Mr W has been admitted to hospital with acute urinary retention.

Mr W is scheduled for a transurethral resection of his prostate gland the next morning. He
asks you how this will be done. Which of the following is your BEST reply?
A) "A small incision will be made in your lower abdominal wall."
B) "It will be done by passing an instrument up through your penis."
C) "The bladder will be sutured back together."
D) "Your prostate gland will be removed."

Which of the following should Mr W be prepared to expect in the FIRST 24 HOURS

postoperatively?
A) Blood in his urine.
B) Possible urinary incontinence.
C) To have oral fluids restricted.
D) The presence of a vacuum drain.

Mr W is transferred to the operating theatre where a transurethral resection of the prostate

gland is performed. He returns to the ward in a stable condition; has an intravenous infusion
in progress, and a urethral catheter in situ.
Which of the following is of primary importance during the first 24 hours after Mr W's
operation? To
A) ensure he remains nil by mouth.
B) provide physical comfort.
C) maintain urinary drainage.
D) prevent post-operative chest complications.

Mr W is encouraged to drink one litre of fluid 8-hourly, in order to

A) replace the fluid that he would have lost during the operation.
B) minimise the risk of dehydration, common with elderly patients post-operatively.
C) ensure that his intake equals his output.
D) maintain a high urine output to dilute the urine and help prevent blockage of the
catheter.

Mr W's catheter has been removed. Later that morning Mr W confides in you that he is able
to pass urine, but the desire to void comes on very quickly and he has had several
"accidents". You will reduce his embarrassment most effectively by
A) telling him that it happens to most patients after this operation.
B) explaining to him that the nurses don't have to do the laundry so he shouldn't worry.
C) explaining that this sometimes happens and providing him with a clean bottle.
D) telling him not to drink so much and then he won't have so much urine to pass.

Mr H, aged 52, is admitted to the coronary care unit with a medical diagnosis of myocardial
infarction.
Which of the following BEST defines the term "myocardial infarction"?
A) Necrosis of a portion of the myocardium.
B) A diminished blood supply to the myocardium.
C) A sudden irregularity of cardiac contraction.
D) Interference with conduction of cardiac impulses.
 The most common cause of a myocardial infarction is thrombus formation. Which of the
following is MOST likely to have contributed towards Mr H's myocardial infarction?
A) Increased viscosity of the blood.
B) Deceleration of the blood flow.
C) Enlargement of the left ventricle.
D) Atheromatous plaques in the vessel wall.

Which of the following clinical features is Mr H MOST likely to present with on admission?
A) Severe pain, sweating, tachycardia.
B) Hypotension, nausea, pyrexia.
C) Shock, dyspnoea, pain on exertion.
D) Bradycardia, cyanosis, atrial fibrillation.

Mr H is to be monitored closely for complications. Which of the following measures is the

MOST common complication immediately following a myocardial infarction?
A) Angina.
B) Heart failure.
C) Arrhythmias.
D) Deep vein thrombosis.

Which of the following measures would be of GREATEST importance during Mr H's first few
days in hospital?
A) Restricting visitors to immediate family.
B) Restricting his oral fluid intake.
C) Providing a low sodium diet.
D) Providing physical rest.

Mr H is prescribed Heparin because

A) it will dissolve the clot in his coronary artery

B) it will help relieve his chest pain.
C) he has an increased risk of blood clotting in his deep veins.
D) it will increase the blood supply to his myocardium.

The prescribed dose of Heparin is 5000 units. The vial contains 25,000 units per ml. How
much will you draw up into your syringe?
A) 0.20 ml.
B) 0.45 ml.
C) 1.35 ml.
D) 1.60 ml.

Mr H tells you that previous to his myocardial infarction, he suffered from angina. Anginal
pain could BEST be differentiated from the pain of a myocardial infarction in that
A) it is not usually relieved by nitroglycerin tablets.
B) it is usually relieved by the client bending forward.
C) it subsides when precipitating factors are removed.
D) attacks usually occur when the client is at rest.

