STUDENT ID……………………… SIGNATURE…………

NOTE: For each of the following questions, select the most appropriate answers and write in the
space provided the letter which corresponds to your choice.
1. Mr. Atsu was scheduled to undergo eye irrigation to remove foreign body from his eyes,
what is the required temperature for the irrigation solution?
A. 102.6 degrees Fahrenheit
B. 96.8 degrees Fahrenheit
C. 98.6 degrees Fahrenheit
D. 98.8 degrees Fahrenheit Ans……

2. Salpingography is usually carried out at ……………………………………

A. 2 to 5 days after menses
B. 2 to 5 days after ovulation.
C. 4 to 6 days after menses
D. 4 to 6 days before ovulation Ans……

3. The following are complications of catheterization EXCEPT:

A. Bladder spasm
B. Periurethral abscess
C. Priapism
D. Urethral trauma Ans…….

4. What are the phases of wound healing?

I. Granulation phase
II. Heamostasis phase
III. Inflammatory phase
IV. Maturation phase
V. Proliferative phase
A. I and III Only
B. I, II and III Only
C. II, III and V Only
D. II, III and IV Only Ans…….
STUDENT ID……………………… SIGNATURE…………
5. Intravenous solution can be classified based on their composition into;
I. Isotonic solution
II. Hypotonic solution
III. Crystalloids
IV. Hypertonic solution
V. Colloids
A. I, II and IV Only
B. III and V Only
C. III and IV Only
D. I, II and III Only Ans…….

6. Which of the following is an example of hypertonic solution?

A. 0.9% sodium chloride
B. 10% Dextrose in normal Saline.
C. 5% Dextrose in normal saline.
D. 5% Dextrose in water and Ringer’s Lactate Ans…..

7. Which of the following is an indication for intravenous fluid resuscitation per NICE’s
2017 guidance on IV fluid therapy?
A. Capillary refill greater than 2 seconds or peripheries cool to touch
B. Heart rate less than 90 beats per minute
C. Respiratory rate less than 20 breaths per minute
D. Systolic blood pressure greater than 100mmHg Ans…..

8. The seeping of intravenous fluid out of the vein into interstitial spaces is called………….
A. Circulatory overload
B. Extravasation
C. Hematoma
D. Phlebitis Ans……

9. Human blood is classified into four main groups based on the presence of which
substance on the erythrocyte.
A. disaccharide antigen
B. monosaccharide antigen
C. polysaccharide antigen
D. rhesus factor antigen Ans…..
STUDENT ID……………………… SIGNATURE…………
10. A client is to receive 2000mls of IV fluid in 12 hours. The drop factor is 10 gtt/mL. At
how many drops per minute should the flow rate be set?
A. 27
B. 28
C. 36
D. 67 Ans……

11. A client has an IV infusion insitu. If the iv infusion infiltrates, the midwife should first:
A. Apply warm moist soaks
B. Attempt to flush the tube
C. Discontinue the infusion
D. Elevate the IV site Ans….

12. The nurse administers serum albumin to a client to assist in:

A. Activation of white blood cells
B. Clotting of blood cells
C. Formation of red blood cells
D. Maintenance of oncotic pressure Ans……

13. The nurse administers an intravenous solution of 0.45% sodium chloride.With respect to
human blood cells, this solution is:
A. Hypertonic
B. Hypotonic
C. Isomeric
D. Isotonic Ans…..

14. Insulin needle is inserted into the skin at an angle of…………………...degrees.

A. 15
B. 45
C. 60
D. 90 Ans…..

15. The following are site suitable for insulin injection, EXCEPT:
A. Abdomen
B. Deltoid
C. Lower outer thighs
D. Upper outer arm Ans……
STUDENT ID……………………… SIGNATURE…………
16. Which of the following is/are classification of wound according to mechanism of injury?
A. Acute and chronic wound
B. Clean or contaminated wound
C. Intentional and unintentional wound
D. Open and closed wound Ans……

17. Heamostasis and phagocytosis are two major processes that occurs during which phase of
wound healing?
A. Granulation
B. Inflammatory
C. Maturation
D. Proliferative Ans…..

