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AIIMS NORCET practice questions

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Question 1Nursing Foundation and Basic Sciences

A patient who had abdominal surgery 3 days ago suddenly develops calf pain, unilateral leg swelling and a low-grade fever. Which complication should the nurse suspect first?

  1. Deep vein thrombosis Correct answer.
  2. Wound dehiscence
  3. Paralytic ileus
  4. Hypovolaemic shock

Explanation

Unilateral calf pain, swelling and low-grade fever appearing after major abdominal surgery are the classic triad suggesting deep vein thrombosis, driven by venous stasis, endothelial injury and hypercoagulability. The nurse should avoid massaging the limb, keep the patient on bed rest and report immediately, because a fragment may embolise to the lungs.

Question 2Nursing Foundation and Basic Sciences

Which route of drug administration completely bypasses the hepatic first-pass effect?

  1. Enteral via nasogastric tube
  2. Sublingual Correct answer.
  3. Oral
  4. Rectal

Explanation

Sublingual absorption drains into the venous plexus under the tongue and reaches the systemic circulation directly, so the drug avoids portal circulation and hepatic first-pass metabolism. This is why glyceryl trinitrate is given sublingually for rapid systemic effect.

Question 3Nursing Foundation and Basic Sciences

While preparing an intravenous infusion, the nurse notices the solution is cloudy with visible particles. What is the most appropriate action?

  1. Filter the solution through gauze before use
  2. Discard the bag and obtain a new one Correct answer.
  3. Shake the bag vigorously and then use it
  4. Warm the bag to dissolve the particles

Explanation

Particulate matter in an intravenous solution indicates contamination or precipitation and must never be infused, because particles can cause phlebitis, embolism or sepsis. The bag should be discarded and a fresh, inspected solution obtained.

Question 4Nursing Foundation and Basic Sciences

A patient with severe vomiting has a serum potassium of 2.9 mEq/L. Which finding should the nurse anticipate on cardiac monitoring?

  1. ST elevation in all leads
  2. Prolonged QT interval with flattened T waves Correct answer.
  3. Peaked T waves
  4. Widened QRS with bradycardia

Explanation

Hypokalaemia prolongs repolarisation, producing a prolonged QT interval, flattened or inverted T waves and visible U waves. It also predisposes to ventricular arrhythmias, so potassium replacement and monitoring are priorities.

Question 5Nursing Foundation and Basic Sciences

Which nursing measure best prevents ventilator-associated pneumonia in an intubated patient?

  1. Suctioning the airway every hour regardless of need
  2. Keeping the head of the bed elevated to 30-45 degrees Correct answer.
  3. Changing the ventilator circuit every 12 hours
  4. Instilling normal saline before each suction pass

Explanation

Semi-recumbent positioning at 30-45 degrees reduces aspiration of oropharyngeal and gastric secretions, which is the main mechanism of ventilator-associated pneumonia. It is combined with oral care, sedation holidays and subglottic suction.

Question 6Nursing Foundation and Basic Sciences

During the immediate postoperative period, which assessment finding is the earliest indicator of hypovolaemic shock?

  1. Warm, flushed skin
  2. Bradycardia
  3. Restlessness and anxiety Correct answer.
  4. Decreased urine output

Explanation

A falling cardiac output triggers sympathetic compensation, and the earliest cerebral sign is restlessness, anxiety and altered mentation, often before blood pressure falls. Urine output falls later as renal perfusion declines, and tachycardia rather than bradycardia develops.

Question 7Nursing Foundation and Basic Sciences

Which statement about hand hygiene according to the WHO five moments is correct for nursing practice?

  1. Hand rub should be applied for at least 3 seconds
  2. Hands must be washed with soap and water after exposure to blood or body fluids Correct answer.
  3. Gloves eliminate the need for hand hygiene between patients
  4. Alcohol-based hand rub is preferred for visibly soiled hands

Explanation

When hands are visibly soiled or contaminated with blood and body fluids, soap and water washing is required because alcohol rubs do not remove organic material or inactivate spore-forming organisms such as Clostridioides difficile. Alcohol rub remains the preferred routine method for otherwise clean hands.

