National NORCET Test-8

National NORCET Test 8
ANATOMY & PHYSIOLOGY

1. Which cells produce the pigment that contributes to hair color?
a. Keratinocytes
b. Melanocytes
c. Langerhans cells
d. Merkel cells
Ans. b. Melanocytes
Rationale:
• Hair color is mainly influenced by melanin which is derived from melanocytes in the
bulb matrix.
• Actual color is determined by genes which direct the amount and type of melanin the
melanocytes produce.
• Dark hair tends to possess more pure melanin while lighter shades have more melanin
derivatives.
2. Carbon dioxide is carried from body tissues in what form?

a. Dissolved CO2 b. Oxyhemoglobin
c. Carbaminohemoglobin d. Bicarbonate ions
Ans. d. Bicarbonate ions
Rationale:
• Bicarbonate ions are also known as hydrogen carbonate ions (HCO3–).
• These are alkaline and have a vital role in maintaining acid–base homeostasis in the
body. They provide resistance to dramatic changes in pH. This is particularly important
in the CNS tissues where pH deviation too far beyond the normal range can be life-
threatening.
• The blood value of bicarbonate ions is one of several indicators of acid–base physiology
in the body.
• Bicarbonate also regulates pH in the small intestine. This is released from the pancreas
in response to the hormone secretin to neutralize the acidic chyme entering the
duodenum from the stomach.
2 National NORCET Test 8
3. Match the features of a neuron in the figure using the terms provided in
column-B.
Column-A Colum-B
A. Axonal terminal
B. Node of Ranvier
C. Receptor organ
D. Myelin sheath
E. Axon
F. Cell body
G. Dendrites
a. 1-F, 2-G, 3- E, 4-D, 5-B, 6-A

b. 1-G, 2-F, 3-E, 4-C, 5-B, 6-D
c. 1-C, 2-G, 3-F, 4-D, 5-B, 6-A
d. 1-D, 2-G, 3-A, 4-C, 5-E, 6-F
Ans. a. 1- F, 2-G, 3- E, 4-D, 5-B, 6-A
Rationale:
• Cell body (or soma): every nerve cell (neuron) has a cell body which contains a
nucleus and granular cytoplasm containing many ribosomes. These ribosomes are
grouped together to form Nissl granules which are involved in the formation of the
neurotransmitter substances. It is the high concentration of Nissl granules in the cell
bodies that gives parts of the brain and spinal cord a grey color (hence the term ‘greys
matter’).
• Dendrites: these are the fine branches which provide a large connection network,
capable of receiving nerve impulses (in the form of an electrical signal called an action
potential) from neighboring nerve cells and receptor organs. The dendrites make
connections with other nerve cells or effector organs (such as muscles) via synapses.
Neurotransmitter substances pass across the synapses to neighboring cells and hence
the nerve impulse is transmitted from one neuron to the next.
• Axon: the axon is the communication route between the cell body and the axon
terminals. The action potential will only travel in one direction along the axon. In
healthy neurons, the axons are wrapped in a segmented fatty deposit called the myelin
sheath.
• Myelin sheath: the myelin sheath is produced by neuroglia called Schwann cells.
Myelin is a fatty mixture of phospholipid and cholesterol which provides insulation
from electrical impulses. Development of the myelin sheath is not complete until late
childhood hence the slow responses and poor coordination often exhibited by infants
and children.
National NORCET Test 8 3
• Nodes of Ranvier: these are small unmyelinated regions located along the axis
between the myelin segments. Due to the absence of myelin, these regions are not
insulated and therefore can conduct the electrical impulse from one node of Ranvier
to the next. This is why the electrical impulse is said to jump along the axon – it cannot
travel smoothly along the myelinated axon and so it is only conducted at the nodes
of Ranvier. The jumping of the action potential from one node to the next is called
saltatory conduction.
• Axonal terminals: the end of the axon consists of numerous projections which are
involved in the transmission of the action potential to the dendrites of neighboring
neurons or the effector organ. Each has a synaptic end plate which stores
neurotransmitter substance for release into the synapse.
Figure: Features of Neurons
4. A nurse is working in an outpatient orthopedic clinic. During the patient’s

history the patient reports, “I tore 3 of my 4 Rotator cuff muscles in the past.”
Which of the following muscles cannot be considered as possibly being torn?
a. Teres minor
b. Teres major
c. Supraspinatus
d. Infraspinatus
Ans. b. Teres major
Rationale:
• The rotator cuff is a group of muscles in the shoulder that allow a wide range of
movement while maintaining the stability of the glenohumeral joint. The rotator cuff
includes the following muscles:
Figure: Rotator Cuff Muscles

Ĕ Subscapularis
Ĕ Infraspinatus
Ĕ Supraspinatus
Ĕ Teres minor
• Tears in the tendons of these muscles are called rotator cuff tears. The most commonly
affected muscle is the supraspinatus.
• The primary biomechanical role of the rotator cuff is to stabilize the glenohumeral
joint by compressing the humeral head against the glenoid.
• These four muscles arise from the scapula and insert into the humerus. The tendons
of the rotator cuff muscles blend with the joint capsule and form a musculotendinous
collar that surrounds the posterior, superior, and anterior aspects of the joint, leaving
the inferior aspect unprotected.
• This arrangement is an important factor since most of the shoulder luxations occur
because the humerus slides inferiorly through the unprotected part of the joint. During
arm movements, the rotator muscles contract and prevent the sliding of the head of the
humerus, allowing full range of motion and providing stability.
5. Which statement accurately describes glomerular filtration rate (GFR)?

a. The primary function of GFR is to excrete nitrogenous waste products.
b. Decreased permeability in the glomerulus causes loss of proteins into the urine.
c. The GFR is primarily dependent on adequate blood flow and adequate hydrostatic
pressure.
d. The GFR is decreased when prostaglandins cause vasodilation and increased renal
blood flow
Ans. c. The GFR is primarily dependent on adequate blood flow and adequate hydrostatic
pressure
Rationale:
• GFR is primarily dependent on adequate blood flow and hydrostatic pressure. The
glomerulus filters the blood.
• The GFR is the amount of blood filtered each minute by the glomeruli, which
determines the concentration of urea in the blood.
• Increased permeability in the glomerulus causes loss of proteins in the urine. The
prostaglandins increase the GFR with increased renal blood flow.
6. An older patient is describing increased rigidity in the shoulders, back, and

hips. The loss of elasticity in what tissue contributes to this?
a. Actin b. Fascia
c. Myosin d. Cartilage
Ans. d. Cartilage
Rationale:
• A loss of elasticity in cartilage, ligaments, and tendons increases rigidity in the neck,
shoulders, back, hips, and knees of older patients.
• Actin (thin) filaments and myosin (thick) filaments make up the contractile unit of the
myofibrils, which decrease in strength with lack of use.
• Fascia is connective tissue that can withstand limited stretching.
7. Boxer’s muscle is:

a. Brachioradialis b. Serratus anterior
c. Biceps brachii d. Deltoid
Ans. b. Serratus anterior
Rationale:
• The serratus anterior is occasionally called the “big swing muscle” or “boxer’s muscle”
because it is largely responsible for the protraction of the scapula.
• The Boxers Muscle is located deep under the scapula (shoulder blade) and wraps
around the rib-cage under the Pectoralis Major (chest muscle).
• Boxer’s fracture is a fracture of the necks of the second and third metacarpals, seen in
professional boxers, and typically of the fifth metacarpal in unskilled boxers.
8. Normal bone cells are known as:

a. Osteocyte b. Osteoblast
c. Osteoclast d. Monocyte
Ans. a. Osteocyte
Rationale:
• Osteocytes: Star-shaped cell that begins as an osteoblast and is trapped in the matrix
that it secretes. Osteocytes are connected by long cytoplasmic extensions that are in
canals called canaliculi. Maintain bone + cellular matrix
• Osteoblasts: Mononuclear cells that differentiate from mesenchymal stem cells in the
periosteum. They are responsible for the synthesis of the calcium and phosphate bone
collagen. Form bone by producing non-mineralized matrix. Stimulate osteoclasts via
cytokines (IL-1, IL-6, and RANKL).
• Osteoclasts: Multinucleated cells that differentiate from hematopoietic lineage. They
secrete acidic and lytic enzymes that function to degrade and subsequently resorb the
bone.
9. Which of the following is QT interval?
a. A b. B
c. C d. D
Ans. c. C
Rationale:
• QT interval is the interval from the beginning of the Q wave to the end of the T wave.
It represents the entire period of depolarization and repolarization of the ventricles.
Figure: Normal ECG wave Pattern

• PR interval is the interval from the beginning of the P wave to the beginning of the Q
wave (initial depolarization of the ventricle).
• QRS complex represents depolarization of the ventricles.
• ST segment is the segment from the end of the S wave to the beginning of the T wave.
It represents the period when the ventricles are depolarized.
• P wave represents atrial depolarization. It does not include atrial repolarization, which
is “buried” in the QRS complex.
• T wave represents ventricular repolarization.
10. Medial geniculate bodies form a part of:

a. Visual pathway
b. Auditory system
c. Limbic system
d. Motor system
Ans. b. Auditory system
Rationale:
• Primary auditory cortex (areas 41 and 42) is found in the transverse gyrus of Heschl
and receives input from the medial geniculate nucleus.
• Auditory pathway: Cochlea → CN VIII → medullary cochlear nuclei → fibers cross
just prior to the superior olivary nuclei, travel along the lateral lemniscus tract →
synapse in the medial geniculate nucleus (MGN) → primary auditory cortex.
• Medial geniculate body: auditory system
• Lateral geniculate body: visual system
BIOCHEMISTRY & NUTRITION

11. A patient with AKI has a serum potassium level of 6.7 mEq/L (6.7 mmol/L) and
the following arterial blood gas results: pH 7.28, PaCO2 30 mm Hg, PaO2 86
mm Hg, HCO3− 18 mEq/L (18 mmol/L). The nurse recognizes that treatment
of the acid-base problem with sodium bicarbonate would cause a decrease in
which value?
a. pH b. Potassium level
c. Bicarbonate level d. Carbon dioxide level
Ans. b. Potassium level
Rationale:
• During acidosis, potassium moves out of the cell in exchange for H+ ions, increasing
the serum potassium level.
• Correction of the acidosis with sodium bicarbonate will help to shift the potassium
back into the cells.
• A decrease in pH and the bicarbonate and PaCO2 levels would indicate worsening
acidosis.
12. Identify the given test for proteins:
a. Barfoed Test
b. Pettenkoffer test
c. Biuret test
d. Molisch test
Ans. c. Biuret Test
Rationale:
• Biuret test is the general test for all proteins.
• Biuret reagent is an alkaline solution of 1% CuSO4, copper sulfate. The violet color is a
positive test for the presence of protein, and the intensity of the color is proportional to
the number of peptide bonds in the solution.
• Ninhydrin test is the test for alpha amino acids.
• Pettenkoffer Test is used to prove the presence of bile salt.
13. The client is instructed regarding foods that are low in fat and cholesterol.
Which diet selection is lowest in saturated fats?
a. Macaroni and cheese
b. Shrimp with rice
c. Turkey breast
d. Spaghetti
Ans. c. Turkey breast
Rationale:
• Turkey contains the least amount of fats and cholesterol. Both turkey and chicken are
rich in high-quality protein.
• Spaghetti is one of the most popular forms of pasta, and it is used in dishes all
around the world. Most spaghetti is made from durum wheat, so it’s high in complex
carbohydrates and includes all the nutrients found in refined white flour. Liver, eggs,
beef, cream sauces, shrimp, cheese, and chocolate should be avoided by the client.
14. The pathway through which a cell produces the maximum number of ATP
molecules is:
a. Pentose phosphate pathway b. Glycolysis
c. Lactic acid fermentation d. TCA cycle
Ans. d. TCA cycle
Rationale:
• The TCA cycle, also known as the citric acid cycle or the Krebs cycle, is the major
energy-producing pathway in the body. The cycle occurs in mitochondria. The cycle
starts with the 4-carbon compound oxaloacetate, adds two carbons from acetyl-CoA,
loses two carbons as CO2, and regenerates the 4-carbon compound oxaloacetate. The
total energy generated by one round of the cycle, starting with 1 mole of acetyl-CoA, is
approximately 10 moles of ATP.
Table: Energetics
Pathway Energetics
Aerobic glycolysis 7 ATP
Anaerobic glycolysis 2 ATP
Glycolysis TCA cycle via Malate shuttle 32 ATP
Glycolysis TCA cycle via Glycerophosphate shuttle 30 ATP
PDH complex reaction 5 ATP
Citric acid cycle 10 ATP
HMP shunt No ATP produced
Rapaport leubering No ATP produced
β - oxidation of palmitic acid 106 ATP
β - oxidation of stearic acid 120 ATP
15. In the test given below to estimate blood glucose, which of the following is true?
a. This is an example of Reducometric method

b. Glucose is converted to glucuronic acid
c. The terminal carbon is oxidized
d. Glucose oxidase is highly specific for beta anomer of glucose
Ans. d. Glucose oxidase is highly specific for beta anomer of glucose

Rationale:
The reaction in glucometer is:
GOD
Glucose +H2O + O2 Gluconic acid +H2O2
GOD
2H2O2 + 4 aminoantipyrine + PHBS Quinoneimine dye + H2O
• This reaction is specific for beta anomer of glucose.
• Here the first carbon atom is oxidized
• This is an example of enzymatic method (Glucose oxidase Peroxidase method).
MICROBIOLOGY
16. The given below agar and media is used for isolation of:
a. N. gonorrhoeae
b. C. diphtheriae
c. B. pertussis
d. N. meningitidis
Ans. b. C. diphtheriae
Rationale:
• The image depicts Tellurite agar and Löffler medium; which used for isolation of C.
diphtheriae
17. IgE is secreted by:

a. Mast cell
b. Basophils
c. Eosinophils
d. Plasma cells
Ans. d. Plasma Cell
Rationale:
• Plasma cells are the antibody secreting cells
• Immunoglobulins are the antibodies.
18. Which of the following diseases and bacteria are matched up incorrectly?
a. Cellulitis – Pasteurella multocida
b. Tularemia – Francisella tularensis
c. Gastritis – Helicobacter pylori
d. Lyme disease – Yersinia pestis
Ans. d. Lyme disease – Yersinia pestis
Rationale:
• Lyme disease is caused by the bacterium Borrelia burgdorferi and rarely, Borrelia
mayonii. It is transmitted to humans through the bite of infected blacklegged ticks.
Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called
erythema migrans.
• Yersinia pestis (Y. pestis) is a gram-negative, non-motile, rod-shaped, coccobacillus
bacterium, without spores. It is a facultative anaerobic organism that can infect humans
via the Oriental rat flea (Xenopsylla cheopis).
• Plague is a disease that affects humans and other mammals. It is caused by the
bacterium, Yersinia pestis.
19. The physician has ordered a histoplasmosis test for the elderly client. The nurse
is aware that histoplasmosis is transmitted to humans by:
a. Cats b. Dogs
c. Turtles d. Birds
Ans. d. Birds
Rationale:
• Histoplasmosis is a fungus carried by birds.
• It is not transmitted to humans by cats, dogs, or turtles.
20. Identify the image shown below
a. Boiler b. Autoclave
c. Fumigator d. Vaccine container
Ans. b. Autoclave
Rationale:
• An autoclave is a machine that uses steam under pressure to kill harmful bacteria,
viruses, fungi, and spores on items that are placed inside a pressure vessel.
• The moisture in the steam efficiently transfers heat to the items to destroy the protein
structure of the bacteria and spores.
PHARMACOLOGY
21. The nurse is caring for the client receiving the medication given below in the
image for mucormycosis (Black fungus). Which of the following indicates that
the client has experienced toxicity to this drug?
a. Urinary frequency
b. Changes in vision
c. Changes in skin color
d. Nausea
Ans. c. Changes in skin color
Rationale:
• Amphotericin B is an antifungal medication that fights infections caused by fungus.
• Amphotericin B injection can cause serious side effects. It should only be used to treat
potentially life-threatening fungal infections. It is used to treat include mucormycosis.
• Due to the similarity of mammalian and fungal membranes, which both contain
sterols (the therapeutic target for amphotericin B), amphotericin B can exhibit cellular
toxicity.
• Clients taking Amphotericin B should be monitored for liver, renal, and bone marrow
function because this drug is toxic to the kidneys and liver, and causes bone marrow
suppression.
• Jaundice is a sign of liver toxicity and is not specific to the use of Amphotericin B.
• Urinary frequency is a side effect. Renal toxicity correlates with conventional
amphotericin B use and can lead to renal failure and requirement for dialysis.
But the azotemia often stabilizes with therapy and renal damage is reversible after
discontinuation of amphotericin B.
• Changes in vision are not related. Other potential uncommon side effects include
demyelinating encephalopathy in patients with bone marrow transplant with total
body irradiation or who are receiving cyclosporine.
• Nausea is a side effect, not a sign of toxicity.
22. Stimulation of the sympathetic nervous system produces which of the following
responses?
a. Decreased myocardial contractility b. Bradycardia
c. Hypotension d. Tachycardia
Ans. d. Tachycardia
Rationale:
• Stimulation of the sympathetic nervous system causes tachycardia and increased
contractility. Norepinephrine released from neurons via the right stellate ganglion
increases heart rate and shortens atrioventricular conduction via the sinus and
atrioventricular nodes.
• The parasympathetic nervous system is responsible for decreasing the heart rate.
• Hypotension is caused by the parasympathetic nervous system. The baroreceptor reflex
stimulates the parasympathetic system. The PSNS causes relaxation of blood vessels,
decreasing total peripheral resistance. It also decreases heart rate. As a result, blood
pressure decreases.
• Decreased myocardial contractility is related to the parasympathetic nervous system,
which is responsible for slowing the heart rate.
23. The client is admitted to the hospital with hypertensive crises. Diazoxide
(Hyperstat) is ordered. During administration, the nurse should:
a. Place the client in Trendelenburg position
b. Utilize an infusion pump
c. Cover the solution with foil
d. Check the blood glucose level
Ans. d. Check the blood glucose level
Rationale:
• Hyperstat is given as an IV push for hypertensive crises, but it often causes
hyperglycemia. The glucose level will drop rapidly when stopped. This medication is
used to treat very low blood sugar (hypoglycemia). Certain conditions (such as tumor
on the pancreas, cancer, leucine sensitivity) can cause the release of too much insulin.
Insulin is a natural substance that lowers blood sugar. This drug works by preventing
insulin release from the pancreas, helping to return the blood sugar to normal levels.
• Option A: The client should be placed in dorsal recumbent position, not a
Trendelenburg position.
• Option B: Diazoxide (Hyperstat) is given by IV push.
• Option C: This medication does not have to be covered with foil. Store at room
temperature away from moisture, heat, and light.
24. The physician has prescribed esomeprazole for a client with erosive gastritis.
The nurse should administer the medication:
a. 30 minutes after meals
b. With each meal
c. 30 minutes before meals
d. In a single dose at bedtime
Ans. c. 30 minutes before meals
Rationale:
• Esomeprazole is a Proton pump inhibitors reduce the production of acid in the
stomach.
• Proton pump inhibitors work best when they are taken 30 minutes before the first meal
of the day. Take each dose with a full glass (8 ounces) of water.
• Esomeprazole is usually given for 4 to 8 weeks only. The doctor may recommend a
second course of treatment if the client needs additional healing time.
25. A nurse is administering the drug given below in the image to a patient admitted
with congestive heart failure. After the infusion, which of the following
symptoms is not expected?
a. Increased urinary output

b. Decreased edema
c. Decreased pain
d. Decreased blood pressure
Ans. c. Decreased pain
Rationale:
• Furosemide, a loop diuretic, does not alter pain.
• The Food and Drug Administration (FDA) has approved the use of furosemide in the
treatment of conditions with volume overload and edema secondary to congestive heart
failure exacerbation, liver failure, or renal failure including the nephrotic syndrome.
• Furosemide acts on the kidneys to increase urinary output.
• Fluid may move from the periphery, decreasing edema. Careful monitoring of
the clinical condition of the patient, daily weight, fluids intake, and urine output,
electrolytes, i.e., potassium and magnesium, kidney function monitoring with serum
creatinine and serum blood urea nitrogen level is vital to monitor the response to
furosemide.
• Fluid load is reduced, lowering blood pressure. Furosemide can be a second-line

agent in heart failure patients with symptoms, and in patients with advanced kidney
disease with an estimated glomerular filtration rate, less than 30 ml per minute the
loop diuretics (furosemide) are preferred over thiazide diuretics to treat hypertension.
26. Nurse Sabina is aware that the statement that best explains why furosemide
(Lasix) is administered to treat hypertension is:
a. It inhibits the angiotensin-converting enzymes
b. It dilates peripheral blood vessels
c. It inhibits the reabsorption of sodium and water in the loop of Henle
d. It decreases sympathetic cardio acceleration
Ans. c. It inhibits the reabsorption of sodium and water in the loop of Henle
Rationale:
• Furosemide is a loop diuretic that inhibits sodium and water reabsorption in the loop
Henle, thereby causing a decrease in blood pressure.
• Angiotensin-converting enzyme inhibitors decrease blood pressure due to their action
on angiotensin.
• Vasodilators cause dilation of peripheral blood vessels, directly relaxing vascular
smooth muscle and decreasing blood pressure.
• Adrenergic blockers decrease sympathetic cardio acceleration and decrease blood
pressure.
27. The client admitted with angina is given a prescription for nitroglycerin. The
client should be instructed to:
a. Take one every 15 minutes if pain occurs
b. Replenish his supply every 3 months
c. Crush the medication and take with water
d. Leave the medication in the brown bottle
Ans. d. Leave the medication in the brown bottle
Rationale:
• Nitroglycerin is most commonly administered as a tablet that is absorbed sublingually.
It is given in hospitals as well as prescribed for outpatient use.
• Patients may be prescribed nitroglycerin to take as prophylaxis for anginal chest pain
prior to an event that may provoke anginal symptoms.
• Nitroglycerine should be kept in a brown bottle (or even a special air- and water-
tight, solid or plated silver or gold container) because of its instability and tendency to
become less potent when exposed to air, light, or water.
• Store nitroglycerin pills in a dark-colored (such as brown), airtight, glass container that
you cannot see through. Keep the container tightly closed.
• Keep nitroglycerin pills and liquid spray away from heat or moisture.
• The supply should be replenished every 6 months, not 3 months.
• One tablet should be taken every 5 minutes until pain subsides. If the pain does not
subside, the client should report to the emergency room. There currently are three
doses available: 0.3 mg, 0.4 mg, and 0.6 mg. The dose is repeatable every 5 minutes
until the achievement of relief.
• The medication should be taken sublingually and should not be crushed.
28. A client is receiving Pyridium (phenazopyridine hydrochloride) for a urinary

tract infection. The client should be taught that the medication may:
a. Cause mental confusion
b. Cause diarrhea
c. Cause changes in taste
d. Change the color of her urine
Ans. d. Change the color of her urine
Rationale:
• Phenazopyridine is a medication which, when excreted by the kidneys into the urine,
has a local analgesic effect on the urinary tract.
• Phenazopyridine comes as a tablet or capsule to take by mouth. It usually is taken three
times a day after meals.
• Phenazopyridine relieves urinary tract pain, burning, irritation, and discomfort,
as well as urgent and frequent urination caused by urinary tract infections, surgery,
injury, or examination procedures.
• Clients taking Pyridium should be taught that the medication will turn the urine
orange or red.
• Pyridium can also cause a yellowish color to skin and sclera if taken in large doses.
However, phenazopyridine is not an antibiotic; it does not cure infections.
• The drug does not cause mental confusion.
• It does not cause diarrhea.
• It is not associated with changes in taste.
29. A physician has diagnosed acute gastritis in a clinic patient. Which of the
following medications would be contraindicated for this patient?
a. Calcium carbonate b. Naproxen sodium
c. Clarithromycin d. Furosemide
1. If a, b, c are correct
2. If a and c are correct
3. If b and d are correct
4. If all four (a, b, c, & d) are correct
Ans. 3. If b and d are correct
Rationale:
• Naproxen sodium is a non-steroidal anti-inflammatory drug that can cause
inflammation of the upper GI tract. For this reason, it is contraindicated in a patient
with gastritis.
• Furosemide is a loop diuretic and is contraindicated in a patient with gastritis. The