You formulate this objective for Mr H. "Mr H will mobilise without complications over the
next five days." Which of the following interventions would BEST achieve this objective?
A) Taking nitrolingual spray prior to mobilisation.
B) Giving him a walking frame for support.
C) Restricting him to mobilise only around his own room.
D) Setting a mobilisation plan and telling him to report any chest pain.

Mr H often apologises for being such a trouble to the nursing staff. What does this MOST
probably indicate?
A) His way of expressing his frustrations at being in hospital.
B) His fear of further heart attacks.
C) An expression of his gratitude for the care he has received.
D) Anxiety that he is losing his independence and self-esteem.

Mr H is to undergo a Cardiac catheterisation. This requires a written consent which is when

A) the consent is specific to this investigation.
B) it is voluntarily given.
C) Mr H has received a full and clear explanation.
D) all of the above.

Mr His prescribed a pre-medication of Omnopon 15 mg. The vial contains 20 mg per ml.
How much will you draw up into your syringe?
A) 0.5 ml. B) 0.75 ml. C) 1.00ml. D) 1.25 ml.

Prior to discharge, you are to educate Mr H about his diet and medications. Which of the
following would be the BEST strategy?
A) Educate Mr H over a period of days, dividing the information into topics.
B) Since there is so much information, write the information rather than educate Mr H
verbally.
C) Give Mr H some pamphlets and tell him you are happy to answer any questions.
D) Wait until the day before discharge when Mr H is likely to be more receptive to learning.

Whilst putting away Mr H's pyjamas, you notice several packets of cigarettes. Which is the
MOST appropriate action to take?
A) Remove the cigarettes from Mr H's locker.
B) Tell Mr H no one will help him unless he helps himself.
C) Explain the hospital rules on cigarette smoking and suggest to Mr H that he has his
cigarettes taken home.
D) Explain to Mr H that each cigarette he smokes will shorten his life by about five minutes.

Following discharge, it is suggested Mr H attends the cardiac exercise group because

exercise helps to
A) stimulate strong impulses from the sinoatrial node.
B) dilate the coronary blood vessels.
C) slow the heart rate and increase cardiac output.
D) stimulate circulation in the collateral coronary blood vessels.

Mr J, aged 72 years, is admitted with a medical diagnosis of emphysema.

Emphysema is characterised by all of the following EXCEPT
A) scant mucus production.
B) dyspnoea.
C) expiratory wheeze.
D) pursed lip breathing.

All of the following investigations would be appropriate in determining the extent of Mr J's
emphysema, EXCEPT
A) blood gas analysis.
B) chest x-ray.
C) vital capacity.
D) bronchoscopy.

Mr J is very short of breath. Which of the following would be the MOST appropriate nursing
intervention?
A) Administer oxygen at 2 litres via nasal prongs.
B) Open a window to let in some fresh air.
C) Position upright well supported with pillows.
D) Encourage him to express his fears about feeling short of breath.

Mr J has a fever of 38 °C and is becoming dehydrated. All of the following nursing measures
would be appropriate EXCEPT
A) measure his fluid intake and output.
B) 2-4 hourly oral hygiene.
C) 4 hourly pressure area care.
D) encourage oral fluid intake of 2-3 litres per 24 hours.

Mr J is unable to effectively cough up his excess sputum. Which of the following nursing
interventions will assist Mr J?
A) Position him upright.
B) Provide a clean sputum container.
C) Encourage an oral intake of 2-3 litres per 24 hours.
D) All of the above.

Which of the following should you include in your education of Mr J?

A) Avoiding activities that produce excessive shortness of breath.
B) Seek prompt treatment of infections.
C) Avoid working with respiratory irritants.
D) All of the above.

Mr J has developed cor pulmonale secondary to his emphysema. Cor pulmonale is

A) right heart failure.
B) left heart failure.
C) congestive heart failure.
D) left ventricular hypertrophy.

All of the following signs and symptoms are characteristic of cor pulmonale EXCEPT
A) dependent peripheral oedema.
B) increased jugular venous pressure.
C) purulent sputum.
D) anorexia and nausea.

