
physical and emotional autonomy, and individuality of each carried out by the nurses in
19. To use community resources as Human being. accomplishing the task that is
an aid in resolving problems that considered patient-centered rather
3. Resolution to act dynamically in than completing the skill itself as the
arise from illness
relation to one's belief. final goal.
20. To understand the role of social
problems as influencing factors Prescriptive Theory Weidenbach
in the cause of illness
Weidenbach's ___ is based on three She determined the 4 main elements
Ernestine Wiedenbach factors; to clinical nursing
Proposed 'The Helping Art of (1) The central purpose which the Philosophy, purpose, practise, art
Clinical Nursing' practitioner recognizes as essential to
the particular discipline What are the 4 key elements to
She is known for her work in theory
clinical nursing?
development and maternal-infant (2) The prescription for the
nursing. fulfillment of central purpose. Philosophy
Her orientation is a philosophy of (3) The realities in the immediate The ___ of nurses are their attitudes
nursing that guides the nurse's situation that influence the central and beliefs of what life is and how
actions in the art of nursing purpose. these would affect them
She wrote Family-Centered The Patient Purpose
Maternity Nursing in 1958
Weidenbach defined this as any According to Weidenbach, the ___
Her theoretical sources are Ida person who receives help might be refers to the nurse's activities in the
Orlando Pelletier, and Patricia James care, instruction, or advice from a accomplishment of the goals towards
and William Dickoff team member who gives care. the patient.
Ida Orlando Pelletier Practice
Known for her understanding of need-for-help According to Weidenbach, the ___ is
the use of self and the effect of the considered empirical or observable
nurse's thoughts and feelings has on A ___ is a desire from the patient nursing actions that influence beliefs
the outcome of her actions. that would help him restore or help and feelings in meeting the patient's
him cope with situations experienced need-for-help.
Patricia James and William in his or her life that would affect his
Dickoff health and wellness. Art
Identified elements of a prescriptive Nurse
theory in Wiedenbach's work, which

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According to Weidenbach, Nursing determined 'Health' as a state of an Joyce Travelbee

is considered as an ___ because it individual's self-awareness in
tends to : exploring the meaning of his or her Developed the Human-to-Human
behavior to identify and overcome Relationship Model
1. understand the patient's needs and problems.
concerns, A writer, psychiatric nurse, and
In her case, The Loeb Center became educator
2. develop goals and actions intended the hospital environment that
to improve patients' ability, and Completed her BSN (1956) at
provides a place for the individual Louisiana State University and
3. direct the activities related to the conducive to their self-development, Master of Science Degree in Nursing
medical plan to improve the patient's not a problematic psychological at Yale University
condition. experience.
Psychiatric nursing instructor at
The Helping Art of Clinical She stated that 'Nursing' is visible in Depaul Hospital Affiliate School in
Nursing the participation of her concepts of New Orleans in 1952 and later In
care, core, and cure model in caring Charity Hospital School of Nursing,
This theory suggested that nurses for an individual. New York University and the
must identify the need-for-help of the University of Mississippi.
patient in the following ways : Her major concepts are the three C's
Core, Care, Cure She based her theory's assumptions
1. Observing patients' behaviors that with the following authors, Soren
are consistent or inconsistent with What are the three C's? Kierkegaard (existentialism) and
their comfort. Viktor Frankl (logotherapy).
Core
2. Exploring the meaning of their existentialist
behavior · Therapeutic use of self
· Patient care is based on social The ___ approach believes that
3. Determining the cause of their science humans are always faced with trials
discomfort or incapability · The patient is able to develop a and choices, and humans are
4. Determining whether they can maturity level when the nurse responsible for their life choices.
resolve their problems or have a need listens to them
· Make informed decisions Logotherapy
for help.
Care ___ theory was first proposed by
Lydia Hall Viktor Frankel, a survivor of
Developed Core, Care, and Cure · Nurturing component of care Auschwitz, in Man's Search for
theory; Established and directed the · It is exclusive to nursing Meaning (1963)
Loeb Center for Nursing and · "Mothering"
Rehabilitation at Montefiore · A nurse is concerned with
Hospital. intimate bodily care Joyce Travelbee
· Nurses goal is to care and
Earned her Nursing Diploma at York provide comfort for the patient She defined 'Person' as a human
Hospital School of Nursing in 1927 · A patient may explore and share being. The nurse and the patient are
feelings with the nurse considered human beings
Received her Master's degree from · Cure
Columbia University in 1942 · Care is focused on pathological She defined 'Health' as both
and therapeutic sciences subjective and objective
Her interest in the field of research in
· Seeing the patient and family
the rehabilitation of chronic patients Subjective
through the medical care
led her to the development of her
· Application of medical ___ health is defined by self-
theory.
knowledge by nurses appraisal of individuals' physical,
Her theoretical source is her · Nurses assisting doctors emotional, spiritual status.
experience in psychiatry and · A nurse is a patient advocate
rehabilitative nursing experience in Objective
True
the Loeb Center. ___ health is the absence of
True or False disabilities and diseases measured
Defined 'Person' as a person whose
age is 16 y.o or older and in the stage measured by physical examination,
Hall's theory is represented by
of chronic illness; Individual care health care provider's assessments,
interconnected circles - core, care,
recipient - the source of motivation and laboratory
and cure. The size of each circle
and energy for healing depends on the condition of the Environment
patient and continuously varies.

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In Joyce Travelbee's theory, the ___ the first encounter of the nurse and Relates 'Environment' to places,
is not clearly defined the patient peopls, objects, sounds, and sights
suffering Emerging Identities Defined 'Nursing' as the education to
the caregivers to facilitate change
A feeling of uneasiness ranging from A bond begins to form in this phase
mild to extreme physical or mental wherein the nurse and the patient parent/caregiver
discomfort, pain, or torture. perceive each other as a unique
being. Healthy child development depends
This experience varies in duration, on the ___ who responds to the
intensity, and depth. Empathy signals from the child with a
dependable and loving manner
Meaning The ability to share in the other even at the moment of child's birth
person's experience (Qaiser, 2014).
It the reason as oneself attributes
Sympathy These are the aspects that need to
Nursing
Nurse alleviating the cause of a exist in the Child
Joyce Trvelbee defined ___ as patient's illness or suffering
assisting the patient in helping to - Physical appearance
find meaning in the experiences of Rapport - Temperament
suffering and illness. - Feeding and sleeping pattern
interactional phase of patient and - Self-regulation
Is responsible for helping not only nurse
the patient but include their families These are the aspects that need to
as well in finding meaning. Kathryn Barnard exist in the Mother/caregiver

Hope She developed the Parent-Child - Psychological assets

Model - Physical health
The nurse assists the patient to - Mental health
develop ___ Kathryn Barnard - Coping skills
- Life changes
It is a faith that helps the patient Received her diploma in Nursing
- Expectations and concerns about
bring change to something better. from the University of Nebraska in
the child
1960
- Caregiving style
communication
Kathryn Barnard - -Educational level
"a strict necessity for good nursing - -Adaptation skills
care." Received her master's degree in
Boston University and recruited in These are the aspects that need to
therapeutic use of self University of Washington in 1963 exist in the Environment
until her retirement in 2006
the ability of the nurse to use - Social Support
therapeutic communication to the She began her studies in infants and
- Financial Resources
patient their parents in the 1970s
- Safe Housing
The perception of self-awareness and She is influenced by the nursing
self-understanding is crucial in theorists - Florence Nightingale, - Adequate Food
perceiving human behavior, Martha Rogers, and Virginia
including predicting one's own and Henderson. - Community Involvement
other's behavior.
Her theory borrows from psychology Evelyn Adam
targeted intellectual approach and human development and focuses
on mother-infant interaction with the She developed the Conceptual
the ability of the nurse to use a environment. Influenced by other Models of Nursing
systematic approach to the patient's scholars
situation intellectually Evelyn Adam
Defined 'Person' To comprehend A Canadian Nurse who applied her
Joyce Travelbee auditory, visual, and tactile stimuli; works of conceptual model in her
In her human-to-human relationship and then put this information to fair book "Between Infirre" in 1979 (To
model, the nurse and the patient use. be a Nurse, 1980).
undergo a series of interactional Defined 'Health' as a dynamic state
phases She adapted Virginia Henderson's
of wellbeing ; viewed health as both concepts within the framework of
Original Encounter illness and wellness Dorothy Johnson's conceptual
[Link] stated that the objective

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of nursing is to maintain and 1970, began investigating the core of

reestablish independence of the nursing
patient in meeting the 14 Ida Jean Orlando-Pelletier
fundamental needs. 1943, she completed nursing school
and began working as a nurse She proposed the Nursing Process
In her definition of 'Person' it is instructor Theory
stated that "Each person is a complex Received a Bachelor of Science
whole, made up of fundamental Winifred Logan
degree in public health nursing in
needs." A nurse teacher 1951
She defined 'Health' as "the 1966, MA in nursing from Columbia Her theory remains one of the most
biological, physiological, and University effective methods and helpful to
psychological needs of the person. nurses in their practice
1960 to 1970's - Nurse Educator at
She only mentioned in her theory the Scottish Office She acknowledges no theoretical
"that the family environment must be sources in developing her theory
taken into consideration when Consultant for the World Health
carrying out the nursing practice." Organization in Malaysia, Europe, She considered 'Person' as
and Iraq developmental individuals with
Described 'Nursing' as "Maintaining needs; person may have subjective
and restoring the person's Alison Tierney perceptions and feelings that a nurse
independence in meeting the 14 basic might not directly perceived
fundamental needs." She involved actively in Research
and health care activities Nationally Defined 'Health' as a sense of
Goal of the profession and Internationally fulfilled needs, adequacy, and
It is what the professional wants to 1990's UK Representative on World comfort
achieve Education News and Reviews The concept of environment was not
(WENR)` mentioned in her theory. she focused
Beneficiary
University of Adelaide - Professor, only on the immediate need of the
An individual or group of people and Head of Department of Nursing patient.
who gets direct care by the Studies
professional Defined 'Nursing' as unique and
Roper-Logan-Tierney independent nursing action
Role concerning an individual's needs for
Their model was influenced by the help in an immediate situation
The responsibilities and functions of works of Virginia Henderson and
the professionals also by the well-known hierarchy of professional nursing
Source of difficulty human needs by Abraham Maslow The function of ___ is to find out and
In the Roper-Logan-Tierney model meet the immediate needs of the
The source of individual's problem in patient requiring help. In other
which the professional directs his of Nursing, the activities of living
include; words, nursing is responsible for
care to solve it. anticipating the patient's immediate
Intervention 1. maintaining a safe needs and providing direct assistance
environment to a patient to relieve the patient's
The intervention of the professional 2. communicating, sense of helplessness.
to their client 3. breathing
4. eating and drinking Presenting Behavior
Consequences 5. eliminating It is the patient's situation wherein he
The result of the effort of the 6. personal cleansing and or she needs help. Through this
professional goals dressing situation, the nurse will provide
7. controlling body assistance for the patient's need for
Models of Nursing Based on temperature mobilizing help
Activities of Living 8. working and playing
9. expressing sexuality Distress
The theory of Roper-Logan-Tierney 10. sleeping and dying.
A patient's behavioral experience
Nancy Roper Biological, Psychological, when a patient's need for help is not
Sociocultural, Environmental, met, causing him or her to
Influenced by her mother to pursue a
Politico-Economic experience distress
nursing career
factors that influenced the AL's Immediate Reaction

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It is the internal response wherein the This is the last stage. In this stage,
patient perceives the situation using the nurse evaluates the development
his or her five senses. These of the patient in relation to the goals
perceptions will stimulate the set in the nursing care plan. Changes
production of thoughts, and each are expected to improve the nursing
thought will produce a feeling, which care plan. If another problem arises,
causes the patient to act this can be addressed by doing again
the stages of the nursing care plan.

Nurse's Reaction
The patient's behavior will elicit a
___. This stimulation is the
beginning of the nursing process.
Nurse's Action
The ___ begins to transpire. Nurse-
patient contact is known as the
nursing process. The action of the
nurse could either be automatic or
deliberative
Ida Jean Orlando-Pelletier
In her theory, she defined the 5
stages of Deliberative Nursing
Process
Assessment
In this stage, the nurse completes a
holistic assessment. By using a
framework, the nurse gathers
information or data that would
identify a patient's problem or need.
Data includes subjective and
objective data.
Diagnosis
this stage, clinical health problems
will be identified. This is confirmed
by linking the defining
characteristics, related factors and
risk factors during the assessment
stage.
Planning
addresses the patient's problem
identified in the diagnosis stage. The
problems identified provided with
proper nursing interventions with a
desired outcome or goal. The nurse
will devise a nursing care plan.
Implementation
In this stage, nursing actions or
interventions are implemented. The
nurse is using the nursing care plan.
Evaluation

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NURSING RESEARCH

Meta-Analysis A short, comprehensive synopsis or Protect the rights of research

summary of a study at the beginning participants
The nurse intends to use specific of the article is called the _____
quantitative statistical methods that The purpose of an institutional review
will allow conclusions to be drawn. Provides evidence to optimize board is to...
What is the best systematic review to patient outcomes
choose? Researcher and credentials are
What is the most important reason the identified
Procedure section average consumer of health care
(patient) should be concerned about
Study, where would you look? To nursing research? Nursing research...
locate legal ethical issues of a Participant selection process is
qualitative research Research provides the nurse with described
evidence-based knowledge needed to an element of informed consent
Relevance of the study to nursing make sound clinical decisions
practice Confidentiality
Why should the registered nurse at the
What can the nurse determine by bedside be concerned about research A study was conducted to evaluate
reading the abstract, introduction, for the delivery of quality nursing staff nurses' perceptions of a good
major headings, and conclusions? care? nurse manager. The researcher shared
Read and study the entire report, the actual response with the managers.
At the end of the literature review This best describes a violation of:
seeking assistance for unclear section
content - Person who has been diagnosed
A nurse researcher is searching for the with AIDS
How can a nurse achieve a purpose of a study in a research report.
comprehensive understanding of any - 74 year old hospitalized patient
Where is the most likely place to find with diabetes
research report? the purpose in the report? - A hospitalized infant
The selection is done based on the Evidence based practice
research question and how much Vulnerable population for research
research has been done What is the most accurate term for project
making patient are decisions on the
How does a researcher choose which basis of research findings?
type of research method to use? False
When they use quantitative
It is the process of critically methodology, bias is evident in the True/False: All health care institutions
evaluating a research report's research design, and each study uses are required to have an IRB
content for scientific merit and small samples of subjects
application to practice False
When does scientific evidence
What does it mean to critique a influence a change in nursing True/False:If participants willingly
research report/article? practice? and knowingly agree to participate in
a study involving undue harm or risk
Quality 2 to themselves, the researcher does not
When the nurse is critiquing a need to refrain from conducting such
An experimental study in which research
research report/article to support a subjects were randomly selected is an
change in nursing practice and looking example of what level of study? - Likelihood of elderly to drop out
for the extent to which the studies' - Primary language of elderly
designs, implementation, and analyses Experience of mother child bonding person
minimized bias, the nurse is critiquing in inner city populations - Cognitive capacity of elderly
what, related to the body of evidence? person
Which study title indicates use of
Abstract qualitative methodology? - Degree of risk to elderly person

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Factors might influence whether it is Independent: Individuals with birth linked to his or her individual
ethical for an elderly adult to defects, individuals without birth response, even by the researcher
participate in a research study? Select defects
all that apply. No
Dependent: The incidence of
Explanation of whom to contact independent-dependence conflicts **Researcher must provide provisions
regarding any area of the study (ways) that minimize the risk of harm;
Individuals with birth defects have a any potential harm must be reasonable
Considered a major essential element higher incidence of independence-
of the informed consent form for a dependence conflicts than individuals What if the participants agree to
research study? with birth defects. participate in a study that would
provide undue (excessive, beyond the
Respect for persons Independent: Sterile norm) harm or risk to them, can the
catheterization, clean catch method researcher still conduct the study?
A patient newly diagnosed with breast
cancer is asked to participate in a Dependent: The number of bacteria 14 years
clinical trial for a new chemotherapy found in patients' urine
ager. The patient's freedom to (in California, if emancipated; 16 if
participate or not participate in the There is a difference in the number of emancipated in other states)
study exercises which ethical bacteria found in patients' urine when
the urine is collected by sterile At what age can children give sole
principle? consent to research?
catheterization compared to a clean
Primary nurses and team nurses catch method. Assent
Identify the independent variable in Null -7 and older
the following hypothesis:
"There is no difference in the Research: With children, there is
There is a difference in patients' preoperative anxiety levels between required parental consent and child's
satisfaction with nursing care when patients who practice relaxation _____ (understanding of the purpose
the care is provided by a primary techniques before surgery and patients and the research being done)
nurse compared to care provided by a who do not practice relaxation
team nursing approach techniques." What type of study is -Children ___ and older can
this? participate in this
Self esteem
The 1990s Who is legally and ethically
Identify the dependent variable in the responsible to protect study
following hypotheses: Unethical research studies have taken participants from physical and
place in the United States as recently mental harm or discomfort?
There is a difference in self esteem as:
levels between teenagers who exercise - The researcher
regularly and those who do not Must an institution have an IRB - The research team
exercise regularly. board? - The nurse
Complex, nondirectional The institution itself doesn't need an - The caregiver
IRB board, burin order to do research - All of the above
There is a difference in the frequency they must reach out to an IRB board in
of practicing breast self exams Contact the medical center's
order to receive approval Institutional Review Board (IRB)
between nurses and women who are
not nurses. This is an example of what At what grade level should informed What should you do if, as a staff
type of hypothesis? consent be written? nurse, you overhear a researcher use
Independent: The use of cathode Eighth grade **Cannot use terms they coercion to make a patient agree to
ray terminals (CRTs) won't understand, and has to be in the participate in a research study?
participant's primary language Research question
Dependent: The incidence of birth
defects Anonymity Is this a research question or a
The use of cathode ray terminals What terms refers to a participant's hypothesis?
(CRTs) increases the incidence of identity not being identifiable or
birth defects.

