Competency appraisal 1 prelims

1. A nurse is discussing hearing aids with a client who began wearing hearing aids 5 weeks earlier. Which statement demonstrates that
the client is successfully adapting to the hearing aids?
A. “I just wear the hearing aids when I go out in public.”
B. “I take a cotton-tipped swab and clean out my ear canals before I insert the hearing aids.”
C. “I store the hearing aids in the protective box.”
D. “I use mild soap and water weekly to soak the plastic parts of the hearing aids after I remove the batteries.”

2. A nurse is caring for a client who cannot perform oral hygiene. The client has dentures, including both upper and lower plates. Which
technique should the nurse use to correctly perform oral hygiene for this client?
A. Don sterile gloves before removing the dentures.
B. Use a foam swab to pry the upper plate loose before removing it.
C. Loosen the upper plate by grasping it at the front teeth with a piece of gauze and moving the plate up and down to loosen
it before removal.
D. Leave the dentures in the client’s mouth and use a toothbrush to brush the plates.

3. A client who underwent surgery for colon cancer 6 weeks earlier has an appointment with a wound care nurse. After correctly
demonstrating the changing of the stoma pouch, the client asks the nurse for advice regarding how to deal with gas coming from the
stoma. To respond to the client’s concern, the nurse should ask the client to do which of the following? SELECT ALL THAT APPLY.
A. Describe the usual dietary intake, including types of foods
B. Include cruciferous vegetables in the diet daily
C. Decrease fluid intake to 1,200 mL per 24 hours
D. Prick the colostomy stoma pouch with a pin
E. Limit intake of gas-producing beverages such as carbonated sodas
F. Go to the restroom to release the gas that collects in the colostomy stoma pouch by opening the pouch clamp

4. A male client undergoes surgery for a hernia repair. The client has orders to be discharged to home when stable. The client has tried
several times to urinate into the urinal while in bed without success. Which interventions are appropriate to promote voiding for this
client? SELECT ALL THAT APPLY.
A. Apply an external catheter
B. Assist the client to stand at the bedside to attempt to void
C. Assess the pain level of the client and administer medication appropriately if in pain
D. Assist the client to the bathroom and turn on running water within hearing distance of the client while the client attempts
to void
E. Discuss relaxation techniques and ask the client to imagine being at home and voiding in his home bathroom
F. Explain that the client should void within 8 hours of surgery or return to the hospital for catheterization.

5. A client who was treated for constipation 1 month earlier comes to a primary care provider’s office for an appointment. A nurse
interviews the client and obtains information from the client about bowel function and the effectiveness of the prescribed treatments.
The nurse determines that the client is no longer constipated based on which statement?
A. The client drinks 2,000 mL of fluids daily; including 4 ounces of prune juice.
B. The client has had a soft, formed bowel movement without straining every other day for the past 2 weeks.
C. The client self-administered one disposable enema on the day of last month’s appointment.
D. The client has minor discomfort from hemorrhoids during bowel movements.

6. A client who is recovering from orthopedic surgery keeps an appointment at a clinic and uses a walker to ambulate with partial
weight bearing as instructed. Which observation should lead the nurse to conclude that the client is using the correct technique?
A. Has elbows bent at a 30-degree angle
B. Is bent over the walker
C. Lifts the walker while walking; holding it about 2 inches above the floor
D. Has a walker that has four wheels in place

7. A nurse reviews the record of a client who has been immobile because of a degenerative neurological condition. The nurse reads
that the client has bilateral foot drop. Which finding during the nurse’s assessment supports the presence of foot drop?
A. The great toe is dorsiflexed and the other toes are fanned out.
B. The feet are unable to be maintained perpendicular to the legs.
C. The client is unable to move feet into a position of plantar flexion.
D. The client is only able to dorsiflex the feet bilaterally.

