Section A Scenario Jack, aged 21 years old was taken to the Emergency Department with a gunshot wound to the right side of his chest. On arrival he was restless, cyanotic and confused. He also had paradoxical breathing. A diagnosis of the Right Pneumothorax was made. 1) Common clinical manifestation of a Pneumothorax would include i, Sharp, knife like chest pain it, Decreased breath sounds ii, Sucking noise on inspiration iv. Unequal movement of chest wall during inspiration A. i, ii, iti isiv C. ii, ili, iv D. ii, iii, iv 2) In what order of priority should the following care be administered to Jack? i Start intravenous infusion i, Give oxygen via face mask iii, Place patient in fowler’s position iv. Seal wound with air-tight dressing ne ili C. iiiiijv,i D. idiviiii 3) Which of the following complications of Pneumothorax will necessitat surgical intervention? Shock Emphysema Haemothorax, Tension Pneumothorax gag 4) Underwater seal drainage is done to achieve the following goals EXCEPT to Reduce the size of the pleural space Remove fluid and air from the pleural space Re-establish normal negative pressure within the lung, Promote re-expansion of the lung and cohesion of the pleura papPp5) The rationale for frequent coughing and deep breathing exercises in the patient with an underwater seal drainage system includes; iii, iv. SCENARIO Promoting lung expansion Clearing the bronchi of secretions Maintaining patency of the drainage tube Increasing intra- pulmonic and intra- pleural pressures AL iii ii B. i,ii,iv wiii,iv D. iiviii,iv SECTION B John Maski age nine (9) years, was taken to Accident and Emergency with a history of cough and dyspnoea. He was evaluated and a diagnosis of Bronchial Asthma as made. The doctor ordered nebulization immediately. 6. Which of the following deformities would the nurse expect to find on inspection of the patient’s chest? A. Barrel chest B, Funnel chest C. Pigeon chest D. Kyphoscoliosis 7) The mechanisms responsible for the obstructive symptoms is asthma include all of the following EXCEPT: A. dilation of the blood vessels in the lungs B. Inflammation and edema of the mucous membrane C. Accumulation of tenacious secretions from muscle glands D. Spasms of the smooth muscles of the bronchi and bronchioles8) Asthma is a complex disorder involving; i. Mechanical factors ii, Biochemical factors iii, Physiological factors iv Immunological factors A. iii B. i,iiiv C. i,itiiv D. iijii,iv 0) The exchange of oxygen and carbon dioxide from the alveoli into the blood occurs by: ‘A. Osmosis B. Diffusion C. Pinocytosis D. Active transport 10. Diagnosis of Asthma is determined on the basis of i. History ii, Ultrasonography iii, Laboratory testing iv . Physical examination A. igi, iii B. is ii, iv C. ii, iti, iv D. ii, iii, iv 11) Health teaching for John would include advising him and the family to; i, Use bronchodilators correctly ii, Take steroids only when wheezing iii, Recognizing early signs and symptoms, iv. Take prophylactic treatment when appropriate A. i, iii B. i,ji,iv C. i iii, iv D. ii, ili, ivSECTION C SCENARIO Miss Sara Penn a 36 year old bank clerk has been admitted to the hospital with a diagnosis of the hyperthyroidism (Grave Disease) for pre-operative preparation and later sub-total Thyroidectomy. Orders by her doctor inelude ugol’s Iodine and Carbimazole orally, dietary restriction and limited act y. 12) Which of the following BEST describes Graves disease? Increased production of thyroid hormones due to abnormal stimulation of the; A. Pituitary gland by the presence of circulating immunoglobulins B. Pituitary gland by the absence of circulating immunoglobulins C. Thyroid gland by presence of circulating hormones D. Thyroid gland by absence of the circulating hormones 13) Which of the following nursing diagnoses would be the MOST appropriate for Ms. Penn? A. Activity intolerance, related to weakness and apathy secondary to decreased metabolic rate B. Altered nutrition, related to accelerated metabolic rate C. Hypothermia, related to decreased metabolic rate D. Fluid overload, resulting from fluid retention 14) Which of the following provisions MUST be included in Ms. Penn plan of care? A. Small Meals B. Extra Blankets C. A high Fiber Diet D. A restful environment 15) The therapeutic effect of the drugs administered to Ms Penn is necessary to; A. Be converted by the body to both T4 and T3 B. Correct thyroid hormone deficiency