A patient with megaloblastic anaemia has not yet had a vitamin B12 level checked. Why should folic acid not be given alone until B12 deficiency is ruled out?

It corrects the anaemia while nerve damage progresses

It causes a sudden fall in the serum potassium level

It blocks absorption of vitamin B12 from the ileum

It worsens the anaemia by suppressing the marrow

The two commonest causes of acute pancreatitis in adults are:

Drugs and hypertriglyceridaemia

A patient on antibiotics for 10 days has an ileostomy. At a pouch change, the peristomal skin under the flange shows a bright red, itchy rash with small separate red spots and pustules at its edges. The pouch has not leaked. What is the most likely cause and the correct care?

Candida infection: antifungal powder, dusted off, then the barrier

Irritant dermatitis from leakage: a smaller flange cut to the stoma

Folliculitis from shaving: clip the hair rather than shave it

Allergy to the adhesive: change to a different brand of pouch

Gastrointestinal, oncology, haematology and musculoskeletal nursing

50 M.Sc Nursing Entrance (AIIMS, LBS, PGIMER, JIPMER) practice questions on Gastrointestinal, oncology, haematology and musculoskeletal nursing, part of Medical-Surgical 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 · Medium
Aprepitant is added to ondansetron and dexamethasone before highly emetogenic chemotherapy. It works by blocking:
1. ANK1 (substance P) receptors
2. B5-HT3 receptors
3. CDopamine D2 receptors
4. DHistamine H1 receptors
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Answer: A · NK1 (substance P) receptors
Aprepitant is a neurokinin-1 receptor antagonist that blocks substance P in the brainstem vomiting centre. It is especially effective against delayed nausea and vomiting 24 hours to 5 days after cisplatin, which 5-HT3 antagonists control poorly. The three-drug combination is standard for highly emetogenic regimens. Aprepitant inhibits CYP3A4, so the dexamethasone dose is reduced.
- B: 5-HT3 receptors are blocked by ondansetron, already in the regimen.
- C: D2 receptors are blocked by metoclopramide and domperidone.
- D: H1 receptors are blocked by antihistamines such as promethazine.
Question 2 · Easy
A low result in which single blood test is most specific for iron-deficiency anaemia?
1. ASerum ferritin
2. BRed cell count
3. CSerum iron
4. DHaemoglobin
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Answer: A · Serum ferritin
Ferritin reflects the body's iron stores, and a low ferritin is diagnostic of iron deficiency. Haemoglobin and the red cell count fall in all anaemias. Serum iron varies through the day and falls in infection and chronic disease too. Ferritin is an acute-phase protein, so it can be falsely normal in inflammation, and a CRP is often checked with it.
- B: A low red cell count occurs in any anaemia.
- C: Serum iron fluctuates and is low in chronic disease as well.
- D: Haemoglobin shows anaemia but not its cause.
Question 3 · Medium
A patient with megaloblastic anaemia has not yet had a vitamin B12 level checked. Why should folic acid not be given alone until B12 deficiency is ruled out?
1. AIt corrects the anaemia while nerve damage progresses
2. BIt causes a sudden fall in the serum potassium level
3. CIt blocks absorption of vitamin B12 from the ileum
4. DIt worsens the anaemia by suppressing the marrow
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Answer: A · It corrects the anaemia while nerve damage progresses
Folic acid can restore DNA synthesis and correct the blood picture in B12 deficiency, but it does not provide the B12 that myelin needs. Subacute combined degeneration of the spinal cord can then progress silently, with possible permanent damage. Both levels are therefore checked before treatment, or B12 is given with folate. Potassium can fall early in the treatment of severe megaloblastic anaemia, but that is not the reason here.
- B: Hypokalaemia follows rapid marrow response to treatment, not folate given alone.
- C: Folic acid does not interfere with intrinsic factor or ileal B12 uptake.
- D: Folate does not suppress the marrow; it supports red cell production.
Question 4 · Easy
The two commonest causes of acute pancreatitis in adults are:
1. ADrugs and hypertriglyceridaemia
2. BTrauma and ERCP
3. CGallstones and alcohol
4. DMumps and hypercalcaemia
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Answer: C · Gallstones and alcohol
Gallstones and alcohol together cause most cases of acute pancreatitis in India and worldwide. A gallstone obstructing the ampulla raises pancreatic duct pressure and activates enzymes within the gland. Alcohol damages acinar cells and makes secretions thick. Every patient therefore has an abdominal ultrasound, and gallstone pancreatitis is followed by cholecystectomy to prevent recurrence.
