RUFAIDAH NURSING COLLEGE

KUWAIT TEACHING HOSPITAL, ABDARA ROAD PESHAWAR

Paper: Adult Health Nursing (AHN) I
Examination: Mid Term Exams MARKS: 30 Class:
BScN 2nd Year, Semester-III TIME: minutes
Student’s Name: ……………………… Roll # ……………......

SECTION-I
MCQs

1. Which one is used to remove fluid and uremic waste products from the body
when the kidneys cannot do so?
a. Dialysis
b. Paracenthesis
c. Thorasynthesis
d. Bladder Irrigation
2. Hypokalemia occurs with …..
a. GI losses.
b. K+ losses.
c. Na losses.
d. K+ increases
3. Choose the best description for urinary tract infection. (UTI).
a. Renal cyst, nephrogenic diabetes esinsipidus, urethritis.
b. Urethritis, bladder infection (cystitis), kidney infection (pyelonephritis).
c. Hypertensive nephropathy. Kidney cancer interstitial nephritis.
d. Nephrolitiasis, Urethritis, cystitis
4. Choose the best description of nephrotic syndrome.
a. A genetic condition resulting large cysts in both kidneys that impair their
function.
b. Damage to the kidneys causes them to spill large amounts of protein
into the urine. Leg swelling (edema) may be a symptom
c. Bacteria usually cause UTI. When bacteria multiply, they can cause an
infection.
d. Inflammation of the kidneys.
5. Involuntary passage of urine accruing soon after a strong sense of urgency to
void is called …….
a. Functional incontinence
b. Urge incontinence
c. Stress incontinence
d. Reflex incontinence

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6. A patient is admitted in a medical ward, the urology team diagnosed her,
bilateral renal stones; being a Nurse you know the types of renal stones
EXCEPT….
a. Calcium Oxalate
b. Sodium chloride
c. Calcium phosphate
d. Uric acid.
7. Which one of the following indicates gastric ulcer?
a. Patient experience abdominal pain at night
b. Vomiting may relief abdominal pain
c. Abdominal pain may lessen with eating
d. Pain occurs when the stomach is empty
8. Which one of the following persons is more likely to develop chronic
gastritis?
a. 25- year –old lady teacher
b. A middle aged man with helicobacter pylori infection
c. A college student on metronidazole therapy for Amoebiasis
d. A 40 – year – old lady with gall bladder disease
9. Which of the following is not a common symptom of esophageal disorders?
a. Dysphagia
b. Nausea
c. Pain
d. Heartburn
10.Which of the following conditions is characterized by impaired motility of
distal esophagus accompanied by failure of the lower esophageal sphincter
to relax?
a. Diffuse spasm
b. Achalasia
c. Gastroesophageal reflux disease
d. Barrett’s esophagus
11.The most common symptom of a sliding hiatal hernia is:
a. Feeling of fullness
b. Difficulty in breathing
c. Gastroesophageal reflux
d. Heart Burn
12. A patient’s gastric analysis test reveals excess secretion of gastric acid. The
nurse would suspect which of the following diagnosis?
a. Duodenal ulcer
b. Gastric ulcer

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KUWAIT TEACHING HOSPITAL, ABDARA ROAD PESHAWAR
c. Gastric cancer
d. Chronic atrophic gastritis
13. A nurse is assessing a patient with duodenal ulcer. Which of the following
findings she is not expected to find?
a. Pain 2-3 hours after eating
b. Melena
c. Weight loss
d. Epigastric tenderness
14. The nurse is teaching a patient with peptic ulcer regarding self-care. Which
of the following instructions she should include?
a. Limit smoking and caffeinated drinks
b. Eat three bland meals
c. Continue drugs till you are symptom free
d. Avoid taking over the counter drugs unless presented by the
physician.
15.Which of the following section of the bowel is mostly affected in Crohn’s
Disease?
a. Rectum and sigmoid colon
b. Entire colon
c. Terminal ileum
d. Duodenum
16.Which of the following pathophysiological changes found in Crohn’s
Disease?
a. Outpouching of the intestinal wall
b. Atrophy and fattening of the intestinal villi
c. Diffuse ulceration involving mucosa and submucosa of intestinal wall
d. Discontinuous, deep longitudinal ulceration involving all layers of
intestinal wall
17. All of the following conditions may precipitate hemorrhoids except:
a. Pregnancy
b. Diverticulosis
c. Portal hypertension
d. Heavy lifting
18.The following are the function of the kidney except
a. Formation of erythropoietin
b. Formation of urea
c. Maintaining water
d. Maintaining acid balance

