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 CONTENTS National NORCET Test-1 1 5. Acid Base Imbalance 475 National NORCET Test-2 94 6. Shock. 477 National NORCET Test-3...

 CONTENTS National NORCET Test-1 1 5. Acid Base Imbalance 475 National NORCET Test-2 94 6. Shock. 477 National NORCET Test-3 182 7. Pneumothorax 479 NORCET Recall 265 8. Hypertension 481 Golden Qs for Last Minute Memorization 345 9. Congestive Cradiac Failure 483 © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. 10. Angina Pectoris 485 FUNDAMENTAL OF NURSING 11. Fracture 489 12. Head Injury 492 1. Nursing Process 406 13. Hodgkin’s Lymphoma 494 2. Health Assessment 408 14. Nephrotic Syndrome 496 3. Instruments 410 15. Occupational Disease 500 4. Nursing Theory 415 16. Traction. 505 5. Types of Nursing Assessment 416 17. Types of Fracture 508 6. Intramuscular Injection 417 18. Cardioversion and Defibrillation 512 7. Oxygen Delivery System 420 19. Intercostal Drainage 516 8. The 10 Rights of Medications Administration. 422 20. Suctioning 520 9. Different Breathing Patterns 424 21. Sutures and Suture Materials 524 10. Normal ECG 425 22. Triage 529 11. Enema 427 23. Fluid Management in Burn 533 12. Normal Values 429 24. CPR Componenets for BLS Providers 535 13. GLASGOW Coma Scale. 433 25. Pain 537 14. Hand Washing. 434 26. Hyperkalemia 541 15. Angles of Injection 436 27. Hypokalemia 542 16. Types of Bed. 437 28. Anemia 543 17. Calculation of Drugs and Dosages 438 29. Analysis of ECG 546 18. Prescription Abbreviations 441 30. Inflammation 548 19. Pain Assessment 442 31. Hemophilia 551 20. Types of IV Fluids 444 32. Ulcerative Colitis 553 21. Z-Track Method 445 33. Meningitis 556 22. Important Positions 446 34. Peptic Ulcer 559 23. Code of Ethics 449 35. Refractive Errors of Eye 561 24. Ethical Principles in Nursing 452 25. Surgical Safety Checklist 453 MENTAL HEALTH NURSING 26. Different Patient Positions in different Conditions 454 1. Erikson Theory of Psychosocial Development 566 27. Drug forms for Oral Administration 459 2. Schizophrenia 567 28. Documentation 460 3. Disorders of Consciousness 569 29. Tracheostomy Care 461 4. Disorder of Memory 570 30. Assessment of Pulse 463 5. Lithium Therapy 572 6. Motor Disorders 575 MEDICAL SURGICAL NURSING 7. Behavioral Therapies 576 1. Bronchial Asthma 468 8. Defense Mechanism 579 2. Wound Healing 470 9. Dementia 581 3. Myocardial Infarction 471 10. Personality Disorders 584 i 4. Pulmonary Tuberculosis 473 11. Dissociative Disorder 585 12. Mini-Mental Status Examination 587 COMMUNITY HEALTH NURSING 13. Neurotransmitters 588 1. Levels of Preventions 680 14. Drugs used in Child Psychiatry 589 2. Anemia Mukt Bharat (2018) Guidelines. 682 15. Psychiatric Emergency 591 3. Days of Public Health Imporatnce 685 16. Phobia 592 4. Formulae in Community Medicine 687 17. Antipsychotics 596 5. Incubation Period of Diseases 689 18. Antidepressants 598 6. National Immunization Schedule 690 19. Obsessive Compulsion Disorders 600 7. RNTCP Guidelines 691 20. Mental Health Care Act 2017 602 8. Committees and Commissions on Health 695 9. Categories of Biomedical Waste 702 © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. OBSTETRICS AND GYNAECOLOGY 10. Accredited Social Health Activist 704 1. Antenatal Care 605 11. National Health Programs 706 2. Nursing Care of Women in Labor 607 3. Postnatal Care 608 PHARMACOLOGY 4. Oligohydramnios 610 1. Anti-tubercular Treatment 711 5. Polyhydramnios 612 2. Management of Anaphylaxis 713 6. Abnormalities of Placenta 615 3. Adverse Effects of Common Drugs 715 7. Fetal Circulation 619 4. Common Antidotes 718 8. Physiological Changes in Pregnancy 620 5. Dopamine and Management of Shock. 722 9. Difference between True and False Labor Pains 624 6. MAO Inhibitors 723 10. Mechanism of Labor 625 7. Routes of Drug Administration 725 11. Episotomy. 627 8. Antihypertensive Drugs 728 12. Types of Pelvis 629 9. Organophosphate Poisoning 729 13. Abruptio Placenta 631 10. Drugs of Choice in Different Diseases 731 14. Lochia 634 11. Commonly used Antidotes, Routes and 15. Fetal Skull 636 Mechanism of Action 734 16. Puerperal Complications 639 12. Antimicrobial Drugs 737 17. Amniocentesis. 640 18. Presentation and FHR 642 PSYCHOLOGY 19. Types of Abnormal 643 20. Cord Prolapse 644 1. Hierarchy of Needs 741 2. Perception 743 PEDIATRIC NURSING PATHOLOGY 1. Apgar Score 647 2. Danger Sings in Neonates 648 1. Mediators of Inflammation 747 3. Reflexes. 649 2. Edema 749 4. Hemolytic Disease of Newborn 651 3. Tumor Markers 751 5. Newborn Assessment 653 4. Blood Group System 752 6. Preterm Baby 657 7. Kangaroo Mother Care 659 ANATOMY AND PHYSIOLOGY 8. Integrated Management of Childhood Illness. 661 1. Nervous System 756 9. Tetralogy of Fallot. 665 2. Bones 759 10. Pediatric Vital Signs-Normal Range 668 3. Joints 762 11. Immunization Schedule 669 4. Cranial Nerves 765 12. Down’s Syndrome (Mongolism) 671 5. Action of Gastrointestinal Hormones 767 13. Management of Low Birth Weight Babies 673 6. Conduction System of Heart 769 14. Head Swellings in a Newborn 675 7. Lung Volumes and Capacities 771 ii 15. Thermal Control in Newborn 676 8. Pituitary Gland 773  9. Respiratory Muscles 775 5. Telemedicine 843 10. Lungs 777 6. eHealth and Telenursing 845 11. Thyroid Glands 778 12. Physiology of Respiration 783 NURSING EDUCATION 1. Methods of Teaching Part I 849 BIOCHEMISTRY AND NUTRITION 2. Communication 851 1. Vitamins 787 3. Difference Between Guidance 2. Water-soluble Vitamins 788 and Counselling 852 3. Body Mass Index 790 4. Methods of Teaching Part 2 853 4. Classification of Fatty Acids 791 © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. SOCIOLOGY NURSING RESEARCH 1. Important Terminologies 858 1. Hypothesis 795 2. Social Processes and 2. Types of Research 796 Social Stratifications 859 3. Classification of Sampling Methods 798 3. Population and Demography 861 4. Measures of Central Tendency 800 5. Parametric and Non-parametric Tests 801 COMPUTERS 1. Nursing Informatics 864 MICROBIOLOGY 2. Keyboard Shortcuts 866 1. Immunity 804 2. Classification of Bacteria 809 GENERAL ENGLISH 3. Hepatitis Virus 814 1. Active and Passive Voice 871 4. Immunoglobins 818 2. Adjectives 877 5. Hypersensitivity 821 6. Sterlization Techniques 822 APTITUDE AND REASONING 7. Disinfection 824 8. Hospital Acquired Infections 828 1. Blood Relations. 882 2. Direction and Distance 884 NURSING MANAGEMENT 3. Image-Based Qs 888 3. Image-Based Qs 979 1. Leadership 835 2. Principles of Management 837 3. Inventory Control 838 GENERAL KNOWLEDGE 4. Torts 841 1. General Knowledge 1018 iii  National NORCET Test-2 MEDICAL SURGICAL NURSING 1. A Registered nurse kept the resuscitation equipment available at the bedside of her assigned patient who is receiving tissue plasminogen activator (t-PA), because reperfusion of the cardiac tissue can result in which of the following? a. Hypertension b. Seizure c. Hypothermia d. Cardiac arrhythmias. Ans. d. Cardiac arrhythmias Option d: Cardiac arrhythmias are commonly observed with administration of t-PA. Cardiac arrhythmias are associated with reperfusion of the cardiac tissue. Option a: Hypotension is commonly observed with administration of t-PA. Option b & c: Seizures and hypothermia are not generally associated with reperfusion of the cardiac tissue. 2. The doctor order for the application of Knee-high sequential compression devices to the newly admitted patient in ICU. When the nurse visited at the patient bedside to perform initial assessment the patient report of new pain localized in the right calf area that is noted to be slightly reddened and warm to touch upon initial assessment. select the best possible intervention to be applied by the nurse? a. Administer analgesics and then apply the compression device b. Do not apply the compression device and contact to physician c. Massage the area before applying the compression devices. d. Apply the compression devices as it will help the patient. Ans. b. Do not apply the compression device and contact to physician option b: Localized pain, tenderness, redness, and warmth may be symptoms of deep vein thrombosis (DVT), in this scenario the nurse should report to the physician and the compression devices should not be applied as intermittent compression may dislodge a thrombus. option a: Analgesics may be administered as per the physician order only but the compression devices should not be applied until further evaluation is completed. option c: Massaging the area may dislodge a thrombus and is not recommended. option d: DVT can become life threatening if a thrombus travels to the lung and becomes a pulmonary embolus and application of the compression device may result into a thrombus dislodgement. 