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N&MC Ghana Exam study materials
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N&MC Ghana Exam practice questions

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Question 1Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

Which body is the statutory regulator of nursing and midwifery practice in Ghana?

  1. Ghana Medical and Dental Council
  2. Ghana Health Service
  3. Ministry of Health
  4. Nurses and Midwives Council Correct answer.

Explanation

The Nurses and Midwives Council is the statutory body responsible for registering nurses and midwives and regulating their practice. The Ghana Health Service delivers public health services, while the Ministry of Health sets policy. The Medical and Dental Council regulates medical and dental practitioners.

Question 2Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

The Nurses and Midwives Council of Ghana is established by which Act?

  1. Act 857 Correct answer.
  2. Act 851
  3. Act 651
  4. Act 852

Explanation

The Health Professions Regulatory Bodies Act, 2013 (Act 857) establishes the Nurses and Midwives Council along with other health professional regulatory bodies. Act 851 is the Public Health Act, Act 651 is the Labour Act, and Act 852 is the National Health Insurance Act.

Question 3Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

Before practising in Ghana, a newly qualified nurse must obtain which of the following from the Nurses and Midwives Council?

  1. A Ghana Health Service identity card
  2. A hospital appointment letter only
  3. Registration and a valid annual practising licence Correct answer.
  4. A recommendation from the Ghana Registered Nurses and Midwives Association

Explanation

Legal practice requires registration with the Council and a current practising licence; employment alone does not confer the right to practise. The licence is renewed periodically and shows that the practitioner is authorised and in good standing. Association membership and institutional identity cards are not substitutes for statutory registration.

Question 4Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A nurse shares a patient's diagnosis with a friend who is not involved in care. This primarily breaches which ethical principle?

  1. Justice
  2. Confidentiality Correct answer.
  3. Autonomy
  4. Beneficence

Explanation

Confidentiality requires that information learned in the professional relationship be protected from unnecessary disclosure. Sharing a diagnosis with an uninvolved friend is a disclosure outside the care team. Beneficence concerns doing good, justice concerns fairness, and autonomy concerns self-determination.

Question 5Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

For informed consent to be valid, the patient must have which combination?

  1. A doctor's instruction, family approval, and hospital policy
  2. A relative's permission, a lawyer, and a court order
  3. Payment of fees, a witness, and a signed form
  4. Capacity, adequate information, and voluntariness Correct answer.

Explanation

Valid consent requires that the patient has decision-making capacity, receives sufficient information about the proposed care, and chooses freely without coercion. A signature alone does not prove valid consent if these elements are missing. Consent is a process of communication, not merely a formality.

Question 6Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A nurse develops a close personal relationship with a current patient. The most appropriate professional response is to...

  1. Recognize the boundary violation and end the personal relationship Correct answer.
  2. Ask the patient to sign a document waiving confidentiality
  3. Continue the relationship secretly provided that nursing care is not affected
  4. Transfer the patient to a colleague but continue the relationship privately

Explanation

Professional boundaries protect patients, who are in a position of vulnerability and dependence. A personal or romantic relationship with a current patient is a boundary violation and should be ended. Transferring care does not make an existing boundary violation acceptable.

Question 7Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

Which entry meets accepted standards for nursing documentation?

  1. An erased and rewritten entry to correct a mistake
  2. A retrospective note written at the end of the entire week
  3. A vague note stating that the patient is fine
  4. A timed, dated, signed note of observations and care Correct answer.

Explanation

Clinical records should be contemporaneous, accurate, objective, and attributable, so each entry is timed, dated, and signed. Late, altered, or vague entries weaken the record and may be regarded as unprofessional. Corrections should preserve the original entry rather than erase it.

Question 8Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A nurse suspects that a child's injuries are non-accidental. The nurse should...

  1. Discharge the child once injuries are dressed
  2. Report through the child protection channels Correct answer.
  3. Keep the suspicion private to avoid family conflict
  4. Confront the parents and demand an explanation

Explanation

Suspected child abuse triggers a duty to protect the child by reporting through established child protection procedures. The nurse should not investigate or confront the family personally. Keeping the suspicion private leaves the child at risk.

Question 9Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

An unconscious adult is brought to the emergency unit and needs immediate life-saving treatment, but no relative is present. What is the most appropriate action?

  1. Ask the patient to sign after regaining consciousness
  2. Treat under the principle of necessity Correct answer.
  3. Withhold treatment until a relative signs consent
  4. Obtain consent from any available bystander

Explanation

When a patient lacks capacity and urgent treatment is necessary to prevent serious harm, treatment may proceed under the principle of necessity. Consent should be obtained later from the patient or an authorised representative where possible. Delay for non-essential consent formalities could cause preventable harm.

