A patient starting weekly oral alendronate for osteoporosis should be taught to take the tablet:

Fasting, with plain water, then upright for 30 min

With milk at bedtime to protect the stomach lining

With the evening meal along with the calcium tablet

Crushed in juice so that it is absorbed more quickly

An 80-year-old woman cannot stand after slipping in the bathroom. Her right leg is shortened and externally rotated. These findings most suggest:

Fracture of the neck of the femur

Posterior dislocation of the hip

Fracture of the shaft of the tibia

Sprain of the lateral knee ligament

The earliest and most reliable warning sign of acute compartment syndrome in a fractured limb is:

Pain out of proportion that worsens on passive stretch

Complete paralysis of the affected muscles

Pale, cold skin over the whole limb

Absence of the pulse distal to the fracture

Orthopaedic, eye and ENT nursing

18 AIIMS NORCET (Nursing Officer) practice questions on Orthopaedic, eye and ENT nursing, part of Medical-Surgical Nursing. The first 18 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 · Medium
A 62-year-old woman comes to casualty with sudden severe pain in the right eye, blurred vision with coloured haloes round lights, vomiting and a red eye with a fixed, mid-dilated pupil. The most likely diagnosis is:
1. ARetinal detachment
2. BAcute angle-closure glaucoma
3. CSenile cataract
4. DPrimary open-angle glaucoma
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Answer: B · Acute angle-closure glaucoma
Acute angle-closure glaucoma follows sudden blockage of aqueous outflow at the angle, and the intraocular pressure may rise above 50 mmHg. It causes severe eye pain, headache, nausea and vomiting, haloes round lights, a red eye, a hazy cornea and a fixed, mid-dilated pupil. It is an emergency because the optic nerve can be damaged within hours. Treatment starts with drugs that lower pressure (acetazolamide, pilocarpine, mannitol), followed by laser iridotomy.
- A: Retinal detachment is painless, with flashes, floaters and a curtain over vision.
- C: Cataract causes slow, painless clouding of vision, not a red painful eye.
- D: Open-angle glaucoma is painless and slow, with gradual loss of peripheral vision.
Question 2 · Easy
Which eye drop must be avoided in a patient with a known narrow (closed) anterior chamber angle?
1. ATimolol
2. BLatanoprost
3. CPilocarpine
4. DAtropine
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Answer: D · Atropine
Atropine is a mydriatic: by dilating the pupil it crowds the iris into a narrow angle and blocks aqueous outflow, which can precipitate acute angle-closure glaucoma. Pilocarpine does the opposite, constricting the pupil and pulling the iris away from the angle. Timolol reduces aqueous production and latanoprost increases uveoscleral outflow. Nurses check for a glaucoma history before giving any anticholinergic, including systemic ones.
- A: Timolol lowers pressure by reducing aqueous production and is safe for the angle.
- B: Latanoprost lowers pressure by increasing outflow and does not dilate the pupil.
- C: Pilocarpine is a miotic that opens the angle and is used to treat angle closure.
Question 3 · Medium
A patient starting weekly oral alendronate for osteoporosis should be taught to take the tablet:
1. AWith milk at bedtime to protect the stomach lining
2. BWith the evening meal along with the calcium tablet
3. CCrushed in juice so that it is absorbed more quickly
4. DFasting, with plain water, then upright for 30 min
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Answer: D · Fasting, with plain water, then upright for 30 min
Alendronate is poorly absorbed, and food, milk, calcium and juice reduce its absorption further. It is taken in the morning on an empty stomach with a full glass of plain water, and the patient stays upright and does not eat for at least 30 minutes. Lying down allows the tablet to reflux and cause oesophagitis or ulcers. Calcium supplements are taken at a different time of day.
- A: Milk calcium binds the drug, and lying down at bedtime risks oesophageal injury.
- B: Food and calcium taken together sharply reduce absorption.
- C: Crushing exposes the oesophagus to the drug and juice reduces absorption.
Question 4 · Medium
An 80-year-old woman cannot stand after slipping in the bathroom. Her right leg is shortened and externally rotated. These findings most suggest:
1. APosterior dislocation of the hip
2. BFracture of the neck of the femur
3. CFracture of the shaft of the tibia
4. DSprain of the lateral knee ligament
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Answer: B · Fracture of the neck of the femur
In a fracture of the neck of the femur the muscles pull the distal fragment upward and the weight of the leg rolls it outward, giving a shortened, externally rotated limb. Osteoporosis makes this fracture common after minor falls in elderly women. A posterior hip dislocation also shortens the leg but rotates it internally, with adduction. The nurse keeps the limb still, gives analgesia and watches for complications of immobility.
- A: Posterior hip dislocation shortens the leg but rotates it inward and adducts it.
- C: A tibial fracture gives local deformity below the knee, not hip rotation.
- D: A knee sprain does not shorten or rotate the whole limb.
Question 5 · Easy
The earliest and most reliable warning sign of acute compartment syndrome in a fractured limb is:
1. AComplete paralysis of the affected muscles
2. BPain out of proportion that worsens on passive stretch
3. CPale, cold skin over the whole limb
4. DAbsence of the pulse distal to the fracture
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Answer: B · Pain out of proportion that worsens on passive stretch
