National NORCET Test-9

National NORCET Test-9
1. In colloidal osmotic pressure leads to:

a. Dehydration b. No change in the body fluids
c. Edema d. Acidosis
Ans. c. Edema
Rationale:
• Excessive abnormal accumulation of fluid in the interstitial space is called edema.
• It can be detected in the tissue only when the volume of the interstitial fluid exceeds
by 30% above normal.
• Edema is mostly extracellular and may develop due to:
Ĕ Increase in capillary hydrostatic pressure: This is seen in:
Atrial dilation
Increase in venous pressure
Increase in blood volume
Ĕ Decreased colloidal osmotic pressure: This is seen in:
Malnutrition
Liver disease
Nephrotic syndrome
Ĕ Increased permeability of the capillary
Ĕ Lymphatic obstruction
Ĕ Failure of kidney to excrete excess water
Ĕ Heart failure
2. Normal ECF value of a 70-Kg person:

a. 10 L b. 14 L
c. 28 L d. 2L
Ans. b. 14 L
Rationale:
• Total body water (TBW) is approximately 60% of body weight. So total Body water of
60
70 Kg adult= 70 × = 42 L.
100
• Extracellular fluid (ECF) is one-third of TBW. Hence ECF will be 42 L × 1/3 = 14L.
2 National NORCET Test-9
• The percentage of TBW is highest in newborns and adult males and lowest in adult
females and in adults with a large amount of adipose tissue.
• ECF is composed of interstitial fluid and plasma. The major cation of ECF is Na+.
• The major anions of ECF are Cl- and HCO3–
3. In a healthy person, which of these lung volumes should be the largest?

a. Tidal volume b. Vital capacity
c. Expiratory reserve volume d. Residual volume
Ans. b. Vital capacity

Rationale:
• Vital capacity = expiratory reserve volume + tidal volume + inspiratory reserve
capacity. So VC is the largest (RV is ~1.2 L).
Table: Respiratory Capacities
Lung Capacity (mL)
Vital capacity (VC. 3500 IRV + TV + ERV, maximum amount of air that can be
exhaled after a maximum inspiration
Inspiratory capacity (IC. 2500 TV + IRV, maximum amount of air that can be inhaled
after a normal expiration
Expiratory Capacity (EC. 1500 TV + ERV
Functional residual capacity 2500 RV + ERV, amount of air remaining in the lungs after a
(FRC. normal tidal expiration
Total lung capacity (TLC. 5000 RV + VC, maximum volume to which the lungs can be
expanded
Closing capacity RV + the volume expired between the beginning of

airway closure and the RV
4. The pH of the stomach and the pH of the small intestine are BEST described
(respectively) as:
a. Acidic and alkaline/basic b. Strongly acidic and weakly alkaline/basic
c. Acidic and weakly alkaline/basic d. Strongly acidic and strongly alkaline/basic
Ans. b. Strongly acidic and weakly alkaline/basic
Rationale:
• The pH of the stomach contents is about 2 (strongly acidic., while the pH of small
intestine is about 8 (weakly alkaline). Thus B is the best answer.
• The stomach functions as both a reservoir and site of digestion for the food bolus. It
has three layers of smooth muscle: longitudinal, circular and oblique, which churn the
food bolus until the digestive contents eventually pass through the pyloric sphincter.
The stomach’s main motor functions include storing, mixing and emptying.
• Approximately 6 m long, the small intestine is the primary site of digestion and
absorption. It is divided into three regions: the duodenum, jejunum and ileum.
National NORCET Test-9 3
5. What structure separates the thoracic cavity from the abdominal cavity?
a. The mediastinum b. The diaphragm
c. The peritoneum d. The pylorus
Ans. b. The diaphragm

Rationale
• The diaphragm is a dome-shaped muscle, which physically separates these two ventral
cavities.
• Thoracic cavity is situated in the upper part of the trunk and abdominal cavity is oval
in shape and it is the largest body cavity, which occupied by the organs and glands of
the digestive system.
• The mediastinum is the space between the lungs, including the structures found there
such as the heart, esophagus and blood vessels.
• The Peritoneum is a serous membrane which lines the walls of the abdominal cavity and
lies on abdominal and pelvic organs. Between its two layers – parietal and visceral – is
the peritoneal cavity.
6. Type of joint shown in the image is:-
a. Gomphosis b. Syndesmosis
c. Symphysis d. Schindylesis
Ans. d. Schindylesis
Rationale
• Schindylesis present between rostrum of sphenoid and upper border of vomer.
• Schindylesis is that form of articulation in which a thin plate of bone is received into
a cleft or fissure formed by the separation of two laminae in another bone, as in the
articulation of the rostrum of the sphenoid and perpendicular plate of the ethmoid
with the vomer, or in the reception of the latter in the fissure between the maxilla and
between the palatine bones.
• Gomphosis is articulation by the insertion of a conical process into a socket; this is

not illustrated by any articulation between bones, properly so called, but is seen in
the articulations of the roots of the teeth with the alveoli of the mandible and maxilla.
• Amphiarthroses (slightly movable articulations): In these articulations the contiguous
bony surfaces are either connected by broad flattened disks of fibrocartilage, of a more
or less complex structure, as in the articulations between the bodies of the vertebrae; or
are united by an interosseous ligament, as in the inferior tibiofibular articulation. The
first form is termed a symphysis, the second a Syndesmosis.
7. The hyperpolarization of a neuron is governed by the actions of which of the

following ions?
a. Potassium and sodium b. Sodium only
c. Chloride and potassium d. Sodium and calcium
Ans. c. Chloride and potassium

Rationale:
• In neurons within the CNS, an inhibitory transmitter will open chloride channels.
• In addition, second messengers may also mediate inhibition. It is likely that they do so
by opening potassium channels.
• When a chloride channel is opened, it will lead to movement of this ion down its
concentration gradient and into the cell. This will make the cell more negative (i.e.
hyperpolarized.. At the same time, there will be an efflux of potassium, which will also
produce hyperpolarization of the cell because positive charges are now being removed.
• On the other hand, sodium and calcium influx are associated with depolarization of
the cell.
8. This hormone acts on the intestines and causes increased calcium absorption:
a. Calcitonin b. Calcitriol
c. Thyroxine d. Pancreatic polypeptide
Ans. b. Calcitriol
Rationale:
• Calcitriol, the hormonally active form of vitamin D, is produced from a precursor
(calcifediol) in the cells of the proximal tubule of the nephron in the kidneys.
• Calcitriol production is stimulated by a decrease in serum calcium alone or in
combination with increased serum phosphate and PTH.
• Calcitriol production is also increased by prolactin. Calcitriol increases blood calcium
levels by increasing absorption of calcium and phosphate from the GI tract and
increasing renal tubular absorption of calcium and phosphate.
• It can also increase blood calcium through bone resorption. Calcitriol also inhibits
calcitonin release, a hormone which reduces blood calcium by counteracting the
effects of PTH.
9. Which one of the following is NOT a plasma protein?

a. Keratin b. Albumin
c. Ferritin d. Globulin
Ans. a. Keratin
Rationale:
• Keratin is the protein in the stratum corneum of the skin and that hair and nails are
made of.
Table: Difference between Serum and Plasma

Characteristics Serum Plasma
Definition Serum is the liquid part of the blood Plasma is a clear and yellowish
after the coagulation. fluid part of the blood.
Composition Serum is the water fluid from blood Plasma is the blood fluid that
without the clotting factors. contains blood clotting agents.
Volume Volume of serum is less in comparison Plasma is a clear yellow liquid
to plasma. which is 55% of total volume of
blood.
Isolation Serum is acquired from the process of Plasma is acquired from the
spinning after clotting. process of spinning before
clotting.
Isolation Procedure Serum is more difficult and time Plasma is easier and less time
consuming to separate. consuming to separate as
compared with serum.
Use of Serum does not need anticoagulants for Anticoagulants are necessary to
Anticoagulants separation. separate plasma.
Composition • Serum contains proteins, • Plasma is considered as the
electrolytes, antibodies, antigens and medium of blood in which
hormones. RBCs (Red Blood Cells), WBC
• Serum contain antibodies and cross (White Blood Cells) and
react with recipient antigen. other components of blood
• Serum contains proteins like albumin are suspended.
and globulins • Blood plasma contains
• Serum contains 90% water antibodies, a type of protein
that can fight a substance
considered foreign to the
host body.
• Plasma contains the clotting
factors and water.
• Plasma contains 92 - 95%
water
Fibrinogen Absent Present
Storage Serum can be stored at 2 - 6 degrees Frozen plasma can be stored for
centigrade for several days up to a year
Arrangement Cells are usually attached together by Cells are not attached together
clot formation and suspended in plasma
Uses Serum is the most preferred part of Plasma is delivered to the
blood used in checking blood groups patients who lack blood cells.
Serum is an important source of Plasma contains proteins that
electrolytes and animal sera are used as help in the transportation
anti-venom, anti-toxins and vaccinations. of material such as glucose
Serum is used for various diagnostic and other dissolved nutrients
tests used for determining the levels of through the blood.
hCG, cholesterol, proteins, sugar, etc., in Plasma aids in the maintenance
the blood of blood pressure and in the
regulation of body temperature
10. Which period of the heart cycle is completely occupied by the ventricles
contracting?
a. Atrial systole b. Atrial diastole
c. Ventricular systole d. Ventricular diastole
Ans. c. Ventricular systole
Rationale:
• Systole is the term applied to contraction of the cardiac muscle.
• Ventricular diastole is the period during which the two ventricles are relaxing from
the contortions/wringing of contraction, then dilating and filling; atrial diastole is the
period during which the two atria likewise are relaxing under suction, dilating and
filling.
• Atrial systole occurs toward the end of ventricular diastole, completing the filling of
the ventricles. In an ECG, atrial systole is associated with atrial depolarization, or the
P wave deflection.
• Atrial diastole: lasting about 0.7 seconds - relaxation of the atria, during which the
atria fill with blood from the large veins (the vena cava..
• Ventricular Systole refers to the phase of the cardiac cycle where the left and right
ventricles contract at the same time and pump blood into the aorta and pulmonary
trunk, respectively.
BIOCHEMISTRY AND NUTRITION
11. In the DNA molecules, adenine always pair with:

a. Guanine b. Uracil
c. Thymine d. Cytosine
Ans. c. Thymine
Rationale:
• DNA contains the bases adenine (A., guanine (G), cytosine (C., and thymine (T). RNA
contains A, G, and C, but has uracil (U) instead of thymine.
• Deoxyribose is present in DNA, whereas RNA contains ribose.
• As per the Chargaff ’s rule is total number of purines=Total number of pyrimidines in
a double standard DNA.
• Chargaff ’s Rule: “In DNA molecules the concentration of deoxyadenosine (A.
nucleotides equals that of thymidine (T) nucleotides (A = T), while the concentration
of deoxyguanosine (G) nucleotides equals that of deoxycytidine (C. nucleotides (G =
C.”.
• Pyrimidine base present in cytidine is cytosine, uridine is uracil.
• Purine bases are Adenine and Guanine.
• Pyrimidine bases are cytosine, uracil and thymine.
12. An enzyme is described as:

a. A protein that slows down reactions
b. A protein that speeds up reactions
c. A carbohydrate that slows down reactions
d. A carbohydrate that speeds up reactions
Ans. b. A protein that speeds up reactions

Rationale:
• Enzymes are ‘biological catalysts’ that speed up the rate of reactions in the body. They
are highly effective because without enzymes many biological reactions would not
occur fast enough to sustain life.
• Enzymes are highly specific; each enzyme will only work on a specific substance
(substrate) or closely related family of substrates.
• The substrate can often be identified by the enzyme name: since the prefix usually
takes the name of the substrate and the suffix ‘-ase’ indicates an enzyme. For example,
the enzyme sucrase helps digest the disaccharide sucrose into its constituent
monosaccharides, glucose and fructose.
• Enzymes have three important properties:
Ĕ Specificity for their substrate
Ĕ Efficiency; and
Ĕ Control
13. Dr. Sudhir tells a patient that an increased intake of foods that are rich in
Vitamin E and beta-carotene are important for healthier skin. The nurse
teaches the patient that excellent food sources of both of these substances are:
a. Carrots and potatoes b. Fish and fruit jam
c. Spinach and mangoes d. Oranges and grapefruit
Ans. c. Spinach and mangoes

Rationale:
• Beta-carotene and Vitamin E are antioxidants which help to inhibit oxidation. Vitamin
E is found in the following foods: wheat germ, corn, nuts, seeds, olives, spinach,
asparagus and other green leafy vegetables. Food sources of beta-carotene include dark
green vegetables, carrots, mangoes and tomatoes.
• Carrots are rich in beta-carotene, a compound the body changes into vitamin A, which
helps keep the eyes healthy. And beta-carotene helps protect the eyes from the sun and
lowers the chances of cataracts and other eye problems. Yellow carrots have lutein,
which is also good for the eyes. Studies have linked potatoes and their nutrients to a
variety of impressive health benefits, including improved blood sugar control, reduced
heart disease risk, and higher immunity. They may also improve digestive health and
combat signs of aging.
• Fish is rich in protein, while fruit jams are rich in fiber and carbohydrates. Fish is
filled with omega-3 fatty acids and vitamins such as D and B2 (riboflavin). Fish is rich
in calcium and phosphorus and a great source of minerals, such as iron, zinc, iodine,
magnesium, and potassium.
• Oranges and grapefruit are rich in Vitamin C. Lemons, limes, grapefruits, and oranges
are high in phytonutrients, such as carotenoids, flavonoids, and polyphenols. These
nutrients are types of antioxidants and give the fruits their bright colors and strong
scents. They can also help protect the body and prevent many health issues.
14. When teaching a patient with coronary artery disease about nutrition, the
nurse should emphasize:
a. Limiting sodium to 7 g per day
b. Adding complex carbohydrates
c. Eating 3 balanced meals a day
d. Avoiding very heavy meals
Ans. d. Avoiding very heavy meals

Rationale:
• Eating large, heavy meals can pull blood away from the heart for digestion and is
dangerous for the patient with coronary artery disease.
15. The given test below depicts:
a. Molisch test b. Benedict’s test

c. Barfoed’s test d. Seliwanoff ’s test
Ans. b. Benedict’s test

Rationale:
• The above given test is Benedict’s test. It is a qualitative as well as semi-quantitative.
• Benedict’s test given positive by all reducing sugars.
• The color gives an idea of the amount of sugar present.
Other options:
• Molisch test: General test for carbohydrates. But one condition is number of carbon
should be 5 or more, only then Molisch test is positive.
Figure 1: Molisch test

• Barfoed’s test: Distinguish between monosaccharides and Disaccharides. It is given
positive by monosaccharides.
Figure 2: Barfoed’s Test

• Seliwanoff ’s test: Distinguish between aldehyde and keto sugar. It is given positive by
keto sugars.
Figure 3: Seliwanoff’s test

MICROBIOLOGY
16. Which disease is caused by myxovirus?

a. Whooping cough b. Rubella
c. Chicken pox d. Mumps
Ans. d. Mumps
Rationale:
• Mumps disease is caused by myxovirus.
• Whooping cough or pertussis is caused by Bordetella pertussis.
• Chicken pox is caused by varicella virus.
17. For effective sterilization in the autoclave, the temperature should be:
a. 121 °F b. 121 °C
c. 100 °F d. 100 °C
Ans. b. 121 °C
Rationale:
• For effective sterilization in the autoclave, the temperature should be 121°C for 15
minutes.
• Sterilization is a procedure to remove all living microbes as well as spores from any
surface. To be effective, the autoclave must reach and maintain a temperature of 121°C
for at least 30 minutes by using saturated steam under at least 15 psi of pressure.
18. A natural power of the body to withstand the toxins or the organisms of disease
is _____________.
a. Resistance b. Sensitivity
c. Transmission d. Immunity
Ans. d. Immunity
Rationale
• A natural power of the body to withstand the toxins or the organisms of disease is
immunity.
• The process of inducing immunity is called immunization. Immunity is of two types:
natural and artificial. Both of them are further divided into active and passive.
• Resistance is ability to tolerate. Commonly used terms are antibiotic resistance among
microorganisms. Due to inadequate exposure to antimicrobials in terms of duration,
the microbes develop the resistance by changing their mechanism of infection.
• Sensitivity is the vulnerability to get affected by specific agent or to a process example
gluten enteropathy or sensitivity to specific antimicrobial.
• Transmission means spread of microbes from one host to another. Transmission can
be horizontal or vertical. Mode of transmission is important to understand as it helps
to break the link in infection cycle.
19. Type I hypersensitivity is mediated by:

a. IgA b. IgE
c. IgM d. IgG
Ans. b. IgE
Rationale:
• Type 1 hypersensitivity also known as immediate hypersensitivity is mediated by IgE.
This type of reaction is provoked by exposure to allergens and severe forms are known
as anaphylaxis.
• There are five different types of immunoglobulins:
Ĕ IgA: It is predominantly found on epithelial surfaces. This immunoglobulin
prevents invading pathogens from attaching and penetrating epithelial surfaces.
Ĕ IgE: It functions in allergic response and anaphylaxis.
Ĕ IgM: IgM is the first antibody built during an immune response. So, detection of
IgM in serum correlates to acute infection.
Ĕ IgG: It is the most common antibody and is produced in a delayed response to an
infection. This is being retained in the body for a long time and is responsible for
long-term immunity.
Ĕ IgD: Function of IgD in human body is not clear.
20. Rod-shaped bacteria are called:

a. Bacillus b. Spirochetes
c. Clusters d. Cocci
Ans. a. Bacillus
Rationale:
• Rod-shaped bacteria are called bacillus, like the E. coli family.
• Spherical bacteria are called cocci, like Staphylococcus and Streptococcus.
• Spirochetes are helical in shape like Leptospira.
• Diplococci bacteria are a subtype of cocci bacteria that occur as a pair (two joined
cells), example Neisseria gonorrhoeae.
PHARMACOLOGY
21. Which of the following anti-tuberculosis drugs can damage the 8th cranial
nerve?
a. Ethambutol hydrochloride b. Isoniazid (INH)
c. Streptomycin d. Para Aminosalicylic acid (PAS)
Ans. c. Streptomycin
Rationale:
• Streptomycin is an aminoglycoside and damage to the 8th cranial nerve (ototoxicity) is
a common side effect of aminoglycosides.
• Ototoxicity and vestibular impairment are often thought to be the hallmark of

streptomycin toxicity. In extreme cases, deafness may occur due to ototoxicity, thus
caution must be exercised when combining streptomycin with other potentially
ototoxic drugs. Vestibular impairment usually manifests during the course of treatment
and is typically permanent.
• Other options:
Ethambutol • One of the most well-known adverse effects is ototoxicity.
hydrochloride • The effect of ototoxicity is dose-related, with greater than 40% of
adults developing toxicity at doses that were greater than 50 mg/kg
and around 0 to 3% of adults developing toxicity at 15 mg/kg/daily.
• The manifestation of EMB-induced optic neuropathy appears to be
from EMB’s chelation of copper. A study with 60 patients undergoing
treatment with ethambutol monitored their serum copper levels.
Isoniazid • It may cause serious damage to the liver. Isoniazid is metabolized
primarily by the liver, by acetylation of N-acetyltransferase 2 (NAT2).
• Three metabolites have implications that correlate with the liver
injury associated with the drug: acetyl hydrazine (AcHz), hydrazine
(Hz), and a metabolite from the bioactivation of isoniazid itself. There
is considerable variation in acetylation rate and elimination half-life
from individual to individual, which is not accounted for by dose and
concentration, and this appears to contribute to risk for hepatotoxicity
as well as the other adverse effects associated with isoniazid.
Para Aminosalicylic • Despite having excellent efficacy against TB in both in vitro
acid (PAS) experiments and clinical trials, PAS was eventually replaced with
better-tolerated ethambutol due to gastrointestinal disturbance
associated with the usage of PAS.
22. A patient has been taking furosemide (Lasix) for the past week. The nurse
recognizes which finding may indicate the patient is experiencing a negative
side effect from the medication?
a. Gastric irritability b. Decreased appetite
c. Weight gain of 5 pounds d. Edema of the ankles
Ans. b. Decreased appetite

Rationale:
• Lasix causes a loss of potassium if a supplement is not taken.
• Signs and symptoms of hypokalemia include anorexia, fatigue, nausea, decreased GI
motility, muscle weakness, dysrhythmias.
23. A patient receiving haloperidol (Haldol) complains of a stiff jaw and difficulty
swallowing. The nurse’s first action is to:
a. Reassure the patient and administer as needed lorazepam (Ativan) IM
b. Administer as needed dose of benztropine (Cogentin) IM as ordered
c. Administer as needed dose of benztropine (Cogentin) by mouth as ordered
d. Administer as needed dose of haloperidol (Haldol) by mouth
Ans. b. Administer as needed dose of benztropine (Cogentin) IM as ordered

