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SGPGI Nursing Officer practice questions

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Question 1Part-A: Common syllabus for all posts

A patient scheduled for surgery is instructed to remain NPO after midnight. Which physiological risk does this preparation primarily aim to reduce during general anaesthesia?

  1. Increased bleeding from the surgical site
  2. Aspiration of gastric contents into the lungs Correct answer.
  3. Intraoperative hypoglycaemia from prolonged fasting
  4. Excessive urine output during the procedure

Explanation

Fasting before anaesthesia reduces gastric volume and acidity so that if the protective airway reflexes are lost, regurgitated stomach contents are less likely to enter the tracheobronchial tree and cause aspiration pneumonitis. Hypoglycaemia, urine output and bleeding are managed by other means and are not the reason for routine fasting.

Question 2Part-A: Common syllabus for all posts

While recording a blood pressure manually, the nurse inflates the cuff and then deflates it at about 2-3 mmHg per second. Why is this controlled deflation rate important?

  1. It prevents the cuff from overheating against the skin
  2. It reduces discomfort by shortening the total procedure time
  3. It allows accurate identification of the first and last Korotkoff sounds Correct answer.
  4. It ensures the manometer needle returns to zero smoothly

Explanation

Korotkoff sounds change in a predictable sequence as pressure falls; a slow, steady deflation allows the nurse to hear the onset (phase I) and disappearance (phase V) of sounds and record systolic and diastolic values accurately. Rapid deflation causes the observer to miss the true points and underestimates or overestimates the reading.

Question 3Part-A: Common syllabus for all posts

A patient with a new colostomy asks how the stoma should look in the first few days. Which description reflects a healthy, viable stoma?

  1. Black and leathery
  2. Yellow with a foul discharge
  3. Pale pink and dry
  4. Beefy red and moist Correct answer.

Explanation

A healthy stoma is moist and beefy red because the bowel mucosa is well perfused. Pallor, dusky discolouration, blackening or purulent discharge suggest ischaemia or infection and require urgent notification of the surgeon.

Question 4Part-A: Common syllabus for all posts

Which route of drug administration is most appropriate when a nurse must deliver a drug for rapid systemic effect during a cardiac arrest?

  1. Subcutaneous
  2. Oral
  3. Topical
  4. Intravenous Correct answer.

Explanation

The intravenous route delivers drug directly into the circulation, bypassing absorption barriers, so onset is fastest and most reliable in an emergency. Oral, subcutaneous and topical routes all depend on absorption and are too slow or unreliable during arrest.

Question 5Part-A: Common syllabus for all posts

A nurse is calculating a fluid balance chart. Over 24 hours the patient received 2500 mL of intravenous fluid and 800 mL orally, and passed 2100 mL of urine plus 400 mL of drainage. What is the net balance?

  1. 1200 mL positive
  2. 400 mL positive
  3. 800 mL positive Correct answer.
  4. 800 mL negative

Explanation

Total intake is 2500 + 800 = 3300 mL and total output is 2100 + 400 = 2500 mL. Subtracting output from intake gives a positive balance of 800 mL. Insensible losses would reduce this further but are not part of the measured figures given.

Question 6Part-A: Common syllabus for all posts

Which instruction should the nurse give a patient who is starting a course of oral metronidazole for a dental infection?

  1. Take the drug with large amounts of milk to reduce nausea
  2. Double the next dose if one dose is forgotten
  3. Stop the drug as soon as the pain subsides
  4. Avoid alcohol-containing drinks and preparations during and shortly after treatment Correct answer.

Explanation

Metronidazole interacts with alcohol to produce a disulfiram-like reaction with flushing, vomiting, tachycardia and hypotension, so alcohol should be avoided during therapy and for about 48 hours afterwards. Completing the prescribed course also matters to prevent relapse and resistance.

Question 7Part-A: Common syllabus for all posts

A patient is admitted with suspected pulmonary tuberculosis. Which precaution is most appropriate while the patient is in a general ward?

  1. Contact precautions with gloves and gown
  2. Droplet precautions with a surgical mask on the patient
  3. Standard precautions only
  4. Airborne precautions in a negative-pressure room Correct answer.

Explanation

Pulmonary tuberculosis spreads by airborne droplet nuclei that remain suspended and can be inhaled at distance, so an airborne precaution room with negative pressure and a fit-tested respirator is required. Standard and droplet precautions alone do not prevent airborne transmission.

