Cedrik Feder A. Principe | Section D Remedial Exam SCIONS 1.

) D: Set Limits on aggressive behavior Behavior therapy can be a powerful treatment tool for helping clients change undesirable behaviors. In the treatment setting, the health-care provider can use praise and other positive reinforcements to help the client with schizophrenia reduce the frequency of maladaptive or deviant behaviors. A limitation of this type of therapy is the inability of some individuals with schizophrenia to generalize what they have learned from the treatment setting to the community setting. . (Townsend, 2011, p. 339)

7.) D: 3,4,5 - An overnight dexamethasone suppression test is the most widely used and most sensitive screening test for diagnosis of pituitary and adrenal causes of Cushings syndrome. Nighttime salivary cortisol levels show promise in screening for Cushings syndrome (Gross, Mindea, Pick, et al., 2007). Other diagnostic studies include a 24-hour urinary free cortisol level and a lowdose dexamethasone suppression test. (Brunner & Suddarth, p.1281) 8.) D: Risk for Infection - The patient should avoid unnecessary exposure to others with infections. The nurse frequently assesses the patient for subtle signs of infection, because the antiinflammatory effects of corticosteroids may mask the common signs of inflammation and infection. (Brunner & Suddarth, p.1283) 9.) A: Fluid Volume Excess - In advanced stages of cirrhosis, arteriolar vasodilation causes underfilling of systemic arterial vascular space. This event, through a decrease in effective blood volume leads to a drop in arterial pressure. Consequently, baroreceptormediated activation of renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system (SNS) and nonosmotic release of antidiuretic hormone (ADH) occur to restore the normal blood homeostasis.These cause more renal sodium and water retention. (Kashani, Landaverde & Medici; 2007) 10.) D: Ask client to extend arms - asterixis: involuntary flapping movements of the hands associated with metabolic liver dysfunction. 11.) A: Low Protein Diet - Protein intake is moderately restricted in patients who are comatose or who have encephalopathy that is refractory to lactulose and antibiotic therapy (Chart 39-5). Long-term restriction of dietary protein to less than 1 g/kg daily should be avoided. If animal protein precipitates encephalopathy, vegetable or dairy proteins may be used as most patients can tolerate a diet of vegetable protein up to 120 g/day (Hauser, et al., 2006). Brunner and Suddarth, p.1136) 12.) C: Lactulose Lactulose (Cephulac) is administered to reduce serum ammonia levels. It acts by several mechanisms that promote the excretion of ammonia in the stool. (Brunner and Suddarth, p.1135) 13.) B: Go on with the infants Immunization Fever, malnutrition, mild respiratory infections, diarrhea and vomiting are not contraindications of vaccination.(Layug;2009:p.313) 14.) B: Sit Up - it is more common for a 6-monthold child to have only a limited ability to sit independently. Six-month-old children often sit with their legs spread and their arms stiffened between them, hands on the

2.) D: Transference - occurs when the client unconsciously attributes (or transfers) to the nurse feelings and behavioral predispositions formed toward a person from his or her past (Sadock & Sadock, 2007). P. 112 3.) D: Inability to remain focused - In this most intense state of anxiety, the individual is unable to focus on even one detail within the environment. Panic anxiety. is associated with a feeling of terror, and individuals may be convinced that they have a life-threatening illness or fear that they are going crazy, are losing control, or are emotionally weak (APA, 2000). 4.) C: Orientation Phase - During the orientation phase, the nurse and client become acquainted. Tasks include: Establishing a contract for intervention that details the expectations and responsibilities of both the nurse and client. . (Townsend, 2011, p. 171)

5.) D: I do not hear the voices - If the patient has auditory hallucinations, explore the content of the hallucinations (what voices are saying to him, whether he thinks he must do what they command) tell him you dont hear voices, but you know theyre real to him. (Townsend, 2011, p. 317) 6.) C: 1 & 4 - When overproduction of the adrenal cortical hormone occurs, arrest of growth, obesity, and musculoskeletal changes occur along with glucose intolerance. The classic picture of Cushings syndrome in the adult is that of central-type obesity, with a fatty buffalo hump in the neck and supraclavicular areas, a heavy trunk, and relatively thin extremities. The skin is thin, fragile, and easily traumatized; ecchymoses (bruises) and striae develop. (Brunner & Suddarth, p.1281)

floor, as a prop. Infants are capable of movement by hitching or sliding backward from this position. (Pillitteri, p. 814) 15.) C: Backyard Herbal Gardening - According to Natural Science Development Board, backyard Gardening is effective in the Philippines due to increasing demand and prices of prescription Drugs. (Public Health Nursing in the Philippines, 2008, p. 324)

