MCQ SEREIS MSN-04.pdf FOR ALL NURSING STUDENTS

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1. YOGITA VERMA MSC(N)
MEDICAL–SURGICAL NURSING — Q601–Q800
! Q601. The earliest sign of hypovolemic shock is:
A. Hypotension
B. Bradycardia
C. Tachycardia ✅
D. Oliguria
Explanation: Heart rate increases first to maintain cardiac output when volume
falls.
! Q602. Best initial nursing action for external hemorrhage is:
A. Elevate limb only
B. Direct pressure to wound ✅
C. Ice application only
D. Apply tourniquet as first step
Explanation: Direct pressure controls bleeding immediately; tourniquet is last-
resort for life-threatening limb hemorrhage.
! Q603. In shock, skin is typically:
A. Warm and dry
B. Flushed
C. Cool, clammy, and pale ✅
D. Jaundiced
Explanation: Peripheral vasoconstriction redirects blood centrally, causing
cool, pale, clammy skin.

! Q604. Priority after giving IV potassium is:
A. Immediate ambulation
B. Oral intake
C. Monitor cardiac rhythm and urine output ✅
D. Check liver enzymes
Explanation: K⁺ can cause arrhythmias; monitor ECG and renal output to
assess elimination.

2. ! Q605. Best measure to prevent medication errors is:
A. Guess dose if label unclear
B. Rely on memory only
C. Use the five rights (right patient/drug/dose/time/route) ✅
D. Skip double-checks for routine meds
Explanation: The five rights are fundamental safeguards against administration
errors.

! Q606. In a patient with COPD, oxygen therapy target SpO₂ is:
A. 100%
B. 98–100%
C. 88–92% ✅
D. <80%
Explanation: Conservative oxygen (88–92%) avoids CO₂ retention in chronic
CO₂ retainers.

! Q607. For acute myocardial infarction, MONA stands for:
A. Morphine, Oxygen, Nitroglycerin, Aspirin ✅
B. Magnesium, Ointment, Nitrate, Amiodarone
C. Monitor, Observe, NPO, Analgesic
D. None of the above
Explanation: MONA are immediate therapies: morphine, oxygen,
nitroglycerin, aspirin.

! Q608. First-line drug for ventricular tachycardia with pulse (stable) is:
A. Amiodarone or lidocaine per protocol ✅
B. IV insulin
C. Heparin
D. Oral beta blocker only
Explanation: Antiarrhythmics like amiodarone are used for stable VT;
instability requires cardioversion.

3. ! Q609. When a chest tube has continuous large bubbling in water-seal
chamber, this indicates:
A. No air leak
B. Tube obstruction
C. Persistent air leak (bronchopleural fistula or leak) ✅
D. Suction malfunction only
Explanation: Continuous bubbling in the water-seal chamber signals ongoing
air entry into pleural space.

! Q610. Sternal precautions after median sternotomy include avoiding:
A. Deep breathing exercises
B. Pushing/pulling heavy objects and using arms to lift ✅
C. Walking
D. Incentive spirometry
Explanation: Avoid activities that stress the sternum to prevent dehiscence;
breathing exercises are encouraged.

! Q611. The most common cause of postoperative fever in first 48 hours
is:
A. Wound infection
B. Pulmonary embolism
C. Inflammatory response/atelectasis or early postop inflammatory
reaction ✅
D. UTI
Explanation: Early fevers are often noninfectious; infection becomes more
likely after 48–72 hours.

! Q612. Best positioning for a patient with air embolism suspicion is:
A. Supine flat
B. Trendelenburg with left lateral decubitus (Durant’s maneuver) ✅
C. Sitting upright
D. Prone
Explanation: Left lateral Trendelenburg traps air in right atrium/ventricle to
reduce pulmonary outflow obstruction.

4. ! Q613. For a patient on heparin, priority lab to monitor is:
A. INR
B. aPTT (or anti-Xa) ✅
C. Platelet count only
D. Troponin
Explanation: aPTT (or anti-Xa) assesses unfractionated heparin anticoagulant
effect; monitor platelets for HIT.

! Q614. Early signs of compartment syndrome include:
A. Fever only
B. Loss of distal pulse only
C. Pain out of proportion and pain with passive stretch ✅
D. Improved mobility
Explanation: Severe, disproportionate pain and pain on passive stretch are
earliest indicators—urgent fasciotomy required.

! Q615. Best nursing action for suspected DVT is:
A. Massage the limb vigorously
B. Avoid massaging, elevate limb, notify provider, prepare for Doppler
ultrasound ✅
C. Apply heat and massage
D. Ambulate immediately without evaluation
Explanation: Massaging risks embolization; immobilize and evaluate.

! Q616. For blood transfusion reaction (fever/chills), immediate step is:
A. Finish transfusion quickly
B. Stop transfusion, keep IV patent with normal saline, notify blood bank
and provider ✅
C. Increase transfusion rate
D. Document and continue
Explanation: Stop transfusion to prevent further reaction; maintain IV and
follow transfusion reaction protocol.

5. ! Q617. Regarding pain assessment, best tool in nonverbal adult is:
A. Numeric scale only
B. Behavioral pain scales (e.g., PAINAD) ✅
C. Family report only
D. Ignore pain if patient nonverbal
Explanation: Observational scales capture pain behaviors in patients unable to
self-report.

! Q618. Most important nursing intervention to prevent pressure ulcers
is:
A. Apply ointment only
B. Reposition patient frequently and use pressure-relieving surfaces ✅
C. Keep patient NPO
D. Limit fluids
Explanation: Regular repositioning and support surfaces reduce pressure
duration and ulcer risk.

! Q619. In diabetic foot care, the best prevention is:
A. Daily soaking of feet
B. Daily inspection, proper footwear, glycemic control ✅
C. Walking barefoot for toughening
D. Delay care until infection
Explanation: Routine inspection and protection prevent ulcers and
complications.

! Q620. For a patient with hyperkalemia and peaked T waves, immediate
medication to stabilize myocardium is:
A. Insulin only
B. Kayexalate only
C. IV calcium gluconate ✅
D. Furosemide only
Explanation: Calcium stabilizes cardiac membranes rapidly; insulin+glucose
lowers serum K⁺ next.

6. ! Q621. Best nursing action for a patient receiving PCA analgesia who
b
A. Increase PCA dose
B. Stop PCA, stimulate patient, administer naloxone if opioid overdose
suspected, notify provider ✅
C. Leave patient sleeping
D. Give more opioids
Explanation: Sedation and respiratory depression require immediate
intervention and reversal if opioid-related.

! Q622. The normal capillary refill time is:
A. >5 seconds
**B. 3–5 seconds
C. <2 seconds ✅
D. Not clinically useful
Explanation: Capillary refill under 2 seconds indicates adequate peripheral
perfusion in most adults.

! Q623. For a patient with acute pancreatitis, initial nursing priorities
include:
A. Early oral feeding
B. NPO, IV fluid resuscitation, pain control, and monitoring ✅
C. Immediate antibiotics always
D. Laxatives
Explanation: Supportive care with bowel rest and fluids is the cornerstone;
antibiotics only if infection.
! Q624. A patient with COPD develops sudden increased dyspnea and
pleuritic pain — immediate concern is:
A. Heart attack only
B. Pneumothorax ✅
C. Sinus infection only
D. Gastritis only
Explanation: COPD patients are at risk for spontaneous pneumothorax
presenting with abrupt dyspnea and unilateral chest pain.
!

7. Q625. For a stroke patient with left-sided weakness, best nursing
intervention to prevent contractures is:
A. Immobilize limb entirely
B. Passive ROM, proper positioning, and splints as needed ✅
C. No movement to avoid pain
D. High-resistance exercise immediately
Explanation: Regular passive ROM and positioning prevent contractures and
maintain joint mobility.

! Q626. The best method to check NG tube placement at bedside is:
A. Auscultation only
B. Aspirate gastric contents and check pH; confirm with x-ray if in doubt
✅
C. Rely on insertion length only
D. Observe patient comfort only
Explanation: pH and aspirate checks are practical; chest x-ray is gold standard
when uncertainty exists.

! Q627. For GI bleed with melena and hypotension, priority nursing
actions include:
A. Oral fluids only
B. Secure IV access, fluid resuscitation, blood type & crossmatch, monitor
vitals ✅
C. Laxative administration
D. Hold oxygenate only
Explanation: Stabilize hemodynamics and prepare for endoscopic
evaluation/therapeutic intervention.

