1.

Upon assessment, Leo was diagnosed to

Introduction have hepatitis A. Which mode of transmission has
the infection agent taken?
Various questions about Medical-Surgical Nursing
that are perfect for reviewing the wide nursing A. Fecal oral
concept. This 100-item examination will help you B. Droplet
practice for your upcoming NCLEX or NLE exams! C. Airborne
D. Sexual contact
Topics
2. Which of the following is concurrent disinfection
 Thoracentesis in the case of Leo?
 Seizure
 Choledocholithotomy A. Investigation of contact
 Pain Management B. Sanitary disposal of feces, urine and blood
 Diabetes Mellitus C. Quarantine of the sick individual
 Perioperative Nursing D. Remove all detachable objects in the room.
 Sterile Technique
 Autoclaving 3. Which of the following must be emphasized
 Perioperative Nursing during mother’s class to Leo’s mother?
 IV Care

A. Administration of immunoglobulin to families

Guidelines B. Thorough hand washing before and after eating
and toileting
 Read each question carefully and choose
C. Use of attenuated vaccines
the best answer.
D. Boiling of food especially meat
 You are given one minute per question.
Spend your time wisely!
4. Disaster control should be undertaken when
 Answers and rationales (if any) are given
there are 3 or more hepatitis A cases. Which of
below. Be sure to read them.
these measures is a priority?
 If you need more clarifications, please
direct them to the comments section.
A. Eliminate fecal contamination from foods
B. Mass vaccination of uninfected individuals
Situation 1: Leo lives in the squatter area. He goes
C. Health promotion and education to families and
to nearby school. He helps his mother gather
communities about the disease it’s cause and
molasses after school. One day, he was absent
transmission.
because of fever, malaise, anorexia and abdominal
D. Mass administration of immunoglobulin
discomfort.

5. What is the average incubation period

of Hepatitis A?
A. 30 days A. Sample
B. 60 days B. Instrument
C. 50 days C. Hypothesis
D. 14 days D. Concept

Situation 2: As a nurse researcher you must have a 10. The use of another persons ideas or wordings
very good understanding of the common terms of giving appropriate credit results from inaccurate
concept used in research. attribution of materials to its sources. Which of
the following is referred to when another persons
6. The information that an investigator collects idea is inappropriate credited as one’s own?
from the subjects or participants in a research
study is usually called: A. Plagiarism
B. Quotation
A. Hypothesis C. Assumption
B. Data D. Paraphrase
C. Variable
D. Concept Situation 3: Mrs. Pichay is admitted to your ward.
The MD ordered “Prepare for thoracentesis this pm
7. Which of the following usually refers to the to remove excess air from the pleural cavity.”
independent variables in doing research?
11. Which of the following nursing responsibilities
A. Result is essential in Mrs. Pichay who will undergo
B. Cause thoracentesis?
C. Output
D. Effect A. Support and reassure client during the procedure
B. Ensure that informed consent has been signed
8. The recipients of experimental treatment is an C. Determine if client has allergic reaction to local
experimental design or the individuals to be anesthesia
observed in a non experimental design are called: D. Ascertain if chest x-rays and other tests have
been prescribed and completed
A. Setting
B. Subjects 12. Mrs. Pichay who is for thoracentesis is assigned
C. Treatment by the nurse to which of the following positions?
D. Sample
A. Trendelenburg position
9. The device or techniques an investigator B. Supine position
employs to collect data is called? C. Dorsal Recumbent position
D. Orthopneic position
13. During thoracentesis, which of the following A. Ease the patient to the floor
nursing intervention will be most crucial? B. Lift the patient and put him on the bed
C. Insert a padded tongue depressor between his
A. Place patient in a quiet and cool room jaws
B. Maintain strict aseptic technique D. Restrain patient’s body movement
C. Advice patient to sit perfectly still during needle
insertion until it has been withdrawn from the chest 17. Mr. Santos is scheduled for CT SCAN for the
D. Apply pressure over the puncture site as soon as next day, noon time. Which of the following is the
the needle is withdrawn correct preparation as instructed by the nurse?

