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NCM 118 Semi Finals BSN-C
  • 1. 1.
    A 58-year-old male presents with hematemesis and melena. His blood pressure is 90/60 mmHg, and pulse is 120 bpm. What is the nurse’s priority action?
A) Start IV fluid resuscitation
B) Administer proton pump inhibitor
C) Prepare for endoscopy
D) Insert a nasogastric tube
  • 2. 2.
    The nurse is caring for a patient with an upper GI bleed. The nasogastric tube returns bright red blood. What does this finding indicate?
A) Bleeding has stopped
B) Ongoing active bleeding
C) Bleeding from lower GI
D) Normal NG output
  • 3. 3.
    After endoscopy for bleeding ulcers, the patient reports black tarry stools. What is the nurse’s interpretation?
A) Normal finding post-endoscopy
B) Rebleeding from ulcer site
C) New onset of lower GI bleed
D) Upper GI bleeding is resolving
  • 4. 4.
    A patient with GI bleeding is scheduled for blood transfusion. Which assessment finding requires immediate attention?
A) Pulse 88 bpm
B) BP 110/70 mmHg
C) Crackles in lungs after transfusion
D) Temperature 37°C
  • 5. 5.
    During octreotide infusion for variceal bleeding, the nurse observes bradycardia. What is the best nursing action?
A) Continue infusion
B) Give atropine
C) Decrease IV fluids
D) Stop infusion and notify physician
  • 6. 6.
    A trauma patient with massive fluid resuscitation has tense abdomen and decreased urine output. What is the nurse’s priority?
A) Measure bladder pressure
B) Administer diuretics
C) Elevate the head of the bed
D) Provide pain relief
  • 7. 7.
    What parameter best reflects intra-abdominal pressure?
A) Bladder pressure
B) Central venous pressure
C) Mean arterial pressure
D) Gastric residual volume
  • 8. 8.
    A patient with intra-abdominal hypertension has decreased cardiac output. What is the underlying cause?
A) Vasodilation
B) Compression of inferior vena cava
C) Increased venous return
D) Increased intrathoracic pressure
  • 9. 9.
    What is the initial management of mild intra-abdominal hypertension?
A) Immediate surgical decompression
B) Optimize fluid balance and positioning
C) insert chest tube
D) Start vasopressors
  • 10. 10.
    In abdominal compartment syndrome, which nursing assessment finding is most alarming?
A) Soft abdomen
B) Urine output 15 mL/hr
C) Heart rate 90 bpm
D) Respiratory rate 18/min
  • 11. 11.
    A patient with liver failure has confusion and flapping tremor (asterixis). What should the nurse suspect?
A) Hypokalemia
B) Hepatic encephalopathy
C) Hypoglycemia
D) Hypocalcemia
  • 12. 12.
    Which lab result is consistent with liver failure?
A) Elevated ALT and AST
B) Decreased ammonia
C) Decreased bilirubin
D) Increased albumin
  • 13. 13.
    A patient with liver failure has ascites. Which intervention is most appropriate?
A) Encourage high-sodium diet
B) Position in high Fowler’s
C) Restrict fluids
D) Encourage deep breathing
  • 14. 14.
    After paracentesis, what is the most important nursing action?
A) Check bowel sounds
B) Monitor blood pressure
C) Record urine output
D) Document color of fluid
  • 15. 15.
    The nurse should withhold lactulose if the patient exhibits which symptom?
A) Two soft stools per day
B) Severe diarrhea
C) Mild abdominal pain
D) Drowsiness
  • 16. 16.
    A patient with severe epigastric pain radiating to the back is diagnosed with acute pancreatitis. Which finding indicates a serious complication?
A) Grey-Turner’s sign
B) Vomiting
C) Nausea
D) Fever
  • 17. 17.
    Which lab result supports the diagnosis of acute pancreatitis?
A) Low WBC count
B) Low bilirubin
C) Elevated amylase and lipase
D) Decreased lipase
  • 18. 18.
    What is the priority nursing intervention in acute pancreatitis?
A) Encourage oral fluids
B) Administer insulin
C) Provide low-fat diet
D) Maintain NPO status
  • 19. 19.
    Which electrolyte imbalance is common in pancreatitis?
A) Hypocalcemia
B) Hypomagnesemia
C) Hyperkalemia
D) Hypernatremia
  • 20. 20.
    Which position best relieves pain in acute pancreatitis?
A) Trendelenburg
B) Left side-lying with knees flexed
C) Prone
D) Supine
  • 21. 21.
    A diabetic patient arrives with fruity odor breath and Kussmaul respirations. What is the priority action?
A) Administer bicarbonate
B) Begin IV fluids
C) Start insulin drip
D) Prepare for dialysis
  • 22. 22.
    Which lab result confirms DKA?
A) Serum ketones positive
B) Blood glucose 180 mg/dL
C) pH 7.45
D) HCO₃ 24 mEq/L
  • 23. 23.
    Which electrolyte must be monitored closely during insulin therapy in DKA?
A) Calcium
B) Sodium
C) Potassium
D) Magnesium
  • 24. 24.
    Which sign indicates effective management of DKA?
A) Dry mucous membranes
B) Increased urine output
C) Decreasing ketones and glucose
D) Fruity odor persists
  • 25. 25.
