← Combined Technical (NG)
Past Questions
During a mass casualty incident, a patient arrives with a penetrating chest wound. On assessment, the patient is conscious, tachypnoeic, and hypotensive. Based on the severity of the injury and the patient’s physiological status, which triage category is most appropriate?
A)
Red
B)
Yellow
C)
Green
D)
Black
The patient is presenting with signs of hemodynamic instability (hypotension) and respiratory distress (tachypnoea) resulting from a penetrating chest wound. In mass casualty triage systems (such as START or SALT), patients with immediate life-threatening injuries to the airway, breathing, or circulation (ABC) who are still viable are categorized as 'Red' (Immediate). This patient requires urgent intervention to prevent cardiac or respiratory arrest.
Incorrect options:
- Yellow (Delayed): Used for patients who are stable and can wait a short period for care; this patient's hypotension makes them unstable.
- Green (Minor): Used for 'walking wounded' with minimal injuries; this patient has a critical chest wound.
- Black (Deceased/Expectant): Used for those who are dead or have injuries so severe they are not salvageable given available resources; this patient is conscious and viable.
Murphy’s sign is seen in which of the following disease condition:
A)
Appendicitis
B)
Splenomegaly
C)
Peritonitis
D)
Acute cholecystitis
Murphy's sign is a clinical indicator used to diagnose acute cholecystitis. It is performed by asking the patient to exhale and then inhale deeply while the examiner applies pressure to the right upper quadrant (gallbladder area). A positive sign occurs when the patient abruptly stops inhaling (inspiratory arrest) due to pain as the inflamed gallbladder descends and hits the examiner's hand.
Incorrect options:
- Appendicitis: Typically associated with McBurney's point tenderness, Rovsing's sign, or Psoas sign.
- Splenomegaly: Diagnosed via palpation of the left upper quadrant or percussion of Traube's space.
- Peritonitis: Characterized by generalized abdominal rigidity (board-like rigidity) and rebound tenderness (Blumberg sign).
The ethical principle that refers to the agreement to keep promises is:
A)
Beneficence
B)
Veracity
C)
Fidelity
D)
Nonmaleficence
The correct option is Fidelity. In ethics, fidelity refers to the obligation to be faithful to commitments, keep promises, and maintain loyalty and trust within a professional relationship.
Other options are incorrect because:
- Beneficence (a) refers to the duty to act in the best interest of the patient or to 'do good'.
- Veracity (b) refers to the obligation to tell the truth and not deceive others.
- Nonmaleficence (d) refers to the duty to 'do no harm' and avoid causing injury to others.
Which ART regimen is recommended as the first-line treatment under national guidelines?
A)
Zidovudine + Efavirenz
B)
Tenofovir + Lamivudine + Dolutegravir (TLD)
C)
Didanosine + Nevirapine
D)
Stavudine + Ritonavir
The correct option is (b) Tenofovir + Lamivudine + Dolutegravir (TLD).
1. Why it is correct: Current national and international (WHO) guidelines recommend TLD as the preferred first-line Antiretroviral Therapy (ART) regimen. Dolutegravir (an Integrase Strand Transfer Inhibitor - INSTI) is preferred due to its high genetic barrier to resistance, superior efficacy in viral load suppression, and better tolerability compared to older drugs.
2. Why other options are incorrect:
- Option (a): Zidovudine + Efavirenz was part of older regimens but is no longer first-line due to the toxicity of Zidovudine (bone marrow suppression) and neuropsychiatric side effects of Efavirenz.
- Option (c): Didanosine and Nevirapine are outdated; Didanosine is rarely used now due to pancreatitis risk, and Nevirapine has a slower onset and risk of severe hepatotoxicity.
- Option (d): Stavudine is largely phased out due to severe side effects like lipodystrophy and peripheral neuropathy; Ritonavir is typically used as a pharmacokinetic booster in second-line or salvage therapy, not as a first-line primary agent.
