Mini Nurses / Learn Nursing. Build Confidence. Excel in Practice.
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1. An adult with asthma speaks only one word at a time and has very little air entry despite visible effort. Which interpretation should guide immediate care? Improvement because wheezing has become quieter A mild attack suitable for routine follow-up Possible life-threatening airflow obstruction requiring emergency treatment Anxiety alone because the chest is not noisy Answer: C. A quiet chest with marked distress can reflect critically reduced airflow rather than recovery.
2. During an outreach assessment, a breathless adult's oxygen saturation is 84% on room air with a reliable waveform. What is the priority? Initiate emergency assessment and protocol-based oxygen while arranging escalation Complete the routine lifestyle questionnaire before treatment Repeat the measurement next week before making a referral Offer oral fluids as the only immediate intervention Answer: A. Reliable severe hypoxaemia needs immediate support and escalation while its cause is assessed.
3. An adult with suspected pneumonia has respiratory rate 34/min, new confusion and blood pressure 86/52 mmHg. Which disposition is most appropriate? Routine oral treatment without further assessment Home observation until the fever settles Emergency transfer with stabilisation and close monitoring Referral only if the cough lasts another month Answer: C. Tachypnoea, confusion and hypotension indicate serious illness; outpatient reassurance is unsafe.
4. A patient coughs during every sip after a recent neurological illness and develops a wet voice. Which nursing action is safest pending assessment? Use a larger cup to make drinking faster Stop oral intake and arrange swallowing assessment with appropriate support Encourage rapid drinking through a straw Continue thin fluids because coughing clears every aspiration Answer: B. Cough and a wet voice with swallowing suggest aspiration risk and require an individualised assessment.
5. A nurse checks inhaler technique. The patient actuates a pressurised metered-dose inhaler after finishing inhalation. What should the nurse prioritise? Increase the number of puffs without correcting technique Demonstrate coordination of actuation with a slow inhalation and reassess technique Advise inhaling as rapidly as possible for every device Recommend spraying the medicine onto the tongue only Answer: B. Incorrect timing can reduce lung delivery; technique must match the specific inhaler and be checked directly.
6. A child with breathing difficulty has stridor while calm. What does this finding require? Routine review after a week of home cough care Feeding a full meal before examining the airway Prompt airway assessment and urgent escalation Assurance that noisy inspiration always indicates a harmless cold Answer: C. Stridor at rest can signal significant upper-airway obstruction and needs urgent assessment.
7. A home oxygen user places a lit candle beside the delivery tubing. What action is needed? Increase oxygen flow to extinguish the flame Coat the tubing with petroleum jelly Remove the ignition source safely and reinforce oxygen fire precautions Allow the candle if a window is open Answer: C. Oxygen supports combustion; flames and other ignition sources must be kept away from oxygen equipment.
8. A patient with a new tracheostomy becomes acutely distressed and the airflow through the tube falls markedly. What should the nurse do first? Call for urgent help and assess airway patency using the tracheostomy emergency protocol Offer oral medication before assessing the airway Leave the patient alone while finding routine paperwork Assume the patient is adjusting normally to the tube Answer: A. Sudden loss of tracheostomy airflow is an airway emergency requiring trained, protocol-based assessment.
9. A patient is using accessory muscles to breathe. After initial treatment, which reassessment best establishes clinical response? Whether the patient likes the mask colour Only whether the wheeze sounds louder The time elapsed since the prescription was written Work of breathing, respiratory rate, oxygenation and mental status together Answer: D. Response requires repeated clinical assessment; one sound or one isolated number may be misleading.
10. An adult using inhaled corticosteroid develops mouth soreness and removable white plaques. What preventive advice should accompany assessment? Stop every prescribed controller permanently without review Share the inhaler with a household member Use extra corticosteroid puffs to treat the plaques Rinse and spit after use and review device technique, including spacer suitability Answer: D. Inhaled corticosteroids can promote oral candidiasis; appropriate mouth rinsing and device technique help reduce risk.
11. A patient with fever, severe headache and neck stiffness becomes drowsy in the clinic. Which action has priority? Waiting for a routine appointment because fever is common Giving a sedative so the patient can travel alone Urgent assessment and referral for possible meningitis with indicated precautions Reassurance based only on the absence of a rash Answer: C. Altered consciousness with meningeal symptoms is an emergency; absence of rash does not exclude serious infection.
12. A person treated for malaria at home develops repeated convulsions and cannot stay awake. What is the safest next step? Continue home oral treatment until every tablet is finished Wait for the next scheduled community review Emergency referral and protocol-based management for possible severe malaria Give oral tablets during an active convulsion Answer: C. Convulsions and impaired consciousness are severe illness signs; oral intake during convulsions is unsafe.