Question 10Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A nurse may disclose confidential patient information without consent in which situation?

  1. When the patient's employer requests sickness details
  2. When a journalist requests details for a news story
  3. When required by a court order or specific law Correct answer.
  4. When a colleague asks out of curiosity

Explanation

Confidentiality is not absolute; disclosure may be justified when required by law or a valid court order, or in limited public-interest situations defined by law. Such disclosures should be limited to the information necessary. Curiosity, media interest, and employer requests are not lawful grounds for disclosure without consent.

Question 11Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A registered nurse delegates to a nursing assistant the task of assessing a postoperative patient's wound. Why is this delegation inappropriate?

  1. Because assessment requires professional nursing judgment Correct answer.
  2. Because the assistant has not requested the task
  3. Because delegation is never permitted in nursing
  4. Because nursing assistants are never employed in hospital settings

Explanation

Delegation is appropriate for tasks that fall within the assistant's competence and do not require professional judgment. Assessment, interpretation, and care planning remain the responsibility of the registered nurse. Delegating assessment risks unsafe care and exceeds the assistant's role.

Question 12Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

To succeed in a negligence claim against a nurse, the complainant must prove...

  1. That a colleague disagreed with the nurse's clinical decision
  2. That the nurse had no licence and the patient paid fees
  3. That the nurse was tired and the patient was dissatisfied
  4. Duty, breach of duty, causation, and harm Correct answer.

Explanation

Negligence requires proof that a duty of care existed, that the standard of care was breached, that the breach caused the harm, and that actual damage resulted. Dissatisfaction, fatigue, or disagreement alone does not establish negligence. The standard is ordinarily that of a reasonably competent practitioner in similar circumstances.

Question 13Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A competent adult patient with a treatable condition refuses surgery after full explanation. The nurse should...

  1. Threaten discharge to force consent
  2. Proceed with preparing the patient for theatre anyway
  3. Respect the refusal and continue supportive care Correct answer.
  4. Ask the family to override the patient's decision

Explanation

A competent adult has the right to refuse treatment even when the refusal may lead to harm. The nurse should ensure the patient is fully informed, document the refusal, and continue appropriate supportive care. Family members cannot override a competent patient's decision.

Question 14Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

Which situation best illustrates professional misconduct rather than ordinary clinical error?

  1. A nurse records a blood pressure after the due time
  2. A nurse falsifies vital signs to cover up neglect Correct answer.
  3. A nurse asks a senior colleague for help with a procedure
  4. A nurse accidentally spills sterile water on the floor

Explanation

Professional misconduct involves a breach of professional standards that is intentional, reckless, or dishonest, such as falsifying records. Ordinary clinical error may result from mistake or system failure and is handled differently. Seeking help and minor incidents are not misconduct.

Question 15Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

Why does the Nurses and Midwives Council require continuing professional development for licence renewal?

  1. To increase hospital revenue
  2. To replace the need for supervision
  3. To guarantee automatic promotion to management
  4. To maintain competence for safe practice Correct answer.

Explanation

Continuing professional development is required to keep knowledge and skills current so that practice remains safe and effective. It does not replace supervision, guarantee promotion, or serve as a revenue measure. Renewal requirements link ongoing learning to the privilege of practice.

Question 16Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A midwife in a health centre manages a woman in normal labour. Which action is within her scope of practice?

  1. Conducting an autopsy on a maternal death
  2. Prescribing chemotherapy for cancer
  3. Monitoring labour and referring complications promptly Correct answer.
  4. Performing a caesarean section without referral

Explanation

A midwife is educated to manage normal pregnancy and labour and to recognise and refer complications promptly. Operative delivery, cancer chemotherapy, and autopsy are outside midwifery scope. Working within scope protects both the woman and the practitioner.

Question 17Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

Before administering a prescribed medicine, the nurse correctly verifies...

  1. The patient's religion and the pharmacy's stock level
  2. The prescriber's signature and the hospital's profit margin
  3. Only the medicine name and the patient's bed number
  4. The right patient, drug, dose, route, and time Correct answer.

Explanation

Safe medication administration includes checking the right patient, drug, dose, route, and time, together with appropriate documentation and patient assessment. Using two patient identifiers helps prevent misidentification. Financial or unrelated personal factors play no part in the clinical check.

