MNMC Nurses' Competency Exam (Maldives)

A registered nurse is conducting an admission interview for an adult patient admitted with acute abdominal pain. During which phase of the nursing process does the nurse collect subjective and objective health data to establish a clinical baseline?

• ADiagnosis phase
• BAssessment phase
• CImplementation phase
• DEvaluation phase

A nurse assesses an adult patient suspected of having orthostatic (postural) hypotension. Which protocol accurately describes the correct procedure for measuring postural vital signs?

• AMeasure blood pressure while sitting, immediately upon lying flat, and 10 minutes post-ex…
• BMeasure blood pressure only while standing after vigorous walking for 2 minutes
• CMeasure blood pressure supine, sit for 15 minutes, and then immediately measure standing…
• DMeasure blood pressure and pulse after the patient is supine for 5 minutes, immediately u…

Upon inspecting an immobilized patient's sacrum, the nurse notes partial-thickness skin loss with an exposed viable pink-red wound bed without slough or granulation tissue. There is also an intact serum-filled blister over the prominence. According to standard pressure injury staging guidelines, what stage is this pressure injury?

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

A 78-year-old patient who is disoriented to time and place is admitted to the medical ward. Which nursing intervention is the most effective and least restrictive priority action to prevent accidental falls?

• AApply bilateral soft wrist restraints while the patient is unattended
• BKeep all four side rails elevated at all times to prevent the patient from exiting the bed
• CPlace the patient near the nurses' station with the bed low and the call bell in reach
• DAdminister PRN oral sedatives at bedtime to maintain continuous sleep

A nurse is inserting an indwelling urinary catheter (Foley) for an adult female patient. After lubricating the catheter and inserting it into the urethral meatus, the nurse observes urine return in the tubing. What is the nurse's immediate next step before inflating the retention balloon?

• AAdvance the catheter an additional 2.5 to 5 cm (1 to 2 inches)
• BImmediately inflate the balloon with the full volume of sterile water
• CPull back gently on the catheter until slight resistance is felt
• DIrrigate the catheter with 30 mL of sterile normal saline

A nurse is preparing to administer oxygen via a non-rebreather mask to a patient experiencing severe hypoxemic respiratory distress. What is the minimum oxygen flow rate required on the flowmeter to prevent the reservoir bag from collapsing during inspiration and to prevent carbon dioxide rebreathing?

• A2 to 4 L/min
• B5 to 6 L/min
• C1 to 2 L/min
• D10 to 15 L/min

When performing open suctioning of an adult patient with a tracheostomy tube, which guideline must the nurse follow to prevent hypoxemia and mucosal trauma?

• APre-oxygenate with 100% oxygen, limit suction application to no more than 10 to 15 second…
• BApply continuous suction while advancing the catheter down the trachea for up to 30 secon…
• CSet suction pressure to greater than 200 mmHg and insert the catheter until meeting resis…
• DInstill 10 mL of sterile water into the tracheostomy tube prior to every suction pass

A patient with severe delirium requires bilateral soft wrist restraints to prevent accidental extubation from mechanical ventilation. According to standard patient safety regulations, what is an essential nursing responsibility regarding restraint care?

• ASecure the restraint straps tightly to the movable side rails of the hospital bed
• BFasten restraints with a square knot that cannot be easily undone by clinical staff
• CRelease each restraint at least every 2 hours to check skin, circulation, and movement
• DObtain a permanent standing physician order that does not require periodic renewal

A nurse calculates an adult patient's 8-hour fluid intake: the patient drank 120 mL of water, 200 mL of clear broth, received 500 mL of intravenous normal saline, and had 50 mL of IV antibiotic piggyback. What total intake in milliliters should the nurse record?

• A820 mL
• B750 mL
• C670 mL
• D870 mL

A nurse has just inserted a small-bore nasogastric (NG) enteral feeding tube for an adult patient. Which method is the definitive clinical gold standard to verify correct tube position in the stomach prior to initiating the first feeding?

• AAuscultating a whoosh of air over the epigastrium while injecting 20 mL of air through th…
• BAn abdominal X-ray (radiography) confirming the tube tip in the gastric body
• CSubmerging the proximal end of the tube in water to check for bubbling
• DVisual inspection of the tube depth marking at the patient's nares alone

A nurse is evaluating pain in a non-verbal, mechanically ventilated adult patient in the intensive care unit. Which standardized clinical assessment tool should the nurse utilize?

• AWong-Baker FACES Pain Rating Scale
• BVisual Analog Scale (VAS) 0 to 100 mm
• CCritical-Care Pain Observation Tool (CPOT)
• DNumeric Rating Scale (NRS) 0 to 10

Before giving a scheduled intravenous antibiotic, a nurse must confirm the patient's identity. Which method meets accepted patient-safety standards?