Rising pressure inside a closed fascial compartment first squeezes the capillaries and nerves, so the earliest finding is severe pain that analgesics do not relieve and that increases when the muscles of the compartment are passively stretched. Paraesthesia follows. Arterial pressure is far higher than compartment pressure, so distal pulses usually stay palpable until very late. A nurse who waits for a lost pulse or paralysis has waited too long; the surgeon must be told at the first sign.
- A: Paralysis signals established nerve and muscle damage, not an early warning.
- C: Pallor and coldness are late findings after tissue perfusion has already failed.
- D: A pulse is usually still present in compartment syndrome; its loss is a late sign.
Question 6 · Medium
A patient returns to the ward with a freshly applied plaster of Paris cast on the forearm. Which care is correct during the first 24-48 hours?
1. ACover the cast with a blanket so it dries faster
2. BRest the cast on a firm table edge to keep its shape
3. CDry the cast quickly with a hair dryer on high heat
4. DLeave it uncovered and lift it with the palms
Answer and explanation in LearnFree account
Question 7 · Medium
Two days after a below-knee amputation, a patient says he feels burning pain in the toes of the foot that was removed. The most appropriate response is to:
1. AIgnore the complaint so that he does not dwell on it
2. BRemind him gently that the foot is no longer there
3. CAccept the pain as real and give analgesia
4. DTell him the feeling shows he has not accepted the loss
Answer and explanation in LearnFree account
Question 8 · Hard
A 58-year-old man with primary open-angle glaucoma started timolol 0.5% eye drops two weeks ago. He has mild asthma controlled with an inhaler. He now reports wheeze and tiredness; his pulse is 52/min. What is the most likely explanation?
1. ASystemic beta-blockade from absorption of the drops
2. BAllergy to the preservative in the eye drops
3. CAn unrelated viral chest infection
4. DProgression of glaucoma raising intraocular pressure
Answer and explanation in LearnFree account
Question 9 · Easy
Buck's extension, applied to an elderly patient awaiting hip surgery, is a type of:
1. ASkin traction
2. BManual traction
3. CBalanced suspension traction
4. DSkeletal traction
Answer and explanation in LearnFree account
Question 10 · Medium
Which activity should the nurse teach a patient to avoid in the first weeks after cataract surgery with lens implantation?
1. AWatching television for short periods
2. BEating a normal diet with fruit and fibre
3. CWalking about the house and garden
4. DBending forward from the waist to pick things up
Answer and explanation in LearnFree account
Question 11 · Easy
Before instilling ear drops in an adult, the nurse straightens the external auditory canal by pulling the pinna:
1. ADownward and backward
2. BUpward and backward
3. CStraight forward
4. DDownward and forward
Answer and explanation in LearnFree account
Question 12 · Easy
By the WHO criteria, osteoporosis is diagnosed when the DEXA bone mineral density T-score is:
1. ABetween -1.0 and -2.5
2. B+2.5 or higher
3. C-1.0 or higher
4. D-2.5 or lower
Answer and explanation in LearnFree account
Question 13 · Hard
A 22-year-old man is in skeletal traction for a femoral shaft fracture sustained 36 hours ago. He suddenly becomes restless and confused. RR 32/min, HR 124/min, SpO2 86% on room air, and a petechial rash is present across the upper chest. What should the nurse do first?
1. AGive high-flow oxygen and summon the rapid response team
2. BGive a sedative to settle the restlessness
3. CStart the heparin infusion kept for thromboprophylaxis
4. DReduce the traction weight to ease the pain
Answer and explanation in LearnFree account
Question 14 · Hard
Six hours after tonsillectomy, a 7-year-old boy is drowsy and swallowing repeatedly. His pulse has risen from 96 to 132/min, and he has just vomited a small amount of dark brown fluid. What is the most likely cause?
1. ABleeding from the tonsillar bed
2. BDehydration from poor oral intake
3. CAspiration pneumonia
4. DNormal postoperative throat pain
Answer and explanation in LearnFree account
Question 15 · Easy
A 25-year-old man with a fractured femoral shaft develops confusion, breathlessness and pinpoint haemorrhages over the chest, axillae and conjunctivae 48 hours after injury. These findings most strongly suggest:
1. AHospital-acquired pneumonia
2. BFat embolism syndrome
3. CDeep vein thrombosis
4. DOpioid-induced respiratory depression
Answer and explanation in LearnFree account
Question 16 · Medium
A patient in skeletal traction for a femoral fracture asks the nurse to take the weights off while the bed linen is changed. The nurse should:
1. ALift the weights by hand while the patient slides up the bed
2. BKeep the weights hanging freely throughout
3. CRemove the weights briefly and replace them after the change
4. DRest the weights on the floor until the patient is repositioned
Answer and explanation in LearnFree account
Question 17 · Hard
Six hours after a long-leg plaster cast is applied for a tibial fracture, a patient reports increasing leg pain that two doses of morphine have not relieved. Passive extension of the toes is very painful, the toes feel numb and the dorsalis pedis pulse is still palpable. What is the priority action?
1. ARaise the leg on pillows well above heart level
2. BNotify the surgeon at once for cast splitting
3. CGive another opioid dose and reassess in an hour
4. DApply ice packs over the cast at the shin
Answer and explanation in LearnFree account
Question 18 · Medium
To prevent a hip flexion contracture after an above-knee amputation, the nurse should:
1. ALet the patient sit in a chair for most of the day
2. BKeep a pillow under the residual limb at all times
3. CLie the patient prone several times a day
4. DSupport the residual limb abducted on a pillow
Answer and explanation in LearnFree account

