Category: Uncategorized

1. 

   
   How many bones are there in human vertebra?

   • 25

   • 64

   • 33

   • 80

2. Which of the following chamber of heart pumps oxygenated blood towards the aorta?

   • Right atrium

   • Right ventricle

   • Left atrium

   • Left ventricle

3. The normal WBC count is……..

   • 4000-11000

   • 400000-900000

   • 150000-400000

   • 4.5-6.5 *10^6

4. The process of blood cells formation is called……..

   • Thrombocytosis

   • Leucocytosis

   • Erythropoiesis

   • Hemolysis

5. The normal intake of water per day is………

   • 1000ml

   • 2000ml

   • 1500ml

   • 2500ml

6. Which type of drug is mebendazole?

   • Antifungal

   • Antihelminitic

   • Antibactericidal

   • Antiviral

7. The safest route for injection is……..

   • Intravenous

   • Intraperitoneal

   • Intrapleural

   • Intracardinal

8. What is the pressure of vitreous humor in eyes?

   • 5-10 mm of Hg

   • 15-20 mm of Hg

   • 10-15 mm of Hg

   • 20-25 mm of Hg

9. The most important electrolyte of intracellular fluid is…….

   • Sodium

   • Calcium

   • Potassium

   • Chloride

10. The beta cell of islets of Langerhans secretes………hormone.

    • Glucagon

    • Glycogen

    • Insulin

    • Amylase

11. A patient is scheduled for a urinary catheterization, in which position should the nurse place the patient…….

    • Dorsal recumbent position

    • Supine position

    • Trendelenburg position

    • Prone position

12. Tachycardia means pulse rate……….

    • Below 60

    • Above 100

    • Below 100

    • Above 60

13. A patient is scheduled for NG feeding. In which position should the nurse place the patient……..

    • Low Fowler’s position

    • Trendelenburg

    • Supine position

    • Side lying position

14. The fastest route to give medicine is………

    • IV (intravenous)

    • ID (intradermal)

    • IM (intramuscular)

    • SC (subcutaneous)

15. Nosocomial infection is the infection acquired by………

    • Infected person

    • Community

    • Hospital

    • None of the above

16. Nepal Nursing Council was established in……

    • 193 BS

    • 2053 BS

    • 1954 BS

    • 2054 BS

17. A nurse administers an intravenous solution of 0.45 sodium chloride. With respect to human blood cell, to which category of fluid does this solution belong?

    • Isotonic

    • Hypotonic

    • Isometric

    • Hypertonic

18. A patient is to have gastric gavage. In which position should the nurse place the client when the gavage tube is being inserted…………

    • Supine position

    • High-Fowler’s position

    • Mid-Fowler’s position

    • Trendelenburg position

19. Which electrolyte of intracellular fluid is the most important?

    • Sodium chloride

    • Chloride

    • Calcium

    • Potassium

20. Sterile urine specimen is collected from…………

    • From clean bedpan or urinal

    • The first small amount of urine voided

    • Urine voided at midstream

    • All of the above

21. A patient is having dyspnea. To facilitate respiration, the nurse would….

    • Remove pillow from under the head

    • Elevate the head of the body

    • Elevate the foot of the body

    • Take the blood pressure

22. A patient has an abnormal, unexpected response to a drug this is defined as…….

    • Drug tolerance

    • A cumulative effect

    • Idiosyncratic effect

    • Anaphylactic

23. You are to administer a medication using a nasogastric tube. Before giving medicine, you should…….

    • Crush the enteric coated pill for mixing in a liquid

    • Flush open the tube with 60ml of very warm water

    • Check for proper placement of NG tube

    • Take the patient’s vital sign

24. Vitamin K, 10mg given IM, is ordered vitamin K is available as 5mg/ml. how much would the nurse administers?

    • 1 ml

    • 2 ml

    • 3 ml

    • 4 ml

25. While administering a blood transfusion, when would the nurse assess the patient for a blood transfusion reaction?

    • Every 15 minutes after the infusion is started

    • After the blood is all infused

    • Every hour

    • Every 15 minutes

26. When assessing a patient at risk for pressure ulcer formation, which site would the nurse identify as being most common?

    • Occipital area

    • Sacrum

    • Sternum

    • Humerus

27. A patient is receiving 100ml of IV fluid per 24 hours. Using an IV set with drop rate of 15 drops/ml the nurse should plan to regulate the IV is………

    • 10 drops/min

    • 15 drops/min

    • 20 drops/min

    • 30 drops/min

28. The identification of client’s health needs occurs in nursing process step of………..

    • Planning

    • Evaluation

    • Assessment

    • Implementation

29. Oxygen, Food and water are which of the following need according to Maslow’s hierarchy of human needs……

    • Physiological needs

    • Safety and security need

    • Love and belonging

    • Self esteem

30. When you find a person lying on the ground with a cardiopulmonary arrest, what will be the immediate action to be taken?

