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1 Latest Model Examination Questions for LJM Examination The new LJM examination structure is as follows: - Application [A]: 70% - Evaluation [E]: 20% - Synthesis [S]: 10% Sample Synthesis [S] and Evaluation [E] Type Questions 1. You have provided your pneumonia patient with health education to prepare him for managing and preventing himself from getting infections. The patient’s statement that best indicates that he needs further information in understanding your health education is [E] A. ‘I can resume a normal diet with emphasis on nutritious, healthy foods.’ B. ‘I can stop taking the prescribed antibiotics once the symptoms have completely resolved.’ C. ‘I should continue using the spirometer provided to keep my airways open and free of secretions.’ D. ‘I am able to continue my daily activities, but I should avoid physical exertion and get adequate rest.’ Answer: D Rationale: The patient should understand that it is necessary to complete the antibiotics course to ensure the bacteria are fully eradicated and to prevent them from mutating. Mutated bacteria will produce enzymes that inactivate the antibiotics, change the antibiotics binding sites, or alter their own cell membranes to prevent antibiotics from binding to them when there is a re-infection. 2. Encik Hamid, a patient with a history of congestive heart failure, arrives at the emergency department complaining of dyspnoea. The first action that should be performed by the nurse in charge is to [S] A. check for blood pressure B. send the patient for a chest X-ray C. ask the patient to lie down on the exam table D. draw blood for chemistry panel and arterial blood gases (ABGs) Answer: A Rationale: Checking the patient’s blood pressure is the first action that should be taken by the nurse to check for hypertension. If a CHF patient complains of dyspnoea, this can be a sign that the patient is experiencing pulmonary oedema which is indicated by hypertension. The patient should not be asked to lie down as this will cause dyspnoea to become worse and reduce venous return. CXR, ABG and other chemistry tests also need to be done but not as the first action.

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Latest Model Examination Questions for LJM Examination

The new LJM examination structure is as follows: - Application [A]: 70% - Evaluation [E]: 20% - Synthesis [S]: 10%

Sample Synthesis [S] and Evaluation [E] Type Questions

1. You have provided your pneumonia patient with health education to prepare him for managing and preventing himself from getting infections. The patient’s statement that best indicates that he needs further information in understanding your health education is [E]

A. ‘I can resume a normal diet with emphasis on nutritious, healthy foods.’ B. ‘I can stop taking the prescribed antibiotics once the symptoms have completely

resolved.’ C. ‘I should continue using the spirometer provided to keep my airways open and free of

secretions.’ D. ‘I am able to continue my daily activities, but I should avoid physical exertion and get

adequate rest.’

Answer: D

Rationale:

The patient should understand that it is necessary to complete the antibiotics course to ensure the bacteria are fully eradicated and to prevent them from mutating. Mutated bacteria will produce enzymes that inactivate the antibiotics, change the antibiotics binding sites, or alter their own cell membranes to prevent antibiotics from binding to them when there is a re-infection.

2. Encik Hamid, a patient with a history of congestive heart failure, arrives at the emergency department complaining of dyspnoea. The first action that should be performed by the nurse in charge is to [S]

A. check for blood pressure B. send the patient for a chest X-ray C. ask the patient to lie down on the exam table D. draw blood for chemistry panel and arterial blood gases (ABGs)

Answer: A

Rationale:

Checking the patient’s blood pressure is the first action that should be taken by the nurse to check for hypertension. If a CHF patient complains of dyspnoea, this can be a sign that the patient is experiencing pulmonary oedema which is indicated by hypertension. The patient should not be asked to lie down as this will cause dyspnoea to become worse and reduce venous return. CXR, ABG and other chemistry tests also need to be done but not as the first action.

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3. Encik Murad has recently been prescribed nitroglycerine for treatment of angina. He complains of frequent headaches. Which of the following statement by a nurse to the patient is the correct response? [S]

A. ‘Stop taking the nitroglycerine and see if the headaches improve.’ B. ‘Headaches are a frequent side effect of nitroglycerine because it causes vasodilation.’ C. ‘Go to the emergency department to be checked because nitroglycerine can cause

bleeding in the brain.’ D. ‘The headaches are unlikely to be related to the nitroglycerine, so you should see your

doctor for further investigation.’