Rationale:
• Haloperidol is a medication that works in the brain to treat schizophrenia. It is also
known as a first generation antipsychotic (FGA. or typical antipsychotic. Haloperidol
rebalances dopamine to improve thinking, mood, and behavior.
• The patient is most likely suffering from muscle rigidity due to haloperidol IM.
• Benztropine should be administered to prevent asphyxia or aspiration.
• Lorazepam treats anxiety, not extrapyramidal effects.
• Another dose of haloperidol would increase the severity of the reaction.
24. Mr. Arora, who was diagnosed with a brain tumor, was scheduled for
craniotomy. In preventing the development of cerebral edema after surgery,
the nurse should expect the use of:
a. Antihypertensive b. Anticonvulsants
c. Diuretics d. Steroids
Ans. d. Steroids
Rationale:
• Glucocorticoids (steroids) are used for their anti-inflammatory action, which decreases
the development of edema. Corticosteroids produce their effect through multiple
pathways. In general, they produce anti-inflammatory and immunosuppressive effects,
protein and carbohydrate metabolic effects, water and electrolyte effects, central
nervous system effects, and blood cell effects.
• Antihypertensive drugs comprise several classes of compound with the therapeutic
intention of preventing, controlling, or treating hypertension. The classes of
antihypertensive drugs differ both structurally and functionally.
• Anticonvulsants suppress the excessive rapid firing of neurons during seizures.
Anticonvulsants, or antiepileptics, are an ever-growing class of medications that act
through multiple different mechanisms to control seizures.
• Diuretics help rid the body of salt (sodium) and water. Most of them help the kidneys
release more sodium into the urine. The sodium takes with it water from the blood,
decreasing the amount of fluid flowing in the veins and arteries, thereby reducing
blood pressure. Diuretics are a medication used in the management and treatment of
edematous and other non-edematous disease conditions. Diuretics are a class of drugs.
25. The drug in the picture is used for:

a. Breast cancer b. Routine contraception

c. Emergency contraception d. Abortion
Ans. c. Emergency contraception

Rationale:
• 2 tablets of levonorgestrel given in the picture are used 12 hours apart for emergency
contraception.
26. As a knowledgeable nurse, you know that the following are part of the five
rights, except:
a. Right dose b. Right route
c. Right drug d. Right room
Ans. d. Right room

Rationale:
• Right room is not one of the five rights.
• The five rights are right patient, route, dose, drug and time.
27. Nurse Reena teaches the patient with angina about common expected side
effects of nitroglycerin including:
a. Stomach cramps b. Shortness of breath
c. High blood pressure d. Headache
Ans. d. Headache
Rationale:
• Because of its widespread vasodilating effects, nitroglycerin often produces side effects
such as headache, hypotension, and dizziness. Headaches can be severe, throbbing,
and persistent and may occur immediately after use. Vasodilation and venous
pooling can increase the amount of blood in the cranial space, resulting in increased
intracranial pressures; this can cause persistent, throbbing headaches, along with
confusion, fever, vertigo, nausea, vomiting, and visual disturbances.
• Stomach cramps are not a side effect of nitroglycerin. Some patients can be more
sensitive to the hypotension caused by nitrates, which can result in nausea, vomiting,
diaphoresis, pallor, and collapse even at therapeutic doses.
• Difficulty of breathing is one of the side effects of nitroglycerin. In the event of
overdose, monitoring of vital signs may be necessary to monitor the hemodynamic
effects of nitroglycerin. Continuous monitoring of blood pressure, heart rate,
respiratory rate, and oxygen saturation is recommended. As intracranial pressure
increases, symptoms will progress to dyspnea secondary to a reduced respiratory
effort, heart block, bradycardia, paralysis, seizures, coma, and, eventually, death.
• Nitroglycerin produces hypotension instead of hypertension due to its vasodilating
effects. Patients may report symptoms of orthostatic hypotension which manifest as
dizziness, weakness, palpitations, and vertigo. Profound hypotension may occur in
patients with preload-dependent conditions.
28. ACEs participate in the renin-angiotensin-aldosterone system to have which of

the following physiologic effects?
a. Inhibit conversion of angiotensin II to angiotensin I
b. Vasoconstriction and sodium depletion
c. Promote sodium and water retention
d. Stimulate vasodilation and inhibit sodium depletion
Ans. c. Promote sodium and water retention

Rationale:
• Angiotensin converting enzyme (ACE) inhibitors are high blood pressure drugs that
widen or dilate the blood vessels to improve the amount of blood the heart pumps and
to lower blood pressure.
• Angiotensin is a potent vasoconstrictor that stimulates the release of aldosterone.
• Aldosterone release promotes sodium and water retention.
• The conversion of angiotensin I to II is not inhibited.
• Aldosterone promotes sodium retention not depletion. Vasoconstriction not
vasodilation results.
29. Which of the following is drug of choice in the condition given below?
a. Propylthiouracil
b. KI
c. Methimazole
d. Thiocyanate
Ans. c. Methimazole
Rationale:
• Exopthalmus in the picture is suggestive of hyperthyroidism.
• Methimazole is the drug of choice for hyperthyroidism.
30. In the operation theatre (OT) an Anesthesiologist, Dr. Dhiramayee asks the
nurse to explain the action of infiltration anesthesia. The nurse’s response is
based on the knowledge that infiltration anesthesia:
a. Is applied only to mucous membranes to provide local anesthesia
b. Blocks a specific group of nerves in tissues close to the operative area
c. Blocks sensation to an entire limb, or a large area of the face
d. Produces numbing to large, regional areas such as the lower abdomen and legs
Ans. b. Blocks a specific group of nerves in tissues close to the operative area
Rationale:
• Infiltration anesthesia blocks a specific group of nerves close to the operative area by
diffusion of a drug into the tissues.
• It is used to anesthetize small areas.
• Topical anesthetics are applied to mucous membranes.
• Nerve blocks provide anesthesia to a large surface area.
• Spinal anesthesia affects large, regional areas.
31. What medication is most likely to be administered to the client with diagnosis
of herpes zoster?
a. Penicillin b. Acyclovir
c. Doxycycline d. Fluconazole
Ans. b. Acyclovir
Rationale:
• Herpes Zoster is usually treated with orally administered acyclovir, an antiviral agent.
• Adults with herpes zoster can be treated with oral acyclovir at a dose of 800 mg five
times daily.
• Other antiviral medications include famciclovir and Valacyclovir.
32. Which is the most important route of excretion of drugs?

a. Kidney b. Saliva and sweat
c. Exhaled air d. Feces
Ans. a. Kidney
Rationale:
• Routes of excretion may include urine, feces (e.g. unabsorbed drugs and drugs secreted
in bile), saliva, sweat, tears, milk (with possible transfer to neonates), and lungs (e.g.
alcohols and anesthetics). Any route may be important for a given drug, but the kidney
is the major site of excretion for most drugs.
33. The drug used to increase the effect of local anesthesia is:
a. Epinephrine/Adrenaline b. Norepinephrine
c. Atropine d. Dobutamine
Ans. a. Epinephrine/Adrenaline
Rationale:
• Local anesthetics cause dilatation of blood vessels.
• The addition of a vasoconstrictor such as adrenaline/epinephrine to the local
anesthetic preparation diminishes local blood flow, slowing the rate of absorption and
thereby prolonging the anesthetic effect.
34. Drug which should not be given in renal disease is?

a. Gentamicin b. Nitroprusside
c. Doxycycline d. Ceftriaxone
Ans. a. Gentamicin
Rationale:
• Gentamicin is an Aminoglycosides; which is Bactericidal in nature.
• Acts: irreversible inhibition of initiation complex through binding of the 30S subunit.
Can cause misreading of mRNA. Also block translocation. Require O2 for uptake;
therefore ineffective against anaerobes.
• Adverse effects of Gentamycin:
Ĕ Nephrotoxicity: So contraindicated renal failure patients.
Ĕ Neuromuscular blockade (absolute contraindication with myasthenia gravis)
Ĕ Ototoxicity (especially with loop diuretics)
Ĕ Teratogenicity
35. All are correct about the given devices below used along with pMDI (pressurized
metered-dose inhaler), except:
a. Decreased the deposition of drug on the oropharynx

b. Increase the delivery of drug to lower airways
c. Increase the incidence of oropharyngeal candidiasis
d. Decrease the systemic absorption of drugs
Ans. c. Increase the incidence of oropharyngeal candidiasis

Rationale:
• The given image is of a spacer device with a face mask, used between the pMDI
(pressurized metered-dose inhaler) and the patient.
• Spacers reduce the velocity and size of particles entering the upper airways. This reduces
the amount of drug that impinges on the oropharynx and increase the proportion of
drug inhaled into lower airways.
• Spacer devices are useful in delivering inhaled drugs to small children (as young as 3
years of age) who are not able to use a pMDI.
PATHOLOGY AND GENETICS
36. Anaplasia is
a. Changing one type of epithelium to another
b. Nuclear chromatin
c. Lack of differentiation
d. Morphological changes
Ans. c Lack of differentiation
Cellular changes
• Hyperplasia: Increase in number of cells. May be a risk factor for future malignancy
(e.g., endometrial hyperplasia. but not considered premalignant.
• Hypertrophy: Increase in size of cells.
• Atrophy: Decrease in tissue mass due to increase in size and/or number of cells. Causes
include disuse, denervation, loss of blood supply, loss of hormonal stimulation, poor
nutrition.
• Dysplasia: Disordered, non-neoplastic cell growth. Term used only with epithelial
cells. Mild dysplasia is usually reversible; severe dysplasia usually progresses to
carcinoma in situ.
• Metaplasia: Replacement of one cell type by another. Usually due to exposure to an
irritant, such as gastric acid or cigarette smoke. Reversible if the irritant is removed but
may undergo malignant transformation with persistent insult (e.g. Barrett esophagus
→ esophageal adenocarcinoma..
• Neoplasia: Uncontrolled, clonal proliferation of cells. Can be benign or malignant.
• Anaplasia: Complete lack of differentiation of cells in a malignant neoplasm.
• Differentiation The degree to which a malignant tumor resembles its tissue of origin:
Ĕ Well-differentiated tumors (often less aggressive) closely resemble their tissue of
origin.
Ĕ Poorly differentiated tumors (often more aggressive) look almost nothing like their
tissue of origin.
37. All of the following are features of Apoptosis, Except:-

a. Cellular swelling b. Nuclear compaction
c. Intact cell membrane d. Cytoplasmic eosinophilia
Ans. A Cellular swelling
Apoptosis Vs Necrosis
Apoptosis Necrosis
• May be physiological or pathological • Always pathological
• Important for development, • Associated with disruption of cellular
• Homeostasis & elimination of pathogens & • Homeostasis
tumor cells
• Affects single cell • Affects contiguous group of cells
• Cell size shrunken • Cell size increased
• Active • Passive
• No inflammatory reaction • Cause inflammatory reaction
• Plasma membrane intact • Plasma membrane disrupted
• Step ladder pattern on electrophoresis • Smear pattern on electrophoresis
CHN
38. Mode of transmission of Hepatitis E virus is:

a. Sexual b. Blood transfusion
c. Injections d. Fecal-oral
Ans. d. Fecal oral

Rationale:
• Hepatitis A is transmitted by close personal contact between individuals in places like
homes and child day care centers and shed in the feces for 2 weeks before symptoms
are apparent.
• Hepatitis B is transmitted by body fluids (blood, saliva, semen, vaginal secretions, and
breast milk) and can be considered a sexually transmitted disease (STD..
• Hepatitis C is a common cause of transfusion and liver transplant associated hepatitis
if the patient’s blood and liver are not prescreened. It can also be considered an STD
and can be transmitted at birth from a HCV-infected mother.
• Hepatitis D transmitted parenteral, sexual and perinatal.
• Hepatitis E is transmitted by fecal-oral especially waterborne.
39. The coverage of the population by primary health centers (PHC. in plain areas
is:
a. 5,000 b. 20,000
c. 30,000 d. 40,000
Ans. c. 30,000
Rationale:
Table: Population covered and levels of health workers
Health worker Population covered Level
AWW (ICDS)-4 months training 400 - 800 in plain, 300 - 900 in hill/tribal Village
area
ASHA (NRHM)- 23 days training 1000 Village
Village Health Guide -200 hours 1000 Village
training in 3 months
Trained Dai 1 in each village Village
USHA (NUHM) 2500 Urban areas
MPW (Male/Female) 5000 [ 3000 hill/tribal] Sub-Center
Health Assistance [Male/Female] 30000 [20000 hill/tribal] PHC
40. In the emergency department, the nurse assesses a child suspected of having
measles. Which of these infection control precautions should the nurse initiate?
a. Airborne precautions b. Contact precautions
c. Reverse isolation d. Droplet precautions
Ans. a. Airborne precautions

Rationale:
• Airborne precautions are used to prevent the transmission of infectious agents that
remain infectious over long distances when suspended in the air.
• Disease requiring airborne precautions include, but are not limited to: Measles, severe
acute respiratory syndrome (SARS), varicella (chicken pox), and mycobacterium
tuberculosis.
• Droplet infection: Respiratory infections, Whooping cough and TB
• Reverse isolation are procedures designed to protect a patient from infectious
organisms carried by staff, patients or other patients. The organisms are typically
spread by droplets in the air or on equipment. All staff should wash their hands prior
to entering the room. Hospitalized patients with neutropenia are commonly placed in
reverse isolation intended to protect them from acquiring serious infections.
41. For the prevention of human rabies, immediate flushing and washing the
wound (s) in animal bite cases, with plenty of soap and water, under running
tab should be carried out for how much time?
a. 2 minutes
b. 1 minutes
c. 15 minutes
d. 5 minutes
Ans. c. 15 minutes
Rationale:
Management of Rabid Animal Bite
Local wound management
• Cleaning/flushing the wound with soap and water (preferably under running tap
water) for 15 min.
• Irrigation with catheter in case of punctured wound
• Chemical treatment: Viricidal agents alcohol and tincture iodine
• Wound should never be sutured immediately (if necessary, it should be done after 24 -
48 hours, applying minimum stitches and undercover of Anti Rabies Serum locally).
42. Hand washing to prevent nosocomial infection is an example of:

a. Primordial prevention
b. Primary prevention
c. Secondary prevention
d. Tertiary prevention
Ans. b. Primary prevention

Rationale:
• Primordial prevention: Prevention of the occurrence of risk factors (Individual and
mass education)
• Primary prevention: Prevention of the occurrence of disease (Health promotion and
Specific protection)
• Secondary prevention: Prevention of the occurrence of complication of disease (Early
diagnosis and Treatment)
• Tertiary prevention: Prevention of the occurrence of disability or fatality due to a
complication from the disease.
Table: Level of prevention and Mode of intervention

Level of prevention Mode of intervention Examples
Primordial Individual and Mass • Discourage adoption of high risk behavior
education in a population where it does not exist.
E.g. Smoking, Drinking in societies where it
is not prevalent yet.
Primary Health promotion • Health education
• Environment modification, e.g. Provision
of safe water, sanitary latrines, control of
insects and rodents
• Life style and behavioral changes, e.g.
Exercise and medication
• Improvement in overall socioeconomic
status of the population
• Promotion of breastfeeding
• Promotion of small family norms
• Marriage counselling
Specific protection • Immunization
• Chemoprophylaxis
• Nutrition supplement, e.g. IFA, Vitamin A,
Iodine
• Avoidance of allergens
• Protection against occupational hazards,
accident, carcinogen
• Control of air pollution, noise control,
chlorination of water
• Use of helmets and seat belts to protect
against head injuries
• Use of mosquito net
• Personal hygiene and environmental
sanitation
• Contraception
Secondary Early diagnosis Screening (Pap smear, self-breast
examination, mammography)active case
search, medical examination of school
children, infants and young children,
industrial workers
Treatment • DOTS
• MDT for leprosy
• Dental filling and tooth extraction
Contd…
Level of prevention Mode of intervention Examples

Tertiary Disability limitation • Resting affected limb in neutral position to
prevent stress n paralyzed muscle
• Plaster cast to a patient with colles
fracture
• Rest, morphine, oxygen and streptokinase
to a patient of acute MI.
Rehabilitation • School for blind
• Reconstructive surgery
• Arranging for schooling of child suffering
from PRPP
• Provision of hearing aids, artificial limb,
and calipers
• Restoration of capacity to earn a live hood
(Vocational)
• Restoration of family and social relation
(Social)
• Restoration of personal dignity and
confidence (Psychological)
43. With which of the following, the “Indradhanush scheme” is associated?

a. Immunization
b. Sanitation
c. Mid-day meal program
d. All of above
Ans. a. Immunization
Rationale:
• The government of India has lunched Mission Indradhanush (MI) on 25th December
2014 as a special drive to vaccinate all unvaccinated and partially vaccinated children
and pregnant women’s by 2020 under the Universal Immunization Program.
• Main aim of Mission Indradhanush: To achieve vaccination coverage of more than
90% by 2020.
44. 1 male health worker, 1 female health worker should be present at each PHC.
This is given by which committee?
a. Jungalwalla Committee
b. Kartar Singh Committee
c. Bhore Committee
d. Mudaliar Committee
Ans. b. Kartar Singh Committee

Rationale:
Table: Recommendation by Various Committees
Committee Recommendation
Kartar Singh Committee • Male and female multipurpose health care workers
(1973) • 1 PHC for a population of 50,000 with 16 sub-center each for
3000 to 3, 500 populations.
Jungalwalla Committee • Integration of health services with unified cadre and common
(1967) seniority.
Committee on integration of • Recognition of extra qualifications.
Health services • Equal pay for equal work and special pay for specialized work.
• No private practice and good service conditions.
Mudaliar Committee (1962) • Strengthening of district hospital with specialist services
Health Survey and Planning • Regional organizations in each state between headquarters
Committee and district
• Each PHC not to serve more than 40,000 population
• Improve the quality of health care provided by the PHC
• Integration of medical and health services
• Constitution of an All India Health Service on pattern of IAS.
Bhore Committee (1946) • Comprehensive [Preventive, Promotive Curative] health care at
Health survey and PHC level. 1 PHC per 40000 population with 30 beds
Development Committee • 3 months training in PSM- Social Physicians
• 3 Million Plan(Development of PHC in 2 stages: Short-term and
Long-term)
45. The nurse gives a lecture at the senior center about preventive health activities
for people over the age of 60 years. The nurse tells the people that the center
for Disease Control and Prevention (CDC. now recommended which of the
following vaccines for this age group?
a. Pertussis (Whopping cough) b. Shingles (herpes zoster)
c. Meningitis d. Diphtheria
Ans. b. Shingles
Rationale:
• The Shingles vaccine reduces the risk of shingles by about half and the risk of
postherpetic neuralgia by two-thirds.
• Pertussis and diphtheria vaccine is given much earlier in life.
• The CDC recommended that college freshmen living in dormitories get the meningitis
vaccine, but this is likely to apply to those over age 60.
46. Which of the following is a killed vaccine?

a. OPV b. BCG
c. MMR d. Rabies
Ans. d. Rabies
Rationale:
• An inactivated vaccine (or killed vaccine) is a vaccine consisting of virus particles,
bacteria, or other pathogens that have been grown in culture and then killed to destroy
disease producing capacity.
• In contrast, live vaccines use pathogens that are still alive (but are almost always
attenuated, that is, weakened..
Table: Types of vaccine and their viral and bacterial infections
Vaccine Viral Bacterial Rickettsial
Live attenuated Polio (OPV/Sabin), Yellow BCG, Epidemic typhus
fever Measles, Mumps, Typhoid (oral) Plague
Rubella, Influenza, JE
(SA 14-14-2) Varicella,
Rotavirus
Killed Polio (Salk/IPV), KFD, Typhoid (IM), Plague, Typhus
Influenza, Hepatitis Cholera, Pertussis,
B and A, Japanese Cerebrospinal Meningitis
encephalitis, Rabies
Toxoid Diphtheria, Tetanus, Anthrax
Protein Acellular Pertussis, Influenza
(HA and NA.
Polysaccharides Pneumococcal vaccine,
Meningococcal vaccine,
Typhoid (Vi), Hib
Recombinant Hepatitis B, HPV Cholera Toxin B, Lyme
disease
47. The nurse is speaking at a community meeting about personal responsibility

for health promotion. A participant asks about chiropractic treatment for
illnesses. What should be the focus of the nurse’s response?
a. Electrical energy fields
b. Exercise of joints
c. Spinal column manipulation
d. Mind-body balance
Ans. c. Spinal column manipulation

Rationale:
• Chiropractors diagnose and treat many different spinal disorders that cause
musculoskeletal or nerve pain. Similar to other types of doctors, a chiropractor
performs a physical and neurological examination as part of his or her process of
making an accurate diagnosis.
• The theory underlying chiropractic is that interference with transmission of mental
impulses between the brain and body organs produces diseases. Such interference is
caused by misalignment of the vertebrae. Manipulation reduces the subluxation.
48. Which of the following is not true for influenza?

a. Secondary attack rate 5 to 15%
b. Virus shedding present before the patient presents with symptoms
c. 1 to 5 years is high risk age group
d. Aquatic birds are reservoirs
Ans. c. 1 to 5 years is high risk age group