Question 8Part-A: Common syllabus for all posts

Which finding should the nurse report immediately in a postoperative patient who had abdominal surgery 6 hours ago?

  1. Absence of bowel sounds on auscultation
  2. Serous ooze on the dressing that is dry at the edges
  3. Mild incisional pain relieved by prescribed analgesia
  4. Sudden restlessness with tachycardia and falling blood pressure Correct answer.

Explanation

Restlessness, tachycardia and hypotension after abdominal surgery suggest hypovolaemia, haemorrhage or shock and require urgent assessment and escalation. Absent bowel sounds and mild pain are common in the early postoperative period, and a dry serous ooze is not alarming.

Question 9Part-A: Common syllabus for all posts

A patient has a prescription for 1000 mL of normal saline over 8 hours using a giving set that delivers 15 drops per mL. What is the correct drip rate?

  1. 42 drops per minute
  2. 21 drops per minute
  3. 15 drops per minute
  4. 31 drops per minute Correct answer.

Explanation

The formula is drops per minute = (volume in mL × drop factor) ÷ time in minutes. Here (1000 × 15) ÷ 480 = 31.25, which rounds to 31 drops per minute. Using the wrong drop factor or the wrong time unit produces the other options.

Question 10Part-A: Common syllabus for all posts

A patient with type 1 diabetes has a blood glucose of 3.1 mmol/L and is conscious and able to swallow. What is the nurse's first action?

  1. Give 15-20 g of fast-acting oral carbohydrate and recheck glucose in 15 minutes Correct answer.
  2. Administer the usual dose of long-acting insulin
  3. Give a high-protein snack and recheck in one hour
  4. Start an intravenous infusion of 5% dextrose immediately

Explanation

For a conscious patient with hypoglycaemia, the priority is rapid oral glucose (about 15-20 g) followed by rechecking after 15 minutes and repeating if still low. Protein alone and long-acting insulin do not correct acute hypoglycaemia and may worsen it.

Question 11Part-A: Common syllabus for all posts

A nurse is preparing to give digoxin. Which assessment finding should prompt withholding the dose and contacting the prescriber?

  1. Apical heart rate of 48 beats per minute Correct answer.
  2. Serum potassium of 4.2 mmol/L
  3. Blood pressure of 138/86 mmHg
  4. Apical heart rate of 88 beats per minute

Explanation

Digoxin slows conduction through the atrioventricular node, and a heart rate below 60 beats per minute (or below the prescriber's specified threshold) warrants withholding the dose and reporting. A normal blood pressure, normal potassium and a heart rate of 88 do not contraindicate the dose.

Question 12Part-A: Common syllabus for all posts

A patient with an indwelling urinary catheter develops a temperature of 38.6 °C with cloudy, offensive urine. Which action should the nurse take first?

  1. Clamp the catheter to allow the bladder to rest
  2. Irrigate the catheter with an antiseptic solution
  3. Increase the patient's oral water intake and reassess in 24 hours
  4. Notify the medical team and send a urine sample for culture as ordered Correct answer.

Explanation

Fever with cloudy, offensive urine in a catheterised patient suggests catheter-associated urinary tract infection, which may progress to urosepsis. The priority is to inform the medical team and obtain a culture before antibiotics are started, while maintaining drainage and hydration.

Question 13Part-A: Common syllabus for all posts

A postoperative patient suddenly reports chest pain and breathlessness and has a heart rate of 124 beats per minute with oxygen saturation of 88% on room air. What is the most appropriate immediate nursing action?

  1. Encourage the patient to walk to improve circulation
  2. Give the prescribed oral analgesic and reassess in 30 minutes
  3. Lie the patient flat and restrict fluids
  4. Sit the patient upright, apply oxygen and call for urgent medical review Correct answer.

Explanation

Sudden dyspnoea, chest pain, tachycardia and hypoxia after surgery suggest pulmonary embolism, and the patient needs immediate oxygen, upright positioning to ease breathing, continuous monitoring and urgent medical assessment. Mobilising or delaying review could be fatal.

Question 14Part-A: Common syllabus for all posts

A patient is prescribed a controlled-release morphine tablet for chronic cancer pain. Which instruction is essential for safe administration?

  1. Crush the tablet and mix it with water for easier swallowing
  2. Take an extra dose whenever breakthrough pain occurs
  3. Take the tablet only when pain becomes severe
  4. Swallow the tablet whole and do not crush or chew it Correct answer.