Answer: B

Rationale:

The therapeutic effects of nitroglycerine are to decrease myocardial oxygen consumption and demand through venous and arterial dilation, which in turn, reduce preload and afterload. However, the blood supply to the brain will be reduced and this may cause headaches.

4. Puan Maimun, who has diabetes mellitus, is in the second post-operative day following cholecystectomy. She has complained of nausea and inability to eat solid foods. In your assessment, she looked confused and shaky. You conclude that she is having [E]

A. hypoglycaemia B. hyperglycaemia C. anaesthesia reaction D. diabetic ketoacidosis

Answer: A

Rationale: A patient who has diabetes mellitus and appears confused and shaky is likely to be experiencing hypoglycaemia. This happens when there is excess insulin in the blood and the blood sugar level falls below normal values. The fact that the patient is unable to eat solid foods following cholecystectomy may have caused her blood sugar level to become excessively low.

5. Azim, a 16-year-old boy, is suspected of acute glomerulonephritis. Which of the following manifestations are consistent with the diagnosis? [S]

I. Proteinuria II. Periorbital oedema III. ‘Cola-coloured’ urine IV. Urine output of 350 ml in 24 hours A. I, II and III B. I, II and IV C. I, III and IV D. II, III and IV

Answer: A

Rationale:

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Proteinuria is a common manifestation of acute glomerulonephritis due to the swelling of glomerular membranes which then become permeable to protein. Oedema, particularly periorbital oedema, is noted due to salt and water retention that increases extracellular fluid volume. The ‘cola-coloured’ urine is due to inflammatory response and proliferation of endothelial cells of the glomerulus.

6. Mr. Lingham is an acute renal failure patient. His arterial blood gases (ABGs) measurement was taken at admission. The expected results of his ABGs are [E]

A. pH 7.49, HCO3 24 mEq, PCO2 46 mmHg B. pH 7.49, HCO3 14 mEg, PCO2 30 mmHg C. pH 7.26, HCO3 24 mEg, PCO2 46 mmHg D. pH 7.26, HCO3 14 mEg, PCO2 30 mmHg

Answer: D Rationale: ABGs measurement of acute renal failure patients often shows metabolic acidosis. The pH falls below 35 mmHg and bicarbonate is less than 22 mEq/L. Metabolic acidosis happens due to the kidneys’ inability to adequately eliminate metabolic wastes and hydrogen ions.

7. You are caring for a post-hip replacement patient. Which of the following findings should be your biggest concern? [S]

A. Complaints of nausea B. Temperature of 38.7

0C

C. Complaints of pain during re-positioning D. Scant bloody discharge on the surgical dressing

Answer: B

Rationale: A post-hip replacement patient with a temperature of 38.70C may indicate an infection

of the surgical wound due to septic operation procedure or incompatibility of prosthesis.

8. Encik Ali had a plaster of Paris (POP) cast applied for a fractured right radius at 10 a.m. on 3rd Dec 2010. On 4

th Dec 2010 at 10 a.m., he came back to the casualty due to a problem

related to the POP cast. The nurse should consider that Encik Ali is having impaired perfusion to his limb when he is having [E]

A. severe itching under the cast B. increased warmth in the fingers C. severe pain in the right shoulder D. severe pain in the right lower arm

Answer: D

Rationale: The severe pain experienced by the patient is due to impaired perfusion to the right lower arm as a result of a closed POP cast. This may also cause neurovascular compromise, thus immediate removal of the cast is required.

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9. A child is admitted to the hospital with suspected rheumatic fever. Which of the following manifestations confirm the diagnosis? [S]

I. An unexplained fever II. History of sore throat for about two to three weeks III. Reddened rash visible over the trunk and extremities IV. Petechiae on trunk, conjunctiva and mucous membrane A. I, II and III B. I, II and IV C. I, III and IV D. II, III and IV

Answer: A

Rationale: Rheumatic fever is caused by an untreated Group A or B Haemolytic Streptococcus. The manifestations of rheumatic fever are characterized by fever, history of sore throat for about 2 to 3 weeks due to streptococcal infection, non-pruritic skin rash over the trunk and extremities as well as fever. Petechiae are a manifestation of acute endocarditis.

