Mrs M is admitted to the ward in an almost comatose state and is medically diagnosed as

having hypothyroidism.
CAUSES of hypothyroidism may include
A) radioactive iodine treatment.
B) treatment with Propranolol (lnderal).
C) thyroid stimulating antibodies.
D) increase production of thyroid stimulating hormone by the pituitary.

Of the following, which are MOST likely to be experienced by Mrs M?

A) Nausea and vomiting.
B) Diarrhoea and weight loss.
C) Fatigue and insomnia.
D) Cold intolerance and weight gain.

Appropriate nursing diagnoses for Mrs M would include.

A) hyperventilation related to decreased respiratory rate.
B) dry skin and hair related to increased metabolic rate.
C) hyperactivity related to increased sympathetic nervous system activity.
D) lethargy and mental dullness related to decreased neuromuscular activity.

The drug MOST LIKELY to be used for treating Mrs M is

A) Potassium Iodide.
B) Thyroxine Sodium (Eltroxin).
C) Carbimazole (Neomercazole).
D) Propranolol (lnderal).

Mrs M responds well to treatment and is now much brighter. Her sister is visiting and asks
"How is my sister feeling?" Your BEST response is
A) "I'm not allowed to tell you anything, it's confidential."
B) "If you ring up the hospital tomorrow, they can tell you then."
C) "Your sister is feeling comfortable, would you like to see her?"
D) "She's feeling like anyone would with that diagnosis, very tired."

Mr A, aged 56 years, has a medical diagnosis of acromegaly.

Mr A's medical diagnosis would have been confirmed by which of the following
investigations?
A) Snellen chart testing.
B) Abdominal x-ray.
C) Perimeter testing.
D) Serum growth hormone levels.

A nursing assessment of Mr A might show which of the following?

A) Absence of body hair and muscle wasting.
B) Enlarged jaw and thick leathery skin.
C) Excessive height and hypoglycaemia.
D) Normal facial appearance and skin bruising.
Appropriate nursing diagnoses for Mr A would include
A) fluid volume deficit related to increased anti- diuretic hormone.
B) hypoglycaemia related to increased growth hormone.
C) visual loss related to compression of motor neurones.
D) disturbance in self-concept related to altered physical appearance.

Mr A has pituitary surgery to remove a benign tumour. Two days later he develops diabetes
insipidus. Nursing interventions which BEST monitor his hydration state include
A) recording his weight weekly.
B) assessing skin turgor daily.
C) recording urine output four hourly.
D) daily measures of urine specific gravity.

Mr A is prescribed DDAVP (Minirin) intra-nasally twice daily. Client education about this
therapy MUST include
A) the drug action and symptoms of recurrent diabetes insipidus.
B) availability of the drug and pharmacy charges.
C) specific side effects, e.g., hair loss.
D) advice that the drug can be stopped once polyuria ceases.

Malignant tumours
A) always metastasis via the lymphatic system.
B) consist of cells showing much mitotic activity.
C) contain cells which are always well- differentiated.
D) are often encapsulated.

Of the following which is a possible early warning sign of a cancer?

A) Bone pain.
B) Increasing huskiness of the voice.
C) Lumpy breasts prior to menstruation.
D) Sunburn.

An EARLY warning sign of cancer of the lower oesophagus is

A) nagging cough or hoarseness.
B) a thickening or lump in front of the neck.
C) pain in the throat and chest.
D) indigestion or difficulty in swallowing.

A cancer treatment used to assist the action of the main form of treatment is known as
A) curative.
B) prophylactic.
C) palliative.
D) adjuvant.

An individual receiving treatment for cancer may experience nausea or vomiting as a side
effect. If your client is prescribed prochlorperazine mesylate (Stemetil) 10 mg
intramuscularly and in stock is Stemetil 12.5 mg/ml, how many ml should you administer?
A) 0.78. B) 0.8. C) 0.9. D) 1.25.

