AMREF VIRTUAL NURSING SCHOOL

SUPPLEMENTARY COLLEGE FINAL EXAMINITION

PAPER I SEPT 2010 CLASS

MONDAY 12TH NOVEMBER 2012

TIME ALLOWED: 3 HOURS TIME: 9:00AM -12:00PM

INSTRUCTIONS TO CANDIDATES.

1. Read the questions carefully and answer only what is asked.

2. Enter YOUR ADMISSION NUMBER in all the answer sheets. The admission
number should be written in figures NOT words.

3. All questions are compulsory.

4.For part I (MCQs), write your answers in the ruled paper provided .The answers
should be written in CAPITAL LETTERS i.e. “A” but NOT “a”.

6. For part II (SAQs), answers to these questions should follow each other on the
provided sheet of paper.

7. For part III (LAQs), answers to each question must be on a separate sheet of paper.

8. Omission of or wrong numbering of examination papers, questions or parts of the

question will result in 10% deduction of the marks scored from the relevant part.

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 PART ONE: MULTIPLE CHOICE QUESTIONS (20Marks)

1. For a patient with suspected increased intracranial pressure (ICP), a most appropriate
respiratory goal is to,
a. Prevent respiratory alkalosis.
b. Lower arterial pH.
c. Promote carbon dioxide elimination.
d. Maintain partial pressure of arterial oxygen (PaO2) above 80 mm Hg
2. The following action is contraindicated for a patient who begins to experience seizure
activity while in bed.

a. Loosening restrictive clothing

b. Restraining the client’s limbs to avoid injury

c. Removing the pillow and raising padded side rails

d. Positioning the client to side, if possible, with the head flexed forward

3. A Nurse should provide the following medication instruction for a patient on co-
trimoxazole (Septrin).
a. “Take the medication with food.”
b. “Drink at least eight glasses of fluid daily.”
c. “Avoid taking antacids during co-trimoxazole therapy.”
d. “Don’t be afraid to go out in the sun.”

4. The following indicate that a patient has an infection caused by Candida albicans.
a. Cottage cheese–like discharge
b. Yellow-green discharge
c. Gray-white discharge
d. Discharge with a fishy odor

5. The priority nursing intervention for a patient with continuous bladder irrigation who
reports bladder pain on the first day after transurethral resection of the prostate is;
a. Increase the intravenous fluid flow rate.
b. Notify the physician immediately.
c. Assess the irrigation catheter for patency and drainage.
d. Administer prescribed analgesic and monitor the patient pulse

6. An appropriate nursing diagnosis for a client with renal calculi is;

a. Ineffective tissue perfusion
b. Functional urinary incontinence
c. Risk for infection
d. Decreased cardiac output

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7. The life span of normal platelets is;

a. 3-4 months
b. 1-2 months

c. 1-3 days

d. 7-10 days

8. A patient who reports stomach pain 2hrs after feeding is likely to have,
a. Duodenal ulcer
b. Gastric ulcer
c. Peptic ulcer
d. Curling’s ulcer

9. In planning care for a patient with ulcerative colitis, the priority nursing diagnosis is;
a. Anxiety
b. Impaired skin integrity
c. Fluid volume deficit
d. Altered nutrition; less than body requirement

10. The following action is contraindicated for a patient post mastectomy;

a. Taking blood pressure on the side of the mastectomy
b. Elevating the arm on the side of the mastectomy
c. Positioning the patient on the unaffected side.
d. Flexing the arm on the unaffected side

11. The best intervention for a patient with hyphema is;

a. Elevate the head of the bed and apply ice to the eye.
b. Place the patient in supine position and apply heat to the eye.
c. Elevate the head of the bed and apply ice to the ear.
d. Place the patient in supine position and apply heat to the ear.

12. The best method of administering syrup FeSO4 is;

a. Administer the medication with milk
b. Administer the medication with meals
c. Administer the medication with orange juice
d. Administer the medication undiluted.

13. The priority nursing action for a client with severe burns of the left arm, hands, face
and neck would be;
a. Starting IV fluids
b. Administering oxygen

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 c. Assessing the blood gases
d. Administering analgesics

14. When managing a patient scheduled for transphenoidal removal of the pituitary
gland, the nurse should be alert for,
a. Nasal congestion
b. Abdominal tenderness
c. Muscle atony
d. Oliguria

15. The following client should be given priority when assigning patients for reverse
barrier nursing ;
a. A patient with Cushing’s syndrome
b. A patient with diabetes mellitus type 1
c. A patient with acromegaly
d. A client with myxedema

16. Pulmonary edema is associated with failing;

a. Right atrium
b. Left atrium
c. Right ventricle
d. Left ventricle

17. Pulse pressure (pp) is;

a. Difference between the systolic and diastolic pressure
b. The sum of the systolic and diastolic pressure
c. The inverse of the blood pressure
d. Half of the systolic pressure

18. If a chest drainage system is accidentally disconnected, the nurse should;

a. Place the end of the chest tube in a container of sterile saline

b. Apply an occlusive dressing and notify the physician.

c. Clamp the chest tube immediately.

d. Secure the chest tube with tape.

