wayground logo

Free Printable Worksheets

Font size

S
M
L
XL
Worksheets

Medical-Surgical Nursing I Major Examination (Midterms)

Total questions: 89

Worksheet time: 2hrs 14mins

Name
Class
Date
1.

A patient presents with confusion, irritability, and a serum sodium level of 119 mEq/L. The provider orders hypertonic saline (3% NaCl). What is the nurse’s priority assessment during this treatment?

a)

Urine output

b)

Peripheral pulses

c)

Signs of fluid overload and neurological status

d)

Bowel sounds

2.

A patient with diabetic ketoacidosis has a serum potassium level of 5.8 mEq/L. Insulin therapy is initiated. What is the best explanation for why potassium levels must be closely monitored during this treatment?

a)

Insulin causes potassium to shift into cells, potentially leading to hypokalemia.

b)

Insulin enhances potassium absorption in the intestines.

c)

Insulin blocks aldosterone, causing hyperkalemia.

d)

Insulin increases renal excretion of potassium directly.

3.

During the endorsement at 6:00am, Nurse Jeff received a patient who is experiencing DKA. Ongoing IVF is PLR 1L x 8 hours at 650cc. What time will it be consumed?

a)

11:15 AM

b)

11:16AM

c)

11:15PM

d)

11:16PM

4.

The first 8-hour period in the Parkland formula is counted from which of the following?

a)

From the time of hospital admission

b)

From the time of fluid therapy initiation

c)

From the time of burn injury

d)

From the time of physician’s order

5.

A 50-kg client with 20% TBSA burns should receive how much total fluid in 24 hours using the Parkland formula?

a)

2,000 mL

b)

4,000 mL

c)

6,000 mL

d)

8,000 mL

6.

A patient presents with both hypokalemia and hypomagnesemia. The physician orders IV potassium replacement, but potassium levels remain low. What action should the nurse take next based on best evidence?

a)

Increase potassium infusion rate

b)

Request to replace magnesium before continuing potassium

c)

Check calcium levels

d)

Encourage high-potassium foods

7.

A patient receiving furosemide develops fatigue and a heart rate of 110 bpm. Lab results show K+ 3.0 mEq/L and Na+ 139 mEq/L. What is the likely cause of the symptoms?

a)

Dehydration

b)

Hypernatremia

c)

Hypokalemia

d)

Cardiac tamponade

8.

Which patient is at highest risk for developing hypocalcemia?

a)

A patient with hyperparathyroidism

b)

A patient with multiple bone fractures

c)

A patient with chronic renal failure

d)

A patient taking thiazide diuretics

9.

A patient with a serum calcium of 7.2 mg/dL is experiencing tingling in the lips and muscle spasms. Which medication would the nurse expect to be prescribed?

a)

Sodium bicarbonate

b)

Calcium gluconate

c)

Potassium chloride

d)

Furosemide

10.

The nurse evaluates a patient’s ECG and notices peaked T waves. The serum potassium level is 6.5 mEq/L. What is the most appropriate nursing action?

a)

Encourage ambulation

b)

Initiate seizure precautions

c)

Notify the healthcare provider immediately

d)

Offer high-potassium snack

11.

A patient with heart failure is on a potassium-sparing diuretic. What dietary plan should the nurse develop to reduce the risk of hyperkalemia?

a)

Include apricots and orange juice daily

b)

Increase intake of leafy green vegetables

c)

Limit potassium-rich foods such as bananas and potatoes

d)

Add salt substitutes to meals

12.

A nurse is designing an educational pamphlet for patients at risk of hyponatremia. Which key point should be included?

a)

Drink plenty of water even when not thirsty.

b)

Limit intake of salty foods.

c)

Report symptoms like confusion, headache, or nausea.

d)

Avoid dairy products.

13.

Which of the following would be an appropriate intervention for a patient with hypomagnesemia?

a)

Restrict green leafy vegetables

b)

Encourage alcohol consumption

c)

Administer magnesium sulfate IV

d)

Increase fluid intake

14.

A patient with a history of alcoholism presents with confusion and tremors. Which electrolyte imbalance should the nurse suspect?

a)

Hyperphosphatemia

b)

Hypomagnesemia

c)

Hyperkalemia

d)

Hypocalcemia

15.