3. You have received a 50 years- old client in emergency unit and documented the following assessment findings: Severe back pain, presence of grey turner’s sign, nausea, Blood pressure 90/40 mmHg, respiration 30 breath/min, Heart rate 128 beats/min. Based on the above assessment findings select the priority nursing intervention? a. Insert the Foley’s catheter for I& O monitoring b. Place a large-bore IV c. Insert a nasogastric tube d. Place the client in left lateral position Ans. b. Place a large-bore IV Option b: There are several conditions commonly associated with Grey Turner’s sign such as: Acute pancreatitis, perforated duodenal ulcer, ruptured abdominal aortic aneurysm and all the presented assessment findings in the questions suggest a ruptured abdominal aortic aneurysm. The priority nursing intervention in this situation to establish an IV line for immediate volume replacement.  National NORCET Test-1 Option a: With hypovolemia, the urine output will be diminished and monitoring intake and output will also be done but the priority is © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. to administer the IV fluids to prevent hypovolemia. option c: Repositioning may potentiate the problem. Option d: A nasogastric tube may be considered with severe nausea and vomiting to decompress the stomach. 4. You are posted in male medicine ward and assigned to provide care to a patient admitted with pernicious anemia. Which of the following lab values should be report to the physician? a. Schilling test result, elevated. b. Intrinsic factor, absent. c. Sedimentation rate, 16 mm/h. d. Red blood cells (RBCs) within normal range Ans. b. Intrinsic factor, absent Option b: The defining characteristic of pernicious anemia, a megaloblastic anemia, is absence of the intrinsic factor. Intrinsic Factor is needed for vitamin B12 absorption in the small intestine folic acid needs vitamin B12 for deoxyribonucleic acid synthesis of RBCs. Option a: An elevated result of Schilling test, indicates that the client has the intrinsic factor and can absorb vitamin B12 in the intestinal tract. Option c: A sedimentation rate of 16 mm/h is normal for both men and women and is a nonspecific test to detect the presence of inflammation; it is not specific to anemias. Option d: An RBC value within the normal range does not indicate an anemia. 5. While treating an elderly client with severe nose bleed, the physician has inserted posterior packing to control bleeding. After insertion of the packing, the nurse will closely monitor the client for which of the following complications? a. Vertigo. b. Bell’s palsy. c. Hypoventilation. d. Loss of gag reflex. Ans. c. Hypoventilation option c: Nostril Packing can alter the respiratory status especially in elder client which can results into hypoventilation. The nurse should closely monitor the client for changes in level of consciousness, respiratory rate, and heart rate and rhythm after the insertion of the packing. Option a: Vertigo does not occur as a result of the insertion of posterior packing. Option b: Bell’s palsy, a disorder of the seventh cranial nerve, is not associated with epistaxis or nasal packing. Option d: Loss of gag reflex does not occur as a result of the insertion of posterior packing. 6. The nurse is performing an endotracheal tube suctioning. Before suctioning the nurse has pre-oxygenated the client. In order to avoid hypoxemia what is the maximum amount of time the nurse should suction the client at a time? a. 10 seconds. b. 15 seconds. c. 25 seconds. d. 30 seconds Ans. a. 10 seconds A client should be suctioned for no longer than 10 seconds at a time. Suctioning for longer than 10 seconds may reduce the client’s oxygen level so much that he becomes hypoxic. 102  National NORCET Test-2 7. A nurse should interpret which of the following as an early sign of a tension pneumothorax in a client with chest trauma? a. Diminished bilateral breath sounds b. Muffled heart sounds c. Respiratory distress d. Tracheal deviation Ans. c. Respiratory distress Respiratory distress or arrest is a universal finding of a tension pneumothorax. Unilateral, diminished, or absent breath sounds is a common finding. Tracheal deviation is an inconsistent and late finding. © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. Muffled heart sounds are suggestive of pericardial tamponade. 8. While performing the physical assessment, the nurse observed that the client is taking small breaths at first, then bigger breaths, then a couple of small breaths, then 10 to 20 seconds of no breaths. The nurse should document the assessment finding as: a. Cheyne-Stokes respiration. b. Hyperventilation. c. Obstructive sleep apnea. d. Biot’s respiration Ans. a. Cheyne-Stokes respiration Option a: Cheyne-Stokes respiration is defined as a regular cycle that starts with normal breaths, which increase and then decrease followed by a period of apnea. It can be related to heart failure or a dysfunction of the respiratory center of the brain. Option b: Hyperventilation is the increased rate and depth of respirations. Option c: Obstructive sleep apnea is recurring episodes of upper airway obstruction and reduced ventilation. Option d: Biot’s respiration, also known as “cluster breathing,” is periods of normal respirations followed by varying periods of apnea 9. A patient admitted with Crohn’s disease with the presenting complaints of fever, diarrhea, cramping, abdominal pain, and weight loss. The nurse should monitor the patient for which of the following? a. Hyperalbuminemia b. Thrombocytopenia c. Hypokalemia d. Hypercalcemia Ans. c. Hypokalemia option c: Hypokalemia is the most expected laboratory finding owing to the diarrhea. Option a: Hypoalbuminemia is also associated with Crohn’s disease; Option b: Anemia is an expected development, but thrombocytopenia is not. Option d: Calcium levels are not affected 10. As per the doctor order you have started the infusion of TPN solution. While making a round you noticed that the TPN solution was running at an incorrect rate and is now 2 hours behind schedule. Which action is most appropriate for the nurse to take to correct the problem? a. Readjust the solution to infuse the desired amount. b. Continue the infusion at the current rate, but run the next bottle at an increased rate. c. Double the infusion rate for 2 hours. d. Notify the physician. Ans. d. Notify the physician TPN solutions must be carefully and accurately infused. When TPN fluids are infused too rapidly or too slowly, the physician should be notified. Rate adjustments should not be made without a written prescription from the physician. Alteration in the infusion rate can lead to increase or decrease in blood glucose level. 103  National NORCET Test-1 11. A nurse has to administer an eye drop and an eye ointment to a client in right eye. How should the nurse best administer the medications? a. Administer the eye drop first, followed by the eye ointment. b. Administer the eye ointment first, followed by the eye drop. c. Administer the eye drop, wait 15 minutes, and administer the eye ointment. d. Administer the eye ointment, wait 15 minutes, and administer the eye drop. Ans. a. Administer the eye drop first, followed by the eye ointment. When an eye drop and an eye ointment are scheduled to be administered at the same time, the eye drop is administered first. The instillation of two medications are separated by 3 to 5 minutes. 12. Post-Operative nurse received a patient following open cholecystectomy with T tube drainage bag. After 6 hours of © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. admission the patient T-tube drainage bag is empty, and the nurse notice slight jaundice of the sclera. Which action by the nurse is most important? a. Repositioning the patient to promote T-tube drainage b. Notifying the surgeon about these findings c. Check the patient blood pressure immediately d. Recording the findings and continuing to monitor the patient Ans. b. Notifying the surgeon about these findings Option b: The T-tube is usually placed in the common bile duct to ensure patency of the duct. Lack of bile draining into the T-tube and presence of jaundice in sclera indicates bile flow obstruction which should be reported to the surgeon. option a: Repositioning might promote bile flow if the catheter is obstructed or having kink. However, the jaundice indicates that the bile duct obstructed not the T tube drain. Option c: Checking Blood Pressure will not resolve the condition Option d: Recording the findings and continuing to monitor the client is inappropriate because the client is experiencing signs of a complication 13. The female patient is admitted with a new diagnosis of Cushing syndrome with elevated serum and urine cortisol levels. Which assessment findings should the nurse expect to see in this patient? a. Hair loss and moon face b. Decreased weight and hirsutism c. Decreased muscle mass and thick skin d. Elevated blood pressure and blood glucose Ans. d. Elevated blood pressure and blood glucose Rationale: The elevated cortisol of Cushing syndrome manifests in elevated blood pressure and blood glucose. Also seen are moon face, hirsutism, decreased muscle mass from protein wasting, increased weight and fragile skin with striae across the abdomen. 