Question 8Nursing Foundation and Basic Sciences

A patient on nasogastric tube feeding develops diarrhoea. Which nursing action is most appropriate first?

  1. Check the formula concentration, rate and temperature and stop the feed if needed Correct answer.
  2. Clamp the tube permanently and withhold all fluids
  3. Administer a routine antidiarrhoeal without review
  4. Increase the feeding rate to compensate for losses

Explanation

Diarrhoea during enteral feeding commonly results from rapid infusion, hyperosmolar or cold formula, or bacterial contamination, so the nurse should review rate, strength and temperature and pause the feed pending reassessment. Fluid and electrolyte losses must also be monitored and reported.

Question 9Nursing Foundation and Basic Sciences

Which position is most appropriate for a patient with acute dyspnoea from left ventricular failure?

  1. High Fowler position Correct answer.
  2. Trendelenburg position
  3. Left lateral position
  4. Prone position

Explanation

High Fowler positioning lowers venous return, reduces pulmonary congestion and improves lung expansion by allowing the diaphragm to descend. This upright posture relieves orthopnoea in acute left ventricular failure.

Question 10Nursing Foundation and Basic Sciences

A patient with a tracheostomy is being suctioned. Which action indicates correct technique?

  1. Applying suction continuously while inserting the catheter
  2. Using the largest catheter that fits the tracheostomy tube
  3. Limiting each suction pass to about 10-15 seconds Correct answer.
  4. Suctioning immediately after a feeding without pausing

Explanation

Each suction pass should be limited to about 10-15 seconds with intermittent suction applied only during withdrawal, to limit hypoxaemia and mucosal trauma. The patient should be pre-oxygenated and observed for desaturation.

Question 11Nursing Foundation and Basic Sciences

Which parameter is used to calculate the body mass index of an adult?

  1. Weight in pounds divided by height in inches
  2. Weight in kilograms divided by height in metres squared Correct answer.
  3. Weight in kilograms multiplied by height in metres
  4. Height in centimetres divided by weight in kilograms

Explanation

Body mass index is calculated as weight in kilograms divided by the square of height in metres, expressed in kg/m². It is used for nutritional screening, with values of 18.5-24.9 kg/m² considered normal for adults.

Question 12Nursing Foundation and Basic Sciences

A patient has a prescription of 500 mL of normal saline to infuse over 4 hours using a macrodrip set with a drop factor of 20 drops/mL. What is the drip rate?

  1. 125 drops/min
  2. 42 drops/min Correct answer.
  3. 21 drops/min
  4. 63 drops/min

Explanation

The drip rate equals volume in mL multiplied by drop factor, divided by time in minutes: 500 × 20 ÷ 240 = 41.7, rounded to 42 drops per minute. Accurate calculation prevents fluid overload or under-infusion.

Question 13Nursing Foundation and Basic Sciences

Which finding is most characteristic of stage 2 pressure injury?

  1. Partial-thickness loss of skin with a shallow open ulcer or blister Correct answer.
  2. Intact skin with non-blanchable redness
  3. Full-thickness loss with exposed fascia
  4. Full-thickness loss with exposed bone or tendon

Explanation

A stage 2 pressure injury involves partial-thickness loss of the dermis, appearing as a shallow open ulcer with a pink wound bed or an intact or ruptured blister. Stage 1 is intact skin with non-blanchable erythema, while stages 3 and 4 involve deeper tissue loss.

Question 14Nursing Foundation and Basic Sciences

A patient with chronic obstructive pulmonary disease has an oxygen saturation of 86%. Which oxygen delivery approach is safest?

