Competency Appraisal 1

DIAGNOSTIC EXAMINATION

1. The most appropriate nursing order for a patient who develops dyspnea and shortness of breath would be…
a. Maintain the patient on strict bed rest at all times
b. Maintain the patient in an orthopneic position as needed
c. Administer oxygen via mask at 24%, as needed
d. Allow a 1 hour rest period between activities

2. The nurse observes that Mr. Adams begins to have increased difficulty breathing. She elevates the head of the bed to the high
Fowler position, which decreases his respiratory distress. The nurse documents this breathing as:
a. Tachypnea
b. Eupnea
c. Orthopnea
d. Hyperventilation

3. The physician orders a platelet count to be performed on Mrs. Smith after breakfast. The nurse is responsible for:
a. Instructing the patient about this diagnostic test
b. Writing the order for this test
c. Giving the patient breakfast
d. All of the above

4. Mrs. Mitchell has been given a copy of her diet. The nurse discusses the foods allowed on a 500-mg low sodium diet. These
include:
a. A ham and Swiss cheese sandwich on whole wheat bread
b. Mashed potatoes and broiled chicken
c. A tossed salad with oil and vinegar and olives
d. Chicken bouillon

5. The physician orders a maintenance dose of 5,000 units of subcutaneous heparin (an anticoagulant) daily. Nursing responsibilities
for Mrs. Mitchell now include:
a. Reviewing daily activated partial thromboplastin time (APTT) and prothrombin time.
b. Reporting an APTT above 45 seconds to the physician
c. Assessing the patient for signs and symptoms of frank and occult bleeding
d. All of the above

6. The four main concepts common to nursing that appear in each of the current conceptual models are:
a. Person, nursing, environment, medicine
b. Person, health, nursing, support systems
c. Person, health, psychology, nursing
d. Person, environment, health, nursing

7. In Maslow’s hierarchy of physiologic needs, the human need of greatest priority is:
a. Love
b. Elimination
c. Nutrition
d. Oxygen

8. The family of an accident victim who has been declared brain-dead seems amenable to organ donation. What should the nurse
do?
a. Discourage them from making a decision until their grief has eased
b. Listen to their concerns and answer their questions honestly
c. Encourage them to sign the consent form right away
d. Tell them the body will not be available for a wake or funeral

9. A new head nurse on a unit is distressed about the poor staffing on the 11 p.m. to 7 a.m. shift. What should she do?
a. Complain to her fellow nurses
b. Wait until she knows more about the unit
c. Discuss the problem with her supervisor
d. Inform the staff that they must volunteer to rotate

10. Which of the following principles of primary nursing has proven the most satisfying to the patient and nurse?
a. Continuity of patient care promotes efficient, cost-effective nursing care
b. Autonomy and authority for planning are best delegated to a nurse who knows the patient well
c. Accountability is clearest when one nurse is responsible for the overall plan and its implementation.
d. The holistic approach provides for a therapeutic relationship, continuity, and efficient nursing care.

11. If nurse administers an injection to a patient who refuses that injection, she has committed:
 Competency Appraisal 1
a. Assault and battery
b. Negligence
c. Malpractice
d. None of the above

12. If patient asks the nurse her opinion about a particular physicians and the nurse replies that the physician is incompetent, the
nurse could be held liable for:
a. Slander
b. Libel
c. Assault
d. Respondent superior

13. A registered nurse reaches to answer the telephone on a busy pediatric unit, momentarily turning away from a 3 month-old
infant she has been weighing. The infant falls off the scale, suffering a skull fracture. The nurse could be charged with:
a. Defamation
b. Assault
c. Battery
d. Malpractice

14. Which of the following is an example of nursing malpractice?

a. The nurse administers penicillin to a patient with a documented history of allergy to the drug. The patient experiences an
allergic reaction and has cerebral damage resulting from anoxia.
b. The nurse applies a hot water bottle or a heating pad to the abdomen of a patient with abdominal cramping.
c. The nurse assists a patient out of bed with the bed locked in position; the patient slips and fractures his right humerus.
d. The nurse administers the wrong medication to a patient and the patient vomits. This information is documented and
reported to the physician and the nursing supervisor.

