2016 Exam -Advanced Nwsing Care of the Adult

SECTION II: SHORT-ANSWER QUESTIONS Total Value: 40 Marks

Instructions:
• This Section consists of 2 Short-Answer Questions.
• You must answer ALL questions in this Section.
• Each question is worth 20 marks.
• Please use a Separate Answer Book for each question.

Questions

I. Ms Chan 53 years old was admitted to the cardiac unit with complaints of palpitations, light-
headedness, and shortness of breath. Her history reveals tricuspid valve stenosis.

In this morning, she was moderately anxious. The cardiac monitor alarm was alarmed and she
developed the following dysrhythmia. Her ECG showed a rate of 250 beat per minute.

a) What is the cardiac dysrhythmia of the above ECG? (2 marks)

Her vital signs 37 .1 °C, Respiratory rate 28 bpm, BP 75/60 mmHg. Peripheral pulses weak but equal,
mucous membranes pale pink, skin cool and dry. She is feeling very anxious and weak.

The doctor has asked the ward nurse to prepare synchronized cardioversion therapy to control Ms
Chan's rapid ventricular rate.

b) Based on the above clinical presentations, what nursing care should be provided iu
preparing and caring Ms Chan for synchronized cardioversiou? (10 marks)

As Ms Chan complained sudden onset of palpitation with increased shortness of breath during the
tachyarrhythmia. The arterial blood gas test was taken to evaluate her respiratory status, Ms Chan's
arterial blood gas (ABG) results were as follows:

Normal range
pH 7.43 (7.35 - 7.45)
Pa02 8.5 Kpa (10.7 - 13.3 Kpa)
PaC02 4.3 Kpa (4.7 - 6.0 Kpa)
HC03 19 mmol/L (22 - 26 mmol/L)
BE/BD -3 (+/- 2)

c) Interpret Mr Tse 's ABG results comprehensively and systematically. (8 marks)

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 Exam -Advanced Nursing Care of the Adult

2. Ms Au, a 70-year-old woman, was initially admitted for chronic obstructive pulmonary disease
(COPD) exacerbation complicated by severe pneumonia and respiratory failure. She had a lot of
sputum and could not cough it up effectively. Finally, she was put on non-invasive ventilation
(BIPAP) in the intensive care unit (ICU) for ventilation support. She was semi-conscious now with
blood pressure 80/40mmHg. She also had naso-gastric tube feeding of Pulmocare 30ml/hr but not
tolerated well.

The BIPAP machine settings for Ms Au were as follows:

Mode Spontaneous /Timed mode

Fi02 0.3
Respiratory rate 10/min
IPAP 8crnH20
EPAP 5cmH20

a) According to the conditions of Ms Au, list FOUR contraindications to apply non-invasive

· ventilation? (8 marks)

b) What is the pressure support (in cmH20) given to Ms Au? (2 marks)

c) What is the airway pressure at the end of exhalation theoretically if there is no air
leakage? (2 marks)

d) Three days later, Ms Au condition further deteriorated and developed acute respiratory
distress syndrome (ARDS). She required intubation and mechanical ventilation. List
FOUR ventilator management goals (with rationales) in Ms Au's case. (8 Marks)

*****END OF THIS QUESTION BOOK*****

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 2017 Exantination -Advanced Nursing Care of the Adult

SECTION II: SHORT-ANSWER QUESTIONS Total Value: 40 Marks

Iustructio11s:
• This Section consists of2 Short-Answer Questions.
• You must answer ALL questions in this Section.
• Each question is worth 20 marks.
• Please use a Separate Answer Book for each question.

Questions

l. Ms Chan 53 years old was admitted to the hospital after experiencing chest pain at work. Upon
arrival to the AED, you notice the patient clutching his chest and moaning. She states that the pain
is in the middle of her chest and radiating to her jaw and left arm. You obtain a partial history from
the patient.

Subjective data
• States she has been told to lose weight but has not had the time to go on a diet or exercise
• Recently divorced and no kids
• Diabetic Mellitus, hyperlipidemia and hypertension for 5 years with medication and
regular follow up

Objective data
• Weight: 250 lb, Height: 160cm
• Diaphoretic, pale, and short of breath
• BP 190/120
• Pulse 110 beats/min and slightly irregular
• Respiratory rate 24
• Temperature 37.5 °C (tympanic)

• Diagnostic studies
• ECG shows ST elevation in leads Vl-V4
• Troponin I elevated

a. What factors are contributing to patient's myocardial infarction?