Explanation

Crushing or chewing a controlled-release morphine tablet releases the whole dose at once, risking a fatal overdose, so it must be swallowed whole. Regular dosing maintains analgesia, and breakthrough pain requires a separate short-acting prescription rather than extra sustained-release doses.

Question 15Part-A: Common syllabus for all posts

A mother brings a 3-month-old infant with a history of poor feeding and a harsh systolic murmur. Which additional assessment finding most supports a diagnosis of heart failure in this infant?

  1. Hypertension with bounding pulses
  2. Increased urine output and weight loss
  3. Tachypnoea with subcostal recession during feeding Correct answer.
  4. Bradycardia with warm peripheries

Explanation

In infants, heart failure commonly presents with feeding difficulty, tachypnoea, recession and poor weight gain because feeding increases metabolic demand. Bradycardia with warm peripheries and hypertension are not typical, and urine output usually falls rather than rises.

Question 16Part-A: Common syllabus for all posts

Which action best prevents pressure injury in a patient who is immobile and confined to bed?

  1. Keep the skin moist with frequent water application
  2. Raise the head of the bed to 90 degrees continuously
  3. Reposition the patient at regular intervals and inspect pressure areas Correct answer.
  4. Massage reddened bony prominences firmly

Explanation

Pressure injury prevention relies on relieving sustained pressure by regular repositioning and skin inspection, together with support surfaces and moisture management. Massaging reddened areas and keeping skin wet damage tissue, and a continuously high head elevation increases shear over the sacrum.

Question 17Part-A: Common syllabus for all posts

A nurse receives a verbal order from a physician for a new medication. What is the safest practice?

  1. Refuse all verbal orders regardless of the situation
  2. Write the order down, read it back for verification and have it countersigned per policy Correct answer.
  3. Ask another nurse to remember the order until the end of the shift
  4. Accept the order and administer the drug without documentation

Explanation

Verbal orders carry a risk of mishearing, so the nurse should record the order, read it back, confirm the drug, dose, route and frequency, and follow the organisation's countersignature policy. Blanket refusal is impractical in emergencies, but undocumented acceptance is unsafe.

Question 18Part-A: Common syllabus for all posts

In calculating a paediatric dose, which measure is the most reliable basis for adjusting an adult dose?

  1. Age in years alone
  2. Body weight in kilograms alone
  3. The child's height percentile
  4. Body surface area Correct answer.

Explanation

Body surface area correlates better than weight or age alone with physiological functions such as renal clearance and metabolic rate, so it is the preferred basis for many paediatric dose calculations. Weight is used for some drugs, but age and height percentile are too imprecise.

Question 19Part-A: Common syllabus for all posts

A patient with chronic kidney disease has a serum potassium of 6.4 mmol/L and peaked T waves on the ECG. Which action should the nurse anticipate first?

  1. Give an oral potassium supplement
  2. Administer intravenous calcium gluconate as prescribed Correct answer.
  3. Encourage a high-protein diet
  4. Start a potassium-sparing diuretic

Explanation

Hyperkalaemia with ECG changes is a cardiac emergency because it can progress to arrhythmia; intravenous calcium stabilises the myocardium immediately while insulin-dextrose or other measures shift potassium intracellularly. Potassium supplements, high-protein intake and potassium-sparing diuretics would worsen the problem.

Question 20Part-A: Common syllabus for all posts

A patient with a new ileostomy has a high-output stoma of 2.5 litres per day. Which complication should the nurse monitor for most closely?

  1. Constipation and faecal impaction
  2. Hypercalcaemia and renal stones
  3. Hyperkalaemia and fluid overload
  4. Hypovolaemia and electrolyte depletion Correct answer.

Explanation

A high-output ileostomy loses large volumes of sodium-rich, bicarbonate-rich fluid, leading to dehydration, hyponatraemia, hypokalaemia and metabolic acidosis. Fluid overload and constipation are the opposite of what occurs with a high-output stoma.

Question 21Part-A: Common syllabus for all posts

Which statement about hand hygiene according to the WHO five moments is correct for a nurse moving from a dirty procedure to a clean one on the same patient?