13. A febrile patient on chemotherapy has a very low neutrophil count. Which response is appropriate? Wait until the next day to see whether the fever resolves Treat this as a time-critical possible neutropenic infection and escalate immediately Assume antibiotics cannot help a person receiving chemotherapy Recommend attending a crowded waiting room without triage Answer: B. Possible neutropenic sepsis needs rapid assessment and treatment; delay can be dangerous.
14. After several days of fever, a patient develops abdominal pain, persistent vomiting and gum bleeding as the temperature falls. What should the nurse consider? Possible severe dengue warning signs requiring urgent evaluation Definite recovery because fever has resolved A routine indication to give aspirin immediately Evidence that no observation is needed Answer: A. Dengue can worsen around defervescence; abdominal pain, persistent vomiting and bleeding warrant urgent review.
15. A person with an infected wound has spreading redness, rapid pulse and new hypotension. What is the priority? Escalate for possible sepsis and initiate available emergency measures Delay assessment until the wound culture returns Limit care to changing the outer dressing Recommend waiting until the next routine dressing day Answer: A. Systemic deterioration with infection may indicate sepsis and requires rapid assessment and management.
16. During wound review, pain is far more severe than the visible skin findings and swelling is progressing quickly. What should the nurse do? Use the small visible wound size to exclude serious disease Seek urgent surgical assessment for possible deep or necrotising infection Schedule a dressing review in two weeks Apply a tight bandage and discharge without reassessment Answer: B. Disproportionate pain and rapid progression can indicate a limb- or life-threatening deep infection.
17. A person on TB treatment reports new yellow eyes, dark urine and persistent vomiting. What is the best nursing response? Arrange urgent assessment for possible medicine-related liver injury and obtain treatment advice Reassure that jaundice is expected and needs no review Double all TB medicine doses Advise using herbal remedies instead of reporting the symptoms Answer: A. These symptoms may indicate significant liver injury; prompt clinical review should guide safe treatment decisions.
18. A client receiving HIV therapy says swallowing is painful and food intake has fallen sharply. What should the nurse prioritise? Advising permanent discontinuation of therapy without review Assuming the symptom is unrelated to health Giving nutrition leaflets without examining the problem Clinical assessment for causes of painful swallowing and nutritional compromise Answer: D. Painful swallowing can impair hydration, nutrition and adherence and needs assessment rather than assumption.
19. A child with fever and a vesicular rash is suspected of having chickenpox in a busy clinic. Which arrangement is most appropriate? Separate promptly and apply disease-appropriate airborne and contact precautions Seat the child beside a pregnant immunocompromised patient Allow shared toys without cleaning between patients Use routine queue order without assessing transmission risk Answer: A. Suspected chickenpox requires measures that address airborne and contact transmission, especially around vulnerable people.
20. A patient with confirmed scabies improves after treatment, but close household contacts remain untreated. What should the nurse discuss? Treating only whichever household member itches most that day Sharing the same unwashed bedding to build immunity Stopping follow-up because one person's itch has improved Coordinated contact management and environmental advice under the treatment protocol Answer: D. Untreated close contacts can sustain transmission; coordinated treatment and appropriate handling of clothing and bedding matter.
21. A calm 18-month-old with cough has a respiratory rate of 48/min counted for a full minute. Under standard IMCI age thresholds, how is this rate classified? Normal because it is below 60/min Fast breathing for this age Uninterpretable unless counted for five seconds only Diagnostic of asthma by itself Answer: B. For children aged 12 months to under five years, 40 breaths/min or more is fast breathing in standard IMCI assessment.
22. A six-week-old has a temperature of 38.4 degrees Celsius and reduced feeding. Which disposition is appropriate? Urgent clinical assessment for possible serious infection Routine home observation for several days without assessment Assume teething is the cause Wait until the infant's first birthday to investigate fever Answer: A. Fever in a young infant, particularly with reduced feeding, requires urgent assessment.
23. A child with diarrhoea is alert but thirsty and drinks eagerly. Which additional finding most supports some dehydration under IMCI assessment? A skin pinch that returns slowly Normal drinking with no thirst A rapidly returning skin pinch alone A normal pulse rate alone Answer: A. Classification uses a combination of signs; eager drinking and a slowly returning skin pinch support some dehydration.
24. A two-year-old repeatedly vomits every offered fluid and cannot retain oral medicine. What should this trigger? Another week of home observation without review Advice to give larger volumes rapidly Assessment as a general danger sign and appropriate urgent referral A conclusion that dehydration is impossible Answer: C. Vomiting everything can prevent effective oral treatment and is an IMCI general danger sign.
