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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) New onset of lower GI bleed
B) Upper GI bleeding is resolving
C) Normal finding post-endoscopy
D) Rebleeding from ulcer site
  • 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) Give atropine
B) Stop infusion and notify physician
C) Decrease IV fluids
D) Continue infusion
  • 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) Central venous pressure
B) Bladder pressure
C) Gastric residual volume
D) Mean arterial pressure
  • 8. 8.
    A patient with intra-abdominal hypertension has decreased cardiac output. What is the underlying cause?
A) Increased venous return
B) Increased intrathoracic pressure
C) Vasodilation
D) Compression of inferior vena cava
  • 9. 9.
    What is the initial management of mild intra-abdominal hypertension?
A) Optimize fluid balance and positioning
B) insert chest tube
C) Start vasopressors
D) Immediate surgical decompression
  • 10. 10.
    In abdominal compartment syndrome, which nursing assessment finding is most alarming?
A) Heart rate 90 bpm
B) Respiratory rate 18/min
C) Soft abdomen
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) Decreased ammonia
B) Elevated ALT and AST
C) Increased albumin
D) Decreased bilirubin
  • 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) 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) Two soft stools per day
C) Mild abdominal pain
D) Severe diarrhea
  • 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) Decreased lipase
B) Low WBC count
C) Low bilirubin
D) Elevated amylase and lipase
  • 18. 18.
    What is the priority nursing intervention in acute pancreatitis?
A) Administer insulin
B) Encourage oral fluids
C) Maintain NPO status
D) Provide low-fat diet
  • 19. 19.
    Which electrolyte imbalance is common in pancreatitis?
A) Hyperkalemia
B) Hypocalcemia
C) Hypernatremia
D) Hypomagnesemia
  • 20. 20.
    Which position best relieves pain in acute pancreatitis?
A) Supine
B) Trendelenburg
C) Left side-lying with knees flexed
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) Administer bicarbonate
C) Begin IV fluids
D) Prepare for dialysis
  • 22. 22.
    Which lab result confirms DKA?
A) Blood glucose 180 mg/dL
B) Serum ketones positive
C) HCO₃ 24 mEq/L
D) pH 7.45
  • 23. 23.
    Which electrolyte must be monitored closely during insulin therapy in DKA?
A) Sodium
B) Potassium
C) Magnesium
D) Calcium
  • 24. 24.
    Which sign indicates effective management of DKA?
A) Fruity odor persists
B) Increased urine output
C) Dry mucous membranes
D) Decreasing ketones and glucose
  • 25. 25.
    The nurse should administer insulin infusion until:
A) D. IV fluids completed
B) A. Ketones disappear
C) C. pH returns to normal
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) A. DKA
C) D. SIADH
D) B. HHNK
  • 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) A. Administer IV insulin bolus
B) C. Start antibiotics
C) D. Provide potassium supplements
D) B. Rehydrate with IV fluids
  • 29. 29.
    What differentiates HHNK from DKA?
A) A. Presence of ketones
B) C. pH value
C) B. Level of glucose
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) 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) B. Oliguric
B) D. Initial
C) C. Recovery
D) A. Diuretic
  • 32. 32.
    Which lab finding indicates renal failure?
A) A. Decreased creatinine
B) C. Low potassium
C) B. Increased BUN and creatinine
D) D. High GFR
  • 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) D. Flat P waves
B) A. ST depression
C) B. Peaked T waves
D) C. U waves
  • 35. 35.
    Which medication helps remove potassium in renal failure?
A) D. Mannitol
B) B. Lasix
C) A. Kayexalate
D) C. Spironolactone
  • 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) D. Anaphylactic
C) C. Neurogenic
D) A. Cardiogenic
  • 37. 37.
    What is the first nursing action in hypovolemic shock?
A) C. Give oxygen
B) D. Draw labs
C) B. Start IV fluids
D) A. Administer vasopressors
  • 38. 38.
    In septic shock, which finding indicates early stage?
A) A. Cold clammy skin
B) C. Bradycardia
C) B. Bounding pulse
D) D. Hypothermia
  • 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) C. RR 14, WBC 5,000
C) B. Temp 36°C, HR 70
D) D. BP 120/80
  • 42. 42.
    What is the primary trigger for SIRS?
A) A. Infection or tissue injury
B) C. Hypoglycemia
C) D. Hypertension
D) B. Dehydration
  • 43. 43.
    MODS is characterized by:
A) C. Mild infection
B) B. Single organ failure
C) D. Local inflammation only
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) B. Multisystem involvement
B) A. Improvement
C) D. Stable condition
D) C. Dehydration
  • 45. 45.
    Nursing priority in SIRS management is:
A) D. High-protein diet
B) A. Early identification and treatment of infection
C) B. Fluid restriction
D) C. Oxygen removal
  • 46. 46.
    In MODS, which intervention prevents further organ injury?
A) A. Maintain oxygenation and perfusion
B) C. Stop antibiotics
C) B. Limit IV fluids
D) D. Withhold nutrition
  • 47. 47.
    Which assessment finding indicates progression from SIRS to MODS?
A) C. Warm, dry skin
B) D. Mild fever
C) A. Stable BP and urine output
D) B. Decreasing LOC and urine output
  • 48. 48.
    Which laboratory marker is typically elevated in SIRS/MODS?
A) C. Sodium
B) B. Hematocrit
C) A. C-reactive protein (CRP)
D) D. Glucose
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) D. Hypoglycemia
B) B. Hyperthyroidism
C) C. Dehydration
D) A. Disseminated intravascular coagulation (DIC)
  • 50. 50.
    What is the ultimate goal in managing SIRS and MODS?
A) B. Restrict fluids
B) D. Lower WBC count
C) A. Prevent sepsis and maintain organ perfusion
D) C. Decrease urine output
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