Suicide

1. A depressed patient says, "Nothing matters anymore." What is the most appropriate
response by the nurse?
a. "Are you having thoughts of suicide?"
b. "I am not sure I understand what you are trying to say."
c. "Try to stay hopeful. Things have a way of working out."
d. "Tell me more about what interested you before you became depressed."
Answer: A. "Are you having thoughts of suicide?"
2. A nurse and patient construct a no-suicide contract. Select the preferable wording.
a. "I will not try to harm myself during the next 24 hours."
b. "I will not make a suicide attempt while I am hospitalized."
c. "For the next 24 hours, I will not in any way attempt to harm or kill myself."
d. "I will not kill myself until I call my primary nurse or a member of the staff."
Answer: C. "for the next 24 hours, I will not in any way attempt to harm or kill myself."
3. Which statement provides the best rationale for closely monitoring a severely depressed
patient during antidepressant medication therapy?
a. As depression lifts, physical energy becomes available to carry out suicide.
b. Patients who previously had suicidal thoughts need to discuss their feelings.
c. For most patients, antidepressant medication results in increased suicidal thinking.
d. Suicide is an impulsive act. Antidepressant medication does not alter impulsivity.
Answer: A. as depression lifts, physical energy becomes available to carry out suicide
4. The nurse cares for a patient diagnosed with depression and encourages the patient to join
the activity. Which of the following approaches by the nurse is BEST?
a) Offer several appealing choices to the patient
b) Tell the patient it is part of the physician's orders
c) Describe in the activity in detail to the patient
d) Invite the patient to join in.
Answer: d) Invite the patient to join in
5. One morning the nurse finds a patient crying and approaches him. The patient says, "What
do you want? Go away, you can't help me. I hate you and I hate myself." Which of the following
responses by the nurse is BEST?
a) Why is it that you dislike me and yourself?
b) I'll come back later when you feel in a better mood.
c) It's difficult for me to communicate with you when you talk this way.
d) You seem to be in pain, I'll stay with you for a while
Answer: d) You seem to be in pain, I'll stay with you for a while

Mania /BIPOLAR
1. A client is in the manic phase of bipolar disorder. To help the client maintain adequate
nutrition, the nurse should plan to:
Correct answer offer finger foods and sandwiches.
2. A client in the manic phase of bipolar disorder constantly belittles other clients and demands
special favors from the nurses. Which nursing intervention is most appropriatefor this client?
Correct answer: Set limits with consequences for belittling or demanding behavior.
3. A client is admitted to the local psychiatric facility with bipolar disorder in the manic phase.
The physician decides to start the client on lithium carbonate therapy. One week after this
therapy starts, the nurse notes that the client's serum lithium level is 1 mEq/L. What should the
nurse do?Correct answer:Continue to administer the medication as ordered.
4. A client is brought in by police to a mental health clinic for admission for bipolar
disorder.During the initial phase of the client’s treatment, which of the following interventions
would benefit the client in the manic phase of bipolar disorder? Select all that apply.
Correct answers:
Encourage the client to avoid extraneous environmental stimuli.
Provide the client with frequent, small meals in the form of finger foods.
Communication with the client should be clear and direct.
5. A client with bipolar disorder, manic phase, makes a fist and says to the nurse, “Watch out!
Here I come.” She then puts her hand down and sits in a chair. After determining that the client
is not going to harm anyone, how should the nurse intervene?
Correct answer:
Take the client to a punching bag for exercise to release excess energy.
6. A client with bipolar disorder, manic phase, is yelling at visitors. The client’s face is flushed
and his fists are clenched. Which nursing action should be taken first? Correct answer: Direct
the client to his room

AGGRESSION
#SPLE
#NLE
1. Social-psychological models describe aggression as:
a. intentional harm toward others.
b. an unhealthy way of managing anxiety.
c. a conflict with others expressed aggressively.
d. a response to frustration in the social environment.
d. a response to frustration in the social environment.
Social-psychological models of aggression focus on the interaction of individuals with their
environment and locate the source of anger in interpersonal requirements and frustrations.
The other options are not consistent with this model.