25. A child with a recent diarrhoeal illness is pale and has markedly reduced urine output. What action is safest? Encourage an unrestricted fluid load without assessment Assume reduced urine proves recovery Delay referral until the next growth-monitoring visit Urgent assessment for renal complications and other serious causes Answer: D. Pallor and oliguria after diarrhoea may indicate serious complications, including haemolytic uraemic syndrome.
26. A preschool child has a suspected foreign body aspiration after sudden choking while eating groundnuts. The child is still coughing forcefully and moving air. What is the appropriate immediate response? Perform blind finger sweeps in the mouth Give water immediately to push the object down Encourage effective coughing, monitor closely and escalate if breathing deteriorates Use abdominal thrusts routinely despite an effective cough Answer: C. An effective cough should be supported while monitoring; blind sweeps can push an object deeper.
27. A five-year-old has an active convulsion. Which nursing action is safest while obtaining urgent help? Hold the limbs rigidly to stop movement Protect from injury, maintain airway safety and time the seizure Place a spoon between the teeth Give oral medicine during the convulsion Answer: B. Seizure care protects the person and airway; restraint and objects in the mouth can cause harm.
28. A toddler who previously walked independently has lost that skill. What should the community nurse do? Reassure that losing established skills is always normal Wait until school entry before mentioning it Recommend exercise alone without examining the regression Arrange prompt developmental and medical assessment Answer: D. Loss of acquired developmental skills warrants assessment for neurological and other underlying problems.
29. A 10-month-old has severe pallor and marked breathlessness at rest. What is the priority? Routine dietary counselling as the only action Urgent assessment for severe anaemia and physiological compromise Waiting three months for the next scheduled weight check Assuming the symptoms are due only to irritability Answer: B. Severe pallor with breathing difficulty can reflect dangerous anaemia and needs urgent clinical evaluation.
30. A child receives ORS correctly but continues losing large volumes of watery stool. What should the nurse monitor to judge whether rehydration is keeping pace? Only whether the ORS packet is empty Ongoing losses, intake, hydration signs and urine output Only the child's clothing size The sweetness of the solution Answer: B. Repeated assessment and accounting for continuing losses guide safe rehydration and timely escalation.
31. A pregnant woman at 10 weeks develops one-sided lower abdominal pain, shoulder-tip pain and dizziness. What is the priority concern? Expected discomfort to review only after delivery A reason to begin routine exercise first Possible rupturing ectopic pregnancy requiring emergency assessment A confirmed urinary infection without further assessment Answer: C. Pain with dizziness and shoulder-tip pain in early pregnancy can indicate internal bleeding from an ectopic pregnancy.
32. A woman two days after birth develops fever, lower abdominal tenderness and foul-smelling vaginal discharge. What should the nurse arrange? Reassurance that foul-smelling discharge is always normal Urgent assessment for postpartum infection Routine review only after six weeks Advice to stop drinking fluids until discharge reduces Answer: B. This cluster suggests possible postpartum infection and needs prompt evaluation and treatment.
33. A pregnant woman suddenly develops breathlessness, pleuritic chest pain and a swollen painful calf. What should the nurse prioritise? Massaging the painful calf before reassessment Emergency assessment for possible venous thromboembolism A routine antenatal appointment next month Assuming all breathlessness in pregnancy is physiological Answer: B. The combination raises concern for pulmonary embolism and needs emergency assessment; calf massage is inappropriate.
34. A woman receiving magnesium sulfate becomes markedly drowsy, has absent patellar reflexes and a respiratory rate of 8/min. What action is required? Increase the infusion because drowsiness proves seizure prevention Stop the infusion, call urgent help and follow the toxicity protocol Allow her to sleep without monitoring Give another dose before assessing breathing Answer: B. Absent reflexes and respiratory depression suggest magnesium toxicity; immediate escalation and protocol-based reversal are required.
35. A woman at 32 weeks reports a sudden gush of clear vaginal fluid. What is the most appropriate plan? Prompt maternity assessment for possible preterm rupture of membranes Routine digital vaginal examination at home before referral Advice to wait until the next scheduled monthly visit Reassurance that all clear fluid in pregnancy is urine Answer: A. Suspected membrane rupture before term needs assessment; unnecessary digital examinations can increase infection risk.
36. At 35 weeks, a woman reports that fetal movements have become much less frequent than her usual pattern. What advice is appropriate? Contact maternity services promptly for assessment Wait until the next week to see whether movements return Use a home Doppler to replace professional assessment Assume less movement is inevitable late in pregnancy Answer: A. A reduction from the baby's usual movement pattern warrants prompt maternity assessment.