14. To prevent leakage of fluid in the thoracic A. Shampoo hair thoroughly to remove oil and dirt
cavity, how will you position the client after B. No special preparation is needed. Instruct the
thoracentesis? patient to keep his head still and stead.
C. Give a cleansing enema and give until 8 AM
A. Place flat in bed D. Shave scalp and securely attach electrodes to it
B. Turn on the unaffected side
C. Turn on the affected side 18. Mr. Santos is placed on seizure precaution.
D. On bed rest Which of the following would be contraindicated?

15. Chest x-ray was ordered after thoracentesis. A. Obtain his oral temperature
When your client asks what is the reason for B. Encourage to perform his own personal hygiene
another chest x-ray, you will explain: C. Allow him to wear his own clothing
D. Encourage him to be out of bed.
A. to rule out pneumothorax
B. to rule out any possible perforation 19. Usually, how does the patient behave after
C. to decongest his seizure has subsided?
D. to rule out any foreign body
A. Most comfortable walking and moving about.
Situation 4: A computer analyst, Mr. Ricardo J. B. Becomes restless and agitated.
Santos, 25 was brought to the hospital for C. Sleeps for a period of time
diagnostic workup after he had D. Say he is thirsty and hungry.
experienced seizure in his office.
20. Before, during and after seizure. The nurse
16.Just as nurse was entering the room, the knows that the patient is ALWAYS placed in what
patient who was sitting on his chair begins to have position?
a seizure. Which of the following must the nurse
do first? A. Low fowler’s
B. Modified trendelenburg
C. Side Lying 25. When a client complains of pain, your initial
D. Supine response is:

Situation 5: Mrs. Damian an immediate post A. Record the description of pain

op cholecystectomy and choledocholithotomy B. Verbally acknowledge the pain
patient, complained of severe pain at the wound C. Refer the complaint to the doctor
site. D. Change to a more comfortable position

21. Choledocholithotomy is: Situation 6: You are assigned at the surgical ward
and clients have been complaining of post pain at
A. The removal of the gallbladder varying degrees. Pain as you know is very
B. The removal of the stones in the gallbladder subjective.
C. The removal of the stones in the
common bile duct 26. A one-day postoperative
D. The removal of the stones in the kidney abdominal surgery client has been complaining of
severe throbbing abdominal pain described as 9 in
22. The simplest pain relieving technique is: 1 – 10 pain rating. Your assessment reveals bowel
sounds on all quadrants and the dressing is dry
A. Distraction and intact. What nursing intervention would you
B. Taking aspirin take?
C. Deep breathing exercise
D. Positioning A. Medicate client as prescribed
B. Encourage client to do-imagery
23. Which of the following statement on pain is C. Encourage deep breathing exercise
true? D. Call surgeon stat

A. Culture and pain are not associated 27. Pentoxide 5 mg IV every 8 hours was
B. Pain accomplished acute illness prescribed for post abdominal pain, which will be
C. Patient’s reaction to pain varies your priority nursing action?
D. Pain produces the same reaction such as
groaning and moaning A. Check abdominal dressing for possible swelling
B. Explain the proper use of PCA to alleviate anxiety
24. In a pain assessment, which of the following C. Avoid overdosing to prevent
condition is a more reliable indicator? dependence/tolerance
D. Monitor VS, more importantly RR
A. Pain rating scale of 1 – 10
B. Facial expression and gestures 28. The client complained of abdominal distention
C. Physiological responses and pain. Your nursing intervention that can
D. Patients description of the pain sensation alleviate pain is:
A. Instruct client to go to sleep and relax C. Older patients do not believe in analgesics, they
B. Advice the client to close the lips and avoid deep are tolerant.
breathing and talking D. Complaining of pain will lead to being labelled a
C. Offer hot and clear soup bad patient
D. Turn to sides frequently and avoid too much
talking 32. Nurses should understand that when a client
responds favourably to a placebo, it is known as
29. Surgical pain might be minimized by which the placebo effect. Placebos do not indicate
nursing action in the O.R. whether or not a client has:

A. Skill of surgical team and lesser manipulation A. Conscience

B. Appropriate preparation for the scheduled B. Real pain
procedure C. Disease
C. Use of modern technology in closing the wound D. Drug tolerance
D. Proper positioning and draping of client.
33. You are the nurse in the pain clinic where you
30. Inadequate anesthesia is said to be one of the have client who has difficulty specify the location
common cause of pain both in intra and post-op of pain. How can you assist such client?
patients. If general anesthesia is desired, it will
involve loss of consciousness. Which of the A. The pain is vague
following are the 2 general types of GA? B. By charting-it hurts all over
C. Identifying the absence and presence of pain
A. Epidural and Spinal D. Ask the client to point to the painful are by just
B. Subarachnoid block and intravenous one finger.
C. Inhalation and Regional
D. Intravenous and inhalation 34. What symptom more distressing than pain,
should the nurse monitor when giving opioids
Situation 7: Nurse’s attitudes toward the pain especially among elderly clients who are in pain?
influence the way they perceive and interact with
clients in pain. A. Forgetfulness
B. Constipation
31. Nurses should be aware of that older adults C. Drowsiness
are at risk of underrated pain. Nursing assessment D. Allergic reactions like pruritus
and management of pain should address the
following beliefs EXCEPT: 35. Physical dependence occurs in anyone who
takes opiods over a period of time. What do you
A. Older patients seldom tend to report pain than tell a mother of a ‘dependent’ when asked for
the younger ones advice?
B. Pain is a sign of weakness
A. Start another drug and slowly lessen the opioid 39. Jane was brought at the emergency room after
dosage four month because she fainted in her clinic. The
B. Indulge in recreational outdoor activities nurse should monitor which of the following test
C. Isolate opioid dependent to a restful resort to evaluate the overall therapeutic compliance of
D. Instruct slow tapering of the drug dosage and a diabetic patient?
alleviate physical withdrawal symptoms.
A. Glycosylated Hemoglobin
Situation 8: The nurse is performing health B. Fasting blood glucose
education activities for Jane Segovia, a 30 years old C. Ketone levels
Dentist with Insulin dependent diabetes Mellitus. D. Uirne glucose level

36. Jane is preparing a mixed dose of insulin. The 40. Upon the assessment of HbA1C of Mrs.
nurse is satisfied with her performance when she: Segovia. The nurse has been informed of a 9 %
HbA1C result. In this case, she will teach the
A. Draw insulin from the vial of clear insulin first patient to:
B. Draw insulin from the vial of the intermediate
acting insulin first A. Avoid infection
C. Fill both syringes with the prescribed insulin B. Take adequate food and nutrition
dosage then shake the bottle vigorously C. Prevent and recognize hypoglycaemia
D. Withdraw the intermediate acting insulin first D. Prevent and recognize hypoglycaemia
before withdrawing the short acting insulin first.
41. The nurse is teaching plan of care for Jane with
37. Jane complains of nausea, vomiting, regards to proper foot care. Which of the following
diaphoresis and headache. Which of the following should be included in the plan?
nursing intervention are you going to carry first?
A. Soak feet in hot water
A. Withhold the client’s next insulin injection B. Avoid using mild soap on the feet
B. Test the client’s blood glucose level C. Apply a moisturizing lotion to dry feet but not
C. Administer Tylenol as ordered between the toes
D. Offer fruit juice, gelatine and chicken bouillon D. Always have a podiatrist to cut your toe nails;
never cut them yourself
38. Jane administered regular insulin at 7 A.M. and
the nurse should instruct Jane to avoid exercising 42. Another patient was brought to the emergency
at around: room in an unresponsive state and a diagnosis of
hyperglycaemic hyperosmolar nonketotic
A. 9 to 11 A.M. syndrome is made. The nurse immediately prepare
B. After 8 hours to initiate which of the following anticipated
C. Between 8 A.M. to 9 A.M. physician’s order?
D. In the afternoon, after taking lunch.
A. Endotracheal intubation C. Advice to physician to reschedule to diagnostic
B. 100 units of insulin examination next day
C. Intravenous infusion of normal saline D. Continue as usual and have the FBS analysis
D. Intravenous infusion of sodium bicarbonate performed and specimen be taken.

43. Jane eventually developed DKA and is being Situation 9: Elderly clients usually produce unusual
treated in the emergency room. Which finding signs when it comes to different diseases. The
would the nurse expect to note as confirming this ageing process is a complicated process and the
diagnosis? nurse should understand that it is an inevitable fact
and she must be prepared to care for the growing
A. Comatose state elderly population.
B. Decreased urine output
C. Increased respiration and increase in pH 46. Hypoxia may occur in the older patients
D. Elevated blood glucose level and plasma because of which of the following physiologic
bicarbonate level changes associated with aging.