23.) B: Action Componen of the Nursing Process Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization and in preparation for discharge needs to be assured. Care is documented in the patients record. . (Taylor,Lillis, LeMone & Lynn, p.119)

24.) D: Have you ever had a transfusion before? Assess the patients knowledge of the transfusion process: Adults learnbest when teaching builds on knowledge or experience.(Gulanick: p.252) 25.) B: Expiration Date - RBCs deteriorate and lose their effectiveness after 2 hours at room temperature. (Brunner and Suddarth, p.1556) 26.) B: 0.9% NaCl - Only isotonic saline (0.9%) is recommended for use with blood components. Other commonly used intravenous solutions will cause varying degrees of difficulty when mixed with red cells. For example, 5% dextrose in water will hemolyze red cells. Intravenous solutions containing calcium, such as Lactated Ringer's solution, can cause clots to form in blood.(http://www.pathology.med.umich.edu/bloodban k/manual/bbch_6/index.html)

16.) B: 10 minutes on each breast - Let your baby finish nursing on one breast before switching to other. This will typically take between ten and 20 minutes. Breastfeeding your baby longer than 20 minutes (depends on the mothers physical tolerance level) may cause the muscles and tissue to tire out from continuous sucking of your baby causing you to have swollen breasts. (Pillitteri, p. 422) 17.) C: Palpate for Distention - With an epidural block, a woman loses sensation of her bladder filling. Remind her to void every 2 hours, monitor intake and output, and observe and palpate for bladder distention to avoid overfilling. (Pillitteri:2010: p. 406) 18) C: Oxytocin - Oxytocin acts to constrict milk gland cells and push milk forward into the ducts that lead to the nipple. (Pillitteri;2010: p. 99) 19.) A: Determine the Fundus - Perform first maneuver: Stand at the foot of the client, facing her, and place both hands flat on her abdomen. Palpate the Superior surface of the fundus. (Pillitteri: 2010: p. 369) 20.) D: Between Symphisis Pubis and Umbilicus At about 12 to 14 weeks of pregnancy, the uterus becomes palpable as a firm globular sphere over the symphysis pubis. It reaches the umbilicus at 20 to 22 weeks and the xiphoid process at 36 weeks, and then often returns to about 4 cm below the xiphoid because of lightening at 40 weeks. (Pillitteri;2010: p. 258) 21.) A: Evaluation - The nurse evaluates the patients progress toward attainment of outcomes. ( Taylor,Lillis, LeMone & Lynn, p.119) 22.) C: Nursing Diagnosis - Alfaro-LeFevre (2010) counsels nurses to understand the types of problems they should focus on to better understand their responsibilities relating to diagnosis and management of health problems. She lists the following as the types of concerns that are clearly nursing responsibilities (2010, p. 95): . ( Taylor,Lillis, LeMone & Lynn, p.243

27.) D: Rash, Itchiness, Chills - Immune-mediated transfusion reactions occur when incompatible blood products are transfused into a patient's circulation, triggering a response from the patient's immune system. The symptoms produced by these transfusion reactions are often similar, beginning with chills, fever, shaking, and aching. Some transfusion reactions are mild and resolve by themselves (e.g., FNHTR) whereas others can develop into a life-threatening reaction. (http://www.pathology.med.umich.edu/bloodbank/man ual/bbch_7/)

28.) A: Nursing Kardex - trademark for a card-filing system that allows quick reference to the particular needs of each patient for certain aspects of nursing care. Included on the card may be a schedule of medications, level of activity allowed, ability to perform basic self-care, diet, any special problems, a schedule of treatments and procedures, and a care plan. The Kardex is updated as necessary and is usually kept at the nurses' station.(http://medicaldictionary.thefreedictionary.com/Kardex)

