Multiple choice

1. A thirty five year old male had been an insulin dependent diabetic for five years and
is now unable to urinate. Which of the following would you most likely suspect?
A. Atherosclerosis
B. Diabetic retinopathy
C. Automatic neuropathy
D. Somatic neuropathy

2. A nurse is caring for a patient that had a major surgery seven days ago. Which
statement by the patient requires the nurse's immediate attention?
A. "I have bad muscle spasms in my lower leg of the affected extremity"
B. "I can't catch my breath"
C. "I need a bedpan beside me all the time"
D. "I think the pain medication is not working well for me"

3. Vuli has been diagnosed with appendicitis. He develops a fever, hypotension and
tachycardia. Which of the following complications should the nurse suspect?
A. Bowel ischaemia
B. Deficient fluid volume
C. Peritonitis
D. Intestinal obstruction

4. Which of the following will be excluded from a stump care teaching plan for a patient
with a post Right below Knee Amputation?
A. Clean and inspect stump daily
B. Treat superficial abrasions and blisters promptly
C. Apply stump shrinkers to reduce and control swelling
D. Use a prosthetic leg a day after Amputation

5. A Nurse is performing s neurological assessment on a patient with cerebrovascular

accident. Which finding would warrant immediate attention?
A. Decrease in the level of consciousness
B. Loss of bladder control
C. Altered sensation to stimuli
D. Emotional liability

6. A patient is admitted to the Emergency Unit with renal calculi and is complaining of
severe flank pain and nausea. Identify from the following the priority nursing goal for
this patient.
A. Maintain fluid and electrolyte balance
B. Control nausea ad patient might vomit
C. Manage pain
D. Prevent urinary tract infection

7. The client asks Nurse Lata the causes of peptic ulcers. Which of the following
responses should Nurse Lata use to describe peptic ulcer?
A. Research indicates that peptic ulcers is a result of stress
B. Research indicates that peptic ulcers is a result of genetic defects in a gastric mucosa
C. Research indicates that peptic ulcers is a result of helicobacter pylori infection
D. Research indicates that peptic ulcers is a result of diet high in fat

8. A surgical nurse receives a call from the Operation Theatre to prepare a patient who
is scheduled for surgery and discovers that the Consent Form for surgery has not been
signed. Which of the following actions should the Nurse take next?
A. Call the OT and inform them to cancel the surgery
B. Inform the Nursing Supervisor
C. Transfer the client to the OT
D. Inform the patient to sign the consent

9. A surgical Nurse cares for a patient with Methicillin-Resistant Staphylococcus

Aureus [MRSA]. Identify the personal protective equipment [PPE] that is appropriate
for the Nurse to use?
A. Gown and mask
B. Shoe covers, gown and gloves
C. Mask, gown and gloves
D. Gloves and mask

10. A patient has been recently diagnosed with late stage of prostate cancer. He yells at
everyone attending to him. The Nurse may interpret his behavior as:
A. The result of previous losses
B. An expression of the anger stage or dying
C. An expression of grief
D. Unacceptable

11. Lily with a chronic infection of the urinary system complains of urinary frequency
and burning sensation. Identify the area of discomfort or pain to figure out whether the
current problem is in the renal origin.
A. Right of left costovertebral angle
B. Urinary meatus
C. Suprapubic area
D. Pain in the labium

12. A nurse is conducting assessment for a patient with headache. She tells the nurse
that medicine given by a traditional healer have done some good. What is the
appropriate response of the nurse at the time?
A. Tell me about it and how often you are using them
B. Refrain from using it
C. Did this medicine cause your headache?
D. Increase the healer's medicine

13. Identify an example of the nurses' role as patients' advocates.

A. Refer conflicting issues to the Nursing Supervisor
B. Document all clinical changes in the medical record in a timely manner
C. Looks out for the best interest of the patient and assists whenever required
D. Assess patient's point of view
14. Mrs. Tilo a 78 year old client is admitted with the diagnosis of mild chronic heart
failure. Identify the sound that the nurse expects to hear when listening to Mrs. Tilo's
lungs that would indicate chronic heart failure.
A. Wheeze
B. Stridor
C. Friction rubs
D. Crackles