2. A patient is shouting loudly and is verbally aggressive. What analysis should the nurse make
about this behavior?
a. It is acceptable if directed toward staff but not toward another patient.
b. It is not harmful and might prevent the patient from physically acting out.
c. It is a significant warning sign that the patient may become physically aggressive.
d. It allows the patient to vent frustration and alleviate stress without hurting anyone.
c. It is a significant warning sign that the patient may become physically aggressive.
Research findings indicate that verbally aggressive attacks on others are among the major
warning signs of assault and battery, making the other answers mutually exclusive. Verbal
aggression is part of the assault cycle.
3.The nurse cares for a patient who was verbally aggressive upon admission. Three days later
the patient says, "My family put me here. They wanted to get rid of me." When should the
nurse be most vigilant for signs of escalating aggression?
a. During one-on-one sessions
b. During group activities
c. During visiting hours
d. In the early morning
c. During visiting hours
Patients are more likely to become aggressive at admission, at shift change, at mealtimes,
during visiting hours, during the evening, when being transported, and during periods of
change. In this case the patient will probably be increasingly upset if the family does not visit,
because it will reinforce her thinking that they are against her. She is also likely to become
increasingly upset if they do visit, because she accuses them of unfairly hospitalizing her. The
other times are possible, but research has not supported them as being exceptionally high risk.
4. A patient is becoming increasingly tense, pacing the hall, alternately whispering and
shouting. Other patients receive hostile, suspicious glares as they walk by. Which phase of the
assault cycle is the patient demonstrating?
a. Crisis phase
b. Triggering phase
c. Escalation phase
d. Depression phase
b. Triggering phase
The triggering phase is characterized by increased tension, readiness to retaliate, pacing,
irritability, suspiciousness, glaring, breathing changes, and diaphoresis. The other stages are
defined by behaviors specific to the stage and are not described in the scenario.
5. A patient is increasingly tense, pacing the hall and glaring angrily at others. Select the
nurse's best comment to this patient.
a. "It looks as though you are feeling upset. Please tell me what's concerning you."
b. "I can see you are on the verge of losing control. What can I do to help you?"
c. "You must maintain control of your feelings even if you are feeling angry."
d. "I'm going to give you an injection of your medication to prevent loss of control."
a. "It looks as though you are feeling upset. Please tell me what's concerning you."
In the triggering phase the patient's behaviors are nonviolent and present no immediate
danger to others. The nurse should convey empathic support and encourage ventilation using
clear, calm, and simple statements.
6. A patient has entered the escalation phase of the assault cycle. Select the most appropriate
nursing intervention.
a. Direct the patient to the quiet room.
b. Process the incident with the patient.
c. Encourage ventilation of feelings.
d. Place the patient in seclusion.
a. Direct the patient to the quiet room.
During the escalation phase the patient is still capable of cooperation when the nurse takes
charge and gives calm, firm directions. This intervention observes the principle of using the
least restrictive alternative. Oral PRN medication might be used if the least restrictive
alternative is not effective. Ventilation of feelings would have been used in the triggering phase.
Processing the incident occurs in the recovery and depression phases. Seclusion is necessary
in the crisis phase.
7. Which principle guides nursing intervention in the assault cycle?
a. Contagiousness of violence
b. Least restrictive alternative
c. Containment
d. Control
b. Least restrictive alternative
It is a regulatory requirement to care for patients using the least restrictive alternatives. These
efforts at treatment should be documented. Only when less restrictive alternatives prove
ineffective can more restrictive alternatives be used.
8. A patient's behavior has continued to escalate despite nursing interventions designed to
achieve de-escalation. The patient begins to kick and strike at staff. This behavior evidences
which phase of the assault cycle?
a. Triggering
b. Depression
c. Escalation
d. Crisis
d. Crisis
The crisis phase is characterized by a patient's loss of self-control with fighting, hitting, kicking,
scratching, biting, and throwing things. Each of the other phases has selected characteristics,
none of which were described in the scenario.
9. A patient whose behavior has continued to escalate despite nursing interventions begins to
kick and strike out at the nurse. What is the priority nursing intervention?
a. Offer an oral PRN medication.
b. Have staff stand by at a distance.
c. Physically control the patient's behavior.
d. Allow the behavior until the patient de-escalates.
c. Physically control the patient's behavior.
When a patient loses control, staff must take physical control to prevent injury to the patient or
others. A determination must then be made as what measures are necessary (intramuscular
medication, involuntary seclusion, or restraint), keeping in mind the importance of using the
least restrictive alternatives that will achieve the goal of safety.
