TOPIC NO.
OF QUESTIONS
GENERAL NURSING 10
IMMUNE SYSTEM 10
RESPIRATORY SYSTEM 10
HAEMATOLOGY 10
GASTROINTESTINAL SYSTEM 20
CARDIOVASCULAR SYSTEM 10 + 10
NERVOUS SYSTEM 10 + 10
ENDOCRINE SYSTEM 20
MUSCULOSKELETAL SYSTEM 20
REPRODUCTIVE SYSTEM 20
CANCER 20
SENSE ORGANS 20
SKIN 20
PRINCIPLES OF CARE 20
GENERAL NURSING
1. The principle of fairness is known as:
a. Advocacy
b. Autonomy
c. Justice
d. Accountability. Accountability
Rationale: JUSTICE in nursing ethics implies that patients have a right to fair and impartial
treatment.
2. The ability to answer for your actions is known as:
a. Confidentiality
b. Accountability
c. Advocacy
d. Veracity. Accountability
Rationale: ACCOUNTABILITY is about maintaining competency and safeguarding quality
patient care outcomes and standards of the profession, while being answerable to those who are
affected by one's nursing or midwifery practice.
3. The most important stage of the nursing process is:
a. Evaluation
b. Assessment
c. Planning
d. Implementation
Rationale: ASSESSMENT is the first step and involves critical thinking skills and data
collection; subjective and objective.
4. The duty to protect privileged information is called:
a. Ethics
b. Morals
c. Confidentiality
d. Honesty. Accountability
Rationale: CONFIDENTIALITY is an important ethical principle in nursing. Matters
regarding patients should not be disclosed to others at any cost.
5. The nurse acts as an advocate in order to:
a. Get their point across
b. Offer confidentiality
c. Assess the patient's point of view and be prepared to articulate this
d. Abide by their contract of employment
Rationale: NURSE ADVOCACY includes helping patients navigate the healthcare system
through medical care, billing, and insurance. It also involves assisting patients with legal
concerns and issues.
6. A side effect or a complication of medicine is:
a. A drug overdose
b. A drug error
c. An adverse drug event
d. A near miss
Rationale: ADVERSE DRUG EVENT is harm caused by the drug (adverse drug reactions and
overdoses) and harm from the use of the drug (including dose reductions and discontinuations
of drug therapy).
7. You take a telephone call from the laboratory with critical blood results; you should:
a. Ask the laboratory to call back when someone more senior is free
b. Memorise the values and find a senior nurse
c. Hand the phone to the healthcare assistant
d. Record and then read back the result, repeat the patient's name, hospital
number and date of birth
Rationale: RECORDING plays an important role here to avoid delivery of any wrong
laboratory results which might lead to fatal circumstances based on the interventions taken for
the same.
8. What does the acronym SBAR stand for?
a. Sit, brace, arise and return
b. Situation, background, assessment, recommendation
c. Subjective, bias, actual, real
d. None of the above
Rationale: The situation, background, assessment and recommendation (SBAR) technique is a
tool that allows health professionals to communicate clear elements of a patient's condition.
9. Cessation of breathing for a short period is called:
a. Dyspnoea
b. Orthopnoea
c. Apnoea
d. Bradypnea
Rationale: APNOEA can be defined as cessation of respiratory effort lasting more than 20
seconds, or if shorter duration, accompanied with bradycardia or cyanosis.
10. To assess the popliteal pulse the nurse palpates:
a. Behind the knee
b. The side of head
c. The wrist
d. The side of the neck
Rationale: The location of THE POPLITEAL PULSE is the soft spots behind your knees. The
normal pulse rate is between 60 – 100 beats per minute.
IMMUNE SYSTEM
1. Which of this cancer is associated with HIV?
a. Astrocytoma
b. Mesothelioma
c. Penile cancer
d. Kaposi's sarcoma
Rationale: KAPOSI’S SARCOMA is a disease in which cancer cells are found in the skin or
mucous membranes that line the gastrointestinal (GI) tract, from mouth to anus, including the
stomach and intestines.
2. After taking an HIV antibody test the patient is required to wait:
a. 30 days
b. 1 hour
c. 30 minutes
d. 10 minutes
Rationale: With a RAPID ANTIBODY TEST, usually done with blood from a finger stick or
with oral fluid, results are ready in 30 minutes or less. The rapid antigen/antibody test, done
with blood from a finger stick, takes 30 minutes or less.
3. In the context of HIV prevention what does PRP stand for?
a. Pre-exposure prophylaxis
b. Post Exposure prophylaxis
c. Post Exposure pneumonia
d. Pre-exposure pneumonia
Rationale: POSTEXPOSURE PROPHYLAXIS means taking medicine to prevent HIV after a
possible exposure. PEP should be used only in emergency situations and must be started within
72 hours after a recent possible exposure to HIV.
4. Systemic lupus erythematosus (SLE) is:
a. Infectious
b. Harmless
c. Always associated with HIV
d. An autoimmune condition
Rationale: SLE is an autoimmune disease in which the immune system attacks its own tissues,
causing widespread inflammation and tissue damage in the affected organs. It can affect the
joints, skin, brain, lungs, kidneys, and blood vessels.
