COLEGIO DE KIDAPAWAN COMPETENCY APPRAISAL 2 Level 4

Situation 1 Concerted work efforts among members of the surgical team is essential to the success of the surgical procedure. 1. The sterile nurse or sterile personnel touch only sterile supplies and instruments. When there is a need for sterile supply which is not in the sterile field, who hands out these items by opening its outer cover? a. Circulating nurse b. Anesthesiologist c. Surgeon d. Nursing aide 2. The OR team performs distinct roles for one surgical procedure to be accomplished within a prescribed time frame and deliver a standard patient outcome. White the surgeon performs the surgical procedure, who monitors the status of the client li e urine output, blood loss? a. Scrub nurse b. Surgeon c. Anesthesiologist d. Circulating nurse !. "urgery schedules are communicated to the OR usually a day prior to the procedure by the nurse of the floor or ward where the patient is confined. #or orthopedic cases, what department is usually informed to be present in the OR? a. Rehabilitation department b. Laboratory department c. aintenance department d. Radiology department $. %inimally invasive surgery is very much into technology. &side from the usual surgical team who else to be present when a client undergoes laparoscopic surgery? a. !nformation technician b. "iomedical technician c. #lectrician d. Laboratory technicial '. (n massive blood loss, prompt replacement of compatible blood is crucial. What department needs to be alerted to coordinate closely with the patient)s family for immediate blood component therapy? a. Security $i%ision b. Chaplaincy c. Social Ser%ice Section d. &athology department Situation ' (ou are assigned in the )rthopedic *ard where clients are complaining of pain in %arying degrees upon mo%ement of body parts. *. Troy is a one day post open reduction and internal fi+ation ,OR(#- of the left hip and is in pain. Which of the following observation would prompt you to call the doctor?

a. $ressing is intact but partially soiled b. Left foot is cold to touch and pedal pulse is absent c. Left leg in limited functional anatomic position d. "& 11+,-./ pulse of .' beats,minute .. There is an order of /emerol '0 mg (.%. now and every * hours p r n. 1ou in2ected /emerol at ' pm. The ne+t dose of /emerol '0 mg (.%. is given3 a. *hen the client asks for the ne0t dose b. *hen the patient is in se%ere pain c. At 11pm d. At 1'pm 4. 1ou continuously evaluate the client)s adaptation to pain. Which of the following behaviors5 indicate appropriate adaptation? a. 1he client reports pain reduction and decreased acti%ity b. 1he client denies e0istence of pain c. 1he client can distract himself during pain episodes d. 1he client reports independence from watchers 6. 7ain in Ortho cases may not be mainly due to the surgery. There might be other factors such as cultural or psychological that influence pain. 8ow can you alter these factors as the nurse? a. #0plain all the possible inter%entions that may cause the client to worry. b. #stablish trusting relationship by gi%ing his medication on time c. Stay with the client during pain episodes d. &romote client2s sense of control and participation in pain control by listening to his concerns 10. (n some hip surgeries, an epidural catheter for #entanyl epidural analgesia is given. What is your nursing priority care in such a case? a. !nstruct client to obser%e strict bed rest b. Check for epidural catheter drainage c. Administer analgesia through epidural catheter as prescribed d. Assess respiratory rate carefully Situation 3 Records are %ital tools in any institution and should be properly maintained for specific use and time. 11. The patient)s medical record can wor as a double5edged swords. When can the medical record become the doctor)s9nurse worst enemy? a. *hen the record is %oluminous b. *hen a medical record is subpoenaed in court c. *hen it is missing d. *hen the medical record is inaccurate/ incomplete/ and inade4uate 12. /isposal of medical records in government hospitals9institutions must be done in close coordination with what agency? a. $epartment of !nterior and Local 5o%ernment 6$!L57 b. etro anila $e%elopment Authority 6 $A7 c. Records anagement Archi%es )ffice 6R A)7 d. $epart of 8ealth 6$)87