  1. High-flow oxygen at 10-15 L/min by mask
  2. Controlled low-flow oxygen titrated to a target saturation of about 88-92% Correct answer.
  3. No oxygen at all
  4. Intermittent oxygen only during meals

Explanation

In some patients with chronic hypercapnia, uncontrolled high-flow oxygen can worsen carbon dioxide retention by altering hypoxic vasoconstriction and the hypoxic drive. Controlled low-flow oxygen titrated to a saturation of about 88-92% maintains oxygenation while avoiding this risk.

Question 15Nursing Foundation and Basic Sciences

Which action is essential before administering a blood transfusion?

  1. Adding calcium gluconate to the unit to prevent reactions
  2. Two-person verification of patient identity and blood unit compatibility at the bedside Correct answer.
  3. Warming the unit to body temperature in a microwave
  4. Starting the transfusion through the same line as a dextrose infusion

Explanation

Bedside two-person verification of patient identity, blood group, unit number and compatibility label prevents the most serious transfusion errors, which are usually clerical. Vital signs are also recorded before starting.

Question 16Nursing Foundation and Basic Sciences

Which statement about standard precautions is correct?

  1. They replace transmission-based precautions in all situations
  2. They apply to all patients regardless of diagnosis Correct answer.
  3. They apply only to patients with a known infectious diagnosis
  4. They require gloves for every patient contact

Explanation

Standard precautions are based on the principle that every patient may carry a transmissible organism, so they apply universally to blood, body fluids, secretions, non-intact skin and mucous membranes. Transmission-based precautions are added when a specific organism is suspected.

Question 17Nursing Foundation and Basic Sciences

A patient receiving morphine for severe pain has a respiratory rate of 8 breaths/min and pinpoint pupils. Which action should the nurse take first?

  1. Give the next scheduled morphine dose
  2. Document the findings and reassess in one hour
  3. Stop the opioid and prepare to administer naloxone Correct answer.
  4. Encourage the patient to sleep

Explanation

Pinpoint pupils, bradypnoea and sedation indicate opioid toxicity. The opioid must be withheld immediately, ventilation supported and naloxone prepared according to protocol while the prescriber is notified.

Question 18Nursing Foundation and Basic Sciences

Which structure is the functional unit of the kidney?

  1. Loop of Henle
  2. Renal pelvis
  3. Glomerulus
  4. Nephron Correct answer.

Explanation

The nephron is the functional unit of the kidney, comprising the glomerulus, Bowman capsule, proximal tubule, loop of Henle, distal tubule and collecting duct. Each kidney contains about one million nephrons that filter, reabsorb and secrete.

Question 19Nursing Foundation and Basic Sciences

A patient has a serum calcium of 7.2 mg/dL after thyroid surgery. Which sign should the nurse assess for?

  1. Cullen sign
  2. Murphy sign
  3. Kernig sign
  4. Trousseau sign Correct answer.

Explanation

Hypocalcaemia after thyroidectomy results from inadvertent parathyroid injury and causes neuromuscular irritability, demonstrated by Trousseau sign (carpal spasm with a blood pressure cuff) or Chvostek sign. It may progress to tetany and seizures.

Question 20Nursing Foundation and Basic Sciences

Which nursing intervention is most important in preventing aspiration in a patient with dysphagia after a stroke?

  1. Encouraging thin liquids with a straw
  2. Positioning upright and using thickened fluids as prescribed Correct answer.
  3. Placing food on the weaker side of the mouth
  4. Feeding quickly to reduce fatigue

Explanation

An upright position of at least 90 degrees and thickened fluids reduce the risk of aspiration in dysphagia by slowing the bolus and protecting the airway. A swallow assessment should precede oral feeding.

Question 21Nursing Foundation and Basic Sciences

Which finding is the earliest sign of increased intracranial pressure in an adult?

  1. Decerebrate posturing
  2. Cushing triad
  3. Change in level of consciousness Correct answer.
  4. Fixed dilated pupils

Explanation

A change in the level of consciousness is the earliest and most sensitive indicator of raised intracranial pressure, because the cerebral cortex is most sensitive to pressure and hypoxia. Pupillary changes, posturing and Cushing triad appear later.