5. Irritable bowel syndrome is most common in:
a. Older white males
b. Children
c. Young black women
d. Women
Rationale: IRRITABLE BOWEL SYNDROME is more common among women. Oestrogen
therapy before or after menopause also is a risk factor for IBS.
6. Which of the following immunity is obtained after birth?
a. Acquired immunity
b. Active immunity
c. Passive immunity
d. None of the above
RATIONALE: Acquired (adaptive or specific) immunity is not present at birth. It is learned.
The learning process starts when a person’s immune system encounters foreign invaders and
recognizes nonself substances (antigens). Then, the components of acquired immunity learn the
best way to attack each antigen and begin to develop a memory for that antigen.
7. Which of the following cells is involved in cell-mediated immunity?
a. Leukaemia
b. T cells
c. Mast cells
d. Thrombocytes
RATIONALE: The activation of naive T cells in response to antigen, and their subsequent
proliferation and differentiation, constitutes a primary immune [Link] activation of
naive T cells in response to antigen, and their subsequent proliferation and differentiation,
constitutes a primary immune response.
8. Which of the following cells of the immune system do not perform phagocytosis?
a. Macrophage
b. Neutrophil
c. Eosinophil
d. Basophil
RATIONALE: Basophils are not phagocytic cells. They are granular leukocytes that
accumulate at sites of allergy. They play a role in immune response by releasing histamine and
heparin.
9. Which of the following statements is true about the IgM of humans?
a. IgM can cross the placenta
b. IgM can protect the mucosal surface
c. IgM is produced by high-affinity plasma cells
d. IgM is primarily restricted in the circulation
RATIONALE: IgM is the first immunoglobulin developed during human foetal development at
20 weeks. Unlike IgG antibody which provides passive immunity to the foetus, IgM antibody is
restricted from crossing the placenta due to its size. It is also the first antibody to respond
during infection.
10. Myelogenous leukemias are caused by the cancerous production of innate (non-specific) immune
system cells: in which tissue is such production most likely to occur?
a. Bone marrow
b. Lymph nodes
c. Spleen
d. Thymus
RATIONALE: The bone marrow is the main reservoir of hematopoietic stem cells. The thymus
is a site of maturation of T-cells, which are part of the adaptive immune [Link] cancerous
production of innate immune system cells associated with myelogenous leukemias is most likely
to occur in the bone marrow.
RESPIRATORY SYSTEM
1. Asthma is:
a. Caused by a virus
b. Caused by a fungus
c. Caused by a bacterium
d. None of the above
Rationale: Common triggers in asthma include infections like colds and flu, allergies – such as
to pollen, dust mites or animals, smoke, fumes and pollution, medicines – particularly anti-
inflammatory painkillers like ibuprofen and aspirin, emotions, including stress, or laughter,
weather – such as sudden changes in temperature, cold air, wind, thunderstorms, heat and
humidity, mould or damp exercise.
2. Pulmonary embolism is:
a. An infectious disease
b. A medical emergency
c. A type of cancer
d. An autoimmune disease
Rationale: PULMONARY EMBOLISM, a blockage in the lung artery, is a life-threatening
medical emergency that requires quick intervention and treatment.
3. D-dimer fibrin is:
a. A type of X-ray
b. A type of endoscopic examination
c. A blood test used to rule out active blood clot formation
d. A blood test used to identify inflammation
Rationale: Once your injury has healed and your body no longer needs the blood clot, your
body makes an enzyme called plasmin to break down the clot into small fragments in order to
remove it. The fragments are known as fibrin degradation products, or fibrin split-products. D-
dimer is one of those fibrin degradation products.
4. The term haemoptysis refers to:
a. The presence of blood in the urine
b. The presence of blood in the vomit
c. The presence of blood in cerebrospinal fluid
d. The presence of blood in the sputum
Rationale: Haemoptysis is when you cough up blood from your lungs. It can be a sign of a
serious medical condition. Infections, cancer, and problems in blood vessels in your lungs can
cause it.
5. Pneumonia is:
a. A type of cancer
b. Another name for bronchitis
c. A form of hepatitis
d. A lung infection
Rationale: Pneumonia is an infection of the lungs that may be caused by bacteria, viruses, or
fungi. The infection causes the lungs' air sacs (alveoli) to become inflamed and fill up with fluid
or pus.
6. In a case of lung cancer if a tumour is less than 4 centimetres (cm) in diameter, wedge
resection is performed in which:
a. The whole lung is removed
b. An aspect of lung tissue is removed
c. A biopsy is taken
d. None of the above
RATIONALE: A wedge resection involves the removal of lung cancer along with a wedge-
shaped section of tissue surrounding the tumour. This procedure removes less lung tissue than a
lobectomy.
7. The term tachypnoea refers to:
a. Cessation of breathing
b. Cheyne–Stokes breathing
c. A reduction in respiratory rate
d. An increase in respiratory rate
RATIONALE: Tachypnoea is a respiratory rate greater than normal, resulting in abnormally
rapid and shallow breathing. Tachypnea is present with pulmonary parenchymal disease,
pulmonary edema, large left-to-right shunts that elevate pulmonary venous pressure, and
conditions causing metabolic acidosis.
