Charge Nurse Past Paper 2023 PDF

Grammar Usage, Vocabulary & Sentence Structuring

1. Neither the head nurse nor the duty staff _____ aware of the sudden change in ICU protocols.

• Answer: B) were

• Explanation: Under the proximity rule for “neither…nor,” the verb agrees with the subject closest to it (“duty staff” is plural).

2. The patient was diagnosed _____ acute appendicitis upon emergency admission.

• Answer: A) with

• Explanation: The verb “diagnosed” takes the preposition “with” when referring to a specific disease or medical condition.

3. Identify the correctly structured sentence:

• Answer: B) Scarcely had the doctor administered the drug when the spasms stopped.

• Explanation: Negative adverbials like “Scarcely” require inversion of the auxiliary verb (had) and pair with “when.”

4. Choose the antonym of “ACUTE”:

• Answer: B) Chronic

• Explanation: Acute conditions are sudden and short-lived; chronic conditions persist over a long period.

5. The Charge Nurse has been supervising the surgical unit _____ three years.

• Answer: B) for

• Explanation: “For” is used to denote a continuous duration of time.

6. If the nurse _____ the IV drip rate, the phlebitis could have been prevented.

• Answer: C) had adjusted

• Explanation: Third conditional structure: If + past perfect, could/would have + past participle.

7. Choose the correct passive form: “The charge nurse checked the medication inventory.”

• Answer: B) The medication inventory was checked by the charge nurse.

• Explanation: Past simple active (checked) transforms to was/were + past participle in passive voice.

8. Synonym of “PALLIATE”:

• Answer: B) Alleviate

• Explanation: To palliate means to make a disease or its symptoms less severe without curing it.

9. The patient is susceptible _____ opportunistic fungal infections.

• Answer: A) to

• Explanation: The adjective “susceptible” is followed by the preposition “to.”

10. The idiom “At the eleventh hour” means:

• Answer: B) At the last possible moment

• Explanation: Refers to doing something or having something happen at the final moments before it is too late.

11. Neither of the two dressing materials _____ sterile enough for this open wound.

• Answer: B) is

• Explanation: “Neither” used as a singular distributive pronoun requires a singular verb.

12. The surgeon required that the assistant nurse _____ the sterile field intact.

• Answer: B) keep

• Explanation: Subjunctive mood after verbs of demand/requirement uses the base form of the verb.

13. Choose the correctly spelled medical term:

• Answer: A) Arrhythmia

• Explanation: Standard medical spelling for an irregular cardiac rhythm.

14. The head nurse told the staff, “Ensure all oxygen cylinders are filled.” (Indirect Speech):

• Answer: B) The head nurse instructed the staff to ensure all oxygen cylinders were filled.

• Explanation: Imperatives convert to reporting verbs (instructed) followed by to + base verb and past tense alignment.

15. Synonym of “COMPLIANCE”:

• Answer: B) Adherence

• Explanation: Compliance in healthcare refers to a patient adhering to recommended medical advice or treatments.

16. This oxygen concentrator is superior _____ the old portable models.

• Answer: B) to

• Explanation: Adjectives ending in “-ior” take “to” in comparative forms.

17. Select the sentence with correct punctuation:

• Answer: B) The patient’s chart was missing from the bedside; however, it was located at the nurses’ station.

• Explanation: Conjunctive adverbs (“however”) linking two independent clauses require a preceding semicolon and a trailing comma.

18. Choose the antonym of “BENIGN”:

• Answer: B) Malignant

• Explanation: Benign means non-cancerous/harmless; malignant means cancerous/destructive.

19. The patient complained _____ severe dyspnea upon exertion.

• Answer: A) of

• Explanation: Clinically, patients “complain of” symptoms.

20. No sooner had the physician finished the examination _____ the lab results arrived.

• Answer: B) than

• Explanation: “No sooner” strictly correlates with “than.”

PART-II: Professional Section (80 Marks)

1. Basic Medical Sciences (Q21–Q35)

21. Damage to Cranial Nerve VII (Facial Nerve) results in which clinical condition?

• Answer: B) Bell’s Palsy

• Explanation: CN VII controls facial muscle motor functions; lesions cause unilateral facial drooping (Bell’s palsy).

