Ethiopian Nursing University Exit Exam Practice Questions (50 Items)-Part 1

Part 1: Adult Health Nursing (Medical-Surgical Nursing)

Q1. A 45-year-old male patient is admitted to the medical ward with a diagnosis of Acute Cirrhosis. The nurse notes severe abdominal distension, shifting dullness, and a positive fluid thrill. Which of the following collaborative interventions is the priority to immediately relieve severe respiratory distress caused by this fluid accumulation? A) Strict dietary sodium restriction to less than 2 grams per day B) Administration of high-dose oral Spironolactone C) Assisting the physician with an emergency therapeutic paracentesis D) Administering a standard dose of intravenous Furosemide

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• Correct Answer: C
• Rationale: While diuretics and sodium restriction treat the underlying fluid retention over time, an emergency therapeutic paracentesis physically removes fluid from the peritoneal cavity, instantly relieving pressure on the diaphragm and resolving acute respiratory distress.

Q2. A nurse is caring for a 55-year-old patient who underwent a total thyroidectomy 24 hours ago. The patient reports a tingling sensation around the mouth and fingertips, and the nurse observes a positive Chvostek’s sign. Which of the following medications should the nurse prepare for immediate administration? A) Potassium Chloride intravenously B) Calcium Gluconate intravenously C) Levothyroxine sodium orally D) Sodium Bicarbonate intravenously

• Correct Answer: B
• Rationale: A tingling sensation and a positive Chvostek’s sign (facial muscle twitching when the facial nerve is tapped) indicate acute hypocalcemia, a common complication of thyroidectomy if the parathyroid glands are accidentally damaged or removed. Intravenous calcium gluconate is the definitive immediate emergency treatment.

Q3. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with an acute exacerbation. The physician orders oxygen therapy. Which oxygen delivery device is most precise for delivering a controlled, specific low fraction of inspired oxygen (FiO2​) to prevent respiratory depression in this patient? A) Simple face mask B) Non-rebreather mask C) Venturi mask D) Nasal cannula

• Correct Answer: C
• Rationale: The Venturi mask is the most accurate and precise device for delivering a specific concentration of oxygen (FiO2​). This is vital for COPD patients who rely on a hypoxic drive to breathe, as excessive unmetered oxygen can suppress their respiratory drive.

Q4. A 62-year-old male patient with Type 2 Diabetes Mellitus is admitted with a deep, non-healing ulcer on the plantar surface of his right foot. He states he did not feel the injury occur. The nurse understands that this ulcer is primarily a consequence of which underlying diabetic complication? A) Autonomic cardiovascular neuropathy B) Peripheral sensory neuropathy C) Microvascular retinopathy D) Acute arterial occlusion

• Correct Answer: B
• Rationale: Peripheral sensory neuropathy leads to a loss of protective sensation (pain, temperature, pressure) in the lower extremities. Consequently, diabetic patients experience repetitive, unperceived trauma that breaks down tissue and forms neuropathic ulcers.

Q5. A nurse is monitoring a patient who is receiving a blood transfusion for severe anemia. Fifteen minutes after the transfusion starts, the patient develops chills, a high fever, lower back pain, and a sudden drop in blood pressure. What is the very first action the nurse must take? A) Notify the physician immediately B) Slow down the rate of the blood transfusion C) Stop the blood transfusion immediately and disconnect the tubing at the hub D) Administer intramuscular Epinephrine

• Correct Answer: C
• Explanation: These signs indicate an acute hemolytic transfusion reaction, a life-threatening emergency. The nurse’s immediate priority is to stop the infusion of incompatible blood completely to minimize the volume of cells hemolyzed, keeping the vein open with a new line of normal saline.

Q6. A 28-year-old male is admitted with a diagnosis of Diabetic Ketoacidosis (DKA). The nurse observes deep, rapid, sighing respirations. How should the nurse document this specific breathing pattern? A) Cheyne-Stokes respirations B) Kussmaul’s respirations C) Biot’s respirations D) Apneustic breathing

• Correct Answer: B
• Rationale: Kussmaul’s respirations are deep, rapid breathing patterns that occur as a compensatory mechanism in metabolic acidosis (like DKA) to blow off excess carbon dioxide and raise systemic pH.