! Q628. In heart failure, the hallmark sign of fluid overload on chest x-ray
is:
A. Normal lungs
B. Pulmonary congestion and interstitial edema (Kerley B lines) ✅
C. Pneumothorax only
D. Pleural effusion never present
Explanation: Congestion and interstitial/alveolar fluid indicate pulmonary
edema in CHF.

8. ! Q629. For a patient on ACE inhibitor who develops cough, nurse should
suspect:
A. Pulmonary embolism only
B. ACE inhibitor–induced cough — notify provider for medication review
✅
C. MI only
D. Anxiety only
Explanation: Dry cough is a common side effect of ACE inhibitors due to
bradykinin accumulation.

! Q630. In an acute asthma exacerbation, the priority is:
A. Antibiotics only
B. Administer inhaled short-acting β₂-agonist and oxygen, assess response
✅
C. Immediate chest tube insertion
D. Blood transfusion
Explanation: Rapid bronchodilation and oxygenation relieve bronchospasm
and hypoxia.

! Q631. For patient with suspected sepsis, the nurse should obtain blood
cultures:
A. After antibiotics always
B. Before starting antibiotics if this does not delay therapy ✅
C. Only urine cultures required
D. Culture not necessary
Explanation: Cultures before antibiotics increase yield; do not delay life-saving
antibiotics if cultures cannot be obtained promptly.
! Q632. In acute renal colic, priority nursing care includes:
A. Encourage prolonged fasting
B. Pain control, hydration, monitor urine output, and strain urine for
stones ✅
C. Apply cold compress only
D. Immediate dialysis for all patients
Explanation: Manage pain and assess stone passage; urology consult if
obstruction persists.

9. ! Q633. For patients with penetrating eye injury, nurse should:
A. Remove foreign body immediately
B. Shield the eye, NPO, and prepare for emergent ophthalmology
evaluation ✅
C. Instill eye drops without assessment
D. Rub the eye vigorously
Explanation: Avoid pressure on globe and preserve ocular structures until
specialist care.

! Q634. Best nursing intervention to reduce surgical site infection risk is:
A. No pre-op preparation
B. Administer prophylactic antibiotics within recommended timeframe and
maintain sterile technique ✅
C. Delay antibiotics until fever develops
D. Shave surgical site immediately before incision with razor
Explanation: Timely prophylactic antibiotics and proper skin prep reduce SSI
risk; avoid razors.

! Q635. In acute GI obstruction, common manifestation is:
A. Excessive bowel movements
B. Abdominal distension, vomiting, absent bowel sounds or high-pitched
tinkling ✅
C. Increased appetite only
D. Frequent urination only
Explanation: Obstruction impedes passage causing distention and vomiting;
auscultation aids assessment.

! Q636. The hallmark of upper GI bleeding is:
A. Melena only
B. Hematemesis (vomiting blood) and possibly melena ✅
C. Bright red blood per rectum only
D. No visible blood
Explanation: Hematemesis points to upper GI source; melena suggests slower
bleeding.

10. ! Q637. For postoperative ileus, nursing care includes:
A. Immediate oral feeding of solids
B. NPO, IV fluids, nasogastric decompression if vomiting, mobilization
when appropriate ✅
C. Aggressive laxatives immediately
D. Ignore bowel sounds
Explanation: Supportive care and gradual reintroduction of diet as bowel
function returns.

! Q638. For hypertensive emergency with pulmonary edema, the
preferred acute therapy is:
A. Oral antihypertensive only
B. IV nitroglycerin/nitroprusside and diuretics as indicated, oxygen ✅
C. No BP treatment needed
D. Immediate dialysis in all cases
Explanation: Rapid lowering of preload/afterload and diuresis relieve
pulmonary congestion.

! Q639. In acute pancreatitis, one should avoid giving:
A. IV fluids and analgesia
B. Early aggressive enteral feeding when tolerated (not prolonged NPO) —
but avoid fatty meals ✅
C. Antibiotics routinely unless infection suspected
D. ERCP only when indicated
Explanation: Early enteral nutrition is preferred over prolonged bowel rest;
avoid empiric antibiotics.
! Q640. For patients with malignant hyperthermia risk, anesthesia team
should avoid:
A. Local anesthetics only
B. Triggering agents like succinylcholine and volatile anesthetics; have
dantrolene available ✅
C. Regional anesthesia always
D. Non-depolarizing muscle relaxants only
Explanation: Certain agents trigger malignant hyperthermia in susceptible
individuals—dantrolene is antidote.

11. ! Q641. Priority nursing care for acute gout attack is:
A. Encourage high purine diet
B. Pain control (NSAIDs/colchicine), joint rest, apply ice ✅
C. Immediate joint aspiration always
D. Start urate-lowering therapy during acute attack
Explanation: Treat acute inflammation and pain; urate-lowering therapy is
usually started or optimized after the attack.

! Q642. For patient with suspected adrenal insufficiency in crisis,
immediate therapy is:
A. Oral steroids only
B. IV hydrocortisone and aggressive fluid resuscitation ✅
C. High-dose insulin only
D. Observe without treatment
Explanation: Replace corticosteroids promptly to correct hypotension and
metabolic disturbances.

! Q643. In acute cholecystitis, Murphy’s sign is:
A. Right lower quadrant tenderness on cough
B. Inspiratory arrest with RUQ palpation (positive) ✅
C. Pain on passive knee flexion
D. Ecchymosis around umbilicus
Explanation: Inspiratory pause during deep palpation under RUQ indicates
gallbladder inflammation.

! Q644. For a patient with suspected acute PE who is hemodynamically
unstable, immediate therapy may include:
A. Oral anticoagulant only
B. Thrombolysis or embolectomy if no contraindications ✅
C. Broad-spectrum antibiotics only
D. No treatment until imaging confirms PE
Explanation: Massive PE with hypotension requires reperfusion therapy
without delay if indicated.

12. ! Q645. In patients with acute liver failure, nursing priorities include:
A. Encourage alcohol intake
B. Monitor for encephalopathy, bleeding, hypoglycemia; maintain
hemodynamics and consult hepatology ✅
C. Increase protein intake aggressively
D. Delay all labs
Explanation: Supportive care and early transplant consideration are vital;
monitor metabolic and neurologic status.

! Q646. For postoperative urinary retention, initial nursing step is:
A. Immediate long-term catheterization only
B. Encourage voiding, bladder scan; if retention confirmed, intermittent
catheterization per protocol ✅
C. Ignore and observe for 3 days
D. Encourage diuretics only
Explanation: Conservative measures first; catheterize if necessary to prevent
bladder damage.

! Q647. The earliest sign of wound dehiscence is often:
A. High fever only
B. Serosanguinous drainage and increased wound tension or a popping
sensation ✅
C. Normal wound healing only
D. Sudden tissue necrosis always
Explanation: Increased drainage and a giving-way sensation may precede full
dehiscence—notify surgeon.
! Q648. For a patient with acute bacterial meningitis started on
antibiotics, an important nursing action is:
A. Delay antibiotics until LP done no matter what
B. Ensure cultures obtained and start empiric antibiotics promptly;
monitor neuro status and ICP signs ✅
C. Stop antibiotics immediately
D. Only treat with antivirals always
Explanation: Early empiric antibiotics after blood cultures improve outcomes;
monitor for complications.

13. ! Q649. In patients with hyperthyroidism, rapid treatment of thyroid
storm includes:
A. Beta-blocker, antithyroid drugs, iodine, and supportive measures ✅
B. Insulin only
C. Immediate thyroidectomy without stabilization
D. Only fluids without meds
Explanation: Multi-pronged therapy addresses hormone synthesis, peripheral
effects, and complications.
! Q650. For suspected bone fracture with deformity, the nurse should
first:
A. Attempt to realign forcefully
B. Immobilize as found, control bleeding, and prepare for x-ray and
reduction by clinician ✅
C. Apply heat and massage
D. Remove protruding bone if present
Explanation: Immobilize to prevent further injury; realignment and definitive
care by trained providers.

! Q651. Best nursing action for patient with hypothermia is:
A. Warm slowly with blankets and warm IV fluids; monitor cardiac rhythm for
arrhythmias ✅
B. Rapid heating in hot tub
C. No rewarming needed
D. Give cold fluids
Explanation: Controlled rewarming and monitoring prevent arrhythmias and
afterdrop phenomenon.