and reverse symptoms C. Treat hyponatremia resulting from impaired water excretion D. Suppress secretion of thyroid hormone ané reduce the size and vascularity of the organ 16) While the nurse is preparing Ms. Penn the day prior to surgery, Ms Penn stated she is afraid of what will happen the next day/ The MOST appropriate nursing intervention is to; ‘A. Assure her that surgery is safe and problems are rare B. Encourage her to talk about her fears as much as she wishes . Explain that she has an excellent doctor and she has nothing to worry about D. Explain that worrying or anxiety has been proven to prolong hospitalizationSCENARIO ‘Mr. Sean John, a 27 year old welder, newly married with an 9/12 old son, was brought to Accident and Emergency Department by the Emergency medical service. History of falling from a height about 20 feet. On arrival to department, the patient was responding to deep pain only. Moderate bleeding observed from ears and nose. Patient was assessed and diagnosed with Depressed Skull Fracture, Vital signs T 98°, P 110, R 32 B/P 110/60. He was subsequently admitted to the male surgical unit for care and management. 17) Which of the following fractures is specific to the skull? A. Diastatic and Basilar B. Greenstick and Linear C. Oblique and Impacted D. Communited and spiral 16) Depressed skull fractures may BEST be explained as: A. Two bone broken between the inner table of the skull and the dura B. Bone fragments from the fracture may cause local brain injury by lacerating brain tissue C. The bone of the frontal lobe is broken from the pro-orbital region to the parietal region D. Bones broken in several irregular fragments and are pushed inward causing pressure on the brain. 17) Which of the following tests will MOST likely be done to contirm a diagnosis of depressed skull fracture? i. Ultra- Sonography Cerebral angiography iii, Radiological Investigations iv Computed tomographic (C:T) Sean ijiiisiv ii,iiiiv moOmm18) Which of the following responses is included on the Glasgow Como scale for detecting, changes in Mr. John’s level of consciousness? i, Motor ii, Verbal iii, Papillary iv. Eye Opening iuii,iv iviii,iv iiviii,iv pao@> 19) The INITIAL goal of care for Mr. John would include; a) Establishing and maintaining a clear airway ) Maintaining safety measures to prevent injury ©) Preventing deterioration in his neurological status 4) Maintaining adequate fluid and electrolyte balance 20) The drugs most likely to be admitted to Mr. John to prevent raised intra-cranial pressure would include: A. Steroids and analgesics B. Osmotic Diuretic and steroids C. Analgesics and anti-inflammatory and osmotic diuretic D. Anti-inflammatory and osmotic diuretic 21) Which of the following nursing interventions would be MOST appropriate to ensure Mr John’s safety? i. Attaching side rails to his bed ii, Turning and positioning him frequently iii, Encourage patient to mobilize as tolerated iv. Monitoring variation in assessment findings A. iand ii B. iandiv ©. ifandiii D. iiiandivSCENARIO Mrs. Jarvis brought her twelve year old daughter Margaret to the Out- Patient Department to see the doctor. She told the doctor that her daughter looks pale, her appetite is poor and she complains about pain in her abdomen and limbs. On admission, Margaret, was seen by the pediatrician who ordered an urgent complete blood count and sickle cell test. 22) Which of the following clinical features are characteristics of sickle cell crisis? i, Anorexia, pallor, swollen joints Pain in the abdomen and joints iii, Sore throat, headache weaknesses iv. Numbness and weakness of the limbs A. iii B. iii ome D. iti,iv iv 23) Which of the following is likely to be experiences by a patient with Sickle Cell Anemia who is dehydrated? A. Vomiting B. Severe pain C. Bradyeardia D. Hypoglycemia 24) Which of the following measure would be MOST effective in relieving Margaret's severe pain during a sickle cell crisis? ‘A) Changing his position every four hours B) Bathing her in warm water every four hours C) Giving prescribed medication when in severe pain D. Carefully positioning and supporting his painful areas SCENARIO CON’T ‘The result of Margaret's blood test showed a haemoglobin of 4.7 gms % and a blood transfusion was ordered.25) Which of the following is the MOST important nursing responsibility during administration of the blood transfusion? A. Monitoring Margaret for any reactions B. Withholding prescribed medication C. Observing the rate of flow frequently D. Ensuring that the blood is at the right temperature 26) Folic acid is prescribed for the patient with the Sickle Cell Anemia because it A. Prevents the formation of sickle cells B. Assists in the formation of red blood cells C. Delays peripheral neurological complications D. Breakdown sickled red blood cells in the systemic circulation. 