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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) Administer proton pump inhibitor
B) Prepare for endoscopy
C) Insert a nasogastric tube
D) Start IV fluid resuscitation
  • 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) Ongoing active bleeding
B) Bleeding from lower GI
C) Normal NG output
D) Bleeding has stopped
  • 3. 3.
    After endoscopy for bleeding ulcers, the patient reports black tarry stools. What is the nurse’s interpretation?
A) Rebleeding from ulcer site
B) New onset of lower GI bleed
C) Upper GI bleeding is resolving
D) Normal finding post-endoscopy
  • 4. 4.
    A patient with GI bleeding is scheduled for blood transfusion. Which assessment finding requires immediate attention?
A) Temperature 37°C
B) BP 110/70 mmHg
C) Pulse 88 bpm
D) Crackles in lungs after transfusion
  • 5. 5.
    During octreotide infusion for variceal bleeding, the nurse observes bradycardia. What is the best nursing action?
A) Stop infusion and notify physician
B) Decrease IV fluids
C) Continue infusion
D) Give atropine
  • 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) Provide pain relief
C) Administer diuretics
D) Elevate the head of the bed
  • 7. 7.
    What parameter best reflects intra-abdominal pressure?
A) Gastric residual volume
B) Mean arterial pressure
C) Central venous pressure
D) Bladder pressure
  • 8. 8.
    A patient with intra-abdominal hypertension has decreased cardiac output. What is the underlying cause?
A) Compression of inferior vena cava
B) Increased venous return
C) Vasodilation
D) Increased intrathoracic pressure
  • 9. 9.
    What is the initial management of mild intra-abdominal hypertension?
A) Start vasopressors
B) insert chest tube
C) Optimize fluid balance and positioning
D) Immediate surgical decompression
  • 10. 10.
    In abdominal compartment syndrome, which nursing assessment finding is most alarming?
A) Heart rate 90 bpm
B) Soft abdomen
C) Urine output 15 mL/hr
D) Respiratory rate 18/min
  • 11. 11.
    A patient with liver failure has confusion and flapping tremor (asterixis). What should the nurse suspect?
A) Hypoglycemia
B) Hepatic encephalopathy
C) Hypokalemia
D) Hypocalcemia
  • 12. 12.
    Which lab result is consistent with liver failure?
A) Decreased bilirubin
B) Decreased ammonia
C) Elevated ALT and AST
D) Increased albumin
  • 13. 13.
    A patient with liver failure has ascites. Which intervention is most appropriate?
A) Encourage deep breathing
B) Restrict fluids
C) Encourage high-sodium diet
D) Position in high Fowler’s
  • 14. 14.
    After paracentesis, what is the most important nursing action?
A) Record urine output
B) Check bowel sounds
C) Document color of fluid
D) Monitor blood pressure
  • 15. 15.
    The nurse should withhold lactulose if the patient exhibits which symptom?
A) Severe diarrhea
B) Mild abdominal pain
C) Drowsiness
D) Two soft stools per day
  • 16. 16.
    A patient with severe epigastric pain radiating to the back is diagnosed with acute pancreatitis. Which finding indicates a serious complication?
A) Nausea
B) Grey-Turner’s sign
C) Vomiting
D) Fever
  • 17. 17.
    Which lab result supports the diagnosis of acute pancreatitis?
A) Elevated amylase and lipase
B) Low bilirubin
C) Low WBC count
D) Decreased lipase
  • 18. 18.
    What is the priority nursing intervention in acute pancreatitis?
A) Maintain NPO status
B) Encourage oral fluids
C) Administer insulin
D) Provide low-fat diet
  • 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) Supine
B) Trendelenburg
C) Prone
D) Left side-lying with knees flexed
  • 21. 21.
    A diabetic patient arrives with fruity odor breath and Kussmaul respirations. What is the priority action?
A) Administer bicarbonate
B) Prepare for dialysis
C) Start insulin drip
D) Begin IV fluids
  • 22. 22.
    Which lab result confirms DKA?
A) Serum ketones positive
B) HCO₃ 24 mEq/L
C) pH 7.45
D) Blood glucose 180 mg/dL
  • 23. 23.
    Which electrolyte must be monitored closely during insulin therapy in DKA?
A) Potassium
B) Magnesium
C) Calcium
D) Sodium
  • 24. 24.
