← Combined Technical (NG)
Past Questions
Absence of an informed consent while performing a procedure on a patient can lead to which of the following charges?
A)
Fraud
B)
Battery & malpractice
C)
Harassment
D)
Breach of confidentiality
Performing a medical procedure without informed consent is legally categorized as both battery and malpractice. 'Battery' occurs because any unauthorized touching of a person without their consent is considered an intentional tort (unlawful physical contact). 'Malpractice' (professional negligence) occurs because failing to obtain informed consent is a breach of the standard of care that a competent healthcare provider is expected to provide.
Other options are incorrect because:
- (a) Fraud involves intentional deception for gain, which is not the primary legal issue in a lack of consent.
- (c) Harassment involves repeated unwanted behavior or intimidation, not the specific act of performing a medical procedure.
- (d) Breach of confidentiality refers to the unauthorized disclosure of private patient information, which is unrelated to the physical act of performing a procedure.
In which stage of pressure ulcer, hyperemia, increased temperature and redness with pressure is noticed?
A)
Stage I
B)
Stage II
C)
Stage III
D)
Stage IV
Stage I pressure ulcers are characterized by non-blanchable erythema (redness) of intact skin. At this stage, the skin is still intact, but there is localized hyperemia (increased blood flow), increased skin temperature, and redness that does not turn white when pressed.
Other options are incorrect because:
- Stage II involves partial-thickness skin loss involving the epidermis or dermis (e.g., blisters or shallow open ulcers).
- Stage III involves full-thickness skin loss where subcutaneous fat may be visible, but bone, tendon, or muscle are not exposed.
- Stage IV involves full-thickness skin loss with exposed bone, tendon, or muscle.
While giving NG tube feeding, which of the following nursing actions prevents complication?
A)
Advance tube 2 cm
B)
Flush with 20 ml of air
C)
Provide high fowlers position
D)
Plug the air vent during feeding
1. Why 'c' is correct: Providing a High Fowler's position (head of bed elevated to 60-90 degrees) is the primary nursing intervention to prevent aspiration pneumonia, the most serious complication of NG tube feeding. Gravity helps the formula move into the stomach and prevents gastric reflux.
2. Why others are incorrect:
- Option 'a': Advancing the tube further is unnecessary and could lead to incorrect placement or mucosal injury.
- Option 'b': Flushing with air is not a standard procedure; tubes are flushed with water to maintain patency.
- Option 'd': Plugging the air vent (in open systems) can increase intragastric pressure and lead to discomfort or reflux; the vent is designed to allow air to escape.
All are quantitative management techniques except:
A)
Management by objectives
B)
Input-output analysis
C)
Cost-benefit analysis
D)
Network analysis
The correct option is (a) Management by Objectives (MBO) because it is a strategic management model and a behavioral approach to management, focusing on goal-setting and performance appraisal rather than mathematical or statistical modeling. In contrast, the other options are quantitative techniques: (b) Input-output analysis uses mathematical models to represent the interdependencies between different sectors of an economy; (c) Cost-benefit analysis is a systematic process for calculating and comparing benefits and costs of a project using numerical data; and (d) Network analysis (such as PERT or CPM) uses mathematical graphs to plan and schedule complex projects.
Difference between apical pulse and radial pulse is called:
A)
Atrial flutter
B)
Atrial fibrillation
C)
Sinus bradycardia
D)
Pulse deficit
The correct answer is Pulse Deficit.
1. Why 'Pulse Deficit' is correct: A pulse deficit occurs when there is a difference between the apical pulse (measured at the apex of the heart) and the radial pulse (measured at the wrist). This happens when some heartbeats are too weak to pump enough blood to create a palpable peripheral pulse, even though the heart is contracting. It is a hallmark sign of Atrial Fibrillation.
2. Why other options are incorrect:
- Sinus bradycardia (c): This refers to a slow heart rate (typically <60 bpm) originating from the SA node, not a difference between two pulse sites.
- Atrial flutter (a) and Atrial fibrillation (b): These are types of cardiac arrhythmias. While Atrial Fibrillation often *causes* a pulse deficit, the term for the actual difference in heart rate measurements is 'pulse deficit', not the name of the arrhythmia itself.
The ratio between the incidence of disease among exposed persons and incidence among non-exposed is termed as:
A)
Incidence
B)
Relative Risk
C)
Prevalence
D)
Odds ratio
The correct option is Relative Risk (RR).
1. **Why Relative Risk is correct**: Relative Risk (also known as Risk Ratio) is defined as the ratio of the incidence of a disease among an exposed group to the incidence of the disease among a non-exposed group. It measures the strength of the association between an exposure and an outcome in cohort studies. Formula: RR = [Incidence among exposed] / [Incidence among non-exposed].