! Q652. For patient with suspected acute coronary syndrome,
nitroglycerin is contraindicated when:
A. Blood pressure is stable
B. Patient has taken phosphodiesterase inhibitor (e.g., sildenafil) within 24–
48 hrs ✅
C. Patient has chest pain only
D. Oxygen is available
Explanation: Combined nitrates and PDE5 inhibitors cause severe
hypotension.

14. ! Q653. In patients with COPD, incentive spirometry goal is primarily to:
A. Decrease sputum only
B. Promote deep breaths to prevent atelectasis and improve lung expansion
✅
C. Reduce heart rate only
D. Increase blood sugar only
Explanation: Encourages sustained maximal inspiration to open alveoli and
prevent pulmonary complications.
! Q654. When caring for a patient on droplet precautions (e.g., influenza),
nurse should wear:
A. N95 respirator only
B. Surgical mask within 1–2 meters of patient, plus standard precautions
✅
C. No mask needed
D. Full hazmat suit
Explanation: Droplet precautions require a surgical mask for close contact;
airborne pathogens require N95.

! Q655. For acute coronary syndrome, aspirin should be given:
A. Only after cath lab
B. Immediately (chewable 160–325 mg) unless contraindicated ✅
C. Never in ACS
D. Only IV antibiotics after aspirin
Explanation: Aspirin reduces platelet aggregation and improves outcomes—
give promptly.

! Q656. Common early sign of lithium toxicity is:
A. Bradycardia only
B. Gastrointestinal upset (nausea, vomiting) and tremor ✅
C. Jaundice only
D. Hypertension only
Explanation: GI symptoms and neurologic signs are early indicators; check
lithium level and renal function.

15. ! Q657. For patient with increased intracranial pressure, nurse should:
A. Keep head flat
B. Elevate head to 30°, avoid neck flexion, maintain normocapnia ✅
C. Hyperventilate continuously always
D. Give large volumes of hypotonic fluids
Explanation: Elevation and avoiding Valsalva reduce ICP; hyperventilation
only temporizing.

! Q658. Early signs of respiratory distress in infants include:
A. Quiet sleep
B. Nasal flaring, grunting, retractions, tachypnea ✅
C. Increased feeding only
D. Decreased crying only
Explanation: Recognize work of breathing signs early for prompt intervention.

! Q659. For patient with systemic inflammatory response, SIRS criteria
include:
A. Only elevated BP
B. Abnormal temperature, tachycardia, tachypnea, and abnormal WBC
count ✅
C. Only rash
D. Only cough
Explanation: SIRS identifies systemic inflammation; infection plus SIRS
suggests sepsis.

! Q660. In acute gout, serum uric acid may be normal during an attack;
nursing implication is:
A. Normal uric acid rules out gout
B. Treat clinically; order uric acid when attack subsides if needed ✅
C. Immediate uric acid lowering is always first step
D. Only diet changes matter
Explanation: Diagnosis often clinical; lab values can be misleading during
acute inflammation.

16. ! Q661. For patient with suspected acute abdomen and peritoneal signs,
b
A. Start oral fluids immediately
B. Keep NPO, IV access, analgesia, and urgent surgical evaluation ✅
C. Encourage walking and exercise
D. Apply warm compresses over abdomen
Explanation: NPO and resuscitation prepare patient for possible operative
management.

! Q662. In patients with anemia and chest pain, transfusion decisions
depend on:
A. Hemoglobin only
B. Clinical status, signs of ischemia, and Hgb — not Hgb alone ✅
C. Platelet count only
D. Electrolyte levels only
Explanation: Consider symptoms and comorbidities when deciding transfusion
thresholds.

! Q663. For postoperative patient, signs of pulmonary embolism include:
A. Gradual improvement in breathing
B. Sudden dyspnea, pleuritic chest pain, tachycardia, hypoxia ✅
C. Increased appetite only
D. Constipation only
Explanation: Sudden onset respiratory symptoms post-op raise suspicion for
PE—act promptly.

! Q664. The nurse recognizes neurogenic shock by presence of:
A. Hypertension and tachycardia
B. Hypotension with bradycardia and warm, dry skin ✅
C. Fever and chills only
D. Severe pain only
Explanation: Loss of sympathetic tone causes hypotension and relative
bradycardia in neurogenic shock.

17. ! Q665. In acute stroke care, nurse must monitor for hemorrhagic
conversion if:
A. Thrombolysis was given or large infarct present ✅
B. Never monitor for hemorrhage
C. Patient has only minor symptoms
D. Only after 6 months
Explanation: Hemorrhagic transformation is a risk—neurologic decline and BP
control are important to monitor.

! Q666. A patient receiving TPN is at risk for which complication that
nurse monitors closely:
A. Hypoglycemia only
B. Catheter-related infections and hyperglycemia ✅
C. Immediate renal failure always
D. Only peripheral nerve palsy
Explanation: TPN requires aseptic handling and glucose monitoring to prevent
infection and metabolic derangements.

! Q667. For a patient with COPD who is sleepy and hypercapnic, nurse
should:
A. Increase oxygen to 100% immediately
B. Titrate oxygen carefully, monitor CO₂ and consider noninvasive
ventilation if indicated ✅
C. Discontinue oxygen entirely always
D. Ignore respiratory status
Explanation: Excess O₂ can worsen hypercapnia; monitor and use NIV for
ventilatory support if needed.

! Q668. In pancreatitis, Cullen’s sign (periumbilical ecchymosis)
indicates:
A. Mild disease only
B. Retroperitoneal hemorrhage and severe disease ✅
C. Superficial skin infection only
D. Viral rash only
Explanation: External signs of hemorrhage suggest more severe or necrotizing
pancreatitis.

18. ! Q669. For patient with suspected intra-abdominal sepsis, priority
nursing action is:
A. Wait 48 hours before antibiotics
B. Obtain cultures and start broad-spectrum IV antibiotics promptly ✅
C. Only give oral analgesia
D. Only perform physical therapy
Explanation: Early antimicrobials reduce mortality in sepsis from abdominal
sources.

! Q670. In heart failure, daily weight gain of >2 kg in 48 hours suggests:
A. Normal variation only
B. Fluid retention and need to notify provider for diuretic adjustment ✅
C. Immediate dialysis always
D. Low risk only
Explanation: Rapid weight gain signals fluid accumulation and worsening
heart failure.

! Q671. For patient with mechanical heart valve, important education
includes:
A. No anticoagulation necessary
B. Lifelong anticoagulation with INR monitoring and bleeding precautions
✅
C. Avoid dental care always
D. Eat high-vitamin K diet only
Explanation: M
type; teach monitoring and interactions.

! Q672. In a patient with pericardial tamponade, classic triad includes:
A. Fever, cough, rash
B. Hypotension, muffled heart sounds, jugular venous distension (Beck’s
triad) ✅
C. Hypertension only
D. Bradycardia only
Explanation: Tamponade causes impaired cardiac filling, producing Beck's
triad.

19. ! Q673. For seizure precautions in hospital, nurse should ensure:
A. Restrict all movement permanently
B. Pad side rails, keep suction and oxygen at bedside, do not restrain
during seizure ✅
C. Insert tongue blade during seizure
D. Hold patient’s limbs forcefully
Explanation: Safety measures protect from injury; avoid oral insertion and
restraint.

! Q674. In diabetic ketoacidosis, potassium levels may be normal or high
despite total body depletion; nurse should:
A. Ignore potassium levels
B. Anticipate need for K⁺ replacement once insulin is given and urine
output established ✅
C. Immediately give large K⁺ bolus before monitoring
D. Stop insulin therapy
Explanation: Insulin drives K⁺ into cells—replace K⁺ to prevent hypokalemia
during treatment.

! Q675. For a patient with suspected bacterial peritonitis (e.g., cirrhosis),
initial nursing action includes:
A. Start home remedies only
B. Paracentesis for diagnostic tap, send ascitic fluid for analysis, start
antibiotics if indicated ✅
C. Avoid any lab testing
D. Only give analgesics always
Explanation: Diagnostic paracentesis guides therapy and should be performed
promptly.