  1. Hands must be cleaned before aseptic tasks even if gloves will be worn Correct answer.
  2. Gloves replace the need for hand hygiene between patients
  3. Alcohol rub is effective when hands are visibly soiled with blood
  4. Hand hygiene is required only after contact with the patient

Explanation

The WHO moments require hand hygiene before an aseptic task regardless of glove use, because gloves can be contaminated during donning and do not sterilise hands. Alcohol rub is ineffective on visibly soiled hands, which require soap and water, and hand hygiene is needed both before and after patient contact.

Question 22Part-A: Common syllabus for all posts

A patient receiving a blood transfusion develops fever, chills, flank pain and dark urine 15 minutes into the transfusion. What is the nurse's immediate action?

  1. Slow the transfusion and give paracetamol
  2. Stop the transfusion, keep the line patent with saline and notify the blood bank and physician Correct answer.
  3. Continue the transfusion and monitor vital signs hourly
  4. Restart the same unit after the symptoms settle

Explanation

Fever, chills, flank pain and haemoglobinuria suggest an acute haemolytic transfusion reaction, which can be fatal. The transfusion must be stopped at once, intravenous access maintained with saline through new tubing, and the reaction reported so the unit and patient samples can be investigated.

Question 23Part-A: Common syllabus for all posts

A patient with severe pre-eclampsia is receiving magnesium sulphate. Which finding is the earliest indicator of magnesium toxicity that the nurse should monitor?

  1. Urine output of 60 mL per hour
  2. Respiratory rate of 18 breaths per minute
  3. Serum magnesium of 1.8 mmol/L
  4. Loss of deep tendon reflexes Correct answer.

Explanation

Magnesium toxicity progresses from loss of deep tendon reflexes to respiratory depression and cardiac arrest, so reflexes are checked hourly along with respiratory rate and urine output. A respiratory rate of 18, good urine output and a magnesium level within the therapeutic range indicate safe therapy.

Question 24Part-A: Common syllabus for all posts

A patient with diabetic ketoacidosis has a blood glucose of 28 mmol/L and is started on an insulin infusion. Why must intravenous fluid and potassium replacement be managed alongside the insulin?

  1. Fluids are given only to dilute the insulin and prevent phlebitis
  2. Insulin causes potassium retention, so replacement prevents hyperkalaemia
  3. Insulin drives potassium and glucose into cells, so potassium can fall dangerously during treatment Correct answer.
  4. Potassium must be withheld until the glucose normalises

Explanation

In DKA total body potassium is depleted even when serum levels appear normal or high, and insulin shifts potassium intracellularly, so serum potassium can drop precipitously and cause arrhythmia. Careful potassium replacement and fluid resuscitation are therefore integral to the protocol, with monitoring throughout.

Question 25Part-A: Common syllabus for all posts

A patient with a tracheostomy becomes acutely breathless with reduced air entry and increasing distress. Which action should the nurse take first?

  1. Remove the tracheostomy tube immediately without preparation
  2. Suction the airway and assess for obstruction while calling for help Correct answer.
  3. Administer a nebulised bronchodilator and reassess later
  4. Deflate the cuff and leave the tube open to air

Explanation

Acute deterioration in a tracheostomised patient is most often due to secretions, mucus plugging or tube obstruction, so suctioning and rapid assessment with help summoned is the first step. Deflating the cuff or removing the tube without preparation risks losing the airway.

Question 26Part-A: Common syllabus for all posts

A patient is scheduled for a contrast-enhanced CT scan. Which baseline laboratory value should the nurse confirm before the procedure because of the risk of contrast-induced nephropathy?

  1. Serum calcium
  2. Platelet count
  3. Serum amylase
  4. Serum creatinine Correct answer.

Explanation

Iodinated contrast is cleared by the kidneys and can precipitate acute kidney injury, especially when baseline renal function is impaired. Serum creatinine (with estimated GFR) is therefore checked before contrast administration so the team can hydrate the patient or choose an alternative study.

Question 27Part-A: Common syllabus for all posts

A nurse is caring for a patient with a new colostomy. Which characteristic of the stoma should the nurse document as normal in the immediate postoperative period?

  1. Retracted below skin level
  2. Black and necrotic
  3. Pale and dry
  4. Beefy red and moist Correct answer.

Explanation

A healthy stoma is moist and beefy red because it is a vascular mucous membrane. Pallor, dusky discolouration, blackening or retraction suggest ischaemia and must be reported to the surgeon.