29
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" What is the effect of perceived job Null hypothesis Immediately after the intervention in
stress on job performance among an experimental study of the negative
nurses who work in medical centers?" "Hyperactivity in school-aged children effects of smoking tobacco, the state
is unrelated to eating desserts every tax on cigarettes increases the cost
Hypothesis **It is predictive and day" from $4 to $8 per pack. Which threat
attempts to answer the research to internal validity does this pose?
question Directional hypothesis
"People who smoke are more likely to Maturation
Is this a research question or a
hypothesis? develop lung cancer than those who Subjects in a multiple group
do not" experimental study are tested for how
"Nurses who work at medical centers much time it takes them to navigate a
with high perceived job stress have There are more than two variables to
be tested in the hypothesis. maze and find the chocolate. The
low job performance." maze is reconstructed after each run,
Yes Which statement describes a study that and three different floor plans are
is designed to test a complex used. Each group is tested eight times
Can research questions have more hypothesis? in eight hours at a different time of
than one hypothesis? day. The runs later in the day have
Social Support, balanced diet, and faster times than the earlier ones.
-Independent variable: Levels of regular exercise decrease the Which threat to internal validity might
exercise postpartum incidence of postpartum depression. account for this difference?
-Dependent variable: Weight Which of the following hypotheses Selection bias
retention represent a complex hypothesis?
A researcher believes that therapy is
"Women who have lower levels of Simple and nondirectional. more effective if patients exercise. He
exercise postpartum will be associated tells his patients that he has arranged
with greater weight retention." The hypothesis, "Postoperative
for them to use the hospital gym, if
pediatric patients who use TENS
they so desire—and that if they are
"Birth weight is lower among (transcutaneous electric nerve
interested, they will then be in the
infants of alcoholic mothers than stimulation) will have a different level
experimental group. This represents
among infants of nonalcoholic of pain than pediatric postoperative
which threat to internal validity?
mothers" patients who do not use TENS" is
Mortality
- -Population: Alcoholic mothers
and nonalcoholic mothers A college health center identifies a
- -IV: Alcohol intake by mother lack of testicular self-examination
- -DV: Birth weight among students and implements an
- -Simple intense summer wellness program
Why is the selection of an focusing on the benefits of testicular
"More postpartum depression and appropriate design for a research self-examination. Afterward, a count
feelings of inadequacy are reported study important? indicates a decreased number of
by women who give birth by
students who are in the program.
cesarean section than those who If the design is an incorrect one, the
deliver vaginally" researcher will examine variables and Selection effect
their interactions in a way that does
- -Population: Pregnant women not answer the research question The volunteers that a researcher gets
- -IV: Type of birth (c section for a study are all college students,
vs. vaginal) Biased most of them are white, and most of
- -DV: Postpartum depression them are from privileged backgrounds.
and feelings of inadequacy Selection of 300 subjects yields a
The researcher worries that the study's
- -Complex sample, but demographic analysis of
results might not be applicable to
that sample reveals that there are 99
people who are not in their late teens
Nondirectional hypothesis teachers in the sample, despite the fact
or early 20s, white, and rich. What
that there are far fewer than 33%
"There is a relationship between threat to external validity is this?
teachers in the total sample. The
serotonin levels and Sudden Infant sample can be said to be
Death Syndrome"
History Hawthorne effect

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A group of nurses are isolated from Internal -Selection bias A quasi-experimental study most often
their work colleagues, for a research differs from a true experimental study
study, where they are being observed Declare which of the following are by the absence of:
for their patient care on a medical- threats to internal validity (I) or
surgical unit. The researcher is external validity (E) in a study and Quasi-experimental
concerned that the individual attention state what it is called.
Patients on two separate units are
and the normal human instinct to feel "People who volunteer have factors given a patient satisfaction with care
'chosen,' may skew the results. What (for example, motivation) that questionnaire to complete at the end of
threat to external validity is this? predispose them to affecting the their first hospital day and on the day
Rosenthal effect results" of discharge. The patients on one unit
receive care directed by a nurse case
During an interview in a research External -Hawthorne manager and the patients on the other
study, the researcher asks the patient, Declare which of the following are unit receive care from the usual
"You don't have anything disgusting threats to internal validity (I) or rotation of nurses. Patient satisfaction
like TB or Hepatitis B do you?" The external validity (E) in a study and scores are compared.
patient answers, "No" even though he state what it is called.
does have Hepatitis B. What threat to Experimental
external validity is this? "Participants are aware they are being Students are randomly assigned to two
observed and change their behavior groups. One group receives an
Quasi-experimental because of this" experimental independent study
A wellness center wishes to determine External-Experimenter program and the other receives the
whether a stress-reduction series of usual classroom instruction. Both
classes increases perceived efficacy of Declare which of the following are groups receive the same post-test to
participants. A pre/post questionnaire threats to internal validity (I) or evaluate learning.
was administered to all participants. external validity (E) in a study and
state what it is called. Experimental
Could something else explain the
results? "Researcher influences the participants A study was conducted to compare the
through facial expressions, clothing, effectiveness of a music relaxation
What question is most important when age, gender, etc.)" program with silent relaxation on
evaluating evidence of experimental lowering blood pressure ratings.
studies? Internal -Maturity Subjects were randomly assigned into
groups and blood pressures were
Methodological research Declare which of the following are measured before, during, and
threats to internal validity (I) or immediately after the relaxation
Which process will the researcher use external validity (E) in a study and
in the following scenario? exercises.
state what it is called.
"A nurse researcher wants to develop Quasi-experimental
"Changes occur in the subject (aging,
a tool to collect information on the gaining more knowledge, etc.) which Reading and language development
experience of families with children in may affect the results" skills were compared between a group
the intensive care unit." of children with chronic otitis media
Internal -History and a group of children without a
Independent/ Dependent
history of ear problems.
Declare which of the following are
The (independent/ dependent) variable threats to internal validity (I) or
is manipulated or controlled and the Ex post facto study
external validity (E) in a study and
(independent/ dependent) variable is state what it is called. A study of education factors
measured to determine the effect. contributing to whether patients made
"Event (news release, illness of life- style change behaviors utilized
Do positive results prove anything? participant) occurs during the course
Support with why or why not. patients' cardiac rehabilitation records
of the study which may affect the to record what education presentations
No, nothing is ever PROVEN- always results" they attended. This is an example of
at least a small doubt that the findings a(n) _____ study.
Random assignment of subjects to
could be caused by something else. No group
true perfect study! Correlational study

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A study was done to examine the A researcher has 25 nursing students nursing student population. The
degree of relationship between the as an accessible population for a study researcher needs a sample size of 100,
amount of time spent in online and needs 10 students for the sample. so the sampling is done until 80
activities during the weeks students The name of each student is placed in students in 18-22 age range, 15
are not meeting in class and their final a container. The first name is drawn students in 23-30 age range, and 5
grades. This is an example of a(n) and recorded as a potential participant. students >30 have been recruited.
_____ study. The name is returned to the container Convenience sampling is then used to
and this process continues until 10 select the participants from each age
Survey study student names have been selected. range. This is an example of what type
A study was done where nurses were Should one of the selected students of sampling strategy?
asked to complete a questionnaire that decline to participate in the study,
another name would be selected in the Purposive sampling
asked questions related to fear and
returning to school. This is an example same manner. This is an example of A researcher is investigating the lived
of a(n) _____ study. what type of sampling strategy? experience of women younger than the
Simple random sampling age of 25 years who have survived a
Methodological study liver transplant. The researcher selects
A recent study was conducted on the In a study to determine student interest women who meet the inclusion criteria
instrument, Assessment of Cultural in creating a smoke-free campus, the for the study. What type of sampling
Competence in Nurses. This is an accessible population is 5,500 strategy is this?
example of a(n) _____ study. undergraduate and graduate students.
The researcher secures a list of all Convenience sampling
Exclusion criteria students enrolled in the university and A researcher desires to conduct a
assigns each name on the list a study of patients with type 2 diabetes
A researcher wants to study coping in number. A sample of 200 students is
adolescents with type 1 diabetes. presenting for treatment at an
necessary. After selecting the start emergency department. Because the
Individuals having another chronic point on a table of random numbers,
disease such as asthma are going to be researcher cannot predict which
the researcher selects additional diabetes patients will use the
excluded from the study. The participants by proceeding vertically
researcher may believe that having emergency department over the course
through the columns until 200 of the study, he elects to use a sample
another chronic disease could affect participants are selected. This is an
the participants' coping. This is an that includes all patients with type 2
example of what type of sampling diabetes who seek care at the
example of... strategy? emergency department. This is an
Cluster sampling Stratified random sampling example of what type of sampling
strategy?
A researcher wants to study A researcher wants to study 150
baccalaureate nursing education in the nursing students' attitudes toward Convenience
US. The researcher first randomly treatment of pain. 10% of the
selects 10 states that will be included You are leaving a grocery store and
accessible nursing student population are approached by an individual who
in the study. Then all baccalaureate are male (15) and 90% are female
nursing programs in each of the 10 identifies herself as a researcher. You
(135). The researcher places the were most likely selected by which
states are identified. The researcher nursing students into two groups that
then randomly selects three schools method of sampling?
have 15 males and 135 females.
from each state and obtains the names Participants are then randomly Concealment without intervention
of baccalaureate students enrolled in selected from each group. This is an
each of the programs selected. example of what type of sampling A researcher uses a one-way mirror to
Sampling is concluded by randomly strategy? observe interactions of caregivers and
selecting 30% of the names on the list. infants who have feeding problems.
This is an example of what kind of Quota sampling
sampling strategy? Physiological measure (blood
In a study about how age is related to pressure, pulse).
. success in nursing programs, a
researcher stratifies according to age The most objective and accurate
by creating three age groups: 18-22, method of measuring a patient's
23-30, and >30. 80% of nursing cardiac status is by
Simple random sampling
students are 18-22, 15% are 23-30,
Observation
and 5% >30 which represents the

32
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In studying motor development of What measure used to test an False

children, the nurse researcher would instrument's validity is where an
most likely use which measurement expert panel of judges are asked to True or false? : "You would expect
method? indicate their agreement with the items most tests to be both perfectly reliable
and whether they represent what is and perfectly valid"
Homogeneity being measured? Number of seconds from the time
What measure used to test an each customer enters a store until a
instrument's reliability refers to items salesperson greets him or her, based
that reflect or measure the same thing? on observations at a distance
Stability The test cannot be valid. Which of the following data collection
measures would probably be easier to
What measure used to test an The internal consistency reliability of measure reliability?
instrument's reliability refers to the the Smith Anxiety Test has been
same results being obtained every time estimated to be .20. Based on this Two
the instrument is used? information, which of the following
statements is true about the validity of What is the minimum number of
Criterion this test? observers you would need to
determine interrater reliability?
What measure used to test an True
instrument's validity refers to the
relationship between the participants' True or false? : "Overall, validity is
responses and their actual behavior? more important than reliability when
evaluating an instrument"
Content
BIOSTATISTICS
· Health related surveys What are some types of
· Immunization and chronic disease demographic surveys?
Biostatistics involves? registries
· Vital statistics (birth/death · Census
· Measures health events in a · American community survey- for
population certificates)
· Outbreak investigations income poverty and health
· Design, analysis, and interpretation · Research insurance of selected community
of data for studies in public health and · US census (q10years) samples every 3 years
medicine · American community survey · Behavioral/risk surveys:
(q3y) NHANES- national health and
What are the uses of data in public · · Behavioral/Risk surveys nutrition examination survey &
health? BRFFS- behavioral risk factor
surveillance system
· Population or community health
assignment Explain the NHANES- national health
· Public Health surveillance and nutrition examination survey
· Disease investigation
· Prevention and control measures · Influences policy
What are vital statistics? · Getting lead removed from
investigation
· Program planning · vital statistics include birth gasoline
· Future health problems and needs certificates and death certificates. · Pediatric growth charts
assessment · marriages and divorces, · National baseline estimates for
· Hypothesis generation spontaneous fetal deaths, and cholesterol, blood pressure and
abortions. hepatitis C
What are some sources of data
collection? How often are demographic Explain the BRFFS- behavioral risk
statistics collected through census? factor surveillance system
· National, state, local health data
sets q 10 years, they're a "snapshot of Collects data on health risk behaviors
· Surveillance data (reporting aggregate"
communicable diseases)

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· Time: onset, duration, trends · Are measures of the frequency at

(measures of time are used to see which a health event occurs over
What are some attributes and how a health event changes over a period of time
characteristics of quality data? time) · Represent the burdens of burden
· Accurate - true diagnosis of disease during a specific time.
How and what do we measure with · Are used to make comparisons
· Complete epidemiology?
· Relevant - to the population and between groups of people
health conditions of interest · Relate the frequency to the · Groups of people
· Timely - appropriate actions can population with ratios, · Places
be taken proportions and rates · Time periods
· Prevalence, incidence, mortality Rates and proportions are used for?
What are some limitations of data? and case-fatality
· All data sets have limitations · Morbidity (prevalence and
numerator / denominator incidence)
· Inaccurate diagnosis or coding
· Poorly constructed data · Numerator: number of events of · Mortality rate
collection, entry, or analysis interest · Disease severity (case
· Non-representative data · Denominator: the population at fatality)
risk What are the types of rates?
What questions does descriptive
epidemiology answer? · Crude rates
· Who has the greatest risk of Ratio · Category specific rates
getting a disease or other health · Age-related rates
outcome? any fraction obtained by dividing the
quantity by another x/y Types of rates: Describe crude
· Where is the health outcome rates.
occurring? proportion
· When did the health outcome · Calculated for the whole
occur and is the frequency of the · a ratio in which the numerator is population
health outcome changing over included in the denominator. A · Summary measure
time? percentage.
· often multiplied by 100 and ex: Cancer death rate in the total
Descriptive epidemiology is a reported as a percentage population
Systematic way to describe a health
problem. What does it investigate? PROPORTIONS A crude rate is calculated by dividing
the total number of events in a
The distribution or the patterns of · ALL WOMEN DIVIDED BY specified time period by the total
health events in populations and THE TOTAL POPULATION number of individuals in the
determinants or the factors that · WOMEN AGED 14-25 population who are at risk for these
influences those patterns DIVIDED BY AlL WOMEN events and multiplying by a constant,
· Women age 41 – 5- divided by such as 1,000 or 100,000 [in other
What's the connection between the total population of the same words, (numerator/denominator) x
Florence Nightingale, the Crimean age constant].
War and the development of · numerator is included in the
epidemiology? denominator Types of rates: Describe category-
specific rates.
· Looked at the relationship between Counts are insufficient to.
the conditions of the environment and · Calculated for a specific group
recovery of soldiers · Understand relationships of within a population (ie: nursing
events to population students, veterans)
Descriptive epidemiology lies in the · Describe population · Measures frequency of health
investigation of? characteristics event
· Person: age, race, sex, marital · Determine risk · ·Used for comparisons
status, behavior, occupation, · ex: Rate of female suicides in
Rates Idaho per 100,000 females
socioeconomic status
· Place: residence, employment Types of rates: Describe age related
rates.

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 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
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· Allows the comparison of age /persons at risk of dying · From October 2013 through
related health events between during that time period October 2014, 17.0% of US
communities with different age · Expressed as number per adults reported smoking cigarettes
structures 1000, 10,000, 100,000 every day or some days, and 6.6%
· ex: age adjusted rate · 1.998 per 1000 reported using e-cigarettes every
· Cancer death rate accounting for · 1.998 per 1000 day, some days, or rarely;
the age of the population · from 2012 through 2013, 18.0%
Calculating incidence: What is the reported smoking cigarettes every
What is prevalence? incidence of chalmydia in Idaho in day or some days, and 4.2%
2004? reported using e-cigarettes every
· Number of existing cases at a
point in time - **new and old. At risk population was 1,393, 262 day, some days, or rarely (2,3).
( I.e. cancer, diabetes, HIV/ Despite a rapid increase in e-
AIDS) 14/68,239 cigarette use, their long-term
· **Evaluates burden of disease in health effects are unknown
What is the incidence rate of an MI in
a community those with low cholesterol, given? Describe the crude mortality rate.
· “snapshot” of the disease of
interest · -14 people with low Deaths from all causes per 100,000
· Helpful with diseases that are cholesterol had MI people
chronic in nature · -person-years 68,239
· a proportion or percentage Describe the cause specific mortality
· good for planning health services Incidence- number of new cases of rate.
salmonella related to backyard
400/35,00 poultry Death rate associated with a particular
disease per 100,000 people
Your town has a population of 35,000. Is the following an example of
In 2010, 300 residents of the town Incidence or Prevalence? ex: people who die from gsw in
were dx with health condition X, Hopkinsville/ all persons in
which is a lifelong condition. In · CDC and multiple states are Hopkinsville
n2011, an additional 100 residents of investigating 10 separate
multistate outbreaks of Describe the age specific mortality
the town were dx with condition X. rate.
No deaths or recoveries have occurred Salmonella infections in people
due to health condition X. What is the who had contact with live poultry Death rate in a certain age group per
prevalence of the health condition in in backyard flocks. 100,000 people
2011. · The outbreak strains of
Salmonella have infected a ex: •# infants who die in the first year /
What is incidence? reported 961 people in 48 states # infants born during that time
and the District of Columbia.
· Number of new cases of a Illnesses started on dates ranging Which is an example of a crude
disease over a period of time from January 4, 2017 to July 31, rate?
(new) 2017.
· Determines causes of health Cancer death rate in the total
· 215 ill people have been population
events hospitalized. One death has been
· Expressed as number of cases of reported. Which is an example of a category
disease per 100,000 persons
specific rate?
· Helpful with diseases that are Prevalence- may be reported as the
occurring quickly in a population number or the percentage of the Rate of female suicides in Idaho per
( I.e. Influenza, measles, population new smoking data 100,000 females
chickenpox, ebola virus)
· Is the following an example of Which is an example of a age
Describe mortality rates. Incidence or Prevalence? adjusted rate?
· Although cigarette smoking
· Used to describe the among US adults declined Cancer death rate accounting for the
incidence of death in a significantly, from 42% in 1965 age of the population
population rather than the to 18% in 2012 the use of
incidence of the disease Describe infant mortality rate.
electronic cigarettes (e-cigarettes)
· # of deaths in a population increased since 2007. · Number of infant deaths during a
during stated time period
stated time period

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 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
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· Infant Mortality rate is the TB prevalence because we have data · Treatment availability
number of infant deaths (that die for new cases, but no old cases
before their 1s year) per 1,000 Validity: Sensitivity Screening
live births Based on the data in the table with of
the following cannot be calculated? · Who’s a true positive
· ex: infant deaths in 2020/#live · Identifies condition
births A decision to screen is... · oPositive predictive value
Describe case fatality rates. A decision to treat Screening Validity: Specificity
· a measure of the severity of the What are some screening · Who’s out
condition characteristics? · Does not have the condition
· Divide number of deaths from a · Negative predictive value
condition by number of persons · Low cost and accessible
with the condition · Acceptable to clients
· ex: 4739 pedestrian fatalities from · Significant benefit outweighs
motor vehicles/78000 pedestrians risks of testing
injured by motor vehicles = · Reliable and valid
0.061x100 = 6.1 deaths per 100 (sensitive/accurate to who has the
persons, or 6.1% disease)
· (specificity/accurate to who
Comparison of mortality & case doesn't have illness)
fatality