15. Which of the following signs and symptoms would the nurse expect to find when assessing an Asian patient for postoperative
pain following abdominal surgery?
a. Decreased blood pressure and heart rate and shallow respirations
b. Quiet crying
c. Immobility, diaphoresis, and avoidance of deep breathing or coughing
d. Changing position every 2 hours

16. Which is the primary goal of community health nursing?

a. To support and supplement the efforts of the medical profession in the promotion of health and prevention of illness
b. To enhance the capacity of individuals, families and communities to cope with their health needs
c. To increase the productivity of the people by providing them with services that will increase their level of health
d. To contribute to national development through promotion of family welfare, focusing particularly on mothers and children.

17. CHN is a community-based practice. Which best explains this statement?

A. The service is provided in the natural environment of people.
B. The nurse has to conduct community diagnosis to determine nursing needs and problems.
C. The services are based on the available resources within the community.
D. Priority setting is based on the magnitude of the health problems identified.

18. Population-focused nursing practice requires which of the following processes?

A. Community organizing
B. Nursing process
C. Community diagnosis
D. Epidemiologic process
19. R.A. 1054 is also known as the Occupational Health Act. Aside from number of employees, what other factor must be considered
in determining the occupational health privileges to which the workers will be entitled?
A. Type of occupation: agricultural, commercial, industrial
B. Location of the workplace in relation to health facilities
C. Classification of the business enterprise based on net profit
D. Sex and age composition of employees

20. A business firm must employ an occupational health nurse when it has at least how many employees?
A. 21
B. 101
C. 201
D. 301

21. When the occupational health nurse employs ergonomic principles, she is performing which of her roles?
A. Health care provider
B. Health educator
C. Health care coordinator
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D. Environmental manager

22. A garment factory does not have an occupational nurse. Who shall provide the occupational health needs of the factory
workers?
A. Occupational health nurse at the Provincial Health Office
B. Physician employed by the factory
C. Public health nurse of the RHU of their municipality
D. Rural sanitary inspector of the RHU of their municipality

23. “Public health services are given free of charge.” Is this statement true or false?
A. The statement is true; it is the responsibility of government to provide basic services.
B. The statement is false; people pay indirectly for public health services.
C. The statement may be true or false, depending on the specific service required.
D. The statement may be true or false, depending on policies of the government concerned.

24. We say that a Filipino has attained longevity when he is able to reach the average lifespan of Filipinos. What other statistic may
be used to determine attainment of longevity?
A. Age-specific mortality rate
B. Proportionate mortality rate
C. Swaroop’s index
D. Case fatality rate

25. Which of the following is the most prominent feature of public health nursing?
A. It involves providing home care to sick people who are not confined in the hospital.
B. Services are provided free of charge to people within the catchment area.
C. The public health nurse functions as part of a team providing a public health nursing services.
D. Public health nursing focuses on preventive, not curative, services.

26. Which of the following is the mission of the Department of Health?

A. Health for all Filipinos
B. Ensure the accessibility and quality of health care
C. Improve the general health status of the population
D. Health in the hands of the Filipino people by the year 2020

27. Which is true of primary facilities?

A. They are usually government-run.
B. Their services are provided on an out-patient basis.
C. They are training facilities for health professionals.
D. A community hospital is an example of this level of health facilities.

28. When assessing the adequacy of sperm for conception to occur, which of the following is the most useful criterion?
a. Sperm count
b. Sperm motility
c. Sperm maturity
d. Semen volume

29. A couple who wants to conceive but has been unsuccessful during the last 2 years has undergone many diagnostic procedures.
When discussing the situation with the nurse, one partner states, “We know several friends in our age group and all of them
have their own child already, Why can’t we have one?”. Which of the following would be the most pertinent nursing diagnosis
for this couple?
a. Fear related to the unknown
b. Pain related to numerous procedures.
c. Ineffective family coping related to infertility.
d. Self-esteem disturbance related to infertility.