! Q676. The most common cause of acute kidney injury (AKI) in
hospitalized patients is:
A. Chronic glomerulonephritis only
B. Prerenal azotemia due to hypovolemia or decreased perfusion ✅
C. Inherited disorders only
D. Always urinary obstruction

20. Explanation: Volume depletion and low perfusion are common reversible AKI
causes in hospitals.

! Q677. For patient with tension pneumothorax, immediate nursing action
is:
A. Obtain CT scan first
B. Needle decompression followed by chest tube insertion ✅
C. Observe and wait
D. Administer oral antibiotics only
Explanation: Tension pneumothorax is life-threatening and requires emergency
decompression.

! Q678. A sign of hepatic encephalopathy to monitor is:
A. Bradycardia only
B. Asterixis (flapping tremor) and altered mental status ✅
C. Increased appetite only
D. Improved coordination only
Explanation: Asterixis and cognitive changes indicate worsening
encephalopathy—treat precipitating causes.
! Q679. For an immunocompromised patient, best infection control
measure is:
A. No precautions needed
B. Strict hand hygiene, protective isolation as required, and prompt
evaluation of fever ✅
C. Only masks for staff always
D. Immediate discharge of patient
Explanation: Hand hygiene and early detection of infection are primary
protective measures
! Q680. In peripheral arterial disease, nurse should advise patient to:
A. Smoke to reduce stress
B. Quit smoking, exercise, and avoid crossing legs; inspect feet daily ✅
C. Avoid walking for exercise
D. Use tight footwear always
Explanation: Smoking cessation and exercise improve symptoms; foot care
prevents ulcers.

21. ! Q681. For a patient on corticosteroids long-term, nursing education
should include:
A. Abruptly stopping steroids at home if feeling better
B. Tapering per provider, infection risk precautions, bone health measures
✅
C. Avoid all vaccines always
D. Only increase sodium intake
Explanation: Tapering prevents adrenal insufficiency; monitor for side effects
and preventive measures.

! Q682. For a patient with metabolic acidosis due to diabetic ketoacidosis,
initial ABG typically shows:
A. High pH and high HCO₃⁻
B. Low pH, low HCO₃⁻, low PaCO₂ (compensatory hyperventilation) ✅
C. Normal pH and high HCO₃⁻
D. Only respiratory alkalosis
Explanation: Primary metabolic acidosis with respiratory compensation
(Kussmaul respirations).

! Q683. The best nursing intervention to prevent aspiration in at-risk
patients is:
A. Feed quickly in supine position
B. Elevate head of bed during and after feeding, assess swallow, consider
NPO if unsafe ✅
C. Give thin liquids only always
D. No special measures needed
Explanation: Positioning and swallow assessment reduce aspiration risk;
enteral access if needed.







! Q684. For patient with sudden onset chest pain and ST-elevation on
ECG, immediate nursing action is:

22. A. Wait for morning rounds
B. Activate STEMI protocol (notify cath lab/PCI team) and give aspirin ✅
C. Only give antibiotics
D. Send home with oral analgesic
Explanation: Rapid reperfusion (PCI) is time-sensitive—activate protocol
immediately.

! Q685. In postoperative pneumonia prevention, the nurse should focus
on:
A. Bed rest only
B. Early ambulation, incentive spirometry, oral care, and head-of-b
elevation ✅
C. Excessive sedation always
D. Withholding fluids always
Explanation: Pulmonary hygiene and mobilization reduce pneumonia risk.

! Q686. For wound irrigation after contaminated injury, best solution is:
A. Tap water only always
B. Normal saline for gentle irrigation; high-pressure for gross
contamination per protocol ✅
C. Hydrogen peroxide routinely
D. Alcohol for deep wounds
Explanation: Saline cleans wounds without cytotoxic effects; antiseptics used
selectively.

! Q687. When monitoring a patient after thrombolytic therapy, nurse
must watch for:
A. Only fever always
B. Signs of bleeding, neurologic changes suggesting intracranial
hemorrhage ✅
C. Improved hearing only
D. Increased appetite only
Explanation: Bleeding is the major complication—frequent neuro checks and
bleeding assessments required.

23. ! Q688. For a patient with an ileostomy, important teaching includes:
A. Expect formed stool like colon output
B. Stoma output is liquid; maintain hydration and electrolyte monitoring,
empty pouch frequently ✅
C. Never change pouch yourself
D. No diet restrictions ever
Explanation: Ileostomy produces liquid effluent—hydration and pouch care
essential.

! Q689. Priority nursing action for a patient with suspected opioid
overdose is:
A. Give benzodiazepines only
B. Assess airway/breathing, provide naloxone and ventilatory support as
needed ✅
C. Observe only at home
D. Give oral antidote only
Explanation: Naloxone reverses opioid respiratory depression—support airway
while administering.

! Q690. For a patient receiving chemotherapy, the nurse should instruct
to:
A. Ignore signs of infection
B. Report fever or signs of infection immediately due to neutropenia risk ✅
C. Stop all medications without consulting provider
D. Increase activity without rest
Explanation: Neutropenia can mask infection—prompt reporting is critical.

! Q691. Serum amylase and lipase are elevated in pancreatitis; which is
more specific?
A. Amylase
B. Both equal always
C. Lipase ✅
D. AST
Explanation: Lipase is more specific to pancreatic inflammation.

24. ! Q692. For an elderly postoperative patient with delirium, nurse should:
A. Use restraints immediately always
B. Assess for reversible causes, provide reorientation, ensure safety,
minimize sedatives ✅
C. Ignore confusion as normal aging
D. Avoid family involvement always
Explanation: Delirium is often reversible—identify causes and use
nonpharmacologic measures first.

! Q693. In myocardial infarction, troponin becomes detectable at about:
A. Immediately at 0 minutes
B. 3–6 hours after symptom onset ✅
C. After 1 month only
D. Never
Explanation: Troponin rises within hours and remains elevated for days—
useful diagnostic window.

! Q694. For patient with hypernatremia due to free water loss, correction
should be:
A. Rapid over 1 hour always
B. Gradual (no more than 10–12 mmol/L per 24 hrs) to avoid cerebral
edema ✅
C. Ignore correction
D. Give hypertonic saline always
Explanation: Rapid correction risks cerebral edema—replace water slowly.

! Q695. For acute bacterial prostatitis, nursing care includes:
A. Immediate prostate massage always
B. Antibiotics, analgesia, hydration, and avoid prostate massage until
healed ✅
C. No antibiotics needed
D. Only herbal remedies
Explanation: Massage can disseminate infection; treat with appropriate
antibiotics and supportive care.

25. ! Q696. For patient with severe hyponatremia with seizures, immediate
therapy is:
A. Oral salt tablets only
B. IV hypertonic saline (3%) cautiously to raise Na and control seizures ✅
C. Restrict all fluids only
D. Give loop diuretics only
Explanation: Hypertonic saline treats life-threatening hyponatremia; monitor
closely to avoid overcorrection.

! Q697. In shock, a narrowing pulse pressure suggests:
A. Hypovolemia or decreased stroke volume ✅
B. Hypertension only
C. Improved perfusion always
D. Bradycardia only
Explanation: Narrow pulse pressure often indicates reduced stroke volume
seen in hypovolemia or cardiogenic shock.

! Q698. For wound packing after incision and drainage of abscess, nurse
should:
A. Leave wound open and pack lightly, teach dressing changes, and monitor for
infection ✅
B. Close wound primarily always
C. Apply only topical antibiotic cream always
D. Ignore wound care
Explanation: Packing prevents premature closure and allows drainage;
education is essential.

! Q699. For a patient with severe anemia and symptomatic heart disease,
transfusion threshold is generally:
A. Always transfuse at Hb <12 g/dL
B. Higher threshold (~8–10 g/dL) individualized to symptoms and cardiac
status ✅
C. Never transfuse
D. Only transfuse when Hb <4 g/dL
Explanation: Cardiac patients may need higher Hgb targets to reduce ischemic
risk.

26. ! Q700. For a patient with suspected acute spinal cord compression,
immediate nursing actions include:
A. Mobilize patient early
B. Immobilize spine, provide high-dose steroids as ordered, and urgent
MRI/neurology consult ✅
C. Allow patient to walk home
D. Only give analgesics and discharge
Explanation: Prevent further injury—stabilize and arrange urgent assessment
and treatment.

! Q701. For a patient with neutropenia post-chemotherapy, priority is:
A. Encourage visitors freely
B. Reverse isolation practices, strict hand hygiene, and immediate eval for
fever ✅
C. No special precautions
D. Only give multivitamins
Explanation: Neutropenic patients are highly susceptible to infections—
protective measures are vital.