Food and Drug Administration (FDA) has approved the use of furosemide in the
treatment of conditions with volume overload and edema secondary to congestive
heart failure exacerbation, liver failure, or renal failure including nephrotic syndrome.
• Calcium carbonate is used as an antacid for the relief of indigestion and is not
contraindicated.
• Clarithromycin is in a class of medications called macrolide antibiotics. It is an
antibacterial often used for the treatment of Helicobacter pylori in gastritis. It works by
stopping the growth of bacteria.
30. In a transplant client, the action of the agent depicted in the image is to:
a. Defend the body against foreign antigens.

b. Inhibit T cells in response to antigens.
c. Inhibit B cell immunoglobulin.
d. Intensify the production of T lymphocytes
Ans. b. Inhibit T cells in response to antigens
Rationale:
• The primary action of cyclosporine is to inhibit T-cell generation in response to
transplant antigens.
31. Mr. Praveen has been diagnosed with gout and wants to know why colchicine
is used in the treatment of gout. Which of the following actions of colchicines
explains why it’s effective for gout?
a. Decreases infection
b. Decreases bone demineralization
c. Replaces estrogen
d. Decreases inflammation
Ans. d. Decreases inflammation

Rationale:
• Gout is a type of arthritis that causes sudden joint inflammation, usually in a single
joint.
• Gout is caused by a condition known as hyperuricemia, where there is too much uric
acid in the body.
• The action of colchicine is to decrease inflammation by reducing the migration of
leukocytes to synovial fluid. Colchicine works by reducing the inflammation caused by
crystals of uric acid in the joints.
• The primary mechanism of action of colchicine is tubulin disruption. This leads to
subsequent down regulation of multiple inflammatory pathways and modulation of
innate immunity.
• Decreasing infection is not a mechanism of action of colchicine.
• Colchicine doesn’t decrease bone demineralization.
• Colchicine does not replace estrogen. The toxic effects of colchicine are related to this
anti-mitotic activity within proliferating tissue such as skin, hair, and bone marrow.
32. Which of the following tests should be performed before beginning a

prescription of Isotretinoin?
a. Obtain a creatinine level
b. Check the calcium level
c. Monitor apical pulse
d. Perform a pregnancy test
Ans. d. Perform a pregnancy test
Rationale:
• Isotretinoin is contraindicated for use by pregnant clients because it causes teratogenic
effects. Isotretinoin was a pregnancy category X drug under the previous FDA system
and is contraindicated in women who are pregnant or who may become pregnant.
There have been severe, documented congenital disabilities when pregnant women
have taken isotretinoin.
• Two negative pregnancy tests are necessary before the initiation of therapy with
isotretinoin. The first pregnancy test occurs up to 30 days prior to medication initiation.
The second pregnancy test must occur at least 19 days after the first negative pregnancy
test and within the first five days of the patient’s menstrual cycle
• Liver function tests (LFTs), fasting lipid profile (including triglycerides), blood glucose,
creatinine phosphokinase (CPK), and complete blood counts (CBC) with differential
should be drawn before initiating therapy with isotretinoin. Screening for mood
alteration, psychosis, aggression, suicidal ideation, skin changes, and visual changes
should also take place prior to starting therapy.
• Calcium levels are unnecessary.
• Apical pulse is not necessary.
33. Dr. Dhiramayee an Anesthesiologist injects the atropine to the preoperative

patient before induction of anesthesia. The nurse caring for this patient
understands that this agent is used to prevent:
a. Anxiety b. Bradycardia
c. Dry mouth d. Hypertension
Ans. b. Bradycardia
Rationale:
• Atropine, an anticholinergic drug, is used as an adjunct to anesthesia to counter the
effects of vagal stimulation, which is caused by surgical manipulations that trigger
parasympathetic reflexes, resulting in bradycardia.
• Atropine is not an anxiolytic.
• Atropine causes dry mouth and sometimes is used to minimize bronchial secretions.
34. Which of the following parameters should be checked before administering

digoxin?
a. Blood pressure
b. Apical pulse
c. Respiratory rate
d. Radial pulse
Ans. b. Apical pulse
Rationale:
• Digoxin is a type of medicine called a cardiac glycoside. It is used to control some heart
problems, such as irregular heartbeats (arrhythmias) including atrial fibrillation. It can
also help to manage the symptoms of heart failure, usually with other medicines.
• The apical pulse is one of eight common arterial pulse sites. It can be found in the left
center of your chest, just below the nipple. This position roughly corresponds to the
lower (pointed) end of your heart.
• Apical pulse is auscultated with a stethoscope over the chest where the heart’s mitral
valve is best heard. In infants and young children, the apical pulse is located at the
fourth intercostal space at the left midclavicular line.
• An apical pulse is essential for accurately assessing the client’s heart rate before
administering digoxin. The apical pulse is the most accurate point in the body.
• Blood pressure is usually only affected if the heart rate is too low, in which case the
nurse would withhold digoxin.
• Digoxin has no effect on respiratory function. Digoxin is used to treat heart failure,
usually along with other medications. It is also used to treat a certain type of irregular
heartbeat (chronic atrial fibrillation).
• The radial pulse can be affected by cardiac and vascular disease and therefore, won’t
always accurately depict the heart rate.
35. Client teaching for the medication depicts in the image; must include
instructions to:
a. Take with food

b. Avoid use of corticosteroid
c. Monitor for adverse effects
d. Practice effective contraception
Ans. d. Practice effective contraception
Rationale:
• Mycophenolate mofetil is a carboxylic ester resulting from the formal condensation
between the carboxylic acid group of mycophenolic acid and the hydroxy group of
2-(morpholin-4-yl) ethanol. In the liver, it is metabolized to mycophenolic acid, an
immunosuppressant for which it is a prodrug.
• Mycophenolate is used in combination with other medications to keep your body from
attacking and rejecting your transplanted organ (such as kidney, liver, heart).
• Effective contraception is essential because of the potential for teratogenic effects.
• It is recommended that the drug be taken on empty stomach.
• The drug is often given with corticosteroid.
• All medication should be monitored for side effects.
COMMUNITY HEALTH NURSING

36. Epidemiological triad includes which of the following factors?
a. Standardized rates
b. Agent, host and environment
c. Rates, ratio and proportion
d. Incidence, prevalence and trends of disease
Ans. b. Agent, host and environment
Rationale:
• Epidemiologic triad or triangle, the traditional model for infectious disease.
• The triad consists of an external agent, a susceptible host, and an environment that
brings the host and agent together.
Figure: Epidemiologic triad

• Agent originally referred to an infectious microorganism or pathogen: a virus,
bacterium, parasite, or other microbe.
• Host refers to the human who can get the disease. A variety of factors intrinsic to
the host, sometimes called risk factors, can influence an individual’s exposure,
susceptibility, or response to a causative agent.
• Environment refers to extrinsic factors that affect the agent and the opportunity for
exposure. Environmental factors include physical factors such as geology and climate,
biologic factors such as insects that transmit the agent, and socioeconomic factors such
as crowding, sanitation.
• In this model, disease results from the interaction between the agent and the susceptible
host in an environment that supports transmission of the agent from a source to that
host.
37. The WHO initiative ‘Right to Sight’ is named as:

a. Vision 2015 b. Vision 2020
c. Vision 2030 d. Vision 2025
Ans. b. Vision 2020
Rationale:
• VISION 2020: The Right to Sight was launched on 18th February 1999 by the World
Health Organization together with the more than 20 international non-governmental
organizations involved in eye care and prevention and management of blindness that
comprise the International Agency for the Prevention of Blindness (IAPB).
• The mission of the VISION 2020 Global Initiative is to eliminate the main causes of all
preventable and treatable blindness as a public health issue by the year 2020.
38. With which of the following, the “Indradhanush scheme” is associated?

a. Immunization b. Sanitation
c. Mid-day meal program d. All of above
Ans. a. Immunization
Rationale:
• The government of India has lunched Mission Indradhanush (MI) on 25th December
2014 as a special drive to vaccinate all unvaccinated and partially vaccinated children
and pregnant women’s by 2020 under the Universal Immunization Program.
• Main aim of Mission Indradhanush: To achieve vaccination coverage of more than
90% by 2020.
39. First observed case from the community for a specific disease is known as:
a. Index case b. Primary case
c. Secondary case d. Tertiary case
Ans. a. Index case
Rationale:
• Index case may indicate the source of the disease, the possible spread, and which
reservoir holds the disease in-between outbreaks. The index case is the first patient that
indicates the existence of an outbreak. It is the first observed case from the community
for a specific disease. It may or may not be the primary case.
• Primary case can only apply to infectious diseases that spread from human to human,
and refers to the person who first brings a disease into a group of people—a school
class, community, or country. It is the first observed case in the community. It may or
may not come to the attention of the investigator.
• Secondary case: These are the subsequent case arising from the primary case within
an incubation period.
40. The coverage of the population by primary health centers (PHC) in plain areas
is:
a. 5,000 b. 20,000
c. 30,000 d. 40,000
Ans. c. 30,000
Rationale:
Table: Population covered and levels of health workers
Health worker Population covered Level
AWW (ICDS) - 4 months training 400 - 800 in plain, 300 - 900 in hill/tribal Village
area
ASHA (NRHM) - 23 days training 1000 Village
Village Health Guide - 200 hours 1000 Village
training in 3 months
Trained Dai 1 in each village Village
USHA (NUHM) 2500 Urban areas
MPW (Male/Female) 5000 [3000 hill/tribal] Sub-Center
Health Assistance [Male/Female] 30000 [20000 hill/tribal] PHC
41. General fertility rate refers to:

a. No. of live births per 1,000 female population
b. No. of live births per 1,000 pregnancies
c. No. of live births per 1,000 females in reproductive age group
d. No. of live births per 1,000 population
Ans. c. No. of live births per 1,000 females in reproductive age group
Rationale:
Table: Terminology for Mortality Rates
Terminology Definition
Birth rate Number of live births per 1,000 total population
Fertility rate Number of live births per 1,000 women ages 15 – 45 years
Fetal mortality rate Number of fetal deaths per 1,000 total births
Neonatal mortality rate Number of neonatal deaths per 1,000 live births
Perinatal mortality rate Number of fetal + neonatal deaths per 1,000 total births
Infant mortality rate Number of infant deaths per 1,000 live births
Maternal mortality ratio Number of maternal deaths per 100,000 live births
42. Method used to transport the vaccine from one place to another is:
a. Cold chain b. Vaccine carrier
c. Deep fridge d. Ice lined refrigerator
Ans. a. Cold chain
Rationale:
• Cold chain is a system of storage and transport of vaccine at low temperature from
manufacturer to the actual vaccination site.
Cold chain Equipment Levels
Walk in cold rooms (WIC)** Regional level
Deep freezers (300 L) and ILRs (300/240 L)* All districts and WIC locations
Small deep freezer and ILR (140 L) set* PHCs, Urban Family Planning Centers and
Postpartum centers
Cold boxes, vaccine carrier, day carrier Outreach centers, Peripheral centers
*Store vaccine for 1 month

**Store vaccines upto 3 months and serve 4 - 5 districts.
43. Isolation of a child with mumps belongs to what level of prevention?

a. Intermediate b. Primary
c. Tertiary d. Secondary
Ans. b. Primary
Rationale:
Table: Level of prevention and Mode of intervention
Level of Mode of Examples
prevention intervention
Primordial Individual and • Discourage adoption of high risk behavior in a
Mass education population where it does not exist. E.g. Smoking,
Drinking in societies where it is not prevalent yet.
Primary Health • Health education
promotion • Environment modification, e.g. Provision of safe water,
sanitary latrines, control of insects and rodents
• Life style and behavioral changes, e.g. Exercise and
medication
• Improvement in overall socioeconomic status of the
population
• Promotion of breastfeeding
• Promotion of small family norms
• Marriage counselling
Specific • Immunization
protection • Chemoprophylaxis
• Nutrition supplement, e.g. IFA, Vitamin A, Iodine
• Avoidance of allergens
• Protection against occupational hazards, accident,
carcinogen
• Control of air pollution, noise control, chlorination of
water
• Use of helmets and seat belts to protect against head
injuries
• Use of mosquito net
• Contraception
Secondary Early diagnosis • Screening (Pap smear, self-breast examination,
mammography)active case search, medical examination
of school children, infants and young children, industrial
workers
Treatment • DOTS
• MDT for leprosy
• Dental filling and tooth extraction
Tertiary Disability • Resting affected limb in neutral position to prevent
limitation stress n paralyzed muscle
• Plaster cast to a patient with colles fracture
• Rest, morphine, oxygen and streptokinase to a patient
of acute MI.
Rehabilitation • School for blind
• Reconstructive surgery
• Arranging for schooling of child suffering from PRPP
• Provision of hearing aids, artificial limb, and calipers
• Restoration of capacity to earn a live hood (Vocational)
• Restoration of family and social relation (Social)
• Restoration of personal dignity and confidence
(Psychological)
44. The time interval between the invasion by an infectious agent and the
appearance of first sign of disease is called:
a. Exacerbation b. Incubation
c. Remission d. Plateau
Ans. b. Incubation
Rationale:
• Incubation: The time interval between invasion by an infectious agent and appearance
of the first sign or symptom of the disease in question. It can only be applied to
infections that result in manifestation of disease.
• Exacerbation may refer to an increase in the severity of a disease or its signs and
symptoms. For example, an exacerbation of asthma might occur as a serious effect of
air pollution, leading to shortness of breath.
• Remission is either the reduction or disappearance of the signs and symptoms of a
disease.
• Plateau: To reach a state or level of little or no growth or decline, especially to stop
increasing or progressing.
45. The Rural Health Scheme was based on the recommendation of which
committee?
a. Shrivastava Committee b. Chadha Committee
c. Kartar Singh Committee d. Jungalwalla Committee
Ans. a. Shrivastava Committee
Rationale:
Shrivastava Committee (1975)

• It is known as Group on Medical Education and Support Manpower.
• Creation of bands of para-professional and semi-professional health workers
from within the community (e.g., school teachers, postmasters) to provide simple,
Promotive, preventive and curative health services - Rural Health Scheme
• 2 cadres of health workers, MHW and HA (Health Assistant) between community
levels and medical officer at PHC
• Develop a ‘Referral Services Complex between PHC and higher level centers
• Medical and Health Education Commission on lines of the UGC.
• Concept of Village Health Guide
• ROME scheme (Reorientation of medical education)
Committee Recommendation
Kartar Singh Committee (1973) • Male and female multipurpose health care workers
• 1 PHC for a population of 50,000 with 16 sub-center each
for 3000 to 3,500 populations.
contd…
Committee Recommendation
Jungalwalla Committee (1967) • Integration of health services with unified cadre and
Committee on integration of common seniority.
Health services • Recognition of extra qualifications.
• Equal pay for equal work and special pay for specialized
work.
• No private practice and good service conditions.
Mudaliar Committee (1962) • Strengthening of district hospital with specialist services
Health Survey and Planning • Regional organizations in each state between headquarters
Committee and district
• Each PHC not to serve more than 40,000 population
• Improve the quality of health care provided by the PHC
• Integration of medical and health services
• Constitution of an All India Health Service on pattern of
IAS.
Bhore Committee (1946) • Comprehensive [Preventive, Promotive Curative] health
Health survey and Development care at PHC level. 1 PHC per 40000 population with 30 beds
Committee • 3 months training in PSM- Social Physicians
• 3 Million Plan(Development of PHC in 2 stages: Short-term
and Long-term)
46. Anganwadi worker is supervised by____________:

a. Mukhyasevika
b. Male health worker
c. Both (a) and (b)
d. None of above
Ans. a. Mukhyasevika
Rationale:
ICDS (Integrated Child Development Services) Scheme

• 1 Anganwadi worker for 1000 population.
• About 100 Anganwadi worker in each ICDS Project.
• Anganwadi worker is a part-time worker selected from the community
• Trained for 4 months in various aspects of health, nutrition, and child development
• Anganwadi worker is supervised by Mukhyasevika.
• She gets an honorarium of 1500 per month for services rendered (i.e. Health check-
up, immunization, supplementary nutrition, health education, non-formal pre-school
education and referral services.
47. The diluent used for reconstitution of BCG vaccine is:

a. Distilled water
b. Dextrose
c. Glycerin
d. Normal saline
Ans. d. Normal saline

Rationale:
• BCG prevents severe form of TB and bladder cancer.
• 0.05 mL BCG dose is given to the child at birth: Because the skin of the newborn is
very thin and intradermal injection with 0.1 mL may break the skin or lead to abscess
formation.
• Currently BCG vaccine is freeze-dried powder and sealed under vacuum in a glass
ampoule. The powder has to be diluted with saline water and injected within hours,
which often incurs errors owing to inappropriate opening of the glass ampoule and
mishandling of the reconstitution.
• BCG given normally till 1 year of age as by 1 year there could be natural acquiring of
the TB immunity or a subclinical infection.
48. All of the following are vector borne diseases, except:

a. Chagas disease b. Malaria
c. Filariasis d. Rubella
Ans. d. Rubella
Rationale:
• Rubella is not a vector borne disease, it is a viral disease.
• The others are vector borne disease:
Ĕ Chagas disease: Trypanosoma cruzi
Ĕ Malaria: Female Anopheles mosquito
Ĕ Filariasis: Culex mosquito (Most common), Anopheles and Aedes mosquitos.
49. Polyvalent vaccines consist of:

a. More strains of the same species
b. A single organism
c. More strains of different species
d. A single species
Ans. a. More strains of the same species
Rationale:
• Polyvalent vaccines: Vaccine prepared from cultures of two or more strains of same
species or microorganism.
• A vaccine containing antigens from multiple serotypes of a pathogen, to induce
immune responses against the broadest range of viruses or bacteria–eg, DTP,
diphtheria, tetanus, and pertussis.
50. All the following are natural contraceptive methods involving abstinence,
except:
a. Observation of cervical mucus b. Calendar method
c. Observation of body temperature d. Diaphragm
Ans. d. Diaphragm
Rationale:
• Natural Method of Contraception: It is the method of planning family without using
any drugs or contraceptives.
PEDIATRIC NURSING
51. An infant with hydrocele is seen in the clinic for a follow-up visit at 1 month of
age. The scrotum is smaller than it was at birth, but fluid is still visible on light.
Which of the following actions is the physician likely to recommend?
a. Referral to a surgeon for repair
b. Massaging the groin area twice a day until the fluid is gone
c. Keeping the infant in a flat, supine position until the fluid is gone
d. No treatment is necessary; the fluid is reabsorbing normally
Ans. d. No treatment is necessary; the fluid is reabsorbing normally
Rationale:
• A hydrocele is a collection of fluid in the scrotum that results from a patent tunica
vaginalis. Illumination of the scrotum with a pocket light demonstrates the clear fluid.
In most cases the fluid reabsorbed within the first few months of life and no treatment
is necessary.
• Surgery is the treatment of choice for hydrocele, and it is warranted when hydrocele
becomes complicated or symptomatic. For congenital hydroceles, herniotomy is
performed, provided they do not resolve spontaneously.
• Congenital hydrocele tends to be intermittent as it usually reduces when lying flat due
to drainage of hydrocele fluid into the peritoneum. However, applying pressure on the
congenital hydrocele does not reduce it.
• Placing the infant in a supine position would have no effect. The majority of patients
with hydrocele present with the complaint of painless scrotal swelling rendering the
testes impalpable with positive transillumination and fluctuation. The examiner should
look at this swelling in both the supine and upright positions.
52. Nurse Nancy is assessing a child with pyloric stenosis; she is likely to note which
of the following?
a. “Currant jelly” stools
b. Regurgitation
c. Steatorrhea
d. Projectile vomiting
Ans. d. Projectile vomiting