    • Assess responsiveness

    • Assess the airway

    • Assess circulation

    • Assess breathing

31. ICN (International Council of Nurses) was established in………

    • 1899 A.D

    • 1888 A.D

    • 1898 A.D

    • 1889 A.D

32. NLEN (National Licensure Examination for Nurses) is conducted by………

    • NNC

    • ICN

    • NAN

    • INC

33. If heat is transferred from one object to another by direct contact, it is……

    • Convection

    • Conduction

    • Evaporation

    • Radiation

34. When the elevated temperature fluctuates wildly but does not reach normal levels between fluctuation is called………

    • Constant fever

    • Remittent fever

    • Intermittent fever

    • Relapsing fever

35. Type of abnormal breathing which is the combination of hyperpnea and apnea………

    • Dyspnea

    • Orthopnea

    • Cheyne-Stokes breathing

    • Asphyxia

36. A client has temperature 104⁰F. This temperature is equal to……………

    • 38⁰C

    • 40⁰C

    • 41⁰C

    • 42⁰C

37. A patient is receiving blood transfusion, if an allergic reaction to the blood develops on patient, the nurse’s first intervention should be…….

    • Call the physician

    • Stop the blood immediately

    • Slow the flow rate of blood

    • Administer anti-allergic drug

38. Which is the unfavorable factor affecting wound healing?

    • Young age

    • Hemorrhage

    • Intake of protein, calcium, vitamin C

    • Blood supply to the injured part

39. For safe administration of drugs, the nurse should follow right …

    • 4 rights

    • 5 rights

    • 6 rights

    • 10 rights

40. For safe administration of drugs, the nurse should follow right …

    • Gluteus medius

    • Deltoid muscle

    • Gluteus minimus

    • Vastus lateralis

41. The process which makes inanimate objects safer to be handled by health personnel before cleaning is………….

    • Sterilization

    • High level disinfection

    • Decontamination

    • Cleaning

42. Recommended temperature, time pressure for autoclaving (steam under pressure)

    • 120⁰C (250⁰F), at 106kpa (15 Ibs/in 2) for 30 minutes

    • 110⁰C at 106 kpa (15 Ibs/in 2) for 30 minutes

    • 100⁰C at 106 kpa (15 Ibs/in 2) for 30 minutes

    • 90⁰C 106 kpa (15 Ibs/in 2) for 30 minutes

43. If nurse is administering a cleansing enema to a client enema to a client with a fecal impaction. Before administering the enema the nurse places the client in which position?

    • Left Sims position

    • Right Sims position

    • On the left side of the body, with the head of the bed elevated at 45 degree

    • None

44. Who will be third line manager for you at PHC?

    • Self

    • Medical superintendent

    • Medical officer

    • Chief of T/OH

45. A nurse is preparing to insert a nasogastric tube in an adult client. To determine the measurements of the length of the tube to be inserted, the nurse should………..

    • Mark the tube at 10 inches

    • Mark the tube at 32 inches

    • Place the tube at the tip of the nose and measures by extending the tube to the earlobe and then down to the xiphoid process

    • Place the tube at the tip of the nose and measure by extending the tube earlobe and then down to the sternum

46. Physician prescribed a hypotonic solution (IV) for a client. Which of the following IV solutions would the nurse except to prescribe………

    • 5% dextrose in water

    • 0.45% sodium chloride

    • 10% dextrose in water

    • 0.9% sodium chloride

47. The nurse has obtained a unit of blood from the blood bank and has checked the blood bag properly with another nurse. Just before beginning the transfusion, the nurse assess which of the following items?

    • Vital sign

    • Skin color

    • Urine output

    • Latest hematocrit level

48. Best type of solution to use for the irrigation of urinary catheter…

    • Distilled water

    • Normal saline

    • Tap water

    • Warm water

    • 

49. The most important way to prevent the spread of infection is………….

    • Wearing gloves

    • Hand washing

    • Wearing mask

    • Wearing coat

50. Which instrument is used to test the client’s hearing?

    • Stethoscope

    • Tuning fork

    • Otoscope

    • Reflex hammers

51. When is international nurse’s day celebrated?

    • 12th May

    • 12th March

    • 2nd May

    • 31st July

52. A nurse is preparing a preoperative client for transfer to the operating room. The nurse should take which action in the care of this client at this time?

    • Ensure that the client has voided

    • Administer all the daily medications

    • Practice postoperative breathing exercises

    • Verify that the client has not eaten for the last 24 hours

53. The nurse is performing an abdominal assessment the nurse performs which assessment at first…..

    • Auscultation

    • Inspection

    • Palpation

    • Percussion

54. While giving an intradermal injection the needle should be held at ……

    • 15⁰

    • 45⁰

    • 30⁰

    • 90⁰

55. Appropriate temperature of solution prepared for sitz-bath should be………

    • 105-110⁰ F

    • 100-105⁰F

    • 110-115⁰F

    • 115-120⁰F

56. The nurse determines that a client is having a transfusion reaction. After the nurse stops the transfusion, which action should immediately be taken next………

    • Remove IV line

    • Run normal saline at a keep vein open rate

    • Run a solution of 5% dextrose in water

    • Obtain a culture of the tip of catheter device removed from the client

57. When suctioning an unconscious client, which nursing intervention should the nurse prioritize in maintaining cerebral perfusion….