After administering IV calcium gluconate for hypocalcemia, which assessment finding indicates the treatment was effective?

a)

Continued presence of Chvostek's sign

b)

Decrease in muscle twitching

c)

Increased numbness around the mouth

d)

Development of constipation

16.

Vincent, 45 years old, male a known long-term alcoholic, came for check and is complaining of abdominal pain and discomfort. He seems to be losing weight and the evidently manifesting deficiencies. And as per assessment it revealed that Mr. Vincent is experiencing Pancreatitis. Which of the following statements would best describe this situation.

a)

Mr. Vincent has acute pancreatitis as he is manifesting abdominal tenderness and distention.

b)

This is a category that falls under Chronic because of elevated enzymes

c)

This Acute pancreatitis because sudden and persistent abdominal pain and tenderness

d)

All of the mentioned signs are Chronic Pancreatitis

17.

Which of the following is true about Acute Pancreatitis?

a)

Surgery is needed despite of the complications

b)

Surgical options include drainage procedures

c)

Pain is severe and often radiating on the back

d)

Pain is severe and often radiates to the hypogastric area.

18.

The following Is true about Pancreatitis Except?

a)

Gallstones leak the pancreatic duct leading to enzyme activation within the pancreas

b)

Can be fatal

c)

Can damage the pancreas overtime

d)

None of the above

19.

The following are the expected findings in percussion during the physical assessment except?

a)

Tympany

b)

Air filled Structures

c)

Dullness

d)

Solid filled structures

20.

Nurse Jherwin is assessing patient Mark and while doing assessment he was able to assess a sudden, intense pain in the upper right part of his patient’s belly and that pain as per patient’s verbalization it gets worse with breathing and spreads back and below the right shoulder blade. And with loose- light colored bowel movements. Nurse Jherwin is suspecting that the patient is having?

a)

Peritonitis

b)

Acute Pancreatitis

c)

Cholecystitis

d)

Acalculous Cholecystitis

21.

A patient with appendicitis suddenly reports relief of pain followed by tachycardia and rigid abdomen. The nurse suspects:

a)

Pain relief from antibiotics

b)

Perforation and peritonitis

c)

Gas accumulation only

d)

Appendiceal abscess formation

22.

A nurse reviews labs of a pancreatitis patient: Amylase 600 U/L, Lipase 700 U/L, Calcium 7.5 mg/dL. What does the low calcium suggest?

a)

Normal finding

b)

Hypocalcemia due to dehydration

c)

Pancreatic pseudocyst rupture

d)

Hypocalcemia due to fat necrosis binding calcium

23.

A patient with ulcerative colitis has 10–12 bloody stools/day, tachycardia, and dehydration. What is the nurse’s priority?

a)

Encourage ambulation

b)

Increase fiber intake

c)

Begin stress management

d)

Monitor electrolytes and fluid status closely

24.

A patient with Crohn’s disease asks about diet. Which statement indicates correct understanding?

a)

I should eat high-fiber foods.

b)

Spicy food prevents flare-ups.

c)

I’ll take bulk laxatives daily.

d)

I’ll avoid dairy and high-fat foods.

25.

After abdominal surgery for peritonitis, which assessment finding requires immediate attention?

a)

Hypoactive bowel sounds

b)

Abdominal distension

c)

Fever 37.8°C

d)

Cloudy drainage in NG tube

26.

Which assessment finding suggests complication of acute pancreatitis?

a)

Grey-Turner’s sign

b)

Kehr’ sign

c)

Occasional nausea

d)

Mild hyperglycemia

27.

A client with peritonitis is prescribed broad-spectrum IV antibiotics. Which nursing action ensures effectiveness?

a)

Obtain culture specimens before starting antibiotic

b)

Administer after meals

c)

Start IV fluids after 4 hours

d)

Mix antibiotics with parenteral nutrition

28.

A patient with ulcerative colitis is prescribed sulfasalazine. The nurse instructs the patient to report:

a)

Orange urine

b)

Headache

c)

Rash and sore throat

d)

Dark stools

29.