22. An ABG value showing pH 7.50, $PaCO_2$ 30 mmHg, and $HCO_3^-$ 24 mEq/L indicates:

• Answer: B) Respiratory Alkalosis

• Explanation: Elevated pH ($>7.45$) paired with decreased $PaCO_2$ ($<35$ mmHg) reflects hyperventilation-induced respiratory alkalosis.

23. Which cellular organelle is responsible for synthesizing lipids and detoxifying drugs?

• Answer: B) Smooth Endoplasmic Reticulum

• Explanation: Smooth ER specializes in lipid synthesis, carbohydrate metabolism, and drug detoxification (especially in hepatocytes).

24. The coronary arteries branch off directly from the:

• Answer: B) Ascending Aorta

• Explanation: Left and right coronary arteries originate immediately above the aortic valve at the base of the ascending aorta.

25. Renin is secreted by the juxtaglomerular cells of the kidney in response to:

• Answer: B) Renal hypoperfusion / low blood pressure

• Explanation: Decreased renal blood flow triggers renin release to initiate the Renin-Angiotensin-Aldosterone System (RAAS).

26. Parathyroid Hormone (PTH) primary acts to elevate blood concentrations of:

• Answer: B) Calcium

• Explanation: PTH increases serum calcium via bone resorption, renal calcium reabsorption, and activation of Vitamin D.

27. What is the dominant extracellular fluid (ECF) cation responsible for osmotic pressure?

• Answer: B) Sodium ($Na^+$)

• Explanation: Sodium is the principal extracellular cation controlling body water distribution and ECF tonicity.

28. AB Positive blood contains which antigens on the surface of its red blood cells?

• Answer: B) Both A and B antigens, plus Rh antigen

• Explanation: AB positive RBCs express A, B, and Rh surface antigens, making them universal recipients for packed RBCs.

29. Pepsinogen, the inactive precursor of the protein-digesting enzyme pepsin, is secreted by:

• Answer: B) Chief cells

• Explanation: Chief cells in gastric glands secrete pepsinogen, which is activated into pepsin by gastric $HCl$.

30. First-pass metabolism occurs when orally ingested drugs are absorbed and routed directly to the:

• Answer: B) Liver via portal circulation

• Explanation: Oral drugs enter the hepatic portal vein and undergo metabolic inactivation in the liver before reaching systemic arterial circulation.

31. The specific reversal agent / antidote for an opioid overdose causing respiratory depression is:

• Answer: B) Naloxone

• Explanation: Naloxone is a competitive mu-opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression.

32. Administration of Hepatitis B Immune Globulin (HBIG) post-exposure provides:

• Answer: B) Artificial Passive Immunity

• Explanation: Exogenous antibody administration yields immediate, short-term protection without invoking host immune memory.

33. The bone that forms the posterior base of the human skull is the:

• Answer: B) Occipital bone

• Explanation: The occipital bone forms the base and back of the cranium and houses the foramen magnum.

34. Surfactant, produced by Type II alveolar cells in the lungs, functions to:

• Answer: B) Reduce alveolar surface tension and prevent collapse

• Explanation: Surfactant decreases surface tension at the air-fluid interface, preventing end-expiratory alveolar atelectasis.

35. Moving a limb away from the midline of the body is anatomically termed:

• Answer: B) Abduction

• Explanation: Abduction moves a structure away from the median sagittal plane of the body.

2. General Nursing (Q36–Q55)

36. A patient presents with acute anaphylactic shock. What is the priority emergency drug of choice?

• Answer: B) Intramuscular Epinephrine (Adrenaline)

• Explanation: Epinephrine causes bronchodilations and vasoconstriction, counteracting severe airway obstruction and hypotension.

37. Developing specific, measurable patient goals occurs during which stage of the Nursing Process?

• Answer: B) Planning

• Explanation: The planning phase involves prioritizing diagnoses, establishing SMART outcomes, and selecting nursing interventions.

