Lesotho Nursing Council Licensure Examination

Under which statute does the Lesotho Nursing Council (LNC) state that it continues to exist as the regulator of nurses and midwives?

• AMedical, Dental and Pharmacy Order No. 13 of 1970
• BPublic Health Order No. 12 of 1970
• CNurses and Midwives Act No. 12 of 1998
• DLesotho Nurses Association (LNA) Constitution, 2009

A competent, alert 42-year-old patient scheduled for an elective cholecystectomy signs the surgical consent form in front of the staff nurse, who then signs as witness. What does the nurse's witness signature primarily confirm?

• AThat the surgeon has fully explained the procedure, its risks and the alternatives
• BThat the patient seemed competent, signed voluntarily, and the signature is genuine
• CThat the nurse accepts shared legal responsibility for the surgical outcome
• DThat the surgeon no longer needs to discuss the procedure with the patient

A client newly diagnosed with pulmonary tuberculosis (TB) asks the clinic nurse not to tell anyone, including household contacts. What is the nurse's correct legal and ethical course of action?

• AExplain that TB is a notifiable disease requiring confidential reporting and contact trac…
• BKeep the diagnosis completely confidential, because confidentiality overrides public heal…
• CInform the client's employer and village chief so that they can protect the community
• DDelay starting treatment until the client agrees to tell the household about the diagnosis

A Registered General Nurse on a surgical ward is working with a Nursing Assistant. Which task can the nurse most appropriately delegate to the Nursing Assistant?

• AConducting the initial admission nursing assessment of an acutely ill patient
• BGiving an intravenous antibiotic through a peripheral cannula
• CMeasuring and recording routine vital signs for a stable postoperative patient
• DRevising the nursing care plan for a patient with diabetic ketoacidosis

A sedated patient falls and fractures a hip after the nurse failed to carry out the documented fall-prevention plan (bed at its lowest height, call bell within reach). To establish negligence against the nurse, which four elements must be proven?

• AIntentional wrongdoing, professional misconduct, physical harm and lack of consent
• BFailure to document, an adverse event, patient dissatisfaction and a hospital error
• CFaulty equipment, patient non-compliance, breach of contract and assault
• DDuty of care, breach of that duty, harm, and causation between breach and harm

A fully conscious adult with severe anaemia, who has decision-making capacity, refuses a prescribed blood transfusion because of religious beliefs. What is the nurse's most appropriate action?

• AProceed with the transfusion because the physician's order overrides the client's religio…
• BRespect the refusal, confirm that it is informed, document it and inform the physician
• CAsk the client's family to sign consent for the transfusion on the client's behalf
• DGive the transfusion under the emergency implied-consent doctrine because the anaemia is…

A nurse realizes that an adult patient has just been given 10 mg of morphine instead of the prescribed 5 mg. What should the nurse do first?

• AComplete an incident report before doing anything else, while the details are fresh
• BNotify the prescriber and wait for instructions before returning to the patient
• CAssess the patient's respiratory rate, level of consciousness and oxygen saturation immed…
• DRecord the dose given and continue routine observations at the next scheduled round

On discharge, a grateful family tries to give a registered nurse M1,000 in cash. What is the most professionally appropriate response?

• AAccept it and share it equally with the ward team so that no one benefits personally
• BAccept it privately, since the gift is voluntary and care has already ended
• CAccept it, because refusing a gift would be disrespectful to the family's culture
• DDecline the cash politely while thanking the family for the kind gesture

While writing a progress note in a paper chart, a nurse realizes that the entry belongs to a different patient. What is the legally acceptable way to correct it?

• AApply correction fluid over the entry, then write the correct information and initial it…
• BStrike through once so it stays legible, mark it as an error with date, time and initials…
• CScribble over the entry until it cannot be read, then write the correct note directly bel…
• DRemove the page and rewrite that shift's notes on a fresh, dated sheet signed by the nurse

An unconscious trauma patient in haemorrhagic shock arrives at a district hospital with no relatives or identification, and the team prepares for an emergency laparotomy. Which legal doctrine allows life-saving treatment to proceed without a signed consent form?

• AThe doctrine of implied consent
• BThe doctrine of informed refusal
• CThe doctrine of respondeat superior
• DThe doctrine of therapeutic privilege

A newly posted medical officer prescribes an intravenous dose of digoxin that is ten times the usual therapeutic dose. The nurse recognizes that the dose could be fatal, but the doctor insists that it be given as written. What should the nurse do?