Orthopaedic, eye and ENT nursing

A 62-year-old woman comes to casualty with sudden severe pain in the right eye, blurred vision with coloured haloes round lights, vomiting and a red eye with a fixed, mid-dilated pupil. The most likely diagnosis is:

Which eye drop must be avoided in a patient with a known narrow (closed) anterior chamber angle?

A patient starting weekly oral alendronate for osteoporosis should be taught to take the tablet:

An 80-year-old woman cannot stand after slipping in the bathroom. Her right leg is shortened and externally rotated. These findings most suggest:

The earliest and most reliable warning sign of acute compartment syndrome in a fractured limb is:

A patient returns to the ward with a freshly applied plaster of Paris cast on the forearm. Which care is correct during the first 24-48 hours?

Two days after a below-knee amputation, a patient says he feels burning pain in the toes of the foot that was removed. The most appropriate response is to:

A 58-year-old man with primary open-angle glaucoma started timolol 0.5% eye drops two weeks ago. He has mild asthma controlled with an inhaler. He now reports wheeze and tiredness; his pulse is 52/min. What is the most likely explanation?

Buck's extension, applied to an elderly patient awaiting hip surgery, is a type of:

Which activity should the nurse teach a patient to avoid in the first weeks after cataract surgery with lens implantation?

Before instilling ear drops in an adult, the nurse straightens the external auditory canal by pulling the pinna:

By the WHO criteria, osteoporosis is diagnosed when the DEXA bone mineral density T-score is:

A 22-year-old man is in skeletal traction for a femoral shaft fracture sustained 36 hours ago. He suddenly becomes restless and confused. RR 32/min, HR 124/min, SpO2 86% on room air, and a petechial rash is present across the upper chest. What should the nurse do first?

Six hours after tonsillectomy, a 7-year-old boy is drowsy and swallowing repeatedly. His pulse has risen from 96 to 132/min, and he has just vomited a small amount of dark brown fluid. What is the most likely cause?

A 25-year-old man with a fractured femoral shaft develops confusion, breathlessness and pinpoint haemorrhages over the chest, axillae and conjunctivae 48 hours after injury. These findings most strongly suggest:

A patient in skeletal traction for a femoral fracture asks the nurse to take the weights off while the bed linen is changed. The nurse should:

To prevent a hip flexion contracture after an above-knee amputation, the nurse should: