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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) Prepare for endoscopy
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 has stopped
B) Normal NG output
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) Normal finding post-endoscopy
B) New onset of lower GI bleed
C) Upper GI bleeding is resolving
D) Rebleeding from ulcer site
  • 4. 4.
    A patient with GI bleeding is scheduled for blood transfusion. Which assessment finding requires immediate attention?
A) Pulse 88 bpm
B) Crackles in lungs after transfusion
C) BP 110/70 mmHg
D) Temperature 37°C
  • 5. 5.
    During octreotide infusion for variceal bleeding, the nurse observes bradycardia. What is the best nursing action?
A) Decrease IV fluids
B) Give atropine
C) Continue infusion
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) Elevate the head of the bed
C) Administer diuretics
D) Measure bladder pressure
  • 7. 7.
    What parameter best reflects intra-abdominal pressure?
A) Central venous pressure
B) Gastric residual volume
C) Bladder pressure
D) Mean arterial 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) 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) Urine output 15 mL/hr
C) Heart rate 90 bpm
D) Respiratory rate 18/min
  • 11. 11.
    A patient with liver failure has confusion and flapping tremor (asterixis). What should the nurse suspect?
A) Hepatic encephalopathy
B) Hypoglycemia
C) Hypocalcemia
D) Hypokalemia
  • 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) Position in high Fowler’s
B) Encourage deep breathing
C) Restrict fluids
D) Encourage high-sodium diet
  • 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) Two soft stools per day
B) Severe diarrhea
C) Mild abdominal pain
D) Drowsiness
  • 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) Fever
C) Nausea
D) Grey-Turner’s sign
  • 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) Maintain NPO status
C) Provide low-fat diet
D) Encourage oral fluids
  • 19. 19.
    Which electrolyte imbalance is common in pancreatitis?
A) Hyperkalemia
B) Hypomagnesemia
C) Hypocalcemia
D) Hypernatremia
  • 20. 20.
    Which position best relieves pain in acute pancreatitis?
A) Prone
B) Supine
C) Trendelenburg
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) Begin IV fluids
B) Administer bicarbonate
C) Prepare for dialysis
D) Start insulin drip
  • 22. 22.
    Which lab result confirms DKA?
A) pH 7.45
B) Blood glucose 180 mg/dL
C) Serum ketones positive
D) HCO₃ 24 mEq/L
  • 23. 23.
    Which electrolyte must be monitored closely during insulin therapy in DKA?
A) Sodium
B) Calcium
C) Potassium
D) Magnesium
  • 24. 24.
    Which sign indicates effective management of DKA?
A) Decreasing ketones and glucose
B) Increased urine output
C) Dry mucous membranes
D) Fruity odor persists
  • 25. 25.
    The nurse should administer insulin infusion until:
A) B. Glucose < 200 mg/dL and patient can eat
B) A. Ketones disappear
C) C. pH returns to normal
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) D. SIADH
B) B. HHNK
C) A. DKA
D) C. Hypoglycemia
  • 27. 27.
    What is the primary cause of HHNK?
A) B. Insulin overdose
B) D. Hypokalemia
C) A. Infection or dehydration
D) C. Excess carbohydrate intake
  • 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) C. Start antibiotics
D) D. Provide potassium supplements
  • 29. 29.
    What differentiates HHNK from DKA?
A) C. pH value
B) B. Level of glucose
C) D. All of the above
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) C. Hypoglycemia
C) B. Fluid overload
D) D. Acidosis
  • 31. 31.
    A patient with acute renal failure has urine output of 200 mL/24 hrs. What phase is this?
A) D. Initial
B) B. Oliguric
C) A. Diuretic
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) C. High sodium
B) D. High fluid intake
C) B. Low potassium and phosphorus
D) A. High protein
  • 34. 34.
    The nurse monitors which ECG change for hyperkalemia in renal failure?
A) B. Peaked T waves
B) A. ST depression
C) C. U waves
D) D. Flat P waves
  • 35. 35.
    Which medication helps remove potassium in renal failure?
A) B. Lasix
B) C. Spironolactone
C) A. Kayexalate
D) D. Mannitol
  • 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) A. Cardiogenic
D) B. Hypovolemic
  • 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) D. Hypothermia
B) C. Bradycardia
C) A. Cold clammy skin
D) B. Bounding pulse
  • 39. 39.
    Which lab test confirms septic shock?
A) B. Increased sodium
B) A. Blood culture positive
C) D. Elevated calcium
D) C. Decreased BUN
  • 40. 40.
    The most reliable indicator of adequate tissue perfusion in shock is:
A) D. Capillary refill
B) C. Blood pressure
C) B. Urine output
D) A. Skin color
  • 41. 41.
    Which of the following meets SIRS criteria?
A) D. BP 120/80
B) B. Temp 36°C, HR 70
C) A. Temp 38.5°C, HR 100, WBC 15,000
D) C. RR 14, WBC 5,000
  • 42. 42.
    What is the primary trigger for SIRS?
A) A. Infection or tissue injury
B) D. Hypertension
C) B. Dehydration
D) C. Hypoglycemia
  • 43. 43.
    MODS is characterized by:
A) B. Single organ failure
B) C. Mild infection
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) A. Improvement
B) D. Stable condition
C) B. Multisystem involvement
D) C. Dehydration
  • 45. 45.
    Nursing priority in SIRS management is:
A) A. Early identification and treatment of infection
B) C. Oxygen removal
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) B. Limit IV fluids
C) C. Stop antibiotics
D) D. Withhold nutrition
  • 47. 47.
    Which assessment finding indicates progression from SIRS to MODS?
A) D. Mild fever
B) B. Decreasing LOC and urine output
C) A. Stable BP and urine output
D) C. Warm, dry skin
  • 48. 48.
    Which laboratory marker is typically elevated in SIRS/MODS?
A) D. Glucose
B) A. C-reactive protein (CRP)
C) B. Hematocrit
D) C. Sodium
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) B. Hyperthyroidism
B) C. Dehydration
C) D. Hypoglycemia
D) A. Disseminated intravascular coagulation (DIC)
  • 50. 50.
    What is the ultimate goal in managing SIRS and MODS?
A) D. Lower WBC count
B) A. Prevent sepsis and maintain organ perfusion
C) C. Decrease urine output
D) B. Restrict fluids
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