2. **Why other options are incorrect**:
- **Incidence (a)**: This refers to the number of new cases of a disease occurring in a specific population during a specific time period, not a ratio between two groups.
- **Prevalence (c)**: This refers to the total number of existing cases (old and new) in a population at a given point in time.
- **Odds Ratio (d)**: This is the ratio of the odds of exposure in the cases to the odds of exposure in the controls. It is primarily used in case-control studies where incidence cannot be directly calculated.
What is the arbitrary limit to define epidemic threshold of common diseases?
A)
Two standard errors from the endemic occurrence
B)
Two standard deviation from the endemic occurrence
C)
One standard errors from the endemic occurrence
D)
One standard deviation from the endemic occurrence
In epidemiology, the epidemic threshold is the level of disease occurrence above which the incidence is considered to be an epidemic rather than the expected endemic level. The standard arbitrary limit used to define this threshold is the mean of the endemic occurrence plus two standard deviations (Mean + 2SD). This is based on the statistical principle that in a normal distribution, approximately 95% of observations fall within two standard deviations of the mean; therefore, any value exceeding this limit is statistically significant and suggests an outbreak. Options 'a' and 'c' are incorrect because 'standard error' measures the precision of a sample mean, not the variability of individual occurrences in a population. Option 'd' is incorrect because one standard deviation only covers about 68% of the data, which would lead to too many false-positive epidemic alerts.
Immediate disinfection of all articles and bodily discharge during the course of disease is known as:
A)
Concurrent disinfection
B)
Recurrent disinfection
C)
Terminal disinfection
D)
Sterilization
1. Concurrent Disinfection: This refers to the immediate disinfection of infectious materials (such as sputum, urine, feces, and used dressings) and contaminated articles while the patient is still suffering from the disease. Its primary goal is to prevent the spread of infection during the course of the illness.
2. Why other options are incorrect:
- Terminal Disinfection (c): This is performed after the patient has been discharged, transferred, or has died. It involves the disinfection of the entire room and all contents to ensure the environment is safe for the next patient.
- Sterilization (d): This is a process that destroys all forms of microbial life, including bacterial spores, rather than just reducing the number of pathogens on articles during a disease course.
- Recurrent Disinfection (b): This is not a standard epidemiological term; disinfection is typically categorized as either concurrent or terminal.
Normal serum potassium level for adult in mEq/L is:
A)
2.5-3.5
B)
3.5-5
C)
5.5-6.5
D)
6.5-7.5
The normal serum potassium (K+) level for a healthy adult is typically between 3.5 and 5.0 mEq/L. This narrow range is critical for maintaining the resting membrane potential of cells, particularly in cardiac and neural tissues.
- Option (b) is correct as it aligns with standard clinical reference ranges (3.5-5.0 mEq/L).
- Option (a) 2.5-3.5 mEq/L represents Hypokalemia (low potassium), which can lead to muscle weakness and cardiac arrhythmias.
- Option (c) 5.5-6.5 mEq/L represents Hyperkalemia (high potassium), which is a medical emergency that can cause cardiac arrest.
- Option (d) 6.5-7.5 mEq/L represents severe Hyperkalemia, which is life-threatening.
A patient present with a chronic, dull, difficult to locate ache that is originating from internal organs. The pain is often accompanied by symptom such as nausea or changes in bowel / bladder function. Which type of pain does this description best fit?
A)
Somatic pain
B)
Neuropathic pain
C)
Visceral pain
D)
Cancer pain
The description provided is a classic presentation of visceral pain.
1. Why 'c' is correct: Visceral pain originates from the internal organs (viscera). Because the innervation of these organs is less dense and more diffuse than that of the skin or muscles, the pain is typically described as dull, aching, and difficult to localize. It is frequently associated with autonomic responses, such as nausea, vomiting, and changes in bowel or bladder function.
2. Why other options are incorrect:
- Somatic pain (a): Originates from the skin, muscles, or joints; it is typically sharp, well-localized, and easy to pinpoint.
- Neuropathic pain (b): Caused by damage to the nervous system; it is usually described as burning, tingling, or electric-shock-like.
- Cancer pain (d): This is a broad category that can include somatic, visceral, and neuropathic pain depending on the tumor's location and progression, rather than a specific physiological type of pain sensation.
A nurse is caring for a 45 year old female patient who had undergone mastectomy. Which of the following intervention is appropriate to prevent the lymphedema as a post- operative complication?
A)
Ensuring patency of wound drainage tube.