8. A home health nurse visits an 82-year-old client who has experienced multiple strokes and is unable to change position
independently in bed. The nurse teaches family caregivers techniques to move and reposition the client, who is in a hospital bed.
Which technique should be included in the teaching plan for this client?
A. Before moving the client, family caregivers should raise the hospital bed to the level of their waists. After completing the
move, the bed must be returned to the lowest level.
B. The pillow should be removed from under the client’s head when positioned in a dorsal recumbent position.
C. Family members should tighten their abdominal muscles and buttocks while keeping their feet about 12 inches apart when using a
lift sheet to pull the client up in bed.
D. The client’s heels should rest on the bed surface and the feet kept in a position perpendicular to the legs when the client is lying on
the back.

9. A hospitalized client, identified to be at risk for thromboembolic disease, has an anti-embolism hose ordered. A nurse discusses the
correct use of the stockings. Which direction should the nurse include in teaching this client?
A. If ambulating 10 times daily for 5 minutes at a time, wearing the hose is unnecessary.
B. The most appropriate time to apply the hose is before standing to get out of bed in the morning.
C. If the hose becomes painful to the skin underneath, notify the nurse and request pain medication.
D. Only cross the legs while wearing the antiembolism hose; otherwise keep the legs uncrossed.

10. A client reports pain at an intravenous infusion site that has infiltrated. When a nurse applies a warm, moist compress to the site,
the client asks how the treatment will help the condition. The nurse answers the client based on the understanding that the application
of moist heat will:
A. Alter tissue sensitivity by producing numbness.
B. Decrease the metabolic needs of the involved tissues.
C. Stop the local release of histamine in the tissues.
D. Increase blood flow and improve capillary permeability.

11. A nurse is caring for a client who has experienced a first-degree sprain of the ankle. A primary care provider prescribes an
analgesic medication. Which intervention, besides the analgesic, should the nurse advise the client to utilize for the first 24 hours after
the injury?
A. Applying ice directly to the ankle
B. Soaking the foot in warm water for 20 minutes, three times per day
C. Applying ice continuously to the ankle
D. Resting and elevating the limb as much as possible

12. An elderly client residing in a nursing home has bilaterally weak handgrips and has difficulty with self-feeding. Which nursing
interventions should be implemented to promote independence for this client? SELECT ALL THAT APPLY.
A. Ask the client for permission to open all containers, remove lids from items on the food tray, and cut up meats
B. Obtain built-up silverware for the client to use
C. Observe the client but do not assist if the client is having difficulty
D. Feed the client if the client is eating too slowly
E. Ensure that the client is wearing prescribed dentures, eyeglasses, or hearing aids before starting to eat

13. A dietitian, who is consulted to see a hospitalized client because of nutritional concerns, orders a calorie count. The nurse should
participate in this intervention by:
A. Asking the client to recall the food and beverages consumed on a normal day.
B. Asking the client to recall the food and beverages consumed on the day the calorie count is initiated.
C. Informing the client that a record is being maintained of food and beverages consumed.
D. Asking the client to approximate how many times per week certain food groups, such as cereals and breads, are eaten.

14. A hospitalized client has daily weights ordered. The client can stand, and the nursing unit has an electronic digital scale to use for
client weights. Which intervention best ensures that the client’s daily weight is accurate?
A. Asking the client to wear supportive shoes before stepping on the scale
B. Ensuring that the scale is calibrated and “zeroed” before weight is obtained
C. Weighing the client by moving the sliding indicator until the scale balances
D. Weighing the client at different times of the day

15. A nurse plans guidelines to assist nursing personnel in meeting the hygiene needs of adult clients with dementia. Which guidelines
are appropriate for the nurse to include? SELECT ALL THAT APPLY.
A. Utilizing two staff members to bathe the client quickly while limiting the client’s ability to physically resist
B. Creating a calm environment during a bed bath by including music and dimmed lighting
C. Allowing clients, who are willing and able, to participate in some of the hygiene activities
D. Assessing and treating clients for pain before initiating hygiene activities
E. Washing the hair and body separately if either activity causes distress or is overwhelming to the client
F. Keeping the temperature of the bathing area warm and limiting body exposure of clients during bathing

16. A nurse should inform a nursing assistant to avoid taking a rectal temperature for which client?
A. The adult client who underwent ileostomy surgery because of a perforated bowel
B. The adult client has a frequent, productive cough and is receiving oxygen by nasal cannula
C. The adult client who developed thrombocytopenia after receiving chemotherapy
D. The adult client with hypothermia