8. Haemothorax is:
a. A collection of air in the pleural space
b. A collection of pus in the pleural space
c. A collection of blood in the pleural space
d. A collection of synovial fluid in the pleural space
RATIONALE: Hemothorax is the presence of blood in the pleural space. Hemothorax is usually
a consequence of blunt or penetrating trauma. Prompt identification and treatment of
traumatic hemothorax is an essential part of the care of the injured patient.
9. When CO2 diffuses into blood in systemic capillaries most of it:
a. Remains in solution as CO2
b. Converts to carbamino compounds
c. Converts to bicarbonate ions in RBC
d. Combines with Hb directly
RATIONALE: Carbon dioxide diffuses into red blood cells. Inside,
carbonic anhydrase converts carbon dioxide into carbonic acid (H2CO3)
( H 2 CO 3 ) , which is subsequently hydrolyzed into bicarbonate
(HCO−3) and H+.
10. Which of the following substances is activated by passage through the pulmonary circulation?
a. Bradykinin
b. Serotonin
c. Noradrenaline
d. Angiotensin 1
RATIONALE: Renin splits angiotensinogen, a protein made in your liver and releases the
pieces. One piece is the hormone angiotensin I. Angiotensin I, which is inactive, flows through
your bloodstream and is split by angiotensin-converting enzyme (ACE) in your lungs and
kidneys.
HAEMATOLOGY
1. A ferritin level test assesses:
a. The amount of haemoglobin in the body
b. How much iron may be stored in the body
c. The ability of the blood to clot
d. The number of white cells in the body
Rationale: A ferritin test measures the amount of ferritin in the blood. Ferritin is a blood
protein that contains iron. This test can be used to find out how much iron the body stores.
2. Which of the following is not a cause of iron deficiency anaemia?
a. Chronic blood loss
b. Infection
c. Malabsorption
d. Decreased intake
Rationale: Iron deficiency anaemia can result due to chronic blood loss, malabsorption, and
decreased intake of iron rich food. It cannot result due to infection.
3. Platelets are manufactured in:
a. The large intestine
b. The liver
c. The bone marrow
d. The small intestine
Rationale: Platelets are produced in the bone marrow by megakaryocytes, highly specialised
precursor cells that extend cytoplasmic projections called proplatelets (PPTs) through the
endothelial barrier of sinusoid vessels.
4. Bleeding due to thrombocytopenia often occurs in small vessels, causing:
a. Infection
b. Pruritus
c. Scarring
d. Petechiae and purpura
Rationale: Purpura occurs when small blood vessels leak blood under the skin. Purpura
measures between 4 and 10 mm (millimetres) in diameter. When purpura spots are less than 4
mm in diameter, they are called petechiae. Purpura spots larger than 1 cm (centimetres) are
called ecchymoses.
5. The most common type of leukaemia in adults over 55 is:
a. Acute lymphatic leukaemia
b. Acute myeloid leukaemia
c. Chronic myeloid leukaemia
d. Chronic lymphocytic leukaemia
Rationale: Chronic lymphocytic leukaemia (CLL) is a type of blood cancer. It’s the most
common form of leukaemia in adults. CLL typically affects people aged 65 and older, but it can
affect people starting at age 30.
6. Which leukocytes release heparin and histamine in blood?
a. Neutrophil
b. Basophil
c. Eosinophil
d. Monocytes
Rationale: Basophil contains heparin which is an anticoagulant. It is a type of white blood cell.
7. Absence of which clotting factor leads to Haemophilia-A?
a. Factor VII
b. Factor VIII
c. Factor IX
d. Factor X
Rationale: Haemophilia-A is also called factor VIII deficiency or classic haemophilia. It is a
genetic disorder caused by missing or defective factor VIII, a clotting protein.
8. Which one of the following statements is true?
a. Normal adult blood contains two haemoglobins
b. Erythropoietin production is 50% renal and 50% hepatic
c. A reticulocyte contains RNA as well as DNA
d. The red cell membrane has a bipolar lipid layer
Rationale: Normal blood contains three haemoglobins, normal adult Hb A , foetal haemoglobin,
Hb F and Hb A2. Erythropoietin is produced by the kidneys. A reticulocyte contains RNA but
not DNA. Red cells survive for about 120 days in the circulation.
9. Which of the following is not present in normal blood plasma
a. Fibrinogen
b. Thrombin
c. Prothrombin
d. Albumin
Rationale: The proteins in plasma include the antibody proteins, coagulation factors, and the
proteins albumin and fibrinogen which maintain serum osmotic pressure.
10. The term ischaemia refers to:
a. Restriction of blood supply to the heart
b. Restriction of blood supply to tissues
c. Restriction of blood supply to the liver
d. Restriction of blood supply to the kidneys
Rationale: Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or
organ of the body, causing a shortage of oxygen that is needed for cellular metabolism Ischemia
is generally caused by problems with blood vessels, with resultant damage to or dysfunction of
tissue i.e. hypoxia and microvascular dysfunction.