Rationale:
Option Discussion
A Yes.
The attack rates are 5–10% for adults and 20–30% for children.
Keeping in view different review of literature...the attack rate are 5–10% for adults
and 20–30% for children. Some studies have shown low attack rate of 5% and
maximum even upto 70%. So this option may or may not be true. But no the false
one.
B Yes, the period of infectivity is from 1–2 days before and 1–2 days after the onset of
symptoms
C No, influenza affects all age groups and gender. Certain high–risk groups are there
which includes infants and children under 18 months (or under 2 years).
High risk groups for severe influenza infection are:
• Infants and young children < 2 years
• Pregnant females
• Person with preexisting COPD
• Persons with preexisting cardiac disease
• Persons with preexisting metabolic syndrome and /or morbid obesity
• Persons with preexisting renal ,liver, neurological or immunosuppressive diseases
• Children receiving chronic aspirin therapy
• Person age> 65 years
D Major reservoirs are animals and birds, especially the aquatic birds
49. Program for Improve quality of labor room come under:

a. LaQshya b. Ayushman Bharat
c. Jannani sishu suraksha Yojana d. PM Surakshit Matrita Abhiyaan
Ans. a. LaQshya
Rationale:
• LaQshya
Ĕ LaQshya, aimed at improving quality of care in labor room and maternity
Operation Theatre (OT).
Ĕ The Program will improve quality of care for pregnant women in labor room,
maternity Operation Theatre and Obstetrics Intensive Care Units (ICUs) and High
Dependency Units (HDUs).
Ĕ The Quality Improvement in labour room and maternity OT will be assessed
through NQAS (National Quality Assurance Standards).
Ĕ LaQshya certified facilities will be done as per the NQAS score. Facilities scoring
more than 90%, 80% and 70% will be given Platinum, Gold and Silver badge
accordingly
• Ayushman Bharat:
Ĕ Health and Wellness center (HWC.-Sub centers to be upgraded to the HWCs which
provide comprehensive package of health care services including RMNCH+A,
communicable, non-communicable. ENT, dental, geriatric disease and mental
health care.
Ĕ National health protection scheme: Providing blanket health insurance
Ĕ Increase GDP spending on health to 2.5%
• Jannani sishu suraksha Yojana (JSSK):
Ĕ Lunched on June1, 2011 to provide free and cashless service in government
hospitals (rural and urban) to
Pregnant women
Sick infants (Up to 1 year)
Ĕ Includes free medical services, free laboratory services, free treatment, free
transport to and from the hospital. The JSSK program basically guarantees
services/Entitlements and elimination out of pocket expenses of pregnant women
and sick newborn.
• PM Surakshit Matrita Abhiyaan:
Ĕ Maternity benefits > 26 weeks for all deliveries
Ĕ Safe antenatal care (ANC. and postnatal care (PNC..
Ĕ Launched on November 4, 2016 with the aim to:
Reduce maternal and infant mortality rates through sage pregnancies and safe
deliveries.
To identify and follow-up on high pregnancies.
Ĕ Services:
Free maternal care to about 30 million core pregnant women across the
country to detect and prevent high risk pregnancies.
Fixed day assured comprehensive and quality and antenatal care to pregnant
women on the 9th of every month.
Special antenatal check up to pregnant women in their second or third
trimesters at Government health facilities by Gynecologists/Physicians
with support from private sector doctors to supplement the efforts to the
government sectors.
50. Given below is the logo of the most important scheme in the field of child
welfare. The services covered by this scheme are provided through:
a. Sub-centres b. PHCs
c. CHCs d. All of the above
Ans. d. All of the above

Rationale:
• The image depicts ICDS logo.
• Integrated Child Development Services (ICDS) scheme is world’s largest community
based programme. The scheme is targeted at children upto the age of 6 years, pregnant
and lactating mothers and women 16 – 44 years of age. The scheme is aimed to improve
the health, nutrition and education (KAP) of the target community.
• The focal point for the delivery of integrated childhood services under the ICDS
scheme is Anganwadi worker. Each Anganwadi unit covers a population of 1000.
• The services provided through ICDS are:
Ĕ Supplementary nutrition
Ĕ Immunization
Ĕ Health check-up
Ĕ Medical referral services
Ĕ Nutrition and health education for women
Ĕ Non-formal education of children upto the age of 6 years, and pregnant and
nursing mothers in rural, urban slums and tribal areas.
• The services of immunization, health check-up and referral services are provided
through sub centers, PHCs and CHCs.
51. Nursing care in a hospital for a duration more than 24 hours is defined as:
a. Outpatient care b. Emergency care
c. Inpatient care d. Observation status patient
Ans. d. Observation status patient

Rationale:
• Observation is a special service or status that allows physicians to place a patient in an
acute care setting, within the hospital, for a limited amount of time to determine the
need for inpatient admission. Observation patients typically stay in the hospital less
than 48 hours.
• Inpatient care: Admission to a health-care facility and discharge after one or more
days.
• Outpatient care: A person who goes to a health-care facility for a consultation, and
who leaves the facility within three hours of the start of consultation. An outpatient is
not formally admitted to the facility.
• Ambulatory care: Medical and paramedical services delivered to patients, formally
admitted for diagnosis, treatment or other types of health care with the intention of
discharging the patient the same day.
• Long-term care: Care is concerned with maintaining or improving the ability of
patient with disabilities to function as independently as possible for as long as possible;
it also encompasses social and environmental needs. It is broader than the medical
model that dominates acute care.
52. A patient in the cardiac unit is concerned about the risk factors associated
with atherosclerosis. Which of the following are hereditary risk factors for
developing atherosclerosis?
a. Overweight b. Smoking
c. Family history of heart disease d. Age
Ans. c. Family history of heart disease

Rationale:
• Family history of heart disease is an inherited risk factor that is not subject to life style
change.
• Having a first degree relative with heart disease has been shown to significantly
increase risk.
• Overweight and smoking are risk factors that are subject to life style change and can
reduce risk significantly.
• Advancing age increases risk of atherosclerosis but is not a hereditary factor.
Pediatrics
53. Nurse Nancy is assessing a child with pyloric stenosis; she is likely to note which
of the following?
a. “Currant jelly” stools b. Regurgitation
c. Steatorrhea d. Projectile vomiting
Ans. d. Projectile vomiting

Rationale:
• Projectile vomiting is a key sign of pyloric stenosis.
Hypertrophic Pyloric Stenosis
• It is the most common surgical disorder of gastrointestinal tract in infants. As the name
suggest this condition occurs due to hypertrophy of circular muscle fibers leading to
thickening and elongation of pylorus with subsequent narrowing of its lumen.
Figure 1: Hypertrophic Pyloric Stenosis

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

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

• In severely malnourished infants, epigastric distension may be seen and peristaltic
waves may be seen passing from left to right, during and after feed.
• Laboratory Findings: Electrolytes, pH, BUN, and creatinine levels should be obtained
at the same time as intravenous access in patients with pyloric stenosis.
Treatment
• Preoperative treatment: correction of dehydration and metabolic alkalosis.
• IV atropine: The intravenous dose of atropine for treatment of pyloric stenosis ranges
in studies from 0.04 to 0.225 mg/kg/day and is given for 1–10 days.
• Oral atropine: Oral atropine (0.08–0.45mg/kg/day) is continued, after IV therapy has
been deemed successful, for 3 weeks to 4 months.
• The surgical procedure of choice is Ramstedt pyloromyotomy
• Other options:
• Regurgitation is seen more commonly with gastroesophageal reflux.
• Steatorrhea is the medical term for fat in stool. Fat in the stool can cause bulky stool
that floats, has an oily or greasy appearance, and smells foul. Fat in the stool is fat
that the digestive tract was unable to absorb. Temporary steatorrhea may result from
dietary changes or intestinal infections. Steatorrhea occurs in malabsorption disorders
such as celiac disease.
• “Currant jelly” stools are characteristic of intussusception.
54. A child was brought to the emergency department with complaints of nausea,
vomiting, fruity-scented breath. The resident on duty diagnosed the child
with diabetes ketoacidosis. Which of the following should the nurse expect to
administer?
a. Ringer’s Lactate
b. Potassium chloride IV infusion
c. Normal saline IV infusion
d. Dextrose 5% IV infusion
Ans. c. Normal saline IV infusion

Rationale:
• Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body
produces high levels of blood acids called ketones. The condition develops when your
body can’t produce enough insulin.
• The initial priority in the treatment of diabetic ketoacidosis is the restoration of
extracellular fluid volume through the intravenous administration of a normal saline
(0.9 percent sodium chloride) solution.
• Ringer’s Lactate and Dextrose 5% IV infusion; these dextrose solutions will be used
only when the blood glucose level is decreased.
• Potassium chloride IV infusion is not part of the initial treatment.
55. You notice that on turning the baby’s head to one side, a reflex response as
shown in the image is elicited. Which of the following statements is not true
regarding this response?
a. The reflex is useful in early hand regard by the baby.
b. It is elicited in supine position
c. It disappears by 5 months
d. It is a brainstem reflex
Ans. c. It disappears by 5 months

Rationale:
• The image shows Asymmetric Tonic Neck Reflex (ATNR). ATNR appears by 35 weeks
of gestation, fully develop by 1 month postnatally and disappears by 6–7 months.
Figure: Asymmetric Tonic Reflex

• The Atonic neck reflex is produced by manually rotating the infant’s head to 1 side and
observing for the characteristic fencing posture (extension of the arm on the side to
which the face is rotated and flexion of the contralateral arm).
• The extended arm aids better hand regard by the baby.
• The tonic neck reflexes are brainstem reflexes.
56. Baby Jonathan was born with cleft lip (CL); Nurse Barbara would be alert that
which of the following will most likely be compromised?
a. Locomotion b. GI function
c. Respiratory status d. Sucking ability
Ans. d. Sucking ability

Rationale:
Figure: Unilateral Cleft Lip

• Cleft lip happens if the tissue that makes up the lip does not join completely before
birth. This results in an opening in the upper lip.
• Because of the cleft lip defect, the child will be unable to form mouth adequately
around the nipple, thereby requiring special devices to allow for feeding and sucking
gratification.
• Locomotion would be a problem for older infants because of the use of restraints.
• GI functioning is not compromised in the child with a Cleft lip
• Respiratory status may be compromised if the child is fed improperly during the
postoperative period.
57. Which of the following disorders leads to cyanosis from deoxygenated blood
entering the systemic arterial circulation?
a. Patent ductus arteriosus (PDA.
b. Aortic stenosis (AS)
c. Tetralogy of Fallot
d. Coarctation of aorta
Ans. c. Tetralogy of Fallot
Rationale:
• Tetralogy of Fallot consists of four major anomalies:
Ĕ ventricular septal defect,
Ĕ right ventricular hypertrophy,
Ĕ pulmonic stenosis (PS),
Ĕ aorta overriding the ventricular septal defect.
Figure: Tetralogy of Fallot

• PS impedes the flow of blood to the lungs, causing increased pressure in the right
ventricle, forcing deoxygenated blood through the septal defect in the left ventricle.
As a result of this decreased pulmonary flow, deoxygenated blood is shunted into the
systemic circulation. The increased workload on the right ventricle causes hypertrophy.
The overriding aorta receives blood from both the right and left ventricles. This is the
definition of defect with decreased pulmonary blood flow where deoxygenated blood
is shunted into the systemic circulation.
• With PDA, blood flows from the aorta through the PDA and back to the pulmonary
artery and lungs (shunting of oxygenated blood to the pulmonic system), causing
increased pulmonary vascular congestion.
• Coarctation of aorta and AS are obstructive defects where obstruction, not shunting,
is the problem.
58. A child with known hemophilia A was brought to the emergency room with
complaints of nose bleeding and some bruises in the joints. Which of the
following should the nurse anticipate to be given to the child?
a. Factor VIII b. Cyclosporine
c. Factor X d. Oral iron supplement
Ans. a. Factor VIII

Rationale:
• Hemophilia A, also called factor VIII (FVIII) deficiency or classic hemophilia, is a
genetic disorder caused by missing or defective factor VIII, a clotting protein. The
initial treatment is the administration of factor VIII to replace the missing factor and
decrease the bleeding episode.
59. Nicklaus was born with hypospadias; which of the following should be avoided
when a child has such condition?
a. Surgery b. Circumcision
c. Intravenous pyelography (IVP) d. Catheterization
Ans. b. Circumcision
Rationale:
• Hypospadias refers to a condition in which the urethral opening is located below the
glans penis or anywhere along the ventral surface (underside) of the penile shaft. The
ventral foreskin is lacking, and the distal portion gives an appearance of a hood. Early
recognition is important so that circumcision is avoided; the foreskin is used for the
surgical repair.
• Option A: Surgery is the procedure of choice to improve the child’s ability to stand
when urinating, improve the appearance of the penis, and preserve sexual adequacy.
• Option C: IVP is contraindicated if the child has an allergy to iodine or shellfish.
• Option D: Catheterization may be used to ensure urinary elimination.
60. Identify the neural tube defect shown in the image:
a. Rachischisis b. Encephalocele
c. Myelocele d. None of the above
Ans. b. Encephalocele
Rationale:
• The image shows a newborn with encephalocele.
• Encephalocele, sometimes known as cranium bifidum, is a neural tube defect
characterized by sac-like protrusions of the brain and the membranes that cover it
through opening in the skull.
• These defects are caused by failure of the neural tube to close completely during fetal
development.
• Note: if the same lesion occurs in the region of spinal cord, it is reffered to as Myelocele.
• Rachischisis refers to cases of anencephaly with a contiguous spinal defect involving
at least the cervical spine region and extending for varying degrees down the spinal
column.
• In Myelocele, the spinal cord is exposed so that nerve tissue lies exposed on the surface
of the back without even a covering of skin or of the meninges, the membranous tissue
surrounding the brain and spinal cord.
61. Nurse Christine is planning a patient education program for sickle cell disease
(SCD. in children; which of the following interventions would be included in
the care plan?
a. Administration of an anticoagulant to prevent sickling
b. Health teaching to help reduce sickling crises
c. Observation of the imposed fluid restriction
d. Avoidance of the use of opioids
Ans. b. Health teaching to help reduce sickling crises

Rationale:
• SCD is a group of inherited red blood cell disorders. Healthy red blood cells are round,
and they move through small blood vessels to carry oxygen to all parts of the body.
In someone who has SCD, the red blood cells become hard and sticky and look like a
C-shaped farm tool called a “sickle”.
• Prevention is one of the principal goals of therapeutic management because there is
no cure for sickle cell disease. Consequently, health education to help lessen sickling
crises is key.
• Anticoagulants do not prevent sickling.
• Fluids are encouraged to increase fluid volume and prevent sickling.
• Opioids usually are required for pain control.
62. Spina bifida is one of the possible neural tube defects that can occur during
early embryological development. Which of the following definitions most
accurately describes Meningocele?
a. Complete exposure of spinal cord and meninges
b. Herniation of spinal cord and meninges into a sac
c. Sac formation containing meninges and spinal fluid
d. Spinal cord tumor containing nerve roots
Ans. c. Sac formation containing meninges and spinal fluid

Rationale:
• Meningocele is a sac formation containing meninges and cerebrospinal fluid (CSF).
• Meningocele doesn’t involve complete exposure of the spinal cord and meninges; this
is a massive defect that’s incompatible with life.
• Myelomeningocele is a herniation of the spinal cord, meninges, and CSF into a sac that
protrudes through a defect in the vertebral arch.
• Tumor formation is not associated with this defect.
63. Nurse Priyanka is administering medication via the intraosseous route to a

child. Intraosseous drug administration is typically used when a child is:
a. Under age 3 b. Over age 3
c. Critically ill and under age 3 d. Critically ill and over age 3
Ans. c. Critically ill and under age 3

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

c. Patau’s syndrome d. Down’s syndrome
Ans. c. Patau’s syndrome

Rationale:
• Trisomy 13, also called Patau syndrome, is a condition in which a person has an
extra chromosome 13 and associated with severe intellectual disability and physical
abnormalities in many parts of the body.
• Down syndrome: A genetic chromosome 21 disorder causing developmental and
intellectual delays. It is a condition in which a person has an extra chromosome.
Chromosomes are small “packages” of genes in the body. They determine how a baby’s
body forms and functions as it grows during pregnancy and after birth. Typically, a
baby is born with 46 chromosomes
• Edwards syndrome: A condition that causes severe developmental delays due to an
extra chromosome 18. It is a chromosomal condition associated with abnormalities
in many parts of the body. Individuals with trisomy 18 often have slow growth before
birth (intrauterine growth retardation) and a low birth weight.
• The image depicts Polydactyly; which is feature of Patau syndrome.
• Down syndrome: Clinodactyly (curving of the fingers).
Figure 1: Clinodactyly
• Edwards syndrome: Flexed digits (or overlapping) and “rocker-bottom” feet.
Figure 2: Rocker-bottom” feet
65. Hydrocortisone cream 1% is given to a child with eczema. The nurse gives
instruction to the mother to apply the cream by?
a. Apply a thick layer of the cream to affected areas only
b. Apply a thin layer of cream and spread it into the area thoroughly
c. Apply the cream to other areas to avoid occurrence
d. Avoid cleansing the area before the application
Ans. b. Apply a thin layer of cream and spread it into the area thoroughly
Rationale:
• Eczema is caused by problems with the skin barrier. Many children with eczema do not
have enough of a special protein called “filaggrin” in the outer layer of skin. Filaggrin
helps skin form a strong barrier between the body and the environment. Skin with too
little of this protein has a harder time holding in water and keeping out bacteria and
environmental irritants.
• Children have eczema (also called atopic dermatitis), an ongoing skin problem that
causes dry, red, itchy skin. Children with eczema have more sensitive skin than other
people
• Topical corticosteroids are administered sparingly and rubbed into the area thoroughly.
• Thickly application and rubbing it on other areas will likely lead to systemic absorption.
• The area should be cleaned first before administration.
66. Which of the following is an early clinical manifestation of increased ICP in

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

Rationale:
• Glomerulonephritis is a group of diseases that injure the part of the kidney that filters
blood (called glomeruli). Other terms you may hear used are nephritis and nephrotic
syndrome. When the kidney is injured, it cannot get rid of wastes and extra fluid in
the body.
• The most common presenting symptoms are the classic triad of glomerulonephritis:
gross hematuria, edema, and hypertension
• Increased urine output, a sign of improving kidney function, typically is the first sign
that a child with acute post-streptococcal glomerulonephritis (APSGN) is improving.
• Increased appetite, an increased energy level, and decreased diarrhea are not specific
to APSGN.
68. Estimate the age of the child from the picture shown below:
a. 5 months b. 7 months
c. 15 months d. 18 months
Ans. a. 5 months
Rationale:
• The image shows a child enjoying watching his image in the mirror at age of 5 months.
• The child can be seen patting the mirror enjoying his mirror image.
69. The parents of a 5-day-old term infant notice that he is jaundiced. Your physical
examination is remarkable only for scleral icterus and jaundice. The infant’s
total bilirubin level is 15 mg/dL, with a direct component of 0.4 mg/dL. Which
of the following is the most likely diagnosis?
a. Breast milk jaundice b. Biliary atresia
c. Breastfeeding jaundice d. Neonatal hepatitis
Ans. c. Breastfeeding jaundice

Rationale:
• Breastfeeding jaundice is typically associated with indirect, or unconjugated,
hyperbilirubinemia and is caused by suboptimal milk intake during the first week of
life, which causes weight loss, poor hydration, and decreased stool output.
• The treatment of breastfeeding jaundice is hydration, which typically includes
increasing the frequency of breastfeeding, along with observation and serial bilirubin
assessments.
• Breast milk jaundice, which occurs later, after the first week of life, is thought to be
associated with high levels of lipase and β-glucuronidase within breast milk.
• Biliary atresia and neonatal hepatitis are more typical causes direct, or conjugated,
hyperbilirubinemia.
70. You are evaluating a 2-month-old healthy full-term male infant at a routine
health care maintenance visit. His mother is concerned because he seems pale.
Although your examination is normal, you draw a hemoglobin (Hb. level to
reassure the parents. Which of the following statements is correct regarding the
expected Hb concentration?
a. Fetal Hb has disappeared by now, and the Hb level will be slightly lower than at birth.
b. Evidence of nutritional iron deficiency anemia is likely.
c. The Hgb was likely low at birth and is now increasing.
d. The Hgb is likely at its physiologic lowest point.
Ans. d. The Hb is likely at its physiologic lowest point

Rationale:
• The hemoglobin of a healthy full-term infant is high at birth and decreases during the
next several months, reaching its nadir, or physiologic lowest point, by 2 – 3 months
of age.
• The hemoglobin of a preterm infant is at its physiologic low point at 1 – 2 months of
age.
• Iron deficiency anemia does not generally appear until 9 – 24 months of age as a result
of inadequate iron intake and depletion of iron stores acquired during fetal life.
• Fetal hemoglobin, a major constituent of red blood cells during early postnatal life,
gradually declines and disappears by 6 – 9 months of age.
71. During a routine health maintenance visit, the mother of a 1-year-old girl is
particularly concerned about the family’s history of food allergies. Which of
the following foods are the most likely to cause food allergic reactions?
a. Soy
b. Citrus fruits
c. Chocolate
d. Tomatoes
Ans. a. Soy
Rationale:
• Egg, milk, peanut, soy, wheat, and fish cause 85 – 90% of food allergies in children.
• Although allergies to citrus fruits, chocolate, and tomatoes may occur, these foods do
not commonly induce allergy.
72. A 25-year-old woman is pregnant with her first child. The woman has human
immunodeficiency virus (HIV) infection that was diagnosed 2 years before
this pregnancy. Which of the following has been shown to increase her risk of
transmitting HIV to her infant?
a. Birth by cesarean section
b. Exclusive bottle formula feeding
c. Orally administered Zidovudine given to the infant after birth
d. Prolonged rupture of membranes
Ans. d. Prolonged rupture of membranes

Rationale:
• Factors that increase the risk of HIV transmission from mother to infant include
high maternal viral load (measured by RNA copy number) at delivery, concomitant
chorioamnionitis or other genital tract infections, primary or advanced maternal HIV
infection, premature birth, and prolonged rupture of membranes.
• Transmission may also occur through breast milk.
• Transmission is decreased through the use of maternal antiretroviral therapy, newborn
prophylaxis with antiretroviral agents (e.g. Zidovudine), birth by cesarean section, and
low maternal viral load.
OBS-GYN
73. Which of the following is NOT true about mastitis?

a. It is an infection in the connective tissue of the breast.
b. Ductal ectasia is the most common cause of the non-lactational type.
c. It can be of lactational or non-lactational type.
d. It presents with no nipple discharge and cyclical pain.
Ans. d. It presents with no nipple discharge and cyclical pain.

