HPCNA Nursing Board Pre-Registration Evaluation — Nurse and Midwife Practitioner (formerly NCNA, Namibia)

A registered nurse is completing an admission assessment on an adult on the medical ward. Which set of observations falls within the usual resting range for a healthy adult?

• ABP 148/94 mmHg, pulse 104/min, respirations 22/min, temperature 38.1 °C
• BBP 116/74 mmHg, pulse 78/min, respirations 16/min, temperature 36.8 °C
• CBP 92/58 mmHg, pulse 54/min, respirations 10/min, temperature 35.6 °C
• DBP 124/82 mmHg, pulse 112/min, respirations 24/min, temperature 37.4 °C

An adult with type 1 diabetes is alert, sweaty and tremulous and can swallow safely. The capillary blood glucose is 2.8 mmol/L. What should the nurse do first?

• AGive 15-20 g of fast-acting oral glucose and recheck glucose after about 15 minutes
• BGive the next scheduled rapid-acting insulin dose early with a meal
• CStart an IV infusion of 0.9% sodium chloride and recheck the glucose level in one hour
• DGive 1 mg glucagon intramuscularly before offering anything by mouth

A 58-year-old has crushing central chest pain radiating to the left arm. The 12-lead ECG shows an anterior ST-elevation myocardial infarction. BP is 142/88 mmHg and SpO2 is 96% on room air. Which immediate drug action is most appropriate while reperfusion is arranged?

• AGive oxygen at 15 L/min by non-rebreather mask regardless of SpO2
• BGive aspirin 300 mg to chew, unless contraindicated
• CGive enteric-coated aspirin 75 mg to swallow with water
• DGive pethidine 100 mg intramuscularly for the chest pain

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

• AIV 10% calcium gluconate, given slowly with ECG monitoring
• BIV soluble insulin with glucose to move potassium into cells
• COral sodium polystyrene sulfonate resin to remove potassium
• DIV furosemide 40 mg to increase urinary potassium loss

A 24-year-old with acute severe asthma has a respiratory rate of 32/min, cannot complete sentences and has a peak expiratory flow of 45% of her best. Which initial drug treatment is indicated?

• AAn oral theophylline loading dose before any inhaled therapy
• BSubcutaneous adrenaline as the main bronchodilator
• CA doubled dose of her inhaled corticosteroid via spacer, alone
• DInhaled salbutamol by spacer or nebuliser plus a systemic corticosteroid

A 20-year-old is admitted with diabetic ketoacidosis: pH 7.12, bicarbonate 9 mmol/L, glucose 28 mmol/L and serum potassium 3.1 mmol/L. What is the correct initial priority for fluids and insulin?

• AStart a fixed-rate insulin infusion now, then begin IV fluids once glucose falls
• BGive IV sodium bicarbonate first to correct the low pH
• CGive IV saline and potassium; hold insulin until potassium is corrected
• DGive IV 5% dextrose first so that insulin can be started safely

On day 3 after open abdominal surgery, a 62-year-old reports pain, swelling and tenderness in the left calf, which is 3.5 cm larger than the right. What is the most appropriate nursing action?

• AMassage the calf gently to ease the cramp and encourage walking
• BKeep the leg still and supported, avoid massage, and inform the doctor promptly
• CApply a tight crepe bandage over the calf and review in 24 hours
• DApply a hot water bottle to the calf and give oral analgesia

Fifteen minutes into a red cell transfusion, a patient develops rigors, low back pain, breathlessness and a temperature of 39.1 °C. The BP falls from 124/80 to 90/54 mmHg. What is the nurse's first action?

• ASlow the transfusion and give oral paracetamol for the fever
• BGive an antihistamine and continue the transfusion under observation
• CStop the transfusion, keep IV access with saline via a new set, and call the doctor
• DFlush the blood line with 5% dextrose and recheck the observations

A patient with a severe head injury is in the high-care unit. Which group of vital signs makes up Cushing's triad, a late sign of raised intracranial pressure?

• AFalling blood pressure, tachycardia and rapid shallow breathing
• BFalling blood pressure, bradycardia and Cheyne-Stokes breathing
• CRising blood pressure with narrowing pulse pressure, tachycardia and rapid hyperventilati…
• DRising systolic pressure with widening pulse pressure, bradycardia and irregular breathing

A 70 kg adult has deep partial-thickness burns of 36% total body surface area. Using the Parkland formula (4 mL x weight in kg x %TBSA over 24 hours), how much Ringer's lactate is planned for the first 8 hours after the burn?

• A5,040 mL
• B10,080 mL
• C3,360 mL
• D2,520 mL

A nurse has passed a fine-bore nasogastric tube for feeding. Which bedside check best confirms that the tip is in the stomach before the first feed?

