Medical-Surgical Nursing: NCK Exam Questions & Revision

What is the primary nursing action for a patient diagnosed with a peritoneal abscess?

• A. Administer analgesics for relief of pain.
• B. Administer intravenous fluids to maintain fluid volume balance.
• C. Reassure the patient to relieve anxiety and co-operate during pre-operative preparation.
• D. Administer parenteral nutrition to obtain optimum weight gain while the gut is rested.

Why: The primary nursing action for a patient with a peritoneal abscess is to maintain fluid volume balance, as these patients are at risk for fluid imbalance due to infection and potential fluid loss into the peritoneal cavity. Administering intravenous fluids helps to stabilize the patient hemodynamically. While analgesics (a) and reassurance (c) are important for comfort and cooperation, they are not the primary action. Parenteral nutrition (d) is not immediately necessary unless there is a prolonged inability to use the gut.

A patient with type 2 diabetes is started on metformin. What is its primary mechanism of action?

• A. Stimulates insulin secretion from the pancreas
• B. Decreases glucose production by the liver
• C. Blocks glucose absorption in the kidney
• D. Replaces the body own insulin

Why: Metformin is a biguanide that mainly reduces hepatic glucose production and improves insulin sensitivity. It does not stimulate insulin release, so on its own it rarely causes hypoglycaemia.

The priority nursing action for a patient with sudden chest pain and suspected myocardial infarction is to:

• A. Encourage the patient to walk around
• B. Give a large oral fluid bolus
• C. Give oxygen and obtain a 12-lead ECG
• D. Lay the patient flat and raise the legs

Why: The priority is to support oxygenation and perfusion and to obtain an ECG to guide urgent management. Airway, breathing and circulation come first.

Which set of findings (Cushing triad) suggests raised intracranial pressure?

• A. Hypotension, tachycardia, rapid breathing
• B. Hypertension with widening pulse pressure, bradycardia, irregular breathing
• C. Low temperature, fast pulse, dilated pupils
• D. Normal vital signs with a headache only

Why: Cushing triad — a rising blood pressure with widening pulse pressure, slow pulse and irregular respirations — is a late sign of raised intracranial pressure.

What is a common cause of chronic bronchitis?

• A. H. influenza and S. pneumonia.
• B. S. aureus and H. influenza.
• C. S. Pneumonia and S. Pyogenes.
• D. H.influenza and S.pyogenes.

Why: Chronic bronchitis is commonly caused by long-term irritation of the airways, often due to smoking or exposure to pollutants, rather than bacterial infections. However, when considering bacterial involvement, H. influenza and S. pneumonia are more commonly associated with respiratory infections that can exacerbate chronic bronchitis. Options b, c, and d include bacteria that are less commonly associated with chronic bronchitis exacerbations.

What are the signs that suggest the presence of inhalation injuries?

• A. History of the burn occurring in an enclosed area, singed nasal hair, anaemia.
• B. Voice hoarseness, bloody sputum, seizures.
• C. Singed nasal hair, the burn occurring in an enclosed area, sooty sputum.
• D. Bloody sputum, hypoventilation, paradoxical breathing.

Why: Option c is correct as it includes key indicators for inhalational burns: singed nasal hair, burns occurring in an enclosed area, and sooty sputum, which suggest exposure to heat and smoke. Option a includes anaemia, which is not a direct indicator of inhalational burns. Option b mentions seizures, which are not typical indicators of inhalational injury, and bloody sputum is less specific. Option d includes hypoventilation and paradoxical breathing, which are more related to respiratory distress rather than specific indicators of inhalational burns.