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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) Insert a nasogastric tube
B) Administer proton pump inhibitor
C) Prepare for endoscopy
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) Normal NG output
B) Ongoing active bleeding
C) Bleeding has stopped
D) Bleeding from lower GI
  • 3. 3.
    After endoscopy for bleeding ulcers, the patient reports black tarry stools. What is the nurse’s interpretation?
A) New onset of lower GI bleed
B) Rebleeding from ulcer site
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) Pulse 88 bpm
B) BP 110/70 mmHg
C) Temperature 37°C
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) Continue infusion
B) Decrease IV fluids
C) Give atropine
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) Provide pain relief
B) Measure bladder pressure
C) Elevate the head of the bed
D) Administer diuretics
  • 7. 7.
    What parameter best reflects intra-abdominal pressure?
A) Mean arterial pressure
B) Gastric residual volume
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) Vasodilation
B) Increased intrathoracic pressure
C) Increased venous return
D) Compression of inferior vena cava
  • 9. 9.
    What is the initial management of mild intra-abdominal hypertension?
A) insert chest tube
B) Immediate surgical decompression
C) Start vasopressors
D) Optimize fluid balance and positioning
  • 10. 10.
    In abdominal compartment syndrome, which nursing assessment finding is most alarming?
A) Soft abdomen
B) Respiratory rate 18/min
C) Heart rate 90 bpm
D) Urine output 15 mL/hr
  • 11. 11.
    A patient with liver failure has confusion and flapping tremor (asterixis). What should the nurse suspect?
A) Hypokalemia
B) Hypocalcemia
C) Hypoglycemia
D) Hepatic encephalopathy
  • 12. 12.
    Which lab result is consistent with liver failure?
A) Increased albumin
B) Decreased ammonia
C) Decreased bilirubin
D) Elevated ALT and AST
  • 13. 13.
    A patient with liver failure has ascites. Which intervention is most appropriate?
A) Restrict fluids
B) Encourage deep breathing
C) Encourage high-sodium diet
D) Position in high Fowler’s
  • 14. 14.
    After paracentesis, what is the most important nursing action?
A) Monitor blood pressure
B) Document color of fluid
C) Record urine output
D) Check bowel sounds
  • 15. 15.
    The nurse should withhold lactulose if the patient exhibits which symptom?
A) Mild abdominal pain
B) Drowsiness
C) Severe diarrhea
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) Fever
D) Vomiting
  • 17. 17.
    Which lab result supports the diagnosis of acute pancreatitis?
A) Elevated amylase and lipase
B) Low WBC count
C) Decreased lipase
D) Low bilirubin
  • 18. 18.
    What is the priority nursing intervention in acute pancreatitis?
A) Maintain NPO status
B) Provide low-fat diet
C) Encourage oral fluids
D) Administer insulin
  • 19. 19.
    Which electrolyte imbalance is common in pancreatitis?
A) Hypocalcemia
B) Hypomagnesemia
C) Hypernatremia
D) Hyperkalemia
  • 20. 20.
    Which position best relieves pain in acute pancreatitis?
A) Left side-lying with knees flexed
B) Prone
C) Trendelenburg
D) Supine
  • 21. 21.
    A diabetic patient arrives with fruity odor breath and Kussmaul respirations. What is the priority action?
A) Begin IV fluids
B) Start insulin drip
C) Administer bicarbonate
D) Prepare for dialysis
  • 22. 22.
    Which lab result confirms DKA?
A) Blood glucose 180 mg/dL
B) HCO₃ 24 mEq/L
C) Serum ketones positive
D) pH 7.45
  • 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) Decreasing ketones and glucose
B) Dry mucous membranes
C) Fruity odor persists
D) Increased urine output
  • 25. 25.
    The nurse should administer insulin infusion until:
A) A. Ketones disappear
B) C. pH returns to normal
C) B. Glucose < 200 mg/dL and patient can eat
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) B. HHNK
C) C. Hypoglycemia
D) D. SIADH
  • 27. 27.
    What is the primary cause of HHNK?
A) A. Infection or dehydration
B) D. Hypokalemia
C) B. Insulin overdose
D) C. Excess carbohydrate intake
  • 28. 28.
    Which intervention is most important in initial management of HHNK?
A) C. Start antibiotics
B) D. Provide potassium supplements
C) B. Rehydrate with IV fluids
D) A. Administer IV insulin bolus
  • 29. 29.