Rationale:
Projectile vomiting is a key sign of pyloric stenosis.
Hypertrophic Pyloric Stenosis

• It is the most common surgical disorder of gastrointestinal tract in infants. As the name
suggest this condition occurs due to hypertrophy of circular muscle fibers leading to
thickening and elongation of pylorus with subsequent narrowing of its lumen.
• It is more common in males (four times more than in females) especially common in
the first newborn.
Figure 1: Hypertrophic Pyloric Stenosis

• Clinical Presentation
Ĕ The symptoms usually appear between 2 - 4 weeks of age.
Ĕ Non-bilious, projectile and progressive vomiting immediately after feeding (After
vomiting infant is hungry and wants to eat again).
Ĕ More common after 3 weeks of age (Can be as early as one week or as late as 5
months)
Ĕ A firm olive shaped mass with visible gastric peristalsis is seen in midepigastrium,
especially after feds.
Figure 2: Gastric peristaltic wave in an infant with pyloric stenosis

Ĕ Persistent vomiting leads to Hypochloremic metabolic alkalosis;
Hyperbilirubinemia is the most common clinical association of pyloric stenosis,
also known as icteropyloric syndrome (due to decrease in the glucuronyl
transferase).
Diagnosis
• A careful physical examination reveals a firm, olive sized mass in the epigastrium, to
the right of midline.
• Ultrasound shows pyloric thickness >4 mm and pyloric length >14 mm.
• Barium contrast studies reveal an elongated pyloric channel (string sign), a bulge of
the pyloric muscle into the antrum (shoulder sign, and parallel streaks of barium seen
in the narrowed channel, producing a “double tract sign”.
Figure 3: Double tract sign

• In severely malnourished infants, epigastric distension may be seen and peristaltic
waves may be seen passing from left to right, during and after feed.
• Laboratory Findings: Electrolytes, pH, BUN, and creatinine levels should be obtained
at the same time as intravenous access in patients with pyloric stenosis.
Treatment
• Preoperative treatment: correction of dehydration and metabolic alkalosis.
• IV atropine: The intravenous dose of atropine for treatment of pyloric stenosis ranges
in studies from 0.04 to 0.225 mg/kg/day and is given for 1 – 10 days.
• Oral atropine: Oral atropine (0.08 – 0.45 mg/kg/day) is continued, after IV therapy
has been deemed successful, for 3 weeks to 4 months.
• The surgical procedure of choice is Ramstedt pyloromyotomy
Other Options:
• Regurgitation is seen more commonly with gastroesophageal reflux.
• Steatorrhea is the medical term for fat in stool. Fat in the stool can cause bulky stool
that floats, has an oily or greasy appearance, and smells foul. Fat in the stool is fat
that the digestive tract was unable to absorb. Temporary steatorrhea may result from
dietary changes or intestinal infections. Steatorrhea occurs in malabsorption disorders
such as celiac disease.
• “Currant jelly” stools are characteristic of intussusception.
53. A child was brought to the emergency department with complaints of nausea,
vomiting, and fruity-scented breath. The resident on duty diagnosed the child
with diabetes ketoacidosis. Which of the following should the nurse expect to
administer?
a. Ringer’s Lactate
b. Potassium chloride IV infusion
c. Normal saline IV infusion
d. Dextrose 5% IV infusion
Ans. c. Normal saline IV infusion
Rationale:
• Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body
produces high levels of blood acids called ketones. The condition develops when your
body can’t produce enough insulin.
• The initial priority in the treatment of diabetic ketoacidosis is the restoration of
extracellular fluid volume through the intravenous administration of a normal saline
(0.9 percent sodium chloride) solution.
• Ringer’s Lactate and Dextrose 5% IV infusion; these dextrose solutions will be used
only when the blood glucose level is decreased.
• Potassium chloride IV infusion is not part of the initial treatment.
54. A child is seen in the emergency department for scarlet fever. Which of the
following descriptions of scarlet fever is not correct?
a. Petechiae occur on the soft palate
b. Scarlet fever is caused by infection with group A Streptococcus bacteria
c. The pharynx is red and swollen
d. “Strawberry tongue” is a characteristic sign
Ans. a. Petechiae occur on the soft palate
Rationale:
• Petechiae on the soft palate are characteristic of rubella infection. Postnatal infection
with rubella can be asymptomatic in approximately 25% to 50% of the patients,
especially in young children. The incubation period ranges from 14 to 21 days and is
followed by a prodromal illness characterized by low-grade fever, malaise, anorexia,
headaches, sore throat, and adenopathy.
• Scarlet fever is caused by streptococcal pyrogenic exotoxins (SPEs) types A, B, and C
produced by group A beta-hemolytic streptococci (GABHS) found in secretions and
discharge from the nose, ears, throat, and skin. The causative bacteria is Streptococcus
pyogenes, which generates an endotoxin mainly responsible for the skin manifestation
of the infection.
• Red, edematous, exudative tonsils are typically observed if the infection originates in
this area. Typically, scarlet fever is associated with acute pharyngitis. As a result, fever,
sore throat, pain with swallowing, and cervical adenopathy is present.
Figure: Strawberry Tongue

• On day 1 or 2, the tongue is heavily coated with a white membrane through which
edematous red papillae protrude (classic appearance of white strawberry tongue).
By day 4 or 5, the white membrane sloughs off, revealing a shiny red tongue with
prominent papillae (red strawberry tongue).
55. Baby Jonathan was born with cleft lip (CL); Nurse Barbara would be alert that
which of the following will most likely be compromised?
a. Locomotion b. GI function
c. Respiratory status d. Sucking ability
Ans. d. Sucking ability
Rationale:
• Cleft lip happens if the tissue that makes up the lip does not join completely before
birth. This results in an opening in the upper lip.
• Because of the cleft lip defect, the child will be unable to form mouth adequately
around the nipple, thereby requiring special devices to allow for feeding and sucking
gratification.
Figure: Cleft Lip

• Locomotion would be a problem for older infants because of the use of restraints.
• GI functioning is not compromised in the child with a Cleft lip
• Respiratory status may be compromised if the child is fed improperly during the
postoperative period.
56. Which of the following disorders leads to cyanosis from deoxygenated blood
entering the systemic arterial circulation?
a. Patent ductus arteriosus (PDA) b. Aortic stenosis (AS)
c. Tetralogy of Fallot d. Coarctation of aorta
Ans. c. Tetralogy of Fallot
Rationale:
• Tetralogy of Fallot consists of four major anomalies:
Ĕ Ventricular septal defect,
Ĕ Right ventricular hypertrophy,
Ĕ Pulmonic stenosis (PS),
Ĕ Aorta overriding the ventricular septal defect.
Figure: Tetralogy of Fallot

• PS impedes the flow of blood to the lungs, causing increased pressure in the right
ventricle, forcing deoxygenated blood through the septal defect in the left ventricle.
As a result of this decreased pulmonary flow, deoxygenated blood is shunted into the
systemic circulation. The increased workload on the right ventricle causes hypertrophy.
The overriding aorta receives blood from both the right and left ventricles. This is the
definition of defect with decreased pulmonary blood flow where deoxygenated blood
is shunted into the systemic circulation.
• With PDA, blood flows from the aorta through the PDA and back to the pulmonary
artery and lungs (shunting of oxygenated blood to the pulmonic system), causing
increased pulmonary vascular congestion.
• Coarctation of aorta and AS are obstructive defects where obstruction, not shunting,
is the problem.
57. A child with known hemophilia A was brought to the emergency room with
complaints of nose bleeding and some bruises in the joints. Which of the
following should the nurse anticipate to be given to the child?
a. Factor VIII b. Cyclosporine
c. Factor X d. Oral iron supplement
Ans. a. Factor VIII
Rationale:
• Hemophilia A, also called factor VIII (FVIII) deficiency or classic hemophilia, is a
genetic disorder caused by missing or defective factor VIII, a clotting protein. The
initial treatment is the administration of factor VIII to replace the missing factor and
decrease the bleeding episode.
58. Nicklaus was born with hypospadias; which of the following should be avoided
when a child has such condition?
a. Surgery b. Circumcision
c. Intravenous pyelography (IVP) d. Catheterization
Ans. b. Circumcision
Rationale:
• Hypospadias refers to a condition in which the urethral opening is located below the
glans penis or anywhere along the ventral surface (underside) of the penile shaft. The
ventral foreskin is lacking, and the distal portion gives an appearance of a hood. Early
recognition is important so that circumcision is avoided; the foreskin is used for the
surgical repair.
• Option A: Surgery is the procedure of choice to improve the child’s ability to stand
when urinating, improve the appearance of the penis, and preserve sexual adequacy.
• Option C: IVP is contraindicated if the child has an allergy to iodine or shellfish.
• Option D: Catheterization may be used to ensure urinary elimination.
59. Identify the neural tube defect shown in the image:
a. Rachischisis b. Encephalocele
c. Myelocele d. None of the above
Ans. b. Encephalocele
Rationale:
• The image shows a newborn with encephalocele.
• Encephalocele, sometimes known as cranium bifidum, is a neural tube defect
characterized by sac-like protrusions of the brain and the membranes that cover it
through opening in the skull.
• These defects are caused by failure of the neural tube to close completely during fetal
development.
• Note: if the same lesion occurs in the region of spinal cord, it is referred to as Myelocele.
• Rachischisis refers to cases of anencephaly with a contiguous spinal defect involving
at least the cervical spine region and extending for varying degrees down the spinal
column.
• In Myelocele, the spinal cord is exposed so that nerve tissue lies exposed on the surface
of the back without even a covering of skin or of the meninges, the membranous tissue
surrounding the brain and spinal cord.
60. Aman who was diagnosed with Hirschsprung’s disease has a fever and watery
explosive diarrhea. Which of the following would Nurse Renna do first?
a. Administer an antidiarrheal
b. Nothing (These findings are common in Hirschsprung’s disease.)
c. Monitor the child every 30 minutes
d. Notify the physician immediately
Ans. d. Notify the physician immediately
Rationale:
• Hirschsprung’s (HIRSH-sproongz) disease is a condition that affects the large intestine
(colon) and causes problems with passing stool. The condition is present at birth
(congenital) as a result of missing nerve cells in the muscles of the baby’s colon.
• For the child with Hirschsprung’s disease, fever and explosive diarrhea indicate
enterocolitis, a life-threatening situation. Therefore, the physician should be notified
directly.
• Generally, because of the intestinal obstruction and inadequate propulsive intestinal
movement, antidiarrheals are not used to treat Hirschsprung’s disease.
• The child is acutely ill and requires intervention, with monitoring more frequently
than every 30 minutes.
• Hirschsprung’s disease typically presents with chronic constipation.
61. Nurse Christine is planning a client education program for sickle cell disease
(SCD) in children; which of the following interventions would be included in
the care plan?
a. Administration of an anticoagulant to prevent sickling
b. Health teaching to help reduce sickling crises
c. Observation of the imposed fluid restriction
d. Avoidance of the use of opioids
Ans. b. Health teaching to help reduce sickling crises

Rationale:
• SCD is a group of inherited red blood cell disorders. Healthy red blood cells are round,
and they move through small blood vessels to carry oxygen to all parts of the body.
In someone who has SCD, the red blood cells become hard and sticky and look like a
C-shaped farm tool called a “sickle”.
• Prevention is one of the principal goals of therapeutic management because there is
no cure for sickle cell disease. Consequently, health education to help lessen sickling
crises is key.
• Anticoagulants do not prevent sickling.
• Fluids are encouraged to increase fluid volume and prevent sickling.
• Opioids usually are required for pain control.
62. Spina bifida is one of the possible neural tube defects that can occur during
early embryological development. Which of the following definitions most
accurately describes Meningocele?
a. Complete exposure of spinal cord and meninges
b. Herniation of spinal cord and meninges into a sac
c. Sac formation containing meninges and spinal fluid
d. Spinal cord tumor containing nerve roots
Ans. c. Sac formation containing meninges and spinal fluid
Rationale:
• Meningocele is a sac formation containing meninges and cerebrospinal fluid (CSF).
• Meningocele doesn’t involve complete exposure of the spinal cord and meninges; this
is a massive defect that’s incompatible with life.
• Myelomeningocele is a herniation of the spinal cord, meninges, and CSF into a sac that
protrudes through a defect in the vertebral arch.
• Tumor formation is not associated with this defect.
63. Nurse Priyanka is administering medication via the intraosseous route to a

child. Intraosseous drug administration is typically used when a child is:
a. Under age 3
b. Over age 3
c. Critically ill and under age 3
d. Critically ill and over age 3
Ans. c. Critically ill and under age 3
Rationale:
• In an emergency, intraosseous drug administration is typically used when a child is
critically ill and under age 3.
64. Which of the following disease is associated with this condition?
a. Turner’s syndrome b. Edward syndrome

c. Patu’s syndrome d. Down’s syndrome
Ans. c. Patu’s syndrome
Rationale:
• Trisomy 13, also called Patau syndrome, is a condition in which a person has an
extra chromosome 13 and associated with severe intellectual disability and physical
abnormalities in many parts of the body.
• Down syndrome: A genetic chromosome 21 disorder causing developmental and
intellectual delays. It is a condition in which a person has an extra chromosome.
Chromosomes are small “packages” of genes in the body. They determine how a baby’s
body forms and functions as it grows during pregnancy and after birth. Typically, a
baby is born with 46 chromosomes
• Edwards’s syndrome: A condition that causes severe developmental delays due to an
extra chromosome 18. It is a chromosomal condition associated with abnormalities
in many parts of the body. Individuals with trisomy 18 often have slow growth before
birth (intrauterine growth retardation) and a low birth weight.
• The image depicts Polydactyly; which is feature of Patau syndrome.
• Down syndrome: Clinodactyly (curving of the fingers).
Figure: Clinodactyly
• Edwards syndrome: Flexed digits (or overlapping) and “rocker-bottom” feet.
Figure: “Rocker-bottom” feet
65. Hydrocortisone cream 1% is given to a child with eczema. The nurse gives
instruction to the mother to apply the cream by?
a. Apply a thick layer of the cream to affected areas only
b. Apply a thin layer of cream and spread it into the area thoroughly
c. Apply the cream to other areas to avoid occurrence
d. Avoid cleansing the area before the application
Ans. b. Apply a thin layer of cream and spread it into the area thoroughly
Rationale:
• Eczema is caused by problems with the skin barrier. Many children with eczema do not
have enough of a special protein called “filaggrin” in the outer layer of skin. Filaggrin
helps skin form a strong barrier between the body and the environment. Skin with too
little of this protein has a harder time holding in water and keeping out bacteria and
environmental irritants.
• Children have eczema (also called atopic dermatitis), an ongoing skin problem that
causes dry, red, itchy skin. Children with eczema have more sensitive skin than other
people
• Topical corticosteroids are administered sparingly and rubbed into the area thoroughly.
• Thickly application and rubbing it on other areas will likely lead to systemic absorption.
• The area should be cleaned first before administration.
66. When performing a physical examination on an infant, the nurse in charge

notes abnormally low-set ears. This finding is associated with:
a. Congenital heart defects
b. Otogenous tetanus
c. Renal anomalies
d. Tracheoesophageal fistula
Ans. c. Renal anomalies

Rationale:
• Normally the top of the ear aligns with an imaginary line drawn across the inner and
outer canthus of the eye. Ears set below this line are associated with renal anomalies or
mental retardation.
• Otogenic tetanus is a subtype of cephalic tetanus, usually limited to the muscles and
nerves of the head and neck, but can also progress to a more generalized form. It
usually is the result of tetanus spores gaining entry into the middle ear of otitis media
through a tympanic membrane perforation
• Congenital anomalies of kidney and urinary tract (CAKUT) is a group of abnormalities
affecting the kidneys or other structures of the urinary tract. CAKUT results from
abnormal development of the urinary system and is present from birth (congenital),
although the abnormality may not become apparent until later in life.
• Low-set ears do not accompany otogenous tetanus, tracheoesophageal fistula, or
congenital heart defects.
67. Which of the following is an early clinical manifestation of increased ICP in

older children?
a. Diplopia
b. Macewen’s sign
c. Setting sun sign
d. Papilledema
Ans. a. Diplopia
Rationale:
• Diplopia is seeing two images of an object, also known as double vision. Itis an early
sign of increased ICP in an older child.
• Macewen’s sign: Percussion (tapping) on the skull at a particular spot (near the junction
of the frontal, temporal and parietal bones) yields an unusually resonant sound in the
presence of hydrocephalus or a brain abscess.
• Macewen’s sign (cracked-pot sound) and the setting sun appearance of the eyes are
noted in infants with increased ICP.
• Papilledema is a term that is exclusively used when a disc swelling is secondary to
increased intracranial pressure (ICP). It must be distinguished from optic disc swelling
from other causes which is simply termed “optic disc edema”. Papilledema is a late sign
of increased ICP.
68. The nurse is evaluating a female child with acute post streptococcal
glomerulonephritis for signs of improvement. Which finding typically is the
earliest sign of improvement?
a. Increased energy level
b. Increased urine output
c. Decreased diarrhea
d. Increased appetite
Ans. b. Increased urine output

Rationale:
• Glomerulonephritis is a group of diseases that injure the part of the kidney that filters
blood (called glomeruli). Other terms you may hear used are nephritis and nephrotic
syndrome. When the kidney is injured, it cannot get rid of wastes and extra fluid in
the body.
• The most common presenting symptoms are the classic triad of glomerulonephritis:
gross hematuria, edema, and hypertension
• Increased urine output, a sign of improving kidney function, typically is the first sign
that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving.
• Increased appetite, an increased energy level, and decreased diarrhea are not specific
to APSGN.
69. Estimate the age of the child from the picture shown below:
a. 5 months
b. 7 months
c. 15 months
d. 18 months
Ans. a. 5 months
Rationale:
• The image shows a child enjoying watching his image in the mirror at age of 5 months.
• The child can be seen patting the mirror enjoying his mirror image.
70. A nurse on the newborn nursery floor is caring for a neonate. On assessment
the infant is exhibiting signs of cyanosis, tachypnea, nasal flaring, and grunting.
Respiratory distress syndrome is diagnosed, and the physician prescribes
surfactant replacement therapy. The nurse would prepare to administer this
therapy by:
a. Subcutaneous injection
b. Intravenous injection
c. Instillation of the preparation into the lungs through an endotracheal tube
d. Intramuscular injection
Ans. c. Instillation of the preparation into the lungs through an endotracheal tube
Rationale:
• The aim of therapy in RDS is to support the disease until the disease runs its course
with the subsequent development of surfactant. The infant may benefit from surfactant
replacement therapy.
• In surfactant replacement, an exogenous surfactant preparation is instilled into the
lungs through an endotracheal tube.
MIDWIFERY & OBSTETRICAL NURSING