BIOETHICS

Respect for autonomy treating people equally and without deciding for those who have never
prejudice been capable (ex: disabled)
· freedom and ability to act in a
self-determined manner Distributive justice Negative vs positive rights
· Right to privacy
fairness in allocating scarce resources; · Negative:
Informed consent requirements assumes that the scarcity is real · easier to grant
· people are entitled to not have
· information Social justice anything hurtful done to them
· Voluntariness · Positive
· capacity everyone should have the same rights,
benefits, and opportunities · Ask someone to do something for
Nurses role in informed consent you. Expect public safety to
Prima facie protect me/ Claim it as your right
· NOT TO GET IT
· To help identify a suitable person · "Primary, on its face" Justice is realted to the IV of
to provide informationed consent · something that is accepted as
correct unit or unless it is shown men and women for others
if patient is not possible
· obligatory care otherwise beneficence is related to the IV of
· most frequent conflict between
Nonmaleficence (postive / negatives) beneficence and autonomy cura personalis
· "Do no harm" = negative right Balancing principles Unavoidable trust
· "treat my illness with standard of
care" positive right · ethical dilemmas: both are right, consequence of vulnerability, power
but which one is more right
Beneficence · Balancing principles: most Fiduciary relationships
common person who holds a legal or ethical
· doing good · autonomy vs beneficence (life
· Dax cause relationship of trust with one or more
support) parties.
Justice Balancing principles: most difficult

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 EMILIO AGUINALDO COLLEGE
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Moral agency ethicist/philosopher supporting · facilitates patient's autonomy

right to autonomy through the knowledge and use of
depicting own agency (speaking from advance directives
own knowledge and taking care of Mill: one doesn't have to answer to
patients) anyone else or be judged for actions if intentional non-disclosure
it doesn't concern others
Moral suffering (revolutionary at the time) · disclosure of medical errors and
near-misses to patients and
deptecting feeling of anguish, Health Insurance Portability and families
uneasiness or angst Accountability Act (HIPPA) · intentionally not disclosing
Justifiable nondisclosure information to a patient or
· Designed to protect people from surrogate is legal in situations of
· Therapeutic privilege disclosure of their personal health emergency or when patients
· Culturally sensitivity to care information waiver their right to be informed
· withholding if for research · Goal: ensure privacy while · other instances on non-disclosure
· If there was no harm done to facilitating the flow of include therapeutic privilege,
pt information necessary to meet the therapeutically using placebos,
needs of patients research subject non-disclosure
Non-justifiable nondisclosure
When do patients tend to lose In what situations would that
· making serious error in autonomy? healthcare team invoke intentional
treatment non-disclosure?
· If there is harm done and you People generally lose the right to
did not tell exercise autonomy or self- · medical errors that cause no harm
determination when actions pose risk to patient (near misses)
Major ethical conflict in ACA to self or others · culturally sensitive care
What is required for informed · therapeutic privilege
market good vs social good
consent? · placebos
libertarian vs communitarian
· Information Therapeutic privilege (intentional
Libertarian · Voluntariness non-disclosure)
· Capacity (competence) · when physicians believe that
every women / man for themselves
Nurse’s role in obtaining informed divulging the information would
Communitarian potentially harm a depressed,
consent
emotionally drained, or unstable
better for privilege
· Identify person to give consent - patient
ANA code of ethics says Verify patient understands · physician's job to decide how and
instructions/teaching when to tell the patient news
Healthcare is a right · + education adjunct to physician's
instruction Culturally sensitive care (intentional
How do we approach healthcare non-disclosure)
· + Assess patient and family for
ethics philosophically?
questions (if questions, bring in · in certain communitarian
We are all natural philosophers: it is a primary researcher or physician to cultures, patients will not be
profoundly human and humanizing address questions) told what is going on
endeavor · Verify consent is obtained · family is put in charge of
Patient Self-Determination Act patient's care
philosophy · (ask: are you the one who is
(1991)
· "the love of wisdom" to be told results and
· wisdom = holistic understanding · requires health care institutions to findings?)
aiming at living well provide written information to
clients concerning the clients' Placebos effect on intentional non-
· merely thought that has been disclosure
thought out rights under state law to make
decisions, including the right to non-disclosure is appropriate when in
on when actions pose risk to self or refuse treatment and formulate a research group because patient is
others advance directives. aware that they may be receiving a
placebo rather than actual treatment

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 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
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conditions are verified at one and danger of beneficence

the same time
non-maleficence · + good action "the road to hell is paved with good
· + intention: good effect intentions"
· duty to do no harm; doesn't mean
doing nothing (action to prevent · + good effect be not produced by rules of beneficence
harm) means of the evil effect
· + the need to avoid negligent care · + grave reason for permitting · Protect and defend the rights of
· + the need to avoid harm when effect others
deciding to continue or withdraw · Prevent harm from occurring to
rule of double effect implementation others
care
a situation in which an action (such as · Remove conditions that will cause
What does non-maleficence look administering opiates) has both a harm to others
like for nurses positive effect (relieving a terminally · Help persons with disabilities
ill person's pain) and a negative effect · Rescue persons in danger
· hard for nurses to grasp because
we do harm to our patients daily (hastening death by suppressing paternalism
· + we do harm to patients all the respiration).
time (IV stick and NG insertion): the deliberate overriding of a patient's
Under what conditions can the opportunity to exercise autonomy
expect outcomes will be better double effect be used?
with temporary pain because of a perceived obligation of
· that the action in itself from its beneficence
negative rights very object be good or at least justice
· duties others have to not interfere indifferent
in certain activities of the person · that the good effect and not the · fairness
who holds the right evil effect be intended · treating people equally and
· example: do no harm · that the good effect be not without prejudice and the
produced by means of the evil equitable distribution of benefits
positive rights effect and burdens
· that there be a proportionately
human rights that depend on positive grave reason for permitting the distributive justice
government action, such as the right to evil effect
education and right to adequate health fair allocation of resources (especially
care Slippery slope argument scarce resources); comes into
questioning when rationing
obligatory care · In order to show that a
proposition is unacceptable, a social justice
The standard of care in place as to not sequence of increasingly
impose risks of harm (duty to patient benefits and burdens should be
unacceptable events is shown to
to use chlorhexidine on skin before IV distributed fairly among members of a
follow.
sticks) society or ideally that people in a
· A slippery slope is an illegitimate
society should have the same rights,
us of the "if - then" operator.
rule of double effect benefits, and opportunities
· examples: marijuana legalization
· states that a harmful effect of leads to increased drug use; we deeper questions that need to be
treatment, even if it results in should not legalize PSA because asked when looking at social justice
death, is permissible if the harm is leads to non-avoluntary
not intended and occurs as a side euthanasia · What is fairness?
effect of a beneficial action · Does the scarcity truly exist?
beneficence · Can we make up now, in the
· performing some actions may
have two potential outcomes (one present, for past injustices?
· Doing good or causing good to be
causing harm, one causing good): Should we? (affirmative action)
done
weigh factors and balances · What about equal access to
· Performing deeds of mercy,
· -a person may licitly perform an resources?
kindness, friendship, charity, and
action that he foresees will · Who is at the table when
the like
produce a good effect and a bad decisions are being made?
· People take actions to benefit and
effect provided that four promote the welfare of other Affordable Care Act
people

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 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
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· -an expansion of medicaid leading to an uneven power · Mitigating following views

· most of employers must provide balance and consequences
health insurance, have insurance · + patients have no other option
or face surtax but trust the healthcare Moral distress
· prevents rejection based on pre- professional the anguish experienced when a
existing condition. · + it creates an asymmetrical person feels unable to act according to
· also referred to as "Obamacare" power structure in relationships closely held core values
· signed into law in 2010. · + nurses' response to this trust
needs to include a promise to In what circumstances, do nurses
aims of the Affordable Care Act being the best they can find themselves in moral distress?
· Improving quality and lowering fiduciary relationship · When care plan is different than
healthcare cost what you think is right and nurse
· Providing greater access to care · a relationship of trust and cannot influence outcome (how to
· Providing new consumer confidence, as between trustee cope)
protections and beneficiary, attorney and · + witness to suffering: raise
client, or principal and agent. concern if bothersome
What underlying debates were at · power uneven: person with more
odds with the introduction of the · + inflict suffering in course of
power looking over interest of treatment
Affordable Care Act? those with less power · moral suffering can be
· market justice vs. social justice What is important to maintain in a experienced when nurses attempt
· libertarian vs. communitarian fiduciary relationship where this to sort out their emotions if they
power difference already exists? find themselves in imperfect
market justice situations that are morally
the philosophy that market forces · Non-abandonment unsatisfactory or when forces
should be relied upon to organize the · Preserving safety and beyond their control prevent them
delivery of healthcare services (does confidentiality from positively influencing or
not lead to distributive justice/ · Respect for persons changing unsatisfactory moral
allocation of resources) situations
ethical dilemmas
libertarian MacIntyre's recommendation
· situations in which none of the regarding virtues of acknowledged
one who believes in limited available alternatives seems dependence
government interference in personal ethically acceptable
and economic liberties · situation in which an individual is · theory counters the idea of self-
compelled to choose between two reliance
communitarian actions that will affect the welfare · a just view of generosity: giving
of sentient beings, and both without keeping score, but with
those who are willing to use actions are reasonably justified as prudence regarding one's need for
government to promote both order and being good, or the goodness of self-care
equality. the actions is uncertain (right vs. · misericordia: giving based on
right) urgent need without prejudice
anti-change factors towards
· truthfulness; each exploring the
universal healthcare most common ethical dilemma seen other's approach to making
in healthcare meaning
· reimbursement
· distribution of technology (greater autonomy vs. beneficence · the virtue of receiving without
than needed) shame (receive gift of thanks that
· fear of death Under which circumstances is it to patient gives)
confront an ethical dilemma? · the virtue of acknowledging
characteristic of professional- relationship (recognize in relation
patient relationship deciding for those who have never patient throughout shift)
been capable
· defined by unavoidable trust NUTRITION DIET THERAPY
placed in the hands of the aftermath of ethical dilemmas
professional I will make sure that I eat a
· unavoidable trust is a · Moral traces balanced diet and exercise regularly
consequence of vulnerability,

39
 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
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Which statement made by an adult 25 g/day for women and 38 g/day A. Perform hand hygiene and put on
patient demonstrates an understanding for men clean gloves
of healthy nutrition teaching? B. Flush tube with 30 mL air.
Total fiber adequate intake C. Draw 5-10 mL gastric aspirated
Protein into a syringe.
Helicobacter pylori
The nurse teaches a patient who has D. Observe the color of gastric
had surgery to increase which nutrient Based on the knowledge of peptic aspirate
to help with tissue repair? ulcer disease (PUD), the nurse E. Dip pH strip into gastric aspirate.
anticipates the presence of which F. Compare strip with the color
· Sit the patient upright in a bacteria when reviewing the chart from the manufacturer.
chair. laboratory data for a patient suspected
· Place food on the strong side of of having PUD? Vitamin C
the mouth. Which vitamin aids in iron
· Feed the patient slowly, 20-35% of cal
absorption?
allowing time to chew and AMDR (acceptable macronutrient
swallow. distribution range) for fats is The nurse is teaching a program on
healthy nutrition at the senior
The nurse is caring for a patient 10-35% of cal community center. Which points
experiencing dysphagia. Which should be included in the program
interventions help decrease the risk of AMDR (acceptable macronutrient for older adults? (Select all that
aspiration during feeding? (Select all distribution range) for protein is apply.)
that apply.)
Gastric residual aspirate of 350 mL o Avoid grapefruit and grapefruit
Turn patient to left lateral decubitus for the second consecutive time juice, which impair drug
position absorption.
The nurse is assessing a patient
The nurse suspects that the patient receiving enteral feedings via a small- o Take a multivitamin that includes
receiving parenteral nutrition (PN) bore nasogastric tube. Which vitamin D for bone health.
through a central venous catheter assessment findings need a further o Cheese and eggs are good sources
(CVC) has an air embolus. What intervention? of protein.
action does the nurse need to take
A recently widowed 76-year-old B12
first?
woman recovering from a mild Vegan diets can lack which vitamin,
45-65% of cal stroke
due to not naturally occurring in
The acceptable macronutrient The home care nurse is seeing the plants?
distribution range for carbohydrates following patients. Which patient is at
Places the patient supine while
greatest risk for experiencing
Placing an order for x-ray film giving a bath.
inadequate nutrition?
examination to check position
The nurse sees the nursing assistive
C and B-complex
Which action is initially taken by the personnel (NAP) perform the
nurse to verify the correct position of a What are the water-soluble vitamins? following for a patient receiving
newly placed small-bore feeding tube? continuous enteral feedings. What
I'm going to an alternate formula intervention does the nurse need to
· Temporarily stop the infusion. with whole milk starting next address immediately with the NAP?
· Flush the line with saline or month. The NAP:
heparin.
· Attempt to aspirate a clot. Which statement made by a patient of Antioxidant, tissue building,
· Use a thrombolytic agent if a 2-month-old infant requires further absorption
ordered or per protocol. education?
What are the major actions of Vitamin
The catheter of the patient receiving D, E, K, A C?
parenteral nutrition (PN) becomes
What are the fat-soluble vitamins? TPN can cause hyperglycemia, and
occluded. Place the steps for caring for
it is important to keep your blood
the occluded catheter in the order in The nurse is checking the feeding glucose level in an acceptable range.
which the nurse would perform them. tube placement. Place the steps in
the proper sequence.

40
 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
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The patient receiving total parenteral Iodine will most likely receive a diet
nutrition (TPN) asks the nurse why his consisting of:
blood glucose is being checked since _____ is used for synthesis of
he does not have diabetes. What is the thyroxine, the thyroid hormone that Low fat, low sodium, and high
best response by the nurse? helps regulate metabolism. carbohydrates

Major sources of Vitamin A Major sources of Potassium Acceptable foods for the Full liquid
diet
orange/yellow fruits and vegetables, oranges, dried fruits, tomatoes,
fatty fish, dairy avocado, dried peas, meats, broccoli, liquids from clear liquid diet, all forms
bananas, dairy products, meats, whole of milk, soups, vegetable/fruit juices,
The nurse is performing blood grains eggnog, plain ice cream and sherbet,
glucose monitoring for a patient refined/strained cereal, puddings
receiving parenteral nutrition. Place The simplest form of a protein.
the steps of the procedure in the Indications for full liquid diet
Amino acid
correct sequence. Transition from liquid to soft diets,
Made up of three fatty acids Post-op, acute gastritis, febrile
attached to a glycerol. conditions, intolerance of solid foods
A. Assess the area of skin to be used Triglycerides
as a puncture site. Contraindications for full liquid diet
B. B. Identify patients using two What is the minimum daily amount lactose intolerance or
identifiers. of water intake needed? 1500 mL hypercholestrolemia
C. Check code on test strip vial.
D. Clean puncture site with an Under normal conditions, the AI for The slenderized liquid (pureed) diet
antiseptic solution. adult fluid intake is 7.5% consists of...
E. E. Gently squeeze fingertip until
Overweight is defined as a BMI of liquids and foods that are pureed to
the drop of blood appears.
____ to ____. 25 to 29.9 liquid form
F. Wick blood drop into the test
strip. Norovirus Indications of slenderized liquid
G. Read results and document in the
Patient symptoms are projectile (pureed) diet
medical records.
vomiting, fever, myalgia, watery chewing/swallowing difficulty,
Major sources of Vitamin D diarrhea, and headache. Consumed oral/facial surgery, wired jaws
contaminated fruits and vegetables,
sunlight, fish, fortified dairy products,
salads prepped by an infected person, Soft (bland, low-fiber) diet consists
egg yolk
oysters, and/or contaminated water. of...
Major sources of Vitamin E Foodborne illness is ____. The onset
of 24-48 hours. whole foods that are low in fiber,
Vegetable oils, grains, nuts, dark lightly seasoned, and easily digested
green vegetables Mrs. Nelson is talking with the
nurse about the dietary needs of her Indications of soft (bland, low-fiber)
Vitamin C & B complex. 23-month-old daughter, Laura. diet
Which of the following responses by Transitioning between full liquid and
Water-soluble vitamins the nurse would be appropriate? regular diets, acute infections,
Inorganic elements that act as "Laura needs fewer calories in relation chewing difficulties, GI disorders
catalysts in biochemical reactions. to her body weight now than she did The mechanical soft diet consists
Basal metabolic rate as an infant." of...
Major sources of Vitamin K All of the following patients are at Foods that require minimal chewing
risk for alteration in nutrition before swallowing (ground meats,
Green leafy vegetables, eggs except: canned fruits, softly cooked
The energy needed to maintain life- Patient L, whose weight is 10% above vegetables)
sustaining activities for a specific his ideal body weight. Indications of mechanical soft diet
period of time at rest.
A patient who has been hospitalized limited chewing ability, dysphagia,
Basal metabolic rate after experiencing a heart attack poorly fitting dentures, clients who are

41
 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
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edentulous (without teeth), surgery to Examples of "honey-like" liquid volumes and lower risk or
head, neck, or mouth; stricures of the consistencies: Honey, tomato sauce, aspiration and diarrhea.
intestinal tract yogurt
Continuous infusion method
What is the dysphagia diet used for? Examples of "spoon-thick" liquid
consistencies: pudding, custard, hot When using the continuous infusion
prescribed when swallowing is cereals method of enteral feeding, residual
impaired, such as following a stroke volumes should be measured every
Examples of "nectar-like" liquid _______ 4-6 hr
Signs of dysphagia consistencies : nectars, cream soups,
buttermilk, thin milkshakes In the continuous infusion method of
drooling, pocketing food, choking, enteral feeding, the feeding tubes
gagging This form of nutrition should be flushed with water every
What are the 3 levels of solid administration is used when a client ___ hr.4 hr
textures of food used in the cannot consume adequate nutrients
and calories orally, but maintains a For this method in enteral feeding,
dysphagia diet? Provide examples of formula is administered at a
each PARTIALLY functional GI system.
CONTINUOUS rate over an 8- to 12-
· Level 1: pureed- pureed fruits, Enteral Nutrition (EN) hr time period, often during
veg, meats, soups, scrambled SLEEPING hours. Cyclic feeding
2 reasons enteral nutrition might be
eggs, pudding, custard, administered This EN delivery method is often used
applesauce for NONcritical clients, home tube
· Level 2: mechanically altered- Medical condition (burns, trauma, feedings, and clients in rehab. It
ground meat with gravy, chicken radiation therapy, demo, liver/renal mostly resembles a NORMAL patter
or tuna salad, moistened pancakes dysfunction, infection, inflammatory of nutrient intake. Intermittent tube
and syrup, poached eggs, soft bowel disease) or when a client is feeding
canned or cooked fruit neuromuscular impaired and cannot
· Level 3: advanced- moist foods chew or swallow food This EN feeding method administers a
such as soups, rice, stuffing, LARGE volume of formula (700mL
tender meats or casseroles, breads What does enteral nutrition consist max, usual 250-500mL) over a
that are not crusty of? SHORT period of time, usually in 15-
Commercial formula administered by 30min, 4-6x daily Bolus feeding
What are the 4 levels or liquid
consistencies in the dysphagia diet? a tube into the stomach or small Contraindication for bolus feedings
Provide examples of each intestine in EN : tube placed into the jejunum
What is gavage feeding for an infant or duodenum.
i. Thin: clear juices, froyo, ice seam,
milk, soda, broth used for? What is the temperature of feeding
ii. Necar-like: thicker than water but AKA EN feeding- for and infant who solution when administering EN
can sip through a straw; consistency is too weak for sucking, unable to feedings? Room temp
of heavy syrup. ex) nectars, cream swallow, and lacks a gag reflex
soups, buttermilk and thin What are some gastrointestinal
milkshakes What are the two general enteral complications that can result from
iii. Honey-like: pourable and thickened, feeding routes? EN feedings?
can be eating with a spoon but not GI complications- constipation,
sipped through a straw. ex) honey, Nasoenteric tubes and Ostomies
diarrhea, cramping, pain, abdominal
tomato sauce, yogurt distention, dumping syndrome,
In this enteral feeding method, the
iv. Spoon-thick: maintain shape and nausea, vomiting
formula is administered at a
eaten with a spoon. ex) pudding,
CONTINUOUS rate over a 12- to
custard, hot cereals What are some mechanical
24-hr period.
complications that can result from
Indications for the Regular diet EN feedings?
Continuous infusion method
(normal or house diet)
This enteral feeding delivery Tube misplacement/dislodgment,
For clients who do not need dietary aspiration, irritation and leakage at the
method is recommended for
restriction insertion site, irritation of the
critically ill clients, because of its
association with smaller residual

