COMPETENCY APPRAISAL

MEDICAL -SURGICAL NURSING

Ms. Charmaine Baniqued, RN, MSN

Instructions: Neither erasures nor superimpositions is accepted. Encircle the letter

of your answer. Choose the best answer.
The client with a Head Injury
1. When an unconscious client
with multiple injuries arrives in
emergency room, which nursing
intervention receives the
highest priority?
a. Establishing an airway
b. Replacing blood loss
c. Stopping bleeding from open
wounds
d. Checking for a neck fracture
2. The nurse monitors the client
who is at risk for increased
intracranial pressure (ICP) for
a. Unequal pupil size
b. Decreasing systolic blood
pressure
c. Tachycardia
d. Decreasing body
temperature
3. What is the correct nursing
intervention when a client with
a head injury begins to have
clear drainage from his nose?
a. Compress the nares
b. Tilt the head back
c. Give the client a white pad
to collect the fluid
d. Administer an antihistamine
for postnasal drip
4. Which of the following
respiratory patterns indicate
increasing ICP in the brain
stem?
a. Slow, irregular respirations
b. Rapid, shallow respirations
c. Asymmetric chest excursion
d. Nasal flaring
5. Which of the following nursing
interventions is appropriate for
a client with an ICP of 20mmHg?

a. Give the client a warming

blanket
b. Administer low-dose
barbiturates
c. Encourage the client to
hyperventilate
d. Restrict fluids
6. A client has signs of increased
ICP. Which of the following is an
early indicator of deterioration
in the clients condition?
a. Widening pulse pressure
b. Decrease in the pulse rate
c. Dilated, fixed pupil
d. Decrease in LOC
7. A nurse obtains a specimen of
clear nasal drainage from a
client with a head injury. Which
of the following tests
differentiates mucus from CSF?
a. pH
b. Specific gravity
c. Glucose
d. Microorganisms
8. The client has a sustained ICP of
20mmHg. The nurse should
position the client
a. With the head of the bed
elevated 30-45 degrees
b. In Trendelenburgs position
c. In Left Sims position
d. With the head elevated on
two pillows
9. The nurse administers mannitol
(Osmitrol) to the client with
increased ICP and closely
monitors
a. Muscle relaxation
b. Intake and output
c. Widening of the pulse
pressure
d. Pupil dilation

COMPETENCY APPRAISAL
MEDICAL -SURGICAL NURSING
Ms. Charmaine Baniqued, RN, MSN

10.A male client with a head injury

regains consciousness after
several days. Which of the
following nursing statements is
most appropriate as the client
awakens?
a. Ill get your family.
b. Can you tell me your name
and where you live?
c. Ill bet youre a little
confused right now.
d. You are in the hospital. You
were in an accident and
unconscious.
11.A client who is regaining
consciousness after a
craniotomy becomes restless
and attempts to pull out her IV
line. Which nursing intervention
protects the client without
increasing her ICP?
a. Place her in a jacket restraint
b. Wrap her hands in a soft
mitten restraints
c. Tuck her arms and hands
under the draw sheet
d. Apply a wrist restraint to
each arm
12.Which post operative activity
does the nurse encourage the
client to avoid when there is a
risk for increased ICP?
a. Deep breathing
b. Turning
c. Coughing
d. Passive range-of-motion
13.Which of the following is most
effective in assessing the client
with a head injury for the
development of diabetes
insipidus?
a. Taking vital signs every 2
hours
b. Measuring urine output
hourly
c. Assessing arterial blood gas
values every other day

d. Checking blood glucose

14.After 4 weeks of hospitalization,
a client who had a serious head
injury with increased ICP is to be
discharged to a rehabilitation
facility to continue his recovery.
Which of the following expected
outcomes would be appropriate
for the client at this stage of
rehabilitation?
a. The client will exhibit no
further episodes of shortterm memory loss
b. The client will be able to
return to his construction job
in three weeks
c. The client will actively
participate in the
rehabilitation process as
appropriate
d. The client will be emotionally
stable and display
personality traits that were
present before injury
15.Which of the following describes
decerebrate posturing?
a. Internal rotation and
adduction of arms with
flexion of elbows, wrists and
fingers
b. Back hunched over, rigid
flexion of all four extremities
with supination of arms and
plantar flexion of feet
c. Supination of arms,
dorsiflexion of the feet
d. Back arched, rigid extension
of all four extremities
16.When noting cluster breathing
in a client who is on a ventilator
in the vent-assisted mode after
a craniotomy for an intracranial
bleed in the occipital lobe, the
nurse should
a. Count the rate to be sure
that ventilations are deep
enough to be sufficient