30. Which of the following urinary symptoms does the pregnant woman most frequently experience during the first trimester?
a. Dysuria
b. Frequency
c. Incontinence
d. Burning

31. Heartburn and flatulence, common in the second trimester, are most likely the result of which of the following?
a. Increased plasma HCG levels
b. Decreased intestinal motility
c. Decreased gastric acidity
d. Elevated estrogen levels

32. On which of the following areas would the nurse expect to observe chloasma?
 Competency Appraisal 1
a. Breast, areola, and nipples
b. Chest, neck, arms, and legs
c. Abdomen, breast, and thighs
d. Cheeks, forehead, and nose

33. A pregnant client states that she “waddles” when she walks. The nurse’s explanation is based on which of the following as the
cause?
a. The large size of the newborn
b. Pressure on the pelvic muscles
c. Relaxation of the pelvic joints
d. Excessive weight gain

34. Which of the following represents the average amount of weight gained during pregnancy?
a. 12 to 22 lb
b. 15 to 25 lb
c. 24 to 30 lb
d. 25 to 40 lb

35. When talking with a pregnant client who is experiencing aching swollen, leg veins, the nurse would explain that this is most
probably the result of which of the following?
a. Thrombophlebitis
b. Pregnancy-induced hypertension
c. Pressure on blood vessels from the enlarging uterus
d. The force of gravity pulling down on the uterus

36. Cervical softening and uterine souffle are classified as which of the following?
a. Diagnostic signs
b. Presumptive signs
c. Probable signs
d. Positive signs

37. Which of the following would the nurse identify as a presumptive sign of pregnancy?
a. Hegar sign
b. Nausea and vomiting
c. Skin pigmentation changes
d. Positive serum pregnancy test

38. Which of the following common emotional reactions to pregnancy would the nurse expect to occur during the first trimester?
e. Introversion, egocentrism, narcissism
f. Awkwardness, clumsiness, and unattractiveness
g. Anxiety, passivity, extroversion
h. Ambivalence, fear, fantasies

39. During which of the following would the focus of classes be mainly on physiologic changes, fetal development, sexuality, during
pregnancy, and nutrition?
i. Prepregnant period
j. First trimester
k. Second trimester
l. Third trimester

40. Which of the following would be disadvantage of breast feeding?

m. Involution occurs more rapidly
n. The incidence of allergies increases due to maternal antibodies
o. The father may resent the infant’s demands on the mother’s body
p. There is a greater chance for error during preparation

41. Which of the following would cause a false-positive result on a pregnancy test?
q. The test was performed less than 10 days after an abortion
r. The test was performed too early or too late in the pregnancy
s. The urine sample was stored too long at room temperature
t. A spontaneous abortion or a missed abortion is impending

42. A client LMP began July 5. Her EDD should be which of the following?
u. January 2
v. March 28
w. April 12
x. October 12
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43. Following surgery, Mario complains of mild incisional pain while performing deep- breathing and coughing exercises. The nurse’s
best response would be:
a. “Pain will become less each day.”
b. “This is a normal reaction after surgery.”
c. “With a pillow, apply pressure against the incision.”
d. “I will give you the pain medication the physician ordered.”

44. The nurse needs to carefully assess the complaint of pain of the elderly because older people
a. are expected to experience chronic pain
b. have a decreased pain threshold
c. experience reduced sensory perception
d. have altered mental function

45. Mary received AtropineSO4 as a pre-medication 30 minutes ago and is now complaining of dry mouth and her PR is
higher, than before the medication was administered. The nurse’s best
a. The patient is having an allergic reaction to the drug.
b. The patient needs a higher dose of this drug
c. This is normal side-effect of AtSO4
d. The patient is anxious about upcoming surgery

46. Ana’s postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32. Suspecting shock,
which of the following orders would the nurse question?
a. Put the client in modified Trendelenberg's position.
b. Administer oxygen at 100%.
c. Monitor urine output every hour.
d. Administer Demerol 50mg IM q4h

47. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal conduit in the morning. He
is wringing his hands and pacing the floor when the nurse enters his room. What is the best approach?
a. "Good evening, Mr. Pablo. Wasn't it a pleasant day, today?"
b. "Mr, Pablo, you must be so worried, I'll leave you alone with your thoughts.
c. “Mr. Pablo, you'll wear out the hospital floors and yourself at this rate."
d. "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?"