    The nurse should administer insulin infusion until:
A) C. pH returns to normal
B) D. IV fluids completed
C) A. Ketones disappear
D) B. Glucose < 200 mg/dL and patient can eat
  • 26. 26.
    An elderly type 2 diabetic is admitted with dehydration and glucose of 700 mg/dL, no ketones. What is the likely diagnosis?
A) C. Hypoglycemia
B) B. HHNK
C) A. DKA
D) D. SIADH
  • 27. 27.
    What is the primary cause of HHNK?
A) B. Insulin overdose
B) C. Excess carbohydrate intake
C) D. Hypokalemia
D) A. Infection or dehydration
  • 28. 28.
    Which intervention is most important in initial management of HHNK?
A) D. Provide potassium supplements
B) C. Start antibiotics
C) B. Rehydrate with IV fluids
D) A. Administer IV insulin bolus
  • 29. 29.
    What differentiates HHNK from DKA?
A) C. pH value
B) B. Level of glucose
C) A. Presence of ketones
D) D. All of the above
  • 30. 30.
    A nurse identifies decreased skin turgor and dry mucous membranes in a HHNK patient. What should the nurse expect?
A) A. Fluid volume deficit
B) C. Hypoglycemia
C) B. Fluid overload
D) D. Acidosis
  • 31. 31.
    A patient with acute renal failure has urine output of 200 mL/24 hrs. What phase is this?
A) B. Oliguric
B) D. Initial
C) C. Recovery
D) A. Diuretic
  • 32. 32.
    Which lab finding indicates renal failure?
A) B. Increased BUN and creatinine
B) D. High GFR
C) A. Decreased creatinine
D) C. Low potassium
  • 33. 33.
    In chronic renal failure, which diet is most appropriate?
A) B. Low potassium and phosphorus
B) C. High sodium
C) A. High protein
D) D. High fluid intake
  • 34. 34.
    The nurse monitors which ECG change for hyperkalemia in renal failure?
A) A. ST depression
B) C. U waves
C) B. Peaked T waves
D) D. Flat P waves
  • 35. 35.
    Which medication helps remove potassium in renal failure?
A) C. Spironolactone
B) B. Lasix
C) A. Kayexalate
D) D. Mannitol
  • 36. 36.
    A trauma patient presents with BP 80/50 mmHg, pulse 130 bpm, cool clammy skin. What type of shock is this?
A) B. Hypovolemic
B) C. Neurogenic
C) D. Anaphylactic
D) A. Cardiogenic
  • 37. 37.
    What is the first nursing action in hypovolemic shock?
A) B. Start IV fluids
B) D. Draw labs
C) C. Give oxygen
D) A. Administer vasopressors
  • 38. 38.
    In septic shock, which finding indicates early stage?
A) B. Bounding pulse
B) D. Hypothermia
C) A. Cold clammy skin
D) C. Bradycardia
  • 39. 39.
    Which lab test confirms septic shock?
A) C. Decreased BUN
B) A. Blood culture positive
C) B. Increased sodium
D) D. Elevated calcium
  • 40. 40.
    The most reliable indicator of adequate tissue perfusion in shock is:
A) A. Skin color
B) C. Blood pressure
C) B. Urine output
D) D. Capillary refill
  • 41. 41.
    Which of the following meets SIRS criteria?
A) D. BP 120/80
B) B. Temp 36°C, HR 70
C) C. RR 14, WBC 5,000
D) A. Temp 38.5°C, HR 100, WBC 15,000
  • 42. 42.
    What is the primary trigger for SIRS?
A) D. Hypertension
B) C. Hypoglycemia
C) B. Dehydration
D) A. Infection or tissue injury
  • 43. 43.
    MODS is characterized by:
A) D. Local inflammation only
B) B. Single organ failure
C) C. Mild infection
D) A. Dysfunction of two or more organ systems
  • 44. 44.
    A patient with MODS develops jaundice, oliguria, and confusion. What does this indicate?
A) C. Dehydration
B) A. Improvement
C) B. Multisystem involvement
D) D. Stable condition
  • 45. 45.
    Nursing priority in SIRS management is:
A) D. High-protein diet
B) B. Fluid restriction
C) C. Oxygen removal
D) A. Early identification and treatment of infection
  • 46. 46.
    In MODS, which intervention prevents further organ injury?
A) B. Limit IV fluids
B) A. Maintain oxygenation and perfusion
C) C. Stop antibiotics
D) D. Withhold nutrition
  • 47. 47.
    Which assessment finding indicates progression from SIRS to MODS?
A) B. Decreasing LOC and urine output
B) D. Mild fever
C) A. Stable BP and urine output
D) C. Warm, dry skin
  • 48. 48.
    Which laboratory marker is typically elevated in SIRS/MODS?
A) C. Sodium
B) B. Hematocrit
C) D. Glucose
D) A. C-reactive protein (CRP)
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) D. Hypoglycemia
B) A. Disseminated intravascular coagulation (DIC)
C) C. Dehydration
D) B. Hyperthyroidism
  • 50. 50.
    What is the ultimate goal in managing SIRS and MODS?
A) B. Restrict fluids
B) A. Prevent sepsis and maintain organ perfusion
C) D. Lower WBC count
D) C. Decrease urine output
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