29.) D:Nursing health history and assessment worksheet. - The nursing admission assessment form records ur nursing observations, the patient's

health history and ur p.e findings. (Lippincott, Williams & Wilkins: p.147) 30.) A: Nursing Kardex - A nursing Kardex "refers to teh kardex during change of shift reportsand throughout the day. The info includes pts. name,age,marital status, religion, medical diagnoses,allergies and doctors order. (Springhouse: p.107) 31.) C: Determining how planned absences, such as vacation time will be scheduled, so that all staff are treated fairly - Effective management makes the organization function, and the nursing manager has a responsibility of nursing care delivery systems that demonstrate ways of organizing nursings work. Within these systems there are advantages and disadvantages for quality of care, use of resources, and staff growth. (Cherie & Gebrekidan, 2005, p.38) 32.) C: Scheduling staff assignments for the next month - As nurse managers learn to accept the principle of delegation, they become more productive and come to enjoy relationships with the staff. The following list suggests ways for nurse managers to successfully delegate. Control and coordinate the work of subordinates, but do not go over their shoulders. To prevent errors, develop ways of measuring the accomplishment of objectives with communication, standards, measurements, feedback and credit.(Cherie & Gebrekidan, 2005, p.63) 33.) A:Work with the doctors and nurses in the hospital and outpatient department to evaluate currentclient education practices and revise as needed. - Decision making-is a choice made between two or more alternatives. It is choosing the best alternative to reach the predetermined objective. Thus decisionmaking is a process of identifying and selecting a course of action to solve specific problem. .(Cherie & Gebrekidan, 2005, p.71) 34.) D: Respiratory Alkalosis - A ventilation perfusion abnormality results in hypoxemia. There is a reduced PaO2 and initial respiratory alkalosis, with a decreased PaCO2 and an increased pH. (Brunner and Suddarth, p.630) 35.) C: Metabolic Acidosis - A low partial pressure of carbon dioxide (PCO2; 10 to 30 mm Hg) reflects respiratory compensation (Kussmaul respirations) for the metabolic acidosis. . (Brunner and Suddarth, p.1226) 36.) B: Adventitious Breath Sounds - An abnormal condition that affects the bronchial tree and alveoli may produce adventitious (additional) sounds. (Brunner and Suddarth, p.504)

37.) D: 2,3,4 - A hyperosmotic agent (mannitol) and a diuretic agent such as furosemide (Lasix) may be administered IV immediately before and sometimes during surgery if the patient tends to retain fluid, as do many who have intracranial dysfunction. (Brunner and Suddarth, p.1875) 38.) B: 1, 2, 3 Maintaining the airway & Monitoring Fluid and Electrolyte Balance Maintaining the unconscious patient in a position that facilitates drainage of oral secretions, with the head of the bed elevated about 30 degrees to decrease intracranial venous pressure (Bader, 2006b) Establishing effective suctioning procedures (pulmonary secretions produce coughing and straining, which increase ICP) Guarding against aspiration . (Brunner and Suddarth, p.1928) 39.) B: 1, 2. 3, 4 Many factors can increase your risk of a stroke. A number of these factors can also increase your chances of having a heart attack (http://www.mayoclinic.com/health/stroke/DS00150/D SECTION=risk-factors) 40.) B:Elevate head of bed at 40 to 40 degrees as prescribed, avoid flexion of neck and hips. -If signs and symptoms of increased ICP occur, efforts to decrease the ICP are initiated: alignment of the head in a neutral position without flexion to promote venous drainage, elevation of the head of the bed to 30 degrees (when prescribed), administration of mannitol (an osmotic diuretic), and possible administration of pharmacologic paralyzing agents. (Brunner and Suddarth, p.1878) 41.) D: Pupillary Changes - The nurse assesses for and immediately reports any of the following early signs or symptoms of increasing ICP: Pupillary changes and impaired extraocular movements; these occur as the increasing pressure displaces the brain against the oculomotor and optic nerves (cranial nerves II, III, IV, and VI), which arise from the midbrain and brain stem. (Brunner and Suddarth, p.1873)