71. Which of the following maneuver performed for shoulder dystocia?
a. Mc Robert maneuver
b. Rubin maneuver
c. Both a &b
d. Leopold’s maneuvers
Ans. c. Both a & b
Rationale:
• Shoulder dystocia is when, after vaginal delivery of the head, the baby’s anterior
shoulder gets caught above the mother’s pubic bone.
• Maneuver performed for shoulder dystocia:
Ĕ McRoberts maneuver: involves hyperflexing the mother’s legs tightly to her
abdomen. This widens the pelvis, and flattens the spine in the lower back (lumbar
spine).
Ĕ Suprapubic pressure (or Rubin I)
Ĕ Rubin II or posterior pressure on the anterior shoulder
Ĕ Gaskin maneuver
72. Kustner’s sign is an indication of:

a. Pregnancy
b. Placental separation
c. Ectopic pregnancy
d. Intrauterine fetal death
Ans. b. Placental separation
Rationale:
• Kustner’s sign: Sign of placental separation. On pushing the uterus upwards does not
move the cord with it (due to the separation).
• Robert’s sign: Earliest sign of intrauterine fetal death. X-ray shows presence of gas in
the fetal great vessels.
• Interstitial line sign: Interstitial ectopic pregnancy.
• Bishop’s sign: Abdominal ectopic pregnancy.
73. A last trimester pregnant client diagnosis with severe preeclampsia. The nurse
reviews the assessment findings and determines that which finding is most
closely associated with a complication of this diagnosis?
a. Complaints of feeling hot when the room is cool
b. Evidence of bleeding, such as in the gums, petechiae, and purpura
c. Breast enlargement
d. Periods of fetal movement followed by quiet periods.
Ans. b. Evidence of bleeding, such as in the gums, petechiae, and purpura
Rationale:
• Severe preeclampsia can trigger disseminated intravascular coagulation (DIC) because
of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and
should be reported to the health care provider if noted on assessment. Other options
are normal occurrence in the last trimester of pregnancy.
74. A young couple is having difficulty conceiving a child. Their physician at a

reproduction and fertility clinic explains to them that:
a. Erection of the penis is a sympathetic response
b. Fertilization occurs in the infundibulum or ampulla of the uterine tube
c. The glans clitoris is formed from the corpus spongiosum
d. Ejaculation follows parasympathetic stimulation
Ans. b. Fertilization occurs in the infundibulum or ampulla of the uterine tube
Rationale:
• Fertilization takes place in the infundibulum or ampulla of the uterine tube.
Fertilization is the process beginning with penetration of the secondary oocyte by the
sperm and completed by fusion of the male and female pronuclei.
• Erection of the penis is caused by parasympathetic stimulation.
• The glans clitoris is derived from the corpora cavernosa.
• Ejaculation is mediated via the sympathetic nerve.
75. Identify the placental removal technique shown in the image:
a. Manual removal b. Cord traction by doctor

c. Expulsion of placenta by fundal pressure
d. Cesarean session
Ans. c. Expulsion of placenta by fundal pressure

Rationale:
• Fundal pressure (Crede manoeuvre) involves placing one hand on the top of the
uterus (uterine fundus) and squeezing it between the thumb and other fingers to help
placental separation and delivery.
• Controlled cord traction involves traction on the umbilical cord while maintaining
counter-pressure upwards by placing a hand on the lower abdomen. Also, controlled
cord traction should only follow signs of placental separation. Both these interventions,
if not performed correctly, may have adverse outcomes including pain, hemorrhage
and inversion of the uterus.
Indications for use of Manual Removal Procedures

• The decision to attempt manual removal of the placenta and membranes in an
otherwise normal labor and birth should be based on one of two indications:
• The sudden occurrence of hemorrhage but the placenta gives no indication of
delivering. This may mean that at least partial separation has occurred. A portion of
the placenta may have remained adhered to the wall of the uterus.
• Hemorrhage after the birth of the placenta and examination of the placenta also shows
evidence of missing placental fragments, membranes or a cotyledon. This indicates the
probability of retained tissue within the uterus.
Figure: Manual Removal Procedures

• Both of these events result in interference with the normal contraction of the uterus
which usually enables the myofibrils of the uterine muscles to close off the small blood
vessels and control bleeding. Removing the placenta and/or retained placental tissue
and membranes is the critical first step to enable the uterus to contract effectively and
stop the hemorrhage.
• Preparation:
Ĕ Quickly draw a sterile glove over your existing glove on your dominant hand. One
size larger than the gloves you are wearing may be put on more rapidly.
Ĕ Fold a sterile towel on the mother’s abdomen with the opening facing you. Place
your non-dominant hand between the folds of the towel and grasp the uterus
through the abdominal wall. The side of your hand should be around the fundus
and your thumb just above the symphysis pubis.
Ĕ Draw the uterus downward and continue to hold it stable with your hand.
• Extraction of the placental tissue and membranes within the uterus: Make a cone
with your dominant hand by holding the tips of your fingers and thumb together. Enter
the vagina and gently push against the cervix to open it further, as you go into the lower
portion of the uterus.
76. Which of the following is the most likely diagnosis in a 27-year-old obese
woman presenting with Oligomenorrhea, infertility and hirsutism?
a. Polycystic ovaries
b. Endometriosis
c. Pelvic inflammatory disease
d. Turner’s syndrome
Ans. a. Polycystic ovary
Rationale:
• A young woman presenting in the third decade with obesity, Oligomenorrhea,
infertility and hirsutism leaves no doubt for the diagnosis of PCOS.
• According to Rotterdam criteria → PCOD is diagnosed if any 2 of the following
criteria are being fulfilled:
Ĕ Ovulatory dysfunction such as oligomernorhea or hyperandrogenism.
Ĕ Clinical or biochemical evidence of hyperandrogenism.
Ĕ USG criteria
• Since this female, has Oligomenorrhea and hirsutism, so 2 of the criteria are being
fulfilled.
77. The vaccine that is contraindicated in pregnancy is_________:

a. MMR
b. Varicella zoster
c. Both (a) and (b)
d. TT
Ans. c. Both (a) and (b
Rationale:
• Live attenuated bacterial vaccines are contraindicated in pregnancy.
Table: Vaccine contraindicate in Pregnancy
Vaccine Use in pregnant women
Influenza (LAIV) Contraindicated
MMR Contraindicated
Varicella Contraindicated
Zoster Contraindicated
Contd…
Vaccine Use in pregnant women

BCG Contraindicated
Rotavirus Contraindicated
Japanese encephalitis (Imojev) Contraindicated

Oral typhoid Contraindicated
Human Papillomavirus (HPV) Not recommended
Yellow fever Not recommended
Smallpox Pre-exposure — contraindicated.
Post-exposure — recommended.
Anthrax Low risk of exposure — not recommended. High risk of
exposure — may be used.
dT (diphtheria-tetanus) Not routinely recommended. Pregnant women can
receive dT vaccine under certain circumstances, such
as to manage a tetanus-prone wound.
Cholera (oral) Not routinely recommended
Hib (Haemophilus influenzae type b) Not routinely recommended.
Pregnant women can receive Hib vaccine if they are at
increased risk of Hib disease (eg women with asplenia).
Meningococcal B Not routinely recommended
13vPCV (13-valent pneumococcal Not routinely recommended
conjugate)
23vPPV (23-valent pneumococcal Not routinely recommended
polysaccharide)
Q fever Not routinely recommended
Hepatitis A and Hepatitis B Not routinely recommended
Rabies Pregnant women can receive rabies vaccine if required,
such as for post-exposure prophylaxis.
dTpa (diphtheria-tetanus-acellular Recommended. A single dose between mid-2nd
pertussis) trimester and early 3rd trimester of each pregnancy
(ideally at 20–32 weeks)
Influenza (Inactivated). Recommended for all pregnant women at any stage of
pregnancy, particularly those who will be in the 2nd or
3rd trimester during the influenza season
78. The characteristics of lochia rubra is:

a. Foul odor
b. Pink/brown with flesh odor
c. Bloody with fishy odor
d. Yellow-white
Ans. c. Bloody with fishy odor

Rationale:
Lochia
• It is the vaginal discharge for the first fortnight during puerperium
• The discharge originates from the uterine body, cervix and vagina.
• It has got a peculiar offensive fishy smell.
• Its reaction is alkaline tending to become acid towards the end.
• Depending upon the variation of the color of the discharge, it is named as:
Name Color Timing after Content
delivery
Lochia Rubra Red First few days Blood, decidua, fetal membranes, vernix,
lanugo, meconium
Lochia Serosa Yellowish/Pink After 3/4 days WBC, cervical mucus, microorganisms
Lochia Alba Pale white After 10th day Decidua cells, WBC, mucin, cholesterol
crystals and fat cells
• The correct order of appearance of lochia is: Rubra → Serosa → Alba
• The average amount of discharge for the first week is 250 mL.
• The normal duration may extend up to 24 – 36 days. The red lochia may persist for
longer duration especially in women who get up from the bed for the first time in later
period.
79. Rh-negative mother should receive _______ globulin:

a. RhO (M) globulin
b. RhO (D) immune
c. Lecithin/Sphingomyelin
d. Acetylcholinesterase
Ans. b. RhO (D) immune
Rationale:
• Rh incompatibility is a condition that occurs during pregnancy if a woman has Rh-
negative blood and her baby has Rh-positive blood. “Rh-negative” and “Rh-positive”
refer to whether your blood has Rh factor. Rh factor is a protein on red blood cells.
• Rh anti D immunoglobulin (IgG) is given to unimmunized Rh negative mothers with
Rh positive fetus to prevent active immunization and formation of antibodies against
fetal RBC’s.
• Anti-D immune globulin (RhoGAM) given to an Rh (D-) woman whose fetus is or
may be Rh (D+) whenever there is a risk of fetomaternal hemorrhage. 60% of Rh-
negative women will have an Rh-positive fetus.
• If the fetus of an Rh-negative woman itself is Rh negative, Rh sensitization will not
occur.
• RhD antigen is expressed only on primate erythrocytes and it is evident by 38 days of
intrauterine life.
80. The diameter that is being assessed in the given image is:
a. Obstetrical conjugate
b. Anatomical conjugate
c. True conjugate
d. Diagonal conjugate
Ans. d. Diagonal conjugate
Rationale:
Normal Female Pelvis

• The female pelvis provides the basic framework of the birth canal.
• Composed of:
Ĕ Paired innominate bones: ilium, ischium, pubis (fuse in adolescence) —> join
anteriorly (symphysis pubis)
Ĕ Sacrum: 5 - 6 fused vertebrae (join with innominate bones via sacroiliac joints)
• The obstetric pelvis is divided into false and true pelvis by the pelvic brim or inlet.
• Divided into (by linea terminalis)
Figure: Bony pelvis

Ĕ Greater pelvis (false) → distributes weight of abdominal organs and gravid uterus
(see Figure, orange). It is formed by iliac portio of innominate bones. Shallow
portion above the pelvic brim. Its only function is to support enlarged uterus
during pregnancy.
Ĕ Lesser pelvis (true) → contains pelvic viscera (see Figure, purple). It is shallow in
front, formed by symphysis pubis, deep posteriorly formed by sacrum and coccyx.
It consists of inlet, cavity and outlet.
Pelvic diameter: Important measurements in obstetrics
Figure: Clinical pelvimetry

• Pelvic inlet
Ĕ Obstetric conjugate: should be 10 to 10.5 cm:
Narrowest fixed distance that fetal head passes through during birth
Cannot measure directly on pelvic exam
Obstetric conjugate normally measures 10 cm or more.
The pelvic inlet is considered to be contracted, if obstetric conjugate is less
than 10 cm.
Ĕ Diagonal conjugate: 12.5 cm
Used as surrogate measure for above (obstetric conjugate)
Distance between lower border of pubis and sacral promontory (at level of
ischial spines)
Must be > 11.5 cm to accommodate fetal head
• Transverse Diameter of Pelvic Inlet (13 to 13.5 cm)
Ĕ It is the distance between the farthest two points on the iliopectineal line. It is the
largest diameter of the pelvic inlet and lies 4 cm anterior to the promontory and 7
cm behind the symphysis.
• Midpelvis
Ĕ Interspinous diameter: distance between ischial spines
Ĕ Should be > 10 cm
• True conjugate or anatomical conjugate (11 cm): This is measured from the midpoint
of sacral promontory to the upper border of pubic symphysis.
• Oblique Diameters of Pelvic Inlet: There are two oblique diameters, right and left (12
cm). The right oblique diameter passes from right sacroiliac joint to the left iliopubic
eminence, whereas the left diameter passes from left sacroiliac joint to the right
iliopubic eminence.
81. A nurse teaches a pregnant client to perform Kegel exercises. Which statement
by the client indicates an understanding of the purpose of these types of
exercises?
a. The exercises will help prevent edema
b. The exercises will help strengthen the pelvic floor in preparation for delivery
c. The exercises will help reduce uterine contraction
d. The exercises will help prevent urinary tenderness
Ans. b. The exercises will help strengthen the pelvic floor in preparation for delivery
Rationale:
• The aim of Kegel exercises is to improve muscle tone by strengthening the
pubococcygeus muscles of the pelvic floor.
• Kegel exercises are good for treating vaginal prolapse, preventing uterine prolapse and
to aid with child birth in females.
• Kegel’s exercises: Time for initiating Kegel’s exercise:
Ĕ Pregnancy 1st trimester
Ĕ After vaginal delivery after 24 hours
Ĕ After cesarean section after 24 hours.
• Thus, in version 1-answer to the question is 24 hrs after delivery and in version 2 -
answer is 3rd trimester of pregnancy
• Limitations of Kegel’s exercises: Kegel’s exercise has a limited effect as it affects mainly
voluntary muscles viz. bulbocavernous, levator ani, and superficial and deep transverse
perineal muscles and not the main fascial supporting tissues.
82. Which of the following clinical presentation would a nurse expect while
assessing a patient with abruptio placenta?
a. Rigid, board-like abdomen
b. Edema in legs
c. Excessive vaginal bleeding
d. Premature rupture of membranes
Ans. c. Excessive vaginal bleeding
Rationale:
• Abruptio placenta is defined as hemorrhage occurring in pregnancy due to the
separation of a normally situated placenta. It is also called accidental hemorrhage or
premature separation of placenta.
• Premature rupture of membranes is one of the risk factor for abruptio placenta
• Symptoms
Ĕ Severe and constant abdominal pain (more in the concealed and less in the revealed
types).
Ĕ Bleeding is present in the revealed and mixed types, but may be absent in the
concealed type.
• Signs:
Ĕ Pallor, which is usually out of proportion to the extent of bleeding
Ĕ Hypertension (if there is associated pre-eclampsia)
Ĕ The uterus will be larger than expected for the period of amenorrhea
Ĕ Uterus may be tense and tender and even rigid (woody hard)
Ĕ Difficulty in palpating the underlying fetal parts easily
Ĕ Fetal distress or absent fetal heart sound
83. The nurse is preparing for a women health fair. Which of the following is correct
when teaching patients about the risk and benefits of hormone replacement
therapy (HRT)?
a. HRT is related to an increased risk for osteoporosis related to bone fracture
b. HRT is related to a decreased risk of deep vein thrombosis (DVT).
c. HRT is related to decreased risk of breast cancer
d. HRT is related to an increased risk for coronary artery disease (CAD)
Ans. d. HRT is related to an increased risk for coronary artery disease
Rationale:
• Risk of coronary heart disease does not decrease by giving HRT but rather risk
increases after giving HRT.
• Coronary artery disease (CAD/CHD) is the leading cause of death among
postmenopausal women.
• Hormone replacement therapy (HRT): Progestins are combined with estrogen as an
HRT for post-menopausal woman where uterus is present. Can be used cyclically or
continuously.
• Absolute contraindications to HRT – ABCD
Ĕ A = Acute liver disease or current gallbladder disease
Ĕ B = Undiagnosed vaginal Bleeding
Ĕ C = Cancer (breast/uterine)
Ĕ D = DVT (thromboembolic disease) or its history
Table: Potential Benefits and Harms of HRT
Benefits Uncertain risks Definite risk
• Hip fracture • Thromboembolic events • Coronary heart disease
• Wrist fracture (use of E + P not with E • Breast cancer (use of E + P
• Vertebral fracture (i.e. alone) not with E alone)
osteoporosis) • Dementia • Stroke
• Symptoms of menopause • Endometrial cancer (use of • Ovarian cancer (E + P)
E alone) • Cholecystitis
84. Bleeding in the first trimester with no uterine contraction or pain and no
dilation of cervix indicates:
a. Threatened abortion
b. Complete abortion
c. Inevitable abortion
d. Missed abortion
Ans. a. Threatened abortion
Rationale:
Threatened Miscarriage
• It is a clinical entity where the process of abortion has started but has not progressed to
a state from which recovery is impossible.
• Uterine bleeding before 20 weeks with a closed cervical os and a confirmed viable
intrauterine gestation.
• Size of uterus: Corresponds
• Vaginal spotting or heavier bleeding occurs in 20 – 25% of pregnant women and may
persist for days or weeks.
• Normal cardiac activity
• Bleeding is painless. There may be mild backache or dull pain lower abdomen usually
following hemorrhage.
• Fetuses that do not miscarry remain at increased risk for preterm delivery, low birth
weight, and perinatal death.
Table: Types of spontaneous abortion (SAB)
Type Symptoms/Signs Diagnosis Treatment
Complete • Bleeding and cramping • Closed os. None
stopped. • Ultrasonography shows
• POC expelled. no POC.
Threatened • Uterine bleeding ± Closed os + intact Pelvic rest for 24 – 48
abdominal pain (often membranes + fetal hours and follow up
painless). cardiac motion on ultrasonography to
• No POC expulsion. ultrasonography. assess the viability of
conceptus.
Incomplete • Partial POC expulsion; • Open os. Manual uterine
bleeding/ mild • POC present on aspiration (MUA)
cramping. ultrasonography. if < 12 weeks or
• Visible tissue on exam. D&C; may also
use misoprostol
or expectant
management in
inevitable and missed
SABs.
Inevitable • Uterine bleeding and • Open os ± ROM.
cramps. • POC present on
• No POC expulsion. ultrasonography.
Contd…
Type Symptoms/Signs Diagnosis Treatment

Missed • Cramping, loss of early • Closed os.
pregnancy symptoms. • No fetal cardiac activity;
• No bleeding. POC present on
ultrasonography
Septic • Foul-smelling discharge, • Hypotension, MUA or D&C and IV
abdominal pain, fever, hypothermia, ↑ WBC antibiotics.
and cervical motion count.
tenderness; ± POC • Blood cultures.
expulsion.
• Maternal mortality is
10 – 15%.
Intrauterine Absence of fetal cardiac Uterus small for GA; Induce labor;
fetal demise activity > 20 weeks GA. no fetal heart tones evacuate the uterus
or movement on (D&E) to prevent DIC
ultrasonography. at GA > 16 weeks.
85. The instrument shown in the given image is related to:
a. Suction evacuation
b. Manual vacuum aspiration
c. Menstruation regulation
d. Hysterosalpingography
Ans. c. Menstruation regulation
Rationale:
• The above image shows a Karman cannula attached to a syringe, which is mainly
used for menstrual regulation.
• Menstrual regulation is the aspiration of the endometrial cavity within 3 weeks of a
missed period in women with previous normal cycles.
• Procedure:
Ĕ The cervix may be gently dilated using 4 - 5 mm size dilator.
Ĕ A 5 - 6 mm Karman Cannula is then inserted and attached to a 50 mL syringe for
suction.
Ĕ The cannula is rotated and pushed in and out with gentle strokes.
Figure 1: Menstrual Regulation Equipment

• The procedure is contraindicated in advanced pregnancy and in the presence of
local pelvic inflammation. There is a risk of continuation of pregnancy and ectopic
pregnancy.
Manual Vacuum Aspiration
Figure 2: Manual Vacuum Aspiration Syringe

• This procedure is similar to menstrual aspiration, but it is used for early pregnancy
failures or elective termination for up to 12 weeks.
86. Amniotic fluid is mainly produced by:

a. Placenta b. Fetus
c. Chorion d. Amnion
Ans. b. Fetus
Rationale:
• The precise origin of the amniotic fluid remains is still not well understood. It is
probably of mixed maternal and fetal origin.” – As per Dutta Obs.
• But this cannot help us to solve this question. Let’s see what Williams Obs. has to say
on Origin of Amniotic fluid.
• In early pregnancy, amniotic fluid is an ultrafiltrate of maternal plasma. By the
beginning of second trimester, it consists largely of extracellular fluid which diffuses
through the fetal skin, and thus reflects the composition of fetal plasma.
• After 20 weeks, however, the cornification of fetal skin prevents this diffusion and
amniotic fluid is composed largely of fetal urine.” —Williams Obs.
• Reading the above text, it can be concluded that in early pregnancy - Mother is the
main contributor whereas during rest of the pregnancy - Fetus is the main contributor
87. Emergency contraception is required in:

a. Unprotected sex
b. Partner not willing to use any contraceptive
c. Contraception failure
d. In emergency, where sexual intercourse is done in camps in emergency like floods
1. If a, b, c are correct 2. If a and c are correct
3. If b and d are correct 4. If all four (a, b, c, & d) are correct
Ans. 2. If a and c are correct
Rationale:
• Emergency contraception: It is an important option for patients and should be
considered when condom break, sexual assault occurs, if diaphragms or cervical caps
dislodge or with the lapsed use of any method.
• Indications for emergency contraception:
Ĕ Unprotected intercourse
Ĕ Condom rupture (Contraception failure)
Ĕ Missed pill (Contraception failure)
Ĕ Sexual assault/teenage assault
Ĕ Rape
88. _______ is the term used to describe the insufficient amount of amniotic fluid:
a. Polyhydramnios b. Hyperemesis
c. Oliguria d. Oligohydramnios
Ans. d. Oligohydramnios
Rationale:
• Oligohydramnios is a condition where liquor amnii is deficient (< 200 mL at term).
Incidence: This is 5 – 8% of all pregnancies.
• Polyhydramnios is a condition where liquor amnii is in excessive amount i.e., > 2 liters.
But since quantitative assessment of liquor amnii is impractical. Incidence: This is 0.5
– 1.5% of all pregnancies.
89. An 8-year-old baby present with fever, cough and confluent rash on hairlines,
face, neck and body. Which of the following is a causative agent?
a. Rubella
b. Varicella
c. Rubeola
d. Variola
Ans. c. Rubeola
Rationale:
• The clinical presentation given is of measles (Aka Rubeola) and is characterized by rash
on face, neck and spreading to rest of the body.
• Chicken pox rash appears on extremities and is maculo-papulo-vesicular. The rash is
red but has vesicles which are not given in the clinical presentation above.
• Rubella presents as measles but has posterior cervical lymphadenopathy.
• Variola is the small pox virus and the vaccine for small pox is made from a virus called
vaccinia.
90. What does the below image indicate?
a. Abruptio placenta b. Placenta accreta

c. Placenta increta d. Placenta percreta
Ans. d. Placenta percreta
Rationale:
• The above image shows the placenta villi penetrating through the myometrium and
getting attached to the serosa. Hence, this is known as placenta percreta.
• Placenta Accrete Syndromes includes any placental implantation with abnormally
firm adherence to myometrium because of the partial or total absence of the decidua
basalis and imperfect development of the fibrinoid.
Ĕ The increased risk conveyed by previous uterine trauma (Ex-Cesarean delivery)
may be partially explained by increased vulnerability of the decidua to trophoblast
invasion following incision into the decidua.
Ĕ Microscopically, placenta villi are anchored to muscle fibers rather than to decidual
cells. Decidual deficiency then prevents normal placental separation after delivery.
Ĕ Variants of placenta accreta syndrome are classified by the depth of trophoblastic
growth:
Types Definition
Placenta accreta Villi are attached to the myometrium
Placenta increta Villi invade the myometrium
Placenta percreta Villi penetrate through the myometrium and to or through the serosa
Ĕ In case of first-and second-trimester accrete syndrome, there is usually hemorrhage
that is consequence of coexisting placenta previa.
Figure: Placenta accreta spectrum
MEDICAL SURGICAL NURSING