37. A mother has a painful red area on one breast and fever but is otherwise stable. What advice should accompany assessment for mastitis? Abruptly stop all milk removal indefinitely Continue physiological breastfeeding or milk removal as tolerated and obtain appropriate treatment advice Aggressively massage the inflamed breast to break up tissue Discard all future breast milk without review Answer: B. Assessment guides treatment; sudden cessation and aggressive massage can worsen problems, while comfortable normal milk removal supports care.
38. A woman using combined hormonal contraception develops new unilateral leg swelling and chest pain. What should the nurse advise? Taking two contraceptive doses to prevent symptoms Waiting for the next routine family-planning visit Urgent medical assessment for possible thromboembolism Treating the swelling with a tight household bandage only Answer: C. New thromboembolic symptoms need urgent evaluation; routine follow-up is not sufficient.
39. A pregnant woman with a convulsion is being stabilised. Which action best protects her airway while skilled help arrives? Position appropriately on her side when feasible and avoid putting objects in her mouth Force an oral drink to reduce the fever Restrain the jaw with a spoon Leave her flat and unattended until movements stop Answer: A. Airway protection and injury prevention are essential during a convulsion; oral objects and fluids are unsafe.
40. At a postnatal visit, a woman reports painful urination, fever and flank pain. What is the safest plan? Assume all urinary discomfort after delivery needs no review Advise using leftover antibiotics selected by a neighbour Prompt medical assessment for a possible upper urinary tract infection Delay assessment until urine becomes visibly bloody Answer: C. Fever with flank pain suggests possible pyelonephritis and requires prompt assessment.
41. An insulin-treated adult is sweaty and shaky, glucose is 2.8 mmol/L, and the person is fully alert and can swallow safely. What should the nurse provide under the local protocol? A long-acting insulin dose as the immediate correction Only a high-fat meal before any rapid carbohydrate Nothing until the next scheduled meal Fast-acting oral carbohydrate followed by glucose reassessment Answer: D. Symptomatic hypoglycaemia in an alert person able to swallow needs prompt fast-acting carbohydrate and reassessment.
42. A person with diabetes is unconscious and breathing normally. What should the nurse avoid while activating emergency care? Checking capillary glucose promptly Protecting the airway Giving food or drink by mouth Preparing protocol-authorised non-oral treatment Answer: C. An unconscious person cannot swallow safely; hypoglycaemia treatment must use an appropriate non-oral route.
43. A person with type 1 diabetes develops vomiting, abdominal pain and deep rapid breathing, with markedly elevated glucose. What is the priority? Routine review after an unrestricted exercise session Stopping all insulin permanently without clinical advice Urgent assessment for diabetic ketoacidosis and protocol-based emergency care Assuming the breathing pattern is harmless anxiety Answer: C. This presentation is compatible with DKA, a potentially life-threatening emergency.
44. An older adult's family reports sudden confusion beginning today; the person was oriented yesterday. What should the nurse consider first? Normal ageing that needs no assessment A definite diagnosis of irreversible dementia from this observation alone A reason to start restraint without assessment An acute delirium requiring evaluation of reversible causes Answer: D. An acute change in attention or cognition suggests delirium and requires assessment for underlying illness or other causes.
45. An older adult feels faint on standing after a recent antihypertensive change. Which assessment is most relevant? A single blood pressure after vigorous exercise Only the tablet's packaging colour Lying and standing blood pressure with symptom and medicine review Only a family history of childhood illness Answer: C. Postural symptoms warrant assessment for orthostatic hypotension and contributing medicines, dehydration or illness.
46. A homebound adult with heart failure reports rapid weight gain over several days, increasing ankle swelling and worsening breathlessness. What should the nurse do? Arrange prompt clinical review for possible fluid overload Advise unrestricted extra fluid without assessment Assume weight gain always means improved nutrition Delay review until all prescribed medicines run out Answer: A. Rapid weight gain with oedema and breathlessness can indicate decompensated heart failure.
47. A person with chronic kidney disease develops marked weakness and a newly irregular pulse. What is the safest response? Recommend potassium supplements before assessment Treat the pulse change as expected and harmless Give a salt substitute without checking its contents Urgent assessment including ECG and electrolytes for possible dangerous disturbance Answer: D. Electrolyte disturbances such as hyperkalaemia can cause arrhythmia and require urgent evaluation.
48. A bedbound adult has persistent non-blanching redness over the sacrum with intact skin. What should the nurse initiate? Massage the red area vigorously Pressure relief and an individualised skin, repositioning and support-surface plan Ignore the finding until the skin breaks Apply a tight ring-shaped device as the only intervention Answer: B. Non-blanching erythema may be an early pressure injury; prompt offloading and preventive care are needed.
