MNMC Nursing Registration and Competency Examinations (မြန်မာနိုင်ငံသူနာပြုနှင့်သားဖွားကောင်စီ — MNMC)

What is the correct logical sequence of the five phases comprising the Nursing Process?

• AAssessment, Diagnosis, Planning, Implementation, Evaluation
• BDiagnosis, Assessment, Implementation, Planning, Evaluation
• CAssessment, Planning, Diagnosis, Evaluation, Implementation
• DPlanning, Assessment, Implementation, Evaluation, Diagnosis

During an admission assessment of a patient with pneumonia, which of the following clinical findings is classified as 'objective data'?

• AA respiratory rate of 28 breaths per minute and fine inspiratory crackles auscultated at…
• BThe patient stating, 'I feel like I cannot catch my breath when I lie flat.'
• CThe patient describing sharp chest pain rated 7 out of 10 on deep breathing
• DThe patient reporting feeling anxious and exhausted after walking to the bathroom

According to the World Health Organization (WHO) Guidelines on Hand Hygiene in Healthcare, which of the following is designated as Moment 2 of the 'My 5 Moments for Hand Hygiene'?

• AImmediately before performing a clean or aseptic procedure
• BBefore touching a patient upon entering the room
• CAfter body fluid exposure risk
• DAfter touching patient surroundings

What is the correct protocol for safely removing (doffing) Personal Protective Equipment (PPE) after caring for an isolated patient to minimize self-contamination, when using gloves, gown, face shield, and particulate respirator?

• ARemove gloves and gown (most contaminated first), perform hand hygiene, remove eye protec…
• BRemove the respirator first, then gloves, then gown, and leave eye protection in place.
• CRemove gown, respirator, gloves, and eye protection simultaneously in one bundle.
• DRemove gloves, leave all other PPE on, and wash hands over the gown.

A patient with suspected active cavitary pulmonary tuberculosis is admitted to the medical ward. Which specific infection control precautions must the nurse implement?

• AAirborne precautions: promptly separate the patient in an appropriate well-ventilated iso…
• BStandard precautions only, placing the patient in an open multi-bed ward.
• CContact precautions: wearing a gown and gloves only, with no respiratory protection.
• DDroplet precautions: placing the patient in a positive-pressure room with surgical paper…

When setting up and maintaining a sterile field for a complex surgical dressing change, which action by the nurse maintains surgical asepsis?

• AKeeping sterile gloved hands above waist level and in sight at all times, and treating th…
• BTurning the back completely to the sterile field to retrieve supplies from an adjacent co…
• CReaching across the open sterile field to pour saline into a sterile basin.
• DResting sterile gloved hands below the level of the hips while waiting for the physician.

Following the administration of an intramuscular injection, what is the mandatory nursing safety practice regarding needle disposal to prevent occupational sharps injury and bloodborne pathogen transmission?

• AImmediately dispose of the unshielded, uncapped needle and syringe into a designated punc…
• BManually recap the contaminated needle using both hands before disposal.
• CBend or clip the contaminated needle with a pair of scissors before throwing it in the ge…
• DPlace the used syringe and needle on the patient's bedside table for disposal at the end…

When measuring blood pressure with an aneroid sphygmomanometer, what is the expected clinical error if the nurse uses a cuff where the inflatable bladder is too narrow or too small for the patient's arm circumference?

• AThe blood pressure reading will be falsely high (overestimated).
• BThe blood pressure reading will be falsely low (underestimated).
• CThe reading will remain perfectly accurate regardless of cuff size.
• DOnly the pulse pressure will narrow with no change in systolic pressure.

A nurse assesses a patient for orthostatic hypotension. The patient's supine blood pressure is 138/84 mmHg with a heart rate of 72 bpm. Upon standing for 3 minutes, the patient reports lightheadedness, and the blood pressure is 114/72 mmHg with a heart rate of 96 bpm. Does this patient meet the clinical definition of orthostatic hypotension?