44. The nurse teaches Jane to know the difference A. Ineffective airway clearance
between hypoglycaemia and ketoacidosis. Jane B. Decreased alveolar surfaced area
demonstrates understanding of the teaching by C. Decreased anterior-posterior chest diameter
stating that glucose will be taken of which of the D. Hyperventilation
following symptoms develops?
47. The older patient is at higher risk
A. Heavy breathing for incontinence because of:
B. Shakiness
C. Blurred vision A. dilated urethra
D. Foul breath odor B. increased glomerular filtration rate
C. diuretic use
45. Jane has been scheduled to have a FBS taken in D. decreased bladder capacity
the morning. The nurse tells Jane to eat or drink
after midnight. Prior to taking the blood specimen, 48. Merle, age 86, is complaining of dizziness when
the nurse noticed that Jane is holding a bottle of she stands up. This may indicate:
distilled water. The nurse asked Jane if she drink
any, and she said yes. Which of the following is the A. dementia
best nursing action? B. a visual problem
C. functional decline
A. Administer syrup of ipecac to remove the D. drug toxicity
distilled water from the stomach.
B. Suction the stomach content using NGT prior to 49. Cardiac ischemia in an older patient usually
specimen collection produces:
A. ST-T wave changes care during the intraoperative phase. As the
B. Very high creatinine kinase level circulating nurse, you make certain that
C. Chest pain radiating to the left arm throughout the procedure:
D. Acute confusion
A. the surgeon greets his client before induction of
50. The most dependable sign of infection in the anesthesia
older patient is: B. the surgeon and anesthesiologist are in tandem
C. strap made of strong non-abrasive materials are
A. change in mental status fastened securely around the joints of the knees
B. fever and ankles and around the 2 hands around an arm
C. pain board.
D. decreased breath sounds with crackles D. Client is monitored throughout the surgery by
the assistant anaesthesiologist
Situation 10 – In the OR, there are safety protocols
that should be followed. The OR nurse should be 54. Another nursing check that should not be
well versed with all these to safeguard the safety missed before the induction of general anesthesia
and quality of patient delivery outcome. is:

51. Which of the following should be given highest A. check for presence underwear
priority when receiving patient in the OR? B. check for presence dentures
C. check patient’s ID
A. Assess level of consciousness D. check baseline vital signs
B. Verify patient identification and informed
consent 55. Some lifetime habits and hobbies affect
C. Assess vital signs postoperative respiratory function. If your
D. Check for jewelry, gown, manicure, and dentures client smokes 3 packs of cigarettes a day for the
past 10 years, you will anticipate increased
52. Surgeries like I and D (incision and drainage) risk for:
and debridement are relatively short procedures
but considered ‘dirty cases’. When are these A. perioperative anxiety and stress
procedures best scheduled? B. delayed coagulation time
C. delayed wound healing
A. Last case D. postoperative respiratory function
B. In between cases
C. According to availability of anaesthesiologist Situation 11: Sterilization is the process of removing
D. According to the surgeon’s preference ALL living microorganism. To be free of ALL living
microorganism is sterility.
53. OR nurses should be aware that maintaining
the client’s safety is the overall goal of nursing
56. There are 3 general types of sterilization use in D. That the items had undergone disinfection
the hospital which one is not included? process but not necessarily disinfected

A. Steam sterilization 60. If a nurse will sterilize a heat and moisture

B. Chemical sterilization labile instruments, it is according to AORN
C. Autoclaving recommendation to use which of the following
D. Sterilization by boiling method of sterilization?

57. Autoclave or steam steam under pressure is A. Ethylene oxide gas

the most common method of sterilization in the B. Autoclaving
hospital. The nurse knows that the temperature C. Flash sterilizer
and time is set to the optimum level to destroy not D. Alcohol immersion
only the microorganism, but also the spores.
Which of the following is the ideal setting of the Situation 12 – Nurses hold a variety of roles when
autoclave machine? providing care to a perioperative patient.