27) What instructions will the nurse give to Margaret’s parents when planning for his follow up care? i, Prevent exposure to chills, ii, Ensure that he gets adequate nutrients iii, Encourage him to avoid contact sports iv. Keep the appointment at the follow-up clinic AL iii, iii B. i, ii, iii ©. iii, iv D. . i, i, ii, iv SECTION D SCENARIO Mr Rosewood is a 49 year old black overscer in a sewing factor. He has been diagnosed as having high blood pressure. 28) Asa health problem, hypertension is difficalt to control because; i, Many persons do not realize they have the disease Many patients have difficulty in complying with the treatment 'ymptoms are not generally present iv . Treatment is expensive to maintain i, ii, iii iii ii, iv iv only isi, iii, iv poeP #29) Blood pressure can be raised by increasing: i. Cardiac output ii, Peripheral Resistance iii. Heart Rate iv Stroke Volume A) ii iii B) i, iii O)ii,iv D) iv only E)i, i, iii, iv 30) The major cause of hypertension is: A. unknown B. Stress C. Increased sodium levels D. Increased epinephrine levels 31) In discussing factors, which would help reduce blood pressure, the nurse should explain the need to: i. Stop smoking ii, Lose Weight iii, Reduce stress iv. Decrease salt intake i, ii, iii i, it ii,iv ivonly roam> i, i, ii, iv32) In patient teaching with Mr, Rosewood, he should know that untreated hypertension may lead to: i. Stroke ii, Heart attack iii, Renal disease iv liver disease i, i, iii i, ii A B. g, D. ivonly E. i, ii, iii, iv 33) Hydrochlorothiazide (Hydrodiuril) is ordered for Mr. Tea, This drug is classified as a: A. Diuretic B. Cardiovascular antagonist, C. Sedative D. Vasodilator SCENARIO Troy, a twenty month old has been admitted to the Paediatric Ward with a history of difficulty in breathing, following nasal congestion and cough for the past forty-eight (48) hours. He is diagnosed with BRONCHIOLITIS . 33) Which of the following BEST DEFINES Bronchiolitis? A, Infection of bronchial epithelium B. B. Infection and inflammation of the lungs C. Inflammation of the bronchial cartilages D. Inflammation and mechanical changes ia the bronchioles 34) Which of the following is NOT a causative Bronchiolitis? A. Pneumocoeci B. Adenoviruses C. Para influenza virus D. Mycoplasma pnemoniae35) Which of the following breathing pattems would Troy be MOST likely to exhibit? i. Tachypnea and nasal flaring ii, Inspiratory stridor and wheezing iii, Inspiratory and expiratory wheezing iv, Intercostals and subcostal retractions AD ini, iit B.)i, ii, iv C) is ii, iv D))ii, iii, iv 36) Auscultation of Troy’s chest may reveal breath sounds which are: A. Low pitched, coarse and loud B. High pitched, squeaky and whistling C. Low pitched, whistling and coarse D. high pitched, wet and squeaky 37) Which of the following are possible to complications of Bronchiolitis? i. Atelectasis ii, Empyema iii, Pneumonia B. i,ii,iv C. iii, iv D. , iii, iv 38) Investigative measures carried out on Troy would include: i. Chest x-ray ii. Nasal smear iii, Sputum culture iv. White blood cell count AL ii itt B. Lii,iv C. Lili, iv D. ii, ii, iv39) All of the following physiological changes occur in the acute stage of Bronchilitis EXCEPT: A. Dry, crust, bronchial walls B. Inflamed bronchial walls C. Mucoid exudates in lamina D. Swollen bronchial mucosa 40) Which of the following are appropriate nursing diagnoses for Troy? i. Pain s evidenced by facial grimace Altered nutrition related to insufficient intake iii, Fluid volume deficit related to inflammatory process iv . Ineffective breathing pattern as evidenced by dyspnoea and wheezing, A. ii iii B. i,ii,iv C. iyi, iv D. i, ii, iii, iv 41) Possible outcome criteria for Troy may inclide: i. Breath sounds Improved breathing pattern as evidenced by diminished nasal flaring iii, Improved nuttitional status as exhibited by increased intake of food iv . Improved respiratory status as evidence by breathing rate 20-40 per minute A. i, ii, iii B. i, ii, iv C. ii ii, iv Dz i, ii, iii, iv