Afghanistan Nursing Exit Exam (Institutes of Health Sciences)

A nurse is caring for a patient admitted with acute diarrhea confirmed to be caused by Clostridioides difficile. Which method of hand hygiene is mandatory for healthcare workers after providing direct care to this patient?

• AApplication of an alcohol-based hand rub for 20 seconds
• BWashing hands thoroughly with soap and running water
• CRinsing hands with chlorhexidine gluconate solution without water
• DWiping hands with an antimicrobial benzalkonium chloride wipe

When removing personal protective equipment (PPE) after leaving an isolation room, which sequence represents the correct standard order for doffing to minimize self-contamination?

• AGown, mask, goggles, gloves
• BGloves, goggles or face shield, gown, mask or respirator
• CMask, gloves, gown, goggles
• DGoggles, gloves, mask, gown

A 45-year-old patient is admitted with active, smear-positive pulmonary tuberculosis. Which type of transmission-based isolation precautions must the nurse immediately implement?

• AStandard precautions only with surgical mask during direct contact
• BDroplet precautions in a standard private room with 1-meter physical distance
• CAirborne precautions in a negative-pressure isolation room with N95 or FFP2 respirators
• DContact precautions with disposable gown and non-sterile gloves

While preparing a sterile field for a surgical wound dressing change, which action by the nurse would immediately contaminate the sterile field?

• AOpening the furthest flap of the sterile package first
• BAllowing sterile forceps to touch within the outer 2.5 cm (1-inch) border of the drape
• CHolding sterile items above the level of the waist
• DPouring sterile normal saline without splashing onto the sterile gauze

A bedridden, elderly patient develops a localized area of intact skin over the sacrum with persistent non-blanchable erythema. How should the nurse classify this pressure injury?

• AStage 1 pressure injury
• BStage 2 pressure injury
• CStage 3 pressure injury
• DUnstageable pressure injury

A nurse is assessing a patient for orthostatic hypotension. Which clinical finding confirms a positive test result after the patient transitions from supine to standing?

• AA drop in systolic blood pressure of ≥ 20 mm Hg or a drop in diastolic blood pressure of…
• BAn increase in systolic blood pressure of ≥ 15 mm Hg with a decrease in heart rate of 10…
• CA decrease in heart rate of ≥ 20 beats per minute with stable blood pressure
• DA transient drop in systolic blood pressure of 5 mm Hg that resolves within 15 seconds

Which principle of body mechanics should the nurse practice when lifting a heavy object or assisting a dependent patient in bed to prevent occupational back injury?

• AKeep feet closely touching together and bend at the waist with straight knees
• BMaintain a wide base of support, bend at the knees and hips, and keep the load close to t…
• CTwist the spine and trunk simultaneously while lifting the patient upward
• DPosition the bed at the lowest possible height before beginning the transfer

Which nursing intervention is most critical for preventing catheter-associated urinary tract infections (CAUTI) in a patient with an indwelling Foley catheter?

• AIrrigating the catheter bladder daily with sterile normal saline solution
• BMaintaining an uninterrupted closed drainage system and keeping the drainage bag below th…
• CChanging the indwelling urinary catheter routinely every 48 to 72 hours
• DClamping the drainage tubing for two hours prior to each emptying

A nurse is preparing to administer enteral feeding through a newly inserted nasogastric (NG) tube. What is the gold standard method to verify correct tube placement in the stomach prior to initiating the first feeding?

• AAuscultation of an injected air bolus (whoosh test) over the epigastrium
• BRadiographic confirmation via an abdominal X-ray
• CImmersing the distal end of the tube in a cup of water to check for bubbling
• DVisual inspection of the tube depth markings at the nares only

To minimize the risk of pulmonary aspiration during continuous enteral tube feeding, which nursing action is essential?

• APosition the patient completely flat in a supine position
• BMaintain the head of the bed elevated at 30 to 45 degrees at all times during feeding and…
• CAdminister the feeding rapidly as a large bolus over 2 minutes
• DAdd blue food dye to the enteral formula to detect tracheal secretions

A patient receiving continuous intravenous (IV) normal saline reports sudden pain and burning at the IV site. Upon inspection, the nurse observes localized swelling, blanching, coolness to touch, and absence of blood return. Which complication has occurred?

• APhlebitis
• BIV Infiltration
• CCatheter-related bloodstream infection
• DAir embolism

Fifteen minutes after initiating a packed red blood cell (PRBC) transfusion, the patient complains of severe lower back pain, chills, shortness of breath, and feeling flushed. What is the immediate priority nursing action?