    Which sign indicates effective management of DKA?
A) Dry mucous membranes
B) Decreasing ketones and glucose
C) Fruity odor persists
D) Increased urine output
  • 25. 25.
    The nurse should administer insulin infusion until:
A) B. Glucose < 200 mg/dL and patient can eat
B) C. pH returns to normal
C) A. Ketones disappear
D) D. IV fluids completed
  • 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) A. DKA
B) D. SIADH
C) B. HHNK
D) C. Hypoglycemia
  • 27. 27.
    What is the primary cause of HHNK?
A) C. Excess carbohydrate intake
B) B. Insulin overdose
C) A. Infection or dehydration
D) D. Hypokalemia
  • 28. 28.
    Which intervention is most important in initial management of HHNK?
A) D. Provide potassium supplements
B) A. Administer IV insulin bolus
C) B. Rehydrate with IV fluids
D) C. Start antibiotics
  • 29. 29.
    What differentiates HHNK from DKA?
A) B. Level of glucose
B) A. Presence of ketones
C) C. pH value
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) B. Fluid overload
B) D. Acidosis
C) C. Hypoglycemia
D) A. Fluid volume deficit
  • 31. 31.
    A patient with acute renal failure has urine output of 200 mL/24 hrs. What phase is this?
A) B. Oliguric
B) A. Diuretic
C) C. Recovery
D) D. Initial
  • 32. 32.
    Which lab finding indicates renal failure?
A) B. Increased BUN and creatinine
B) C. Low potassium
C) D. High GFR
D) A. Decreased creatinine
  • 33. 33.
    In chronic renal failure, which diet is most appropriate?
A) D. High fluid intake
B) A. High protein
C) B. Low potassium and phosphorus
D) C. High sodium
  • 34. 34.
    The nurse monitors which ECG change for hyperkalemia in renal failure?
A) A. ST depression
B) B. Peaked T waves
C) D. Flat P waves
D) C. U waves
  • 35. 35.
    Which medication helps remove potassium in renal failure?
A) D. Mannitol
B) C. Spironolactone
C) A. Kayexalate
D) B. Lasix
  • 36. 36.
    A trauma patient presents with BP 80/50 mmHg, pulse 130 bpm, cool clammy skin. What type of shock is this?
A) A. Cardiogenic
B) B. Hypovolemic
C) C. Neurogenic
D) D. Anaphylactic
  • 37. 37.
    What is the first nursing action in hypovolemic shock?
A) A. Administer vasopressors
B) B. Start IV fluids
C) D. Draw labs
D) C. Give oxygen
  • 38. 38.
    In septic shock, which finding indicates early stage?
A) B. Bounding pulse
B) C. Bradycardia
C) A. Cold clammy skin
D) D. Hypothermia
  • 39. 39.
    Which lab test confirms septic shock?
A) C. Decreased BUN
B) A. Blood culture positive
C) D. Elevated calcium
D) B. Increased sodium
  • 40. 40.
    The most reliable indicator of adequate tissue perfusion in shock is:
A) B. Urine output
B) C. Blood pressure
C) D. Capillary refill
D) A. Skin color
  • 41. 41.
    Which of the following meets SIRS criteria?
A) B. Temp 36°C, HR 70
B) D. BP 120/80
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) A. Infection or tissue injury
B) D. Hypertension
C) C. Hypoglycemia
D) B. Dehydration
  • 43. 43.
    MODS is characterized by:
A) A. Dysfunction of two or more organ systems
B) C. Mild infection
C) B. Single organ failure
D) D. Local inflammation only
  • 44. 44.
    A patient with MODS develops jaundice, oliguria, and confusion. What does this indicate?
A) A. Improvement
B) C. Dehydration
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) A. Early identification and treatment of infection
D) C. Oxygen removal
  • 46. 46.
    In MODS, which intervention prevents further organ injury?
A) A. Maintain oxygenation and perfusion
B) D. Withhold nutrition
C) C. Stop antibiotics
D) B. Limit IV fluids
  • 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) A. C-reactive protein (CRP)
C) B. Hematocrit
D) D. Glucose
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) B. Hyperthyroidism
B) C. Dehydration
C) A. Disseminated intravascular coagulation (DIC)
D) D. Hypoglycemia
  • 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) C. Decrease urine output
D) D. Lower WBC count
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