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KUWAIT TEACHING HOSPITAL, ABDARA ROAD PESHAWAR
19.A patient with suspected urinary tract infection is advised for urine culture
and sensitivity. The nurse instructs the patient to collect the specimen from:
a. First stream of urine from bladder
b. Middle stream of urine from bladder
c. Last stream of urine from bladder
d. Full volume of urine from bladder
20.The nurse recognizes that the most common pathogen in the bladder and
upper urinary tract is :
a. Escherichia coli
b. Klebsiella
c. Proteus
d. Candida
21. 90 percent of urinary stones are made up of:
a. Calcium
b. Phosphate
c. Oxalate
d. Uric acid
22. The most common intrarenal cause of acute renal failure (ARF) is:
a. Acute Glomerulonephritis
b. Renal thrombosis
c. Acute tubular necrosis
d. Septic shock
23. In oliguric phase of acute renal failure the amount of urine output will be :
a. No urine output
b. Urine output of 50-100 ml/day
c. Urine output is less than 400 ml/day
d. Urine output of 600-700 ml/day
24.In chronic renal failure, there is progressive destruction of :
a. Glomerulus
b. Bowman’s Capsule
c. Tubular System
d. Nephron
25. A patient with chronic renal failure has been ordered EpoietIn Alpha
(Epogen) S/C three times a week. The nurse is aware that this hormone is
given to:
a. Increase white blood cell production
b. To stimulate synthesis of platelets
c. To stimulate synthesis of Red blood cells
d. To control bleeding

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KUWAIT TEACHING HOSPITAL, ABDARA ROAD PESHAWAR
26. Most patients with diverticulosis are most likely to have diverticula located
in the?
a. Transverse colon
b. Sigmoid Colon
c. Rectum
d. Ascending Colon
27.A patient asks what type of testing is performed to assess for diverticulosis.
As the nurse, you know that which test below is used to assess for
diverticulosis?
a) Colonoscopy
b) Fleets enema
c) Bronchoscopy
d) Cystoscopy
28.A patient is experiencing an acute episode of diverticulitis. The patient is
having abdominal pain, temperature 102.6 ‘F, and elevated WBCs. As the
nurse, you know it is important to:
a) Encourage intake of high-fiber foods
b) Monitor the patient for peritonitis
c) Apply a heating pad to the patient’s abdomen to help alleviate pain
d) Encourage intake of full liquids
29.The following is the function of kidney except:
a. Formation of erythropoietin
b. Formation of urea
c. Maintain water balance
d. Maintaining acid balance
30.A patient with acute renal failure is admitted in hospital. During the oliguric
phase the nurse should monitor the patient for:
a. Kussmaul respiration and hypotension
b. Crackles and ECG changes
c. Urine for high creatinine and low sodium concentration
d. Hypernatremia and fatigue

 31. 1. On morning assessment of your patient in room 2502 who has severe
burns. You notice that fluid is starting to accumulate in his abdominal tissue. You note
that his weight has not changed and his intake and output is equal. What do you
suspect?*

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KUWAIT TEACHING HOSPITAL, ABDARA ROAD PESHAWAR

A. Third spacing

B. This is normal and expected after a burn and it is benign

C. Document this finding as non-pitting abdominal edema.

D. Intravascular compartment syndrome

2. Which patient is at more risk for an electrolyte imbalance?*

o A. An 8 month old with a fever of 102.3 'F and diarrhea

o B. A 55 year old diabetic with nausea and vomiting

o C. A 5 year old with RSV

o D. A healthy 87 year old with intermittent episodes of gout

 3. A patient is admitted to the ER with the following findings: heart rate of 110
(thready upon palpation), 80/62 blood pressue, 25 ml/hr urinary output, and Sodium
level of 160. What interventions do you expect the medical doctor to order for this
patient?*
o A. Restrict fluid intake and monitor daily weights

o B. Administer hypertonic solution of 5% Dextrose 0.45% Sodium

Chloride and monitor urinary output

o C. Administer hypotonic IV fluid and administer sodium tablets.