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nose/esophagus/mucosa, clogging of ______, and ______. soybean oil, all that apply). "The preferences for
the feeding tube eggs, safflower oil salty taste eventually will decrease"
C. "Reducing sodium intake will
What are some metabolic PN IV lipids are contraindicated for lower my blood pressure"
complications that can result from clients who have these 2 diseases.
EN feedings? hyperlipidemia, severe hepatic A client with Diabetes Mellitus states,
disease "I cannot eat big meals; I prefer to
Dehydration, hyperglycemia, snack throughout the day." The nurse
electrolyte imbalances, fluid overload, PN protein solutions are available in should carefully explain that:
refeeding syndrome, rapid weight gain concentrations of _ to _%. 3.5% to Regulated food intake is basic to
15% controlling blood glucose levels.
To avoid food poisoning in EN,
replace the feeding bag, administration What two medications can be added to The healthcare provider is teaching a
tubing, and any equipment used to mix PN solution by pharmacy services? client diagnosed with Celiac disease
the formula ever ____ hr. 24 insulin and heparin about the disease process. Which of
To avoid food poisoning in EN, fill Why would insulin be added to a the following statements made by the
generic bags with only ____ hr worth patient's PN solution? To reduce the client would indicate a correct
of formula. 4 potential of hyperglycemia understanding of the teaching? "My
immune system reacts to gluten and
What does TPN stand for? Total Why would heparin be added to a damages my gut"
Parenteral Nutrition patient's PN solution? To prevent
fibrin buildup on the catheter tip
What does PPN stand for? Peripheral
Parenteral nutrition What are 3 desired therapeutic Which of the following are likely to
outcomes of PN? increase your chances of getting
What are 2 reasons parenteral chronic kidney disease? Access to
nutrition would be used?  improved nutritional status Healthcare
 weight maintenance/gain
1. clients GI tract is not functioning Which foods are included in a Lacto-
 positive nitrogen balance
2. client cannot Ovo vegetarian diet? Eggs, Milk,
physically/psychologically What is the expected reference range Honey, Plant food
consume sufficient nutrients of albumin levels? 3.5 to 5.0 g/dL
orally/enterally Which of the following are functions
What is the expected reference range of the kidneys? (Select all that apply)
A client's caloric needs are very high of pre albumin levels? 15 to 36 mg/dL
and anticipated duration of therapy is · Secretion of renin
greater than 7 days. Which PN would Change the PN tubing and bag every · Excretion of nitrogenous waste
be administered, TPN or PPN? TPN _____ hr or per facility protocol 24hr · Secretion of erythropoietin

TPN can only be administered in a To avoid hypoglycemia, an IV of Which of the following is an

________ central vein dextrose ___ to ___% in water is appropriate lunch for a patient on a
administered if the PN solution is level 1 dysphagia diet? Pureed
TPN is used when the solution to be unavailable. 10% to 20% meatloaf, pureed broccoli, and
administered is _____, meaning it is chocolate pudding The correct
composed of >10% dextrose. A nurse is developing a teaching plan answer is A. A level 1 dysphagia diet
hypertonic for a client taking insulin? Which of requires all of the food to be pureed.
the following foods should the client
Peripheral PN is administered into a carry with him as a minor snack to A nurse is conducting teaching with a
______, resulting in a limited help treat hypoglycemia? Life saver client regarding nutrition therapy for
nutritional value. Peripheral vein gastroparesis. Does the nurse know
A nurse is educating a prediabetic the teaching is successful when the
A client requires short-term nutritional client about the Mediterranean diet. client states that the following are
support with fewer calories per day. Which of the following statements ways to increase nutrition? (Select 3
What PN should be administered, indicates that the teaching was that apply.)
TPN or PPN? PPN successful? "This diet will likely
minimize my waistline" · b. Chew foods thoroughly
PN IV lipids are contraindicated for · d. Consume fats in liquids if fat
clients who are allergic to _____, A client expresses an understanding of in solids is not tolerated
seasoning food when he states (Select

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· e. Consume smaller, more does not want to give up his eating CARE FOR MOTHER CHILD
frequent meals and drinking habits. He asks the nurse AND ADOLESCENTS
why it is so important for him to lose
When recommending a healthy after weight. The best response is: TRUE or FALSE: The umbilical cord
school snack, the nurse should suggest is made up of two umbilical veins and
which of the following? Select all that d) Losing weight will help promote one artery. TRUE
apply. your overall health and decrease the
risk for future health problems Which of the following best describes
· Low-fat yogurt topped with effacement? Cervix becomes thinner
fresh fruit 7) A woman in her mid-40's decides to
· Apple slices with cottage cheese lose weight to improve blood pressure. TRUE or FALSE: No skull molding
· Air-popped popcorn she starts following a diet reducing occurs when a fetus is breech. TRUE
sodium, incorporating fruits and After the nurse teaches a couple about
The nurse knows that children who are vegetables, and eliminating all meat.
overweight or obese are at risk for contraceptive methods, the couple is
she lost 30 lbs. last month and feels asked to identify fertility awareness
developing what comorbidities? Select "more motivated than ever." She
all that apply. [Link] of the following
presents to the clinic for a wellness identified by the couple would
· Coronary artery disease checkup and is found to be anemic. indicate the need for additional
· Hypertension What is the best priority nursing instruction? Female condom method
· Gastroesophageal reflux disease intervention? ask the women what
(GERD) she is eating at home and assess diet During which of the following stages
of labor would the nurse assess "
crowning"? Second stage
1) Darius has a son who is 30 and is
curious if type 2 diabetes can affect 8) An 18-year-old male presents to the
him. What would be the most Fill in the blanks: The pressure in the
hospital with severe pain later fetal lungs before birth is _____,which
appropriate response? "diabetes runs attributed to multiple large kidney
in the family, but is a preventable allows blood from the _____ to shunt
stones. He is treated with surgery but into the ______ via the ______. high,
disease with proper nutrition and needs to stay in a post-op recovery
exercise" pulmonary artery, aorta, ductus
unit, and while he is there, he arteriosus
2) Darius just came out of the nutrition continues to request milk with every
class. which would show that he meal and every snack. The nurse Which of the following should the
understood the nutrition class? Select should first: advise him to drink less nurse do FIRST when dealing with a
all that apply (select 2) milk to improve his recovery couple having sexual problems after
20 years of marriage? Allow the
· I must limit sodium to 2300 per An 80-year-old male is admitted to the couple to talk about their sexual
day ER after an episode of hyperglycemia. problems
· I do not have to watch my He has been stabilized. His daughter
carbohydrates because I am comes to visit him and scolds him for Passive antibody transfer from the
taking insulin not taking his insulin. What is the mother to fetus begins at which
priority intervention for the nurse? gestational age? Second stage
3)The nurse is educating a client with Ask him why he did not take his
hypertension who is obese and insulin. In a labor room,the nurse is timing the
prediabetic about foods with contractions in a patient who is 7cm
cardiometabolic benefits. The client A local nursing home receives a new dilated. Frequency of contraction is
lives alone and is not used to cooking. admission this morning. She has been measured from the; Beginning of
the nurse knows the client understands diagnosed with gastroparesis. The contraction to the beginning of the
the teaching when he states which of dietitian is unavailable this morning next
the following: and you, an experienced RN, are
instructed to plan meals for her. An expectant mother asks the nurse in
c) eating fruits and vegetables will Which of the following eating patterns the prenatal clinic,"When can I expect
help improve my blood pressure is most appropriate? Multiple small to feel my baby move?"Which of the
meals per day. following would be the best response?
4) The physician has advised a client At about 4 months
to lose 50lbs due to the risk factors
associated with his weight. The client

44
 EMILIO AGUINALDO COLLEGE
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Which of the following terms is Carbon dioxide and other wastes are Cervical softening and uterine souffle
regarded as an indicator of a country's passed from the fetus to the mother are classified as which of the
general health? Infant Mortality through: Umbilical artery following? Probable signs
Rate
During stage 3 of labor,you noted a The diameter,measuring 10cm or more
A nurse was asked;"What is a gush of blood and that the uterus at the midpelvis is usually the smallest
zygote?".Her answer will likely be: changes shape from an oval shape to diameter of the pelvis: Obstetrical
Cells that result from the globular [Link] indicates? Signs conjugate
fertilization of ovum by a of placental separation
spermatozoa During a pelvic exam,the nurse notes a
Which of the following terms refers to purple-blue tinge of the [Link]
Which of the following factors the thickened endometrium in which nurse documents this as which of the
affecting labor is associated with the the fertilized embryo implants? following? Chadwick's sign
passageway? The presentation of the Decidua
fetus in relation to the maternal The zygote enters the uterus how
pelvis The second stage of labor is the stage many hours after fertilization? 72
when the: Baby is delivered hours
The zygote is normally implanted in
what part of the uterus? Corpus Which of the following would the A fetal heart rate of more than 160
nurse identify as a presumptive sign of beats/min or less than 110 beats/min is
The fetal nervous system is formed by pregnancy? Nausea and vomiting a normal occurrence in the baby.
the germ layer known as which of the FALSE
following? Mesoderm Which of the following methods
would be avoided for a woman who is When describing fetal position,the
38 years old,has three children and first letter in the series denotes which
smokes one pack cigarettes per day? of the following? Side of the
Oral contraceptive maternal pelvis
Which of the following best defines
the intrapartum period? Period from
the onset of contractions to the first The corpus luteum acts as the placenta A client's last menstrual period began
1 to 4 hours of delivery for the implanted ovum until the end July 5. Her estimated date of delivery
of which of the following gestational should be which of the following?
Blood vessels of the retina are formed months? Second April 12
and are extremely susceptible to
damage from high oxygen Fetal heart rate can be auscultated When reviewing contraceptive
concentration at which gestational with a fetoscope as early as which of methods before teaching a class, the
week? End of 28th week the following? 20 weeks gestation nurse would keep in mind which of
the following methods MOST likely to
When taking a sexual history, which Station "0" means that the presenting be the LEAST effective for most
of the following denotes the correct part of the fetus is: At the level of couples? Coitus interruptus
manner from which the nurse would ischial spine
proceed? Simple to complex Which category of pregnancy signs
problems Which of the following fetal heartbeat are subjective and can only be
per minute is indicative of fetal reported by the patient? Presumptive
The nurse documents positive distress? 165 signs
ballottement in the client's prenatal
[Link] nurse understands that this When assessing for signs that a Which is the correct order? zygote,
indicates which of the following? pregnant mother is entering the embryo, fetus
Passive movement of an unengaged transitional phase of labor,the nurse
fetus would anticipate her to have: Which of the following reproductive
Crowning of fetal head organs contains the perimetrium,
Fill in the blanks: In fetal myomertrium and endometrium?
circulation,the umbilical artery With the fetus in the left-anterior Uterus
carries__,while the umbilical vein breech presentation,the nurse would
carries_. deoxygenated blood, expect the fetal heart rate would be Leopold's Maneuver involves
oxygenated blood. most audible in which of the following abdominal palpation. All of the
areas? Above the maternal following may be assessed in the third
umbilicus and to the left of midline maneuver,EXCEPT: Variety

45
 EMILIO AGUINALDO COLLEGE
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During the menstrual cycle, ovulation Which of the following is an essential Family- centered nursing care for
generally occurs at which of the intrapartum fetal assessment? women and newborns focuses on
following times? 14 days before the Determination of the duration, which of the following? Assisting
end of menstrual cycle frequency and intensity of the individuals and families to achieve
contractions optimal health
By which of the following does the
placenta transport nutrients and Susan's last LMP started on October Which of the following terms refer to
oxygen to the fetus? Diffusion [Link] her first prenatal check -up,the the tissue lying between the vagina
nurse infroms her that her EDC will be orifice and the anus? Perineum
This is an opening in the fetal heart on: July 19
that allows blood to move directly The nurse is palpating the uterus of a
from the right to the left atrium. A client's last menstrual period began client who is 20 weeks pregnant to
Foramen ovale Feb 5, [Link] estimated date of measure fundal [Link] the
delivery should be? November 11, area on the abdomen where the nurse
Lanugo is well-formed at which 2020 should expect to feel the uterine
gestational age? End of 16th week fundus. At the level of umbilicus
The nurse is reviewing the record of a
A client asks, ''How much blood do I client in the labor room and note that The nurse understands that the fetal
lose during menstruation?.Which of the health care provider had head is in which of the following
the following would be the nurse's documented the fetal presenting part is positions with a face presentation?
BEST response? Normal blood loss is at -1 [Link] indicates that the Completely extended
about 1/4 cup fetal presenting part is located at
which area? 1 inch above the ischial The nurse can recognize the end of
A maternal pulse rate greater than 100 first stage of labor if contractions:
beats/min during labor is unusual and sign
Occur a regular intervals of 5-10
should be reported because it may be Increasing apprehension in a laboring minutes lasting from 40-60 second
another indication of hemorrhage. woman can be a sign of oxygen
TRUE deprivation or internal hemorrhage. Immediately before expulsion, which
True of the following cardinal movements
occur? External rotation
An expectant mother in the prenatal Passive antibody transfer from the
mother to fetus begins at which It is safe to note the third stage of
clinic informs the nurse that she labor has been accomplished with the
smokes and asks if she could continue gestational age? Second stage
delivery of: Placenta
to do [Link] of the following Which of the following would the
responses best demonstrates the nurse estimate as the approximate Dilatation refers to the enlargement or
nurse's understanding of smoking's gestational age for 19-centimeter fetus widening of the cervical canal from an
effect on a pregnancy? Smoking may expelled by a client? 5 months opening a few millimeters wide to one
adversely affect your baby's large enough to permit passage of a
development Quickening in primigravidas usually fetus. TRUE
can be detected during which of the
After tubal ligation,which of the following? 18-20 weeks An expectant mother in the prenatal
following choices should be avoided? clinic states,"I'm sure I'm going to
Lifting a child In the pelvic inlet,the shortest have a boy because my husband says
anteroposterior diameter through he knows it's a boy." Which of the
TRUE or FALSE: Stage 2 of labor which the fetal head passes in following would be the nurse's best
begins with the delivery of the baby descending the pelvis is the: response? The man determines the
and ends with the delivery of the Conjugate vera sex of the newborn
placenta. FALSE
In counseling a married couple about [Link] is in the beginning of the
Which of the following is NOT a sign Bilateral Tubal Ligation,which of the first stage of [Link] symptoms that
of true labor? Uterine contraction following should be the main focus of would described her labor contractions
are more frequent and pf shorter the nurse? assist the couple to make are all of these,EXCEPT:
duration a sound, well informed decision to Contractions at irregular intervals
A woman using a diaphragm for undergo the procedure
The characteristics posture of the fetus
contraception should be instructed to The first stage of labor is terminated or the relationship of the fetal
leave it in place for at least how long when Cervix is completely dilated structures to one another determines
after intercourse? 6 hours the: Attitude

46
 EMILIO AGUINALDO COLLEGE
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The mother has delivered the urinary [Link] of the Alteration in the tubal transport of
[Link] noted that the shiny following is the best response of the sperm
surface of the placenta was delivered nurse? This is expected because of
[Link] delivery mechanism is this the compression of your ascending The nurse determines the usually
known as and is this the maternal or uterus constant duration of menstrual flow
baby's surface of the placenta? when it ranges: 4-6 days
Schultze mechanism, baby Which of the following hormones
causes the Spinnbarkeit phenomenon A client's last menstrual period began
Which finding indicates that the and fern-like pattern to occur: September 6, [Link] estimated date
pregnant woman has achieved the first Estrogen of delivery should be? June 13, 2021
stage of labor? Cervical dilatation of Which of the following fundal heights
10 cm Which of the following is a probable
sign? Softening of cervix indicates less than 12 weeks gestation
TRUE or FALSE: A healthy fetus when the date of the last menstrual
moves with a degree of consistency at Fetal hyperactivity is a subtle sign that period is unknown? Uterus in the
about 8 times per hour. FALSE hypoxia is occurring. TRUE pelvis

Which of the following hormones Which of the following characteristics CARE OF MOTHER & CHILD
stimulates the ovary to produce of contractions of would the nurse AT-RISK OR W/ PROBLEMS
estrogen during the menstrual cycle? expect to find in a client experiencing ACUTE & CHRONIC
Luteinizing hormone true labor? Increasing intensity with
walking What abnormal placental implantation
Fill in the blanks: The_ carries is described as, "chorionic villi that
oxygenated blood from the placenta to Which of the following indicates penetrates beyond the myometrium
the [Link] of the blood flow from placental separation after delivery of into the entire uterine wall and
this structure is shunted from the _ to the baby? Protrusion of umbilical possibly to other adjacent organs such
the__ via the __. umbilical vein, cord uterus becomes form and as the bladder"? Placenta Percreta
liver, inferior vena cava, ductus rounded
This condition is commonly
venosus sudden gush of blood from the experienced as one-sided, lower
What structures in fetal circulation vagina abdominal pain associated with
play a role in shunting blood away ovulation, depending on which side
When providing sexual care to release of the egg occurs, sometimes
from the lungs? Ductus arteriosus clients,the nurse knows that the most
and Foramen ovale accompanied by slight vaginal
common nursing diagnosis is which of bleeding or discharge. Mittelschmerz
Select the structures in fetal the following? Knowledge deficit
circulation that play a role with related to altered sexual function Among the abnormal placenta, what is
shunting blood away from the lungs described as the "placenta that has one
When using the basal body or more accessory lobes connected to
and liver. Ductus venosus, foramen temperature for contraception, the
ovale, ductus arteriosus the main placenta by blood vessels"?
nurse would instruct the couple to Placenta succenturiate
Which of the following would the abstain from intercourse during which
nurse identify as an advantage to using of the following times? From the first A mother brought her 4 years old son
a cervical cap for contraception? day of menses until the woman in the health center. Upon assessment
Provides continuous protection for experiences mittelschmerz the nurse observed that the child has
48 hours pus draining from his eye and has
TRUE or FALSE: The transition mouth ulcers. The following are the
TRUE or FALSE: If a mother forget phase of stage 1 is the longest phase of management for this child
to take her contraceptive pill for one stage 1 and contractions are very
day,she must take two pills at the intense and long in duration. FALSE · Treat mouth ulcers with gentian
same time the following day. FALSE violet
TRUE or FALSE: In a pregnancy of · Treat eye infection with
At the beginning of menstruation, the 24 weeks,the fundal height should be tetracycline eye ointment
following physiologic changes occur, 24 [Link] · Give Vitamin A treatment
except; Luteinizing hormone at its Which of the following would the
peak The World Health Organization
nurse use as the basis for explaining (WHO) recommend the use of this
[Link] claims to be amenorrheic how an IUD prevents conception? tool to monitor the progress of labor,
for one [Link] complains of identify and intervene in cases of