14. You have received an ABG report of your assigned patient admitted with Chronic COPD. ABG report shows: pH 7.35 PCO2 62 PO2 70 HCO3 34 Based on the above findings which of the following intervention the nurse should perform? a. Assess the vital signs. b. Reposition the client. c. Prepare for intubation d. Apply a 100% nonrebreather mask. Ans. a. Assess the vital signs Patient with chronic COPD have CO2 retention and the respiratory drive is stimulated when the PO2 decreases. The patient needs to be evaluated to assess hemodynamically stability by checking the heart rate, respiratory rate, and blood pressure Option b: Repositioning will not help in this situation 104 option c: There is no indication that the client is experiencing respiratory distress requiring intubation. Option d: Oxygen supplementation, if indicated, should be titrated upward in small increments.  National NORCET Test-1 15. Which of the following complications is associated with prolonged mechanical ventilation? a. Immunosuppression. b. Increased cardiac output. c. Gastrointestinal hemorrhage. d. Pulmonary emboli. Ans. c. Gastrointestinal hemorrhage Prolonged mechanical ventilation can lead to gastrointestinal haemorrhage because of the development of stress ulcers. If the patient is receiving steroid therapy or having any previous history of ulcers are more prone for GI haemorrhage. Other possible complications include Incorrect ventilation, Oxygen toxicity, Fluid imbalance, Decreased cardiac output, © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. Pneumothorax, Infection, Atelectasis. 16. You have received a new admission with the provisional diagnosis of ulcerative colitis. Initial assessment findings include persistent diarrhea, and has lost 11 lb since the exacerbation of the disease. Which of the following is an effective way to meet the patient nutritional needs? a. Provide Continuous enteral feedings. b. Provide total parenteral nutrition (TPN). c. Provide intermittent enteral feeding d. a&c Ans. b. Provide total parenteral nutrition (TPN). In case of ulcerative colitis with severe symptoms the management include to rest the bowel. To maintain the patient’s nutritional status, the client will be started on TPN. option a & c: Continuous Enteral feedings or intermediate feeding does not allow the bowel to rest. 17. Which of the following indicates that total parenteral nutrition is having an expected outcome? a. Increased cell nutrition. b. Does not result to metabolic acidosis. c. Provide hydration d. Result into negative nitrogen balance. Ans. a. Increased cell nutrition The TPN is provided through the parenteral route to meet the nutritional need of the patient. TPN is a hypertonic solution containing carbohydrates, amino acids, electrolytes, trace elements, and vitamins. TPN is not used to treat metabolic acidosis; ketoacidosis can actually develop as a result of administering TPN. It is not used to meet the hydration needs. TPN is administered to provide a positive nitrogen balance. 18. A patient has received multiple antibiotics and now is experiencing diarrhea. The doctor has prescribed a transmission- based precaution. Which of the following types of precautions would be most appropriate in this case? a. Airborne precautions. b. Contact precautions. c. Droplet precautions. d. Standard Precaution Ans. b. Contact precautions. Airborne precautions are required for clients with presumed or proven pulmonary tuberculosis (TB), chickenpox, or other airborne pathogens. Contact precautions are used for organisms that are spread by skin-to-skin contact, such as antibiotic-resistant organisms or Clostridium difficile. Droplet precautions are used for organisms such as influenza or meningococcus that can be transmitted by close respiratory or mucous membrane contact with respiratory secretions. Transmission based precaution include: Contact, Airborne and Droplet precaution where standard precaution is to be applied to all the patient regardless of their infection condition. 106  National NORCET Test-2 19. You are formulating a nursing care plan for a patient with an arterial line (A-line). The nurse is well aware that this line can be used for which of the following? a. Monitoring blood pressure and heart rate, and infusing medications b. Monitoring blood pressure and heart rate, and obtaining blood gases and other laboratory samples c. Monitoring heart rate, obtaining blood gases and other laboratory samples, and infusing medications d. Obtaining blood gases and other laboratory samples, and infusing medications Ans. b. Monitoring blood pressure and heart rate, and obtaining blood gases and other laboratory samples Medications should never be infused through an arterial line. Arterial lines are used for monitoring blood pressure and heart rate, or ABG sampling. © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. 20. You have received a client with emphysema in emergency becomes restless and confused. Which of the following actions should the nurse take next? a. Measure the body temperature b. Instruct to perform pursed lip breathing c. Assess serum potassium level d. Increase the oxygen flow rate to 6 L/min. Ans. b. Instruct to perform pursed lip breathing Encourage the client to perform pursed-lip breathing—prevents collapse of lung unit and helps client control rate and depth of breathing option a: Monitoring the temperature will not help as confusion is probably due to decreased oxygenation option c: potassium level assessment will not help in identifying the confusion option d: client should receive low flow rate of oxygen to prevent carbon dioxide narcosis. 21. Select the correct intervention from the following for the plan of care for a patient with severe liver disease? a. Administer Kayexelate enemas. b. Provide a low-protein, high-carbohydrate diet. c. Insert a Sengsteken-Blakemore tube. d. All of the above Ans. b. Provide a low-protein, high-carbohydrate diet. Severe liver diseases can lead to hepatic coma caused by increased levels of ammonia from breakdown of protein. Due to which it is recommended to provide low-protein, high-carbohydrate diet to such patients. option a: Kayexelate enemas is used in case of hyperkalemia to decreases serum potassium levels option c: Sengsteken-Blakemore tube is usually used in case of upper GI bleeding to applies pressure against bleeding esophageal varices. 22. A patient present with jaundice due to pancreatic cancer. While prioritizing the patient needs which of the following nursing diagnosis the nurse should give the HIGHEST priority? a. Imbalanced Nutrition b. Disturb Self-image c. Impaired Skin integrity d. Impaired gas exchange Ans. a. Imbalanced Nutrition Pancreatic cancer is associated with profound weight loss and anorexia due to which nutritional needs become the highest priority for this patient. Disturb self-image can be a concern due to the presence of jaundice but physiological needs take priority Impaired skin integrity can be placed for second highest priority as jaundice causes dry skin and pruritis; scratching can lead to skin breakdown Impaired gas exchange is not a definitive nursing diagnosis for the patient with pancreatic cancer 23. Identify the ECG rhythm as demonstrated in the given video link? https://vimeo.com/440573811/339d18b7f7 a. Sinus tachycardia b. Paroxysmal supraventricular tachycardia c. Sinus rhythm d. All of the above Ans. b. Paroxysmal supraventricular tachycardia 107  National NORCET Test-1 RATIONALE: The correct answer is Paroxysmal supra ventricular tachycardia. Supraventricular tachycardia is a series of rapid heartbeats that begin in or involve the upper chambers (atria) of the heart. Types of SVT are Atrial Fibrillation (A fib), Paroxysmal Supraventricular Tachycardia (PSVT) and Atrial Flutter (A Flutter). Recognizing PSVT on an EKG Ĕ The EKG will show a fast heart rate anywhere from 100 to up to 300 bpm. Ĕ The QRS is narrow at a regular rhythm. Ĕ Sometimes the P waves are inverted, this is referred to as retrograde P waves. Ĕ It can also be drug induced; Digoxin and Theophylline can cause PSVT. Signs and symptoms: Ĕ Anxiety © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. Ĕ Shortness of breath Ĕ Tachycardia Ĕ Palpitations Ĕ Dizziness Ĕ Syncope Sinus tachycardia is a sinus rhythm with a heart rate greater than 100 beats per minute in an adult. Note that the p waves are still present. Rhythm = Regular Figure 1: Sinus Tachycardia Sinus rhythm P wave PR Interval QRS Rate Rhythm Before each QRS complex Constant, regular Rate 60 - 100 Regular interval (0.12 - 0.20) Interval =/< 0.10 Figure 2: Sinus rhythm 108  National NORCET Test-2 24. Identify the image given below: © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. a. Laminar flow hood b. C coil machine c. C arm machine d. USG machine Ans. c. C arm machine RATIONALE: The correct answer is C arm machine. A C arm machine categorizes itself as an advanced medical imaging device that works on the basic premise of the X-ray technology. They are fluoroscopy machines and are colloquially called image intensifiers. C arm gets its name from the C-shaped arm present in the device, which is used to connect the X-ray source and the detector. These C arm machines are widely used during orthopedic, complicated surgical, pain management (Anesthetics) and emergency procedures. A laminar flow cabinet or tissue culture hood is a carefully enclosed bench designed to prevent contamination of semiconductor wafers, biological samples, or any particle sensitive materials. Air is drawn through a HEPA filter and blown in a very smooth, laminar flow towards the user. Due to the direction of air flow, the sample is protected from the user, but the user is not protected from the sample. Figure 1: Laminar flow hood An ultrasound machine makes images so that organs inside the body can be examined. The machine sends out high-frequency sound waves, which reflect off body structures. A computer receives the waves and uses them to create a picture. Unlike with an 109 X-ray or CT scan, this test does not use ionizing radiation.  National NORCET Test-2 © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. Figure 2: USG machine Other option is a distractor. 25. Identify the laparoscopic instrument in the given image? a. Maryland dissector b. Maxigrip garsper c. Fenestrated mediclinch grasper d. Harmonic ace Ans. a. Maryland dissector RATIONALE: The correct answer is Maryland dissector is ideal for precise dissection. Option2: Maxi-Grip Fundus Grasper Figure 1: Maxi-Grip Fundus Grasper Option 3: Fenestrated mediclinch grasper widely used on tissues of stomach wall and gall bladders Figure 2: Fenestrated Mediclinch grasper 111  National NORCET Test-1 Option 4: The harmonic scalpel is a surgical instrument used to simultaneously cut and cauterize tissue. © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. Figure 3: Harmonic Ace 26. By using the surgical diathermy machine in operation theatre which of the following functions can be achieved? a. cutting, coagulation, fulguration b. cutting, fulguration c. cutting, coagulation d. coagulation, fulguration Ans. a. cutting, coagulation, fulguration Cutting happens when the heat is given is so high frequency that the cell burns and is separated which is called as incision. Coagulation happens when the cytoplasm is heated so much and joins together. Fulguration is a process in which the heat is applied and it destroy the superficial layer of tissue by means of high-frequency. 27. Identify the name of the instrument given below? a. Right angle forceps b. Cervical punch biopsy forceps c. Tonsillar snare d. Yaunker tonsil tip Ans. c. Tonsillar snare RATIONALE: 112 option b: A biopsy punch is a circular hollow blade attached to a long, pencil-like handle. Commonly used in cervix biopsy.  National NORCET Test-2 Figure: Cervical punch biopsy forceps Option a: Right Angle Forceps are ratcheted, finger ring forceps commonly used for working in obscured surgical sites. They are most frequently used for clamping, dissection, or grasping tissue. © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. Figure: Right angle forceps Option c: Tonsil Snare is a commonly used tool in tonsillectomy procedures. The wire loop snare is designed to encircle the affected tonsil for removal. Figure: Tonsillar snare Option d: Yanker tonsil tip is an oral suctioning tool used in medical procedures. It is typically a firm plastic suction tip with a large opening surrounded by a bulbous head and is designed to allow effective suction without damaging surrounding tissue. This tool is used to suction oropharyngeal secretions in order to prevent aspiration. A Yankauer can also be used to clear operative sites during surgical procedures. 113 Figure: Yanker Tonsil tip  National NORCET Test-1 28. Which of the following term describes a fungal infection in scalp? a. Tinea capitis b. Tinea corporis c. Tinea cruris d. Tinea pedis Ans. a. Tinea capitis Rationale: Tinea capitis is a superficial fungal infection of the skin of the scalp, eyebrows, and eyelashes, with a propensity for attacking hair shafts and follicles. Commonly seen in 3-7 yrs. old children. Caused by Trichophyton and Microsporum Tinea corporis, is a superficial fungal infection of the arms and legs, especially on glabrous skin; however, it may occur on any part © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. of the body. Tinea cruris is a fungal infection of the groin. Athlete’s foot (tinea pedis) is a fungal infection that usually begins between the toes. 29. Catgut is preserved in: a. Glutaraldehyde b. Isopropyl alcohol c. Iodine d. Formaldehyde Ans. b. Isopropyl alcohol Catgut sutures are packaged in alcohol solution (ethanol or isopropanol or Isopropyl alcohol) to retain their flexibility and the packages are sterilized by either Co60 gamma-irradiation or ethylene oxide. 30. The nurse should use which of the following technique test to assess peripheral response to pain of an unconscious patient during the motor and sensory function test? a. Nail bed pressure b. Squeezing of the sternocleidomastoid muscle c. Sternal rub d. Pressure on the orbital rim Ans. a. Nail bed pressure Rationale: Nail bed pressure tests a basic motor and sensory peripheral response. Cerebral responses to pain are tested using a sternal rib, placing upward pressure in the orbital rim, or squeezing the clavicle or sternocleidomastoid muscle. MIDWIFERY AND OBSTETRICAL NURSING 31. A pregnant female at 22 weeks of come for antenatal visit. On routine checkup her hemoglobin is 11.6 gm% & her pre-pregnancy hemoglobin was 12.6gm%. The nurse advices her the following as per “Anemia Mukt Bharat Programme”:- a. 1 tab of 60mg iron and 500 mcg of folic acid b. 2 tabs of 60 mg iron and 500 mcg folic acid c. 1 tab 100 mg iron and 500 mcg folic acid d. 2 tabs of 100 mg iron and 500 mcg folic acid Ans. a. 1 tab of 60mg iron and 500 mcg of folic acid If a female hemoglobin drops but remains above 11 gms percent- it means she has physiological anemia of pregnancy. For physiological anemia she should be given 1 iron and folic acid tablet per day starting from 4th month of pregnancy for 180 days, i.e. throughout pregnancy and for 180 days after that. Each tablet contains 60 mg elemental iron and 500 mcg folic acid. If a pregnant female has pathological anemia – i.e. Hb is less than 11 gms percent – then she should be given 2 tabs per day. 114  National NORCET Test-1 32. Identify the Leopold maneuver shown in figure? © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. a. 1st Maneuver b. 2nd Maneuver c. 3rd Maneuver d. 4th Manouver Ans. c. i.e 3rd Maneuver The maneuver shown in image is being done at the pelvic are with one hand and while facing the face of patient – hence it is leopold third maneuver 33. Which of the following is true statement about screening for diabetes in pregnancy? a. It is done between 20 -24 weeks of pregnancy b. Fasting is needed by patient c. Done with 100 g of glucose d. Done in first antenatal visit Ans. d. done in first antenatal visit. 