COMPETENCY APPRAISAL
MEDICAL -SURGICAL NURSING
Ms. Charmaine Baniqued, RN, MSN

b. Call the physician while

another nurse checks the
vital signs and ascertains the
patients Glasgow Coma
Scale Score
c. Call the physician to adjust
the ventilator settings
d. Check deep tendon reflexes
to determine the best motor
response
17.In planning the care for the
client who has had a posterior
fossa (infratentorial)
craniotomy, the nurse
understands that when
positioning the client, which of
the following is contraindicated?
a. Keeping the client flat on
one side or the other
b. Elevating the head of the
bed to 30 degrees
c. Log rolling or turning as a
unit when turning
d. Keeping the neck in a
neutral position
The Client with Seizures
18.Which of the following is
contraindicated for a client with
seizure precaution?
a. Encouraging him to perform
his own personal hygiene
b. Allowing him to wear his own
clothing
c. Assessing oral temperature
with a glass thermometer
d. Encouraging him to be out of
bed
19.Which of the following will the
nurse observe in the client in
the ictal phase of a generalized
grand-mal (tonic-clonic)
seizure?
a. Jerking in one extremity that
spreads gradually to
adjacent areas
b. Vacant staring and an abrupt
cessation of all activity

c. Facial grimaces, patting

motions, and lip smacking
d. Loss of consciousness, body
stiffening, and violent
muscle contractions
20.Which statement best prepares
the client for a computed
tomographic (CT) scan of the
head without contrast to be
completed the next morning?
a. You must shampoo your
hair tonight to remove all oil
and dirt.
b. You may drink fluids until
midnight; but after that drink
nothing until the scan is
completed.
c. You will have some hair
shaved to attach the small
electrode to your scalp.
d. You will need to hold your
head very still during the
examination.
21.An electroencephalogram (EEG)
is ordered for the client. What
nursing intervention does the
nurse take when the client is
served a breakfast consisting of
a soft-boiled egg, toast with
butter and marmalade, orange
juice, and coffee on the morning
of EEG?
a. Remove all the food
b. Remove the coffee
c. Remove the toast, butter,
and marmalade only
d. Substitute vegetable juice
for the orange juice
22.The client asks the nurse, What
caused me to have a seizure?
Ive never had one before. The
primary cause of tonic-clonic
seizures in adults older than 20
years is
a. Head trauma
b. Electrolyte imbalance
c. A congenital defect

COMPETENCY APPRAISAL
MEDICAL -SURGICAL NURSING
Ms. Charmaine Baniqued, RN, MSN

d. Epilepsy
23.What does the nurse include in
the teaching plan for a client
with seizures who is going home
with a prescription for
gabapentin (Neurontin)?
a. Take all the medication until
it is gone
b. Notify the physician if vision
changes occur
c. Store gabapentin in the
refrigerator
d. Take gabapentin with an
antacid to protect against
ulcers
24.What is the priority nursing
intervention in the post ictal
phase of a seizure?
a. Reorient the client to time,
person, and place
b. Determine the clients level
of sleepiness
c. Assess the clients breathing
pattern
d. Position the client
comfortably
25.Which intervention is most
effective in minimizing the risk
of seizure activity in a client
who is undergoing diagnostic
studies after having
experienced several episodes of
seizures?
a. Maintain the client on bed
rest
b. Administer butabarbital
sodium sodium
(phenobarbital) 30mg orally,
three times per day
c. Close the door to the room
to minimize stimulation
d. Administer carbamazepine
(Tegretol) 200mg orally,
twice per day
26.What nursing assessments
should be documented at the