! Q702. For sudden onset severe abdominal pain and rigid boardlike
abdomen, nurse suspects:
A. Mild gastritis only
B. Peritonitis (possible perforation) — NPO, IV fluids, pain control, urgent
surgical consult ✅
C. Constipation only
D. Viral gastroenteritis only
Explanation: Rigid abdomen indicates peritoneal irritation—prepare for
emergent intervention.


! Q703. In a patient with chronic kidney disease, medication doses often
need to b
A. Increased arbitrarily
B. Reduced or adjusted according to renal function ✅

27. C. Unchanged always
D. All stopped permanently
Explanation: Renal clearance affects many drugs—dose adjust to prevent
toxicity.

! Q704. For patient with pericarditis, pain improves when:
A. Lying flat
B. Sitting forward and leaning ✅
C. Standing on head
D. Holding breath
Explanation: Sitting forward reduces pericardial friction and eases pain
characteristic of pericarditis.

! Q705. Best nursing action for a patient with hypoglycemia who is
unconscious is:
A. Give oral glucose gel
B. Give IV dextrose (D50) or IM glucagon if IV not available ✅
C. Offer sugary drink only
D. Wait and observe
Explanation: IV dextrose rapidly restores blood glucose; glucagon if IV access
unavailable.

! Q706. For acute stroke, NIHSS is used to:
A. Diagnose diabetes only
B. Quantify neurologic deficit and guide treatment decisions ✅
C. Replace imaging always
D. Only assess mood disorders
Explanation: NIHSS score helps determine stroke severity and eligibility for
therapies.

! Q707. In atrial fibrillation with rapid ventricular rate, immediate
nursing measure is:
A. Ignore rate control
B. Administer prescribed rate-control agents (beta-blocker or diltiazem)
and monitor BP/ECG ✅

28. C. Only give antibiotics
D. Start insulin infusion
Explanation: Control ventricular rate to improve symptoms and
hemodynamics; anticoagulate as indicated.

! Q708. For deep venous thrombosis prophylaxis post-op, nurse should
implement:
A. No measures required
B. Early ambulation, pneumatic compression devices, and pharmacologic
prophylaxis per protocol ✅
C. Prolonged bedrest only
D. Only leg massage always
Explanation: Combined mechanical and pharmacologic measures reduce DVT
risk.

! Q709. In acute COPD exacerbation with hypercapnia and worsening
mental status, next step is:
A. Continue oxygen only
B. Consider noninvasive ventilation or intubation and mechanical
ventilation if indicated ✅
C. Immediate diuretics only
D. Discharge home
Explanation: Ventilatory support needed for respiratory failure and
hypercapnic encephalopathy.

! Q710. For patient with suspected acute mesenteric ischemia, priorities
include:
A. Start oral feeding
B. NPO, IV fluids, broad-spectrum antibiotics, and urgent
surgical/vascular evaluation ✅
C. Only laxatives always
D. Encourage high-fiber diet
Explanation: Rapid diagnosis and revascularization are key to reduce bowel
infarction.

29. ! Q711. Best nursing action to reduce catheter-associated urinary tract
infections is:
A. Routine catheter changes every 24 hrs
B. Use aseptic technique, maintain closed drainage system, remove catheter
as soon as possible ✅
C. Irrigate catheter regularly regardless of need
D. Encourage bedrest with catheter always
Explanation: Minimize catheter use and maintain sterile care to prevent
CAUTI.

! Q712. For a patient with acute pancreatitis and hypotension, fluid
resuscitation should be:
A. Conservative only
B. Aggressive isotonic crystalloid resuscitation early, monitoring urine
output ✅
C. Give only colloids always
D. No fluids needed
Explanation: Early aggressive fluids reduce complications and improve organ
perfusion.



! Q713. For a patient with suspected opioid-induced constipation, safe
laxative choice is:
A. Bulk-forming laxative only
B. Stimulant laxative or osmotic and consider peripherally acting μ-opioid
receptor antagonists if refractory ✅
C. No intervention required
D. Anticholinergics only
Explanation: Opioid-related constipation often requires stimulant/osmotic
laxatives; PAMORAs for severe cases.

! Q714. In acute coronary syndrome, beta blockers are contraindicated
in:
A. Hypertension only

30. B. Signs of heart failure, hypotension, bradycardia, or high-degree AV
block ✅
C. All patients always
D. Only in diabetics always
Explanation: Assess hemodynamics before giving beta blockers; avoid when
signs of low output or conduction block.

! Q715. For patients with severe burns, early transfer to burn unit is
indicated for:
A. Minor first-degree burns only
B. Partial-thickness burns >10% TBSA, burns to face/hands/genitals,
electrical/chemical burns ✅
C. Small superficial sunburn only
D. Chronic eczema only
Explanation: Specialized care required for extensive or complicated burns to
improve outcomes.

! Q716. For a patient with a peripherally inserted central catheter
(PICC), nurse should:
A. Flush only once a month
B. Use aseptic technique, flush per protocol, and monitor for signs of
infection/thrombosis ✅
C. Use bright colored fluids always
D. Never access PICC for labs
Explanation: Proper maintenance prevents complications and ensures catheter
patency.



! Q717. In acute stroke, permissive hypertension is allowed initially to:
A. Reduce cerebral perfusion
B. Maintain cerebral perfusion to penumbra unless thrombolysis indicated
(then target BP per protocol) ✅
C. Cause further bleeding always
D. No rationale exists

31. Explanation: Elevated BP may support perfusion to ischemic brain; targets
change if tPA planned.

! Q718. For patient with aspiration pneumonia risk, nursing should:
A. Feed thin liquids right away
B. Evaluate swallow, modify diet consistency, position upright during
feeding, and perform oral care ✅
C. Prohibit all oral intake forever
D. Encourage rapid ingestion
Explanation: Swallow assessment and precautions reduce aspiration risk.

! Q719. For a patient with COPD, teaching about inhaler use should
include:
A. Using without exhalation first
B. Shake MDI, exhale fully, inhale slowly during actuation, hold breath 5–
10 seconds ✅
C. Use two puffs at once always
D. No need to rinse mouth after steroid inhaler
Explanation: Proper technique ensures optimal drug delivery; rinse after
steroid use to reduce thrush.

! Q720. The earliest detectable lab change in hemolytic transfusion
reaction is often:
A. Hyperglycemia only
B. Hemoglobinuria and rising plasma free hemoglobin; monitor urine and
renal function ✅
C. Elevated triglycerides only
D. Low WBC only
Explanation: Hemolysis releases free hemoglobin, which may appear in urine
and harm kidneys.

! Q721. For patient with elevated intracranial pressure, mannitol is given
to:
A. Increase ICP
B. Create osmotic diuresis to reduce cerebral edema and lower ICP ✅

32. C. Cause seizures always
D. Replace electrolytes
Explanation: Osmotic agent draws fluid from brain tissue for temporary ICP
control; monitor volume and electrolytes.

! Q722. For acute alcohol withdrawal with severe agitation and
autonomic instability, treatment of choice is:
A. Antidepressants only
B. Benzodiazepines titrated per protocol and supportive care ✅
C. Only haloperidol always
D. Immediate ECT
Explanation: Benzodiazepines prevent seizures and reduce withdrawal
severity; monitor closely.

! Q723. For suspected acute coronary syndrome, nurse should also
obtain:
A. Blood cultures only
B. 12-lead ECG within 10 minutes and cardiac biomarkers per protocol ✅
C. Only chest X-ray always
D. Only urinalysis always
Explanation: Rapid ECG is essential to identify STEMI and guide immediate
treatment.
! Q724. For a patient with acute hemorrhagic stroke, blood pressure
management aims to:
A. Maintain very high BP always
B. Lower BP carefully to reduce further bleeding while preserving cerebral
perfusion per guidelines ✅
C. Ignore BP entirely
D. Induce hypertension always
Explanation: Balance needed to prevent expansion but avoid ischemia—follow
protocol targets.

! Q725. In suspected necrotizing fasciitis, urgent nursing actions include:
A. Oral antibiotics only at home
B. Rapid surgical consultation, broad-spectrum IV antibiotics, and
aggressive fluid resuscitation ✅

33. C. Apply topical creams only
D. Observe for several days
Explanation: Necrotizing infection is surgical emergency—early debridement
and antibiotics save tissue and life.