42.) A: 1,2,3 - Behavioural symptoms are those things the survivor does, expresses or feels that are generally visible to others. This includes observable reactions, patterns of behaviour, lifestyle changes and changes in relationships. (http://rapecrisis.org.za/information-for-survivors/rapetrauma-syndrome/) 43.) B: 2, 3, 4 2, 3 and 4 are included because pregnancy and STDs are the issues here. Taking note of dates of ALL sexual intercourse would be unnecessary. (Videbeck; 2011: P.192)

44.) D:Tell me what it is about the incident that causes you to feel like the rape has just happened. - Letters A, B and C are non-therapeutic. A is disagreeing, B is reassuring and C is interpreting while on the other hand D is on way of encouraging the client to talk about her experience(s). Retelling the experience can help the client to identify the reality of what has happened and help to identify and work through related feelings. (Videbeck; 2011: P.105-106) 45.) A: Normal Reactions to Devastating Event Being withdrawn, confused, and at times physical immobile are normal reactions of the patients immediately after a rape. (Rape Crisis Organization. (2013). Rape Trauma Syndrome. Retrieved October 26, 2013, from Rape Crisis Cape Town Trust: http://rapecrisis.org.za/information-for-survivors/rapetrauma-syndrome/) 46.) D: Evidence that the Client is at High Risk for Suicide. - A person may or may not resolve feelings of fear and anxiety for a short period of time. When a persons habitual coping ability becomes ineffective to meet the demands of a situation, a crisis may occur and it may take four to six weeks (but may vary widely) before it can be resolve. A Post Traumatic Stress Disorder may occur 3 months or more after the trauma. (Videbeck; 2011: P.194) 47.) A: Check when the last pain med was give. Administrativen Decision: made by senior management, which have significant impact throughout the organization. Usually this type of decision is concerned with policy, resource allocation and utilization. 48.) D: d. A client receiving oxygen via nasal cannula who had difficulty of breathing during the previous shift. FIRST LEVEL PRORITY: Airway problems; breathing problems; cardiac and circulation problems; Signs (vital signs concerns) (Brunner and Suddarth, p.645) 49.) D: A client who has fever and is diaphoretic and restless. - patients with unstable condition should be given highest priority by the nurse. The client who has fever, and who is diaphoretic and restless is with unstable condition. . (Cherie & Gebrekidan, 2005, p.74) 50.) A:Nursing personnel are led by an RN leader in providing care to a group of clients - In team nursing, nursing personnel are led by a registered nurse leader in providing care to a group of clients. Option A identifies functional nursing. Option B identifies a component of case management. Option D identifies primary nursing. (Cherie & Gebrekidan, 2005, p.67)

51.) A: A client with a Leg Ulcer is demonstrating signs of wound healing. - Controlling Is the regulation of activities in accordance with the plan. Controlling is a function of all managers at all levels. Its basic objective is to ensure that the task to be accomplished is appropriately executed. (Cherie & Gebrekidan, 2005, p.69) 52.) D: 1,2,3,4,5,6 - Alcohol, stress triggers seizure. The nurse should ofcourse tell the importance of lifelong medication intake so client will take it faithfully to keep the drug level constant. The patient should never discontinue medications, even if there is no seizure activity. Also, antisezure medication serum levels should be checked regularly. Nurse should also teach client to develop regular sleep patterns to minimize fatigue. Lastly, the client should have a contact with the community resources for help, guidance and protection as well. (Bare, Cheever, Hinkle & Smeltzer: p. 1888) 53.) D: 1,3,4 - A leadership function is to arouse, excite, or influence another person to behave in some role or perform some action the person would not ordinarily do. . (Cherie & Gebrekidan, 2005, p.102) 54.) D: the individual rejects proposed new ideas without crtically thinking about the proposal. Management should educate employees about upcoming changes before they occur. It should communicatenot only the nature of the change but its logic. The process include one-on-one discussions, presentations to groups (variety of conferences), brochures, or reports and memos. (Cherie & Gebrekidan, 2005, p.241) 55.) D: 1,2,3 -Assigning priorities to the nursing diagnoses and collaborative problems is a joint effort by the nurse and the patient or family members. Any disagreement about priorities is resolved in a way that is mutually acceptable. Consideration must be given to the urgency of the problems, with the most critical problems receiving the highest priority. (Brunner and Suddarth, p.34) 56.) D: I do not see you as a failure - Teach effective communication techniques, such as the use of I messages (e.g., I feel hurt when you say those things.).: I statements help to avoid making judgmental statements. (Brunner and Suddarth, p.374) 57.) A: You are Having Difficulty Sleeping? Restating.The nurse repeats what the client has said in approximately or nearly the same words the client has used. This restatement lets the client know that he or she communicated the idea effectively. (Videbeck; 2011: P.117)