47
 EMILIO AGUINALDO COLLEGE
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abnormal labor. Which of the Which of the following is the third · Mc Robert's maneuver
following has been established stage of Human Immunodeficiency · Wood's screw maneuver
universally as the "gold standard" virus (HIV)? Asymptomatic period · Supra pubic maneuver
labor monitoring tool for maternal and
fetal well-being? Partograph Which of the following is the priority Carla Hernandez came in for
nursing intervention of a child victim consultation, upon assessment, you
A nurse complete a health history of a of abuse? Implement measures to found out that she is having premature
client from a couple with history of ensure the victims safety labor contractions. The obstetrician
infertility. What are the two ordered to give her Terbutaline sulfate
assessment possibilities? Semen Which of the following is NOT true 25 mg SC to relax her uterus. Which
analysis and cervical mucus about asymptomatic Urinary tract of the following would you consider
observation Infection (UTI)? It's signs and to refer as a side effect of that
symptoms are obvious and can be medicine? Refer for maternal heart
You are in charge of a client who is dangerous to both mother and baby rate over 110 BPM
just diagnosed of pre-eclampsia. The
attending physician ordered: An infant was seen in the clinic for a In uterine atony, which of the
Hydralizine (Apresoline) 5 mg IV follow-up visit and was found to have following independent nursing actions
now. Which of the following is a yellow fluids in scrotum that is visible should be done immediately to help
priority nursing action before on illumination, this disorder is called: contract the uterus, thus, preventing
medication. Check blood pressure Hydrocele hemorrhage? Massage the fundus to
Which of the following positions is stimulate uterine contractions
Which of the following is the BEST
intervention for a client experiencing recommended for placing an infant to Marinara admits that she is using
premature cervical dilatation? sleep? Supine position cocaine almost daily. She asked the
Complete bed rest Which of the following type of anemia nurse, what will be the effect of
has enlarged, yet immature red blood cocaine to her pregnancy? What will
As the student nurse you learned that be the best response of the nurse to
sexual dysfunction in man and woman cell? Folic-Acid deficiency anemia
explain the harmful effects of cocaine
can be prevented through the to fetal growth? Cocaine use can
following management: [Link] cause extreme vasoconstriction to
health conditions 2. Talk to a the mother
counselor or mental health
professionals 3. Practice healthy life A client was admitted due to A woman comes to the clinic for
style 4. Do not use recreational drugs premature rupture of the membrane. prenatal check-up. Which of the
such as opioids (1, 2, 3 and 4) Which of the following is a possible following assessment is an indicative
complication of PROM? Umbilical of Hydatidiform Mole? Complaints
For a female client with anorexia cord prolapse of nausea and vomiting
nervosa, Nurse Lei aware that which
goal takes the highest priority? The Retained placental fragments have The following are conditions that
client will: Establish adequate daily been associated with pregnancy leave the uterus unable to contract
nutritional intake complications, this is the most readily posing at risk for postpartal
common cause of bleeding in which of hemorrhage
The following are the causes of the following types of postpartum
inversion of the uterus, hemorrhage? Late postpartum · Multiparity
hemorrhage · Deep anesthesia or analgesia
· Straining or coughing while the · Prolonged use of tocolytic drugs
uterus is relaxed Sandra is a 14-year-old girl who wears
· Forceful pulling of the umbilical brace for structural scoliosis; which of Short umbilical cord can cause which
cord to hasten delivery the following statements indicate of the following? Umbilical cord
· Fundal pressure on uncontracted effective use of brace? "I'll look prolapse
uterus forward to taking thing off to take
my bath everyday" Which of the following techniques
12. The doctor ordered infrared, how during labor and delivery can lead to
many minutes should the infrared be You are assisting a mother who uterine inversion? Tugging strongly
administered if plugged to 220 volts? happened to have shoulder dystocia. on the umbilical cord to deliver the
15 minutes The following are the maneuvers you placenta and hastening placental
would expect separation.

48
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Which of the following client/s are at weeks of gestation that may result would: Provide eye and genital
risk for developing placenta previa? in cervical changes." shields
· A 37-year-old woman who is A 35-year-old client is diagnosed of While walking around Puting Kahoy a
pregnant with her 7th child. Gestational Trophoblastic Disease man approach Bea and suddenly
· A 20-year-old pregnant female (Hydatidiform Mole). Which of the exposed his genitals, what type of
who is a cocaine user. following procedure is likely to be sexual alteration is this? Exhibitionist
done for the client that would remove
You also assessed another parturient the products of conception? Dilation May, 4 years old, was brought to the
who is 35 weeks AOG. During and Curettage health center because of ear pain.
Leopold's maneuver, you palpated the When the community nurse further
head of the fetus on the right side of The nurse is assigned to care for a assessed the patient, he observed that
the abdomen. You would expect that newly delivered primiparous client pus is draining from the ear. The
the fetal presentation is which of the and her term neonate 1 hour after a mother verbalized that she noticed the
following? Transverse Presentation vaginal delivery. The nurse observes discharge for 3 weeks already. How
that the neonate's APGAR score at 5 will the nurse classify her condition?
The client is a 36 year old woman, minutes was 9. The nurse interprets Chronic ear infection
gravida 6, and para 6 who delivers a this as which of the following about
baby girl at 38 weeks AOG after 8 the neonate? The neonate is in stable Which of the following is NOT a
hours of labor. The baby weighed 7 condition. general danger sign? Difficulty of
lbs and 14 ounces. The clients VS are breathing
stable and her lochia is heavy and The nurse conducts a physical
contains various clots. The nurse assessment of the neonate as the initial Which of the following is an
would consider the client to be at risk bath is given several hours after birth. inflammation of the male reproductive
for uterine atony because of which of In assessing the baby's skin, which of system where there is inguinal and
the following? Grandmultiparity the following observations most likely scrotal pain, fever, and tenderness of
require special attention? Jaundice the affected part? Urinalysis result of
At 2AM you have monitored a G5P4 patient with this condition shows
parturient, 4AM she delivered to a live Which of the following characteristics bacteria and WBCs. Treatments for
term baby girl. You would consider is most commonly associated with a this includes antibiotics and
this as precipitate labor which is large for gestational age newborn? symptomatic relief. Epididymitis
describe as labor process that last less Risk for birth injury
than: 3 hours of labor
A nurse is performing an assessment
Maria is a chemist and was exposed to on a postmature neonate. Which What disorder is caused by forceful
poisonous substances. Her situation physical characteristic would the nurse bending of the penis during vaginal
falls under what factor that categorizes expect to observe? Desquamation intercourse or by a sharp blow to the
pregnancy as high risk? Social factors over the body erect penis during a fall, car accident,
or other mishap and may also be
You admitted a primigravid patient When a neonate is delivered with caused by a traumatic masturbation?
who is 28 weeks AOG and is meconium staining in the amniotic Penile fracture
complaining of mild to moderate fluid, which sequence of events will
uterine contractions. Upon assessment, most effectively decrease the risk of If pneumonia is present with major
you observed that she is having meconium aspiration? Deliver the signs and symptoms, which of the
premature labor contractions. Your head and then suction the mouth following treatment is needed?
client asked you what is Preterm and then the nose Amoxicyllin P.O. BID
labor? Your best response is which of What type of infertility is described as
the following? ALL What is the chronic irreversible
complication of hyperbilirubinemia? inability to conceive despite
· All choices are correct Kernicterus management done? Sterility
· "Uterine contractions that may CARE OF CLIENTS WITH
precede to premature delivery of Ms. S delivers a 6 lb 5 oz (2863 g)
boy. Because his serum bilirubin level PROBLEMS IN OXYGENATION,
an infant if uncontrolled." FLUIDS & ELECTROLYTES,
· "Uterine contractions that occur is elevated, the baby is receiving
phototherapy. To meet the safety INFECTIOUS, INFLAMMATORY
as a result of infections before 37 AND IMMUNOLOGIC
weeks of AOG." needs of the baby while he is
undergoing phototherapy, the nurse RESPONSE, CELLULAR
· "Uterine contractions that occur ABERRATIONS
after 20th week and before 37

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 EMILIO AGUINALDO COLLEGE
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The patient X is diagnosed with A 22 year old lay is displaying facial Nurse Martha is teaching her students
constipation. As a knowledgeable grimaces during her treatment in the about bacterial control. Which
nurse which nursing intervention is hospital due to burn trauma. Which intervention is the most important
appropriate for maintaining normal nursing intervention should included factor in preventing the spread of
bowel movement? Assessing dietary for reducing pain due to cellular microorganism? Correct hand-
intake injury? Administering anti- washing technique
inflammatory agents as prescribed
A 12 year old boy was admitted in the A patient with tented skin integrity,
hospital two days ago due to Lisa, a client with altered urinary dry mucous membranes, & decreased
hyperthermia. His attending nurse, function, is under the care of nurse urinary output is under nurse Mark's
Dennis, is quite unsure about his plan Tine. Which intervention is care. Which nursing intervention
of care. Which of the following appropriate to include when should be included the care of plan of
nursing interventions should be developing a plan for care for Lisa, Mark for his patient? Administering
included in the car of plan for the who is experiencing urinary dribbling? IV & oral fluids
client? Room temperature Having the client perform kegal
exercises Khaleesi is admitted in the hospital
Tom is ready to be discharged from due to having lower than normal
the med-surg unit after 5 days of Jeron is admitted in the hospital due to potassium levels in her bloodstream.
hospitalization. Which client bacterial pneumonia. He is febrile, Her medical history reveals vomiting
statement indicates to the nurse that diaphoretic, & has shortness of breath & diarrhea prior to hospitalization.
Tom understands the discharge & asthma. Which goal is the most Which foods should the nurse instruct
teaching about cellular injury? "If I important for this client? the client to increase? Orange juice &
have redness, drainage, or fever, I Maintenance of adequate oxygen. bananas
should call my healthcare provider"
Mang Rogelio, a 32 year old patient is Mary Jean, a first year nursing
Nurse Katee is caring for Adam, a 22 about to be discharged from the acute student, was rushed to the clinic
year old client in a long term facility. care setting. Which nursing department due to hyperventilation.
Which nursing intervention would be intervention is the most important to Which nursing intervention is the most
appropriate when identifying nursing include in the plan of care? Home appropriate for the client who is
interventions aimed at promoting & environment evaulation subsequently developing respiratory
preventing contractures? alkalosis? Encouraging slow, deep
Mrs. Dela Riva is in her first trimester breaths
- Maintaining correct body of pregnancy. She has been lying all
alignment at all times. day because her OBGYN requested Nurse John Joseph is totaling the
- Using a footboard or pillows to her to have complete bed rest. Which intake & output for Elena Reyes, a
keep feet in correct position. nursing intervention is appropriate client diagnosed with septicemia who
- Performing active & passive when addressing the client's need to is on a clear liquid diet. The client
range of motion exercises maintain skin integrity? Keeping intakes 8 oz of apple juice, 850 ml of
linens dry & wrinkle free water, 2 cups of beef broth, & 900 ml
A 36 year old male client is about to of half-normal saline solution &
be discharged from the hospital after 5 Maya who is admitted in a hospital, is outputs 1,500 ml of urine during the
days due to surgery. Which scheduled to have her general checkup shift. How many ml should the nurse
intervention should be included in the & physical assessment. Nurse Tim document as the client's intake? 2,470
home health care nurse's instructions observed a reddened area over her left
about measures to prevent hip. Which should the nurse do first? Marie Joy's lab test revealed that her
constipation? Instructing the client Turn the client to the right for 2 serum calcium is 2.5 mEq/L. Which
to fill a 2-L bottle with water every hours. assessment data does the nurse
night & drink it the next day. document when a client diagnosed
Pierro was noted to be displaying with hypocalcemia develops a
Mr. McPartlin suffered abrasions & facial grimaces after nurse Kara carpopedal spasm after the blood-
lacerations after a car accident. He assessed his complaints of pain rated pressure cuff is inflated? Positive
was hospitalized & was treated for a as an 8 on a scale of 1 (no pain) to 10 Trousseau's sign
couple of weeks. When planning care (worst pain). Which intervention
for a client with cellular injury, the should the nurse do? Attempting to Lab tests revealed that patient Z's
nurse should consider which scientific rule out complications before (Na+) is 170 mEq/L. Which clinical
rationale? The presence of infection administering pain medication manifestation would nurse Natty
may slow down the healing process.. expect to assess? Tented skin turgor
& thirst an example of hypernatremia

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 EMILIO AGUINALDO COLLEGE
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Mang Teban has a history of COPD & may deplete serum potassium, leading Antagonize the cardiac effects of
has the following ABG results: partial to hypokalemia. magnesium
pressure of oxygen (PO2), 55 mm Hg,
& partial pressure of carbon dioxide Ms. Salcedo has the following ABG For a patient with hypomagnesemia,
(PCO2), 60 mm Hg. When attempting values: pH of 7.34, partial pressure of which of the following medications
to improve the client's blood gas arterial oxygen of 80 mm Hg, partial may become toxic? Digoxin
values through improved ventilation & pressure of arterial carbon dioxide of
49 mm Hg, & a bicarbonate level of Which of the following is the most
oxygen therapy, which is the clients important physical assessment
primary stimulus for breathing? Low 24 mEq/L. Based on these results,
which intervention should the nurse parameter the nurse would consider
PO2 when assessing fluid & electrolyte
implement? Encouraging the client
A client with very dry mouth, skin, & to cough & deep breathe The ABG imbalance? Cardiac rate & rhythm
mucous membranes is diagnosed of results indicate respiratory acidosis Insensible fluid losses include:
having dehydration. Which requiring improved ventilation & Perspiration
intervention should the nurse perform increased oxygen to the lungs.
when caring for a client diagnosed Which of the following intravenous
with fluid volume deficit? Assessing A client is diagnosed with metabolic solutions would be appropriate for a
urinary intake & output acidosis, which would the nurse patient with severe hyponatremia
expect the health care provider to secondary to syndrome of
Which client situation requires the order? Sodium bicarbonate inappropriate antidiuretic hormone
nurse to discuss the importance of (SIADH)? Hypertonic solution
avoiding foods high in potassium? 18 Lee Angela's lab test just revealed that
year old Albert who has renal her chloride level is 96 mEq/L. As a Aldosterone secretion in response to
disease Clients with renal disease are nurse, you would interpret this serum fluid loss will result in which one of
predisposed to hyperkalemia & should chloride level as: Within normal the following electrolyte imbalances?
avoid foods high in potassium. range Hypokalemia
Geneivieve is diagnosed with Which of the following conditions is When assessing a patient for signs of
hypomagnesemia, which nursing associated with elevated serum fluid overload, the nurse would expect
intervention would be appropriate? chloride levels? Eclampsia to observe: Bounding pulse
Instituting seizure precaution to In the extracellular fluid, chloride is a
prevent injury A bounding pulse is a sign of fluid
major: Anion overload as more volume in the
Which electrolyte would the nurse Nursing intervention for the patient vessels causes a stronger sensation
identify as the major electrolyte with hyperphonsphatemia include against the vessels walls.
responsible for determining the encouraging intake of: Amphogel
concentration of extracellular fluid?
Sodium Etiologies associated with The physician has ordered IV
hypocalcemia may include all of the replacement of potassium for a patient
Jon has a potassium level of 6.5 following except: Metastatic bone
mEq/L, which medication would nurse with severe hypokalemia. The nurse
lesions would administer this: Diluted in 100
Wilma anticipate? Kayexalate The
client's potassium level is elevated, Which of the following findings cc over 1 hour
therefore Kayexalate would be would the nurse expect to assess in Which of the following findings
ordered to help reduce the potassium hypercalcemia? Urinary calculi would the nurse expect to assess in a
level
Which of the following is not an patient with hypokalemia?
Which clinical manifestation would appropriate nursing intervention for a Hyporeflexia
lead the nurse to suspect that a client patient with hypercalcemia? Vick is receiving oral potassium
is experiencing hypermagnesemia? Administering calcium glucontate supplements for his condition. How
Hot, flushed skin & diaphoresis
A patient in which of the following should the supplements be
Josh is receiving furosemide & disorders is at high risk to develop administered? Diluted Oral potassium
digoxin, which lab data would be the hypermagnesemia? Renal failure supplements are known to irritate GI
most important to assess in planning mucosa & should be diluted.
the care for the client? Potassium Nursing interventions for a patient
with hypermangesemia include Normal venous blood pH ranges from:
level Diuretics such as furosemide
administering calcium gluconate to: 7.31 to 7.41

