NUR 265 Exam 3 COMPLETE EXAM LATEST
VERSION VERIFIED QUESTIONS AND ANSWERS
WITH DETAILED RATIONALES GUARANTEED
PASS
During a physical assessment, the nurse closes and door and provides drape to promote privacy. The
nurse is performing her role as a/an:
A. Advocate
B. Communicator
C. Change agent
D. Caregiver - Correct Answer-D. Caregiver
The role of a nurse as caregiver helps client promote, restore and maintain dignity, health and wellness
by viewing a person holistically. As an advocate the nurse intercedes or works on behalf of the client.
Identifying the need and problems of the client and communicating it to other members of the health
team is doing the role of a communicator. As a change agent, the nurse assists the client to MODIFY
their BEHAVIOR.
During the nursing rounds Nurse Cathy is instructing the patient to avoid smoking to prevent the
worsening of respiratory problems. The patient asked about the things that he can do when feelings of
wanting to smoke arises. The nurse enumerates ways of dealing the situation. This is an example of a
nurse's role as a/an:
A. Advocate
B. Clinician
C. Change agent
D. Caregiver - Correct Answer-C. Change agent
As a change agent, the nurse assists the client to MODIFY their BEHAVIOR. As an advocate the nurse
intercedes or works on behalf of the client. As a clinician, the nurse would use technical expertise to
administer nursing care. The role of a nurse as caregiver helps client promote, restore and maintain
dignity, health and wellness by viewing a person holistically.
1
,Nurse Cathy on the other hand, knows the case immediately even before a diagnosis is done. Based on
Benner's theory she is a/an:
A. Novice
B. Expert
C. Competent
D. Advanced beginner - Correct Answer-B. Expert
The ability to perceive something without further evidence is the development of intuition and is seen in
Expert nurses. A novice nurse is governed by rules and usually inflexible. Competent nurses are planning
nursing care consciously. Advanced beginners demonstrate acceptable performance.
Newborn screening is done to every newborn in the Philippines. This is an example of:
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Rehabilitation - Correct Answer-B. Secondary prevention
Promotion of early detection and early treatment of the disease is under secondary prevention.
Example, breast self exam, TB screening, genetic counseling.
One of Nurse Cathy's co-workers is Annie who is flexible in any given situation. Annie is performing her
duties well without supervision but still needs more experience and practice to develop a consciously
planned nursing care. According to Patricia Benner's category in specialization in nursing, Annie is a/an:
A. Novice
B. Expert
C. Competent
D. Advanced beginner - Correct Answer-D. Advanced beginner
A- Novice is governed by rules and usually inflexible. B- Expert nurses have intuitive grasp on the
situation dealt. C- Competent nurses are planning nursing care consciously. D- Advanced beginners
demonstrate acceptable performance.
2
,The clinical instructor is discussing about the Nursing Process. She mentioned that when a cluster of
actual or high-risk diagnosis are present because of a certain situation it is called:
A. Wellness nursing diagnosis
B. Actual nursing diagnosis
C. Syndrome nursing diagnosis
D. Risk nursing diagnosis - Correct Answer-C. Syndrome nursing diagnosis
Presence of both actual and high-risk diagnosis is called a syndrome nursing diagnosis. Wellness nursing
diagnosis focuses on the clinical judgment on an individual from a specific to higher level of wellness.
Actual diagnoses are clinical judgment of the nurse that is validated. A risk diagnosis is based on the
clinical are based on clinical judgment that the client may develop vulnerability to the problem.
The nurse in charge measures a patient's temperature at 101 degrees F. What is the equivalent
centigrade temperature?
A. 36.3 degrees C
B. 37.95 degrees C
C. 40.03 degrees C
D. 38.01 degrees C - Correct Answer-B. 37.95
To convert °F to °C use this formula, ( °F - 32 ) (0.55). While when converting °C to °F use this formula, (
°C x 1.8) + 32. Note that 0.55 is 5/9 and 1.8 is 9/5.