What is the primary goal of hemodynamic monitoring in critical care?
A)
Assessing neurological status
B)
Monitoring urine output
C)
Evaluating respiratory function
D)
Optimizing cardiac output
Hemodynamic monitoring refers to the measurement and analysis of blood flow and pressure within the cardiovascular system. Its primary goal is to ensure adequate tissue perfusion by optimizing cardiac output (the volume of blood the heart pumps per minute) and managing systemic vascular resistance.
Incorrect options:
- Option (a): Neurological status is assessed via the Glasgow Coma Scale (GCS) or pupillary response, not hemodynamic monitoring.
- Option (b): Urine output is a marker of renal perfusion and fluid balance, but it is a secondary outcome of hemodynamic stability, not the primary goal of the monitoring itself.
- Option (c): Respiratory function is evaluated via pulse oximetry, arterial blood gases (ABGs), and ventilator settings, which falls under pulmonary monitoring.
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.
Discharge planning of the patient begins:
A)
When the physician order for discharge
B)
When patient start showing positive response to the treatment
C)
At the time of initiative of treatment
D)
At the time of admission
1. Why Option 'd' is correct: Discharge planning is a multidisciplinary process that begins at the time of admission. Starting early ensures that the patient's needs (social, financial, and medical) are assessed immediately, allowing for a seamless transition from the hospital to home or another care facility, which reduces the risk of readmission and ensures continuity of care.
2. Why other options are incorrect:
- Option 'a': Waiting for the physician's order is too late; this is the execution of the discharge, not the planning phase.
- Option 'b': Waiting for a positive response ignores patients with chronic or terminal illnesses who still require complex discharge planning regardless of treatment success.
- Option 'c': While similar to admission, 'initiative of treatment' may occur after the admission process has already begun; standard nursing and administrative protocols dictate that planning starts the moment the patient enters the healthcare system (admission).
Drug of choice in hookworm infestation is:
A)
Piperazine citrate
B)
Bephenium hydroxynaphthoate
C)
Mebendazole
D)
Albendazole
Albendazole is considered the drug of choice for hookworm infestation (Ancylostoma duodenale and Necator americanus) due to its broad-spectrum efficacy, superior pharmacokinetic profile (better absorption), and the convenience of a single-dose regimen. It works by inhibiting microtubule synthesis in the parasite.
Comparison with other options:
- Mebendazole (c): While effective and similar in mechanism to Albendazole, it generally requires a longer course of treatment and has lower systemic absorption, making Albendazole the preferred first-line choice in most modern guidelines.
- Piperazine citrate (a): This is primarily used for Ascaris lumbricoides (roundworm) and is not effective against hookworms.
- Bephenium hydroxynaphthoate (b): This is an older drug used specifically for Strongyloides stercoralis, not the primary choice for hookworms.
Which of the following is the main cause of increased risk for osteoporosis after menopause?
A)
Fall in LH level
B)
Decrease in estrogen level
C)
Increase in estrogen level
D)
Fall in FSH level
1. Why 'b' is correct: Estrogen plays a critical role in maintaining bone density by inhibiting the activity of osteoclasts (cells that break down bone) and promoting the activity of osteoblasts (cells that build bone). During menopause, the ovaries stop producing significant amounts of estrogen. This decrease leads to an imbalance where bone resorption exceeds bone formation, resulting in a loss of bone mass and an increased risk of osteoporosis.
2. Why other options are incorrect:
- Option 'a' and 'd': During menopause, LH (Luteinizing Hormone) and FSH (Follicle Stimulating Hormone) levels actually increase, not fall. This happens because the lack of negative feedback from estrogen causes the pituitary gland to secrete more of these hormones.
- Option 'c': Estrogen levels decrease during menopause, not increase. An increase in estrogen would generally have a protective effect on bone density.
In COPD patients receiving supplemental oxygen, which oxygen saturation range helps prevent CO2 retention while ensuring adequate oxygenation?
