Test Guidelines forthe National Licensure Examination for Nurses （NLEN）2012 1st edition Effective 2012 Nepal Nursing Council Kathmandu, Nepal
Prepared by:Examination Committee, Nepal Nursing Council (NNC) Ms. Chandrakala Sharma, Coordinator Dr. Sarala Shrestha , member Ms. Takma K.C. , member Ms. Pramila Dewan , member Ms. Jamuna Sayami , memberMs. Kei MIYAMOTO, Japan International Cooperation Agency (JICA)Approved by:Board of Nepal Nursing Council (NNC) on February 27, 2012Published by:Nepal Nursing CouncilAddress: Bansbari, Kathmandu, NepalTel : 977-1-4372521Fax : 977-1-4377214E-mail : email@example.comWebsite : http://www.nnc.org.np
TableI. BackgroundII. Test Guidelines for the 1st National Licensure Examination for Nurses Introduction Beliefs Scope of Examination Definition of the National Licensure Examination for Nurses Definition of Nurse Legal Force Groups to the development and administration of the NLEN examination Type of Questions Distribution of Test ItemsIII. NLEN ContentIV. Licensure Requirements Education Requirements Examination RequirementsV. Administrative Process of the NLEN Duration of Examination Number of Test Items Time and Frequency of the NLEN Fee Application Process Scoring System Passing Standard Result of NLEN RegistrationAppendixTest Items / Answers samples
I. BackgroundNepal Nursing Council is an autonomous body under Nepal Nursing Council Act 2052 formulated by theGovernment of Nepal with the aim to bring effectiveness in nursing service in the country, scientificmanagement and mobilization of nurses according to their qualification.Nursing in Nepal commenced in 1956 at Bir hospital. Currently nursing educational program such as AuxiliaryNurse Midwife, Proficiency Certificate level, Bachelor of Science in Nursing, Bachelor of Nursing, Master inNursing, and Master of Science in Nursing are available in Nepal.To maintain the aim of Nepal Nursing Council it is important that the council accreditates nursing courses andsupervises nursing education institutions to ensure quality nursing care for the people in Nepal. Registration ofall nurses is required to assist workforce planning, nurse immigration and professional misconduct reporting.II. Test Guidelines for the 1st National Licensure Examination for Nurses Guidelines Introduction The Licensure Examination for Nurses is a national, standardized examination for nurses developed by theNepal Nursing Council. The examination is practical oriented in relation to the job functions most commonlyrequired for entry-level nurses. The examination tests current medical knowledge, nursing competencies anddetermines eligibility to earn a nurse license and begin working as a nurse The licensure examination was developed in several steps. Firstly, the NNC requested a technical person toJapan International Cooperation Agency (JICA) and gained one nursing professional deputed by JICA forstarting preparation of the National Licensure Examination for Nurses. Secondary, an Examination Committeewas established and started collecting information nationally and internationally how to conduct the licensureexamination including observation visits to India Nursing Council, Texas Board Nursing Council, UnitedStates, and Nepal Medical Council. Thirdly, the Council conducted orientation programs in five regions inorder to make stakeholders, such as nursing institutions, nursing faculties, nursing students, practitioner inclinical fields and consumers, aware of the licensure examination. The total number of participants was over250 and those who participated in the programs gave feedback positively. After that, the ExaminationCommittee drafted the National Licensure Examination for Nurses Guidelines. Guidelines were moderatedthrough one workshop with representatives of nursing campuses and Council of Technical Education andVocational Training (CTEVT). The guidelines for licensure examination were approved by the board of NepalNursing Council and disseminated to all the nursing campuses and candidates. The guidelines provideinformation on selection of content, behaviors to prepare for test, and administration of the examination.The objectives of licensure examination are as follows: To maintain quality nursing services to the public To maintain professional standard of knowledge and skills among new graduates To recommend for strengthening the capability of nursing institutions for quality nursing educationThe guidelines for National Licensure Examination for Nurses provide a concise summary of the content andscope of the licensing examination. It serves as a guide for examination development as well as candidatepreparation. Each licensure examination is based on the guidelines. The licensure examination assesses theknowledge, skills, medical ethic and abilities that are essential in order to cure, care, rehabilitate and promotethe health of clients.