(4 marks)

b. As Ms. Chan complained sudden onset of palpitation with increased shortness of breath.
What are the nursing interventions for Ms. Chan? (4 marks)

Ms. Chan is not suitable for fibrinolytic therapy as she has her BP 190/120mmHg.
Percutaneous coronary intervention (PCI) is not available at the moment.

c. What are the medications for this patient? Why? (8 marks)

d. List 4 possible complications of myocardial infarction? (4 marks)

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 Examination -Advanced Nursing Care of the Adult

2. A 70-year-old woman, was initially admitted for chronic obstructive pulmonary disease
(COPD) exacerbation complicated by severe pneumonia and respiratory failure. She was
put cm non-invasive ventilation (BIP AP) in the intensive care unit (ICU) for ventilation
support. One weeks later, she is put on total parenteral nutrition through peripheral line at
her right arm. She develops fever today and the body is shivering now despite Panadol
just given to her via rectal route.

The BIPAP machine settings for this woman were as follows

Mode Spontaneous /Timed mode
Fi02 0.3
Respiratory rate 10/min
IPAP ScmH20
EPAP ScmH20

a) How to prevent possible asphysix and to reduce carbon dioxide rebreathing in this
client? (10 marks)

b) What is the pressure support (in cmH20) given to this client? (2 marks)

c) What is the airway pressure at the end of exhalation theoretically if there is no air
leakage? (2 marks)

d) When you are taking the vital sign for this woman, you find you cannot get a reliable
pulse oximetry signal and you suspect there are some error in taking the pulse oximetry.
What is the possible sources of_ error based on the condition ofthis woman? ( 6 marks)

*****END OF Tms QUESTION BOOK*****

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 2018 Examination -Advanced Nursing Care of the Adult

SECTION II: SHORT-ANSWER QUESTIONS Total Value: 40 Marks

Instructions:
• This Section consists of2 Short-Answer Questions.
• You must answer ALL questions in this Section.
• Each question is worth 20 marks.
• Please use a Separate Answer Book for each question.

Questions

1. Ms Chan, 60 years old, was admitted to the cardiac unit with complaints of palpitations, light-
headedness, and shortness of breath. Her history reveals ischemic heart disease.

In this morning, the cardiac monitor alarm rang and she developed the following dysrhythrnia. Her
ECG showed as below:

~'"""'" "" ·! ..,_,. •.<,{;;· ••:. • j-.:.• -·· .:i::·: < ••·' ,_,:,..., ,;,.;..•.,,,a,).,,-~ w •., O··-·
,~ - --~·": :-f'. :. ;';, . .--' j---:·---f~}--i --:,._:j~-T -1,·
, -.~·-''• •.:_.j,.- , • ,~,) .. -
0

:.->,:·-<.. , .. ~- ••v : ·, · - .'. .. , . , · -, • • "<: ••, ·· - : ,: _. - :·..:.· .. • .. !:•·• ••, ·, ,,. •,:•·-·••, ". '••••. ,,-., .. .,:.-.,.,
'7< , •• >-, •· ~,.>,,.: ,,

a) What type of dysrhythmia showed above? (2 marks)

. Her vital signs were: tympanic temperature 36.8°C, respiratory rate 26 bpm, BP 85/60 mmHg.
Peripheral pulses were weak, mucous membranes were pale pink, skin cool and dry. She was very
anxious and weak.

The doctor asked the ward nurse to prepare synchronized .cardioversion therapy to control Ms
Chan's dysrhythrnia.

b) Based on the above clinical presentations, what nursing care should be provided in preparing
and caring Ms Chan for synchronized cardioversion? (10 marks)

After 2nd shock, the ECG showed as below:

c) What type of dysrhythmia showed above? (2 marks)

d) What are the appropriate nursing actions after the above cardiac rhythm was noted? (6 marks)

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 Examination - Advanced Nursing Care of the Adult ·

2. A 78-year.cold man with chronic obstructive airway disease is admitted to the Special Care Unit. He
refused intubation: His blood pressure is 128/86 mmHg; heart rate: 105 beats/minute; respiratory
rate: 28 breaths/min; and tympanic temperature: 36.6·C.

Patient's arterial blood gas (ABG) results as below:

Normal range
pH 7. 19 (7.35 - 7.45)
Pa02 9.0 Kpa (10.0 - 13.3 Kpa)
PaC02 7.5 Kpa (4.7 - 6.0 Kpa)
HC03 23 ..6 mmoVL . (22-: 26 mmol/L)
BE/BD +l . (+/- 2)

Arterial oxygen saturation is 94%.

a) Interpret patient's ABG results systematically. (8 marks)

After the doctor reviewed and reassessed the patient, .the patient was required on Non-Invasive
.Ventilation (NN)support. .

The bi-level positive airway pressure (BiPAP) settings as follows:

Mode: SIT (Spontaneous/Time)

IPAP (inspiratory) 12 cmH20
· EPAP (expiratory). 7 cmH20
RR: 10/min
. Ti (Inspiratory time) 2.0 seconds

b) Based on the above bi-level positive airway pressure (BiPAP) settings, please calculate the
value of the pressure support {incm.H20}? (2 marks)

. c) Based on the above clinical situation, what nursing care should be provided in preparing and
monitoring for patient with Non-Invasive Ventilation (NN)? (10 marks)

. .
***** END OFTHIS QUESTION BOOK***.**

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