Mr M, aged 80 years, had cancer of the prostate diagnosed five years ago. It was treated
with a course of external radiotherapy to the pelvic area.
Of the following which is a side effect of radiotherapy that Mr M may have experienced?
A) Fatigue.
B) Constipation.
C) Alopecia.
D) Stomatitis.

Mr M now has bone metastases and has been having hormone therapy. He is admitted to
your ward for pain control. Which type of hormonal manipulation is Mr M MOST LIKELY to
have been receiving?
A) Anti oestrogen.
B) Glucocorticoid.
C) Anti androgen.
D) Mineralocorticoid.

Which of the following statements BEST reflects current nursing beliefs related to the
treatment of cancer pain?
A) Because of the risk of addiction, opiates should be used sparingly by a person with
advanced cancer.
B) A pain assessment should be done prior to initiating pain medications.
C) The minimum recommended dose of analgesia should be administered.
D) Morphine is the only satisfactory way of relieving pain a person with cancer may
experience.

Mr M is aware that his disease is at an advanced stage. The MOST appropriate way for you
to help Mr M would be to
A) make decisions for him because he already has enough to cope with.
B) advise him that there will be support available to him throughout the progression of his
illness.
C) leave him alone so that he can consider his situation and adjust to it.
D) explain to his family that he won't want to talk about his condition.

According to Elisabeth Kubler-Ross, the first stage of the grieving process is denial. An
example of denial is when a client says
A) "I am certain a mistake has been made and the diagnosis is incorrect."
B) "I know this is happening to me but I just cannot believe it."
C) "If only I had gone to my doctor earlier, none of this would have happened."
D) "I shall wait for a miracle to happen."

Mrs N has leukaemia and is to commence a course of cancer chemotherapy.

Mrs N's drug regime involves using a combination of cytotoxic drugs rather than any single
drug. Of the following, which is a valid reason for this combination therapy?
A) Treatment cycles can be repeated more frequently.
B) The drugs work best at destroying cells in their resting phase.
C) Cells can be destroyed at different stages of their cycles.
D) The other body systems are not adversely affected.

After chemotherapy Mrs N develops leukopenia. The cause of her leukopenia is

A) current infection.
B) suppression of bone marrow.
C) an abnormal reaction to chemotherapy.
D) a proliferation of red blood cells at the expense of white blood cells.

Mrs N is moved to a side room while she has leukopenia. The reason for this is to
A) reduce exposure to other patients to Mrs N's infections.
B) reduce exposure of Mrs N to other people's infections.
C) ensure Mrs N has the opportunity to rest.
D) ensure privacy while Mrs N has nausea and vomiting.

Mrs N also develops thrombocytopenia (a condition in which your blood has a lower than
normal number of blood cell fragments called platelets). A drug that should NOT be given to
Mrs N at this time is
A) Aspirin (Solprin).
B) Triazolam (Halcion).
C) Morphine Sulphate.
D) Lactulose (Duphalac).

Mrs N requests pain relief for a mild headache. She is prescribed Paracetamol (Panadol)
elixir (120 mg/5 ml) 500 mg orally 4 hourly. The volume you should administer is how many
ml?
A) 1.2. B) 4.2. C) 12. D) 21.

The marrow cavity is hollowed out in the shaft of a 'long bone' through the action of
A) osteoblasts. B) osteoclasts. C) fibroblasts. D) osteocytes.

Movement of a limb away from the mid line of the body is known as
A) extension. B) flexion.
C) abduction. D) adduction.

The osteocyte
A) converts cartilage to bone.
B) maintains homeostasis in formed bone.
C) consumes damaged or weak bone.
D) is a mature osteoblast.

The correct name for the shaft of a bone is

A) epiphysis. B) diaphysis. C) metaphysis. D) periosteum.

At HIGHEST risk for fat embolism is the patient who has

A) a long bone fracture.
B) a fractured pelvis.
C) multiple rib fractures.
D) a fractured neck or femur.