Mrs S, aged 46 years, is admitted to hospital during an acute asthma attack.

TYPICAL symptoms of an asthma attack include
A) strider, frothy haemoptysis, chest pain.
B) wheeze, cough, tachypnoea.
C) bradypnoea, inspiratory wheeze, dry cough.
D) tachypnoea, haemoptysis, chest pain.

The MOST objective assessment of her asthma attack would be

A) whether or not she can talk easily.
B) her respiratory rate, depth and rhythm.
C) whether or not she is using her accessory muscles to breathe.
D) her peak flow reading.

During your initial assessment of Mrs S you notice she is hyperventilating. You should
A) give her some oxygen.
B) call the doctor immediately.
C) ask her why she is doing this.
D) assist her to do diaphragmatic breathing.

Which of the following is MOST likely to trigger an attack in a person with non-allergic
(intrinsic) asthma?
A) Cat fur or dog hair.
B) Exercise in cold or polluted air.
C) House dust mite.
D) Pollens.

Mrs S is to have Ventolin (Salbutamol) via a nebuliser. After commencing the nebuliser she
complains of palpitations and feeling dizzy. Your MOST appropriate action should be to
A) call for medical assistance.
B) explain to Mrs S why this is happening and stay with her until the nebuliser is finished.
C) tell her it is normal and that it will soon pass.
D) ask the doctor to chart a different bronchodilator.

When evaluating the effect of her Ventolin nebuliser you would consider all of the following
EXCEPT
A) rate, depth and rhythm of respiration.
B) colour of sputum.
C) the peak flow readings.
D) client responses on how she feels.
Mrs S is commenced on an aminophylline infusion. The purpose of this drug is to
A) reduce bronchial swelling.
B) dry up secretions in the bronchi.
C) stimulate the respiratory centre in the medulla.
D) relax bronchial smooth muscle spasm.

Mrs S improves and is to take her reliever medication by metered-dose inhalers. Which of
the following statements would indicate she understands the use of bronchodilator
inhalers?
A) "I need to use it only when I am about to get short of breath."
B) "It's all right if I take the entire daily dose in the morning."
C) "I should take it only if I'm going to exercise."
D) "I need to take it all the time, even if I feel well."

An asthma action plan is written for Mrs S. The purpose of an action plan is to
A) help the doctor keep control of the client's asthma.
B) assist the client to take responsibility for their asthma.
C) be of use in an emergency when the client cannot talk. D) help the client identify and
avoid triggers for her asthma.

Mrs S says to you, "I will have to give up my daily walks now that I have had this bad attack."
Your BEST response would be
A) "Speak to the doctor about it first."
B) "Yes. Your asthma attack was probably caused by exercise in the cold air."
C) "If your asthma is well controlled you should have no problems with walking."
D) "You need to keep fit as the steroid drugs will increase your weight."

Mrs L, aged 7 4 years, has developed congestive heart failure and is admitted to hospital.
Which of the following clinical features would Mrs L MOST LIKELY notice first?
A) Abdominal ascites.
B) Dyspnoea on exertion.
C) An enlarged, pulsating jugular vein. D) A decreased urinary output.

Mrs L has both peripheral and sacral oedema. She is to be given a STAT dose of Frusemide
100mg intravenously. An ampoule contains 40 mg in 2 ml. How much should you draw up
into your syringe?
A) 1.5 ml. B) 2.5 ml. C) 4.0 ml. D) 5.0 ml.

Which of the following would be the MOST accurate way of measuring a reduction in her
oedema?
A) Abdominal girth measurements daily.
B) Measuring her urine output over 24 hours.
C) Assessing the indentation left when pressing her oedematous legs.
D) Weighing her daily.
The doctor orders a chest x-ray but Mrs L states to you that she does not want one. Which
of the following would be your BEST action?
A) Discuss with Mrs L the reason for her refusal. B) Cancel the x-ray.
C) Tell her that it must be done.
D) Discuss the situation with Mrs L's daughter.