38. The semi-Fowler’s position requires elevating the head of the bed to:

• Answer: B) 30 to 45 degrees

• Explanation: Semi-Fowler’s position involves head elevation of 30–45 degrees, promoting lung expansion and reducing aspiration risk.

39. When delivering chest compressions on an adult victim during CPR, the recommended rate is:

• Answer: B) 100 to 120 compressions per minute

• Explanation: Current BLS guidelines mandate a compression rate of 100–120 beats per minute to optimize coronary perfusion pressure.

40. Before administering a tube feeding via gastrostomy tube, residual volume should be checked. Feeding is typically delayed if residual volume exceeds:

• Answer: B) 250 to 500 mL (per agency policy guidelines)

• Explanation: High gastric residual volumes ($>250\text{–}500$ mL) indicate delayed gastric emptying and heighten aspiration risks.

41. The maximum recommended medication volume for a single intramuscular injection in a well-developed adult deltoid muscle is:

• Answer: A) 1 mL

• Explanation: The deltoid muscle can safely accommodate only up to 1 mL of fluid; larger volumes require gluteal or vastus sites.

42. Which infection control isolation precautions are required when caring for a patient with Clostridioides difficile ($C. diff$)?

• Answer: B) Contact Precautions with hand washing using soap and water

• Explanation: $C. diff$ spores are resistant to alcohol rub sanitizers; mechanical hand washing with soap and water is mandatory.

43. A client exhibits signs of severe hyperkalemia. Which medication is administered urgently to stabilize the cardiac membrane?

• Answer: B) IV Calcium Gluconate

• Explanation: Calcium gluconate antagonizes membrane excitability effects of hyperkalemia instantly, stabilizing myocardium without shifting $K^+$.

44. What type of IV tubing with filter must be used during the administration of Blood and Blood Components?

• Answer: B) Y-tubing with a standard 170-to-260 micron filter

• Explanation: Standard blood Y-sets feature an inline filter to trap fibrin clots and cellular debris during transfusion.

45. Placing a patient in Trendelenburg position is contraindicated in cases of:

• Answer: B) Increased Intracranial Pressure (ICP)

• Explanation: Trendelenburg position impairs venous drainage from the head, dangerously elevating intracranial pressure.

46. To monitor the therapeutic efficiency of oral Acenocoumarol or Warfarin therapy, target INR range for uncomplicated DVT is:

• Answer: B) 2.0 – 3.0

• Explanation: An INR range of 2.0 to 3.0 provides therapeutic anticoagulation while minimizing bleeding risks.

47. Chemical disinfection of clinical equipment using Glutaraldehyde (Cidex) requires immersion for sterilization of at least:

• Answer: B) 10 hours

• Explanation: High-level disinfection occurs in 20 minutes, but complete sporicidal sterilization requires 10 hours of continuous soak.

48. A rapid, thready pulse paired with low blood pressure, cold clammy skin, and oliguria is indicative of:

• Answer: B) Hypovolemic shock

• Explanation: Intravascular volume depletion triggers compensatory tachycardia, peripheral vasoconstriction (clammy skin), and hypotension.

49. Infusing a hypertonic IV solution (e.g., 3% $NaCl$) causes water movement from the:

• Answer: B) Intracellular space into the intravascular/extracellular space

• Explanation: Hypertonic solutions exert high osmotic pressure, pulling fluid out of swollen cells into the vascular compartment.

50. Airborne precautions require the nurse to wear which PPE item when entering the patient room?

• Answer: B) N95 particulate respirator mask

• Explanation: N95 masks filter out small airborne particles ($<5\mu\text{m}$) such as tuberculosis, measles, and varicella.

51. When suctioning an adult tracheostomy, suction pressure setting on the wall regulator should be set between:

• Answer: B) –80 to –120 mmHg

• Explanation: Adult endotracheal/tracheostomy suctioning requires negative pressure between –80 and –120 mmHg to avoid mucosal trauma.