Pathologic effects most often occur when

A) emboli lodge in systemic veins.
B) emboli lodge in the brain.
C) emboli lodge in lung capillaries.
D) glomerular function is impaired.

The most characteristic sign of a fat embolism is

A) dyspnoea - shortness of breath
B) petechiae - a small (1 - 2 mm) red or purple spot on the skin, caused by a minor
haemorrhage (broken capillary blood vessels).
C) altered level of consciousness.
D) moist chest sounds.

The best treatment for fat embolism would be

A) oxygen.
B) steroid therapy.
C) antiembolism stockings.
D) intravenous therapy.

Jim, a 16-year-old school boy, has been knocked from his bicycle sustaining a mid-shaft
compound fracture of his right femur. He is admitted to hospital where balanced skeletal
traction is applied to his injured leg.
According to Erikson, the developmental task of adolescents is
A) autonomy versus shame and doubt.
B) self-identify versus role confusion.
C) role acceptance versus role confusion.
D) integrity versus despair.

A compound fracture is best defined as where the bone

A) is fractured in more than one place.
B) fragments are displaced anteriorly.
C) breaks the skin continuity at the fracture site.
D) at the fracture site has become infected.

Which would be first priority in the emergency treatment of a compound fracture?

A) Reducing the fracture if possible.
B) Leaving the wound open to allow fluid to escape.
C) Immobilising the fracture only after the wound is cleaned out.
D) Placing a clean covering firmly over the wound.

Reduction of Jim's fracture means

A) inserting a metal plate.
B) bringing the bone fragments into alignment.
C) applying a plaster cast.
D) applying skeletal traction.

After the doctor applies skeletal traction you would check Jim's toes for
A) change in temperature.
B) change in colour.
C) change in sensation.
D) all of the above.

Jim can't feel pressure applied to his toes and complains of tingling. These signs indicate
A) pressure on a nerve.
B) analgesic overdose.
C) improper alignment of the fracture.
D) low pain threshold.

Skeletal traction is best defined as

A) any form of traction other than that applied directly to the skin.
B) any form of traction which does not involve the use of weights and pulleys.
C) traction which is always applied directly to the bone.
D) any form of traction which is fixed.

Which of the following symptoms indicate that the traction is not maintaining adequate
alignment?
A) Continuous pain in the extremity.
B) Continuous muscle spasms.
C) Coldness of the extremity.
D) Feeling of pins and needles at the fracture site.

Which nursing intervention will prevent atrophy of Jim's leg muscles?

A) Encourage isometric leg muscle exercises hourly.
B) Passive stimulation by the nursing staff hourly.
C) Encourage him to move about in the bed hourly.
D) Active massage to the calf and thigh muscles hourly.

Acute osteomyelitis
A) has systemic effects.
B) begins in the epiphysis.
C) begins under the periosteum.
D) does not cause infarction of the bone.

A most likely causative organism for osteomyelitis is

A) streptococcus.
B) E coli.
C) clostridium botulinum.
D) bacillus anthracis.

The most common site for osteomyelitis is in the

A) epiphysis of long bone.
B) metaphysis of long bone.
C) cancellous bone.
D) periosteum.

A sequestrum is a piece of
A) soft tissue. B) dead skin. C) dead tooth. D) dead bone.

The nurse enters Mrs Jones' room to give her oral medications. Mrs Jones is in the
bathroom and asks the nurse to leave the pills on the bedside table. The nurse should do
which of the following?
A) Leave the medication on the bedside table.
B) Tell Mrs Jones she will return in a little while.
C) Record the medication was not taken.
D) Withhold the medication until the next drug round.