58.) A: Focusing on self-disclosure about food preferences. - Do not attack delusions or try to argue or convince the person that the thoughts are wrong or not real. Nor should you indicate that you believe in the delusion; instead explain I believe you are telling me this is as you see it.. Ask whether there is anything you can do to make the person feel more comfortable, and explain your intentions before you act. (www.cmha-bc.org, 2005;) 59.) D: You are feeling angry that your family continues to hope for you to be cured? - Options a, b, and c are non-therapeutic. A doesnt attend to the way the patient feels about his or her family hoping. B is disagreeing while option c is advising. Option D is the best answer because it uses a therapeutic technique restating. (Videbeck; 2011: P.103, 105) 60.) C- 1,3,4 - Physical abuse of a child includes any nonaccidental physical injury (ranging from minor bruises to severe fractures or death) as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or otherwise harming a child, that is inflicted by a parent, caregiver, or other person who has responsibility for the child (CWIG, 2008). (Brunner and Suddarth, p.652) 61.) D: 1,3,4 Documenting and assessing is the initial approach of the nurse when implementing their interventions. For the parents/family members: The focus of therapy with families who use violence is to help them develop democratic ways of solving problems. Studies show that the more a family uses the democratic means of confl ict resolution, the less likely they are to engage in physical violence. (Brunner and Suddarth, p.662) 62.) A: Document the PA of the child accurately. In collaboration with physician, ensure that all physical wounds, fractures, and burns receive immediate attention. Take photographs if the victim will permit. (for evidence and documentation purposes/legal actions). (Brunner and Suddarth, p.658) 63.) D: Difficulty Walking - Child abuse may be considered a possibility when the child (CWIG, 2007): Has diffi culty walking or sitting. Suddenly refuses to change for gym or to participate in physical activities. Reports nightmares or bedwetting. Experiences a sudden change in appetite. Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior. Becomes pregnant or contracts a venereal disease, particularly if under age 14. Runs away. Reports sexual abuse by a parent or another adult caregiver. (Brunner and Suddarth, p.653)

64.) A: 1,3,4 - The possibility of neglect may be considered when the child (CWIG, 2007): Is frequently absent from school. Begs or steals food or money. Lacks needed medical or dental care, immunizations, or eyeglasses. Is consistently dirty and has severe body odor. Lacks suffi cient clothing for the weather. Abuses alcohol or other drugs. States that there is no one at home to provide care. The possibility of neglect may be considered when the parent or other adult caregiver (CWIG, 2007): Appears to be indifferent to the child. Seems apathetic or depressed. (Brunner and Suddarth, p.653) 65.) B: One on One Suicide Precaution - One-toone suicide precautions are required for the client who has attempted suicide. The best option is constant supervisionso that the nurse may intervene as needed if the client attempts to cause harm to himself or herself. (Stuart, G., & Laraia, M. (2005). Principles and practice of psychiatric nursing (8thed.). St. Louis: Mosby, p. 288.)

66.) A: Keeping the client talking and signaling to another staff member to trace the call, so that appropriate help can be sent. - In a crisis, the nurse must take an authoritative, active role to promote the clients safety. Usingtherapeutic communication is important, but overuse of reflection may sound uncaring or superficial and is lacking direction and solutions to the immediate problem of the clients safety. (Keltner, N., Schwecke, L., & Bostro, C. (2003). Psychiatric nursing (4th ed.). St.Louis: Mosby, p. 363.) 67.) A: a. The client gives away a prized compact disc and a cherished autograph picture of a favorite performer. - Individuals may leave both behavioral and verbal clues as to the intent of their act. Examples of behavioral clues include giving away prized possessions, getting financial affairs in order, writing suicide notes, or sudden lifts in mood (may indicate a decision to carry out the intent). (Brunner and Suddarth, p.690) 68.) A:Requesting that a peer stays with the client at all times. - Hanging is a serious suicide attempt. The plan of care must reflect action that will promote the clients safety. Constant observation status (one on one) with a staff member who isnever less than an arms length away is the safest intervention.