Rationale:
• It presents with no nipple discharge and cyclical pain is NOT true about mastitis as
discharge is present in mastitis. Mastitis is an infection in the connective tissue of the
breast that occurs most frequently during the time of breastfeeding.
• It is of both types: lactational (most common), non-lactational (rare). Non lactational
mastitis is similar to lactational mastitis, but it occurs in women who are not
breastfeeding. Ductal ectasia is the most common cause of the non-lactational type.
Ductal ectasia occurs when a milk duct in the breast widens and its walls thicken. Ductal
ectasia is more common in women nearing menopause. Cyclical breast pain is related to
the hormonal changes occurs during the menstrual cycle.
• Symptoms are as follows:
Ĕ Pain or burning sensation in the breast while breastfeeding (this breast infection
usually only affects one breast).
Ĕ Tenderness or soreness of the breast.
Ĕ Swelling of the breast.
Ĕ Feeling of warmth in the breast.
Ĕ Redness of the breast (often in a wedge-shaped pattern).
Ĕ Feeling tired and run down.
Ĕ Fever and chills
Ĕ Nipple discharge
74. A woman in labor is known as:

a. Gravida b. Parturient
c. Para d. Puerperia
Ans. b. Parturient
Rationale:
• A woman in labor is known as parturient. Labor is known as parturition.
• Gravida is the number of times the women is pregnant.
• Para: The number of past pregnancies and pregnancies carried to viable age.
• Puerperia is the women followed by childbirth.
75. The third stage of labor comprises:

a. Delivery of fetus b. Effacement of cervix
c. Placental separation d. Descent of fetus
Ans. c. Placental separation

Rationale:
• The third stage of labor comprises Placental separation.
• There are four stages of labor:
i. 1 stage: starts with onset of true labor pains and ends on full cervical dilatation
(approx. 10 cm)
ii. 2 stage: delivery of the baby
iii. 3 stage: placenta expulsion
iv. 4 stage: observation stage
• Effacement of cervix and descent of fetus are included in the cardinal events of first
stage of labor.
76. Braxton-Hicks are:

a. Eye contractions b. Abdominal contractions
c. Muscle contractions d. Uterine contractions
Ans. d. Uterine contractions

Rationale:
• Braxton hicks are the painless uterine contractions which are experienced by the
women throughout the pregnancy. It does not lead to progress of labor. It appears after
20 weeks’ and it is also considered the sign of the pregnancy. Braxton-Hicks is called
false labor pain.
• Eye contraction also known as blepharospasm or myokymia, is a sudden, involuntary

movement of the eyelid. It is also referred to as an eye muscle spasm. It can be due to
myasthenia gravis or magnesium deficiency.
• Abdominal contractions or stomach spasms (abdominal muscle spasms) are
involuntary contractions of the abdomen. It is common in food poisoning.
• Muscle contractions or muscle cramps is sudden and involuntary contraction of the
muscle.
77. Dystocia is:

a. Abortion
b. Normal labor
c. Abnormal labor
d. Cesarean section
Ans. c. Abnormal labor

Rationale:
• Dystocia is also termed abnormal labor, when it does not fulfill the criteria of normal
labor or eutocia. Such as not spontaneous in onset, presentation is not vertex, before
or after term labor (37 to 42 weeks), prolonged labor and without using any further
assisted devices.
• Abortion is the termination of pregnancy either spontaneous or induced before the
period of viability till 28 weeks of gestation.
• Normal labor: When the labor is having spontaneous onset, completed the term and
completes without any complications to mother and baby without use of any further
aid is called eutocia or normal labor.
• Cesarean section is the surgical method to extract the fetus. It can be classical cesarean
section or lower segment cesarean section.
78. Abnormal pregnancy in which the conceptus implants outside the uterine
cavity is called:
a. Ectopic pregnancy
b. Molar pregnancy
c. Antepartum hemorrhage
d. Abortion
Ans. a. Ectopic pregnancy

Rationale:
• When the conceptus implants outside the uterine cavity, it is called ectopic pregnancy.
There may be various abnormal sites of implantation such as the most common site is
fallopian tubes and parts can be ampulla (70%), isthmus (12%), fimbriae (11%) and
cornea (02%).
• Molar pregnancy is an abnormal form of pregnancy characterized by development of
non-cancerous tumor which forms in the uterus due to a nonviable fertilized egg in
the uterus.
• Antepartum hemorrhage is defined as bleeding from or into the genital tract after 28th
week of pregnancy but before the birth of the baby. The main causes of antepartum
placental bleeding are placenta previa, abruptio placenta, extra placental causes such
as cervical polyp, carcinoma of cervix, etc.
• Abortion is defined as ending of pregnancy done by expulsion of embryo before it is
viable.
79. ____________ is the condition in women which gives them a feeling of

something coming out from vagina:
a. Disc prolapse b. Cord prolapse
c. Rectal prolapse d. Uterine prolapse
Ans. d. Uterine prolapse

Rationale:
• Uterine prolapse is a condition where the uterus descends into the vagina or comes
out. It could result due to weak pelvic floor muscles or during delivery of placenta
when force is applied. The women can feel that something is coming out of vagina.
There is feeling as if the person sitting on a small ball.
• Cord prolapse is a condition when the cord is felt as the presenting part on vaginal
examination. Cord prolapse is a complication and can lead to cord compression and
eventually fetal anoxia.
• Disc prolapse is condition where the outer fibers of intervertebral disc are injured and
the nucleus pulposus, i.e. a soft material from its enclosed space ruptures out of spinal
bones.
• Rectal prolapse occurs when the rectum loses its attachment and telescopes out
through the anus. It could result due to multiple births, vaginal delivery, etc. due to
force exerted on the part of the intestine.
80. In choriocarcinoma, which hormone’s level is high?

a. Human chorionic somatomammotropin
b. Human chorionic gonadotropin
c. Human papilloma virus
d. Human leukocyte antigen
Ans. b. Human chorionic gonadotropin

Rationale:
• Human chorionic gonadotropin (hCG) hormone is seen high in choriocarcinoma.
This is produced by the syncytiotrophoblastic cells of the placenta during pregnancy.
hCG levels are increased in choriocarcinoma, hydatidiform mole and germ cells
tumors.
• Human chorionic somatomammotropin (HCS) is another name for human placental
lactogen (HPL) which is a polypeptide placental hormone.
• Human papilloma virus is a viral sexually transmitted infection spread through skin-
to-skin contact.
• Human leukocyte antigen (HLA. is a gene complex, which encodes the major
histocompatibility complex proteins in humans. These proteins are responsible for
regulations of immune system in humans.
81. Medical term for pain associated with menstruation is called ____________:
a. Dysuria b. Dysphagia
c. Dystocia d. Dysmenorrhea
Ans. d. Dysmenorrhea
Rationale:
• Dysmenorrhea is a term used to describe pain during menstruation or it can be called
painful menstruation. It may be primary or secondary. Secondary occurs due to any
underlying disease condition such as endometriosis.
• Dysuria is a term used for painful urination or discomfort during urination. It occurs
as a result of any infection of urinary tract. Sexually transmitted diseases (STDs) are
also the cause behind dysuria.
• Dysphagia is referred to as difficulty in swallowing. It occurs as a result of any disease
or in sore throat, tonsillitis, pharyngitis, etc.
• Dystocia is a term used for abnormal labor. Labor may be abnormal in various
circumstances such as obstructed labor, precipitated labor, large size of baby, pelvic
structure abnormalities.
82. What is permanent cessation of menstruation called?

a. Menopause b. Amenorrhea
c. Menarche d. Pregnancy
Ans. a. Menopause
Rationale:
• Menopause is the permanent cessation of menstruation or when menstrual periods
are no longer there and female cannot get pregnant. There is a natural decline in the
reproductive hormones when a woman reaches 40s or 50s.
• Menarche is the occurrence of first menstruation or first menstruation cycle. The
normal average age of menarche varies between 12 and 13 years of age.
• Amenorrhea is the absence of menstruation during the reproductive years.
• Pregnancy is a condition or period of being pregnant. Medically, pregnancy is defined
as period from conception to birth. After the egg is fertilized by a sperm and then is
implanted in the lining of the uterus, it develops into the placenta and embryo and
becomes a fetus.
83. For induction of labor, Bishop score should be:

a. 6 b. 7
c. 4–5 d. 8
Ans d. 8
Rationale:
• For induction of labor, bishop score must be 8 or above. Bishop score has five
parameters to be measured for checking the readiness of elective induction. It includes
dilatation, effacement, station of the fetal head, consistency and position. A score of 8
or higher indicates that the cervix is ready for birth and induction can be performed.
• Bishop score is used to assess the ripening of cervix or ready for dilatation. After it
ripens, administration of oxytocin is done to initiate labor contractions. Other options
are not the normal value for a Bishop score.
84. The dusky hue of the vestibule and anterior vaginal wall due to local vascular
congestion is called:
a. Osiander’s sign b. Chadwick’s sign
c. Goodell’s sign d. Homans signs
Ans. b. Chadwick’s sign

Rationale:
• Chadwick’s sign: It is the dusky hue of the vestibule and anterior vaginal wall visible at
about 8th week of pregnancy. The discoloration is due to the local vascular congestion.
• Goodells sign: Cervix becomes soft as early as 6th week, a little earlier in multipara.
• Osiander’s sign: There is increased pulsation felt through the lateral fornices at 8th week
is called Osiander’s sign.
• Homan sign: Homans’ sign (sometimes spelled as Homans sign) or the dorsiflexion
sign is considered a sign of deep vein thrombosis (DVT).
85. Which of the following babies are called ‘post-term’ babies?

a. 39 to 41 weeks of gestation b. More than 42 weeks of gestation
c. 36 to 38 weeks of gestation d. 33 to 35 weeks of gestation
Ans. b. More than 42 weeks of gestation

Rationale:
• ‘Post term’ implies to the period of gestation more than 42 weeks’.
• Normal gestation is 37 to 40 weeks’.
• Pre-term is the period of gestation when birth of child happens before the age of 37
complete weeks.
86. Which of the following is NOT a common cause of vaginitis?

a. Salmonella b. Trichomonas
c. Candida d. Gardnerella
Ans. a. Salmonella
Rationale:
• Salmonella is NOT a common cause of vaginitis. Vaginitis is the inflammation of the
vagina that results in discharge, itching and pain.
• Salmonella: It is responsible for typhoid fever and food poisoning. Symptoms are
diarrhea, abdominal cramps and fever.
• Trichomonas: It causes trichomonas vaginitis, symptoms are pruritus, frothy greenish
or gray discharge.
• Candida: It causes vulvovaginal candidiasis; symptoms are thick white curd-like
discharge.
• Gardnerella: It causes bacterial vaginosis, symptoms are watery discharge with a fishy
odor.
87. The settling of fetal head into the brim of the pelvis is called:
a. Crowning of head
b. Engagement
c. Lightening
d. Descent
Ans. c. Lightening
Rationale:
• Lightening is the process of lowering and settling the presenting part usually head in
cephalic presentation (96%) into the pelvis of the mother which occurs at the end of
third trimester. It can occur 4 weeks to few hours before labor. As the fetus drops down,
it changes the shape of abdomen, provides easy breathing and relief from heartburn
but at the same time, puts pressure on the lower abdomen especially bladder causing
frequent urination.
• Engagement is the passage of the widest transverse diameter of the presenting part,
which is the biparietal in vertex presentation, through the pelvic inlet.
• Descent is the movement of fetal head through the pelvic brim to the midcavity as a
result of contraction of uterus, as the labor progresses.
• Crowning is the term used to represent the visualization of fetal head through the
vaginal opening.
88. Which of the following is the most important tumor marker to diagnose
carcinoma of ovary?
a. Serum alpha fetoprotein
b. Human placental lactogen
c. Serum human chorionic gonadotropin
d. CA125
Ans. d. CA125
Rationale:
• CA125 is the only tumor marker recommended for diagnosis and management of
ovarian cancer. 80% of women with ovarian cancer of epithelial origin have elevated
CA125 in serum. CA125 may be elevated in certain other malignancies besides ovarian
cancer like pancreatic cancer, breast cancer, lung cancer and certain benign causes like
liver cirrhosis.
• Human chorionic gonadotropin is a hormone produced primarily by syncitiotrophoblast
cells of the placenta during pregnancy. This hormone stimulates the corpus luteum
to produce progesterone which is required to maintain pregnancy. Its detection can
therefore confirm pregnancy.
• Alpha fetoprotein is a plasma protein made by embryonic yolk sac and fetal liver.
Alpha fetoprotein in serum is used for detection of liver cancer.
• Human placental lactogen is produced by placenta. It helps in breaking down fats from
mother to provide fuel for the developing fetus.
89. Post-term pregnancy is a pregnancy which continues beyond:

a. 200 days b. 250 days
c. 170 days d. 294 days
Ans. d. 294 days

Rationale:
• Childbirth usually occurs 40 weeks from the start of last menstrual period. This is just
over 9 months, considering a monthly average of 31 days.
• Normal or term is considered to be 3 weeks before the Expected Date of delivery (EDD.
or 2 weeks post EDD.
• So, pre-term is before 37 weeks and post-term is 42 weeks or 294 days.
90. What is the correct sequence of mitosis?

a. Prophase, Metaphase, Anaphase, Telophase
b. Metaphase, Anaphase, Prophase, Telophase
c. Anaphase, Prophase, Metaphase, Telophase
d. Telophase, Anaphase, Prophase, Telophase
Ans. a. Prophase, Metaphase, Anaphase, Telophase

Rationale:
• Mitosis is one of the stages of eukaryotic cell cycle, other namely interphase in which
a cell is divided into two daughter cells. The daughter cells have equal number of
chromosomes and other organelles. During interphase, cell grows and duplicates its
DNA and its cellular components followed by different phases of mitosis in a sequence
of Prophase, Metaphase, Anaphase and Telophase.
• Prophase is the first stage of mitosis and is characterized by condensation of the
chromatin and the disappearance of the nucleolus. The centrosome moves to the
opposite poles of the cell where the microtubules in the centrosome forms a mitotic
spindle
• In metaphase, the chromosomes align along the metaphase plate in the center of the
cell and are joined by centromere.
• The main occurrence in anaphase is the splitting and pulling of sister chromatids by the
microtubule towards the opposite poles of the cell.
• Telophase is the last stage of mitosis where the sister chromatids, also known as
daughter chromosomes on both the poles are starts to decondense, are covered by
nuclear envelope and nucleoli reappear.
• Mitosis is followed by cytokinesis which is the division of cytoplasm of the mother cell
into cytoplasm of the two daughter cells.
91. The outer most membrane of placenta is called:

a. Meningitis b. Amnion
c. Yolk sac d. Chorion
Ans. d. Chorion
Rationale:
• The placenta is an organ that attaches fetus to the wall of the uterus of mother through
umbilical cord which has 2 umbilical arteries and 1 umbilical vein. It helps in up taking
of nutrition, antibodies, elimination of waste, regulation of temperature and exchange
of gases from mother’s blood. It has two surfaces, fetal and maternal. The fetal placenta
(Chorion frondosum) arises from blastocyst and maternal placenta (Decidua basalis)
arises from tissue of mother’s uterus. The average length of the placenta is 22 cm and
average thickness is 2–2.5 cm. It weighs around 500 grams. Chorion is the outermost
layer of the placenta, followed by amnion which covers the allantois. Allantois is sac
like structure which contains embryo and amniotic fluid.
• Meningitis is the inflammation of covering of brain and spinal cord (meninges).
• Yolk sac is membranous pouch connected to an embryo and developed in the early
embryonic period for the maintenance of blood supply to the embryo.
92. Golden color of amniotic fluid indicates which condition?

a. Fetal distress b. Post maturity
c. Rh incompatibility d. IUD
Ans. c. Rh incompatibility
Rationale:
• Normal amniotic fluid is clear liquid.
• Golden color indicates Rh incompatibility.
• Greenish color indicates fetal distress.
• Dark brown color indicates IUD.
• Reddish color indicates accidental hemorrhage.
• Greenish yellow indicates post maturity.
93. After Vesicovaginal fistula repair, important intervention is:

a. Avoid urine collection in bladder
b. Adequate rest
c. Antibiotics
d. Early ambulation
Ans. a. Avoid urine collection in bladder
Rationale:
• Vesicovaginal fistula or urogenital fistula is an abnormal connection between bladder
and vagina that results in continuous drainage of urine into vaginal vault. VVF repair is
the surgical intervention for the problem. And keeping the bladder empty is of higher
priority because it helps in relieving pressure on the wound thereby enhancing easy
healing of the surgical repair.
• Adequate rest, antibiotics and early ambulation are also postoperative management of
VVF repair, but not the most important interventions.
94. After hydatidiform mole surgery, the nurse should assess:

a. Urinary output b. hCG
c. Vaginal discharge d. Biopsy result
Ans. b. hCG
Rationale:
• Nurse should assess hCG levels as there is a chance of raised levels.
• Hydatidiform mole patients are regularly followed up till 1 year, as this period is
confined to the occurrence of choriocarcinoma. Thus, this period is observed for
development of trophoblastic disease. Regression of hCG levels within 3 months is
also expected. In the initial 4 - 8 weeks patient is observed during the interval of 1 week
to detect serum hCG level to become negative.
• Urine output, biopsy and vaginal discharges do not contribute or lead to complications
in molar pregnancy.
95. Which of the following is an indication of adequate breast-feeding in newborn?

a. Passes urine 8 to 10 times per day
b. Cries frequently
c. Restless
d. Good sucking reflex
Ans. a. Passes urine 8 to 10 times per day

Rationale:
• The adequacy of milk intake can be assessed by counting the number of wet diapers:
6-8 diapers per day and weight gain of 20 - 30 g a day.
• Restlessness and frequent cry are suggestive of poor feeding.
• Good sucking reflex shows ability of baby to breastfeed.
• It does not indicate about adequate feeding.
96. What is the common cause of constipation during pregnancy?

a. Lack of fluid intake
b. Decreased fiber intake
c. Reduced intestinal motility
d. Lack of activity
Ans. c.Reduced intestinal motility

Rationale:
• There are many causes for constipation during pregnancy, such as: reduced intestinal
motility, under the effect of relaxin and progesterone, is the most common cause.
• Pressure over intestines by the gravid uterus, anxiety, minimal physical exercise and a
low-fiber diet may also cause constipation.
• Here the lack of fluid intake decrease, fiber intake and lack of activity are distractors
as these are the factors, which can be modified, whereas reduced intestinal motility is
physiological cause of constipation.
97. Which of the following is most appropriate intervention to reduce stress in a

preterm infant at 32-week gestation?
a. An attitude of extension when prone or side lying
b. Sensory stimulation including several senses at a time
c. Kangaroo care
d. Tactile stimulation until signs of over stimulation develop
Ans. c. Kangaroo care