Q7. A nurse is assessing a patient with a suspected deep vein thrombosis (DVT) in the left lower leg. Which of the following clinical findings is most characteristic of an acute DVT? A) Symmetrical bilateral pedal edema with cold, pale skin B) Unilateral calf tenderness, swelling, warmth, and erythema C) Absent popliteal and dorsalis pedis pulses with a shiny skin appearance D) Pain that decreases when the affected leg is placed in a dependent position

• Correct Answer: B
• Rationale: An acute DVT causes a localized inflammatory and obstructive response, manifesting typically as unilateral calf pain, measurable swelling, localized warmth, and redness.

Q8. A patient is admitted to the emergency unit with severe, crushing substernal chest pain radiating to the left jaw, accompanied by diaphoresis and nausea. The electrocardiogram (ECG) reveals ST-segment elevation in leads V1 to V4. Which area of the myocardium is affected? A) Inferior wall B) Lateral wall C) Anterior wall D) Posterior wall

• Correct Answer: C
• Rationale: ST-segment elevation in leads V1 through V4 indicates an acute anterior wall myocardial infarction, typically associated with an occlusion of the left anterior descending (LAD) coronary artery.

Q9. While evaluating a patient with a closed chest injury and a newly inserted chest tube drainage system, the nurse notes continuous, vigorous bubbling in the water-seal chamber. How should the nurse interpret this finding? A) The system is functioning perfectly and expanding the lung normally B) There is a significant structural air leak somewhere in the system or at the insertion site C) The suction control chamber pressure is set too low D) The patient is experiencing normal end-expiratory pressure clearance

• Correct Answer: B
• Rationale: Intermittent bubbling in the water-seal chamber is normal during exhalation or coughing when air exits the pleural space. However, continuous, persistent bubbling indicates a structural air leak in the system connections or an unsealed chest wound.

Q10. A nurse is developing a plan of care for a patient who is immobilized following a complex orthopedic surgery. Which nursing intervention is most effective in preventing the development of atelectasis and hypostatic pneumonia? A) Administering prophylactic oral antibiotics daily B) Teaching and encouraging the use of an incentive spirometer, coughing, and deep breathing every 2 hours C) Restricting oral fluid intake to avoid fluid overload D) Maintaining the patient in a strict flat, supine position

• Correct Answer: B
• Rationale: Incentive spirometry and deep breathing exercises promote maximal alveolar expansion, mobilize pulmonary secretions, and prevent alveolar collapse (atelectasis) caused by prolonged immobility.

Q11. A 40-year-old male patient with a history of chronic peptic ulcer disease presents with sudden, agonizing abdominal pain that rapidly becomes generalized. On examination, the abdomen is rigid, board-like, and demonstrates extreme rebound tenderness. What underlying surgical emergency do these signs indicate? A) Acute cholecystitis B) Intestinal intussusception C) Perforation of a peptic ulcer causing peritonitis D) Acute mechanical bowel obstruction

• Correct Answer: C
• Rationale: A sudden, severe, generalized abdominal pain followed by a rigid, board-like abdomen and rebound tenderness is the classic clinical presentation of a hollow viscus perforation (such as a peptic ulcer), leading to chemical and bacterial peritonitis.

Q12. A nurse is providing discharge education to a patient who has been newly prescribed Warfarin sodium for atrial fibrillation. Which of the following statements by the patient indicates a correct understanding of the dietary instructions? A) “I need to dramatically increase my intake of green leafy vegetables like spinach.” B) “I should maintain a consistent, stable intake of foods rich in Vitamin K without sudden changes.” C) “I must completely avoid all types of dietary protein and dairy products.” D) “I can take aspirin whenever I have a mild headache.”

• Correct Answer: B
• Rationale: Vitamin K is the direct antagonist of Warfarin. Drastic increases or decreases in dietary Vitamin K (found in green leafy vegetables) will alter the International Normalized Ratio (INR), so keeping intake consistent is essential for stable anticoagulation.

Q13. A patient is diagnosed with Chronic Renal Failure (CRF) and is undergoing regular hemodialysis. Laboratory values reveal a serum potassium level of 6.8 mEq/L. Which of the following cardiac manifestations is the nurse most likely to observe on the patient’s ECG monitor? A) Prominent U waves and ST-segment depression B) Tall, tented, or peaked T waves and a widened QRS complex C) Shortened PR interval and a narrow QRS complex D) Disappearance of the T wave entirely

• Correct Answer: B
• Rationale: Severe hyperkalemia (>6.0 mEq/L) alters myocardial conduction, characteristically causing tall, narrow, peaked T waves, prolonged PR intervals, and eventual widening of the QRS complex, which can progress to ventricular fibrillation if untreated.

