During an intermittent nasogastric feed, an elderly patient suddenly coughs violently, becomes breathless and his SpO2 falls from 96% to 85%. What is the nurse's first action?

Flush the tube with 30 mL water

Slow the feed and recheck in 10 minutes

The lithotomy position is mainly used for:

Vaginal examination and perineal procedures

Lumbar puncture in an adult patient

Postural drainage of the lower lobes

Feeding a patient with dysphagia

A 35-year-old with a head injury had BP 130/80 mmHg, pulse 84/min and regular breathing at admission. Two hours later, BP is 176/72 mmHg, pulse 52/min and breathing is irregular. These signs most likely show:

A response to pain from his wounds

Neurogenic shock from a cord injury

Hypovolaemic shock from bleeding

Vital signs, assessment and basic procedures

26 AIIMS NORCET (Nursing Officer) practice questions on Vital signs, assessment and basic procedures, part of Fundamentals of Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
In the NEX method used to mark a nasogastric tube, the tape measure runs from the nose tip to the earlobe and then on to which landmark?
1. AThe suprasternal notch
2. BThe umbilicus
3. CThe left costal margin
4. DThe xiphisternum
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Answer: D · The xiphisternum
NEX stands for nose, earlobe, xiphisternum, and the total estimates the distance from the nostril to the stomach. The length is marked on the tube before insertion. Stopping short leaves the ports in the oesophagus, with a risk of aspiration. Placement is still confirmed by aspirate pH or X-ray after insertion.
- A: The suprasternal notch is too short, leaving the tip in the oesophagus.
- B: Measuring to the umbilicus overestimates the length and may coil the tube.
- C: The costal margin is not the standard landmark and gives a variable length.
Question 2 · Hard
During an intermittent nasogastric feed, an elderly patient suddenly coughs violently, becomes breathless and his SpO2 falls from 96% to 85%. What is the nurse's first action?
1. AFlush the tube with 30 mL water
2. BSlow the feed and recheck in 10 minutes
3. CStop the feed at once
4. DLower the head of the bed flat
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Answer: C · Stop the feed at once
Coughing, dyspnoea and falling saturation during a feed suggest aspiration or a misplaced tube. Stopping the feed prevents more fluid entering the airway. The nurse then keeps the head raised, suctions if needed, gives oxygen as ordered and reports at once. Tube position is checked before any further feed.
- A: Flushing adds more fluid that could enter the lungs.
- B: Continuing at any rate risks more aspiration.
- D: Lying flat increases the risk of further aspiration.
Question 3 · Hard
A post-operative patient's blood pressure is 96/54 mmHg. What is the mean arterial pressure?
1. A75 mmHg
2. B68 mmHg
3. C82 mmHg
4. D61 mmHg
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Answer: B · 68 mmHg
MAP = diastolic + one third of the pulse pressure. Pulse pressure is 96 - 54 = 42, and one third is 14, so MAP = 54 + 14 = 68 mmHg. A MAP of at least 65 mmHg is the usual target to keep organs perfused. The simple average of the two pressures, 75, overestimates MAP because diastole lasts longer than systole.
- A: 75 is the simple average of 96 and 54, which overweights systole.
- C: 82 comes from subtracting one third of the pulse pressure from the systolic value.
- D: 61 comes from adding one sixth rather than one third of the pulse pressure.
Question 4 · Easy
The lithotomy position is mainly used for:
1. AVaginal examination and perineal procedures
2. BLumbar puncture in an adult patient
3. CPostural drainage of the lower lobes
4. DFeeding a patient with dysphagia
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Answer: A · Vaginal examination and perineal procedures
In lithotomy the patient lies supine with hips and knees flexed and the legs supported in stirrups. It exposes the perineum for vaginal examination, catheterisation of difficult cases, delivery and perineal surgery. The legs are raised and lowered together to avoid hip strain and nerve injury. Prolonged use risks pressure on the popliteal area.
- B: Lumbar puncture uses the lateral fetal position or sitting forward.
- C: Lower-lobe drainage uses head-down positions, not lithotomy.
- D: Feeding with dysphagia needs the upright high Fowler's position.
Question 5 · Hard
A 35-year-old with a head injury had BP 130/80 mmHg, pulse 84/min and regular breathing at admission. Two hours later, BP is 176/72 mmHg, pulse 52/min and breathing is irregular. These signs most likely show:
1. ARising intracranial pressure
2. BA response to pain from his wounds
3. CNeurogenic shock from a cord injury
4. DHypovolaemic shock from bleeding
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Answer: A · Rising intracranial pressure
Rising systolic pressure with a widening pulse pressure, bradycardia and irregular respiration is Cushing's triad. It is a late sign of raised intracranial pressure threatening brainstem herniation. The nurse reports immediately and checks GCS and pupils. Measures such as head elevation to 30 degrees and the ordered osmotic therapy follow.
- B: Pain raises the pulse rate rather than slowing it.
- C: Neurogenic shock gives low blood pressure with bradycardia.
- D: Hypovolaemic shock gives low blood pressure and a fast pulse.
Question 6 · Medium
A clean-catch midstream urine sample for culture cannot reach the laboratory for 3 hours. What should the nurse do with it?
1. AAdd a few drops of formalin to the sample
2. BRefrigerate it at about 4 °C until it is sent
3. CLeave it at room temperature in the tray
4. DKeep it in the ward incubator at 37 °C
Answer and explanation in LearnFree account
Question 7 · Medium
A patient with atrial fibrillation has an apical rate of 112 beats/min and a radial rate of 86 beats/min, counted at the same time. The pulse deficit is:
1. A26 beats/min
2. B99 beats/min
3. C198 beats/min
4. D13 beats/min
Answer and explanation in LearnFree account