• AGive the dose as written, because the physician carries full responsibility for the presc…
• BGive the dose once the physician countersigns the medication chart to accept responsibili…
• CWithhold the dose without telling the physician and record 'not given' at the end of the…
• DWithhold the dose, explain the concern to the prescriber, and escalate if the order stands

During a night shift on a labour ward, a midwife notices that a colleague has slurred speech, an unsteady gait and smells of alcohol while preparing an oxytocin infusion. What is the midwife's primary professional duty?

• ATake over the colleague's charting and let the colleague rest in the staff room until the…
• BStop the colleague giving care now, keep the women safe, and report to the nurse in charg…
• CMention the observation informally at the morning handover so the day staff are aware
• DLet the colleague finish the infusion under observation and report the matter to the Leso…

A 15-year-old comes alone to a health centre in Lesotho asking for an HIV test. According to Lesotho's national HIV guidelines, how should the nurse handle consent?

• ATest only after a parent or guardian gives written consent, because the client is under 18
• BTest only if the adolescent is married, pregnant or already a parent, as these confer adu…
• CTest on the adolescent's own informed consent, since clients aged 12 and above may consent
• DRefer the adolescent to the district hospital, where only doctors may test minors

The LNC keeps separate registrations and scope-of-practice documents for the Registered General Nurse and the Registered Midwife. Which statement best describes the distinct role of the Registered Midwife?

• AThe Registered Midwife is limited to postnatal care, while all deliveries must be conduct…
• BAny Registered General Nurse posted to a maternity ward may conduct deliveries independen…
• CThere is no practical difference, because both cadres share a single register and the sam…
• DThe Registered Midwife conducts normal births and starts emergency management of obstetri…

A patient with terminal metastatic cancer has a valid, documented Do Not Resuscitate (DNR) order. When the patient has a cardiac arrest, a distressed relative demands that the nurse start chest compressions. What is the nurse's sound response?

• AHonour the valid DNR order, do not start compressions, and support the relative compassio…
• BStart full CPR because a family member's request overrides the written order
• CGive intravenous adrenaline but withhold chest compressions as a compromise
• DStart CPR while calling the doctor to decide whether the DNR order still applies

A 56-year-old man presents to the outpatient department with a blood pressure of 210/125 mmHg, a severe occipital headache, blurred vision and mild confusion. How should the triage nurse categorize this presentation?

• AHypertensive emergency
• BHypertensive urgency
• CPrimary essential hypertension
• DWhite-coat hypertension

A 60-year-old arrives with crushing central chest pain radiating to the jaw, sweating and nausea. While the 12-lead ECG is being prepared, which drug should the nurse give immediately unless it is contraindicated?

• AIntravenous furosemide 80 mg
• BAspirin 162–325 mg, chewed
• CSubcutaneous enoxaparin 100 mg
• DOral warfarin 10 mg

A patient with heart failure receives intravenous furosemide 40 mg for acute pulmonary congestion. Which laboratory value must the nurse monitor most closely during loop diuretic therapy?

• ASerum calcium
• BSerum albumin
• CSerum troponin
• DSerum potassium

An adult with severe chronic obstructive pulmonary disease (COPD) and known chronic carbon dioxide retention is admitted with a chest infection. What oxygen saturation (SpO2) should the nurse target when giving supplemental oxygen?

• A88% to 92%
• B94% to 98%
• C75% to 80%
• D98% to 100%

A 24-year-old presents to health centre triage with an acute asthma attack, audible wheeze and a respiratory rate of 28 breaths/min. Which inhaled medicine is the immediate first-line bronchodilator?

• ABeclomethasone
• BSalmeterol
• CSalbutamol
• DIpratropium bromide on its own

A 48-year-old woman is admitted with community-acquired pneumonia. Intravenous ceftriaxone, blood cultures and sputum culture are ordered. What is the correct nursing sequence?

• AGive the antibiotic first and collect the cultures 24 hours later
• BCollect the blood and sputum cultures, then give the first antibiotic dose without delay
• CWithhold antibiotics until the culture and sensitivity results are available
• DCollect cultures only if the patient has not improved after 48 hours of antibiotics

A person living with HIV screens positive for TB symptoms at a Lesotho health centre. Under the national guidelines, which test should be requested on the sputum sample?

• AA chest X-ray alone, without a sputum test
• BA tuberculin skin test (Mantoux)
• CSputum smear microscopy only after a two-week course of antibiotics
• DGeneXpert MTB/RIF

Which transmission-based precautions must the nurse use when caring for an inpatient with active, sputum-positive pulmonary tuberculosis?