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 EMILIO AGUINALDO COLLEGE
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Respiratory regulation of acids & diphenhydramine (Benadryl) and

bases involves Carbon dioxide hydroxyzine (Atarax) include:
1. Walter, teenage patient is admitted
To determine if a patient's respiratory to the hospital because of a. Reye's syndrome.
system is functioning, the nurse would acetaminophen (Tylenol) overdose. b. Cholinergic effects.
assess which of the following Overdoses of acetaminophen can c. Paradoxical CNS stimulation.
parameters: Arterial blood gas An precipitate life-threatening d. Nausea and diarrhea.
ABG will indicate CO2 & O2 levels abnormalities in which of the
following organs? 3. Answer C. Typically, first
Which of the following conditions is generation OTC antihistamines have a
an equal decrease of extracellular fluid a. Lungs sedating effect because of passage into
(ECF) solute & water volume? b. Liver the CNS. However, in some
Isotonic FVD c. Kidney individuals, especially infants and
d. Adrenal Glands children, paradoxical CNS stimulation
When monitoring the daily weight of a occurs and is manifested by
patient with fluid volume deficit 1. Answer B. Acetaminophen is excitement, euphoria, restlessness, and
(FVD), the nurse is aware that fluid extensively metabolized by pathways confusion. For this reason, use of first
loss may be considered when weight in the liver. Toxic doses of generation OTC antihistamines has
loss begins to exceed: 0.5 lb acetaminophen deplete hepatic declined, and second generation
glutathione, resulting in accumulation product usage has increased. Reye's
Dietary recommendations for a patient of the intermediate agent, quinine,
with a hypotonic fluid excess should syndrome is a systemic response to a
which leads to hepatic necrosis. virus. First generation OTC
include Increased sodium intake Prolonged use of acetaminophen may
Hypotonic fluid volume excess (FVE) antihistamines do not exhibit a
result in an increased risk of renal cholinergic effect. Nausea and
involves an increase in water volume dysfunction, but a single overdose
without an increase in sodium diarrhea are uncommon when first
does not precipitate life-threatening generation OTC antihistamines are
concentration problems in the respiratory system, taken.
Osmotic pressure is created through renal system, or adrenal glands.
the process of Diffusion 4. Reye's syndrome, a potentially fatal
2. A contraindication for topical illness associated with liver failure and
A rise in arterial pressure causes the corticosteroid usage in a male patient encephalopathy is associated with the
baroreceptors & stretch receptors to with atopic dermatitis (eczema) is: administration of which over-the-
signal an inhibition of the sympathetic a. Parasite infection. counter (OTC) medication?
nervous system, resulting in b. Viral infection.
Increased urine output a. acetaminophen (Tylenol)
c. Bacterial infection. b. ibuprofen (Motrin)
Normal serum sodium concentration d. Spirochete infection. c. aspirin
ranges from 136-145 mEq/L [Link] B. Topical agents produce a d. brompheniramine/
localized, rather than systemic effect. psudoephedrine (Dimetapp)
When assessing a patient for
electrolyte balance, the nurse is aware When treating atopic dermatitis with a 4. Answer C. Virus-infected children
that etiologies for hyponatremia steroidal preparation, the site is who are given aspirin to manage pain,
include vulnerable to invasion by organisms. fever, and inflammation are at an
Viruses, such as herpes simplex or increased risk of developing Reye's
- Weight gain varicella-zoster, present a risk of syndrome. Use of acetaminophen has
- Diuretic therapy disseminated infection. Educate the not been associated with Reye's
- Diaphoresis patient using topical corticosteroids to syndrome and can be safely given to
avoid crowds or people known to have patients with fever due to viral
Nursing interventions for a patient infections and to report even minor illnesses. Ibuprofen adverse effects
with hyponatremia include signs of an infection. Topical include GI irritation and bleeding, and
Restricting fluid intake corticosteroid usage results in little in toxic doses, both renal and hepatic
danger of concurrent infection with failure are reported. However,
The nurse would analyze an arterial
these agents. ibuprofen has not been associated with
pH of 7.46 as indicating Alkalosis
3. In infants and children, the side the onset of Reye's disease.
effects of first generation over-the- Brompheniramine/psudoephedrine
counter (OTC) antihistamines, such as contains a first generation OTC
PHARMACOLOGY
antihistamine and a decongestant.

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 EMILIO AGUINALDO COLLEGE
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Neither agent has been associated with and is useful in describing and blood cells make the patient
the development of Reye's syndrome. classifying patient reactions to drugs. susceptible to infection. And, a
Type I reactions are immediate reduced number of platelets cause the
5. The nurse is aware that the patients hypersensitivity reactions and are blood not to clot as easily. Treatment
who are allergic to intravenous mediated by: for mild cases is supportive.
contrast media are usually also allergic Transfusions may be necessary.
to which of the following products? a. immunoglobulin E (IgE). Severe cases require a bone marrow
b. immunoglobulin G (IgG). transplant. Option 2 is an elevated
a. Eggs c. immunoglobulin A (IgA).
b. Shellfish platelet count. Option 3 is an elevated
d. immunoglobulin M (IgM). white count. Option 4 is an elevated
c. Soy
d. acidic fruits [Link] A. IgE, the least common granulocyte count. A granulocyte is a
serum immunoglobulin (Ig) binds very type of white blood cell.
5. Answer B. Some types of contrast tightly to receptors on basophils and
media contain iodine as an ingredient. 9. Serious adverse effects of oral
mast cells and is involved in allergic contraceptives include:
Shellfish also contain significant reactions. Binding of the allergen to
amounts of iodine. Therefore, a patient the IgE on the cells results in the a. Increase in skin oil followed
who is allergic to iodine will exhibit release of various pharmacological by acne.
an allergic response to both iodine mediators that result in allergic b. Headache and dizziness.
containing contrast media and symptoms. IgG is the major Ig (75 c. Early or mid-cycle bleeding.
shellfish. These products do not percent of serum Ig is IgG). Most d. Thromboembolic
contain iodine. versatile Ig because it is capable of complications.
6. A 13-month-old child recently carrying out all of the functions of Ig
molecules. IgG is the only class of Ig 9. Answer D. Oral contraceptives have
arrived in the United States from a been associated with an increased risk
foreign country with his parents and that crosses the placenta. It is an
opsonin, a substance that enhances of stroke, myocardial infarction, and
needs childhood immunizations. His deep vein thrombosis. These risks are
mother reports that he is allergic to phagocytosis. IgA, the second most
common serum Ig is found in increased in women who smoke.
eggs. Upon further questioning, you Increased skin oil and acne are effects
determine that the allergy to eggs is secretions (tears, saliva, colostrum,
and mucus). It is important in local of progestin excess. Headache and
anaphylaxis. Which of the following dizziness are effects of estrogen
vaccines should he not receive? (mucosal) immunity. IgM, the third
most common serum Ig, is the first Ig excess. Early or mid-cycle bleeding
a. Hepatitis B to be made by the fetus and the first Ig are effects of estrogen deficiency.
b. inactivated polio to be made by a virgin B cell when it 10. The most serious adverse effect of
c. diphtheria, acellular pertussis, is stimulated by antigen. IgM Alprostadil (Prostin VR pediatric
tetanus (DTaP) antibodies are very efficient in leading injection) administration in neonates
d. mumps, measles, rubella to the lysis of microorganisms. is:
(MMR)
8. Drugs can cause adverse events in a a. Apnea.
6. Answer D. The measles portion of patient. Bone marrow toxicity is one b. Bleeding tendencies.
the MMR vaccine is grown in chick of the most frequent types of drug- c. Hypotension.
embryo cells. The current MMR induced toxicity. The most serious d. Pyrexia.
vaccine does not contain a significant form of bone marrow toxicity is:
amount of egg proteins, and even 10. Answer A. All items are adverse
children with dramatic egg allergies a. aplastic anemia. reactions of the drug. However, apnea
are extremely unlikely to have an b. thrombocytosis. appearing during the first hour of drug
anaphylactic reaction. However, c. leukocytosis. infusion occurs in 10-12 percent of
patients that do respond to egg contact d. granulocytosis. neonates with congenital heart defects.
with anaphylaxis should be in a 8. Answer A. Aplastic anemia is the Clinicians deciding to utilize
medically controlled setting where full result of a hypersensitivity reaction alprostadil must be prepared to
resuscitation efforts can be and is often irreversible. It leads to intubate and mechanically ventilate
administered if anaphylaxis results. pancytopenia, a severe decrease in all the infant. Careful monitoring for
The vaccines in options a,b and c do cell types: red blood cells, white blood apnea or respiratory depression is
not contain egg protein. cells, and platelets. A reduced number mandatory. In some institutions,
of red blood cells causes hemoglobin elective intubation occurs prior to
7. The cell and Coombs classification initiation of the medication.
system categorizes allergic reactions to drop. A reduced number of white

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 EMILIO AGUINALDO COLLEGE
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11. Mandy, a patient calls the clinic 13. Answer C. Lactic acidosis is the following always require cross-
today because he is taking atrovastatin most dangerous adverse effect of matching?
(Lipitor) to treat his high cholesterol metformin administration with death
and is having pain in both of his legs. resulting in approximately 50 percent a. packed red blood cells
You instruct him to: of individuals who develop lactic b. platelets
acidosis while on this drug. Metformin c. plasma
a. Stop taking the drug and make an does not induce insulin production; d. granulocytes
appointment to be seen next thus, administration does not result in
week. 16. Answer A. Red blood cells contain
hypoglycemic events. Some nausea, antigens and antibodies that must be
b. Continue taking the drug and vomiting, and diarrhea may develop
make an appointment to be seen matched between donor and recipient.
but is usually not severe. NVD is not The blood products in options 2-4 do
next week. specific for metformin. Metformin
c. Stop taking the drug and come to not contain red cells. Thus, they
does not induce sleepiness. require no cross-match.
the clinic to be seen today.
d. Walk for at least 30 minutes and 14. The most serious adverse effect of 17. A month after receiving a blood
call if symptoms continue. tricyclic antidepressant (TCA) transfusion an immunocompromised
overdose is: male patient develops fever, liver
11. Answer C. Muscle aches, soreness,
and weakness may be early signs of a. Seizures. abnormalities, a rash, and diarrhea.
myopathy such as rhabdomyolysis b. Hyperpyrexia. The nurse would suspect this patient
associated with the HMG-CoA c. Metabolic acidosis. has:
reducatase class of antilipemic agents. d. Cardiac arrhythmias. a. Nothing related to the blood
This patient will need an immediate transfusion.
evaluation to rule out myopathy. 14. Answer D. Excessive ingestion of
TCAs result in life-threatening wide b. Graft-versus-host disease
Additional doses may exacerbate the (GVHD).
problem. Exercise will not reverse QRS complex tachycardia. TCA
overdose can induce seizures, but they c. Myelosuppression.
myopathy and delays diagnosis. d. An allergic response to a recent
are typically not life-threatening.
12. Which of the following adverse TCAs do not cause an elevation in medication.
effects is associated with body temperature. TCAs do not cause [Link] B. GVHD occurs when
levothyroxine (Synthroid) therapy? metabolic acidosis. white blood cells in donor blood
a. Tachycardia 15. The nurse is aware that the attack the tissues of an
b. Bradycardia following solutions is routinely used immunocompromised recipient. This
c. Hypotension to flush an IV device before and after process can occur within a month of
d. Constipation the administration of blood to a patient the transfusion. Options 1 and 4 may
is: be a thought, but the nurse must
12. Answer A. Levothyroxine, remember that immunocompromised
especially in higher doses, can induce a. 0.9 percent sodium chloride transfusion recipients are at risk for
hyperthyroid-like symptoms including b. 5 percent dextrose in water GVHD.
tachycardia. An agent that increases solution
the basal metabolic rate would not be c. Sterile water 18. Jonas comes into the local blood
expected to induce a slow heart rate. d. Heparin sodium donation center. He says he is here to
Hypotension would be a side effect of donate platelets only today. The nurse
bradycardia. Constipation is a 15. Answer A. 0.9 percent sodium knows this process is called:
symptom of hypothyroid disease. chloride is normal saline. This
solution has the same osmolarity as a. Directed donation.
13. Which of the following adverse blood. Its use prevents red cell lysis. b. Autologous donation.
effects is specific to the biguanide The solutions given in options 2 and 3 c. Allogenic donation.
diabetic drug metformin (Glucophage) are hypotonic solutions and can cause d. Apheresis.
therapy? red cell lysis. The solution in option 4 [Link] D. The process of
may anticoagulate the patient and apheresis involves removal of whole
a. Hypoglycemia result in bleeding.
b. GI distress blood from a donor. Within an
c. Lactic acidosis 16. Cris asks the nurse whether all instrument that is essentially designed
d. Somulence donor blood products are cross- as a centrifuge, the components of
matched with the recipient to prevent whole blood are separated. One of the
a transfusion reaction. Which of the separated portions is then withdrawn,

54
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and the remaining components are because of a fear of contracting an could receive from the transfusion.
retransfused into the donor. Directed infection. He asks the nurse what are The nurse teaches him that
donation is collected from a blood his options. The nurse teaches the approximately 1 in 250,000 patients
donor other than the recipient, but the person that the safest blood product is: contract:
donor is known to the recipient and is
usually a family member or friend. a. An allogenic product. a. Human immunodeficiency
Autologous donation is the collection b. A directed donation product. disease (HIV).
and reinfusion of the patient's own c. An autologous product. b. Hepatitis C infection.
blood. Allogenic donation is collected d. A cross-matched product. c. Hepatitis B infection.
from a blood donor other than the d. West Nile viral disease.
[Link] C. This process is the
recipient. collection and reinfusion of the [Link] C. Hepatitis B is the most
19. Nurse Bryan knows that the age patient's own blood. It is common infection spread via blood
group that uses the most units of blood recommended by the American transfusion. Donors are screened by a
and blood products is: Medical Association's Council on questionnaire that includes symptoms.
Scientific Affairs as the safest product The donated blood is also tested for
a. Premature infants. since it eliminates recipient infection. The risk of infection with
b. Children ages 1-20 years. incompatibility and infection. The the agents in options 2 and 3 has
c. Adults ages 21-64 years. product in option 1 is collected from a decreased to approximately 1 in 2
d. The elderly above age 65 years. blood donor other than the recipient. million secondary to donor
The process in option 2 is also questioning and donor blood testing.
[Link] D. People older than 65 collected from a blood donor other The incidence of West Nile viral
years use 43 percent of donated blood. than the recipient, but the donor is transmission is unknown, but donor
This number is expected to increase as known to the recipient and is usually a infection is still relatively rare.
the population ages. family member or friend. Cross-
matching significantly enhances 24. A male patient with blood type
20. A child is admitted with a serious AB, Rh factor positive needs a blood
infection. After two days of compatibility. It does not detect
infection. transfusion. The Transfusion Service
antibiotics, he is severely neutropenic. (blood bank) sends type O, Rh factor
The physician orders granulocyte 22. A severely immunocompromised negative blood to the unit for the nurse
transfusions for the next four days. female patient requires a blood to infuse into this patient. The nurse
The mother asks the nurse why? The transfusion. To prevent GVHD, the knows that:
nurse responds: physician will order:
a. This donor blood is incompatible
a. "This is the only treatment left to a. Diphenhydramine hydrochloride with the patient's blood.
offer the child." (Benadryl). b. Premedicating the patient with
b. "This therapy is fast and reliable b. The transfusion to be diphenhydramine hydrochloride
in treating infections in children." administered slowly over several (Benadryl) and acetaminophen
c. "The physician will have to hours. (Tylenol) will prevent any
explain his rationale to you." c. Irradiation of the donor blood. transfusion reactions or side
d. "Granulocyte transfusions d. Acetaminophen (Tylenol). effects.
replenish the low white blood c. This is a compatible match.
cells until the body can produce [Link] C. This process eliminates d. The patient is at minimal risk
its own." white blood cell functioning, thus, receiving this product since it is
preventing GVHD. Diphenhydramine the first time he has been
20. Answer D. Granulocyte HCl is an antihistamine. It's use prior
(neutrophil) replacement therapy is transfused with type O, Rh
to a blood transfusion decreases the negative blood.
given until the patient's blood values likelihood of a transfusion reaction.
are normal and he is able to fight the Option 2 will not prevent GVHD. Use [Link] C. Type O, Rh negative
infection himself. Options 1 and 3 are of acetaminophen prevents and treats blood has none of the major antigens
not therapeutic responses. The the common side effects of blood and is safely administered to patients
treatment in option 2 takes days and is administration caused by the presence of all blood types. It is also known as
not always able to prevent morbidity of white blood cells in the transfusion the universal donor. Premedicating
and mortality. product: fever, headache, and chills. with these agents will not prevent a
21. A neighbor tells nurse Maureen he major transfusion reaction if the blood
23. Louie who is to receive a blood type and Rh factors of the donor blood
has to have surgery and is reluctant to transfusion asks the nurse what is the
have any blood product transfusions most common type of infection he

55
 EMILIO AGUINALDO COLLEGE
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are incompatible with the recipient's intravenous (IV) device should the a. CVADs are less expensive than a
blood. nurse consider starting? peripheral IV.
b. Once a week administration is
a. A small catheter to decrease possible.
patient discomfort c. Caustic agents in small veins can
b. The type of IV device the patient be avoided.
25. Dr. Rodriguez orders 250 has had in the past, which worked d. The patient or his family can
milliliters of packed red blood cells well administer the drug at home.
(RBC) for a patient. This therapy is c. A large bore catheter
administered for treatment of: d. The type of device the physician [Link] C. Many chemotherapeutic
prefers drugs are vesicants (highly active
a. Thrombocytopenia. corrosive materials that can produce
b. Anemia. [Link] C. Large bore catheters tissue damage even in low
c. Leukopenia. prevent damage to blood components concentrations). Extravasations of a
d. Hypoalbuminemia. and are less likely to develop clotting vesicant can result in significant tissue
problems than a small bore catheter. necrosis. Administration into a large
[Link] B. A red blood cell The nurse should determine the vein is optimal. CVADs are more
transfusion is used to correct anemia correct device without asking the expensive than a peripheral IV.
in patients in which the low red blood patient what type has been used before Dosing depends on the drug. IV
cell count must be rapidly corrected. or asking the physician which type he chemotherapeutic agents are not
RBC transfusion will not correct a low prefers and start the IV. administered at home. They are given
platelet count. RBC transfusion will in an outpatient or clinic setting if not
not correct a low white blood cell 28. Dr. Smith orders a gram of human
salt poor albumin product for a given during hospitalization.
count. Packed RBCs contain very little
plasma and, thus, only a small amount patient. The product is available in a 30. A female patient's central venous
of albumin. This amount will not 50 milliliter vial with a concentration access device (CVAD) becomes
correct low albumin levels. of 25 percent. What dosage will the infected. Why would the physician
nurse administer? order antibiotics to be given through
26. A female patient needs a whole the line rather than through a
blood transfusion. In order for a. The nurse should use the entire 50
milliliter vial. peripheral IV line?
transfusion services (the blood bank)
to prepare the correct product a b. The nurse should determine the a. To prevent infiltration of the
sample of the patient's blood must be volume to administer from the peripheral line
obtained for: physician. b. To reduce the pain and discomfort
c. This concentration of product associated with antibiotic
a. A complete blood count and should not be used. administration in a small vein
differential. d. The nurse will administer 4 c. To lessen the chance of an
b. A blood type and cross-match. milliliters. allergic reaction to the antibiotic
c. A blood culture and sensitivity. d. To attempt to sterilize the catheter
d. A blood type and antibody screen. [Link] D. A 25 percent solution
contains one quarter of a gram per and prevent having to remove it
[Link] B. This is needed to utilize milliliter. Thus, the nurse will [Link] D. Microorganisms that
the correct type of donor blood and to administer 4 milliliters to provide a infect CVADs are often coagulase-
match the donor product with the complete gram of albumin. The negative staphylococci, which can be
patient. Incompatible matches would volume in option 1 would provide eliminated by antibiotic administration
result in severe adverse events and 12.5 grams of albumin. The nurse through the catheter. If unsuccessful in
possible death. The tests in options 1 should determine the volume. It is eliminating the microorganism, the
and 3 are unnecessary. The test in unnecessary to seek the answer from CVAD must be removed. CVAD use
option 4 is utilized to determine the the physician. A 25 percent solution is lessens the need for peripheral IV
patient's blood type and presence of an acceptable product and can safely lines and, thus, the risk of infiltration.
antibodies to blood antigens. It does be used. In this case however, the antibiotics
not determine donor blood are given to eradicate microorganisms
compatibility with the patient. 29. Central venous access devices
(CVADs) are frequently utilized to from the CVAD. CVAD use has this
administer chemotherapy. What is a effect, but in this case, the antibiotics
27. A male patient needs to receive a
distinct advantage of using the CVAD are given through the CVAD to
unit of whole blood. What type of
for chemotherapeutic agent eliminate the infective agent. The third
administration? option would not occur

