← Combined Technical (NG)
Past Questions
In Parkland formula for: Ringer’s Lactate = ?
A)
2 mL × kg × % TBSA
B)
3 mL × kg × % TBSA
C)
4 mL × kg × % TBSA
D)
5 mL × kg × % TBSA
The Parkland formula is the gold standard for calculating fluid resuscitation in burn patients during the first 24 hours. The formula is: 4 mL × body weight (kg) × percentage of Total Body Surface Area (% TBSA) burned. This total volume of Ringer's Lactate is administered as follows: half in the first 8 hours from the time of injury, and the remaining half over the next 16 hours.
Options a, b, and d are incorrect because they use different multipliers (2 mL, 3 mL, and 5 mL). While some modern guidelines (like the ABA) may suggest starting at 2 mL/kg for adults to avoid 'fluid creep,' the classic 'Parkland Formula' specifically refers to the 4 mL constant.
A male patient enquires about the effectiveness of vasectomy compared to female tubectomy. Which statement is MOST accurate?
A)
Tubectomy is more effective than vasectomy
B)
Vasectomy is safer, simpler, and equally effective
C)
Vasectomy requires general anaesthesia
D)
Fertility returns faster after vasectomy
The correct option is 'b' because vasectomy is widely recognized as a safer, simpler, and more cost-effective procedure compared to tubectomy. It is a minor surgical procedure that can be performed under local anesthesia, whereas tubectomy is a more invasive abdominal surgery. In terms of efficacy, both are highly effective methods of permanent sterilization.
Incorrect options:
- Option 'a': Tubectomy is not more effective; both methods provide high levels of permanent contraception.
- Option 'c': Vasectomy does NOT require general anesthesia; it is typically performed under local anesthesia.
- Option 'd': Neither procedure is designed for the return of fertility; both are intended to be permanent. While reversals exist, they are complex and not guaranteed, and 'speed of return' is not a standard clinical comparison for effectiveness.
The nurse taking care of a patient with chest tube drainage suddenly notices that there is no fluctuation in the water seal tube. Which of the following action should the nurse take first?
A)
Turn the patient to the unaffected side
B)
Inform the physician
C)
Check the tubing to ensure there is no kinking
D)
Start milking the chest tube
In a chest tube drainage system, 'tidaling' (fluctuation) in the water seal chamber indicates that the system is patent and communicating with the pleural space. When fluctuation stops, it typically means one of two things: either the lung has fully re-expanded (a positive outcome) or there is an obstruction in the tubing. The nurse's first action should always be the least invasive assessment to identify the cause. Checking for kinks or obstructions in the tubing is the immediate priority to ensure the system is functioning correctly.
Why other options are incorrect:
- Option a: Turning the patient to the unaffected side is not a standard intervention for a lack of tidaling and does not address the potential cause of the issue.
- Option b: Informing the physician is necessary if the lung has re-expanded or if a complication is found, but the nurse must first assess the equipment to provide an accurate report.
- Option d: 'Milking' or 'stripping' chest tubes is generally contraindicated in modern nursing practice as it can create excessive negative pressure and cause tissue damage.
Which of the following represents the essential components of palliative care?
A)
Rehabilitation, continuity of care, treatment
B)
Effective communication, terminal care, bereavement planning
C)
Terminal care, symptom control, rehabilitation
D)
Education, research, grief planning
Palliative care is a holistic approach designed to improve the quality of life for patients with life-limiting illnesses. The essential components include: 1) Effective communication to manage expectations and goals of care, 2) Terminal care (end-of-life care) to ensure dignity and comfort, and 3) Bereavement planning to support the family after the patient's death.
Other options are incorrect because:
- Option 'a' focuses on 'Rehabilitation' and 'Treatment', which are primary goals of curative care rather than palliative care.
- Option 'c' includes 'Rehabilitation', which is generally not a core component of palliative care (which focuses on comfort over functional restoration).
- Option 'd' lists 'Education' and 'Research', which are academic or systemic supports rather than the direct clinical components of patient care.
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.
A patient is scheduled for right total hip replacement. The nurse should teach which of the following postoperative leg position?
A)
Maintain legs in adduction
B)
Maintain legs in abduction
C)
Maintain internal leg rotation
D)
Maintain > 90 degree hip flexion
The primary goal after a total hip replacement is to prevent dislocation of the new prosthesis.