GASTROINTESTINAL SYSTEM
1. Barrett's oesophagus is a potentially serious complication of:
a. Gastro-oesophageal reflux disease
b. Stomach cancer
c. Liver cancer
d. None of the above
RATIONALE: In Barrett's oesophagus, normally flat, pink cells are replaced with a thick, red
lining with potential for cancerous changes, which is a serious complication of GERD.
2. Diverticula are:
a. Small ruptures in the wall of the digestive tract
b. Small pouches in the wall of the mouth
c. Small pouches in the wall of the digestive tract
d. Large pouches in the wall of the digestive tract
RATIONALE: Diverticula are multiple small sac-like protrusions develop along the
gastrointestinal tract. Though diverticula may form at weak points in the walls of either the
small or large intestines, the majority occur in the large intestine (most commonly the sigmoid
colon).
3. Which of the following is an osmotic agent used for constipation?
a. Aracis oil
b. Macrogol
c. Ispaghula husk
d. Docusate sodium
RATIONALE: Macrogol is an osmotically acting laxative; that is, an inert substance that passes
through the gut without being absorbed into the body. It relieves constipation because it causes
water to be retained in the bowel instead of being absorbed into the body.
4. Faecal impaction refers to:
a. Hard dry stools collecting in the rectum
b. Loose stools collecting in the rectum
c. Hard dry stools collecting in the ascending colon
d. Hard dry stools collecting in the descending colon
RATIONALE: A faecal impaction is a large lump of dry, hard stool that stays stuck in the
rectum. It is most often seen in people who are constipated for a long time.
5. Which of the following is NOT an accessory structure of the digestive system?
A. Liver.
B. Gallbladder.
C. Pancreas.
D. Spleen.
RATIONALE: Accessory organs of digestion are organs that secrete substances needed for the
chemical digestion of food but through which food does not actually pass as it is digested.
Besides the liver, the major accessory organs of digestion are the gallbladder and pancreas.
6. Salivary amylase secreted into the oral cavity starts the digestion of
A. Proteins.
B. Starch.
C. Lipids.
D. Amino acids.
RATIONALE: Saliva contains special enzymes that help digest the starches in your food. An
enzyme called amylase breaks down starches (complex carbohydrates) into sugars, which your
body can more easily absorb.
7. Which of these is a structural modification unique to the small intestine?
A. Plicae circulares.
B. Villi.
C. Microvilli.
D. All of the above.
RATIONALE: The inner wall of the small intestine contains evaginations formed by plicae
circulares, villi, and microvilli. These structural modifications enhance the digestive process by
increasing the surface area of the small intestine which makes it highly adapted for efficient
absorption of nutrients from the digested food.
8. What mouth part helps to mix food with saliva, moves food toward the pharynx for swallowing,
and houses taste receptor cells?
A. Lips.
B. Palate.
C. Tongue.
D. Cheeks.
RATIONALE: The tongue helps in swallowing by moving the bolus from the mouth into the
pharynx. Apart from mixing saliva and swallowing, tongue helps in identifying different tastes
by the help of taste buds. The function of food swallowing and digestion is aided by the tongue.
9. What initiates the swallowing reflex?
A. Fear of choking on food.
B. The tongue rolling the bolus to the pharynx.
C. Sensory receptors detecting the bolus in the pharynx.
D. Secretion of saliva at the thought of food.
RATIONALE: The reflex is initiated by touch receptors in the pharynx as a bolus of food is
pushed to the back of the mouth by the tongue, or by stimulation of the palate (palatal reflex).
10. The pancreas secretes enzymes that enter the small intestine and chemically digest chyme. Choose
the enzyme(s) that break(s) down fats.
A. Carboxypeptidase.
B. Pancreatic lipase.
C. Trypsinogen.
D. Pancreatic amylase.
RATIONALE: Pancreatic lipase is usually secreted by the pancreas and transferred to the
duodenum to participate in the hydrolysis and digestion of fat, cholesterol esters, and fat-soluble
vitamins.
11. What is the primary purpose of the liver in aiding digestion?
A. Produces digestive enzymes.
B. Produces alkaline solution to neutralise stomach acidity.
C. Produces bile to emulsify fats in the small intestine.
D. Produces substances that aid the large intestine in water absorption.
RATIONALE: The two main functions of the liver related to digestion are to make and secrete
bile and to process and purify the blood containing newly absorbed nutrients that are coming
from the small intestine.
12. How are the components of fats absorbed in the small intestine?
A. Specific receptor proteins carry fatty acids across the intestinal wall and into the
bloodstream.
B. Fatty acids are transported by active transport to the bloodstream.
C. Components of lipids diffuse through small intestinal cell membranes, are
reconstructed in the cells, then carried off by lacteals as chylomicrons.
D. Components of lipids diffuse through small intestinal cell membranes and into the
bloodstream where they are carried to the liver for processing.
RATIONALE: The majority of fat digestion happens once it reaches the small intestine. Dietary
fats in the small intestine are absorbed by the lacteals and are transported into the venous
circulation through the formation of lipoprotein called chylomicrons.
13. A 55 year old woman presents with intermittent bright red PR bleeding. On examination she is
stable, and PR shows small external haemorrhoid. What is appropriate treatment for this woman ?