Q14. A nurse is evaluating a patient with a history of left-sided congestive heart failure. Which of the following clinical manifestations is a direct reflection of pulmonary congestion secondary to left ventricular dysfunction? A) Jugular venous distension and right upper quadrant tenderness B) Dependent bilateral pitting pedal edema C) Dyspnea, orthopnea, and bilateral bibasilar crackles on auscultation D) Splenomegaly and ascites

• Correct Answer: C
• Rationale: Left-sided heart failure causes blood to back up into the left atrium and pulmonary veins. This increases pulmonary capillary hydrostatic pressure, leading to fluid transudation into the alveoli, causing dyspnea, orthopnea, and crackles. Right-sided failure leads to systemic systemic venous congestion (edema, jugular distension).

Q15. A nurse is assigned to care for a patient with an advanced traumatic brain injury. The nurse notes a progressive pattern of neurological deterioration characterized by a widening pulse pressure, bradycardia, and irregular, bradypneic respirations. What is this triad called, and what does it indicate? A) Beck’s Triad; acute cardiac tamponade B) Cushing’s Triad; severely increased intracranial pressure (ICP) C) Virchow’s Triad; high risk for deep vein thrombosis D) Horner’s Syndrome; localized cervical sympathetic chain injury

• Correct Answer: B
• Rationale: Cushing’s triad (widening pulse pressure/systolic hypertension, bradycardia, and irregular respirations) is a late sign of significantly elevated intracranial pressure, indicating imminent brain herniation.

Q16. A nurse is providing pre-operative teaching for a patient scheduled for an exploratory laparotomy. The patient states, “I am so afraid that my stomach stitches will pop open when I try to cough after surgery.” Which mechanical technique should the nurse teach the patient to minimize this risk? A) Maintaining a hyperextended spine while coughing B) Splinting the abdominal incision firmly with a pillow during coughing and deep breathing C) Avoiding all forms of coughing or deep breathing for the first 5 postoperative days D) Inhaling rapidly and shallowly through the mouth only

• Correct Answer: B
• Rationale: Splinting or supporting the incision line with a pillow provides structural reinforcement, minimizes tissue stretching, reduces pain, and prevents wound dehiscence or evisceration during forced expiratory maneuvers.

Q17. A patient presents to the outpatient clinic with a history of polyuria, polydipsia, unexplained weight loss, and a random plasma glucose level of 245 mg/dL. The nurse understands that this clinical profile satisfies the diagnostic criteria for which condition? A) Impaired fasting glucose tolerance B) Diabetes Mellitus C) Diabetes Insipidus D) Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

• Correct Answer: B
• Rationale: A random plasma glucose level ≥200 mg/dL in an individual presenting with classic symptoms of hyperglycemia (polyuria, polydipsia, weight loss) is diagnostic for Diabetes Mellitus.

Q18. A 35-year-old female patient is admitted with an acute flare of Rheumatoid Arthritis. On physical assessment, the nurse notes painful, symmetrical swelling in the small joints of both hands. Which of the following interventions is most appropriate to reduce morning joint stiffness during the acute phase? A) Applying localized ice packs continuously for 60 minutes B) Enforcing strict, absolute immobilization of all affected joints for 1 week C) Administering a warm shower or applying moist heat packs upon awakening D) Encouraging high-impact resistive exercise immediately after waking up

• Correct Answer: C
• Rationale: Moist heat application promotes localized vasodilation, relaxes muscle spasms, increases tissue elasticity, and is highly effective in relieving the severe joint stiffness characteristic of rheumatoid arthritis in the morning.

Q19. A nurse is caring for a patient who returned to the ward 2 hours ago following a subtotal gastrectomy. The nurse notes that the nasogastric (NG) tube is draining small amounts of dark, old-red material. The patient’s vital signs are stable. What is the most appropriate nursing action? A) Immediately irrigate the NG tube with 50 mL of sterile water B) Notify the surgeon immediately of an active postoperative hemorrhage C) Document the finding as a normal, expected occurrence in the early postoperative period D) Reposition the NG tube by advancing it 10 cm further into the stomach

• Correct Answer: C
• Rationale: Small amounts of dark, old blood or drainage are normal and expected during the first 6 to 12 hours after gastric surgery due to intraoperative trauma. Large amounts of bright red blood or hemodynamic instability would indicate active hemorrhage.