• AInject 20 mL of air and listen over the epigastrium for a 'whoosh'
• BPlace the end of the tube in a cup of water and watch for bubbling
• CAspirate and test with pH strips; a pH of 5.5 or below supports gastric placement
• DConfirm placement if the patient is not coughing and can speak normally

After a hip operation, a patient on the surgical ward has an indwelling urinary catheter that will stay in for several days. While planning care, which measure should the nurse maintain to reduce the risk of catheter-associated urinary tract infection?

• AHang the drainage bag on the bed rail at mattress level during transfers
• BKeep a closed drainage system with the bag below bladder level
• CReplace the catheter routinely every 48 hours to limit colonisation
• DIrrigate the bladder daily with chlorhexidine through the catheter

A 45-year-old vomits about 800 mL of bright red blood and becomes pale and cold. BP is 82/50 mmHg, pulse 128/min and capillary refill 4 seconds. What is the immediate nursing priority?

• ATwo large-bore IV cannulae, rapid fluid resuscitation and urgent cross-match
• BSit the patient upright and give oral sucralfate suspension
• CGive sips of iced water to slow the bleeding by vasoconstriction
• DGive vitamin K intramuscularly and record observations hourly

A patient with acute severe pancreatitis has epigastric pain radiating to the back and a very high serum lipase. Which finding suggests retroperitoneal haemorrhage and a poorer prognosis?

• AA fine maculopapular rash over the anterior chest
• BBilateral painless enlargement of the parotid glands
• CBilateral pitting ankle oedema without abdominal signs
• DBruising around the umbilicus or over the flanks

A 14-month-old with acute watery diarrhoea is lethargic, has sunken eyes, cannot drink, and the skin pinch goes back very slowly. Using IMCI, how is the child classified and treated?

• ANo dehydration: Plan A, extra fluids and ORS at home
• BSome dehydration: Plan B, 75 mL/kg ORS over 4 hours in the clinic
• CSevere dehydration: Plan C, IV Ringer's lactate 100 mL/kg
• DSevere dehydration: Plan B ORS by cup, plus loperamide syrup

A 9-month-old has had a cough for 3 days. Counted over a full minute while calm, the respiratory rate is 54/min. There is no chest indrawing, no stridor and no general danger sign. How does IMCI classify and treat this child?

• ACough or cold: no antibiotic; soothe the throat and advise follow-up
• BPneumonia: oral amoxicillin for 5 days, with follow-up
• CSevere pneumonia: first dose of IM antibiotic and urgent referral
• DWheeze only: inhaled salbutamol, with no antibiotic needed

A feverish 2-year-old has a generalised tonic-clonic seizure in the clinic waiting area. What is the nurse's immediate priority?

• ATurn the child on the side, protect from injury, and time the seizure
• BPut a padded spoon between the teeth to protect the tongue
• CHold the arms and legs firmly to stop the jerking movements
• DGive paracetamol syrup by mouth to bring the fever down

A 3-year-old is admitted with complicated severe acute malnutrition, bilateral pitting oedema and poor appetite. Under WHO guidance, which feeding approach is used in the initial stabilisation phase?

• AReady-to-use therapeutic food in unrestricted amounts from admission
• BF-100 catch-up formula with daily iron from the first day
• CDiluted cow's milk after an IV saline bolus of 20 mL/kg
• DF-75 starter formula given in small, frequent feeds

An emergency unit uses a colour-coded triage scale such as the South African Triage Scale (SATS). Which patient belongs in the red (emergency) category?

• AAn adult with a closed forearm fracture, moderate pain and normal vital signs
• BAn adult with a 2-day productive cough, temperature 38.2 °C and respirations 20/min
• CAn adult with stridor, respirations 38/min, cyanosis and SpO2 82% on room air
• DAn adult with localised lower abdominal pain and normal vital signs

Minutes after an IV cephalosporin dose, a 22-year-old develops generalised urticaria, lip and eyelid swelling, wheeze and a BP of 78/42 mmHg. After stopping the infusion, which drug and route are first-line?

• AOral cetirizine 10 mg and observation for 30 minutes
• BIV hydrocortisone 200 mg as the first drug
• CNebulised salbutamol with oxygen as the first drug
• DIM adrenaline 0.5 mg (1 mg/mL) into the anterolateral thigh

During CPR for an adult in cardiac arrest without an advanced airway, which compression-to-ventilation ratio, rate and depth should rescuers use?

• A30:2, at 100-120 compressions/min, to a depth of 5-6 cm
• B15:2, at 60-80 compressions/min, to a depth of about 3 cm
• C30:2, at 140-160 compressions/min, to a depth of about 8 cm
• D5:1, at 80 compressions/min, to a depth of about 4 cm

A patient with Gram-negative sepsis is receiving multiple-daily-dose IV gentamicin. When should the nurse take the blood sample for a trough level?