10. The nurse in charge of a crisis team determines that a patient who has lost control requires
restraint. What is the most important factor in the safe and effective use of physical restraint?
a. A calm, well-trained staff
b. Taking the patient off guard
c. Administering an antipsychotic drug
d. Talking to the patient throughout the procedure
a. A calm, well-trained staff
Six to eight staff members are required. Each must know his or her role. With training, staff can
carry out the various functions smoothly and calmly. Calmness helps ensure that physical
contact is protective, rather than aggressive. Hospital protocols and legal requirements must
be observed. The other options are either less important elements or inappropriate.

SITUATION: Burnout not only affects nurses, but also cascades onto the patients they care for.
Studies show the link between nursing burnout and an increased likelihood of infections in
patients. And hospitals with high burnout rates tend to have lower patient satisfaction overall.
1. Burnout is
A) loss of idealism, energy, and purpose.
B) feelings of indifference and professional failure.
C) stress caused by job dissatisfaction and personal performance.
D) emotional exhaustion, depersonalization, and reduced personal accomplishment.
Answer: D
RATIONALE: HISTORY AND DEFINITION OF BURNOUT
Maslach emphasizes that burnout is not a problem related to an individual . Instead, her
research indicates that burnout is a problem of the social environment in which people work
and is a function of how people within that environment interact with one another and perform
their jobns . She notes that burnout is more likely when there is a "major mismatch between the
nature of the job and the nature of the person who does the job" . These mismatches are at the
core of the development of burnout. The term burnout is now usually limited to mean burnout
as described by Maslach: a syndrome of emotional exhaustion, depersonalization, and
reduced personal accomplishment
2. Isolation and apathy characterize which stage of burnout?
A) Stage 1
B) Stage 2
C) Stage 3
D) Stage 4
answer: D
Ratio:
Stages
1 disappointment and fatigue
2 frustration and indiference
3 sense of powerlessness and prof. Failure
4 isolation and apathy
5 BURNOUT
3. The root of burnout is in
A) personality traits.
B) demographic variables.
C) the work environment.
D) interpersonal relationships.
Answer: C
Rationale:
DEVELOPMENT OF BURNOUT
The specific factors within the work environment that lead to stress and subsequent burnout
vary across occupations and among individuals within a single occupation. The root of burnout
is in the work environment, but because not all individuals working in a single environment will
experience burnout, personal risk factors must have a role in making an individual vulnerable.
These personal risk factors include demographic variables and personality traits
4. Which of the following statements regarding personal risk factors for burnout is TRUE?
A) Burnout is more prevalent among older individuals.
B) Across most work settings, levels of burnout are greater in men than in women.
C) The rates of burnout are higher among married workers and those with children.
D) There are higher levels of burnout among workers with higher levels of education.
Answer: D
Rationale:
DEVELOPMENT OF BURNOUT
Burnout is less prevalent among older individuals because they tend to be more stable and
have a more balanced perspective on life. In addition, the increased rate of burnout among
younger individuals is a function of a "survival of the fittest" concept. Burnout usually occurs
early in one's career (in the first one to five years), and many young, burned out individuals
leave the profession; as a result, the remaining individuals in an occupation are the
"survivors".
Comparing burnout across racial/ethnic groups is difficult, as most studies have been small or
have not involved sufficient numbers of minority workers. For example, one study involved 180
childcare professionals (131 white and 49 black women), in which the scores for components
of burnout were higher among black professionals than among white professionals. Family
status also seems to play an important role in burnout; rates of burnout are higher among
single workers and workers with no children than among married workers and those with
children. The emotional resources provided by a family are thought to be the reason for this
difference.
Educational status seems to have an effect, with higher levels of burnout among workers with
higher levels of education. This difference could be the result of the expectations associated
with advanced education and job choices.
Across most work settings, levels of burnout have been somewhat consistent among men and
women. One meta-analysis demonstrated similar overall rates of burnout among men and
women, but there were gender differences in burnout components, with slightly higher levels of
emotional exhaustion among women and somewhat higher levels of depersonalization among
men . Gender differences have also been found with respect to other demographic variables .
For example, a survey of 3,424 employees in a Finnish study indicated that a low educational
level and low social status increased the risk of burnout for women, whereas marital status
(single, divorced, or widowed) increased the risk for men.