! Q726. Best practice for handoff communication between nurses is using:
A. Verbal only with no structure
B. A standardized tool like SBAR (Situation, Background, Assessment,
Recommendation) ✅
C. Passing notes without discussion
D. No handoff required
Explanation: SBAR ensures complete, structured, and clear transfer of critical
information.

! Q727. In heart failure patient with hyponatremia, nurse recognizes this
as:
A. Mild and never significant
B. Marker of poor prognosis and fluid overload — manage per provider
guidance ✅
C. Indication for immediate high-sodium diet only
D. Unrelated to outcome
Explanation: Hyponatremia often reflects neurohormonal activation and worse
HF severity.


! Q728. For patient receiving epidural analgesia, monitor for:
A. Always safe with no monitoring
B. Hypotension, motor block, urinary retention, and signs of high spinal
block ✅
C. Only respiratory rate changes always
D. Only skin rash always

34. Explanation: Epidural effects can cause hemodynamic and neurologic changes;
monitor vitals and sensory/motor status.

! Q729. When discontinuing isolation for C. difficile, nurse ensures:
A. Only alcohol-based hand rub used
B. Soap and water handwashing specifically, as alcohol not effective vs
spores ✅
C. No special hand hygiene needed
D. Use of N95 mask required always
Explanation: C. difficile spores resist alcohol; soap-and-water handwashing
removes spores.

! Q730. For a patient with gout, long-term urate-lowering therapy should
b
A. During acute flare only
B. After acute attack resolves or for recurrent gout per guidelines ✅
C. For all individuals with hyperuricemia always
D. Never start therapy
Explanation: Starting during an acute flare may worsen symptoms; plan
chronic therapy appropriately.

! Q731. In chest tube management, clamping a tube without order can
cause:
A. Improved drainage always
B. Tension pneumothorax or retained blood leading to tamponade ✅
C. No effect at all
D. Reduced need for monitoring
Explanation: Clamping risks dangerous accumulation—only clamp if
explicitly ordered and monitored.

! Q732. For patient with sepsis, source control means:
A. Provide only fluids and antibiotics
B. Identify and remove or drain source of infection (e.g., abscess, infected
device) ✅
C. Only monitor vitals

35. D. Do nothing
Explanation: Antibiotics plus definitive source control improve outcomes in
sepsis.

! Q733. In assessment of nutritional status, most reliable short-term
indicator is:
A. Serum albumin only
B. Recent weight change and % weight loss ✅
C. Hair color only
D. Nail length only
Explanation: Weight trends reflect acute changes; albumin is influenced by
hydration and chronic illness.

! Q734. For patient with acute asthma not responding to inhaled
bronchodilator, next step is:
A. Stop bronchodilators
B. Administer systemic corticosteroids and consider adjuncts like
magnesium sulfate or epinephrine as indicated ✅
C. Immediate discharge always
D. Only antibiotics
Explanation: Steroids address inflammation; second-line therapies and
escalation to ICU if needed.

! Q735. For post-op patient with sudden oliguria and rising creatinine,
nurse should first:
A. Ignore and wait 24 hours
B. Assess volume status, check Foley patency, and notify provider for
further evaluation ✅
C. Increase PO intake only
D. Immediately give diuretics without assessment
Explanation: Rule out obstruction and hypovolemia before other interventions.

! Q736. In patient with chronic liver disease, avoid giving:
A. Acetaminophen in excessive doses (limit to safe dose) ✅
B. All antibiotics always

36. C. Oral fluids always
D. Multivitamins always
Explanation: Hepatotoxic drugs must be used cautiously—acetaminophen in
moderation; check dosing.

! Q737. For diabetic foot ulcer, best initial nursing measure is:
A. Encourage barefoot walking
B. Offloading pressure, wound care, glycemic control, and referral to
podiatry ✅
C. Immediate amputation always
D. Only topical antibiotic without evaluation
Explanation: Offloading and multidisciplinary care promote healing and
prevent progression.

! Q738. For patient undergoing hemodialysis, assess for:
A. Only BP changes after session
B. Hypotension, access site integrity, and electrolyte shifts pre- and post-
dialysis ✅
C. Only appetite always
D. No monitoring needed
Explanation: Dialysis can cause rapid hemodynamic and electrolyte changes—
monitor closely.
! Q739. In wound care, signs of infection include:
A. Decreased pain and clear drainage
B. Increased pain, erythema, warmth, purulent drainage, and systemic
signs ✅
C. Intact sutures only
D. Dry wound with no redness always
Explanation: Local and systemic inflammatory signs indicate infection that
warrants treatment.
! Q740. For a patient with severe asthma in ED with impending
respiratory failure, nurse should:
A. Observe and wait for slow improvement
B. Prepare for intubation and assist with airway management while
continuing bronchodilators ✅
C. Only give oral antibiotics
D. Encourage exertion

37. Explanation: Rapid deterioration requires airway readiness and aggressive
respiratory support.

! Q741. When suctioning an endotracheal tube, limit each pass to:
A. 60–90 seconds always
B. 10–15 seconds to minimize hypoxia, with pre-oxygenation ✅
C. No limit necessary
D. At least 2 minutes per pass
Explanation: Short suction passes reduce hypoxemia and trauma.

! Q742. For patient on warfarin, foods high in vitamin K can:
A. Have no effect on INR
B. Decrease INR (make warfarin less effective) — maintain consistent
intake ✅
C. Increase INR always
D. Substitute for warfarin entirely
Explanation: Vitamin K lowers warfarin effect—consistency in diet helps
maintain stable INR.

! Q743. In acute hyperosmolar hyperglycemic state (HHS), initial nursing
priority is:
A. Immediate oral feeding
B. Aggressive IV fluids and insulin infusion after initial fluid resuscitation
✅
C. Only antibiotic therapy
D. Slow rehydration over weeks
Explanation: Correct dehydration first, then insulin to avoid rapid osmolar
shifts.

! Q744. For epidural hematoma after spinal procedure, earliest sign is:
A. Fever and chills only
B. New severe back pain, motor weakness, sensory changes — urgent
surgical evaluation ✅
C. Improved mobility always
D. Mild headache only

38. Explanation: Rapid neurologic deterioration from compression requires
immediate intervention.

! Q745. For patient with severe hypermagnesemia, expected cardiac
manifestation is:
A. Peaked T waves only
B. Hypotension and widened QRS, depressed reflexes — monitor and treat
(calcium) ✅
C. Hypertension only
D. No cardiac effects
Explanation: High Mg²⁺ causes cardiac conduction depression; IV calcium
antagonizes effects.

! Q746. For acute transplant rejection suspicion, nurse should:
A. Ignore changes in urine output or graft function
B. Notify transplant team, monitor vitals and labs, prepare for
biopsy/therapy per protocol ✅
C. Stop all immunosuppressants at home
D. Discharge patient immediately
Explanation: Early detection allows timely treatment to preserve graft.

! Q747. For patient with sudden onset unilateral leg swelling and
tenderness, nurse should prioritize:
A. Immediate massage of limb
B. Doppler ultrasound for DVT evaluation and implement anticoagulation
precautions ✅
C. Warm compress and discharge
D. Encourage vigorous exercise
Explanation: DVT needs prompt diagnostic evaluation to prevent
embolization.

! Q748. In coronary artery bypass grafting (CABG) patient, mediastinal
chest tube output >200 mL/hr suggests:
A. Normal drainage always
B. Possible postoperative bleeding — notify surgeon urgently ✅

39. C. Only serous drainage expected
D. Immediate clamping of tube without order
Explanation: High chest tube output may indicate hemorrhage—surgical
evaluation needed.
! Q749. For a patient with acute ischemic limb (cold, pulseless),
immediate nursing action is:
A. Apply warm compress only
B. Notify vascular surgery urgently; keep limb warm and prepare for
reperfusion therapy ✅
C. Elevate limb high without evaluation
D. Massage vigorously
Explanation: Acute limb ischemia requires urgent revascularization to prevent
tissue loss.
! Q750. For patient receiving IV amphotericin B, monitor for:
A. Only GI symptoms always
B. Renal function, electrolytes (K⁺, Mg²⁺), and infusion-related reactions ✅
C. No labs required
D. Only BP daily
Explanation: Amphotericin is nephrotoxic and causes electrolyte
disturbances—monitor frequently.

! Q751. For patients with sickle cell crisis, priority nursing interventions
include:
A. Discourage analgesia
B. Aggressive pain control, IV fluids, oxygen, and treat precipitating causes
✅
C. Only transfusion always
D. Isolate without treatment
Explanation: Pain management and hydration are central; transfusion if
indicated for complications.

