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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) Bleeding has stopped
C) Ongoing active bleeding
D) Normal NG output
  • 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) Upper GI bleeding is resolving
C) Rebleeding from ulcer site
D) New onset of lower GI bleed
  • 4. 4.
    A patient with GI bleeding is scheduled for blood transfusion. Which assessment finding requires immediate attention?
A) Crackles in lungs after transfusion
B) Pulse 88 bpm
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) Give atropine
B) Continue infusion
C) Stop infusion and notify physician
D) Decrease IV fluids
  • 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) Measure bladder pressure
C) Administer diuretics
D) Provide pain relief
  • 7. 7.
    What parameter best reflects intra-abdominal pressure?
A) Mean arterial pressure
B) Bladder pressure
C) Gastric residual volume
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) Increased intrathoracic pressure
C) Compression of inferior vena cava
D) Vasodilation
  • 9. 9.
    What is the initial management of mild intra-abdominal hypertension?
A) Optimize fluid balance and positioning
B) Start vasopressors
C) Immediate surgical decompression
D) insert chest tube
  • 10. 10.
    In abdominal compartment syndrome, which nursing assessment finding is most alarming?
A) Soft abdomen
B) Respiratory rate 18/min
C) Heart rate 90 bpm
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) Hepatic encephalopathy
C) Hypoglycemia
D) Hypocalcemia
  • 12. 12.
    Which lab result is consistent with liver failure?
A) Increased albumin
B) Decreased ammonia
C) Decreased bilirubin
D) Elevated ALT and AST
  • 13. 13.
    A patient with liver failure has ascites. Which intervention is most appropriate?
A) Encourage deep breathing
B) Position in high Fowler’s
C) Encourage high-sodium diet
D) Restrict fluids
  • 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) Two soft stools per day
B) Drowsiness
C) Severe diarrhea
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) Vomiting
C) Fever
D) Nausea
  • 17. 17.
    Which lab result supports the diagnosis of acute pancreatitis?
A) Low bilirubin
B) Low WBC count
C) Elevated amylase and lipase
D) Decreased 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) Hyperkalemia
B) Hypernatremia
C) Hypocalcemia
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) Begin IV fluids
B) Prepare for dialysis
C) Start insulin drip
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) Potassium
C) Calcium
D) Sodium
  • 24. 24.
    Which sign indicates effective management of DKA?
A) Decreasing ketones and glucose
B) Fruity odor persists
C) Increased urine output
D) Dry mucous membranes
  • 25. 25.
    The nurse should administer insulin infusion until:
A) B. Glucose < 200 mg/dL and patient can eat
B) A. Ketones disappear
C) D. IV fluids completed
D) C. pH returns to normal
  • 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) D. Hypokalemia
B) A. Infection or dehydration
C) B. Insulin overdose
D) C. Excess carbohydrate intake
  • 28. 28.
    Which intervention is most important in initial management of HHNK?
A) C. Start antibiotics
B) D. Provide potassium supplements
C) B. Rehydrate with IV fluids
D) A. Administer IV insulin bolus
  • 29. 29.
    What differentiates HHNK from DKA?
A) C. pH value
B) B. Level of glucose
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) D. Acidosis
B) A. Fluid volume deficit
C) C. Hypoglycemia
D) B. Fluid overload
  • 31. 31.
    A patient with acute renal failure has urine output of 200 mL/24 hrs. What phase is this?
A) A. Diuretic
B) C. Recovery
C) D. Initial
D) B. Oliguric
  • 32. 32.
    Which lab finding indicates renal failure?
A) A. Decreased creatinine
B) B. Increased BUN and creatinine
C) D. High GFR
D) C. Low potassium
  • 33. 33.
    In chronic renal failure, which diet is most appropriate?
A) A. High protein
B) D. High fluid intake
C) C. High sodium
D) B. Low potassium and phosphorus
  • 34. 34.
    The nurse monitors which ECG change for hyperkalemia in renal failure?
A) C. U waves
B) A. ST depression
C) B. Peaked T waves
D) D. Flat P waves
  • 35. 35.
    Which medication helps remove potassium in renal failure?
A) A. Kayexalate
B) D. Mannitol
C) C. Spironolactone
D) B. Lasix
  • 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) B. Hypovolemic
D) A. Cardiogenic
  • 37. 37.
    What is the first nursing action in hypovolemic shock?
A) A. Administer vasopressors
B) D. Draw labs
C) B. Start IV fluids
D) C. Give oxygen
  • 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) A. Skin color
D) B. Urine output
  • 41. 41.
    Which of the following meets SIRS criteria?
A) B. Temp 36°C, HR 70
B) A. Temp 38.5°C, HR 100, WBC 15,000
C) C. RR 14, WBC 5,000
D) D. BP 120/80
  • 42. 42.
    What is the primary trigger for SIRS?
A) D. Hypertension
B) C. Hypoglycemia
C) A. Infection or tissue injury
D) B. Dehydration
  • 43. 43.
    MODS is characterized by:
A) C. Mild infection
B) A. Dysfunction of two or more organ systems
C) D. Local inflammation only
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) C. Dehydration
D) D. Stable condition
  • 45. 45.
    Nursing priority in SIRS management is:
A) D. High-protein diet
B) C. Oxygen removal
C) B. Fluid restriction
D) A. Early identification and treatment of infection
  • 46. 46.
    In MODS, which intervention prevents further organ injury?
A) D. Withhold nutrition
B) A. Maintain oxygenation and perfusion
C) C. Stop antibiotics
D) B. Limit IV fluids
  • 47. 47.
    Which assessment finding indicates progression from SIRS to MODS?
A) C. Warm, dry skin
B) D. Mild fever
C) B. Decreasing LOC and urine output
D) A. Stable BP and urine output
  • 48. 48.
    Which laboratory marker is typically elevated in SIRS/MODS?
A) D. Glucose
B) C. Sodium
C) B. Hematocrit
D) A. C-reactive protein (CRP)
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) C. Dehydration
B) A. Disseminated intravascular coagulation (DIC)
C) B. Hyperthyroidism
D) D. Hypoglycemia
  • 50. 50.
    What is the ultimate goal in managing SIRS and MODS?
A) C. Decrease urine output
B) B. Restrict fluids
C) D. Lower WBC count
D) A. Prevent sepsis and maintain organ perfusion
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