A. Reassure, prescribe treatment for haemorrhoids
B. Refer to surgeons for elective haemorrhoidectomy
C. Prescribe treatment for haemorrhoids, and arrange outpatient colonoscopy with
surgical follow-up.
D. No further treatment necessary.
RATIONALE: The primary treatment of haemorrhoids consists of treatment like a high-fibre
diet (25 to 35 g per day), fibre supplementation, increased water intake, warm water (sitz)
baths, and stool softeners and arrange for outpatient colonoscopy with surgical follow up.
14. What does the pancreatic duct directly join to?
A. Jejunum.
B. Liver.
C. Ileum.
D. Duodenum.
RATIONALE: The pancreatic duct joins the common bile duct just prior to the ampulla of
Vater, after which both ducts perforate the medial side of the second portion of the duodenum
at the major duodenal papilla.
15. The appendix is an extension of which structure?
A. Transverse colon.
B. Descending colon.
C. Ascending colon.
D. Small intestine.
RATIONALE: The vermiform appendix is also enveloped in peritoneum and usually hangs free
on its own mesentery, although it may occasionally be tucked extra peritoneally behind the
ascending colon, or it may adhere to the back of the caecum.
16. Gastrin secretion will stop when the stomach pH reaches:
A. 7.0
B. 4.5
C. 1.5
D. 3.0
RATIONALE: Gastrin release is invariably inhibited by a pH below 1·5, the inhibition becomes
total as the pH falls to 1. On the other hand, high pH levels enhance gastrin release.
17. The Kupffer cells are phagocytic cells found in the:
A. Gallbladder.
B. Pancreas.
C. Intestine.
D. Liver.
RATIONALE: Kupffer's cell is a type of phagocytic cell. It forms the lining of the sinusoids of
the liver. Kupffer's cell protects the liver from various bacterial infections and it is also involved
in the breakdown of red blood cells.
18. How long can it take for food to completely pass through the colon?
A. 10 minutes
B. 1 hour
C. 5 hours
D. 20 hours
RATIONALE: The average transit time through the colon in someone who is not constipated is
30 to 40 hours. Up to a maximum of 72 hours is still considered normal, although transit time in
women may reach up to around 100 hours.
19. Which is not a risk factor for gallstones?
A. Cystic fibrosis
B. Congestive cardiac failure
C. Familial tendency
D. Diabetes
RATIONALE: The risk factors for gallstones are:
Age and female sex.; Genetic susceptibility.; Pregnancy.; Diabetes mellitus.; Dyslipidemia.; Diet
and lifestyle factors; Obesity; Rapid weight loss; and Medications.
20. Which is the first line pharmacological agent in the use of upper GI bleeding from esophageal
varices?
A. H2 antagonists
B. Vasopressin
C. Octreotide
D. Proton pump inhibitors
RATIONALE: Octreotide works as a synthetic Somatostatin analogue and decreases blood flow
to the Gastrointestinal system. It is reported that octreotide could decrease endothelial nitric
oxide levels, inhibiting the release of glucagon, a potent vasodilator, leading to splanchnic
vasoconstriction and reduced bleeding.
CARDIOVASCULAR SYSTEM
1. Which of the following is the most common symptom of myocardial infarction?
a. Haemorrhage
b. Oedema
c. Dyspnoea
d. Chest pain
RATIONALE: The symptoms of MI include chest pain, which travels from left arm to neck,
shortness of breath, sweating, nausea, vomiting, abnormal heart beating, anxiety, fatigue,
weakness, stress, depression, and other factors.
2. What is the primary reason for administering morphine to a client with an MI?
a. To sedate the person
b. To decrease the person's anxiety
c. To decrease oxygen demand on the person's heart
d. To decrease the person's pain
RATIONALE: Morphine recommended based on assumptions that adequate pain control
modulates sympathetic nervous system activation and therefore decreasing myocardial oxygen
demand.
3. The severity of heart failure can be classified using:
a. The Royal Brompton Classification
b. The Bow Street Classification
c. The Broad Green Heart Failure Index
d. The New York Heart Association Functional Classification
RATIONALE: The New York Heart Association (NYHA) Classification provides a simple way
of classifying the extent of heart failure and is used widely.
4. The acronym CPAP refers to:
a. Continuous positive airway pressure
b. Continuous potential airway pressure
c. Continuous positive air pressure
d. Continuous positive airway potential
RATIONALE: Continuous positive airway pressure (CPAP) is a type of positive airway
pressure that is used to deliver a set pressure to the airways that is maintained throughout the
respiratory cycle, during both inspiration and expiration.
5. Angina is classically defined as:
a. A sharp pain that radiates across the legs, sometimes down the arm, into the neck, jaw
or teeth, or into the back
b. A crushing pain felt in the back, sometimes down the leg, into the neck, jaw or teeth, or
into the back
c. A crushing pain that radiates across the chest, sometimes down the arm, into the
neck, jaw or teeth, or into the back
d. A crushing pain across the chest, sometimes down the head, into the back, jaw or teeth,
or into the leg
RATIONALE: Angina usually causes uncomfortable pressure, fullness, squeezing or pain in the
centre of the chest. You may also feel discomfort in your neck, jaw, shoulder, back or arm.