! Q752. For patient with acute hemorrhage, priority is to:
A. Place in Trendelenburg position always
B. Control bleeding, restore circulating volume with crystalloids/blood, and
monitor perfusion ✅
C. Delay resuscitation until tests complete
D. Only give oral fluids

40. Explanation: Hemorrhage control and volume resuscitation are immediate life-
saving measures.

! Q753. In COPD exacerbation, antibiotics are indicated when:
A. Never indicated
B. Increased sputum purulence or signs of bacterial infection ✅
C. Always indicated for all COPD patients regardless
D. Only if patient is asthmatic too
Explanation: Sputum purulence suggests bacterial infection—treat according
to severity and guidelines.

! Q754. Best nursing practice for insulin administration in hospitalized
patient includes:
A. Give same dose at random times
B. Coordinate insulin with meal timing, monitor glucose frequently, and
adjust per sliding scale/protocol ✅
C. Hold insulin on all NPO patients always
D. Use only long-acting insulin for all needs
Explanation: Timing and monitoring are key to prevent hypo- and
hyperglycemia.

! Q755. For newly placed tracheostomy, important nursing measures are:
A. Never suction the tube
B. Keep spare obturator and trach tube at bedside, maintain patency, and
provide humidified oxygen ✅
C. Leave ties loose always
D. Remove dressing daily with force
Explanation: Immediate availability of replacement equipment and airway care
is critical.

! Q756. In patient with severe hyperkalemia and ECG changes, besides
calcium and insulin, another rapid option is:
A. Oral potassium supplement
B. Nebulized salbutamol (beta-agonist) to shift K⁺ intracellularly ✅
C. Only sodium polystyrene sulfonate always

41. D. No other measures exist
Explanation: Nebulized beta-agonists lower serum K⁺ transiently; use with
other therapies.

! Q757. For postoperative patients, incentive spirometry frequency
recommended is:
A. Once daily
B. 10 breaths every hour while awake ✅
C. Only when symptomatic
D. Never required
Explanation: Frequent use promotes lung expansion and prevents atelectasis.

! Q758. For patients with hyperthyroidism on antithyroid drugs, nurse
watches for:
A. Improved hearing only
B. Agranulocytosis signs (fever, sore throat) — advise immediate reporting
✅
C. No lab monitoring needed
D. Only GI upset always
Explanation: Antithyroid drugs can cause agranulocytosis—prompt
recognition and stopping drug critical.

! Q759. For a patient with chest trauma and flail chest, initial nursing
priorities include:
A. No respiratory support needed
B. Pain control, respiratory support (oxygen, ventilation if needed), and
chest stabilization ✅
C. Immediate discharge
D. Ambulate vigorously
Explanation: Pain relief and respiratory management prevent hypoventilation
and pulmonary complications.

! Q760. For the care of a patient with central line, the nurse should:
A. Change dressing aseptically per protocol and scrub the hub before access
✅**

42. B. Never change dressings
C. Use alcohol swabs without drying time
D. Flush with tap water only
Explanation: Aseptic technique and hub disinfection prevent catheter-related
bloodstream infections.

! Q761. For patients with atrial fibrillation, stroke prevention is guided
by:
A. Heart rate only
B. CHA₂DS₂-VASc score to determine anticoagulation need ✅
C. Only rhythm status always
D. Blood glucose only
Explanation: Stroke risk score informs anticoagulation decisions balancing
bleeding risk.

! Q762. In GERD, lifestyle measures include:
A. Lying flat after meals
B. Weight loss, avoid late meals, raise head of bed, avoid triggers ✅
C. Smoking more tobacco
D. Eat high-fat meals before bed
Explanation: Lifestyle modification reduces reflux symptoms and medication
needs.

! Q763. For patient with septic shock unresponsive to fluids, next
hemodynamic support is:
A. Immediate dialysis only
B. Vasopressors (norepinephrine first-line) to maintain MAP ≥65 mmHg ✅
C. Only further fluids always
D. No further measures needed
Explanation: Vasopressors restore vascular tone and perfusion when fluids
inadequate.

! Q764. For a patient with suspected meningitis, lumbar puncture is
contraindicated if:
A. Fever only

43. B. Signs of raised ICP or focal neurologic deficits without prior CT ✅
C. Neck stiffness only
D. Photophobia only
Explanation: Elevated ICP risks herniation; imaging should precede LP if
indicated.

! Q765. For patient with acute renal failure and hyperphosphatemia,
nursing should:
A. Encourage high-phosphate diet
B. Administer phosphate binders and monitor labs per orders ✅
C. Ignore phosphorus levels
D. Give milk products liberally
Explanation: Control phosphorus to limit complications; coordinate with
nephrology for management.

! Q766. For suspected anaphylaxis, in addition to epinephrine, nurse
should:
A. Delay all other interventions
B. Maintain airway, give high-flow oxygen, IV fluids, and
antihistamines/steroids as adjuncts ✅
C. Only give oral antihistamines and send home
D. Apply tourniquet only
Explanation: Multiple supportive steps including airway and hemodynamic
support are essential.

! Q767. For patient with left-sided heart failure, auscultation typically
reveals:
A. Clear lungs always
B. Crackles (rales) due to pulmonary edema ✅
C. Only wheeze always
D. No breath sounds only
Explanation: Fluid in alveoli causes inspiratory crackles, commonly at bases.

! Q768. For patients on long-term corticosteroids, nursing should teach
to:

44. A. Stop med abruptly when feeling ok
B. Taper per provider and carry steroid emergency card; monitor for
infection ✅
C. Always double dose during illness without consulting provider
D. Avoid all vaccines forever
Explanation: Taper prevents adrenal crisis; stress dosing per guidelines during
illness or surgery.

! Q769. For a patient with suspected acute glomerulonephritis, priority
nursing assessments include:
A. Only BP monthly
B. Monitor BP, urine output, urine analysis for hematuria/protein, and
weight ✅
C. Only heart sounds always
D. No specific monitoring needed
Explanation: Hypertension and fluid status are important to detect and manage
in GN.

! Q770. For patient with warm autoimmune hemolytic anemia, nursing
care includes:
A. Immediate iron supplementation only
B. Monitor hemoglobin, transfuse if necessary, and support
immunosuppressive therapy per orders ✅
C. No interventions necessary
D. Only vitamin supplements always
Explanation: Hemolysis requires monitoring, transfusion support, and treating
underlying immune cause.



! Q771. For a patient with acute rheumatic fever, major manifestations
include:
A. Hypertension only
B. Migratory polyarthritis, carditis, chorea, erythema marginatum ✅
C. Only GI symptoms always

45. D. Only renal failure always
Explanation: Recognize Jones criteria and manage promptly to prevent cardiac
sequelae.

! Q772. For a patient with suspected pulmonary embolism, nurse should
prepare for:
A. Outpatient management only always
B. CT pulmonary angiography if hemodynamically stable or bedside echo
if unstable; give anticoagulation per protocol ✅
C. Only wait for symptoms to progress
D. No diagnostic tests required
Explanation: Imaging based on stability; anticoagulate unless contraindicated.

! Q773. For a patient with acute bacterial cellulitis, nursing priorities
include:
A. Massage area vigorously
B. Elevation, warm compresses, antibiotics, and monitor for spreading/
systemic signs ✅
C. No systemic antibiotics required
D. Only hydrate orally
Explanation: Early antibiotics and supportive measures prevent progression to
deeper infection.

! Q774. For patient with hypervolemia (CHF), signs include:
A. Dry mucous membranes only
B. Peripheral edema, jugular venous distension, pulmonary crackles ✅
C. Weight loss only
D. Bradycardia only
Explanation: Volume overload causes systemic and pulmonary congestion
features.

! Q775. For postoperative patient with new-onset atrial fibrillation, initial
nursing action is:
A. Ignore rhythm change
B. Assess hemodynamic stability, inform provider, prepare for rate control

46. or cardioversion as ordered ✅
C. Start antibiotics only
D. Immediate discharge home
Explanation: AF may compromise output—assess and treat according to
stability and protocols.

! Q776. For patient with C. difficile infection, besides infection control,
key nursing measure is:
A. Use alcohol hand rub only
B. Soap-and-water handwashing and contact precautions; provide
supportive care and stool testing ✅
C. No precautions needed
D. Only oral probiotics always
Explanation: Spores resist alcohol; soap-and-water handwashing and contact
precautions reduce spread.