    • Administer diuretics

    • Administer analgesics

    • Provide hygiene

    • Hyper oxygenate before

58. Savlon is……..

    • Cetrimide

    • Chlorhexidine

    • Chloroxylenol

    • A and B

59. Scald is a burn caused by……….

    • Dry heat

    • Radiation

    • Moist heat

    • Friction

    • 

60. When you perform CPR on an unresponsive adult, you should correctly assess the pulse of which location?

    • Over the radial artery

    • Over the carotid artery

    • Over the brachial artery

    • Over the temporal artery

61. Which of the following would the nurse use as the most reliable indicator of a patient’s fluid balance status?

    • Intake and output

    • Skin turgor

    • Complete blood count

    • Daily weight

62. Health policy formation in Nepal since……

    • 1991 AD

    • 1998 AD

    • 1995 AD

    • 1999 AD

63. Trachoma is a disease of………….

    • Eye lid

    • Cornea

    • Conjunctiva

    • Lachrymal gland

64. Koplik’s spot is the clinical feature of……….

    • Measles

    • Tuberculosis

    • Chicken pox

    • Leprosy

65. BCG vaccine is against………..

    • Measles

    • Diphtheria

    • Tuberculosis

    • Whooping cough

66. DOTS stand for………….

    • Directly observed treatment short course

    • Direct observed treatment short course

    • Direct observed treatment system

    • Directly observed treatment system

67. The vector for malaria is………….

    • Plasmodium vivax

    • Plasmodium falciparum

    • Plasmodium malaria

    • Female anopheles mosquito

68. HIV/AIDS is caused by a………….

    • Retro virus

    • Rhabdo virus

    • Rota virus

    • Pox virus

69. Which of the following is waterborne disease?

    • Meningitis

    • Typhoid

    • Hepatitis A

    • Malaria

70. Kala-azar is caused by…………vector

    • Malaria

    • Sand fly

    • Housefly

    • Bee

71. Syphilis is caused by………….

    • Salmonella Typhi

    • Neisseria gonorrhea

    • Treponema pallidum

    • Streptococcus

72. What type of vaccination is given against measles?

    • Live attenuated

    • Killed

    • Toxoid

    • Inactive

73. Which of the following is principle of primary health care?

    • Health education

    • Dental health

    • Mental health

    • Community participation

74. Oral contraceptives act by……………

    • Preventing ovulation

    • Making endometrial non-reactive to embryo

    • Making inactive to sperm

    • Inhibiting sperm penetration to the ovum

75. The ages of child to receive DPT vaccine are………….

    • 6 week, 10 week, 14 week

    • 6 week, 7 week, 8 week

    • 6 week, 7 week, 8 week

    • 1 week, 2 week, 3 week

76. When was the ALMA Ata conference held?

    • 1972

    • 1988

    • 1978

    • 1990

77. Which of the following comes under STDs disease?

    • HIV/AIDS

    • Typhoid

    • Diarrhea

    • Leprosy

78. When oral contraceptives are prescribed for a patient, the nurse should teach the client about the potential of developing……….

    • Cervicitis

    • Fibrocystic disease

    • Ovarian cyst

    • Break through bleeding

79. Which of the following are not the 6 killer diseases?

    • ARI

    • Diarrhea

    • Measles

    • Meningitis

80. When emergency contraceptive should be taken after the unprotected sexual intercourse?

    • Within 24 hrs

    • Within 48 hrs

    • Within 36 hrs

    • Within 72 hrs

81. What is the best method of solid waste disposal?

    • Composting

    • Incineration

    • Dumping

    • Burial

82. Which of the following permanent family planning method requires contraceptives at least for 20 ejaculation surgery?

    • Vasectomy

    • Laparoscopy

    • Minilap

    • Norplant

83. The comprehensive assessment of the health status of an entire community is called……….

    • Community diagnosis

    • Micro-teaching

    • Home visit

    • Health education

84. Which type of approach is used in home visit?

    • Individual approach

    • Group approach

    • Mass approach

    • Media approach

85. Which of following contraceptives is excluded in the outreach clinic?

    • Oral pills

    • ORS packet

    • Condom

    • Norplant

86. The cases occurs irregular haphazardly form time to time and generally infrequently is…………

    • Epidemic

    • Sporadic

    • Pandemic

    • None

NNC License Model Questions Set (May 2025)

Table of Contents(toc)