Staff Nurse Mason has prepared a preoperative intramuscular injection for her client, Mr
Smith. Suddenly another client yells for help and Staff Nurse Mason rushes to assist. She
asks Staff Nurse Jacobs, to give Mr Smith his injection since the orderly is waiting to take Mr
Smith to surgery. The most appropriate response for Staff Nurse Jacobs would be to
A) help the other client so Staff Nurse Mason can give Mr Smith his injection.
B) give Mr Smith his pre-op injection.
C) prepare a new syringe for Mr Smith.
D) ask the orderly to return at a more convenient time.

Roger, aged 49, a private building contractor, has been troubled over the past 18 months
with pain in the right calf muscle when walking any distance. He smokes about 30 cigarettes
a day, drinks alcohol only occasionally, and is slightly overweight.
Following a right femoral arteriogram, the surgeon advises Roger that the blood supply to
his right foot is inadequate and the only treatment he can offer is a below knee amputation
to avoid the possible complication of gangrene. Roger is admitted for surgery.
The most important advice for Roger would be to
A) avoid alcohol.
B) reduce his weight.
C) give up his cigarettes.
D) wear elasticised hosiery when walking.

All of the following are expected characteristics of the midlife crisis EXCEPT
A) ambivalence and uncertainty about the future.
B) concern about the physical signs of aging.
C) deterioration in memory and problem-solving ability.
D) concerns about one's health status.

Roger is in severe pain. The doctor has prescribed Omnopon (Papaveretum) 28 mg IM 4

hourly. The drug is available in 20 mg in 1 ml ampoule. How much will you give?
A) 0.4 ml. B) 1.4 ml. C) 1.45 ml. D) 1.5 ml.
Roger is prepared for operating theatre. An important aspect of preoperative care is to
ensure that the patient does not have food or drink for a certain period before surgery. In
Roger's case the minimum time for withholding oral fluids would be
A) 4 hours. B) 6 hours. C) 8 hours. D) 12 hours.

While the primary nurse is at lunch, another patient gives a drink to Roger. The FIRST action
of the nurse should be to
A) notify the anaesthetist.
B) telephone the primary nurse and tell her what has happened.
C) pass a nasogastric tube and aspirate.
D) stay with Roger and reassure him until the primary nurse returns.

On return to the ward Roger is constantly trying to get out of bed and sometimes acts
hostile and uncooperative. How best can you cope with his behaviour?
A) Sedate him.
B) Restrain him immediately to protect him.
C) Include him in decision making and avoid restraining him.
D) Ring a relative to come and sit with him.

Roger's next door neighbour rings the ward inquiring about Roger's condition. Which of the
following would be the most appropriate reply for you to give?
A) "He is as comfortable as can be expected."
B) "I am sorry but I cannot give you that information."
C) "I am sorry, but the doctor is with him at present. Would you phone back later when I
have had an opportunity to speak to Roger?"
D) "Roger is recovering following surgery to amputate his right leg."

Following amputation, the IMMEDIATE danger to Roger while in the recovery ward would
be
A) primary haemorrhage.
B) deep vein thrombosis.
C) infection.
D) reactionary haemorrhage.

Twenty-four hours post operatively you notice that the cast has completely slipped off the
stump. The MOST appropriate nursing action is to
A) elevate the limb on pillows.
B) apply an elastic compression bandage.
C) reapply the cast immediately.
D) leave the incision site exposed.

To prevent flexion deformity of the limb you should do all the following EXCEPT
A) give Roger a knee pillow to relax his quadriceps muscles.
B) encourage Roger to lie prone TDS.
C) place Roger in a chair BD with his left leg extended.
D) assist Roger to do straight leg raising.
Forty-eight hours after surgery, Roger is introduced to the use of auxiliary crutches. When
learning to use these he should be advised to take the weight of his body from the
A) shoulders.
B) axilla.
C) wrists.
D) hands.

Mr A, aged 40 years, has been digging in the garden when he experiences an excruciating
pain in the small of his back radiating through his buttock and down the back of his leg.
The nucleus pulposus is the central part of
A) the spinal cord.
B) the cerebrum.
C) a cell.
D) an intervertebral disc.

