COMPETENCY OF THE FOURTH YEAR NURSING STUDENTS INSIDE THE OPERATING ROOM AND ITS

RELATIONSHIP TO BOARD EXAM

RATINGS AMONG BIG UNIVERSITIES IN ANGELES CITY
_____________
A Thesis
Presented to the
Faculty of the College of Nursing
Philippine Rehabilitation Institute

____________

In Partial Fulfillment of the

Requirement for the Degree
Bachelors of Science in Nursing
____________

By:
David, Camille Z.

Jingco, Ramquielle D.
Odiaman, Liza Vanessa Farhana O.
Sarmiento, Kreinzy Ann B.
Tableza, Alvin S.
November, 2015

Chapter I
THE PROBLEM AND ITS BACKGROUND

Being a nurse is to go above and beyond the call of dutyThe first to work and the last to leave.They are the heart and
soul of caring.
~Anonymous

The nurse competence of graduating nursing students is an important issue in health care as it is related to
professional standards, patient safety and the quality of nursing care (World Health Organization 2010). When

approaching graduation, nursing students are expected to have adequate nurse competence to fulfill their duties safely
and effectively, as an adequate supply of competent RNs is necessary to provide high-quality, safe and patient-centered
care. Tamse (2004) has proposed that nurse competence develops along a continuum from novice to expert. Novices are
nurses who have no experience in the situation they are practicing in. Through being an advanced beginner, competent
and proficient, a nurse will finally become an expert. However, according to Benner, competent nurses have usually been
in the same job or situation for two to three years. (Benner 1982). The RN4CAST study has reported that the educational
level of nurses is crucial as higher competence level among nurses in hospital wards leads to reduced incidence of
mortality, morbidity and adverse events. The purpose of this empirical study is to improve the level of competency of
Filipino nursing graduates, potentially increasing the passing rate in the Nursing Licensure Exam (NLE), and to produce
nurses that are highly qualified and globally competent in the health care field.
In the global setting, a problem faced by health care institutions is the shortage of nurses (American Association of
Colleges of Nursing). Filipino nurses had been the preference of foreign employers especially in the United States.
Employers not only seek Filipino nurses for their caring nature, but also because of the quality education Filipino nurses
have. However, with technology evolving together with health practices, the local curriculum must keep up with the current
innovations if we want our nurses to meet the global demand. (http://www.nursinguniforms.net/top-7-countries-from-whichthe-us-imports-nurses)

In the local setting, the problem identified by CHED is the low passing rate in the NLE .Only about half of the total
examinees pass the local board exam. The Professional Regulation Commission (PRC) announces that 9,707 out of
17,891 (54.26%) passed the Nurse Licensure Examination (NLE) given by the Board of Nursing last May 30 and 31, 2015
(Philippine Board Exam Results).
The solution of CHED to ensure a better passing rate is the CHED Memorandum Order No.14 which is the
curriculum being implemented now. One particular interest of the researchers is how this can help in the competency of
students in the operating room or Perioperative Nursing.
To assess the effectiveness of the curriculum, the researchers will investigate the performance of nursing students
inside the operating room. This is because Article V, section 7.2 of CHED Memorandum Order No.14 states that: At the
end of the school year, the student shall have acquired the holistic understanding of the human person as a bio-psycho
cultural being focusing on the concept of health and illness as it is related to Perioperative Nursing in varied settings. The
student shall be able to demonstrate the competencies in the following key areas of responsibility such as safe and quality
nursing care, communication, collaboration and teamwork, health education, legal responsibility, ethico-moral
responsibility, personal and professional development, quality improvement, research, management of resources and
environment, and record management.
The Core Competency Standards, developed by the Board of Nursing (BON) with the Technical Committee on
Nursing Education (TCNE) of the Commission on Higher Education (CHED), served as a basis in the curriculum reform.

By focusing on the Eleven (11) Core Competencies, the new curriculum will ensure quality education for nursing students
if it is implemented well (Tamse, July-Dec 2012).
Using the Core Competency Standards as an evaluation tool, this study will determine if the new curriculum Ched
Memorandum OrderNo.14 2009 is effective in improving the level of competency of Angeles University Foundation and
Holy Angel University nursing students in Perioperative Nursing.
STATEMENT OF THE PROBLEM
This study aims to evaluate the competency of level 4 students of Angeles University Foundation and Holy Angel
University in the operating room.
It seeks to answer the following questions:
1. What is the profile of the respondents in terms of the following:
a. Age, and
b. Gender
c. University (present)

2. What is the level/rating of the competency of the 4 th year students in terms of the following:
a. Safety and quality nursing care
b. Management of resources and environment
c. Health education
d. Personal and professional development
e. Perioperative nursing knowledge

3. Is there a difference between the competency level between Angeles University Foundation and Holy Angel
University level IV student nurses?
4. Is there a difference between the competency level of students depending on the school they are studying that
could affect their upcoming board examinations?
5. What is the implication of this research in the field of nursing?

SIGNIFICANCE OF THE STUDY

Nursing Practice.To the nursing profession, the study will test the students competency in the operating room.
This is to ensure that the students competency level will be identified and efforts will be made to help the
students reach the highest level of competence so that the school will be able to produce nurses capable of
delivering quality nursing services.