During a change-of-shift report, it would be important for the nurse relinquishing responsibility for care
of the patient to communicate. Which of the following facts to the nurse assuming responsibility for
care of the patient?
A. That the patient verbalized, "My headache is gone."
B. That the patient's barium enema performed 3 days ago was negative
C. Patient's NGT was removed 2 hours ago
D. Patient's family came for a visit this morning. - Correct Answer-C. Patient's NGT was removed 2 hours
ago
The change-of-shift report should indicate significant recent changes in the patient's condition that the
nurse assuming responsibility for care of the patient will need to monitor. The other options are not
critical enough to include in the report
3
, A client is receiving 115 ml/hr of continuous IVF. The nurse notices that the venipuncture site is red and
swollen. Which of the following interventions would the nurse perform first?
A. Stop the infusion
B. Call the attending physician
C. Slow that infusion to 20 ml/hr
D. Place a cold towel on the site - Correct Answer-A. Stop the infusion
The sign and symptoms indicate extravasation so the IVF should be stopped immediately and put warm
not cold towel on the affected site.
Which data would be of greatest concern to the nurse when completing the nursing assessment of a 68-
year-old woman hospitalized due to Pneumonia?
A. Oriented to date, time and place
B. Clear breath sounds
C. Capillary refill greater than 3 seconds and buccal cyanosis
D. Hemoglobin of 13 g/dl - Correct Answer-C. Capillary refill greater than 3 seconds and buccal cyanosis
Capillary refill greater than 3 seconds and buccal cyanosis indicate decreased oxygen to the tissues
which requires immediate attention/intervention. Oriented to date, time and place, hemoglobin of 13
g/dl are normal data.
What is the order of the nursing process?
A. Assessing, diagnosing, implementing, evaluating, planning
B. Diagnosing, assessing, planning, implementing, evaluating
C. Assessing, diagnosing, planning, implementing, evaluating
D. Planning, evaluating, diagnosing, assessing, implementing - Correct Answer-C. Assessing, diagnosing,
planning, implementing, evaluating
The correct order of the nursing process is assessing, diagnosing, planning, implementing, evaluating.
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VERSION VERIFIED QUESTIONS AND ANSWERS
WITH DETAILED RATIONALES GUARANTEED
PASS
During a physical assessment, the nurse closes and door and provides drape to promote privacy. The
nurse is performing her role as a/an:
A. Advocate
B. Communicator
C. Change agent
D. Caregiver - Correct Answer-D. Caregiver
The role of a nurse as caregiver helps client promote, restore and maintain dignity, health and wellness
by viewing a person holistically. As an advocate the nurse intercedes or works on behalf of the client.
Identifying the need and problems of the client and communicating it to other members of the health
team is doing the role of a communicator. As a change agent, the nurse assists the client to MODIFY
their BEHAVIOR.
During the nursing rounds Nurse Cathy is instructing the patient to avoid smoking to prevent the
worsening of respiratory problems. The patient asked about the things that he can do when feelings of
wanting to smoke arises. The nurse enumerates ways of dealing the situation. This is an example of a
nurse's role as a/an:
A. Advocate
B. Clinician
C. Change agent
D. Caregiver - Correct Answer-C. Change agent
As a change agent, the nurse assists the client to MODIFY their BEHAVIOR. As an advocate the nurse
intercedes or works on behalf of the client. As a clinician, the nurse would use technical expertise to
administer nursing care. The role of a nurse as caregiver helps client promote, restore and maintain
dignity, health and wellness by viewing a person holistically.
1
,Nurse Cathy on the other hand, knows the case immediately even before a diagnosis is done. Based on
Benner's theory she is a/an:
A. Novice
B. Expert
C. Competent
D. Advanced beginner - Correct Answer-B. Expert
The ability to perceive something without further evidence is the development of intuition and is seen in
Expert nurses. A novice nurse is governed by rules and usually inflexible. Competent nurses are planning
nursing care consciously. Advanced beginners demonstrate acceptable performance.
Newborn screening is done to every newborn in the Philippines. This is an example of:
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Rehabilitation - Correct Answer-B. Secondary prevention
Promotion of early detection and early treatment of the disease is under secondary prevention.