- A: Drugs and high triglycerides cause only a small share of cases.
- B: Trauma and post-ERCP pancreatitis are less common causes.
- D: Mumps and hypercalcaemia are recognised but uncommon causes.
Question 5 · Hard
A patient on antibiotics for 10 days has an ileostomy. At a pouch change, the peristomal skin under the flange shows a bright red, itchy rash with small separate red spots and pustules at its edges. The pouch has not leaked. What is the most likely cause and the correct care?
1. AIrritant dermatitis from leakage: a smaller flange cut to the stoma
2. BFolliculitis from shaving: clip the hair rather than shave it
3. CAllergy to the adhesive: change to a different brand of pouch
4. DCandida infection: antifungal powder, dusted off, then the barrier
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Answer: D · Candida infection: antifungal powder, dusted off, then the barrier
A red, itchy rash with satellite spots at its border is typical of Candida, which thrives under occlusive flanges and after antibiotics. The nurse applies a thin dusting of antifungal powder such as nystatin, brushes off the excess and then applies the barrier so that it still sticks. Irritant dermatitis follows the shape of a leak, which did not happen here. Allergy follows the exact outline of the product, and folliculitis shows pustules centred on hair follicles.
- A: Irritant dermatitis is a raw area where output has leaked; the pouch did not leak.
- B: Folliculitis gives pustules on hair follicles, not a red rash with satellite spots.
- C: Allergic dermatitis matches the outline of the product, without satellite lesions.
Question 6 · Medium
Ascitic fluid from a new patient gives a serum-ascites albumin gradient (SAAG) of 1.8 g/dL. This result most strongly suggests ascites due to:
1. APeritoneal carcinomatosis
2. BPortal hypertension, as in cirrhosis
3. CNephrotic syndrome
4. DTuberculous peritonitis
Answer and explanation in LearnFree account
Question 7 · Hard
On day 1 of acute pancreatitis, a patient had SpO2 86% needing oxygen; this recovered within 24 hours. On day 6, CT shows an acute peripancreatic fluid collection. Urine output and creatinine are normal throughout. By the revised Atlanta classification, the severity is:
1. AMild acute pancreatitis
2. BCritical acute pancreatitis
3. CModerately severe acute pancreatitis
4. DSevere acute pancreatitis
Answer and explanation in LearnFree account
Question 8 · Easy
The first stage of healing in a fractured long bone is:
1. ACallus formation
2. BRemodelling
3. CConsolidation
4. DHaematoma formation
Answer and explanation in LearnFree account
Question 9 · Medium
A patient with cirrhosis is lethargic and disoriented to time but obeys commands, and has an obvious flapping tremor. By the West Haven criteria, this hepatic encephalopathy is grade:
1. A2
2. B1
3. C3
4. D4
Answer and explanation in LearnFree account
Question 10 · Hard
Two days after a hip spica cast for a femoral fracture, a 15-year-old has repeated vomiting, abdominal distension and epigastric pain; bowel sounds are present. Which complication should the nurse suspect and report?
1. AFat embolism from the femoral fracture
2. BParalytic ileus from opioid analgesia
3. CAcute appendicitis from immobility
4. DCast syndrome (superior mesenteric artery syndrome)
Answer and explanation in LearnFree account
Question 11 · Hard
A 64-year-old with metastatic breast cancer has 3 days of confusion, thirst, polyuria, constipation and vomiting. Serum calcium is 14.2 mg/dL (8.5-10.5), albumin 4.0 g/dL, creatinine 1.5 mg/dL. Which measure comes first?
1. AIV normal saline to restore volume
2. BIV zoledronic acid before any fluids
3. COral calcium-free diet and laxatives
4. DIV furosemide to increase calcium excretion
Answer and explanation in LearnFree account
Question 12 · Medium
Acute pancreatitis is diagnosed when two of three criteria are met. The biochemical criterion is a serum lipase or amylase of at least:
1. ATen times the upper limit of normal
2. BFive times the upper limit of normal
3. CThree times the upper limit of normal
4. DTwice the upper limit of normal
Answer and explanation in LearnFree account
Question 13 · Easy
After a dose of most myelosuppressive chemotherapy drugs, the neutrophil count is usually lowest (the nadir) at about:
1. A1 to 2 days
2. B6 to 8 weeks
3. C7 to 14 days
4. D3 to 4 weeks
Answer and explanation in LearnFree account
Question 14 · Medium