1!. (n the hospital, when you need5the medical record of a discharged patient for research, you will re:uest permission through3 a. $octor in charge b. 1he hospital director c. 1he nursing Ser%ice d. edical records section 1$. 1ou readmitted a client who was in another department a month ago. "ince you will need the previous chart, from whom do you re:uest the old chart? a. Central supply section b. &re%ious doctor2s clinic c. $epartment where the patient was pre%iously admitted d. edical records section 1'. Records %anagement and &rchives Offices of the /O8 is responsible for implementing its policies on record, disposal. 1ou now that your institution is covered by this policy it; a. (our hospital is considered tertiary b. (our hospital is in etro anila c. !t obtained permit to operate from $)8 d. (our hospital is &hilhealth accredited Situation + !n the )R/ there are safety protocols that should be followed. 1he )R nurse should be well %ersed with all these to safeguard the safety and 4uality to patient deli%ery outcome. 1*. Which of the following should be given highest priority when receiving patient in the OR? a. Assess le%el of consciousness b. 9erify patient identification and informed consent c. Assess %ital signs d. Check for :ewelry/ gown/ manicure and dentures 1.. "urgeries li e ( and / ,incision and drainage- and debribement are relatively short procedures but considered <dirty cases). When are these; procedures best scheduled? a. Last case b. !n between cases c. According to a%ailability of anesthesiologist d. According to the surgeon2s preference 14. OR nurses should be aware that maintaining the client)s safety is the overall goal of nursing care during the intraoperative phase. &s the circulating nurse, you ma e certain that throughout the procedure= a. the surgeon greets his client before induction of anesthesia b. the surgeon and anestheriologist are in tandem c. strap made of strong non;abrasi%e material are fastened securely around the :oints of the knees and ankles and around the ' hands around an arm board d. client is monitored throughout the surgery by the assistant anesthesiologist 16. &nother nursing chec that should not be missed before the induction of general anesthesia is3 a. check for presence underwear b. check for presence dentures

c. check patient2s blood studies d. check baseline %ital signs 20. "ome different habits and hobbies affect postoperative respiratory function. (f your client smo es ! pac s of cigarettes a day for the part 10 years, you will anticipate increased ris for3 a. perioperati%e an0iety and stress b. delayed coagulation time c. delayed wound healing d. postoperati%e respiratory function Situation < Nurses hold a %ariety of roles when pro%iding care to a perioperati%e patient. 21. Which of the following role would be the responsibility of the scrub nurse? a. Assess the readiness of the client prior to surgery b. #nsure that the airway is ade4uate c. Account for the number of sponges/ needles/ supplies/ =sed during the surgical procedure d. #%aluate the type of anesthesia appropriate for the surgical client 22. &s a perioperative nurse, how can you best meet the safety need of the client after administering preoperative narcotic? a. &ut side rails up and ask client not to get out of bed b. Send the client to )R$ with the family c. Allow client to get up to go to the comfort room d. )btain consent form 2!. (t is the responsibility of the pre5op, nurse to do s in prep for patients undergoing surgery. (f hair at the operative site is not shaved, what should be done to ma e suturing easy and lessen chance of incision infection? a. $raped b. &ulled c. Clipped d. Shampooed 2$. (t is also the nurse)s function to determine when infection is developing in the surgical incision. The perioperative nurse should observe for what signs of impending infection? a. Locali>ed heat and redness b. Serosanguinous e0udates and skin blanching c. Separation of the incision d. "lood clots and scar tissue are %isible 2'. Which of the following nursing intervention is done when e+amining the incision wound and changing the dressing? a. )bser%e the dressing and type and odor of drainage if any b. 5et patient2s consent c. *ash hands d. Re4uest the client to e0pose the incision wound Situation ? Carlo/ 1? years old/ comes to the #R with acute asthmatic attack. RR is +?,min and he appears to be in acute respiratory distress. 2*. Which of the following nursing actions should be initiated first?