• ASlow the infusion rate to keep-vein-open and administer oral acetaminophen
• BImmediately stop the blood transfusion and infuse normal saline through new IV tubing
• CNotify the physician while allowing the remaining unit of blood to finish infusing
• DRe-check the crossmatch label on the blood bag without stopping the infusion

On the sixth postoperative day following major abdominal surgery, a patient suddenly reports a 'popping sensation' in the incision during a coughing episode. The nurse observes loop of bowel protruding through the opened wound. What is the nurse's immediate action?

• AGently push the exposed bowel loops back into the abdominal cavity using sterile gloved h…
• BCover the exposed abdominal organs with sterile gauze soaked in sterile normal saline and…
• CApply a tight abdominal binder over the wound and encourage vigorous coughing
• DPlace the patient in a steep Trendelenburg position and apply dry sterile dressings

A patient with severe acute hypoxemia requires an inspired oxygen fraction (FiO2) of approximately 80% to 90%. Which oxygen delivery device should the nurse select to achieve this high concentration?

• AStandard nasal cannula at 4 L/min
• BSimple face mask at 6 L/min
• CNon-rebreather mask with reservoir bag inflated at 10–15 L/min
• DVenturi mask set at 24% FiO2

When performing open suctioning of an adult patient with a tracheostomy tube, which guideline must the nurse adhere to in order to prevent mucosal trauma and severe hypoxia?

• AApply continuous suctioning while inserting the catheter into the trachea
• BLimit each suction pass to no more than 10 to 15 seconds and hyperoxygenate the patient b…
• CInstill 10 mL of normal saline directly into the trachea routinely before every suction p…
• DUse high negative suction pressure exceeding 200 mm Hg for thick secretions

A nurse sustains an accidental needlestick injury from a hollow-bore needle previously used on a patient with unknown viral status. What is the immediate first step the nurse should take?

• ASqueeze the wound forcefully to promote bleeding and apply concentrated bleach
• BWash the puncture site immediately with soap and water for several minutes
• CApply a sterile tourniquet proximal to the puncture site for 30 minutes
• DWait 48 hours to see if local signs of infection develop before reporting

According to standard healthcare waste management guidelines, into which color-coded container should gauze heavily soaked with infectious blood and body fluids be discarded?

• ABlack waste bin for general non-risk municipal waste
• BYellow biohazard bag for infectious and pathological waste
• CPuncture-proof yellow safety box for sharps
• DBlue container for non-infectious recyclable cardboard

A nurse is assessing pain in an alert, cognitively intact adult patient following orthopedic surgery. Which pain assessment tool is the most valid and reliable primary measure of pain intensity?

• AObservation of facial grimacing and restlessness by the nurse
• BThe patient's self-report on a 0-to-10 Numeric Rating Scale (NRS)
• CMeasurement of changes in systolic blood pressure and heart rate
• DThe FLACC behavioral pain scale

A postoperative patient is being taught how to use an incentive spirometer. Which instruction correctly describes how the patient should perform this respiratory exercise?

• AExhale forcefully into the mouthpiece as hard and fast as possible
• BInhale slowly and deeply through the mouthpiece, hold breath for 3 to 5 seconds, then exh…
• CRapidly inhale and exhale 20 times in quick succession through the device
• DBlow short, shallow puffs of air into the device until the piston reaches the top

When administering a cleansing enema to an adult patient, what position should the nurse place the patient in, and how high should the enema solution bag be held above the anus?

• ARight lateral position; bag held 60 cm (24 inches) high
• BLeft Sims (left lateral recumbent) position; bag held 30 to 45 cm (12 to 18 inches) high
• CProne position with hips elevated; bag held at bed mattress level
• DHigh Fowler position; bag held 90 cm (36 inches) high

A violent, agitated patient requires physical wrist restraints to prevent accidental extubation after all de-escalation strategies have failed. Which nursing standard must be strictly followed regarding restraint care?

• ATie the restraint straps securely to the moveable side rails using a square knot
• BAssess skin integrity, neurovascular status, and release restraints for range of motion a…
• CLeave the restraints in place continuously for 24 hours without removal to maintain staff…
• DTighten the wrist restraint so that not even a finger can fit beneath the strap

Which operating parameters represent the standard minimum temperature, pressure, and exposure time required for steam sterilization (autoclaving) of wrapped surgical instruments?

• A100°C at 0 psi for 60 minutes
• B121°C (250°F) at 15 psi (103 kPa) for 15 to 30 minutes
• C160°C at atmospheric pressure for 10 minutes
• D80°C at 30 psi for 45 minutes

A patient with severe dehydration presents with dry mucous membranes, poor skin turgor, tachycardia, and oliguria. Which laboratory finding is most consistent with fluid volume deficit (hypovolemia)?