52. Waterlow Scale is a specialized assessment tool utilized by nurses to predict risk for:

• Answer: B) Pressure injury / bed sore development

• Explanation: The Waterlow scale assesses pressure sore vulnerability based on body build, skin type, mobility, nutrition, and neurological deficit.

53. A patient taking Digoxin must have their pulse checked for one full minute prior to administration. Hold the drug if apical heart rate is below:

• Answer: B) 60 bpm

• Explanation: Digoxin slows AV node conduction; administering it with a heart rate below 60 bpm risks profound bradycardia and toxicity.

54. Urinary output exceeding 2500 mL to 3000 mL in 24 hours in an adult without diuretic therapy is documented as:

• Answer: B) Polyuria

• Explanation: Polyuria is defined as excessive urine volume exceeding 2.5–3 liters per day.

55. The phase of the nurse-patient relationship focused on evaluating goals and facilitating a smooth transition to discharge is the:

• Answer: C) Termination phase

• Explanation: The termination phase reviews achievement of goals, addresses loss feelings, and transitions care upon discharge.

3. Ward Administration (Q56–Q70)

56. In the SBAR structured communication tool, “B” stands for:

• Answer: B) Background

• Explanation: Background provides context, such as admitting diagnosis, past history, and recent interventions.

57. Controlled substance emergency drug cupboards in hospital wards must be secured using:

• Answer: B) Double-lock system with keys held by designated registered nurses

• Explanation: Legal regulations require narcotic substances to be stored under double-lock security with physical key possession restricted.

58. In the hospital fire safety mnemonic “RACE”, “C” stands for:

• Answer: B) Contain the fire by closing doors and windows

• Explanation: Containment prevents oxygen flow from feeding the fire and limits smoke propagation across hospital sectors.

59. In hospital material inventory management, “FSN Analysis” categorizes items based on their:

• Answer: B) Rate of consumption (Fast-moving, Slow-moving, Non-moving)

• Explanation: FSN analysis classifies stock based on turnover speed to prevent overstocking stagnant items.

60. Team Nursing as an organizational model relies heavily on the leadership of a:

• Answer: B) Registered Nurse (Team Leader) delegating and coordinating care for a small group of patients using diverse staff

• Explanation: Team nursing utilizes a modular approach where a team leader coordinates skill mix to care for assigned beds.

61. Before delegating a task to a nursing assistant, the charge nurse must evaluate the “Right Circumstance”. This means:

• Answer: B) Assessing patient stability, environment, and available resources

• Explanation: Right circumstance ensures the patient is clinically stable and the setting is appropriate for delegated care.

62. Bio-medical waste consisting of contaminated plastic tubing, IV catheters, and urine bags should be disposed in:

• Answer: B) Red Bag / Container

• Explanation: Red bags/containers are designated for recyclable contaminated plastic waste (catheters, tubing, blood bags).

63. When handling a blood spill on the ward floor, the recommended disinfectant solution to use is:

• Answer: B) Sodium Hypochlorite (Bleach 1:10 dilution)

• Explanation: Sodium hypochlorite (10% bleach) neutralizes bloodborne viruses (HIV, HBV, HCV) on non-porous ward surfaces.

64. A Charge Nurse who resolves ward staff disputes by encouraging open discussion to achieve a mutually satisfying outcome uses which conflict resolution style?

• Answer: B) Collaborating / Problem-solving

• Explanation: Collaboration actively addresses both parties’ needs to achieve a high-commitment, win-win consensus.

65. A leadership style where the leader motivates staff through shared vision, empowerment, and personal inspiration is termed:

• Answer: B) Transformational

• Explanation: Transformational leaders inspire personal growth, innovation, and organizational commitment among team members.

66. The process of tracking near-misses in ward administration is vital because near-misses:

• Answer: B) Expose underlying system vulnerabilities before actual patient harm occurs

• Explanation: Near-miss analysis provides proactive error identification without actual adverse outcomes occurring.

67. Minimum stock level below which inventory should not fall before a reorder is placed is known as:

• Answer: B) Reorder Level / Safety Stock

• Explanation: Reorder points signal replenishment triggers to prevent stockouts during delivery lead times.