1. Why 'b' is correct: Maintaining the legs in abduction (moving the legs apart, often using an abduction pillow) keeps the femoral head securely seated within the acetabulum and prevents the hip from crossing the midline, which is the most critical precaution to avoid dislocation.
2. Why other options are incorrect:
- 'a' (Adduction): Adduction (bringing the legs together or crossing them) is strictly contraindicated as it increases the risk of the prosthesis popping out of the socket (dislocation).
- 'c' (Internal rotation): Internal rotation of the affected leg can cause the prosthesis to dislocate; external rotation or a neutral position is generally preferred.
- 'd' (> 90 degree hip flexion): Patients must avoid flexing the hip beyond 90 degrees (e.g., sitting in a low chair or bending forward to tie shoes), as excessive flexion can force the femoral head out of the socket.
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.
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.
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.
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.
The vector of Dengue is:
A)
Aedes aegypti
B)
Culex fatigans
C)
Mansonia uniformis
D)
Anopheles culifacies
The correct option is (a) Aedes aegypti. Dengue fever is caused by the Dengue virus (DENV) and is primarily transmitted to humans through the bite of an infected female Aedes aegypti mosquito.
Reasons why other options are incorrect:
- (b) Culex fatigans: Primarily known as a vector for Japanese Encephalitis and Filariasis.
- (c) Mansonia uniformis: Primarily associated with the transmission of Brugian Filariasis.
- (d) Anopheles culifacies: The primary vector for Malaria in many regions.
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.
The type of fluid which causes water to shift from cells into blood stream?
A)
Hypotonic
B)
Hypertonic
C)
Isotonic
D)
Albumin
The movement of water between cells and the bloodstream is governed by osmosis, where water moves from an area of lower solute concentration to an area of higher solute concentration.
1. **Why Hypertonic is correct**: A hypertonic fluid has a higher concentration of solutes compared to the intracellular fluid (inside the cell). This creates an osmotic gradient that pulls water out of the cells and into the bloodstream to balance the concentration, causing the cells to shrink.
2. **Why other options are incorrect**:
- **Hypotonic (a)**: These fluids have a lower solute concentration than the cell. Water moves from the bloodstream into the cells, causing them to swell or burst.
- **Isotonic (c)**: These fluids have an equal solute concentration to the cell, resulting in no net movement of water.
- **Albumin (d)**: While albumin is a protein that helps maintain oncotic pressure in the blood, it is a specific protein/solute, not a 'type of fluid' in the context of tonicity classifications.
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).
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.
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.
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.
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.
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.
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.
Stool discharge from a colostomy is called:
A)
Effluent
B)
Cathartics
C)
Mucosa
D)
Colonic fluid
The correct term for the waste material (stool) that exits a stoma, such as a colostomy or ileostomy, is 'effluent'.
- Option (a) Effluent: In medical terminology, specifically regarding ostomy care, effluent refers to the liquid or semi-solid discharge that flows out of the stoma into the collection pouch.
- Option (b) Cathartics: These are strong laxatives used to induce bowel movements; they are medications, not the discharge itself.
- Option (c) Mucosa: This refers to the mucous membrane lining the inside of the colon or other organs; it is a tissue type, not a discharge.
- Option (d) Colonic fluid: While the discharge contains fluid from the colon, this is a descriptive phrase rather than the formal clinical term used in nursing and medical examinations.
Open vial policy allows reuse of partially used multi dose vials of applicable vaccines under UIP in subsequent session. Which of the following vaccine follow this policy?
A)
MR
B)
BCG
C)
RVV
D)
IPV
The Open Vial Policy (OVP) allows the reuse of partially used multi-dose vials of certain vaccines in subsequent sessions to reduce wastage.
1. **Correct Option (a) MR:** The Measles-Rubella (MR) vaccine, along with others like DPT, HepB, TT, and Pentavalent, follows the OVP. These vaccines can be used for up to 28 days after opening, provided they are stored at the correct temperature and the vial is not expired.
2. **Incorrect Options (b, c, d):**
- **BCG (b):** This is a freeze-dried vaccine that becomes unstable once reconstituted; it must be discarded after 6 hours.
- **RVV (c):** Rotavirus Vaccine is an oral liquid vaccine that does not follow the OVP; it must be discarded after the session.
- **IPV (d):** While some guidelines vary by region, under the standard UIP OVP, reconstituted or specific live/fragile vaccines are excluded. In the context of this specific set of options, MR is the definitive OVP-compliant vaccine.
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.
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 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.