o D. No interventions are expected

 4. After obtaining an EKG on a patient you notice that ST depression is present

along with an inverted T wave and prominent U wave. What lab value would be the
cause of this finding?*
o A. Magnesium level of 2.2

o B. Potassium level of 5.6 (ormal potassium levels are 3.5 to 5.1) will
present with these type of EKG findings.)

o C. Potassium level of 2.2

o D. Phoshorus level of 2.0

 5. Which patient below would have a potassium level of 5.5?*

o A. A 76 year old who reports taking lasix four times a day

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KUWAIT TEACHING HOSPITAL, ABDARA ROAD PESHAWAR

o B. A patient with Addison's disease

o C. A 55 year old woman who have been vomiting for 3 days

consistently

o D. A patient with liver failure

 6. You are taking a patient's blood pressure manually. As you pump up the cuff
above the systolic pressure for a few minutes you notice that the patient develop a
carpal spasm. Which of the following is true?*
o A. The patient is having a normal nervous response to an inflating
blood pressure cuff that is inflated above the systolic pressure

o B. This is known as Trousseau's Sign and is present in patients with

HYPERcalcemia

o C. This is known as Chvostek's Sign

o D. This is known as Trousseau's Sign and is present in patients

with hypocalcemia

 7. Which patient is at most risk for hypomagnesemia?*

o A. A 55 year old chronic alcoholic

o B. A 57 year old with hyperthroidism

o C. A patient reporting overuse of anatacids and laxatives

o D. A 25 year old suffering from hypoglycemia

 8. In report from a transferring facility you receive information that your patient's
Magnesium level is 1.2. When the patient arrives you are ordered by the doctor to
administer Magnesium Sulfate via IV. Which of the following interventions takes priority?
*
o A. Set-up bedside suction

o B. Set-up IV Atropine at bedside due to the bradycardia effects of

Magnesium Sulfate

o C. Monitor the patient's for reduced deep tendon reflexes and

initiate seizure precautions

o D. None of the above are correct

 9. Which patient is at most risk for fluid volume deficient?*

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KUWAIT TEACHING HOSPITAL, ABDARA ROAD PESHAWAR

o A. A patient who has been vomiting and having diarrhea for 2 days.

o B. A patient with continous nasogastric suction.

o C. A patient with an abdominal wound vac at intermittent suction.

o D. All of the above are correct.

 10. A patient is admitted with exacerbation of congestive heart failure. What

would you expect to find during your admission assessment?*
o A. Flat neck and hand veins

o B. Furrowed dry tongue

o C. Increased blood pressure and crackles throughout the lungs

o D. Bradycardia and pitting edema in lower extremities

Submit

 1 . In metabolic alkalosis, the blood pH level:*

o A. Increases

o B. Decreases

o C. Stays the same

 3. A patient is in metabolic alkalosis due to diuretic therapy. How do you expect

the potassium level and bicarbonate level to be affected?*
o A. Increased potassium level and increased bicarb level

o B. Decreased potassium level and decreased bicarb level

o C. Increased potassium level and decreased bicarb level

o D. Decreased potassium level and increase bicarb level

 4. A patient has the following arterial blood gases: HCO3 38, pH 7.50, PaCO2
50. Which of the following signs may this patient exhibit as a compensatory
mechanism?*
o A. Hyperventilation (tachypnea)

o B. Hypoventilation (bradypnea)