BeliefsThere are more than 245 nursing educational programs in Nepal that have commenced after the governmentprivatized health manpower education production. As the number of institutes is growing the quality has beenreported as deteriorating due to the lack of clinical placements and frequent turnover of nursing faculty. At thesame time development of modern medicine has identified patients right to receive quality health care/services and make them aware of care/services. Therefore, qualified nursing education is essential for jobopportunity in the country and immigration abroad. To maintain the standard in all the nursing educationalprogram is becoming difficult even though Nepal Nursing Council is monitoring and accrediting all theprogram regularly.With the aim of quality of nursing education and registration of new graduates, Nepal Nursing Councilbelieves that Licensure Examination shall have to be conducted as one method for maintaining quality of bothnursing education and nursing care in the clinical sector. Scope of ExaminationStandardize knowledge, skills and abilities essential to public safety and effective nursing practice Definition of the National Licensure Examination for NursesNational Licensure Examination for Nurses is defined to be an entrance examination to be qualified to beidentified? as a nursing professional. This National Licensure Examination for Nurses is applied to all the newgraduates from Proficiency Certificate Level (P.C.L.) and Bachelor of Science in Nursing (B.Sc.N.) .Graduation or completion of nursing education in P.C.L. or B.Sc. N is a requirement to sit the NationalLicensure Examination. All the graduates of P.C.L and B.Sc. N must pass the National Licensure Examinationbefore they start working as a nursing professional.The National Licensure Examination for Nurses is the entry qualification to be a nursing professional. Itshould be distinguished differently from academic degree so that the Licensure Examination is applied to bothB.SC.N and P.C.L at diploma level.The title was recognized by the Board of Nepal Nursing Council, and also has exclusive right on the title. Noone can employ the title with making alterations. The abbreviated title is NLEN in this context. Definition of NurseNurse is a person who has a degree in nursing and has passed an examination to be allowed to work in Nepal.It can be defined differently from A.N.M. which completes a- 18 month nursing educational program afterS.L.C. passed or a- 24 month nursing educational program after 10th grades, and work as a nurse. Legal forceNepal Nursing Council First Amendment Act 2052 (1996) lays down a Licensing Examination issue on ActNo.15 of 2052 B.S. and Nursing Council Act Section 24 "Ka" has the provision of conducting NationalLicensing Examination for Nurses. Groups to the development and administration of the NLEN examination.
The groups listed below contributed to the development and administration of the NLEN. Nepal Nursing Council Board All related process and documents have been approved by the Board of Nepal Nursing Council. Examination Committee The Examination Committee provides general oversight of the examination process of administration and quality assurance to ensure consistency and fairness. Type of QuestionsAll of test items are based on Multiple Choice Question (MCQ) with four items. Applicants are to select themost appropriate choice (key). Situational questions may also be included. Applicants are advised to read testitems carefully before answering. Distribution of Test Items Table 1 Distribution of test items in subject wise Subjects Distribution of test items (%) Possible numbers of itemsIntegrated Science 5% 10Fundamental of Nursing 25% 50Community Health Nursing 15% 30Adult Nursing 20% 40Child Health Nursing 10% 20Midwifery and Gynecology 20% 40Leadership and Management 5% 10