Question 18Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A nurse realizes that a previous entry in the clinical record is incorrect. The correct action is to...

  1. Leave the error and write nothing further
  2. Strike a line through the error, correct, sign, and date Correct answer.
  3. Cover the error with correction fluid
  4. Tear out the entire page and rewrite the whole clinical record

Explanation

Corrections must preserve the original record so that the sequence of events remains transparent. The accepted method is to draw a single line through the error, write the correct information, and sign and date the correction. Erasing, obliterating, or rewriting records undermines their integrity.

Question 19Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A patient's cultural beliefs conflict with a proposed care plan that is medically necessary. The nurse should...

  1. Ask the patient to abandon all cultural beliefs before treatment
  2. Ignore the beliefs and proceed as planned
  3. Explore beliefs and negotiate safe care within ethical limits Correct answer.
  4. Report the patient for refusing care

Explanation

Culturally competent care involves exploring the patient's beliefs, providing clear information, and negotiating a plan that respects values while maintaining safety. Ignoring beliefs damages trust and may lead to non-adherence. Reporting a patient for holding cultural beliefs is inappropriate.

Question 20Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

During a shortage of beds, a nurse must decide which patient to admit first. The most ethically defensible approach is to...

  1. Admit patients in the order they arrive regardless of condition
  2. Let the most senior nurse admit personal acquaintances
  3. Use a consistent triage system based on clinical need Correct answer.
  4. Give priority to patients who can pay faster

Explanation

When resources are scarce, allocation should be based on transparent, consistent criteria such as clinical urgency and likely benefit. Arrival order, ability to pay, and personal connections are unjust and clinically unsafe. A triage system supports fairness and accountability.

Question 21Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A patient with HIV refuses to inform a sexual partner. The nurse should...

  1. Refuse to continue caring for the patient
  2. Encourage disclosure and follow partner-notification guidance Correct answer.
  3. Inform the partner immediately without discussing it
  4. Tell the patient's employer and neighbours

Explanation

Confidentiality should be maintained unless disclosure is permitted or required by law. The nurse should encourage voluntary disclosure and follow national guidance on partner notification, which may involve supported disclosure. Breaching confidentiality without legal authority is unjustified.

Question 22Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A nurse wants to conduct a study on patients' wound care experiences. Which step is essential before collecting data?

  1. Publish the findings first and seek approval later
  2. Collect data anonymously without any review
  3. Obtain only the ward manager's verbal permission
  4. Obtain ethics approval and participants' informed consent Correct answer.

Explanation

Research involving patients requires review and approval by a recognized ethics committee before data collection. Participants must give voluntary informed consent and be protected from harm. Publication or managerial permission does not replace ethical review.

Question 23Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A terminally ill patient asks the nurse to administer a lethal injection. What is the most appropriate response?

  1. Discharge the patient immediately without any further discussion
  2. Explain that euthanasia is illegal and offer palliative care Correct answer.
  3. Ask a colleague to perform the injection
  4. Agree because the patient has autonomy

Explanation

Euthanasia is unlawful, and nurses must not intentionally end a patient's life. The patient's distress should be acknowledged and addressed through palliative and psychosocial care. Autonomy does not authorise a lethal act by a health professional.

Question 24Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A doctor asks a nurse to perform a procedure that is outside the nurse's scope and for which the nurse is not trained. The nurse should...

  1. Document that the doctor performed it and then proceed
  2. Ask an untrained assistant to do it instead
  3. Perform it to avoid conflict with the doctor
  4. Decline, explain the scope limit, and escalate Correct answer.

Explanation

Nurses are accountable for practising within their scope of competence and for declining tasks that exceed it. The correct response is to explain the limitation and escalate so that a competent practitioner can provide care. Performing or delegating the procedure would endanger the patient.

Question 25Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A nurse observes a colleague repeatedly coming to work impaired and endangering patients. The most professional first action is to...

  1. Ignore the behaviour to avoid damaging the colleague's career
  2. Report through internal safety and regulatory channels Correct answer.
  3. Post the details on social media to warn the public
  4. Discuss it with patients to gather evidence

Explanation

Patient safety takes priority, and concerns about impaired practice should be reported promptly through proper internal and regulatory channels. This allows appropriate assessment, support, and protection of patients. Public or patient-facing disclosure is inappropriate and breaches confidentiality.

Question 26Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

Which institution is legally responsible for regulating the practice of nursing and midwifery in Ghana?