Question 22Nursing Foundation and Basic Sciences

Which type of isolation is required for a patient with active pulmonary tuberculosis?

  1. Contact precautions only
  2. Droplet precautions only
  3. Airborne precautions with a negative-pressure room Correct answer.
  4. Standard precautions only

Explanation

Mycobacterium tuberculosis is transmitted by airborne droplet nuclei that remain suspended and travel on air currents, so airborne precautions with a negative-pressure room and a fit-tested N95 respirator are needed. Droplet precautions do not provide adequate protection.

Question 23Nursing Foundation and Basic Sciences

A patient with a chest drain after lobectomy has continuous bubbling in the water-seal chamber. What does this indicate?

  1. Complete lung re-expansion
  2. Normal tidal movement of the water column
  3. Blocked chest tube
  4. An air leak in the system or lung Correct answer.

Explanation

Continuous bubbling in the water-seal chamber indicates an air leak, either from the patient's lung or from a loose connection in the system. The nurse should check connections and report persistent bubbling, whereas intermittent bubbling or tidaling is normal.

Question 24Nursing Foundation and Basic Sciences

Which action best prevents medication administration errors at the bedside?

  1. Administering a drug when the patient requests it without an order
  2. Following the rights of medication administration and checking the label at the bedside Correct answer.
  3. Relying on memory for drug doses
  4. Preparing medications for several patients at once

Explanation

Checking the right patient, drug, dose, route and time against the order, and verifying the label at the bedside, prevents most medication errors. Preparing drugs one patient at a time and using a second checker for high-risk drugs further reduces risk.

Question 25Nursing Foundation and Basic Sciences

A patient has a serum sodium of 158 mEq/L and is confused. Which fluid does the nurse anticipate as the safest initial therapy?

  1. Free water restriction
  2. Rapid infusion of 0.9% sodium chloride
  3. Slow correction with isotonic or hypotonic fluid as prescribed with frequent monitoring Correct answer.
  4. Rapid infusion of 3% sodium chloride

Explanation

Hypernatraemia is corrected slowly to avoid cerebral oedema from rapid osmotic shifts; the rate of correction should not exceed about 10-12 mEq/L per day. Isotonic or hypotonic fluid is used with frequent sodium checks, and free water restriction would worsen the deficit.

Question 26Nursing Foundation and Basic Sciences

A nurse is preparing to insert a peripheral intravenous cannula in an adult. Which site selection principle is most appropriate?

  1. Select a joint area so the cannula is splinted and less likely to dislodge
  2. Choose a distal vein on the non-dominant arm, starting low and moving proximally on later attempts Correct answer.
  3. Always select the antecubital fossa first because the vein is largest and easiest to cannulate
  4. Use a vein distal to a previous puncture site on the same limb to preserve proximal vessels

Explanation

Peripheral cannulation follows the principle of starting distal and progressing proximally, so that proximal veins remain available if the first attempt fails or infiltrates. The non-dominant arm is preferred to preserve function. Joint areas and previously used segments are avoided where possible.

Question 27Nursing Foundation and Basic Sciences

A patient is prescribed 40 mg of furosemide intravenously. The vial contains 20 mg in 2 mL. How many millilitres will the nurse draw up?

  1. 8 mL
  2. 2 mL
  3. 4 mL Correct answer.
  4. 1 mL

Explanation

Using ratio and proportion, 20 mg is contained in 2 mL, so 40 mg requires 40 divided by 20 multiplied by 2 mL, which equals 4 mL. Dimensional reasoning confirms the dose doubles the volume of the stated concentration.

Question 28Nursing Foundation and Basic Sciences

Which statement correctly describes the normal pacemaker of the heart?