a. &romote emotional support b. Administer o0ygen at ?L,min c. Suction the client e%ery 3@ min d. Administer bronchodilator by nebuli>er 2.. &minophylline was ordered for acute asthmatic attac . The mother as ed the nurse, what its indication the nurse will say is3 a. Rela0 smooth muscles of the bronchial airway b. &romote e0pectoration c. &re%ent thickening of secretions d. Suppress cough 24. 1ou will give health instructions to >arlo, a case of bronchial asthma. The health instruction will include the following ?@>?7T3 a. A%oid emotional stress and e0treme temperature b. A%oid pollution like smoking c. A%oid pollens/ dust seafood d. &ractice respiratory isolation 26. The asthmatic client as ed you what breathing techni:ue he can best practice when asthmatic attac starts. What will be the best position? a. Sit in high;Aowler2s position with e0tended legs b. Sit;up with shoulders back c. &ush on abdomen during e0halation d. Lean forward 3@;+@ degrees with each e0halation !0. &s a nurse you are always alerted to monitor status asthmaticus who will li ely and initially manifest symptoms of3 a. metabolic alkalosis b. respiratory acidosis c. respiratory alkalosis d. metabolic acidosis Situation - Boint Commission on Accreditation of 8ospital )rgani>ation 6BCA8&7 patient safety goals and re4uirements include the care and efficient use of technology in the )R arid elsewhere in the healthcare facility. !1. &s the head nurse in the OR, how can you improve the effectiveness of clinical alarm systems? a. limit suppliers to a few so that 4uality is maintained b. implement a regular in%entory of supplies and e4uipment c. Adherence to manufacturer2s recommendation d. !mplement a regular maintenance and testing of alarm systems !2. Over dosage of medication or anesthetic can happen even with the aid of technology li e infusion pump, sphymomanometer, and similar devices9machines. &s a staff, how can you improve the safety of using infusion pumps? a. Check the functionality of the pump before use b. Select your brand of infusion pump like you do with your cellphone C. Allow the technician to set theC infusion pump before use d. 9erify the flow rate against your computation

!!. A>&8Os universal protocol for surgical and invasive procedures to prevent wrong site, wrong person, and wrong procedures9surgery includes the following ?@>?7T3 a. ark the operati%e site if possible b. Conduct pre;procedure %erification process c. 1ake a %ideo of the entire intra;operati%e procedure d. Conduct time out immediately before starting the procedure !$. 1ou identified a potential ris of pre and post operative clients. To reduce the ris of patient harm resulting from fall, you can implement the following ?@>?7T3 a. Assess potential risk of fail associated with the patient2s the following #DC#&1E medication regimen b. 1ake action to address any identified risks through !ncident Report 6!R7 c. Allow client to walk with relati%e to the )AF d. Assess and periodically reassess indi%idual client2s risk for falling !'. &s a nurse you now you can improve on accuracy of patient)s identification by 2 patient identifiers, ?@>?7T3 a. identify the client by his,her wrist tag and %erify with family members b. identify client by his,her wrist tag and call his,her by name c. call the client by his,her case and bed number d. call the patient by his,her name and bed number Situation . 1eam efforts is best demonstrated in the )R !*. (f you are the nurse in charge for scheduling surgical cases, what important information do you need to as the surgeon? a. *ho is your internist b. *ho is your assistant and anesthesiologist/ and what is your preferred time and type of surgeryF c. *ho are your anesthesiologist/ internist/ and assistant d. *ho is your anesthesiologist. !.. (n the OR, the nursing tandem for every surgery is3 a. !nstrument technician and circulating nurse b. Nurse anesthetist/ nurse assistant/ and instrument technician c. Scrub nurse and nurse anesthetist d. Scrub and circulating nurses !4. While team effort is needed in the OR for efficient and :uality patient care delivery, we should limit the number of people in the room for infection control. Who comprise this team? a. Surgeon/ anesthesiologist/ scrub nurse/ radiologist/ orderly b. Surgeon/ assistants/ scrub nurse/ circulating nurse/ anesthesiologist c. Surgeon/ assistant surgeon/ anesthesiologist/ scrub nurse/ pathologist d. Surgeon/ assistant surgeon/ anesthesiologist/ intern/ scrub nurse

!6. When surgery is on5going, who coordinates the activities outside, including the family? a. )rderly,clerk b. Nurse super%isor c. Circulating nurse d. Anaesthesiologist