116  National NORCET Test-2 A universal screening which is simple, feasible, acceptable and a single step procedure is applicable in Indian scenario as Indian women have an eleven-fold increased risk of developing glucose intolerance during pregnancy. Criteria In Pregnancy 2hours ≥ 200 mg/dl Diabetes Mellitus 2hours ≤ 140 mgdl GDM Hence in Indian scenario - DIPSI recommended a single step procedure irrespective of the last meal. Pregnant women attending the antenatal OPD are given 75g anhydrous glucose in 250-300ml of water and plasma glucose is estimated after 2 hour. A 2-hours plasma glucose ≥ 140 mg/dl is taken as GDM 34. All of the following are normal during pregnancy except © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. a. Increased viscosity b. Increased globulin level c. Decreased hemoglobin concentration d. Decreased peripheral vascular resistance Ans. a. increased viscosity During pregnancy – both plasma volume and blood volume increase- but increase in plasma volume is more than blood volume so during pregnancy there is hemodilution and blood viscosity decreases. Plasma protein mass increases in pregnancy, but plasma protein concentration decreases. Globulin increases in pregnancy and albumin decreases WBC count increases in pregnancy – platelet count decreases Hb mass increases in pregnancy but Hb concentration decreases in pregnancy Cardiac output, heart rate and stroke volume increases in pregnancy but peripheral vascular resistance decreases 35. A 12 weeks pregnant female whose BP was 140/90 mmHg suddenly at 22 weeks of pregnancy has BP increases to 160/110 mmHg with +1 proteinuria. What can be the diagnosis? a. Severe Pre-eclampsia b. Chronic Hypertension with superimposed pre-eclampsia c. Gestational hypertension d. Mild pre-eclampsia Ans. b. chronic hypertension with superimposed pre-eclampsia This female had high BP -140/90 mm of hg at 12 weeks of pregnancy – means she has chronic hypertension of pregnancy.Suddenly after 20 weeks if BP becomes uncontrollable or if proteinuria u develops or she develops end organ damage – means she has chronic hypertension with superimposed pre eclampsia. In pre eclampsia and gestational hypertension – the increase in BP is seen after 20 weeks of pregnancy. In pre eclampsia there is associated proteinuria or signs of end organ damage may be present. In gestational hypertension – neither proteinuria nor signs of end organ damage are seen 36. A 26 years old female came with complains of scanty curdy white vaginal discharge. She also complains of itching and dysuria. Most probable diagnosis is a. Trichomonas vaginitis b. Bacterial vaginosis c. Candidiasis d. Leukorrhea Ans. c. candidiasis Curdy white, scanty discharge with lot of itching indicates candidiasis. In bacterial vaginosis female complains of greyish white discharge , with no itching. In trichomonas – discharge is yellowish green in colour. 117  National NORCET Test-1 37. Identify the maneuver? © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. a. Pinard maneuver b. Loveset maneuver c. Burn-Marshall maneuver d. Prague maneuver Ans. c. burn Marshall maneuver Burn Marshall technique is for delivery of after coming had of breech where the baby’s body is allowed to hang by its own weight and then when occipital protuberance is visible- feet of the baby are held and taken towards mother’s abdomen. 38. The plotting of partogram should begin from:- a. left of alert line b. right of alert line c. left of action line d. right of action line Ans. a. left of alert line The partogram used these days is Modified WHO partogram – where plotting begins from active phase I.e 4cms dilatation of cervix. Ideally plotting should begin on alert line. Now since in options- on alert line is not given we will mark the answer as – left of alert line 39. What is the position of fetus in the following image? a. Right occipito-posterior b. Left occipito-posterior c. Left occipito-anterior d. Right occipito-anterior Ans. b. left occipito-posterior position In questions like these – identify the posterior fontanelle first. To identify posterior fontanelle remember- it is a triangular shaped fontanelle whereas anterior fontanelle is quadrangular fontanelle. 118  National NORCET Test-2 Now see whether post fontanelle is near the pubic symphysis or sacral promontory 1. If it is near pubic symphysis – it means occipito-anterior 2. If it is near sacral promontory – it means occipito-posterior 3. 3. If midway between pubic symphysis and sacral promontory – occipito-transverse Now see whether – post-fontanelle is facing your right hand side or your left hand side 1. If post fontanelle/occiput is towards your left- its mothers right 2. If post fontanelle/occiput is towards your right – its mothers left In the image – posterior fontanelle is towards sacral promontory i.e. its occipito-posterior position and because it’s towards your right so it will be mothers left © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. Hence left occipito-posterior position 40. Which of the following is true regarding cephalhematoma? a. Collection of blood above the periosteum b. Can cross suture lines c. Pits on applying pressure d. Collection of blood below the periosteum Ans. d. collection of blood below periosteum Caput Succedaneum Cephalohematoma Condition marked by localized soft tissue edema with poorly defined Condition marked by soft, fluctuant, localized swelling with well- outline defined outline Caused by pressure of the fetal head against the cervix during labor, Caused by subperiosteal hemorrhage which decreases blood flow to the area and results in edema Appears after birth; increases in size for 2-3 days Present at birth; does not increase in size Swelling crosses suture lines Swelling does not cross suture lines Disappears within a few hours to several days Complications are rare Disappears in several weeks to even months Complications include defective blood clotting, underlying skull fracture or intracranial bleeding, and jaundice 41. Identify the type of fibroid given in the image :- a. Sub-serosal fibroid b. Intra-mural fibroid c. Sub-mucosal fibroid d. Sub-peritoneal fibroid 119 Ans. c. submucosal fibroid  National NORCET Test-2 Fibroids/ leiomyoma are smooth muscle tumours of uterus. They arise from myometrium of uterus and are called intramural variety. Some of them then grow towards uterine cavity- called as Submucous type and some grow towards uterine serous and are called as subserosal. M/c type is – intramural M/c fibroid leading to symptoms/ menorrhagia – submucosal fibroid M/c fibroid causing abortions- submucosal fibroid 42. During Pap smear following instrument takes biopsy from - © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. a. Internal Os b. Vagina c. Endocervix d. Transformation zone Ans. c. Endocervix The instrument shown in image is endocervical brush. It is used to take sample from endocervix. Ayers spatula- takes sample from transformation zone. If TZ is not given in options – answer should be marked as squamous columnar junction and if that is also not given then- external os. First sample taken using Ayers spatula from TZ and then using endocervical brush from endocervix and both sample as are put on same slide. The preservative used is – 95% ethyl alcohol and 5% ether 43. All of the following Vaccines can be given in pregnancy except:- a. COVID 19 b. HPV c. Rabies d. Flu vaccine Ans. b. HPV All live vaccines and HPV vaccine( which is not live )– are contraindicated in pregnancy List of vaccines absolutely contraindicated in pregnancy 1. Mumps vaccine 2. Measeles vaccine 3. Rubella vaccine 4. Small pox 5. Chicken pox 6. Bcg 7. HPV 44. A 29-year-old multigravida at 37 weeks’ gestation is being treated for severe preeclampsia and has magnesium sulfate infusing at 3 g/hour. The nurse has determined the priority nursing diagnosis to be: risk for central nervous system injury related to hypertension, edema of cerebrum. To maintain safety for this client, the nurse should: a. Maintain continuous fetal monitoring. b. Encourage family members to remain at bedside. c. Assess reflexes, clonus, visual disturbances, and headache. d. Monitor maternal liver studies every 4 hours Ans. c. Assess reflexes, clonus, visual disturbances, and headache. 121  National NORCET Test-1 option c: If the mother suffers CNS injury related to hypertension or stroke, oxygenation status is compromised and the well-being of both mother and infant are at risk. In preeclampsia, frequent assessment of maternal reflexes, clonus, visual disturbances, and headache give clear evidence of the condition of the maternal CNS system. option a: Continuous fetal monitoring is an assessment strategy for the infant only and would be of secondary importance to maternal CNS assessment because maternal oxygenation will dictate fetal oxygenation and well-being. Option b: Psychosocial care plays an important role but physiological needs should be the priority. option d: Monitoring the liver studies does give an indication of the status of the maternal system but the less invasive and highly correlated condition of the maternal CNS system in assessing reflexes, maternal headache, visual disturbances, and clonus is the highest priority. 45. The nurse should do which of the following actions first when admitting a multigravida client at 36 weeks’ gestation © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. with a probable diagnosis of abruptio placentae? a. Prepare the client for a vaginal examination. b. Obtain a brief history from the client. c. Insert a large-gauge intravenous catheter. d. Prepare the client for an ultrasound scan Ans. c. Insert a large-gauge intravenous catheter. option c: Abruptio placentae is a medical emergency because of the degree of hypovolemic shock. On admission, the nurse should plan to first insert a large-gauge intravenous catheter for fluid replacement and provide oxygen by mask to decrease fetal anoxia. option a: Vaginal examination usually is not performed on pregnant clients who are experiencing third-trimester bleeding due to abruptio placentae because it can result in damage to the placenta and further fetal anoxia. option b: The client’s history can be obtained once the client has been admitted and the intravenous line has been started. The nurse should also plan to monitor the client’s vital signs and the fetal heart rate. option d: Ultrasound is of limited use in the diagnosis of abruptio placentae. 46. The plane of engagement in the following image is: a. Biparietal-Suboccipitobregmatic b. Biparietal-mento-vertical c. Biparietal-Occipitofrontal d. Biparietal-Submentobregmatic Ans. a. Biparietal-Suboccipitobregmatic Rationale: The plane of engagement in the image is biparietal-suboccipito-bregmatic. It is seen in the vertex presentation with complete flexion attitude of head. Its circumference is 27.5 cm. Biparietal-mento-vertical: is seen in incomplete extension of head in vertex presentation with circumference of 37.5 cm. Biparietal-Occipitofrontal: is seen in deflexed head in vertex presentation with circumference of 34 cm. Biparietal-Submentobregmatic: is seen in complete extension of head vertex presentation with circumference of 27.5 cm. 122  National NORCET Test-2 47. The nurse is assessing fetal position for a 32-year-old client in her eighth month of pregnancy. As shown below, the fetal position can be described as which of the following? © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. a. Left occipital transverse. b. Left occipital anterior. c. Right occipital transverse. d. Right occipital anterior Ans. a. Left occipital transverse. option a: In left occipital transverse lie, the occiput faces the woman’s left hip. option b: In left occipital anterior lie, the occiput faces the left anterior segment of the woman’s pelvis. option c: In right occipital transverse lie, the occiput faces the woman’s right hip. option d: In right occipital anterior lie, the occiput faces the right anterior segment of the woman’s pelvis. 48. A 31-year-old multigravida client at 39 weeks’ gestation admitted to the hospital in active labor is receiving intravenous lactated Ringer’s solution and a continuous epidural anesthetic. During the first hour after administration of the anesthetic, the nurse should monitor the client for: a. Hypotension. b. Diaphoresis. c. Headache. d. Tremors. Ans. a. Hypotension. When a client receives an epidural anesthetic, sympathetic nerves are blocked along with the pain nerves, possibly resulting in vasodilation and hypotension. Other adverse effects include bladder distention, prolonged second stage of labor, nausea and vomiting, pruritus, and delayed respiratory depression for up to 24 hours after administration. Diaphoresis and tremors are not usually associated with the administration of epidural anesthesia. Headache, a common adverse effect of many drugs, also is not associated with administration of epidural anesthesia. 49. Feature of diabetes mellitus in pregnancy: i. Hydramnios ii. ↑ congenital defect iii. PPH iv. Neonatal hyperglycemia a. If i, ii, iii are correct b. If i and iii are correct c. If ii and iv are correct d. If all four (i, ii, iii, & iv) are correct Ans. a. If i, ii, iii are correct Rationale: Maternal hyperglycemia leads to fetal hyperglycemia, which in turn causes polyuria and thus causes polyhydramnios. Polyhydramnios leads to preterm delivery and not postdatism. Excessive uterine enlargement because of polyhydramnios and macrosomia causes increased incidence of atonic PPH. Diabetes leads to increased incidence of congenital defects in fetus. Maternal hyperglycemia → to fetal hyperglycemia → hyperinsulinemia → to neonatal hypoglycemia at birth. 123  National NORCET Test-1 Remember: In Diabetes Maternal and fetal – hyperglycemia Neonatal – hypoglycemia 50. Uterine tachysystole is defined as: a. More than 5 contraction in a 5 min period b. More than 5 contraction in a 10 min period c. More than 10 contraction in a 5 min period d. More than 10 contraction in a 10 min period Ans. b. More than 5 contractions in a 10-min period © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. Rationale: Uterine tachysystole is defined as ≥ 5 contractions in a 10 min period. It should always be qualified by the presence or absence of fetal heart rate abnormalities. It is caused by pharmacological agents used for cervical ripening and induction such as misoprostol (both oral and vaginal), dinoprostone. It can also be associated with placental abruption. NURSING FOUNDATIONS 51. The nurse is completing a client’s preoperative checklist prior to an early morning surgery. The nurse obtains the client’s vital signs: temperature 97.4° F (36° C), radial pulse 84 strong and regular, respirations 16 and unlabored, and blood pressure 132/74. Which of the following actions should the nurse take FIRST? a. Notify the physician of the client’s vital signs. b. Obtain orthostatic blood pressures lying and standing. c. Lower the side rails and place the bed in its lowest position. d. Record the data on the client’s preoperative checklist. Ans. d. Record the data on the client’s preoperative checklist. All the parameters are within the normal range and should be properly documented in the client’s preoperative checklist. other options are distracters. 52. A day care nurse is assigned to administer an IM injection to a client with pernicious anemia. The nurse selects which of the following muscles to administer this injection? a. Gluteus maximus b. Deltoid c. Vastus lateralis d. Dorsogluteal Ans. c. Vastus lateralis option a: Administration of IM injection in Gluteus maximus is associated with possible injury to sciatic nerve Option b: Deltoid can only use for small amount of medications and doesn’t have enough muscle mass to support the absorption. option c: Vastus lateralis is best for the administration of IM injection as no major nerves or blood vessels option d: Administration of IM injection in Dorsolateral is associated to possible injury to sciatic nerve 53. Suction of drainage in chest drain should be maintained at pressure: a. -10 to -20 cm of H2O b. -6 cm of H2O c. 10 to 20 cm of H2O d. 60 cm of H2O Ans. a. -10 to -20 cm of H2O 124  National NORCET Test-1 Rationale: Suction drainage system Chest drains also known as under water sealed drains (UWSD) are inserted to allow draining of the pleural spaces of air, blood or fluid, allowing expansion of the lungs and restoration of negative pressure in the thoracic cavity. Chest tube is connected to active suction drain usually with a pressure of -20 cm of H2O. If the lung expands well the chest tube is left under suction drainage for a period of 5 - 7 days or until the space is permanently obliterated. ICD is removed when output is less than 100 mL. 54. Which of the following is the proper sequence for examination of the lungs? a. Inspection, auscultation, percussion, and palpation b. Inspection, percussion, palpation, and auscultation © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. c. Inspection, palpation, auscultation, and percussion d. Inspection, palpation, percussion, and auscultation Ans. d. Inspection, palpation, percussion, and auscultation Rationale: The proper sequence for examination of the lungs is: Inspection for chest wall abnormalities, symmetry, and retractions Palpation for fremitus and crepitus (“crinkly” sensation) Percussion for dullness and diaphragmatic excursion Auscultation of breath sounds 55. Nurse Reena is ICU 1 head nurse and during her morning shift she received a handover report from the emergency nurse who will be transferring a patient to ICU. The patient has a Sengstaken-Blackmore Tube. While taking the handover about the Sengstaken-Blackmore tube which among the following is incorrect? (MSN) a. It is a three-lumen gastric tube b. one lumen to inflate gastric balloon c. second lumen to inflate esophageal balloon d. third lumen is for esophageal suction port Ans. d. third lumen is for esophageal suction port RATIONALE: The correct answer is option d. Sengstaken-Blakemore tube is a 3 lumen tube, one lumen to inflate gastric balloon, a second lumen to inflate esophageal balloon and a third lumen to aspirate gastric contents. There is no esophageal suction port. This causes saliva to pool in the esophagus and thus put patients at risk of aspiration. Figure: Sengstaken-Blakemore tube 126  National NORCET Test-2 56. The nurse understands that lumbar Puncture is useful to diagnose which of following condition? a. Tuberculosis meningitis b. Multiple sclerosis c. subarachnoid Hematoma d. All of the above Ans. d. All of the above In Tuberculosis meningitis, Cerebrospinal fluid protein level increased. Presence of oligoclonal immunoglobulin (antibodies) bands in the CSF is considered as the single most useful laboratory marker to diagnose multiple sclerosis. Subarachnoid Hematoma can be detected with CSF sample anticipated with blood. © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. 