91. The nurse is instructing a male client on the proper use of crutches for an ankle
injury. He will be required to be non-weight bearing for 4 – 6 weeks. Which of
the following crutch gaits should the nurse teach this client for safe ambulation?
a. The two-point gait
b. The three-point gait
c. The four-point gait
d. None, there is no special gait for crutch training
Ans. b. The three-point gait
Rationale:
• The three-point gait is the safest to use when one leg is injured. Both crutches and the
injured leg move forward, followed by swinging the stronger lower extremity as the rest
of the body weight is placed on the crutches.
• Option A: The two-point gait is an advanced four-point gait and allows for faster
ambulation with minimal support.
• Option C: The four-point gait is used as a slow and stable gait for those who can bear
weight on each leg.
• Option D: Gait training is part of client education when crutches or adaptive equipment
is used for ambulation.
92. A client with pyrexia will most likely demonstrate:

a. Dyspnea
b. Increased pulse rate
c. Elevated blood pressure
d. Precordial pain
Ans. b. Increased pulse rate
Rationale:
• The pulse increases to meet increased tissue demand for oxygen in the febrile state.
• Fever may not cause difficulty in breathing.
• Pain is not related to fever.
• Blood pressure in not necessarily elevated in fever.
93. In which of the following types of cardiomyopathy does cardiac output remain
normal?
a. Dilated
b. Hypertrophic
c. Obliterative
d. Restrictive
Ans. b. Hypertrophic
Rationale:
• Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the
ventricle remains relatively unchanged.
• Dilated cardiomyopathy, obliterative cardiomyopathy, and restrictive cardiomyopathy
all decrease cardiac output.
94. Identify the equipment given in the image:
a. Nasopharyngeal airway
b. Guedel airway
c. Tracheostomy tube
d. Tongue depressor
Ans. b. Guedel airway

Rationale:
• An oropharyngeal airway (also known as an oral airway, OPA or Guedel airway) is a
medical device, which lifts the tongue and prevents it from obstructing the airway. It
is rigid intraoral devise that confines tongue and displaces it away from the posterior
pharyngeal wall, thereby restoring patency.
• There are various sizes of airways available to insert. Right size is chosen by measuring
from center or angle of mouth to angle of mandible.
Figure 1: Oropharyngeal Airway Insertion

• Insertion: The OPA is inserted in the patient’s mouth upside down so the tip of the
device faces the roof of the patient’s mouth. As the airway is inserted. It is rotated at
180° until flange comes to rest on the patient’s lip or teeth.
Oropharyngeal Airway (Guedel Oropharyngeal Airway)

Figure 2: Guedel Oropharyngeal Airway
Indications
• Bilateral choanal atresia
• In condition where there is tendency of tongue fall back
• Persistent seizure
• Status epilepticus.
95. A patient is admitted to the hospital with a diagnosis of primary

hyperparathyroidism. A nurse checking the patient’s lab results would expect
which of the following changes in laboratory findings?
a. Elevated serum calcium
b. Low serum parathyroid hormone (PTH)
c. Elevated serum vitamin D
d. Low urine calcium
Ans. a. Elevated serum calcium
Rationale:
• The parathyroid glands regulate the calcium level in the blood.
• In hyperparathyroidism, the serum calcium level will be elevated.
• Parathyroid hormone levels may be high or normal but not low.
• The body will lower the level of vitamin D in an attempt to lower calcium.
• Urine calcium may be elevated, with calcium spilling over from elevated serum levels.
This may cause renal stones.
96. The nurse working in an outpatient clinic has the opportunity to teach an
insulin-dependent client. Which of the following topics would be MOST
appropriate for the nurse to include when teaching personal hygiene?
a. Oral care is not a top priority.
b. Hair care is the most important part of personal hygiene for the diabetic client.
c. It is most important to keep skin clean and dry, especially the feet.
d. Personal hygiene is not included in diabetic teaching because it is an individual choice.
Ans. c. It is most important to keep skin clean and dry, especially the feet
Rationale:
• Skin care is essential to prevent infection and skin breakdown. This is especially true
for the feet, where a client may not see or feel problem areas.
• Oral care is an important part of diabetic hygiene to prevent cavities and infections.
• Hair care is not the most important part of personal hygiene, although it is important
for self-esteem.
• Personal hygiene is definitely a part of self-care teaching for an insulin-dependent
client.
97. A patient with Addison’s disease asks a nurse for nutrition and diet advice.
Which of the following diet modifications is NOT recommended?
a. A diet high in grains
b. A diet with adequate caloric intake
c. A high protein diet
d. A restricted sodium diet
Ans. d. A restricted sodium diet
Rationale:
• A patient with Addison’s disease requires normal dietary sodium to prevent excess
fluid loss.
• Adequate caloric intake is recommended with a diet high in protein and complex
carbohydrates, including grains.
98. Which of the following positions would best aid breathing for a patient with
acute pulmonary edema?
a. Lying flat in bed
b. Left side-lying position
c. High Fowler’s position
d. Semi-Fowler’s position
Ans. c. High Fowler’s position
Rationale:
• The High Fowler’s position is a position in which a patient, typically in a hospital, is
placed when the head of the bed needs to be elevated as high as possible. The upper
half of the patient’s body is between 60 degrees and 90 degrees in relation to the lower
half of their body.
• High Fowler’s position facilitates breathing by reducing venous return.

• Lying flat and side-lying positions worsen breathing and increase the heart’s workload.
99. Identify the image given below:
a. IV fluid bag
b. Enteral feeding bag
c. Peritoneal dialysis bag
d. Enema bag
Ans. a. Enteral feeding bag
Rationale:
• Enteral Feeding pump sets are bags that are designed to be used with feeding pumps.
Some feeding bags do not require an enteral feeding pump to be used and these are
gravity feeding bags.
• These feeding bags come with or without Spike Sets and in either 500 or 1000 mL.
100. A nurse assigned to the emergency department evaluates a patient who

underwent fiberoptic colonoscopy 18 hours previously. The patient reports
increasing abdominal pain, fever, and chills. Which of the following conditions
poses the most immediate concern?
a. Bowel perforation b. Viral gastroenteritis
c. Colon cancer d. Diverticulitis
Ans. a. Bowel perforation
Rationale:
• Bowel perforation is the most serious complication of fiberoptic colonoscopy.
• Important signs include progressive abdominal pain, fever, chills, and tachycardia,
which indicate advancing peritonitis.
• Viral gastroenteritis and colon cancer do not cause these symptoms. Diverticulitis may
cause pain, fever, and chills, but is far less serious than perforation and peritonitis.
101. A client recently started on hemodialysis wants to know how the dialysis will
take the place of his kidneys. The nurse’s response is based on the knowledge
that hemodialysis works by:
a. Passing water through a dialyzing membrane
b. Eliminating plasma proteins from the blood
c. Lowering the pH by removing nonvolatile acids
d. Filtering waste through a dialyzing membrane
Ans. d. Filtering waste through a dialyzing membrane
Rationale:
• Hemodialysis works by using a dialyzing membrane to filter waste that has accumulated
in the blood.
• It does not pass water through a dialyzing membrane nor does it eliminate plasma
proteins or lower the pH, so options A, B, and C are incorrect.
102. A nurse caring for several patients on the cardiac unit is told that one is
scheduled for implantation of an automatic internal cardioverter-defibrillator.
Which of the following patients is most likely to have this procedure?
a. A patient admitted for myocardial infarction without cardiac muscle damage
b. A post-operative coronary bypass patient, recovering on schedule
c. A patient with a history of ventricular tachycardia and syncopal episodes
d. A patient with a history of atrial tachycardia and fatigue
Ans. c. A patient with a history of ventricular tachycardia and syncopal episodes
Rationale:
• An automatic internal cardioverter-defibrillator delivers an electric shock to the heart
to terminate episodes of ventricular tachycardia and ventricular fibrillation.
• This is necessary in a patient with significant ventricular symptoms, such as tachycardia
resulting in syncope.
• A patient with myocardial infarction that resolved with no permanent cardiac damage
would not be a candidate.
• A patient recovering well from coronary bypass would not need the device.
• Atrial tachycardia is less serious and is treated conservatively with medication and
cardioversion as a last resort.
103. A 16-year-old patient involved in a motor vehicle accident arrives in the ED

unconscious and severely hypotensive. He’s suspected to have several fractures
of his pelvis and legs. Which of the following parenteral fluids is the best choice
for his current condition?
a. Fresh frozen plasma
b. 0.9% sodium chloride solution
c. Lactated Ringer’s solution
d. Packed red blood cells
Ans. d. Packed red blood cells

Rationale:
• In a trauma situation, the first blood product given is unmatched (O negative) packed
red blood cells.
• Fresh frozen plasma often is used to replace clotting factors.
• Lactated Ringer’s solution or 0.9% sodium chloride is used to increase volume and
blood pressure, but too much of these crystalloids will dilute the blood and won’t
improve oxygen-carrying capacity.
104. Identify the size of scalpel blade in the following image:
a. 10 b. 11
c. 12 d. 13
Ans. b. 11
Rationale:
• Identification of the blade:
Size 10 It has a large curved cutting edge is one of the more traditional blade shapes
Size 11 It is an elongated, triangular blade sharpened along the hypotenuse edge. It has a
pointed tip making it ideal for stab incisions and precise short cuts in shallow recessed
areas.
Size 12 Small, pointed crescent-shaped blade sharpened along the inside edge of the curve
Size 15 It has a small, curved cutting edge ideal for making short, precise incisions
Size 20 A large curved blade commonly used for cutting tissue and other procedures that
require a puncture or cut.
Size 22 It is a larger version of the number 10 blade with a curved cutting edge and a flat,
unsharpened back edge.
Size 23 Similar to size 22, leaf-shaped. It also has a pointier tip.
Size 24 A wide, flat, angled cutting edge
105. A patient comes to the emergency department with abdominal pain. Work-up
reveals the presence of a rapidly enlarging abdominal aortic aneurysm. Which
of the following actions should the nurse expect?
a. The patient will be admitted to the medicine unit for observation and medication
b. The patient will be admitted to the day surgery unit for sclerotherapy
c. The patient will be admitted to the surgical unit and resection will be scheduled
d. The patient will be discharged home to follow-up with his cardiologist in 24 hours
Ans. c. The patient will be admitted to the surgical unit and resection will be scheduled
Rationale:
• A rapidly enlarging abdominal aortic aneurysm is at significant risk of rupture and
should be resected as soon as possible.
• No other appropriate treatment options currently exist.
106. A client hospitalized with MRSA (methicillin-resistant staph aureus) is placed

on contact precautions. Which statement is true regarding precautions for
infections spread by contact?
a. The client should be placed in a room with negative pressure
b. Infection requires close contact; therefore, the door may remain open
c. Transmission is highly likely, so the client should wear a mask at all times
d. Infection requires skin-to-skin contact and is prevented by hand washing, gloves, and a
gown
Ans. d. Infection requires skin-to-skin contact and is prevented by hand washing, gloves, and
a gown
Rationale:
• The client with MRSA should be placed in isolation.
• Gloves, a gown, and a mask should be used when caring for the client and hand
washing is very important. The door should remain closed, but a negative-pressure
room is not necessary, so Option A & B are incorrect.
• MRSA is spread by contact with blood or body fluid or by touching the skin of the client.
It is cultured from the nasal passages of the client, so the client should be instructed to
cover his nose and mouth when he sneezes or coughs. It is not necessary for the client
to wear the mask at all times; the nurse should wear the mask, so option C is incorrect.
107. Claudication is a well-known effect of peripheral vascular disease. Which of the

following facts about claudication is correct?
a. It results when oxygen demand is greater than oxygen supply
b. It is a result of tissue hypoxia
c. It is characterized by cramping and weakness
d. It is characterized by pain that often occurs during rest
1. If a, b, c are correct
2. If a and c are correct
3. If b and d are correct
4. If all four (a, b, c, & d) are correct
Ans. 1. If a, b, c are correct

Rationale:
• Claudication describes the pain experienced by a patient with peripheral vascular
disease when oxygen demand in the leg muscles exceeds the oxygen supply.
• This most often occurs during activity when demand increases in muscle tissue. The
tissue becomes hypoxic, causing cramping, weakness, and discomfort.
108. A 19-year-old patient comes to the ED with acute asthma. His respiratory rate
is 44 breaths/minute, and he appears to be in acute respiratory distress. Which
of the following actions should you take first?
a. Take a full medical history
b. Give a bronchodilator by nebulizer
c. Apply a cardiac monitor to the patient
d. Provide emotional support for the patient
Ans. b. Give a bronchodilator by nebulizer
Rationale:
• The patient having an acute asthma attack needs more oxygen delivered to his lungs
and body.
• Nebulized bronchodilators open airways and increase the amount of oxygen delivered.
• The patient may not need cardiac monitoring because he’s only 19 years old, unless he
has a medical history of cardiac problems.
109. Identify the x-ray image:
a. Pneumothorax
b. Tetralogy of Fallot
c. Flail chest
d. Hiatal hernia
Ans. a. Pneumothorax
Rationale:
Pneumothorax
• CXR is the initial examination of choice.
• An expiratory Chest-X ray is much better for detection of minimal pneumothorax.
Figure 1: Pneumothorax
• Four Classical findings are:
Ĕ Visceral pleural lines: As air collects in the pleural space it separates the parietal
and visceral pleura, with the latter being pushed inwards. Thus there is air density
lining the visceral pleura (water density) –this gives rise to a sharp margin of the
visceral pleura becoming visible-DEDS/Silhouette sign.
Ĕ Hyperlucency with absent vascular marking: The pleural space filled with air
appearance hyperlucent (excessive black) with absent vascular marking-as there
are no blood vessels in the pleural space.
Ĕ Mediastinal shift: Pleural air causes mass effect and results in mediastinal shift
that is always towards the opposite side.
Figure 2: Right pneumothorax seen in a patient on a ventilator

Ĕ Deep sulcus sign: Mass effect may also be exerted on the ipsilateral dome of
diaphragm which is pushed down and hence the CP angle sulcus appears deep
down.
Tension Pneumothorax
• Most important complication of pneumothorax.
• Of the above 4 classical imaging findings, if the last 2 findings are prominently seen
then Tension pneumothorax should be considered.
• Mediastinal shift: Towards contralateral side is greater in inspiration-is diagnostic.
Figure 3: Tension Pneumothorax

• Deep sulcus sign: As result of diaphragm depression. Sometimes the dome of
diaphragm may be inverted.
110. A patient is admitted to the oncology unit for diagnosis of suspected Hodgkin’s
disease. Which of the following symptoms is typical of Hodgkin’s disease?
a. Painful cervical lymph nodes
b. Night sweats and fatigue
c. Nausea and vomiting
d. Weight gain
Ans. b. Night sweats and fatigue
Rationale:
• Symptoms of Hodgkin’s disease include night sweats, fatigue, weakness, and
tachycardia.
• The disease is characterized by painless, enlarged cervical lymph nodes.
• Weight loss occurs early in the disease.
• Nausea and vomiting are not typically symptoms of Hodgkin’s disease.
111. A client who is admitted with an above-the-knee amputation tells the nurse that
his foot hurts and itches. Which response by the nurse indicates understanding
of phantom limb pain?
a. “The pain will go away in a few days.”
b. “The pain is due to peripheral nervous system interruptions. I will get you some pain
medication.”
c. “The pain is psychological because your foot is no longer there.”
d. “The pain and itching are due to the infection you had before the surgery.”
Ans. b. “The pain is due to peripheral nervous system interruptions. I will get you some pain
medication.”
Rationale:
• Pain related to phantom limb syndrome is due to peripheral nervous system
interruption.
• Option A is incorrect because phantom limb pain can last several months or indefinitely.
• Option C is incorrect because it is not psychological.
• It is also not due to infections, as stated in option D.
112. Which patient is at risk for hypernatremia?

a. Has a deficiency of aldosterone
b. Has prolonged vomiting and diarrhea
c. Receives excessive IV 5% dextrose solution
d. Has impaired consciousness and decreased thirst sensitivity
Ans. d. Has impaired consciousness and decreased thirst sensitivity
Rationale:
• A major cause of hypernatremia is a water deficit, which can occur in those with a
decreased sensitivity to thirst, the major protection against hyperosmolality.
• All other conditions lead to hyponatremia.
113. After surgical repair of a hip, which of the following positions is best for the
patient’s legs and hips?
a. Abduction
b. Adduction
c. Prone
d. Subluxated
Ans. a. Abduction
Rationale:
• After surgical repair of the hip, keep the legs and hips abducted to stabilize the
prosthesis in the acetabulum.
114. Identify the image
a. Linear stapler b. Punch biopsy

c. Bone marrow needle d. Trocar
Ans. a. Linear stapler

Rationale:
Liner Stapler
Figure 1: Liner Stapler

• Used for side to side anastomosis of bowel as in gastro jejunostomy.
Circular Stapler
Figure 2: Circular Stapler

• Used to do end to end anastomosis of bowels in anterior resection, Oesophago-jejunal
anastomosis.
115. A patient with no history of heart disease has a rhythm strip that shows an
occasional distorted P wave followed by normal AV and ventricular conduction.
What should the nurse question the patient about?
a. The use of caffeine
b. The use of sedatives
c. Any aerobic training
d. Holding of breath during exertion
Ans. a. The use of caffeine
Rationale:
• A distorted P wave with normal conduction of the impulse through the ventricles is
characteristic of a premature atrial contraction.
• In a normal heart, this dysrhythmia is frequently associated with emotional stress or
the use of caffeine, tobacco, or alcohol.
• Sedatives rarely slow the heart rate (HR). Aerobic conditioning and holding of breath
during exertion (Valsalva maneuver) often cause bradycardia.
116. The nurse is assisting the physician with removal of a central venous catheter.
To facilitate removal, the nurse should instruct the client to:
a. Perform the Valsalva maneuver as the catheter is advanced
b. Turn his head to the left side and hyperextend the neck
c. Take slow, deep breaths as the catheter is removed
d. Turn his head to the right while maintaining a sniffing position
Ans. a. Perform the Valsalva maneuver as the catheter is advanced
Rationale:
• The client who is having a central venous catheter removed should be told to hold his
breath and bear down. This prevents air from entering the line.
• Options B, C, and D will not facilitate removal.
117. What manifestation in the patient does the nurse recognize as an early sign of
hepatic encephalopathy?
a. Manifests asterixis
b. Becomes unconscious
c. Has increasing oliguria
d. Is irritable and lethargic
Ans. d. Is irritable and lethargic
Rationale:
• Early signs (grade 1) of this neurologic condition include changes in mentation (e.g.,
depression, apathy, irritability, confusion, agitation, drowsiness, lethargy).
• Loss of consciousness (grade 4) is usually preceded by asterixis (grades 2 and 3),
disorientation, hyperventilation, hypothermia, and alterations in reflexes. Increasing
oliguria is a sign of hepatorenal syndrome.
118. Adequate fluid replacement and vasopressin replacement are objectives of

therapy for which of the following disease processes?
a. Diabetes mellitus
b. Diabetes insipidus
c. Diabetic ketoacidosis
d. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Ans. b. Diabetes insipidus
Rationale:
• Maintaining adequate fluid and replacing vasopressin are the main objectives in
treating diabetes insipidus.
• An excess of antidiuretic hormone leads to SIADH, causing the patient to retain fluid.
• Diabetic ketoacidosis is a result of severe insulin insufficiency.
119. Identify the image given below:
a. Monopolar cautery
b. Bipolar cautery
c. Harmonic scalpel
d. Surgical scalpel
Ans. a. Monopolar cautery
Rationale:
Table: Types of Cautery
Features Monopolar Bipolar
Flow of Cautery pencil→ Tissue→ Cautery Only between tips of the instrument
current pad→Machine/ground Hence less chance of burn
Hence more chance of burn.
Modes • Coagulation: Alternate waveforms Only coagulation
(Bursts)
• Desiccation: Low power
• Fulguration: High power
Dissipation • More thermal dissipation current. • Less lateral dissipation current.
• Hence can cause damage to nerves • Hence safer in procedures to vital
and other vital structures. structures.
Image
Harmonic Scalpel
• It can cause coagulation without heat production.

