Nurse Licensing Examination (Сувилагчийн мэргэжлийн үйл ажиллагаа эрхлэх зөвшөөрлийн шалгалт, Mongolia)

A nurse is preparing to administer an oral antihypertensive medication to an alert adult patient. What is the most reliable method to confirm the patient's identity according to nursing safety standards?

• ACheck the room number and bed label against the medication administration record
• BAsk the patient to state their full name and date of birth while checking their identific…
• CAsk the patient if they are the individual listed on the medication packet
• DVerify the patient's identity with a visiting family member at the bedside

When assessing an adult patient's radial pulse, the nurse notes that the rhythm is irregular. What is the nurse's next immediate action?

• ADocument the radial pulse rate as normal and recheck in four hours
• BAdminister a prescribed PRN dose of digoxin immediately
• CCount the apical pulse with a stethoscope for a full 60 seconds
• DNotify the attending physician before obtaining any further vital signs

A bedridden elderly patient has non-blanchable erythema over the intact skin of the sacrum. The area is firm and painful compared to adjacent tissue. How should the nurse categorize this pressure injury?

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

A patient with severe dysphagia following a cerebrovascular accident requires nasogastric (NG) tube feeding. Prior to administering each intermittent bolus feeding, which bedside method is most appropriate to confirm tube position?

• AInject 20 mL of air through the tube while auscultating the epigastric area
• BPlace the external end of the NG tube into a cup of water to check for bubbling
• CRely solely on the centimeter marking at the naris documented during initial insertion
• DAspirate gastric contents, verify fluid appearance, and measure pH with litmus paper belo…

A nurse is measuring blood pressure on an adult patient. Which error will lead to a falsely elevated systolic and diastolic blood pressure reading?

• AUsing a blood pressure cuff bladder that is too wide for the arm circumference
• BUsing a blood pressure cuff bladder that is too narrow for the arm circumference
• CPositioning the patient's arm slightly above the level of the right atrium
• DDeflating the cuff bladder too rapidly at a rate exceeding 5 mm Hg per second

In the five-step nursing process (Assessment, Diagnosis, Planning, Implementation, Evaluation), formulating measurable, patient-centered goals and selecting nursing interventions occurs during which phase?

• AAssessment
• BDiagnosis
• CPlanning
• DImplementation

A post-stroke patient with left-sided hemiplegia is learning to ambulate using a single-point cane. How should the nurse instruct the patient to hold and advance the cane?

• AHold the cane on the unaffected (right) side, advance the cane with the affected (left) l…
• BHold the cane on the affected (left) side, advance the cane first, and then step forward…
• CHold the cane on the unaffected side, step forward with the strong leg first, and then ad…
• DHold the cane in whichever hand feels more comfortable and move both legs together

Which principle is essential when practicing proper body mechanics to prevent back injury during heavy patient transfers?

• AKeep feet tightly together and bend forward at the waist while lifting
• BMaintain a narrow center of gravity and twist the torso during the lift
• CLift with back extensor muscles rather than using leg and gluteal muscles
• DMaintain a wide base of support, keep the load close to the body, and bend at the knees

A nurse is administering a subcutaneous injection of unfractionated heparin. Which technique represents correct clinical practice?

• AAspirate for blood return prior to injecting the medication
• BInject at a 45- to 90-degree angle into the abdominal fat pad at least 5 cm away from the…
• CVigorously massage the injection site for 30 seconds after needle withdrawal to speed abs…
• DUse the deltoid intramuscular muscle mass as the primary preferred injection site

A patient with acute hypocalcemia exhibits carpopedal spasm within three minutes of the nurse inflating a blood pressure cuff to 20 mm Hg above the systolic pressure. What clinical sign has the nurse elicited?

• AChvostek's sign
• BKernig's sign
• CTrousseau's sign
• DBrudzinski's sign

When assessing a conscious patient's pain, what is considered the single most reliable indicator of pain intensity and characteristics?

• AThe patient's self-report of their pain
• BChanges in physiological vital signs such as heart rate and blood pressure
• CThe degree of tissue damage observed on physical inspection
• DThe behavioral observations made by family members and nursing staff

A patient is prescribed 500 mL of 0.9% Normal Saline to be infused over 4 hours. The IV administration set delivers 15 drops per mL (gtt/mL). What is the calculated flow rate in drops per minute (gtt/min)?

• A21 gtt/min
• B42 gtt/min
• C31 gtt/min
• D52 gtt/min

A nurse is inserting an indwelling urinary catheter in a female patient. After inserting the catheter into the urethral meatus, urine begins to flow into the tubing. What should the nurse do next before inflating the retention balloon?