Mrs L is prescribed Slow K. The action of this drug is to

A) enhance the action of Frusemide.
B) replace potassium which has been lost by increased diuresis.
C) replace sodium which has been lost by increased diuresis.
D) slow and strengthen the heartbeat.

A diet suitable for Mrs L should

A) have high calorie content.
B) be light and easily digestible.
C) include a large amount of roughage. D) contain a large amount of protein.

Mrs L is commenced on a trial dose of Enalapril (Renitec) an ACE Inhibitor. When getting up
for her shower, Mrs L reports dizziness and feeling faint. You should
A) tell her it is normal and that it will pass. B) take her blood pressure.
C) call the medical staff immediately.
D) give her oxygen at 2 litres.

Mrs A is admitted with shock.

The type of shock resulting from haemorrhage is
A) cardiogenic. B) vasogenic.
C) neurogenic. D) hypovolaemic.

It is likely that Mrs A would present all of the following signs and symptoms EXCEPT
A) fever.
B) tachycardia. C) confusion. D) hypotension.

Which of the following data would be important to collect during your assessment of Mrs A?
A) Level of consciousness, blood pressure and pulse.
B) Level of consciousness, pulse rate and urinary output. C) Pulse rate, respiratory status,
urinary output.
D) All of the above.

Which of the following changes in Mrs A's observations and recordings would indicate
shock?
A) Rise in blood pressure, increase in pulse rate, restlessness and cold, moist skin.
B) Drop in blood pressure, increase in pulse rate and rapid, shallow respirations.
C) Drop in blood pressure, increase in pulse rate, cyanosed lips and slow, deep respirations.
D) Rise in blood pressure, decrease in pulse rate, cyanosed lips and shallow
respirations.
Mrs A is very anxious. Nursing interventions which will reduce her anxiety include all of the
following EXCEPT
A) telling her that she will be all right.
B) making sure she is informed about what is happening. C) staying with her as much as
possible.
D) encouraging her to discuss her feelings.

Nursing care of Mrs A should include all of the following EXCEPT

A) maintaining bed rest.
B) keeping her warm and quiet.
C) elevating the head of the bed.
D) administering oxygen therapy as prescribed.

Mrs A is to have a blood transfusion. Intravenous whole blood 350 ml three-hourly is

ordered using a 20 drop/ml giving set. The drop rate per minute is
A) 20 B) 25 C) 31 D) 39

The nursing responsibilities when giving intravenous blood include all of the following
EXCEPT
A) taking base line recordings of temperature, pulse, blood pressure and respirations before
the commencement of the blood transfusion.
B) staying with the client for the first 10 minutes.
C) taking recordings every 15 minutes throughout the blood transfusion.
D) taking recordings 15 minutes and 30 minutes after the commencement of the blood
transfusion and then hourly until the transfusion is completed.

Mrs A has an allergic reaction to the blood transfusion. Signs and symptoms of the reaction
include all of the following EXCEPT
A) fever and chills.
B) pruritus.
C) nausea and vomiting. D) distended neck veins.

Nursing responsibilities in a transfusion reaction include all of the following EXCEPT

A) notifying the doctor.
B) turning off the infusion.
C) discarding the blood bag and tubing immediately. D) notifying blood bank.

Mr A, a 57 year old air traffic controller who has hypertension, describes himself as a tense
man, smokes 30 cigarettes a day, is overweight and drinks a glass of wine with his evening
meal most days.
A person is said to be hypertensive when their
A) diastolic pressure is less than 90 mm Hg. B) diastolic pressure exceeds 90 mm Hg. C)
systolic pressure exceeds 130 mm Hg. D) systolic pressure is less than 160 mm Hg.

Which of the following factors in Mr A's background are MOST likely to contribute to his
hypertension?
A) Alcohol, working hours and smoking. B) Obesity, alcohol and smoking.
C) Anxiety, obesity and headaches.
D) Anxiety, obesity and smoking.

Factors involved in the maintenance of normal arterial blood pressure include all of the
following EXCEPT the
A) strength of the heartbeat. B) position of the body.
C) volume of the blood.
D) peripheral resistance.