Nursing Education.To the students, instructors and the school, this study will be beneficial in identifying the
students weak points in the 11 Core Competencies. Students and instructors can focus on these weak points
and strengthen learning in these aspects. The core competencies are also the basis of the Nursing Licensure
Exam. By enhancing learning in the core competencies, the students can improve their chances in passing the
board exam.
Nursing Research.To future researchers, this study will provide information on the strengths and weaknesses
of students in the operating room in terms of the core competencies. Researchers can use this information to
examine other subjects and contribute suggestions to improve the implementation of the new curriculum.
Nursing Competency. To the future aspiring nursing students, this study will help provide information to know
the kind of university you wish to pursue your nursing studies to help you achieve your goal to become a
competent nurse that will be productive to be of help to the society.

SCOPE AND LIMITATION

The study aims to evaluate the competence of the level IV student nurses in the operating room by using
questionnaires based on Pre-operative Nursing.
The respondents of the study will be all level IV student nurses of Angeles University Foundation and Holy Angel
University Foundation test questionnaires will be used for data gathering. The questions will cover concepts in

Perioperative Nursing and will be based on the Eleven Core Competencies. There will be 50 questions to be answered by
level IV students. Students will be given 1 hour to answer the questions.
The topic covered will only be about Perioperative nursing while other subject areas are not included in this study.
The respondents of the study will be limited to level IV student nurses of Angeles University Foundation and Holy Angel
University Foundation who enrolled in SY 2015-2016. Other year levels will not be part of the study.

DEFINITION OF TERMS:
Board

of

Nursing

(BON).

This

is the

regulatory

body

of

the

nursing

profession

in

the

Philippines.

(http://www.prc.gov.ph/prb/?id=33&content=191)
Commission on Higher Education (CHED). CHED is the governing body covering both public and private higher
education institutions as well as degree-granting programs in all tertiary educational institutions in the Philippines.
(www.ched.gov.ph/)
Competency. It is a combination of attributes enabling performance of a range of professional tasks to the appropriate
standards. (www.merriam-webster.com/dictionary/competency)
Competent.This is used to describe a nurse who uses analysis and conscious deliberate planning that helps achieve
efficiency and organization. (www.merriam-webster.com/dictionary/competent)

Core Competency Standards.This represents the minimum knowledge, skills and attitudes necessary to provide nursing
care (Tamse, 2004).
Curriculum. It is an educational plan that spells out which goals and objectives should be achieved, which topics should
be covered and which methods are to be used for learning, teaching and evaluation.
(http://www.unesco.org/new/en/education/themes/strengthening-education-systems/quality-framework/technicalnotes/different-meaning-of-curriculum/)
Expert. This is a nurse described as one who no longer relies on rules, guidelines or maxims to link their understanding of
the situation with the correct action. (http://www.americannursetoday.com/from-our-readers-novice-to-expert-anurse-educators-personal-journey/)
Perioperative nursing. It is a nursing specialty that works with patients who are having operative or other invasive
procedures. (http://www.mayo.edu/mshs/careers/perioperative-nursing)

Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

FOREIGN LITERATURE
Global Standards in Nursing
One of the reasons for the nursing curricular reform is to incorporate global standards in the Philippines nursing
curriculum. Implementation of the standards will facilitate progress towards the highest level of education attainable in a
country or region, assure equitable and appropriate placement of nurses in health-care roles and, potentially, simplify
recruitment practices throughout the world (WHO, 2009).
The goal of the global standards is to establish educational criteria and assure outcomes that:
a. are based on evidence and competency
b. promote the progressive nature of education and lifelong learning; and
c. ensure the employment of practitioners who are competent and who, by providing quality care, promote positive
health outcomes in the populations they serve.
The global standards in the nursing curriculum are divided into four areas. These are Curriculum Design, Core
Curriculum, Curriculum partnership, and Assessment of Students. Each has its own criteria as stated below:
1. Curriculum Design
Take into account workforce planning flows
Meet national and international education criteria
Delivers the knowledge and skills required to meet the needs of their respective populations.
Demonstrate balance between the theory and practice components of the curriculum.
Use of recognized approaches to teaching and learning
Provide classroom and clinical learning based on established competencies
Enable the development of clinical reasoning, problem solving and critical thinking

Conduct regular evaluations of curricula and clinical learning

Offer opportunities for multidisciplinary content and learning experiences

2. Core Curriculum
provide core content that will enable their graduates to meet the established competencies
provide core content in nursing theory
provide core through the primary health-care approach
provide supervised clinical learning experiences
3. Curriculum Partnership
develop partnerships with other healthcare disciplines
use inter-professional teamwork approaches
have access to, and arrangements for, the clinical learning sites
4. Assessment of Students
assess student learning using reliable evaluation methodologies
use a variety of methods to assess the subject matter
have student retention systems in place
The new curriculum adopted the global standards in nursing curriculum. The global standards was adopted to
enhance global competitiveness. The Core Competencies also have the same goal to improve global competitiveness.
Under the criteria of the core competencies, the researchers will evaluate if the new nursing curriculum will or will not be
able to meet the goals of international standards.
LOCAL LITERATURE
The New Curriculum