Q20. A patient with a history of chronic stable angina is experiencing substernal chest pain while walking. He places a tablet of Nitroglycerin under his tongue. The nurse instructs the patient that if the pain is not relieved after the first dose, he should take which immediate step? A) Take an additional 3 tablets simultaneously and wait 20 minutes B) Wait another 15 minutes before taking any further action C) Call the emergency medical services (or go to the nearest hospital) and take a second dose 5 minutes after the first D) Walk rapidly to the nearest health center for an evaluation

• Correct Answer: C
• Rationale: For stable angina, if chest pain is not relieved or worsens 5 minutes after taking one sublingual nitroglycerin tablet, it could indicate an evolving acute myocardial infarction. The patient should immediately seek emergency care and may take up to 3 doses 5 minutes apart while waiting.

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Part 2: Maternal and Neonatal Health Nursing

Q21. A 24-year-old primigravida woman at 36 weeks of gestation presents to the antenatal clinic with a blood pressure reading of 155/105 mmHg on two separate measurements. A dipstick urinalysis confirms 2+ proteinuria. She denies having any headaches, visual disturbances, or epigastric pain. How should the nurse classify this condition? A) Gestational Hypertension B) Chronic Hypertension C) Preeclampsia without severe features D) Eclampsia

• Correct Answer: C
• Rationale: Preeclampsia is defined as new-onset hypertension (≥140/90 mmHg) after 20 weeks of gestation accompanied by proteinuria. Since her blood pressure is <160/110 mmHg and she lacks systemic signs (headache, epigastric pain, visual changes), it is classified as preeclampsia without severe features.

Q22. A nurse is monitoring a woman in the active phase of labor. The electronic fetal monitor reveals a pattern of fetal heart rate decelerations that begin after the peak of the uterine contraction and return to baseline well after the contraction has ended. What is the cause of this pattern, and what is the nurse’s priority action? A) Umbilical cord compression; perform an immediate vaginal examination B) Uteroplacental insufficiency; turn the patient to her left side and administer oxygen via face mask C) Fetal head compression; document as a normal, reassuring finding D) Maternal hypotension; place the patient in a strict prone position

• Correct Answer: B
• Rationale: Late decelerations are caused by uteroplacental insufficiency, which reduces fetal oxygenation during contractions. The priority nursing actions are intrauterine resuscitation measures: repositioning the mother laterally, administering oxygen, and increasing IV fluids.

Q23. A G3P2 woman at 39 weeks of gestation has just delivered a healthy 4.1 kg infant. Ten minutes post-delivery, the nurse observes a sudden gush of blood from the vagina, lengthening of the umbilical cord, and the uterus becoming firm and globular. What do these clinical updates indicate? A) Acute uterine inversion B) Impending abruptio placentae C) Normal, expected signs of placental separation D) Partial retained products of conception

• Correct Answer: C
• Rationale: The classic signs of placental separation include a sudden gush of vaginal blood, lengthening of the visible umbilical cord, and the uterus rising and changing from a discoid to a firm, globular shape.

Q24. A nurse is conducting an immediate assessment of a newborn infant exactly 1 minute after birth. The infant has a heart rate of 110 beats per minute, a vigorous and loud cry, some flexion of the extremities, grimaces in response to a suction catheter, and a pink body with blue hands and feet (acrocyanosis). What is this infant’s APGAR score? A) 5 B) 7 C) 9 D) 10

• Correct Answer: B
• Rationale: The breakdown of the APGAR score is: Heart rate >100 (2 points); Loud cry/Respiratory effort (2 points); Flexion of extremities (1 point); Grimace/Reflex irritability (1 point); Acrocyanosis/Color (1 point). Total = 2+2+1+1+1=7.

Q25. A 29-year-old multigravida woman at 32 weeks of gestation is admitted with sudden, severe, painful vaginal bleeding. Her abdomen is rigid and hypertonic, and the uterus is exquisitely tender to touch. Fetal distress is noted. Which condition is most consistent with this presentation? A) Total Placenta Previa B) Abruptio Placentae C) Cervical incompetence D) Hydatidiform mole

• Correct Answer: B
• Rationale: Abruptio placentae (premature separation of a normally implanted placenta) classically presents with painful vaginal bleeding, uterine hypertonicity/rigidity, abdominal tenderness, and signs of fetal compromise. Placenta previa is characteristically painless.