The best position for a postoperative patient after appendectomy is:

a)

Supine

b)

Trendelenburg

c)

Semi-Fowler’s

d)

Prone

30.

A pancreatitis patient develops respiratory distress. Chest x-ray shows left pleural effusion. The nurse suspects:

a)

Infection spread to pleural space

b)

Fluid shift due to enzymatic inflammation

c)

Pulmonary embolism

d)

Normal finding

31.

A 58-year-old woman on diuretics for heart failure presents with the following ABG results: • pH: 7.47 • PaCO2: 44 mmHg • HCO3-: 30 mEq/L • PaO2: 98 mmHg What is the acid-base disturbance?

a)

Respiratory acidosis, uncompensated

b)

Metabolic acidosis, uncompensated

c)

Metabolic alkalosis, uncompensated

d)

Respiratory alkalosis, uncompensated

32.

A 40-year-old male with severe vomiting for two days presents with these ABG results: • pH: 7.52 • PaCO2: 46 mmHg • HCO3-: 34 mEq/L • PaO2: 96 mmHg What is the acid-base disturbance?

a)

Respiratory alkalosis, partially compensated

b)

Metabolic alkalosis, partially compensated

c)

Metabolic acidosis, partially compensated

d)

Respiratory acidosis, partially compensated

33.

A 55-year-old woman presents to the ICU after a cardiac arrest. Her ABG results are: • pH: 7.15 • PaCO2: 65 mmHg • HCO3-: 22 mEq/L • PaO2: 58 mmHg What is the acid-base disturbance?

a)

Metabolic alkalosis

b)

Respiratory acidosis, uncompensated

c)

Mixed acidosis

d)

Metabolic acidosis

34.

A 28-year-old woman presents to the ER with a drug overdose. Her ABG results are: • pH: 7.35 • PaCO2: 47 mmHg • HCO3-: 26 mEq/L • PaO2: 85 mmHg What is the acid-base disturbance?

a)

Respiratory acidosis, fully compensated

b)

Metabolic acidosis, fully compensated

c)

Metabolic alkalosis, uncompensated

d)

Respiratory acidosis, uncompensated

35.

A 60-year-old male presents with diabetic ketoacidosis (DKA). ABG results are: • pH: 7.28 • PaCO2: 30 mmHg • HCO3-: 18 mEq/L What is the acid-base imbalance?

a)

Metabolic acidosis

b)

Respiratory acidosis

c)

Metabolic alkalosis

d)

Respiratory alkalosis

36.

A nurse is reviewing the electrolyte results of an assigned client and notes that the potassium level is 5.6 mEq/L. Which of the following would the nurse expect to note on the ECG as a result of this laboratory value?

a)

ST depression

b)

Prominent U wave

c)

Inverted T wave

d)

Tall peaked T waves

37.

A nurse is reviewing the electrolyte results of an assigned client and notes that the potassium level is 3.2 mEq/L. Which of the following would the nurse expect to note on the ECG as a result of this laboratory value?

a)

U waves

b)

Elevated T waves

c)

Absent P waves

38.

A patient’s arterial blood gas shows: pH 7.51, PaCO2 28 mmHg, HCO3- 24 mEq/L. What is the primary disturbance?

a)

Metabolic acidosis

b)

Respiratory alkalosis

c)

Metabolic alkalosis

d)

Respiratory acidosis

39.

Which compensatory response occurs with metabolic acidosis?

a)

Hypoventilation to retain CO2

b)

Hyperventilation to lower PaCO2

c)

Renal retention of H+

d)

Increased bicarbonate secretion immediately

40.

A patient with COPD has ABG: pH 7.32, PaCO2 58 mmHg, HCO3- 30 mEq/L. The nurse interprets this as:

a)

Acute respiratory acidosis without compensation

b)

Chronic respiratory acidosis with metabolic compensation

c)

Metabolic acidosis with respiratory compensation

d)

Mixed metabolic and respiratory alkalosis

41.

Which intervention is the highest priority for a patient with metabolic acidosis and decreased level of consciousness?

a)

Encourage oral bicarbonate intake

b)

Assess airway and respiratory effort — prepare for possible ventilatory support

c)

Provide high-fat diet

d)

Give IV calcium gluconate

42.