Question 8 · Medium
During a physical assessment of the abdomen, the correct order of techniques is:
1. APalpation, inspection, auscultation, percussion
2. BInspection, palpation, percussion, auscultation
3. CAuscultation, inspection, palpation, percussion
4. DInspection, auscultation, percussion, palpation
Answer and explanation in LearnFree account
Question 9 · Easy
The apical pulse of an adult is best heard at the:
1. AFifth left intercostal space, anterior axillary line
2. BFifth left intercostal space, midclavicular line
3. CFourth left intercostal space, sternal border
4. DSecond right intercostal space, sternal border
Answer and explanation in LearnFree account
Question 10 · Easy
For a cleansing enema, the adult patient is placed in the:
1. ASupine position
2. BRight lateral position
3. CProne position
4. DLeft lateral (Sims') position
Answer and explanation in LearnFree account
Question 11 · Easy
In semi-Fowler's position, the head of the bed is raised to about:
1. A30-45 degrees
2. B90 degrees with a table
3. C60-90 degrees
4. D5-10 degrees
Answer and explanation in LearnFree account
Question 12 · Easy
The systolic blood pressure is recorded at the:
1. ADisappearance of sounds (Korotkoff phase V)
2. BMuffling of the sounds (Korotkoff phase IV)
3. CFirst clear tapping sound (Korotkoff phase I)
4. DSwishing murmur (Korotkoff phase II)
Answer and explanation in LearnFree account
Question 13 · Medium
Which bedside check confirms nasogastric tube placement before the first feed, X-ray being the gold standard?
1. AThe patient being able to speak
2. BA whoosh heard over the epigastrium
3. CAspirate pH of 5.5 or less
4. DNo bubbling with the tube end in water
Answer and explanation in LearnFree account
Question 14 · Medium
A 70-year-old on antihypertensives has BP 128/80 mmHg lying. Two minutes after standing it is 104/72 mmHg and he feels dizzy. These readings show:
1. AOrthostatic hypotension
2. BWhite-coat hypertension
3. CWidened pulse pressure
4. DNormal postural adjustment
Answer and explanation in LearnFree account
Question 15 · Hard
During an admission assessment, a woman weighs 72 kg and her height is 160 cm. What is her body mass index?
1. A25.6 kg/m2
2. B22.5 kg/m2
3. C28.1 kg/m2
4. D45.0 kg/m2
Answer and explanation in LearnFree account
Question 16 · Hard
An 80-year-old with heart failure and a recent stroke breathes in cycles: breaths become gradually deeper and faster, then shallower, followed by a pause of about 20 seconds without breathing. This pattern is:
1. AApneustic breathing
2. BBiot's respiration
3. CCheyne-Stokes respiration
4. DKussmaul respiration
Answer and explanation in LearnFree account
Question 17 · Medium
During insertion of an indwelling urinary catheter, why is the balloon not inflated until urine flows?
1. AUrine flow shows the balloon is in the bladder, not the urethra
2. BUrine must first wet the balloon so that it expands evenly
3. CEarly inflation causes the detrusor muscle to go into spasm
4. DFlowing urine flushes the catheter eye free of lubricant gel
Answer and explanation in LearnFree account
Question 18 · Easy
The normal respiratory rate of a resting adult is:
1. A12-20 breaths per minute
2. B30-40 breaths per minute
3. C8-10 breaths per minute
4. D20-30 breaths per minute
Answer and explanation in LearnFree account
Question 19 · Hard
A urine culture is ordered for a patient who has had an indwelling catheter for 4 days. How should the nurse collect the sample?
1. ADisconnect the catheter from the tubing and collect the drip
2. BPour urine from the drainage bag into a sterile container
3. CClean the sampling port and aspirate with a sterile syringe
4. DRemove the catheter and send its tip for culture
Answer and explanation in LearnFree account
Question 20 · Medium
A post-operative patient with an indwelling catheter walks to the toilet holding his drainage bag above his waist. The main risk the nurse explains is:
1. AUrine leaking out around the catheter at the meatus
2. BReflux of urine causing catheter-associated infection
3. CAccidental pull-out of the inflated catheter balloon
4. DKinking of the tubing leading to bladder spasm
Answer and explanation in LearnFree account
Question 21 · Medium
A 24-hour urine collection for protein is ordered to start at 8 am. How does the nurse begin and end it?
1. ASave the 8 am void and every void until 8 am next day, including the last
2. BSave the first urine after breakfast and the last urine before bed each day
3. CSave the 8 am void, then save all urine up to 8 am next day except the last
4. DDiscard the 8 am void, then save all urine up to and including 8 am next day
Answer and explanation in LearnFree account
Question 22 · Medium
A patient with acute heart failure is breathless at rest and coughing frothy sputum. Which position should the nurse place him in first?
1. ASupine with legs raised on pillows
2. BLeft lateral with knees flexed
3. CTrendelenburg with head lowered
4. DHigh Fowler's with legs dependent
Answer and explanation in LearnFree account
Question 23 · Medium
A patient with a 3-week cough is asked to give sputum for acid-fast bacilli. Which sample gives the best yield?
1. ASaliva spat out after the evening meal
2. BA sample taken just after a mouthwash
3. CNasal secretions collected on a swab
4. DA deep-cough sample on waking, before food
Answer and explanation in LearnFree account
Question 24 · Medium
A nurse measures the blood pressure of an obese patient with a standard adult cuff that is too narrow for his arm. The reading will be:
1. AFalsely low
2. BFalsely high
3. CAccurate if deflated slowly
4. DFalsely low diastolic only
Answer and explanation in LearnFree account
Question 25 · Medium
Halfway through a soap-water enema, the patient complains of cramping abdominal pain. What should the nurse do?
1. ARaise the can higher so the remaining fluid runs in fast
2. BLower the can or clamp briefly, and ask for slow breaths
3. CTurn the patient onto the right side and keep the flow
4. DRemove the tube and give the rest of the fluid next day
Answer and explanation in LearnFree account