15. Which of the following instructions should Nurse Ana include in her teaching plan
for the parents of Kovidi with otitis media?
A. Placing the child in the supine position to bottle-feed.
B. Giving prescribed amoxicillin (Amoxil) on an empty stomach.
C. Cleaning the inside of the ear canals with cotton swabs.
D. Avoiding contact with people who have upper respiratory tract infections.
Surgical
Mr. RK a 52-year-old iTaukei male admitted into the ward for a left below knee amputation
as a complication of Diabetes Mellitus. He is a newly diagnosed Diabetic and this is his first
hospital admission. He is married with 3 children under the age of 16. He lives with his
nuclear family and the extended family who have little support towards his illness. He is a
well-known person in his community.
1. List the pre- operative nursing management for Mr. RK?
Pre - operative
- Give a clear explanation to the patient about procedure to allay anxiety and respect
autonomy of the patient
- Ensure that concern formed is signed. If not then inform nursing supervisor.
- Inform family members about the length of surgery and recovery time.
- Keep patient on nil by mouth of the patient.
- Sponge the patient in the morning before surgery to maintain hygiene.
- Dress the patient in OT Suit such as gown, head cover and shoe cover.
- Take the patients baseline vital signs.
- Ensure that patient wound dressing is done before surgery.
- Follow up all blood test result, Look for hB level. If the HB level is low. Check for
cross match is either done or not and units of available blood or still awaiting for
donation.
- Check the patients voiding status to avoid bladder distension after surgery.
- Fill the Pre- Operative Checklist
- Notify to physician for any abnormal result.
- Await for the call for OT
- Handover to client to OT foyer nurse.
- Reassure the client and family.

2. List the post- operative nursing management for Mr. RK?

Post - operative
- Check for the airway patency for the client.
- Check the consciousness level of the client
- Take the post - operative vital signs. Report any abnormal findings immediately to
physician.
- Once the patient has returned in the ward provide sponge bath.
- Assess the post - operative site for bleeding, swelling and redness.
- Perform aseptic dressing as ordered by physician.
- Explain family members about client’s condition and encourage them to provide
family and emotional support which can aid in healing process.
- Monitor fluids input and output.
- Position the patient to assist ventilation and pain.
- Administer pain reliefs as ordered by physician.
- Reassure the client to allay anxiety and fear of unknown.
- Provide appropriate Nutritional intake as per Diabetic diet.

3. List the clinical manifestation of diabetes mellitus?

- Increased thirst.
 - Frequent urination.
- Excessive hunger.
- Weight loss.
- Fatigue.
- Blurred vision.
- Slow-wound healing.

4. Identify three (3) Nursing Problems for Mr. Marika

- Risk of infection related to foot ulcer

- Risk of impaired skin integrity related to tissue damage
- Risk for uncontrolled sugar related to poor lifestyle behaviour
- Poor family support related to negligence

5. Mr. Marika is discharged with some medications, including Glipizide 10mg BD. Educate
patient on Glipizide under each sub-topic in the table provided in your answer booklet.

Sub-topic Patient Education points

1. Drug Class/Group sulfonylureas
2. Effects on the body They act on pancreatic beta cells and induce insulin
secretions. It is cleared by liver and kidney.
3. Side-effects Uncontrollable shaking of a part of the body,
diarrhoea, rashes and dizziness.
4. Home management on the low blood Patient need to be educated on the side effects upon
sugar experiencing of low blood sugar and what to do if
symptoms persists such as having a candy by the
side at all time.
5. When to return to the hospital/health Educate on when the client experiences danger signs
facility and symptoms