A)
96–100%
B)
93–95%
C)
88–92%
D)
70–80%
In patients with COPD, the target oxygen saturation (SpO2) is typically maintained between 88–92%. This is because many COPD patients develop a 'hypoxic drive' for respiration; they rely on low oxygen levels rather than high CO2 levels to stimulate breathing. Providing too much oxygen can suppress this drive, leading to hypoventilation and dangerous CO2 retention (hypercapnia).
- Option (a) 96–100% and Option (b) 93–95% are targets for healthy individuals or non-COPD patients; in COPD patients, these levels increase the risk of respiratory acidosis and CO2 narcosis.
- Option (d) 70–80% is dangerously low and would result in severe hypoxemia and organ failure.
A patient with Guillian Barre Syndrome is experiencing ascending weakness. Which of the following is the most common and critical complication that the nurse should monitor for?
A)
Cardiac arrhythmia
B)
Respiratory failure
C)
Renal failure
D)
Liver failure
Guillain-Barré Syndrome (GBS) is characterized by ascending symmetrical paralysis. The most critical complication occurs when this weakness reaches the diaphragm and intercostal muscles, leading to respiratory failure and the need for mechanical ventilation. Monitoring vital capacity and respiratory effort is the priority nursing intervention.
Other options are incorrect because:
- (a) Cardiac arrhythmias can occur due to autonomic dysfunction, but respiratory failure is the more common and immediate life-threatening priority.
- (c) Renal failure and (d) Liver failure are not typical complications of the demyelinating process associated with GBS.
A 35 years old male patient is brought to the emergency room after he sustained multiple injuries from a road traffic accident. which of the following assessment should take the highest priority?
A)
Grey turner’s sign in the flank
B)
Irregular pulse
C)
Pupils unequal
D)
A deviated trachea
In trauma management, the priority follows the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) protocol. A deviated trachea is a classic sign of a tension pneumothorax, which is a life-threatening emergency that compromises both the Airway and Breathing (the 'A' and 'B' of the protocol). It requires immediate needle decompression to prevent cardiovascular collapse.
Other options are lower priority based on the ABCDE sequence:
- Option b (Irregular pulse) and Option a (Grey Turner's sign) relate to 'Circulation' (C), which is assessed after Airway and Breathing. Grey Turner's sign is a late sign of retroperitoneal hemorrhage and is not an immediate priority.
- Option c (Pupils unequal) relates to 'Disability' (D), which is assessed after Airway, Breathing, and Circulation.
A 53 year old male patient is admitted with COPD. The nurse notes that he has neck vein distention and slight peripheral edema. These signs indicate the onset of:
A)
Cardiogenic shock
B)
Cor- pulmonale
C)
Left sided heart failure
D)
Pneumothorax
1. Why Cor pulmonale is correct: Cor pulmonale is right-sided heart failure resulting from primary lung disease (such as COPD). In COPD, chronic hypoxia leads to pulmonary vasoconstriction and pulmonary hypertension. This increases the workload on the right ventricle, eventually leading to right-sided heart failure. The classic clinical manifestations include systemic venous congestion, which presents as neck vein distention (jugular venous distention) and peripheral edema.
2. Why other options are incorrect:
- a) Cardiogenic shock: This is a state of critical cardiac dysfunction resulting in inadequate tissue perfusion, characterized by hypotension and altered mental status, not isolated edema and vein distention.
- c) Left sided heart failure: This typically presents with pulmonary congestion (crackles, dyspnea, orthopnea) because blood backs up into the lungs, rather than systemic venous congestion.
- d) Pneumothorax: This is the collapse of a lung due to air in the pleural space, presenting with sudden chest pain, absent breath sounds on the affected side, and respiratory distress, not chronic systemic edema.
Which of the following patients does not have a risk factor for hypertension?
A)
A 25 year old male with a BMI of 35.
B)
A 35 year old female with a total cholesterol level of 100.