III. NLEN ContentThe following provides information on the NLEN test content that will be used by item writers and itemreviewers.Integrated ScienceIntegrated Science means subjects related to Anatomy/ Physiology, microbiology, and pharmacology, andmechanism of diseases and promotion. Related content includes but is not limited to: Anatomy/ Physiology Composition, Structure, Functions of each organ and accessory organs Cardiovascular/ Lymphatic System: Body fluid/Electrolytes and Acid-Base Balance Blood Composition, Plasma and Plasma Proteins Physiology of Red Blood Cells, White Blood Cells, Plates Blood Groups and blood transfusion Anatomy of Cardiovascular System: The Heart and Blood Vessels Physiological Activities of the Heart Physiology of Circulation Cardiovascular Regulation and Adjustments Lymphatic/ Immune system Musculoskeletal System The Human Skeleton, its structure and physiology The Joints The Skeletal Muscles of Human Body Neuromuscular Junction and Muscle Physiology Nervous System Functional unit of nervous system Central Nervous System Peripheral Nervous System Autonomic Nervous System Somatosensory, Somatomotor System and Reflexes Meninges, Cerebrospinal Fluid, Blood-Brain Barrier and Central Blood Flow Respiratory System Structure and Functions of Respiratory System Physiology/Mechanism/ Control of Respiration Gastro-Intestinal System Structure and Functions of Digestive System Digestion and Absorption Accessory organs of Gastro-Intestinal system Endocrine System Organization and General Principles of Endocrinal System: Hypothalamus, Pituitary Gland, Thyroid Gland, Parathyroid Glands, Thymus, and Adrenal Glands Physiology of Hormones: e.g. Pancreatic and Gastrointestinal Hormones of other organs Urinary System Functional unit of urinary system Physiology of urine formation Reproductive System Growth and Development in sexual organs Male Reproductive System Female Reproductive System Physiology of Contraception Special Sensory System
Eye, Ear, Nose, Throat The Skin and Fascia Common disorders in each system Medicine used for clients with common disorders in each system Microbiology/ Parasitology Human cell and its structure Factors affecting the growth and survival of micro organisms Types of parasites affecting to human body and its mechanism to develop diseases Pharmacology Types and Function of Drugs Pharmacokinetics: absorption, distribution, metabolism, excretion of drug, and factors influencing the pharmacokinetics Pharmacodynamics: drug action, adverse reaction to drugs Essential, emergency and Life Saving Drugs used in Nepal Drugs used in different body system ( e.g. antibiotics, antipyretic, antiinflammatory, antianalgic, anticoagulant, anti-tubercular, anti-leprosy, anti-malarial, anti-leishmaniases, anti-filarial, cytotoxic, and drugs for HIV/AIDS)Fundamental of NursingRelated content includes but is not limited to: Foundation of nursing Law and ethics in nursing: International Councils of Nurses (ICN) Code, Nepal Nursing Council Act and Regulation. Patient’s Rights Informed Consent Nursing Process Communication: types and its characteristics Client’s needs, Maslow’s hierarchy Taking vital signs and assessment of changes Physical examination Nursing care planning Recording/ Documentation Caring Admission and discharge procedure The role and responsibility of nurse in laboratory test/examination: invasive and non- invasive procedures: e.g. blood test, lumbar puncture, thoracentesis, ultrasonography Personal hygiene Safety and Infection Control: Safety Devices, Accident/ Injury Prevention, Infectious Materials, Universal Precaution Rest and Sleep Comfort/ Relief pain Care of Nutritional needs Care of Elimination Rehabilitative care Care for dead body Nursing responsibility for drug administration Route of administration of the drug :topical, instillation, oral, injectable medicine and inhalation, medicine through rectum and vagina
Dosage Calculation and Administration Indications, contraindications and interactions, adverse effect , side-effect Responsibility of nurses on administration of medicine: e.g. Six rules on administration of the drug Administration and management of IV fluids, Blood and Blood products First Aid Basic Cardiopulmonary Resuscitation (CPR) Bites: insects, snake, animals Burn Wounds: Dressing and Bandage Hemorrhage Choking Fracture Drowning Frostbite PoisoningCommunity Health NursingRelated content includes but is not limited to: Community Health and Community Health Nursing Communication skills Community resources Health Education Home visiting Primary Health Care (PHC): elements and role of nurses in PHC Demography/ Health Indicators: (e.g. IMR. MMR, TFR) Epidemiology Role of epidemiology Community Diagnosis Role and responsibilities of Nurses in epidemiological approach Environmental Health: Sanitation, Water, Housing, Pollution Nutrition Components of nutrition and its function Nutritional Deficiency: types and characteristics Management for the clients with nutritional deficiency Immunization Types, Purposes, Functions of immunization Administration of each immunization National Immunization Program in Nepal Maternal and Child Health MCH clinics: Antenatal Care (ANC), Postnatal Care (PNC) Growth Monitoring of Under Five Children Under Five’s Clinic IMCI guidelines Gender Issues Sex and gender Gender issues: e.g. gender equity, gender equality, gender discrimination, Domestic Violence Family Planning Population problems in Nepal Types, methods, advantages and disadvantages of each family planning method in male and female
