Nokea
Which of the following statement best describe battery?
- A. Failure to meet the standard of care
- B. An intentional threat
- C. Touching the client without consent
- D. Causes emotional harm
Correct Answer: C
Rationale: Battery is touching without consent (C), per law e.g., unpermitted procedure. Standards (A) is malpractice, threat (B) assault, emotional harm (D) not key. C best defines battery's physical breach, making it correct.
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The nurse is caring for a client who sustained a traumatic brain injury. Which intervention should the nurse perform to prevent an increase in intracranial pressure (ICP)?
- A. Suction the client every hour
- B. Maintain the head of the bed at 30 degrees
- C. Encourage the client to cough frequently
- D. Administer a bolus of intravenous fluids
Correct Answer: B
Rationale: Maintaining HOB at 30 degrees (B) reduces ICP by aiding venous drainage. Hourly suctioning (A) or coughing (C) raises ICP. Fluid bolus (D) may worsen it. B is correct. Rationale: Elevation optimizes cerebral perfusion pressure while minimizing ICP, per brain injury care standards, unlike actions that increase intrathoracic pressure.
An 8.5 lb, 6 oz infant is delivered to a diabetic mother. Which nursing intervention would be implemented when the neonate becomes jittery and lethargic?
- A. Administer insulin
- B. Administer oxygen
- C. Feed the infant glucose water (10%)
- D. Place infant in a warmer
Correct Answer: C
Rationale: Jitteriness and lethargy suggest hypoglycemia, common in infants of diabetic mothers; glucose water corrects this.
The nurse ensured Mr. Gary's bed rails were up. This is an example of?
- A. Patient safety
- B. Collaboration
- C. Health promotion
- D. Nursing informatics
Correct Answer: A
Rationale: Ensuring bed rails up is patient safety (A) harm prevention, per definition. Collaboration (B) teams, promotion (C) well-being, informatics (D) tech not safety-specific. A fits protective action, making it correct.
A staff nurse who is promoted to assistant nurse manager may feel uncomfortable initially when supervising her former peers. She can best decrease this discomfort by:
- A. Writing down all assignments
- B. Making changes after evaluating the situation and having discussions with the staff
- C. Telling the staff nurses that she is making changes to benefit their performance
- D. Evaluating the clinical performance of each staff nurse in a private conference
Correct Answer: B
Rationale: Evaluating and discussing changes eases transition and builds trust.
Which of the following provides that nurses must be a member of a national nurse organization?
- A. R.A 877
- B. 1981 Code of ethics approved by the house of delegates
- C. R.A 7164
- D. PNA memorandum no. 22 series of 1922
Correct Answer: B
Rationale: The 1981 Philippine Nursing Code of Ethics, approved by delegates, mandates membership in a national organization (PNA) e.g., ensuring ethical accountability. R.A. 877 (old law), R.A. 7164 (1991 law), and PNA memos differ. This reflects nursing's collective responsibility, reinforcing professional unity and standards.