• AAirborne precautions with an N95/FFP2 respirator and a negative-pressure or well-ventilat…
• BContact precautions, with a plastic apron and gloves for all direct patient contact
• CDroplet precautions, with a surgical mask worn whenever within 1 metre of the patient
• DProtective (reverse) isolation in a positive-pressure room with restricted visitors

A client starting TB treatment that includes isoniazid is also prescribed pyridoxine (vitamin B6). What is the main reason for giving pyridoxine?

• ATo enhance the bactericidal action of rifampicin
• BTo prevent optic neuritis caused by ethambutol
• CTo prevent isoniazid-induced peripheral neuropathy
• DTo treat hyperuricaemia caused by pyrazinamide

When teaching a patient who is starting rifampicin-containing TB treatment, which harmless effect should the nurse warn about in advance so that the patient is not alarmed?

• ARinging in the ears and hearing loss
• BOrange-red urine, sweat, saliva and tears
• CYellowing of the eyes and skin
• DBlack discoloration of the tongue

Using the WHO clinical staging of HIV disease for adults and adolescents, which condition places a patient in clinical stage 4?

• AUnexplained moderate weight loss (less than 10% of body weight)
• BPersistent oral candidiasis (thrush)
• CPersistent generalized lymphadenopathy
• DOesophageal candidiasis

Under Lesotho's 2022 national HIV guidelines, what is the preferred first-line antiretroviral regimen for adolescents and adults weighing at least 35 kg, including pregnant and breastfeeding women?

• AZidovudine + lamivudine + nevirapine (AZT/3TC/NVP)
• BTenofovir + lamivudine + efavirenz (TLE)
• CTenofovir + lamivudine + dolutegravir (TLD)
• DAbacavir + lamivudine + lopinavir/ritonavir

A client who has taken TLD for 12 months has a routine viral load of 1,800 copies/mL. There are no symptoms of illness. According to Lesotho's national HIV guidelines, what is the appropriate next step?

• ASwitch to a second-line regimen at today's visit to prevent resistance
• BGive enhanced adherence counselling and repeat the viral load after three months
• CRepeat the viral load the same week and switch regimens if it is still above 1,000 copies…
• DRequest a CD4 count and switch regimens only if immunological failure is confirmed

A patient with a baseline CD4 count of 35 cells/mm3 starts ART. Three weeks later the patient develops high fever, enlarging cervical lymph nodes and a productive cough while the viral load is falling. Drug toxicity has been excluded. What is the most likely explanation?

• AImmune reconstitution inflammatory syndrome (IRIS)
• BVirological failure of the first-line regimen
• CAn allergic reaction to lamivudine
• DAcute retroviral syndrome (seroconversion illness)

An 18-year-old with type 1 diabetes has lethargy, a blood glucose of 28 mmol/L, deep sighing (Kussmaul) breathing and a fruity odour on the breath. Blood gases show pH 7.18 and bicarbonate 10 mmol/L. What condition is this?

• AHyperosmolar hyperglycaemic state
• BMetabolic alkalosis caused by dehydration
• CLactic acidosis caused by severe hypoglycaemia
• DDiabetic ketoacidosis

An adult is confirmed to have diabetic ketoacidosis (DKA) with signs of dehydration. What is the first treatment priority before the intravenous insulin infusion is started?

• AInfuse 5% dextrose to prevent hypoglycaemia
• BGive a sodium bicarbonate infusion to correct the acidosis
• CGive a rapid infusion of 0.9% sodium chloride to restore circulating volume
• DGive 0.45% sodium chloride as the first bolus to correct the high osmolality

A conscious inpatient on insulin is trembling, sweating and tachycardic, with a blood glucose of 3.2 mmol/L. The patient can swallow safely. What is the nurse's immediate action?

• AGive 1 mg of glucagon intramuscularly
• BGive 50 mL of 50% dextrose by IV push
• CGive a protein snack such as bread with peanut butter and recheck in 1 hour
• DGive 15 g of fast-acting carbohydrate by mouth, wait 15 minutes, and recheck the glucose

Which pain pattern classically helps to distinguish a duodenal ulcer from a gastric ulcer?