Emergency Contraceptive Methods Nursing management: e.g. Counseling HIV/AIDs, STI Prevention and management of HIV/AIDs, STI Medication for the clients with HIV/AIDs, STI Family Health NursingAdult NursingRelated content includes but is not limited to: Characteristics of adulthood with developmental tasks in each stage: young adult, middle-aged adults, elderly adults Aging process Disorders of each system: Blood, Body Fluids/Electrolytes, Nervous System, Circulatory System, Respiratory System, Musculoskeletal System, Gastro-Intestinal and Nutritional System, Urinary System, Endocrine System, Sensory System Common disorders, investigations and medical/surgical treatment in each system Medical/Surgical nursing management for the client with disorders in each system Mental Health Problems Assessment of mentally ill clients Major and minor disorders, treatment and nursing management Operational Theatre Nursing (OT nursing) Characteristics of OT nursing OT technique (e.g. aseptic technique, sterilization, scrubbing, gowning, gloving) Role and Responsibilities of scrub nurse, circulatory nurse, and recovery nurse Common surgical materials, equipments, and supplies in OT and their preparation Pre-, Post-operative nursing care Rehabilitation Disability: types and characteristics Role and responsibility of nurses in rehabilitation Nursing management to disability on chronic process Nursing care for the client in the terminal stage Stages of dying Grief and Loss Holistic Care Stress and Crisis Management Body’s response to stress Role of nurses in stress and crisis managementChild Health NursingRelated content includes but is not limited to: Terminology of Child Health Nursing Growth and development of child in each stage: neonate, infant toddler、pre-school children, school-age children, adolescent Nursing role on promotion of growth and development Nursing care to child and family Influences brought by diseases and hospitalization Nursing care for children with accident/ injury Nursing care for children with common communicable diseases on children of Nepal
Nursing care for children with congenital/ chromosomal disorders Common Childhood Disorders of different system, investigation, treatment and medical/surgical nursing management Nursing care for children with major diseases in : nervous system, musculoskeletal system, respiratory system, circulatory system, blood, gastro-intestinal, urinary system, endocrine system, sensory Health Promotion for sick children: nutrition, exercise, play, anticipatory guidance Mortality and Morbidity of Child in Nepal Role of nurse to reduce Mortality and Morbidity on Under Five Children Nursing role on prevention and management of children with HIV/AIDs Integrated Management of Childhood Illness (IMCI) program Identification of Child unit: meeting physical and comfort needs (e.g. bed size, paediatric set up, placement of the ward) Paediatric Procedure Oxygen administration (e.g. head box, oxygen tent) Nebulization Positioning/ Restraining Calculation of drugs and its administration Feeding in different types IV fluid administration and management Phototherapy Care for incubator Colostomy and tracheostomy care Cardio Pulmonary Resuscitation (CPR) Specimen collection Assisting common invasive procedures (e.g. lumbar puncture)Midwifery and GynecologyRelated contents include the following but not limited to: Sex/ sexuality and Reproduction of human being Components of reproductive health Reproductive health/rights Maternal and Newborn Health status in Nepal Strategies and policies of reproductive health in Nepal Skill Birth Attendant (SBA) policy Safe Motherhood Program Nursing care in every stage of female life cycle Puberty/ Adolescent Health: physical and psychological changes, nursing care for during puberty /adolescent Reproductive age/years: nursing care for the client of reproductive ages/years Climacteric care: physical and psychological changes during the peri-menopause, counseling medical management(e.g. Hormone Replacement Therapy; HRT) Fetal growth and development: normality and abnormalities on fetal, placenta, membrane and cord Care during Pregnancy Health promotion of pregnant women Components of antenatal care Birth Preparedness and Complication readiness Care of pregnant women with minor/major disorders of pregnancy (e.g. constipation, varicose veins, back pain, edema, threatened abortion , placenta preavia) Care during labor and birth