Rationale:
• Kangaroo care helps in stabilization of baby’s heart rate, improves breathing pattern,
improves oxygen saturation, gain in sleep time and decreases cry. So automatically it
reduces the stress of newborn. So, option (c. is correct answer.
• An attitude of extension when prone and side lying position increases the intra-
thoracic pressure which cause stress to the baby. So, it’s not a correct answer.
• Sensory stimulation to be given one by one. Sensory stimulation including several
senses at a time creates stress to the newborn. So, option (b. is not a correct answer.
• Tactile stimulation can be given to the newborn. Over stimulation of tactile sense may
induce stress to the newborn. So, option (d. is not a correct answer.
MSN
98. During which interval on the electrocardiogram (ECG) below does the aortic
valve close?
a. A b. B
c. C d. D
Ans. d. D
Rationale:
• The aortic valve closes when the pressure within the ventricle falls below the pressure
within the aorta. This occurs when the ventricular muscle begins to relax. Relaxation
begins at the end of the ventricular action potential, which corresponds to the end of
the T wave (segment D. on the ECG recording.
99. Mrs. Arora is diagnosed with osteoporosis. Which electrolytes are involved in
the development of this disorder?
a. Phosphorus and potassium b. Calcium and sodium
c. Potassium and sodium d. Calcium and phosphorous
Ans. d. Calcium and phosphorous
Rationale:
• Osteoporosis: A condition in which bones become weak and brittle.
• Osteoporosis-related fractures most commonly occur in the hip, wrist or spine. Bone
is living tissue that is constantly being broken down and replaced.
• The main cause of osteoporosis is bone loss due to a drop in your body’s estrogen levels.
Estrogen is a hormone that helps build and maintain your bones. The most common
cause of estrogen loss in women is menopause.
• In osteoporosis, bones lose calcium and phosphate salts, becoming porous, brittle, and
abnormally vulnerable to fracture.
• Potassium is not involved in osteoporosis. Potassium salts aid in bone health. A study,
published in the journal Osteoporosis International, also revealed that high intake of
potassium salts significantly reduces the excretion of calcium and acid in urine.
• Sodium increases calcium excretion and higher calcium excretion is associated with
lower bone mineral density, a predictor of osteoporotic fractures.
100. A nurse is evaluating a postoperative patient and notes a moderate amount of

serous drainage on the dressing 24 hours after surgery. Which of the following
is the appropriate nursing action?
a. Remove the dressing and leave the wound site open to air
b. Notify the surgeon about evidence of infection immediately
c. Change the dressing and document the clean appearance of the wound site
d. Leave the dressing intact to avoid disturbing the wound site
Ans. c. Change the dressing and document the clean appearance of the wound site
Rationale:
• A moderate amount of serous drainage from a recent surgical site is a sign of normal
healing. Serous drainage is clear, thin, and watery. The production of serous drainage
is a typical response from the body during the normal inflammatory healing stage.
• The surgical site is typically covered by gauze dressings for a minimum of 48 - 72 hours
to ensure that initial healing has begun. Changing the dressing less allows the wound
bed to be left undisturbed, which allows for the migration of new cells. When wound
beds are left undisturbed in an optimal moist environment, they are able to heal at a
faster rate.
• Purulent drainage would indicate the presence of infection. Purulent drainage is milky,
typically thicker in consistency, and can be gray, green, or yellow in appearance. If the
fluid becomes very thick, this can be a sign of infection. Yet, if there is a large amount
of serous drainage, it can be the result of a high bioburden count.
• A soiled dressing should be changed to avoid bacterial growth and to examine the
appearance of the wound. Overall, it should be noted that the dressing selection should
be based on the individual patient and wound characteristics. If the wound is not in the
normal inflammatory phase of healing, the clinician must investigate what is the root
cause and how to manage the drainage.
101. The term “pink puffer” depicted in the image refers to the female patient with
which of the following conditions?
a. Asthma
b. Adult respiratory distress syndrome (ARDS)
c. Chronic obstructive bronchitis
d. Emphysema
Ans. d. Emphysema
Rationale:
• Emphysema is a lung condition that causes shortness of breath. In people with
emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls
of the air sacs weaken and rupture — creating larger air spaces instead of many small
ones.
• Because of the large amount of energy it takes to breathe, patients with emphysema
are usually cachectic. They’re pink and usually breathe through pursed lips, hence the
term “puffer.”
• Patients with asthma don’t have any particular characteristics.
• Patients with ARDS are usually acutely short of breath.
• Patients with chronic obstructive bronchitis are bloated and cyanotic in appearance.
102. A female patient arrives at the emergency department with chest and stomach
pain and a report of black tarry stool for several months. Which of the following
orders should the nurse Priyanka anticipate?
a. Prothrombin time, partial thromboplastin time, fibrinogen and fibrin split product
values
b. Cardiac monitor, oxygen, creatine kinase and lactate dehydrogenase levels
c. Electroencephalogram, alkaline phosphatase, and aspartate aminotransferase levels,
basic serum metabolic panel
d. Electrocardiogram, complete blood count, testing for occult blood, comprehensive
serum metabolic panel
Ans.. d. Electrocardiogram, complete blood count, testing for occult blood, comprehensive
serum metabolic panel
Rationale:
• An electrocardiogram evaluates the complaints of chest pain, laboratory tests determine
anemia, and the stool test for occult blood determines blood in the stool.
• Prothrombin time, partial thromboplastin time, fibrinogen and fibrin split products
are measured to verify bleeding dyscrasias.
• Cardiac monitoring, oxygen, and creatine kinase, and lactate dehydrogenase levels
are appropriate for a cardiac primary problem. A basic metabolic panel and alkaline
phosphatase and aspartate aminotransferase levels assess liver function.
• An electroencephalogram evaluates brain electrical activity.
103. Which is the most common HIV-related malignancy?

a. Neuroblastoma b. Cell Lymphoma
c. Hodgkin’s Lymphoma d. Kaposi’s sarcoma
Ans. d. Kaposi’s sarcoma

Rationale:
• Kaposi’s sarcoma is a type of cancer that can form masses in the skin, lymph nodes or
other organs. It forms purple lesions over skin and is usually raised or flat. It is caused
by the herpes virus also called Kaposi’s related herpes virus. It spreads through mainly
saliva, such as during sexual contact or in interactions between mother and child. As
clients with HIV have weakened immune systems, the virus spreads very easily and
triggers developing cancers.
• Neuroblastoma is a type of cancer that is found in nerve tissue. It is usually developed
in neck, chest, abdominal or spine. It is usually found in children as a part of defective
gene mutations.
• Lymphomas are cancerous cell development in the lymph nodes. It develops more
frequently in older adults and in immunocompromised individuals. The cells
commonly affected are B cells. They include both Hodgkin’s and non-Hodgkin’s
lymphoma in which cancer originates from WBC.
104. Which ophthalmic diagnostic test measures the intraocular pressure?

a. Tonometry b. Perimetry
c. Gonioscopy d. Amsler grid
Ans. a. Tonometry
Rationale:
• Tonometry is the procedure performed to determine the intraocular pressure (IOP),
the fluid pressure inside the eye. It is an important test in the evaluation of patients at
risk from glaucoma. It is usually performed upon on an anesthetized ocular surface and
the tonometer device lightly touches the surface of the eye, ever so slightly indenting
the cornea. The resistance to indentation is measured by a precisely calibrated pressure-
sensing device, called tonometer.
• Perimetry is the measurement of visual field function in which the total area, where
the objects can be seen in peripheral vision, while the eye is focused on a central point
is assessed using an automated perimetry.
• Gonioscopy is a procedure to diagnosing and monitoring various eye conditions
associated with glaucoma using a goniolens (also known as a gonioscope) together with
a slit lamp or operating microscope to view the iridocorneal angle, or the anatomical
angle formed between the eye’s cornea and iris.
• Amsler grid is a grid of horizontal and vertical lines used to monitor a person’s central
visual field. It is a diagnostic tool that aids in the detection of visual disturbances caused
by changes in the retina as well as the optic nerve and the visual pathway to the brain.
In the test, the person looks with each eye separately at the small dot in the center of the
grid. Patients with macular disease may see wavy lines or some lines may be missing.
105. Presence of currant jelly stools is the characteristic feature of:

a. Hirschsprung’s disease
b. Pyloric stenosis
c. Tracheoesophageal fistula
d. Intussusception
Ans. d. Intussusception
Rationale:
• Intussusception is a medical condition in which a part of the intestine folds into a
section immediately ahead of it. It usually involves the small intestine rather than
large intestine. The cause is unknown but the disease usually arises in children due
to infections, or anatomical defects or altered mobility. In the most common type of
intussusceptions, the ileum enters the cecum which thereby leads to blood supply cut
off which causes ischemia and the mucosa sloughs off into the gut. This creates the
classically described red currant jelly stool which is a mixture of sloughed mucosa,
blood and mucus. The other symptoms accompanying it are periodical abdominal
pain, nausea, vomiting, pulling legs to the chest area and intermittent abdominal
cramps. Physical examination reveals a “sausage shaped” mass felt upon palpating the
abdomen. The condition can be treated with either barium or water-soluble enema or
by surgical reduction in case of failure of medical management.
• Hirschsprung’s disease is a birth defect in which there is absence of nerve cells at the
end of a child’s bowel. It results in abnormal movement of stool through the bowel.
The child manifests with constipation or infrequent bowel movements, growth failure,
unexplained fever and vomiting. Child with this disorder does not respond to laxatives
and is treated surgically.
• Pyloric stenosis is an uncommon condition in infants that blocks food from entering
the small intestine. The pylorus muscle of the stomach thickens and become abnormally
large, blocking food from reaching the small intestine. This condition results in forceful
vomiting, dehydration and weight loss.
• Tracheoesophageal fistula is a congenital or acquired communication between the
trachea and esophagus. The child manifests with frothy, white bubbles in the mouth,
coughing or choking when feeding, vomiting, cyanosis, difficulty breathing and round
and full abdomen.
106. What is the drug of choice for Thalassemia?

a. Vincristine
b. Vinblastine
c. Dilantin
d. Deferoxamine
Ans. d. Deferoxamine
Rationale:
• Thalassemia is an inherited blood disorder characterized by abnormal hemoglobin
production which results in excessive destruction of RBC which leads to anemia.
People with thalassemia can get an overload of iron in their bodies either from the
disease itself or from frequent blood transfusions which can damage heart, liver and
endocrine system and it is characterized by excessive deposits of iron. Without adequate
iron chelation therapy, almost all patients with beta thalassemia accumulate potentially
fatal iron levels. Deferoxamine (DFO) is an iron chelator as it has an excellent safety
and efficacy profile. It has poor oral bioavailability and is administered subcutaneously,
intravenously or occasionally intramuscularly. Generally, iron is removed much more
efficiently when this drug is infused over a longer period of time. It is effective in
chelating non-transferring bound iron and can reverse cardiac arrhythmias and left
ventricular dysfunction.
• Vinblastine is an alkaloid used for cancer treatment. It prevents cell division by binding
to microtubular proteins in the mitotic spindle.
• Vincristine is an alkaloid used in the treatment of cancer. It prevents cell separation
and inhibits leukocyte production and maturation.
• Dilantin or phenytoin is an anti-epileptic drug also called an anticonvulsant. It reduces
the impulses in the brain that cause seizures.
107. What is the normal intracranial pressure?

a. 20–30 mmHg b. 30–40 mmHg
c. 5–15 mmHg d. 0–10 mmHg
Ans. c. 5–15 mmHg

Rationale:
Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid
(CSF) inside the skull and on the brain tissue and it is measured in mmHg. At rest, the ICP
is normally 5–15 mmHg for a supine adult. Any causes such as mass effect in case of brain
tumor or generalized brain swelling, hypertensive encephalopathy, any obstruction to CSF
flow or increased CSF production may increase ICP. Any occult leak of CSF into another
body cavity as a result of lumbar puncture can cause decreased ICP. Hence the option 5–15
mmHg is the correct one.
108. What is the characteristic feature of biliary colic?

a. Midepigastric pain that radiates to the back
b. Upper right abdominal pain that radiates to the back or right shoulder
c. Localized lower right abdominal pain
d. Localized pain in the hypogastric region
Ans. b. Upper right abdominal pain that radiates to the back or right shoulder
Rationale:
• Biliary colic is a steady or intermittent ache in the upper abdomen, usually under the
right side of the rib cage. It is usually caused due to the obstruction of the bile flow from
the gall bladder. The most common factor for biliary colic is presence of gall stones.
A person with biliary colic usually complains of an ache or a feeling of pressure in the
upper abdomen. The pain is usually in the upper right abdomen and may radiate to
back towards the shoulder.
• Midepigastric pain that radiates to back is found in patients with pancreatitis. It is
inflammation of pancreas which can either be acute or chronic due to inadequate
release of enzymes from the pancreas.
• Lower right abdominal pain indicates serious conditions that may require immediate
medical assistance and could be a sign of appendicitis, wherein there is inflammation
of vermiform appendix.
• Pain in hypogastric region can be a sign of disorders in ovary, bladder or sigmoid
colon.
109. PEEP in ventilator is given to:

a. Prevent collapse of alveoli b. Prevent oxygen toxicity
c. Prevent ventilator fighting d. Avoid over ventilation
Ans. a. Prevent collapse of alveoli

Rationale:
• Positive-end-expiratory pressure (PEEP) in ventilator is given to prevent the collapse
of alveoli
• PEEP includes increased aeration of patent alveoli, aeration of previously collapsed
alveoli, and prevention of alveolar collapse.
• Other options are not true about PEEP mode.
110. Which of the following is the correct maintenance infusion dose of intravenous
heparin to prevent the further pulmonary embolism (PE)?
a. 48 U/kg per hour b. 18 U/kg per hour
c. 28 U/kg per hour d. 38 U/kg per hour
Ans. b. 18 U/kg per hour
Rationale:
• Pulmonary embolism is the blockage of one of the pulmonary arteries in the lungs.
Pulmonary embolism is usually a consequence of deep vein thrombosis, and together
the two conditions are known as venous thromboembolism.
• Anticoagulation therapy is the primary treatment option for most patients with acute
PE.
• It is advised, patients with proven acute PE should be promptly anticoagulated with
intravenous unfractionated heparin with a bolus of 80 units per kilogram followed
by infusion, and maintenance infusion dose of 18 U/kg per hour as a standard dosing
treatment of pulmonary embolism.
• Other options are incorrect.
111. Which hormone has permissive role in puberty?

a. Leptin b. GnRH
c. Insulin d. GH
Ans. a. Leptin
Rationale:
• Leptin is secreted by fat cells.
• The adipocyte-derived hormone leptin as a permissive factor for the onset of puberty
by increasing the pulsatile rate of GnRH secretion acting in the brain
• It stimulates anorexigenic neurons and inhibits orexigenic neurons, thus decreasing
appetite.
112. Which of the following actions should the nurse prioritize when taking care of
a patient with a platelet count of 23,000/mm3?
a. Request an order for an anticoagulant
b. Protect the patient from injury
c. Encourage the patient to drink plenty of fluids
d. No action is necessary
Ans. b. Protect the patient from injury
Rationale:
• The normal value of platelets is 150,000 - 400.000/mm3.
• In the above-mentioned situation, the number of platelets is 23,000/mm ; therefore,

3
such patients are at risk of uncontrolled bleeding if injured. So, the priority nursing
intervention would be to protect the patient from injury.
113. Which of the following is a cause of metabolic alkalosis?

a. Ingestion of ethylene glycol
b. Hyperaldosteronism
c. Diarrhea
d. Treatment with acetazolamide
Ans. b. Hyperaldosteronism
Rationale:
• A cause of metabolic alkalosis is hyperaldosteronism; increased aldosterone levels
cause increased H+ secretion by the distal tubule and increased reabsorption of “new”
HCO3–.
• Diarrhea causes loss of HCO3- from the gastrointestinal (GI) tract and acetazolamide
causes loss of HCO3- in the urine, both resulting in hyperchloremic metabolic acidosis
with normal anion gap.
• Ingestion of ethylene glycol leads to metabolic acidosis with increased anion gap.
114. Which of the following needle is used to suture skin?

a. Cutting needle
b. Reverse cutting needle
c. Round body needle
d. Straight needle with eye
Ans. a. Cutting needle

Rationale:
• Cutting needle is used to suture skin, aponeurosis and tough structures.
• Reverse cutting needle is used to suture mucoperiosteum.
• Round body needles are used in soft structures like peritoneum, muscle, vessel, nerves,
tendons, and bowel and soft tissues.
115. What is the angle subtended by the biggest letter of Snellen’s chart at Nodal
point of eye?
a. 5 min
b. 20 min
c. 30 min
d. 50 min
Ans. d. 50 Min
Rationale:
• Angle subtended by the biggest letter of Snellen’s chart at 60 meters is 5 min of arc
therefore at 6 meters = 5 × 10 = 50 meters.
116. The nurse is reviewing a 45-year-old patient’s record; who has diagnosed with
chronic renal disease. On review of the laboratory results, the nurse most likely
would expect to note which finding?
a. Decreased red blood cell count
b. Elevated creatinine level
c. Increased number of white blood cells in the urine
d. Decreased hemoglobin level
Ans. b. Elevated creatinine level

Rationale:
• The creatinine level is the most specific laboratory test to determine renal function. The
creatinine level increases when at least 50% of renal function is lost.
• Decreased hemoglobin level and red blood cell count are associated with anemia or
blood loss and not specifically with decreased renal function.
• Increased white blood cells in the urine are noted with urinary tract infection.
117. All are true about cross-matching of blood; except:

a. Mandatory in all cases except emergency
b. Recipient serum is tested against donor packed cells
c. Donor serum is tested against recipient packed cells
d. Involves visible agglutination
Ans. c. Donor serum is tested against recipient packed cells
Rationale:
• Cross-matching blood is performed prior to a blood transfusion in order to determine
if the donor’s blood is compatible with the blood of an intended recipient, or to identify
matches for organ transplantation.
118. A patient with pernicious anemia is receiving Vitamin B12 injection. The
patient asks to the nurse how long will I receive the therapy. The best nursing
response is:
a. Till blood level of B12 become normal
b. Till your hemoglobin level improves
c. Life long
d. For 1 month
Ans. c. Life Long
Rationale:
• Injections of vitamin B12 will be necessary because without intrinsic factor vitamin B12
absorption would not take place. So, the person need B12 injection lifelong.
119. The nurse completes peripherally inserted central catheter (PICC. line dressing
change. Which of the following is the appropriate sequence when removing the
personal protective Equipment (PPE)?
a. Remove the gloves and then the mask
b. Remove the gown and then the gloves
c. Remove the mask and then the gloves
d. Remove the goggles and then the mask
Ans. a. Remove the gloves and then the mask

Rationale:
• Remove all PPE before exiting the patient’s room. Gloves are removed first. If hands
become contaminated during glove removal immediately wash hands or use alcohol-
based hand sanitizer.
• Wearing of Gown and goggles are not indicated in changing PICC line dressing. So,
option B and D are ruled out.
• Removing the mask with gloves on could transfer contamination from gloves to the
mask.
120. Troponin-T is a marker of:

a. Renal disease b. Muscular disease
c. Cirrhosis of liver d. Myocardial infraction
Ans. d. Myocardial infraction

Rationale:
• Troponin T is a marker of myocardial infraction.
• Troponin T is a marker of choice for detecting acute myocardial infraction (early
diagnosis and late diagnosis).
• Creatine phosphokinase is very sensitive test. It is the test of choice for detecting
recurrent ischemic event in 4-to-10-day window.
121. A 42-year-old female has just been admitted to the nursing unit following
thyroidectomy. Which assessment is the priority for this client?
a. Level of hoarseness b. Edema at the surgical site
c. Hypoglycemia d. Respiratory distress
Ans. d. Respiratory distress

Rationale:
• Thyroidectomy is the removal of the thyroid gland, which is located in the anterior
neck.
• It is very important to monitor airway status, as any swelling to the surgical site could
cause respiratory distress.
• Although all of the options are important for the nurse to monitor, the priority nursing
action is to monitor the airway.
122. The nurse receives a prescription from the health care provider to remove the
patient’s sutures. Which of the following action is most appropriate for the
nurse to perform?
a. Use sterile technique when removing sutures
b. Use gloves when removing sutures
c. Nothing, suture removal is outside of the nurse’s scope of practice
d. Apply hydrogen peroxide gauze pads to cleanse the area first, and then remove the
sutures.
Ans. a. Use sterile technique when removing sutures

Rationale:
• To prevent incision contamination, sterile procedure preferred; like sterile suture
removal tray is used and sterile gloves are applied.
• Wearing regular gloves is not sufficient to prevent incision contamination.
• Option D: This answer choice does not provide enough information to determine if
proper sterile procedures are being followed. So, this option is ruled out.
123. A patient is brought to the emergency department in an unresponsive state,

and a diagnosis of hyper osmolar hyperglycemic syndrome is made. The nurse
would immediately prepare to initiate which anticipated health care provider’s
prescription?
a. Intravenous infusion of normal saline
b. Endotracheal intubation
c. Intravenous infusion of sodium bicarbonate
d. 100 units of NPH insulin
Ans. a. Intravenous infusion of normal saline

Rationale:
• The primary goal of treatment in hyperosmolar hyperglycemic syndrome (HUS) is to
rehydrate the patient to restore fluid volume and to correct electrolyte deficiency.
• Intravenous fluid replacement is similar to that administered in diabetic ketoacidosis
(DKA. and begins with IV infusion normal saline. Regular insulin, not NPH insulin,
would be administered.
• The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate
a further drop in serum potassium levels.
• Intubation and mechanical ventilation are not required to treat HUS.
124. The nurse is preparing to administer heparin sodium to a patient diagnosed

with atrial fibrillation with embolization. The nurse should ensure that which of
the following is available if the client develops a significant bleeding problem?
a. Fresh Frozen Plasma
b. Phytonadione
c. Protamine Sulfate
d. Reteplase
Ans. c. Protamine Sulfate

Rationale:
• Heparin sodium is an anticoagulant used for treatment of atrial fibrillation
with embolization and it is also used as prophylaxis and treatment for venous
thromboembolism. Protamine Sulfate is the antidote for heparin.
• Fresh Frozen Plasma reverses bleeding associated with warfarin therapy.
• Phytonadione antidote for warfarin.
• Reteplase a thrombolytic agent; it is not an antidote.
125. The nurse teaches foot care to a patient with type 2 diabetes mellitus. Which of
the following should the nurse teach the patients?
a. Wear open-toe, flat shoes
b. Take the diabetes medications as prescribed by the health care provider
c. Use over the counter remedies for calluses
d. Wash feet daily with mild shop
Ans. d. Wash feet daily with mild shop

