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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) Administer proton pump inhibitor
B) Insert a nasogastric tube
C) Prepare for endoscopy
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) Ongoing active bleeding
B) Bleeding has stopped
C) Normal NG output
D) Bleeding from lower GI
  • 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) Rebleeding from ulcer site
C) Upper GI bleeding is resolving
D) Normal finding post-endoscopy
  • 4. 4.
    A patient with GI bleeding is scheduled for blood transfusion. Which assessment finding requires immediate attention?
A) Temperature 37°C
B) Crackles in lungs after transfusion
C) BP 110/70 mmHg
D) Pulse 88 bpm
  • 5. 5.
    During octreotide infusion for variceal bleeding, the nurse observes bradycardia. What is the best nursing action?
A) Continue infusion
B) Stop infusion and notify physician
C) Decrease IV fluids
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) Elevate the head of the bed
D) Administer diuretics
  • 7. 7.
    What parameter best reflects intra-abdominal pressure?
A) Gastric residual volume
B) Mean arterial pressure
C) Central venous pressure
D) Bladder pressure
  • 8. 8.
    A patient with intra-abdominal hypertension has decreased cardiac output. What is the underlying cause?
A) Increased venous return
B) Compression of inferior vena cava
C) Vasodilation
D) Increased intrathoracic pressure
  • 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) Urine output 15 mL/hr
B) Respiratory rate 18/min
C) Soft abdomen
D) Heart rate 90 bpm
  • 11. 11.
    A patient with liver failure has confusion and flapping tremor (asterixis). What should the nurse suspect?
A) Hepatic encephalopathy
B) Hypocalcemia
C) Hypokalemia
D) Hypoglycemia
  • 12. 12.
    Which lab result is consistent with liver failure?
A) Elevated ALT and AST
B) Decreased ammonia
C) Increased albumin
D) Decreased bilirubin
  • 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) Encourage high-sodium diet
D) Restrict fluids
  • 14. 14.
    After paracentesis, what is the most important nursing action?
A) Monitor blood pressure
B) Record urine output
C) Check bowel sounds
D) Document color of fluid
  • 15. 15.
    The nurse should withhold lactulose if the patient exhibits which symptom?
A) Two soft stools per day
B) Severe diarrhea
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) Nausea
C) Vomiting
D) Fever
  • 17. 17.
    Which lab result supports the diagnosis of acute pancreatitis?
A) Elevated amylase and lipase
B) Low WBC count
C) Low bilirubin
D) Decreased lipase
  • 18. 18.
    What is the priority nursing intervention in acute pancreatitis?
A) Encourage oral fluids
B) Administer insulin
C) Maintain NPO status
D) Provide low-fat diet
  • 19. 19.
    Which electrolyte imbalance is common in pancreatitis?
A) Hypernatremia
B) Hypocalcemia
C) Hyperkalemia
D) Hypomagnesemia
  • 20. 20.
    Which position best relieves pain in acute pancreatitis?
A) Supine
B) Left side-lying with knees flexed
C) Prone
D) Trendelenburg
  • 21. 21.
    A diabetic patient arrives with fruity odor breath and Kussmaul respirations. What is the priority action?
A) Prepare for dialysis
B) Begin IV fluids
C) Start insulin drip
D) Administer bicarbonate
  • 22. 22.
    Which lab result confirms DKA?
A) Blood glucose 180 mg/dL
B) HCO₃ 24 mEq/L
C) Serum ketones positive
D) pH 7.45
  • 23. 23.
    Which electrolyte must be monitored closely during insulin therapy in DKA?
A) Potassium
B) Magnesium
C) Sodium
D) Calcium
  • 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) C. pH returns to normal
B) B. Glucose < 200 mg/dL and patient can eat
C) A. Ketones disappear
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) C. Hypoglycemia
B) D. SIADH
C) A. DKA
D) B. HHNK
  • 27. 27.
    What is the primary cause of HHNK?
A) D. Hypokalemia
B) B. Insulin overdose
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) D. Provide potassium supplements
C) B. Rehydrate with IV fluids
D) C. Start antibiotics
  • 29. 29.
    What differentiates HHNK from DKA?
A) C. pH value
B) D. All of the above
C) A. Presence of ketones
D) B. Level of glucose
  • 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) B. Fluid overload
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) C. Recovery
C) D. Initial
D) A. Diuretic
  • 32. 32.
    Which lab finding indicates renal failure?
A) D. High GFR
B) A. Decreased creatinine
C) B. Increased BUN and creatinine
D) C. Low potassium
  • 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) C. U waves
D) B. Peaked T 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) A. Cardiogenic
B) B. Hypovolemic
C) C. Neurogenic
D) D. Anaphylactic
  • 37. 37.
    What is the first nursing action in hypovolemic shock?
A) B. Start IV fluids
B) A. Administer vasopressors
C) C. Give oxygen
D) D. Draw labs
  • 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) B. Urine output
B) A. Skin color
C) C. Blood pressure
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) B. Temp 36°C, HR 70
C) C. RR 14, WBC 5,000
D) D. BP 120/80
  • 42. 42.
    What is the primary trigger for SIRS?
A) C. Hypoglycemia
B) D. Hypertension
C) B. Dehydration
D) A. Infection or tissue injury
  • 43. 43.
    MODS is characterized by:
A) C. Mild infection
B) D. Local inflammation only
C) A. Dysfunction of two or more organ systems
D) B. Single organ failure
  • 44. 44.
    A patient with MODS develops jaundice, oliguria, and confusion. What does this indicate?
A) D. Stable condition
B) A. Improvement
C) C. Dehydration
D) B. Multisystem involvement
  • 45. 45.
    Nursing priority in SIRS management is:
A) A. Early identification and treatment of infection
B) D. High-protein diet
C) C. Oxygen removal
D) B. Fluid restriction
  • 46. 46.
    In MODS, which intervention prevents further organ injury?
A) C. Stop antibiotics
B) A. Maintain oxygenation and perfusion
C) D. Withhold nutrition
D) B. Limit IV fluids
  • 47. 47.
    Which assessment finding indicates progression from SIRS to MODS?
A) D. Mild fever
B) A. Stable BP and urine output
C) B. Decreasing LOC and urine output
D) C. Warm, dry skin
  • 48. 48.
    Which laboratory marker is typically elevated in SIRS/MODS?
A) D. Glucose
B) B. Hematocrit
C) A. C-reactive protein (CRP)
D) C. Sodium
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) C. Dehydration
B) D. Hypoglycemia
C) B. Hyperthyroidism
D) A. Disseminated intravascular coagulation (DIC)
  • 50. 50.
    What is the ultimate goal in managing SIRS and MODS?
A) D. Lower WBC count
B) C. Decrease urine output
C) A. Prevent sepsis and maintain organ perfusion
D) B. Restrict fluids
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