An 85-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with shortness of breath and increased sputum production. His vital signs are: • Blood pressure: 135/85 mmHg • Heart rate: 98 bpm • Respiratory rate: 24 breaths/min • SpO2: 88% on room air An arterial blood gas (ABG) sample is obtained with the following results: • pH: 7.30 • PaCO2: 55 mmHg • HCO3-: 30 mEq/L • PaO2: 60 mmHg Based on the ABG results, what is the most likely acid-base disturbance?

a)

Metabolic acidosis, partially compensated

b)

Metabolic alkalosis, partially compensated

c)

Respiratory acidosis, partially compensated

d)

Respiratory alkalosis, partially compensated

43.

A 19-year-old female student with anxiety is hyperventilating. Her ABG results are: • pH: 7.55 What is the acid-base disturbance?

a)

Respiratory alkalosis, uncompensated

b)

Respiratory acidosis, fully compensated

c)

Metabolic alkalosis, partially compensated

d)

Metabolic acidosis, uncompensated

44.

A 90-year-old female with chronic renal failure presents with the following ABG results: • pH: 7.28 • PaCO2: 38 mmHg • HCO3-: 18 mEq/L • PaO2: 90 mmHg What is the acid-base disturbance?

a)

Respiratory acidosis, uncompensated

b)

Metabolic acidosis, uncompensated

c)

Metabolic alkalosis, uncompensated

d)

Respiratory alkalosis, uncompensated

45.

A patient in the ICU is on a ventilator. His ABG results are as follows: • pH: 7.40 • PaCO2: 40 mmHg • HCO3-: 24 mEq/L • PaO2: 100 mmHg What is the acid-base disturbance?

a)

Normal ABG

b)

Metabolic acidosis

c)

Respiratory acidosis

d)

Metabolic alkalosis

46.

You are the PHN in the city health center. A client underwent screening for AIDS using ELISA. His result was positive. What is the best course of action that you may take?

a)

Get a thorough history of the client, focusing on the practice of high risk behaviors.

b)

Ask the client to be accompanied by a significant person before revealing the result.

c)

Refer the client to the physician since he is the best person to reveal the result to the client.

d)

Refer the client for a supplementary test, such as Western blot, since the ELISA result may be false.

47.

Which is the BEST control measure for AIDS?

a)

Being faithful to a single sexual partner

b)

Using a condom during each sexual contact

c)

Avoiding sexual contact with commercial sex workers

d)

Making sure that one’s sexual partner does not have signs of AIDS

48.

After 8 hours of fluid therapy based on the Parkland formula, the nurse observes that the patient’s urine output is 20 mL/hr. What should the nurse do next?

a)

Increase the rate of IV fluids

b)

Continue current fluid rate

c)

Decrease the rate of IV fluids

d)

Stop IV fluids

49.

To determine possible sources of sexually transmitted infections, which is the BEST method that may be undertaken by the public health nurse?

a)

Contact tracing

b)

Community survey

c)

Mass screening tests

d)

Interview of suspects

50.

Antiretroviral agents, such as AZT, are used in the management of AIDS. Which of the following is NOT an action expected of these drugs?

a)

They prolong the life of the client with AIDS.

b)

They reduce the risk of opportunistic infections.

c)

They shorten the period of communicability of the disease.

d)

They are able to bring about a cure of the disease condition.

51.

A 42-year-old man diagnosed with pulmonary tuberculosis is started on a 6-month DOTS regimen. During health teaching, the nurse emphasizes drug adherence. Which statement by the patient indicates understanding of the purpose of DOTS?

a)

It shortens my treatment from 6 months to 3 months.

b)

It helps me finish my medication even if I forget.

c)

It prevents the spread of TB by making me less contagious.

d)

It allows me to stop the drugs when symptoms disappear.

52.

A client with tuberculosis is admitted in the hospital for 2 weeks. When the client’s family comes to visit, which precaution should they observe?

a)

Wash their hands when leaving

b)

Put on gowns, gloves, and masks

c)

Avoid contact with the client’s roommate

d)

Keep the door open

53.