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1. An infection in a central venous d. The chemotherapy dose can be [Link] A. Occlusion occurs with
access device is not eliminated by reduced. slow infusion rates and concurrent
giving antibiotics through the catheter. administration of some medications.
How would bacterial glycocalyx [Link] C. In patients unable to take Lipid occlusions may be treated with
contribute to this? oral nutrition, parenteral 70 percent ethanol or with 0.1
hyperalimentation is an option for mmol/mL NaOH. Lipids provide
a. It protects the bacteria from providing nutritional support. High essential fatty acids. It is
antibiotic and immunologic concentrations of dextrose, protein, recommended that approximately 4
destruction. minerals, vitamins, and trace elements percent of daily calories be EFAs. A
b. Glycocalyx neutralizes the can be provided. Dosing is not deficiency can quickly develop. Daily
antibiotic rendering it ineffective. affected with options a and d. essential fatty acids are necessary for
c. It competes with the antibiotic for Crystalloid can provide free water but constant prostaglandin production.
binding sites on the microbe. has very little nutritional benefits. Lipids are almost isotonic with blood.
d. Glycocalyx provides nutrients for Hyperalimentation can provide free
microbial growth. water and considerable nutritional 6. A male patient needs a
benefits. percutaneously inserted central
[Link] C. Glycocalyx is a viscous catheter (PICC) for prolonged IV
polysaccharide or polypeptide slime 4. Some central venous access devices therapy. He knows it can be inserted
that covers microbes. It enhances (CVAD) have more than one lumen. without going to the operating room.
adherence to surfaces, resists These multi lumen catheters: He mentions that, "at least the doctor
phagocytic engulfment by the white won't be wearing surgical garb, will
blood cells, and prevents antibiotics a. Have an increased risk of
infiltration. he?" How will the nurse answer the
from contacting the microbe. patient?
Glycocalyx does not have the effects b. Only work a short while because
in options B-D. the small bore clots off. a. "You are correct. It is a minor
c. Are beneficial to patient care but procedure performed on the unit
2. Central venous access devices are are prohibitively expensive. and does not necessitate surgical
beneficial in pediatric therapy d. Allow different medications or attire."
because: solutions to be administered b. "To decrease the risk of infection,
simultaneously. the doctor inserting the PICC will
a. They don't frighten children.
b. Use of the arms is not restricted. [Link] D. A multilumen catheter wear a cap, mask, and sterile
c. They cannot be dislodged. contains separate ports and means to gown and gloves."
d. They are difficult to see. administer agents. An agent infusing c. "It depends on the doctor's
in one port cannot mix with an agent preference."
[Link] B. The child can move his infusing into another port. Thus, d. "Most doctors only wear sterile
extremities and function in a normal agents that would be incompatible if gloves, not a cap, mask, or sterile
fashion. This lessens stress associated given together can be given in gown."
with position restriction and promotes separate ports simultaneously.
normal activity. Fear may not be 6. Answer C. Strict aseptic technique
eliminated. All lines can be dislodged. 5. Some institutions will not infuse a including the use of cap, mask, and
Even small catheters can be readily fat emulsion, such as Intralipid, into sterile gown and gloves is require
seen. central venous access devices when placing a central venous line
(CVAD) because: including a PICC. Options A, B, and
3. How can central venous access D are incorrect statements. They
devices (CVADs) be of value in a a. Lipid residue may accumulate in increase the risk of infection.
patient receiving chemotherapy who the CVAD and occlude the
has stomatitis and severe diarrhea? catheter. 7. A male patient is to receive a
b. If the catheter clogs, there is no percutaneously inserted central
a. The chemotherapy can be rapidly treatment other than removal and catheter (PICC). He asks the nurse
completed allowing the stomatitis replacement. whether the insertion will hurt. How
and diarrhea to resolve. c. Lipids are necessary only in the will the nurse reply?
b. Crystalloid can be administered to most extreme cases to prevent
prevent dehydration. a. "You will have general anesthesia
essential fatty acid (EFA) so you won't feel anything."
c. Concentrated hyperalimentation deficiency.
fluid can be administered through b. "It will be inserted rapidly, and
d. Fat emulsions are very caustic. any discomfort is fleeting."
the CVAD.

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c. "The insertion site will be device. A syringe is attached and the CVAD but are not the primary
anesthetized. Threading the sample is obtained. One of the primary problem. Once placed, these lines do
catheter through the vein is not reasons for insertion of a portacath not cause pain and discomfort.
painful." device is the need for frequent or long-
d. "You will receive sedation prior term blood sampling. A vacutainer 12. Nurse Blessy is doing some patient
to the procedure." will exert too much suction on the education related to a patient's central
central line resulting in collapse of the venous access device. Which of the
7. Answer C. Pain related to PICC line. Only special portacath needles following statements will the nurse
insertion occurs with puncture of the should be used to access the portacath make to the patient?
skin. When inserting PICC lines, the device.
insertion site is anesthetized so no a. "These type of devices are
pain is felt. The patient will not essentially risk free."
receive general anesthesia or sedation. b. "These devices seldom work for
Statement 2 is false. Unnecessary pain more than a week or two
should be prevented. necessitating replacement."
10. What is the purpose of "tunneling" c. "The dressing should only the
8. What volume of air can safely be (inserting the catheter 2-4 inches changed by your doctor."
infused into a patient with a central under the skin) when the surgeon d. "Heparin in instilled into the
venous access device (CVAD)? inserts a Hickman central catheter lumen of the catheter to decrease
device? Tunneling: the risk of clotting."
a. It is dependent on the patient's
weight and height. a. Increases the patient's comfort [Link] D. A solution containing
b. Air entering the patient through a level. heparin is used to reduce catheter
CVAD will follow circulation to b. Decreases the risk of infection. clotting and maintain patency. The
the lungs where it will be c. Prevents the patient's clothes from concentration of heparin used depends
absorbed and cause no problems. having contact with the catheter on the patient's age, comorbidities, and
c. It is dependent on comorbidities d. Makes the catheter less visible to the frequency of catheter
such as asthma or chronic other people. access/flushing. Although patients
obstructive lung disease. [Link] B. The actual access to the have few complications, the device is
d. None. subclavian vein is still just under the not risk free. Patients may develop
clavicle, but by tunneling the distal infection, catheter clots, vascular
[Link] B. Any air entering the right obstruction, pneumothorax,
heart can lead to a pulmonary portion of the catheter several inches
under the skin the risk of migratory hemothorax, or mechanical problems
embolus. All air should be purged (catheter breakage). Strict adherence
from central venous lines none should infection is reduces compared to a
catheter that enters the subclavian vein to protocol enhances the longevity of
enter the patient. central access devices. They routinely
directly and is not tunneled. The
9. Kent a new staff nurse asks her catheter is tunneled to prevent last weeks to months and sometimes
preceptor nurse how to obtain a blood infection. years. The patient will be taught how
sample from a patient with a portacath to perform dressing changes at home.
device. The preceptor nurse teaches 11. The primary complication of a
central venous access device (CVAD) 13. The chemotherapeutic DNA
the new staff nurse: alkylating agents such as nitrogen
is:
a. The sample will be withdrawn mustards are effective because they:
into a syringe attached to the a. Thrombus formation in the vein.
b. Pain and discomfort. a. Cross-link DNA strands with
portacath needle and then placed covalent bonds between alkyl groups
into a vacutainer. c. Infection.
d. Occlusion of the catheter as the on the drug and guanine bases on
b. Portacath devices are not used to DNA.
obtain blood samples because of result of an intra-lumen clot.
the risk of clot formation. [Link] C. A foreign body in a a. b. Have few, if any, side effects.
c. The vacutainer will be attached to blood vessel increases the risk of b. Are used to treat multiple types of
the portacath needle to obtain a infection. Catheters that come outside cancer.
direct sample. the body have an even higher risk of c. Are cell cycle-specific agents.
d. Any needle and syringe may be infection. Most infections are caused
utilized to obtain the sample. [Link] A. Alkylating agents are
by skin bacteria. Other infective highly reactive chemicals that
[Link] A. A special portacath organisms include yeasts and fungi. introduce alkyl radicals into
needle is used to access the portacath Options 1 and 4 are complications of a biologically active molecules and

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thereby prevent their proper a. The patient's hemoglobin and d. neuroblastoma.

functioning, replication, and hematocrit are normal.
transcription. Alkylating agents have b. Red blood cells are affected first. [Link] A. Prostate tissue is
numerous side effects including c. Folic acid levels are normal. stimulated by androgens and
alopecia, nausea, vomiting, and d. The current white cell count is not suppressed by estrogens. Androgen
myelosuppression. Nitrogen mustards affected by chemotherapy. antagonists will block testosterone
have a broad spectrum of activity stimulation of prostate carcinoma
against chronic lymphocytic leukemia, 15. Answer D. The time required to cells. The types of cancer in options 2-
non-Hodgkin's lymphoma, and breast clear circulating cells before the effect 4 are not androgen dependent.
and ovarian cancer, but they are that chemotherapeutic drugs have on
precursor cell maturation in the bone 18. Serotonin release stimulates
effective chemotherapeutic agents vomiting following chemotherapy.
because of DNA cross-linkage. marrow becomes evident. Leukopenia
is an abnormally low white blood cell Therefore, serotonin antagonists are
Alkylating agents are noncell cycle- effective in preventing and treating
specific agents. count. Answers A-C pertain to red
blood cells. nausea and vomiting related to
14. Hormonal agents are used to treat chemotherapy. An example of an
some cancers. An example would be: effective serotonin antagonist
antiemetic is:
a. Thyroxine to treat thyroid cancer.
b. ACTH to treat adrenal carcinoma. a. ondansetron (Zofran).
16. Currently, there is no way to b. fluoxetine (Prozac).
c. Estrogen antagonists to treat prevent myelosuppression. However,
breast cancer. c. paroxetine (Paxil).
there are medications available to d. sertraline (Zoloft).
d. Glucagon to treat pancreatic elicit a more rapid bone marrow
carcinoma. recovery. An example is: [Link] A. Chemotherapy often
[Link] C. Estrogen antagonists are induces vomiting centrally by
a. Epoetin alfa (Epogen, Procrit). stimulating the chemoreceptor trigger
used to treat estrogen hormone- b. Glucagon.
dependent cancer, such as breast zone (CTZ) and peripherally by
c. Fenofibrate (Tricor). stimulating visceral afferent nerves in
carcinoma. A well-known estrogen d. Lamotrigine (Lamictal).
antagonist used in breast cancer the GI tract. Ondansetron (Zofran) is a
therapy is tamoxifen (Nolvadex). This [Link] A. Epoetin alfa (Epogen, serotonin antagonist that bocks the
drug, in combination with surgery and Procrit) is a recombinant form of effects of serotonin and prevents and
other chemotherapeutic drugs reduces endogenous erythropoietin, a treats nausea and vomiting. It is
breast cancer recurrence by 30 hematopoietic growth factor normally especially useful in single-day highly
percent. Estrogen antagonists can also produced by the kidney that is used to emetogenic cancer chemotherapy (for
be administered to prevent breast induce red blood cell production in the example, cisplatin). The agents in
cancer in women who have a strong bone marrow and reduce the need for options 2-4 are selective serotonin
family history of the disease. blood transfusion. Glucagon is a reuptake inhibitors. They increase the
Thyroxine is a natural thyroid pancreatic alpha cell hormone, which available levels of serotonin.
hormone. It does not treat thyroid cause glycogenolysis and 19. Methotrexate, the most widely
cancer. ACTH is an anterior pituitary gluconeogenesis. Fenofibrate (Tricor) used antimetabolite in cancer
hormone, which stimulates the adrenal is an antihyperlipidemic agent that chemotherapy does not penetrate the
glands to release glucocorticoids. It lowers plasma triglycerides. central nervous system (CNS). To
does not treat adrenal cancer. Lamotrigine (Lamictal) is an treat CNS disease this drug must be
Glucagon is a pancreatic alpha cell anticonvulsant. administered:
hormone, which stimulates
glycogenolysis and gluconeogenesis. 17. Estrogen antagonists are used to a. Intravenously.
It does not treat pancreatic cancer. treat estrogen hormone-dependent b. Subcutaneously.
cancer, such as breast carcinoma. c. Intrathecally.
15. Chemotherapeutic agents often Androgen antagonists block d. By inhalation.
produce a certain degree of testosterone stimulation of androgen-
myelosuppression including dependent cancers. An example of an [Link] C. With intrathecal
leukopenia. Leukopenia does not androgen-dependent cancer would be: administration chemotherapy is
present immediately but is delayed injected through the theca of the spinal
several days to weeks because: a. Prostate cancer. cord and into the subarachnoid space
b. Thyroid cancer. entering into the cerebrospinal fluid
c. Renal carcinoma. surrounding the brain and spinal cord.

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The methods in options A, B, and D 22. Superficial bladder cancer can be d. Irritating the gastric mucosa.
are ineffective because the medication treated by direct instillation of the
cannot enter the CNS. antineoplastic antibiotic agent [Link] A. Vomiting (emesis) is
mitomycin (Mutamycin). This process initiated by a nucleus of cells located
20. Methotrexate is a folate antagonist. is termed: in the medulla called the vomiting
It inhibits enzymes required for DNA center. This center coordinates a
base synthesis. To prevent harm to a. Intraventricular administration. complex series of events involving
normal cells, a fully activated form of pharyngeal, gastrointestinal, and
folic acid known as leucovorin (folinic b. Intravesical administration. abdominal wall contractions that lead
acid citrovorum factor) can be c. Intravascular administration. to expulsion of gastric contents.
administered. Administration of Catecholamine inhibition does not
leucovorin is known as: d. Intrathecal administration. induce vomiting. Chemotherapy does
not induce vomiting from autonomic
a. Induction therapy. [Link] B. Medications instability. Chemotherapy, especially
b. Consolidation therapy. administered intravesically are oral agents, may have an irritating
c. Pulse therapy. instilled into the bladder. effect on the gastric mucosa, which
d. Rescue therapy. Intraventricular administration could result in afferent messages to
involves the ventricles of the brain. the solitary tract nucleus, but these
[Link] B. Leucovorin is used to Intravascular administration involves
save or "rescue" normal cells from the pathways do not project to the
blood vessels. Intrathecal vomiting center.
damaging effects of chemotherapy administration involves the fluid
allowing them to survive while the surrounding the brain and spinal cord. 25. Myeloablation using
cancer cells die. Therapy to rapidly chemotherapeutic agents is useful in
reduce the number of cancerous cells 23. The most common dose-limiting cancer treatment because:
is the induction phase. Consolidation toxicity of chemotherapy is:
therapy seeks to complete or extend a. It destroys the myelocytes
the initial remission and often uses a a. Nausea and vomiting. (muscle cells).
different combination of drugs than b. Bloody stools. b. It reduces the size of the cancer
that used for induction. Chemotherapy c. Myelosuppression. tumor.
is often administered in intermittent d. Inability to ingest food orally c. After surgery, it reduces the
courses called pulse therapy. Pulse due to stomatitis and amount of chemotherapy needed.
therapy allows the bone marrow to mucositis. d. It destroys the bone marrow prior
recover function before another course to transplant.
[Link] C. The overall goal of
of chemotherapy is given.
cancer chemotherapy is to give a dose [Link] A. Myelo comes from the
21. A male Patient is undergoing large enough to be lethal to the cancer Greek word myelos, which means
chemotherapy may also be given the cells, but small enough to be tolerable marrow. Ablation comes from the
drug allopurinol (Zyloprim, Aloprim). for normal cells. Unfortunately, some Latin word ablatio, which means
Allopurinol inhibits the synthesis of normal cells are affected including the removal. Thus, myeloablative
uric acid. Concomitant administration bone marrow. Myelosuppression chemotherapeurtic agents destroy the
of allopurinol prevents: limits the body's ability to prevent and bone marrow. This procedure destroys
fight infection, produce platelets for normal bone marrow as well as the
a. Myelosuppression. clotting, and manufacture red blood cancerous marrow. The patient's bone
b. Gout and hyperuricemia. cells for oxygen portage. Even though marrow will be replaced with a bone
c. Pancytopenia. the effects in options a, b, and d are marrow transplant. Myelocytes are not
d. Cancer cell growth and uncomfortable and distressing to the muscle cells Tumors are solid masses
replication patient, they do not have the potential typically located in organs. Surgery
for lethal outcomes that may be performed to reduce tumor
[Link] B. Prevent uric acid myelosuppression has.
nephropathy, uric acid lithiasis, and burden and require less chemotherapy
gout during cancer therapy since afterward.
24. Chemotherapy induces vomiting
chemotherapy causes the rapid by: 26. Anticipatory nausea and vomiting
destruction of cancer cells leading to associated with chemotherapy occurs:
excessive purine catabolism and uric a. Stimulating neuroreceptors in
acid formation. Allopurinol can induce the medulla. a. Within the first 24 hours after
myelosuppression and pancytopenia. b. Inhibiting the release of chemotherapy.
Allopurinol does not have this catecholamines. b. 1-5 days after chemotherapy.
function. c. Autonomic instability.