When taking Mr A's blood pressure the diastolic reading would indicate the pressure during
A) ventricular contraction.
B) atrial and ventricular relaxation. C) ventricular relaxation.
D) atrial relaxation.

Normally blood pressure increases with age because of

A) arteriosclerosis. B) ischaemia.
C) arteritis.
D) vasodilation.

A person with hypertension will be advised by his/her doctor to

A) get ten hours sleep a day.
B) take up vigorous exercise such as squash.
C) reduce work hours to no more than 20 hours per week. D) learn stress reducing
techniques.

In mild hypertension which of the following drugs could be sufficient for control?
A) Antihypotensives. B) Tranquilisers.
C) Diuretics.
D) Vasoconstrictors.

Mr A has been prescribed antihypertensive medication. He states he has been unable to

take the medication every day because it makes him feel dizzy. In response you should tell
Mr A that his drug therapy
A) is important and he should report the symptom to his doctor. B) is prescribed from a
standardised treatment scale and should not give him side effects.
C) is unlikely to be causing his symptom.
D) will stop when his course of tablets is finished.

Which of the following foods should hypertensive persons avoid?

A) Potatoes.
B) Fish.
C) Lettuce.
D) Tinned soup.

As part of his overall management, Mr A should be advised to

A) lose weight, discontinue smoking and undertake regular moderate exercise.
B) lose weight, reduce his alcohol intake, stop drinking coffee. C) discontinue smoking, stop
drinking coffee and undertake regular moderate exercise.
D) all of the above.

Mr S, aged 72 years, has been referred to the ophthalmic clinic where you work, for
assessment of his vision.
Visual acuity is assessed by a/an
A) slit lamp.
B) Schiotz tonometer. C) Snellen chart.
D) ophthalmoscope.

In New Zealand, which of the following organisms COMMONLY causes a dendritic ulcer?
A) Chlamydia.
B) Herpes simplex.
C) Candida albicans.
D) Haemophilus influenzae.

Which of the following features is NOT likely to be present if a person has a dendritic ulcer?
A) Pain.
B) Redness.
C) Photophobia. D) Tearing.

The drug of choice in the treatment of a dendritic ulcer is

A) Idoxuridine (Herplex).
B) Betamethasone (Betnesol).
C) Chloromycetin (Chloramphenicol). D) Timolol (Timoptol).

When instilling Mrs M's eye drops you should

A) place the drop as close as possible to the inner canthus of the eye.
B) ask Mrs M to tip her head right back and look at the ceiling.
C) first carry out an eye toilet to remove any previous eye medication.
D) place the drop into a pouch formed by pulling down the lower lid.

Mrs B has been admitted to the ward with open angle (chronic) glaucoma.
The normal range of intraocular pressure is approximately how many mm Hg?
A) 15-25. B) 25-35. C) 35-45. D)45-55.

Glaucoma, whether acute, chronic or congenital, is always INITIALLY associated with

A) severe pain.
B) partial blindness.
C) increased production of aqueous humor. D) reduced drainage of aqueous humor.

Symptoms of open angle (chronic) glaucoma may include

A) severe pain.
B) floaters.
C) reduced peripheral vision. D) improved visual acuity.
Mrs B is prescribed Timolol Maleate (Timoptol) 0.25%. The action of this drug is to
A) increase permeability of the trabecular meshwork. B) decrease production of aqueous
humor.
C) increase the filtration angle.
D) constrict the pupil.

Open angle (chronic) glaucoma has an insidious onset and preventative practices for people
over 40 years include
A) changing spectacles every 6 months.
B) being aware of early warning signs.
C) protecting the eye from harsh lights.
D) having intraocular pressure measured annually.

Mrs T, aged 35 years, has a hearing loss due to otosclerosis. She is admitted for a right
stapedectomy.
Otosclerosis occurs when
A) spongy bone fixes the stapes in the oval window. B) serous fluid impedes vibration of the
stapes.
C) trauma detaches the stapes from the incus.
D) degeneration of the ossicles is complete.