Important Nursing MCQs Model Questions

1. What is the pressure of vitreous humor in the eyes?

• 5-10 mm of HG

• 15-20 mm of HG

• 10-15 mm of HG

• 20-25 mm of HG

2. How many bones are present in the human vertebra?

• 25

• 64

• 33

• 80

3. The process of blood cell formation is known as…

• Thrombocytosis

• Leucocytosis

• Erythropoiesis

• Hemolysis

4. Which of the following is the most important electrolyte of intracellular fluid?

• Sodium

• Calcium

• Potassium

• Chloride

5. The safest route for injection is…

• Intravenous

• Intraperitoneal

• Intrapleural

• Intracardial

6. The normal WBC count is…

• 4000-11000

• 400000-900000

• 150000-400000

• 4.5-6.5 *10⁶

7. A nurse is administering a hypotonic IV solution. Which of the following is the correct solution?

• 5% dextrose in water

• 0.45% sodium chloride

• 10% dextrose in water

• 0.9% sodium chloride

8. What is the normal intake of water per day?

• 1000 ml

• 2000 ml

• 1500 ml

• 2500 ml

9. The beta cells of Islets of Langerhans secrete which hormone?

• Glucagon

• Glycogen

• Insulin

• Amylase

10. Which chamber of the heart pumps oxygenated blood to the aorta?

• Right atrium

• Right ventricle

• Left atrium

• Left ventricle

11. A patient is scheduled for urinary catheterization. In which position should the nurse place the patient?

• Dorsal recumbent position

• Supine position

• Trendelenburg position

• Prone position

12. The fastest route for administering medicine is…

• IV (Intravenous)

• ID (Intradermal)

• IM (Intramuscular)

• SC (Subcutaneous)

13. When is International Nurses Day celebrated?

• 12th May

• 12th March

• 2nd May

• 31st July

14. The most effective way to prevent the spread of infection is…

• Wearing gloves

• Hand washing

• Wearing a mask

• Wearing a coat

15. A patient is having dyspnea. To facilitate respiration, the nurse would…

• Remove the pillow from under the head

• Elevate the head of the bed

• Elevate the foot of the bed

• Take the blood pressure

How to check ctevt result with marksheet?

.link-area {
display: flex;
justify-content: center;
align-items: center;
height: 100vh;
margin: 0;
background-color: #f0f8ff;
}

.decorated-box {
padding: 40px;
border: 3px dashed #007BFF;
border-radius: 15px;
background-color: #e6f7ff;
box-shadow: 5px 5px 15px rgba(0, 0, 0, 0.1);
}

.decorated-link {
font-size: 24px;
font-weight: bold;
color: white;
background-color: #007BFF;
padding: 15px 30px;
border-radius: 12px;
text-decoration: none;
box-shadow: 3px 6px 10px rgba(0, 0, 0, 0.2);
transition: background-color 0.3s ease, box-shadow 0.3s ease;
}

.decorated-link:hover {
background-color: #0056b3;
box-shadow: 5px 8px 12px rgba(0, 0, 0, 0.3);
}

Deep tendon reflexes roots

Superficial reflexes roots

Model Question 

Vital Signs

• Blood Pressure: <120 mmHg Systolic, <80 mmHg Diastolic
• Heart Rate: 60 – 100 bpm
• Respirations: 12 – 20 breaths/min
• Oxygen Saturation: 92% – 100%
• Temperature: 97.8°F – 99°F

Complete Blood Count (CBC)

• Hemoglobin: 12 – 18 g/dL
• Hematocrit: 35% – 55%
• Total RBC: 4 – 6 million/mm³
• Platelets: 150,000 – 400,000 /mm³
• WBC: 4,000 – 10,000 /mm³

Electrolytes

• Sodium: 135 – 145 mEq/L
• Potassium: 3.5 – 5 mEq/L
• Magnesium: 1.3 – 2.1 mEq/L
• Calcium: 9 – 10.5 mg/dL
• Phosphorous: 3.0 – 4.5 mg/dL
• Ammonia: 15 – 45 µg/dL

Liver Panel

• ALT: 10 – 36 U/L
• AST: 0 – 35 U/L
• Bilirubin: 0.2 – 1.2 mg/dL
• Total Protein: 6 – 8 g/dL

Arterial Blood Gas (ABG)

• pH: 7.35 – 7.45
• PaCO2: 35 – 45 mmHg
• PaO2: 80 – 100 mmHg
• HCO3 (Bicarbonate): 22 – 26 mEq/L

Coagulation / Cardiac Enzymes

• PT: 10 – 20 seconds
• PTT: 25 – 35 seconds
• INR: 2 – 3
• Troponin T: <0.10 ng/mL
• Troponin I: <0.03 ng/mL
• BNP: <100

Renal Function

• BUN: 7 – 20 mg/dL
• Creatinine: 0.6 – 1.2 mg/dL
• Creatinine Clearance: 85 – 135 mL/min
• Serum Albumin: 3.5 – 5.5 g/dL
• Specific Gravity: 1.010 – 1.030

Random Values

• ICP: 7 – 15 mmHg
• MAP: 70 – 100 mmHg
• Amylase: 30 – 200 U/L
• Lipase: 0 – 160 U/L

Metabolism

• Cholesterol: <200
• LDL: <70
• HDL: >60
• Triglycerides: <150
• Glucose: <200
• Hemoglobin A1C: 4 – 5.7%

TU Staff Nurse Mode Questions 1-20

1. Providing health education about environmental hygiene to community
   members is:

   • A. Structural communication
   • B. Social communication
   • C. Formal communication
   • D. Therapeutic communication