  1. Purkinje fibres depolarise spontaneously at 40 to 60 beats per minute and drive the normal rhythm
  2. The bundle of His generates the fastest intrinsic rate and therefore sets the resting heart rate
  3. The sinoatrial node depolarises at 60 to 100 beats per minute and normally initiates the cardiac impulse Correct answer.
  4. The atrioventricular node fires at 60 to 100 beats per minute and initiates each normal beat

Explanation

The sinoatrial node has the highest rate of spontaneous depolarisation and therefore acts as the dominant pacemaker, normally firing at 60 to 100 beats per minute. Lower pacemakers are latent and take over only if the sinus node fails or conduction is blocked.

Question 29Nursing Foundation and Basic Sciences

A patient has been on bed rest for five days. Which assessment finding most suggests a deep vein thrombosis of the left leg?

  1. Cramping calf pain that is relieved by walking and resolves within minutes
  2. Bilateral pitting ankle oedema that improves with elevation
  3. Unilateral calf tenderness, warmth, and measurable increase in calf circumference Correct answer.
  4. A cool, pale foot with absent dorsalis pedis pulsation

Explanation

Deep vein thrombosis typically produces unilateral calf pain, tenderness, warmth, and increased limb girth due to venous obstruction and inflammation. The finding is compared with the opposite limb to confirm asymmetry. Bilateral oedema or arterial signs point elsewhere.

Question 30Nursing Foundation and Basic Sciences

A nurse is caring for a patient with a new ileostomy. Which finding in the first 24 hours after surgery is expected?

  1. Absence of any output from the stoma
  2. Complete absence of stoma swelling and a flush stoma
  3. Formed brown stool from the stoma
  4. Liquid green-yellow effluent with high enzyme content Correct answer.

Explanation

Immediately after ileostomy formation the small bowel output is liquid, greenish-yellow, and rich in digestive enzymes, which is highly irritating to peristomal skin. Output typically begins within the first day and gradually thickens over weeks.

Question 31Nursing Foundation and Basic Sciences

A patient with diabetic ketoacidosis is receiving an insulin infusion. Which parameter is the most important reason to add dextrose to the intravenous fluid?

  1. To provide calories that directly reverse the acidosis
  2. To prevent hypoglycaemia while continuing insulin to clear ketones Correct answer.
  3. To slow the insulin infusion rate by diluting it
  4. To increase the serum sodium concentration

Explanation

Insulin must continue until ketogenesis is suppressed, even after glucose falls toward normal. Adding dextrose allows continued insulin delivery while avoiding hypoglycaemia, so ketones can be cleared safely.

Question 32Nursing Foundation and Basic Sciences

A patient is receiving a continuous enteral feed through a nasogastric tube. Which action best reduces the risk of aspiration?

  1. Flushing the tube with 50 mL of water before each feed
  2. Positioning the patient supine for one hour after the feed
  3. Keeping the head of the bed elevated to 30 to 45 degrees during and after feeding Correct answer.
  4. Checking residual volume every 12 hours and withholding feed if any remains

Explanation

Semi-recumbent positioning of 30 to 45 degrees during feeding and for about 30 to 60 minutes afterwards reduces gastro-oesophageal reflux and aspiration. This is a core element of enteral feeding safety.

Question 33Nursing Foundation and Basic Sciences

A postoperative patient has a haemoglobin of 7.0 g/dL, blood pressure 88/54 mmHg, heart rate 118 beats/min, and cool clammy skin. Which action should the nurse take first?

  1. Notify the surgical team and prepare for fluid resuscitation while monitoring for bleeding Correct answer.
  2. Ambulate the patient to assess whether the tachycardia resolves
  3. Transfuse packed red cells immediately without further assessment
  4. Give oral iron supplements and recheck the haemoglobin in 24 hours

Explanation

Tachycardia, hypotension, cool clammy skin, and a falling haemoglobin after surgery suggest hypovolaemia from bleeding. The nurse should escalate to the surgical team, support circulation with intravenous fluids and blood products as ordered, and monitor closely; transfusion is not initiated independently.