(Many types of chest discomfort — such as heartburn, lung infection or inflammation — aren‘t
related to angina.)
6. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?
a. Plaques obstruct the vein
b. Plaques obstruct the artery
c. Blood clots form outside the vessel wall
d. Hardened vessels dilate to allow the blood to flow through
RATIONALE: Plaques obstruct the artery. Arteries, not veins, supply the coronary arteries
with oxygen and other nutrients. Atherosclerosis is a direct result of plaque formation in the
artery. Hardened vessels can’t dilate properly and, therefore, constrict blood flow.
7. Which of the following blood tests is most indicative of cardiac damage?
a. Lactate dehydrogenase
b. Complete blood count
c. Troponin I
d. Creatine kinase
RATIONALE: Troponin I levels rise rapidly and are detectable within 1 hour of myocardial
injury. Troponin I levels aren’t detectable in people without cardiac injury. Lactate
dehydrogenase is present in almost all body tissues and not specific to heart muscle. LDH
isoenzymes are useful in diagnosing cardiac injury.
8. Which of the following complications is indicated by a third heart sound (S3)?
a. Ventricular dilation
b. Systemic hypertension
c. Aortic valve malfunction
d. Increased atrial contractions
RATIONALE: Rapid filling of the ventricles causes vasodilation that is auscultated as S3.
Increased atrial contraction or systemic hypertension can result in a fourth heart sound. Aortic
valve malfunction is heard as a murmur.
9. A pulsating abdominal mass usually indicates which of the following conditions?
a. Abdominal aortic aneurysm
b. Enlarged spleen
c. Gastric distention
d. Gastritis
RATIONALE: The presence of a pulsating mass in the abdomen is an abnormal finding,
usually indicating an outpouching in a weakened vessel, as in abdominal aortic aneurysm. The
finding, however, can be normal on a thin person.
10. Which of the following risk factors for coronary artery disease cannot be corrected?
a. Cigarette smoking
b. DM
c. Heredity
d. HPN
RATIONALE: Because “heredity” refers to our genetic makeup, it can’t be changed. Cigarette
smoking cessation is a lifestyle change that involves behaviour modification. Diabetes mellitus is
a risk factor that can be controlled with diet, exercise, and medication.
11. The key objective in coronary artery bypass graft is to:
a. Extend life
b. Improve blood flow and oxygen supply to the heart
c. Improve blood flow and oxygen supply to the lungs
d. Relieve pain
RATIONALE: The key objective in coronary artery bypass graft (CABG) surgery is to improve
blood flow to the heart muscle. This is achieved by bypassing blocked or narrowed coronary
arteries using a graft.
12. Atrial fibrillation is:
a. A type of infection
b. A dysrhythmia
c. A malignant condition
d. More common in people who are physically active
RATIONALE: Atrial fibrillation (AF) is clinically defined as a supraventricular
tachyarrhythmia characterised by uncoordinated atrial activation leading to ineffective atrial
contraction. The hallmark of AF is an irregular heart rhythm without distinct P waves on an
electrocardiogram (ECG).
13. In postoperative coronary artery bypass graft the person should be encouraged to:
a. Reduce mobility
b. Drink 3 L of fluid as soon as possible
c. Splint the incision when coughing and moving
d. Close the eyes when coughing
RATIONALE: Splinting the incision after coronary artery bypass graft (CABG) surgery is
crucial to reduce pain, prevent wound dehiscence, and encourage effective coughing and deep
breathing. This practice helps prevent respiratory complications, supports early mobility, and
enhances overall recovery.
14. Most coronary artery bypass grafts are performed on:
a. Women aged 60 years and over
b. Men with lung cancer
c. Women with lung cancer
d. Men who are aged 60 years and over
RATIONALE: Most coronary artery bypass grafts (CABG) are performed on men aged 60
years and over because cardiovascular disease risk increases with age, and men have a higher
prevalence of coronary artery disease (CAD).
15. Abnormality of the valve is identified as:
a. Dilation or regurgitation
b. Stenosis, regurgitation or dilation
c. Stenosis or regurgitation
d. Regurgitation
RATIONALE: Stenosis: This occurs when a heart valve becomes narrowed or stiffened,
restricting blood flow through the valve. It forces the heart to work harder to pump blood
through the smaller opening.
Regurgitation: This happens when a heart valve does not close properly, allowing blood to flow
backward. This can lead to increased volume in the heart chambers and inefficient blood
circulation.
16. Cardiac valves allow for:
a. One-way, low-resistance blood flow
b. Two-way, low-resistance blood flow
c. One-way, high-resistance blood flow
d. Two-way, high-resistance blood flow
RATIONALE: Cardiac valves ensure that blood flows efficiently in the correct direction
through the heart's chambers and into the major arteries, preventing backflow and maintaining
proper circulation.
17. Varicose veins are often:
a. Long and thick
b. Short and thin
c. Dilated and tortuous
d. Constricted and tortuous
RATIONALE: Varicose veins are dilated (enlarged) and tortuous (twisted). They typically
occur when the valves in the veins, which help regulate blood flow, become weakened or
damaged. This leads to blood pooling in the veins, causing them to swell and become visible
under the skin, often in the legs.