  1. The Nurses and Midwives Council Correct answer.
  2. The Ministry of Health
  3. The Ghana Health Service
  4. The Ghana Medical and Dental Council

Explanation

The Nurses and Midwives Council is the statutory regulator established to register, license, and discipline nurses and midwives. Other bodies may employ or represent health workers, but they do not regulate the nursing and midwifery profession.

Question 27Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A patient who has recovered offers a nurse an expensive wristwatch as a token of gratitude. What is the most appropriate professional response?

  1. Ask the patient to give it to the hospital instead.
  2. Accept it but share the value with the ward team.
  3. Politely decline and explain the conflict-of-interest risk. Correct answer.
  4. Accept it because refusing a grateful patient's gift would embarrass the patient.

Explanation

Professional codes warn against accepting gifts that could influence judgment or create an obligation. A valuable gift should be declined politely, and any permitted token gift should follow facility policy.

Question 28Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

Which ethical principle directs a nurse to act in a way that promotes the patient's well-being?

  1. Justice
  2. Beneficence Correct answer.
  3. Veracity
  4. Autonomy

Explanation

Beneficence is the duty to promote good and act in the patient's best interest. Autonomy concerns self-determination, justice concerns fairness, and veracity concerns truthfulness.

Question 29Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A nurse whose annual practising licence has expired continues to provide direct patient care. This behaviour is best described as...

  1. An acceptable practice if the nurse is experienced.
  2. A civil dispute between the nurse and the patient.
  3. A minor administrative matter for the facility.
  4. Professional misconduct attracting disciplinary action. Correct answer.

Explanation

The law requires a valid practising licence for nursing and midwifery practice. Practising without one is an offence and can be treated as professional misconduct by the regulator.

Question 30Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

During the informed consent process, the nurse's professional responsibility is to...

  1. Obtain the patient's signature on the consent form on behalf of the doctor.
  2. Persuade the patient to accept the treatment recommended by the team.
  3. Give the patient a copy of the consent form without further discussion.
  4. Confirm the patient understands and is deciding voluntarily. Correct answer.

Explanation

The nurse supports informed consent by verifying understanding, ensuring voluntariness, and answering questions. The clinician obtaining consent remains responsible for explaining the procedure, and the nurse must not coerce the patient.

Question 31Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A patient asks to see the entries made in his clinical record. The nurse should...

  1. Remove the doctor's notes before showing the file.
  2. Provide an informal verbal summary instead of the record.
  3. Verify identity and follow facility policy for lawful access. Correct answer.
  4. Refuse because clinical records are the property of the hospital.

Explanation

Patients have a right of access to their personal health information, subject to identity verification and lawful procedures. The record belongs to the facility, but that does not deny the patient access.

Question 32Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A nurse takes a photograph of a patient's leg ulcer and posts it on a personal social media account without the patient's name. The nurse has...

  1. Acted appropriately because the patient cannot be identified by name.
  2. Breached only facility policy, not professional ethics.
  3. Breached confidentiality because a clinical image is patient data. Correct answer.
  4. Acted appropriately if the post is deleted within 24 hours.

Explanation

Clinical images are personal health information and can identify a patient even without a name. Posting them without consent breaches confidentiality and professional ethics, not merely local policy.

Question 33Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A nurse has evidence that a colleague is practising with a forged practising licence. The nurse should report the matter to...

  1. A social media professional group.
  2. The colleague's family for guidance.
  3. The Nurses and Midwives Council. Correct answer.
  4. The hospital's patients' relatives.

Explanation

The Council is the regulator with authority to investigate registration and licensing offences. Reporting to the regulator protects patients and upholds the profession.

Question 34Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

When a nurse faces a complex ethical dilemma, which action should come first in a structured decision-making process?

  1. Implement the option preferred by the patient's family.
  2. Consult the hospital lawyer before speaking to anyone.
  3. Choose the option that saves the most money.
  4. Gather the relevant clinical and ethical facts. Correct answer.

Explanation

A structured ethical decision-making model begins by identifying the facts, stakeholders, values, and relevant principles. Options should be evaluated only after the situation is understood.

Question 35Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

An adult patient with capacity is being pressured by relatives to refuse a blood transfusion that the team considers necessary. The nurse should...

  1. Transfer the patient to another ward.
  2. Support the relatives because family involvement is culturally important.
  3. Ask the doctor to proceed without further discussion.
  4. Ensure the patient's own wishes are heard and respected. Correct answer.

Explanation

Advocacy requires the nurse to support the patient's autonomous decision, especially when relatives apply pressure. The nurse ensures the patient's voice is heard without taking sides.

