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11. A patient who had undergone abdominal surgery experienced wound evisceration . Which of the following is the most appropriate immediate nursing action? A. Cover the wound with sterile gauze moistened with sterile normal saline. B. Cover the wound with sterile dry gauze. C. Cover the wound with water-soaked gauze. D. Leave the wound uncovered and pull the skin edges together 12. The nurse is preparing to take vital sign in an alert client admitted to the hospital with dehydration secondary to vomiting and diarrhea. What is the best method used to assess the client's temperature? A. Oral C. Heat sensitive tape B. Axillary D. Rectal 13. Mr. Ibrahim has a fever of 38.50C. It increases suddenly at around 40 Degrees and go back to 38.5 Degree 6 times today in a typical pattern what kind of fever is Mr . Ibrahim having? A. Relapsing C. Remittent B . Intermittent D. Constant 14. Which of the following constitutes a break in sterile technique while preparing a sterile field for a dressing change? A. Using sterile forceps . rather than sterile gloves , to handle a sterile item B. Touching the outside wrapper of sterilized material without sterile gloves C. Placing a sterile object on the edge of the sterile field D. Pouring out a small amount of solution (15 to 30 ml)before pouring the solution into a sterile container 15. All of the following measures are recommended to prevent pressure ulcers except: A. Massaging the reddened are with lotion B. Using a cotton or air ring C. Adhering to a schedule for positioning and turning D. Providing meticulous skin care 16. Which of the following steps of instrument processing is the correct one? A. Cleaning -Decontaminat ion-Sterilization -Cooling B. Cooling -Decontaminatio n-Cleaning -Sterilization C Decontaminatior -Cleaning -Cooling -Sterilization D . Decontamination-Cleaning -Sterilization-Cooling 17. The mid-DEL .TOID injection site is seldom used for I.M . injections because it: A.Accommodate only 2 ml or less B. Does not readily parenteral medication C. Bruises too easily D. Can be used only when the patient is lying down 18. A client is to receive 3.000 mL of 0.9% NaCl IV in 24 hours.The intravenous set delivers 15 drops per milliliter. The nurse should regulate the flow rate, so that the client receives how many drops of fluid per minute? A. 21 C. 31 B. 28 D. 42

6. The nurse is performing a respiratory assessment of an adult patient and is attempting to distinguish between vesicular Broncho vesicular, and bronchial breath sounds . The nurse should distinguish between these normal breath sounds on what basis? A. Their location over a specific area of the lung B. The volume of the sounds C. Whether they are heard on inspiration or expiration D. Whether or not they are continuous breath sounds 7. The nurse is assessing the skin conditions of the patients and the nurse notes that the hypertrophic scarring because of excess collagen formation; raised and irregular overgrows of the original wound. The conditions would likely; A. Petechiae B. Ecchymosis C. Keloid D. Fibrosis 8. Which of the following theorist decreased mortality by improving sanitation in the battlefields. resulting in a decrease in illness and infection? A. Dorothea Orem C. Martha Rogers B. Florence Nightinga D. Virginia Henderson 9. Which of the following degree of needle insertion is used for the intradermal route of drug administration? A. 45^0 B. 10^0 to 15^0 C. 90^circ D. 25^0 10. A nurse is planning care for the client diagnosed with chronic obstructive pulmonary disease (COPD) who has a respiratory rate of 32breath/minute elevated blood pressure , and fatigue. Which nursing diagnosis is the priority for this client? A. Ineffective Coping B. Impaired nutrition C. Anxiety D. Ineffective Breathing Pattern

4. Which of the following best describes the logical order in which auscultations should be made during a cardiac examination? A. Pulmonary, Aortic , tricuspid and mitral B. Aortic, Pulmonary., tricuspid and mitral C. Pulmonary, Aortic , mitral and tricuspid D. Aortic, pulmonic mitral and tricuspid

4. Which of the following best describes the logical order in which auscultations should be made during a cardiac examination? A. Pulmonary, Aortic , tricuspid and mitral B. Aortic, Pulmonary , tricuspid and mitral C. Pulmonary, Aortic , mitral and tricuspid D. Aortic, pulmonic mitral and tricuspid

I.Choose the best answer from the given alternatives 1. A nurse is assessing the patient according to Gordon's functional approach and mentioned about the patient's perception of what is vital in life that guides his choice. What is it such type of data indicates? A. Self-perception pattern B. Role-relationship pattern C. Value-belief pattern D. Cognitive-perceptual pattern 2.A nurse is undertaking a comprehensive health assessment. What should be considered during the health assessment? A. Maintain privacy and proper draping B. Examine merely few body parts C. Obtain only negligible health history D. Follow random examination order 3. The nurse is assessing a newly admitted medical patient and notes there is a depression in the lower portion of the patient's sternum. This patient's health record should note the presence of what chest deformity? A. A barrel chest C. A pigeon chest B. A funnel chest D. Kyphoscoliosis 4. Which of the following best describes the logical order in which auscultations should be made during a cardiac examination? A. Pulmonary, Aortic , tricuspid and mitral B. Aortic, Pulmonary,tricuspid and mitral C. Pulmonary, Aortic mitral and tricuspid D. Aortic, pulmonic , mitral and tricuspid 5. A patient is undergoing testing to see if he has a pleural effusion. Which of the nurses' respiratory assessment findings would be most consistent with this diagnosis? A. Decreased tactile fremitus, wheezing, and a hyper resonant sound upon percussion of the chest wall B. Increased tactile fremitus, egophony, and a dull sound upon percussion of the chest wall C. Lung fields dull to percussion, absent breath sounds, and a pleural friction rub D. Normal tactile fremitus, decreased breath sounds, and a resonant sound upon percussion of the chest wall