Q26. A nurse is caring for a postpartum woman 4 hours after a prolonged vaginal delivery. On assessment, the nurse notes that the uterine fundus is soft, boggy, and located 2 centimeters above the umbilicus and deviated to the right side. What is the nurse’s immediate priority action? A) Administer an immediate intramuscular injection of Oxytocin B) Instruct the patient to empty her bladder or assist her with catheterization C) Perform a vigorous bimanual uterine massage for 45 minutes D) Notify the surgical team for an immediate laparotomy

• Correct Answer: B
• Rationale: A uterine fundus that is high and deviated to the right is most commonly displaced by a distended bladder. A full bladder prevents the uterus from contracting effectively, leading to uterine atony and increased risk of hemorrhage. Emptying the bladder is the immediate step.

Q27. A nurse is providing prenatal education to a group of pregnant women. The nurse emphasizes that the standard recommended schedule for routine antenatal care (ANC) contacts according to the updated WHO guidelines includes a minimum of how many contacts? A) 4 contacts B) 6 contacts C) 8 contacts D) 12 contacts

• Correct Answer: C
• Rationale: The updated World Health Organization (WHO) antenatal care model recommends a minimum of 8 routine ANC contacts to reduce perinatal mortality and improve the quality of maternal care.

Q28. A 22-year-old primigravida woman at 10 weeks of gestation presents for her first antenatal visit. Her blood type is determined to be A-Negative, and her husband’s blood type is O-Positive. The nurse should explain that she will need to receive Rho(D) immune globulin (RhoGAM) at which standard gestational milestone to prevent isoimmunization? A) Immediately at her current 10-week visit B) Prophylactically at 28 weeks of gestation and within 72 hours of delivery if the infant is Rh-positive C) Only if she exhibits signs of premature rupture of membranes D) At the beginning of the second trimester at 14 weeks

• Correct Answer: B
• Rationale: To prevent Rh isoimmunization in an unsensitized Rh-negative woman carrying an Rh-positive fetus, standard protocol requires administering prophylactic Rho(D) immune globulin at 28 weeks of gestation and a postpartum dose within 72 hours of birth if the baby is confirmed to be Rh-positive.

Q29. During a home visit on the third postpartum day, a nurse assesses a mother’s vaginal discharge. The nurse notes that the discharge is red-brown in color, contains small clots, and has a fleshy odor. How should the nurse document this specific type of lochia? A) Lochia rubra B) Lochia serosa C) Lochia alba D) Lochia purulenta

• Correct Answer: A
• Rationale: Lochia rubra is the initial postpartum vaginal discharge occurring from days 1 to 3 to 4. It is characteristically red or red-brown, composed primarily of blood, decidual tissue, and membranes, and has a normal fleshy odor.

Q30. A multigravida woman at 39 weeks of gestation is in the second stage of labor. Following the delivery of the fetal head, the nurse notes that the head retracts tightly against the maternal perineum (the “turtle sign”). Gentle downward traction fails to deliver the anterior shoulder. What is the nurse’s immediate priority collaborative intervention? A) Apply strong fundal pressure to assist the descent B) Hyperflex the mother’s thighs tightly against her abdomen (McRoberts maneuver) and apply suprapubic pressure C) Prepare the patient for an immediate emergency classic Cesarean delivery D) Administer a high-dose bolus of intravenous Oxytocin

• Correct Answer: B
• Rationale: The clinical presentation describes shoulder dystocia. The first-line interventions are the McRoberts maneuver (hyperflexing the mother’s legs to open the pelvic angle) combined with targeted suprapubic pressure to dislodge the impacted shoulder. Fundal pressure is strictly contraindicated as it worsens the impaction.

Q31. A nurse is providing family planning counseling to a postpartum mother who is exclusively breastfeeding her 2-month-old infant. The mother wishes to use the Lactational Amenorrhea Method (LAM). The nurse instructs her that LAM is highly effective only if which of the following criteria are met? A) The infant is supplemented with cow’s milk once a day B) The mother has experienced her first normal menstrual period post-delivery C) The infant is under 6 months of age, the mother is completely amenorrheic, and breastfeeding is exclusive and on demand D) The mother pumps her breast milk twice a day and avoids night feeding

• Correct Answer: C
• Rationale: The three strict criteria for LAM efficacy are: the infant must be under 6 months old, the mother must remain amenorrheic, and the infant must be exclusively breastfed on demand (including night feedings) without regular supplements.

Q32. A 32-year-old pregnant woman at 14 weeks of gestation presents to the emergency unit with severe, persistent vomiting, significant weight loss (>5% of pre-pregnancy weight), and mild dehydration. Urinalysis reveals 3+ ketones. What condition do these findings describe? A) Gestational Diabetes Mellitus B) Hyperemesis Gravidarum C) Acute Viral Gastritis D) Physiological morning sickness

• Correct Answer: B
• Rationale: Hyperemesis gravidarum is characterized by severe, intractable vomiting during pregnancy that leads to fluid and electrolyte imbalances, weight loss exceeding 5% of body weight, and ketonuria, differentiating it from normal morning sickness.