    What differentiates HHNK from DKA?
A) A. Presence of ketones
B) C. pH value
C) D. All of the above
D) B. Level of glucose
  • 30. 30.
    A nurse identifies decreased skin turgor and dry mucous membranes in a HHNK patient. What should the nurse expect?
A) C. Hypoglycemia
B) A. Fluid volume deficit
C) D. Acidosis
D) B. Fluid overload
  • 31. 31.
    A patient with acute renal failure has urine output of 200 mL/24 hrs. What phase is this?
A) C. Recovery
B) D. Initial
C) B. Oliguric
D) A. Diuretic
  • 32. 32.
    Which lab finding indicates renal failure?
A) C. Low potassium
B) A. Decreased creatinine
C) D. High GFR
D) B. Increased BUN and creatinine
  • 33. 33.
    In chronic renal failure, which diet is most appropriate?
A) B. Low potassium and phosphorus
B) A. High protein
C) D. High fluid intake
D) C. High sodium
  • 34. 34.
    The nurse monitors which ECG change for hyperkalemia in renal failure?
A) D. Flat P waves
B) B. Peaked T waves
C) A. ST depression
D) C. U waves
  • 35. 35.
    Which medication helps remove potassium in renal failure?
A) B. Lasix
B) D. Mannitol
C) C. Spironolactone
D) A. Kayexalate
  • 36. 36.
    A trauma patient presents with BP 80/50 mmHg, pulse 130 bpm, cool clammy skin. What type of shock is this?
A) D. Anaphylactic
B) C. Neurogenic
C) B. Hypovolemic
D) A. Cardiogenic
  • 37. 37.
    What is the first nursing action in hypovolemic shock?
A) C. Give oxygen
B) B. Start IV fluids
C) D. Draw labs
D) A. Administer vasopressors
  • 38. 38.
    In septic shock, which finding indicates early stage?
A) B. Bounding pulse
B) A. Cold clammy skin
C) C. Bradycardia
D) D. Hypothermia
  • 39. 39.
    Which lab test confirms septic shock?
A) B. Increased sodium
B) C. Decreased BUN
C) D. Elevated calcium
D) A. Blood culture positive
  • 40. 40.
    The most reliable indicator of adequate tissue perfusion in shock is:
A) B. Urine output
B) D. Capillary refill
C) C. Blood pressure
D) A. Skin color
  • 41. 41.
    Which of the following meets SIRS criteria?
A) B. Temp 36°C, HR 70
B) C. RR 14, WBC 5,000
C) A. Temp 38.5°C, HR 100, WBC 15,000
D) D. BP 120/80
  • 42. 42.
    What is the primary trigger for SIRS?
A) C. Hypoglycemia
B) B. Dehydration
C) D. Hypertension
D) A. Infection or tissue injury
  • 43. 43.
    MODS is characterized by:
A) A. Dysfunction of two or more organ systems
B) B. Single organ failure
C) D. Local inflammation only
D) C. Mild infection
  • 44. 44.
    A patient with MODS develops jaundice, oliguria, and confusion. What does this indicate?
A) A. Improvement
B) C. Dehydration
C) D. Stable condition
D) B. Multisystem involvement
  • 45. 45.
    Nursing priority in SIRS management is:
A) C. Oxygen removal
B) A. Early identification and treatment of infection
C) B. Fluid restriction
D) D. High-protein diet
  • 46. 46.
    In MODS, which intervention prevents further organ injury?
A) B. Limit IV fluids
B) A. Maintain oxygenation and perfusion
C) D. Withhold nutrition
D) C. Stop antibiotics
  • 47. 47.
    Which assessment finding indicates progression from SIRS to MODS?
A) C. Warm, dry skin
B) D. Mild fever
C) B. Decreasing LOC and urine output
D) A. Stable BP and urine output
  • 48. 48.
    Which laboratory marker is typically elevated in SIRS/MODS?
A) A. C-reactive protein (CRP)
B) C. Sodium
C) D. Glucose
D) B. Hematocrit
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) B. Hyperthyroidism
B) A. Disseminated intravascular coagulation (DIC)
C) D. Hypoglycemia
D) C. Dehydration
  • 50. 50.
    What is the ultimate goal in managing SIRS and MODS?
A) B. Restrict fluids
B) D. Lower WBC count
C) C. Decrease urine output
D) A. Prevent sepsis and maintain organ perfusion
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