Physiology and mechanism of labor Nursing management of mother in labor : normal delivery, induction and augmentation of labor Monitoring fetal condition: prevention of its abnormalities in labor Postnatal Care Physical and psychological changes during puerperial period Nursing care for women with minor/major problems of puerperium (e.g. hemorrhage, infection) Breast Feeding: importance, mechanism of secretion of breast milk, nursing care for mother with problems on breast feeding (e.g. mastitis) Breast feeding in HIV / Hepatitis B positive mothers (e.g. PMTCT) Newborn Baby Care Neonatal assessment Immediate care of newborn Nursing care for newborn baby with dysfunction and problems (e.g. Respiratory distress syndrome, meconium aspiration syndrome Obstetric Emergencies Nursing management for the clients with high risk/ critical condition in antenatal period (e.g. PIH) Nursing management for the clients with high risk/ critical condition in perinatal period (e.g mal presentation and prolapse of the cord. ) Nursing management for the clients with high risk/ critical condition in postnatal period (e.g. PPH, ruptured uterus ) Nursing Care for Gynecological problems Sub-infertility/ Infertility: Types, cause and treatment and nursing management of infertility in both male and female, Sexual Transmitted Infection (STI): National Protocol to manage STIs, Nursing management Nursing management for Cervical Cancer, Breast Cancer Nursing management for Uterine prolapsed Nursing management for other problems on reproductive and genital organs (e.g. obstetric fistula)Leadership and ManagementRelated content includes but is not limited to: Concept of Leadership and Management Role, Styles, Characteristics and Functions of Leadership Role and Responsibilities of Health Care Team Members Principles, Types, Functions of Management Conflict Management Purpose, principles, categories of Supervision Qualities of Supervisor Health Service Delivery System: Hospital and Community Methods of Organizational management Organogram Management of Resources Patient assignment methods: Rotation Plan, assignment Job Description of different categories of health personnel Job Description of different level of nursing personnel Professional Development Definition and Criteria of Profession Professional Organizations: Nursing Association of Nepal (NAN), Nepal Nursing Council
(NNC), International Council of Nurses (ICN), International Confederation of Midwives (ICM)Health Policy and Planning National Health Planning: SLTHP and Five Year Plans Country Profile
IV. Licensure Requirements Education Requirements (A) Nepali citizen graduated from Nepal To meet the professional education requirement for licensure as a qualified professional nurse, candidates must present satisfactory evidence of having received at least a four-year degree (B.Sc N.) or 3 years of Proficiency Certificate Level (Diploma level) program that is approved by NNC. (B) Nepali citizen graduated from other countries Applicants, who have completed general nursing education out of country, must have their equivalence certificate from the concerned authority. (C) Foreigners graduated from Nepal Foreign applicants, who have completed nursing program from Nepal approved by NNC, must submit required documents. (D) Foreigners graduated from other countries Person who were sent from governmental organizations or international cooperation agencies are not required to sit in the National Licensure Examination for Nurses in Nepal. A person, who come to Nepal voluntarily on an individual basis to work, must sit in the National Licensure Examination for Nurses. Person, who stay with tourist visa are not allowed to apply. Examination Requirements (A) Reporting prior convictions or discipline against licenses Applicants are required under Regulation of the National Licensure Examination for Nurses to report all misdemeanor and felony convictions. Failure to report prior or disciplinary action is considered falsification of application and is grounds for denial of licensure or revocation of license. (B) Applicants with differently abled Applicants, who are differently abled, are under Civil Law.