Q33. A woman who is 24 weeks pregnant presents for a routine checkup. The nurse measures her fundal height. At this gestational age, where should the nurse normally expect to palpate the top of the uterine fundus? A) At the level of the symphysis pubis B) Midway between the symphysis pubis and the umbilicus C) At the level of the umbilicus D) At the level of the xiphoid process

• Correct Answer: C
• Rationale: As a general rule of thumb during pregnancy, the uterine fundus reaches the level of the umbilicus at approximately 20 to 24 weeks of gestation. By 12 weeks, it is at the symphysis pubis, and by 36 weeks, it reaches the xiphoid process.

Q34. A nurse is caring for a patient who is receiving an intravenous infusion of Magnesium Sulfate for the management of severe preeclampsia. On routine assessment, the nurse finds that the patient’s deep tendon reflexes are completely absent, her respiratory rate is 9 breaths per minute, and she is lethargic. Which medication should the nurse ensure is at the bedside? A) Protamine Sulfate B) Calcium Gluconate C) Naloxone Hydrochloride D) Terbutaline Sulfate

• Correct Answer: B
• Rationale: Loss of deep tendon reflexes, bradypnea, and lethargy are classic signs of magnesium sulfate toxicity. Calcium gluconate is the direct antidote and must be administered intravenously to reverse cardiac and respiratory depression.

Q35. A G2P1 woman at 38 weeks of gestation is admitted in active labor. Her cervical dilation is 5 cm, and membranes are intact. The nurse notes that the fetal heart rate drops abruptly by 40 beats per minute below baseline, lasting for 30 seconds, with an irregular variable shape that does not correlate with the timing of contractions. What is the most likely cause of this monitoring pattern? A) Head compression during descent B) Maternal hyperthermia C) Umbilical cord compression D) Uteroplacental insufficiency

• Correct Answer: C
• Rationale: Variable decelerations are characterized by an abrupt drop in fetal heart rate with a variable shape, and they are caused by umbilical cord compression. Early decelerations indicate head compression, while late decelerations reflect uteroplacental insufficiency.

Q36. A nurse is providing preconception care to a woman with a history of a previous infant born with a neural tube defect (anencephaly). The nurse instructs the woman to take a daily oral supplement of Folic Acid. What is the recommended dosage for a patient with this specific high-risk obstetric history? A) 0.4 mg per day B) 1.0 mg per day C) 4.0 mg per day D) 0.1 mg per day

• Correct Answer: C
• Rationale: While the standard low-risk recommendation for folic acid is 0.4 mg daily, women with a prior history of a child affected by a neural tube defect require a higher dose of 4.0 mg daily, starting 1 to 3 months before conception, to prevent recurrence.

Q37. A 26-year-old female patient presents with a history of missing her last menstrual period 6 weeks ago, light vaginal bleeding, and sharp, severe unilateral lower abdominal pain. On pelvic examination, there is severe cervical motion tenderness. Her blood pressure is stable. What life-threatening condition must be ruled out first? A) Acute Appendicitis B) Ruptured or expanding Ectopic Pregnancy C) Incomplete spontaneous abortion D) Pelvic Inflammatory Disease

• Correct Answer: B
• Rationale: In any woman of childbearing age presenting with amenorrhea, unilateral lower abdominal pain, and vaginal bleeding, an ectopic pregnancy must be suspected immediately. Early recognition prevents life-threatening intra-abdominal hemorrhage.

Q38. A postpartum nurse is conducting a discharge teaching session for a mother who is bottle-feeding her infant. The mother asks how she can safely relieve the discomfort of breast engorgement. Which intervention should the nurse recommend? A) Expressing milk manually from both breasts every 2 hours B) Applying warm, moist heat packs to the breasts before every meal C) Wearing a supportive, snug-fitting brassiere continuously and applying cold ice packs to the breasts D) Stimulating her nipples under a warm shower twice a day

• Correct Answer: C
• Rationale: For non-breastfeeding mothers, avoiding breast stimulation, wearing a snug bra, and applying cold ice packs helps suppress lactation and reduces the localized swelling and vascular congestion associated with engorgement. Expressing milk or applying heat would promote further milk synthesis.