• ADecreased serum sodium and low hematocrit
• BElevated urine specific gravity (> 1.030) and increased hematocrit due to hemoconcentrati…
• CDecreased blood urea nitrogen (BUN) with low serum osmolarity
• DLow urine osmolality with marked hypokalemia

Before administering any prescribed medication to an inpatient, what is the mandatory first step the nurse must perform to ensure patient safety?

• AAsk the patient's roommate to confirm the patient's room number
• BVerify the patient's identity using at least two unique identifiers (e.g., full name and…
• CCheck the patient's name on the bed label only
• DAdminister the medication and document identification afterward

When providing post-mortem care to a deceased patient in a hospital setting in Afghanistan, which cultural and ethical nursing consideration is most important?

• APerform immediate embalming before notifying the family
• BMaintain respectful handling, ensure modesty by keeping the body covered, close the eyes,…
• CImmediately dispose of all personal belongings in biohazard containers
• DPlace the body in a prone position for 12 hours prior to transfer

A 58-year-old male arrives at the emergency department with severe, crushing substernal chest pain radiating to his left jaw and arm, diaphoresis, and nausea. An ECG shows ST-segment elevation in leads II, III, and aVF. Which initial nursing intervention is a top priority?

• AAdminister oral metoprolol and encourage the patient to walk to relieve anxiety
• BInitiate continuous cardiac monitoring, establish IV access, administer chewable aspirin…
• CSchedule an elective outpatient treadmill stress test for the following week
• DAdminister an intramuscular injection of morphine into the deltoid muscle

A nurse is assessing a patient with chronic congestive heart failure. Which clinical finding is specifically characteristic of left-sided heart failure rather than right-sided heart failure?

• AJugular venous distension (JVD) and hepatomegaly
• BDependent peripheral bilateral ankle edema
• CBilateral pulmonary crackles (rales), orthopnea, and paroxysmal nocturnal dyspnea
• DAscites and abdominal distension with positive fluid wave

Which dietary instruction should the nurse emphasize when educating a hypertensive adult patient on non-pharmacological blood pressure management?

• AIncrease dietary sodium intake to over 4,000 mg per day
• BAdopt the DASH diet (Dietary Approaches to Stop Hypertension), rich in fruits, vegetables…
• CCompletely eliminate all dietary proteins and carbohydrates
• DRely solely on herbal supplements instead of prescribed antihypertensives

A 66-year-old patient with severe Chronic Obstructive Pulmonary Disease (COPD) and chronic carbon dioxide retention is admitted with acute exacerbation. What is the target oxygen saturation (SpO2) range the nurse should aim to maintain with titrated oxygen therapy?

• A98% to 100%
• B88% to 92%
• C75% to 80%
• D100% with high-flow non-rebreather mask

A patient is prescribed first-line anti-tuberculosis therapy including Isoniazid (INH), Rifampicin (RIF), Pyrazinamide (PZA), and Ethambutol (EMB). What specific adverse effect should the nurse educate the patient to report immediately regarding Ethambutol?

• AHarmless reddish-orange discoloration of urine and tears
• BVisual disturbances, loss of visual acuity, or red-green color blindness
• CSevere generalized alopecia
• DMetallic taste in the mouth

A patient hospitalized with bacterial community-acquired pneumonia has thick, tenacious secretions and difficulty expectorating. Which nursing intervention is most effective in thinning respiratory secretions?

• ARestricting daily oral fluid intake to under 1,000 mL
• BEncouraging increased oral fluid intake (2 to 3 liters/day, unless contraindicated) and h…
• CAdministering high-dose cough suppressants around the clock
• DKeeping the patient strictly immobilized in the supine position

A 22-year-old patient with Type 1 Diabetes is brought to the emergency department unconscious with Kussmaul respirations, fruity (acetone) breath odor, blood glucose of 480 mg/dL, and positive urine ketones. What is the initial priority fluid and pharmacological management for this Diabetic Ketoacidosis (DKA)?

• ASubcutaneous NPH insulin followed by oral fluid replacement
• BRapid IV hydration with 0.9% Normal Saline followed by continuous IV Regular Insulin infu…
• CIV bolus of 50% Dextrose followed by potassium restriction
• DHigh-dose oral metformin and potassium chloride IV push

Which foot care instruction must the nurse emphasize to a patient diagnosed with Type 2 Diabetes Mellitus to prevent diabetic foot ulcers and amputations?

• ASoak feet in hot water with Epsom salt for 30 minutes daily
• BInspect feet and between toes daily for cuts, blisters, redness, and never walk barefoot
• CCut corns and calluses off at home using sharp razor blades
• DWalk barefoot on warm sand or heated carpets to stimulate peripheral circulation

A patient with severe hyperthyroidism (Graves' disease) suddenly develops high fever (40°C), severe tachycardia (160 bpm), extreme agitation, delirium, and diarrhea. The nurse recognizes this life-threatening endocrine crisis as which condition?