Three weeks after surgery, a patient's colostomy has retracted to below skin level, and his flat pouches leak every few hours. Which appliance change is most likely to help?
1. AA flange cut 1 cm wider than the stoma
2. BA larger flat flange with paste
3. CA convex flange with a belt
4. DA one-piece closed pouch
Answer and explanation in LearnFree account
Question 15 · Medium
Five weeks after an attack of acute pancreatitis, a man has early satiety, a full feeling in the epigastrium and a persistently raised amylase. Ultrasound shows a round, fluid-filled, walled-off collection. This is most likely a:
1. APancreatic abscess
2. BPancreatic carcinoma
3. CChronic pancreatitis
4. DPancreatic pseudocyst
Answer and explanation in LearnFree account
Question 16 · Easy
A patient asks why there are white threads of mucus in the urine in his urostomy pouch after an ileal conduit. The nurse explains that this is:
1. ACaused by crystals forming from a high-protein diet
2. BA sign of urinary infection needing a culture
3. CNormal, from the bowel segment used for the conduit
4. DA sign that the ureters are leaking into the bowel
Answer and explanation in LearnFree account
Question 17 · Medium
In predicted severe acute pancreatitis, early enteral feeding by nasogastric or nasojejunal tube is preferred to parenteral nutrition because it:
1. AAvoids the need for any later blood glucose monitoring
2. BRests the pancreas more completely than parenteral feeding
3. CGives more calories in the first week of the illness
4. DKeeps the gut barrier intact and lowers infected necrosis
Answer and explanation in LearnFree account
Question 18 · Hard
Three years after a total gastrectomy, a 58-year-old man has tiredness and tingling feet. Hb 8.6 g/dL, MCV 116 fL, hypersegmented neutrophils, serum B12 110 pg/mL (200-900), folate normal. Which treatment plan should the nurse teach?
1. ALifelong intramuscular vitamin B12 injections
2. BOral vitamin B12 until the Hb is normal
3. COral folic acid for four months, then stop
4. DOral iron with vitamin C for three months
Answer and explanation in LearnFree account
Question 19 · Medium
A woman has a sealed intracavitary brachytherapy source in place for cervical cancer. Which nursing practice is correct?
1. AKeep the patient in a shared ward near the station
2. BAllow visits of any length from pregnant relatives
3. CPick up a dislodged source with gloved hands
4. DPlan care so that time close to the patient is short
Answer and explanation in LearnFree account
Question 20 · Medium
At endoscopy for a bleeding peptic ulcer, which finding carries the highest risk of rebleeding?
1. AA flat, pigmented spot in the ulcer base
2. BActive arterial spurting from the ulcer
3. CAn adherent clot covering the ulcer
4. DA clean ulcer base with no stigmata
Answer and explanation in LearnFree account
Question 21 · Medium
Before and after each dose of cisplatin, the nurse gives large volumes of IV normal saline and checks urine output. The main purpose is to prevent:
1. AHaemorrhagic cystitis
2. BKidney damage from the drug
3. CPeripheral neuropathy
4. DCardiomyopathy
Answer and explanation in LearnFree account
Question 22 · Easy
An end ileostomy is formed with a spout that protrudes about 2-3 cm above the skin. The main purpose of the spout is to:
1. APrevent the stoma from prolapsing through the abdominal wall
2. BAllow the patient to irrigate the stoma each morning
3. CMake the stoma easier to see and to clean in the mirror
4. DDirect enzyme-rich effluent into the pouch, away from the skin
Answer and explanation in LearnFree account
Question 23 · Medium
Which parameter forms part of the Child-Pugh score but is not used in the MELD score?
1. AProthrombin time (INR)
2. BSerum creatinine
3. CSerum bilirubin
4. DSerum albumin
Answer and explanation in LearnFree account
Question 24 · Hard
A woman with cirrhotic ascites and no leg oedema is on spironolactone 100 mg and furosemide 40 mg. Over 3 days her weight fell from 64.0 to 59.5 kg, serum sodium from 134 to 126 mmol/L and creatinine from 0.8 to 1.6 mg/dL. What should the nurse do?
1. AHold the next dose and report over-diuresis
2. BIncrease oral salt and continue the diuretics
3. CContinue, since the weight loss is on target
4. DGive the dose and restrict fluids to 1 L a day
Answer and explanation in LearnFree account
Question 25 · Medium
A motorcyclist arrives with an open tibial fracture with bone visible through a wound. Apart from analgesia and splinting, which action is most time-critical?
1. AClose the wound tightly with sutures now
2. BClean the wound and push the bone back in
3. CStart IV antibiotics, ideally within one hour
4. DTake wound swabs before any antibiotic
Answer and explanation in LearnFree account