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KUWAIT TEACHING HOSPITAL, ABDARA ROAD PESHAWAR

o C. Increased potassium level (hyperkalemia)

o D. Constipation

 5. What of the following is NOT a cause of metabolic alkalosis?*

o A. Hyperaldosteronism

o B. Usage of Diamox

o C. Nasogastric suctioning

o D. Diuretic therapy

 A patient states they have been vomiting for the last 4 days. The patient is
irritable, weak, and reporting muscle cramping and weakness. On assessment, the
patient is experiencing bradypnea with a respiratory rate of 10. The patient has the
following ABGs result: HCO3 36, pH 7.52, PaCO2 48. Which condition below is
presenting?*
o A. Metabolic alkalosis partially compensated

o B. Metabolic alkalosis fully compensated

o C. Metabolic acidosis partially compensated

o D. Metabolic acidosis not compensated

 7. Which of the following is NOT a cause of metabolic acidosis?*

o A. Aspirin toxicity

o B. Ileostomy

o C. Hyperaldosteronism

o D. Carbonic anhydrase inhibitors

 8. A patient reports taking Diamox and has been reporting confusion, fatigue, and
headaches. On assessment, you note the patient is exhibiting deep and rapid
respirations. Which arterial blood gas finding below confirms the acid-base imbalance
for this patient given their symptoms and medication usage?*
o A. HCO3 12, pH 7.19, PaCO2 29

o B. HCO3 23, pH 7.36, PaCO2 36

o C. HCO3 10, pH 7.65, PaCO2 47

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KUWAIT TEACHING HOSPITAL, ABDARA ROAD PESHAWAR

o D. PaCO2 49, pH 7.55, HCO3 21

 9. A patient is in high anion gap metabolic acidosis due to diabetic ketoacidosis.

Which of the following signs and symptoms would you expect to see in this patient?*
o A. Kussmaul’s respirations

o B. Glucose 110

o C. Hypoventilation

o D. Neuro-excitability

 10. A patient has the following arterial blood gases: PaCO2 33, HCO3 15, pH
7.23. Which condition below is presenting?*
o A. Metabolic alkalosis partially compensated

o B. Metabolic acidosis partially compensated

o C. Respiratory alkalosis not compensated

o D. Metabolic acidosis fully compensated

  A patient is post-opt from knee surgery. The patient has been receiving
Morphine 4 mg IV every 2 hours. You notice the patient is exhibiting a respiratory
rate of 8 and is extremely drowsy. Which of the following conditions is the patient
at risk for?*
o A. Respiratory acidosis

o B. Respiratory alkalosis

o C. Hypokalemia

o D. Metabolic acidosis

 2. A patient attempted to commit suicide by ingesting a bottle of Aspirin. Which of

the following conditions is this patient at risk for?*
o A. Hyperkalemia

o B. Hypercalcemia

o C. Respiratory alkalosis

o D. Respiratory acidosis

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 3. Respiratory alkalosis can affect other electrolyte levels in the body. Which of
the following electrolyte levels can also be affected in this condition?*
o A. Calcium and sodium levels

o B. Potassium and sodium levels

o C. Calcium and potassium levels

o D. Potassium and phosphate levels

 4. A patient is experiencing respiratory alkalosis. What is the most classic sign

and symptom of this condition?*
o A. Bradypnea

o B. Tachypnea

o C. Bradycardia

o D. None of the options are correct

 5. A patient has the following blood gases: PaCO2 25, pH 7.50, HCO3 19. Which
of the following could NOT be the cause of this condition?*
o A. Anxiety attack

o B. Chronic obstructive pulmonary disease (COPD)

o C. Fever

o D. Aspirin toxicity

 6. A patient on mechanical ventilation has the following blood gases: PaCO2 29,
pH 7.56, HCO3 23. Which of the following conditions is the patient experiencing?
*
o A. Respiratory alkalosis not compensated

o B. Respiratory alkalosis partially compensated

o C. Respiratory alkalosis fully compensated

o D. Respiratory acidosis partially compensated

 7. A patient is experiencing respiratory acidosis due to brain trauma. Which of the

following lab values correlates with this acid imbalance?*
o A. Potassium level of 6.0