Characteristics associated with otosclerosis include a/an

A) onset in those over seventy years of age. B) unilateral hearing loss.
C) rapid deterioration of hearing.
D) insidious onset in adolescence.

Mrs T has an audiogram to identify her degree of hearing loss. Pure tone audiometry
A) measures the compliance (flexibility) of the ear drum.
B) indicates Eustachian tube occlusion.
C) indicates the cause of hearing loss.
D) measures the hearing threshold at varying sound frequencies.

Mrs T's audiogram would MOST probably indicate

A) poor compliance of the tympanic membrane. frequencies. B) difficulty in discriminating
certain frequencies.
C) sensorineural hearing loss. D) conductive hearing loss.

In order that Mrs T can give an informed consent to a stapedectomy it should be explained
that, following surgery she will have
A) to be positioned on the operative side for the first 12 hours. B) some hearing loss until
packing is removed and oedema reduces.
C) an intravenous infusion for the first 48 hours.
D) facial paralysis which will resolve as oedema reduces.

Mr F is admitted acutely to your ward with severe vertigo and vomiting. He also complains
of tinnitus and some hearing loss.
Tinnitus and vertigo could result from
A) otosclerosis.
B) Meniere's disease C) presbycusis.
D) otitis externa.

Sensoineural hearing loss could be caused by

A) otitis media.
B) otosclerosis.
C) wax in auditory canal. D) noise.

Mr F has tuning fork assessments. The Rinne test is used to

A) indicate the probable cause of hearing loss.
B) compare hearing by air conduction with bone conduction.
C) assess his ability to hear sounds at different frequencies.
D) test for lateralisation of sound.

The Weber test is used to

A) indicate the probable cause of hearing loss.
B) compare hearing by air conduction with bone conduction.
C) assess his ability to hear sounds at different frequencies.
D) test for lateralisation of sound.

When the voice is used as a test stimulus, it is important to

A) ask challenging questions to make sure of comprehension. B) make sure Mr F is not lip
reading.
C) instruct Mr F to ignore all background noises.
D) make sure there is no interference due to bone conduction.

Mary, aged 16 years, was recently diagnosed insulin dependent diabetes mellitus (IDDM).
You are involved in a teaching programme for Mary and during your teaching sessions she
asks you some questions.
"Why should I inject insulin into my stomach and not my limbs?"
A) "You can prevent tissue breakdown."
B) "It is likely to be cleaner than other areas."
C) "When limbs are exercised, insulin absorption is variable." D) "It is harder to reach the
back of your legs or arms."

"Why is it important for me to prevent foot infection or injury?"

A) "Organisms flourish when there are high blood sugar levels." B) "Your feet will be
hypersensitive and this predisposes to complications."
C) "Persons with diabetes can have poor circulation which delays healing if infection or
injury occurs."
D) "Antibiotics are less effective in persons with diabetes so you must take the utmost care
to avoid infection."

"One of my teachers has diabetes and she takes tablets, why can't I?"
A) "You may be able to in a few months when we've got your insulin requirements, diet and
exercise regulated."
B) "Different doctors have different preferences with regard to drugs. Why don't you discuss
it with your doctor?"
C) "The doctors only give tablets to people who are overweight." D) "Sometimes oral drugs
are used, but only if the person can produce some insulin."

"Will I still be able to play tennis?"

A) "Yes, eventually, but it isn't advisable to engage in strenuous activity until your diabetes
has been stable for a year."
B) "Yes, but you need extra carbohydrate beforehand to provide extra calories."
C) "Yes, but you shouldn't take your morning dose of insulin on the day that you're playing."
D) "Yes, but you should be aware that unless you modify your lifestyle you are likely to
develop complications in later life."

"If diabetes means my body can't deal with sugars, why do I have to limit foods high in fat?"
A) "Fats are changed to sugar during digestion."
B) "Weighing all food is good practice for using the scales and keeping to your diet."
C) "Those foods are high in calories."
D) "When your appetite improves you'll be able to eat more."