18. Which assessment data should the nurse anticipate when admitting a client with an
extracellular fluid excess?
A. Distended jugular veins
B. Elevated hematocrit
C. Increased serum sodium
D. Rapid, thready pulse Ans……

19. The most important aspect of hand washing is:

A. Friction
B. Soap
C. Time
D. Water Ans……..

20. When changing a client’s postoperative dressing, the nurse is careful not to introduce
micro-organisms into the surgical incision. This is an example of:
A. Concurrent asepsis
B. Medical asepsis
C. Surgical asepsis
D. Wound asepsis Ans…..

21. The nurse is preparing to change a client’s dressing. The statement that best explains the
basis of surgical asepsis that the nurse will follow in this procedure is:
A. Confine the microorganisms to the surgical site
B. Keep the area free from microorganisms
C. Keep the number of opportunistic microorganisms to minimum
D. Protect self from microorganisms in the wound Ans…..
STUDENT ID……………………… SIGNATURE…………
22. A female has a higher risk for developing cystitis than does a male. This is because of
the:
A. Altered urinary Ph
B. Hormonal secretion
C. Juxtaposition of the bladder
D. Proximity of the urethra and anus Ans….

23. When collecting a 24-hour urine specimen, the nurse should:

A. Check if preservatives needed to be added
B. Check the intake and output for the previous 24-hour period
C. Discard the last voided specimen of the 24-hour period
D. Weigh the client before starting the collection Ans…..

24. A client experiences difficulty in voiding after an indwelling urinary catheter is removed.
This is probably related to:
A. An interruption in normal voiding habits
B. Fluid and electrolyte imbalances
C. Nervous tension following the procedure
D. The client’s recent sedentary lifestyle Ans……

25. The nurse can prevent infection from retention catheters by:
A. Cleansing around the meatus periodically
B. Cleansing the perineum
C. Encouraging adequate fluids
D. Irrigating the catheter once daily Ans……

26. A routine urinalysis is ordered for a client. If the specimen cannot be sent immediately to
the laboratory, the midwife should:
A. Discard and collect new specimen later
B. Refrigerate the specimen
C. Store on “dirty” side of utility room
D. Take no special action Ans…..

27. During a blood transfusion a client develops chills and headache. The midwife’s best
action is to:
A. Lightly cover the client
B. Notify the physician stat
C. Slow the blood flow to keep vein open
D. Stop the transfusion immediately Ans…..
STUDENT ID……………………… SIGNATURE…………
28. The type of blood component responsible for fighting infection and its rarely transfused
after chemotherapy or bone marrow transplant is?
A. Granulocyte
B. Lymphocyte
C. Monocyte
D. Plasma Ans…..

29. The following are symptoms of blood transfusion reaction EXCEPT:

A. Aprexia
B. Dyspnea
C. Lower back pain
D. Nausea and vomit Ans…..

30. The collection and infusion of compatible blood from another person to a patient is
called……………blood transfusion.
A. Autologous
B. Heterologous
C. Homologous
D. Xenologous Ans…...

31. Which of the following is NOT a right to check in the administration of medication?
A. Right package
B. Right reason
C. Right time
D. Right to refuse Ans…..

32. Which of following blood groups lacks the presence of agglutinogen on its erythrocyte?
A. Blood group A
B. Blood group AB
C. Blood group B
D. Blood group O Ans……

33. Sim’s sperculum is also known as …………………………….

A. Cusco’s sperculum
B. Duck-bill speculum
C. Green armytage
D. Hegar’s dilator Ans…..
STUDENT ID……………………… SIGNATURE…………
34. Which of the following is not an indication for the use of Alli’s forceps?
A. Colporrhaphy
B. Myomectomy
C. Pelvic inflammatory disease
D. Total abdominal hysterectomy Ans…..

35. What is the length of a female urethra………………… cm long.

A. 2 to 4
B. 2.5 to 5
C. 3 to 4
D. 3.5 to 4 Ans….

36. Which of these is not a principle in catherization?

A. Anatomic position
B. Emptying of the bladder
C. Ensuring asepsis
D. Lubrication of the catheter Ans…..

37. In selecting a urinary catheter, the midwife should consider the following, EXCEPT:
A. Colour
B. Length
C. Material
D. Size Ans…….
38. Which of these is an example of absorbable suture?
A. Chromic
B. Novafil
C. Nylon
D. Silk Ans…..