49. An adult taking warfarin reports black stools and new dizziness. What is the priority? Urgent assessment for possible gastrointestinal bleeding Assume dark stools always reflect a harmless diet change Advise an extra warfarin dose Schedule only a routine review in three months Answer: A. Possible bleeding with circulatory symptoms in an anticoagulated person needs urgent evaluation.
50. An older adult is prescribed several medicines by different clinics and is unsure which to take. What is the best next step? Ask the patient to stop every medicine immediately Keep only medicines in the largest boxes Reconcile all prescribed, non-prescribed and herbal products with the care team Use each clinic list separately without comparing them Answer: C. Medication reconciliation identifies discrepancies, duplication and interactions across care settings.
51. A worker has heavy external bleeding from a forearm wound. What should the nurse do immediately while seeking help? Apply firm direct pressure with suitable protection and dressing Wait for a full medical history before touching the dressing Remove every clot repeatedly to inspect the wound Give oral fluids as the sole intervention Answer: A. Direct pressure is a key immediate measure for controlling external bleeding while further care is organised.
52. A person spills a hot drink on the arm; the burn occurred minutes ago. What immediate first aid is most appropriate? Apply ice directly for prolonged periods Cool the burn with cool running water while preventing whole-body chilling Cover the fresh burn with butter Burst blisters immediately with a household needle Answer: B. Cool running water limits thermal injury; ice and household substances may worsen damage or contaminate the burn.
53. A farm worker has a pesticide splash in one eye. What is the immediate priority? Keep the eye closed until a clinician arrives hours later Begin copious irrigation with clean water and arrange urgent assessment Neutralise it using another household chemical Rub the eye firmly to remove the irritant Answer: B. Immediate irrigation reduces contact time; chemical neutralisation attempts can worsen injury.
54. A person is found after a suspected spinal injury and has noisy obstructed breathing. What takes priority? Airway management using trained spinal precautions with urgent assistance Leaving the airway obstructed to avoid all movement Sitting the person up abruptly without assessment Completing a limb strength chart before addressing breathing Answer: A. Airway compromise is immediately life-threatening; spinal precautions should accompany rather than prevent essential airway care.
55. An adult with a suspected fracture has increasing pain, a tense swollen limb and pain on passive movement of the fingers. What should the nurse suspect? Expected discomfort that needs no further observation Definite healing because swelling is present A reason to massage the limb forcefully Possible acute compartment syndrome requiring urgent surgical assessment Answer: D. Disproportionate pain and pain on passive stretch can signal compartment syndrome before pulses disappear.
56. After a head injury, a patient becomes progressively drowsy and vomits repeatedly. What is the priority? Giving a sedative to improve sleep at home Emergency reassessment and transfer for possible intracranial injury Waiting for a visible scalp wound before referral Allowing unobserved discharge because the patient walked initially Answer: B. Progressive neurological deterioration after head trauma requires urgent evaluation.
57. A child swallows an unknown amount of a household cleaning product. What should the nurse advise while obtaining urgent poison-specific help? Induce vomiting immediately using salt water Do not induce vomiting; assess the airway and identify the product safely Give an acid to neutralise every cleaner Delay advice until symptoms have lasted a day Answer: B. Induced vomiting or attempted chemical neutralisation can cause additional injury; management depends on the product and condition.
58. An adult has chest pressure radiating to the jaw with sweating and nausea. What should the nurse do? Advise walking briskly to test exercise tolerance Activate urgent assessment for acute coronary syndrome and monitor while arranging definitive care Delay review until the pain has persisted for several days Treat only as indigestion without checking for cardiac disease Answer: B. This presentation can reflect acute coronary syndrome; prompt assessment and escalation are needed.
59. A patient develops lip swelling, wheeze and hypotension within minutes of an injection. Which treatment is first-line under emergency protocols? An oral antihistamine as the sole initial treatment Intramuscular adrenaline with immediate resuscitation support A routine inhaled controller as the sole treatment Observation alone until a rash appears Answer: B. Anaphylaxis with airway, breathing or circulatory compromise requires prompt intramuscular adrenaline and emergency support.
60. A person with a snakebite arrives with a tight tourniquet placed by bystanders. What is the best approach? Cut the wound to release venom Urgent assessment and protocol-guided management, avoiding new cutting, suction or constricting measures Suck the wound before referral Apply another tighter tourniquet above the first Answer: B. Snakebite needs rapid skilled care; cutting, suction and constriction can cause harm. Existing tourniquet management requires clinical guidance.