5. What is the most common physical symptom of stress?
A) Fatigue
B) Dizziness
C) Teeth grinding
D) Change in appetite
answer: A
IDENTIFICATION AND MEASUREMENT OF BURNOUT
MOST COMMON PHYSICAL AND PSYCHOLOGIC SYMPTOMS RELATED TO STRESS
Physical Symptoms Frequency
Fatigue 51%
Headache 44%
Upset stomach 34%
Muscle tension 30%
Change in appetite 23%
Teeth grinding 17%
Change in sex drive 15%
Dizziness 13%
Psychologic Irritability or anger 50%
Nervousness 45%
Lack of energy 45%
Feeling of wanting to cry 35%
6 . In measuring burnout, which of the following is the best approach to gain a better
understanding of the sources of stress for an individual?
A) The full Maslach Burnout Inventory alone
B) Three items from the Maslach Burnout Inventory
C) The full Maslach Burnout Inventory with the General Health Questionnaire
D) Two items from the Maslach Burnout Inventory and the Burnout Risk Survey
Answer: C
IDENTIFICATION AND MEASUREMENT OF BURNOUT
The use of psychologic assessment tools in conjunction with the MBI can help professionals
gain a better understanding of the sources of stress for individuals. The General Health
Questionnaire, developed by Goldberg, is designed to measure common mental health
problems (domains of depression, anxiety, somatic symptoms, and social withdrawal) and was
developed as a measure to identify individuals who are likely to have or be at risk for the
development of psychiatric disorders. The General Health Questionnaire is frequently used in
conjunction with the MBI to evaluate psychologic morbidity and burnout, as the pathways to
both are related.
7 . According to the most recent data for nurses, the overall burnout rate is
A) 3% to 4%.
B) 14% to 20%
C) 34% to 43%
D) 52% to 63%.
ANSWER: C
BURNOUT AMONG NURSES
As with physicians, the rate of burnout among nurses is higher than the average rate among
other workers. According to the most recent data for nurses, the overall burnout rate is 34% to
43%, with rates varying according to several factors.
8 . The prevalence of burnout is higher in which of the following specialties?
A) Pediatrics
B) Oncology
C) Long-term care
D) Outpatient surgery
ANSWER: B
BURNOUT AMONG NURSES
As has been reported for physicians, many studies have indicated that the prevalence of
burnout among nurses is higher in some specialties, such as oncology, mental health,
emergency medicine, and critical care [79,80,81,82]. Factors contributing to stress and
burnout may differ according to specialty. For example, substandard staffing was associated
with burnout among oncology nurses whereas low manager support was a significant predictor
of burnout among emergency room nurses [79,83].
9 . Which of the following has been the most common reason given for leaving a nursing job or
position?
A) Too many hours
B) Advancement opportunities
C) Lack of collaboration/communication
D) Lack of good management/leadership
ANSWER:
BURNOUT AMONG NURSES
REASONS GIVEN FOR LEAVING A NURSING JOB OR POSITION IN THE 2008 NATIONAL
SAMPLE SURVEY OF REGISTERED NURSES
Specific Work-Related ReasonPercentage
Too many hours----27%
Low salary-----22%
Inadequate staffing----21%
Lack of good management/leadership--///13%
Lack of collaboration/communication----10%
Lack of advancement opportunities--/--8%
10 . In a large survey of nurses, the highest level of satisfaction was given to relationships with
A) patients.
B) physicians.
C) other nurses.
D) colleagues in other departments.
ANSWER:C
BURNOUT AMONG NURSES
In a survey of 76,000 registered nurses, the highest level of satisfaction was given to
relationships with other nurses, Still, the survey showed that one-third of nurses were
dissatisfied with interactions with their peers . A 2017 survey of 600 nurses found that 45% had
been verbally harassed by other nurses. Interpersonal conflict with other nurses is a stress
factor in and of itself, but a lack of close working relationships deprives nurses of their
colleagues as a source of support. This lack of support is important, as nurses have ranked
their peers as providing the most support within the hospital community, and higher levels of
support from co-workers have been related to lower levels of emotional exhaustion on the MBI.
Similarly, lack of peer cohesion has correlated with high levels of emotional exhaustion and
depersonalization
11. Which of the following conflict resolution styles has associated with a lower rate of burnout
among nurses?