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o B. Potassium level of 2.5

o C. Potassium level of 5.0

o D. Potassium level of 3.5

 8. Which patient is experiencing partially compensated respiratory acidosis?*

o A. PaCO2 30, pH 7.35, HCO3 26

o B. PaCO2 53, pH 7.23, HCO3 28

o C. PaCO2 45, pH 7.49, HCO3 21

o D. PaCO2 50, pH 7.30, HCO3 23

 9. Which of the following is not a cause of respiratory acidosis?*

o A. Pulmonary emboli

o B. Asthma

o C. Chronic obstructive pulmonary disease (COPD)

o D. Hyperventilation

 10. A patient with COPD has the following blood gases: PCO2 59, pH 7.26,
HCO3 42. Which of the following conditions is presenting?*
o A. Respiratory alkalosis

o B. Respiratory acidosis

o C. Metabolic alkalosis

o D. Metabolic acidosis
Q.1- A person was admitted in a coma. Analysis of the arterial blood gave the
following
values: PCO2 16 mm Hg, HCO3- 5 mmol/l and pH 7.1. What is the underlying
acid-base
disorder?
a) Metabolic Acidosis
b) Metabolic Alkalosis
c) Respiratory Acidosis
d) Respiratory Alkalosis

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Q.2- In a man undergoing surgery, it was necessary to aspirate the contents of the
upper
gastrointestinal tract. After surgery, the following values were obtained from an
arterial
blood sample: pH 7.55, PCO2 52 mm Hg and HCO3- 40 mmol/l. What is the
underlying
disorder?
a) Metabolic Acidosis
b) Metabolic Alkalosis
c) Respiratory Acidosis
d) Respiratory Alkalosis

Q.3- A young woman is found comatose, having taken an unknown number of

sleeping pills
an unknown time before. An arterial blood sample yields the following values:
pH – 6.90,
HCO3- 13 meq/liter, PaCO2 68 mmHg. This patient’s acid-base status is most
accurately
described as
a) Uncompensated metabolic acidosis
b) uncompensated respiratory acidosis
c) simultaneous respiratory and metabolic acidosis
d) respiratory acidosis with partial renal compensation

Q.4- A student is nervous for a big exam and is breathing rapidly, what do you
expect out
of the followings
a) Metabolic Acidosis
b) Metabolic Alkalosis
c) Respiratory Acidosis
d) Respiratory Alkalosis

Q.5- A 45- year-old female with renal failure, missed her dialysis and was feeling
sick, what could be the reason ?
a) Metabolic Acidosis
b) Metabolic Alkalosis
c) Respiratory Acidosis
d) Respiratory Alkalosis

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Q.6- An 80-year-old man had a bad cold. After two weeks he said, “It went in to
my chest, I
am feeling tightness in my chest, I am coughing, suffocated and unable to
breathe!” What
could be the possible reason?
a) Metabolic Acidosis
b) Metabolic Alkalosis
c) Respiratory Acidosis
d) Respiratory Alkalosis

Q.7- A post operative surgical patient had a naso gastric tube in for three days.
The nurse caring for the patient stated that there was much drainage from the tube
that is why she felt so sick. What could be the reason?
a) Metabolic Acidosis
b) Metabolic Alkalosis
c) Respiratory Acidosis
d) Respiratory Alkalosis

Q.8- The p H of the body fluids is stabilized by buffer systems. Which of the
following compounds is the most effective buffer system at physiological pH ?
a) Bicarbonate buffer
b) Phosphate buffer
c) Protein buffer
d) All of the above

Q.9- Which of the following laboratory results below indicates compensated

metabolic alkalosis?
a) Low p CO2, normal bicarbonate and, high pH
b) Low p CO2, low bicarbonate, low pH
c) High p CO2, normal bicarbonate and, low p H
d) High pCO2, high bicarbonate and High pH

Q.10- The greatest buffering capacity at physiological p H would be provided by

a protein rich in which of the following amino acids?
a) Lysine
b) Histidine
c) Aspartic acid
d) Leucine

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Q.11- Which of the following is most appropriate for a female suffering from
Insulin
dependent diabetes mellitus with a pH of 7.2, HCO3-17 mmol/L and pCO2-20
mm HG
a) Metabolic Acidosis
b) Metabolic Alkalosis
c) Respiratory Acidosis
d) Respiratory Alkalosis

Q.12- Causes of metabolic alkalosis include all the following except.

a) Mineralocorticoid deficiency.
b) Hypokalemia
c) Thiazide diuretic therapy.
d) Recurrent vomiting.