• It works on the ultrasonic principle.
120. A leukemia patient has a relative who wants to donate blood for transfusion.
Which of the following donor medical conditions would prevent this?
a. A history of hepatitis C five years previously
b. Cholecystitis requiring cholecystectomy one year previously
c. Asymptomatic diverticulosis
d. Crohn’s disease in remission
Ans. a. A history of hepatitis C five years previously
Rationale:
• Hepatitis C is a viral infection transmitted through bodily fluids, such as blood,
causing inflammation of the liver. Patients with hepatitis C may not donate blood for
transfusion due to the high risk of infection in the recipient.
• Cholecystitis (gall bladder disease), diverticulosis, and history of Crohn’s disease do
not preclude blood donation.
121. The nurse is monitoring a client following a lung resection. The hourly output
from the chest tube was 300 mL. The nurse should give priority to:
a. Turning the client to the left side
b. Milking the tube to ensure patency
c. Slowing the intravenous infusion
d. Notifying the physician
Ans. d. Notifying the physician
Rationale:
• The output of 300 mL is indicative of hemorrhage and should be reported immediately.
• Option A does nothing to help the client.
• Milking the tube is done only with an order and will not help in this situation, and
slowing the intravenous infusion is not correct; thus, option B and C are incorrect.
122. Which of the following techniques is correct for obtaining a wound culture
specimen from a surgical site?
a. Thoroughly irrigate the wound before collecting the specimen.
b. Use a sterile swab and wipe the crusty area around the outside of the wound.
c. Gently roll a sterile swab from the center of the wound outward to collect drainage.
d. Use a sterile swab to collect drainage from the dressing
Ans. c. Gently roll a sterile swab from the center of the wound outward to collect drainage
Rationale:
• Rolling a swab from the center outward is the right way to obtain a culture specimen
from a wound.
• Irrigating the wound washes away drainage, debris, and many of the colonizing or
infecting microorganisms.
• The outside of the wound and the dressing may be colonized with microorganisms that
haven’t affected the wound, so specimens from these sites could give inaccurate results.
123. The nurse has a pre-op order to administer Valium (diazepam) 10 mg and
Phenergan (promethazine) 25 mg. The correct method of administering these
medications is to:
a. Administer the medications together in one syringe
b. Administer the medication separately
c. Administer the Valium, wait 5 minutes, and then inject the Phenergan
d. Question the order because they cannot be given at the same time
Ans. b. Administer the medication separately
Rationale:
• Valium is an antianxiety medication, and Phenergan is used as an antiemetic.
• Valium is not given in the same syringe with other medications, so option A is incorrect.
• These medications can be given to the same client, so option D is incorrect.
• In option C, it is not necessary to wait to inject the second medication.
124. Trace the ECG of a 65-year-old diabetic with excessive sweating and dizziness:
a. Hypoglycemia b. Hypoglycemic Unawareness

c. Anterior wall MI d. Inferior wall MI
Ans. c. Anterior wall MI

Rationale:
ECG shows presence of ST elevations from V2 - V5 diagnostic of anterior wall MI.
Anterior wall Myocardial Infarction

The ECG findings of an acute anterior myocardial infarction wall include:
• ST segment elevation in the anterior leads (V3 and V4) at the J point and sometimes
in the septal or lateral leads, depending on the extent of the MI. This ST segment
elevation is concave downward and frequently overwhelms the T wave. This is called
“tombstoning” for obvious reasons; the shape is similar to that of a tombstone.
• Reciprocal ST Segment depression in the inferior leads (II, III and aVF).
MENTAL HEALTH NURSING

125. Which substance, when abused, can cause euphoria, drowsiness, decreased
respiratory rate, and slurred speech?
a. Opioids
b. Alcohol
c. Cannabis
d. Depressants
Ans. a. Opioids
Rationale:
• Opioids produce these physiologic responses. Although alcohol intake can cause
euphoria, drowsiness, and slurred speech, the abuser of alcohol develops tolerance and
does not usually have these manifestations.
• Effects of chronic alcohol abuse include impairment of all body systems.
• Cannabis produces euphoria, sedation, and hallucinations.
• Depressants may cause slurred speech and drowsiness but not euphoria or decreased
respirations unless there is an overdose.
126. With regards to diagnosis of Mental disorder, the term DSM stands for:
a. Disease System Manual
b. Diagnostic System manual
c. Diagnostic and Statistical Manual
d. Diagnostic System for mental disorder
Ans. c. Diagnostic and Statistical Manual
Rationale:
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used
by health care professionals in the United States and much of the world as the authoritative
guide to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and
other criteria for diagnosing mental disorders.
127. A perception that occurs when a sensory stimulus is present but is incorrectly
perceived and misinterpreted is known as:
a. Illusion
b. Delusion
c. Hallucination
d. Delirium
Ans. a. Illusion
Rationale:
• A perception that occurs when a sensory stimulus is present but is incorrectly perceived
and misinterpreted is known as illusion. Example: when a child in a dark bedroom at
night sees monsters emanating from the shadows on the walls.
• The difference between an illusion a hallucination is:
Ĕ Illusion: Incorrect perception or misinterpretation of a sensory stimulus. E.g.
There is a rope in front of you but you see it as a snake.
Ĕ Hallucination: Perception in the absence of any stimulus. E.g. There is nothing in
front of you but you can see a snake.
128. Dependent personality traits are related to which phase?

a. Oral
b. Anal
c. Phallic
d. Genital
Ans. a. Oral
Rationale:
• The development of dependent personality traits is due to fixation in the oral stages
of development, according to the psychosexual stages of development proposed by
Sigmund Freud. He proposed five stages of development and stated that when the
development of a child gets arrested at one stage, called fixation, it results in psychiatric
disorders.
• The Phases are:
Phase of Sexual development Disorder resulting from fixation in this phase
Oral Phase • Alcohol dependence or drug dependence
• Birth - 1.5 Years • Schizophrenia
• Learning how to eat, mouth is the site of • Severe mood disorders
pleasure • Dependent personality disorder
Anal Phase • OCD
• 1.5 years - 3 years
• Toilet training, the site of pleasure is anal
region
Phallic/Oedipal Phase • Oedipus/Electra complex, which is primary
• 3 - 5 years cause of hysteria
• Site of pleasure is the genital region • Also Castration anxiety in boys and penis envy
in girls
Latency phase • Neurotic disorder
• Age: 5 - 12 years
Genital phase • Neurotic disorder
• Age > 12 years
129. A major cause of death in schizophrenia is:

a. Infection b. Suicide
c. Drug reactions d. Homicide
Ans. b. Suicide
Rationale:
• A major cause of death in schizophrenia is suicide.
• The leading causes of premature death among patients with schizophrenia at present
are Cardiovascular Diseases, suicide, accidents, and common physical diseases.
• In the past, the excess mortality among individuals with schizophrenia was due mainly
to communicable diseases such as tuberculosis.
130. A person in a banquet “high” on alcohol is verbally abusing the DJ for not
playing his favorite song. He has gross motor incoordination, and slurred
speech. What would be his blood alcohol concentration (mg/dL) at that point
of time??
a. 100 - 200 b. 300 - 400
c. 0 - 90 d. 210 - 300
Ans. a. 100 - 200
Rationale:
• Ethanol is rapidly absorbed across both the gastric mucosa and the small intestine,
reaching a peak concentration 20 - 60 minutes after ingestion.
• As a general rule, serum ethanol levels less than 25 mg/dL are associated with a sense
of warmth and well-being.
• Euphoria and decreased judgment occur at levels between 25 and 50 mg/dL.
• Incoordination, decreased reaction time/reflexes, and ataxia occur at levels of 50 - 100

mg/dL.
• Cerebellar dysfunction (e.g. ataxia, slurred speech, and nystagmus) is common at
levels of 100 - 250 mg/dL.
• Coma can occur at levels greater than 250 mg/dL, whereas respiratory depression, loss
of protective reflexes, and death occur at levels greater than 400 mg/dL.
131. Who proposed Attachment theory?

a. John Bowlby b. P.F. Skinner
c. Otto Rank d. Abraham Maslow
Ans. a. John Bowlby
Rationale:
• Attachment theory explains how the parent-child relationship emerges and influences
subsequent development. Attachments are most likely to form with those who
responded accurately to the baby’s signals, not the person they spent more time with.
Schaffer and Emerson called this sensitive responsiveness.
• Bowlby believed that the earliest bonds formed by children with their caregivers have
a tremendous impact that continues throughout life. He suggested that attachment
also serves to keep the infant close to the mother, thus improving the child’s chances
of survival.
132. Which of the following is NOT a mature defense mechanism?

a. Anticipation b. Intellectualization
c. Suppression d. Sublimation
Ans. b. Intellectualization
Rationale:
Defense mechanisms are three types.
• Mature defense mechanisms are healthy and adaptive, and they are seen in normal
adults. These defenses often help people integrate conflicting emotions and thoughts.
E.g. Altruism, Humor, Sublimation and Suppression.
• Neurotic defenses are encountered in obsessive-compulsive patients, patients with
other anxiety disorders, and adults under stress. E.g. Controlling, Displacement,
Intellectualization, Isolation of affect, Rationalization, Reaction formation and Repression.
• Immature defenses are seen in children, adolescents, psychotic patients, and some
nonpsychotic patients, such as patients with severe personality disorders. They are the
most primitive defense mechanisms. E.g. Acting out, Denial, Regression and projection.
133. The teachers, peers, and adults outside the home become important in shaping
attitudes towards oneself in Erikson’s stage of:
a. Trust Vs Mistrust b. Initiative Vs Guilt
c. Industry Vs Inferiority d. Integrity Vs despair
Ans. c. Industry Vs Inferiority

Rationale:
• Teachers, peers, and adults outside the home become important in shaping attitudes
towards oneself in the stage of industry Vs inferiority according to Eric Erikson’s
psychological stages of development.
• In this stage, children mature and their level of self-awareness increases. They
understand logical that are typically taught in school. Children also become more
competitive, they want to do things that other make the effort to perform a task and
succeed, and they develop self-confidence. However, if they fail, they tend to feel that
they are inferior to others.
134. Which of the following are dermatologic side effects of lithium?

a. Acne b. Rashes
c. Psoriasis d. Pemphigus
1. If a, b, c are correct 2. If a and c are correct
3. If b and d are correct 4. If all four (a, b, c, & d) are correct
Ans. 1. If a, b, c are correct
Rationale:
• The common dermatologic side effects of lithium include acne, hair loss, psoriasis and
rash
• Dermatologic side effects of Typical Antipsychotic Agents are: Skin eruptions,
photosensitivity, and blue-gray skin discoloration.
• Pemphigus is a group of skin disorders that cause blisters or pus-filled bumps. Lesions
usually develop on the skin, but they can also form in the mucous membranes (soft
linings of the eyes, nose, mouth, throat, and genitals). The blisters are soft and break
open easily to form painful sores.
• Psoriasis is a skin disease that causes red, itchy scaly patches, most commonly on the
knees, elbows, trunk and scalp. Psoriasis is a common, long-term (chronic) disease
with no cure. It tends to go through cycles, flaring for a few weeks or months, then
subsiding for a while or going into remission.
135. Freud’s model of development which compromise id, ego and superego is
called:
a. Genetic model
b. Unconscious model
c. Constrictive model
d. Structural model
Ans. d. Structural model
Rationale:
• Freud developed the psychoanalytic theory of personality development, which argued
that personality is formed through conflicts among three fundamental structures of
the human mind.
• Sigmund Freud’s structural theory of mind divides mental apparatus into the
following:
Ĕ Id (new born): is a reservoir for basic survival instincts, aggression, and survival
drives. It is based on the pleasure principle (immediate gratification). It is entirely
unconscious.
Ĕ Ego (reality principle): is the executive part of the mind that maintains the balance
between id and superego. It is based on exposure to reality and utilizes influences
from the external world to modify the id. It is conscious except for unconscious
defense mechanism.
Ĕ Superego (Idealism principle): establishes and maintains a moral conscience in
an individual by constantly comparing a person’s thoughts and feelings to expected
standard of behavior.
136. All of the following are the features of alcohol dependence syndrome, except:
a. Craving b. Withdrawal symptoms
c. Tolerance d. Financial loss
Ans. d. Financial loss

Rationale:
• Alcohol withdrawal cause symptoms like tremors, hallucinations, seizures and
delirium tremens.
• Seizures may be seen 6 – 12 hours after the last drink.
• The diagnosis of all alcohol withdrawal–related syndromes is made clinically, not by
lab values.
• Alcohol toxicity can present with agitation, hypoglycemia, arrhythmia and respiratory
depression.
• Benzodiazepines are the drug of choice for treatment of alcohol withdrawals as well
as toxicity.
• For withdrawal seizures intravenous lorazepam or diazepam is used, whereas for
others long acting oral drug like chlordiazepoxide is used.
• Diet is important in treatment (high in calorie, high in carbohydrates, thiamin,
multivitamins and folic acid).
• For alcohol toxicity short acting intravenous drug like lorazepam used.
137. Which of the following is not a feature of mania?

a. Disorientation
b. Delusion of grandeur
c. Elation
d. Pressure of speech
Ans. a. Disorientation
Rationale:
• Presence of disorientation or disturbance of consciousness suggests an organic mental
disorder Like delirium
Symptoms of Delirium Symptoms of Mania
• Elevated mood • Disturbances of Consciousness
• Grandiosity and expensiveness • Disorientation to time, place and person
• Irritability and impulsivity • Perceptional Disturbances like illusions &
• Disinhibition Hallucinations
• Assaultiveness
• Distractibility
• Flight of ideas
• Pressured speech
• Impaired judgment
• Psychotic symptoms
138. Persistent felling of guilt is seen in:

a. Obsessive compulsive disorder
b. Mania
c. Depression
d. Schizophrenia
Ans. c. Depression
Rationale:
Symptoms of Depression
• SWAG (Suicidality, Weight loss, anhedonia and guilt feelings) is quite suggestive of
depression.
• Suicidal thoughts and sadness of mood (depressed mood)
• Appetite: Usually the appetite and weigh are lost; in some patients weight gain may
be seen.
• Interest (Loss): Patient losses interest in the activities which used to interest him
earlier (Anhedonia).
• Guilt: patient may have excessive guilt feelings and may blame himself for trivial
matters
139. Anorexia nervosa can be differentiated from bulimia by:

a. Intense fear of weight gain
b. Disturbance of body image
c. Adolescent age
d. Peculiar patterns of food handling
Ans. d. Peculiar patterns of food handling
Rationale:
• Unlike patients with bulimia, patients with anorexia remain preoccupied with food
and show peculiar behavior like hiding food in the house, trying to dispose food
in napkins, cutting food into very small pieces and rearranging the food repeatedly
around the plate.
Table: Eating disorders
Characteristics Anorexia Nervosa Bulimia Nervosa
Sex F>M F>M
Age Mid-teenage years adulthood Late adolescence/early
Socioeconomic status (SES) May be high or low May be high or low
Weight * >15% ideal body weight loss Varies, Usually normal or > normal
Neurotransmitters Serotonin/norepinephrine? Serotonin/norepinephrine?
Binge/purge Yes Yes
Laxative/diuretics Yes Yes
Sexual adjustment Poor Good
Medical • Amenorrhea • Dental cavities
Complications • Lanugo • Calluses on hands/fingers
• High mortality • Enlarged parotid glands
• Dental cavities • Electrolyte imbalances
• Electrolyte imbalances • Cardiac abnormalities
• Cardiac abnormalities
FUNDAMENTALS OF NURSING
140. An emergency nurse receives a victim who suffered multiple injuries from
a head-on car collision. Which of the following assessment should take the
highest nursing priority?
a. Unequal pupils
b. Irregular pulse
c. Ecchymosis in the flank area
d. A deviated trachea
Ans. d. A deviated trachea
Rationale:
• Option D: A deviated trachea is a symptom of tension pneumothorax, which will result
in respiratory distress if left untreated. As an emergency nurse the victim should be
assessed for deviated tracheal injury.
• The trachea should be checked to see if it is in the normal central position. This means
the distance between the trachea and the sternomastoid muscles should be equal on
both sides. Slight displacement of the trachea to the right is fairly common in healthy
people
• Checking the position of the trachea
Ĕ Using the forefinger of the right hand, identify the suprasternal notch
Ĕ Gently push forefinger upwards and back until the trachea is palpated
Ĕ Check to see if the finger slots more easily into one side of the trachea;
Ĕ Check the position of the apex beat to confirm/exclude mediastinal displacement
(take care where cardiomegaly is evident as this may render this check unreliable).
141. Reena, a triage nurse encountered a client who complained of mid-sternal chest
pain, dizziness, and diaphoresis. Which of the following nursing action should
take priority?
a. Administer oxygen therapy via nasal cannula
b. Notify the physician
c. Complete history taking
d. Put the client on ECG monitoring
Ans. a. Administer oxygen therapy via nasal cannula

Rationale:
• Option A: The priority goal is to increase myocardial oxygenation as per the chief
complaint of patient.
• Options B, C, and D: These actions are also appropriate and should be performed
immediately but priority is to increase the myocardial oxygenation by providing
oxygen therapy.
142. The first and second digits of a victim get amputated in a wooden cutting
machine by accident. The victim rushes to the nursing clinics. What should the
nurse do with the amputated pieces of victim’s first and second digits?
a. Cleansing the amputated digits and placing them directly into an ice slurry
b. Wrapping the cleansed digits in saline-moistened gauze, sealing in a plastic container,
and placing it in icy water
c. Gently cleansing the amputated digits and the hand with povidone-iodine
d. Cleansing the digits with sterile normal saline and placing it in a sterile cup with sterile
normal saline
Ans. b. Wrapping the cleansed digits in saline-moistened gauze, sealing in a plastic container,
and placing it in an icy water
Rationale:
• Option B: Once a finger amputation has occurred, ischemic tolerance times are 12
hours if warm and up to 24 hours if cold. For more proximal amputations, these
times are halved. The amputated part should be covered in a normal saline-soaked
gauze, sealed in a plastic bag, and submerged in icy water with no direct contact with
ice. If there is direct contact with ice, it could result in tissue damage and render the
amputated part non-viable.
143. A victim arrived in the emergency unit with the complaint of splash of a
concentrated household cleaner in both his eyes. Which of the following
nursing actions is a priority?
a. Examine the victim visual acuity
b. Do nothing as it is not harmful
c. Apply patch to the eye
d. Flush the eye repeatedly using sterile normal saline
Ans. D. Flush the eye repeatedly using sterile normal saline.
Rationale:
• Option D: Initial emergency action during a chemical splash to the eye includes
immediate continuous irrigation of the affected eye with normal saline.
• Option A: After flushing the eye with copious amount of Water then visual acuity is
assessed.
• Option B: Patching the eye is not part of the first-line treatment of a chemical splash.
144. You have received a call from the Police control room informing an hit &
run case nearby your hospital. Soon after the hit & run accident the victim
shifted to the emergency department of your hospital. The victim was suffering
a closed head injury and lacerations around the face due to accident. The
victim is unconscious and has a minimal response to noxious stimuli. Which
of the following assessment findings, should be reported to the physician
immediately?
a. Drainage of a clear fluid from the client’s nose
b. Withdrawal of the client in response to painful stimuli
c. Bruises and minimal edema of the eyelids
d. Bleeding around the lacerations
Ans. A. Drainage of a clear fluid from the client’s nose
Rationale:
• Option A: Clear drainage from the victim nose is known as rhinorrhea which indicates
that there is a leakage of CSF (cerebrospinal fluid) and should be reported to the
physician immediately.
145. You are working as a triage nurse and received four victims. Which of the
following victim the nurse should assess first?
a. An irritable infant with a fever, petechiae, and nuchal rigidity
b. An ambulatory dazed 25-year-old male with a bandaged head wound
c. A 50-year-old female with moderate abdominal pain and occasional vomiting
d. A 35-year-old jogger with a twisted ankle, having a pedal pulse, and no deformity
Ans. a. An irritable infant with a fever, petechiae, and nuchal rigidity
Rationale:
• An irritable infant with fever and petechiae should be further assessed for other
meningeal signs and among other option requires more attention
• The patient with the head wound needs additional history and assessment for
intracranial pressure. The patient with moderate abdominal pain is uncomfortable,
but not unstable at this point. For the ankle injury, a medical evaluation can be delayed
24 – 48 hours if necessary.
146. Which of the following fluid type is used to manipulate fluid shifts among
compartments?
a. Whole blood b. TPN
c. Albumin d. Ensure
Ans. c. Albumin
Rationale:
• Albumin (most abundant plasma protein) is a colloid that is used to manipulate fluid
shifts among compartments. Albumin is also a colloid fluid administered to patients in
need of fluid resuscitation, especially in the setting of trauma (i.e. hypovolemic shock)
or in the setting of large-volume paracentesis. Strength albumin has over crystalloids is

that it leads to an increase in intravascular oncotic pressure.
• Option A: Whole blood is used to replace blood volume. Nowadays whole blood
transfusion is not much common due to complication of circulatory overload.
• Option B: TPN is used for patients who are unable to take in food or fluid. Total
parenteral nutrition (TPN) supplies all daily nutritional requirements. TPN can be
used in the hospital or at home.
• Option D: Ensure is a high-calorie nutritional supplement; it is not used to manipulate
fluid shifts. It contains well-balanced proportions of macronutrients that conform to
guidelines for Dietary Reference Intake and the latest American Heart Association
Guidelines for healthy diets.
147. You have received a new admission of 85-year-old patient with a feeding tube,
has been experiencing severe watery stool. The patient is lethargic and has
poor skin turgor, a pulse of 120, and hyperactive reflexes. Which among the
following nursing interventions should be applied in this case?
a. Measuring and recording intake and output and daily weights.
b. Increase the dietary salt intake
c. Monitor level of consciousness
d. a&c
Ans. d. a & c
Rationale:
• The patient is exhibiting signs of hypernatremia and dehydration. The most appropriate
nursing intervention is to measure and record intake and output and daily weight.
Monitor intake and output and specific gravity. Assess the presence and location of
edema. Weigh the client daily. These parameters are variable, depending on the fluid
status, and are indicators of therapy needs and effectiveness.
• Option B: Restrict sodium intake and administer diuretics as indicated. Option C:
Monitor level of consciousness and muscular strength, tone, and movement. Sodium
imbalances may cause changes that vary from irritability and confusion to seizures and
coma. In the presence of a water deficit, rapid rehydration may cause cerebral edema.
148. Your assigned patient lab test revealed that her serum calcium is 2.5 mEq/L.
Which assessment data does the nurse document when a patient diagnosed
with hypocalcemia develops a carpopedal spasm after the blood-pressure cuff
is inflated?
a. Positive Trousseau’s sign
b. Positive Chvostek’s sign
c. Tetany
d. Paresthesia
Ans. a. Positive Trousseau’s sign