Question 28Part-A: Common syllabus for all posts

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

  1. Flushing the tube with 50 mL of water before each feed
  2. Elevating the head of the bed to 30–45 degrees during and after feeding Correct answer.
  3. Changing the feeding tube every 48 hours
  4. Checking residual volume every 12 hours

Explanation

Semi-recumbent positioning uses gravity to keep gastric contents below the level of the pharynx, which is the single most effective measure against aspiration during enteral feeding. Residual checks and flushing address tube patency and tolerance, not aspiration risk directly.

Question 29Part-A: Common syllabus for all posts

Which finding in a patient receiving intravenous furosemide should the nurse report to the prescriber?

  1. Serum potassium of 2.9 mmol/L Correct answer.
  2. Weight loss of 0.5 kg in 24 hours
  3. Urine output of 120 mL/hour
  4. Blood pressure of 128/78 mmHg

Explanation

Loop diuretics increase renal potassium excretion, and a value below 3.0 mmol/L predisposes to dangerous ventricular dysrhythmias, especially in patients also taking digoxin. The prescriber needs to know so potassium can be replaced and the dose reviewed.

Question 30Part-A: Common syllabus for all posts

A patient is admitted with active pulmonary tuberculosis. Which type of mask should the nurse wear when entering the room?

  1. Fit-tested N95 respirator Correct answer.
  2. Full-face visor alone
  3. Cloth mask
  4. Standard surgical mask

Explanation

Tuberculosis spreads by airborne droplet nuclei, so a fit-tested particulate respirator (N95 or equivalent) is required for airborne precautions. A surgical mask does not seal to the face and cannot filter small droplet nuclei reliably.

Question 31Part-A: Common syllabus for all posts

A patient is prescribed a 1500 kcal diet with restriction of saturated fat. Which food choice best meets this prescription?

  1. Fried chicken with white bread and butter
  2. Full-fat cheese sandwich with mayonnaise
  3. Grilled fish with steamed vegetables and brown rice Correct answer.
  4. Mutton curry with coconut milk and white rice

Explanation

Grilled fish is low in saturated fat and provides lean protein, while vegetables and brown rice add fibre and complex carbohydrate without added fat. Frying and coconut milk add substantial saturated fat.

Question 32Part-A: Common syllabus for all posts

A patient with a fractured femur is in skin traction. Which action should the nurse take to maintain effective traction?

  1. Rest the weights on the bed frame
  2. Elevate the foot of the bed on blocks periodically
  3. Remove the traction for 10 minutes every hour
  4. Keep the weights hanging freely and off the floor Correct answer.

Explanation

Traction works through a continuous counterforce, so weights must hang free and never touch the floor or bed frame. Interrupting traction or resting the weights abolishes the pull and can cause muscle spasm and malalignment.

Question 33Part-A: Common syllabus for all posts

A patient is prescribed oxygen at 2 L/min by nasal cannula. Which instruction is most important for the nurse to give?

  1. Keep the cannula prongs in the nostrils and avoid petroleum jelly near the face Correct answer.
  2. Increase the flow to 6 L/min if breathless
  3. Use a plastic bag to store the tubing between uses
  4. Remove the cannula at night while sleeping

Explanation

Oxygen supports combustion, so petroleum-based products on the face or nose create a fire hazard. Correct prong placement ensures the prescribed fraction reaches the airway.

Question 34Part-A: Common syllabus for all posts

A nurse is preparing a patient for a lumbar puncture. Which position should the patient assume?

  1. Lateral decubitus with knees drawn to chest and chin flexed Correct answer.
  2. Prone with legs extended
  3. Supine with head elevated 45 degrees
  4. Sitting upright with legs dangling and neck extended

Explanation

Flexing the spine in the lateral decubitus position widens the spaces between lumbar vertebrae, making needle insertion easier and safer. Maintaining a flexed neck and knees also helps the patient stay still.

Question 35Part-A: Common syllabus for all posts

A patient with chronic obstructive pulmonary disease has a respiratory rate of 28 per minute and an oxygen saturation of 88% on room air. Which action should the nurse take first?

  1. Encourage the patient to breathe into a paper bag
  2. Place the patient flat and withhold oxygen
  3. Start controlled low-flow oxygen and reassess saturation Correct answer.
  4. Administer a high-flow oxygen mask at 15 L/min

Explanation

In COPD, hypoxic drive may be relied upon for ventilation, so oxygen is titrated to a target saturation (often 88–92%) with controlled low-flow delivery. This corrects hypoxaemia while limiting the risk of hypercapnia.