68. In hospital organization, “Span of Control” refers to the:

• Answer: B) Number of subordinates directly supervised by a single manager

• Explanation: Span of control defines managerial oversight capacity; narrow spans mean fewer direct reports per leader.

69. Standardized clinical pathways (Care Maps) in ward management are designed to:

• Answer: B) Outline evidence-based interdisciplinary care plans and target timelines for specific medical diagnoses

• Explanation: Clinical pathways standardize evidence-based interventions to improve outcomes and streamline hospital stays.

70. A retrospective nursing audit involves evaluating care quality by examining:

• Answer: B) Discharged patient medical records after treatment completion

• Explanation: Retrospective audits analyze completed discharge records to measure compliance against standards post-care.

4. Hospitality of the Patients (Q71–Q80)

71. “Hospitality” in modern nursing healthcare management is centered around:

• Answer: B) Treating patients with dignity, empathy, respect, and seamless compassionate service

• Explanation: Healthcare hospitality combines clinical competence with human dignity, reducing anxiety during vulnerable hospital stays.

72. When communicating with a distressed patient, therapeutic empathy is best expressed by:

• Answer: B) Acknowledging “I can see this diagnosis is overwhelming for you; I am here to help you through it.”

• Explanation: Validates emotional distress without making false promises or diminishing the patient’s lived experience.

73. What simple action preserves patient dignity during a physical examination in an open ward?

• Answer: B) Closing privacy curtains completely and keeping unexamined body parts covered

• Explanation: Preserves modesty, maintains physical boundaries, and protects patient rights to privacy.

74. In the AIDET patient communication model, the letter “D” stands for:

• Answer: B) Duration (explaining how long a procedure or wait will take)

• Explanation: Duration provides time expectations, mitigating anxiety linked to unknown delays or diagnostic procedures.

75. What environmental intervention reduces night-time sleep disruption in adult inpatient wards?

• Answer: B) Clustering routine night nursing tasks and minimizing alarm volumes

• Explanation: Task clustering consolidated care reduces sleep fragmentation and lowers hospital delirium risk.

76. Which body language posture demonstrates active listening and approachability?

• Answer: A) Sitting face-to-face at eye level with an open, relaxed posture

• Explanation: Equalizes eye level, communicates warmth, and lowers power distance between nurse and patient.

77. When managing an angry, verbal outburst from a patient’s relative, the nurse should first:

• Answer: B) Remain calm, maintain an non-defensive posture, and listen actively to their grievance

• Explanation: Active listening de-escalates emotional agitation by signaling respect and willingness to solve issues.

78. Culturally sensitive nursing care requires the nurse to:

• Answer: B) Assess and integrate patient cultural values and preferences into the plan of care where safe

• Explanation: Individualized cultural care fosters mutual trust, compliance, and clinical cooperation.

79. A discharge planning process that reflects hospitality principles includes:

• Answer: B) Providing verbal and written self-care instructions in plain language and verifying understanding

• Explanation: Plain-language discharge instructions reduce anxiety and prevent post-discharge drug misadventures.

80. Applying Florence Nightingale’s Environmental Theory to ward management involves prioritizing:

• Answer: B) Fresh air, clean water, adequate lighting, cleanliness, and quiet surroundings

• Explanation: Nightingale established that environmental sanitation directly supports host immunity and natural healing.

5. Care vs. Cure for Health Management (Q81–Q90)

6. In nursing philosophy, “Cure” primarily belongs to the domain of medicine, while “Care” represents the core of nursing because “Care” focuses on:

• Answer: B) The holistic human response to health, illness, and healing

• Explanation: While cure targets physical disease mechanisms, care encompasses emotional, physical, and social responses.

82. Palliative care management differs from curative care because palliative care:

• Answer: B) Focuses on comfort, symptom relief, and quality of life when cure is unattainable

• Explanation: Palliative care optimizes comfort and dignified support regardless of disease trajectory.

83. Jean Watson’s Theory of Human Caring posits that caring:

• Answer: B) Is the central unifying concept of nursing that promotes healing and human dignity

• Explanation: Watson’s theory frames transpersonal caring relationships as vital drivers of psychological and physical healing.