57. You are posted in burn unit and assigned to provide care to a newly admitted 13 years old patient with total body burn surface area 30% and body weight is 20 kg. While administering the initial fluid, the nurse will set flow rate of infusion at how many ml/hr? a. 2400 ml/hr b. 100 ml/hr c. 150 ml/hr d. 210 ml/hr Ans. c. 150 ml/hr Here, in the given scenario we already have TBSA (total body surface area) = 30% Body weight in kg =20 kg Now we need to identify the total amount of fluid need to administered in 24 hours by using the parkland formula The Parkland formula for the total fiuid requirement in 24 hours is as follows: =4ml/kg × TBSA (%) × body weight (kg) (50% given in first eight hours; 50% × given in next 16 hours.) Total amount of fluid need to administered in 24 hours = 4 X 20kg X 30% Total amount of fluid need to administered in 24 hours =2400 ml As we know in burn patient fluid need to administered initially in the first 8 hour. So now next step will be to identify the volume of fluid need to be administered in first 8 hours. volume of fluid need to be administered in first 8 hours= TOTAL VOLUME OF FLUID ADMINISTERED IN 24 HOURS ÷ 2 volume of fluid need to be administered in first 8 hours=2400÷ 2 volume of fluid need to be administered in first 8 hours = 1200 Now we need to figure out at what ml/hr the nurse will set the flow rate while administering the initial fluid for the first 8 hours to burn patient. Flow rate = total volume in ml/ time in hours Flow rate = 1200 ml/8 hours Flow rate = 150 ml/hrs 58. What purpose does the pilot balloon of an endotracheal or tracheostomy tube used in airway management? a. To minimize mucosal trauma during insertion b. To protect the airway against aspiration c. To monitor cuff integrity and pressure d. All of the above Ans. b. To monitor cuff integrity and pressure 127  National NORCET Test-1 The cuff is designed to provide a seal within the airway, allowing airflow through the ETT but preventing passage of air or fluids around the ETT. © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. 59. Who has given the theory of interpersonal relationship? a. Hildegard peplau b. Florence Nightingale c. Dorothea Elizabeth d. Imogene M king Ans. a. Hildegard peplau Hildegard Elizabeth Peplau has given the theory of Interpersonal Relations Theory Phases of IPR theory 1. Orientation 2. Working phase includes Identification & Exploitation 3. Resolution /Termination Dorothea Elizabeth Orem developed Self-Care Theory. Focuses on each individual’s ability to perform self-care. Composed of three interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the theory of nursing systems, which is further classified into wholly compensatory, partially compensatory, and supportive-educative. Imogene M. King: Theory of Goal Attainment. Explains that the nurse and patient go hand-in-hand in communicating information, set goals together, and then take actions to achieve those goals. Florence Nightingale founder of Modern Nursing and Pioneer of the Environmental Theory. Identified the act of utilizing the patient’s environment to assist him in his recovery.” 60. The trainee nurse is helping the assigned nurse who is providing care to the kidney transplant patient. The trainee nurse asks about the type of isolation to be used for such patients: a. Positive pressure room b. Negative pressure room c. General room d. Droplet precaution Ans. a. Positive pressure room Rationale: Positive pressure isolation rooms are used to isolate immunocompromised patients, for example like oncology and some transplant patients to reduce the risk of airborne transmission of infection to a susceptible patient. Here, the concept of reverse barrier nursing is applied where the patient needs to be protected from the risk of infections. In Positive pressure room, the air pressure is higher than outside, in order to keep the microorganism outside the room. This is done by the following the principle of the exhaust air to run at 10–15 percent lower than the supply air. The pressure differential is more than 2.5 Pa and ideally should be 8 Pa. In Negative pressure room, the air pressure is lower than outside in order to avoid the flow of contaminated air inside out. Exhaust air is run 10–15 per cent higher than the supply air. The patient who requires airborne precaution needs to be kept in negative pressure room. The air exiting a negative pressure environment has to be filtered with a high-efficiency particulate air (HEPA) filter. 61. Doctor prescribed colloid solution to the patient. Identify which of the following is the example of colloid solution. a. 25 % albumin b. Dextran c. Haemaccel d. All of the above 128 Ans. d. All of the above  National NORCET Test-2 RATIONALE: The correct answer is option 4. Colloids are gelatinous solutions that maintain a high osmotic pressure in the blood. Particles in the colloids are too large to pass semi- permeable membranes such as capillary membranes, so colloids stay in the intravascular spaces longer than crystalloids. Examples of colloids are albumin, dextran, hydroxyethyl starch (or hetastarch), Haemaccel and Gelofusine. 62. You are assigned to provide care to a ventilated patient. While charting the baseline vital data nurse noticed that the low-exhaled volume alarm sounds on a mechanical ventilator. The nurse determines that the cause for alarm activation may be which of the following complication? a. Excessive secretions b. Kinks in the ventilator tubing © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. c. Displacement of the endotracheal tube d. All of the above Ans. a. Displacement of the endotracheal tube RATIONALE: The correct answer is option 3. The low-exhaled volume alarm will sound if the patient does not receive the preset tidal volume. Possible causes of inadequate tidal volume include disconnection of the ventilator tubing from the artificial airway, a leak in the endotracheal or tracheostomy cuff, displacement of the endotracheal tube or tracheostomy tube, and disconnection at any location of the ventilator parts. Whereas high-pressure ventilator alarm is in case of Water or a kink in the tubing and Increased secretions in the airway. 63. The nurse informs the Occupational therapy department that the patient is too weak to use a walker and needs to be transported by wheelchair. Which step of the nursing process is the nurse engaged in at this time? a. Assessment b. Planning c. Implementation d. Evaluation Ans. b. Planning RATIONALE: The correct answer is option b The nurse is responsible for coordinating the plan of care with other disciplines to ensure the patient safety. This action represents the implementation phase of the nursing process. Data gathering occurs during assessment Goal setting occurs during planning. Determining attainment of client goals occurs as part of evaluation.\ 64. To assess for the sign of phlebitis over the intravenous site which among the following score to be used by the nurse? a. VIP score b. FLACC scale c. Braden risk assessment scale d. NIPS Ans. a. VIP score RATIONALE: The correct answer is option 1 VIP Score is visual infusion phlebitis score. The tool helps the nurses to determine appropriate assessment, discontinuation of peripheral intravenous catheters based on the presence and severity of symptoms. 