CHED Memorandum Order No. 14, series of 2009 (CMO No.14, s. 2009) contains provisions on the BSN course,
including the course specification, standard curriculum, competency standards, and other requirements. It is the basis of
implementation of the new nursing curriculum in the Philippines which took effect on the academic year 2009-2010.
Core Competency Standards
Core Competency Standards, as defined by Tamse (July-Dec 2004), represent the minimum knowledge, skills and
attitudes necessary to provide nursing care. It reflects complex nature of nursing activities and determines the level of
accountability. Graduate of the BSN program must be able to apply analytical and critical thinking in the nursing practice.
The nurse must be competent in the eleven (11) core competency areas for nursing practice that were identified as
follows (CMO No.14, s.2009):
1. Safe and quality nursing care. The nurse must be able to demonstrate knowledge base and provide safety
and sound decisions in the care of the client. The nurse must also utilize the nursing process and
prioritization in the care of the client.
2. Management of resources and environment. The nurse must maintain a safe environment for the client and
utilize resources properly.
3. Health education. The nurse must be able to assess the clients learning needs and develop an educational
plan for the client.
4. Legal responsibility. The nurse must adhere to practices in accordance to the law.
5. Ethico-moral responsibility. The nurse must respect the rights of the client and take responsibility for ones
decisions and actions.

6. Personal and professional development. The nurse must be able to assess ones own learning needs and
pursue growth and development in the field. The nurse must also project of professional image of the nurse.
7. Quality improvement. The nurse must be able to identify variances and recommend solutions to the
identified problems.
8. Research. The nurse must participate in research studies and utilize the research findings.
9. Record management. The nurse must maintain accurate and updated documentation of client care.
10. Communication. The nurse must be able to establish rapport with the client, clients family, and members of
the health team and respond to their needs.
11. Collaboration and Teamwork. The nurse must establish collaborative relationship with members of the health
team and plan a collaborative care for the client.
The Need for a Curriculum Reform
What prompted CHED to revise the nursing curriculum is the low passing rate of graduates in the Nursing
Licensure Examination (NLE). The passing rate in December 2007 was 42.71%. There were only 28,924 passers out of
67,728 total examinees.According to CHED acting chairman Romulo Neri, international standards are adopted into the
local curriculum. This is to ensure better performance of nursing graduates in the NLE (GMANews.TV, April 30, 2008).
Although the new curriculum is met with objections, UST College of Nursing Dean Glenda Vargas points out
needed changes in the old curriculum in favor of the new. Patient assessment needs to be a stand-alone subject rather
than just be integrated in nursing professional subjects. In abroad, nurses are expected to do a thorough health
assessment and students need to be trained more in this area (The Varsitarian Vol. LXXIX, No. 12 ; June 10, 2008).
In a press release by the Philippine Nurses Association (PNA), they supported the new curriculum stating that
nursing leaders and educators firmly believe that this curricular reform will improve the quality of current Philippine

nursing education products by honing critical competencies to provide safe and high quality health care for their patients
here and abroad. Core competencies for 11 key areas of responsibilities that are important in nursing are spelled out in
the various nursing professional courses together with their indicators. (PNA, July 8, 2008)
The Board of Nursing (BON) also supports the implementation of CMO No.14. Strengths of the new curriculum
enumerated by the BON are as follow (BON, April 6, 2009):

The Core Competencies with their indicators are spelled out in the various professional courses.
Common core values identified by the Board of Nursing and the various professional organizations during the

workshop on good governance were also included in the curriculum.

Total General Education Courses is 90 Units
Total Professional Courses is 115 Units
The following professional courses included in CMO NO. 5 were retained. (CMO No. 5 was the prototype of CMO
No. 14)
> Theoretical Foundations in Nursing
> Health Assessment
> Pharmacology
> Nutrition and Diet Therapy
> Nursing Research
> Competency Appraisal
> IV Therapy is introduced in NCM 106

Two Nursing Electives are included (6 Suggested Nursing Electives are included for the third year and senior year

level)
Intensive Nursing Practicum both for community-based and hospital-based experience are included
Guide for RLE are incorporated
The Intraoperative, Intrapartal and Immediate Care of the Newborn are spelled out as part of the curriculum
More Specific Admission policies are encouraged
Guide for Hospital Affiliation are more specific
Proper Implementation of Nursing Education Standards is encouraged. However, sanctions for schools who are not
performing well are spelled out.
One of the changes in the curriculum is the rearrangements of topics in the Nursing Care Management (NCM)

course. In the old curriculum based on CMO No.30, NCM 101, 102 and 104 is an integration of Medical-Surgical Nursing,
Psychiatric Nursing, and Maternal and Child Health Nursing(MCN). It means that in NCM 101, there are three subjects
altogether. However, in the new curriculum CMO No.14, Nursing Care Management Courses were separated according to
nursing specialties. For example, NCM 101 and 102 deals with only Maternal and Child Health Nursing.
Since CMO No. 14 was implemented only lately, the first batch under the new curriculum is currently in the second
year level. Article V, section 7.2 of CMO No. 14 states that:
At the end of the fourth year, the student shall have acquired the holisticunderstanding of the human person as a
bio-psycho cultural being focusing on theconcept of health and illness as it is related to Perioperative nursing in
variedsettings. The student shall be able to demonstrate the competencies in the following keyareas of responsibility such
as safe and quality nursing care, communication,collaboration and teamwork, health education, legal responsibility,

ethico-moralresponsibility, personal and professional development, quality improvement, research,management of

resources and environment, and record management.
Specifically, the student shall:
a.
b.
c.
d.
e.
f.
g.
h.
i.