84. Supporting a patient’s right to make decisions regarding their own healthcare options, even if the nurse disagrees, honors:

• Answer: B) Autonomy

• Explanation: Autonomy upholds self-determination, acknowledging patient rights to make informed choices.

85. Holistic health management considers the individual as a dynamic combination of:

• Answer: B) Mind, body, spirit, and environment

• Explanation: Holistic models address interconnected physical, mental, emotional, spiritual, and environmental dimensions.

86. Chronic health condition management (e.g., Asthma, Diabetes) prioritizes “Care” interventions such as:

• Answer: B) Patient education, self-management skills, and long-term coping support

• Explanation: Chronic illnesses require sustained self-management and lifestyle care rather than acute curative cures.

87. The ethical rule of “Veracity” in nursing practice requires the nurse to:

• Answer: B) Tell the truth and avoid deception

• Explanation: Veracity forms the basis of trust, requiring healthcare professionals to communicate truthfully.

88. Primary health promotion activities aim to:

• Answer: B) Prevent disease onset through health education, immunizations, and lifestyle modification

• Explanation: Primary prevention targets risk factor elimination before pathology develops.

89. “Therapeutic Presence” by a charge nurse is defined as:

• Answer: B) Bringing focused attention, active empathy, and authentic human connection to patient interactions

• Explanation: Therapeutic presence means being fully attentive and emotionally available during care.

90. How does psychological “Care” influence biological “Cure” processes?

• Answer: B) Reducing anxiety lowers cortisol levels, suppresses excess inflammation, and promotes physiological healing

• Explanation: Lower stress hormones optimize immune function and accelerate tissue repair.

6. Developing Training & Instructional Materials for Nursing Courses (Q91–Q100)

7. In the ADDIE instructional model, conducting a task analysis to identify learning gaps occurs during:

• Answer: A) Analysis Phase

• Explanation: The Analysis phase identifies learning needs, target audience characteristics, and entry competencies.

92. In writing SMART educational objectives, “T” stands for:

• Answer: B) Time-bound / Time-specific

• Explanation: Objectives must state a clear timeframe within which learning will be achieved.

93. Bloom’s Taxonomy domain that involves physical motor skills and procedural hand-eye coordination is:

• Answer: C) Psychomotor Domain

• Explanation: The psychomotor domain focuses on physical skills, coordination, and practical motor tasks.

94. Which instructional material or method is best suited for teaching complex cardiovascular hemodynamics?

• Answer: B) Interactive digital flow diagrams and dynamic visual simulations

• Explanation: Dynamic visual simulations help learners grasp multi-variable physiological processes effectively.

95. Formative assessment during a clinical nursing skills workshop is conducted to:

• Answer: B) Provide ongoing feedback to correct student errors during practice

• Explanation: Formative assessment occurs during instruction, guiding improvements before final evaluation.

96. A key educational advantage of “Return Demonstration” in nursing skill training is that it:

• Answer: B) Verifies student procedural competence and corrects technical errors immediately

• Explanation: Return demonstration confirms that students can execute a skill safely and correctly.

97. An analytic grading rubric for evaluating student clinical performance provides:

• Answer: B) Specific descriptive criteria for evaluating distinct skill components objectively

• Explanation: Analytic rubrics outline detailed criteria across performance levels, reducing evaluator bias.

98. Malcolm Knowles’ principles of Andragogy emphasize that adult learners:

• Answer: B) Are self-directed and prefer learning that connects to real-world clinical application

• Explanation: Adult learners thrive when learning is problem-centered and practically relevant.

99. When designing health educational brochures for community health courses, text readability should be set at:

• Answer: B) Plain language, 5th to 8th grade reading level

• Explanation: Ensures broad comprehension across diverse literacy backgrounds.

100. Objective Structured Clinical Examinations (OSCE) assess clinical competencies through:

• Answer: B) Rotational standardized stations evaluating specific skills using structured scoring checklists

• Explanation: OSCE evaluates practical competence objectively across standardized timed performance stations.