beginning of the ictal phase of

seizure?
a. Heart rate, respirations,
pulse oximeter, and blood
pressure
b. Last dose of anticonvulsant
and circumstances at the
time
c. Type of visual, auditory, and
olfactory aura the client
experienced
d. Movement of the head, eyes,
and muscle rigidity
27.Which clinical manifestation
does the nurse expect in the
client in the post ictal phase of
grand mal seizure?
a. Drowsiness
b. Inability to move
c. Paresthesia
d. Hypotension
28.A client with seizures asks the
nurse how phenytoin sodium
(Dilantin) will help. Based on
knowledge of the drugs action,
what is the nurses best
response? The drug is thought
to act by
a. Correcting the abnormal
synthesis of norepinephrine
in the body
b. Depressing transmission of
abnormal impulses in the
spinal cord
c. Reducing the responsiveness
of neurons in the brain to
abnormal impulses
d. Interrupting the flow of
abnormal impulses from
peripheral neurons in the
viscera to the brain
29.The nurse is preparing to teach
the client about phenytoin
sodium (Dilantin) therapy. It is
most important for the nurse to
include the fact that Dilantin

COMPETENCY APPRAISAL
MEDICAL -SURGICAL NURSING
Ms. Charmaine Baniqued, RN, MSN

should not be stopped suddenly

because
a. Physical dependency on the
drug develops over time
b. Status epilepticus may
develop
c. A hypoglycemic reaction
develops
d. Heart block is likely to
develop
30.A client states that she is afraid
she will not be able to drive
again because of her seizures.
The nurses best response
should indicate that driving will
depend on local laws, but that
most laws require
a. That a person with a history
of seizures drive only during
daytime hours
b. Evidence that the seizures
are under medical control
c. Evidence that seizures occur
no more often than every 12
months
d. That a person with a history
of seizures carry a medical
identification card when
driving
31.A client tells the nurse that he is
unclear about what an aura is.
The nurses response should
indicate that an aura is
a. A post ictal state of amnesia
b. A hallucination that occurs
during a seizure
c. A symptom that occurs just
before a seizure
d. A feeling of relaxation as yhe
seizure begins to subside
32. Which of the following
statements by a client with a
seizure disorder who is taking
topiramate (Topamax) indicates
the client has understood the
nurses instruction?

a. I will take the medicine

before going to bed.
b. I will drink 6-8 glasses of
water a day.
c. I will eat plenty of fresh
fruits.
d. I will take the medicine with
a meal or snack.
33.Which clinical manifestation in a
client does the nurse assess as
a typical reaction to long-term
phenytoin sodium (Dilantin)
therapy?
a. Weight gain
b. Insomnia
c. Excessive growth of gum
tissue
d. Deteriorating eyesight
The Client with a Cerebrovascular
Accident
34.Regular oral hygiene is an
essential intervention for the
client who has had a
cerebrovascular accident (CVA).
Which of the following nursing
measures is inappropriate when
providing oral hygiene?
a. Placing the client on the
back with a small pillow
under the head
b. Keeping portable suctioning
equipment at the bedside
c. Opening the clients mouth
with a padded tongue blade
d. Cleansing the clients mouth
and teeth with a toothbrush
35.When a client arrives in the
emergency department with an
ischemic CVA, what is the
priority for the nurse to assess
in relation to the treatment of
tissue plasminogen activator (tPA) administration?
a. Current medication
b. Complete physical and
history
c. Time of onset of current CVA

COMPETENCY APPRAISAL
MEDICAL -SURGICAL NURSING
Ms. Charmaine Baniqued, RN, MSN

d. Upcoming surgical
procedures
36. During the first 24 hours after
thrombolytic treatment for an
ischemic CVA, the primary goal
is to control the clients
a. Pulse
b. Respirations
c. Blood pressure
d. Temperature
37.What is a priority nursing
assessment in the first 24 hours
after admission for the client
with a thrombotic CVA?
a. Cholesterol level
b. Pupil size and pupillary
response
c. Bowel sounds
d. Echocardiogram
38.What is a priority nursing
intervention when suctioning an
unconscious client to maintain
cerebral perfusion?
a. Hyperoxygenate before and
after suctioning
b. Administer analgesics
c. Provide oral hygiene
d. Administer diuretics
39.The nursing assessment of a
clients functional status before
and after a CVA is essential.
Why is it so important?
a. The rehabilitation plan will
be guided by it
b. Functional status before the
CVA will help predict
outcomes
c. It will help the client
recognize his physical
limitations
d. The client can be expected
to regain much of his
functioning
40.Which of the following
techniques does the nurse avoid
when changing a clients

