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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) Insert a nasogastric tube
C) Administer proton pump inhibitor
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) Bleeding has stopped
C) Bleeding from lower GI
D) Ongoing active bleeding
  • 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) Upper GI bleeding is resolving
C) New onset of lower GI bleed
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) Crackles in lungs after transfusion
D) Pulse 88 bpm
  • 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) Stop infusion and notify physician
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) Elevate the head of the bed
C) Administer diuretics
D) Provide pain relief
  • 7. 7.
    What parameter best reflects intra-abdominal pressure?
A) Mean arterial pressure
B) Gastric residual volume
C) Bladder pressure
D) Central venous pressure
  • 8. 8.
    A patient with intra-abdominal hypertension has decreased cardiac output. What is the underlying cause?
A) Increased venous return
B) Compression of inferior vena cava
C) Vasodilation
D) Increased intrathoracic pressure
  • 9. 9.
    What is the initial management of mild intra-abdominal hypertension?
A) insert chest tube
B) Immediate surgical decompression
C) Optimize fluid balance and positioning
D) Start vasopressors
  • 10. 10.
    In abdominal compartment syndrome, which nursing assessment finding is most alarming?
A) Soft abdomen
B) Respiratory rate 18/min
C) Urine output 15 mL/hr
D) Heart rate 90 bpm
  • 11. 11.
    A patient with liver failure has confusion and flapping tremor (asterixis). What should the nurse suspect?
A) Hypokalemia
B) Hepatic encephalopathy
C) Hypocalcemia
D) Hypoglycemia
  • 12. 12.
    Which lab result is consistent with liver failure?
A) Decreased ammonia
B) Elevated ALT and AST
C) Decreased bilirubin
D) Increased albumin
  • 13. 13.
    A patient with liver failure has ascites. Which intervention is most appropriate?
A) Restrict fluids
B) Encourage high-sodium diet
C) Position in high Fowler’s
D) Encourage deep breathing
  • 14. 14.
    After paracentesis, what is the most important nursing action?
A) Monitor blood pressure
B) Record urine output
C) Check bowel sounds
D) Document color of fluid
  • 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) Vomiting
B) Grey-Turner’s sign
C) Nausea
D) Fever
  • 17. 17.
    Which lab result supports the diagnosis of acute pancreatitis?
A) Low bilirubin
B) Decreased lipase
C) Elevated amylase and lipase
D) Low WBC count
  • 18. 18.
    What is the priority nursing intervention in acute pancreatitis?
A) Maintain NPO status
B) Provide low-fat diet
C) Administer insulin
D) Encourage oral fluids
  • 19. 19.
    Which electrolyte imbalance is common in pancreatitis?
A) Hypomagnesemia
B) Hypocalcemia
C) Hyperkalemia
D) Hypernatremia
  • 20. 20.
    Which position best relieves pain in acute pancreatitis?
A) Left side-lying with knees flexed
B) Trendelenburg
C) Supine
D) Prone
  • 21. 21.
    A diabetic patient arrives with fruity odor breath and Kussmaul respirations. What is the priority action?
A) Start insulin drip
B) Begin IV fluids
C) Prepare for dialysis
D) Administer bicarbonate
  • 22. 22.
    Which lab result confirms DKA?
A) pH 7.45
B) Serum ketones positive
C) HCO₃ 24 mEq/L
D) Blood glucose 180 mg/dL
  • 23. 23.
    Which electrolyte must be monitored closely during insulin therapy in DKA?
A) Magnesium
B) Calcium
C) Sodium
D) Potassium
  • 24. 24.
    Which sign indicates effective management of DKA?
A) Increased urine output
B) Dry mucous membranes
C) Fruity odor persists
D) Decreasing ketones and glucose
  • 25. 25.
    The nurse should administer insulin infusion until:
A) C. pH returns to normal
B) D. IV fluids completed
C) B. Glucose < 200 mg/dL and patient can eat
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) B. HHNK
B) C. Hypoglycemia
C) A. DKA
D) D. SIADH
  • 27. 27.