39. Tearing of a structure from its normal anatomic position which may include damage to
blood vessels, nerves and other structures is which type of wound?
A. Abrasion
B. Avulsion
C. Contusions
D. Laceration Ans……

40. Which of these is NOT an example of transfusion reaction?

A. Allergic reaction
B. Circulatory overload
C. Febrile reaction
D. Hysteria Ams…….
 OBJECTIVE

SCHEME

1. C
2. B
3. C
4. C
5. B
6. B
7. A
8. C
9. C
10. B
11. B
12. D
13. C
14. B
15. B
16. B
17. A
18. C
19. A
20. C
21. D
22. D
23. A
24. C
25. D
26. B
27. C
28. C
29. A
30. A
31. B
32. D
33. B
34. A
35. A
36. A
37. D
 38. A
39. B
40. A

QUESTION ONE
As a staff nurse on duty at the emergency ward, Madam Karaba was rushed into your ward
through the maternity wing with head in vagina and bleeding per vaginum. After delivering of
the baby, blood loss was estimated to be more than 1000mls. The house officer on duty ordered
for madam Karaba to be transfused with 1000mls of whole blood.
a. Outline your responsibilities before, during, and after blood transfusion. (8 marks)

b. Enumerate four (4) types of blood group that can be use in transfusion. (2 marks)

c. State six (6) indications for blood transfusion. (3 marks)

d. List eight (8) observations to be made on blood transfusion process. (4 marks)

e. State six (6) complications of blood transfusion (3 marks)

Total Marks 20 Marks

QUESTION TWO
Madam Hannah a 65 years old woman and farmer presents to your out patient clinic with a non-
healing ulcer which she sustained after accidentally hitting her leg with a machete. Its located
midway between the knee and ankle of the right leg with well defined edges. Its measures 4cm
x4cm by 4cm deep and the base is 75% red, non-granulating and 25% covered with yellow
slough.

a. List ten (10) factors that impairs wound healing process. (5 marks)

b. Describe how you would dress the wound. (trolley set already) (8 marks)

c. Outline the procedure for taking wound swab. (7 marks)

Total Marks 20 marks

 MARKING SCHEME FOR EASSY QUESTIONS

QUESTION ONE
a. RESPONSIBILITES OF THE STAFF MIDWIFE FOR TRANSFUSION

Before the procedure

1. Explain procedure to the patient to win his co-operation

a. Reassurance
b. Check vital signs
2. Allow patient to void or empty his bowel before procedure
3. Prepare and send trolley to bed side
4. Make patient comfortable in bed
5. Check for patient line
6. Ensure all documentations are written on the blood bag
During the procedure

1. Insert the needle/cannula in the vein with complete aseptic technique.

2. Keep the needle in position with an adhesive plaster
3. In cases of difficult patient or children a splint or an arm board is needed which is
securely placed with a proper bandage under the patient limb
4. After transfusion or blood has been set up, regulate rate of flow as instructed by the
physician
5. Observe the patient frequently and inspect the bag constantly
 6. In there is any chills or shivering or any other complications immediately stop the
transfusion and irrigate the tubing with infusion or sterile fluid or N/S and inform the
DOCTOR.
After care

1. Make patient comfortable after the procedure

2. Discard trolley and collect all items to the treatment room
3. Discard the used transfusion set
4. Wash hand, record and report findings
½ X 16 POINTS EACH ABOVE = 8 MARKS

b. TYPES OF BLOOD GROUP

Blood are grouped into four types namely A, B, AB, O.

Blood group A has A antigens in the red cells and Anti B antibodies in the plasma.

Blood Group B has B antigens in the red cells and Anti A antibodies in the plasma.

Blood Group AB has A & B antigens in the red cells and no antibodies in the plasma

Blood Group O has no antigens but has both Anti A & B antibodies.