• A30 minutes after the infusion has finished
• BJust before the next scheduled dose
• CMidway between two doses
• DAt any time, because gentamicin levels stay constant

A patient on warfarin for atrial fibrillation has an INR of 8.5 and no signs of bleeding. What is the expected management?

• AGive the usual dose tonight and recheck the INR in one week
• BGive IV protamine sulphate now to reverse the warfarin effect
• CWithhold warfarin, inform the prescriber, give oral vitamin K as ordered
• DHalve tonight's dose and advise the patient to eat more green leafy vegetables

Before discharge, a 64-year-old with stable angina asks how to use the newly prescribed sublingual glyceryl trinitrate (GTN) tablets if chest pain starts at home. Which advice should the nurse give?

• ASwallow one tablet whole with water as soon as the chest pain starts
• BSit down, place one tablet under the tongue, and repeat after 5 minutes if needed
• CMove the tablets into a clear plastic pill box so they are easy to carry
• DTake a tablet only if the chest pain has lasted for more than 30 minutes

On day 6 after a laparotomy, a patient coughs and feels 'something give'. The wound has opened and a loop of bowel is protruding. What is the immediate nursing action?

• APush the bowel back gently with sterile gloves and apply a dressing
• BApply a dry pressure dressing and encourage the patient to walk
• CGive oral analgesia and reassess the wound at the end of the shift
• DCover with sterile saline-soaked dressings, flex the knees and call the surgeon

A 26-year-old with a closed tibial shaft fracture in a circumferential plaster cast has severe, increasing leg pain despite IV morphine. Pain worsens when the toes are passively stretched, and pedal pulses are still palpable. What should the nurse suspect and do?

• AAcute compartment syndrome: split the cast and call the surgeon urgently
• BExpected fracture pain: reassure and increase the analgesia
• CDeep vein thrombosis: give low-molecular-weight heparin
• DAcute osteomyelitis: start IV antibiotics and elevate the leg

A 65-year-old developed right-sided weakness and expressive aphasia 60 minutes ago. Which investigation must be done urgently before IV thrombolysis is considered?

• ALumbar puncture to look for blood in the cerebrospinal fluid
• BTransthoracic echocardiogram to look for a cardiac clot
• CNon-contrast CT scan of the brain to exclude haemorrhage
• D24-hour Holter ECG to detect paroxysmal atrial fibrillation

A bedbound older adult with hemiplegia is at high risk of pressure injury. Which plan is most effective in preventing one?

• AMassage reddened bony areas with surgical spirit twice daily to improve the circulation
• BKeep the head of the bed raised at 60-90 degrees day and night to aid breathing
• CPlace a ring (doughnut) cushion under the sacrum whenever the patient lies in bed
• DReposition regularly on a pressure-redistributing mattress; keep skin clean and dry

A 68-year-old with severe COPD and known chronic hypercapnic respiratory failure has an exacerbation, with SpO2 84% on room air. What oxygen target and delivery method are appropriate?

• ATarget 98-100% using a non-rebreather mask at 15 L/min
• BTarget 88-92% using a 24% or 28% Venturi mask
• CTarget 94-98% using nasal prongs at 6 L/min
• DWithhold oxygen to avoid suppressing the respiratory drive

A postoperative patient in septic shock remains hypotensive after initial fluid resuscitation, with a mean arterial pressure below 65 mmHg. According to the Surviving Sepsis Campaign guidelines, which vasopressor is first-line?

• ADopamine infusion as the preferred first agent, titrated to heart rate
• BVasopressin infusion as the sole first-line agent, without norepinephrine
• CNorepinephrine (noradrenaline) titrated to a MAP of at least 65 mmHg
• DPhenylephrine boluses as the preferred first agent to raise the MAP

A 22-year-old attends her first antenatal (booking) visit at 10 weeks. Which group of routine screening tests is standard at booking?

• AHIV, syphilis, haemoglobin, blood group and Rh, and urine dipstick
• BFasting lipids, thyroid function, liver ultrasound, HbA1c and vitamin D
• CAmniocentesis, chest X-ray, HIV test, rubella IgM and cervical swab
• DSerum beta-hCG, Pap smear, urine culture, pelvic X-ray and blood group

A woman with a regular 28-day cycle reports that her last normal menstrual period began on 14 May 2025. Using Naegele's rule, what is her expected date of delivery?

• A14 February 2026
• B28 February 2026
• C21 March 2026
• D21 February 2026

Why do antenatal care guidelines give pregnant women daily iron and folic acid supplements?