10. An infant with congestive heart failure is receiving frusemide as diuretic therapy at home. The nurse considers the dosage prescribed is inadequate when the assessment finding shows [E]

A. bradycardia B. sudden weight gain C. slow, shallow breathing D. decreased blood pressure

Answer: B

Rationale: Diuretics relieve symptoms related to fluid retention and cause rapid fluid loss if adequate doses are prescribed. The effects of a diuretic can be measured by observing the reduction in body weight as compared to body weight taken before the diuretic is administered. In this case, if the patient’s body weight is suddenly increased, it may indicate an inadequate dose. . Slow, shallow breathing only happens when the patient is experiencing pulmonary oedema.

11. A patient arrives at the emergency department complaining of mid-sternal chest pain. The appropriate action that should be taken by the nurse immediately after the patient arrived is [S]

A. an electrocardiogram B. chest exam with auscultation C. careful assessment of vital signs D. complete history with emphasis on preceding events

Answer: C

Rationale: The immediate nursing action for a patient with mid-sternal chest pain is to assess his/her of vital signs. The vital signs may indicate the extent of physical compromise and provides a baseline for further assessment and treatment. An ECG will be done next after the vital signs

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are taken. General health assessment including chest examination and complete history can be done once the patient is stabilized.

12. A patient arrives and reports of splashing concentrated household cleaner in her eye. The priority nursing action by the emergency nurse should be [S]

A. testing visual acuity B. instilling fluorescein drops in the eye C. patching the affected eye with eye shield D. irrigating the affected eye repeatedly with normal saline solution

Answer: D

Rationale: Irrigation with normal saline to the affected eye to remove the chemical is of higher

priority than assessment of the eye. This should be continued for at least 10 minutes. Visual

acuity will be assessed after irrigation is done. Patching of the eye and fluorescein drops are not

part of the initial care of a chemical splash.

13. An evening shift emergency nurse is presented with four patients at the same time. Which of the following patients should be triaged as highest priority? [E]

A. A patient with abdominal and chest pain following a large, spicy meal B. A patient with low-grade fever, headache, and myalgias for the past 72 hours C. A child with a one-inch bleeding laceration on the chin but otherwise well after falling

while jumping on his bed D. A patient who is unable to bear weight on the left foot, with swelling and bruising following

a running accident

Answer: A

Rationale: The patient with chest pain following a large, spicy meal need to be triaged as highest priority because he may be having an acute myocardial infarction, although the symptom may indicate heartburn.

14. Your patient is lethargic, nauseated and has a pulse of 52. You see that he is taking digoxin (Lanoxin) 0.25mg daily, and also has hydrochlorothiazide (HydroDiuril) 50mg twice daily. Therefore, you should check his [E] A. sodium levels B. digoxin levels C. calcium levels D. potassium levels

Answer: D

Rationale: The patient may be having hypokalaemia as a result of taking hydrochlorothiazide (the

potassium-wasting diuretic). Hypokalaemia can precipitate digitalis toxicity even when the serum

digitalis level is in the normal range.

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15. A child weighing 30 kg who is having diffuse itching after an insect bite is prescribed with an antihistamine, Diphenhydramine 25 mg 3 times a day. If the correct paediatric dose for the drug is 5mg/kg/day, which of the following is true about the prescribed drug dose? [E]

A. The dose is too low B. The dose is too high C. It is the correct dose D. The dose should be increased or decreased, depending on the symptoms

Answer: A

Rationale: This child weighs 30 kg, and the paediatric dose of Diphenhydramine is 5 mg/kg/day. Therefore, the correct dose is 150 mg/day (5 mg/kg/day X 30 kg = 150 mg/day). Divided into 3 doses per day, the child should receive 50 mg 3 times a day rather than 25 mg 3 times a day which is lower than the recommended dose.

16. The team leader on the coronary care unit is planning assignments for her shift. Which of the following is the most appropriate assignment for the float staff nurse who specialized in maternity nursing? [S]

A. A patient with unstable angina being closely monitored for pain and medication titration B. A post-operative valve replacement patient who was recently admitted to the unit

because all surgical beds were filled C. A one-week post-operative coronary bypass patient, who is being evaluated for

placement of a pacemaker prior to discharge D. A suspected myocardial infarction patient on telemetry, just admitted from the Emergency

Department and scheduled for an angiogram

Answer: C

Rationale: When planning the assignment, the team leader should consider the skills of the staff and the needs of the patients. The maternity-trained staff nurse who is not experienced with cardiac patients should be assigned to those with the least acute needs. Therefore, assigning the float staff to the one-week post-operative patient who is nearing discharge and likely to require routine care is appropriate.

