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STAFF NURSE EXAM MULTIPLE CHOICE QUESTIONS

1. Ms. Pushparaj suddenly develops a decrease in her level of consciousness, even though she has not received any additional sedatives or analgesics. She is on broad spectrum antibiotics, levophed, vasopressin, steroids and intensive insulin. She is being fed via a nasal gastric feeding tube. She develops gastric distention with residual volumes equal to 6 hours feeding volume. Which one of the following interventions is a priority?
a. Change feeding tube to small bowel placement
b. Obtain a blood glucose measurement
c. Initiate a prokinetic agent
d. Change feeds to elemental solution

2. Mr. Padmanavha is admitted with decreased level of consciousness. His admission labs are: Blood glucose 56 mmol/L, Na 149 K 4.8 Cl 105 HCO3 22, ABGs PaO2 72 PCO2 45 pH 7.39 HCO3 23. Which one of the problems is indicated by these findings?
a. Diabetic ketoacidosis
b. Glucagon overdose
c. Non-ketotic hyperosmolar coma
d. Adrenal crisis

3. Mr. Lijosh Kuriyakose is admitted with alcoholic pancreatitis. He has a T 38.2 WBC 14,000 (with left shift and increased neutrophils). Following 4 litres of normal saline, his BP increases to 117/80 from 70/50, HR decreases from 144 to 92 and urine output increases from 10 to 60 ml/hr. He requires intubation for worsening hypoxemia. Which one of the following best explains these findings?
a. Sepsis
b. Severe sepsis
c. Septic shock
d. Systemic Inflammatory Response Syndrome

4. Mr. Nikhil George is admitted following a motor vehicle collision. Her past medical history includes daily prednisone for the treatment of systemic lupus. Despite fluid replacement therapy and initiation of levophed, her blood pressure remains low. Which one of the following interventions is the priority?
a. Cosyntropinin
b. Epinephrine
c. Hydrocortisone
d. Vasopressin

5. Which one of the following pharmacological agents should be administered with levothyroxine for the
treatment of myxedema coma?
a. Insulin
b. Glucagon
c. Epinephrine
d. Steroids

6. Which one of the following factors increases the risk for central line infection?
a. Subclavian venous access
b. Chorhexidine skin prep
c. Tunneled catheters
d. TPN

7. Ms. Sandriya, 80 kg, drops her platelet count by >50% 10 days after starting subcutaneous heparin.
She develops a swollen right calf and positive Homan’s sign. Which one of the following interventions would you anticipate?
a. Change anticoagulant to dalteparin 15,000 units SC daily
b. Administer protamine sulphate and discontinue heparin
c. Initiate anticoagulation with fondaparinux
d. Stop all anticoagulation and initiate pneumatic compression stockings

8. Mrs. Kamala has been on steroids for the past 6 years to treat severe rheumatoid arthritis. Which one of the following problems would you anticipate?
a. Hypercalcemia
b. Hyperkalemia
c. Hyperlipidemia
d. Hypoglycemia

9. Ms. Yakshitha is admitted with coma. She has a BP of 158/75 HR 52 (sinus) and requires intubation for level of consciousness and pulmonary edema. Her temperature is 34 (oral). Which of the following lab tests is the priority?
a. TSH, T3, T4
b. Serum and urine osmolalities
c. Cosyntropinin stimulation test
d. Serum renin and angiotensin levels

10. Mr. Jayaraj is admitted with hypoxemic and hypercarbic respiratory arrest requiring intubation and ventilation. He has a RLL consolidation on xray, with copious purulent secretions. WBC is 24,000 T 39.2. BP 88/55 HR 136 and CVP 18 after 6 L of 0.9% normal saline. Urine output is 10 ml/hr. Which one of the following interventions is a priority?
a. Levophed
b. Dopamine
c. Dobutamine
d. Labetolol
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