• AYes; systolic blood pressure dropped by 24 mmHg (exceeding the diagnostic threshold of ≥2…
• BNo; diastolic blood pressure must drop by at least 30 mmHg to confirm orthostatic hypoten…
• CNo; orthostatic hypotension can only be diagnosed if the heart rate drops below 50 bpm.
• DNo; blood pressure changes are considered clinically insignificant unless systolic pressu…

Which of the following clinical factors can cause an inaccurate or unreliable pulse oximetry (SpO2) reading by disrupting optical light absorption through the sensor?

• ASevere peripheral hypoperfusion, hypothermia, dark nail polish, and carbon monoxide poiso…
• BMild systemic hypertension with normal warm extremities
• CAdministering supplemental oxygen via nasal cannula at 2 L/min
• DNormal sinus rhythm at 75 beats per minute

A nurse uses the PQRST mnemonic to conduct a comprehensive assessment of a patient presenting with acute chest discomfort. What does the 'Q' component of the PQRST assessment represent?

• AQuality of the pain (how the pain feels in the patient's own words, such as crushing, sha…
• BQuantity of medications the patient has taken for relief
• CQuickness of onset from the moment symptoms began
• DQuestions regarding family history of cardiovascular disease

Which of the following represents the core 'Rights of Medication Administration' that every registered nurse must systematically verify before administering any pharmaceutical agent?

• ARight Patient, Right Medication, Right Dose, Right Route, Right Time, and Right Documenta…
• BRight Room, Right Doctor, Right Cost, Right Pharmacy, and Right Insurance
• CRight Manufacturer, Right Expiration Date, Right Syringe Size, and Right Floor
• DRight Diagnosis, Right Relative, Right Appointment, and Right Department

A physician orders 1,000 mL of 0.9% Normal Saline to infuse intravenously over 8 hours. The administration tubing has a drop factor of 15 drops/mL (gtt/mL). At what flow rate in drops per minute (gtt/min) should the nurse set the manual gravity IV infusion?

• A31 drops per minute
• B21 drops per minute
• C45 drops per minute
• D125 drops per minute

Which anatomical site is recommended as the safest, first-choice site for administering deep intramuscular (IM) injections of volume up to 3 mL in adults?

• AThe ventrogluteal site (gluteus medius and minimus)
• BThe dorsogluteal site (upper outer quadrant of the buttock)
• CThe deltoid muscle of the upper arm
• DThe rectus abdominis muscle

What is the correct nursing technique for administering a subcutaneous injection of unfractionated heparin or low-molecular-weight heparin (enoxaparin)?

• APinch a skin fold on the abdomen at least 2 inches away from the umbilicus, insert the ne…
• BInject into the deltoid muscle, aspirate for 5 seconds to check for blood, and rub the si…
• CInject intradermally on the ventral forearm until a small bleb forms.
• DInject into the inner thigh at a 15-degree angle while stretching the skin flat.

A hospitalized client with congestive heart failure receives excessive intravenous crystalloid infusions. Which cluster of assessment findings indicates fluid volume excess (hypervolemia)?

• ABilateral pitting pedal edema, distended jugular veins at 45 degrees, basilar lung crackl…
• BDry mucous membranes, poor skin turgor, sunken eyes, and concentrated dark urine with hig…
• CPostural hypotension, flat neck veins when supine, tachycardia, and weight loss.
• DHyperthermia, extreme thirst, dry tongue, and serum sodium of 155 mEq/L.

A patient with prolonged nasogastric suctioning and furosemide diuretic therapy has a serum potassium level of 2.8 mEq/L (normal: 3.5–5.0 mEq/L). Which clinical and electrocardiographic (ECG) manifestations should the nurse monitor for?

• AMuscle weakness, hyporeflexia, paralytic ileus, flattened T waves, ST-segment depression,…
• BPeaked tall T waves, widened QRS complexes, and hyperactive deep tendon reflexes.
• CPositive Chvostek's sign, carpopedal spasm, and prolonged QT interval.
• DSevere hypertension, oliguria, and peaked P waves.

A patient with acute oliguric renal failure has a critically elevated serum potassium level of 7.2 mEq/L with ECG showing tall peaked T waves and widening of the QRS complex. Which emergency medication should the nurse anticipate administering first to immediately stabilize the cardiac membrane and prevent fatal ventricular fibrillation?