18. The valve most commonly replaced is the:
a. Ileocaecal valve
b. Aortic valve
c. Pulmonary valve
d. Hydrocephalic valve
RATIONALE: The aortic valve is the most commonly replaced valve because it is frequently
affected by conditions such as aortic stenosis and aortic regurgitation. These conditions are
prevalent due to the high pressure and workload the aortic valve endures as it regulates blood
flow from the heart to the rest of the body.
19. Varicosities are usually examined:
a. With the patient standing
b. With the patient lying flat
c. With the patient in the left lateral position
d. After the patient has had a hot bath
RATIONALE: Standing position allows for -
Optimal visualisation: Varicose veins become more prominent and easier to see when the
patient is upright.
Assessment of venous pressure: The standing position increases venous pressure, making it
easier to identify incompetent valves and reflux.
20. Vascular competency can be tested by:
a. Perthes' test
b. Trendelenburg test
c. Von Willebrand test
d. Needle biopsy
RATIONALE: The Trendelenburg test is a clinical examination used to assess the competency
of the valves in the superficial and deep veins of the legs. Rapid filling of the veins after
releasing the tourniquet indicates incompetent deep or communicating veins.
NERVOUS SYSTEM
1. A female client has clear fluid leaking from the nose following a basilar skull fracture. The nurse
assesses that this is cerebrospinal fluid if the fluid:
a. Is clear and tests negative for glucose
b. Is grossly bloody in appearance and has a pH of 6
c. Clumps together on the dressing and has a pH of 7
d. Separates into concentric rings and test positive of glucose
RATIONALE: Leakage of cerebrospinal fluid (CSF) from the ears or nose may accompany
basilar skull fracture. CSF can be distinguished from other body fluids because the drainage
will separate into bloody and yellow concentric rings on dressing material. called a halo sign.
The fluid also tests positive for glucose.
2. The nurse is caring for the male client who begins to experience seizure activity while in bed.
Which of the following actions by the nurse would be contraindicated?
a. Loosening restrictive clothing
b. Restraining the client’s limbs
c. Removing the pillow and raising padded side rail
d. Positioning the client to the side. if possible. with the head flexed forward
RATIONALE: The limbs are never restrained because the strong muscle contractions could
cause the client harm. If the client is not in bed when seizure activity begins. the nurse lowers
the client to the floor. if possible. protects the head from injury. and moves furniture that may
injure the client.
3. The client with a brain attack (stroke) has residual dysphagia. When a diet order is initiated. the
nurse avoids doing which of the following?
a. Giving the client thin liquids
b. Thickening liquids to the consistency of oatmeal
c. Placing food on the unaffected side of the mouth
d. Allowing plenty of time for chewing and swallowing
RATIONALE: It is important to assess the gag and swallow reflex of the client before starting
the diet. Thickened liquids flow more slowly than thin liquids, and this provides extra time for a
person with dysphagia to achieve airway protection during swallowing.
4. A female client has experienced an episode of myasthenic crisis. The nurse would assess whether
the client has precipitating factors such as:
a. Getting too little exercise
b. Taking excess medication
c. Omitting doses of medication
d. Increasing intake of fatty foods
RATIONALE: Myasthenic crisis often is caused by under medication and responds to the
administration of cholinergic medications. such as neostigmine (Prostigmin) and pyridostigmine
(Mestinon).
5. A male client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The nurse
would avoid which of the following measures to minimise the risk of recurrence?
a. Strict adherence to a bowel retraining program
b. Keeping the linen wrinkle-free under the client
c. Preventing unnecessary pressure on the lower limbs
d. Limiting bladder catheterization to once every 12 hours
RATIONALE: The most frequent cause of autonomic dysreflexia is a distended bladder.
Straight catheterization should be done every four (4) to six (6) hours. and foley catheters
should be checked frequently to prevent kinks in the tubing.
6. Parkinsonism includes combination of the following:
a. tremor, bradykinesia & muscles rigidity
b. paresis, anaesthesia & muscles spasticity
c. chorea & muscles hypotonia
d. tremor, ataxia & muscles hypotonia
RATIONALE: Parkinsonism is a broad term referring to various neurodegenerative diseases
that manifest with motor symptoms such as rigidity, tremors, and bradykinesia.
7. The presence of ptosis suggests damage to cranial nerve:
a. IV
b. V
c. III
d. VII
RATIONALE: Ptosis (a droopy eyelid) and diplopia are the hallmark symptoms of third nerve
palsies. Disruption may occur at any location along the path of the nerve and subsequent paresis
may occur in any muscle or combination of muscles innervated by the oculomotor nerve.
8. The Broca’s area is located in the lobe:
a. frontal
b. parietal
c. temporal
d. occipital
RATIONALE: The Broca area is a region in the inferior frontal gyrus of (usually) the left
hemisphere of the human brain with functions linked to speech production.