• AAsk the patient to state full name and date of birth, and check both against the ID band…
• BCheck the room and bed number against the medication chart
• CAsk, 'Are you Mr. Ibrahim?', and proceed when the patient says yes
• DConfirm the patient's diagnosis and attending doctor's name with the chart

According to standard infection prevention and control principles, which statement accurately defines the scope of 'Standard Precautions' in healthcare settings?

• AStandard precautions apply only to patients with confirmed cultures positive for multidru…
• BStandard precautions are applied only in operating suites and intensive care units
• CStandard precautions apply to all patients receiving care in healthcare facilities, regar…
• DStandard precautions require wearing a sterile gown, mask, and shoe covers for every rout…

The World Health Organization (WHO) outlines 'My 5 Moments for Hand Hygiene' for healthcare workers. Which clinical moment is specifically designated as Moment 1?

• AAfter touching a patient's immediate surroundings
• BAfter body fluid exposure risk
• CImmediately after completing a shift
• DBefore touching a patient

A nurse is responsible for maintaining an indwelling urinary catheter (Foley) in a bedridden medical patient. Which action prevents Catheter-Associated Urinary Tract Infections (CAUTI)?

• AHang the urine collection bag on the movable bed side rail for easy visualization
• BKeep the drainage system closed and the bag below bladder level at all times
• CRoutinely irrigate the bladder with antimicrobial solutions twice daily
• DDisconnect the catheter from the drainage tubing every 4 hours to drain urine into a bedp…

Which structure is the normal pacemaker of the heart, initiating impulses at a resting rate of about 60 to 100 beats per minute?

• ASinoatrial (SA) node
• BAtrioventricular (AV) node
• CBundle of His
• DPurkinje fibres

A nurse is auscultating heart sounds. Where on the chest wall is the mitral valve area best heard?

• ASecond right intercostal space at the right sternal border
• BSecond left intercostal space at the left sternal border
• CFourth left intercostal space at the lower left sternal border
• DFifth left intercostal space at the midclavicular line (the apex)

Which hormone, released from the posterior pituitary gland, stimulates uterine contraction during labour and the milk-ejection (let-down) reflex during breastfeeding?

• AProlactin
• BAntidiuretic hormone (vasopressin)
• COxytocin
• DFollicle-stimulating hormone

A patient who received a large dose of opioid is hypoventilating. Why does the patient's arterial blood pH fall?

• AThe kidneys excrete more bicarbonate in response to the opioid
• BRetained carbon dioxide forms carbonic acid, increasing hydrogen ion concentration
• CLow oxygen levels are directly converted into hydrogen ions in the plasma
• DHypoventilation increases chloride loss through the lungs

A patient with poorly controlled diabetes has glucose in the urine. In a healthy kidney, where is almost all filtered glucose normally reabsorbed?

• ALoop of Henle
• BDistal convoluted tubule
• CProximal convoluted tubule
• DCollecting duct

A physician prescribes 1,000 mL of 0.9% normal saline to be infused intravenously over 8 hours. The IV administration set delivers 15 drops per milliliter (gtt/mL). At what drop rate in drops per minute (gtt/min) should the nurse regulate the gravity infusion?

• A21 gtt/min
• B31 gtt/min
• C42 gtt/min
• D63 gtt/min

An adult patient receiving continuous intravenous unfractionated heparin for pulmonary embolism has a baseline platelet count of 320,000/mm3. On day 6 of therapy, routine laboratory testing reveals a platelet count of 140,000/mm3 (a 56% drop) without active bleeding. What condition should the nurse suspect, and what is the required immediate action?

• AImmune thrombocytopenic purpura; administer high-dose aspirin
• BNormal physiological dilution from IV fluids; continue the heparin infusion at the curren…
• CHeparin-induced thrombocytopenia; stop all heparin and start a non-heparin anticoagulant
• DHeparin overdose; immediately administer subcutaneous low-molecular-weight heparin

A patient taking oral digoxin 0.25 mg daily reports loss of appetite, nausea, vomiting, and seeing yellow-green halos around lights. Heart rate is 46 beats/min. Which serum electrolyte imbalance significantly increases the risk of this digitalis toxicity?

• AHypernatremia
• BHypercalcemia
• CHypermagnesemia
• DHypokalemia

A patient newly started on enalapril (an ACE inhibitor) for hypertension calls the clinic reporting sudden, painless swelling of the lips, tongue, and eyelids, along with a sensation of throat tightness. What adverse drug reaction is this patient experiencing?

• AStevens-Johnson syndrome
• BAngioedema
• CSerum sickness
• DToxic epidermal necrolysis

A patient receiving an intravenous infusion of vancomycin 1,000 mg over 30 minutes develops flushing, erythematous rash on the face, neck, and upper torso, and mild pruritus. Vital signs show BP 104/68 mmHg, HR 88 beats/min, and SpO2 98%. What is the nurse's priority action?