Example, breast self exam, TB screening, genetic counseling.
One of Nurse Cathy's co-workers is Annie who is flexible in any given situation. Annie is performing her
duties well without supervision but still needs more experience and practice to develop a consciously
planned nursing care. According to Patricia Benner's category in specialization in nursing, Annie is a/an:
A. Novice
B. Expert
C. Competent
D. Advanced beginner - Correct Answer-D. Advanced beginner
A- Novice is governed by rules and usually inflexible. B- Expert nurses have intuitive grasp on the
situation dealt. C- Competent nurses are planning nursing care consciously. D- Advanced beginners
demonstrate acceptable performance.
2
,The clinical instructor is discussing about the Nursing Process. She mentioned that when a cluster of
actual or high-risk diagnosis are present because of a certain situation it is called:
A. Wellness nursing diagnosis
B. Actual nursing diagnosis
C. Syndrome nursing diagnosis
D. Risk nursing diagnosis - Correct Answer-C. Syndrome nursing diagnosis
Presence of both actual and high-risk diagnosis is called a syndrome nursing diagnosis. Wellness nursing
diagnosis focuses on the clinical judgment on an individual from a specific to higher level of wellness.
Actual diagnoses are clinical judgment of the nurse that is validated. A risk diagnosis is based on the
clinical are based on clinical judgment that the client may develop vulnerability to the problem.
The nurse in charge measures a patient's temperature at 101 degrees F. What is the equivalent
centigrade temperature?
A. 36.3 degrees C
B. 37.95 degrees C
C. 40.03 degrees C
D. 38.01 degrees C - Correct Answer-B. 37.95
To convert °F to °C use this formula, ( °F - 32 ) (0.55). While when converting °C to °F use this formula, (
°C x 1.8) + 32. Note that 0.55 is 5/9 and 1.8 is 9/5.
During a change-of-shift report, it would be important for the nurse relinquishing responsibility for care
of the patient to communicate. Which of the following facts to the nurse assuming responsibility for
care of the patient?
A. That the patient verbalized, "My headache is gone."
B. That the patient's barium enema performed 3 days ago was negative
C. Patient's NGT was removed 2 hours ago
D. Patient's family came for a visit this morning. - Correct Answer-C. Patient's NGT was removed 2 hours
ago
The change-of-shift report should indicate significant recent changes in the patient's condition that the
nurse assuming responsibility for care of the patient will need to monitor. The other options are not
critical enough to include in the report
3
, A client is receiving 115 ml/hr of continuous IVF. The nurse notices that the venipuncture site is red and
swollen. Which of the following interventions would the nurse perform first?
A. Stop the infusion
B. Call the attending physician
C. Slow that infusion to 20 ml/hr
D. Place a cold towel on the site - Correct Answer-A. Stop the infusion
The sign and symptoms indicate extravasation so the IVF should be stopped immediately and put warm
not cold towel on the affected site.
Which data would be of greatest concern to the nurse when completing the nursing assessment of a 68-
year-old woman hospitalized due to Pneumonia?
A. Oriented to date, time and place
B. Clear breath sounds
C. Capillary refill greater than 3 seconds and buccal cyanosis
D. Hemoglobin of 13 g/dl - Correct Answer-C. Capillary refill greater than 3 seconds and buccal cyanosis
Capillary refill greater than 3 seconds and buccal cyanosis indicate decreased oxygen to the tissues
which requires immediate attention/intervention. Oriented to date, time and place, hemoglobin of 13
g/dl are normal data.
What is the order of the nursing process?
A. Assessing, diagnosing, implementing, evaluating, planning
B. Diagnosing, assessing, planning, implementing, evaluating
C. Assessing, diagnosing, planning, implementing, evaluating
D. Planning, evaluating, diagnosing, assessing, implementing - Correct Answer-C. Assessing, diagnosing,
planning, implementing, evaluating
The correct order of the nursing process is assessing, diagnosing, planning, implementing, evaluating.
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