A) Avoidance
B) Competing
C) Cooperative
D) Confrontational
ANSWER: C
BURNOUT AMONG NURSES
Although resolving conflicts can mitigate stress, the style of conflict resolution has also been a
significant predictor of burnout. A study of three conflict resolution styles—avoidance,
confrontational, and cooperative—showed that the avoidance and confrontational styles were
associated with a higher rate of burnout, while the cooperative style was associated with a
lower rate .
12. Levels of emotional exhaustion on the Maslach Burnout Inventory have been higher
among nurses who
A) cried often.
B) masked their emotions.
C) grieved with patients' families
D) had close relationships with patients.
ANSWER: B
BURNOUT AMONG NURSES
The emotional demands of the nursing profession are well recognized, and human suffering
has been noted to be a stressor for nurses .In a 2002 American Nurses Association (ANA)
survey, 44% of nurses said they left their job each day feeling discouraged and saddened by
what they could not provide for their patients. Despite this prevailing emotion, little is known
about how emotional demands relate to burnout. A 2007 study represented a step forward in
that area; the findings of that study indicated that how nurses handle their emotions influences
the risk of burnout . Levels of emotional exhaustion on the MBI were higher among nurses who
masked their emotions or who pretended to feel "expected" emotions.
13. In a meta-analysis, job dissatisfaction among nurses was associated with which of the
following health issues?
A) Headaches
B) Impaired immune system
C) Gastrointestinal disorders
D) Musculoskeletal disorders
Answer: D
CONSEQUENCES OF STRESS AND BURNOUT
Data are limited on the health effects of burnout among nurses specifically, but some studies
have evaluated the effect of its predecessor, job dissatisfaction. One meta-analysis showed
higher rates of musculoskeletal disorders and musculoskeletal injuries reported by nurses who
also reported dissatisfaction with staffing, scheduling, interpersonal relations, or decision
making. In addition, more needlestick injuries occurred among nurses dissatisfied with these
same work-related factors . A weak but significant association between burnout and
depression among nurses has also been noted .
14. All of the following are part of the nursing shortage/burnout cycle, EXCEPT:
A) Burnout
B) Job satisfaction
C) Nursing turnover
D) Inadequate staffing
Answer: B
THE NURSING SHORTAGE/BURNOUT CYCLE
The relationship between burnout and the nursing shortage is cyclical: job dissatisfaction leads
to burnout, which in turn leads to nursing turnover and subsequent nursing shortage, and the
inadequate staffing further increases job dissatisfaction.
15. Which of the following is the most essential element of self-care in preventing burnout
among nurses?
A) Engagement in hobbies
B) Appropriate sleep hygiene
C) Cognitive behavior training
D) Physical relaxation techniques
Answer: B
STRATEGIES TO PREVENT AND COPE WITH STRESS AND BURNOUT
Self-care involves several universal lifestyle habits, such as proper diet, exercise, sleep, and
regular health care
Maintaining a healthy lifestyle through these habits is vital to avoiding the physical effects of
stress
The need for appropriate sleep hygiene is the most essential element for nurses, as in one
survey, 64% of nurses said they rarely get seven to eight hours of sleep per night .
There is widespread documentation that this lack of sleep is associated with a high risk of
fatigue, which is linked to job satisfaction and burnout .
In its white paper on nurse fatigue, the Emergency Nurses Association offers several
recommendations for nutrition, exercise, and proper sleep.
Avoid unhealthy foods—decrease the amount of sugars and foods with empty calories
Participate in regular exercise—find activities that fit into your daily routine
Do not eat a heavy meal before going to bed
Avoid caffeine for at least five hours before going to bed (consider all sources of caffeine, such
chocolate, gum, sodas)
Do not rely on medications to enhance alertness
Eat nutritious foods during your work shift to avoid large fluctuations in blood glucose levels
16 . All of the following tactics for "working smarter" should be especially emphasized to
nurses, EXCEPT:
A) Set realistic goals
B) Vary the work routine
C) Take frequent breaks during the work shift
D) Become more emotionally involved with interactions
Answer:D
STRATEGIES TO PREVENT AND COPE WITH STRESS AND BURNOUT
Maslach defined working smarter as setting realistic goals, doing things differently (when
possible), not taking things personally, and taking time away.