B)
Frequently elevating the arm of the affected side above the level of the heart
C)
Placing the arm on the affected side in a dependent position.
D)
Restricting moving of the affected arm.
1. Correct Option (b): Elevating the affected arm above the level of the heart uses gravity to promote venous and lymphatic drainage from the extremity. This reduces fluid accumulation in the interstitial spaces, which is the primary mechanism for preventing lymphedema following a mastectomy where lymph nodes may have been removed.
2. Incorrect Options:
- (a) Ensuring patency of the wound drainage tube is important for preventing seromas at the surgical site, but it does not specifically prevent lymphedema in the arm.
- (c) Placing the arm in a dependent position (below the heart) would increase hydrostatic pressure and encourage fluid accumulation, thereby increasing the risk of lymphedema.
- (d) Restricting movement of the arm can lead to joint stiffness and decreased muscle pump action, which actually hinders lymphatic flow; gentle, progressive range-of-motion exercises are typically encouraged.
When assessing the abdomen in sequence, which technique should be conducted after inspection for best evaluation?
A)
Percussion
B)
Palpation
C)
Auscultation
D)
Sequence does not matter
In a standard physical examination, the sequence is typically Inspection, Palpation, Percussion, and Auscultation. However, for the abdominal assessment, the sequence is modified to Inspection, Auscultation, Percussion, and Palpation.
1. Why Auscultation is correct: Auscultation is performed immediately after inspection because palpation and percussion can stimulate the bowel, potentially altering bowel sounds (increasing or decreasing motility) and leading to an inaccurate assessment.
2. Why other options are incorrect: Palpation (b) and Percussion (a) are performed after auscultation to avoid altering the natural state of the bowel. Option (d) is incorrect because the sequence is critical for diagnostic accuracy in abdominal exams.
Gastric lavage procedure should be avoided in which of the following situation?
A)
Corrosives poisoning
B)
Organophosphate poisoning
C)
Food poisoning
D)
Ethanol poisoning
Gastric lavage is strictly contraindicated in corrosive poisoning (e.g., strong acids or alkalis). The primary reasons are: 1) Risk of esophageal or gastric perforation due to the weakened wall of the mucosa caused by the chemical burn, and 2) Risk of aspiration of the corrosive agent into the lungs during the procedure, which can cause severe pulmonary damage.
Regarding other options:
- Organophosphate poisoning (b): Lavage is indicated to remove unabsorbed poison, provided the airway is protected.
- Food poisoning (c): While not always necessary, it is not contraindicated if specific toxins need removal.
- Ethanol poisoning (d): Lavage may be performed if the ingestion was recent and massive, although supportive care is primary.
All the following modes of disease transmission are direct except:
A)
Contact
B)
Inoculation into skin or mucosa
C)
Vector-borne
D)
Transplacental (vertical)
Direct transmission occurs when an infectious agent is passed from an infected person to a susceptible host through immediate physical contact or direct projection.
1. Why 'c' is correct: Vector-borne transmission is a form of **indirect transmission**. It requires an intermediary living organism (the vector), such as a mosquito, tick, or flea, to carry the pathogen from the reservoir to the host. Since there is a biological intermediary, it is not direct.
2. Why other options are incorrect:
- 'a' (Contact): Direct physical contact (e.g., touching, kissing, sexual intercourse) is the primary form of direct transmission.
- 'b' (Inoculation): Direct entry of a pathogen into the skin or mucosa (e.g., via a needle stick or animal bite) is considered direct transmission.
- 'd' (Transplacental): Vertical transmission from mother to fetus via the placenta is a direct route of transmission.
The nurse is caring for a client who is tearfully expressing feelings of worthlessness after a bilateral mastectomy. Which communication technique is most appropriate for the nurse to use?
A)
“Many women have body image concerns after this surgery.”
B)
“Tell me more about how you feel.”
C)
“Why do you feel depressed and worthless?”
D)
“Your feelings of depression will be better in the morning.”
The correct option is 'b' because 'Tell me more about how you feel' is an open-ended communication technique that encourages the client to express their emotions and elaborate on their feelings. This demonstrates empathy and active listening, which is essential when a patient is experiencing emotional distress and feelings of worthlessness.
Other options are incorrect because:
- Option 'a' is a generalizing statement that minimizes the client's unique experience by comparing them to others.
- Option 'c' uses 'Why,' which often puts clients on the defensive and can be perceived as demanding a justification for their emotions.
- Option 'd' provides false reassurance and dismisses the client's current emotional state, which shuts down therapeutic communication.