• AImmediately inflate the retention balloon with 10 mL of sterile water
• BAdvance the catheter an additional 2.5 to 5 cm (1 to 2 inches)
• CWithdraw the catheter slightly until urine flow ceases
• DConnect the drainage bag and pull firmly on the catheter tubing

Which of the following is considered an objective assessment finding rather than a subjective symptom?

• APatient reporting a sharp headache rated 7/10
• BPatient describing feelings of nausea and dizziness
• CBilateral pitting pedal edema measured at +2 (4 mm depression)
• DPatient stating that they have felt depressed for two weeks

A patient with chronic obstructive pulmonary disease (COPD) is experiencing shortness of breath. Which position should the nurse assist the patient into to optimize diaphragmatic excursion and ease breathing?

• AOrthopneic or tripod position leaning forward over a bedside table
• BTrendelenburg position with the feet elevated above the head
• CFlat supine position without pillows
• DLeft lateral Sim's position with knees flexed

A nurse is performing tracheal suctioning on a patient with a tracheostomy. What is the maximum duration that suction pressure should be applied during a single suctioning pass to prevent severe hypoxia?

• A20 to 25 seconds
• B30 seconds
• C15 to 20 seconds
• D10 to 15 seconds

A postoperative patient's 24-hour intake consists of 1,200 mL IV fluids, 300 mL oral water, and 200 mL soup. The output includes 900 mL urine and 150 mL Jackson-Pratt wound drainage. What is the patient's net fluid balance for this 24-hour period?

• A+650 mL positive balance
• B+800 mL positive balance
• C-250 mL negative balance
• D+450 mL positive balance

An arterial blood gas (ABG) analysis on an acutely ill patient reveals: pH 7.28, PaCO2 56 mm Hg, HCO3- 25 mEq/L, and PaO2 78 mm Hg. How should the nurse interpret these findings?

• ACompensated metabolic acidosis
• BUncompensated metabolic alkalosis
• CUncompensated respiratory acidosis
• DFully compensated respiratory alkalosis

A patient receiving continuous intravenous potassium chloride (KCl) via a peripheral IV line complains of burning and stinging at the site. The nurse observes mild erythema without swelling. What is the nurse's priority action?

• AStop the infusion immediately, assess the IV site, and establish a new line if needed
• BIncrease the IV infusion rate to finish the potassium administration faster
• CApply a tight tourniquet proximal to the site to reduce venous irritation
• DReassure the patient that potassium burning is harmless and leave the infusion running

A nurse is evaluating a postoperative care plan. The goal states: 'Patient will ambulate 30 meters independently with a walker by postoperative day 2.' On day 2, the patient ambulates 10 meters with moderate physical assistance from the nurse. What is the nurse's evaluative judgment?

• AGoal completely met; discontinue the nursing intervention
• BGoal unmet due to nurse documentation failure; delete the outcome
• CGoal unmet; re-evaluate baseline mobility, revise interventions, and extend the timeframe
• DGoal partially met; discharge the patient to home immediately

On the first postoperative day following abdominal laparotomy, a patient reports sudden severe pain and feeling 'something pop' during a coughing spell. On examination, the nurse notes separation of the surgical incision layers with protrusion of intestinal loops. What is the nurse's immediate priority intervention?

• AAttempt to gently push the protruding intestinal loops back into the abdominal cavity
• BAdminister oral analgesics and leave the patient in a prone position
• CApply a firm abdominal binder over the wound and encourage deep ambulation
• DCover the protruding viscera with sterile gauze soaked in sterile normal saline and keep…

A patient who underwent a total thyroidectomy 12 hours ago reports numbness and tingling around the lips and in the fingertips. Which complication should the nurse suspect and immediately prepare to manage?

• AThyroid storm crisis
• BAccidental hypoparathyroidism leading to acute hypocalcemia
• CSuperior laryngeal nerve paralysis
• DSystemic lidocaine toxicity

A nurse is initiating a transfusion of packed red blood cells (PRBCs). What is the maximum duration permitted for infusing a single unit of blood to minimize the risk of bacterial proliferation?

• A4 hours
• B6 hours
• C8 hours
• D12 hours

A patient with deep vein thrombosis (DVT) is receiving a continuous intravenous unfractionated heparin infusion. Which laboratory test must the nurse monitor to adjust the heparin dosage safely?

• AProthrombin Time (PT)
• BInternational Normalized Ratio (INR)
• CPlatelet count and activated Partial Thromboplastin Time (aPTT)
• DSerum fibrinogen level only

A patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). After initiating fluid resuscitation with 0.9% normal saline and a regular insulin infusion, the patient's blood glucose drops from 540 mg/dL to 240 mg/dL. What adjustment in IV fluids should the nurse expect?