17. A nursing assistant (NA), who is taking routine vital signs, tells a nurse that the small adult cuff is nowhere to be found and that a
client’s arm is too small to use an adult-size cuff. In response to the NA’s report, which direction should the nurse give to the NA?
A. Document the other vital signs and note that proper blood pressure (BP) equipment is not available
B. Contact the nursing supervisor, obtain a small, adult BP cuff, and take the client’s BP with the small, adult-size cuff
C. Use the adult-size BP cuff to obtain the blood pressure, add 10 to both the diastolic and systolic readings, and document on the
client’s record the BP was obtained with an adult cuff
D. Take the client’s BP using any available cuff

18. A nurse takes a client’s blood pressure with an automatic blood pressure machine. The blood pressure is 86/56 mm Hg with a pulse
rate of 64 beats per minute. Which action should the nurse take first?
A. Assess the client for dizziness and assess the skin on the extremities for warmth
B. Obtain a manual blood pressure cuff and retake the client’s blood pressure
C. Elevate the head of the client’s bed
D. Read the client’s medical record and determine the client’s normal range of blood pressure
19. A nurse is using a tympanic thermometer to measure a client’s temperature. When using a tympanic thermometer, the nurse
should:
A. Check the setting to know the type of measurement reading, such as oral or core temperature.
B. Irrigate the ear canal with sterile saline 6 hours before obtaining the temperature.
C. Pull downward on the pinna in an adult when inserting the thermometer.
D. Hold the thermometer loosely in the ear until the thermometer sounds that the reading is finished.

20. A client who underwent a surgical procedure the preceding day has a normal assessment with an oral temperature of 99.7°F
(37.6°C) at 0800 hours. The client is to be discharged later in the day if the client’s condition is stable. Based on the client’s current
temperature, which action should be taken by the nurse?
A. Inform the surgeon that the discharge should be canceled.
B. Instruct the client to use the incentive spirometer 10 times every hour drink plenty of fluids and then recheck the
temperature in 2 hours
C. Administer the dose of aspirin 81 mg earlier than the scheduled time
D. Realize that the temperature is only mildly elevated and was taken during the time of day when temperatures are highest according
to normal diurnal deviations

21. A nurse is preparing to provide phototherapy to a 4-day-old newborn who was admitted with hyperbilirubinemia. The nurse instructs
the parents on how to care for their baby while receiving phototherapy in the hospital. The nurse’s teaching should include:
A. Keeping the baby fully clothed to prevent hypothermia.
B. Covering the baby’s eyes with eye shields to prevent retinal damage.
C. Decreasing the number of feedings for their baby to reduce the number of soiled diapers.
D. Discontinuing the phototherapy if a mild skin rash develops.

22. When using a hypothermia blanket for a febrile client, which findings should lead the nurse to suspect hypothermia? SELECT ALL
THAT APPLY.
A. Increased urine output
B. Drowsiness
C. Decreased heart rate (HR)
D. Decreased blood pressure (BP)
E. Increased BP F. Increased HR

23. Which signs should indicate to a nurse that a client is experiencing a surgical site infection? SELECT ALL THAT APPLY.
A. Temperature of 100.4°F (38°C)
B. Localized pain and tenderness
C. Well-approximated wound edges
D. Redness or warmth at the affected site
E. Purulent drainage at the incision site
F. Thick, white drainage in the Jackson-Pratt (JP) tubing

24. A nurse is assessing a wound while completing a dressing change. The nurse documents the pressure ulcer as stage III. Which is
the best description of the stage III pressure ulcer?
A. Partial-thickness skin loss involving the epidermis, dermis, or both
B. Full-thickness skin loss involving damage to subcutaneous tissue
C. Redness with intact skin that the client reports as “itchy”
D. Full-thickness skin loss with undermining and sinus tracks