48. After surgery, Gina returns from the Post-anesthesia Care Unit (Recovery Room) with a nasogastric tube in place following a gall
bladder surgery. She continues to complain of nausea. Which action would the nurse take?
a. Call the physician immediately.
b. Administer the prescribed antiemetic.
c. Check the patency of the nasogastric tube for any obstruction.
d. Change the patient’s position.

49. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he
refuses to move. The nurse should plan to:
a. Reassure him that the nurses will not hurt him
b. Let him perform his own activities of daily living
c. Handle him gently when assisting with required care
d. Complete A.M. care quickly as possible when necessary

50. A client returns from the recovery room at 9AM alert and oriented, with an IV infusing. His pulse is 82, blood pressure is 120/80,
respirations are 20, and all are within normal range. At 10 am and at 11 am, his vital signs are stable. At noon, however, his
pulse rate is 94, blood pressure is 116/74, and respirations are 24. What nursing action is most appropriate?
a. Notify his physician.
b. Take his vital signs again in 15 minutes.
c. Take his vital signs again in an hour.
d. Place the patient in shock position.

51. A 56 year old construction worker is brought to the hospital unconscious after falling from a 2-story building. When assessing the
client, the nurse would be most concerned if the assessment revealed:
a. Reactive pupils
b. A depressed fontanel
c. Bleeding from ears
d. An elevated temperature

52. Which of the ff. statements by the client to the nurse indicates a risk factor for CAD?
a. “I exercise every other day.”
b. “My father died of Myasthenia Gravis.”
 Competency Appraisal 1
c. “My cholesterol is 180.”
d. “I smoke 1 1/2 packs of cigarettes per day.”

53. Mr. Braga was ordered Digoxin 0.25 mg. OD. Which is poor knowledge regarding this drug?
a. It has positive inotropic and negative chronotropic effects
b. The positive inotropic effect will decrease urine output
c. Toxixity can occur more easily in the presence of hypokalemia, liver and renal problems
d. Do not give the drug if the apical rate is less than 60 beats per minute.

54. Valsalva maneuver can result in bradycardia. Which of the following activities will not stimulate Valsalva's maneuver?
a. Use of stool softeners.
b. Enema administration
c. Gagging while toothbrushing.
d. Lifting heavy objects

55. The nurse is teaching the patient regarding his permanent artificial pacemaker. Which information given by the nurse shows her
knowledge deficit about the artificial cardiac pacemaker?
a. take the pulse rate once a day, in the morning upon awakening
b. may be allowed to use electrical appliances
c. have regular follow up care
d. may engage in contact sports

56. A patient with angina pectoris is being discharged home with nitroglycerine tablets. Which of the following instructions does the
nurse include in the teaching?
a. “When your chest pain begins, lie down, and place one tablet under your tongue. If the pain continues, take another tablet
in 5 minutes.”
b. “Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the hospital.”
c. “Continue your activity, and if the pain does not go away in 10 minutes, begin taking the nitro tablets one every 5 minutes
for 15 minutes, then go lie down.”
d. “Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the hospital if the pain is
unrelieved.

57. A client with chronic heart failure has been placed on a diet restricted to 2000mg. of sodium per day. The client demonstrates
adequate knowledge if behaviors are evident such as not salting food and avoidance of which food?
a. Whole milk
b. Canned sardines
c. Plain nuts
d. Eggs

58. Nurse Hazel is caring for a male client who experience false sensory perceptions with no basis in reality. This perception is
known as:
a. Hallucinations
b. Delusions
c. Loose associations
d. Neologisms

59. Nurse Monet is caring for a female client who has suicidal tendency. When accompanying the client to the restroom, Nurse
Monet should…
a. Give her privacy
b. Allow her to urinate
c. Open the window and allow her to get some fresh air
d. Observe her

60. Nurse Maureen is developing a plan of care for a female client with anorexia nervosa. Which action should the nurse include in
the plan?
a. Provide privacy during meals
b. Set-up a strict eating plan for the client
c. Encourage client to exercise to reduce anxiety
d. Restrict visits with the family