Q39. A nurse is conducting a newborn physical examination and notes a soft swelling on the infant’s scalp that crosses the cranial suture lines. The infant was delivered via a vacuum-assisted vaginal extraction. The nurse documents this finding as which of the following? A) Cephalohematoma B) Caput succedaneum C) Subgaleal hemorrhage D) Hydrocephalus

• Correct Answer: B
• Rationale: Caput succedaneum is localized edema of the scalp caused by pressure from the cervix or vacuum extraction during labor. It is characterized by fluid accumulation that crosses cranial suture lines and typically resolves spontaneously within a few days. Cephalohematoma does not cross suture lines.

Q40. A nurse is administering an intramuscular injection of Vitamin K (Phytomenadione) to a newborn infant within 1 hour of birth. What is the fundamental physiological rationale for this intervention? A) To stimulate early hepatic enzyme maturity B) To prevent newborn hemorrhagic disease due to a sterile intestinal tract that cannot synthesize Vitamin K C) To enhance the intestinal absorption of dietary iron from colostrum D) To protect the infant against early-onset neonatal sepsis

• Correct Answer: B
• Rationale: Newborns are born with low Vitamin K levels because transport across the placenta is poor and their sterile intestinal tract lacks the bacterial flora necessary to synthesize it. Administering Vitamin K prevents early vitamin K deficiency bleeding (hemorrhagic disease of the newborn).

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Part 3: Pediatrics and Child Health Nursing

Q41. A 14-month-old infant is brought to the pediatric outpatient department with a 3-day history of a dry cough and low-grade fever, followed by the sudden onset of an audible wheeze. On physical examination, the nurse notes asymmetric chest expansion and decreased breath sounds localized to the right lung field. What is the most likely cause of this presentation? A) Acute viral bronchiolitis B) Foreign body aspiration C) Severe lobar bacterial pneumonia D) Pulmonary tuberculosis

• Correct Answer: B
• Rationale: The sudden onset of a localized, unilateral wheeze with asymmetric breath sounds and expansion in a toddler is a classic presentation for foreign body aspiration, where an object blocks a main bronchus.

Q42. According to the Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines, which of the following clinical signs is classified as a “General Danger Sign” requiring immediate urgent referral or inpatient stabilization? A) A recorded axillary temperature of 38.5°C B) Presence of a mild maculopapular skin rash C) Inability to drink or breastfeed due to persistent vomiting or lethargy D) A respiratory rate of 45 breaths per minute in a 13-month-old child

• Correct Answer: C
• Rationale: The IMNCI general danger signs include: inability to drink or breastfeed, vomiting everything, convulsions during the illness, and lethargy or unconsciousness. Any child with these signs requires urgent life-saving care.

Q43. An 18-month-old child is admitted to the nutritional rehabilitation unit. On assessment, the nurse notes severe wasting of the muscle masses, a “skin and bones” appearance, a prominent rib cage, and a loss of subcutaneous fat. No edema is present. How should the nurse document this nutritional condition? A) Kwashiorkor B) Severe Stunting C) Marasmus D) Nutritional Marasmic-Kwashiorkor

• Correct Answer: C
• Rationale: Marasmus is a form of severe acute malnutrition caused by energy deficiency. It is characterized by severe wasting of muscle and subcutaneous fat, resulting in a classic “old man” face and a “skin and bones” appearance, without edema. Kwashiorkor is defined by the presence of bilateral pitting edema.

Q44. A 4-year-old child is brought to the emergency department with a high fever, a severe sore throat, and difficulty swallowing. The child is sitting forward in a “sniffing” or “tripod” position, drooling saliva, and appears anxious. What is the most critical immediate nursing action? A) Examine the throat thoroughly using a tongue depressor to check for a peritonsillar abscess B) Keep the child calm, avoid agitating them, and prepare for controlled airway establishment C) Place the child in a flat, supine position and apply a tight non-rebreather oxygen mask D) Administer an empirical dose of oral amoxicillin syrup

• Correct Answer: B
• Rationale: This presentation is highly indicative of acute epiglottitis, a medical emergency. Any direct examination or irritation of the throat with a tongue depressor can trigger an immediate, fatal laryngospasm. The priority is to keep the child calm and secure the airway in a controlled environment.