(Morrison-Valfre, M. (2005).Foundations of mental health care (3rd ed.). St. Louis:Mosby, p. 288.) 69.) B or C - The bag technique is a tool by which the nurse, during her visit will enable her to perform a nursing procedure with ease and deftness, to save time and effort with the end view of rendering effective nursing care to clients. (Matt Vera; Community Health Nursing, 2012: http://nurseslabs.com/home-visits-bagtechnique/) 70.) A: Test the clients urine for the presence of albumin -Vasospasm in the kidney increases blood flow resistance. Degenerative changes develop in kidney glomeruli because of back-pressure. This leads to increased permeability of the glomerular membrane, allowing the serum proteins albumin and globulin to escape into the urine (proteinuria). (Pillitteri, p. 575) 71.) B: Progressive Ankle Edema - Edema develops, as mentioned, because of the protein loss, sodium retention, and lowered glomerular filtration rate. The edema is not just the typical ankle edema of pregnancy but begins to accumulate in the upper part of the body. (Pillitteri, p. 576) 72.) C: Moderate sodium, low calories, and ample protein. - A woman needs a diet moderate to high in protein and moderate in sodium to compensate for the protein she is losing in urine. (Pillitteri, p. 579) 73.) C: BP and Apical Pulse - These drugs act to lower blood pressure by peripheral dilatation and thus do not interfere with placental circulation. They can cause maternal tachycardia. Therefore, assess pulse and blood pressure before and after administration. (Pillitteri, p. 579) 74.) B: Calcium Gluconate - In addition to making the above assessments when magnesium sulfate is being given, a solution of 10 mL of a 10% calcium gluconate solution (1 g) should be kept ready nearby for immediate intravenous administration should a woman develop signs and symptoms of magnesium toxicity, as calcium is the specific antidote for magnesium toxicity. (Pillitteri, p. 579) 75.) D: Abdominal Distention - During the early stages of ovarian cancer, symptoms are often vague and ill-defined. Symptoms may include pelvic or abdominal discomfort, bloating, difficulty eating or feeling full, increased abdominal size, or urinary symptoms (urgency and frequency). (Chen & Berek; 2013 : http://www.uptodate.com/contents/ovariancancer-diagnosis-and-staging-beyond-the-basics) 76.) C: Starting with low doses of medication and gradually increasing to a dose that relieves pain, not exceeding the maximum daily dose. - The most

appropriate approach is to begin with low doses and increase as needed to maintain a dose that relieves the pain. Option 2 ignores the benefits of other options that may relieve pain such as massage, therapeutic touch, or music. Keeping the client at a baseline level is inappropriate practice. Multiple medication interventions do not guarantee effectiveness and can also be unsafe. (Brunner and Suddarth, p.385) 77.) D: Nausea & Vomitting - Chemotherapy can cause nausea (an urge to vomit or throw up) and vomitinga risk that depends on the type and dose of chemotherapy. With appropriate medications, nausea and vomiting can be prevented in nearly all patients. (Schuchter; 2005: http://www.cancer.net/all-aboutcancer/cancernet-feature-articles/treatments-testsand-procedures/side-effects-chemotherapy) 78.) D: Patient Verbalizes feelings of Anxiety Verbalizing feelings is the clients first step in coping with the situational crisis. It also helps the health care team gain insight into the clients feelings, helping guide psychosocial care. (Brunner and Suddarth, p.386) 79.) A: Regular dialysis treatment along with medication, diet, and fluid restriction will help you minimize the signs and symptoms. - The patient with increasing symptoms of renal failure is referred to a dialysis and transplantation center early in the course of progressive renal disease. Dialysis is usually initiated when the patient cannot maintain a reasonable lifestyle with conservative treatment. (Brunner and Suddarth, p.1328) 80.) B: Be sure to eat mear every meal. - People on dialysis need to eat more protein. Protein can help maintain blood protein levels and improve health. Eat a high protein food (meat, fish, poultry, fresh pork, or eggs) at every meal, or about 8-10 ounces of high protein foods everyday. (http://www.kidney.org/atoz/content/dietary_hemodial ysis.cfm) 81.) A: Increase RBC Production - Treatment of anaemia associated with chronic renal failure (renal anaemia) in patients on dialysis. (Tilkian, Tzekov, Pandeva, Kumchev, Nikolov, Dimitrakov; http://www.ncbi.nlm.nih.gov/pubmed/11347329) 82.) D: Subcutaneous - Treatment of Anemic Patients with Chronic Renal Failure: The solution can be administered SC or IV. In case of IV administration, the solution should be injected over approximately 2 min eg, in hemodialysis patients via the arteriovenous fistula at the end of dialysis. (https://www.mims.com/Philippines/drug/info/Recormo n/?type=full)