✔️ Setting realistic goals involves moving from abstract, idealistic goals to well-defined specific
goals, which can help individuals gain a better sense of accomplishment. ✔️Varying work
routines can help avoid feelings of being in a rut and provide a sense of better control.
✔️ Taking things less personally involves objectifying negative interactions and situations to
help decrease emotional involvement, thereby reducing stress.
Working smarter also means taking time away and organizing time more effectively. A typical
response to work overload is to work longer or harder to help make the situation "get better" .
However, this approach will only exacerbate stress and burnout, not relieve it. The need to
take some time away from work must be especially emphasized to nurses, most of whom do
not routinely take breaks; in one survey, 37% of nurses said they "usually" took time for a meal
and 24% said they "usually" took a break during their shift. Other studies have shown that
appropriate breaks are least likely among nurses working the longest hours, and that nurses
are usually not completely free of patient care responsibilities during breaks for rest or meals .
Rest breaks are particularly important for nurses working the night shift, to relieve symptoms of
fatigue, which can be detrimental to both nurses' well-being and patient safety. Taking some
time away from work—even if only a few minutes at a time—to stretch, take a walk, make a
personal phone call, read, meditate, or just sit and relax can help nurses "recharge" and will
improve performance and increase productivity more effectively than working continuously.
Facilities must help ensure that nurses take breaks and meals appropriately, as will be
discussed later. Other time management techniques include scheduling a block of
uninterrupted time (no phones, pagers, or e-mails) to complete paperwork more efficiently,
creating "to do" lists to maintain control over tasks, and increasing organizational skills .
17. Which of the following is NOT one of the components of the American Association of
Critical-Care Nurses' standards for a healthy work environment?
A) Appropriate staffing
B) Meaningful recognition
C) Effective decision making
D) Allowing more time for solo work
Answer: D
STRATEGIES TO PREVENT AND COPE WITH STRESS AND BURNOUT
Organizations and institutions can help protect nurses from burnout by creating an
organizational culture of trust, support, and open communication and fostering a healthy work
environment
Creating a healthy work environment has become a priority for enhancing nurse job
satisfaction and retention and improving patient safety and satisfaction
The American Association of Critical-Care Nurses (AACN) developed standards for a healthy
work environment, noting that such an environment is necessary for clinical excellence and
good patient outcomes. Six components were noted to be essential for establishing and
sustaining a healthy work environment :
Appropriate staffing
Meaningful recognition
True collaboration
Skilled communication
Effective decision making
Authentic leadership
18. Which of the following approaches to nurse staffing does the American Nurses Association
support?
A) Committee planning for staffing
B) Mandated specific nurse-patient ratios
C) Public reporting of nurse-patient ratios
D) Nurse leadership assessment and determination of staffing
ANSWER: A
STRATEGIES TO PREVENT AND COPE WITH STRESS AND BURNOUT
Nurses' work schedules and appropriate staffing should be the highest priority for reducing
burnout. Defining "appropriate staffing" has been subject to debate, however. Some have
argued for specific patient-nurse ratios, while others have advocated for hospitals to establish
staffing committees, with nurses as members, charged with creating staffing plans that reflect
the specific needs of the institution . The ANA supports the committee approach
19 . Which of the following has been recommended by many nursing associations to address
fatigue?
A) Rotate shifts
B) Increase the number of on-call hours
C) Allow nurses to create their own schedules
D) Limit work shifts to 12 hours in a 24-hour period
Answer: D
STRATEGIES TO PREVENT AND COPE WITH STRESS AND BURNOUT
Institutions should also implement staffing policies that address nurse fatigue. In 2014, the
ANA revised its position statement on nurse fatigue and noted the following evidence-based
recommendations.
Employers should include nurse input when designing work schedules and implement a
"regular and predictable schedule" that allows nurses to plan for work and personal
obligations.
Nurses should work no more than 40 hours in a seven-day period and limit work shifts to 12
hours in a 24-hour period, including on-call hours worked.
Employers should stop using mandatory overtime as a "staffing solution."
Employers should encourage "frequent, uninterrupted rest breaks during work shifts."