6. Prior to discharge, you are tasked to educate Mr. Marika on his health care needs at home
to ensure a safe transition of care from hospital to home. Explain three (3) of your
teaching points.
- Provide the family the discharge summary and clinic card and discuss the
next clinic date with them.
- Educate the patient and family members on the stump care; daily dressing
using aseptic technique, note for any discharge and lesions and if any then
visit the nearest health centre at the earliest.
- Educate patient on the medication compliance for instance if he is prescribed
glipizide 10mg two times a day then he should take it on time every day.
 - Emphasize on foot care
- Focus on diabetic diet
Medical Nursing
Case Study Medical Nursing
Case study 1
JW, a patient with and exacerbation Chronic Obstructive/Airway Pulmonary Disease
(COPD/COAD), is admitted in your medical unit. You need to obtain his signs and give
him a bath. His vital signs at 8 am were as follows: temperature 37°C; pulse 86 beats
per minute and regular; respiration 18 per minute; blood pressure 130/68 mmHg. The
physiotherapist who is working with JW for his exercise has just brought him back.
You noticed that his breathing is laboured, with audible expiratory wheezes. While you
are obtaining his oral temperature, and vital signs, you continue to hear audible
expiratory wheezing. His vital signs now are as follows: temperature 36°C; pulse 106
beats per minute and irregular; respiration 26 per minute; blood pressure 140/78
mmHg.
You check and the medical orders are as follows:
*Daily physical therapy for conditioning
*Vital signs every 4 hours
*Oxygen at 2L via nasal prongs prn for pulse oximetry<90%
*Oxygen saturation levels via pulse oximeter every shift and evening

1. Determine whether the second set of vital signs were taken at the appropriate
time
No
2. Explain your reason for your answer to (1) above.
Because at first the medical order as per written is that vital signs should be taken
every four hourly and also as the patient just returned from the physiotherapist he
needs to be stabilized before taking the vital signs.

3. Describe a good time and type of bath to be given to JW.

In the morning to maintain personal hygiene and prevent odour. To make the
comfortable while lying in the bed while meeting family members and health
professionals.

4. Describe your management for JW's elevated respiratory rate and noisy
breathing.
Elevated respiratory rate MX:
- Elevate the head of the bed to improve the respiratory effort.
- Assess the rise and fall of the chest.
 - Administer oxygen as prescribed by the physician.
- Allay anxiety of the patient
- Provide adequate resting period of the patient
Noisy breathing MX:
- Encourage client to do deep breathing techniques and coughing exercise
- Remove secretions
- Participate in chest rehabilitation program.

Case study 2
Mr. John is a 56 year old farmer, a known Case of hypertension on medications. But
most of the time he is non-compliant. He has been brought to ED at 9am. With severe
headache, blurry vision, nausea and vomiting. On examination his BP was 240/140
mmHg. The medical doctor on call examined and said that the blood pressure was
uncontrollable, diagnosed him as hypertensive crisis/emergency and admitted him in
the Medical Ward.

1. You are approached by Mrs. John to explain to her of the husband's diagnosis.
Explain what is hypertensive emergency/crisis?
I as a nurse will explain to Mrs. John that your husband is having Hypertensive
emergency/crisis which means there is a severe increase in blood pressure that can
lead to a stroke. Extremely high blood pressure — a top number (systolic pressure) of
180 millimeters of mercury (mm Hg) or higher or a bottom number (diastolic
pressure) of 120 mm Hg or higher which can damage blood vessels.

2. You gathered the family members to plan together the Nursing management of
Mr. John. Discuss 4 nursing management/interventions appropriate for Mr.
John upon admission.
- Prepare admission form, nursing observation chart, drug chart and fluid balance
chart.
- Prepare the patients bed; ensure the linen is clean, the wheels of the bed are safely
locked and one side of the railing is up and after the patient settles down the other
railing to be placed up as well.
- Give a clear explanation to the patient about the ward layout, ward protocols and
policies such as meal time and shower time.
- Take the initial vital signs upon the admission and document it in the nursing care
plan form and ensure family members and the patient are settled and rest assured.

Provide calm, restful surroundings, minimize environmental activity and noise. Limit
the number of visitors and length of stay.
It helps lessen sympathetic stimulation; promotes relaxation.
Maintain activity restrictions (bedrest or chair rest); schedule uninterrupted rest
periods; assist patient with self-care activities as needed.
Lessens physical stress and tension that affect blood pressure and the course of
hypertension.

Provide comfort measures (back and neck massage, the elevation of head).
Decreases discomfort and may reduce sympathetic stimulation.

Instruct in relaxation techniques, guided imagery, distractions.

Can reduce stressful stimuli, produce a calming effect, thereby reducing BP.

Monitor response to medications to control blood pressure.