$0. The brea down in teamwor is often times a failure in3 a. #lectricity b. !nade4uate supply c. Leg work d. Communication Situation G Colostomy is a surgically created anus; !t can be temporary or permanent/ depending on the disease condition. $1. " in care around the stoma is critical. Which of the following is not indicated as a s in care barriers? a. Apply liberal amount of mineral oil to the area b. =se karaya paste and rings around the stoma c. Clean the area daily with soap and water before applying bag d. Apply talcum powder twice a day $2. What health instruction will enhance regulation of a colostomy ,defecation- of clients? a. !rrigate after lunch e%eryday b. #at fruits and %egetables in all three meals c. #at balanced meals at regular inter%als d. Restrict e0ercise to walking only $!. &fter ileostomy, which of the following condition is BOT e+pected? a. increased weight b. !rritation of skin around the stoma c. Li4uid stool d. #stablishment of regular bowel mo%ement $$. The following are appropriate nursing interventions during colostomy irrigation ?@>?7T3 a. !ncrease the irrigating solution flow rate when abdominal cramps is felt b. !nsert ';+ inches of an ade4uately lubricated catheter to the stoma c. &osition client in semi;Aowler d. 8and the solution 1. inches abo%e the stoma $'. What sensation is used as a gauge so that patients with ileostomy can determine how often their pouch should be drained? a. Sensation of taste b. Sensation of pressure c. Sensation of smell d. =rge to defecate

Answers & Rationale

1. 2. 3. 4. A. Circulating Nurse C. Anesthesiologist D. Radiology department B. Biomedical technician

5. !. %. &. (. 1+. 11. 12. 13. 14. 15. 1!. 1%. 1&. 1(. 2+. 21. 22. 23. 24. 25. 2!. 2%. 2&. 2(. 3+. 31. 32. 33. 34. 35. 3!. 3%. 3&. 3(. 4+.

C. Social Ser ice Section B. "e#t #oot is cold to touch and pedal pulse is a$sent C. At 11 pm C. 'he client can distract himsel# during pain episodes D. )romote client*s sense o# control and participation in control $y listening to his concerns D. Assess respiratory rate care#ully D. ,hen the medical record is inaccurate- incomplete- and inade.uate D. Department o# /ealth 0D1/2 B. 'he hospital director D. 3edical records section C. 4t o$tained permit to operate #rom D1/ B. 5eri#y patient identi#ication and in#ormed consent A. "ast case C. strap made o# strong non6a$rasi e materials are #astened securely around the 7oints o# the 8nees and an8les and around the 2 hands around an arm $oard. D. chec8 $aseline ital signs D. postoperati e respiratory #unction C. Account #or the num$er o# sponges- needles- supplies- used during the surgical procedure. A. )ut side rails up and as8 the client not to get out o# $ed C. Clipped A. "ocali9ed heat and redness A. 1$ser e the dressing and type and odor o# drainage i# any D. Administer $ronchodilator $y ne$uli9er A. Rela: smooth muscles o# the $ronchial air;ay D. )ractice respiratory isolation D. "ean #or;ard 3+64+ degrees ;ith each e:halation C. respiratory al8alosis D. 4mplement a regular maintenance and testing o# alarm systems A. Chec8 the #unctionality o# the pump $e#ore use C. 'a8e a ideo o# the entire intra6operati e procedure C. Allo; client to ;al8 ;ith relati e to the 1R C. call the client $y his<her case and $ed num$er B. ,ho is your assistant and anesthesiologist- and ;hat is your pre#erred time and type o# surgery= D. Scru$ and circulating nurses B. Surgeon- assistants- scru$ nurse- circulating nurse- anesthesiologist C. Circulating Nurse D. Communication

41. 42. 43. 44. 45.

A. Apply li$eral amount o# mineral oil to the area C. >at $alanced meals at regular inter als A. 4ncreased ;eight A. 4ncrease the irrigating solution #lo; rate ;hen a$dominal cramps is #elt B. Sensation o# pressure

"ituation 10E1he nurse works with relationship.