61. Before preparing an IV connection, a nurse's clean glove touches a contaminated phone. What should happen? Proceed because the glove was clean at the start Wipe only the phone after completing the IV procedure Remove contaminated gloves, perform hand hygiene and use appropriate clean aseptic technique Cover the contaminated glove with adhesive tape Answer: C. Aseptic tasks require protection from contamination; gloves do not preserve cleanliness after contact with contaminated surfaces.
62. A peripheral IV site becomes painful, red and swollen during infusion. What should the nurse do? Increase the rate to clear the obstruction Stop the infusion and assess for infiltration, phlebitis or extravasation using the relevant protocol Ignore it if some fluid still flows Massage the site before identifying the infused substance Answer: B. Infusion-site changes require prompt assessment; management depends on whether a harmful drug has extravasated.
63. A urine drainage bag is lying on the floor with tubing pulled taut. Which correction is most appropriate? Raise the bag above the bladder Disconnect the system routinely to shorten the tubing Clamp the tubing continuously to prevent backflow Keep the bag off the floor, below bladder level, with unobstructed supported tubing Answer: D. A closed unobstructed drainage system with the bag below the bladder helps reduce infection and reflux risk.
64. A nurse needs a urine culture from an indwelling catheter. Which collection method is appropriate? Pour urine from the drainage bag into the specimen pot Aseptically collect from the designated sampling port under the local protocol Disconnect the tubing and leave it open during collection Collect from the outside of the catheter near the skin Answer: B. A drainage bag sample may be contaminated; an appropriate port sample preserves the closed system.
65. A dressing pack is opened and its sterile field becomes wet from a non-sterile surface. What should the nurse do? Replace compromised sterile materials and re-establish the field Allow the wet field to dry and assume sterility returns Cover the wet area and proceed without reassessment Use the materials only on the deepest part of the wound Answer: A. Moisture can transfer contamination across a sterile barrier; drying does not restore sterility.
66. A nurse removes gloves after wound care and plans to examine the next patient. What is required before that contact? Appropriate hand hygiene and new task-appropriate protection A new pair of gloves without hand hygiene Rinsing the used gloves for reuse Hand hygiene only at the end of the clinic session Answer: A. Hand contamination can occur during glove removal; gloves do not replace hand hygiene between patients.
67. A reusable blood pressure cuff has been used on a patient requiring contact precautions. What should happen before reuse? Clean and disinfect it with a compatible method according to local instructions Store it in a drawer without cleaning Spray perfume to cover any odour Use the same cuff immediately on a newborn Answer: A. Shared patient-care equipment needs appropriate reprocessing between patients, including compatibility with the device and disinfectant.
68. A cough triage area opens into the same crowded waiting space as newborn visits. What is the best service redesign? Rely only on a sign saying cough etiquette Close ventilation to reduce outdoor dust regardless of risk Delay screening until after everyone registers in one queue Separate respiratory flow where feasible and combine triage, ventilation and source-control measures Answer: D. Combining administrative, environmental and source-control measures reduces avoidable exposure.
69. During a blood collection, a nurse plans to recap a used needle with both hands before disposal. What is the safer routine practice? Dispose of the needle immediately in a nearby appropriate sharps container without recapping Recap more quickly to reduce exposure time Leave the needle on a tray for someone else Break the needle manually before disposal Answer: A. Avoiding recapping and placing sharps containers at the point of use reduce needlestick risk.
70. A cleaner is instructed to mix chlorine disinfectant with an acidic toilet cleaner. What is the appropriate response? Mix them outdoors and assume the reaction is harmless Increase the acid concentration for better disinfection Use warm water to make the mixture safe automatically Stop the mixing and follow product-specific safety instructions Answer: D. Mixing chlorine products with acids can release dangerous gas; chemical compatibility instructions must be followed.
71. An adult's medicine chart lists a severe penicillin allergy, but a newly prescribed medicine is a penicillin. What should the nurse do? Administer it slowly to test whether the allergy still exists Remove the allergy entry without asking the patient Withhold that dose pending prompt prescriber clarification and an appropriate alternative Give an extra dose to overcome the previous reaction Answer: C. A documented severe allergy is a medication safety signal requiring clarification before exposure.
72. A child's antibiotic order has a dose but no frequency. What is the safest action? Choose the most common frequency from memory Divide the dose between every visit at random Clarify the incomplete prescription before administration Ask another parent how often their child takes it Answer: C. An incomplete order needs clarification; guessing can result in underdosing or toxicity.
73. A prescribed dose is due, but the label on the prepared syringe is unreadable and its contents cannot be verified. What should the nurse do? Do not administer it; replace it with a correctly identified preparation Identify it only by colour Ask the patient to taste a drop Use it if the syringe size matches the usual dose Answer: A. Medicines must be identifiable and verified before administration; appearance is insufficient.