describe the health care delivery system and the nurses role in it;
demonstrate ethico-moral, legal responsibilities in the care of individual family and community;
demonstrate the beginning skills in the provision of independent and collaborative nursing function;
relate the stages of growth and development in the care of clients;
demonstrate beginning skills in the preparation of healthy and therapeutic diets in varied client cases;
explain the dynamics of the disease process caused by microbes and parasites and the environment;
imbibe the core values cherished by the nursing profession such as love of God, country and people, and caring;
design a plan that will focus on health promotion and risk reduction to clients; and
utilize the nursing process in the care of the high risk mother and child in the family.
Statements from several sources, such as CHED, PNA, and BON, suggest that they support the implementation of

the new curriculum. These sources have enumerated the strengths of the new curriculum and emphasized the relevance
of incorporating the Core Competencies in the new curriculum. According to Tamse (July-Dec 2004), the Core
Competency Standards serve as a framework for program development and also serve as a tool for performance
evaluation. With this information, the researchers will use the same Core Competency Standards to evaluate the
effectiveness of the new curriculum with regards to Perioperative Nursing. The result of this study may either support or
refute the statements of the said sources.
Foreign Studies
A study by Richard W. Redman, et al. 1999 deals with competency assessment in nursing education.
Competency Assessment: Methods for Development and Implementation in Nursing Education

Competent performance by health care professionals is expected throughout society. However, defining what it is
and teaching students how to perform competently faces many challenges. This article provides a brief overview of the
contemporary focus on competency assessment in nursing education. The redesigned nursing curriculum at the
University of Colorado is presented as an exemplar of a practice-oriented model that requires competent performance
among students. Methods for implementing a competency-based curriculum and lessons learned during the process are
discussed.
Competency assessment is always outcome oriented; the goal is to evaluate performance for the effective
application of knowledge and skill in the practice setting. Competency assessment techniques address psychomotor,
cognitive, and affective domains. Competencies can be generic to clinical practice in any setting, specific to a clinical
specialty, basic or advanced.
Competency-based education has been found to be equally effective in both didactic and self-learning
approachespresents hallmarks of competency-based education that make them applicable both in practice and in
educational settings. These include competencies based on validation of what performance by competent practitioners
actually comprises. In addition, competency assessment is based on criterion-referenced evaluation methods where the
learners performance is evaluated against a set of criteria provided to the learner so that both the learner and the
assessor are clear on what performance is required. Finally, competency-based education is learner-centered in that
outcomes are specified and describe what the learner must do to demonstrate competency.

The experience in converting to a competency-based curriculum has been both successful and challenging.
Faculty and student experiences to date have been positive. The redesigned curriculum is viewed as responsive to the
competency-oriented environment and employers believe the transition of graduates into practice settings will be more
effective, efficient, and successful. This competency-based approach to education can serve as a model which offers a
wide variety of applications to education and service environments.
The researchers adopted the criterion-referenced evaluation methods. Competency is evaluated against a set of
criteria. In this study, the criteria to be used is the Eleven Core Competency Standards.

Local Study
A similar study of evaluating a curriculum was conducted by Helen Villarico-Correa, RN, MN, EdD published in The
Philippine Journal of Nursing Volume 73 No.2. (2008)
The Associate in Health Science Education Curriculum: An Evaluation
This paper presents the result of a survey conducted in Region VI as to the implementation of the Associate in
Health Science Education (AHSE) Curriculum. The survey was conducted among all the higher education institutions in
the region that offers the health-related professions and the associate in health science education curriculum. The
respondents were 35 deans of the health-related professions in the region which include Bachelor of science in Nursing,
Bachelor of Science in Medical Technology, Bachelor of Science in Physical Therapy, Bachelor of Science in Pharmacy,
Bachelor of Science in Nutrition and Dietetics, Bachelor of Science in Radio Technology, and the two-year Midwifery

Program. In addition, this paper also provides an overview of the AHSE curriculum including the views and experiences of
the deans who actually implemented the said programs since the academic year, 1998-1999.
Specifically, this study aimed to determine:

whether the objectives of the AHSE curriculum were met

the strengths and the weaknesses of the curriculum;
the problems encountered in implementing the program
the facilitating factors that help in the implementation of the program; and
the preferred curriculum of the respondents

The results of the study show that majority of the respondents replied that the objectives of the AHSE curriculum
has not been met. Several advantages and disadvantages of the AHSE curriculum were mentioned. And according to the
study, 85.71% of the respondents preferred the generic curriculum over the AHSE curriculum.

Synthesis
CMO No. 14 mandates the implementation of the new nursing curriculum. It contains the standard curriculum and
syllabi of the nursing subjects. This memorandum was developed to improve the competency of Filipino nurses and
produce highly qualified nurses.
From the literatures collected, the researchers are able to extract the information that fourth year nursing students
are expected to be knowledgeable in Perioperative nursing and be able to develop competencies in the 11 Core

Competency areas. With this, the researchers will utilize the Core Competencies to test the students knowledge in
Perioperative nursing that it can also be used as an evaluation tool.

Chapter III
THE PROBLEM AND ITS BACKGROUND
Research Design
The researchers will use a quantitative, non-experimental research design. Specifically, the design will be a
descriptive evaluative survey.
Descriptive evaluative surveys are concerned with the development, testing, and evaluation of methods,
procedures, guidelines, and instruments. After which, an evaluative judgment is done. This research design further aims
to test the viability, quality, or effectiveness of a product, program, method or procedure and answer specific questions on
these.
Since the researchers cannot control and manipulate the independent variable, a non-experimental design was
used. The researchers will also utilize the descriptive evaluative survey to collect intellective data from the subjects and be
able to evaluate the their competency level. This design will enable the researchers to test the hypothesis and assess the
level of competency of Level IV student nurses in Holy Angel University and Angeles University Foundation.