2. Which of the following is not a visual aid used in health
   education?

   • A. Chart
   • B. Film strip
   • C. Audio cassette
   • D. Poster

3. Which hepatitis is transferred through institutional and health
   settings?

   • A. Hepatitis D
   • B. Hepatitis C
   • C. Hepatitis B
   • D. Hepatitis A

4. Iodination of salt is an example of which level of prevention?

   • A. Primary prevention
   • B. Primordial prevention
   • C. Secondary prevention
   • D. Tertiary prevention

5. Capnography measures:

   • A. CO
   • B. N2
   • C. Carbon dioxide
   • D. Hydrogen

6. Which of the following is not a side effect of morphine
   sulfate?

   • A. Absence of deep tendon reflex
   • B. Decreased respiration
   • C. Increased respiration rate
   • D. Decreased CNS

Subscribe to YouTube Channel


7. The plasma osmolarity range is:

   • A. 240-250 mosl/kg H2O
   • B. 270-280 mosl/kg H2O
   • C. 220-230 mosl/kg H2O
   • D. 280-295 mosl/kg H2O

8. Arterial blood pH is:

   • A. 7.2
   • B. 7.4
   • C. 7.3
   • D. 7.8

9. Which is not included in ethical principles?

   • A. Justice
   • B. Maleficence
   • C. Autonomy
   • D. Non-maleficence

10. Aspirin should be taken with which of the following drinks?

• A. Milk
• B. Orange juice
• C. Soda
• D. Full glass of water

11. The first branch of the human aorta is:

• A. Left subclavian artery
• B. Brachiocephalic artery
• C. Coronary artery
• D. Left common carotid artery

12. The least blood pressure is found in:

• A. Aorta
• B. Capillary
• C. Vein
• D. Vena cava

13. Extracellular fluids are rich in the following except:

• A. K+
• B. HCO3-
• C. Na+
• D. Ca2+

14. The left border of the heart is formed by:

• A. Right ventricle
• B. Left atrium
• C. Left atrium and left ventricle
• D. Left ventricle

15. Which of the following is the correct pathway for the propagation of the
    cardiac impulse?

• A. AV node → Bundle of His → SA node → Purkinje fibers
• B. SA node → Purkinje fibers → AV node → Bundle of His
• C. SA node → AV node → Bundle of His → Purkinje fibers
• D. Purkinje fibers → AV node → SA node → Bundle of His

16. The blood in the mammalian heart pumped by the right ventricle passes out
    of the orifice guarded by:

• A. Bicuspid valve
• B. Tricuspid valve
• C. Aortic arch
• D. Pulmonary valve

17. Fibrous cords called ___________ connect the free valve margins and
    ventricular surfaces of the valve cusps to papillary muscles and
    ventricular walls.

• A. Chordae tendineae
• B. Lunulae
• C. Bundle of His
• D. Kent bundles

18. Intra-aortic balloon pump therapy is used for the treatment of:

• A. Congestive heart failure
• B. Cardiogenic shock
• C. Pulmonary edema
• D. Aortic insufficiency

19. Which of the following assessment findings would elicit specific
    information regarding the left ventricular function of a patient with left
    ventricular failure?

Subscribe to YouTube Channel

• A. Assessing peripheral and sacral edema
• B. Assessing jugular vein distention
• C. Monitoring for organomegaly
• D. Listening to lung sounds

20. Which of the following ECG findings indicates the presence of
    hypokalemia?

• A. Tall, peak T wave
• B. ST segment depression
• C. Widening of the QRS complex
• D. Prolonged PR interval

21. Bruce protocol is related to:

• A. CABG
• B. Echocardiogram
• C. Angiogram
• D. Exercise ECG test

22. A patient has developed atrial fibrillation and his ventricular rate is
    150 beats per minute. What should the patient be assessed for
    next?

• A. Flat neck veins
• B. Complaints of nausea
• C. Complaints of headache
• D. Hypotension

23. Which of the following beverages can be included in the menu of a patient
    with myocardial infarction?

• A. Coffee
• B. Tea
• C. Cola
• D. Lemonade

24. A patient is undergoing cardiac catheterization. Which of the following
    sensations reported by the patient during the procedure has the highest
    priority?

• A. Pressure at the insertion site
• B. Urge to cough
• C. Warm, flushed feeling
• D. Chest pain

25. A patient recovering from cardiac surgery has a pleural effusion on the
    left side and is having thoracentesis. The patient should be placed in
    which position for the procedure?

• A. Upright and leaning forward with the arms on the over-the-bed table
• B. Right-side lying with legs curled up into a fetal position
• C. Left-lateral with the right arm supported by a pillow
• D. Dorsal recumbent

26. Which of the following statements about Prinzmetal’s (variant) angina is
    correct?

• A. Managed most effectively with beta-blocking drugs
• B. Drug of choice in variant angina is nitrates
• C. Generally treated with calcium channel blockers
• D. Improves with low-sodium, high-potassium diet

27. The cardiac rhythm is:

• A. Sinus bradycardia
• B. Sinus tachycardia
• C. Normal sinus rhythm
• D. First-degree heart block

28. A patient with myocardial infarction experiencing new multiform,
    premature contractions. The patient is allergic to lidocaine
    hydrochloride. What is the next drug of choice for immediate use?