74. A medicine is ordered in micrograms, while the available product is labelled in milligrams. What safety step is essential? Treat the numbers as equivalent Move the decimal arbitrarily until the dose looks familiar Assume every microgram order is a printing error Convert units explicitly and verify the calculation before preparation Answer: D. Unit mismatches can produce thousand-fold errors; explicit conversion and verification are needed.
75. An IV infusion pump alarm shows occlusion and the patient's arm is swollen. Which action is appropriate? Silence the alarm and increase the pressure limit immediately Flush forcefully without examining the site Stop and assess the line and site before restarting or replacing the infusion Assume the alarm is harmless because the pump is powered Answer: C. Pump alarms must be assessed in clinical context; swelling may indicate infiltration or another complication.
76. A patient reports taking an unlisted herbal preparation alongside prescribed anticoagulation. What should the nurse do? Assume natural products cannot interact with medicines Recommend increasing both products together Delete the prescription because every herbal product is incompatible Document it and arrange a review for possible interactions or bleeding risk Answer: D. Herbal and non-prescription products belong in medication review because clinically important interactions may occur.
77. A nurse detects that a near-identical medicine package contains ten times the expected concentration before giving it. What is the best response? Ignore it because no patient was harmed Hide the package so the team cannot learn from it Prevent administration, correct the preparation and report the near miss through the safety system Give one full ampoule regardless of concentration Answer: C. Near-miss reporting allows system improvement before an error reaches a patient.
78. A patient cannot explain how to use a newly prescribed oral liquid and has only a household spoon. What should the nurse provide? Instructions to estimate every dose by eye Advice to use the largest kitchen spoon A syringe intended for injection without clear oral-use safeguards A suitable calibrated oral dosing device and a demonstration checked by return demonstration Answer: D. Calibrated oral devices and demonstrated understanding reduce dosing errors from variable household utensils.
79. A person taking a sedating medicine is very drowsy and has slow breathing. What should the nurse prioritise? Airway and breathing assessment with urgent escalation for possible toxicity Another sedating dose to reduce distress Walking the person outside without assessment Waiting for the next clinic day to review the medicine Answer: A. Respiratory depression is a time-critical toxicity sign needing immediate assessment and appropriate treatment.
80. Before administering a medicine, a patient states a name different from the one on the chart. What should happen? Use the bed location as the only identifier Ask another patient to guess the correct name Proceed because the medicine is commonly prescribed Stop and resolve identification using approved identifiers before administration Answer: D. Identity discrepancies must be resolved; location and familiarity are not adequate patient identifiers.
81. A nurse refers a deteriorating patient but the receiving facility has no information about treatment already given. What handover is most useful? Only the patient's age and destination A statement that the patient is somebody else's responsibility An unlabelled bag containing the treatment supplies A structured summary of condition, observations, treatment times, response and referral reason Answer: D. A structured handover supports continuity and helps prevent duplicated or delayed treatment.
82. A patient sent home after assessment asks when to return. Which discharge instruction is most useful? Say only 'come back if necessary' Provide a medication list without explaining deterioration Explain specific warning symptoms, where to seek help and the planned review date Advise waiting until every tablet is finished regardless of symptoms Answer: C. Specific safety-net advice helps patients recognise deterioration and know how to obtain timely care.
83. A home visit record says 'patient is difficult' but contains no observed behaviour or care barriers. How should the documentation improve? Replace the phrase with a stronger personal judgement Delete every concern to avoid an awkward conversation Use only unexplained abbreviations Record objective observations, relevant patient statements and actions taken Answer: D. Objective, relevant documentation communicates care needs more safely than judgemental labels.
84. A client with limited literacy cannot read a complex discharge leaflet. What is the most effective adaptation? Use plain language and suitable visual or spoken instructions, then check understanding Hand over more copies of the same leaflet Ask for a signature as proof of comprehension Remove all information because reading is difficult Answer: A. Accessible communication and a check of understanding are needed; a signature alone does not show comprehension.
85. A patient returns repeatedly with the same untreated wound because dressing materials are unaffordable. What should the nurse address in the care plan? Only whether the patient followed the written instruction A demand to buy the most expensive product Clinical wound needs and practical access to an affordable dressing pathway Stopping all reviews until materials are purchased Answer: C. A feasible plan addresses access barriers as well as the clinical problem.
86. A nurse receives an abnormal laboratory result after a patient has left. What action is safest? File the result without checking its significance Assess urgency, communicate through an approved confidential route and document follow-up Post the patient's result in a community group Assume another clinician will notice it without handover Answer: B. Abnormal-result systems require timely review, appropriate communication and confirmation of follow-up.
