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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) Normal NG output
C) Bleeding has stopped
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) Upper GI bleeding is resolving
B) Rebleeding from ulcer site
C) New onset of lower GI bleed
D) Normal finding post-endoscopy
  • 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) Temperature 37°C
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) Give atropine
C) Stop infusion and notify physician
D) Continue infusion
  • 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) Administer diuretics
C) Elevate the head of the bed
D) Provide pain relief
  • 7. 7.
    What parameter best reflects intra-abdominal pressure?
A) Bladder pressure
B) Mean arterial 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 intrathoracic pressure
B) Increased venous return
C) Compression of inferior vena cava
D) Vasodilation
  • 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) Respiratory rate 18/min
B) Heart rate 90 bpm
C) Soft abdomen
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) Hypoglycemia
B) Hypocalcemia
C) Hepatic encephalopathy
D) Hypokalemia
  • 12. 12.
    Which lab result is consistent with liver failure?
A) Decreased bilirubin
B) Decreased ammonia
C) Increased albumin
D) Elevated ALT and AST
  • 13. 13.
    A patient with liver failure has ascites. Which intervention is most appropriate?
A) Restrict fluids
B) Position in high Fowler’s
C) Encourage deep breathing
D) Encourage high-sodium diet
  • 14. 14.
    After paracentesis, what is the most important nursing action?
A) Record urine output
B) Monitor blood pressure
C) Check bowel sounds
D) Document color of fluid
  • 15. 15.
    The nurse should withhold lactulose if the patient exhibits which symptom?
A) Mild abdominal pain
B) Two soft stools per day
C) Drowsiness
D) Severe diarrhea
  • 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) Vomiting
D) Grey-Turner’s sign
  • 17. 17.
    Which lab result supports the diagnosis of acute pancreatitis?
A) Low WBC count
B) Decreased lipase
C) Elevated amylase and lipase
D) Low bilirubin
  • 18. 18.
    What is the priority nursing intervention in acute pancreatitis?
A) Administer insulin
B) Encourage oral fluids
C) Provide low-fat diet
D) Maintain NPO status
  • 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) 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) Start insulin drip
C) Begin IV fluids
D) Prepare for dialysis
  • 22. 22.
    Which lab result confirms DKA?
A) Serum ketones positive
B) HCO₃ 24 mEq/L
C) pH 7.45
D) Blood glucose 180 mg/dL
  • 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) Dry mucous membranes
B) Fruity odor persists
C) Decreasing ketones and glucose
D) Increased urine output
  • 25. 25.
    The nurse should administer insulin infusion until:
A) D. IV fluids completed
B) C. pH returns to normal
C) B. Glucose < 200 mg/dL and patient can eat
D) A. Ketones disappear
  • 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) A. DKA
C) B. HHNK
D) D. SIADH
  • 27. 27.
    What is the primary cause of HHNK?
A) B. Insulin overdose
B) A. Infection or dehydration
C) C. Excess carbohydrate intake
D) D. Hypokalemia
  • 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) B. Level of glucose
B) D. All of the above
C) A. Presence of ketones
D) C. pH value
  • 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) A. Fluid volume deficit
C) C. Hypoglycemia
D) D. Acidosis
  • 31. 31.
    A patient with acute renal failure has urine output of 200 mL/24 hrs. What phase is this?
A) A. Diuretic
B) B. Oliguric
C) D. Initial
D) C. Recovery
  • 32. 32.
    Which lab finding indicates renal failure?
A) C. Low potassium
B) B. Increased BUN and creatinine
C) A. Decreased creatinine
D) D. High GFR
  • 33. 33.
    In chronic renal failure, which diet is most appropriate?
A) C. High sodium
B) B. Low potassium and phosphorus
C) A. High protein
D) D. High fluid intake
  • 34. 34.
    The nurse monitors which ECG change for hyperkalemia in renal failure?
A) C. U waves
B) B. Peaked T waves
C) A. ST depression
D) D. Flat P waves
  • 35. 35.
    Which medication helps remove potassium in renal failure?
A) A. Kayexalate
B) B. Lasix
C) D. Mannitol
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) A. Cardiogenic
B) B. Hypovolemic
C) C. Neurogenic
D) D. Anaphylactic
  • 37. 37.
    What is the first nursing action in hypovolemic shock?
A) A. Administer vasopressors
B) C. Give oxygen
C) D. Draw labs
D) B. Start IV fluids
  • 38. 38.
    In septic shock, which finding indicates early stage?
A) C. Bradycardia
B) D. Hypothermia
C) A. Cold clammy skin
D) B. Bounding pulse
  • 39. 39.
    Which lab test confirms septic shock?
A) A. Blood culture positive
B) B. Increased sodium
C) D. Elevated calcium
D) C. Decreased BUN
  • 40. 40.
    The most reliable indicator of adequate tissue perfusion in shock is:
A) A. Skin color
B) C. Blood pressure
C) B. Urine output
D) D. Capillary refill
  • 41. 41.
    Which of the following meets SIRS criteria?
A) C. RR 14, WBC 5,000
B) B. Temp 36°C, HR 70
C) A. Temp 38.5°C, HR 100, WBC 15,000
D) D. BP 120/80
  • 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) C. Mild infection
B) A. Dysfunction of two or more organ systems
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) B. Multisystem involvement
B) A. Improvement
C) C. Dehydration
D) D. Stable condition
  • 45. 45.
    Nursing priority in SIRS management is:
A) B. Fluid restriction
B) C. Oxygen removal
C) A. Early identification and treatment of infection
D) D. High-protein diet
  • 46. 46.
    In MODS, which intervention prevents further organ injury?
A) C. Stop antibiotics
B) A. Maintain oxygenation and perfusion
C) B. Limit IV fluids
D) D. Withhold nutrition
  • 47. 47.
    Which assessment finding indicates progression from SIRS to MODS?
A) A. Stable BP and urine output
B) B. Decreasing LOC and urine output
C) C. Warm, dry skin
D) D. Mild fever
  • 48. 48.
    Which laboratory marker is typically elevated in SIRS/MODS?
A) B. Hematocrit
B) A. C-reactive protein (CRP)
C) D. Glucose
D) C. Sodium
  • 49. 49.
    The nurse monitors for which complication in MODS?
A) D. Hypoglycemia
B) B. Hyperthyroidism
C) A. Disseminated intravascular coagulation (DIC)
D) C. Dehydration
  • 50. 50.
    What is the ultimate goal in managing SIRS and MODS?
A) B. Restrict fluids
B) C. Decrease urine output
C) A. Prevent sepsis and maintain organ perfusion
D) D. Lower WBC count
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