Question 36Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

In a negligence claim, the standard of care expected of a nurse is determined by...

  1. The nurse's personal view of what is reasonable.
  2. The patient's expectation of a perfect outcome.
  3. The most advanced practice described in any textbook.
  4. What a reasonably competent nurse would do. Correct answer.

Explanation

Negligence is judged against the standard of a reasonably competent practitioner in similar circumstances, not perfection or personal opinion. Expert evidence may help the court apply that standard.

Question 37Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A 6-year-old child needs a minor surgical procedure. Who is legally competent to give consent for the procedure?

  1. The child, if the procedure is explained in simple language.
  2. Any adult relative who accompanies the child.
  3. The child's parent or legal guardian. Correct answer.
  4. The nurse in charge of the ward.

Explanation

A young child lacks legal capacity to consent, so a parent or legal guardian provides consent. An unrelated adult or nurse cannot consent merely because they are present.

Question 38Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

A nurse notices that a colleague has administered the wrong dose of a medicine to a patient. The patient is stable. What is the most appropriate immediate action?

  1. Wait to see whether the patient develops any symptoms before acting.
  2. Assess the patient, inform the clinician, and report the error. Correct answer.
  3. Discuss the error with other nurses during handover only.
  4. Correct the medication chart quietly to avoid blame.

Explanation

Patient safety comes first: assess the patient, inform the clinician, and report the error through the incident system. Honest disclosure and documentation are professional duties.

Question 39Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

After a patient dies, a relative asks the nurse for details of the patient's HIV status. The nurse should...

  1. Tell the relative only if they promise to keep it secret.
  2. Disclose the information because confidentiality ends at death.
  3. Read the entire file aloud so the family can decide.
  4. Withhold unless authorised by law or the patient's agent. Correct answer.

Explanation

Confidentiality continues after death, and health information may be released only where law or a proper representative authorises it. Family relationship alone does not create a right to know.

Question 40Professional Foundations, Ethics and Regulation of Nursing and Midwifery Practice

During a night shift, the nurse in charge finds that staffing is so low that patients' basic needs cannot be met safely. What is the most professionally appropriate action?

  1. Document the concern and escalate it to the appropriate manager immediately. Correct answer.
  2. Ask unlicensed assistants to perform nursing assessments to save time.
  3. Leave the ward to look for staff in other departments without informing anyone.
  4. Continue silently because raising concerns may damage team morale.

Explanation

Nurses are accountable for patient safety and must escalate unsafe staffing through appropriate channels and document their concerns. Silence or unsafe substitution of untrained staff worsens risk.

Question 41Medical-Surgical Nursing and Adult Health

A patient with chronic obstructive pulmonary disease is prescribed oxygen therapy. Which target oxygen saturation range should the nurse aim for?

  1. 88% to 92% Correct answer.
  2. 94% to 98%
  3. 80% to 85%
  4. Above 98%

Explanation

In COPD, chronic hypercapnia blunts the respiratory drive so that hypoxaemia becomes the main stimulus to breathe. High-flow oxygen can therefore worsen carbon dioxide retention, so controlled oxygen is titrated to a saturation of 88% to 92%. Saturation is reviewed alongside the patient's acid-base status and clinical condition.

Question 42Medical-Surgical Nursing and Adult Health

A patient arrives in the emergency department with crushing central chest pain and ST elevation on the ECG. Which medication should the nurse give first for the patient to chew?

  1. Nebulised salbutamol
  2. Chewed aspirin 300 mg Correct answer.
  3. Sublingual glyceryl trinitrate
  4. Oral clopidogrel 75 mg

Explanation

Chewed aspirin is absorbed rapidly and inhibits platelet aggregation, limiting thrombus extension in acute coronary syndrome. It is given early to every patient with suspected myocardial infarction unless there is a genuine allergy or active bleeding. Other agents are added afterwards according to the local protocol.

Question 43Medical-Surgical Nursing and Adult Health

A patient presents with haematemesis, a pulse of 118 beats per minute and a blood pressure of 92/60 mmHg. Which action should the nurse take first?

  1. Withhold all fluids until endoscopy is completed
  2. Insert two large-bore cannulae and start crystalloid infusion Correct answer.
  3. Give oral fluids freely to replace losses
  4. Insert a nasogastric tube and perform lavage

Explanation

The priority in an upper gastrointestinal bleed with hypovolaemia is restoring circulating volume, which requires secure large-bore intravenous access and rapid crystalloid or blood replacement. Oral intake cannot correct intravascular depletion in a shocked patient. Endoscopy follows once the patient is stabilised.