25. Which actions should a nurse plan when caring for a client with a stage III pressure ulcer to the right lower-extremity heel? SELECT
ALL THAT APPLY.
A. Monitor the client’s nutritional intake
B. Assess for pain and pre-medicate before dressing changes
C. Monitor pedal pulses and capillary refill of the affected extremity
D. Use hydrogen peroxide to clean of ulcer wound
E. Turn and reposition the client every 1 to 2 hours
F. Elevate the extremity on pillows

26. A nurse is assessing a client who was just admitted to a surgical unit following abdominal surgery. Which assessment finding would
require an immediate intervention by the nurse?
A. A nasogastric tube (NG) to low intermittent suction with small amounts of dark bloody returns
B. A compressed Jackson-Pratt (JP) drain with 30 mL of bright red blood
C. A NG tube to low intermittent suction with pale green returns
D. A round Jackson-Pratt (JP) drain with 20 mL serosanguineous drainage

27. A nurse is teaching a client, who is 24 hours post–abdominal surgery, how to use an incentive spirometer. Which instructions
should the nurse include in the teaching? SELECT ALL THAT APPLY.
A. Inhale slowly and deeply through the mouth
B. Seal lips tightly around the mouthpiece
C. After inhaling, hold your breath for 2 to 3 seconds
D. Sit with the head of the bed down and the bed almost flat
E. Splint incision with pillows
F. Exhale forcefully, fast, and hard
28. A 33-year-old client reports left leg pain, right-sided chest pain, and a sudden onset of shortness of breath. Which action should be
taken immediately by the nurse?
A. Take the client’s temperature
B. Auscultate the client’s lung sounds
C. Percuss the client’s abdomen
D. Request a stat chest x-ray

29. Which rationale should a nurse use to explain the reason for oxygen being bubbled through a humidifier to a client receiving 2 liters
of oxygen by nasal cannula?
A. Prevents the burning sensation of direction oxygen
B. Prevents drying of the nasal passages
C. Prevents a chemical reaction between the tubing and oxygen
D. Prevents contamination with environmental gases

30. A nurse, checking newly written physician orders, determines that which orders require the nurse to contact the physician to clarify
the order? SELECT ALL THAT APPLY.
A. Aspirin 325 mg orally qd
B. MS 4 mg IV q1hr pr
C. Furosemide (Lasix®) 40 mg IV now
D. D5W with 20 mEq KCL IV at 125 mL/hr
E. Heparin 5,000 u subcutaneously bid

31. A nurse receives a medication order for an adult client to administer ferrous sulfate 300 mg PO bid. After thinking critically about
this order, the nurse should:
A. Administer the medication as ordered.
B. Contact the physician to clarify the route of the medication.
C. Contact the physician to question the twice daily administration of the medication.
D. Withhold the medication because the dosage is not within acceptable ranges.

32. Before a child’s hospital discharge, a nurse is teaching the parents how to administer an oral medication to the child. Which nurse
instruction would be most appropriate?
A. Administer the medication and then follow it with a small glass of milk
B. Give the child a flavored ice pop just before the medication
C. Tell the child that the medication will taste good
D. Open all capsules and mix the contents with applesauce

33. A nurse is evaluating whether a client on multiple oral medications is taking the medications correctly. Which finding should be most
concerning to the nurse because the absorption rate of medications can be increased?
A. Taking afternoon oral medications with a carbonated soft drink
B. Drinking a glass of milk with the tetracycline antibiotic oral medication
C. Taking morning oral medications with water and consuming 2,500 mL of water daily
D. Taking mealtime oral medications with a meal low in fiber and high in fatty foods

34. A nurse is observing a nursing student prepare and administer medications to adult clients. Which action by the nursing student
warrants intervention by the nurse?
A. Injecting air into a vial before withdrawing 20 mg furosemide (Lasix®) from a vial labeled 20 mg/mL
B. Selecting a 1-mL syringe with a 5/8-inch needle to be used for administering 0.5 mL of heparin subcutaneously
C. Instructing a client to place a buccal medication under the client’s tongue and allow it to absorb
D. Pouring the ordered medication “Robitussin® 2 tsp now” to the 10 mL mark on a medication cup