83.) B: Short Attention Span - Presence of family usually does not interfere with the clients ability in learning. It is actually encouraged so that the family members will also know the situation of the patient and how to take care of him or her when they are at home. (Ralph & Taylor; 2008: p.476) 84.) A: a. Burning and aching, located in the epigastric area, and radiating to the umbilicus. - A rigid or boardlike abdomen may develop and is generally an ominous sign, usually indicating peritonitis. Ecchymosis (bruising) in the flank or around the umbilicus may indicate severe pancreatitis. (Brunner and Suddarth, p.1182) 85.) A: Use of Alcohol - Pain is frequently acute in onset, occurring 24 to 48 hours after a very heavy meal or alcohol ingestion, and it may be diffuse and difficult to localize. It is generally more severe after meals and is unrelieved by antacids. (Brunner and Suddarth, p.1182) 86.) D: Ensuring Adequate Nutrition - Ongoing research hasshown positive outcomes with the use of enteral feedings.The current recommendation is that, whenever possible, the enteral route should be used to meet nutritional needs in patients with pancreatitis. This strategy also has been found to prevent infectious complications, safely and cost effectively (DiMagno & DiMagno, 2007; Zinner & Ashley, 2007). (Brunner and Suddarth, p.1183) 87.) D: Does not cause spasm of the Sphicter of Oddi Other pain medication such as Morphine causes Spasm of the sphincter of oddi, but Meperidine (Demerol) Causes Toxic Metabolites. (Brunner and Suddarth, p.1186) 88.) A&D: Fat and Protein - These foods increase caloric intake without stimulating pancreatic secretions beyond the ability of the pancreas to respond. (Brunner and Suddarth, p.1187) 89.) A: It first occurs in a joint following a traumatic injury - the rheumatic diseases are more than 100 different types of disorders that primarily affect skeletal muscles, bones, cartilage, ligaments, tendons, and joints in males and females of all ages (Porth & Matfin, 2009). (Brunner and Suddarth, p.1632) 90.) B: Elevated Sedimentation Rate - People with rheumatoid arthritis tend to have an elevated erythrocyte sedimentation rate (ESR, or sed rate), which indicates the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. (Brunner and Suddarth, p.1636)