Question 34Nursing Foundation and Basic Sciences

A patient with a permanent pacemaker is scheduled for surgery and the pacemaker is set to a fixed-rate mode. Which precaution is most important?

  1. Apply a magnet only if the device is a defibrillator and the patient is conscious
  2. Withhold all cardiac monitoring during electrocautery use
  3. Place the electrocautery return pad so current passes through the pacemaker generator
  4. Use bipolar electrocautery where possible and keep the return pad close to the surgical site Correct answer.

Explanation

Monopolar current can be misinterpreted by a pacemaker as intrinsic cardiac activity and inhibit pacing, or can cause heating at the lead tip. Bipolar cautery and a return pad positioned so current does not cross the generator reduce this risk. Continuous ECG and pulse monitoring are maintained.

Question 35Nursing Foundation and Basic Sciences

A patient with chronic kidney disease has a serum potassium of 6.8 mEq/L and peaked T waves on the ECG. Which prescribed intervention should the nurse anticipate giving first?

  1. Oral potassium binder with a low-potassium diet
  2. Oral sodium polystyrene sulfonate
  3. Subcutaneous regular insulin without glucose
  4. Intravenous calcium gluconate Correct answer.

Explanation

Peaked T waves with severe hyperkalaemia indicate a risk of lethal arrhythmia, so membrane stabilisation with intravenous calcium is the immediate priority. Insulin with dextrose and other measures to shift or remove potassium follow.

Question 36Nursing Foundation and Basic Sciences

A patient with a spinal cord injury at T4 develops sudden severe headache, hypertension, and bradycardia during bladder catheterisation. What is the priority nursing action?

  1. Administer a prescribed antihypertensive and continue the procedure
  2. Stop the procedure, sit the patient upright, and check for and remove the triggering stimulus Correct answer.
  3. Document the findings and reassess in 15 minutes
  4. Complete the catheterisation quickly to relieve the stimulus

Explanation

The picture is autonomic dysreflexia, triggered by a noxious stimulus below the injury level such as bladder distension. The priority is to stop the stimulus and sit the patient upright to reduce blood pressure, then identify and remove the cause and give antihypertensives if ordered.

Question 37Nursing Foundation and Basic Sciences

A patient with severe pre-eclampsia is receiving magnesium sulphate infusion. Which assessment finding is the earliest sign of magnesium toxicity?

  1. Urine output of 60 mL per hour
  2. Respiratory rate of 20 breaths per minute
  3. Increased fetal heart variability
  4. Loss of deep tendon reflexes Correct answer.

Explanation

Magnesium toxicity progresses from loss of deep tendon reflexes, to respiratory depression, to cardiac arrest. Monitoring reflexes, respiratory rate, and urine output guides safe infusion, and calcium gluconate is the antidote.

Question 38Nursing Foundation and Basic Sciences

A nurse is calculating the fluid requirement for an adult who weighs 70 kg using the 4-2-1 rule. What is the hourly maintenance rate?

  1. 140 mL/hour
  2. 110 mL/hour Correct answer.
  3. 210 mL/hour
  4. 70 mL/hour

Explanation

The 4-2-1 rule gives 4 mL/kg/hour for the first 10 kg, 2 mL/kg/hour for the next 10 kg, and 1 mL/kg/hour thereafter. For 70 kg this is 40 plus 20 plus 50, totalling 110 mL/hour.

Question 39Nursing Foundation and Basic Sciences

A patient with a large sacral pressure injury has a wound culture showing methicillin-resistant Staphylococcus aureus. Which precaution is required in addition to standard precautions?