A. 10,000 degree Celsius for 1 hour 61. Which of the following role would be the
B. 5,000 degree Celsius for 30 minutes responsibility of the scrub nurse?
C. 37 degree Celsius for 15 minutes
D. 121 degree Celsius for 15 minutes A. Assess the readiness of the client prior to surgery
B. Ensure that the airway is adequate
58. It is important that before a nurse prepares the C. Account for the number of sponges, needles,
material to be sterilized. A chemical indicator strip supplies, used during the surgical procedure.
should be placed above the package, preferably, D. Evaluate the type of anesthesia appropriate for
Muslin sheet. What is the color of the striped the surgical client
produced after autoclaving?
62. As a perioperative nurse, how can you best
A. Black meet the safety need of the client after
B. Blue administering preoperative narcotic?
C. Gray
D. Purple A. Put side rails up and ask the client not to get out
of bed
59. Chemical indicators communicate that: B. Send the client to OR with the family
C. Allow client to get up to go to the comfort room
A. The items are sterile D. Obtain consent form
B. That the items had undergone sterilization
process but not necessarily sterile 63. It is the responsibility of the pre-op nurse to do
C. The items are disinfected skin prep for patients undergoing surgery. If hair at
the operative site is not shaved, what should be
done to make suturing easy and lessen chance of C. Infection control committee
incision infection? D. Pathology department

A. Draped 67. An air crash occurred near the hospital leading

B. Pulled to a surge of trauma patient. One of the last
C. Clipped patients will need surgical amputation but there
D. Shampooed are no sterile surgical equipments. In this case,
which of the following will the nurse expect?
64. It is also the nurse’s function to determine
when infection is developing in the surgical A. Equipments needed for surgery need not be
incision. The perioperative nurse should observe sterilized if this is an emergency necessitating life
for what signs of impending infection? saving measures
B. Forwarding the trauma client to the nearest
A. Localized heat and redness hospital that has available sterile equipment is
B. Serosanguinous exudates and skin blanching appropriate
C. Separation of the incision C. The nurse will need to sterilize the item before
D. Blood clots and scar tissue are visible using it to the client using the regular sterilization
setting at 121 degree Celsius in 15 minutes.
65. Which of the following nursing interventions is D. In such cases, flash sterilizer will be use at 132
done when examining the incision wound and degree Celsius in 3 minutes.
changing the dressing?
68. Tess, the PACU nurse discovered that Malou,
A. Observe the dressing and type and odor of who weighs 110 lbs prior to surgery, is in severe
drainage if any pain 8 hours after cholecystectomy. Upon checking
B. Get patient’s consent the chart, Malou found out that she has an order
C. Wash hands of Demerol 100 mg I.M. prn for pain. Tess should
D. Request the client to expose the incision wound verify the order with:

Situation 13: The preoperative nurse collaborates A. Nurse supervisor

with the client significant others, and healthcare B. Anesthesiologist
providers. C. Surgeon
D. Intern on duty
66. To control environmental hazards in the OR,
the nurse collaborates with the following 69. Rosie, 57, who is diabetic is for debridement if
departments EXCEPT: incision wound. When the circulating nurse
checked the present IV fluid, she found out that
A. Biomedical division there is no insulin incorporated as ordered. What
B. Chaplaincy services should the circulating nurse do?
A. Double check the doctor’s order and call the A. Instrument technician and circulating nurse
attending MD B. Nurse anesthetist, nurse assistant, and
B. Communicate with the ward nurse to verify if instrument technician
insulin was incorporated or not C. Scrub nurse and nurse anesthetist
C. Communicate with the client to verify if insulin D. Scrub and circulating nurses
was incorporated
D. Incorporate insulin as ordered 73. While team effort is needed in the OR for
efficient and quality patient care delivery, we
70. The documentation of all nursing activities should limit the number of people in the room for
performed is legally and professionally vital. infection control. Who comprise this team?
Which of the following should NOT be included in
the patients chart? A. Surgeon, anesthesiologist, scrub nurse,
radiologist, orderly
A. Presence of prosthetic devices such as dentures, B. Surgeon, assistants, scrub nurse, circulating
artificial limbs hearing aid, etc. nurse, anesthesiologist
B. Baseline physical, emotional, and psychosocial C. Surgeon, assistant surgeon, anesthesiologist,
data scrub nurse, pathologist
C. Arguments between nurses and residents D. Surgeon, assistant surgeon, anesthesiologist,
regarding treatment intern, scrub nurse
D. Observed untoward signs and symptoms and
interventions including contaminant intervening 74. Who usually act as an important part of the OR
factors. personnel by getting the wheelchair or stretcher,
and pushing/pulling them towards the operating
Situation 14 – Team efforts is best demonstrated in room?
the OR.
A. Orderly/clerk
71. If you are the nurse in charge for scheduling B. Nurse Supervisor
surgical cases, what important information do you C. Circulating Nurse
need to ask the surgeon? D. Anesthesiologist