Employers should adopt official policy that gives RNs the "right to accept or reject a work
assignment" to prevent risks from fatigue. The policy should be clear that rejecting an
assignment under these conditions is not patient abandonment and that RNs will not be
retaliated against or face negative consequences for rejecting such an assignment.
Employers should encourage nurses to be proactive about managing their health and rest,
including getting seven to nine hours of sleep per day; managing stress effectively; developing
healthy nutrition and exercise habits; and using naps according to employer policy.
20. The nurse -to- patient ratio in hospitals should be
A) 1:15
B) 1:12
C) 1 : 50
D) 1:5
Answer: A
The ideal nurse to patient ratio, according to thePhilippines Department of Health, is 1:12
Strict compliance to a safe nurse-patient ratio of 1:12 (DOH standards) must be ensured.

LEADERSHIP and Management

1. The nurse stresses the importance of promoting ‘esprit d corps’ among the members of the
unit. Which of the following remarks of the staff indicates that they understand what he pointed
out?
A. “Let’s work together in harmony; we need to be supportive of one another”
B. “In order that we achieve the same results; we must all follow the directives of Julius and not
from other managers.”
C. “We will ensure that all the resources we need are available when needed.”
D. “We need to put our efforts together in order to raise the bar of excellence in the care we
provide to all our patients.”
Answer: A
2. Which of the following is the most likely root cause of medication errors in health care
entities?
A. Carelessness of nurses
B. Illegible physician handwriting
C. Look-alike, sound-alike drugs
D. Systems failure
Answer: D
3. Each of the following is part of the hospital discharge process EXCEPT:
A. Assessment of the needs of a patient
B. Coordination of appropriate resources for a patient
C. Development of statistical profiling
D. Integration of the action of team members
Answer: C
4. Standard Operating Procedure (SOP) refers to:
A. An optimal balance between possibilities realized and a framework of norms and values.
B. Doing the right thing right, right away, the first time
C. Detailed, written instructions to achieve uniformity of the performance of a specific function.
D. A process of meeting the needs and expectations of the customers,both internal and
external
Answer: C
5. Who is associated with the concept of Total Quality Management?
A. Rensis Likert
B. Kurt Lewin
C. Max Weber
D. W. Edwards Deming
Answer Key: D
6. Which definition of quality of care represents the entire continuum from structure to process
and to outcome?
A. Deming's
B. WHO, 1988
C. Donabedian
D. Kurt Lewin
Answer Key: C
7. Plan-Do-Check -Act cycle is related to:
A. Donabedian
B. Deming
C. Henry Gantt
D. B.F. Skinner
Answer key: B
8. The acronym SWOT stands for
A.Special Weapons for Operations Timeliness
B.Services, Worldwide Optimization and Transport
C.Strengths, Weakness, Opportunities and Threats
D.None of the above
Answer: C
9. The two internal elements of SWOT analysis are
A.weaknesses and threats
B.opportunities and threats
C.strength and weaknesses
D.strengths and threats
Answer: C
10. The type of leadership with strict supervision and appropriate in cases of emergency
situation is
a. Autocratic b. democratic c. participative d. laize faire
Answer: A

O.A and R.A

The client diagnosed with OA is a resident in a long term care facility. The resident is refusing
to bathe because she is hurting. Which instruction should the nurse give the unlicensed
nursing assistant?
--c. Try to encourage the client to get up and go to the shower
The client has been diagnosed with OA for the last 7 years and has tried multiple medical
treatments and alternative treatments but still has significant joint pain. Which psychosocial
client problem would the nurse identify
--d. Depression
Which member of the health care team should the nurse refer the client diagnosed with OA
who is complaining of not being able to get in and out of the bathtub?
c. Physical therapist
The occupational health nurse is teaching a class on the risk factors for developing OA. Which
is a modifiable risk for developing OA?
a. Being overweight
The client is diagnosed with osteoarthritis. Which sign/symptom would the nurse expect the
client to exhibit?
b. Joint stiffness
Which client goal would be most appropriate for a client diagnosed with OA?
b. Maintain optimal functional ability
The client is complaining of joint stiffness, especially in the morning. Which diagnostic tests
would the nurse expect the HCP to order to R/O OA?
c. X-ray of the affected joints
The client diagnosed with OA is prescribed a NSAID. Which instruction should the nurse teach
the client?