35. A nurse is planning to administer medications through a nasogastric (NG) tube. Which interventions should the nurse plan after
checking the medications, checking client identification, and verifying tube placement? SELECT ALL THAT APPLY.
A. Crush together all medications that are acceptable for crushing
B. Pour crushed medications into one medication cup and mix with water
C. Withdraw all medications and water solution from the medication cup with a syringe and administer
D. Crush each medication separately
E. Pour each individual crushed medication into individual medication cups and mix with water
F. With a syringe, withdraw the single dose of medication from the medication cup and administer.
G. Flush the tubing with water between medications

36. A nurse is observing a nursing student administering a clonidine (Catapres®) transdermal patch to a client diagnosed with
hypertension. Which action requires the nurse to intervene?
A. Applies gloves
B. Asks the client to state name and also checks the client’s name band
C. Applies patch, rubbing the patch against the skin, and then securing it in place
D. Folds old patch with medication to the inside and discards in a medication disposal receptacle

37. A nurse administers a prochlorperazine (Compazine®) suppository to an adult client. Which action by the nurse best ensures that
the medication is correctly administered?
A. Positioning the client on the left side
B. Lubricating the suppository before insertion
C. Feeling the sensation of the suppository pulling away when inserted against the rectal wall past the internal anal sphincter
D. Noting soft, formed stool 30 minutes after the suppository
38. A new clinic nurse is teaching the mother of a 2-year-old child how to administer ear drops while an experienced nurse is observing.
The new nurse is using an illustration of a child’s ear to teach the mother and states the following actions while pointing to the picture:
clean the child’s ear, warm the solution, pull the child’s ear up and back, instill the medication, depress on the tragus of the ear, keep
the child side-lying for about 5 minutes, and then insert a small cotton fluff loosely in the auditory canal for about 20 minutes. Which
action should the experienced nurse take during or following the teaching?
A. Suggest to the new nurse that the mother return to demonstrate instilling ear drops
B. Confirm with the new nurse and mother that the procedure was correctly described
C. Interrupt to state that the child’s ear should be pulled down and back
D. Praise the new nurse for the thorough teaching provided to the mother

39. An experienced nurse is supervising a new registered nurse who is administering medications to adult clients. Which action by the
new registered nurse requires the experienced nurse to intervene?
A. Withdraws 1 mL of purified protein derivative (PPD) from a vial for intradermal injection
B. Pinches the abdominal tissue of a thin adult and inserts the needle at a 45-degree angle to administer insulin subcutaneously
C. Measures three finger-breadths below the acromion process to inject codeine 15 mg/0.5 mL in the deltoid muscle
D. Administers 5,000 units of heparin subcutaneously in the abdomen without aspirating for a blood return

40. A nurse, who is working the evening shift, is planning to administer insulin subcutaneously to a hospitalized child. Which statement
made by the nurse to the mother would be inappropriate?
A. “It is okay for your child to say ‘ouch,’ cry, or even scream when receiving an injection.”
B. “I can give the injection while your child is sleeping; then the injection won’t be noticed.”
C. “I will apply lidocaine/prilocaine (EMLA®) cream, a topical analgesic, 1 hour before the injection to reduce pain.”
D. “The child will need to be lying, but after theinjection you can hold and comfort your child.”

41. An experienced nurse is supervising a new nurse caring for a hospitalized child who is receiving intravenous (IV) therapy. Which
action should indicate to the experienced nurse that the new nurse needs additional orientation regarding IV therapy for children?
A. Determines that the current solution has been infusing for 24 hours and should be changed
B. Selects a 1,000-mL bag of the prescribed IV solution and checks it against the orders
C. Prepares new tubing and the prescribed IV solution 1 hour before it is due to be changed
D. Removes the plastic cover, spikes the bag with the tubing spike, and squeezes the drip chamber

42. A client adamantly refuses to take an oral dose of cephalexin (Keflex®) despite implementing measures to treat the client’s nausea.
What is the action by the nurse?
A. Administer the medication 1 hour after repeating the dose of antiemetic
B. Have the client suck on ice chips for several minutes before taking the medication
C. Crush the medication and mix it with applesauce for administration
D. Report the information to the client’s physician and request a different medication order