Research Locale
A) Sources of Data
The research will be conducted at Angeles University Foundation and Holy Angel University, College of Nursing. The
researchers selected this area in order to assess the competency of Level IV student nurses.
Purposive sampling is used in the study. The subjects are selected by setting an inclusion criteria, that is: all level
IV student nurses enrolled in 1st Semester 2015 in Holy Angel University and Angeles University Foundation. The students
must have taken all NCM subjects prior to the enrolment in 1 st Semester 2015. There are ______ sections and a total of
______ students.
Level IV student nurses were chosen to be subjects of the study because they are under the new curriculum, and
this study aims to test the students competency under the new curriculum.
B) Background of the Universities
Holy Angel University a private Roman Catholic university in Angeles City, Pampanga, Philippines. Founded in 1933, it
is considered the first lay-founded Catholic school as well as the first co-educational Catholic high school.

With a student population of over 21,000, it is the largest private institute of education and the largest student population
in a single campus in Central Luzon.
Holy Angel University also has a Level II reaccredited status from the Philippine Accrediting Association of Schools,
Colleges and Universities (PAASCU) for its Accountancy, Arts & Sciences, Business Administration, Education,
Engineering, Hospitality Management and High School programs, as well as Level I accredited status for its Elementary
School and candidate status for its Graduate School.
The national government recognizes the institution as among the country's top universities in terms of academic
excellence when the Commission on Higher Education renewed the university's Autonomous Status. This follows the
acquisition of an international accreditation from the International Assembly for Collegiate Business Education (IACBE)the only school in the Philippines and the Far East to have done so.
CHED has also declared seven programs as centers of development, namely, Teacher Education, Hospitality
Management, Information Technology and Computer Science, Business Administration, Civil Engineering, Industrial
Engineering, and Electrical Engineering. (http://www.hau.edu.ph/)
The Angeles University Foundation is a private Roman Catholic university in Angeles City, Philippines and it is
considered as the premiere university of Central Luzon. It is a non-stock, non-profit educational institution established on

May 25, 1962 by Mr. Agustin P. Angeles, Dr. Barbara Y. Angeles and family. After only less than nine years of operation,
the Institution was granted University status on April 16, 1971 by the Department of Education, Culture and Sports.
It is one of few Philippine universities granted autonomous status, with a number of its degree programs having been duly
recognized as Centers of Excellence and Centers of Development by the Commission on Higher Education.
Today, AUF has the highest percentage of faculty with graduate degrees in the Central Luzon region, and among the
highest in the Philippines. These qualifications are the foundation for its vaunted quality instruction and research, as
evidenced by: Autonomous Status since 2003; Institutional Quality Assurance Monitoring and Evaluation (IQUAME)
certification from the Commission on Higher Education (CHED); Accreditation by the Philippine Accrediting Association of
Schools, Colleges and Universities (PAASCU); ISO 9001-2000 Certification by TUV-SUD; Center of Excellence
information Technology and Teacher Education as accredited by the Commission on Higher Education; and Center of
Development for Computer Engineering and Nursing from the same government arm. Now on its 50th year of operation,
AUF has a total of 63 academic programs scattered across 8 colleges excluding a Medical and Law school.
(http://www.auf.edu.ph/)
Instrumentation and Data Collection
The researchers will use a questionnaire. The questionnaire contains the title of the research and a letter asking for
the consent of the respondents to take part in the study. The first part of the questionnaire contains the demographic

profile of level IV student nurses which include their name which is optional, age, and gender. The second part will be
composed of 50 questions of multiple choice type that will cover the Eleven Core Competencies and will all be related to
the concepts of Perioperative Nursing. Answer sheets will be provided where respondents will encircle their answers. The
content of the questionnaire will be checked and validated by the researchers itself.
Data gathering procedure will be done in classrooms. Level IV student nurses will be divided by block per room.
One proctor will be assigned to each room to administer the test. Students will be given 1 hour to answer the 50
questions. Respondents will be asked to fill in their names, age and gender. They will be instructed to answer all
questions by encircling the letter of the best answer on the answer sheet. The floating of questionnaires will be done in
______

Tools for Data Analysis

respondent will be recorded. The scores will then be tallied into frequencies under different range of scores, 0, 1-16, 1736, and 36-50.

Range of Scores
36-50
17-36
0-16

Descriptive Equivalence
Competent
Advanced beginner
Novice

The range of score within 36-50 corresponds to competent performance of level IV nursing students. Scores within
the range of 17-36 indicates that Level IV students are in the advanced beginner level. Scores in the range of 0-16
pertains to the novice level.

NAME:
AGE:
SCHOOL:
I. Encircle the letter of the correct answer in this questions. All questions are in the scope of Peri-operative Nursing.
1.) Which of the following is most dangerous complication during induction of spinal anesthesia?
A.)Tachycardia
B.)Hypotension
C.)Hyperthermia
D.)Bradypnea
2.) Which type of surgery is most likely to predispose a patient to postoperative atelectasis, pneumonia or
respiratory failure?

A.)Upper abdominal surgery on an obese patient with a long history of smoking

B.)Upper abdominal surgery on a patient with normal pulmonary function
C.)Lower abdominal surgery on a young patient with diabetes mellitus
D.)Surgery on the extremities of a nonsmoking football player
3.) Which of the following characterizes excitement stage of anesthesia?
A.) Occurs from the administration of anesthesia to the loss of consciousness
B.) Extends from the loss of consciousness to the loss of lid reflex, characterized by
struggling and talking
C.) From the loss of lid reflex to the loss of most reflexes
D.) From the loss of most reflexes to respiratory and circulatory failure
4.) To prevent headache after spinal anesthesia the patient should be positioned:
A.) Semi-fowlers
B.) Flat on bed for 6 to 8 hours
C.) Prone position
D.) Modified trendelenburg
5.) Which of the following nursing actions should be given highest priority when

admitting the patient into the operating room?

A.) Level of consciousness
B.) Vital signs
C.) Patient identification and correct operative consent
D.) Positioning and skin preparation
6.) What is the primary reason for the gradual change of position of the patient after surgery?
A.) To prevent muscle injury
B.) To prevent sudden drop of BP
C.) To prevent respiratory distress
D.) To promote comfort

7.) Which of the following assessment data is most important to determine when caring for a patient who has
received spinal
anesthesia?
A.) The time of return of motion and sensation in the legs and toes
B.) The character of respiration

C.) Level of consciousness

D.) Amount of wound drainage
8.) Which of the following postop findings should the nurse report to the M.D.?
A.) The patient pushes out the oral airway with his tounge
B.) Urine output is 20ml/hr for the past two hours
C.) VS are as follows: BP=110/70;PR=95;RR=19,Temp=36.8C
D.) Wound drainage is serosanguinous
9.) Which of the following is the earliest sign of poor respiratory function?
A.) Cyanosis
B.) Fast thready pulse
C.) Restlessness
D.) Faintness
10.) If wound eviscerations occurs, the immediate nursing action is:
A.) Cover the wound with sterile gauze moistened with sterile NSS
B.) Cover the wound with water-soaked gauze

C.) Cover the wound with sterile dry gauze

D.) Leave the wound uncovered and pull the skin edges together
11.) Appendectomy is classified as
A.) Ablative
B.) Constructive
C.) Reconstructive
D.) Palliative
12.) The worst of all fears among clients undergoing surgery is:
A.) Fear of financial burden
B.) Fear of death
C.) Fear of the unknown
D.) Fear of loss of job
13.) The best time to provide preoperative teaching on deep breathing, coughing and turning exercises is:
A.) Before administration of preoperative medications
B.) The afternoon or evening prior to surgery

C.) Several days prior to surgery

D.) Upon admission of the client in the recovery room
14.) The following are the appropriate nursing actions before administration of
preoperative medications EXCEPT:
A.) Ascertain the consent has been signed
B.) Ensure that NPO has been maintained
C.) Instruct patient to empty his bladder
D.) Shave the skin at the site of surgery
15.) The patient has been observed pacing along the hallway, goes to the bathroom frequently and asks
questions repeatedly during preoperative assessment. The most likely cause of the behavior is:
A.) She is anxious about the surgical procedure
B.) She is worried about separation from the family
C.) She has urinary tract infection
D.) She has an underlying emotional problem
16.) Which of the following nursing actions would help the patient decrease anxiety during the preoperative
period?

A.) Explaining all procedures thoroughly in

chronological order
B.) Spending time listening to the patient and answering questions
C.) Encouraging sleep and limiting interruptions
D.) Reassuring the patient that the surgical staff are competent professional
17.) Which of the following is the primary purpose of maintaining NPO for 6 to 8 hours before surgery?
A.) To prevent malnutrition
B.) To prevent electrolyte imbalance
C.) To prevent aspiration pneumonia
D.) To prevent intestinal obstruction

18.) The following ensure validity of informed written consent EXCEPT:

A.) The patient is of legal age with proper mental disposition
B.) The consent has been secured within 24 hours before the surgery
C.) If the patient is unable to write, secure the consent from a relative

D.) The consent is secured before administration of any medication that alter
the level of consciousness
19.) Which of the following drugs is administered to minimize respiratory
secretions preop?
A.) Valium (Diazepam)
B.) Nubain ( Nalbuphine HCL)
C.) Phenergan (Promethazine)
D.) Atropine Sulfate
20.) Which of the following is experienced by the patient who is under spinal anesthesia?
A.) The patient is unconscious
B.) The patient is awake
C.) The patient experiences amnesia
D.) The patient experiences total loss of sensation
21.) The patient who has undergone TAHBSO complains of pain. Which of the following is an initial nursing
action?
A.) Administer the PRN analgesics

B.) Instruct to do deep breathing exercises

C.) Assess the VS
D.) Change the patients position
22.) How frequent should the nurse monitor the VS of the patient in the recovery room?
A.) Every 15 minutes
B.) Every 30 mins
C.) Every 45 mins
D.) Every 60 mins
23.) Which of the following drugs is given to relieve nausea and vomiting?
A.) Mepivacaine
B.) Aquamephyton
C.) Nubain
D.) Plasil
24.) The most important factor in the prevention of postop infection is:
A.) Proper administration of antibiotics