The spinal cord ends at the

A) first sacral vertebrae.
B) second lumbar vertebrae.
C) coccyx.
D) second sacral vertebrae.

The spinal nerves are

A) sensory.
B) motor.
C) mixed.
D) autonomic.

Which of the following describes the condition known as 'slipped disc'. It is a

A) subluxation of one vertebrae on another.
B) herniation of the nucleus pulposus.
C) tearing of an intervertebral ligament.
D) severe form of muscle cramp.

Which of the following postures is the correct one to adapt when lifting objects from the
ground?
A) Feet apart, hips and knees flexed.
B) Feet together, hips and knees.
C) Feet apart, hips flexed and knees straight.
D) Feet together, hips flexed and knees straight.

Pressure on which one of the following nerves produces pain radiating down the back of the
leg to the ankle?
A) Obturator.
B) Gluteal.
C) Sciatic.
D) Femoral.
After one week of conservative treatment, Mr A's condition was reassessed and it was
decided that a laminectomy would be performed.
Which of the following positions would Mr A be nursed in?
A) Upright.
B) Supine.
C) Semi-Fowlers.
D) Prone.

Mr A was turned frequently by the nurses until he was able to turn himself. The main reason
for turning him regularly was in order to
A) change the wound dressing.
B) relieve pressure on the bony prominences.
C) prevent deep vein thrombosis.
D) prevent oedema of the lungs.

Which of the following would Mr A be encouraged to do when allowed out of bed on the
second or third post-operative day?
A) Rest comfortably in an easy chair.
B) Sit on the side of the bed.
C) Stand erect.
D) Move around freely in a wheelchair.

You come upon a motor vehicle accident where a passenger has been thrown through a
window. He is unconscious, with a patent airway. What is your first aid priority?
A) Log roll him onto his side carefully.
B) Lie him flat on his back and turn his head to the side.
C) Do not move him.
D) Place him carefully in the recovery position.

A client who sustains a fracture dislocation of the cervical spine will MOST PROBABLY have
A) hemiplegia.
B) paraplegia.
C) monoplegia.
D) quadriplegia.

A cord lesion occurring at the level of the fifth cervical spine will cause paralysis of all the
following EXCEPT the
A) arms.
B) chest.
C) diaphragm.
D) legs.

On admission to hospital her fractured arm is manipulated and a plaster of Paris cast is
applied.
Until Sally's plaster is dry the nurse should
A) handle the cast with the palms of the hands.
B) rest the cast on a firm surface.
C) leave the whole limb completely uncovered.
D) avoid moving Sally.

The main reason that heat should not be applied to wet plaster is that
A) a plaster that dries too quickly will not retain its shape.
B) the client may be burnt through the plaster.
C) heat may cause the plaster to shrink and become too tight.
D) heat will cause blood vessels to dilate and this increases the risk of oedema.

Information about all of the following should be included in Sally's discharge teaching
EXCEPT
A) monitoring of circulation.
B) avoid exercising the affected limb.
C) keeping the cast dry.
D) elevating the arm in a sling.

A permanent shortening of a muscle and the eventual shortening of associated ligaments

and tendons is known as
A) dysplasia.
B) contracture.
C) kyphoscoliosis.
D) myoplasia.

Susan is pregnant for the first time and attends antenatal clinic for a routine check. Which of
the following is a positive sign of pregnancy?
A) Obvious uterine enlargement.
B) Amenorrhoea for 3 months.
C) The reporting of quickening.
D) Detection of fetal heart sounds.

Which of the following symptoms should Susan be instructed to report to her health care
provider immediately?
A) Ankle oedema.
B) Heart burn.
C) Urinary frequency.
D) Vaginal bleeding.