V. Administrative Process of the NLEN Duration of ExaminationA Licensure Examination will be of three and half hours. Applicants are not allowed to enter the examinationroom after 15 minutes from starting examination. Applicants can leave the room after 1 hour of starting. Number of Test ItemsThe number of test item would be 200 Multiple Choice Questions (MCQs). Time and Frequency of the NLENThe Nepal Nursing Council conducts the Licensure Examination for Nurses biannually in April / May andNovember / December every year. If applicant fails an examination, s/he should apply for the next examinationdate. FeeThe fee for the National Licensure Examination for Nurses is NRs 1,500. Fees are not refundable even if anapplicant is found ineligible. Applicants are totally responsible for their application to sit the examination. Application processApplicants must complete an application form for the licensure examination and pay examination fee.The following documents are required to be submitted with an application form. Table 2 The list of documentation and payment required for P.C.L. Nursing Items Published by Number Application form of NNC, original Nepal Nursing Council 1 Mark sheet and Character of S.L.C., original HMG Board, School 1 with photocopy Citizenship certificate, original with District Office 1 photocopy Academic Transcript and character of Nursing Institute graduated 1 P.C.L. Nursing, original with photocopy Bank receipt, original SBI Bank 1 Passport size photo - 5
Table 3 The list of documentation and payment required for B.Sc. Nursing Items Published by Number Application form of NNC, original Nepal Nursing Council 1 Mark sheet and Character of S.L.C., original HMG Board, School 1 with photocopy Mark sheet and Character of I.Sc. or 10+2, HSEB / TU, College 1 Original with photocopy Mark sheet, Character and Academic Nursing Institute graduated 1 Transcript of B.Sc. Nursing, original with photocopy Citizenship certificate, original with District Office 1 photocopy Bank receipt, original SBI Bank 1 Passport size photo - 5 Table 4 The list of documentation and payment required for Foreign Nurse Items Published by Number Application form of NNC, original Nepal Nursing Council 1 Certificate of nursing educational degree, Nursing Institution 1 original with photocopy Certified copy of transcript from nursing Nursing Institution 1 degree in original language and Nepali, original with photocopy Certificate of Home country registration as a Nursing Council 1 nurse Recommendation letter from the organization Organization 1 in which the applicant is going to, original Valid visa or citizenship who do not need to - 1 have visa to entry Nepal, original with photocopy Bank receipt, original SBI Bank 1 Passport size photo - 5The process is: 1. An applicant must submit all the documents required at one time to Nepal Nursing Council 2. When an applicant submits all documents and they are recognized at NNC, s/he receives a examination card with entry number, date and time of the examination, but no name of examination center. 3. The name of examination center will be informed to all applicants two days prior to the examination. ATTENTION! - If an applicant changes her/his name and/or address after submitting an application for licensure, the applicant must notify the Examination Committee immediately in order to receive current information. Applicants are required to submit legal documentation of any change to the Examination Committee immediately change occurs. - Applicant’s name must match EXACTLY as it appears on photo identification that will be at the test center. The same name must also be provided to the NLEN test service at the time s/he register in order to prevent delays with issuing examination authorization. Scoring System
There is no negative scoring system. It means when applicant gives wrong answer, no minus marking occurs.Marks count only for correct answers. Passing StandardThe grading system on the Licensure Examination for Nurses Examination is either pass or fail. There is nonumerical score. Examination Committee may have to make fine adjustments to the passing standard,however, total mark is required to be over 60 % aggregate. An applicant’s performance on the examinationmust be above the pass standard. Result of NLENThe result of NLEN will be published within a week after the examination. Results will be published on NepalNursing Council notice board. Nepal Nursing Council individually will not inform or contact anyone for thispurpose. RegistrationOnce applicants have successfully passed NLEN they may apply for registration to get their nursing license.Registration fee is NRs 800. Application is required within one month of NLEN examination result. Requireddocuments are the following. a. Certification of NLEN pass, original b. Registration fee: NRs 800For further information please contact e-mail address: firstname.lastname@example.org
