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NCM 118 Semi Finals BSN-C
Contributed by: Forones
  • 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) Prepare for endoscopy
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) Bleeding from lower GI
B) Normal NG output
C) Ongoing active bleeding
D) Bleeding has stopped
  • 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) Rebleeding from ulcer site
D) Upper GI bleeding is resolving
  • 4. 4.
    A patient with GI bleeding is scheduled for blood transfusion. Which assessment finding requires immediate attention?
A) BP 110/70 mmHg
B) Crackles in lungs after transfusion
C) Pulse 88 bpm
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) Stop infusion and notify physician
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) Administer diuretics
C) Provide pain relief
D) Measure bladder pressure
  • 7. 7.
    What parameter best reflects intra-abdominal pressure?
A) Central venous pressure
B) Mean arterial pressure
C) Gastric residual volume
D) Bladder pressure
  • 8. 8.
    A patient with intra-abdominal hypertension has decreased cardiac output. What is the underlying cause?
A) Vasodilation
B) Compression of inferior vena cava
C) Increased intrathoracic pressure
D) Increased venous return
  • 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) Soft abdomen
B) Heart rate 90 bpm
C) Urine output 15 mL/hr
D) Respiratory rate 18/min
  • 11. 11.
    A patient with liver failure has confusion and flapping tremor (asterixis). What should the nurse suspect?
A) Hypokalemia
B) Hypocalcemia
C) Hepatic encephalopathy
D) Hypoglycemia
  • 12. 12.
    Which lab result is consistent with liver failure?
A) Elevated ALT and AST
B) Decreased bilirubin
C) Decreased ammonia
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 high-sodium diet
C) Restrict fluids
D) Encourage deep breathing
  • 14. 14.
    After paracentesis, what is the most important nursing action?
A) Check bowel sounds
B) Record urine output
C) Document color of fluid
D) Monitor blood pressure
  • 15. 15.
    The nurse should withhold lactulose if the patient exhibits which symptom?
A) Severe diarrhea
B) Two soft stools per day
C) Drowsiness
D) Mild abdominal pain
  • 16. 16.
    A patient with severe epigastric pain radiating to the back is diagnosed with acute pancreatitis. Which finding indicates a serious complication?
A) Grey-Turner’s sign
B) Fever
C) Vomiting
D) Nausea
  • 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) 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) Hypocalcemia
C) Hypomagnesemia
D) Hyperkalemia
  • 20. 20.
    Which position best relieves pain in acute pancreatitis?
A) Trendelenburg
B) Left side-lying with knees flexed
C) Prone
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) pH 7.45
B) Serum ketones positive
C) Blood glucose 180 mg/dL
D) HCO₃ 24 mEq/L
  • 23. 23.
    Which electrolyte must be monitored closely during insulin therapy in DKA?
A) Potassium
B) Calcium
C) Magnesium
D) Sodium
  • 24. 24.
    Which sign indicates effective management of DKA?
A) Fruity odor persists
B) Decreasing ketones and glucose
C) Increased urine output
D) Dry mucous membranes
  • 25. 25.
    The nurse should administer insulin infusion until:
A) C. pH returns to normal
B) D. IV fluids completed
C) A. Ketones disappear
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) D. SIADH
C) A. DKA
D) B. HHNK
  • 27. 27.
    What is the primary cause of HHNK?
A) B. Insulin overdose
B) D. Hypokalemia
C) C. Excess carbohydrate intake
D) A. Infection or dehydration
  • 28. 28.
    Which intervention is most important in initial management of HHNK?
A) A. Administer IV insulin bolus
B) B. Rehydrate with IV fluids
C) D. Provide potassium supplements
D) C. Start antibiotics
  • 29. 29.
    What differentiates HHNK from DKA?
A) B. Level of glucose
B) D. All of the above
C) C. pH value
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) B. Fluid overload
B) D. Acidosis
C) C. Hypoglycemia
D) A. Fluid volume deficit
  • 31. 31.
    A patient with acute renal failure has urine output of 200 mL/24 hrs. What phase is this?
A) C. Recovery
B) A. Diuretic
C) B. Oliguric
D) D. Initial
  • 32. 32.
    Which lab finding indicates renal failure?
A) D. High GFR
B) C. Low potassium
C) B. Increased BUN and creatinine
D) A. Decreased creatinine
  • 33. 33.
    In chronic renal failure, which diet is most appropriate?
A) A. High protein
B) B. Low potassium and phosphorus
C) D. High fluid intake
D) C. High sodium
  • 34. 34.
    The nurse monitors which ECG change for hyperkalemia in renal failure?
A) A. ST depression
B) B. Peaked T waves
C) D. Flat P waves
D) C. U waves
  • 35. 35.
    Which medication helps remove potassium in renal failure?
A) D. Mannitol
B) B. Lasix
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) B. Hypovolemic
B) D. Anaphylactic
C) A. Cardiogenic
D) C. Neurogenic
  • 37. 37.
    What is the first nursing action in hypovolemic shock?
A) A. Administer vasopressors
B) B. Start IV fluids
C) C. Give oxygen
D) D. Draw labs
  • 38. 38.
    In septic shock, which finding indicates early stage?
A) B. Bounding pulse
B) C. Bradycardia
C) A. Cold clammy skin
D) D. Hypothermia
  • 39. 39.
    Which lab test confirms septic shock?
A) B. Increased sodium
B) C. Decreased BUN
C) A. Blood culture positive
D) D. Elevated calcium
  • 40. 40.
    The most reliable indicator of adequate tissue perfusion in shock is:
A) C. Blood pressure
B) B. Urine output
C) A. Skin color
D) D. Capillary refill
  • 41. 41.
    Which of the following meets SIRS criteria?
A) A. Temp 38.5°C, HR 100, WBC 15,000
B) D. BP 120/80
C) B. Temp 36°C, HR 70
D) C. RR 14, WBC 5,000
  • 42. 42.
    What is the primary trigger for SIRS?
A) D. Hypertension
B) B. Dehydration
C) C. Hypoglycemia
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) B. Multisystem involvement
C) A. Improvement
D) D. Stable condition
  • 45. 45.
    Nursing priority in SIRS management is:
A) D. High-protein diet
B) A. Early identification and treatment of infection
C) C. Oxygen removal
D) B. Fluid restriction
  • 46. 46.
    In MODS, which intervention prevents further organ injury?
A) C. Stop antibiotics
B) D. Withhold nutrition
C) B. Limit IV fluids
D) A. Maintain oxygenation and perfusion
  • 47. 47.
    Which assessment finding indicates progression from SIRS to MODS?
A) C. Warm, dry skin
B) A. Stable BP and urine output
C) B. Decreasing LOC and urine output
D) D. Mild fever
  • 48. 48.
    Which laboratory marker is typically elevated in SIRS/MODS?
A) C. Sodium
B) A. C-reactive protein (CRP)
C) D. Glucose
D) B. Hematocrit
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) C. Dehydration
B) A. Disseminated intravascular coagulation (DIC)
C) D. Hypoglycemia
D) B. Hyperthyroidism
  • 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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