91.) A: Low Grade Fever - Patients with RA frequently experience anorexia, weight loss, and anemia. Musculoskeletal: Inflammation.(Brunner and Suddarth, p.1635, 1645) 92.) C:Help him to select a high-calorie, highprotein, and high calcium diet. - Food selection should include the daily requirements from the basic food groups, with emphasis on foods high in vitamins, protein, and iron for tissue building and repair. For the patient who is extremely anorexic, small, frequent feedings with increased protein supplements may be prescribed. Supplemental vitamins and minerals may also be prescribed as needed (Klippel, Stone, Crofford, et al., 2008). (Brunner and Suddarth, p.1645) 93.) B: Troponin I - Troponin, a protein found in the myocardium, regulates the myocardial contractile process. There are three isomers of troponin: C, I, and T. Troponins I and T are specific for cardiac muscle, and these biomarkers are currently recognized as reliable and critical markers of myocardial injury (Carreiro- Lewandowski, 2006). (Brunner and Suddarth, p.770) 94.) B: Myocardial Ischemia - In an MI, an area of the myocardium is permanently destroyed, typically because plaque rupture and subsequent thrombus formation result in complete occlusion of the artery. Vasospasm (sudden constriction or narrowing) of a coronary artery, decreased oxygen supply (eg, from acute blood loss, anemia, or low blood pressure), and increased demand for oxygen (eg, from a rapid heart rate, thyrotoxicosis, or ingestion of cocaine) are other causes of MI. In each case, a profound imbalance exists between myocardial oxygen supply and demand. ). (Brunner and Suddarth, p.768) 95.) B: X-ray and Incidence Report if the missing item is not located, an X-ray is obligatory prior to the patient leaving the operating room (unless contraindicated by the patients condition) and the outcome documented. (Hamlin, Tench & Davies; 2009) 96.) C: Surgeon the surgeon is notified immediately of any discrepancy in the count and appropriate interventions are undertaken to rectify this situation. (Hamlin, Tench & Davies; 2009) 97.) A: Before peritoneum is closed Sponges, needles and intruments are counted before patient enters OR and then, for open abdominal cases, three times during surgery: immediately before closing peritoneum (if it is closed), before fascia, and skin closure; if count not correct, patient x-rayed for

material left behind before leaving OR. (Benso;2010:P.302) 98) B: 5,4,1,2,3 the abdominal wall encloses the ventral (front) part of the abdominal cavity and extends from the diaphragm to the pubis. It is composed of distinct tissue layers, which support the abdominal organs. These layers are: Skin, Subcutaneous fatty tissue (often called sub-cu), fascia, muscle and peritoneum. (Kotcher Fuller;2013:P.484) 99.) A: Scrub and Circulating Nurse before surgery begins, during the pre-incision phase, the scrub and the circulating nurse should count sponges, sharps, and instruments together (and out loud) as each item is separated and identified. (Fairchild;1993:p. 270) 100.) The most important lesson would be, Making the most out of Everything while its still there; st meaning, I shouldve studied harder during the 1 semester of the course, and procrastinating in the end, like this remedial exam is so much harder. Do your best in everything that you do. And I learned a lot of things from this remedial exam, since I have to look thoroughly for the answers and analyze it well.

REFERENCES: Brunner and Suddarths Textbook of th Medical Surgical Nursing 12 Ed. 2010 th Daviss Drug Guide for Nurses; 13 Ed. 2013 Mary C. Townsend;Essentials of Psychiatric Mental Health Nursing (Concepts of th Evidenced Based Practice; 5 Ed. 2011 Carol R. Taylor, Carol Lillis, Priscilla LeMone, Pamela Lynn ; Fundamentals of Nursing (The Art and Science of Nursing th Care) 7 Ed. 2011 Amsale Cherrie, Ato Ababa Gebrekidan; Ethiopia Public Health Training Initiative; Nursing Leadership and Management:2005 Adele Pillitteri: Maternal and Child Health Nursing (Care of the Childbearing & th Childbearing family) 6 Ed. 2010 Joanna Kotcher Fuller: Surgical Technology th (Principles and Practice) 6 Ed. 2013 Michael D. Benson: OB/GYN Mentor ( Your th Clerkship & Shelf Exam Companion) 4 Ed. 2010 Keltner, N., Schwecke, L., & Bostro, C. (2003). Psychiatric nursing (4th ed.). St.Louis: Mosby, p.363. Layug: Comprehensive Exam for the NLE: 2009. P. 313 Public Health Nursing in the Philippines, 2008, p. 324 Springhouse; 2002: Charting Made Easy Videbeck, S. (2011). Psychiatric-Mental Health Nursing, 5th Ed. Philadelphia: Lippincott Williams & Wilkins. Bare, B., Cheever, K., Hinkle, J., & Smeltzer, S. (2010). Medical-Surgical th Nursing. 12 . Philadelphia: Lippincot Williams & Wilkins. Ralph, S. & Taylor, C. (2008). Nursing Diagnosis Reference Manual.7th ed. Philadelphia: Lippincott Williams & Wilkins.