Rationale:
• To maintain the healthy feet washing g the feet daily with mild shop is an appropriate
suggestion for the patient.
• Although taking medication as prescribed by the health care provider is important
for the diabetes patients, but it does not address the topic of foot care. So, option B is
ruled out.
• Use over the counter remedies for calluses is avoided to prevent injury to the foot.
• Option A: it may increase the risk of foot injury and infection.
126. The nurse teaches a male patient about testicular cancer. The nurse emphasizes
that the patient should be aware of which manifestations as an early sign of
testicular cancer?
a. Urinary urgency b. Lumbar pain
c. Painless testicular enlargement d. Urinary frequency
Ans. c. Painless testicular enlargement

Rationale:
• Risk factors of testicular cancer:
Ĕ H/o of testicular carcinoma
Ĕ Cryptorchidism
Ĕ Contra lateral testis with unilateral testis cancer
Ĕ Infertility
• Clinical Features of testicular cancer:
Ĕ Most common and early sign: Painless testicular mass
Ĕ Acute testicular pain: may be due to hemorrhage or infraction in tumor
Ĕ Retroperitoneal metastasis: Produces flank pain due to bilateral ureter obstruction
Ĕ Back pain due to nerve root or psoas involvement.
127. Fish mouth appearance of mitral valve in RHD due to?

a. Rupture of valve
b. Calcification and fibrosis
c. Hypertrophy of ventricular wall
d. None of the above
Ans. b. Calcification and fibrosis

Rationale:
• The most frequently valve (affected in almost 50% of cases) involved in rheumatic
heart disease is mitral valve.
• It can be affected by stenosis with fish-mouth buttonhole deformity, insufficiency, or a
combination of both.
Acute rheumatic heart Disease Chronic rheumatic heart Disease
• It affects myocardium, endocardium, and • It is characterized by mitral and aortic
pericardium. valvular fibrosis, characterized by valve
• The myocardium can develop myocarditis, thickening and calcification; fusion of the
whose most distinctive feature is the valve commissures; and damaged chordae
Aschoff body, in which fibrinoid necrosis is tendineae (short, thickened, and fused.
surrounded by macrophages (Anitschkow
cells), lymphocytes, and plasma cells.
• Fibrinous pericarditis may be present
• Mitral stenosis is marked by diastolic pressure higher in the left atrium than in the left
ventricle.
128. A patient who has chronic leg pain asks the nurse about alternative therapies
in conjunction with traditional treatment. Which form of alternative therapy
could the nurse provide for this patient?
a. Kegel exercise
b. Music therapy or guided imagery
c. Acupuncture
d. None, nurse do not provide alternative treatment
Ans. b. Music therapy or guided imagery

Rationale:
• Music therapy and guided imagery have been proven to increase a patient’s ability to
perform activities of daily living by helping to focus on something other than pain.
• Kegel exercises are done independently by the patient to tighten the muscles of the
pelvic floor. They do not provide pain relief.
• Acupuncture must be performed by a skilled practitioner and is not typically done by
a staff nurse.
• Nurse may participate in many forms of alternative therapies as nursing interventions
when trained properly.
129. The nurse should take which initial action after hypophysectomy and notes
clear nasal drainage from the client’s nostril?
a. She continues to observe the drainage
b. She should lower the head of the bed
c. She obtains a culture of the drainage
d. She should test the drainage for glucose
Ans. d. She should test the drainage for glucose

Rationale:
• A hypophysectomy is the surgical removal of the pituitary gland to treat cancerous or
benign tumors.
• After hypophysectomy, the client should be monitored for rhinorrhea; which could
indicate a cerebrospinal fluid leak. If this occurs, the drainage should be collected and
tested for the presence of CSF. CSF contains glucose, and if positive, this would indicate
that the drainage is CSF.
130. Which of the following is not included in the spectrum of COPD?

a. Emphysema
b. Chronic bronchitis without airflow obstruction
c. Small airway disease
d. Chronic bronchitis with airflow obstruction
Ans. b. Chronic bronchitis without airflow obstruction

Rationale:
• Chronic obstructive pulmonary disease (COPD. is defined as a disease state
characterized by airflow limitation that is not fully reversible
• COPD includes emphysema, an anatomically defined condition characterized by
destruction and enlargement of the lung alveoli; chronic bronchitis, a clinically defined
condition with chronic cough and phlegm; and small airways disease, a condition in
which small bronchioles are narrowed.
• COPD is present only if chronic airflow obstruction occurs; chronic bronchitis without
chronic airflow obstruction is not included within COPD.
131. The nurse prepares to test a patient who has allergies from an unknown a cause.
Which of the following test should be performed by the nurse?
a. Rinne test b. Tzank test
c. Stress test d. Patch test
Ans. d. Patch test

Rationale:
• Patch test identifies the cause of allergic contact sensitization and is indicated in
patients with suspected allergies or allergies from unknown cause.
• Patch test detects antigens (allergens) responsible for type IV allergy, as in allergic
contact dermatitis.
• Patch test us done to find out whatever the skin condition may be caused or aggravated
by an allergic contact dermatitis.
• Drop of known allergen is placed on aluminium cap (Finn chamber), which is placed
on the back of patients with the help of hypoallergenic cape.
Figure: Patch testing: confirms the cause of allergic dermatitis

• Reading: 48 hours and 96 hours (best reading), day 7 reading (taken for late reaction
due to metals, PPD, etc.).
• Interpretation of patch tests:
Ĕ Depending on the degree of inflammation, the reaction is graded from 0 to 3+
Clinical findings Grading
Negative Normal skin 0
Equivocal/Uncertain Minimal macular erythema ?
Weak positive Edema and Erythema 1+
Strong positive Edema, Erythema, papules, vesicles 2+
Extreme reaction Bullae, Erythema and papules 3+
Irritant reaction Cauterization IR
• Patch test should not be done during active dermatitis.
Clinical Pearls:
• It is not necessary that the antigen which has been tested positive in patch test is the cause of
current episode of dermatitis.
• So, results of patch test should be interpreted keeping the clinical picture in mind.
Other options:
• Rinne test: It compares bone conduction to air conduction in the ear.
• Tzank test: Used to detect herpes virus
• Stress test: It assesses cardiovascular response to increased workload.
132. A 40-year-old male patient came to ED with complaints of weakness, paresthesia

and breathing difficulty. Relevant investigations have taken. ECG obtained is
suggestive of:
a. Hyperkalemia b. Hypokalemia
c. Hypercalcemia d. Hypocalcemia
Ans. b. Hypokalemia
Rationale:
• There is depression of the ST segment, a decrease in the amplitude of the T wave, and
an increase in the amplitude of U waves which occurs at the end of the T waves. These
are the findings of Hypokalemia.
• ECG changes in hypokalemia appear as follows:
Ĕ U and T wave fuse.
Ĕ Increased QRS amplitude
Ĕ Increased QRS duration.
Ĕ Increased P wave amplitude,
Ĕ Increased P wave duration.
Figure 1: ECG findings in Hypokalemia

Ĕ ST segment depression.
Ĕ PR interval slightly prolonged.
Ĕ T wave inversion.
Ĕ Prominent U waves.
Ĕ Long QU interval.
Table: ECG Findings in Hyperkalemia
Mild Hyperkalemia Severe Hyperkalemia
• P wave Normal • P wave: Amplitude decreases, duration increases
• QRS Normal until it eventually disappears.
• T wave: Tall and tented, often • QRS: Broadens, wide S waves in the left precordial
symmetric with narrow base; leads.
usually best seen in leads II. III, V2 • QRS axis: Superior (left axis deviation).
and V4. The corrected QT interval • ST segment: The terminal S waves becomes
not prolonged. continuous with the tall, tented T wave.
Figure 2: ECG findings in Hyperkalemia

• ECG changes in Hypocalcemia
Ĕ Hypocalcemia causes QTc prolongation primarily by prolonging the ST
segment.
Ĕ The T wave is typically left unchanged.
Ĕ Dysrhythmias are uncommon, although atrial fibrillation has been reported.
Ĕ Torsades de pointes may occur, but is much less common than with hypokalemia or
hypomagnesemia.
Figure 3: ECG findings in Hypocalcemia

• ECG Changes in Hypercalcemia

Ĕ The main ECG abnormality seen with hypercalcemia is shortening of the QT
interval
Ĕ In severe hypercalcemia, Osborn waves (J waves) may be seen.
Ĕ Ventricular irritability and VF arrest has been reported with extreme hypercalcemia.
Image -1
• Bizarre-looking QRS complexes
• Very short QT interval
• J waves = notching of the terminal QRS, best seen in lead V1
Image -2
• Hypercalcemia causing marked shortening of the QT interval (260 ms).
• ECG changes in Hypomagnesaemia

Ĕ The primary ECG abnormality seen with hypomagnesaemia is a prolonged QTc.
Ĕ Atrial and ventricular ectopy, atrial tachyarrhythmias and torsades de pointes are
seen in the context of hypomagnesaemia.
Ĕ Tall T wave
Ĕ Depressed ST segment.
Figure 4:
• ECG changes in Hypermagnesemia
Ĕ Prolonged PR interval
Ĕ Widened QRS complex
MHN
133. Nurse is developing a plan of care for a female client with anorexia nervosa.
Which action should the nurse include in the plan?
a. Provide privacy during meals
b. Set-up a strict eating plan for the client
c. Encourage client to exercise to reduce anxiety
d. Restrict visits with the family
Ans. b Set-up a strict eating plan for the client

• Anorexia nervosa — often simply called anorexia — is an eating disorder characterized
by an abnormally low body weight, an intense fear of gaining weight and a distorted
perception of weight.
• Establishing a consistent eating plan and monitoring client’s weight are important to
this disorder.
Eating Disorder
Anorexia nervosa Bulimia nervosa Being eating disorder
Avoidance of food + – –
(Calorie deficit)
Binge eating +/– + +
Compensation +/– + –
(Purge/Vomit)
Contd…
Anorexia nervosa Bulimia nervosa Being eating disorder

Low (In typical Normal High
anorexia nervosa, all
features of anorexia
nervosa will be
present, but the
patient will have
normal BMI.
134. Inferiority v/s guilt shown in the age of:

a. 0–1 year b. 1–3 year
c. 3–6year d. 6–12 year
Ans. c. 3-6year
• The 8 stage of psychological development was given by Erik Erikson.
• He states that through the course of development there are critical time periods, each
of which poses a particular psychological conflict o the individual. The resolution of
this conflict results in either psychosocial growth or regression.
Stage and Age Goal
Stage-1 • Infancy Trust Vs Mistrust
• Birth-18 months
Stage-2 • Toddler Autonomy Vs Shame and Doubt
• 18 months-3 years
Stage-3 • Pre-school Initiative Vs Guilt
• 3-6 years
Stage-4 • School going Industry Vs Inferiority
• 6-12 YEARS
Stage-5 • Adolescence Identity Vs Role confusion
• 12-18 years
Stage-6 • Young Adulthood Intimacy vs isolation
• 18-35 years
Stage-7 • Middle adulthood Generativity vs Stagnation
• 35-65 years
Stage-8 • Late Adulthood Ego integrity Vs Despair
• > 65 years
135. A 39-year-old mother with obsessive-compulsive disorder has become

immobilized by her elaborate hand washing and walking rituals. Nurse
recognizes that the basis of OC disorder is often:
a. Problems with being too conscientious
b. Problems with anger and remorse
c. Feelings of guilt and inadequacy
d. Feeling of unworthiness and hopelessness
Ans. c. Feelings of guilt and inadequacy

• Ritualistic behavior seen in this disorder is aimed at controlling guilt and inadequacy
by maintaining an absolute set pattern of behavior.
136. A client with delusional thinking shows a lack of interest in eating at meal
times. She states that she is unworthy of eating and that her children will die if
she eats. Which nursing action would be most appropriate for this client?
a. Telling the client that she may become sick and die unless she eats
b. Paying special attention to the client’s rituals and emotions associated with meals
c. Restricting the client’s access to food except at specified meal and snack times
d. Encouraging the client to express her feelings at meal times
Ans. c. Restricting the client’s access to food except at specified meal and snack times
• Restricting access to food except at specified times prevents the client from eating
when she feels anxious, guilty, or depressed; this, in turn, decreases the association
between these emotions and food.
137. Patient with a borderline personality disorder who is tonbe discharged soon
give comments “do something” to herself if discharged. Which of the following
actions by the nurse would be most important?
a. Ask a family member to stay with the client at home temporarily
b. Discuss the meaning of the client’s statement with her
c. Request an immediate extension for the client
d. Ignore the client’s statement because it’s a sign of manipulation
Ans. b. Discuss the meaning of the client’s statement with her

• Any suicidal statement must be assessed by the nurse. The nurse should discuss the
client’s statement with her to determine its meaning in terms of suicide.
138. The nurse is caring for a client with schizophrenia who experiences auditory
hallucinations. The client appears to be listening to someone who isn’t visible.
He gestures, shouts angrily, and stops shouting in mid-sentence. Which nursing
intervention is the most appropriate?
a. Approach the client and touch him to get his attention
b. Encourage the client to go to his room where he’ll experience fewer distractions
c. Acknowledge that the client is hearing voices but make it clear that the nurse doesn’t
hear these voices
d. Ask the client to describe what the voices are saying
Ans. c. Acknowledge that the client is hearing voices but make it clear that the nurse doesn’t
hear these voices
• By acknowledging that the client hears voices, the nurse conveys acceptance of the
client. By letting the client know that the nurse doesn’t hear the voices, the nurse avoids
reinforcing the hallucination & helping him by facing the reality
139. Patient Ram is experiencing alcohol withdrawal exhibits tremors, diaphoresis

and hyperactivity. Blood pressure is 190/87 mm Hg and pulse is 92 bpm. Which
of the medications would the nurse expect to administer?
a. Naloxone (Narcan)
b. Benztropine (Cogentin)
c. Lorazepam (Ativan)
d. Haloperidol (Haldol)
Ans. c. Lorazepam (Ativan)

• The nurse would most likely administer benzodiazepine. Such as lorazepam (Ativan)
to the client who is experiencing symptom: The client’s experiences symptoms of
withdrawal because of the rebound phenomenon when the sedation of the CNS from
alcohol begins to decrease.
140. Nurse is caring for a client diagnosed with catatonic stupor. When nurse enters
the client’s room, the client is found lying on the bed with a body pulled into a
fetal position. Nurse should?
a. Ask the client direct questions to encourage talking
b. Take the client into the dayroom to be with other clients
c. Sit beside the client in silence and occasionally ask open-ended question
d. Leave the client alone and continue with providing care to the other clients
Ans. c. Sit beside the client in silence and occasionally ask open-ended question
• When a patient is conscious but mute, immobile and unresponsive to the environment,
he is said to be in stupor.
• Clients who are withdrawn may be immobile and mute, and require consistent,
repeated interventions. Communication with withdrawn clients requires much
patience from the nurse.
The difference between Stupor, Sopor and Coma

Stupor Sopor Coma
Consciousness Conscious, but Drowsy, abnormally Unconscious, cannot
mute and immobile deep sleep, difficult to be awakened
arouse
Responds to the No/Decreased Responds to harsh No
environment sound, bright light
Responds to painful Yes Yes Yes
stimulus
• Twilight state: A state of disturbed consciousness with hallucinations.
141. A60-year-old female client who lives alone tells the nurseat the community
health center “I really don’t need any-one to talk to. The TV is my best friend.
The nurse recognizes that the client is using the defense mechanismknown as:
a. Displacement
b. Sublimation
c. Projection
d. Denial
Ans. d. Denial
• The client statement is an example of the use of denial, a defensethat blocks problem by
unconscious refusing to admit they exist.
Immature Defenses Description Example
Denial Avoiding the awareness of some A patient with cancer plans a
painful reality. full-time work schedule despite
being warned of significant fatigue
during chemotherapy.
Displacement Redirection of emotions or A teacher is yelled at by the
impulses to a neutral person or principal. Instead of confronting
object (vs projection). the principal directly, the teacher
goes home and criticizes her
husband’s dinner selection.
Mature Defenses Description Example

Sublimation Replacing an unacceptable wish Teenager’s aggression toward his
with a course of action that is father is redirected to perform
similar to the wish but does not well in sports.
conflict with one’s value system
(vs reaction formation).
142. New name of mental retardation according to American Association of Mental

Retardation:
a. Feeble Mindedness
b. Madness
c. Intellectual disability
d. Mentally unstable
Ans. c. Intellectual disability

Rationale:
• Intellectual disability (ID, intellectual developmental disorder) replaces the term
mental retardation (MR) as per US law (Rosa’s Law), with the intention of decreasing
stigmatization.
• ID is characterized by severely impaired cognitive and adaptive/social functioning.
• Severity level is currently based on adaptive functioning, indicating degree of support
required.
• A single IQ score does not adequately capture this and is no longer used solely to
determine ID severity.
143. Select the correct match:

a. Sigmoid Freud-Theory of cognitive development
b. Jean Piaget-Founder of psychoanalysis
c. Eugene Bleuler – 4 A’s schizophrenia
d. Al of the above
Ans. c. Eugene Bleuler – 4 A’s schizophrenia

Rationale:
• The correct match of scientists and their contributions is as follows:
Ĕ Sigmoid Freud- Founder of psychoanalysis
Ĕ Jean Piaget- Theory of cognitive development
Ĕ Eugene Bleuler – 4 A’s schizophrenia
• 4 A’s of schizophrenia: They are the fundamental disturbances characteristic of
schizophrenia; affect, association, ambivalence and autism.
• Psychoanalysis: It involves bringing repressed memories and feelings to the surface
and resolving unconscious conflicts through understanding.
• Theory of cognitive development: It describes four major stages of cognitive
development (from birth to adolescence) that lead to the capacity for adult thought
144. What differentiates delirium from dementia?

a. Confusion b. Difficulty in communicating
c. Hallucination d. Sudden change
Ans. d. Sudden change

Rationale:
Table: Delirium versus Dementia
Characteristics Delirium Dementia
History Acute, identifiable date Chronic, cannot be dated
Onset Rapid Insidious
Duration Days to weeks Months to years
Course Fluctuating Chronically progressive
Level of Consciousness Fluctuating Normal
Orientation Impaired periodically Disorientation to person

Memory Recent memory markedly impaired Remote memories seen as recent
Perception Visual hallucinations Hallucinations less common
Sleep Disrupted sleep-wake cycle Less sleep disruption
Reversibility Reversible Mostly irreversible
Physiologic changes Prominent Minimal
Attention span Very short Not reduced
145. A patient says she loves her child and wants to hug him but also hates him and
wants to hurt him. She is unable to decide what to express. This is known as:
a. Abulia b. Ambivalence
c. Anhedonia d. Alexithymia
Ans. b. Ambivalence
Rationale:
• Ambivalence is the inability to secede for or against, due to co-existence of two opposing
impulses for the same thing at the same time in the same person. It is an important
feature of schizophrenia. It is also seen with OCD and other borderline conditions.
• Abulia: Inability to make a decision generally. Unlike ambivalence, there are no
opposing impulses present.
• Anhedonia: Loss of pleasure in previously pleasurable activities.
• Alexithymia: Inability to recognize and describe feelings.
146. Which of following symptom appears first in alcohol withdrawal?

a. Delirium b. Sleep disturbance
c. Visual hallucinations d. Tremors
Ans. d. Tremors
Rationale:
• Tremor is the classic and most common withdrawal symptoms (excluding the
hangover). It usually appears 6 - 8 hours after last alcohol intake.
• Alcoholic hallucinosis: After 12 - 24 hours.
• Alcohol withdrawal seizure (Generalized and tonic-clonic.: After 24 - 48 hours.
• Delirium tremens: After 48 - 72 hours.
147. A patient is mute and immobile but conscious. He is unresponsive to the

environment. He is known to be:
a. Coma b. Stupor
c. Sopor d. Twilight state
Ans. b. Stupor
Rationale:
• When a patient is conscious but mute, immobile and unresponsive to the environment,
he is said to be in stupor.
Table: The difference between Stupor, Sopor and Coma
Stupor Sopor Coma
Consciousness Conscious, but mute Drowsy, abnormally deep Unconscious, cannot
and immobile sleep, difficult to arouse be awakened
Responds to the No/Decreased Responds to harsh sound, No
environment bright light
Responds to painful Yes Yes Yes
stimulus
• Twilight state: A state of disturbed consciousness with hallucinations.
FON
148. Select which among the following Nursing theory describes the nurse -patient
relationship concepts?
a. Leininger b. Dorothea Orem
c. Hildegard Pepau d. Betty Neumann
Ans. c. Hildegard Pepau

Rationale:
The correct answer is option 3
• Hildegard Elizabeth Peplau (September 1, 1909 – March 17, 1999) was an American
nurse and she served the American Nurses Association (ANA. as Executive Director
and later as President. She became the first published nursing theorist since Florence
Nightingale.
• Hildegard Peplau’s Interpersonal Relations Theory focuses on the nurse-client
relationship as the foundation of nursing practice. It reflect the give-and-take of
nurse-client relationships. The nursing model identifies four sequential phases in the
interpersonal relationship: orientation, identification, exploitation, and resolution.
It also includes seven nursing roles: Stranger role, Resource role, Teaching role,
Counseling role, Surrogate role, Active leadership and Technical expert role.
KINDLY REDRAW THE IMAGE

Option 1: Madeleine Leininger is a nursing theorist who developed the Transcultural
Nursing Theory or Culture Care Nursing Theory.