• AIntravenous 10% Calcium gluconate (10 mL given over 2 to 5 minutes)
• BOral sodium polystyrene sulfonate (Kayexalate)
• CIntravenous bolus of potassium chloride
• DSubcutaneous regular insulin alone with no glucose

An 82-year-old patient admitted with mild confusion, nocturia, and osteoarthritis is evaluated as high risk for falls. Which nursing intervention is an evidence-based, safe fall-prevention measure?

• APlace the bed in the lowest position, ensure the call light and personal items are within…
• BRaise all four side rails and apply tight wrist restraints to prevent the patient from le…
• CAdminister high-dose sedative medications at bedtime to ensure the patient remains asleep.
• DProhibit the patient from walking even with physical therapy assistance throughout the ho…

In caring for a bedbound patient at high risk of pressure injury, which prevention plan is most appropriate?

• AUse an individualised repositioning schedule, offload the heels, manage moisture and nutr…
• BMassaging vigorously over reddened bony prominences twice daily.
• CKeeping the head of the bed continuously elevated at 90 degrees.
• DApplying dry heat lamps to the sacral area for 30 minutes every shift.

A nurse inspects a sacral wound and observes full-thickness skin loss extending into subcutaneous tissue. Subcutaneous fat is visible, but bone, tendon, and muscle are not exposed. Slough is present on part of the wound bed, but does not obscure the depth of tissue loss. What stage is this pressure injury?

• AStage 3 pressure injury
• BStage 1 pressure injury
• CStage 2 pressure injury
• DStage 4 pressure injury

Following blind bedside insertion of a nasogastric tube in an adult, which method provides definitive initial confirmation before the tube is first used when radiography is required by protocol?

• AA radiograph interpreted along the entire tube path, confirming that the tube follows the…
• BAuscultating a whooshing sound over the epigastrium while injecting 20 mL of air through…
• CImmersing the distal end of the tube in a cup of water to observe for bubbling
• DRelying on the patient's statement that they feel the tube in their stomach

Which of the following nursing interventions is an essential component of the evidence-based bundle to prevent Catheter-Associated Urinary Tract Infections (CAUTI) in a patient with an indwelling Foley catheter?

• AMaintaining a closed, sterile drainage system with the collection bag continuously positi…
• BDisconnecting the catheter tubing every shift to irrigate the bladder with normal saline.
• CPlacing the urine drainage bag on the patient's bed or abdomen during transport.
• DRoutinely changing the indwelling catheter every 3 days regardless of clinical indication.

Why may a Venturi mask be selected when controlled supplemental oxygen is needed for a client at risk of hypercapnic respiratory failure?

• AThe Venturi mask delivers a precise, fixed fraction of inspired oxygen (FiO2) regardless…
• BThe Venturi mask delivers 100% pure oxygen at high flow rates to completely eliminate car…
• CThe Venturi mask eliminates the need for any supplemental humidification.
• DThe Venturi mask can be comfortably worn while eating and talking.

A newly admitted patient who is tearful and trembling says to the nurse, 'I am terrified that I have cancer and will not survive this surgery.' Which response by the nurse demonstrates effective therapeutic communication?

• A'You seem very frightened about what might happen during and after surgery. Would you lik…
• B'Don't worry, our surgeons are the best in the country and everything will be completely…
• C'You shouldn't feel that way; thousands of people have this surgery every single day.'
• D'Why are you crying before you even get your biopsy results?'

A 58-year-old man arrives at the emergency department reporting severe, substernal, crushing chest pain radiating to his left jaw and shoulder for 45 minutes, accompanied by diaphoresis and nausea. What is the priority diagnostic action that must be completed within 10 minutes of arrival?

• APerform a 12-lead electrocardiogram (ECG) and have it reviewed by a clinician immediately.
• BObtain a routine abdominal ultrasound to rule out acute pancreatitis.
• CDraw blood for a lipid panel and complete blood count.
• DAdminister an intramuscular injection of morphine sulfate before doing any tests.