87. A person declines a recommended referral but appears able to understand and weigh the information. What should the nurse do? Force transport solely because the recommendation was declined Explore reasons, explain material risks and alternatives, assess decision-making capacity and document an agreed safety plan Withhold every future service as punishment Record refusal without providing information or checking understanding Answer: B. An informed refusal needs assessment, clear communication and documentation while respecting a capable person's decision.
88. A home care plan requires a relative to perform a procedure they have never been taught. What should happen before delegating it? Assess suitability, teach the task, check competence and provide escalation instructions Assume family members can perform all nursing procedures Leave written instructions without a demonstration or assessment Require completion regardless of the relative's willingness Answer: A. Safe task sharing needs consent, appropriate scope, competence checks and a support pathway.
89. A client privately describes partner violence but says public disclosure would increase danger. What response is most appropriate? Confront the partner without discussing risk Make disclosure in a community meeting Listen, validate, assess immediate safety and offer confidential, survivor-centred support and referral Insist the client must leave immediately without assessing circumstances Answer: C. Support should prioritise safety, privacy and the person's choices within safeguarding obligations.
90. Two home-care workers disagree about a patient's changing symptoms at shift handover. What should they do? Choose the more senior person's memory without checking Leave the discrepancy until the next month Reassess the patient, compare objective observations and escalate unresolved deterioration Rewrite earlier observations to make them identical Answer: C. Reassessment and accurate communication are safer than suppressing conflicting information.
91. An oral medicine order is 375 mg. The suspension contains 125 mg per 5 mL. What volume is required for this prescribed dose? 5 mL 10 mL 20 mL 15 mL Answer: D. 375 divided by 125 gives three 5-mL portions: 15 mL. This tests arithmetic, not selection of a clinical dose.
92. A prescribed infusion contains 750 mL to run over 6 hours. What pump rate delivers that volume over the stated time? 125 mL/hour 75 mL/hour 150 mL/hour 450 mL/hour Answer: A. 750 mL divided by 6 hours equals 125 mL/hour.
93. A prescribed 500 mL infusion is to run over 4 hours using a set labelled 20 drops/mL. To the nearest whole drop, what rate is needed? 25 drops/minute 83 drops/minute 125 drops/minute 42 drops/minute Answer: D. 500 times 20 divided by 240 minutes is 41.67, rounded to 42 drops/minute.
94. A prescription requires 0.75 mg. How many micrograms is this? 75 micrograms 750 micrograms 7.5 micrograms 7,500 micrograms Answer: B. One milligram equals 1,000 micrograms; 0.75 multiplied by 1,000 equals 750.
95. A patient's measured intake is 1,650 mL and total measured output is 1,220 mL over the same period. What is the recorded fluid balance? Negative 430 mL Positive 2,870 mL Negative 1,220 mL Positive 430 mL Answer: D. Recorded balance is measured intake minus measured output: 1,650 minus 1,220 equals positive 430 mL.
96. A 60-kg adult produces 180 mL of urine over 6 hours. What is the average urine output per kilogram per hour? 0.5 mL/kg/hour 3 mL/kg/hour 0.05 mL/kg/hour 1.8 mL/kg/hour Answer: A. 180 mL divided by 6 hours divided by 60 kg equals 0.5 mL/kg/hour; clinical interpretation also requires context.
97. A medicine concentration is 40 mg/mL. A verified prescription requires 100 mg. What volume contains the prescribed amount? 0.4 mL 4 mL 25 mL 2.5 mL Answer: D. Required volume is 100 mg divided by 40 mg/mL, which equals 2.5 mL.
98. A prescription states 12 mg/kg for one dose and the child's verified weight is 18 kg. What is the calculated dose before checking the product's limits and suitability? 30 mg 150 mg 1.5 mg 216 mg Answer: D. 12 mg/kg multiplied by 18 kg equals 216 mg. The prescription, maximum dose and preparation must still be verified.
99. A nurse counts 22 respirations over 30 seconds in a stable adult with a regular pattern. What is the estimated respiratory rate per minute? 11 breaths/minute 22 breaths/minute 44 breaths/minute 66 breaths/minute Answer: C. A 30-second count is doubled to estimate a minute: 22 times 2 equals 44. An abnormal result needs reassessment.
100. A chart records temperature 39.2 degrees Celsius at 08:00 and 38.4 degrees Celsius at 10:00. What temperature change should be documented? A rise of 0.8 degrees Celsius A fall of 1.8 degrees Celsius A fall of 8 degrees Celsius A fall of 0.8 degrees Celsius Answer: D. 39.2 minus 38.4 equals 0.8 degrees Celsius. Temperature trend must be interpreted with the patient's overall condition.