Q.13- Renal Glutaminase activity is increased in

a) Metabolic acidosis
b) Respiratory Acidosis
c) Both of the above
d) None of the above

Q.14- Causes of lactic acidosis include all except

a) Acute Myocardial infarction
b) Hypoxia
c) Circulatory failure
d) Infections

Q.15- Which out of the following conditions will not cause respiratory alkalosis?
a) Fever
b) Anxiety
c) Laryngeal obstruction
d) Salicylate toxicity

Q.16- All are true about metabolic alkalosis except one

a) Associated with hyperkalemia
b) Associated with decreased ionic calcium concentration
c) Can be caused due to Primary hyperaldosteronism
d) Can be caused due to Renin secreting tumor

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Q.17- Choose the incorrect statement out of the followings

a) Deoxy hemoglobin is a weak base
b) Oxyhemoglobin is a relatively strong acid
c) The buffering capacity of hemoglobin is lesser than plasma protein
d) The buffering capacity of Hemoglobin is due to histidine residues.

Q.18- Carbonic anhydrase is present at all places except

a) Gastric parietal cells
b) Red blood cells
c) Renal tubular cells
d) Plasma

Q.19- All are true for renal handling of acids in metabolic acidosis except
a) Hydrogen ion secretion is increased
b) Bicarbonate reabsorption is decreased
c) Urinary acidity is increased
d) Urinary ammonia is increased.

Q.20- Choose the incorrect statement about anion gap out of the followings
a) In lactic acidosis anion gap is increased
b) Anion gap is decreased in Hypercalcemia
c) Anion gap is decreased in Lithium toxicity
d) Anion gap is decreased in ketoacidosis.

Q.21- Excessive citrate in transfused blood can cause which of the following
abnormalities?
a) Metabolic alkalosis
b) Metabolic acidosis
c) Respiratory alkalosis
d) Respiratory acidosis
22.In a man undergoing surgery, it was necessary to aspirate the contents of the
upper gastrointestinal tract. After surgery, the following values were obtained
from an arterial blood sample: pH 7.55, PCO2 52 mm Hg and HCO3- 40
mmol/l. What is the underlying disorder?
e. Respiratory acidosis
f. Metabolic alkalosis
g. Respiratory alkalosis
h. Metabolic acidosis
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i. Respiratory alkalosis with compensation
37. A student is nervous for a big exam and is breathing rapidly, what do you expect out
of the followings
a. Respiratory acidosis
b. Metabolic alkalosis
c. Respiratory alkalosis
d. Metabolic acidosis
e. None of the above
38.A post operative surgical patient had a naso gastric tube in for three days. The nurse
caring for the patient stated that there was much drainage from the tube that is why she
felt so sick. What could be the reason?
a) Respiratory acidosis
b) Metabolic alkalosis
c) Respiratory alkalosis
d) Metabolic acidosis
e) None of the above

39..After obtaining an EKG on a patient you notice that ST depression is present along
with an inverted T wave and prominent U wave. What lab value would be the cause of
this finding?

1. Magnesium level of 2.2

2. Potassium level of 5.6

3. Potassium level of 2.2

4. Phoshorus level of 2.0

5. Calcium level of 5.5

40…In report from a transferring facility you receive information that your
patient’s Magnesium level is 1.2. When the patient arrives you are ordered by the
doctor to administer Magnesium Sulfate via IV. Which of the following
interventions takes priority?

a) Set-up bedside suction

b) Set-up IV Atropine at bedside due to the bradycardia effects of Magnesium

Sulfate.

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c) Monitor the patient’s for reduced deep tendon reflexes and initiate seizure
precautions

d) None of the above are correct

e) Monitor phosphate level

b)

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