Susan has read that some women has 'chloasma' during pregnancy. You tell her it is
A) the mucus plug at the cervical.
B) the feeling of foetal movements by the mother.
C) a patchy brown pigmentation of the skin.
D) a jelly-like substance which surrounds the cord vessels.
E) a craving for unusual foods

Susan says the pregnancy has seemed more real since she first felt the baby move. This is
MOST likely to have happened at
A) 10-14 weeks. B) 15-17 weeks. C) 18-20 weeks. D) 21-24 weeks.
While you are carrying out an abdominal examination with Susan, she feels faint. Your FIRST
action would be to
A) put her head between her legs.
B) take her blood pressure.
C) examine her for signs of bleeding.
D) turn her on her side.

During pregnancy the fundus will be at the umbilicus by

A) 16 weeks. B) 22 weeks. C) 32 weeks. D) 36 weeks.

The relationship of the foetal spine to the long axis of the uterus is known as the
A) lie.
B) attitude.
C) station.
D) position.

A woman with an Rh negative blood group, who has had a previous pregnancy, is pregnant.
She should be tested for antibodies
A) not at all.
B) once only.
C) regularly throughout the pregnancy.
D) after the delivery.
E) at each visit.

Susan complains of heart burn as her pregnancy progresses. You suggest she
A) avoids fruits and vegetables high in acid content.
B) drinks a glass of carbonated beverage before meals.
C) rests after each meal and refrains from snacking.
D) eats smaller and more frequent meals.

Susan mentions she has felt faint of several occasions lately. The nurse explains that during
the last trimester a pregnant woman may experience dizziness, faintness and a decreasing
blood pressure when she lies on her back. This occurrence is referred to as
A) supine hypotensive syndrome.
B) circulatory insufficiency.
C) essential hypertension.
D) hypotension oedema proteinuria syndrome.

The nurse suggests that Susan devise a birth plan. What should be included in this plan?
A) A list of couples preferences for care during labour.
B) Priorities for activities.
C) Options that may be available to the couple.
D) A plan for the natural approach to childbirth.

Susan's pregnancy progresses normally and she is admitted to delivery at term. Susan is said
to be definitely established in labour when
A) she has contractions and backache.
B) her contractions are painful.
C) the membranes rupture spontaneously.
D) the cervical os is dilating.

Which of the following is true in normal labour?

A) The foetus is born at term.
B) The foetus presents by vertex.
C) The onset is spontaneous.
D) All of the above.

The midwife palpates Susan's abdomen to check the foetal position. Foetal position is the
term referring to the
A) relationship of the foetal parts to each other.
B) relationship of the long axis of the foetus to the long axis of the uterus.
C) relationship of the presenting part to the mother's pelvis.
D) part of the foetus which is lowest in the pelvis.

Effective timing of contractions is done by the nurse by placing the fingers lightly on the
fundus of the uterus. This is because the fundus is the
A) most contractile part of the uterus.
B) the least discomfort felt by the mother.
C) most accessible area.
D) area that never fully relaxes.

A woman in labour should receive hourly fluids to prevent

A) albumin appearing in the urine.
B) dehydration and acidosis.
C) sugar appearing in her urine.
D) dehydration and subsequent urinary infection.

The normal foetal heart rate recorded between contractions is

A) 100-120 beats per minute.
B) 120-140 beats per minute.
C) 120-160 beats per minute.
D) 140-160 beats per minute.

The second stage of labour is from

A) the birth of the baby to delivery of the placenta and membranes.
B) the onset of true labour until full dilation of the cervix.
C) the onset of true labour until the birth of the baby.
D) full dilation of the cervix until the birth of the baby.

The primary reason for examining a placenta and membranes postpartum is to

A) determine the type of placenta.
B) determine its completeness.
C) detect foetal abnormalities.
D) prevent postpartum haemorrhage.

The Registrar of Births and Deaths must be notified of birthplace, sex of child and parents
address within
A) 14 days by the occupier of the premises.
B) 48 hours by the occupier of the premises.
C) 7 days by the person in charge of the delivery or an officer of the hospital designated for
this purpose.
D) 14 days by the medical practitioner or an officer of the maternity hospital.