B.) Fluid intake of 2-3L/day

C.) Practice of strict aseptic techniques
D.) Frequent change of wound dressings
25.) Which of the following primarily prevents postop complications?
A.) Adequate fluid intake
B.) Early ambulation
C.) Well-balanced diet
D.) Administration of antimicrobials
Situation: A female client, 23 y/o was admitted for the first time at the Fatima
Hospital with the chief complaint of Right Iliac Pain, accompanied by nausea and
vomiting, chills and fever. She was diagnosed to have acute appendicitis. She was scheduled to have emergency
appendectomy under spinal anesthesia. ( For questions 26-31)
26.) Pre-op instructions to the client would include the following EXCEPT:
A.) Deep breathing and coughing exercise
B.) Turning to sides
C.) Foot and leg exercises

D.) reassuring her that narcotics will be given every 4 hours round the clock until she
is discharged.
27.) The client gave her consent for the surgery. To ensure the legality of the consent, the following conditions
must be met EXCEPT:
A.) She gave her consent freely
B.) She must understand the nature of the surgery
C.) The consent must be signed by a witness
D.) Signing should be done after the administration of pre-anesthesia meds
28.) The skin is shaved prior to surgery in order to:
A.) Facilitate skin incision
B.) Indicate the site to be draped
C.) To prevent wound infection
D.) Reduce post op scarring
29.) The important nursing intervention prior to administration of pre-anesthetic medication is:
A.) Ask patient to empty the bladder
B.) Do deep breathing and coughing exercises

C.) Regulate IVF accurately

D.) Shave the skin
30.) Immediately following spinal anesthesia, the greatest risk is:
A.) Severe hemorrhage
B.) Severe Hypotension
C.) Severe Hypoglycemia
D.) Hypertensive crisis
31.) Nursing measures to promote the clients respiratory function during recovery from anesthesia are the
following EXCEPT:
A.) Encourages deep breathing and coughing exercises
B.) Administer Humidified oxygen
C.) Place in semi-fowlers position
D.) Place in supine position with head turned to the side without pillow support
32.) Which of the following criteria must be met before the client is released from the RR to the unit.
A.) Breathes with ease, coughs freely

B.) Has regained consciousness

C.) Vital signs fluctuates erratically
D.) Able to move four extremities
33.) Early signs of poor respiratory function include which of the following
A.) Cyanosis
B.) Hypotension
C.) Loss of consciousness
D.) Restlessness
34.) Post operatively, the client must be encouraged to turn, cough and deep breathe:
A.) Every 1-2 hours
B.) Every 4 hours
C.) Every 30 Mins
D.) Every 8 hours
35.) A client in shock must be placed in:
A.) High-fowlers position
B.) Sims position

C.) Modified trendelenburg

D.) Prone position

36.) The most important factor in the prevention of post op wound infection is:
A.) Adequate fluid intake
B.) Proper administration of antibiotics
C.) Practice of strict aseptic technique
D.)Frequent cleaning of the wound

37.) When the patient vomits, the most important nursing objective is to prevent:
A.) Dehydration
B.) Aspiration
C.) Rupture of suture line

D.) Met. Alkalosis

38.) Post operatively, a patient is expected to void after:
A.) 6-8 hours
B.) 2-4 hours
C.) 12-24 hours
D.) 10-12 hours
39.) Headache after spinal anesthesia is due to:
A.) Paralysis of vasomotor nerves
B.) Traction placed on structures within abdomen
C.) Loss of CSF through dural hole
D.) Administration of large amounts and heavy concentration of anesthetic agents

40.) Nursing measures for post-op thrombophlebitis include the following

EXCEPT:
A.) Maintain bedrest
B.) Elevate affected leg with pillow support

C.) Massage the painful extremities

D.) Apply antiembolic stockings
41.) Nursing measures to relieve hiccups include the following EXCEPT:
A.) Exhale and inhale through a paper bag
B.) Apply pressure over the eyeball through closed eye lids
C.) Hold breath while taking a large pulp of water
D.) Administer high concentration of oxygen
42.) Modified radical mastectomy involves:
A.) Removal of the entire breast, axillary lymph nodes, pectoralis muscle
B.) Removal of the lump of the breast
C.) Removal of the entire breast, axillary and neck lymph nodes, including pectoralis
muscles
D.) Removal of the entire breast but nipple remains intact

43.) Which of the following is not appropriate nursing intervention after modified radical mastectomy?
A.) Place in semi fowlers position and elevate arm on the affected side with pillow

support
B.) Check behind the client for bleeding
C.) Monitor output from wound suction drainage
D.) Immobilize the arm on affected side in adduction
44.) A fluid challenge is begun with a post-op gastric surgery client. Which assessment will give the best
indication of client response to this treatment?
A.) CVP readings and hourly urine output
B.) Blood pressure and apical rate checks
C.) Lung sounds and arterial blood gases
D.) Electrolytes, BUN, creatinine results
45.) A client is scheduled for a subtotal gastrectomy. In anticipation of clarifying
information for client education, the nurse knows that vagotomy is done as part of the surgical treatment for
peptic ulcers in order to:
A.) Decrease secretion of hydrochloric acid
B.) Improve the tone of the GI muscles

C.) Increase blood supply to the jejunum

D.) Prevent the transmission of pain impulses
46.) Which of the following facts best explains why the duodenum is not removed
during a subtotal gastrectomy?
A.) The head of the pancreas is adherent to the duodenal wall
B.) The common bile duct empties into the duodenal lumen
C.) The wall of the jejunum contains no intestinal villi
D.) The jejunum receives its blood supply through the duodenum
47.) During the immediate postoperative period following gastric surgery, why must the nurse be particularly
conscientious about encouraging a client to cough and deep-breathe at regular intervals?
A.) Marked changes in intrathoracic pressure will stimulate gastric drainage
B.) The high abdominal incision will lead to shallow breathing to avoid pain
C.) The phrenic nerve will have been permanently damaged during the surgical
procedure
D.) Deep-breathing will prevent post op vomiting and intestinal distention