61. A client is experiencing anxiety attack. The most appropriate nursing intervention should include?
a. Turning on the television
b. Leaving the client alone
c. Staying with the client and speaking in short sentences
d. Ask the client to play with other clients

62. A female client is admitted with a diagnosis of delusions of GRANDEUR. This diagnosis reflects a belief that one is:
a. Being Killed
 Competency Appraisal 1
b. Highly famous and important
c. Responsible for evil world
d. Connected to client unrelated to oneself

63. A 20 year old client was diagnosed with dependent personality disorder. Which behavior is not most likely to be evidence of
ineffective individual coping?
a. Recurrent self-destructive behavior
b. Avoiding relationship
c. Showing interest in solitary activities
d. Inability to make choices and decision without advice

64. A male client is diagnosed with schizotypal personality disorder. Which signs would this client exhibit during social situation?
a. Paranoid thoughts
b. Emotional affect
c. Independence need
d. Aggressive behavior

65. Nurse Claire is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is?
a. Encourage to avoid foods
b. Identify anxiety causing situations
c. Eat only three meals a day
d. Avoid shopping plenty of groceries

66. Nurse Tony was caring for a 41 year old female client. Which behavior by the client indicates adult cognitive development?
a. Generates new levels of awareness
b. Assumes responsibility for her actions
c. Has maximum ability to solve problems and learn new skills
d. Her perception are based on reality

67. A neuromuscular blocking agent is administered to a client before ECT therapy. The Nurse should carefully observe the client
for?
a. Respiratory difficulties
b. Nausea and vomiting
c. Dizziness
d. Seizures

68. Nurse Anna can minimize agitation in a disturbed client by?

a. Increasing stimulation
b. limiting unnecessary interaction
c. increasing appropriate sensory perception
d. ensuring constant client and staff contact

69. A 39 year old mother with obsessive-compulsive disorder has become immobilized by her elaborate hand washing and walking
rituals. Nurse Trish recognizes that the basis of O.C. disorder is often:
a. Problems with being too conscientious
b. Problems with anger and remorse
c. Feelings of guilt and inadequacy
d. Feeling of unworthiness and hopelessness

70. Mario is complaining to other clients about not being allowed by staff to keep food in his room. Which of the following
interventions would be most appropriate?
a. Allowing a snack to be kept in his room
b. Reprimanding the client
c. Ignoring the clients behavior
d. Setting limits on the behavior

80. Conney with borderline personality disorder who is to be discharge soon threatens to “do something” to herself if discharged.
Which of the following actions by the nurse would be most important?
a. Ask a family member to stay with the client at home temporarily
b. Discuss the meaning of the client’s statement with her
c. Request an immediate extension for the client
d. Ignore the clients’ statement because it’s a sign of manipulation

SITUATION 1: Martha just passed the Philippine Nurse Licensure Examination. She plans to apply for her new job as a
staff nurse in a tertiary hospital.

81. During the interview, the Director of Nursing asks Martha about the key areas of responsibilities that she can do as a
beginning professional. Which of the following is a correct response of Martha? “I can…
 Competency Appraisal 1
a. administer medications to patients”
b. deliver safe and quality care to patients”
c. discuss the pathophysiology of the patient’s disease process”
d. set priorities in rendering care to patients”

82. Which of the following key areas of responsibilities is included in the empowering competencies of a nurse like
Marta?
a. Research
b. Management of resources and environment
c. Personal and professional development
d. Collaboration and teamwork

83. Which of the following qualifications is NOT mandated in order for Martha to be accepted to the position of a staff
nurse?
a. BSN graduate
b. Licensed and registered nurse
c. Must be physically and mentally fit
d. With 60 credit units in CPE

84. Which THREE of the following core competencies should Martha demonstrate under safe and quality care?
1. Demonstrates knowledge base on the health /illness status of individual
2. Utilizes resources to support patient care
3. Promotes safety and comfort of patients
4. Responds to the urgency of the patient’s condition
a. 1, 2, 3
b. 1, 3, 4
c. 2, 3, 4
d. 1, 2, 4