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c. Before chemotherapy [Link] C. Drugs and drug a. Adrenergic receptors.

administration. metabolites with molecular weights b. Muscarinic receptors.
d. While chemotherapy is being higher than 300 may be excreted via c. Cholinergic receptors.
administered. the bile, stored in the gallbladder, d. Nicotinic receptors.
delivered to the intestines by the bile
[Link] C. Nausea and vomiting duct, and then reabsorbed into the [Link] A. Epinephrine
(N&V) are common side effects of circulation. This process reduces the (adrenaline) rapidly affects both alpha
chemotherapy. Some patients are able elimination of drugs and prolongs and beta adrenergic receptors eliciting
to trigger these events prior to actually their half-life and duration of action in a sympathetic (fight or flight)
receiving chemotherapy by the body. Hepatic clearance is the response. Muscarinic receptors are
anticipating, or expecting, to have amount of drug eliminated by the cholinergic receptors and are primarily
these effects. N&V occurring post- liver. Total clearance is the sum of all located at parasympathetic junctions.
chemotherapeutic administration is not types of clearance including renal, Cholinergic receptors respond to
an anticipatory event but rather an hepatic, and respiratory. First-pass acetylcholine stimulation. Cholinergic
effect of the drug. N&V occurring effect is the amount of drug absorbed receptors include muscarinic and
during the administration of from the GI tract and then metabolized nicotinic receptors. Nicotinic receptors
chemotherapy is an effect of the drug. by the liver thus, reducing the amount are cholinergic receptors activated by
of drug making it into circulation. nicotine and found in autonomic
27. Medications bound to protein have ganglia and somatic neuromuscular
the following effect: 29. An adult patient has been taking a junctions.
a. Enhancement of drug drug (Drug A) that is highly
metabolized by the cytochrome p-450 1. The nursery nurse is putting
availability. erythromycin ointment in the
b. Rapid distribution of the drug system. He has been on this
medication for 6 months. At this time, newborn's eyes to prevent infection.
to receptor sites. She places it in the following area of
c. The more drug bound to he is started on a second medication
(Drug B) that is an inducer of the the eye:
protein, the less available for
desired effect. cytochrome p-450 system. You should a. under the eyelid
d. Increased metabolism of the monitor this patient for: b. on the cornea.
drug by the liver. a. Increased therapeutic effects of c. in the lower conjunctival sac
Drug A. d. by the optic disc.
[Link] C. Only an unbound drug
can be distributed to active receptor b. Increased adverse effects of Drug 1. C. The ointment is placed in the
sites. Therefore, the more of a drug B. lower conjunctival sac so it will not
that is bound to protein, the less it is c. Decreased therapeutic effects of scratch the eye itself and will get well
available for the desired drug effect. Drug A. distributed.
Less drug is available if bound to d. Decreased therapeutic effects of
protein. Distribution to receptor sites Drug B. 2. The physician orders penicillin for a
is irrelevant since the drug bound to patient with streptococcal pharyngitis.
[Link] C. Drug B will induce the The nurse administers the drug as
protein cannot bind with a receptor cytochrome p-450 enzyme system of
site. Metabolism would not be ordered, and the patient has an allergic
the liver thus, increasing the reaction. The nurse checks the
increased. The liver will first have to metabolism of Drug A. Therefore,
remove the drug from the protein medication order sheet and finds that
Drug A will be broken down faster the patient is allergic to penicillin.
molecule before metabolism can and exert decreased therapeutic
occur. The protein is then free to Legal responsibility for the error is:
effects. Drug A will be metabolized
return to circulation and be used again faster, thus reducing, not increasing its a. only the nurse's—she should have
28. Some drugs are excreted into bile therapeutic effect. Inducing the checked the allergies before
and delivered to the intestines. Prior to cytochrome p-450 system will not administering the medication.
elimination from the body, the drug increase the adverse effects of Drug B. b. only the physician's—she gave
may be absorbed. This process is Drug B induces the cytochrome p-450 the order, the nurse is obligated to
known as: system but is not metabolized faster. follow it.
Thus, the therapeutic effects of Drug c. only the pharmacist's—he should
a. Hepatic clearance. B will not be decreased. alert the floor to possible allergic
b. Total clearance. reactions.
c. Enterohepatic cycling. 30. Epinephrine is administered to a d. the pharmacist, physician, and
d. First-pass effect. female patient. The nurse should nurse are all liable for the mistake
expect this agent to rapidly affect:

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2. D. The physician, nurse, and a. call the physician if she has c. report your findings to the
pharmacist all are licensed any breathing difficulties. RN, requesting an alternate
professionals and share responsibility b. take it with meals so it medication order be obtained
for errors. doesn't cause an upset from the physician.
stomach. d. call her daughter to come and
3. James Perez, a nurse on a geriatric c. take all of the medication sit with her.
floor, is administering a dose of prescribed even if the
digoxin to one of his patients. The symptoms stop sooner. 7. C. Morphine sulfate depresses the
woman asks why she takes a different d. not share the pills with respiratory center. When the rate is
pill than her niece, who also has heart anyone else. less than 10, the MD should be
trouble. James replies that as people notified.
get older, liver and kidney function 5. C. Frequently patients do not
decline, and if the dose is as high as complete an entire course of antibiotic 8. When counseling a patient who is
her niece's, the drug will tend to: therapy, and the bacteria are not starting to take MAO (monoamine
destroyed. oxidase) inhibitors such as Nardil for
a. have a shorter half-life. depression, it is essential that they be
b. accumulate. 6. Mr. Jessie Ray, a newly admitted warned not to eat foods containing
c. have decreased distribution. patient, has a seizure disorder which is tyramine, such as:
d. have increased absorption. being treated with medication. Which
of the following drugs would the nurse a. Roquefort, cheddar, or Camembert
3. B. The decreased circulation to the question if ordered for him? cheese.
kidney and reduced liver function tend
to allow drugs to accumulate and have a. Phenobarbitol, 150 mg hs a. b. grape juice, orange juice,
toxic effects. b. Amitriptylene (Elavil), 10 mg or raisins.
QID. b. onions, garlic, or scallions.
4. The nurse is administering c. Valproic acid (Depakote), c. ground beef, turkey, or pork.
Augmentin to her patient with a sinus 150 mg BID
infection. Which is the best way for 8. A. Monoamine oxidase inhibitors
d. Phenytoin (Dilantin), 100 mg react with foods high in the amino
her to insure that she is giving it to the TID
right patient? acid tyramine to cause dangerously
6. B. Elavil is an antidepressant that high blood pressure. Aged cheeses are
a. Call the patient by name lowers the seizure threshold, so would all high in this amino acid the other
b. Read the name of the patient not be appropriate for this patient. The foods are not.
on the patient's door other medications are anti-seizure
c. Check the patient's wristband 9. The physician orders an
drugs. intramuscular injection of Demerol for
d. Check the patient's room
number on the unit census list 7. Mrs. Jane Gately has been dealing the postoperativepatient's pain. When
with uterine cancer for several preparing to draw up the medication,
4. C. The correct way to identify a months. Pain management is the the nurse is careful to remove the
patient before giving a medication is primary focus of her current admission correct vial from the narcotics cabinet.
to check the name on the medication to your oncology unit. Her vital signs It is labeled
administration record with the on admission are BP 110/64, pulse 78,
patient's identification band. The nurse a. simethicone.
respirations 18, and temperature 99.2 b. albuterol.
should also ask the patient to state F. Morphine sulfate 6mg IV, q 4
their name. The name on the door or c. meperidine.
hours, prn has been ordered. During d. ibuprofen.
the census list are not sufficient proof your assessment after lunch, your
of identification. Calling the patient by findings are: BP 92/60, pulse 66, 9. C. The generic name for Demerol is
name is not as effective as having the respirations 10, and temperature 98.8. meperidine.
patient state their name patients may Mrs. Gately is crying and tells you she
not hear well or understand what the is still experiencing severe pain. Your 10. The nurse is administering an
nurse is saying, and may respond to a action should be to antibiotic to her pediatric patient. She
name which is not their own. checks the patient's armband and
a. give her the next ordered verifies the correct medication by
5. The most important instructions a dose of MS. checking the physician's order,
nurse can give a patient regarding the b. give her a back rub, put on medication kardex, and vial. Which of
use of the antibiotic Ampicillin some light music, and dim the following is not considered one of
prescribed for her are to the lights in the room.

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 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42Error! Hyperlink reference not valid. [Link]
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the five "rights" of drug food or milk. Antacids should be triamterene (Dyrenium). The nurse
administration? avoided for 2 hours after it is taken plans to include which of the
because gastric acid is needed to following in a list of foods that are
a. Right dose activate the medication. The client acceptable?
b. Right route should avoid concurrent use of
alcohol, because the medication is a. baked potato
c. Right frequency hepatotoxic. The client should also b. bananas
avoid exposure to sunlight, because c. oranges
d. Right time the medication increases d. pears canned in water
photosensitivity. 15. D. Triamterene is a potassium-
10. C. The five rights of medication
administration are right drug, right 13. A nurse has taught a client taking a sparing diuretic, and clients taking this
dose, right route, right time, right xanthine bronchodilator about medication should be cautioned
patient. Frequency is not included. beverages to avoid. The nurse against eating foods that are high in
determines that the client understands potassium, including many vegetables,
11. A nurse is preparing the client's fruits, and fresh meats. Because
the information if the client chooses
morning NPH insulin dose and notices potassium is very water-soluble, foods
which of the following beverages from
a clumpy precipitate inside the insulin that are prepared in water are often
the dietary menu?
vial. The nurse should: lower in potassium.
a. chocolate milk
a. draw up and administer the 16. A client with advanced cirrhosis of
b. cranberry juice
dose the liver is not tolerating protein well,
c. coffee
b. shake the vial in an attempt to as eveidenced by abnormal laboratory
d. cola
disperse the clumps values. The nurse anticipates that
c. draw the dose from a new 13. B. Cola, coffee, and chocolate which of the following medications
vial contain xanthine and should be will be prescribed for the client?
d. warm the bottle under avoided by the client taking a xanthine
running water to dissolve the bronchodilator. This could lead to an a. lactulose (Chronulac)
clump increased incidence of cardiovascular b. ethacrynic acid (Edecrin)
and central nervous system side c. folic acid (Folvite)
11. C. The nurse should always d. thiamine (Vitamin B1)
effects that can occur with the use of
inspect the vial of insulin before use
these types of bronchodilators. 16. A. The client with cirrhosis has
for solution changes that may signify
loss of potency. NPH insulin is 14. A client is taking famotidine impaired ability to metabolize protein
normally uniformly cloudy. Clumping, (Pepcid) asks the home care nurse because of liver dysfunction.
frosting, and precipitates are signs of what would be the best medication to Administration of lactulose aids in the
insulin damage. In this situation, take for a headache. The nurse tells clearance of ammonia via the
because potency is questionable, it is the client that it would be best to take: gastrointestinal (GI) tract. Ethacrynic
safer to discard the vial and draw up acid is a diuretic. Folic acid and
the dose from a new vial. a. aspirin (acetylsalicylic acid, thiamine are vitamins, which may be
ASA) used in clients with liver disease as
12. A client with histoplasmosis has b. ibuprofen (Motrin) supplemental therapy.
an order for ketoconazole (Nizoral). c. acetaminophen (Tylenol)
The nurse teaches the client to do d. naproxen (Naprosyn) 17. A female client tells the clinic
which of the following while taking nurse that her skin is very dry and
this medication? 14. C. The client is taking famotidine, irritated. Which product would the
a histamine receptor antagonist. This nurse suggest that the client apply to
a. take the medication on an implies that the client has a disorder the dry skin?
empty stomach characterized by gastrointestinal (GI)
b. take the medication with an irritation. The only medication of the a. glycerin emollient
antacid ones listed in the options that is not b. aspercreame
c. avoid exposure to sunlight irritating to the GI tract is c. myoflex
d. limit alcohol to 2 ounces per acetaminophen. The other medications d. acetic acid solution
day could aggravate an already existing GI 17. A. Glycerin is an emollient that is
problem. used for dry, cracked, and irritated
12. C. The client should be taught that
ketoconazole is an antifungal 15. A nurse is planning dietary skin. Aspercreame and Myoflex are
medication. It should be taken with counseling for the client taking used to treat muscular aches. Acetic

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 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42Error! Hyperlink reference not valid. [Link]
ISO 9001:2015 CERTIFIED
SCHOOL OF NURSING QUALITY MANAGEMENT
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acid solution is used for irrigating, frequent side effects of the 2) Read the name of the patient
cleansing, and packing wounds medication. on the patient's door
infected by Pseudomonas aeruginosa. 3) Check the patient's wristband
20. A client has been taking 4) Check the patient's room
18. A nurse is providing instructions benzonatate (Tessalon) as ordered. number on the unit census
to a client regarding quinapril The nurse tells the client that this list.
hydrochloride (Accupril). The nurse medication should do which of the
tells the client: following? The correct answer is (3).
a. to take the medication with a. take away nausea and The correct way to identify a patient
food only vomiting before giving a medication is to check
b. to rise slowly from a lying to b. calm the persistent cough the name on the medication
a sitting position c. decrease anxiety level administration record with the
c. to discontinue the medication d. increase comfort level patient's identification band. The nurse
if nausea occurs should also ask the patient to state
d. that a therapeutic effect will 20. B. Benzonatate is a locally acting their name. The name on the door or
be noted immediately antitussive. Its effectiveness is the census list are not sufficient proof
measured by the degree to which it of identification. Calling the patient by
18. B. Accupril is an angiotensin- decreases the intensity and frequency name is not as effective as having the
converting enzyme (ACE) inhibitor. It of cough, without eliminating the patient state their name patients may
is used in the treatment of cough refle not hear well or understand what the
hypertension. The client should be nurse is saying, and may respond to a
instructed to rise slowly from a lying 1. The physician orders penicillin for a
patient with streptococcal pharyngitis. name which is not their own.
to sitting position and to permit the
legs to dangle from the bed The nurse administers the drug as 3. Tom R., a newly admitted patient,
momentarily before standing to reduce ordered, and the patient has an allergic has a seizure disorder which is being
the hypotensive effect. The medication reaction. The nurse checks the treated with medication. Which of the
does not need to be taken with meals. medication order sheet and finds that following drugs would the nurse
It may be given without regard to the patient is allergic to penicillin. question if ordered for him?
food. If nausea occurs, the client Legal responsibility for the error is
should be instructed to take a noncola 1) Phenobarbitol, 150 mg hs
1) only the nurse's—she should have 2) Amitriptylene (Elavil), 10 mg
carbonated beverage and salted checked the allergies before
crackers or dry toast. A full QID.
administering the medication. 3) Valproic acid (Depakote), 150 mg
therapeutic effect may be noted in 1 to
2 weeks. 2) only the physician's—she gave the BID
order, the nurse is obligated to follow 4) Phenytoin (Dilantin), 100 mg TID
19. Auranofin (Ridaura) is prescribed it.
for a client with rheumatoid arthritis, The correct answer is (2).
and the nurse monitors the client for 3) only the pharmacist's—he should Elavil is an antidepressant that lowers
signs of an adverse effect related to alert the floor to possible allergic the seizure threshold, so would not be
the medication. Which of the reactions. appropriate for this patient. The other
following indicates an adverse effect? medications are anti-seizure drugs.
4) the pharmacist, physician, and
a. nausea nurse are all liable for the mistake. 4. When counseling a patient who is
b. diarrhea starting to take MAO
c. anorexia The correct answer is (4).
(monoamineoxidase) inhibitors such
d. proteinuria as Nardil for depression, it is essential
The physician, nurse, and pharmacist
19. D. Auranofin (Ridaura) is a gold all are licensed professionals and share that they be warned not to eat foods
preparation that is used as an responsibility for errors. containing tyramine, such as
antirheumatic. Gold toxicity is an 1) Roquefort, cheddar, or
2. The nurse is administering
adverse effect and is evidenced by Camembert cheese.
Augmentin to her patient with a sinus
decreased hemoglobin, leukopenia, 2) grape juice, orange juice, or
infection. Which is the best way for
reduced granulocyte counts, raisins.
her to insure that she is giving it to the
proteinuria, hematuria, stomatitis, 3) onions, garlic, or scallions.
right patient?
glomerulonephritis, nephrotic 4) ground beef, turkey, or pork.
syndrome, or cholestatic jaundice. 1) Call the patient by name
Anorexia, nausea, and diarrhea are

64
 EMILIO AGUINALDO COLLEGE
Gov. D. Mangubat Ave., Brgy. Burol Main, City of Dasmariñas, Cavite 4114, Philippines
Tel. Nos. (046) 416-4341-42Error! Hyperlink reference not valid. [Link]
ISO 9001:2015 CERTIFIED
SCHOOL OF NURSING QUALITY MANAGEMENT
SYSTEMS

The correct answer is (1). hours, prn has been ordered. During 1) have a shorter half-life.
your assessment after lunch, your 2) accumulate.
Monoamine oxidase inhibitors react findings are: BP 92/60,pulse 66, 3) have decreased distribution.
with foods high in the amino acid respirations 10, and temperature 98.8. 4) have increased absorption.
tyramine to cause dangerously high Mrs. Garvey is crying and tells you 1) The correct answer is (2).
blood pressure. Aged cheeses are all she is still experiencing severe pain.
high in this amino acid the other foods Your action should be to The decreased circulation to the
are not. kidney and reduced liver function tend
1) give her the next ordered dose of to allow drugs to accumulate and have
5. The nurse is administering an MS. toxic effects.
antibiotic to her pediatric patient. She 2) give her a back rub, put on some
checks the patient's armband and light music, and dim the lights in 10. The nursery nurse is putting
verifies the correct medication by the room. erythromycin ointment in the
checking the physician's order, 3) report your findings to the RN, newborn's eyes to prevent infection.
medication kardex, and vial. Which of requesting an alternate medication She places it in the following area of
the following is not considered one of order be obtained from the the eye:
the five "rights" of drug physician.
administration? 1) under the eyelid.
4) call her daughter to come and sit 2) on the cornea.
1) Right dose with her. 3) in the lower conjunctival sac.
2) Right route The correct answer is (3). 4) by the optic disc.
3) Right frequency
4) Right time Morphine sulfate depresses the The correct answer is (3).
respiratory center. When the rate is The ointment is placed in the lower
The correct answer is (3). less than 10, the MD should be conjunctival sac so it will not scratch
The five rights of medication notified. the eye itself and will get well
administration are right drug, right 8. The most important instructions a distributed.
dose, right route, right time, right nurse can give a patient regarding the
patient. Frequency is not included. use of the antibiotic Ampicillian
prescribed for her are to

6. The physician orders an 1) call the physician if she has any

intramuscular injection of Demerol for breathing difficulties.
the post-operative patient's pain. When 2) take it with meals so it doesn't
preparing to draw up the medication, cause an upset stomach.
the nurse is careful to remove the 3) take all of the medication
correct vial from the narcotics cabinet. prescribed even if the symptoms
It is labeled stop sooner.
4) not share the pills with anyone
1) simethicone. else.
2) albuterol.
3) meperidine. The correct answer is (3).
4) ibuprofen. Frequently patients do not complete an
The correct answer is (3). entire course of antibiotic therapy, and
the bacteria are not destroyed.
The generic name for Demerol is
meperidine. 9. Frank Jones, a nurse on a geriatric
floor, is administering a dose of
7. Mrs. Garvey has been dealing with digoxin to one of his patients. The
uterine cancer for several months. woman asks why she takes a different
Pain management is the primary focus pill than her niece, who also has heart
of her current admission to your trouble. Frank replies that as people
oncology unit. Her vital signs on get older, liver and kidney function
admission are BP 110/64, pulse 78, decline, and if the dose is as high as
respirations 18,and temperature 99.2 her niece's, the drug will tend to
F. Morphine sulfate 6mg IV, q 4

65