C)
A 68 year old male who reports smoking 2 packs of cigarettes a day.
D)
A 40 year old female with a family history of hypertension and diabetes.
The correct option is (b) because a total cholesterol level of 100 mg/dL is considered low/optimal and is not a risk factor for developing hypertension. In contrast, the other options list well-established risk factors: (a) A BMI of 35 indicates obesity, which significantly increases the risk of hypertension; (c) Advanced age (68) and heavy smoking are major cardiovascular risk factors that contribute to hypertension; (d) Family history of hypertension and the presence of diabetes are strong genetic and metabolic risk factors for high blood pressure.
In 2020, RNTCP was renamed to emphasize the goal of eliminating TB. What is the new name?
A)
National Tuberculosis Control Program
B)
National Tuberculosis Elimination Program
C)
Revised National Tuberculosis Elimination Program
D)
Revised Tuberculosis Elimination Program
The Revised National Tuberculosis Control Program (RNTCP) was renamed to the National Tuberculosis Elimination Program (NTEP) in 2020. This change reflects a strategic shift from merely 'controlling' the disease to 'eliminating' it, aligning with India's goal to end TB by 2025 (five years ahead of the global SDG target of 2030).
- Option (a) is incorrect as it refers to a 'Control Program', which was the focus of the previous nomenclature.
- Option (c) is incorrect because the word 'Revised' was dropped during the renaming to signify a new, more aggressive phase of elimination.
- Option (d) is incorrect as it omits 'National' and retains 'Revised', neither of which are part of the official new title.
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.
Nurse is collecting history and preparing care plan for her client. In which step of nursing process the nurse identifies the problem with the client?
A)
Assessment
B)
Diagnosis
C)
Planning
D)
Implementation
The nursing process consists of five sequential steps: Assessment, Diagnosis, Planning, Implementation, and Evaluation (ADPIE).
1. **Diagnosis (Correct):** This is the step where the nurse analyzes the data collected during assessment to identify the client's actual or potential health problems (Nursing Diagnosis). The act of 'identifying the problem' is the core definition of this phase.
2. **Assessment (Incorrect):** This is the initial step involving the collection of data (history taking, physical exam). While data is gathered here, the problem is not yet 'identified' or labeled until the analysis phase.
3. **Planning (Incorrect):** This step occurs after the diagnosis. It involves setting goals and determining the specific nursing interventions needed to resolve the identified problem.
4. **Implementation (Incorrect):** This is the action phase where the nurse carries out the interventions planned in the previous step.
An old woman was hit by motor cycle while crossing the road. As a nurse who was the witness there, the first intervention that she will do is:
A)
Immobilize the leg
B)
Call for help
C)
Reduce the fracture manually
D)
Move the person to a safer place
In any emergency situation, the first priority according to standard First Aid and Basic Life Support (BLS) protocols is 'Scene Safety.' Before providing care, the rescuer must ensure that the environment is safe for both the victim and the provider to prevent further injuries (e.g., preventing the victim from being hit by other vehicles).
- Option (d) is correct because moving the person to a safer place ensures the scene is secure before medical interventions begin.
- Option (b) is a priority, but scene safety always precedes calling for help or treating the patient.
- Option (a) is a secondary intervention that occurs after the scene is safe and the primary survey is complete.
- Option (c) is contraindicated; manual reduction of a fracture should only be performed by qualified professionals in a controlled setting to avoid nerve or vascular damage.
What is PRN order for medication?
A)
Immediately
B)
At bed time
C)
Whenever necessary
D)
Early morning
PRN is an abbreviation for the Latin phrase 'pro re nata', which translates to 'as the thing is needed' or 'whenever necessary'. In medical prescriptions, a PRN order indicates that a medication should be administered only when the patient experiences specific symptoms (e.g., pain or fever), rather than on a fixed schedule.
Incorrect options:
- Option (a) 'Immediately' is denoted by the term 'STAT'.
