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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) Prepare for endoscopy
B) Start IV fluid resuscitation
C) Insert a nasogastric tube
D) Administer proton pump inhibitor
  • 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 from lower GI
B) Bleeding has stopped
C) Normal NG output
D) Ongoing active bleeding
  • 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) Upper GI bleeding is resolving
D) New onset of lower GI bleed
  • 4. 4.
    A patient with GI bleeding is scheduled for blood transfusion. Which assessment finding requires immediate attention?
A) BP 110/70 mmHg
B) Pulse 88 bpm
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) 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) Elevate the head of the bed
B) Measure bladder pressure
C) Provide pain relief
D) Administer diuretics
  • 7. 7.
    What parameter best reflects intra-abdominal pressure?
A) Central venous pressure
B) Gastric residual volume
C) Mean arterial 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 venous return
C) Increased intrathoracic pressure
D) Compression of inferior vena cava
  • 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) Urine output 15 mL/hr
B) Soft abdomen
C) Respiratory rate 18/min
D) Heart rate 90 bpm
  • 11. 11.
    A patient with liver failure has confusion and flapping tremor (asterixis). What should the nurse suspect?
A) Hepatic encephalopathy
B) Hypokalemia
C) Hypoglycemia
D) Hypocalcemia
  • 12. 12.
    Which lab result is consistent with liver failure?
A) Decreased bilirubin
B) Decreased ammonia
C) Increased albumin
D) Elevated ALT and AST
  • 13. 13.
    A patient with liver failure has ascites. Which intervention is most appropriate?
A) Encourage deep breathing
B) Position in high Fowler’s
C) Encourage high-sodium diet
D) Restrict fluids
  • 14. 14.
    After paracentesis, what is the most important nursing action?
A) Document color of fluid
B) Monitor blood pressure
C) Check bowel sounds
D) Record urine output
  • 15. 15.
    The nurse should withhold lactulose if the patient exhibits which symptom?
A) Drowsiness
B) Mild abdominal pain
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) Fever
C) Grey-Turner’s sign
D) Vomiting
  • 17. 17.
    Which lab result supports the diagnosis of acute pancreatitis?
A) Low WBC count
B) Low bilirubin
C) Decreased lipase
D) Elevated amylase and lipase
  • 18. 18.
    What is the priority nursing intervention in acute pancreatitis?
A) Encourage oral fluids
B) Maintain NPO status
C) Provide low-fat diet
D) Administer insulin
  • 19. 19.
    Which electrolyte imbalance is common in pancreatitis?
A) Hypernatremia
B) Hypomagnesemia
C) Hypocalcemia
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) Administer bicarbonate
C) Prepare for dialysis
D) Start insulin drip
  • 22. 22.
    Which lab result confirms DKA?
A) Serum ketones positive
B) Blood glucose 180 mg/dL
C) HCO₃ 24 mEq/L
D) pH 7.45
  • 23. 23.
    Which electrolyte must be monitored closely during insulin therapy in DKA?
A) Magnesium
B) Sodium
C) Calcium
D) Potassium
  • 24. 24.
    Which sign indicates effective management of DKA?
A) Increased urine output
B) Fruity odor persists
C) Dry mucous membranes
D) Decreasing ketones and glucose
  • 25. 25.
    The nurse should administer insulin infusion until:
A) D. IV fluids completed
B) B. Glucose < 200 mg/dL and patient can eat
C) C. pH returns to normal
D) A. Ketones disappear
  • 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) D. SIADH
B) A. DKA
C) C. Hypoglycemia
D) B. HHNK
  • 27. 27.
    What is the primary cause of HHNK?
A) A. Infection or dehydration
B) B. Insulin overdose
C) C. Excess carbohydrate intake
D) D. Hypokalemia
  • 28. 28.
    Which intervention is most important in initial management of HHNK?
A) B. Rehydrate with IV fluids
B) A. Administer IV insulin bolus
C) D. Provide potassium supplements
D) C. Start antibiotics
  • 29. 29.
    What differentiates HHNK from DKA?
A) B. Level of glucose
B) A. Presence of ketones
C) D. All of the above
D) C. pH value
  • 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) A. Fluid volume deficit
C) D. Acidosis
D) C. Hypoglycemia
  • 31. 31.
    A patient with acute renal failure has urine output of 200 mL/24 hrs. What phase is this?
A) A. Diuretic
B) D. Initial
C) B. Oliguric
D) C. Recovery
  • 32. 32.
    Which lab finding indicates renal failure?
A) B. Increased BUN and creatinine
B) C. Low potassium
C) A. Decreased creatinine
D) D. High GFR
  • 33. 33.
    In chronic renal failure, which diet is most appropriate?
A) A. High protein
B) C. High sodium
C) D. High fluid intake
D) B. Low potassium and phosphorus
  • 34. 34.
    The nurse monitors which ECG change for hyperkalemia in renal failure?
A) B. Peaked T waves
B) C. U waves
C) A. ST depression
D) D. Flat P 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) C. Neurogenic
B) B. Hypovolemic
C) A. Cardiogenic
D) D. Anaphylactic
  • 37. 37.
    What is the first nursing action in hypovolemic shock?
A) C. Give oxygen
B) D. Draw labs
C) A. Administer vasopressors
D) B. Start IV fluids
  • 38. 38.
    In septic shock, which finding indicates early stage?
A) D. Hypothermia
B) C. Bradycardia
C) A. Cold clammy skin
D) B. Bounding pulse
  • 39. 39.
    Which lab test confirms septic shock?
A) C. Decreased BUN
B) B. Increased sodium
C) A. Blood culture positive
D) D. Elevated calcium
  • 40. 40.
    The most reliable indicator of adequate tissue perfusion in shock is:
A) A. Skin color
B) D. Capillary refill
C) C. Blood pressure
D) B. Urine output
  • 41. 41.
    Which of the following meets SIRS criteria?
A) A. Temp 38.5°C, HR 100, WBC 15,000
B) B. Temp 36°C, HR 70
C) C. RR 14, WBC 5,000
D) D. BP 120/80
  • 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) 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) C. Dehydration
B) D. Stable condition
C) A. Improvement
D) B. Multisystem involvement
  • 45. 45.
    Nursing priority in SIRS management is:
A) A. Early identification and treatment of infection
B) B. Fluid restriction
C) C. Oxygen removal
D) D. High-protein diet
  • 46. 46.
    In MODS, which intervention prevents further organ injury?
A) C. Stop antibiotics
B) B. Limit IV fluids
C) D. Withhold nutrition
D) A. Maintain oxygenation and perfusion
  • 47. 47.
    Which assessment finding indicates progression from SIRS to MODS?
A) B. Decreasing LOC and urine output
B) A. Stable BP and urine output
C) D. Mild fever
D) C. Warm, dry skin
  • 48. 48.
    Which laboratory marker is typically elevated in SIRS/MODS?
A) A. C-reactive protein (CRP)
B) D. Glucose
C) B. Hematocrit
D) C. Sodium
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) B. Hyperthyroidism
B) D. Hypoglycemia
C) A. Disseminated intravascular coagulation (DIC)
D) C. Dehydration
  • 50. 50.
    What is the ultimate goal in managing SIRS and MODS?
A) B. Restrict fluids
B) C. Decrease urine output
C) A. Prevent sepsis and maintain organ perfusion
D) D. Lower WBC count
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