• AMyxedema coma
• BThyroid storm (Thyrotoxic crisis)
• CAddisonian crisis
• DPheochromocytoma paroxysm

A 40-year-old patient with a history of peptic ulcer disease suddenly develops acute, excruciating epigastric pain. On physical examination, the nurse notes a rigid, board-like abdomen with severe rebound tenderness and absent bowel sounds. What complication should the nurse suspect?

• AAcute gastrointestinal bleeding without perforation
• BPerforation of the peptic ulcer with generalized peritonitis
• CSimple constipation with fecal impaction
• DBiliary colic secondary to cholelithiasis

A 19-year-old patient is admitted with suspected acute appendicitis, presenting with right lower quadrant pain at McBurney's point, low-grade fever, and nausea. Which nursing intervention is strictly contraindicated during the pre-operative period?

• AMaintaining the patient on strict NPO (nothing by mouth) status
• BApplying a warm heating pad to the abdomen to relieve local pain
• CEstablishing intravenous access for hydration
• DPositioning the patient in semi-Fowler position with knees flexed for comfort

A patient with end-stage liver cirrhosis is admitted with hepatic encephalopathy, manifesting with confusion, lethargy, and asterixis (flapping hand tremor). The physician prescribes oral lactulose. What is the therapeutic mechanism of lactulose in this condition?

• AIt stimulates hepatic synthesis of albumin to reduce ascites
• BIt acidifies colonic contents, converting ammonia (NH3) into unabsorbable ammonium (NH4+)…
• CIt acts as a potent systemic diuretic to decrease portal venous pressure
• DIt provides calories to counteract severe malnutrition

A 28-year-old patient is admitted with confirmed Typhoid (Enteric) Fever during the second week of illness, presenting with a step-ladder fever pattern, relative bradycardia, rose spots on the abdomen, and severe abdominal pain. Which life-threatening complication must the nurse monitor for most vigilantly during this phase?

• AAcute nephrolithiasis
• BIntestinal perforation and hemorrhage secondary to necrosis of Peyer's patches
• CPulmonary embolism
• DCerebral aneurysm rupture

A shepherd from a rural province presents with chronic undulant fever, profuse nocturnal sweating, joint pain (arthralgia), and fatigue. Brucellosis (Malta fever) is diagnosed. Which primary mode of transmission should the nurse address when providing preventive education?

• AInhalation of respiratory droplets from coughing humans
• BIngestion of unpasteurized (raw) milk or unpasteurized dairy products from infected lives…
• CBites from infected Anopheles mosquitoes
• DDirect contact with chlorinated swimming pool water

A patient in the oliguric phase of Acute Kidney Injury (AKI) has a serum potassium level of 6.8 mEq/L. Which electrocardiogram (ECG) abnormality should the nurse expect to see on the telemetry monitor as an early sign of severe hyperkalemia?

• AProminent U waves and ST-segment depression
• BTall, peaked, narrow T waves with shortened QT interval
• CDisappearance of the QRS complex with wide P waves
• DProlonged QT interval and inverted T waves

Which dietary modification is essential for a patient diagnosed with Stage 4 Chronic Kidney Disease (CKD) who is managed conservatively without dialysis?

• AHigh-protein diet with unlimited intake of potassium-rich fruits and bananas
• BRestriction of dietary phosphorus, potassium, sodium, and controlled moderate protein int…
• CHigh-sodium diet to stimulate renal tubular filtration
• DUnrestricted fluid intake exceeding 4 liters daily

A 35-year-old patient presents with acute, severe, spasmodic flank pain radiating to the groin and genitalia, accompanied by nausea, vomiting, and microscopic hematuria. What is the most important nursing intervention regarding urine collection for this patient with suspected nephrolithiasis?

• ADiscard all urine immediately to maintain room hygiene
• BStrain all voided urine through a fine mesh strainer or filter to capture renal calculi f…
• CCollect only the first morning urine in an unsterile basin
• DInstruct the patient to hold urine for at least 8 hours before voiding

A 62-year-old patient is admitted with sudden onset of right-sided hemiplegia and expressive aphasia that started 90 minutes ago. A non-contrast head CT scan rules out intracranial hemorrhage. What is the time window from symptom onset for administering intravenous recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke?

• AWithin 3 to 4.5 hours of symptom onset
• BWithin 12 to 24 hours of symptom onset
• CBetween 24 and 48 hours after symptom onset
• DOnly after 7 days of observation