17. Which of the following is the most important nursing action of a nurse who cares for a neutropenic patient in the oncology ward? [S]

A. Minimize patient contact B. Change gloves immediately after use C. Minimize conversation with the patient D. Change the disposable mask immediately after use

Answer: B

Rationale: The neutropenic patient is at risk of infection due to impaired immunity and inflammatory response. Changing gloves immediately after use protects the patient from opportunistic microorganisms that may infect the patient (by cross infection).

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18. Madam Kong is now in remission after undergoing surgery and chemotherapy for colon cancer and completing therapy in the last 3 months. She complains of fatigue following evening walks and difficulty with concentrating at work. Which of the following problems is best to explain her symptoms? [E]

A. She may be depressed B. She may be dehydrated C. She may be immune-suppressed D. She may be having anaemia caused by chemotherapy

Answer: D

Rationale: The chemotherapy drugs will affect the bone marrow tissues and depress most blood cells including erythrocytes, causing severe anaemia. Fatigue following activities and lack of concentration are some of the manifestations of anaemia.

19. A severe anaemic patient is ordered to have packed cell infusion as a treatment. Which of the following nursing intervention is the best action in handling packed cell infusion? [S]

A. Packed cells should be flushed with a 5% dextrose solution B. Packed cells are best infused slowly through a non-filter chamber IV giving set C. Transfusion reaction is most likely to manifest immediately after the infusion is completed D. Close observation by a nurse on the patient should be ensured during the first 15 minutes

of infusion

Answer: D

Rationale: Blood transfusion reaction and febrile reaction (fever and chills) typically begin during the first 15 minutes of the transfusion. Besides that, hypersensitivity and haemolytic reaction may also occur. The nurse should observe the patient closely for transfusion reaction by monitoring and recording vital signs and comparing results with the baseline data.

20. A patient who received 2 packs of blood for the last 4 hours is found sitting up in bed and appears dyspnoeic and uncomfortable. By chest auscultation, crackles are heard in the bases of both lungs. The most likely blood transfusion complication experienced by this patient is [S]

A. fluid overload B. acute haemolytic reaction C. allergic transfusion reaction D. febrile non-haemolytic reaction

17. Answer: A

Fluid overload is another risk of blood infusion. Most patients can tolerate an infusion of a unit of blood (ranging from 250 to 500ml) in 2 hours. However, when a high volume of fluid is infused over a short period of time, it can affect the patient’s vascular system by causing the fluid to leak into the lungs. Dyspnoea, rapid respirations, lung sounds that sound like crackles and discomfort are symptoms of fluid overload.

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21. A dengue patient with a platelet count of 20,000/millilitre of blood and body temperature of 39

0C is complaining of headaches. Which of the following is the most important

intervention by the nurse? [E]

A. Limit visitors to family only B. Impose immune precautions C. Give aspirin in case of headaches D. Observe for evidence of spontaneous bleeding

Answer: D

Rationale: A platelet count of less than 100,000 per millilitre of blood can lead to abnormal bleeding. If the platelet count is less than 20,000 per millilitre, it can lead to spontaneous bleeding and haemorrhage from minor trauma. Therefore, the patient should be observed for petechiae, epitaxis, gum bleeding, hematuria, and spontaneous bleeding from the GI tract and vagina.

22. Encik Ahmad, a 70-year-old, asks a nurse to recommend strategies to prevent constipation. Which of the following suggestions are appropriate for Encik Ahmad? [S]

I. Take laxatives to ensure daily bowel movement II. Take more high-fibre diet such as vegetables and fruits III. Do moderate exercises such as walking to the mosque IV. Drink 2 to 3 litres of water each day if there is no contraindication A. I, II and III B. I, II and IV C. I, III and IV D. II, III, and IV

Answer: D

Rationale: High fibre foods are recommended because they are indigestible and help increase stool bulk. Fibre also helps draw water into the faecal mass, softening the stool and making defecation easier. The nurse should also encourage the patient to engage in some form of exercise such as walking to stimulate the bowel movement and promote faecal transit in the large intestine. Drinking plenty of water helps to soften the stool and makes defecation easier.