A patient with long-standing congestive heart failure is admitted to the medical ward. Which clinical manifestations are specifically characteristic of Left-Sided Heart Failure, as opposed to Right-Sided Heart Failure?

• ADyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral pulmonary crackles, and cough…
• BJugular venous distension, hepatosplenomegaly, ascites, and bilateral pitting ankle edema.
• CSplinter hemorrhages under the fingernails and Osler nodes.
• DIntermittent claudication and absent pedal pulses.

A patient diagnosed with heart failure is receiving oral digoxin 0.25 mg daily. Prior to administering the scheduled morning dose, what specific assessment must the nurse perform?

• AAuscultate the apical pulse for one full minute; withhold the medication and notify the p…
• BCheck the patient's blood glucose level; withhold the medication if glucose is >140 mg/dL.
• CMeasure the patient's respiratory rate; withhold if respiration is >20 breaths per minute.
• DAssess deep tendon reflexes; withhold if hyperreflexia is present.

A 24-year-old patient experiencing an acute severe asthma attack has been wheezing loudly for 2 hours. Suddenly, upon re-auscultation, the nurse notes that wheezing has ceased and breath sounds are virtually inaudible ('silent chest'). The patient is increasingly lethargic and cyanotic. What does this 'silent chest' signify?

• AOminous sign of severe airway narrowing, fatigue, and impending respiratory arrest requir…
• BComplete resolution of bronchospasm indicating immediate recovery.
• CSpontaneous development of acute lobar pneumonia.
• DNormal clearing of airway secretions following coughing.

The nurse teaches a client with chronic obstructive pulmonary disease (COPD) how to perform 'pursed-lip breathing'. What is the primary physiological mechanism and benefit of this breathing technique?

• AIt creates positive end-expiratory pressure in the airways, preventing premature bronchio…
• BIt strengthens the diaphragm by forcing the patient to inhale against resistance.
• CIt increases the rapid breathing rate to blow off carbon monoxide.
• DIt prevents deep inspiration so that the lungs do not overexpand.

In the nursing care of a patient with an indwelling chest tube attached to a three-chamber water-seal drainage system, what is the clinical interpretation if the nurse observes gentle, rhythmic rising and falling of the fluid level in the water-seal chamber with spontaneous respirations ('tidaling')?

• ANormal physiological finding indicating that the chest tube is patent and responsive to i…
• BSevere system obstruction requiring immediate vigorous milking of the chest tube.
• CA massive air leak originating from a tear in the patient's pulmonary parenchyma.
• DImmediate indication that the chest tube must be removed.

A patient with a chest tube drainage unit suddenly develops continuous, vigorous bubbling in the water-seal chamber that does not stop during expiration. What does this continuous bubbling indicate, and what is the nurse's first action?

• AIt indicates an air leak in the system or a large persistent pleural air leak; the nurse…
• BIt is a normal finding indicating that the lung is fully re-expanded.
• CIt indicates that the drainage collection chamber is completely full of purulent fluid.
• DIt confirms that suction pressure has been accidentally disconnected.

A patient with a documented history of peptic ulcer disease suddenly experiences sudden, excruciating, generalized abdominal pain. On physical examination, the abdomen is rigid, board-like, and exquisitely tender with rebound tenderness. Bowel sounds are absent. What acute surgical catastrophe should the nurse suspect?

• AAcute peptic ulcer perforation into the peritoneal cavity causing chemical peritonitis
• BMild functional dyspepsia following a heavy meal
• CAcute viral gastroenteritis
• DGradual resolution of an uncomplicated duodenal ulcer

A 19-year-old patient presents to the clinic with acute right lower quadrant abdominal pain, low-grade fever, nausea, and localized tenderness at McBurney's point. While awaiting surgical evaluation for suspected appendicitis, the patient suddenly states that the severe pain has completely disappeared. What does this sudden cessation of pain indicate to the nurse?

• APotential rupture (perforation) of the appendix relieving intraluminal pressure, which ca…
• BSpontaneous healing of the appendix requiring immediate discharge.
• CSuccessful non-surgical resolution of the acute infection.
• DTransformation of appendicitis into benign irritable bowel syndrome.