• AStop the infusion, assess airway and vital signs, and restart at a slower rate once sympt…
• BImmediately administer intramuscular epinephrine 1:1,000 for anaphylactic shock
• CIncrease the infusion rate to finish the medication before the rash worsens
• DPermanently discontinue vancomycin and document a severe anaphylactic allergy

A nurse is administering morning subcutaneous insulins to a hospitalized patient with type 2 diabetes. The order reads: Insulin glargine (Lantus) 24 units once daily at 0800, and Insulin lispro (Humalog) 4 units with breakfast. Which administration practice is correct?

• AAdminister insulin glargine and insulin lispro in separate syringes at separate injection…
• BDraw up both insulins into the same syringe, drawing the clear lispro before the glargine
• CDraw up both insulins into the same syringe, drawing the glargine before the lispro
• DWithhold insulin glargine until the patient finishes the entire breakfast meal

A postoperative patient receives IV naloxone (Narcan) to reverse severe opioid-induced respiratory depression (respiratory rate 4 breaths/min, pinpoint pupils). Within 2 minutes, the patient awakens and respiratory rate improves to 16 breaths/min. Why must the nurse continue close observation for at least 2 to 3 hours?

• ANaloxone causes permanent tolerance to all future narcotic analgesics
• BNaloxone causes severe delayed hypoglycemia 2 hours after administration
• CNaloxone stimulates profound delayed sedation through secondary GABA receptors
• DNaloxone wears off sooner than most opioids, so respiratory depression can return

A patient with stable angina is discharged with a prescription for sublingual nitroglycerin tablets. Which instruction regarding proper use during an acute chest pain episode is correct according to modern guidelines?

• ASwallow the tablet immediately with 250 mL of water and lie completely flat
• BChew the tablet thoroughly and take up to 6 doses consecutively every 2 minutes
• CWait until the pain has lasted 20 minutes, then take three tablets together
• DTake one tablet under the tongue; if pain is not relieved in 5 minutes, call emergency se…

A patient is prescribed intravenous gentamicin for severe Gram-negative bacteremia. To ensure therapeutic efficacy while minimizing nephrotoxicity and ototoxicity, the nurse must obtain a serum trough level. When should the nurse draw the blood sample for the trough concentration?

• AExactly 30 minutes after completing the intravenous infusion
• BImmediately before (within 30 minutes prior to) administering the next scheduled dose
• CMidway between two scheduled doses
• DAt 0800 regardless of when the dose was actually given

Ten minutes after initiating a transfusion of packed red blood cells (PRBCs), an adult patient complains of chills, lower back pain, dyspnea, and feeling hot. The nurse notes a temperature spike from 37.0°C to 38.8°C and dark red urine in the Foley catheter. What is the nurse's immediate priority action?

• ASlow the blood transfusion rate to 50 mL/hr and administer oral acetaminophen
• BFlush the blood tubing vigorously with 50 mL of sterile water
• CStop the transfusion, replace the tubing, and keep the vein open with 0.9% saline
• DAdminister IV furosemide directly into the running blood line

A physician orders potassium chloride (KCl) 20 mEq IV for a patient with persistent hypokalemia. Which safety rule must the nurse strictly adhere to when administering intravenous potassium?

• AAlways administer potassium chloride diluted in IV infusion fluids using an electronic in…
• BAdminister the medication as a rapid direct IV push over 30 seconds to quickly correct hy…
• CMix the potassium chloride in a 10 mL syringe and inject it via a central venous line as…
• DInfuse the undiluted potassium at a rate of 50 mEq/hr through a small peripheral hand vein

A pediatric patient weighing 18 kg is prescribed oral amoxicillin suspension for acute otitis media. The prescription reads: 80 mg/kg/day in two equally divided doses every 12 hours. How many milligrams should the child receive per individual dose?

• A1,440 mg
• B720 mg
• C360 mg
• D480 mg

A patient is admitted to an atoll hospital with suspected active pulmonary tuberculosis (TB) manifesting cough, hemoptysis, and night sweats. Which transmission-based precaution and room placement are mandatory?

• AContact Precautions in an open multi-bed ward with a surgical paper mask
• BAirborne precautions: a negative-pressure isolation room and fitted N95 respirators
• CDroplet Precautions in a positive-pressure room with standard examination gloves only
• DStandard Precautions with no personal protective equipment necessary unless performing ve…

A nurse experiences a percutaneous puncture wound from a hollow-bore needle contaminated with blood from an HIV- and Hepatitis B-unknown patient. What is the nurse's immediate first step?