23. A schizophrenic patient is taking haloperidol for treatment since the last five years. She complains of abnormal movements of her face and tongue. Which of the following indicates that the patient is experiencing a side effect of haloperidol?

A. Tardive dyskinesia B. Co-morbid depression C. Psychotic hallucinations D. Negative symptoms of schizophrenia

Answer: A

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Rationale: Tardive dyskinesia is a side effect of long-term or high-dose use of antipsychotic drugs such as haloperidol. Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements, such as grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. The abnormal facial movements and tongue protrusion experienced by this patient is most likely due to tardive dyskinesia.

24. A nurse is counselling the mother of a newborn infant with hyperbilirubinaemia. Which of the following instructions by the nurse is correct? [E]

I. Breastfeed infant 8 to 12 times a day II. Keep the baby quiet and swaddled, and place the bassinet in a dimly lit area III. Watch for signs of dehydration, including decreased urinary output and changes in skin

turgor IV. Follow up with the infant's physician within 72 hours of discharge for a re-check of the

serum bilirubin and exam A. I, II and III B. I, II and IV C. I, III and IV D. II, III and IV

Answer: C

Rationale: Increasing the frequency of breastfeeding decreases the likelihood of subsequent

significant hyperbilirubinemia. Poor caloric intake and/or dehydration associated with inadequate

breastfeeding may contribute to the development of hyperbilirubinemia. All infants should be examined by a qualified

health care professional in the first few days after discharge

to assess

infant well-being and the presence or absence of jaundice.

25. A bowel obstruction patient has a nasogatric tube connected to the low suction apparatus. The gastric content and juice was collected. Which of the following arterial blood gasses results indicate that he is having acid base imbalance related to his condition? [E]

A. pH 7.52, HCO3 27mEq/L B. pH 7.42, HCO3 26mEq/L C. pH 7.25, HCO3 25mEq/L D. pH 7.38, HCO3 23mEq/L

Answer: A

Rationale: Metabolic alkalosis occurs when there is an excess of bicarbonate in relation to the amount of hydrogen ion. The ABGs pH is above 7.45 and the bicarbonate concentration is greater than 26 mEq/L. The common cause of metabolic alkalosis is acid loss during gastric suction.

26. Madam Nana is scheduled for an elective surgery. Upon admission, the nurse is informed that she is currently on warfarin (Coumadin) at a high dose. If the nurse is concerned about the possible effects of warfarin, particularly in a patient scheduled for surgery, which of the following actions should the nurse take? [S]

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A. Inform doctor and administer vitamin K as prescribed B. Draw a blood sample for type, cross-match and request blood from the blood bank C. Draw a blood sample for prothrombin (PT) and international normalized ratio (INR) level D. Cancel the surgery after the patient reports stopping the Coumadin one week previously

Answer: A

Rationale: Warfarin is an anticoagulant drug. The nurse needs to inform the doctor and administer vitamin K as prescribed as vitamin K is an antidote to warfarin to prevent excessive bleeding or haemorrhage during and after surgery.

27. Mr Kamal is at 24 hours post-abdominal surgery. The nurse conducts a dressing assessment and found a moderate amount of serous drainage on the dressing. Which of the following is the appropriate decision taken by the nurse? [E]

A. Remove the dressing and leave the wound site open to air B. Notify the surgeon about evidence of infection immediately C. Leave the dressing intact to avoid disturbing the wound site D. Change the dressing and document the clean appearance of the wound site

Answer: D

Rationale: A moderate amount of bleeding from the wound 24 hours after surgery is expected. The nurse can change the dressing to prevent infection by pathogenic microorganisms since blood or even serum is a good medium for microorganism growth.

28. Puan Nor, who has fibromyalgia syndrome, is experiencing stress in response to chronic pain and stiffness. Which of the following activities should be suggested by the nurse as a mind-body therapy for Puan Nor?[S]

A. Tai Chi B. Colour therapy C. Aromatherapy D. Magnetic therapy

Answer: A

Rationale: Tai Chi is an exercise which involves movement of the general muscles and mind concentration to help divert the feeling of pain. Colour therapy and aromatherapy are suggested for the stimulation of senses. Magnetic therapy is a localized therapy.