A postoperative patient develops mechanical small bowel obstruction. What cluster of clinical manifestations should the nurse expect to assess?

• ACramping abdominal pain, profuse vomiting (becoming bilious or feculent), marked abdomina…
• BProfuse watery bloody diarrhea, severe hunger, and a flat non-tender scaphoid abdomen.
• CIsolated right shoulder tip pain with normal soft abdomen and normal bowel movements.
• DHyperactive bowel sounds in all quadrants with regular daily soft formed stools.

A patient with advanced liver cirrhosis and severe portal hypertension presents with massive hematemesis from ruptured esophageal varices. Which vasoactive medication is administered intravenously to reduce portal venous inflow and stem variceal hemorrhage?

• AOctreotide (or Terlipressin)
• BOral loperamide
• CIntravenous nitroprusside
• DSublingual nitroglycerin alone

A patient with end-stage liver disease exhibits asterixis ('flapping tremor' of dorsiflexed hands), lethargy, and disorientation. Laboratory analysis reveals elevated serum ammonia levels. Why is oral lactulose prescribed as the primary pharmacological treatment for this condition (hepatic encephalopathy)?

• ALactulose acidifies the colon contents, trapping toxic ammonia as non-absorbable ammonium…
• BLactulose stimulates the hepatic synthesis of albumin and coagulation factors.
• CLactulose directly destroys viral hepatitis pathogens in the bloodstream.
• DLactulose acts as a central nervous system stimulant to reverse hepatic coma.

A patient presents with an acute disabling ischaemic stroke. Which statement best describes the time-sensitive assessment for intravenous thrombolysis?

• AEvaluate immediately: standard eligibility is generally within 4.5 hours of last known we…
• BWait 24 hours before brain imaging because thrombolysis is safer after the infarct matures
• CUse the calendar date rather than last-known-well time to determine eligibility
• DGive thrombolysis at any time in the first month if weakness persists

A patient with traumatic head injury is monitored in the intensive care unit. The nurse recognizes that which triad of vital sign changes ('Cushing's Triad') indicates critically elevated intracranial pressure (ICP) and impending brainstem herniation?

• AProgressive systolic hypertension with widening pulse pressure, bradycardia, and irregula…
• BHypotension, tachycardia, and rapid tachypnea.
• CNarrowing pulse pressure, hyperactive bowel sounds, and hypothermia.
• DHigh fever, profuse diaphoresis, and severe postural hypotension.

A hospitalized client suddenly has a generalized tonic-clonic seizure in bed. What are the nurse's priority actions during the active seizure to ensure patient safety?

• AStay with the patient, ease them onto their side (lateral decubitus) to prevent aspiratio…
• BRestrain the patient's arms and legs firmly to the bed rails to stop the jerking movement…
• CInsert a plastic airway or padded tongue blade between the teeth immediately.
• DAdminister oral water and sedatives while the patient is convulsing.

A patient with type 1 diabetes mellitus is found confused, diaphoretic, tremulous, and tachycardic (heart rate 112 bpm). Fingerstick capillary blood glucose measures 52 mg/dL. The patient is awake and able to swallow safely. In accordance with the standard 'Rule of 15', what is the nurse's immediate action?

• AAdminister 15 grams of fast-acting simple carbohydrates (such as 120 mL of fruit juice or…
• BAdminister 10 units of regular insulin subcutaneously immediately.
• CGive the patient a large meal consisting of high-fat cheese and steak.
• DWithhold all food and fluids and wait 2 hours to recheck blood glucose.

A 21-year-old with type 1 diabetes is admitted with Diabetic Ketoacidosis (DKA): blood glucose 540 mg/dL, arterial pH 7.15, positive serum ketones, dehydration, and deep, rapid Kussmaul respirations. What is the priority initial intravenous fluid prescribed to restore circulating intravascular volume?

• AAn isotonic crystalloid such as 0.9% saline or a balanced crystalloid, with the initial r…
• B5% Dextrose in Water (D5W) rapid bolus
• CHypertonic 3% Saline rapid infusion
• DPure sterile water intravenous infusion