• A. Digoxin
• B. Metoprolol
• C. Verapamil
• D. Procainamide

29. A patient with complete heart block has had a permanent demand pacemaker
    inserted. The pacemaker function is considered to be proper if the ECG
    rhythm strip shows the presence of a pacemaker spike:

• A. Just after each T wave
• B. Before each QRS complex
• C. Just after each P wave
• D. Before each P wave

30. Which of the following interventions is contraindicated in a patient with
    deep vein thrombosis of the right leg?

• A. Elevation of the limb
• B. Ambulation in the hall every 4 hours
• C. Application of moist heat to the right leg
• D. Administration of analgesics

31. The circumflex artery is a branch of:

• A. Right coronary artery
• B. Anterior descending artery
• C. Left coronary artery
• D. Descending aorta

32. Apical pulse is taken by placing the diaphragm of the stethoscope at the
    area of:

• A. Right atrium
• B. Right ventricle
• C. Pulmonic valve
• D. Mitral area

33. A female patient who has had a myocardial infarction asks the nurse why
    she should not bear down or strain to ensure having a bowel movement. The
    nurse informs her that this would trigger:

• A. Vagus nerve stimulation, causing a decrease in heart rate and cardiac
  contractility

Subscribe to YouTube Channel

• B. Vagus nerve stimulation, causing an increase in heart rate and cardiac
  contractility
• C. Sympathetic nerve stimulation, causing an increase in heart rate and
  cardiac contractility
• D. Sympathetic nerve stimulation, causing a decrease in heart rate and
  cardiac contractility

34. Which of the following interventions is NOT indicated in a patient with
    stable ventricular tachycardia?

• A. Assess airway, breathing, and circulation
• B. Administer oxygen
• C. Obtain an ECG
• D. Defibrillate the patient

35. Which of the following manifestations differentiates pericarditis from
    other cardiopulmonary problems?

• A. Chest pain that worsens on expiration
• B. Pericardial friction rub
• C. Anterior chest pain
• D. Weakness and irritability

36. Which of the following is NOT associated with cardiac tamponade?

• A. Pulsus paradoxus
• B. Distant heart sounds
• C. Distended jugular veins
• D. Bradycardia

37. Digitalis functions to improve congestive heart failure by:

• A. Induction of emesis
• B. Activation of beta-adrenergic receptors
• C. Improving survival in patients with heart failure
• D. Binding to and inhibiting the Na–K ATPase enzyme in cardiac myocytes

38. A nurse is caring for a client who is being discharged after cardiac
    surgery. The client has a prescription for enoxaparin to take at home.
    Which of the following discharge information should the nurse give to this
    client?

• A. Do not eat red meat or any substance that contains tyramine
• B. Drink an eight-ounce glass of water each evening before going to bed
• C. Use a soft toothbrush for brushing teeth and an electric razor for
  shaving
• D. Avoid wearing sandals or shoes for longer than 6 hours at a time

39. Nurse Kumari, a triage nurse, encountered a client who complained of
    mid-sternal chest pain, dizziness, and diaphoresis. Which of the following
    nursing actions should take priority?

• A. Administer oxygen therapy via nasal cannula
• B. Notify the physician
• C. Complete history taking
• D. Put the client on ECG monitoring

40. The emergency medical service has transported a client with severe chest
    pain. As the client is being transferred to the emergency stretcher, you
    note unresponsiveness, cessation of breathing, and an unpalpable pulse.
    Which of the following tasks is appropriate to initiate first?

• A. Establish an IV line and administer oxygen
• B. Begin cardiopulmonary resuscitation (CPR)
• C. Administer aspirin and morphine
• D. Perform defibrillation if indicated

healthy salad

Introduction (What is intermittent fasting?)

Intermittent fasting (IF) has become popular for its potential health
benefits. However, whether it is actually useful depends on various factors
such as individual goals, lifestyle, and health conditions. Here are some key
points on its usefulness:

Benefits of intermittent fasting

1. Weight Loss

• Supports Calorie Control:
  By restricting the eating window, many people naturally consume fewer
  calories, which can lead to weight loss.
• Increases Fat Burning:
  Fasting periods trigger hormonal changes that increase fat breakdown and
  use it for energy.

2.
Improved Insulin Sensitivity

• Helps Manage Blood Sugar:
  Intermittent fasting can improve insulin sensitivity, making it beneficial
  for managing blood sugar levels, particularly for people with Type 2
  diabetes or prediabetes.
• Reduces Insulin Resistance: It may help reduce the risk of developing insulin resistance, which is
  a key factor in obesity and type 2 diabetes.

3.
Cellular Repair and Autophagy

• Cellular Maintenance:
  During fasting, the body enters a state of autophagy, where it breaks down
  and removes dysfunctional proteins and cells, promoting cellular repair.
• Boosts Longevity: Some
  studies suggest that intermittent fasting may contribute to longevity by
  stimulating autophagy and reducing oxidative stress.

4.
Mental Clarity and Cognitive Function

• Improved Brain Function: Fasting may support brain health by boosting the production of
  brain-derived neurotrophic factor (BDNF), which plays a role in cognitive
  function and mood regulation.
• Reduced Inflammation:
  Intermittent fasting may help reduce inflammation, which is linked to
  neurological diseases like Alzheimer’s and Parkinson’s.