In ECG, the T-wave represents ventricular repolarization, whereas QRS complex represents:
A)
Ventricular depolarization
B)
Atrial depolarization
C)
Ventricular fibrillation
D)
Atrial repolarization
The QRS complex in an Electrocardiogram (ECG) represents ventricular depolarization, which is the electrical impulse spreading through the ventricles, triggering their contraction to pump blood to the lungs and body.
Incorrect options:
- Option b (Atrial depolarization) is represented by the P-wave.
- Option d (Atrial repolarization) occurs during the QRS complex but is electrically masked by the much larger ventricular depolarization signal.
- Option c (Ventricular fibrillation) is a pathological arrhythmia characterized by chaotic electrical activity, not a standard component of a normal ECG waveform.
The most sensitive indicator of community health status is:
A)
Crude death rate
B)
Infant mortality rate
C)
Case fatality rate
D)
Proportional mortality rate
1. Why Infant Mortality Rate (IMR) is correct: IMR is widely regarded as the most sensitive indicator of the health status of a community because infants are the most vulnerable segment of the population. IMR reflects not only the quality of obstetric and pediatric care but also the broader socio-economic conditions, including maternal nutrition, sanitation, environmental hygiene, and the overall standard of living. A rise or fall in IMR quickly signals changes in the general health of the community.
2. Why other options are incorrect:
- Crude Death Rate (a): This is a general measure that is heavily influenced by the age structure of the population (e.g., an aging population will have a higher CDR regardless of health quality), making it an insensitive indicator of specific health status.
- Case Fatality Rate (c): This measures the killing power of a specific disease (the proportion of people diagnosed with a disease who die from it), rather than the overall health of the community.
- Proportional Mortality Rate (d): This indicates the proportion of total deaths attributed to a specific cause, which helps in identifying the leading causes of death but does not reflect the overall health or vulnerability of the population.
A teenage girl nearly drowned during her swimming session at school. Which of the following signs indicates that she has respiratory arrest?
A)
No pulse
B)
Absent lung sound
C)
Pulses paradoxus
D)
Cyanosis
Respiratory arrest is defined as the cessation of breathing. The most definitive sign of respiratory arrest among the choices is the absence of lung sounds (or absence of chest rise/air movement), as it directly indicates that air is not entering or leaving the lungs.
Incorrect options:
- Option (a) 'No pulse' indicates cardiac arrest, not specifically respiratory arrest (though respiratory arrest can lead to cardiac arrest).
- Option (c) 'Pulses paradoxus' is a clinical sign often associated with cardiac tamponade or severe asthma, not a primary indicator of respiratory arrest.
- Option (d) 'Cyanosis' (bluish discoloration of the skin) is a sign of hypoxia (low oxygen), which can occur in respiratory distress or failure, but it is not exclusive to respiratory arrest and can be seen in various cardiovascular or pulmonary conditions.
During history collection, a 30 year old female patient complaint to the nurse that she passes small amount of urine while she coughs or sneezes. Nurse identified this as:
A)
Urge incontinence
B)
Overflow incontinence
C)
Functional incontinence
D)
Stress incontinence
The patient is describing Stress Incontinence.
1. Why 'd' is correct: Stress incontinence occurs when physical movement or activity—such as coughing, sneezing, laughing, or lifting—puts pressure (stress) on the bladder, causing the pelvic floor muscles and urethral sphincter to weaken and allow urine to leak.
2. Why other options are incorrect:
- Urge incontinence (a): Characterized by a sudden, intense urge to urinate followed by involuntary loss of urine (often called 'overactive bladder').
- Overflow incontinence (b): Occurs when the bladder doesn't empty completely, leading to constant dribbling of urine.
- Functional incontinence (c): Occurs when physical or cognitive impairments (e.g., dementia or severe arthritis) prevent the patient from reaching the toilet in time, despite having normal bladder control.
Which component of ICDS aim to provide supplementary nutrition to children?
A)
Anganwadi services
B)
Midday meal scheme
C)
Kishori Shakti Yojana
D)
National Rural Employment Guarantee Scheme
The Integrated Child Development Services (ICDS) is a government program that provides a package of services through a network of Anganwadi centers. Anganwadi services are the primary delivery mechanism for ICDS, providing supplementary nutrition, immunization, health check-ups, and pre-school non-formal education to children under 6 years, pregnant women, and lactating mothers.
Incorrect options:
- Midday meal scheme: This is a school-based program providing nutrition to children in primary and upper primary classes, not a component of ICDS.
- Kishori Shakti Yojana: This is a scheme focused on the empowerment and health of adolescent girls.