48.) Prior to having a subtotal gastrectomy, a client is told about the dumping syndrome.
The nurse explains that it is:
A.) The bodys absorption of toxins produced by liquefaction of dead tissue
B.) Formation of an ulcer at the margin of the gastrojejunal anastomosis
C.) Obstruction of venous flow from the stomach into the portal system
D.) Rapid emptying of food and fluid from the stomach into the jejunum
49.) Which of the following statements by a client recovering from a subtotal
gastrectomy would indicate a need for additional teaching about the diet protocol
for dumping syndrome?
A.) I plan to eat a diet low in carbohydrates and high in protein and fat
B.) I plan to eat a diet high in CHO and low in CHON and fat
C.) I will eat slowly and avoid drinking fluids
during meals
D.) I will try to assume a recumbent position after meals for 30 mins to 1 hour to enhance digestion and relieve symptoms
50.) A 40 y/o female client has arrived in the post anesthesia room following a
cholecystectomy and a common bile duct exploration. She is semi conscious. Her vital

signs are within normal limits. Which of the following nursing actions would be
inappropriate?
A.) Apply a warm blanket to her body
B.) Place her in a semi-fowlers position
C.) Attached her T-tube to gravity drainage
D.) Set up low, intermittent suction for her

PERFORMANCE OF ANGELES UNIVERSITY FOUNDATION AND HOLY ANGEL UNIVERSITY

FIRST TIMER

REPEATERS

OVERALL PERFORMANCE

scho
ol
AUF
holy

Jul-12
pass fail
ed
ed
359
27
185
41

con
d
0
0

tot
al
386
226

%pass
ed
93.01%
81.86%

pass
ed
12
10

fail
ed
13
18

con
d
0
0

tot
al
25
28

%pass
ed
48.00%
35.71%

pass
ed
371
195

fail
ed
40
59

con
d
0
0

tot
al
411
254

%pass
ed
90.27%
76.77%

scho
ol
AUF
holy

Nov-12
pass fail
ed
ed
14
5
0
2

con
d
0
0

tot
al
19
2

%pass
ed
73.68%
0.00%

pass
ed
18
16

fail
ed
12
38

con
d
0
0

tot
al
30
54

%pass
ed
60.00%
29.63%

pass
ed
32
16

fail
ed
17
40

con
d
0
0

tot
al
49
56

%pass
ed
65.31%
28.57%

scho
ol

Jun-13
pass fail
ed
ed

con
d

tot
al

%pass
ed

pass
ed

fail
ed

con
d

tot
al

%pass
ed

pass
ed

fail
ed

con
d

tot
al

%pass
ed

AUF
holy

149
94

10
37

0
0

159
131

93.71%
71.76%

3
3

6
19

0
0

9
22

33.33%
13.64%

152
97

16
56

0
0

168
153

90.48%
63.40%

scho
ol
AUF
holy

Dec-13
pass fail
ed
ed
24
9
1
1

con
d
0
0

tot
al
33
2

%pass
ed
72.73%
50.00%

pass
ed
6
14

fail
ed
15
40

con
d
0
0

tot
al
21
54

%pass
ed
28.57%
25.93%

pass
ed
30
15

fail
ed
24
41

con
d
0
0

tot
al
54
56

%pass
ed
55.56%
26.79%

scho
ol
AUF
holy

May-14
pass fail con
ed
ed
d
85
5
0
44
23
0

tot
al
90
67

%pass
ed
94.44%
65.67%

pass
ed
6
3

fail
ed
7
19

con
d
0
0

tot
al
13
22

%pass
ed
46.15%
13.64%

pass
ed
91
47

fail
ed
12
42

con
d
0
0

tot
al
103
89

%pass
ed
88.35%
52.81%

scho
ol

Nov-14
pass fail
ed
ed

co
nd

tot
al

%pass
ed

pass
ed

fail
ed

co
nd

tot
al

%pass
ed

pass
ed

fail
ed

co
nd

tot
al

AUF

23

24

95.83%

11

15

73.33%

34

39

holy

100.00
%

21

17

38

55.26%

22

17

39

co
nd

tot
al

%pass
ed
100.00
%

pass
ed

fail
ed

co
nd

tot
al

%pass
ed

pass
ed

fail
ed

co
nd

tot
al

62.50%

72

75

83.78%

11

18

38.89%

38

17

55

scho
ol

May-15
pass fail
ed
ed

AUF

67

67

holy

31

37

%pass
ed
87.18
%
56.41
%

%pass
ed
96.00
%
69.09
%

HAU
Chelsy Bermudez= 35 Verozo, Raiza= 41 Ocampo, shara= 20 Carolin, Alyssa= 40
Santos, chris= 28 Capili, marlone= 41 Dungca, cerise= 39 Salunga, christian= 32
Jacob, geraldine=35 Panahon, Shane= 40 Pancito, lorraine= 33 Guanlao, kath= 38
Milan, mika= 46 Garcia, Loiue= 27 Mirandan, Chris= 40 Wilkerson, marie= 25
AUF
hernandez en47 , 21 , 28 , 39, 41 , 43 , 44, 14 , 41 , 31 , 31 , 24 , 38 , 33 , 42