• AChange IV fluids to 0.45% normal saline without dextrose and increase insulin rate
• BAdd 5% dextrose to the IV infusion fluid while maintaining insulin administration
• CDiscontinue both the insulin infusion and all intravenous fluids immediately
• DAdminister an IV bolus of 50% dextrose and clamp the IV infusion line

A postoperative patient following general anesthesia is prescribed incentive spirometry. Which instruction should the nurse provide to ensure proper technique and prevent postoperative atelectasis?

• AInhale slowly and deeply through the mouthpiece, hold the breath for 3 to 5 seconds, and…
• BExhale forcefully into the mouthpiece as hard and fast as possible to register peak flow
• CRapidly inhale and exhale through the mouthpiece ten times consecutively without pausing
• DUse the device only if fever or productive purulent cough develops

A patient with stage 4 chronic kidney disease (CKD) requires comprehensive dietary counseling. Which dietary modification is most critical to prevent fatal cardiac dysrhythmias and progressive bone mineral disease?

• AIncrease daily intake of citrus fruits, bananas, and dairy products
• BDouble daily dietary protein intake using red meats and organ meats
• CConsume unrestricted table salt and canned processed broths
• DLimit foods high in potassium, phosphorus, and sodium while consuming controlled biologic…

A nurse is conducting discharge education for a patient diagnosed with chronic congestive heart failure (CHF). Which parameter should the patient be taught to monitor daily at home as the earliest indicator of fluid retention?

• AMeasurement of abdominal girth every evening before bedtime
• BSkin turgor assessment over the clavicular area
• CHourly pulse oximetry readings at rest
• DBody weight measured every morning upon waking after voiding and before breakfast

An adult patient presents to the emergency department with substernal crushing chest pain radiating to the left jaw, diaphoresis, and nausea. Which sequence of immediate nursing interventions is most appropriate for suspected ST-elevation myocardial infarction (STEMI)?

• AAdminister oral antacids, wait 30 minutes, and discharge if pain resolves
• BPerform a complete cranial nerve examination before obtaining an electrocardiogram
• CObtain a 12-lead ECG within 10 minutes, establish IV access, administer aspirin, and moni…
• DSend the patient for a routine chest radiograph before initiating any monitoring or medic…

A 68-year-old patient arrives at the emergency unit with sudden right-sided hemiparesis and expressive aphasia. For intravenous recombinant tissue plasminogen activator (rtPA) thrombolytic therapy to be safely considered, within what timeframe from last known well must it be administered?

• AWithin 3 to 4.5 hours of symptom onset
• BWithin 12 to 24 hours of symptom onset
• CWithin 48 hours of symptom onset
• DAnytime within 7 days provided the patient is conscious

A patient with a documented history of peptic ulcer disease suddenly cries out in agony and develops severe epigastric pain that rapidly spreads throughout the entire abdomen. On palpation, the abdomen is board-like and rigid. What complication has occurred?

• AAcute cholecystitis with biliary colic
• BIntestinal paralytic ileus
• CSpontaneous bacterial peritonitis from ascites
• DPerforation of the ulcer into the peritoneal cavity

A patient with end-stage liver cirrhosis is admitted with flapping hand tremors (asterixis) and confusion. The physician orders lactulose 30 mL orally three times daily. How should the nurse assess the therapeutic effectiveness of this treatment?

• AConfirming that the patient has zero bowel movements over 48 hours
• BObserving 2 to 3 soft bowel movements per day and improvement in cognitive orientation
• CNoting that serum bilirubin levels drop below 1.0 mg/dL
• DVerifying that the patient's prothrombin time normalizes completely

A 22-year-old patient with an acute asthma exacerbation is experiencing audible expiratory wheezing, tachypnea, and an oxygen saturation of 91% on room air. Which medication should the nurse administer first?

• AOral montelukast tablet
• BInhaled fluticasone propionate corticosteroid
• CInhaled short-acting beta-2 agonist (albuterol) via nebulizer
• DSubcutaneous immunotherapy allergen extract

A patient returns to the orthopedic unit following a total hip replacement via a posterior surgical approach. Which nursing measure is essential to prevent prosthetic dislocation during the immediate postoperative period?

• AKeep an abduction pillow between the legs and prevent hip flexion beyond 90 degrees
• BInstruct the patient to cross their legs whenever sitting in an upright armchair
• CPlace the patient on a low toilet seat without a raised toilet seat adapter
• DEncourage the patient to bend at the waist to put on their own socks and shoes

A young adult with a closed tibial fracture treated with a circumferential fiberglass cast complains of severe, escalating pain in the lower leg that is unresponsive to IV morphine. On assessment, passive dorsiflexion of the great toe elicits excruciating pain, and the toes appear tense and pale. What action must the nurse take first?