9. Which of the following would lead the nurse to suspect that meningitis has developed disseminated
intravascular coagulation?
a. Hemorrhagic skin rash
b. Pulmonary oedema
c. Pallor
d. Haemoptysis
RATIONALE: Disseminated intravascular coagulation often markedly manifests on the skin as
acrocyanosis or as petechiae and purpura with progression to hemorrhagic
[Link] hematomas may occur, as may thrombotic findings including necrosis and
gangrene.
10. The ability to walk along a straight line is most often impaired with:
a. cerebellar dysfunction
b. parietal lobe damage
c. temporal lobe damage
d. ocular motor disturbances
RATIONALE: Cerebellar dysfunction causes balance problems and gait disorders along with
difficulties in coordination, resulting in ataxia, uncoordinated movements, imbalance,
dysarthria, nystagmus, and vertigo as a part of the vestibulocerebellar system.
11. Pneumocephalus occurs when:
a. Air enters the cranium
b. The patient also has pneumonia
c. The head is tilted below heart level
d. There is raised intracranial pressure
RATIONALE: Pneumocephalus is the presence of air in the cranial cavity. It's often caused by
head trauma, neurosurgery, or rarely, spontaneously. Symptoms include headache, nausea,
dizziness, and in severe cases, seizures. Treatment varies from observation to surgical
intervention.
12. Reasons for craniotomy include:
a. Biopsy of tissue
b. Evacuation of haematoma
c. Clipping of aneurysm
d. All of the above
RATIONALE: Craniotomy involves opening the skull to access the brain. It's used for various
conditions like tumour removal, trauma, aneurysm treatment, and infections. Post-surgery care
is crucial to manage pain, prevent infection, and aid recovery.
13. An aneurysm is:
a. A bulging in the weak wall of an artery
b. A bulging in the wall of a vein
c. A bulging in the weak wall of the heart
d. A bulging in the pleural cavity
RATIONALE: An aneurysm is a bulge or weakened area in the wall of an artery caused by
pressure exerted on the weakened area by the blood flowing through it.
14. Most early complications in postoperative craniotomy occur within:
a. The first week after surgery
b. The first 6 hours after surgery
c. The first month after surgery
d. The first month after surgery
RATIONALE: The first six hours post-craniotomy are critical due to the body's recovery from
surgery, anaesthesia effects, potential brain swelling, risk of bleeding, and the need for close
monitoring. Complications like haemorrhage, brain swelling, and decreased consciousness can
occur during this period.
15. The signs and symptoms of raised intracranial pressure include:
a. Hypotension and tachycardia
b. Hypertension and tachycardia
c. Hypertension and bradycardia
d. Hypotension and bradycardia
RATIONALE: Increased intracranial pressure (ICP) manifests with a variety of symptoms.
Early signs often include headache, nausea, vomiting, and altered mental status. As ICP
worsens, it can lead to Cushing's triad, characterised by hypertension, bradycardia, and
irregular respirations.
16. The term hemiparesis refers to:
a. Weakness of the eyelid
b. Inability of the patient to use their sense of smell
c. Weakness below the level of the chin
d. Weakness on one side of the body
RATIONALE: Hemiparesis refers to weakness on one side of the body. It can affect the face,
arm, and leg. This condition often stems from neurological issues such as stroke, brain tumours,
or traumatic brain injury. Individuals with hemiparesis may experience difficulty with daily
activities like walking, dressing, and eating due to impaired motor function.
17. A patient with a suspected stroke is brought to the emergency department. Which of the following
is the priority nursing intervention?
a) Obtain a complete medical history.
b) Assess blood glucose level.
c) Administer aspirin.
d) Initiate IV access.
RATIONALE: Hyperglycemia can mimic stroke symptoms. It's crucial to differentiate between
a stroke and hypoglycemia as treatment differs significantly.
18. A patient with a severe TBI is intubated and placed on mechanical ventilation. Which of the
following nursing interventions is most important to prevent increased intracranial pressure (ICP)?
a) Administering osmotic diuretics as ordered.
b) Maintaining head elevation at 30 degrees.
c) Sedating the patient to reduce agitation.
d) Avoiding suctioning the patient.
RATIONALE: Head elevation promotes venous drainage, reducing ICP. The other options are
also important but not the primary intervention for ICP management.
19. A patient with MS is experiencing increasing fatigue. Which of the following nursing
interventions is most appropriate?
a) Encourage the patient to push through fatigue to maintain independence.
b) Assist the patient with activities of daily living (ADLs) to conserve energy.
c) Administer stimulants to increase energy levels.
d) Discourage daytime napping to improve sleep quality.
RATIONALE: Fatigue is a common symptom of MS and energy conservation is crucial.
Assisting with ADLs helps manage fatigue effectively.
20. A patient with Alzheimer's Disease (AD) is wandering around the hospital at night. Which of the
following interventions is most appropriate to prevent falls?
a) Restrain the patient to the bed.
b) Use physical restraints to prevent wandering.
c) Create a safe environment with adequate lighting.
d) Administer sedatives to promote sleep.
RATIONALE: Creating a safe environment, such as using nightlights and removing fall
hazards, is essential to prevent falls in patients with AD. Restraints should be avoided as they
can cause harm and distress.