• AGastric ulcer pain is relieved by food, whereas duodenal ulcer pain is made worse by eati…
• BDuodenal ulcer pain comes 2–3 hours after meals and is eased by food; gastric ulcer pain…
• CDuodenal ulcer pain starts during swallowing and is felt behind the sternum, unlike gastr…
• DBoth ulcers always cause identical pain, so timing never helps to tell them apart

A 21-year-old has abdominal pain that started around the umbilicus and moved to the right lower quadrant, with low-grade fever, nausea and loss of appetite. There is marked tenderness at McBurney's point and rebound tenderness. What is the most likely diagnosis?

• AAcute appendicitis
• BAcute pancreatitis
• CAcute cholecystitis
• DRenal colic from a ureteric stone

Why must a patient fast (nil by mouth) before surgery under general anaesthesia?

• ATo reduce postoperative nausea and vomiting after the anaesthetic
• BTo prevent postoperative constipation and paralytic ileus
• CTo reduce the risk of wound breakdown after surgery
• DTo prevent aspiration of stomach contents during anaesthesia

On the first day after major abdominal surgery, which nursing intervention is most effective in preventing atelectasis and pneumonia?

• ADeep breathing, incentive spirometry, supported coughing and early walking
• BStrict bed rest for 48 hours to protect the incision from strain
• CDiscouraging coughing so that the incision is not painful or strained
• DRoutine prophylactic antibiotics for all postoperative patients

After orthopaedic surgery, a patient develops swelling, warmth, redness and tenderness of one calf. What should the nurse suspect, and what should the nurse do?

• ASuperficial thrombophlebitis; apply warm compresses and massage the calf
• BDeep vein thrombosis; avoid massaging the leg and notify the doctor immediately
• CMuscle strain from physiotherapy; encourage vigorous calf exercises
• DCellulitis; apply a tight elastic bandage and encourage walking

On day 5 after a laparotomy, a patient coughs violently and says something 'gave way'. The nurse finds the wound has opened and loops of bowel are protruding. What are the nurse's immediate actions?

• AGently push the bowel back into the abdomen with gloved hands and apply a firm dressing
• BCover the wound with dry sterile gauze and give sips of water to keep the patient hydrated
• CCover the bowel with sterile saline-soaked dressings, flex the knees, keep nil by mouth,…
• DLay the patient flat and apply a tight abdominal binder over the wound to hold it closed

A patient with stage 5 chronic kidney disease has a serum potassium of 7.2 mmol/L, and the cardiac monitor shows peaked T waves and a widening QRS complex. Which intravenous medicine should the nurse expect to give first to protect the heart?

• AInsulin with dextrose
• BOral sodium polystyrene sulfonate
• CFurosemide
• DCalcium gluconate

A 68-year-old develops sudden right-sided weakness and expressive aphasia 45 minutes before arrival. Which imaging test is required before thrombolysis can be considered?

• AMagnetic resonance angiography with contrast
• BA non-contrast CT scan of the brain
• CA lumbar puncture
• DAn electroencephalogram (EEG)

A patient with decompensated liver cirrhosis develops hepatic encephalopathy with asterixis and confusion, and oral lactulose is prescribed. How does the nurse judge whether lactulose is working?

• AThe serum bilirubin returns to normal within 24 hours of starting
• BThe abdominal girth decreases as the ascites resolves
• C2–3 soft stools a day, with a clearer mental state and less asterixis
• DThe patient passes one hard, formed stool every two days

A 70 kg adult has partial- and full-thickness burns covering 40% of total body surface area (TBSA). Using the Parkland formula (4 mL × kg × % TBSA of Ringer's lactate over 24 hours), what is the total 24-hour volume, and how much should be given in the first 8 hours after the burn?

• ATotal 5,600 mL; first 8 hours 2,800 mL
• BTotal 11,200 mL; first 8 hours 5,600 mL
• CTotal 8,400 mL; first 8 hours 4,200 mL
• DTotal 11,200 mL; first 8 hours 3,733 mL

According to the WHO 'My 5 Moments for Hand Hygiene', when must a nurse perform hand hygiene even though gloves were worn?

• AOnly if a glove visibly tore or was punctured during the procedure
• BOnly if the hands look visibly soiled after the gloves are removed
• COnly at the start and end of each shift, when gloves are changed
• DImmediately after removing gloves used for contact with blood or body fluids

To prevent central line-associated bloodstream infection (CLABSI), what should the nurse do every time a central venous catheter hub is accessed?

• AScrub the hub with an antiseptic swab using friction and let it dry before connecting
• BWipe the hub quickly with dry sterile gauze before connecting the syringe
• CSpray alcohol onto the hub and connect the syringe while it is still wet
• DChange the central line dressing every 4 hours to keep the site sterile