    What is the primary cause of HHNK?
A) D. Hypokalemia
B) B. Insulin overdose
C) A. Infection or dehydration
D) C. Excess carbohydrate intake
  • 28. 28.
    Which intervention is most important in initial management of HHNK?
A) C. Start antibiotics
B) B. Rehydrate with IV fluids
C) A. Administer IV insulin bolus
D) D. Provide potassium supplements
  • 29. 29.
    What differentiates HHNK from DKA?
A) C. pH value
B) D. All of the above
C) B. Level of glucose
D) A. Presence of ketones
  • 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) B. Fluid overload
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) D. Initial
B) A. Diuretic
C) B. Oliguric
D) C. Recovery
  • 32. 32.
    Which lab finding indicates renal failure?
A) C. Low potassium
B) A. Decreased creatinine
C) B. Increased BUN and creatinine
D) D. High GFR
  • 33. 33.
    In chronic renal failure, which diet is most appropriate?
A) B. Low potassium and phosphorus
B) C. High sodium
C) D. High fluid intake
D) A. High protein
  • 34. 34.
    The nurse monitors which ECG change for hyperkalemia in renal failure?
A) D. Flat P waves
B) C. U waves
C) A. ST depression
D) B. Peaked T waves
  • 35. 35.
    Which medication helps remove potassium in renal failure?
A) C. Spironolactone
B) D. Mannitol
C) B. Lasix
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) A. Cardiogenic
B) C. Neurogenic
C) B. Hypovolemic
D) D. Anaphylactic
  • 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) A. Cold clammy skin
B) D. Hypothermia
C) C. Bradycardia
D) B. Bounding pulse
  • 39. 39.
    Which lab test confirms septic shock?
A) A. Blood culture positive
B) B. Increased sodium
C) D. Elevated calcium
D) C. Decreased BUN
  • 40. 40.
    The most reliable indicator of adequate tissue perfusion in shock is:
A) A. Skin color
B) D. Capillary refill
C) B. Urine output
D) C. Blood pressure
  • 41. 41.
    Which of the following meets SIRS criteria?
A) C. RR 14, WBC 5,000
B) B. Temp 36°C, HR 70
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) A. Infection or tissue injury
B) B. Dehydration
C) D. Hypertension
D) C. Hypoglycemia
  • 43. 43.
    MODS is characterized by:
A) C. Mild infection
B) D. Local inflammation only
C) A. Dysfunction of two or more organ systems
D) B. Single organ failure
  • 44. 44.
    A patient with MODS develops jaundice, oliguria, and confusion. What does this indicate?
A) B. Multisystem involvement
B) A. Improvement
C) C. Dehydration
D) D. Stable condition
  • 45. 45.
    Nursing priority in SIRS management is:
A) C. Oxygen removal
B) A. Early identification and treatment of infection
C) D. High-protein diet
D) B. Fluid restriction
  • 46. 46.
    In MODS, which intervention prevents further organ injury?
A) A. Maintain oxygenation and perfusion
B) D. Withhold nutrition
C) B. Limit IV fluids
D) C. Stop antibiotics
  • 47. 47.
    Which assessment finding indicates progression from SIRS to MODS?
A) A. Stable BP and urine output
B) D. Mild fever
C) C. Warm, dry skin
D) B. Decreasing LOC and urine output
  • 48. 48.
    Which laboratory marker is typically elevated in SIRS/MODS?
A) A. C-reactive protein (CRP)
B) B. Hematocrit
C) D. Glucose
D) C. Sodium
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) B. Hyperthyroidism
B) A. Disseminated intravascular coagulation (DIC)
C) C. Dehydration
D) D. Hypoglycemia
  • 50. 50.
    What is the ultimate goal in managing SIRS and MODS?
A) C. Decrease urine output
B) A. Prevent sepsis and maintain organ perfusion
C) D. Lower WBC count
D) B. Restrict fluids
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