Response to drug therapy (usually consisting of several drugs, including diuretics,
angiotensin-converting enzyme [ACE] inhibitors, vascular smooth muscle relaxants,
beta and calcium channel blockers) is dependent on both the individual and as the
synergistic effects of the drugs. Because of side effects, drug interactions, and patient’s
motivation for taking antihypertensive medication, it is important to use the smallest
number and lowest dosage of medications.
At around 5pm on the day of admission, his relatives notified the nurse on duty that Mr.
John complained of dizziness and hemiparesis. He suddenly lost his consciousness. The
doctor on call diagnosed him having ischaemic cerebrovascular accident (CVA).

3. You approached the family members to assist them understand Mr. John's
condition after the doctor explained to them. Describe how the CVA has come
about on Mr. John.

4. Identify the rationales for each nursing intervention for Mr. John's CVA.

NURSING RATIONALE
INTERVENTION

1. Nil orally or nil by To avoid aspiration

mouth
2. Elevate head of the To improve respiratory effort
bed
3. Monitor vital signs To monitor the progress of the clients status
4. Positioning To avoid bed sores and to maintain proper alignment of
the body
5. Assess skin to determine the development of the pressure ulcer
 Common Conditions: Develop your answers according to the listed conditions under
the following headings:
COVID and its protocols –
Hand hygiene, face mask,
PPE’s isolation and social
distancing

Leptospirosis

Asthma

Hypertension Crisis Definition

Pathophysiology
Dengue fever Clinical Signs and symptoms
Investigations/diagnostic tests
Stroke - (right or left sided) Medications – classifications, side effects, dosage
(General)
Drug dose Formula: Dose required x Quantity = Dose
Cerebrovascular accident – Dose on hand
Rt CVA – left side of the body
is affected such as facial Nursing Management/ Intervention with rationale (ADPIE)
drooping, arm and leg Discharge plan – include rehabilitative care
weakness and vice versa

Head injury

Multiple Trauma

Burns

Pneumonia

Immunocompromised state

Tuberculosis
Myocardial Infarction

OT – pre-op
https://quizlet.com/360096729/nurs-309-quiz-1-preoperative-patients-flash-cards/

Cardiac
https://quizlet.com/29147347/253-cardiovascular-nclex-questions-flash-cards/
https://quizlet.com/86946251/cardiac-nursing-flash-cards/
Intensive care
https://quizlet.com/225649441/nclex-critical-care-nurse-question-flash-cards/
Burns
https://quizlet.com/44040207/burn-nclex-flash-cards/
Asthma
https://quizlet.com/105675474/respiratory-nclex-questions-asthma-and-more-flash-
cards/
Emergency Nursing
https://quizlet.com/344582493/emergency-trauma-nursing-nclex-flash-cards/

Medical Surgical Nursing

https://quizlet.com/80381694/medical-surgical-nclex-practice-quiz-flash-cards/

COVID 19
https://quizlet.com/507440563/covid-questions-flash-cards/

Leptospirosis
https://quizlet.com/546026281/leptospirosis-flash-cards/

Dengue Fever
https://quizlet.com/357430245/dengue-flash-cards/

Head Injury
https://quizlet.com/37961595/nclex-head-injury-flash-cards/
https://quizlet.com/147687625/icphead-injury-nursing-4-test-1-flash-cards/
 Column A Column B Answer
[Drug] [Therapeutic Outcome]
Frusemide f A. Decrease BP, heart rate, prevention of f
i.
[Lasix] Angina.
ii. Spironalactone d B. Decrease Angina Pectoris,
[Aldactone] Dysrhythmias – SvT/AF.
iii. Methyldopa d C. Decrease B/P and after load in congestive d
[Aldomet] heart failure.
iv. Atenolol g D. Decrease B/P in hypertension, preload, g
[Ternomin] after load in CHF.
v. Propranolol] a E. Decrease in polyuria, polydipsia, a
[Inderal] polyphagia.
vi. Hydrallazine k F. Decrease B/P and oedema in lung tissues, k
[Apresoline] diuretic.
vii. Verapamil c G. Decrease B/P and heart rate. c
[Isoptin]
viii. Enalapril j H. Prevention of clotting. j
[Vasotec]
ix. Warfarin h I. Decrease pain, inflammation, fever, h
[Coumadin] thrombosis.
x. Glipizide e J. Decrease B/P in hypertension. e
[Glucotrol]
K. Diuretic and antihypertensive

Circle the letter of the correct answer.