Q45. A 9-month-old infant is brought to a local clinic with a 3-day history of profuse watery diarrhea. On assessment, the child is irritable, thirsty, has slightly sunken eyes, and a skin pinch on the abdomen returns slowly (taking less than 2 seconds). According to IMNCI guidelines, what is the hydration classification and corresponding management plan? A) No Dehydration; Plan A (Home management) B) Some Dehydration; Plan B (Oral Rehydration Salts therapy in the clinic) C) Severe Dehydration; Plan C (Urgent intravenous fluid resuscitation) D) Persistent Diarrhea; Plan B

• Correct Answer: B
• Rationale: Under IMNCI criteria, a child with two signs among irritability, sunken eyes, fast skin pinch (<2 seconds), or drinking eagerly is classified as having “Some Dehydration” and should be managed with oral rehydration salts over 4 hours in the clinic (Plan B).

Q46. A 6-month-old infant is brought to the pediatric clinic for a routine immunization visit. According to the Ethiopian Expanded Programme on Immunization (EPI) schedule, which vaccines should this child normally receive at this age if all prior doses were completed on time? A) BCG and Oral Polio Vaccine (OPV) Dose 1 B) Pentavalent Dose 3, PCV Dose 3, OPV Dose 3, and Rota Dose 2 C) Measles Dose 1 and Yellow Fever vaccine D) Vitamin A supplementation only

• Correct Answer: B
• Rationale: According to the standard schedule, the 6-week, 10-week, and 14-week milestones complete the primary series. At 14 weeks (often matching completed 3rd-month series tracking), children complete Pentavalent 3, PCV 3, OPV 3, and Rota 2. At 6 months, vitamin A can be initiated, but no new primary multi-dose combinations are introduced if tracking was structurally integrated at 14 weeks. If evaluating regular catch-up, standard completions are monitored. (Note: Measles is given at 9 months and 15 months).

Q47. A 3-year-old child is diagnosed with regular iron-deficiency anemia and is prescribed oral iron supplements. What instructions should the nurse provide to the parents to maximize the gastrointestinal absorption of the medication? A) Administer the iron supplement with a glass of whole cow’s milk B) Give the iron supplement with a drink rich in Vitamin C, such as orange juice, preferably between meals C) Mix the iron supplement directly into warm maize porridge D) Administer the medication simultaneously with an antacid syrup

• Correct Answer: B
• Rationale: Vitamin C enhances the absorption of non-heme iron by converting it into a more soluble ferrous form. Administering iron with milk or antacids inhibits absorption because calcium and antacids bind to iron.

Q48. A 5-year-old child presents with a 1-week history of generalized periorbital edema, dark tea-colored urine, and mild hypertension. The parents note that the child recovered from a severe skin infection (impetigo) 2 weeks ago. What condition should the nurse suspect? A) Minimal Change Disease B) Post-Streptococcal Glomerulonephritis (PSGN) C) Acute Pyelonephritis D) Nephrotic Syndrome

• Correct Answer: B
• Rationale: PSGN is an immune-complex mediated complication that develops 1 to 2 weeks after a Group A beta-hemolytic streptococcal pharyngeal or skin infection, presenting with the classic nephritic triad: hematuria (tea-colored urine), periorbital edema, and hypertension.

Q49. A nurse is assessing a 2-month-old infant brought to the health center with fast breathing. The nurse counts the infant’s respiratory rate while the child is calm. According to IMNCI guidelines, what is the minimum respiratory rate threshold to classify fast breathing in a child aged 2 to 11 months? A) 60 breaths per minute or more B) 50 breaths per minute or more C) 40 breaths per minute or more D) 30 breaths per minute or more

• Correct Answer: B
• Rationale: IMNCI fast breathing thresholds are: 60 breaths/min or more for infants under 2 months; 50 breaths/min or more for infants aged 2 to 11 months; and 40 breaths/min or more for children aged 12 to 59 months.

Q50. A 10-month-old infant is brought with a history of a high fever and a generalized rash for 4 days. On assessment, the nurse notes conjunctivitis, coryza, a harsh cough, and a maculopapular rash that began on the face and has spread down to the trunk. Small white spots on an erythematous base are also visible inside the buccal mucosa. What is the priority nursing action to prevent serious ocular complications? A) Administer a high-dose supplement of Vitamin A immediately B) Wash the eyes with soap and water every hour C) Apply thick steroid ointments to the buccal lesions D) Administer broad-spectrum intravenous antiviral medications

• Correct Answer: A
• Rationale: This case describes Measles, which depletes Vitamin A stores and can cause blindness and corneal ulceration. Immediate high-dose Vitamin A supplementation is recommended by the WHO for all children diagnosed with measles to prevent complications and reduce mortality.