• AWash the puncture site thoroughly with soap and copious running water for several minutes…
• BSqueeze the puncture wound aggressively to express as much blood as possible, then apply…
• CTake oral broad-spectrum antibiotics and wait 7 days before notifying anyone
• DSubmerge the injured hand in a basin of povidone-iodine for 30 minutes

Which sterilization method uses saturated steam under high pressure and is considered the most dependable, non-toxic, and widely accessible method for sterilizing heat- and moisture-stable surgical instruments?

• AImmersion in 70% ethyl alcohol for 5 minutes
• BEthylene oxide gas sterilization at ambient room temperature
• CAutoclaving (steam sterilization at 121°C at 15 psi for 15 to 30 minutes)
• DUltraviolet light irradiation in a dark room

A nurse is caring for an adult patient hospitalized with severe Clostridioides difficile (C. diff) colitis. Which hand hygiene practice is mandatory after providing direct care to this patient?

• ARinse hands with water alone for 5 seconds
• BApply alcohol-based hand rub thoroughly for 20 seconds
• CWipe hands with an alcohol-soaked sterile gauze pad
• DWash hands thoroughly with soap and running water for at least 20 seconds

Which organism is the most common cause of surgical site infections and is frequently carried in the anterior nares of healthy people?

• AEscherichia coli
• BStreptococcus pneumoniae
• CClostridium tetani
• DStaphylococcus aureus

A patient's wound culture grows methicillin-resistant Staphylococcus aureus (MRSA). In addition to standard precautions, which precautions should the nurse implement?

• AAirborne precautions with an N95 respirator and a negative-pressure room
• BContact precautions with gloves and gown, a single room or cohorting, and dedicated equip…
• CDroplet precautions with a surgical mask within 1 to 2 metres of the patient
• DProtective (reverse) isolation for the patient's own protection

A nurse on a general medical ward assesses an adult patient whose respiratory rate has increased from 16 to 34 breaths/min, oxygen saturation has dropped to 87% on room air, and systolic blood pressure has fallen from 120 to 82 mmHg. The patient is increasingly lethargic. What is the nurse's most appropriate immediate action?

• AWait 1 hour and repeat the vital signs to establish a consistent downward trend
• BInitiate high-flow supplemental oxygen and activate the hospital's Rapid Response Team (M…
• CAdminister an oral antipyretic and encourage deep breathing exercises
• DIncrease the IV maintenance rate and document the findings for the next scheduled medical…

A nurse is calling a physician to report a sudden clinical deterioration in a postoperative patient. Which structured communication framework should the nurse use to convey urgent clinical information clearly and concisely?

• ASOAP (Subjective, Objective, Assessment, Plan)
• BPIE (Problem, Intervention, Evaluation)
• CSBAR (Situation, Background, Assessment, Recommendation)
• DDAR (Data, Action, Response)

The evening before a biopsy, a patient says, 'I'm scared the results will show cancer.' Which response by the nurse is most therapeutic?

• A'You're worried about what the biopsy might show. Can you tell me more about what concern…
• B'Don't worry—your surgeon is excellent, and I'm sure everything will be fine.'
• C'Why are you thinking so negatively before the results are even back?'
• D'Many patients feel that way. Let's go over your fasting instructions for tomorrow.'

After handover on a medical ward, a nurse reviews four patients. Which patient should the nurse assess first?

• AA patient 1 day after hernia repair who rates pain at 4/10 and is due for oral analgesia
• BA patient with chronic COPD whose SpO₂ is 90% on 1 L/min oxygen, unchanged from baseline
• CA patient with type 2 diabetes whose pre-breakfast capillary glucose is 12 mmol/L (216 mg…
• DA patient who became restless and breathless, with SpO₂ 88%, 15 minutes after a blood tra…

According to the Maldives National Expanded Programme on Immunization (EPI) schedule administered across health centers and atoll hospitals, which disease antigens are contained within the childhood Pentavalent combination vaccine?

• AMeasles, Mumps, Rubella, Varicella, and Polio
• BDiphtheria, Tetanus, Pertussis, Hepatitis B, and Haemophilus influenzae type b (Hib)
• CTuberculosis, Polio, Rotavirus, Pneumococcal, and Hepatitis A
• DHuman Papillomavirus, Influenza, Meningococcal, Cholera, and Typhoid

In the Maldives, dengue fever is endemic with seasonal peaks during monsoon rains. A nurse in an atoll hospital is monitoring a patient with confirmed dengue on day 4 of illness as the fever begins to subside (defervescence phase). Which clinical finding represents a critical 'warning sign' of progression to severe dengue?

• AA fine maculopapular rash spreading over the chest and arms
• BPersistent vomiting, severe abdominal pain, mucosal bleeding, and a rising hematocrit
• CA dry cough, a mild sore throat, and a runny nose
• DA mild headache and muscle aches relieved by paracetamol