Question 36Part-A: Common syllabus for all posts

A patient is admitted with severe dehydration and hyponatraemia. Which assessment finding is most consistent with this presentation?

  1. Bounding pulse and jugular venous distension
  2. Sunken eyes, dry mucous membranes and postural hypotension Correct answer.
  3. Pitting oedema of the ankles
  4. Crackles at both lung bases

Explanation

Severe dehydration reduces intravascular volume, producing sunken eyes, dry mucous membranes, postural hypotension and tachycardia. Fluid overload signs such as oedema and crackles point in the opposite direction.

Question 37Part-A: Common syllabus for all posts

A patient is receiving a continuous infusion of heparin. Which laboratory test should the nurse monitor to assess the therapeutic effect?

  1. Activated partial thromboplastin time Correct answer.
  2. Prothrombin time with INR
  3. D-dimer
  4. Bleeding time

Explanation

Unfractionated heparin potentiates antithrombin and prolongs the intrinsic pathway, which is assessed by the activated partial thromboplastin time. The target range is typically 1.5–2.5 times the control value.

Question 38Part-A: Common syllabus for all posts

A patient who had a stroke has left-sided weakness and hemianopia. Which nursing measure best prevents injury during ambulation?

  1. Darken the room to reduce visual stimuli
  2. Approach the patient from the right side and stand on the weaker left side Correct answer.
  3. Instruct the patient to turn the head only to the left
  4. Place the walking frame on the left and encourage independent walking

Explanation

With a left hemianopia the patient cannot see objects on the left, so the nurse stands on the affected side and approaches from the intact side to guard the patient. This compensates for the visual field loss.

Question 39Part-A: Common syllabus for all posts

A patient with a new below-knee plaster cast reports severe pain that is not relieved by the prescribed analgesic, and the toes are pale with reduced sensation. Which action should the nurse take?

  1. Apply a warm compress to the toes
  2. Elevate the limb above heart level and reassess in 2 hours
  3. Notify the orthopaedic surgeon immediately as a possible compartment syndrome Correct answer.
  4. Administer a second dose of analgesia and document

Explanation

Unrelieved severe pain, pallor, paraesthesia and reduced sensation under a cast suggest compartment syndrome or cast constriction. This is a limb-threatening emergency requiring urgent surgical review and possible cast splitting.

Question 40Part-A: Common syllabus for all posts

A patient is prescribed a low-molecular-weight heparin injection subcutaneously. Which technique should the nurse use?

  1. Aspirate before injecting to check for blood
  2. Inject into the deltoid muscle at a 45-degree angle
  3. Massage the site vigorously after injection
  4. Inject into the abdominal wall at a 90-degree angle without expelling the air bubble Correct answer.

Explanation

Low-molecular-weight heparin is given deep subcutaneously into the abdominal fatty layer at 90 degrees, and the air bubble is left in the syringe to flush the needle track. Aspiration and massage increase bruising and are avoided.

Question 41Part-A: Common syllabus for all posts

A patient with acute gastroenteritis has a serum potassium of 3.0 mmol/L and is prescribed oral potassium chloride. Which instruction should the nurse give?

  1. Take the solution diluted in water or juice with food Correct answer.
  2. Take the dose with a potassium-sparing diuretic
  3. Take the solution undiluted on an empty stomach
  4. Crush the tablets and swallow them dry

Explanation

Concentrated potassium chloride irritates the gastrointestinal mucosa and can cause ulceration, so it must be diluted and taken with food. Taking it with a potassium-sparing diuretic risks hyperkalaemia.

Question 42Part-A: Common syllabus for all posts

A nurse is teaching a patient about the use of a peak flow meter for asthma. Which statement by the patient indicates correct understanding?

  1. I will measure my peak flow at the same time each morning before using my inhaler Correct answer.
  2. I will use the meter immediately after my reliever inhaler
  3. I will measure only when I feel breathless
  4. I will take a single measurement and record the best of one attempt

Explanation

Peak flow is most informative when measured at a consistent time, usually in the morning before bronchodilator use, so readings reflect the baseline airway calibre. Three attempts are made and the best value recorded.

Question 43Part-A: Common syllabus for all posts

A patient is receiving total parenteral nutrition through a central venous catheter. Which action is most important to prevent catheter-related bloodstream infection?