• AElevate the affected leg on three pillows above heart level and apply warm compresses
• BAdminister a double dose of IV opioid analgesics and reassess in two hours
• CRecognize signs of acute compartment syndrome, notify the surgeon immediately, and prepar…
• DEncourage active weight-bearing exercises to promote venous return

When changing the sterile transparent semipermeable dressing on a patient's subclavian central venous line, which antiseptic solution and application technique are recommended to prevent central line-associated bloodstream infections (CLABSI)?

• A70% ethyl alcohol applied in circular motions from periphery to the center and wiped dry…
• BPovidone-iodine solution scrubbed vigorously and blotted dry with sterile cotton balls
• CHydrogen peroxide solution applied with sterile cotton swabs around the insertion site
• DChlorhexidine gluconate (>0.5% with 70% alcohol) scrubbed back and forth with friction fo…

A nurse is assessing a closed underwater chest drainage system connected to a patient recovering from a traumatic pneumothorax. What does gentle, rhythmic fluctuation (tidaling) of the fluid column in the water-seal chamber indicate?

• AA dangerous air leak somewhere along the chest tube connections
• BNormal pressure changes within the pleural cavity corresponding to patient inspiration an…
• CComplete obstruction or clotting within the intrathoracic chest tube
• DImmediate resolution of the pneumothorax requiring chest tube removal

A patient with a new descending colostomy is being taught stoma and ostomy pouch care. What instruction should the nurse include regarding normal stoma appearance and pouch emptying?

• AThe stoma should appear moist, shiny, and reddish-pink, and the pouch should be emptied w…
• BThe stoma should appear dark purple or black, and the pouch should only be emptied when c…
• CThe stoma should be pale grey and completely dry, and the pouch should be replaced every…
• DThe skin barrier wafer should be cut 2 centimeters larger than the stoma diameter to expo…

A patient with chronic autoimmune arthritis abruptly stopped taking prescribed high-dose oral prednisone three days ago. The patient is brought to the clinic lethargic, with a blood pressure of 78/46 mm Hg, heart rate 118 bpm, serum sodium 128 mmol/L, and blood glucose 3.1 mmol/L. What life-threatening condition should the nurse suspect?

• AThyroid storm crisis
• BDiabetic hyperosmolar hyperglycemic state
• CAcute pheochromocytoma paroxysm
• DAcute Addisonian (adrenal) crisis due to secondary adrenal insufficiency

A patient with severe acute pancreatitis has bluish discoloration around the umbilicus and across the flanks. How should the nurse document these clinical signs, and what do they indicate?

• AHomans' sign and Kernig's sign, indicating deep venous thrombosis
• BMurphy's sign and McBurney's sign, indicating acute gangrenous appendicitis
• CCullen's sign (periumbilical) and Grey Turner's sign (flanks), indicating retroperitoneal…
• DChvostek's sign and Trousseau's sign, indicating acute hypercalcemia

During a routine prenatal clinic assessment of a pregnant woman at 20 weeks of gestation, where should the nurse expect to palpate the uterine fundus?

• AJust above the symphysis pubis
• BAt the level of the umbilicus
• CMidway between the symphysis pubis and the umbilicus
• DAt the level of the xiphoid process

A patient with preeclampsia with severe features is receiving a continuous intravenous infusion of magnesium sulfate for eclampsia seizure prophylaxis. During hourly assessment, the nurse notes: respiratory rate 10 breaths/min, absent deep tendon reflexes (patellar), and urine output 15 mL/hr. What is the nurse's priority action?

• AStop the magnesium sulfate infusion immediately and prepare to administer intravenous cal…
• BIncrease the IV rate of magnesium sulfate to treat impending eclamptic seizures
• CAdminister an oral dose of labetalol and continue the magnesium infusion
• DEncourage the patient to drink large amounts of water to improve urine output

A woman who delivered a 4.1 kg infant vaginally 30 minutes ago experiences sudden heavy vaginal bleeding. On palpation, the fundus is boggy, soft, and displaced upward and to the right of the umbilicus. What is the nurse's immediate sequence of interventions?

• APrepare the patient for an immediate emergency hysterectomy without attempting conservati…
• BPlace the patient in a prone position and apply a tight pelvic binder
• CPerform vigorous uterine fundal massage until firm and assist the patient to empty her bl…
• DAdminister oral iron supplements and advise the patient to rest quietly