A child with bacterial pneumonia is admitted. Which finding does the nurse expect?

a)

High fever

b)

Nonproductive cough

c)

Rhinitis

d)

Vomiting and diarrhea

54.

In pneumonia, what pathophysiological change primarily causes hypoxemia?

a)

Decreased cardiac output

b)

Mucus obstruction in bronchioles

c)

Alveolar-capillary membrane thickening

d)

Increased alveolar ventilation

55.

A patient with Ebola virus presents with bleeding gums, fever, and hypotension. What PPE is essential before providing care?

a)

Full PPE

b)

Gloves only

c)

Surgical mask

d)

Apron only

56.

A 42-year-old male arrives at the emergency department complaining of high-grade fever, dry cough, and shortness of breath. His oxygen saturation is 88% on room air, respiratory rate 30/min, and he recently attended a crowded event. The triage nurse suspects COVID-19. What should be the nurse’s first action?

a)

Administer supplemental oxygen and call the physician.

b)

Place the patient in an airborne isolation room immediately.

c)

Obtain a nasopharyngeal swab for RT-PCR before isolation.

d)

Transfer the patient to the general ward for monitoring.

57.

A nurse is assigned to a COVID-19 ward. She prepares to enter the isolation room to suction a patient with severe pneumonia. Which sequence of donning PPE is correct according to CDC/DOH protocols?

a)

Mask → Goggles → Gown → Gloves

b)

Gloves → Gown → Goggles → Mask

c)

Gown → Mask (N95) → Goggles/Face shield → Gloves

d)

Mask → Gown → Gloves → Face shield

58.

During nasopharyngeal swabbing, the nurse’s glove tears, and a droplet contacts her wrist. The nurse washes the area immediately. According to DOH infection control protocols, what is the next appropriate step?

a)

Self-isolate immediately for 14 days.

b)

Continue swabbing since the area was washed.

c)

Take prophylactic antibiotics.

d)

Report exposure to infection control and undergo risk assessment.

59.

A 32-year-old client with mild COVID-19 is instructed to isolate at home. Which statement by the client indicates need for further teaching?

4 lines
60.

A 40-year-old woman complains of persistent fatigue, brain fog, and palpitations 8 weeks after recovery from COVID-19. What should the nurse include in her discharge teaching plan?

a)

Encourage gradual return to activity and report any worsening cardiopulmonary symptoms.

b)

Advise complete bed rest until all symptoms disappear.

c)

Take over-the-counter energy supplements to hasten recovery.

d)

Avoid vaccination until six months post-infection.

61.

The nurse is planning care for a client with celiac disease. Which breakfast food should be avoided?

a)

Puffed wheat

b)

Banana

c)

Puffed rice

d)

Cornflakes.

62.

The nurse is teaching about irritable bowel syndrome (IBS). Which teaching is most important?

a)

Reinforce need for a balanced diet

b)

Encourage 16 oz. fluid with meals

c)

Eat low-fiber diet

d)

Limit fruits and vegetables

63.

The nurse teaching a mother of a child with celiac disease recognizes understanding if she selects which food?

a)

Whole-wheat bread

b)

Spaghetti

c)

Hamburger on wheat bun

d)

Cheese omelet

64.

If after surgery the patient’s abdomen becomes distended and no bowel sounds appreciated, what would be the most suspected complication?

a)

Intussusception

b)

Paralytic ileus

c)

Hemorrhage

d)

Ruptured colon

65.

A patient with chest pain is given thrombolytic therapy. Thirty minutes later, he complains of severe back pain and hematuria. What should the nurse do first?

a)

Continue infusion but monitor closely.

b)

Stop the thrombolytic infusion immediately and notify the provider.

c)

Give additional aspirin.

d)

Encourage fluids.

66.

A 58-year-old hypertensive patient with confirmed COVID-19 develops severe dyspnea and PaO2 of 54 mmHg on high-flow nasal cannula. The physician orders prone positioning. The nurse understands this position is primarily intended to:

a)

Promote drainage of pulmonary secretions.

b)

Reduce cardiac workload during hypoxia.

c)

Improve alveolar recruitment and ventilation-perfusion ratio.

d)

Prevent aspiration of gastric contents.

67.