  1. Change the giving set every 72 hours
  2. Flush the line with tap water when not in use
  3. Use strict aseptic technique when accessing the catheter hub Correct answer.
  4. Add medications to the bag after it is connected

Explanation

The catheter hub is the main entry point for microorganisms, so scrubbing the hub with antiseptic and using aseptic technique is central to prevention. Giving sets for lipid-containing parenteral nutrition are changed more frequently than 72 hours.

Question 44Part-A: Common syllabus for all posts

A patient in the emergency department has a blood pressure of 80/50 mmHg, a heart rate of 122 per minute and cool clammy skin after a road traffic collision. Which action should the nurse take first?

  1. Obtain a full set of baseline blood tests before any treatment
  2. Establish large-bore intravenous access and begin a crystalloid bolus Correct answer.
  3. Apply a warming blanket and observe for 30 minutes
  4. Give oral fluids to replace volume

Explanation

The findings describe hypovolaemic shock, in which perfusion depends on rapid volume replacement. Two large-bore cannulae allow simultaneous fluids and blood products while the source of bleeding is investigated.

Question 45Part-A: Common syllabus for all posts

A patient with type 2 diabetes is started on metformin. Which instruction should the nurse include?

  1. Increase the dose whenever glucose is above target
  2. Take the tablet with or immediately after meals Correct answer.
  3. Take the drug on an empty stomach at bedtime
  4. Stop the drug permanently if nausea occurs

Explanation

Taking metformin with food reduces the gastrointestinal upset that commonly occurs at the start of therapy. Patients should also be told to withhold it during acute illness or before contrast studies because of the lactic acidosis risk.

Question 46Part-A: Common syllabus for all posts

A patient is prescribed a 24-hour urine collection. Which instruction is essential for accuracy?

  1. Store the container at room temperature in sunlight
  2. Collect only the daytime specimens
  3. Collect the first voided specimen of the day and stop at midnight
  4. Discard the first voided specimen and collect all urine thereafter until the collection ends Correct answer.

Explanation

The collection begins after the first void is discarded, so the container holds urine formed during the exact 24-hour period. All subsequent urine, including the final void at the end of the period, is collected.

Question 47Part-A: Common syllabus for all posts

A nurse is caring for a patient who has just returned from surgery with a drain in situ. Which observation should be reported to the surgeon?

  1. Drain site tenderness on palpation
  2. A drain output that decreases gradually over 24 hours
  3. Sudden drainage of 200 mL of bright red blood in one hour Correct answer.
  4. Serous drainage of 20 mL over four hours

Explanation

A sudden large volume of fresh blood suggests active haemorrhage and possible hypovolaemic shock. Gradual decreases and small serous amounts are expected postoperative findings.

Question 48Part-A: Common syllabus for all posts

A patient with a permanent pacemaker is scheduled for magnetic resonance imaging. Which action is most appropriate?

  1. Confirm with the cardiology team that the device is MRI-conditional before proceeding Correct answer.
  2. Proceed with the scan and monitor the rhythm during the procedure
  3. Disconnect the pacemaker leads before entering the scanner room
  4. Place a magnet over the generator during the scan

Explanation

Strong magnetic fields can heat or reprogram a pacemaker and displace its leads. Only devices certified as MRI-conditional, with the correct programming and monitoring plan, may be scanned.

Question 49Part-A: Common syllabus for all posts

A patient with acute pancreatitis has severe abdominal pain, vomiting and a serum calcium of 1.85 mmol/L. Which finding should the nurse interpret as a sign of worsening prognosis?

  1. Serum amylase that is three times the upper limit
  2. Grey-blue discolouration around the umbilicus Correct answer.
  3. Reduced bowel sounds
  4. Pain relieved by sitting forward

Explanation

Periumbilical ecchymosis (Cullen sign) reflects retroperitoneal haemorrhage and is associated with severe necrotising pancreatitis and a worse outcome. Amylase elevation and positional pain relief are typical but not prognostic markers.

Question 50Part-A: Common syllabus for all posts

A patient with a head injury has a Glasgow Coma Scale score that has fallen from 14 to 9 over two hours. Which action should the nurse take?

  1. Give the prescribed analgesic and dim the lights
  2. Raise the head of the bed and continue routine observations
  3. Escalate immediately for airway assessment and urgent neurosurgical review Correct answer.
  4. Document the score and recheck in four hours

Explanation

A falling Glasgow Coma Scale score indicates deteriorating cerebral function and impending airway compromise at a score of 8 or below. Immediate escalation allows airway protection, imaging and neurosurgical intervention.