Option 2: Dorothea Elizabeth Orem (July 15, 1914 – June 22, 2007) was one of America’s
foremost nursing theorists who developed the Self-Care Deficit Nursing Theory, which is
also known by the name of Orem Model of Nursing.
Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to perform
self-care, defined as ‘the practice of activities that individuals initiate and perform on their
own behalf in maintaining life, health, and well-being.’”
The Self-Care or Self-Care Deficit Theory of Nursing is composed of three interrelated
theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of
nursing systems, which is further classified into wholly compensatory, partial compensatory
and supportive-educative.

Option 4: Betty Neuman develops a broad, holistic and system based nursing theory which
is based on the person’s relationship to stress, the response to it, and reconstitution factors
that are progressive in nature.
149. A 40-year-old male patient brought to the emergency department. Doctor

confirm that the patient is experiencing the sickle cell crisis. The assigned
nurse will place the patient in which of the following position?
a. Knee-chest b. Semi-fowler’s Position
c. Trendelenburg Position d. Supine Position
Ans. b. Semi-fowler’s Position

Rationale:
The correct answer is option 2.
Sickle Cell diseases is a condition which is characterized by a genetic mutation in the HBB
(Hemoglobin Subunit Beta. gene leading to the formation of abnormal hemoglobin, called
sickle hemoglobin or hemoglobin S. Hemoglobin is a protein found in red blood cells that
binds oxygen. Hemoglobin S has reduced oxygen-binding capacity.
Patients with Sickle Cell diseases frequently experience hypoxia, due to the reduced oxygen-
carrying capacity of hemoglobin S. Hypoxia can lead to various complications in sickle cell
disease patients.
So, here the priority nursing action is to place the patient in such position which has
maximum lung expansion.
• Placing the client in semi-Fowler’s position provides the best oxygenation for this
client.
• Flexion of the hips and knees, which includes the knee chest position, impedes
circulation and is not correct positioning for this client.
• Trendelenburg Position will further pushes the diaphragm upwards and make less
space for lung expansion.
150. A patient is to receive a proton pump inhibitor through a nasogastric (NG)

feeding tube. Which is the most important nursing action to ensure effective
absorption?
a. Thoroughly shake the medication before administering.
b. Position patient in the supine position for 30 minutes to 1 hour.
c. Hold feeding for at least 30 minutes after medication administration.
d. Flush tube with 10 to 15 mL of water, after all medications are administered.
Ans. c. Hold feeding for at least 30 minutes after medication administration.

Rationale:
• If a medication needs to be given on an empty stomach or is not compatible with
the feeding (e.g., phenytoin, carbamazepine [Tegretol], warfarin [Coumadin],
fluoroquinolones, proton pump inhibitors), hold the feeding for at least 30 minutes
before or 30 minutes after medication administration.
• Thoroughly shaking the medication mixes the medication before administration but
does not affect absorption.
• Flushing the tube is done to prevent the clogging of the NG tube
• Patients with NG tubes should never be positioned supine but instead should
be positioned at least to a 30-degree angle to prevent aspiration, provided no
contraindication condition is known.
151. When teaching an adult client to self-administer subcutaneous insulin, the

nurse should provide which of the following instructions? Select all that apply.
a. Insert the syringe at a 30–45 degree angle.
b. Aspirate for blood return following needle insertion.
c. Clean the rubber stopper on the vial with an alcohol swab.
d. All of the above
Ans. c. Clean the rubber stopper on the vial with an alcohol swab.
Rationale
Correct Answers: 3
• If insulin is administered by using the insulin pen (prefilled syringe) then the angle of
administration will be 90 degree. If insulin is administered by using the insulin syringe
with attached needle, then the angle of administration will be 45 degree
• The client should be instructed to discard the needle and syringe after each use. Reusing
the syringe and needle can compromise insulin sterility. In addition, needle tips on
smaller gauged needles can become bent to form a “hook”, which can injure tissue.
• The client should not be instructed to aspirate for blood prior to injection into
subcutaneous tissue. There is little chance of the needle entering a blood vessel during
the administration of subcutaneous injections.
• The client should be instructed to clean the rubber stopper prior to withdrawal of the
insulin. Vials of insulin contain multi-doses. The rubber stopper should be cleansed
with an alcohol swab each time the vial is used to reduce the chance of bacterial growth.
152. Which preparation must be shaken prior to administration?

a. Suspension b. Solution
c. Spirit d. Syrup
Ans. a. Suspension
Rationale:
A suspension must be shaken before administering. A suspension is a liquid with small
pieces of drug. The drug is not complete dissolved in the solution. The nurse should always
shake (or stir) it so that the right amount of drug administered every time.
• Other options are distractors.
153. The nurse is preparing to administer a vaginal cream to her assigned patient
with the help of an applicator. Which among the following instructions the
nurse would tell the patient for proper use of vaginal cream at home?
a. Make sure to empty the bladder before receiving this drug
b. Remain lying down for 10 minutes after taking this drug
c. Insert applicator approximately 5 to 7.5 cm
d. All of the above
Ans. d. All of the above

Rationale:
• The correct answer is, All of the above.
• Before the vaginal cream administration, instruct the patient to empty her bladder, so
that the medication remains in place.
• Patient is instructed to remain lying down for at least 10 to 15 minutes so that the
medication will be distributed and absorbed evenly throughout the vaginal cavity and
not lost through the orifice.
Figure: Administration of medication into the Vaginal cavity

• The patient is also instructed to use the applicator correctly in order to administer the
vaginal drug, by inserting applicator for approximately 5 to 7.5 cm (2-3 inches) then
push applicator plunger to deliver the vaginal medications.
154. Which term describes a way to organize and chart patient progress?
a. SOAP
b. POMR
c. PIE
d. All of the above
Ans. a. SOAP
Rationale:
The correct answer is option 1
• SOAP Acronym
S= Subjective
0=Objective
A=Assessment
P= Planning
SOAP method of documentation is used as an organized structure for keeping progress

notes in the chart. Each entry contains the date, number, and title of the patient’s problem.
If the patient has multiple problems, a SOAP entry on the chart is made for each problem.
• POMR Acronym
P=Problem
O=oriented
M=Medical
R=Record
A method of establishing and maintaining the patient’s medical record so that problems are
clearly stated. These data are kept in the front of the chart and are evaluated as frequently
as indicated with respect to recording changes in the patient’s problems as well as progress
made in solving the problems. Use of this system may bring a degree of comprehensiveness
to total patient care that might not be possible with conventional medical records. Internists,
family practitioners, and pediatricians use the POMR system.
• PIE Acronym
P= Process
O=Oriented
D=Documentation
The progress notes in the patient record use (P) to define the particular Problem; (I) to
document Intervention; and (E) to Evaluate the patient outcome. PIE charting integrates
care planning with progress notes.
155. Which action should the nurse take when preparing patient-controlled
analgesia for a postoperative patient?
a. Caution the patient to limit the number of times he presses the dosing button.
b. Ask another nurse to double-check the setup before patient use.
c. Instruct the patient to administer a dose only when experiencing pain.
d. Provide clear, simple instructions for dosing if the patient is cognitively impaired.
Ans. b. Ask another nurse to double-check the setup before patient use.
Rationale:
The correct answer is option
As a safeguard to reduce the risk for dosing errors, the nurse should request another nurse
to double-check the setup before patient use. The nurse should reassure the patient that the
pump has a lockout feature that prevents him from overdosing even if he continues to push
the dose administration button. The nurse should also instruct the patient to administer a
dose before potentially painful activities, such as walking.
Patient-controlled analgesia is contraindicated for those who are cognitively impaired.
156. The nurse is inserting an indwelling urinary catheter into a male patient
admitted in medicine ward with the complaint of urinary incontinence. The
nurse has inserted the tip of the catheter into the urethra, immediately the
urine begins to flow into the tubing. At what point the nurse should inflate the
balloon?
a. Soon after urine begins to flow into the catheter inflate the balloon
b. Advance the urinary catheter till the bifurcation point and then inflate the balloon
c. Insert the catheter 2.5 to 3 cm then inflate the balloon
d. Before inserting the catheter inflate the balloon
Ans. b. Advance the urinary catheter till the bifurcation point and then inflate the balloon
Rationale:
• The correct answer is option 2.
• While inserting the catheter when urine begins to flow then gently advance the catheter
to the point of bifurcation and then inflates the balloon. When inserting an indwelling
catheter, the nurse has to ensure the balloon is in the bladder before inflating it. If the
balloon is inflated in the urethra of the male client, trauma may occur. The nurse then
pulls the catheter back until slight resistance is felt and then secure the catheter onto
the thigh to hold the catheter in place.
Figure: Parts of indwelling urinary catheter

Other options are distractors.
157. Babita a registered nurse is working in the Surgery ward. During her morning
shift she is assigned to provide care to a female patient who is posted for
laparoscopic cholecystectomy. Before shifting the patient to the pre-operative
area the nurse has to insert the urinary catheter. Nurse Babita will use which
size of urinary catheter for catheterization procedure?
a. 8 to 10 French b. 12 to 16 French
c. 14 to 16 French d. 18 to 20 French
Ans. b. 12 to 16 French
Rationale:
• The correct answer is option 2 which is common size of foley’s catheter used in female
is 12 to 16 French.
• The size of a urinary catheter is based on the French (Fr) scale, which reflects the
internal diameter of the tube. Recommended catheter size is 12 to 16 French for
females, and 14 to 16 French for males.
• Other options are distractors.
158. You are giving pre-operative instruction on how to use incentive spirometer to
the patient posted for surgery. Select which of the following points suggest that
the nurse requires further understanding of incentive spirometry?
a. Instruct the client to assume a sitting or upright position while using incentive
spirometer
b. Instruct the client to inhale slowly to raise and maintain the flow rate indicator
c. Instruct the client to hold the breath for 30 seconds and then to exhale through pursed
lips
d. None of the above
Ans. c. Instruct the client to hold the breath for 30 seconds and then to exhale through pursed
lips
Rationale:
• The correct answer is instructing the client to hold the breath for 30 seconds and then
to exhale through pursed lips.
• Steps for using an incentive spirometry:
Ĕ Instruct the client to assume a sitting or upright position while using incentive
spirometer
Ĕ Instruct the client to place the mouth tightly around the mouthpiece.
Ĕ Instruct the client to inhale slowly to raise and maintain the flow rate indicator,
usually between the 600 and 900 marks on the device or as high as possible.
Ĕ Instruct the client to hold the breath for 5-10 seconds and then to exhale through
pursed lips.
Ĕ Instruct the client to repeat this process 10 times every hour.
159. You have received a patient who is operated under the spinal anesthesia in the
post-operative unit. Which of the following action the nurse should include in
the plan of care for a patient who had spinal anesthesia?
a. Keep the patient in semi-fowler position
b. Elevating the patient’s feet to increase blood pressure
c. Place the patient in supine position for 6 hours
d. Place the patient in Trendelenburg position
Ans. c. Place the patient in supine position for 6 hours

Rationale:
• The correct answer is the patient should be placed in supine position for 6 hours.
• Instructing the patient to remain flat in bed for 6 hours.
• One of the most common complication that occur after spinal anesthesia is post-dural
puncture headache (PDPH) which occurs as a result of leakage of spinal fluid through
the tiny puncture site from where the spinal needle is inserted to administer spinal
anesthesia.
• To indirectly replace lost spinal fluid after administration of spinal anesthesia, the
patient is instructed to lie flat for 6 to 8 hours. Elevating the head of the bed after spinal
anesthesia can precipitate “spinal headache” or nausea related to losses of cerebrospinal
fluid or changes in ICP. Elevating the patient’s feet or administering oxygen are not
necessary interventions unless the patient becomes hypotensive or hypoxic.
160. All of the following describes under the category of negligence EXCEPT?
a. Failure to follow standards of care
b. Failure to use equipment in a responsible manner
c. Breech of privacy
d. All of the above
Ans. c. Breech of privacy

Rationale:
The correct answer is Breech of privacy.
• six major categories of negligence that result in malpractice lawsuits: failure to
follow standards of care, failure to use equipment in a responsible manner, failure to
communicate, failure to document, including failure to note in the patient’s medical
record, failure to assess and monitor, failure to act as a patient advocate.
While the Breech of privacy comes under Intentional Torts
161. You are inserting an IV line into a client’s vein. After the initial prick, you
should continue to advance the catheter if:
a. Immediately after pricking advance the cannula
b. The client does not complain of discomfort
c. Blood return shows in the backflash chamber of the catheter.
d. None
Ans. c. Blood return shows in the backflash chamber of the catheter.

Flashback
chamber
the nurse advances the IV cannula once blood appear in flashback Chamber
162. The nurse noticed that the patient IV line is reddened, warm, painful, and
slightly edematous proximal to the insertion point of the IV catheter. While
documenting the patient condition which term the nurse will use?
a. Phlebitis b. Infiltration
c. Hypersensitivity d. Allergic reaction
Ans. a. Phlebitis
• Infiltration occurs when IV fluid or medications leak into the surrounding tissue.
Infiltration can be caused by improper placement or dislodgment of the catheter.
Patient movement can cause the catheter to slip out or through the blood vessel lumen.
It is characterized by:
Ĕ Swelling, discomfort, burning, and/or tightness
Ĕ Cool skin and blanching
Ĕ Decreased or stopped flow rate
• Extravasation is the leaking of vesicant drugs into surrounding tissue. Extravasation can
cause severe local tissue damage, possibly leading to delayed healing, infection, tissue
necrosis, disfigurement, loss of function, and even amputation. It is characterized by:
Ĕ Blanching, burning, or discomfort at the IV site
Ĕ Cool skin around the IV site
Ĕ Swelling at or above the IV site
Ĕ Blistering and/or skin sloughing
• Phlebitis is inflammation of a vein.
Ĕ Redness or tenderness at the site of the tip of the catheter or along the path of the
vein.
Ĕ Puffy area over the vein.
Ĕ Warmth around the insertion site.
Hypersensitivity occurs when it became systemic infection and result into
Ĕ Redness and discharge at the IV site
Ĕ Elevated temperature
163. A nurse administers an intravenous solution of 0.45% sodium chloride. In

what category of fluids does this solution belong?
a. Isotonic b. Hypotonic
c. Hypertonic d. Both a & c
Ans. a. Isotonic
Isotonic solution • 0.9% Saline

• 5% dextrose in water (D5W) also used as a hypotonic solution after
it is administered because the body absorbs the dextrose BUT it is
considered isotonic.
• 5% Dextrose in 0.225% saline (D5W1/4NS)
• Lactated Ringer’s
Hypotonic solutions 0.45% Saline (1/2 NS)
0.225% Saline (1/4 NS)
0.33% saline (1/3 NS)
Hypertonic solutions 3% Saline
5% Saline
10% Dextrose in Water (D10W)
5% Dextrose in 0.9% Saline
5% Dextrose in 0.45% saline
5% Dextrose in Lactated Ringer’s
164. Select which of the following solution comes under the Hypotonic solution?
a. 5% Dextrose in 0.9% Saline
b. 5% Dextrose in 0.45% saline
c. 5% Dextrose in 0.225% saline (D5W1/4NS)
d. Both a & b
Ans. d. Both a & b
Isotonic solution • 0.9% Saline

• 5% dextrose in water (D5W) also used as a hypotonic solution
after it is administered because the body absorbs the dextrose
BUT it is considered isotonic.
• 5% Dextrose in 0.225% saline (D5W1/4NS)
• Lactated Ringer’s
Hypotonic solutions 0.45% Saline (1/2 NS)
0.225% Saline (1/4 NS)
0.33% saline (1/3 NS)
Hypertonic solutions 3% Saline
5% Saline
10% Dextrose in Water (D10W)
5% Dextrose in 0.9% Saline
5% Dextrose in 0.45% saline
5% Dextrose in Lactated Ringer’s
165. Who among the following has described the nursing as autonomous and
collaborative care of individuals of all ages, families, groups and communities,
sick or well and in all settings?
a. Indian Nursing council b. American nurses association
c. International Council of Nurses d. Virginia Henderson
Ans. c. International Council of Nurses

Rationale:
• International Council of Nurses (2002) encompasses autonomous and collaborative
care of individuals of all ages, families, groups and communities, sick or well and in all
settings. Nursing includes the promotion of health, prevention of illness, and the care
of ill, disabled and dying people.
• Indian Nursing Council (2006) Nursing is a professional service for enabling a person
to maintain and sustain health and wellbeing’ whereas Health is a state of dynamic
balance of an individual’s ability to perform personally valued roles and responsibilities
to deal and cope with physical, biological, psychological and social stresses and
challenges throughout the life while continuing to maintain the sense of wellbeing.
• American Nurses Association (1973) The nursing is the protection, promotion, and
optimization of health and abilities, prevention of illness and injury, alleviation of
suffering through the diagnosis and treatment of human response, and advocacy in the
care of individuals, families, communities, and populations
• Virginia Henderson (1966) The unique function of the nurse is to assist the individual,
sick or well, in the performance of those activities contributing to health or its recovery
(or to peaceful death) that he would perform unaided if he had the necessary strength,
will or knowledge”
166. A nurse came into the patient’s rooms for a routine round and noticed that the
patient is trying to read his ultrasonography report. The patient is then asked
to the nurse ‘oh sister can you please tell me the result of this report. The nurse
replied and said according to this report you have enlargement of liver grade 2,
and presence of multiple calculi in gallbladder. Identify which ethical principle
is followed by the nurse in this scenario?
a. Principle of fidelity
b. Principle of veracity
c. Principle of non-maleficence
d. Principle of autonomy
Ans. b. principle of veracity

Rationale:
• Principle of veracity is defined as telling the truth. Telling the truth is basic to
communication and social relationship. Health care provider should give accurate,
reality based information about health status and treatment prospective.
• Principle of Fidelity refers to the concept of keeping a commitment and is based upon
the virtue of caring. This principle hold that a person should be faithful and truthful
for his/her duties and obligations.
• Principle of Non-maleficence means duty to do no harm.
• Principle of autonomy means respect for an individual’s right to self-determination,
independence and ability to self-direct. It is an ethical action on the part of nurse to
allow the patient to make decisions. It refers to the personal freedom of choices and
make decisions freely.
Other ethical principles are:
• Principle of Beneficence: The duty to do good to others and to maintain a balance
between benefits and harms; paternalism is an undesirable outcome of beneficence, in
which the health care provider decides what is best for the client and encourages the
client to act against his or her own choices
• Principle of Justice: The equitable distribution of potential benefits and tasks
determining the order in which clients should be cared and treated equally and fairly.
• Principle of confidentiality is the duty to respect privileged information. The principle
of confidentiality provides a caregivers should respect a patient’s need for privacy and
use of the personal information of patient to improve their care only.
167. Elimination of all micro-organism including bacterial spores is known as?

a. Disinfection
b. Sterilization
c. Pasteurization
d. Mechanical Cleaning
Ans. b. sterilization
Rationale:
• Sterilization is the process of elimination and killing of micro-organism including the
bacterial spores.
• Disinfection is the process of removal of micro-organism except bacterial spores
• Pasteurization is the process in which the packed food items are treated with mild heat,
to eliminate pathogens and to extend shelf life.
• Mechanical cleaning is the process of physically removing the dirt, stains
168. The recommended time duration for pasteurization at 63 degree C is?

a. 30 min
b. 1 hour
c. 45 min
d. 2 hours
Ans. a. 30 minutes
Rationale:
The process of pasteurization was given after the name of Louis Pasteur. Louis Pasteur
discovered the way to deactivate the organisms in wine by applying heat at temperatures
below its boiling point. This research was later on used for milk and became an important
factor for milk processing.
Milk mild heat pasteurization done at 63° C for not less than 30 min.
169. You are assigned to provide care to a patient with neutropenia. Which of the
following should the nurse avoid while provide care to this patient?
a. Performing oral hygiene after each meal
b. Using suppositories or enemas
c. Performing perineal hygiene after each bowel movement
d. All of the following
Ans. c. Using suppositories or enemas