d. Notify the HCP if vomiting blood
The HCP prescribes glucosamine and chondroitin for a client diagnosed with OA. What is the
scientific rationale for prescribing this medication?
b. It improves tissue function and may decrease breakdown of cartilage
The nurse is admitting the client with OA to the medical floor. Which statement by the client
indicates a complementary form of treatment for OA?
c. "I wear a copper bracelet to help with my OA"
The client diagnosed with RA is receiving care through a nurse practitioner clinic. Which
preventive care should the nurse include in the regularly scheduled clinic visits?
c. Recommend the flu and pneumonia vaccines
The nurse is assessing a client diagnosed with RA. Which assessment findings warrant
immediate intervention?
d. The client is crying, has a flat facial affect, and refuses to speak to the nurse
The client diagnosed with RA has developed swan-neck fingers. Which referral would be the
most appropriate for the client?
b. Occupational therapy
Which client problem is priority for a client diagnosed with RA?
c. Alteration in comfort
The nurse is caring for clients on a medical floor. Which client should the nurse assess first?
c. The client diagnosed with advanced RA who is receiving antineoplastic drugs IV
Which intervention has the highest priority when caring for a client diagnosed with RA?
d. Teach the client the proper use of hot and cold therapy to provide pain relief
Which psychosocial problem would be priority for a client diagnosed with RA?
d. Altered body image
The client with RA has nontender movable nodules in subcutaneous tissue over the elbows
and shoulders. Which statement is the best explanation for the nodules?
a. The nodules indicate a rapidly progressive destruction of the affected tissue

Situation: Appendicitis is inflammation of the vermiform appendix is a common cause of acute

abdominal pain. Most common reason for emergency abdominal surgery.
1. The health care team is assessing a patient for acute pancreatitis after he presented to the
emergency department with severe abdominal pain. Which laboratory value is the best
diagnostic indicator of acute pancreatitis?
A. Gastric pH
B. Blood glucose
C. Serum amylase and lipase
D. Serum potassium
Correct: C
Serum amylase levels indicate pancreatic function, and they are used to diagnose acute
pancreatitis. Blood glucose, gastric pH, and potassium levels are not direct indicators of acute
pancreatic dysfunction.
2. Which client requires immediate nursing intervention? "The client who:
a) complains of epigastric pain after eating.
b) complains of anorexia and periumbilical pain.
c) presents with ribbonlike stools.
d) presents with a rigid, boardlike abdomen.
Correct: D
A rigid, boardlike abdomen is a sign of peritonitis, a possibly life-threatening condition.
Epigastric pain occurring 90 minutes to 3 hours after eating indicates a duodenal ulcer.
Anorexia and periumbilical pain are characteristic of appendicitis. Risk of rupture is minimal
within the first 24 hours, but increases significantly after 48 hours. A client with a large-bowel
obstruction may have ribbonlike stools.
3. Which of the following complications is thought to be the most common cause of
appendicitis?
a. A fecalith
b. Internal bowel occlusion
c. Bowel kinking
d. Abdominal wall swelling"
Answer: A. A fecalith
Rationale: A fecalith is a hard piece of stool which is stone like that commonly obstructs the
lumen. Due to obstruction, inflammation and bacterial invasion can occur. Tumors or foreign
bodies may also cause obstruction."
4 .A client has surgery for a perforated appendix with localized peritonis. In which position
should the nurse place the client?
A) Sims position
B) trendelenburg
C) semi-fowlers
D)dorsal recumbant
C. Semi-fowlers aids in drainage and prevents spread of infection throughout the abodominal
cavity.
5. A client with acute appendicitis develops a fever, tachycardia, and hypotension. Based on
these assessment findings, the nurse should further assess the client for which of the following
complications?" "
A. Deficient fluid volume.
B. Intestinal obstruction.
C. Bowel ischemia.
D. Peritonitis.
Answer D
Complications of acute appendicitis are perforation, peritonitis, and abscess development.
Signs of the development of peritonitis include abdominal pain and distention, tachycardia,
tachypnea, nausea, vomiting, and fever. Because peritonitis can cause hypovolemic shock,
hypotension can develop. Deficient fluid volume would not cause a fever. Intestinal obstruction
would cause abdominal distention, diminished or absent bowel sounds, and abdominal paIn.
Bowel ischemia has signs and symptoms similar to those found with intestinal obstruction.