19. The amount of air inspired and expired with each breath is called:
a. Tidal volume.
b. Residual volume.
c. Vital capacity.
d. Dead-space volume.

20. Indicate whether the following statements are true or false.

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 a. Osteomalacia is caused by insufficient calcium absorption from the intestine. T
b. Pathologic fractures result from many repeated small stresses on a bone. F

PART TWO: SHORT ANSWER QUESTIONS 40MKS

1. Outline four (4) complications of oxygen therapy. (4mks)

 Lung damage
 Fatique
 Damage to sinuses
 Rapture of the middle ear
 Myopia/nearsightedness
 Bloody dry nose

2. Describe the pathophysiology of rheumatic heart disease. (3mks)

3.
a. Define the term status epilepticus. (1mk)
 Epilepsy: a state of recurrent seizures not due to reversible transient metabolic
or toxic disorder
b. State four (4) nursing interventions for a patient with status epilepticus. (4mks)
 Assess airway
 Avoid injury
 Monitor breathing pattern
 Remove tight clothes
 Monitor vital signs
 Give phenytoin

4. State five (5) causes of uterine prolapse. (5mks)

 Precipitate labor
 Relaxed uterine muscles
 combination of fundal pressure & cord traction
 Short cord
 Pathological adherence of the placenta

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5. Explain five (5) clinical features of hyperthyroidism. (5mks)
 Weight loss
 Thin skin
 Tachycardia
 Hair loss
 Graves disease
 Warm sweaty skin
6. State five (5) classes of drugs used in management of hypertension.(5mks)
a. Angiotensin-converting enzyme (ACE) inhibitors e.g. captopril
b. b-adrenergic blockers e.g. atenolol (lols)
c. Calcium channel blockers e.g. nifedipine
d. Centrally acting adrenergics e.g. methyldopa
e. Diuretics e.g. lasix
f. Vasodilators e.g. hydralazine

7. State five (5) health messages you would share with a patient with renal failure. (5mks)
 Low salt intake
 Encourage little fluid intake
 Restrict protein intake
 Have enough rest
 Advise on hygiene
8. Describe the rennin-angiotensin system. ( 6mks)
 When blood volume is low, juxtaglomerular cells in the kidneys secrete renin
directly into circulation. Plasma renin then carries out the conversion of
angiotensinogen released by the liver to angiotensin I. Angiotensin I is
subsequently converted to angiotensin II by the enzyme ACE found in the lungs.
 Angiotensin II is a potent vaso-active peptide that causes blood vessels to
constrict, resulting in increased blood pressure. Angiotensin II also stimulates

the secretion of the hormone aldosterone from the adrenal cortex. Aldosterone

causes the tubules of the kidneys to increase the reabsorption of sodium and
water into the blood. This increases the volume of fluid in the body, which also
increases blood pressure.
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 9. List four (4) complications of pneumonia. (2mks)
 Lung abscess
 Pleural effusion
 Difficulty in breathing
 Bacteremia
 atelectasis

PART THREE: LONG ANSWER QUESTIONS (40 marks)

1. Mr. Y is admitted in the medical ward with a newly diagnosed diabetes mellitus type 2.
a. State four (4) differences between type 1 and type 2 diabetes mellitus. (4mks)
 Type 1 insulin dependent while type 2 is not
 Type 1 theirs weight loss while in type 2 there is weight gain
 Type 1 onset is 30years while in type 2 onset is 40years
 Type 1 theirs autoimmune beta cell destruction while in type 2 no
autoimmune
b. Describe the management of Mr. Y from admission to discharge. (13mks)

c. State three (3) microvascular complications of diabetes mellitus. (3mks)

 Aneurysm
 Arteriosclerosis
 Retinopathy
 Nephropathy
 Gangrene foot

2. Mrs. M is admitted to your surgical ward with intestinal obstruction.

a) Draw and label a diagram of the alimentary canal and its accessory organs ( 5
marks)

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b) State four (4) causes of mechanical intestinal obstruction. (4 marks)
 adhesions,
 hernias,
 volvulus,
 intussusception,
 bands,
 inflammatory or neoplastic masses.

c) Describe the post operative nursing management for Mrs M. ( 11 marks)

 Monitor vital signs
 NPO b4 commencement of diet
 Pain mnx
 Hygiene
 Monitor input output
 Antibiotic
 Monitor for bowel sounds.

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