position in bed if the client has

hemiparalysis?
a. Rolling the client onto her
side
b. Sliding the client to move
her up in bed
c. Lifting the client when
moving her up in bed
d. Having the client help lift
herself off the bed using a
trapeze
41. Which nursing intervention has
been found to be the most
effective means of preventing
plantar flexion in a client who
has had a CVA with residual
paralysis?
a. Place the clients feet
against a firm footboard
b. Reposition the client every 2
hours
c. Have the client wear anklehigh tennis shoes at
intervals throughout the day
d. Massage the clients feet
and ankles regularly
42.The nurse is planning the care
of a hemiplegic client to prevent
joint deformities of the arm.
What position is not
appropriate?
a. Placing a pillow in the axilla
so that the arm is away from
the body
b. Placing a pillow under the
slightly flexed arm so that
the hand is higher than the
elbow
c. Positioning the hands in a
slightly pronated position
d. Positioning a roll in the hand
so that the fingers are barely
flexed
43.For the client who is
experiencing expressive
aphasia, which nursing

COMPETENCY APPRAISAL
MEDICAL -SURGICAL NURSING
Ms. Charmaine Baniqued, RN, MSN

intervention is most helpful in

promoting communication?
a. Speaking loudly
b. Using a picture board
c. Writing directions so client
can read them
d. Speaking in short sentences
44.The nurse is teaching the family
of a client with dysphagia about
decreasing the risk of aspiration
while eating. Which of the
following strategies is
inappropriate?
a. Maintaining an upright
position
b. Restricting the diet to liquid
until swallowing improves
c. Introducing foods on the
unaffected side of the mouth
d. Keeping distractions to a
minimum
45.Which food-related behaviors
would the nurse observe in a
client who has had a CVA that
has left him with homonymous
hemianopia?
a. Increased preference for
foods high in salt
b. Eating food on only half of
the plate
c. Forgetting the names of
foods
d. Inability to swallow liquids
46.The nurse is teaching the client
about ways to adapt to a visual
disability. Which does the nurse
identify as the primary safety
precaution to use?
a. Wear a patch over one eye
b. Place personal items on the
sighted side
c. Lie in bed with the
unaffected side toward the
door
d. Turn the head from side to
side when walking

47.A client is experiencing mood

swings after a CVA and often
has episodes of tearfulness that
are distressing to the family.
Which is the best technique for
the nurses to instruct family
members to try when the client
experiences a crying episode?
a. Sit quietly with the client
until the episode is over
b. Ignore the behavior
c. Attempt to divert the clients
attention
d. Tell the client that this
behavior is unacceptable
48.The client who has had a CVA
with residual physical handicaps
becomes discourage by his
physical appearance. What
attitude is best for the nurse to
display to help the client
overcome his negative selfconcept?
a. Helpfulness and sympathy
b. Concern and charity
c. Directives and firmness
d. Encouragement and
patience
49.When communicating with a
client who has aphasia, which of
the following nursing
interventions is inappropriate?
a. Present one thought at a
time
b. Encourage the client not to
write messages
c. Speak with normal volume
d. Make use of gestures
50.Based on the nurses knowledge
of thrombolytic therapy, what is
the expected outcome of this
drug therapy?
a. Increased vascular
permeability
b. Vasoconstriction
c. Dissolved emboli
d. Prevention of hemorrhage

COMPETENCY APPRAISAL
MEDICAL -SURGICAL NURSING
Ms. Charmaine Baniqued, RN, MSN

The Client with Parkinsons

Disease
51.Which of the following is an
initial sign of Parkinsons
disease?
a. Rigidity
b. Tremor
c. Bradykinesia
d. Akinesia
52.The nurse develops a teaching
plan for a client newly
diagnosed with Parkinsons
disease. Which of the following
topics that the nurse plans to
discuss is the most important?
a. Maintaining a balanced
nutritional diet
b. Enhancing the immune
system
c. Maintaining a safe
environment

d. Engaging in diversional
activity
53.The nurse observes that a
clients upper arm tremors
disappear as he unbuttons his
shirt. Which statement best
guides the nurses analysis of
these observations about the
clients tremors?
a. The tremors are probably
psychological and can be
controlled at will
b. The tremors sometimes
disappear with purposeful
and voluntary movements
c. The tremors disappear when
the clients attention is
diverted by some activity
d. There is no explanation for
the observation; it is
probably a chance
occurrence