APPENDIXTest Items/ Answers Samples1. The nurse calculates the IV flow rate for a postoperative client. The client is to receive 3,000 ml of Ringer’s lactate solution IV to run over 24 hours. The IV infusion set has 10 drops per milliliter. The nurse should regulate the client’s IV to deliver how many drops per minute? a. 18 b. 21 (key) c. 35 d. 402. The nurse in a primary care clinic is caring for a 68-year-old man. History reveals that the client has smoked one pack of cigarettes per day for 45 years and drinks two beers per day. He is complaining of a non-productive cough, chest discomfort, and dyspnea. The nurse hears isolated wheezing in the right middle lobe. It would be MOST important for the nurse to complete which of the following orders? a. Pulmonary function tests b. Echocardiogram c. Chest X-ray (key) d. Sputum culture3. An adult client with a history of gastrointestinal bleeding has a platelet count of 300,000 cells/mm3. Which action by the nurse is MOST appropriate after seeing the laboratory results? a. Report the abnormally low count. b. Report the abnormally high count. c. Place the client on bleeding precautions. d. Place the normal report in the client’s record (key)4. When collecting a 24-hour urine specimen for creatinine clearance, it is MOST important for the to do which of the following? a. Obtain an order from the physician for insertion of a Foley catheter. b. Obtain the client’s weight prior to beginning the urine collection. c. Discard the last voided specimen prior to ending the collection. d. Ask if preservative is present in the container (key)5. A client with emphysema becomes restless and confused. What step should the nurse take next? a. Encourage the client to perform pursed-lip breathing.(key) b. Check the client’s temperature. c. Assess the client’s potassium level. d. Increase the client’s oxygen flow rate to 5 litre/min.6. Haloperidol (Haldol) 5 mg tid is ordered for a client with schizophrenia. Two days later, the client complains of “tight jaws and a stiff neck.” The nurse should recognize that these complains are
a. common side effects of antipsychotic medications that will diminish over time. b. early symptoms of extrapyramidal reactions to the medication. (key) c. psychosomatic complains resulting from a delusional system. d. permanent side effects of haldol.7. The nurse cares for a client following surgery for removal of a cataract in her right eye. The client complains of severe eye’s pain in her right eye. The nurse knows this symptom a. is expected and should administer analgesic to the client b. is expected and should maintain the client on the bed rest c. is unexpected and may signify s detached retina. d. is unexpected and may signify hemorrhage.(key)8. The nurse is teaching a class on natural family planning. Which of the following statements, is made by a client, indicates that teaching has been successful? a. “When I ovulate, my basal temperature will be elevated for two days and then will decrease.” b. “My cervical mucus will be thick, cloudy, and sticky when I ovulate.” c. “Since I am regular, I will be fertile about 14 days after the beginning of my period.” (key) d. “When I ovulate, my cervix will feel firm.”9. The nurse is caring for clients on the pediatric ward. An eight –old- year client with second- and third- degree burn on the right thigh is being admitted. The nurse should assign the new client to which one of the following roommates? a. A two-year-old with chicken pox b. A four-year-old with asthma (key) c. A nine-year-old with acute diarrhea d. A ten-year-old with methicillin-resistant staph auerus (MRSA)10. Which one is the characteristic to high risk of suffocation in the infant? a. Because the nasal cavity is wide b. Because the respiratory tract has small diameter (key) c. Because the epiglottis is in the low position d. Because the occupied ratio of tongue in the mouth is small11. Which is incorrect one as the explanation of chlamydiosis in female? a. The symptoms easily become apparent. (key) b. It might be caused of infertility. c. The partner of female should be treated. d. Pelvic inflammatory disease can be occurred.12. The nurse is caring for an RH negative mother who has delivered an Rh positive child. The mother states, “The doctor told me about Rho GAM, but I’m still a little confused.” Which of the following responses, if made by the nurse, is MOST appropriate?
a. “Rho GAM is given to your child to prevent the development of antibodies.” b. “Rho GAM is given to your child to supply the necessary antibodies.” c. “Rho GAM is given to you to prevent the formation of antibodies.” (key) d. “Rho GAM is given to you to encourage the production of antibodies.”13. A nurse in a maternity unit is reviewing the records of the clients on the unit. Which client would the nurse identify as being at the greatest risk for developing disseminated coagulation (DIC)? a. A primigravida with mild pre-eclampsia b. A primigravida who delivered a 10-lb baby 3hours ago c. A gravida II who has just been diagnoses with dead fetus syndrome (key) d. A gravida IV who delivered 8 hours ago and has lost 500 mL of blood14. To determine the structural relationship of one hospital department with another, the nurse should consult which of the following? a. Organization chart (key) b. Job descriptions c. Personnel policies d. Policies and procedure manual15. A new unit nurse, manager is holding her first staff meeting. The manager greets the staff and comments that she has been employed to bring about performance improvement. The manager provides a plan that she developed, as well as a list of tasks and activities for which each staff member must volunteer to perform. In addition, she instructs staff members to report any problems directly to her. What type of leadership style do the new manager’s characteristics suggest? a. Autocratic (key) b. Situational c. Democratic d. Laisses-faire