5. Hormonal Benefits

• Increases Growth Hormone: Fasting increases the secretion of human growth hormone (HGH), which
  plays a role in fat loss and muscle preservation.
• Improved Fat Metabolism: It enhances the breakdown of stored fat for energy, making it easier to
  burn fat rather than carbohydrates.

6. Heart Health

• Reduces Blood Pressure:
  Some studies suggest intermittent fasting can help lower blood pressure
  and reduce the risk of heart disease.
• Improves Lipid Profiles: IF may reduce LDL cholesterol, triglycerides, and other markers of
  heart disease, contributing to overall cardiovascular health.

7.
Simplicity and Flexibility

• Easy to Follow: Many
  people find intermittent fasting simple because it doesn’t require complex
  meal plans or calorie counting.
• Fits Various Lifestyles: It offers flexibility in terms of when to eat, making it easier to
  adopt into different routines.

8. Sustainability

• Long-Term Commitment:
  For IF to be effective, it needs to be practiced consistently over time,
  and some individuals may find it difficult to maintain.
• Possible Plateaus: Some
  people experience weight loss plateaus after extended periods of fasting,
  requiring adjustments in the routine.

9. Scientific Support

• Positive Research:
  Numerous studies support the benefits of intermittent fasting for weight
  loss, metabolic health, and disease prevention.
• More Research Needed:
  While there is promising evidence, more long-term research is needed to
  fully understand the long-term effects of intermittent fasting.

Potential Drawbacks of Intermittent fasting (IF)

• Hunger and Cravings:
  Initially, people may struggle with hunger and cravings, which could
  lead to overeating during eating windows.
• Disrupts Social Life:
  IF may interfere with social gatherings or family meals, as it requires
  strict eating windows.
• Not Suitable for Everyone: It may not be appropriate for people with certain health conditions
  like eating disorders, low blood pressure, or pregnant and breastfeeding
  women.

Types of Intermittent Fasting (How to do intermittent fasting?)

Intermittent fasting includes different strategies, with alternate-day
fasting and time-restricted feeding (TRF) being two of the most popular
approaches. Both have been shown to be effective for weight loss, but
they do not appear to offer significant benefits over other
calorie-restricting diets.

Alternate-Day Fasting

Alternate-day fasting involves alternating between fasting days and
eating days. On fasting days, a person consumes about 25% of their daily
caloric needs, while on feast days, they can eat more freely, typically
around 125% of their caloric needs.

• Effectiveness for Weight Loss: Studies show that alternate-day fasting is an effective strategy
  for weight reduction. A network meta-analysis of 24 randomized trials
  found that alternate-day fasting was comparable to regular caloric
  energy restriction diets in terms of weight loss.
• Example Study: In a
  trial involving 100 individuals with obesity, those following
  alternate-day fasting (25% of total energy needs on fast days and 125%
  on feast days) experienced a weight loss of 6.8% of their body weight
  over six months. This was comparable to those following a regular
  calorie restriction diet (75% of energy needs daily), who lost 6.0% of
  their body weight.

Subscribe to YouTube Channel

Time-Restricted Feeding (TRF)

Time-restricted feeding is a type of intermittent fasting where eating
is limited to a specific window of time, usually between 8 to 10 hours a
day (e.g., eating between 12 PM to 8 PM). The extended fasting period
between meals aligns with natural circadian rhythms and has been
associated with various health benefits.

• Simplicity and Benefits: TRF offers a simplified meal-planning approach as it doesn’t
  require calorie counting. The focus is on limiting the eating window,
  which naturally leads to prolonged periods of fasting.
• Weight Loss and Metabolic Benefits: Short-term studies have suggested that TRF, when aligned with
  circadian rhythms, can help with weight loss and improve metabolic
  parameters, such as insulin sensitivity and fat metabolism.
• Effectiveness Compared to Calorie Restriction: Some trials have shown that TRF may be beneficial, but its efficacy
  compared to regular calorie restriction remains uncertain. For
  instance, in a randomized trial with 139 adults with obesity,
  participants who followed calorie restriction with TRF (eight
  hours/day) lost 8 kg, while those who followed calorie restriction
  without TRF lost 6.4 kg. However, the difference in weight loss
  between the two groups was not statistically significant at 12 months.

Mechanisms of Action

The mechanisms by which intermittent fasting, including TRF, influences
health are still not completely understood. However, some key factors
include:

• Caloric Restriction: Both alternate-day fasting and TRF lead to reduced overall caloric
  intake, contributing to weight loss.
• Improved Insulin Sensitivity: Intermittent fasting may enhance insulin sensitivity, which can
  lead to better metabolic control and a reduced risk of Type 2
  diabetes.
• Anti-inflammatory Effects: Both fasting methods may exert anti-inflammatory effects,
  potentially lowering the risk of chronic diseases such as
  cardiovascular disease.

