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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) Start IV fluid resuscitation
C) Prepare for endoscopy
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) 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) Pulse 88 bpm
C) Crackles in lungs after transfusion
D) BP 110/70 mmHg
  • 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) Measure bladder pressure
B) Provide pain relief
C) Administer diuretics
D) Elevate the head of the bed
  • 7. 7.
    What parameter best reflects intra-abdominal pressure?
A) Bladder pressure
B) Gastric residual volume
C) Mean arterial pressure
D) Central venous pressure
  • 8. 8.
    A patient with intra-abdominal hypertension has decreased cardiac output. What is the underlying cause?
A) Vasodilation
B) Increased intrathoracic pressure
C) Compression of inferior vena cava
D) Increased venous return
  • 9. 9.
    What is the initial management of mild intra-abdominal hypertension?
A) Immediate surgical decompression
B) Optimize fluid balance and positioning
C) insert chest tube
D) Start vasopressors
  • 10. 10.
    In abdominal compartment syndrome, which nursing assessment finding is most alarming?
A) Heart rate 90 bpm
B) Soft abdomen
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) Hypoglycemia
C) Hepatic encephalopathy
D) Hypocalcemia
  • 12. 12.
    Which lab result is consistent with liver failure?
A) Increased albumin
B) Decreased bilirubin
C) Decreased ammonia
D) Elevated ALT and AST
  • 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) Check bowel sounds
C) Document color of fluid
D) Record urine output
  • 15. 15.
    The nurse should withhold lactulose if the patient exhibits which symptom?
A) Severe diarrhea
B) Two soft stools per day
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) Nausea
B) Fever
C) Grey-Turner’s sign
D) Vomiting
  • 17. 17.
    Which lab result supports the diagnosis of acute pancreatitis?
A) Decreased lipase
B) Elevated amylase and lipase
C) Low WBC count
D) Low bilirubin
  • 18. 18.
    What is the priority nursing intervention in acute pancreatitis?
A) Encourage oral fluids
B) Maintain NPO status
C) Administer insulin
D) Provide low-fat diet
  • 19. 19.
    Which electrolyte imbalance is common in pancreatitis?
A) Hypernatremia
B) Hyperkalemia
C) Hypocalcemia
D) Hypomagnesemia
  • 20. 20.
    Which position best relieves pain in acute pancreatitis?
A) Left side-lying with knees flexed
B) Trendelenburg
C) Prone
D) Supine
  • 21. 21.
    A diabetic patient arrives with fruity odor breath and Kussmaul respirations. What is the priority action?
A) Administer bicarbonate
B) Prepare for dialysis
C) Begin IV fluids
D) Start insulin drip
  • 22. 22.
    Which lab result confirms DKA?
A) Blood glucose 180 mg/dL
B) HCO₃ 24 mEq/L
C) pH 7.45
D) Serum ketones positive
  • 23. 23.
    Which electrolyte must be monitored closely during insulin therapy in DKA?
A) Sodium
B) Potassium
C) Calcium
D) Magnesium
  • 24. 24.
    Which sign indicates effective management of DKA?
A) Fruity odor persists
B) Dry mucous membranes
C) Decreasing ketones and glucose
D) Increased urine output
  • 25. 25.
    The nurse should administer insulin infusion until:
A) A. Ketones disappear
B) C. pH returns to normal
C) D. IV fluids completed
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) A. DKA
B) D. SIADH
C) C. Hypoglycemia
D) B. HHNK
  • 27. 27.
    What is the primary cause of HHNK?
A) C. Excess carbohydrate intake
B) B. Insulin overdose
C) D. Hypokalemia
D) A. Infection or dehydration
  • 28. 28.
    Which intervention is most important in initial management of HHNK?
A) D. Provide potassium supplements
B) B. Rehydrate with IV fluids
C) C. Start antibiotics
D) A. Administer IV insulin bolus
  • 29. 29.
    What differentiates HHNK from DKA?
A) B. Level of glucose
B) C. pH value
C) A. Presence of ketones
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) C. Hypoglycemia
B) A. Fluid volume deficit
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) B. Oliguric
B) D. Initial
C) A. Diuretic
D) C. Recovery
  • 32. 32.
    Which lab finding indicates renal failure?
A) A. Decreased creatinine
B) C. Low potassium
C) D. High GFR
D) B. Increased BUN and creatinine
  • 33. 33.
    In chronic renal failure, which diet is most appropriate?
A) C. High sodium
B) D. High fluid intake
C) A. High protein
D) B. Low potassium and phosphorus
  • 34. 34.
    The nurse monitors which ECG change for hyperkalemia in renal failure?
A) A. ST depression
B) B. Peaked T waves
C) C. U waves
D) D. Flat P waves
  • 35. 35.
    Which medication helps remove potassium in renal failure?
A) D. Mannitol
B) A. Kayexalate
C) B. Lasix
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) C. Neurogenic
B) B. Hypovolemic
C) A. Cardiogenic
D) D. Anaphylactic
  • 37. 37.
    What is the first nursing action in hypovolemic shock?
A) B. Start IV fluids
B) D. Draw labs
C) C. Give oxygen
D) A. Administer vasopressors
  • 38. 38.
    In septic shock, which finding indicates early stage?
A) A. Cold clammy skin
B) B. Bounding pulse
C) D. Hypothermia
D) C. Bradycardia
  • 39. 39.
    Which lab test confirms septic shock?
A) B. Increased sodium
B) D. Elevated calcium
C) C. Decreased BUN
D) A. Blood culture positive
  • 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) C. RR 14, WBC 5,000
B) D. BP 120/80
C) A. Temp 38.5°C, HR 100, WBC 15,000
D) B. Temp 36°C, HR 70
  • 42. 42.
    What is the primary trigger for SIRS?
A) C. Hypoglycemia
B) D. Hypertension
C) A. Infection or tissue injury
D) B. Dehydration
  • 43. 43.
    MODS is characterized by:
A) D. Local inflammation only
B) A. Dysfunction of two or more organ systems
C) C. Mild infection
D) B. Single organ failure
  • 44. 44.
    A patient with MODS develops jaundice, oliguria, and confusion. What does this indicate?
A) A. Improvement
B) B. Multisystem involvement
C) D. Stable condition
D) C. Dehydration
  • 45. 45.
    Nursing priority in SIRS management is:
A) B. Fluid restriction
B) A. Early identification and treatment of infection
C) C. Oxygen removal
D) D. High-protein diet
  • 46. 46.
    In MODS, which intervention prevents further organ injury?
A) D. Withhold nutrition
B) C. Stop antibiotics
C) B. Limit IV fluids
D) A. Maintain oxygenation and perfusion
  • 47. 47.
    Which assessment finding indicates progression from SIRS to MODS?
A) A. Stable BP and urine output
B) C. Warm, dry skin
C) D. Mild fever
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) D. Glucose
C) B. Hematocrit
D) C. Sodium
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) A. Disseminated intravascular coagulation (DIC)
B) C. Dehydration
C) D. Hypoglycemia
D) B. Hyperthyroidism
  • 50. 50.
    What is the ultimate goal in managing SIRS and MODS?
A) C. Decrease urine output
B) D. Lower WBC count
C) A. Prevent sepsis and maintain organ perfusion
D) B. Restrict fluids
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