129  National NORCET Test-2 © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. VIP Score 65. Which among the following practice is implemented by the nurse as the Reverse barrier nursing a. The nurse has placed a renal transplant patient into a positive pressure room b. The nurse has provided surgical mask to the patient who is immune-compromised while shifting to the diagnostic department c. The nurse uses appropriate personal protective equipment’s to prevent the transmission of infection. d. Both a & b Ans. d. Both a & b RATIONALE: The correct answer is option 4. Protective isolation or reverse isolation denotes the practices used for protecting vulnerable patient for contracting an infection. When patient with weakened immune systems are exposed to organisms, it could lead to infection and serious complications. Both option 1 & 2 are considered as Reverse barrier nursing techniques where the patient is protected from the infection. While in option 3 use of PPE by the nurse is considered as an example of barrier nursing. ANATOMY & PHYSIOLOGY 66. Compression of nerve within the carpel tunnel produces inability to: a. Abduct the thumb b. Adduct the thumb c. Flex the distal phalanx of thumb d. Oppose the thumb Ans. d. Oppose the thumb Rationale: Flexion of the distal phalanx of thumb is by flexor pollicis longus and supplied by anterior interosseous nerve Adduction of thumb is by adductor pollicis supplied by deep branch of ulnar nerve Abduction of thumb by abductor pollicis longus and supplied by radial nerve Oppose the thumb by opponents pollicis and supplied by median nerve 67. Abduction and adduction of foot occurs at which joints? a. Ankle b. Subtalar c. Tarsometatarsal d. Transverse tarsal Ans. d. Transverse tarsal 131  National NORCET Test-1 Rationale: Adduction is movement of the foot towards the middle in the transverse plane; abduction is movement away from the midline. This movement occurs at the transverse tarsal joints (a compound joint made up of calcaneocuboid and talonavicular joints) and also by the first tarsometatarsal and metatarsophalangeal joints. 68. Incretins causes: a. Decrease in insulin secretion b. Increase in blood glucose levels c. Increase in glucagon levels d. Increase in insulin secretion Ans. d. Increase in insulin secretion © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. Rationale: Oral glucose stimulates the release of certain hormones that acts on beta cells of pancreas to increase insulin secretion. Such GI hormones are termed as Incretins Incretin hormones are: Ĕ Glucagon-like peptide-1 (GLP1) – most potent incretin Ĕ Gastric inhibitory peptide (GIP) or Glucose dependent insulinotropic peptide 69. When a person is standing, blood flow in the lungs is: a. Lowest at the base because that is where alveolar pressure is greater than arterial pressure b. Equal at the apex and the base c. Highest at the apex owing to the effects of gravity on arterial pressure d. Highest at the base because that is where the difference between arterial and venous pressure is greatest Ans. d. Highest at the base because that is where the difference between arterial and venous pressure is greatest Rationale: The distribution of blood flow in the lungs is affected by gravitational effects on arterial hydrostatic pressure. Thus, blood flow is highest at the base, where arterial hydrostatic pressure is greatest and the difference between arterial and venous pressure is also greatest. This pressure difference drives the blood flow. 70. If the lungs get punctured, which of the following would happen? a. The lung would collapse on the side of the puncture b. Both the lung and the chest wall would collapse on the side of the puncture c. The relaxation pressure of the chest wall would increase until it surpassed the atmospheric d. The relaxation pressure of the chest wall would increase, but stop before it reached atmospheric pressure Ans. a. The lung would collapse on the side of the puncture Rationale: When the muscles of the chest and diaphragm contract they expand the chest, causing the lungs to inflate. Like a balloon, the lungs stretch as they inflate. When you exhale, the muscles relax, and like a balloon that’s been released, the lungs spring back. But if the air escapes from the lung and into the chest around the lung, the lung can collapse inside the chest. This can occur from the bursting of a weak spot of the lung, either from another medical condition, infection, or cancer. Or it could be caused by a puncture of the lung such as from a fractured rib. 71. Burning pain is carried by which type of fibers? a. Aδ fiber b. Aβ fiber c. Aα fiber d. C fibers Ans. d. C fibers Rationale: Pain is transmitted via two fibers types: 132 Ĕ Thinly myelinated A delta fiber (2 - 5 m in diameter) which conduct at rates 2 - 3 m/s.  National NORCET Test-2 Ĕ Unmyelinated C fibers (0.4 - 1.2 m in diameter) which conduct at low rates of 0.5 - 2 m/s. Thermoreceptors also span these two fiber types. Cold receptors are on dendrite ending of A delta fibers and C fibers, whereas warmth (heat) receptors are on C fibers. 72. Antibodies are formed from which white blood cell? a. Neutrophil b. Basophil c. B-lymphocyte d. Monocyte Ans. c. B-lymphocyte Rationale: There are two types of lymphocyte – T-lymphocyte (T-cell) and B-lymphocyte (B-cell). The type of lymphocyte is determined by © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. the location of cell maturation. All lymphocytes are formed from stem cells in either the thymus gland or lymphoid tissue. B-lymphocytes complete their development in the spleen or lymph nodes. Lymphocytes that mature in the thymus are referred to as T-lymphocytes (or T-cells). Within a few months of birth, the T-cells are fully mature and leave the thymus to circulate in the blood and body fluids. 73. The blood filtering capacity of the renal corpuscles is enhanced by: a. The thin porous endothelial-capsular membrane b. A large capillary surface area c. High capillary pressure d. All of the above Ans. d. All of the above Rationale: Glomerular capillaries are the most permeable in the body, being about 50 times more porous than other types of capillary. The presence of relatively large pores in the glomerular capillaries prevents the filtration of blood cells but allows all components of plasma through. Large proteins are prevented from filtering into the glomerular fluid by the basement membrane. Within the glomerulus, the capillary network is extensive, providing a large surface area for filtration. This is complemented by the relatively high glomerular capillary blood pressure. 74. Occlusion of the LAD will lead to infarction of which area: a. Posterior part of the interventicular septum b. Anterior wall of the left ventricle c. Lateral part of the heart d. Inferior surface of right ventricle Ans. b. Anterior wall of the left ventricle Rationale: LAD (Left anterior descending) artery is also known as anterior interventricular artery and runs in the same named groove, supplying anterior 2/3 of interventricular septum lying deep to it and also the adjacent anterior wall of the left ventricle. 75. All of the following are true about cavernous sinus thrombosis, except: a. Spreads through ethmoidal sinus b. Loss of sensation around orbit c. Loss of jaw jerk d. Infection spreads to cavernous sinus from danger area of face via superior ophthalmic vein muscles of mastication and temporomandibular joint Ans. c. Loss of jaw jerk Rationale: Routes of spread: From the infection of sphenoid sinus, ethmoid sinus and frontal sinus Through facial vein draining danger area of face via superior ophthalmic vein and angular vein 133 Clinical features of cavernous sinus thrombosis:  National NORCET Test-1 Ĕ Headache Ĕ Involvement of 3, 4, 5, 6 cranial nerve Ĕ Papilledema – increase of intra cranial tension Ĕ Loss of vision – involvement of optic nerve Ĕ Proptosis – protrusion of eyeball Ĕ Ophthalmoplegia – paralysis of eyeball muscles Ĕ Chemosis – swelling of conjunctiva Microbiology: 76. HEPA filter is used to disinfect: a. Water b. Air © This content is the copyright of Nursing Next Live. No part of this notes may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and sharing. c. Culture d. Blood Ans. b. Air Rationale: HEPA is High efficiency particulate air filter Used in operation theatres and laboratories It removes >95% particles with a diameter of more than 0.3um 77. Blood spill in operation theatre is cleaned with: a. Chlorine compound b. Phenolic compound c. Quartnery ammounium compounds d. Alcoholic compounds Ans. a. Chlorine compound Rationale: Chlorine is mainly used for disinfection of water – swimming pools, tanks Its compound sodium hypochlorite is the best disinfectant for surface blood spills Concentration used is 0.5 to 5% depend upon the contamination Immediately seeing a blood spill, cover the area with tissue paper and pour 1% sodium hypochlorite over it for 15-30 minutes and then discard with universal precautions 78. Blood culture is positive in which infection of Staphlococcus aureus- a. TSS b. SSSS c. Infective endocarditis d. Impetigo Ans. c. Infective endocarditis Rationale: TSS and SSSS are toxin mediated diseases and impetigo is localized infection of skin and subcutaneous tissue. So the infecting organism is not cultivable from blood. Infective endocarditis due to Staphylococcus aureus is an endovascular infection and so is blood culture positive. 79. The “string of pearl” colonies on nutrient agar is produced by- a. Kleb