29. Mr Ramoo, a 60-year-old businessman, has been a heavy drinker for the past 30 years. He came to the clinic to seek treatment for acute gastritis. The nurse identifies that the patient is in the contemplation stage of change when he says [E]

A. ‘Alcohol has never bothered my stomach. I may just have the flu.’ B. ‘I’m older and wiser now, and I know I can change my drinking habit.’ C. ‘I think my drinking is affecting my stomach, but maybe some drugs will help calm it down.’ D. ‘My wife keeps telling me that I am killing myself with alcohol, but I really feel pretty good

except for my stomach.’

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Answer: C

Rationale: The patient is aware that his drinking behaviour is affecting his condition. He is still motivated to change his behaviour and hopes there is a medication to treat his drinking complication. This indicates that the patient is considering the possibility of changing his habits and is open to receiving information and suggestions to improve his health.

30. A patient, who is a drug addict, was found unconscious by the roadside and brought in to the emergency unit by a passerby. Upon examination, you found that he is unresponsive with pinpoint pupils. Based on your assessment, you anticipate the treatment by preparing him for [S]

A. caffeine B. naloxone C. diazepam D. methadone

Answer: B

Rationale: Unconsciousness and pinpoint pupils indicate that the patient was under opium effect. Naloxone is an antidote for opium.

31. A nurse has established the nursing diagnosis for a patient who has undergone a bowel surgery due to bacterial peritonitis as hyperthermia related to infection with a body temperature of 38.5

0C and diaphoresis. The intervention by the nurse should include [S]

A. reducing the patient’s caloric intake to slow the body’s metabolic rate B. changing linens frequently to prevent rapid heat loss and subsequent chilling C. administering anti-pyretic drugs immediately to prevent fever-induced cell damage D. covering the patient with additional blankets to promote heat loss through sweating

Answer: B

Rationale: The wet linens due to diaphoresis need to be changed to ensure the patient’s comfort and prevent rapid heat loss through evaporation. The patient’s caloric intake is under control since the patient is required to fast until bowel sounds are heard. The patient should not be covered by blankets as this will increase the body temperature. Anti-pyretics should not be administered since nurses are not allowed to prescribe medications.

32. A paraplegic patient is admitted for intensive management of an open, infected pressure ulcer on the left buttock at the prominence of the ischial tuberosity. The initial assessment of the patient’s pressure ulcer indicates that it is 5cm long, 25cm wide and involves subcutaneous tissue. The nurse classifies the pressure ulcer as [E]

A. Stage I B. Stage II C. Stage III D. Stage IV

Answer: C

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Rationale: Pressure ulcer staging is done by assessing the anatomic depth of soft tissue damage. Intact skin with redness over a bony prominence is considered as Stage I pressure ulcer. Stage II pressure ulcer is recognized by shiny or dry, shallow open ulcer without slough or bruising while Stage III pressure ulcer is when the full thickness of tissue is lost revealing subcutaneous fat. Stage IV ulcer is when the full thickness of tissue is lost to reveal muscle, tendon or bone. Since the pressure ulcer of the paraplegic patient involves subcutaneous tissue, it can be classified as in Stage III.

33. Mr Heng is admitted for renal failure. His ABG results are: pH 7.32, PO2 88mmHg, PCO2 34 mmHg and HCO3 16mEq/L. His ECG pattern is as shown below.

The nurse interprets these results as [E]

A. Metabolic alkalosis with hypokalaemia B. Metabolic acidosis with hyperkalaemia C. Respiratory alkolosis with hypokalaemia D. Respiratory acidosis with hyperkalaemia

Answer: B

Rationale: The pH is < 35mmHg, HCO3 < 22mEq/L and PCO2 < 35mmHg, which indicate metabolic acidosis. The ECG indicates he is having hyperkalaemia when the ECG shows prolonged QRS and tall T wave

34. A preoperative patient’s CBC results include: RBC 4.6x106/µl; WBC, 10.2 x 10

3/µl; Hb

15g/dl; Hct 45%; platelet 150x103/µl. Based on these results, the nurse concludes that the

patient [E]

A. is at risk for intraoperative bleeding B. needs packed red blood cells intraoperative infusion C. has impaired oxygen-carrying capacity of the blood D. has no obvious risk for intraoperative or post-operative bleeding

Answer: D

Rationale: The CBC results indicate normal values.