A 29-year-old nurse assigned in the surgical ward discovers she is HIV-positive after a routine checkup. She is asymptomatic but worries about continuing clinical duty. Which is the most appropriate nursing/legal response?

a)

She must immediately disclose her status to all patients under her care.

b)

She must take medical leave until declared noninfectious.

c)

The hospital should reassign her permanently to non-clinical work.

d)

She may continue working while observing standard precautions and confidentiality.

68.

A 48-year-old overseas worker from the Middle East presents with fever, cough, and difficulty breathing. The triage nurse suspects MERS-CoV. What isolation precaution should be implemented immediately upon patient arrival at the emergency room?

a)

Standard and droplet precautions

b)

Airborne, contact precautions

c)

Contact isolation only

d)

Droplet isolation with negative pressure

69.

A 34-year-old nurse accidentally gets pricked by a needle used on a known HBsAg-positive patient. She reports the incident immediately. Her records show incomplete Hepatitis B vaccination (only 2 doses). The most appropriate post-exposure prophylaxis is to:

a)

Administer a complete 3-dose Hepatitis B vaccine series starting today

b)

Test the nurse for HBsAg before giving any prophylaxis

c)

Observe the nurse for 6 months before deciding further treatment

d)

Give Hepatitis B immune globulin (HBIG)

70.

A client with AIDS reports receiving acupuncture. Why should the nurse question this treatment?

a)

It uses herbal extracts

b)

It uses electrical stimulation

c)

It uses needles that can transmit infection

d)

It manipulates skeletal muscles

71.

A 26-year-old poultry farm worker is brought to the hospital with high fever, cough, and severe respiratory distress. Chest x-ray shows diffuse infiltrates. He mentions that several chickens on their farm died recently. The nurse is aware that the most critical infection control intervention is to:

a)

Administer oseltamivir immediately and report to the local health unit.

b)

Implement airborne and contact isolation precautions

c)

Limit visitors to one at a time and provide surgical masks.

d)

Collect nasopharyngeal swabs before instituting any isolation measures.

72.

A 32-year-old woman, 30 weeks pregnant, presents with high-grade fever, sore throat, and dry cough. She tests positive for Influenza A (H1N1). Which nursing action is most appropriate?

a)

Start oseltamivir immediately

b)

Delay antiviral therapy due to pregnancy risk.

c)

Provide aspirin for fever control and body aches.

d)

Isolate only if she develops shortness of breath.

73.

A 29-year-old nurse is accidentally pricked by a needle used on a patient later confirmed HBsAg-positive. The nurse received two doses of Hepatitis B vaccine but missed the third. What should the infection control nurse do first?

a)

Observe jaundice over the next 6 months.

b)

Repeat the entire vaccination series from the beginning.

c)

Administer Hepatitis B immune globulin (HBIG)

d)

Order blood tests for anti-HBs after 3 months before any intervention.

74.

A 39-year-old male IV drug user diagnosed with chronic Hepatitis B develops worsening jaundice, ascites, and elevated bilirubin levels. Blood test: positive HBsAg and anti-HDV. What pathophysiologic concept explains the patient’s deterioration?

a)

Hepatitis D infection occurs only in patients with Hepatitis B

b)

Hepatitis D virus cannot replicate without Hepatitis A

c)

The virus directly infects hepatocytes independent of Hepatitis B.

d)

HDV infection replaces HBV infection, preventing cirrhosis.

75.

A 25-year-old restaurant worker is admitted with fatigue, nausea, jaundice, and dark-colored urine. Laboratory results show elevated ALT and positive anti-HAV IgM. Several co-workers have mild flu-like symptoms. As a community health nurse, what is the most critical action to prevent an outbreak?

a)

Advise the patient to wear gloves and continue working with precautions.

b)

Report the case to the local health authorities and educate food handlers on hygiene and handwashing.

c)

Administer antibiotics to co-workers who were exposed.

d)

Require stool culture testing for all customers.

76.

In Guillain-Barré Syndrome, ascending paralysis is due to:

a)

Nerve Demyelination

b)

Cerebral edema

c)

Muscle necrosis

d)

Brainstem infarction

77.