Table of Contents(toc)

High Altitude Pulmonary Edema (HAPE) in Nepal: A Silent Killer in the
Himalayas

Nepal, home to eight of the world’s fourteen highest peaks, including Mount
Everest, is a paradise for trekkers and mountaineers. However, the
breathtaking landscapes also pose serious health risks, one of the most
dangerous being High Altitude Pulmonary Edema (HAPE). This
life-threatening condition affects individuals who ascend to high altitudes
too quickly without proper acclimatization, leading to fluid accumulation in
the lungs and potentially fatal respiratory failure.

What is HAPE?

HAPE is a severe form of altitude sickness caused by exposure to low oxygen
levels at high elevations, typically above
2,500 meters (8,200 feet).

It is characterized by fluid
leakage from pulmonary capillaries into the lungs due to hypoxic pulmonary
vasoconstriction, which increases pulmonary arterial pressure. 

Unlike other
forms of altitude sickness, HAPE can develop even in healthy individuals with
no prior history of altitude illness.

How does HAPE occur?

Essentially, elevated mean pulmonary artery pressure (>35-40 mmHg) plays a
crucial role in initiating HAPE, but it is not sufficient by itself. The
second key factor is uneven vasoconstriction in the pulmonary circulation.

The process can be explained as follows:

1. Elevated Pulmonary Artery Pressure:
   The increase in pulmonary artery pressure is triggered by the lower oxygen
   levels at high altitudes, which causes hypoxic pulmonary vasoconstriction.
   This elevated pressure is a significant factor in HAPE but is not the only
   cause.

2. Uneven Vasoconstriction:
   In the lungs, hypoxia induces vasoconstriction, but this response is not
   uniform across the pulmonary vasculature. Certain capillary beds in the
   lungs constrict less than others, and those areas are exposed to higher
   microvascular pressures (>20 mmHg).

3. Overperfusion and Capillary Stress:
   These areas of uneven vasoconstriction receive disproportionately more
   blood flow, leading to overperfusion. This increases the stress on the
   alveolar-capillary barrier, which eventually fails under the pressure.

4. Alveolar-Capillary Barrier Failure and Pulmonary Edema:
   The failure of the alveolar-capillary barrier results in leakage of fluid
   into the alveoli, leading to pulmonary edema. This edema tends to be
   patchy, which is characteristic of HAPE.

Risk Factors for HAPE

Several factors contribute to the development of HAPE, including:

• Rapid Ascent: Climbing too quickly without proper
  acclimatization.
• Individual Susceptibility: Genetic predisposition can make
  some individuals more prone.
• Cold Temperatures: Cold exposure can exacerbate pulmonary
  hypertension.
• Strenuous Physical Activity: Excessive exertion at high
  altitudes increases oxygen demand and stress on the lungs.
• History of HAPE: Those who have had HAPE before are at
  higher risk.

Symptoms of HAPE

HAPE symptoms usually appear within 1-4 days of ascent and worsen if ignored.
Early signs include:

• Shortness of breath at rest
• Persistent dry cough or frothy sputum
• Rapid heart rate and breathing
• Cyanosis (bluish skin or lips)
• Fatigue, confusion, or difficulty walking
• Crackling sounds in the lungs on auscultation

Without prompt intervention, HAPE can rapidly progress to
respiratory failure and death.

HAPE in Nepal: A Major Concern

Nepal’s trekking routes, such as
Everest Base Camp (5,364m), Annapurna Circuit (5,416m), and Manaslu Circuit
(5,106m), attract thousands of adventurers yearly. However, many suffer from
altitude-related illnesses due to poor acclimatization and underestimating the
risks. HAPE cases are frequently reported in places like
Lukla, Namche Bazaar, and Gorak Shep, where rapid altitude
gain is common.

Prevention: The Key to Safety

Preventing HAPE is crucial, as it is easier to avoid than to treat in remote
areas. Follow these guidelines:

• Gradual Ascent: Follow the “300-500 meters per day” rule above 3,000m.
• Acclimatization Days: Spend an extra night at intervals to
  allow your body to adjust.
• Hydration and Nutrition: Drink plenty of fluids and consume
  high-energy foods.
• Avoid Alcohol and Sedatives: These can depress breathing
  and worsen symptoms.
• Recognize Symptoms Early: Immediate descent is the best
  treatment.
• Medications: Acetazolamide (Diamox) can aid
  acclimatization, and nifedipine may help prevent HAPE in susceptible
  individuals.

Treatment and Emergency Response

If HAPE develops, immediate action is critical:

• Descend Immediately: The single most effective treatment.
• Oxygen Therapy: Supplemental oxygen can relieve symptoms.
• Portable Hyperbaric Chambers: These simulate lower altitude
  conditions and are used in remote trekking areas.
• Medications: Nifedipine, a calcium channel blocker, reduces
  pulmonary artery pressure.

Conclusion

HAPE remains a significant yet preventable hazard for
trekkers and climbers in Nepal. Proper acclimatization, awareness, and timely
intervention can save lives. Whether you are trekking to
Everest Base Camp or exploring the Annapurna Circuit,
respecting the altitude and listening to your body can ensure a safe and
memorable journey in the majestic Himalayas.

Stay informed, climb responsibly, and enjoy Nepal’s mountains
safely!