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Vital signs, assessment and basic procedures

In the NEX method used to mark a nasogastric tube, the tape measure runs from the nose tip to the earlobe and then on to which landmark?

During an intermittent nasogastric feed, an elderly patient suddenly coughs violently, becomes breathless and his SpO2 falls from 96% to 85%. What is the nurse's first action?

A post-operative patient's blood pressure is 96/54 mmHg. What is the mean arterial pressure?

The lithotomy position is mainly used for:

A 35-year-old with a head injury had BP 130/80 mmHg, pulse 84/min and regular breathing at admission. Two hours later, BP is 176/72 mmHg, pulse 52/min and breathing is irregular. These signs most likely show:

A clean-catch midstream urine sample for culture cannot reach the laboratory for 3 hours. What should the nurse do with it?

A patient with atrial fibrillation has an apical rate of 112 beats/min and a radial rate of 86 beats/min, counted at the same time. The pulse deficit is:

During a physical assessment of the abdomen, the correct order of techniques is:

The apical pulse of an adult is best heard at the:

For a cleansing enema, the adult patient is placed in the:

In semi-Fowler's position, the head of the bed is raised to about:

The systolic blood pressure is recorded at the:

Which bedside check confirms nasogastric tube placement before the first feed, X-ray being the gold standard?

A 70-year-old on antihypertensives has BP 128/80 mmHg lying. Two minutes after standing it is 104/72 mmHg and he feels dizzy. These readings show:

During an admission assessment, a woman weighs 72 kg and her height is 160 cm. What is her body mass index?

An 80-year-old with heart failure and a recent stroke breathes in cycles: breaths become gradually deeper and faster, then shallower, followed by a pause of about 20 seconds without breathing. This pattern is:

During insertion of an indwelling urinary catheter, why is the balloon not inflated until urine flows?

The normal respiratory rate of a resting adult is:

A urine culture is ordered for a patient who has had an indwelling catheter for 4 days. How should the nurse collect the sample?

A post-operative patient with an indwelling catheter walks to the toilet holding his drainage bag above his waist. The main risk the nurse explains is:

A 24-hour urine collection for protein is ordered to start at 8 am. How does the nurse begin and end it?

A patient with acute heart failure is breathless at rest and coughing frothy sputum. Which position should the nurse place him in first?

A patient with a 3-week cough is asked to give sputum for acid-fast bacilli. Which sample gives the best yield?

A nurse measures the blood pressure of an obese patient with a standard adult cuff that is too narrow for his arm. The reading will be:

Halfway through a soap-water enema, the patient complains of cramping abdominal pain. What should the nurse do?