  1. No additional precautions, because the organism is only in the wound
  2. Contact precautions with gown and gloves for room entry Correct answer.
  3. Airborne precautions with an N95 respirator
  4. Droplet precautions with a surgical mask within one metre

Explanation

Methicillin-resistant Staphylococcus aureus is transmitted mainly by direct and indirect contact, so contact precautions with gown and gloves on room entry are added to standard precautions. Airborne and droplet precautions apply to organisms spread by aerosols or large droplets, such as tuberculosis or influenza.

Question 40Nursing Foundation and Basic Sciences

A patient with an acute exacerbation of asthma has a silent chest, drowsiness, and a rising arterial carbon dioxide level. What do these findings indicate?

  1. Mild exacerbation that can be managed with a bronchodilator alone
  2. Improving airflow obstruction because wheeze is no longer audible
  3. Life-threatening asthma with impending respiratory failure requiring urgent escalation Correct answer.
  4. Anxiety requiring reassurance and reduction of oxygen therapy

Explanation

A silent chest means airflow is too poor to generate wheeze, and rising carbon dioxide with drowsiness signals fatigue and impending respiratory failure. This is a life-threatening emergency requiring immediate senior and critical care support.

Question 41Medical-Surgical Nursing

A patient with acute decompensated heart failure is receiving intravenous furosemide. Which assessment finding most directly indicates that the diuretic is producing the desired therapeutic effect?

  1. A heart rate increase from 88 to 104 beats per minute
  2. A rise in blood urea nitrogen from 18 to 30 mg/dL
  3. A weight loss of 1.5 kg over 24 hours with reduced bibasilar crackles Correct answer.
  4. A fall in serum potassium from 4.2 to 3.4 mEq/L

Explanation

Loop diuretics relieve congestion, so the therapeutic endpoint is measurable fluid removal (daily weight loss, typically up to 0.5–1 kg/day) together with clearing of pulmonary crackles and improved dyspnea. Falling potassium, rising BUN, and tachycardia are predictable adverse effects or signs of worsening status rather than evidence of decongestion.

Question 42Medical-Surgical Nursing

Which electrocardiographic change is the earliest and most reliable indicator of acute myocardial infarction before cardiac biomarkers become positive?

  1. ST-segment elevation in contiguous leads Correct answer.
  2. T-wave inversion in a single lead
  3. Peaked T waves in the precordial leads
  4. Development of a new left bundle branch block

Explanation

ST-segment elevation in anatomically contiguous leads reflects transmural injury and appears within minutes, making it the trigger for reperfusion therapy. Troponin rises only after several hours, so serial biomarkers are used for confirmation and prognostication rather than early diagnosis.

Question 43Medical-Surgical Nursing

A patient with chronic obstructive pulmonary disease has an arterial blood gas showing pH 7.32, PaCO2 62 mm Hg, and HCO3 30 mEq/L. How should the nurse interpret this result?

  1. Chronic respiratory acidosis with metabolic compensation Correct answer.
  2. Acute respiratory alkalosis with metabolic compensation
  3. Combined respiratory and metabolic alkalosis
  4. Uncompensated metabolic acidosis

Explanation

The low pH with a raised PaCO2 identifies a primary respiratory acidosis, and the elevated bicarbonate shows renal retention of base that takes days to develop, indicating chronicity. In an acute rise in PaCO2, bicarbonate would increase by only about 1 mEq/L per 10 mm Hg, so 30 mEq/L points to compensation.

Question 44Medical-Surgical Nursing

A patient is admitted with deep partial-thickness burns over 35 percent of total body surface area. Using the Parkland formula, what volume of Ringer lactate should be infused in the first 8 hours after injury?

  1. 9,800 mL
  2. 2,450 mL
  3. 7,350 mL
  4. 4,900 mL Correct answer.

Explanation

The Parkland formula gives 4 mL per kg per percent burn over 24 hours, with half given in the first 8 hours. For an 70 kg adult with 35 percent burns, 4 × 70 × 35 equals 9,800 mL in 24 hours, so 4,900 mL is due in the first 8 hours, timed from the moment of injury rather than from admission.