Question 44Medical-Surgical Nursing and Adult Health

A patient has been admitted after a first generalised seizure. Which measure should the nurse include in the plan of care?

  1. Insert a tongue blade between the teeth at the start of a seizure
  2. Keep suction and oxygen equipment at the bedside Correct answer.
  3. Restrain the limbs firmly during the seizure
  4. Raise the bed to its highest position

Explanation

Airway protection is the central safety concern during a seizure, so suction and oxygen must be immediately available. The bed should be kept low with padded side rails and the patient turned to the side once the seizure ends. Nothing should be forced into the mouth.

Question 45Medical-Surgical Nursing and Adult Health

Which finding is the earliest compensatory sign of hypovolaemic shock in an adult?

  1. Bradycardia with a bounding pulse
  2. Warm, flushed skin
  3. Hypertension with a widened pulse pressure
  4. Tachycardia with a narrowing pulse pressure Correct answer.

Explanation

Loss of circulating volume triggers a sympathetic response that raises the heart rate and increases peripheral resistance. The rise in diastolic pressure narrows the pulse pressure before the systolic pressure falls. Hypotension is therefore a late and unreliable sign.

Question 46Medical-Surgical Nursing and Adult Health

A patient receiving chemotherapy has a neutrophil count of 0.4 x 10^9/L. Which nursing measure is appropriate?

  1. Keep fresh flowers and potted plants in the room
  2. Provide a private room and screen visitors for infection Correct answer.
  3. Share a bathroom with other patients on the ward
  4. Allow visits from people who have recently had a live vaccine

Explanation

Severe neutropenia leaves the patient unable to mount an effective response to infection, so protective isolation and visitor screening are used to reduce exposure to pathogens. Fresh plants, stagnant water and ill visitors are avoided. Any temperature rise is treated as an emergency.

Question 47Medical-Surgical Nursing and Adult Health

A patient with acute asthma is breathless with widespread expiratory wheeze and a peak flow of 45% of predicted. Which treatment should the nurse prepare to give first?

  1. Oral corticosteroids alone
  2. Oral antibiotics
  3. Nebulised salbutamol Correct answer.
  4. Intravenous morphine

Explanation

Acute asthma is driven by bronchospasm, so a rapid-acting inhaled beta-2 agonist is the first-line treatment and is given by oxygen-driven nebuliser or spacer. Systemic corticosteroids are added early but act over hours. Sedatives are avoided because they depress respiration.

Question 48Medical-Surgical Nursing and Adult Health

Which intervention most effectively prevents atelectasis in a patient recovering from abdominal surgery?

  1. Scheduled opioid analgesia around the clock
  2. Incentive spirometry every hour while awake Correct answer.
  3. Strict bed rest for the first 48 hours
  4. Clear fluids only for the first 24 hours

Explanation

Atelectasis follows shallow breathing and retained secretions after anaesthesia and abdominal incision. Deep-breathing exercises with an incentive spirometer, together with early mobilisation, re-expand the alveoli. Pain must be controlled adequately enough to allow these exercises.

Question 49Medical-Surgical Nursing and Adult Health

A patient with acute kidney injury has a serum potassium of 6.9 mmol/L and peaked T waves on the ECG. Which prescription should the nurse administer first?

  1. Oral sodium polystyrene sulfonate
  2. Oral potassium chloride
  3. Intravenous calcium gluconate Correct answer.
  4. Subcutaneous insulin alone

Explanation

Peaked T waves indicate that hyperkalaemia is already affecting the myocardium and the patient is at risk of ventricular arrhythmia. Intravenous calcium antagonises the membrane effect of potassium within minutes and is therefore given first. Measures that shift or remove potassium follow afterwards.

Question 50Medical-Surgical Nursing and Adult Health

An arterial blood gas shows pH 7.30, PaCO2 30 mmHg and HCO3 15 mmol/L. How should the nurse interpret this result?

  1. Metabolic alkalosis with respiratory compensation
  2. Respiratory acidosis with metabolic compensation
  3. Respiratory alkalosis with metabolic compensation
  4. Metabolic acidosis with respiratory compensation Correct answer.

Explanation

A low pH confirms acidaemia and the low bicarbonate identifies the metabolic origin of the acidosis. The low PaCO2 shows hyperventilation that is compensating for the metabolic defect. The values are consistent with a primary metabolic acidosis with respiratory compensation.