1. While doing triage in the Accident and Emergency Department which of the

following patients should be triaged first?

A. A 2 year old child with head laceration who is awake and crying.
B. An 85 year old woman with crushing chest pain, diaphoretic and pale.
 C. A 32 year old complaining of fever and chills.
D. A 16 year old with swollen ankle.

2. A patient with drug overdose was brought into the Accident and Emergency

Department. The management of this patient is

A. cathartics.
B. antacids.
C. a gastric lavage.
D. activated charcoal.

3. A patient with severe trauma has been treated for hypovolemic shock. The nurse

observes that the patient is in refractory stage of shock. The finding that would indicate that the
patient is in a refractory stage is:

A. a lactic acidosis with a Ph of 3.32.

B. unresponsiveness.
C. profound vasoconstriction with absent peripheral pulse.
D. marked hypotension that does not respond to vasopressors and fluids.

4. The nursing management for the prevention of shock is:

A. frequently monitoring vital signs.

B. using aseptic technique to invasive procedures.
C. to be aware of the potential for shock in all patients at risk.
D. teaching patients health promotion activities to prevent shock.

5. A primary difference in the skills of an Intensive Care Unit nurse compared to a

Medical Surgical nurse is the ability to:

A. diagnose and treat life-threatening disease.

B. detect and manage early complications of health problems.
C. provide intensive psychological support to the patient and family.
D. use advanced technology to assess and maintain physiological function.
MARKS CANDIDATE NO.: ______________

6. A nursing intervention for a patient in the Intensive Care Unit [ICU] diagnosed with

anxiety related to ICU environment and sensory overload is:

A. eliminating unnecessary alarms and overhead paging.

B. providing flexible visiting schedules for family members.
C. administering sedatives or psychotropic drugs to promote rest.
D. allowing the patient to do much self-care in daily activities as possible.

7. Assessing clients with obstructive jaundice the nurse would expect to find

A. clay coloured stool.

B. dark urine and stools.
C. pyrexia and severe pruritis.
D. elevated urinary urobilinogen level.

8. Gastro-oesophageal reflux is a disorder that

A. results in acid erosion, an ulceration of the oesophagus caused by frequent vomiting.

B. requires surgical wrapping or repair of the pyloric sphincter to control the symptoms.
C. protrudes from a portion of the stomach into the oesophagus through an opening in the
diaphragm.
D. involves relaxation of the lower oesophageal sphincter, allowing stomach contents to flow.

9. The nursing management of the patient with cholecystitis associated with

cholelithiasis is based on the knowledge that:

A. a low fat diet is recommended.

B. gallstones once removed tend not to recur.
C. pethidine is to be avoided in the management of pain.
D. bile salts dissolve gallstones.
 10. A patient is admitted to the hospital with severe renal colic caused by renal calculi.

The nurse’s first priority in the management of the patient is to:

A. administer narcotics as prescribed.

B. obtain supplies for straining all urine.
C. encourage fluid intake of 3 – 4 litres per day.
D. keep patient nil by mouth in preparation for surgery.

MARKS CANDIDATE NO.: ______________

11. Which of the following factors predispose to having allergies?

A. A family history of allergies.

B. Environmental conditions.
C. Number and type of exposure.
D. All of the above.

12. Which of the following patient is likely to have a stroke?

A. A 65 year old man with hypertension.

B.A 20 year old female on contraceptives.
C.An obese 13 year old.
D. A 30 year old who smokes.

13. The common response of a stroke patient to the change in body image is

A. denial.
B. depression.
C. disassociation.
 D. intellectualization.

14. In caring for an unconscious patient the nurse needs to do all of the following

except:

A. place the patient on the side with the head of the bed elevated.
B. put side rails up for safety.
C. clear the airway as needed.
D. limit care activities that increase the intracranial pressure.