- National Rural Employment Guarantee Scheme (MGNREGS): This is a social security measure that guarantees the 'right to work' by providing 100 days of wage employment in a financial year to rural households.
Which electrolyte imbalance is commonly associated with renal failure in critically ill patients?
A)
Hyperkalemia
B)
Hyponatremia
C)
Hypocalcemia
D)
Hypophosphatemia
1. Why Hyperkalemia is correct: The kidneys are primarily responsible for the excretion of potassium. In renal failure, the glomerular filtration rate (GFR) decreases significantly, leading to the retention of potassium in the blood. In critically ill patients, this is often exacerbated by metabolic acidosis and tissue breakdown (rhabdomyolysis), making hyperkalemia a common and life-threatening complication.
2. Why other options are incorrect:
- Hyponatremia (b): While it can occur due to fluid overload (dilutional hyponatremia), it is not as characteristic or consistently associated with the failure of renal excretion as hyperkalemia.
- Hypocalcemia (c): Renal failure typically causes hypocalcemia (due to decreased Vitamin D activation), but hyperkalemia is the more immediate and common critical electrolyte emergency associated with acute renal failure.
- Hypophosphatemia (d): Renal failure typically leads to Hyperphosphatemia (high phosphate) because the kidneys cannot excrete phosphorus, not hypophosphatemia.
The nurse administers cleansing enema. The common position for this procedure is:
A)
Sims left lateral
B)
Dorsal recumbent
C)
Supine
D)
Prone
The correct position for administering a cleansing enema is the Sims left lateral position. In this position, the patient lies on their left side with the right knee flexed, which allows the enema solution to flow by gravity into the sigmoid colon and descending colon, following the natural anatomical curve of the large intestine.
Other options are incorrect because:
- Dorsal recumbent (on back with knees flexed) and Supine (flat on back) do not allow for proper anatomical flow of the fluid and make access to the rectum difficult.
- Prone (lying face down) is impractical and unsafe for this procedure as it restricts breathing and prevents the nurse from monitoring the patient's response.
What is the best reason for the nurse in instructing the patient to rotate injection sites for insulin?
A)
Lipodystrophy can result and is extremely painful
B)
Poor rotation technique can cause superficial hemorrhaging
C)
Lipodystrophic areas can result, causing erratic insulin absorption rates from these
D)
Injection sites can never be reused
The primary reason for rotating insulin injection sites is to prevent lipodystrophy (specifically lipohypertrophy), which is the thickening or hypertrophy of subcutaneous fat. When insulin is injected into lipodystrophic tissue, the absorption rate becomes unpredictable and erratic, leading to poor glycemic control and unstable blood glucose levels.
Regarding the other options:
- Option (a) is incorrect because while lipodystrophy occurs, it is typically painless; the danger is the absorption rate, not pain.
- Option (b) is incorrect because superficial hemorrhaging is not the primary clinical concern associated with poor rotation technique.
- Option (d) is incorrect because injection sites can be reused; they simply must be rotated within a specific area to avoid repeated trauma to the exact same spot.
How many health and wellness centers are typically under one Primary Health Centre (PHC)?
A)
2
B)
4
C)
6
D)
10
Under the Ayushman Bharat - Health and Wellness Centres (HWC) initiative, existing Sub-Centres (SCs) and Primary Health Centres (PHCs) are being upgraded to HWCs. In the standard administrative hierarchy of the Indian public health system, one Primary Health Centre (PHC) typically oversees 6 Sub-Centres. Since each Sub-Centre is being converted into a Health and Wellness Centre, there are typically 6 HWCs under one PHC. Options a, b, and d are incorrect as they do not align with the standard population-based norms and administrative mapping of the rural health infrastructure in India.
Client admitted in the ward refuses a treatment option. This will come under:
A)
Nurse practice act
B)
Common law
C)
Civil law
D)
Statutory law
The correct option is Common Law.
1. Why Common Law is correct: The right of a competent adult to refuse medical treatment is based on the principle of 'autonomy' and 'self-determination.' These principles are established through judicial precedents and court rulings over time rather than written legislation. In legal terms, treating a patient against their will can be classified as 'battery,' which is a concept rooted in common law.
2. Why other options are incorrect:
- Nurse Practice Act (a): This is a statutory law that defines the scope of nursing practice and licensure requirements; it does not govern the fundamental right of a patient to refuse care.
- Civil Law (c): While medical malpractice falls under civil law (torts), the specific right to refuse treatment is a foundational common law principle that informs civil litigation.
- Statutory Law (d): These are laws enacted by legislative bodies (e.g., Acts of Parliament or Congress). While some patient rights are now codified in statutes, the core doctrine of informed refusal originates from common law.