85. This key area of responsibility allows Martha to enhance the delivery of effective and efficient care to patients
a. Research
b. Communication
c. Health education
d. Record management

86. In performing her enabling competencies, Martha should demonstrate which of the following competencies?
a. Management of resources an environment
b. Research
c. Collaboration and teamwork
d. Ethico-moral responsibility

87. She is aware that the BON Resolution No. 112 was promulgated by the Board of Nursing to
a. set the standards for safe nursing practice in the country
b. guide practitioners on continuing professional education
c. Adopt the core competency standards for nursing practice
d. set the ethical standards for the nursing profession

88. As a registered nurse, Martha is covered by the Code of Ethics for Registered Nurses in the Philippines which is
promulgated in:
a. BON Resolution No. 1955
b. EO No. 220
c. BON Resolution No. 220
d. R.A 9173

89. She knows that the implementing rules and regulations (IRR) of the Nursing Law was passed through:
a. BON Resolution No. 425, s. 2003
b. EO 220
c. BON Resolution No. 459 s. 2002
d. BON Resolution No.220 s. 2004

SITUATION 2: Kamille successfully passed the PNLE. She has just received her professional identification card as a
Registered nurse.

90. She assessed a three- year old boy for fever, but the boy would not want to go near her. Which of the following
remarks of Kamille would constitute an assault?
a. “You don’t want to have your temperature taken? I will call the guard to hold you and give you an injection
instead!”
b. “Alright, just tell me when you are ready to have your temperature taken.”
 Competency Appraisal 1
c. “This will not hurt you; just put it under your tongue.”
d. “If you will let me take your temperature your fever will be gone.”

91. Which of the following conditions would BEST prevent Kamille from a malpractice suit?
a. Performs her duty as prescribed in her job description
b. Records the intervention and outcomes of care
c. Does not allow patient’s relatives to participate in the care of her patients.
d. Performs her functions pursuant to the law.

92. If Kamille divulges the information that she is caring for the child of a patient with sexually transmitted disease, she
can be liable for unprofessional conduct specifically:
a. Libel
b. Slander
c. Breach of Confidentiality
d. Invasion of privacy

93. Which of the following information is NOT indicated in the professional identification card issued to Kamille?
a. A Signature of the Chairman of the Board
b. Registration date
c. Date of issuance and expiration
d. License number

94. Kamille knows that she is duty-bound to renew her professional identification card every how often?
a. Every five years
b. Every three years
c. Annually
d. Biannually

SITUATION 3 – Ms. Sheena Perez is the Health Education Program Officer of the Municipal Health Office. She plans to
develop programs based on the various laws and directives from the DOH.

95. She knows that all prescriptions of the municipal health officer should be in generics. What law provides for this
mandate?
a. R.A 9173
b. R.A. 6675
c. R.A. 1080
d. R.A. 7160

96. Sheena has to consider managing the resources of the MHO. She knows that the delivery of basic services and
facilities of the national government was transferred to the local government units. Which of the following laws
mandated this?
a. R.A 7305
b. R.A. 7160
c. R.A.1080
d. R.A. 8423

97.Which of the following provisions does NOT apply to R.A 7305?

a. Promotes and improves the socio-economic well being of health workers
b. Develop their skills and capabilities
c. Encourage those qualified and with abilities to remain in government service.
d. Standardizes the salaries of nurses working in the government

98. She deems it necessary for her to undergo continuing professional education. Which of the following supports this
objective?
a. PRC Resolution No. 2004 -179
b. BON Resolution No. 220 s.2004
c. EO No. 220
d. BON Resolution No. 425 s. 2003

99. She develops programs on Drug Prevention. As a basis for her program, she quoted which of the following acts?
a. RA 9165
b. RA 6125
c. RA 6675
d. RA 2382

100. Ms. Perez conducts counseling to parents of newborns about heritable diseases. Which of the following
procedures is covered by RA 9288?
a. Newborn Apgar Score
b. Newborn Screening
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c. Denver Developmental Screening Test
d. Metro Manila Developmental Screening Test