43. A nurse is to administer promethazine (Phenergan®) 12.5 mg intramuscularly (IM) stat to a client. The medication is supplied in an
ampule of 50 mg/mL. How many milliliters should the nurse administer to the client?
A. 0.125 mL B. 0.25 mL C. 0.3 mL D. 1 mL

44. A client with a left-sided weakness is to be discharged to home, where the client has an electrical bed. In preparation for discharge,
a nurse assesses the client’s ability to get out of bed independently. Which client actions indicate that further instruction is needed?
SELECT ALL THAT APPLY.
A. Place the bed in the lowest position
B. Raises the head of the bed (HOB)
C. Rolls onto the left side
D. Pushes against the mattress with the weak elbow and stronger hand to rise to a sitting position
E. Slides legs off the bed while pushing against the mattress to raise the body off the bed
F. Once in a sitting position, sit at the edge of the bed for a few minutes before standing

45. An experienced nurse is observing a new nurse providing care to a client. Which action requires the experienced nurse to intervene
to ensure client safety?
A. Turning on the client’s bathroom light and turning out the room lights after settling the client for sleep
B. Checking the client’s room number and name on the client’s name band to verify client identity before administering
medications
C. Taking a telephone order from a physician, writing the order, and reading it back to the physician before implementing the order
D. Delaying an on-coming physician from performing a right thoracentesis scheduled by a previous physician by calling “a timeout” to
verify the client’s identity, consent, procedure, and site

46. An 82-year-old client has a right total hip arthroplasty with a hip prosthesis and is planning to move in with his son following
discharge. A nurse is discussing home modifications with the son. Which modifications should the nurse recommend? SELECT ALL
THAT APPLY.
A. Pad bedside rails
B. Install safety bars around the toilet and shower
C. Install an elevated toilet seat in the bathroom
D. Plan for the client’s bed to be in a main floor room
E. Place a nonskid bathmat in the bathtub and have the client bathe daily
F. Remove scatter rugs and secure electrical cords against baseboards
47. A nurse enters a client’s hospital room at the beginning of the shift. A nurse surveys the client and the care area for potential
sources of infection. Which options represent potential sources of infection for this client? SELECT ALL THAT APPLY.
A. A bottle of saline irrigation solution has the cap tightly closed and a label identifying that it was opened 10 hours previously.
B. The client’s abdominal dressing has three different areas of moist drainage saturating the dressing and soiling the client’s
gown.
C. The tubing of the client’s intravenous (IV) fluid is not labeled with the date of the last tubing change.
D. The bathroom contains a calibrated graduate used to measure urine that is labeled with the word urine and the client’s initials.
E. An opened package of gauze sponges is present on the window sill.

48. A nurse is preparing a sterile field for a dressing change using a surgical aseptic technique. The nurse gathers the supplies and
prepares the sterile field using a packaged sterile drape. Which option correctly describes how the nurse should set up the sterile field?
A. Donning sterile gloves before opening the packaged sterile drape
B. Cleansing the bottle of irrigating solution with alcohol before placing the bottle on the field
C. Holding items 6 inches above the field and dropping them on the sterile field inside the 1-inch border along the edge of the
drape
D. Leaving the sterile field unattended to obtain supplies not in the area

49. A client with a wound infection is ordered contact precautions based on culture results. When should a nurse caring for the client
don disposable medical examination gloves?
A. Upon entering the client’s room
B. When anticipating contact with drainage from the wound
C. When determining a potential for contamination with blood or body fluids of the client
D. When providing care within 3 feet of the client

50. A nurse instructs a client on the safe disposal of insulin syringes and needles when at home. Which statement by the client
indicates that additional teaching is needed?
A. “After I draw up my insulin, I scoop the cap to cover it while I cleanse my skin.”
B. “I have a needle destruction device that breaks the needles from the syringes so that others won’t get stuck by the needles.”
C. “I plan to use this plastic milk container to discard my used needles and syringes and take it to the clinic for disposal.”
D. “Because the needles are capped, the syringes are safe to dispose of with my household trash.”