Question 45Medical-Surgical Nursing

A patient with a new ileostomy has a stoma that appears dusky blue and feels cool two hours after surgery. What is the nurse's priority action?

  1. Apply a tight ostomy belt to improve appliance seal
  2. Document the finding and reassess in four hours
  3. Irrigate the stoma with warm saline
  4. Notify the surgeon immediately Correct answer.

Explanation

A dusky, cool, or cyanotic stoma suggests compromised arterial perfusion or venous congestion and is a surgical emergency that may require revision. The nurse should report it at once rather than wait, because prolonged ischemia leads to stomal necrosis.

Question 46Medical-Surgical Nursing

Which finding should the nurse report as a possible sign of fat embolism syndrome in a patient 24 hours after a femoral shaft fracture?

  1. Serum calcium of 9.5 mg/dL
  2. Localized swelling at the fracture site
  3. Bradycardia with hypertension
  4. Petechial rash over the chest and axillae with sudden confusion Correct answer.

Explanation

Fat embolism syndrome classically presents with a triad of hypoxemia, neurologic changes, and a petechial rash on the chest, axillae, and conjunctivae, usually 24 to 72 hours after long-bone fracture. Early recognition matters because respiratory failure can progress rapidly.

Question 47Medical-Surgical Nursing

A patient with chronic kidney disease has a serum potassium of 6.9 mEq/L with peaked T waves on the monitor. Which prescription should the nurse anticipate giving first to protect the myocardium?

  1. Nebulized salbutamol
  2. Oral sodium polystyrene sulfonate
  3. Intravenous calcium gluconate Correct answer.
  4. Intravenous regular insulin with dextrose

Explanation

Intravenous calcium stabilizes the myocardial membrane within minutes and is the first measure when hyperkalemia produces electrocardiographic changes. Insulin with dextrose, salbutamol, and potassium binders lower serum potassium but act over 15 to 30 minutes or longer, so they follow membrane stabilization.

Question 48Medical-Surgical Nursing

A patient with a head injury has a Glasgow Coma Scale score that has fallen from 13 to 8 over one hour, and the right pupil is now dilated and nonreactive. What does this pattern most likely indicate?

  1. Postictal state after a seizure
  2. Diffuse axonal injury without mass effect
  3. Metabolic encephalopathy from hyponatremia
  4. Right-sided uncal herniation Correct answer.

Explanation

A declining level of consciousness with an ipsilateral dilated, fixed pupil points to uncal herniation compressing the third cranial nerve, which is a neurosurgical emergency. The nurse should report immediately, prepare for airway protection, and anticipate osmotic therapy or decompression.

Question 49Medical-Surgical Nursing

Which instruction is most important for a patient starting phenytoin for seizure control?

  1. Double the dose whenever a seizure is missed
  2. Take the drug with a high-protein meal to improve absorption
  3. Stop the drug abruptly once seizures are controlled
  4. Perform meticulous oral hygiene and report gum tenderness Correct answer.

Explanation

Phenytoin causes gingival hyperplasia, so consistent oral hygiene and dental review reduce complications and allow early detection. Abrupt withdrawal can precipitate status epilepticus, and missed doses should be managed according to the prescriber's advice rather than doubled.

Question 50Medical-Surgical Nursing

A patient with myasthenia gravis reports increasing difficulty in chewing and swallowing toward the end of the day. Which medication-related issue should the nurse assess for first?

  1. Corticosteroid-induced hyperglycemia
  2. Antibiotic-induced nephrotoxicity
  3. Undermedication with pyridostigmine causing muscle weakness Correct answer.
  4. Overmedication with pyridostigmine causing cholinergic crisis

Explanation

Worsening weakness that appears late in the dosing interval suggests the pyridostigmine dose is inadequate, a myasthenic crisis pattern that can progress to respiratory failure. Cholinergic crisis from excess drug would instead produce fasciculations, diarrhea, bradycardia, and small pupils.