! Q777. For patient with acute pancreatitis, avoid which analgesic due to
spasm risk of sphincter of Oddi:
A. Morphine — use alternatives like fentanyl or meperidine per policy ✅
B. NSAIDs always
C. Acetaminophen only
D. No analgesia required
Explanation: Morphine may increase sphincter tone; choose appropriate
alternatives per protocol.

! Q778. For patients with osteoporosis, nursing interventions include:
A. Encourage immobility only
B. Weight-b
medication adherence ✅
C. High-dose steroids routinely
D. No lifestyle changes needed
Explanation: Multifactorial approach reduces fracture risk and improves bone
health.

47. ! Q779. In acute ischemic limb revascularization, compartment syndrome
risk increases after reperfusion; nurse should:
A. Ignore limb pain after reperfusion
B. Monitor for increasing pain, tense swelling, and prepare to notify
surgeon for fasciotomy if indicated ✅
C. Apply tight bandages to limb always
D. Encourage early vigorous exercise
Explanation: Reperfusion can cause swelling and compartment syndrome—
early detection is essential.

! Q780. For patient with septic arthritis, nursing care includes:
A. Oral analgesics only
B. Joint drainage (aspiration/surgery), IV antibiotics, immobilization, and
pain control ✅
C. Only topical creams always
D. No intervention needed
Explanation: Prompt drainage and targeted antibiotics prevent joint
destruction.

! Q781. In patients with polytrauma, the nurse uses primary survey
ABCDE; “D” stands for:
A. Discharge planning
B. Disability (neurologic status) — quick neuro assessment including GCS
✅
C. Diet only
D. Defibrillation only
Explanation: Disability evaluates neurologic function and guides further
management.


! Q782. For patient with suspected hypovolemic shock from GI bleed,
measure:
A. Only temperature always
B. Hemoglobin/hematocrit, lactate, urine output, and hemodynamics to

48. guide resuscitation ✅
C. Only platelet count always
D. Only cholesterol levels
Explanation: Labs and hemodynamics guide volume replacement and
transfusion needs.

! Q783. For a patient with chronic venous insufficiency, nursing care
includes:
A. Prolonged standing only
B. Compression stockings, leg elevation, skin care, and exercise ✅
C. Smoking encouragement only
D. Avoid walking altogether
Explanation: Compression and mobility improve venous return and prevent
ulceration.

! Q784. For patient with suspected acute diverticulitis, nurse should:
A. Encourage high-fiber diet immediately
B. NPO or clear liquids, IV antibiotics, and surgical consult if complicated
✅
C. Give laxatives immediately
D. Recommend immediate colonoscopy at bedside
Explanation: Bowel rest and antibiotics for uncomplicated cases; avoid
colonoscopy during acute inflammation.

! Q785. For patients with pulmonary edema related to left heart failure,
nursing assessment includes monitoring for:
A. Dry cough only
B. Pink frothy sputum, crackles, hypoxia, rising work of breathing ✅
C. Only abdominal pain always
D. Only increased appetite always
Explanation: Recognize pulmonary edema signs early and intervene with
oxygen and diuretics per orders.

! Q786. For anticoagulation with warfarin, patient teaching includes:
A. Avoid INR checks once stable

49. B. Maintain consistent vitamin K intake, report bleeding, and attend
regular INR monitoring ✅
C. Stop warfarin when feeling better always
D. Take aspirin concurrently without guidance
Explanation: Education on diet, monitoring, and interactions is essential for
safe anticoagulation.

! Q787. For patient with acute cholangitis (fever, jaundice, RUQ pain),
nursing priorities include:
A. Immediate oral feeding only
B. IV fluids, antibiotics, pain control, and prepare for urgent biliary
decompression (ERCP) ✅
C. Discharge home with stool softener
D. Only topical creams always
Explanation: Supportive care and biliary drainage are central to management.



! Q788. For a patient with acute rheumatic fever carditis, nurse monitors
for:
A. Only kidney function always
B. Heart failure signs, murmurs, arrhythmias, and hemodynamic stability
✅
C. Only skin changes always
D. Only GI symptoms always
Explanation: Carditis can rapidly worsen—monitor cardiac status and support
per orders.


! Q789. For patient with myasthenic crisis, priority nursing care is:
A. Start oral pyridostigmine only
B. Airway protection, possible intubation, IVIG or plasmapheresis, and
treat precipitating cause ✅
C. Only give antibiotics always

50. D. Wait for spontaneous recovery
Explanation: Respiratory muscle weakness can progress rapidly—support
airway and initiate definitive therapy.

! Q790. For patient with hyperosmolar hyperglycemic state, nurse
ensures:
A. Only oral rehydration always
B. Aggressive IV fluids, insulin therapy after initial fluid resuscitation,
electrolyte monitoring ✅
C. Immediate high-potassium infusion always
D. Only blood transfusion always
Explanation: Correct dehydration first, then insulin; monitor and replace
electrolytes carefully.

! Q791. For prevention of DVT in immobilized surgical patient, nursing
uses:
A. No prophylaxis needed
B. Sequential compression devices, early ambulation, and pharmacologic
prophylaxis unless contraindicated ✅
C. Prolonged bedrest only
D. Massage limbs daily only
Explanation: Combine mechanical and pharmacologic measures to reduce
thromboembolism risk.
! Q792. For patient with suspected acute cholestatic jaundice, nurse
should monitor for:
A. Only cough always
B. Pruritus, dark urine, pale stools, and LFT patterns; prepare for imaging
✅
C. Only headache always
D. Only toothache always
Explanation: Cholestasis has characteristic symptoms and lab patterns—
evaluate biliary obstruction.

! Q793. In chest tube drainage, tidaling (rise and fall with respiration) in
the water-seal chamber indicates:
A. Tube obstruction

51. B. Normal intrapleural pressure changes with respiration ✅
C. Air leak always
D. No drainage expected
Explanation: Tidaling reflects respiratory pressure transmission—absence may
indicate obstruction or lung expansion.

! Q794. For patient with suspected acute appendicitis, nursing should:
A. Encourage laxatives and enem¯ˀas
B. Keep NPO, IV fluids, pain control, and prepare for surgical evaluation
✅
C. Provide immediate antibiotics only at home
D. Allow heavy meals
Explanation: Avoid increasing peristalsis; prepare for operative management if
indicated.
! Q795. For patient with pleural effusion causing respiratory distress,
nursing priorities include:
A. Encourage supine positioning only
B. Oxygen therapy, monitor respiratory status, and assist with
thoracentesis as ordered ✅
C. Immediate diuretics only always
D. No intervention needed
Explanation: Drainage may relieve dyspnea; supportive care and monitoring
are key.
! Q796. For patient's postop glucose control, perioperative hyperglycemia
increases risk of:
A. Improved wound healing always
B. Surgical site infection and poor outcomes — monitor and control glucose
✅
C. Lower mortality always
D. No clinical effect
Explanation: Hyperglycemia impairs immunity and healing—glycemic control
reduces complications.

! Q797. For patient presenting with sudden painless vision loss, nurse
should suspect:
A. Migraine only
B. Retinal artery occlusion or vitreous hemorrhage — urgent

52. ophthalmology evaluation ✅
C. Always only benign condition
D. Only chronic refractive error
Explanation: Sudden painless vision loss can indicate vascular occlusion
needing emergent care.

! Q798. For patient with severe sepsis, nurse tracks lactate trends
b
A. Lactate has no clinical use
B. Decreasing lactate indicates improving tissue perfusion and response to
resuscitation ✅
C. Increasing lactate means better prognosis
D. Lactate only reflects liver function
Explanation: Lactate clearance is a marker of resuscitation effectiveness in
sepsis.
! 799. For patient on high-dose opioids, constipation prevention includes:
A. No bowel regimen required
B. Scheduled stimulant laxatives and stool softeners proactively ✅
C. Only give opioids without bowel meds
D. Only fiber supplements always
Explanation: Opioid-induced constipation is common—prophylactic bowel
regimen is recommended.
! Q800. For patient with impending respiratory failure, the most
important nursing action is:
A. Reassure family only
B. Call for immediate respiratory support (NIV/intubation), prepare
equipment, and monitor oxygenation/ventilation continuously ✅
C. Delay intervention until morning rounds
D. Only provide oral fluids
Explanation: Early recognition and timely respiratory support are critical to
prevent arrest