15. Meningitis is an acute infection of the

A. lateral third and fourth ventricles.

B. cranial sinuses.
C. pia mater and arachniod membrane.
D. subarachnoid cisterus.

CARDIOVASCULAR SYSTEM

17. Mr. P. is a 35 year old Part European male who has been admitted into the

Coronary Care Unit with Congestive Heart Failure, chest pain, shortness of

breath, cyanosis and cool clammy skin. His vital signs are as follows:

Temperature 36°C, Pulse 118/meats/min, Respiration 36/breaths/min ad Blood

Pressure 140/100 mmHg.

6
[a] Describe the pathophysiological changes associated with Congestive

Heart Failure.

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Mr. P was examined by the doctor. A 12 lead electro cardiogram [ECG] was ordered.

3 [b] Label PQRST on the diagram below.

6
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3
[c] Explain the purpose of ECG.
6
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3
6 [d] List three [3] complications of Congestive Heart Failure.

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MARKS CANDIDATE NO.: ______________

20 [f] Design a Nursing Care Plan for Mr. P. who has severe chest pain, shortness of

breath, cyanosis and cool clammy skin. His vital signs are:

Temperature - 36°C, Pulse – 118 beats/min, Respiration – 36 breaths/min and

Blood Pressure – 140/100 mmHg.

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MARKS CANDIDATE NO.: ______________

RESPIRATORY SYSTEMS

18. Mrs. Brown is a 48 year old Fijian female, who has been having low-grade fever, night sweats,
weight loss and anorexia for the last two [2] years. Recently, she has been coughing out blood
and was lethargic. She was examined by the doctor and admitted to Acute Medical Ward for
further investigations on Pulmonary Tuberculosis.
 2 [a.] Define Pulmonary Tuberculosis.

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2 [b] Identify three [3] diagnostic tests to be carried out.

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15 19. In the table below, identify the appropriate Tuberculosis drugs, dosage and side

effects.

DRUGS DOSAGE SIDE EFFECT

MARKS CANDIDATE NO.: ______________

 REPRODUCTIVE SYSTEM
20. Mrs. Cama is a 30 year old Fijian woman who was admitted into Women’s

Surgical Ward with suspected cancer of the breast. After the doctor confirmed her diagnosis,
she was booked for Radical Mastectomy.

4 [a] Explain the pathophysiological changes associated with breast cancer.

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3 [b] List three [3] specific diagnostic test for breast cancer.

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21. Mrs. Cama is scheduled for surgery the next day. You noticed that she is

anxious, emotional and undergoing a lost of stress.

3 [a] Identify three [3] characteristics of anxiety.

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_________

5 [b] As part of preparing her for surgery, you are expected to counsel her
 using Hildergard Peplau’s Interpersonal theory.

Discuss how you would relieve her anxiety.

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MARKS CANDIDATE NO.: ______________

10 [c] Discuss pre-operative preparations on the night before operation.

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2 22. Mrs. Cama returned to the ward after operation. Postoperatively, her vital signs

were:

Temp-37°C, Pulse-90 beats/min, Respiartion-30 breaths/min, B/P -100/50

mmHg, - 140/90 mmHg. She has a wound drain in-situ and draining out a lot of

haemoserous fluids.

10 [a] Discuss your nursing management in the first 24 hours post-operatively.

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MARKS CANDIDATE NO.: ______________

23. Mrs. Cama experienced secondary haemorrhage. Her Haemoglobin [Hb] level is

8 g/L. She needs blood transfusion, however, she belongs to the Jehovah’s Witness faith and
has refused to receive blood.

5 [a] Discuss ethical principles regarding this case.

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Mrs. Cama has been ordered to be given three [3] litres of intravenous Normal Saline [0.9%]
with drop factor of 10 drop/ml in twenty-four [24 hours.
 5 [b] Calculate how many milliliters [mls.] she will receive in each hour.

Show your calculation.

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5 She has also been ordered to receive intravenous [IV] chloramphenicol 3g in 24 hours.

[c] Calculate how much she will receive every 6 hours.

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MARKS CANDIDATE NO.: ______________

24. Mrs. Cama had a cardiac arrest and resuscitation was unsuccessful.

8 [a] Explain your responsibility towards the deceased and her family.

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