25 more Gastrointestinal, oncology, haematology and musculoskeletal nursing questions

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Gastrointestinal, oncology, haematology and musculoskeletal nursing

Aprepitant is added to ondansetron and dexamethasone before highly emetogenic chemotherapy. It works by blocking:

A low result in which single blood test is most specific for iron-deficiency anaemia?

A patient with megaloblastic anaemia has not yet had a vitamin B12 level checked. Why should folic acid not be given alone until B12 deficiency is ruled out?

The two commonest causes of acute pancreatitis in adults are:

A patient on antibiotics for 10 days has an ileostomy. At a pouch change, the peristomal skin under the flange shows a bright red, itchy rash with small separate red spots and pustules at its edges. The pouch has not leaked. What is the most likely cause and the correct care?

Ascitic fluid from a new patient gives a serum-ascites albumin gradient (SAAG) of 1.8 g/dL. This result most strongly suggests ascites due to:

On day 1 of acute pancreatitis, a patient had SpO2 86% needing oxygen; this recovered within 24 hours. On day 6, CT shows an acute peripancreatic fluid collection. Urine output and creatinine are normal throughout. By the revised Atlanta classification, the severity is:

The first stage of healing in a fractured long bone is:

A patient with cirrhosis is lethargic and disoriented to time but obeys commands, and has an obvious flapping tremor. By the West Haven criteria, this hepatic encephalopathy is grade:

Two days after a hip spica cast for a femoral fracture, a 15-year-old has repeated vomiting, abdominal distension and epigastric pain; bowel sounds are present. Which complication should the nurse suspect and report?

A 64-year-old with metastatic breast cancer has 3 days of confusion, thirst, polyuria, constipation and vomiting. Serum calcium is 14.2 mg/dL (8.5-10.5), albumin 4.0 g/dL, creatinine 1.5 mg/dL. Which measure comes first?

Acute pancreatitis is diagnosed when two of three criteria are met. The biochemical criterion is a serum lipase or amylase of at least:

After a dose of most myelosuppressive chemotherapy drugs, the neutrophil count is usually lowest (the nadir) at about:

Three weeks after surgery, a patient's colostomy has retracted to below skin level, and his flat pouches leak every few hours. Which appliance change is most likely to help?

Five weeks after an attack of acute pancreatitis, a man has early satiety, a full feeling in the epigastrium and a persistently raised amylase. Ultrasound shows a round, fluid-filled, walled-off collection. This is most likely a:

A patient asks why there are white threads of mucus in the urine in his urostomy pouch after an ileal conduit. The nurse explains that this is:

In predicted severe acute pancreatitis, early enteral feeding by nasogastric or nasojejunal tube is preferred to parenteral nutrition because it:

Three years after a total gastrectomy, a 58-year-old man has tiredness and tingling feet. Hb 8.6 g/dL, MCV 116 fL, hypersegmented neutrophils, serum B12 110 pg/mL (200-900), folate normal. Which treatment plan should the nurse teach?

A woman has a sealed intracavitary brachytherapy source in place for cervical cancer. Which nursing practice is correct?

At endoscopy for a bleeding peptic ulcer, which finding carries the highest risk of rebleeding?

Before and after each dose of cisplatin, the nurse gives large volumes of IV normal saline and checks urine output. The main purpose is to prevent:

An end ileostomy is formed with a spout that protrudes about 2-3 cm above the skin. The main purpose of the spout is to:

Which parameter forms part of the Child-Pugh score but is not used in the MELD score?

A woman with cirrhotic ascites and no leg oedema is on spironolactone 100 mg and furosemide 40 mg. Over 3 days her weight fell from 64.0 to 59.5 kg, serum sodium from 134 to 126 mmol/L and creatinine from 0.8 to 1.6 mg/dL. What should the nurse do?

A motorcyclist arrives with an open tibial fracture with bone visible through a wound. Apart from analgesia and splinting, which action is most time-critical?