A. Who is your internist? 75. The breakdown in teamwork is often times a

B. Who is your assistant and anesthesiologist, and failure in:
what is your preferred time and type of surgery?
C. Who are your anesthesiologist, internist, and A. Electricity
assistant? B. Inadequate supply
D. Who is your anesthesiologist? C. Leg work
D. Communication
72. In the OR, the nursing tandem for
every surgery is:
Situation 15: Basic knowledge on Intravenous C. Infiltration
solutions is necessary for care of clients with D. Thrombophlebitis
problems with fluids and electrolytes.
79. A nurse reviews the
76. A client involved in a motor vehicle crash client’s electrolytes laboratory report and notes
presents to the emergency department with that the potassium level is 3.2 mEq/L. Which of the
severe internal bleeding. The client is severely following would the nurse note on the
hypotensive and unresponsive. The nurse electrocardiogram as a result of the laboratory
anticipates which of the following intravenous value?
solutions will most likely be prescribed to increase
intravascular volume, replace immediate blood A. U waves
loss and increase blood pressure? B. P waves
C. Elevated T waves
A. 0.45 % sodium chloride D. Elevated ST segment
B. Normal saline solution
C. o.33% sodium chloride 80. One patient has a runaway IV of 50 % dextrose.
D. Lactated ringer’s solution To prevent temporary excess of insulin or
transient hyperinsulin reaction what solution you
77. The physician orders the nurse to prepare an prepare in anticipation of the doctor’s order?
isotonic solution. Which of the following IV
solution would the nurse expect the intern to A. Any IV solution available to KVO
prescribe? B. Isotonic solution
C. Hypertonic solution
A. 5 % dextrose in water D. Hypotonic solution
B. 10 % dextrose in water
C. 0.45 % sodium chloride 81. An informed consent is required for:
D. 0.5 % dextrose in 0.9% sodium chloride
A. Closed reduction of a fracture
78. The nurse is making initial rounds on the B. Insertion of intravenous catheter
nursing unit to assess the condition or assigned C. Irrigation of the external ear canal
clients. The nurse notes that the client’s IV site is D. Urethral catheterization
cool, pale and swollen and the solution is not
infusing. The nurse concludes that which of the 82. Which of the following is not true with regards
following complications has been experienced by to the informed consent?
the client?
A. It should describe different treatment
A. Infection alternatives
B. Phlebitis B. It should contain a thorough and detailed
explanation of the procedure to be done
C. It should describe the client’s diagnosis 86. As an OR nurse, what are your foremost
D. It should given an explanation of the client’s considerations for selecting chemical agents for
prognosis disinfection?

83. You know that the hallmark of nursing A. Material compatibility and efficiency
accountability is the: B. Odor and availability/
C. Cost and duration of disinfection process
A. Accurate documentation and reporting D. Duration of disinfection and efficiency
B. Admitting your mistakes
C. Filing an incidence report 87. Before you used disinfected instrument it is
D. Reporting a medication error essential that you:

84. A nurse is assigned to care for a group of A. Rinse with tap water followed by alcohol
clients. On review of the client’s medical records B. Wipe the instrument with sterile water
the nurse determines that which client is at risk C. Dry the instrument thoroughly
for excess fluid volume? D. Rinse with sterile water

A. The client taking diuretics 88. You have a critical heat labile instrument to
B. The client with renal failure sterilize and are considering to use high level of
C. The client with an ileostomy disinfectant. What should you do?
D. The client who requires gastrointestinal
suctioning A. Cover the soaking vessel to contain the vapour
B. Double the amount of high level of disinfectant
85. A nurse is assigned to care for a group of C. Test the potency of the high level of disinfectant
clients. On review of the client’s medical records, D. Prolong the exposure time according to
the nurse determines that which client is at risk manufacturer’s direction
for deficient fluid volume?
89. To achieve sterilization using disinfectants,
A. A client with colostomy which of the following is used?
B. A client with congestive heart failure
C. A client with decreased kidney function A. Low level disinfectants immersion in 24 hours
D. A client receiving frequent wound irrigation B. Intermediate level disinfectants immersion in 12
hours
Situation 16: As a perioperative nurse, you are C. High level disinfectants immersion in 1 hour
aware of the correct processing methods for D. High level disinfectants immersion in 10 hours
preparing instruments and other devices for patient
use to prevent infection. 90. Bronchoscope, Thermometer, Endoscope, ET
tube, Cystoscope are all BEST sterilized using
which of the following?
A. Autoclaving at 121 degree Celsius in 15 minutes C. Kept in narcotic cabinet
B. Flash sterilizer at 132 degree Celsius in 3 minutes D. Store in the freezer
C. Ethylene Oxide gas aeration for 20 hours
D. 2% Glutaraldehyde immersion for 10 hours 95. Insulin using insulin syringe are given using
how many degrees of needle insertion?
Situation 17: The OR is divided in three zones to
control traffic flow and contamination. A. 45
B. 180
91. What OR attires are worn in the restricted C. 90
area? D. 15

A. Scrub suit, OR shoes, head cap Situation 18: Maintenance of sterility is an

B. Head cap scrub suit, mask, OR shoes important function a nurse should perform in any
C. Mask, OR shoes, scrub suit OR setting.
D. Cap, Mask, gloves, shoes
96. Which of the following is true with regards to
92. Nursing intervention for a patient on low dose sterility?
IV insulin therapy includes the following EXCEPT:
A. Sterility is time related items are not considered
A. Elevation of serum ketones to monitor ketosis sterile after a period of 30 days of being not in use.
B. Vital signs including BP B. for 9 months sterile items are considered sterile
C. Estimate serum potassium as long as they are covered with sterile muslin
D. Elevation of blood glucose levels cover and stored in a dust proof covers.
C. Sterility is event related, not time related.
93. The doctor ordered to incorporate 1000 “u” D. For 3 weeks, items double covered with muslin
insulin to the remaining ongoing IV. The strength is are considered sterile as long as they have
500/ml. How much should you incorporate into undergone the sterilization process
the IV solution?
97. Two (2) organizations endorsed that sterility
A. 10 ml are affected by factors other that the time itself,
B. 2 ml these are:
C. 0.5 ml
D. 5 ml A. The PNA and the PRC
B. AORN and JCAHO
94. Multiple vial-dose-insulin when in use should C. ORNAP and MCNAP
be: D. MMDA and DILG