Neutopenic means the presence of abnormally few neutrophils in the blood, leading to
increased susceptibility to infection. (Neutropenia is the most abundant WBCs is the blood.
Neutropenic clients are at risk for infection especially bacterial infection of the
gastrointestinal and respiratory tract. An incorrectly administered enema can damage tissue
in your rectum/colon, cause bowel perforation and, if the device is not sterile, infections.
Option A: Performing oral hygiene consistently after meals could help prevent infection of
the oral mucous membranes. Recommend the use of soft-bristled toothbrushes and stool
softeners to protect mucous membranes. Hard-bristled toothbrushes can compromise the
integrity of the mucous membrane and provide a port of entry for pathogens.
Option C: Proper perineal hygiene helps prevent urinary tract infections. Wash hands or
perform hand hygiene before having contact with the patient.
170. You have to administer an optic solution to an adult male patient in left ear.
Which of the following action should the nurse avoid while administering the
optic solution?
a. Pulling the auricle backward and upward.
b. Keep the solution at room temperature.
c. Pacing the tip of the dropper on the edge of the ear canal.
d. Placing the client in a side lying position.
Ans. c. Placing the tip of the dropper on the edge of the ear canal.
The dropper should not touch any object or any part of patient’s ear in order to avoid the
contamination.
Option A: For adults, pull the auricle backward and UPWARD to prepare the ear for
insertion of the drop and ensure the drop reaches the required area.
For Children under Age 3: Gently pull the outer flap of the affected ear DOWNWARD and
backward to straighten the ear canal.
Option B: The solution generally used should be at room temperature. This can help reduce
any discomfort that could be caused by cold drops in the ear.
Option D: Side-lying position is the best position for instillation of the drops and this also
ensures comfort for the service user. Position the head so that the ear faces upward. If giving
the drops to someone else, it may be easiest if the person tilts their head or lies down on
their side.
171. You have received a new admission with the provisional diagnosis of
hypertension. While formulating the nursing care plan which nursing diagnosis
is considered as the priority?
a. Ineffective health maintenance
b. Impaired skin integrity
c. Deficient fluid volume
d. Acute Pain
Ans. a. Ineffective health maintenance

Managing hypertension is the priority for the patient with hypertension. Patient with
hypertension frequently do not experience pain, deficient volume, or impaired skin integrity.
Among all the options ineffective health maintenance is considered as the correct answer as
hypertension is also considered as the risk factor for many other diseases conditions like if
we doesn’t control BP than it can affect the cardiovascular system as well as the renal system.
So, in such situation the priority is to maintain the health.
172. When percussing the client’s chest, the nurse would expect to find which
assessment data as a normal sign over his lungs?
a. Dullness b. Resonance
c. Hyperresonance d. Tympany
Ans. b Resonance
Normally, when percussing a client’s chest, percussion over the lungs reveals resonance, a
hollow or loud, low-pitched sound of long duration. Since lungs are mostly filled with air that
we breathe in, percussion performed over most of the lung area produces a resonant sound,
Option A: Dullness is typically heard on percussion of solid organs, such as the liver or areas
of consolidation. Dullness to percussion indicates denser tissue, such as zones of effusion or
consolidation. Once an abnormality is detected, percussion can be used around the area of
interest to define the extent of the abnormality. Normal areas of dullness are those overlying
the liver and spleen at the anterior bases of the lungs.
Option C: Hyperresonance would be evidenced by percussion over areas of overinflation
such as an emphysematous lung. Hyperresonant sounds may also be heard when percussing
lungs hyperinflated with air, such as may occur in patients with COPD, or patients having
an acute asthmatic attack. An area of hyper resonance on one side of the chest may indicate
a pneumothorax.
Option D: Tympany is typically heard on percussion over such areas as a gastric air bubble
or the intestine. Tympanic sounds are hollow, high, drumlike sounds. Tympany is normally
heard over the stomach but is not a normal chest sound. Tympanic sounds heard over the
chest indicate excessive air in the chest, such as may occur with pneumothorax.
173. Match the following with their correct respective statements?

1.Airborne transmission a. Direct or indirecttransmission of infection between an
infected person and a susceptible person
2.Droplet Transmission b.Respiratory droplets are >5-10 μm in diameter
3.Contact Transmission c. Spread of an infectious agent caused by the dissemination
of droplet nuclei (aerosols)
a. 1-a,2-c,3-b b. 1-b,2-a,3-c
c. 1-c, 2-b, 3-a d. 1-b, 2-c, 3-a
Ans. c. 1-c, 2-b, 3-a
Rationale:
Droplet Transmission Respiratory droplet(>5-10 μm in diameter) transmission can occur
when a person is in close contact (within 1 metre) with an infected
person who has respiratory symptoms (e.g. coughing or sneezing) or
who is talking or singing; in these circumstances, respiratory droplets
that include virus can reach the mouth, nose or eyes of a susceptible
person and can result in infection.
Airborne transmission Airborne transmission is different from droplet transmission as it refers
to the presence of microbes within droplet nuclei, which are generally
considered to be particles <5μm in diameter, can remain in the air
for long periods of time and be transmitted to others over distances
greater than 1 m.
Contact Transmission Direct contact with the infected person or Indirect contact
transmission involving contact of a susceptible host with a
contaminated object or surface (fomite transmission)
174. Select the normal appearance of colostomy stoma?

a. The stoma appears dry with no nerve sensation
b. The stoma is pink to red
c. The stoma is moist and round
d. Both b & c
Ans. d. Both b & c

A stoma typically protrudes above the skin, is pink to red in colour, moist, and round, with
no nerve sensations.
NURSING RESEARCH
175. The scatter in a series of values about the average is called?

a. Central tendency
b. Dispersion
c. Skewness
d. All of the above
Ans. b. Dispersion
Option b: In statistics, dispersion (also called variability, scatter, or spread. is the extent to
which a distribution is stretched or squeezed.
Option a: A measure of central tendency is a summary statistic that represents the center
point or typical value of a dataset. Measure of Central Tendency includes mean, mode,
median
Option c: The lack of uniformity or symmetry is called Skewness. In other words, skewness
measures the asymmetry of probability distribution about its mean. The curve of skewness
appears distorted as is seen in the given below image:
Figure 1: Skewness
176. A graph of a cumulative frequency distribution is called as?

a. Ogive Curve
b. Frequency Polygon
c. Pie Chart
d. Bar Chart
Ans. a. Ogive Curve

Option a: An ogive, sometimes called a cumulative frequency polygon, is a type of
frequency polygon that shows cumulative frequencies.
Option b: Histogram is converted into frequency polygon by joining the mid points of class
intervals at the heights of frequencies by straight lines.
• Other options are distracters.
177. Which of the following best describes a Type I error?

a. We reject H0 if it is True b. We reject H0 if it is False
c. We accept H0 if it is True d. We accept H0 if it is False
Ans. a. We reject H0 if it is True

Rationale:
• While testing the hypothesis statistically, if the researcher rejects the null hypothesis
but actually the null hypothesis was true, it is known as Type 1 error. It is also known
as “false-positive” conclusion.
Other options are distracters.
178. Which sampling method the research use to select the sample randomly to
ensure that each sample gets an equal opportunity of being selected in the
study?
a. Purposive Sampling b. Quota Sampling
c. Probability sampling d. Non-probability sampling
Ans. c. Probability sampling

Rationale:
• Probability Sampling method allow the researcher to randomly select the subject for
the study by giving equal opportunity to all the subject of being selected. It is also
known as Random sampling
• Non-probability sampling is a type of sampling where the subject doesn’t have equal
opportunity of being selected in a study. It is a non-random method of sampling.
Choice of selection is generally depend upon the researcher.
• Option a & b: quota and purposive sampling are the type of Non-probability sampling
technique.
179. Comprehensive summary of what a researcher intends to do and how it will be

done is known as:
a. Blueprint b. Conceptual framework
c. Statement d. Research proposal
Ans. d. Research proposal

Rationale:
A research proposal is a comprehensive summary of what you intend to do, how it will be
done, and why it is important.
A research proposal is a written document specifying what the investigator proposes to
study, and is, therefore, written before the project commences.
A research plan or approach is a framework or blueprint for conducting a research project.
A conceptual framework is like a roadmap for your study, helping you visualize your
research project and putting it into action.
180. Which of the following is a parametric test of significance?

a. Chi-square test b. Fisher’s exact test
c. Mean d. T-test
Ans. d. T-test
Rationale:
There are several parametric and non-parametric tests to establish the statistical significance.
Parametric tests: t-test, Z-test, ANOVA.
Non-parametric test: Chi-square, Fisher’s test, McNemar test, etc.
Nursing education and management
181. Which among the following is NOT the advantage of a checklist?

a. It gives real-time visibility
b. There is an opportunity to classify judgement
c. It helps to obtain a large number of data
d. It can easily be validated
Ans. a. It gives real-time visibility

Rationale:
The only statement that is not an advantage of checklist includes that it gives a real-time
visibility as it doesn’t do so. No checklist contains special instructions as when to start filling
it, moreover, immediate trends can npt be spotted through this which leads to delay in
appropriate action.
Other options are incorrect as they all are the advantages of a checklist
182. Which of the following is incorrect about SWOT analysis?

a. S for strength b. W for weakness
c. O for opportunity d. T for time
Ans. d. T for time

Rationale:
The only incorrect options regarding SWOT analysis is T for “time” as SWOT analysis
evaluates:
S-Strength
W-Weaknesses
O-Opportunity
T-Threats
These SWOTS analysis of organisation assess overall strategy of that organisation, of an
individual project or a product.
Other options are incorrect as they are correct regarding SWOT
183. Audio visual aids helps ________students in the class.

a. Slow learning b. Playful
c. Intelligent d. Curious
Ans. a. Slow learning

Rationale:
Audio-visual aids helps slow learning students in class as such children usually hate writing
and for them spellings, grammar, and absolute physical efforts are onerous. Writing is not
just their cup of tea. Slow learners may prefer reading over writing, provided it is associated
with some positive reinforcement. Audio visual aids helps in removing the abstract concepts
which improves learning, conveys a clear meaning, supplements spoken words, expresses
the idea better, makes teaching realistic, attracts the attention, helps in creating better ideas,
create interest and change the attitude of the learners.
• Playful, intelligent and curious students are self-motivated and eager to learn therefore
no extra efforts are required to make them understands things better.
184. Non-verbal communication does not involve:

a. Gestures b. Proxemics
c. Words d. Silence
Ans. c. Words
Rationale:
Non-verbal communication does not involve words. Non-verbal communication is a type
of communication in which the idea or information is conveyed through gestures, facial
expressions, eye contact, silence, movement, postures, touch and personal appearance. In
other words, non- verbal communication is the communication in which the sender and
receiver are physically present at the same place but they communicate through means
other than language or spoken words. The most beneficial role of such communication over
verbal communication is that it helps to understand the emotional state of the sender as
well as the receiver. In addition to this, it helps in implicating and explicating the meaning
of words, improving the communication process as a whole, makes understanding better,
come to know the intentions and reinforces the meaning of words.
185. What is the main objective in Educational Technology 2?

a. Orient b. Facilitate
c. Integrate d. Evaluate
Ans. c. Integrate
Rationale:
The main objective of the educational technology 2 is to integrate the educational
technology so that it becomes easier and flawless for the user to make efficient use of it.
When the learning process is integrated with the latest technology an insurgence can be
seen in the entire activity. It overall impacts the learning experience and helps in taking it to
another level. The cornerstone of this is the introduction, reinforcement, supplementation,
extension of knowledge and skills to the learner enabling him to become tech-friendly.
• Orienting, facilitating and evaluating are not the main objectives of Educational
technology 2. These all are the objectives of education technology in general.
186. Which among the following is the type of education theory and practice that
focuses on design and use of messages which controls the learning process?
a. AECT b. ISPI
c. ITEA d. ISTE
Ans. a. AECT
Rationale:
AECT is the type of education theory and practice that focuses on design and use of
messages which controls the learning process. They used audio-visual communications in
the year 1923. At the beginning it was centred on radio. It swiftly focused on the instructional
filmstrips and educational television. Nowadays they include global satellite broadcasting,
visual communication and two-way audio.
• ISPI is another form of theory which explains the application of behaviour theory
while using the instructional system approach
• ITEA is International Technology Education Association that focuses on making
the students learn technology that is applicable in the real world like robotics,
manufacturing systems and computer-assisted designs
• ISTE lays emphasis on both the instructions and the application of computers in the
training of students
COMPUTER
187. Which of the following is NOT a purpose of Patient Electronic Records?

a. Patient Care b. Communication
c. Legal Documentation d. Problem List
Ans. d. Problem List

Rationale:
Generating problem list is not the purpose of the patient electronic record. Problem list can
be generated by the health care professionals or the health information system. The primary
purpose of the patient’s record is to assist the health professionals in providing quality care
to the patient. Other purposes include:
• Communication
• Legal documentation
• Billing & reimbursement
• Quality review
• Education
• Research
• Credentialing
• Security (Public health & homeland.
188. Which among the following is used as an input device?

a. USB b. Scanner
c. Printer d. Modem
Ans. b. Scanner
Rationale:
Scanner is used as an input device. The main principle used by scanner is conversion of an
image, handwritten material or printed text into digital images in the form of “bit matrix”,
known as “bit map”. Such images can be viewed, stored or edited through special software
(commonly OCR system is used to edit such images). There are many types of scanners
available in market like flatbed scanner, drum scanner, hand-held scanner, pen scanner, etc
• Modem is a device used for sending digital data over a phone line. It is a combination of
two words, i.e. “MO” and “DEM”. “MO” stands for modular and “DEM” is demodulator,
it serves as a medium for exchange of data between computer and internet through
telephone lines.
• USB is a storage device
• Printer is an output device
189. What is full form of GUI in terms of computers?

a. Graphical user Instrument
b. Graphical unified Interface
c. Graphical unified Instrument
d. Graphical user Interface
Ans. d. Graphical user Interface

Rationale:
The full form of GUI is “Graphical user Interface”. It is a form of user interface through
which users interact with electronic devices through visual indicator representations.
Other options are distractors
190. Which of the following is NOT true about nursing informatics?

a. It is not a multidisciplinary science practice
b. It is specific to nursing and nursing practice
c. Graves and Corcoran provided the first definition
d. It is not to be equated with the generic term informatics
Ans. a. It is not a multidisciplinary science practice

Rationale:
The only statement that is not true about nursing informatics is that “it is not
a multidisciplinary science practice” because in reality nursing informatics is a
multidisciplinary science practice.
Other options are incorrect as they all are true regarding nursing informatics
191. Telemedicine uses which of the tools for diagnosis of patient?

a. Video conferencing b. SMS
c. Telephone d. Email
Ans. a. Video conferencing

Rationale:
Telemedicine uses Video conferencing as a tool for making diagnosis of patient.
Other options are incorrect as they are not used to make diagnosis in telemedicine
GENERAL KNOWLEDGE
192. Who has become the first Indian paddler to be elected in ITTF’s Athletes
Commission?
a. Soumyajit Ghosh
b. Sharath Kamal
c. Manika Batra
d. Harmeet Desai
Ans. b. Sharath Kamal

Rationale
Ace Indian paddler Sharath Achanta Kamal has become the first Indian player to get elected
to the Athletes’ Commission of the International Table Tennis Federation (ITTF).
193. Which state has emerged as an overall team champion of the North East
Olympic Games 2022?
a. Meghalaya b. Assam
c. Tripura d. Manipur
Ans. a. Meghalaya
Rationale
The 2nd edition of the North East Olympic Games concluded in Shillong, Meghalaya with
Manipur emerging as the overall team champion with a total of 240 medals which included
88 Gold Medals, 75 Silver Medals, and 77 Bronze Medals. Assam took the second spot with
a total of 203 medals.
194. According to the United Nations estimates, what is the global population, as of
November 2022?
a. 7 billion b. 10 billion
c. 8 billion d. 6 billion
Ans. c. 8 billion
Rationale
As per the United Nations estimates, the world’s population reached 8 billion on November
15, 2022.
ENGLISH
195. Fill in the blank with appropriate preposition You can see the doctor
_____________ 8 am and 12 noon.
a. at b. in
c. between d. on
Ans. c. between
Rationale
When the range is connected with and then the preposition used is between.
196. Which of the following is synonym of the word “Showy”

a. Rowdy b. Hungry
c. Greedy d. Gaudy
Ans. d. Gaudy
Rationale
Rowdy: noisy and disorderly.
Hungry: feeling or displaying the need for food.
Greedy: having or showing an intense and selfish desire for something, especially wealth
or power.
Gaudy: extravagantly bright or showy, typically so as to be tasteless
Showy: having a striking appearance or style, typically by being excessively bright, colorful,
or ostentatious.
Therefore the synonym of the word Showy is Gaudy
197. Give the one word substitution “One who cannot easily pleased”
a. Cosmopolitan
b. Frightening
c. Fastidious
d. Feminist
Ans. c. Fastidious
Rationale
Cosmopolitan: familiar with and at ease in many different countries and cultures.
Frightening: making someone afraid or anxious; terrifying.
Feminist: a person who supports feminism.
Fastidious: very attentive to and concerned about accuracy and detail.
198. Find the correctly spelt word

a. Affactionately
b. Affectionately
c. Afectionately
d. Affectionnality
Ans. b. Affectionately
Rationale
The correct spelling is Affectionately
199. Pointing to a man, a woman said, “His mother is the only daughter of my
mother.” How is the woman related to the mother?
a. Mother
b. Daughter
c. Sister
d. Grandmother
Ans. a. Mother
Rationale
Only daughter of my mother – Myself. So, the woman is man’s mother
200. When Anuj saw Manish, he recalled, “He is the son of the father of my daughter’s
mother.” Who is Manish to Anuj?
a. Brother-in-law b. Brother
c. Cousin d. Uncle
Ans. a. Brother-in-law
Rationale
Anuj’s daughter’s mother – Anuj’s wife; Anuj’s wife’s father – Anuj’s father-in-law; Father-in-
law’s son – Anuj’s brother-in-law. So, Manish is Anuj’s brother-in-law.
201. What is the difference between simple interest and compound interest for
2 years on the sum of Rs 1500 at 5% per annum? (ARITH)
a. Rs 3.75b. Rs 4.75
c. Rs 6.75 d. Rs 2.75
Ans. a. Rs 3.75
Rationale:
If the difference between simple and compound interest is of 2 years, then
Difference = P(R)²/(100)²
Where P = Principal, R = Rate of Interest
= 1500(5)²/(100)²
= 1500 × 25/100 × 100
= 3.75
Hence, the difference between simple interest and compound interest for 2 years on the sum
of Rs. 1500 at 5% per annum is Rs 3.75.
202. If the price of a fan is first decreased by 25% and then increased by 20%, what
would be the net change in the price? (ARITH)
a. 5% b. 10%
c. 15% d. 20%
Ans. b. 10%
Rationale:
Let the original price be Rs. 100.
New final price = 120% of (75% of Rs. 100) = Rs. [(120/100) × (75/100) × 100] = Rs. 90
Net change in the price will decrease by 10%.

National NORCET Test-9

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National NORCET Test-9

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National NORCET Test-9

1. In colloidal osmotic pressure leads to:

2. Normal ECF value of a 70-Kg person:

3. In a healthy person, which of these lung volumes should be the largest?

Ans. b. Vital capacity

Closing capacity RV + the volume expired between the beginning of

Ans. b. Strongly acidic and weakly alkaline/basic

Ans. b. The diaphragm

6. Type of joint shown in the image is:-

• Gomphosis is articulation by the insertion of a conical process into a socket; this is

7. The hyperpolarization of a neuron is governed by the actions of which of the

Ans. c. Chloride and potassium

9. Which one of the following is NOT a plasma protein?

Table: Difference between Serum and Plasma

Ans. c. Ventricular systole

BIOCHEMISTRY AND NUTRITION

11. In the DNA molecules, adenine always pair with:

12. An enzyme is described as:

Ans. b. A protein that speeds up reactions

Ans. c. Spinach and mangoes

Ans. d. Avoiding very heavy meals

15. The given test below depicts:

a. Molisch test b. Benedict’s test

Ans. b. Benedict’s test

Figure 1: Molisch test

Figure 2: Barfoed’s Test

Figure 3: Seliwanoff’s test

16. Which disease is caused by myxovirus?

19. Type I hypersensitivity is mediated by:

20. Rod-shaped bacteria are called:

• Ototoxicity and vestibular impairment are often thought to be the hallmark of

Ans. b. Decreased appetite

Ans. b. Administer as needed dose of benztropine (Cogentin) IM as ordered

25. The drug in the picture is used for:

a. Breast cancer b. Routine contraception

Ans. c. Emergency contraception

Ans. d. Right room

28. ACEs participate in the renin-angiotensin-aldosterone system to have which of

Ans. c. Promote sodium and water retention

32. Which is the most important route of excretion of drugs?

34. Drug which should not be given in renal disease is?

a. Decreased the deposition of drug on the oropharynx

Ans. c. Increase the incidence of oropharyngeal candidiasis

PATHOLOGY AND GENETICS

Ans. c Lack of differentiation

37. All of the following are features of Apoptosis, Except:-

Ans. A Cellular swelling

38. Mode of transmission of Hepatitis E virus is:

Ans. d. Fecal oral

Ans. a. Airborne precautions

42. Hand washing to prevent nosocomial infection is an example of:

Ans. b. Primary prevention

Table: Level of prevention and Mode of intervention

Level of prevention Mode of intervention Examples

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

Ans. b. Kartar Singh Committee

46. Which of the following is a killed vaccine?

47. The nurse is speaking at a community meeting about personal responsibility

Ans. c. Spinal column manipulation

48. Which of the following is not true for influenza?

Ans. c. 1 to 5 years is high risk age group

49. Program for Improve quality of labor room come under:

Ans. d. All of the above