ina to help her work through termination of the nurse;patient

+?. &reparation for termination of the nurse;patient relationship begins during theE A. termination phase C. pre;orientation phase ". working phase $. orientation phase +-. ina2s past reactions to ending relationships is withdrawal. 1he nurse assists her to practice better ways of coping termination by pro%iding opportunities toE A. test new patterns of beha%ior C. conceptuali>e her problem ". plan for alternati%es $. %alue and find meaning in e0perience +.. $uring the early part of the interaction/ the nurse asked after a period of silence. H&erhaps we would talk about my lea%ingI. 1he nurse utili>ed which communication techni4ueE A. encouraging C. focusing on client ". suggesting $. understanding +G. inaE 6angrily7 H ! am angry/ ! should ne%er ha%e gotten in%ol%ed with youI 6silence7NurseE H(ou ha%e reason to be disappointed and to feel angry. Bust when we were getting somewhere. ! lea%e you.I A. reflecting words C. orienting ". understanding $. reflecting feelings <@. 1he ob:ection of the nurse;patient relationship is to pro%ide an opportunity of the patient toE A. clarify problems C. ha%e a correcti%e emotional e0perience ". de%elop insights $. de%elop interpersonal relationship Situation 11E As a program manager/ the mental health psychiatric nurse is tasked to pro%ide general patient management. <1. 1he nurse is aware that identifying the aspects of general patient management and identifying inter%entions for meeting these basic needs are distinctions ofE A. psychotherapy C. pharmacotherapy ". therapeutic milieu $. beha%ior therapy <'. !n order to get acti%e participation of the clients to carry out the ob:ecti%e of the program/ it is "#S1 for the nurse to conduct a,anE A. community meeting C. obser%ation ". sur%ey $. selecti%e inter%iew of patients <3. 1hrough the nurse2s role modeling of effecti%e communication/ the clients learned new ways of dealing with authority figures. 1his gi%es the clients a %enue toE A. communicate C. identify their problems ". sociali>e $. test new patterns of beha%ior <+. 1his element of communication facilitates e%aluation of the programE A. recei%er C. sender ". message $. feedback <<. 1he nurse2s style of leadership in milieu therapy isE

A. autocratic ". laisse>;faire

C. democratic $. bene%olent

Situation 1'E Loretta is a '. years old/ unemployed patient/ admitted to the psychiatric unit with a diagnosis of chronic undifferentiated schi>ophrenia. She described herself as the H9irgin aryI and her mission is to propagate peace. She was obser%ed laughing and talking to herself. 8er thought processes were profoundly disorgani>ed. She was also fearful and suspicious of others. <?. Loretta2s claim of being the H9irgin aryI is a,anE A. imagination C. hallucination ". delusion $. obsession <-. 8er mission to propagate peace isE A. a serious call for a need of transformation ". an attempt to o%ercome low self;esteem C. realistic and laudable $. an ad%ocacy that she can participate in

<.. *hich of this inter%ention would N)1 be therapeutic in decreasing Loretta2s an0ietyF A. :oke about her thought to help her feel at ease ". listen to her thoughts and feelings C. simply accept $. do not con%ince her that her perception is unreal <G. 1he nurse e%aluates that Loretta2s ready for a rehabilitation program when sheE A. approaches the nurse at fre4uent inter%als C. goes to the coffee shop alone more often ". ceases to talk about H9irgin aryI $. carries a book H1he &urpose $ri%en LifeI ?@. 1he nurse is leading a group meeting of patients to prepare them to be discharged. An appropriate goal for the group members is to de%elopE A. attitudes of society towards the mentally ill ". skills for maintaining daily li%ing C. awareness of interpersonal patterns of interactions $. insight into personal problems Situation 13E A group of adult chronic schi>ophrenic patients were recommended to undergo social skills training. ?1. 1he following are the ob:ecti%es of a social skills training program #DC#&1E A. e0plore deep seated intrapsychic conflicts C. help build self esteem and self confidence ". practice skills in relating with people $. de%elop and practice general coping skills ?'. Social skills training is N)1 primarily indicated for psychiatric patients who areE A. in acute stage of illness ". ha%ing difficulties starting and maintaining interpersonal relationships C. ha%ing chronic episodes of stress and an0iety while interacting with others $. e0periencing recurrence of symptoms in front of particular people or among people in general ?3. 1he focus of the group interaction is Hhere and nowI. An appropriate topic would beE A. ways to celebrate 9alentine2s $ay in Aebruary ". how to spend the summer %acation C. an unforgettable e0perience as a child $. how to tell a :oke ?+. An appropriate techni4ue for the participants to practice how to communicate effecti%ely is through,aE A. lecture C. role play ". SEMINAR D. psychodrama ?<. Considering that it is "#S1 to learn by e0ample/ it is A. model good social skills throughout the session ". relate successful past e0periences C. in%ite a resource person $. watch a mo%i# )S1 practical toE