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35. Puan Minah is placed in PACU to recover from anaesthesia. For the past hour, her vital signs show the following: blood pressure 110/80–114/82 mmHg, pulse rate 76–80 bpm, respiration rate 22–6, her SpO2 is 90%. She is sleepy but awakens easily and is oriented when spoken to. Her surgical dressing is dry and intact. The most appropriate action by the nurse is to [S]

A. position the patient in a lateral position B. encourage the patient to take deep breaths C. check the patient’s temperature and apply warm blankets D. notify the anaesthesia care provider that the patient is ready for discharge from the PACU

Answer: D

Rationale: Puan Minah’s vital signs and consciousness level indicate she is recovering from anaesthesia. She is able to protect her airway and ready to be transferred to general surgical ward.

36. Miss Ina, a 24-year-old, spilled hot oil from a deep fryer on her anterior and posterior right lower leg and foot. Her leg and foot are red and swollen, covered with large blisters and she states that they are very painful. The nurse should classify the burn as [E]

A. major; full-thickness skin destruction B. major; deep partial-thickness skin destruction C. minor; superficial partial-thickness skin destruction D. moderate uncomplicated; deep partial-thickness skin destruction

Answer: B

Rationale: Hot liquid will cause a deep partial-thickness burn. The dermis changes to red and becomes swollen and large blisters that form may easily rupture.

37. Referring to the scenario in Question 36, if the nurse follows the ‘rule of nine’ to estimate the total body surface area (TBSA) percentage of Miss Ina’s burn, what is the percentage of the area involved? [E]

A. 4½% B. 9% C. 18% D. 36%

Answer: B

Rationale: According to the ‘rule of nine’, Miss Ina’s burn on the right anterior and posterior lower limb contributes to 9% TBSA.

38. While administering IV nitroglycerine to a patient with myocardial infarction, the patient asks the nurse about the medication. The nurse decides to explain the expected outcome of the drug. Which of the following statement is correct? [S]

A. ‘It will relieve the chest pain.’

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B. ‘It will increase your cardiac output.’ C. ‘It will control your cardiac arrhythmias.’ D. ‘It will decrease myocardium contractility.’

Answer: A

Rationale: The best statement is A since the other statements require further explanation by the nurse.

39. After evaluating the CK-MB level (6%) of a patient with chest pain who was admitted 12 hours ago by comparing it with the normal value (0–3%), the nurse found the CK-MB level is markedly elevated. The nurse immediately informs the cardiologist because she predicts this is as evidence of [S]

A. lactic acidosis B. a need for thrombolytic therapy C. deterioration of cardiac function D. cellular necrosis of myocardial tissue

Answer: D

Rationale: Elevated CK-MB greater than 5% is considered the most sensitive indicator of myocardial infarction, the necrosis of myocardial tissues. The treatment will be decided after the patient is reviewed by the cardiologist.

40. Total parenteral nutrition (TPN) is initiated for a patient who has multiple fractures with burns after a motor vehicle accident. The capillary blood sugar level is 8.9 mmol/L after 6 hours of administration. The most appropriate action by the nurse is to [S]

A. notify the doctor the capillary blood glucose level B. re-check the capillary blood glucose in 4 hours time C. check the catheter insertion site for signs of inflammation D. slow the rate of the TPN solution to prevent hyperglycaemia

Answer: B

Rationale: Capillary blood sugar level of 8.9 mmol/L is not only due to TPN but it also maybe due to the stress experienced by the patient. Therefore, it is not necessary to inform the doctor immediately. The inflammation of the insertion site does not cause the increase in blood glucose level. Slowing the rate of TPN will cause inadequate calorie and volume intake.

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Summary of Question Type:

No. Level No. Level No. Level No. Level

1 Evaluation 11 Synthesis 21 Evaluation 31 Synthesis

2 Synthesis 12 Synthesis 22 Synthesis 32 Evaluation

3 Synthesis 13 Evaluation 23 Evaluation 33 Evaluation

4 Evaluation 14 Evaluation 24 Evaluation 34 Evaluation

5 Synthesis 15 Evaluation 25 Evaluation 35 Synthesis

6 Evaluation 16 Synthesis 26 Synthesis 36 Evaluation

7 Synthesis 17 Synthesis 27 Evaluation 37 Evaluation

8 Evaluation 18 Evaluation 28 Synthesis 38 Synthesis

9 Synthesis 19 Synthesis 29 Evaluation 39 Synthesis

10 Evaluation 10 Synthesis 30 Synthesis 40 Synthesis