• ATo prevent pre-eclampsia and reduce the risk of gestational diabetes
• BTo support fetal bone mineralisation and prevent neonatal rickets
• CTo prevent maternal anaemia and reduce the risk of neural tube defects
• DTo prevent neonatal jaundice and reduce the risk of Rh isoimmunisation

At 32 weeks, a woman has a BP of 165/112 mmHg on two readings 15 minutes apart, severe epigastric pain, headache and blurred vision. Urinalysis shows 3+ protein. What is the most likely diagnosis?

• AGestational hypertension without severe features
• BPre-eclampsia with severe features
• CChronic hypertension with acute gastroenteritis
• DHELLP syndrome, confirmed on clinical signs alone

A primigravida in spontaneous labour has a cervix 6 cm dilated and fully effaced, with the vertex at station 0 and 4 contractions in 10 minutes each lasting 45 seconds. Which stage and phase of labour is she in?

• AActive phase of the first stage
• BLatent phase of the first stage
• CSecond stage of labour
• DThird stage of labour

A midwife is using the WHO modified partograph. The plotted cervical dilatation moves to the right of the alert line and then crosses the action line. What does this mean, and what should be done?

• ANormal progress for a primigravida; continue routine hourly observations
• BPrecipitate labour; prepare the delivery pack for an imminent birth
• CProlonged active phase; reassess mother and fetus and get urgent obstetric review
• DFalse labour; give a sedative and send her home until the contractions strengthen

Which set describes the components of active management of the third stage of labour (AMTSL) as taught in midwifery practice?

• AImmediate cord clamping, fundal pressure, and IV ergometrine for every woman
• BManual removal of the placenta, vaginal packing, and oral misoprostol for every woman
• CWait up to 1 hour for spontaneous separation, then apply firm fundal pressure
• DOxytocin 10 IU IM within 1 minute, controlled cord traction, uterine tone checks

How is primary postpartum haemorrhage (PPH) defined after a vaginal birth?

• ABlood loss of 200 mL or more within 6 hours of birth
• BBlood loss of 500 mL or more within 24 hours of birth
• CAny bleeding between day 2 and day 42 after birth
• DBlood loss of 1,500 mL or more with loss of consciousness

A 26-year-old at 36 weeks arrives having generalised convulsions, with a BP of 178/118 mmHg. Which anticonvulsant regimen and monitoring are correct?

• AMgSO4 4 g IV slowly plus 10 g IM, with reflex, breathing and urine checks
• BDiazepam 10 mg IV, repeated as needed, followed by oral methyldopa
• CIV phenytoin loading dose, followed by oral phenytoin maintenance
• DIM phenobarbital, repeated every 30 minutes until the convulsions have stopped

During the birth of a large baby, the head delivers but then retracts against the perineum (the 'turtle sign'), and gentle downward traction does not deliver the anterior shoulder. What is the correct immediate action?

• AApply fundal pressure while pulling the head firmly downwards
• BCut a wide episiotomy and apply strong lateral traction to the baby's head
• CAsk the mother to push harder while the head is rotated forcefully
• DCall for help, stop pushing, and use McRoberts with suprapubic pressure

The membranes rupture in active labour with the cervix 6 cm dilated, and the midwife feels a pulsating loop of umbilical cord in front of the fetal head. What is the immediate management?

• APush the cord gently back into the uterus above the presenting part
• BEncourage strong pushing so that the baby is born within the next few contractions
• CCall for help, relieve cord pressure in knee-chest position, expedite birth
• DLie her flat on her back and recheck the fetal heart every 15 minutes

A midwife explains normal lochia to a new mother. Which sequence is correct?

• ARubra for about the first 3-4 days, serosa to about day 10, then alba
• BAlba for the first 3 days, then rubra for 2 weeks, then serosa
• CBright red lochia with small clots throughout the whole of the first 6 weeks
• DSerosa for the first 4 days, then rubra from day 5, then alba

A breastfeeding mother asks about the lactational amenorrhoea method (LAM). Which three conditions must all be met for LAM to be reliable?

• AInfant under 12 months, at least 3 feeds a day, menses already returned
• BNo return of menses, full or nearly full breastfeeding, infant under 6 months
• CInfant under 6 months, mixed feeding allowed, light bleeding acceptable
• DInfant under 9 months, solids started, no bleeding for 30 days

A term baby is born limp and not breathing. The midwife dries, warms and stimulates the baby and clears the airway as needed, but at 60 seconds (the Golden Minute) the baby is still not breathing and the heart rate is 70/min. What is the next action?

• AGive naloxone and dextrose through the umbilical vein
• BContinue drying and rubbing the back for another minute
• CGive 100% oxygen by face mask held near the baby's face
• DStart bag-and-mask ventilation with room air at 40-60 breaths/min