Rationale:
• In a client with hypocalcemia, a positive Trousseau’s sign refers to carpopedal spasm

that develops usually within 2 to 5 minutes after applying and inflating a blood pressure
cuff to about 20 mm Hg higher than systolic pressure on the upper arm. This spasm
occurs as the blood supply to the ulnar nerve is obstructed.
• Option B: Chvostek’s sign refers to twitching of the facial nerve when tapping below
the earlobe. In the late 1800s, Dr. Chvostek noticed that mechanical stimulation of the
facial nerve (as with the fingertip of the examiner, for example) could lead to twitching
of the ipsilateral facial muscles. The long-accepted explanation is that this resulted
from hypocalcemia, and this relationship became known as the Chvostek sign.
• Option C: Tetany is a clinical manifestation of hypocalcemia denoted by tingling in
the tips of the fingers around the mouth and muscle spasms in the extremities and
face. Tetany is generally induced by a rapid decline in serum ionized calcium. Tetany
is usually most dangerous and most commonly seen in the presence of respiratory
alkalosis causing hypocalcemia.
• Option D: Paresthesia refers to numbness or tingling. Paresthesia is an abnormal
sensation of the skin (tingling, pricking, chilling, burning and numbness) with no
apparent physical cause. Paresthesia may be transient or chronic and may have any of
dozens of possible underlying causes.
149. A patient is admitted with the chief complaint of dryness of mucus membrane
of mouth, skin, and is diagnosed with fluid volume deficit. Which intervention
should the nurse perform when caring for this patient?
a. Assessing urinary intake and output.
b. Obtaining weight weekly at different times of the day.
c. Monitoring arterial blood gas (ABG) results.
d. Maintaining I.V. therapy at the keep-vein-open rate.
Ans. a. Assessing urinary intake and output.
Rationale:
• For the client with fluid volume deficit, assessing the client’s urine output (using an
urometer if necessary) is essential to ensure an output of at least 30 mL/hour. Assess
color and amount of urine. Report urine output less than 30 mL/hr for 2 consecutive
hours. A normal urine output is considered normal not less than 30 mL/hour.
Concentrated urine denotes fluid deficit.
• Option B: The client should be weighed daily, not weekly, and at the same time each
day, usually in the morning. Weigh daily with the same scale, and preferably at the same
time of day. Weight is the best assessment data for possible fluid volume imbalance. An
increase of 2 lbs a week is considered normal.
• Option C: Monitoring ABGs is not necessary for this client. Rather, serum electrolyte
levels would most likely be evaluated. Monitor serum electrolytes and urine osmolality,
and report abnormal values. Elevated blood urea nitrogen suggests fluid deficit. Urine-
specific gravity is likewise increased.
• Option D: The client also would have an I.V. rate of at least 75 mL/hour, if not higher, to
correct the fluid volume deficit. Administer parenteral fluids as prescribed.
150. The major difference between pursed-lip breathing and diaphragmatic

breathing is with diaphragmatic breathing the patient:
a. Inhales through the mouth
b. Exhales through pursed lips
c. Raises both shoulders while breathing deeply
d. Tightens the abdominal muscles while exhaling
Ans. d. Tightens the abdominal muscles while exhaling
Rationale:
Figure: Diaphragmatic Breathing

• With diaphragmatic breathing, the contraction of abdominal muscles at the end of
expiration helps to reduce the amount of air left in the lungs at the end of expiration
(residual volume).
• Option a: Inhalation is through the nose for both diaphragmatic and pursed-lip
breathing.
• Option b: Exhalation through pursed lips is performed only with pursed-lip breathing.
• Option c: This action is not part of diaphragmatic or pursed-lip breathing. The use
of these accessory muscles of respiration is a compensatory mechanism that helps to
increase thoracic excursion when inhaling.
151. Which nursing assessment best indicates a patient’s ability to tolerate activity?
a. Results of vital signs before and after activity
b. Presence of adventitious breath sounds
c. Flexibility of muscles and joints
d. Complaints of weakness
Ans. a. Results of vital signs before and after activity
Rationale:
• Option a: Vital signs reflect functioning of the major body organ. Vital signs obtained
before and after activity provides a baseline data that can be compared to determine the
body’s response to the energy demands of ambulation.
• Option b: The presence of unexpected (abnormal) breath sounds (adventitious
sounds) indicates the presence of a respiratory problem (narrowed airways, presence
of excessive respiratory secretions, or pleural inflammation), not a response to activity.
• Option c: Flexibility relates to mobility, not one’s physiologic capacity to endure
activities that require energy.
• Option d: Although this may reflect a response to activity, this evaluation is subjective
and vague. Measurable, specific outcomes that are objective are the best way to evaluate
a patient’s physiologic response to activity.
152. The nurse is caring for a patient who has a chest tube after thoracic surgery.
The nurse should:
a. Clamp the tube when providing for activities of daily living
b. Position the collection device at the same level as the chest
c. Maintain an airtight dressing over the puncture wound
d. Empty chest tube drainage every eight hours
Ans. c. Maintain an airtight dressing over the puncture wound
Rationale:
• Option c: An airtight dressing seals the pleural space from the environment. If left
open to the environment, atmospheric pressure causes air to enter the pleural space,
which results in a tension pneumothorax
• Option a: This is contraindicated because clamping a chest tube may cause a tension
pneumothorax by generating a negative pressure.
• Option b: The chest drainage system should be kept below the level of the insertion site
to promote the flow of drainage from the pleural space and prevent the flow of drainage
back into the pleural space.
• Option d: This is unnecessary. Chest drainage systems are closed, self-contained
systems that have a chamber for drainage. At routine intervals, as per hospital policy,
the date, time, and nurse’s initials mark the level of drainage on the drainage collection
chamber.
153. You are assigned to provide care to an unconscious patient. Due to immobility
the patient develops thrombophlebitis. The nurse understands that the most
serious complication associated with thrombophlebitis is:
a. Postural hypotension b. Blanchable erythema
c. Dependent edema d. Acute chest pain
Ans. d. Acute chest pain
Rationale:
• Option d: Immobility promotes venous stasis, which in conjunction with
hypercoagulability and injury to vessel walls predisposes patients to thrombophlebitis.
These three factors are known as Virchow’s triad.
• A thrombus can break loose from the vein wall and travel through the circulation
(embolus) where eventually it obstructs a pulmonary artery or one of its branches
causing sudden, acute chest pain, dyspnea, coughing, and frothy sputum.
• Option a: Postural hypotension is unrelated to phlebitis caused by immobility. Postural
hypotension (orthostatic hypotension) is a decrease in blood pressure related to
positional or postural changes from the lying down to sitting or standing positions.
• Option b: Blanchable erythema is unrelated to phlebitis caused by immobility.
Blanchable erythema (reactive hyperemia) is a reddened area caused by localized
vasodilation in response to lack of blood flow to the underlying tissue. The reddened
area will turn pale with fingertip pressure.
• Option c: Dependent edema is unrelated to phlebitis caused by immobility. Although
fluid will collect in the interstitial compartment (edema) around the phlebitis, it is
localized, not dependent, edema. Dependent edema is the collection of fluid in the
interstitial tissues below the level of the heart; it occurs bilaterally and usually is caused
by cardiopulmonary problems.
154. An unconscious patient who had oral surgery under GA is shifted to the
Postoperative unit. In which position should the nurse place the patient?
a. Prone position b. Supine position
c. Lateral position d. Fowler’s position
Ans. c. Lateral position
Rationale:
• Option c: The lateral position facilitates the flow of secretions out of the mouth by
gravity, keeps the tongue to the side of the mouth maintaining the airway, and permits
effective assessment of the oropharynx and respiratory status.
• Option a: Although the prone position allows for drainage from the mouth, it is
contraindicated because lying on the side of the face compresses oral tissues, impedes
assessment, complicates oral suctioning, and may compromise the airway.
• Option b: The supine position is unsafe. In an unconscious patient, the gag and
swallowing reflexes may be impaired, which increases the risk for aspiration as the
tongue falls to the back of the oropharynx occluding the airway.
• Option d: The Fowler’s position is unsafe. An unconscious patient is unable to maintain
an upright position.
155. The nurse should perform which of the following assessment while caring for a
patient receiving oxygen via a nasal cannula?
a. Reassess the nares, cheeks, and ears for signs of pressure injury every 2 hours
b. Loop the tubing over the patient’s ears and adjust the tubing firmly under the chin
c. Apply oil-based lubricant to the patient’s nares
d. All of the above
Ans. a. Reassess the nares, cheeks, and ears for signs of pressure injury every 2 hours
Rationale:
• Option a: This ensures that tissue irritation or capillary compression does not occur
from the nasal prongs, tubing, or elastic strap. The elastic strap should be snug enough
to keep the nasal prongs from becoming displaced but loose enough not to compress
or irritate tissue.***
• Option b: This is the correct placement of the tubing; however, it should be secured
gently, not firmly, under the chin.
• Option c: A water-based, not oil-based, lubricant should be applied to the nares.
156. To increase both the respiratory and the circulatory functions of a patient in a
coma, what is the most important thing the nurse should do?
a. Encourage the patient to cough
b. Massage the patient’s bony areas
c. Assist the patient with breathing exercises
d. Change the patient’s position every two hours
Ans. d. Change the patient’s position every two hours
Rationale:
• Option d: This helps respirations by preventing fluid from collecting in the lung, which
can cause infection; it helps circulation since activity increases circulation, and it
relieves local pressure.
• Option a: A patient in a coma is unable to respond.
• Option b: This helps only skin circulation in the small area being massaged.
• Option c: A patient in a coma is unable to respond.
157. Doctor order to administered 500 mg of antibiotics added in 50 ml of 0.9%

normal saline IV four times a day. The antibiotic is supplied in single dose vial
of 1 gram. The direction advice that the instillation of 0.8 mL of NS will yield
1.2 mL of solution. How much (mL) of antibiotic solution should be added to
the 50 ml of NS.
a. 0.6 mL
b. 0.8 mL
c. 1 mL
d. 5 mL
Ans. a. 0.6 mL
Rationale:
• Antibiotic comes in powder form and to administered it we need to dissolve it by using
Normal saline
• In the given scenario,
• Doctor order = 500 mg of antibiotic added in 50 ml NS
• And we need to figure out how much ml of antibiotic (not mg) will the nurse add into
50 mL NS?
• Available in stock is 1 g antibiotic vial in powdered form in which nurse has added 0.8
ml of NS and the final solution in the vial becomes 1.2 mL which the nurse can add
into 50 mL of NS solution
• But
• Here We need to give 500 mg
• So first we need to convert 500 mg into g
• Mg is the smaller unit and g is higher unit.
• To convert smaller unit into higher we need to divide by 1000
1g
Antibiotic dose in g = 500 g ×
1000 g
Antibiotic dose in g = 0.5 g
1 gram powdered form antibiotic is = 1.2 mL of antibiotic solution
So 0.5 gram powdered form antibiotic = X (Find out)
0.5 gram Antibiotic in solution form = 0.5 X 1.2 mL
If the nurse will add 0.8 mL of NS in 0.5 g of antibiotic then it will be 0.6 ml of solution
which will be added in 50 mL of NS for infusion
158. Which of the following electrolytes are not present in 0.9% Normal saline?
a. Chloride
b. Potassium
c. Lactate
d. Both b & c
Ans. d. Both b & c
Rationale:
Solution Type Osmolarity Content
Normal Saline 0.9% Isotonic solution 308 mOsmol/L • Water
• Sodium (154 mEq/L)
• Chloride (154 mEq/L)
Ringer lactate Isotonic Solution 273 mOsmol/L • Water
• Sodium (130 mEq/L)
• Chloride(109 mEq/L)
• Potassium (4 mEq/L)
• Calcium (3mEq/L)
• Lactate (28 mEq/L)
159. You are posted in the corona virus screening zone. As per the Indian government
directives, the health care provider has to take nasopharyngeal /oropharyngeal
(Throat) swab. It may cause discomfort to the clients during administration,
but the benefits of early recognition of this corona virus both for the individual
and society, outweigh the temporary discomforts. Which principle is involved
in this situation?
a. Non-maleficence b. Respect for autonomy
c. Beneficence d. Principle of justice
Ans. c. Beneficence
Rationale:
The duty to do well to others and to maintain a balance between benefits and harms.
Rationale:
• As in the given scenario the nasopharyngeal/oropharyngeal swab test may cause
some degree of discomfort to the patient but the early recognition about the patient
condition related to corona virus weather positive or negative will be beneficial for
both the individual as well as to the society. As we all are aware that this novel corona
virus can easily spread from person to another so the primary motives for all of us is to
limit or reduce the transmission of this virus.
• Option a: Principle of non-maleficence means doing no harm to the patient, which
can’t consider as a correct answer because here in the given scenario the priority action
is doing good for the patient which is by early detection of diseases condition.
• Option b: Respect for autonomy means the patient/client make independent decision.
This option will be considered as a distractor.
• Option d: Principle of justice means being impartial and fair. Nurses making impartial
medical decisions demonstrate this, whether it relates to limited resources or new
treatments regardless of economic status, ethnicity, sexual orientation, etc. This option
also considered as a distractor.
160. What is the purpose of giving carminative enema?

a. Provides relief from gaseous distention
b. Contracts tissue to control bleeding
c. Lubricates the rectum and colon
d. To soften hard fecal matter
Ans. a. Provides relief from gaseous distention
Rationale:
• Carminative enema is administration of small volume enema to release flatus. The
enema stimulated peristalsis resulting in a bowel movement in which feces and flatus
are expelled
• Oil-Retention Enemas is used to lubricates the rectum and colon; the feces absorb the
oil and become softer and easier to pass
• Astringent Enema is to Contracts tissue to control bleeding.
161. Fill in the blank BP = _____ × _____

a. Diastolic Blood pressure × Systolic blood pressure
b. Cardiac output × Systemic vascular resistance
c. Heart Rate × Stroke volume
d. Mean arterial pressure × Cardiac output
Ans. b. Cardiac output × Systemic vascular resistance
Rationale:
• The correct answer is Cardiac output × Systemic vascular resistance.
• Blood pressure is calculated by multiplying the cardiac output by the systemic vascular
resistance. Blood pressure mediation is by a balance of the cardiac output and the
peripheral vascular resistance.
• Option c: Cardiac output is calculated by multiplying the stroke volume by the heart
rate.
• Cardiac Output = Stroke volume × Heart rate
• Other options are distractors.
162. You are assigned to provide care to the patient admitted into the medical floor.
You have monitored the vital signs of the patient as Temperature = 98.6 °F,
Pulse = 74 beats/min, respiration = 20 breaths/min, BP = 132/82 mmHg. While
documenting the vital sign report, a junior resident asked you what is the pulse
pressure of this patient? Select the most appropriate response of nurse.
a. 100
b. 1.6
c. 214
d. 50
Ans. d. 50
Rationale:
• Pulse pressure is the difference between the systolic and diastolic blood pressure.
• The patient blood pressure is 132/82 mmHg.
• Where the systolic blood pressure is 132 mmHg
• Diastolic pressure is 82 mmHg
• Pulse pressure = Systolic blood pressure (SBP) – Diastolic blood pressure (DBS)
• Pulse pressure = 132 - 82
• Pulse pressure = 50
163. You are assigned to provide care to the patient admitted with the complaint of
fever and diarrhea. During your morning shift, the temperature of the patient
was 99.8°F orally. While the evening shift nurse recorded the temperature
103°F orally over the last 24 hours. The nurse will classify this fever as:
a. Constant fever b. Intermittent
c. Relapsing d. Remittent
Ans. d. Remittent
Rationale:
• Remittent fever is characterized by variations of more than 2 degrees between morning
and evening but doesn’t reach normal.
• Continuous fever: Constant or continuous fever is one in which the temperature varies
not more than 2 degrees between morning and evening and doesn’t reach normal for
a period of days or week.
• Intermittent fever: It is also known as quotidian fever. The temperature rises from
normal or subnormal to high fever and back to normal at regular interval. The interval
may vary from few hours to 3 days. This type of fever usually occurs during the course
of an infectious disease.
• Relapsing fever: brief febrile periods, followed by one or more days of normal
temperature, e.g. dengue.
164. In the case of infection, the rise in body temperature to 1°F:

a. Pulse rate remains normal
b. Pulse rate will increase by 5 beats per minute
c. Pulse rate will decrease by 5 beats per minute
d. Pulse rate will increase by 10 beats per minute
Ans. d. Pulse rate will increase by 10 beats per minute
Rationale:
• The correct answer is the pulse rate will increase by 10 beats per minute. With most
infections, the pulse rate will increase about 10 beats per minute for each 0.5 degree
Celsius (each degree Fahrenheit) of temperature increase. The respiratory rate will also
be increased by about 4 breaths/minute for every one-degree rise in temperature.
165. After the vital signs, monitoring the nurse’s documentation indicates that a
patient has a pulse deficit of 14 beats. The pulse deficit is measured by:
a. Assessing the apical pulse and 30 minutes later assessing the carotid pulse and
subtracting the difference
b. Subtracting the client’s pulse rate from the heart rate
c. Assessing the apical pulse and the radial pulse for the same minute and subtracting the
difference
d. Assessing the apical pulse for 1 minute and radial pulse for 15 seconds and subtracting
the difference.
Ans. c. Assessing the apical pulse and the radial pulse for the same minute and subtracting the
difference
Rationale:
• The correct answer is: Assessing the apical pulse and the radial pulse for the same
minute and subtracting the difference is known as pulse deficit.
• Pulse deficit is a clinical sign wherein, one is able to find a difference in count between
heartbeat (Apical beat or Heart sounds) and peripheral pulse. This occurs even as the
heart is contracting, the pulse is not reaching the periphery. This can occur in few
clinical situations.
Ĕ Atrial fibrillation
Ĕ Very early diastolic ventricular ectopic beats
Ĕ Some patients with Pacemaker
NURSING RESEARCH & STATISTICS

166. Which of the following is not a type of Non-Experimental Research design?
a. Descriptive Design
b. Cohort studies
c. Correlational design
d. Solomon four group design
Ans. d. Solomon four group design
Rationale:
• Option d: Solomon four group design is a type of True Experimental Design which
involves two experimental group (Experimental group 1 and experimental group 2)
and two control group (control group 1 & control group 2)
• Option a: Descriptive Design is a type of Non-experimental design which are design to
gain more information about characteristics within a particular field.
• Example: A descriptive study on the awareness of importance of Hand Hygiene among
nurses of a selected of hospital of New Delhi.
• Option b: Cohort studies is a subtype of epidemiological research design which comes
under non-experimental design. In this a longitudinal approach is used to investigate
the occurrence of a disease condition.
• Example: A longitudinal study to observe the alcoholic for the development of liver
cirrhosis.
• Option c: Correlational design is a type of non-experimental study done in natural
setting without manipulation or control.
• Example: A correlational study to assess the effect of alcohol on liver cirrhosis among
people residing in selected urban area of New Delhi.
167. Which type of research Study involves Control, manipulation and

Randomization?
a. Descriptive
b. Correlational
c. Quasi experimental
d. True Experimental
Ans. d. True Experimental
Rationale:
• The correct answer is true Experimental Study.
• The experimental research designs are those where researchers have complete control
over the extraneous variables and can predict confidently that the observed effects on
the dependent variable is only due to the manipulation of the independent variable.
• Quasi Experimental study involves manipulation of independent variable but it lacks
at least one of the two characteristics of true experimental study either control or
randomization.
• Correlation study involves non experimental design without manipulation or control.
• Descriptive study do not involves the manipulation of the variables, and the variables
are studies as they exist in the real world.
168. Quasi experimental research design lack which of the main features of a true
experimental study?
a. Control
b. Randomization
c. Manipulation
d. Either control or randomization
Ans. d. Either control or randomization
Rationale:
• Quasi-experimental studies lack atleast one of the two main features of a true
experimental study either control or randomization and this is more often
randomization.
• This is often because subjects in close proximity may share elements that might spoil
or ‘contaminate’ the results, or there are ethical difficulties in giving an intervention to
one group but not the other.
169. Select which of the following is not a type of Non-experimental Research

design?
a. Descriptive design
b. Solomon four group design
c. Correlational design
d. Developmental research design
Ans. b. Solomon four group design
Rationale:
Experimental Research design True experimental design
• Posttest only control design
• Pre-test-posttest control group design
• Solomon four group design
• Factorial design
• Randomized block design
• Cross over design
Quasi experimental design
• Non randomized control group design
• Time series design
Pre experimental design
• One shot case design
• One group pretest-posttest design
Non-experimental research Design Descriptive design

• Univariant descriptive design
• Exploratory design
• Comparative design
Correlational Design
• Prospective design
• Retrospective design
Survey research design
Epidemiological design
• Case control
• Cohort studies
Developmental research design
170. Identify the appropriate statement to the given below example?