A. Kept at room temperature 98. All of these factors affect the sterility of the OR
B. Kept in the refrigerator equipment, these are the following except:
A. The material used for packaging 2. B. Sanitary disposal of feces, urine and
B. The handling of the materials as well as its blood
transport 3. B. Thorough hand washing before and
C. Storage after eating and toileting
D. The chemical or process used in sterilizing the 4. C. Health promotion and education to
material families and communities about the
disease it’s cause and transmission.
99. When you say sterile, it means: 5. A. 30 days
6. B. Data
A. The material is clean. 7. B. Cause
B. The material as well as the equipments are 8. A. Setting
sterilized and had undergone a rigorous sterilization 9. B. Instrument
process 10. A. Plagiarism
C. There is a black stripe on the paper indicator 11. D. Ascertain if chest x-rays and other
D. The material has no microorganism nor spores tests have been prescribed and
present that might cause an infection completed
12. D. Orthopneic position
100. In using liquid sterilizer or autoclave machine, 13. C. Advise patient to sit perfectly still
which of the following is true? during needle insertion until it has been
withdrawn from the chest
A. Autoclave is better in sterilizing OR supplies 14. A. Place flat in bed
versus liquid sterilizer 15. A. to rule out pneumothorax
B. They are both capable of sterilizing the 16. A. Ease the patient to the floor
equipments, however, it is necessary to soak 17. B. No special preparation is needed.
supplies in the liquid sterilizer for a longer period of Instruct the patient to keep his head still
time. and steady.
C. Sharps are sterilized using autoclave and not 18. A. Obtain his oral temperature
cidex. 19. C. Sleeps for a period of time
D. If liquid sterilizer sterilization process is used, 20. C. Side Lying
rinsing it before using is not necessary. 21. C. The removal of the stones in the
common bile duct
Answers 22. D. Positioning
23. C. Patient’s reaction to pain varies
Here are the answers for the exam. Unfortunately, 24. D. Patients description of the pain
rationales are not given. If you need clarifications or sensation
disputes, please direct them to the comments 25. B. Verbally acknowledge the pain
section and we’ll be glad to give you an explanation. 26. A. Medicate client as prescribed
27. D. Monitor VS, more importantly RR
1. A. Fecal oral
28. D. Turn to sides frequently and avoid too the joints of the knees and ankles and
much talking around the 2 hands around an arm
29. B. Appropriate preparation for the board.
scheduled procedure 54. D. check baseline vital signs
30. D. Intravenous and inhalation 55. D. postoperative respiratory function
31. C. Older patients do not believe in 56. D. Sterilization by boiling
analgesics, they are tolerant. 57. D. 121 degree Celsius for 15 minutes
32. B. Real pain 58. A. Black
33. D. Ask the client to point to the painful 59. B. That the items had undergone
are by just one finger. sterilization process but not necessarily
34. D. Allergic reactions like pruritus sterile
35. D. Instruct slow tapering of the drug 60. A. Ethylene oxide gas
dosage and alleviate physical withdrawal 61. C. Account for the number of sponges,
symptoms. needles, supplies, used during the
36. A. Draw insulin from the vial of clear surgical procedure.
insulin first 62. A. Put side rails up and ask the client not
37. B. Test the client’s blood glucose level to get out of bed
38. A. 9 to 11 A.M. 63. C. Clipped
39. A. Glycosylated Hemoglobin 64. A. Localized heat and redness
40. C. Prevent and recognize hypoglycaemia 65. A. Observe the dressing and type and
41. C. Apply a moisturizing lotion to dry feet odor of drainage if any
but not between the toes 66. B. Chaplaincy services
42. C. Intravenous infusion of normal saline 67. D. In such cases, flash sterilizer will be
43. D. Elevated blood glucose level and use at 132 degree Celsius in 3 minutes.
plasma bicarbonate level 68. C. Surgeon
44. B. Shakiness 69. A. Double check the doctor’s order and
45. D. Continue as usual and have the FBS call the attending MD
analysis performed and specimen be 70. C. Arguments between nurses and
taken. residents regarding treatment
46. B. Decreased alveolar surfaced area 71. B. Who is your assistant and
47. D. decreased bladder capacity anesthesiologist, and what is your
48. C. functional decline preferred time and type of surgery?
49. D. Acute confusion 72. D. Scrub and circulating nurses
50. A. change in mental status 73. B. Surgeon, assistants, scrub nurse,
51. B. Verify patient identification and circulating nurse, anesthesiologist
informed consent 74. A. Orderly/clerk
52. A. Last case 75. D. Communication
53. C. strap made of strong non-abrasive 76. D. Lactated ringer’s solution
materials are fastened securely around 77. A. 5 % dextrose in water
78. C. Infiltration
79. A. U waves
80. C. Hypertonic solution
81. A. Closed reduction of a fracture
82. B. It should contain a thorough and
detailed explanation of the procedure to
be done
83. A. Accurate documentation and
reporting
84. B. The client with renal failure
85. A. A client with colostomy
86. A. Material compatibility and efficiency
87. D. Rinse with sterile water
88. D. Prolong the exposure time according
to manufacturer’s direction
89. D. High level disinfectants immersion in
10 hours
90. D. 2% Glutaraldehyde immersion for 10
hours
91. B. Head cap scrub suit, mask, OR shoes
92. A. Elevation of serum ketones to
monitor ketosis
93. B. 2 ml
94. A. Kept at room temperature
95. A. 45
96. C. Sterility is event related, not time
related.
97. B. AORN and JCAHO
98. D. The chemical or process used in
sterilizing the material
99. D. The material has no microorganism
nor spores present that might cause an
infection
100. B. They are both capable of
sterilizing the equipment, however, it is
necessary to soak supplies in the liquid
sterilizer for a longer period of time.