Design an effective health teaching line for preventing Hepatitis A among food handlers.

a)

Eat more fatty food to protect the liver.

b)

Take antibiotics after each meal.

c)

Avoid cooking when tired.

d)

Wash hands thoroughly before handling food and use clean water sources.

78.

A patient with chronic kidney disease asks why he is always tired. The nurse recalls that fatigue is commonly due to:

a)

Increased CSF protein with normal cell count

b)

CSF pleocytosis with neutrophil predominance.

c)

Decreased CSF protein and high glucose.

d)

Positive blood culture for Campylobacter.

79.

A 24-year-old with acute hepatitis presents with jaundice; labs show very high ALT/AST, positive anti-HAV IgM, and recent travel to an endemic region. Which instruction should a nurse give about transmission?

a)

Avoid sharing utensils only — airborne risk.

b)

Strict hand hygiene

c)

Condoms will prevent transmission because it’s sexually transmitted.

d)

Mosquito avoidance recommended.

80.

A 60-year-old with COVID-19 is hypoxic and has D-dimer elevated. The team considers anticoagulation. What is the correct nursing understanding?

a)

COVID-19 causes hypercoagulability

b)

Anticoagulation is contraindicated in COVID-19.

c)

D-dimer alone mandates full therapeutic anticoagulation.

81.

A 30-year-old with chlamydia is allergic to doxycycline (severe reaction). Which is appropriate alternative therapy?

a)

No treatment necessary.

b)

Penicillin IM.

c)

Azithromycin single dose orally.

d)

Metronidazole only.

82.

A patient with suspected COVID-19 has negative nasopharyngeal PCR but high suspicion and progressive hypoxia. Next best step?

a)

Repeat testing.

b)

Rule out COVID and stop isolation.

c)

Start steroids only if PCR positive.

d)

Discontinue monitoring.

83.

A 33-year-old with suspected gonorrhea is co-infected with chlamydia until proven otherwise. Which regimen addresses both per CDC (tricky/knowledge-level)?

a)

Azithromycin only.

b)

Penicillin IM only.

c)

Ceftriaxone IM single dose plus doxycycline orally for chlamydia

d)

No treatment until culture confirms.

84.

A 40-year-old with recurrent herpes simplex reports decreased outbreaks after starting suppressive valacyclovir. Which is correct about suppressive therapy?

a)

Suppressive antivirals reduce outbreak frequency and viral shedding but do not eradicate latent viruses.

b)

They permanently cure HSV.

c)

They increase transmission risk.

d)

They are ineffective if taken daily.

85.

A sexually active patient tests positive for trichomonas vaginalis. Which teaching is correct?

a)

Treat both patient and sexual partner(s) with metronidazole or tinidazole; avoid alcohol with metronidazole for 24–48 hours.

b)

No treatment needed; it resolves spontaneously.

c)

Only the patient needs treatment; partner risk is negligible.

d)

Vaccine available.

86.

A patient has sudden ascending paralysis and autonomic instability from GBS. Which monitoring is essential?

a)

Frequent vital signs and serial measurement of vital capacity to detect respiratory failure; readiness to intubate if VC declines.

b)

Only a neurological exam once per day.

c)

No monitoring needed until respiratory failure occurs.

d)

Bed rest only.

87.

A patient with suspected bacterial endocarditis has fever and new murmur; blood cultures grow MRSA. Which statement about antibiotic selection is correct?

a)

Vancomycin is first-line for MRSA endocarditis

b)

Nafcillin is appropriate for MRSA.

c)

Oral clindamycin is adequate.

d)

No antibiotics until TEE confirms vegetations.

88.

Which feature distinguishes primary TB infection from reactivation TB?

a)

Current interventions are effective; continue monitoring only

b)

Interventions are inadequate; likely hypovolemic shock is unresolved and requires immediate escalation

c)

Fluid resuscitation should be stopped because of risk of overload

d)

Vasopressor infusion alone is sufficient for stabilization

89.

A 29-year-old with acute Hepatitis A asks about returning to work in food service. Best advice?

a)

Do not return to food handling until stool tests are negative

b)

Return immediately if feeling better.

c)

Vaccination eliminates the need to be excluded from work.

d)

Only wear gloves and return.