“The participants behave formally because they know they are being observed
by the researcher”
a. Experimental effect
b. Hawthorne effect
c. Reactive effect of pretest
d. Novelty effect
Ans. b. Hawthorne effect
Rationale:
• Hawthorne effect is the form of external validity in which the subject may behave in
particular manner because they are aware that they are being observed.
• Experimental effect: It is a threat to study results when researcher characteristics,
mannerisms, or behavior may influence subject behavior.
• Reactive effect of pretest: It occurs when subjects have been sensitized to the treatment
because of taking a pretest. People might not respond to the treatment in a manner
they finally do if they had not received the pretest.
• Novelty effect: When a treatment is new, subjects and researcher might behave in
different ways. Once treatment is more familiar and as the novelty wears off, results
might different.
NURSING EDUCATION & NURSING MANAGEMENT

171. Professional negligence is legally termed as:
a. Crime
b. Assault
c. Malpractice
d. Slander
Ans. c. Malpractice
Rationale:
• Professional negligence is legally termed as malpractice. When negligence is done by
a professional person like doctors, nurses etc., it is termed as malpractice. When a
professional does not act in a reasonable and prudent manner, he is guilty of performing
malpractice. Example: A Bollywood film named “Ankur Arora Murder Case” is based
on a real-life situation in which the doctor forgets to empty the stomach before surgery,
knowing that the child was not NPO which resulted in post-operative aspiration by the
patient leading to death.
• Five elements of Malpractice include:
Ĕ Duty
Ĕ Breach of duty
Ĕ Foreseeability
Ĕ Causation
Ĕ Injury or harm
• Crime is the act prohibited by statute, common law principles
• Assault is a type of intentional tort in which the person intentionally causes harm to
the client.
• Slander is a type of oral defamation (harming the reputation of others through spoken
words or gestures)
172. A nurse introducing an employee to new responsibilities through teaching and

guidance is known as___________
a. Preceptorship
b. Professionalism
c. Leadership
d. Mentorship
Ans. a. Preceptorship
Rationale:
• A nurse introducing an employee to new responsibilities through teaching and guidance
is known as preceptorship. In simple words, a preceptor is an experienced and qualified
person who is responsible for supporting the new staff. In nursing, preceptorship is the
transition period in which the new staff gets time to adjust for this change ad this also
helps to improve the practice. Example: A student nurse is supported to enhance her
skills before she becomes a staff nurse.
• Professionalism is a method to do a job that displays skills and experience
• Leadership is an act of influencing others to achieve the common goals
• Mentorship is 75% leadership but in this, the mentor is trained and he willingly helps
others. Mentoring helps in developing leadership skills.
173. Human Relation theory was proposed by:

a. Max Weber b. Henri Fayol
c. Frederic Winslow Taylor d. Elton Mayo
Ans. d. Elton Mayo

Rationale:
• Human Relation theory was proposed by Elton Mayo who was the first to introduce
psychological approach or relational approach in management. He emphasized that
not only money can be a motivating factor for the workers but if their social needs are
met, it can motivate the workers far more.
• Max Weber proposed bureaucratic theory of management that focuses on using strict
rules and firm distribution of powers for effective management
• Henri Fayol proposed theory of management that emphasized on specialization of
work and he gave 14 principles of management.
• Frederick Winslow Taylor proposed scientific management theory that states that if job
is optimized and simplified, it will increase the productivity.
174. __________ is a teacher training and faculty development technique where the
teacher teaches 5–10 pupil for 5–10 minutes:
a. Lecture
b. Role play
c. Microteaching
d. Symposium
Ans. c. Microteaching
Rationale:
• Microteaching is a social skill teaching to provide feedback to teacher trainee for
modification of teacher behavior. This method can be applied or used in a small group
consisting of 5 - 10 pupil and the duration of microteaching is 5 - 10 minutes.
• Lecture method is the method which is mainly teacher-controlled and can be used in
classrooms to teach students.
• Role play is a method to teach in a way that students explore realistic situations such as
by acting and developing interpersonal skills of the learners. They can participate and
perform the role of character they are reading.
• Symposium is a conference or a meeting in which speakers are present to speak on
particular topics to solve common problem. Symposium is usually completed in
a single day, whereas conference may have pre-conference discussions and it could
continue for a couple of days.
175. Syllabus is a part of:

a. Student b. College
c. Institution d. Curriculum
Ans. d. Curriculum
Rationale:
• The nursing tutor knows that syllabus is a part of curriculum. Where curriculum is a
combination of various factors helping in the planning of an educational program, a
syllabus is one that covers the portion of what topics should be taught in a particular
subject.
• Other options are distractors.
G.K. & CURRENT AFFAIRS

176. Recently who has been appointed as the CEO of Hero MotoCorp:
a. Humza Yusuf
b. Niranjan Gupta
c. Pawan Munjal
d. Natalie Batalha
Ans. b. Niranjan Gupta
Rationale:
• Niranjan Gupta has been appointed as the new CEO of Hero MotoCorp, Indian
universal producer of motorcycles and scooters.
• Humza Yusuf has been selected as the next leader of Scottish National Party.
• Pawan Munjal is the acting chairman of Hero MotoCorp.
• Natalie Batalha is an astrophysicist at NASA.
177. The extended deadline for PAN- Aadhar linking is till:

a. 30 June, 2023
b. 1 December, 2023
c. 1 January, 2025
d. 5 March, 2023
Ans. a. 30 June 2023
Rationale:
• Extended deadline for linking PAN- Aadhar is 30 June, 2023 to provide extra time to
the taxpayers who have obtained their PAN Cards by July 2017.
178. How many satellites are launched through LVM3 rocket into the Earth’s lower
orbit?
a. 32 b. 36
c. 38 d. 33
Ans. b. 36
Rationale:
• LVM3 has been launched by ISRO ON 26 March, 2023 with 36 satellites.
179. Geoffrey Hinton recently left Google for which of the following reason?
a. Google is not serving its employees fairly
b. To spread awareness towards rising threats of AI to the Society
c. Being a God father of AI he got another opportunity
d. He knew nothing about AI
Ans. b. To spread awareness towards rising threats of AI to the Society

Rationale:
• Geoffrey Hinton has worked extensively on Neural networks in cognitive psychology.
Recently he left Google to spread awareness about the alarming dangers of technological
robotic devices or chatbots.
180. The event on 2 May, 2023 for the start of ASEAN Maritime Exercise 2023 in
Harbour stage was held at:
a. Changi Naval Base
b. Western Naval Command
c. Washington Navy Yard
d. Norfolk Naval Base
Ans. d. Norfolk Naval Base
Rationale:
• The maritime exercise of the Association of Southeast Asian Nations (ASEAN)
started on May 02, 2023, at Changi Naval Base of Singapore in order to enhance
intergovernmental collaborations and teamwork among various military groups.
GENERAL ENGLISH
181. Riya was thinking about joining …….. Nurses or …….. Doctors.
a. a, an
b. an, an
c. the, the
d. the, an
Ans. b. an, an
Rationale:
• Here we are talking about special classes of people i.e. Nurses and Doctors. As we are
discussing about the specific things, ‘the’ will be used at both places.
182. Find the word with wrong spelling.

a. Promiscuos
b. Priority
c. Permission
d. Proclaimation
Ans. d. Proclaimation
Rationale:
• All spellings are correct except Proclaimation.
• Correct spelling is Proclamation.
183. Kindly rearrange the words to form a meaningful sentence:

1. I
2. exam
3. immediately
4. clear
5. the
6. want
7. to
a. 1652473
b. 1367452
c. 1742365
d. 1436572
Ans. b. 1367452
Rationale:
• Correct sentence after arranging the words sequentially is:
I immediately want to clear the exam.
184. He is left with no money now…

a. Because he was very greedy
b. Because he has given up all his wealth
c. Because he got a new job
d. Because he has received a huge donation
Ans. b. Because he has given up all his wealth
Rationale:
• He is left with no money now because he has given up all his wealth.
• Only this is making a meaningful cause and effect statement. That’s why this is the
correct answer.
185. Kindly opt the segment with error:

Natasha has cleared/ the Civil services exam,/ isn’t it?
a. Natasha has cleared
b. The Civil services exam
c. isn’t it?
d. No error
Ans. c. isn’t it?
Rationale:
• Here we are talking about Natasha so, instead of isn’t it hasn’t she will be used.
• So, correct sentence would be:
Natasha has cleared the Civil services exam, hasn’t she?
ARITHMETIC
186. If the product of three consecutive integers is 120, then the sum of the integers
is
a. 9
b. 12
c. 14
d. 15
e. 18
Ans. d. 15
Rationale:
120 = 2 × 2 × 2 × 3 × 5 = (2 × 2) × 5 × (2 × 3) = 4 × 5 × 6.
Clearly, the three consecutive integers whose product is 120 are 4, 5 and 6
Required sum = 4 + 5 + 6 = 15
187. 5 out of 2250 parts of earth is sulphur. What is the percentage of sulphur in
earth?
a.
11 b.
2
50 9
c.
1 d.
2
45 45
Ans. b.
2
9
 5  2
Required percentage =  × 100  % = %.
 2250  9
188. A sells an article which costs him `z400 to B at a profit of 20%. B then sells it to
C, making a profit of 10% on the price he paid to A. How much does C pay B?
a. ` 472
b. ` 476
c. ` 528
d. ` 532
Ans. c. ` 528
Rationale:
 120 
C.P. for B = 120% of ` 400 = `  × 400  = ` 480
 100 
 110 
C.P. for C = 110% of ` 480 = `  × 480  = ` 528
 100 
189. A train 110 metres long is running with a speed of 60 kmph. In what time will it
pass a man who is running at 6 kmph in the direction opposite to that in which
the train is going?
a. 5 sec
b. 6 sec
c. 7 sec
d. 10 sec
Ans. b. 6 sec
Rationale:
Sped of train relative to man = (60 + 6) km / hr = 66
 5  55 
km / hr =  66×  m/sec =   m/sec
 18   3 
 3 
∴ Time taken to pass the man = 110 ×  sec = 6sec.
 55 
190. The diagonal of a rectangle is 10 cms and is twice the length of one of the sides.
What is the area of the rectangle in sq. cm?
a. 10 3
b. 25
c. 25 3
d. 100
Ans. c. 25 3
Rationale:
10
Length of one side = cm = 5 cm
2
Let the length of the other side be × cm
Then, x2 + 52 = (10)2 ⇒ x2 = 75 ⇒ x = 5 3
∴ Area of the rectangle= (5 × 5 3 ) cm 2

= 25 3 cm 2
191. Which of the following is considered as an important measure to decrease

threats to internal validity in an experimental study?
a. Apply the intervention consistently
b. Improve the precision of measurement methods
c. Increase the sample size
d. Randomly assign subjects to study groups.
Ans. d. Randomly assign subjects to study groups.
Rationale:
• A Consistent application of the intervention and improved precision of measurements
help minimize threats to statistical conclusion validity.
• Consistent application of the intervention and improved precision of measurements
help minimize threats to statistical conclusion validity. Increasing sample size
minimizes threats to external validity.
• An important threat to internal validity is any concern about subject selection and
assignment to groups. Randomly assigning subjects to treatment and control groups
helps to minimize this threat.
192. Which action will the researcher take to improve construct validity?
a. Ensure that operational definitions reflect theoretical constructs
b. Make sure that the researcher is involved in data collection
c. Utilize only one measurement method to measure study variables
d. All of the above
Ans. a. Ensure that operational definitions reflect theoretical constructs
Rationale:
• Construct validity depends on adequate definition and measurement of constructs.
The conceptual definition should emerge from the concept analysis and the operational
definition should clearly reflect both.
• Allowing data collectors to know which subjects are assigned to which groups and
involving the researcher in data collection, both increase the risk of bias.
• Using only one measurement tool increases the risk of bias.
193. Which of the following is used to clean delicate instruments with detachable
parts?
a. Sterilization
b. Disinfection
c. Ultrasonic cleaning
d. Decontamination
Ans. c. Ultrasonic cleaning
Rationale:
• Ultrasonic cleaning machine is most commonly used to clean the laparoscopic
instruments or instruments with detachable parts.
• Manual cleaning of instruments is intended to remove gross debris from the instrument’s
surfaces while ultrasonic cleaners are designed to remove microorganisms and other
fine debris from less accessible surfaces.
• Once the detachable instruments manually cleaned, the instrument is then placed in
the ultrasonic cleaner. The machine has a vibratory flow of action which is particularly
important for removing fine debris that may not have been removed during manual
cleaning. It is important to follow the manufacturer’s instructions for the ultrasonic
cleaning cycle.
194. Which of the following was the first widely used antiseptic and disinfectant?
a. Isopropanol
b. Carbolic acid
c. Chlorine
d. Iodine
Ans. b. Carbolic acid
Rationale:
• The introduction of antiseptic surgical methods was initiated by Joseph Lister, who
was inspired by Louis Pasteur’s germ theory. Lister advocated the use of carbolic acid
(phenol) as a method of killing the germs.
195. A 50-year-old man is hospitalized for the treatment of adrenal crisis. In the
morning rotation, the nurse is evaluating the care provided to the patient for
his treatment. Which of the following changes would indicate the nurse that
the patient is responding favorably to medical and nursing treatment?
a. The patient has experienced weight loss
b. The patient’s urinary output has increased
c. The patient’s peripheral edema has decreased
d. The patient’s blood pressure has increased
Ans. d. The patient’s blood pressure has increased
Rationale:
• The question indirectly asks about what shows a positive response to treatment of
adrenal crisis.
• Hypotension is a sign of adrenal insufficiency. Without treatment, sodium level
decreases, which leads to volume depletion and hypotension; if the patient’s blood
pressure increases, that means it is responding favorably to medical and nursing
treatment.
• Patient’s weight loss indicates continuing loss of water and continuing lack of hormone,
which one is not responding, favors medical and nursing treatment.
• Increase in patient’s urine output indicates continuing lack of hormones; will decrease
with treatment.
• Edema is not seen with adrenal crisis.
196. Antimicrobial dressing is composed of which of the following metals?

a. Copper
b. Zinc
c. Sodium
d. Silver
Ans. d. Silver
Rationale:
• Antimicrobial dressings are applied topically to the wound where they exert a broad
spectrum of non-selective antibacterial action. They act at multiple sites within
microbial cells, thereby reducing the likelihood of bacteria developing resistance.
• Silver-impregnated dressings are becoming popular antimicrobial dressings.
• Antimicrobial dressing used for temporary coverage of open wounds exert both
mechanical and physiologic effects by protecting the wound, maintaining microbial
control, and hastening wound maturation. Synthetic wound dressings modelled after
the biologic dressings have been evaluated by several investigators.
197. Which of the following is false regarding prolonged latent phase?

a. Greater than 14 hours in nullipara
b. Oxytocin stimulation given
c. Excessive sedation causes prolonged latent phases
d. Morphine is used managements
Ans. a. Greater than 14 hours in nullipara
Rationale:
• Latent phase is aid to be prolonged if it is
Ĕ > 20 h in nullipara
Ĕ > 14 h in multipara
• Causes of prolonged latent phase:
Ĕ Excessive sedation /epidural analgesia
Ĕ Poor cervical conditions (thick, uneffaced)
Ĕ False labor (most common cause in multipara)
• Friedman’s curve is used in the diagnosis of prolonged labor
• Management included morphine administration, rest and oxytocin stimulation.
198. A 35-year-old cancer patient is cachectic and has a poor appetite. You decide to
start therapy with which agent?
a. Phentermine
b. Granisetron
c. Dronabinol
d. Megestrol
Ans. d. Megestrol
Rationale:
• Megestrol is used to stimulate appetite in patients with cancer-related cachexia.
• Dronabinol is used in the treatment of AIDS wasting, specifically to increase appetite.
• Granisetron is effective for nausea and vomiting in chemotherapy.
• The other agent, phentermine is used to aid in weight loss.
199. Which of following is not a two way communication?

a. Group discussion
b. Role playing
c. Symposium
d. Panel discussion
Ans. c. Symposium
Rationale:
• Two-way communication is a form of transmission in which both parties involved
transmit information. Two-way communication has also been referred to as
interpersonal communication.
• The symposium forum serves as an excellent device for informing an audience,
crystallizing opinion and in general preparing the listeners for arriving at decision
policies, values, judgment or understanding.
• Symposium consists of a set of program of prepared speeches followed by audience
discussion.
• Symposium is a technique in which two or more person under the direction of a
chairman presents several speeches, which give several aspect of one question.
200. The newborn cardiac output is:

a. 200 ml/kg/min
b. 250 ml/kg/min
c. 300 ml/kg/min
d. 350 mL/kg/min
Ans. d. 350 mL/kg/min
Rationale:
• The newborn cardiac output (about 350 mL/kg/min) falls in the 1st 2 months of life to
about 150 mL/kg/min and then more gradually to the normal adult cardiac output of
about 75 mL/kg/min.

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National NORCET Test-8

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National NORCET Test 8

ANATOMY & PHYSIOLOGY

2. Carbon dioxide is carried from body tissues in what form?

Ans. d. Bicarbonate ions

a. 1-F, 2-G, 3- E, 4-D, 5-B, 6-A

Ans. a. 1- F, 2-G, 3- E, 4-D, 5-B, 6-A

Figure: Features of Neurons

4. A nurse is working in an outpatient orthopedic clinic. During the patient’s

Ans. b. Teres major

Figure: Rotator Cuff Muscles

5. Which statement accurately describes glomerular filtration rate (GFR)?

6. An older patient is describing increased rigidity in the shoulders, back, and

7. Boxer’s muscle is:

Ans. b. Serratus anterior

8. Normal bone cells are known as:

9. Which of the following is QT interval?

Figure: Normal ECG wave Pattern

10. Medial geniculate bodies form a part of:

Ans. b. Auditory system

BIOCHEMISTRY & NUTRITION

Ans. b. Potassium level

12. Identify the given test for proteins:

Ans. c. Biuret Test

Ans. c. Turkey breast

Ans. d. TCA cycle

a. This is an example of Reducometric method

Ans. d. Glucose oxidase is highly specific for beta anomer of glucose

17. IgE is secreted by:

Ans. d. Plasma Cell

Ans. d. Lyme disease – Yersinia pestis

20. Identify the image shown below

Ans. c. Changes in skin color

Ans. d. Check the blood glucose level

Ans. c. 30 minutes before meals

a. Increased urinary output

Ans. c. Decreased pain

• Fluid load is reduced, lowering blood pressure. Furosemide can be a second-line

Ans. d. Leave the medication in the brown bottle

28. A client is receiving Pyridium (phenazopyridine hydrochloride) for a urinary

Ans. d. Change the color of her urine

Ans. 3. If b and d are correct

• Furosemide is a loop diuretic and is contraindicated in a patient with gastritis. The

a. Defend the body against foreign antigens.

Ans. b. Inhibit T cells in response to antigens

Ans. d. Decreases inflammation

32. Which of the following tests should be performed before beginning a

Ans. d. Perform a pregnancy test

33. Dr. Dhiramayee an Anesthesiologist injects the atropine to the preoperative

34. Which of the following parameters should be checked before administering

Ans. b. Apical pulse

a. Take with food

Ans. d. Practice effective contraception

COMMUNITY HEALTH NURSING

Ans. b. Agent, host and environment

Figure: Epidemiologic triad

37. The WHO initiative ‘Right to Sight’ is named as:

Ans. b. Vision 2020

38. With which of the following, the “Indradhanush scheme” is associated?

Ans. a. Index case