½ X 4 POINTS EACH ABOVE = 2 MARKS.

c. INDICATIONS OF BLOOD TRANSFUSION

1. In case of severe Anaemia: for anaemiac patient and to increase oxygen carrying
capacity.
2. In cases of severe Haemorrhage when the blood pressure and blood volume has reduced.
3. To correct deficiencies of plasma proteins, clotting factors and haemophilia
4. To combat infection in patient with leukemia (decrease number of leukocytes in the
body).
5. In cases of severe burns.
6. In cases of bleeding disorders such as leukemia, haemophilia
 7. In severe operative status.
½ X ANY 6 POINTS EACH ABOVE = 3 MARKS

d. OBSERVATIONS ON BLOOD TRANSFUSION PROCESS

1. Observe patient for early signs of complication and inform Doctor immediately
2. Observe the rate of flow
3. Persistently be observing the blood level on the bag
4. Observe the needle site for signs of dislodgement or swelling
5. Observe for signs of circulatory overload
6. Observe the urine output
7. Observe for the patency of the transfusion set
8. Observe and monitor the vital signs
9. Keep the patient warm and comfortable throughout the procedure
½ X ANY 8 POINTS EACH = 4 MARKS

e. COMPLICATIONS OF BLOOD TRANSFUSION

1. Allergic reaction.
2. Haemolytic reaction.
3. Delayed reaction may occur 1—2 weeks after transfusion and symptoms are manifested
by a gradual fall in the haemoglobin level.
4. Circulatory overload
5. Air or pulmonary embolism
6. Thrombophlebitis
7. Haematoma at the site
8. Shock infection could also occur
9. Infection could also occur.

½ X ANY 6 POINTS ABOVE = 3 MARKS

QUESTION TWO
a. FACTORS THAT IMPAIR WOUND HEALING
 1. Presence of disease condition e.g. diabetes
2. Old age
3. Prolong use of certain drugs e.g. corticosteroids and antibiotics
4. Poor aseptic technique of wound dressing
5. Inadequate nutrition
6. Obesity
7. Smoking hardens the vessels therefore leading to atherosclerosis
8. Stressing wounds
9. Poor general health ( personal and environmental hygiene)
10. Radiation
½ X 10 POINTS ABOVE = 5 MARKS

b. WOUNDS DRESSING
STEPS
 Explain procedure to patient and ensure privacy by screening
 Prepare and trolley to the patient’s bedside
 Position patient in a comfortable position, protect bed clothes with mackintosh covered with
a sterile dressing towel and expose the area of the wound with a single layer of sterile gauze.
 Pour out lotions into a gallipot and remove plaster (by tearing the plaster into strips or make
bandage ready for use
 Wash and dry hands (put on a disposable glove for the removal of soiled dressing if
instruments are not used.
 Remove soil dressing with dissecting forceps or a forceps or a disposable gloved hand and
discard
 Wash and dry hands thoroughly
 Wear sterile gloves if instruments are not going to be used
 Clean wound with swab soaked in a normal saline using sterile forceps or gloves (sterile)
 Clean wound from within outwards (inside out) using a swab once only and discard into
receiver or a receptacle
 Clean wounds with series of swabs until wounds is clean
 Apply sterile dressing and secure into position with strips of plaster or a bandage
 Make patient comfortable in bed and explain relevant findings (the extent of wounds healing
process) to patient and also thank him/her for co-operation
 Discard trolley and decontamination instrument into parazone 1 in 10
 Remove gloves and screen wash hands and dry hands
 Document and report the state of the wounds in the nurses notes and to the ward in-charge if
possible
½ X 16 POINTS ABOVE = 8 MARKS

c. TAKING A WOUND SWAB

  Explain procedure to patient and provide privacy
 Puts on mask, prepares trolley and takes it to beside
 Ask assistants to ;
a. Put patient into comfortable, position, protect bed linen and exposed
area to be dressed only
b. Pour out lotions into gallipots
c. And remove plaster or bandage
 Washes and dries hands and puts on gloves
 Removes soiled dressing with dissecting forceps and discards
 Swabs wound from the most discharging part
 Puts swabs back into the tube avoiding contamination
 Cleans wound, applies dressing and secure into position
 Thanks and makes patients comfortable in bed
 Discard trolley and decontaminate instrument.
 Removes gloves, wash and dries hands and removes screen
 Labels specimen
 Documents procedures and reports state of wound
 Ensure specimen is sent to the laboratory
½ X 14 POINTS ABOVE = 7 MARKS