- Option (b) 'At bed time' is denoted by the abbreviation 'hs' (hora somni).
- Option (d) 'Early morning' is not a standard single-abbreviation order, though medications may be scheduled for 'AM'.
Which of the following medication will be prescribed for reducing high intracranial pressure?
A)
Osmotic diuretic
B)
Dilantin sodium
C)
Lorazepam
D)
Syndopa
The correct option is 'Osmotic diuretic' (such as Mannitol). These medications work by increasing the osmotic pressure of the blood, which draws excess water out of the brain tissue and into the bloodstream to be excreted by the kidneys, thereby reducing cerebral edema and lowering intracranial pressure (ICP).
Incorrect options:
- Syndopa (Levodopa/Carbidopa): Used primarily for the treatment of Parkinson's disease.
- Dilantin sodium (Phenytoin): An anticonvulsant used to prevent and treat seizures.
- Lorazepam: A benzodiazepine used for anxiety, insomnia, or as an acute treatment for status epilepticus, but not specifically for reducing ICP.
The theory given by Florence Nightingale mainly focuses on:
A)
Love and affection
B)
Evidence based practice
C)
Reliable and valid care
D)
Utilizing environment for recovery
Florence Nightingale's 'Environmental Theory' is the foundation of modern nursing. She proposed that the nurse's primary role is to manipulate the patient's environment to allow nature to act upon the patient for recovery. Key environmental factors she emphasized include fresh air (ventilation), pure water, efficient drainage, cleanliness, and light.
Other options are incorrect because:
- Option (a): While compassion is part of nursing, Nightingale's formal theory was based on sanitary science, not emotional affection.
- Option (b): Evidence-based practice (EBP) is a modern clinical approach; while Nightingale used statistics, the core of her theory is environmental management.
- Option (c): Reliability and validity are terms related to research methodology and measurement, not the central focus of Nightingale's nursing theory.
Priority nursing management after the surgery for retinal detachment is:
A)
Prevent increase in IOP
B)
Decrease pain
C)
Promote rest
D)
Maintain nutritional status
The priority nursing management after retinal detachment surgery (such as scleral buckling or vitrectomy) is to prevent an increase in Intraocular Pressure (IOP). Increased IOP can lead to surgical failure, damage the optic nerve, or cause the retina to detach again. Nurses achieve this by instructing the patient to avoid activities that increase pressure, such as coughing, sneezing, bending over, lifting heavy objects, or straining during bowel movements (Valsalva maneuver).
Other options are incorrect because:
- (b) Decrease pain: While pain management is important for comfort, it is not the priority over preventing permanent vision loss due to high IOP.
- (c) Promote rest: Rest is beneficial, but specific positioning (e.g., prone or side-lying as ordered) is more critical than general rest.
- (d) Maintain nutritional status: Nutrition is a general supportive care measure and does not directly impact the immediate surgical outcome of the retina.
A paradoxical chest wall movement is a hallmark sign of:
A)
Simple pneumothorax
B)
Flail chest
C)
Pulmonary contusion
D)
Hemothorax
Paradoxical chest wall movement occurs when a segment of the thoracic wall moves inward during inspiration and outward during expiration, which is the opposite of normal chest wall motion. This is the hallmark sign of a Flail Chest, which occurs when three or more contiguous ribs are fractured in two or more places, creating a 'floating' segment that is no longer structurally connected to the rest of the rib cage.
Why other options are incorrect:
- Simple pneumothorax (a): Characterized by air in the pleural space leading to decreased breath sounds and hyper-resonance, but the chest wall moves symmetrically.
- Pulmonary contusion (c): This is a bruise of the lung parenchyma; while it causes hypoxia and respiratory distress, it does not cause mechanical instability of the chest wall.
- Hemothorax (d): This is the accumulation of blood in the pleural space, leading to dullness on percussion and decreased breath sounds, but not paradoxical movement.
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.
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.