ANGLICAN UNIVERSITY COLLEGE OF TECHNOLOGY

SCHOOL OF NURSING

BSc. NURSING LEVEL 300 (WEEKENDS)

END OF SEMESTER EXAMINATION, FEBRUARY, 2019.

NURS 353: SURGICAL NURSING II

CREDIT HOURS: 3

TIME: 2 Hours: 30 Minutes

SECTION A

MULTIPLE CHOICE QUESTIONS

INSTRUCTION: Read the questions carefully and select the right answer

1. The surgical ligation of the vagus nerve to decrease the secretion of gastric acid is termed
as
a. Antrectomy
b. Vagotomy
c. Pylorosplasty
d. Gastroduodenostomy (Bilroth I)
2. The surgical removal of the antrum of the stomach is termed as
a. Antrectomy
b. Vagotomy
c. Pylorosplasty
d. Esophagojejunostomy
3. Mr. Kodua has been scheduled for an endoscopy after being diagnosed of Peptic ulcer
disease. The following are the most important post operative nursing care that would be
required from the nurse.
I. Withhold food and fluids until gag reflex returns
II. Assess gag and cough reflexes
III. Assess vasovagal responses
IV. Ensure consent form is signed
a. I,II and IV
b. I, II and III
c. I, III, and IV
d. I, II and IV
4. A five years old boy, diagnosed of pyloric stenosis has been booked for Fredest-Ramsted
Operation (Pyloromyotomy). In explaining it to a student nurse, you will say it is an/the
a. Operation to enlarge the outlet of the pylorus
b. Longitudinal incision into the pylorus and sutured transversely.
c. Incision of the pylorus to relieve congenital pyloric stenosis
d. Surgical dilatation of the pylorus to increase the rate of gastric emptying
5. The interference with the normal flow of the intestinal content through the intestinal tract
which could be gas, digestive juice or food is known as
a. Pyloric stenosis
b. Gastric perforation
c. Volvulus
d. Intestinal obstruction
6. Total or complete intestinal obstruction present itself as
I. Absolute constipation
II. Constant colicky abdominal
III. Shinny abdominal skin
IV. Borborygmi
a. I, II, and IV only
b. I, III and IV only
c. All the above
d. None of the above
7. These are the causes of intraluminal obstruction
I. Worm (Ascriasis) infestation
II. Foreign bodies
III. Impacted faeces
IV. Atresia
a. I, II, and III
b. I, II, and IV
c. I, III and IV
d. All the above
8. These are types of intussusception except
a. Ileo-ileal
b. Ileo-caecal
c. Caeco-colic
d. Colo-ileal
9. The diagnostic triad of intussusception in children consists of the following except
a. Paroxysms of colicky abdominal pain with or without vomiting
b. Rectal bleeding
c. Distention of the abdomen
d. A palpable lump
10. The parts of hernia includes the following except
 a. Neck
b. Sac
c. Content
d. Tail

From question 11 to 15, match the terms below to the appropriate

statement/definition/procedure.

a. Cryo-surgery
b. Pyelolithomy
c. Anal fissure (fissure-in-Ano)
d. Anal fistula (fistula-in-Ano)
e. Sclerotherapy
11. The renal pelvis is incised and the stone removed from the pelvis calyx
12. A sclerosing agent, example 5% phenol in oil (combined solution of quinine and urea) is
injected into the tissue around the haemorrhoid with a special syringe and proctoscope.
The aim is to obliterate the vessel.
13. The haemorrhoids are freezed. Rapid freezing followed by rapid thawing destroys
cellular membrane, this leads to necrosis of circumscribed areas of tissue.
14. This is a tear between the anal canal and the perinal skin.
15. This is an abnormal tract-like communication between the anorectal canal and the perinal
skin.

Question 16 to 20 describes the teaching goals or instructions given to a patient with hiatal
hernia. Identify which statement or instruction is true and which is false.

16. Eat small, frequent meals

17. Stop drinking carbonated beverages and alcohol but drink cold water
18. Stay upright for hours after eating
19. Increase intake of potato, carrot, seaweed or sea foods
20. Always wear constrictive clothing

SECTION B
INSTRUCTIONS: ANSWER ALL THE QUESTIONS IN THE BOOKLET PROVIDED

QUESTION ONE

Fiifi, a-45 year old man, was diagnosed with depression 3 months ago after his wife who was his
childhood girlfriend passed on. He started developing an irregular eating pattern and put on a lot
of weight. He often ate a lot of ‘junk’ foods late at night and took a bite from leftovers in the
morning before leaving to work. He recently complained of urinary retention, strangury,
dribbling, urgency and burning sensation on urination. Upon further investigations, he was
diagnosed with peptic ulcer and hypertrophy of the prostate gland. He was admitted to the
surgical ward to undergo surgical operation of the prostate.

(a) List four signs and symptoms of peptic ulcer disease (2 marks)
(b) Enumerate four specific investigations that might be carried out to confirm the diagnosis
of benign prostate hypertrophy (2 marks)
(c) Mention three (3) types of operation that can be performed on the prostrate (3 marks)
(d) Describe the post-operative nursing care that would be given to Fiifi under the following
headings:
(i) Observations (2 marks)
(ii) Drainage tube/catheter/irrigation (4 marks)
(e) Describe the education that would be given to Fiifi on discharge under the following
headings:
(i) Exercise (2 marks)
(ii) Sexual intercourse (2 marks)
(f) List four (4) complications of prostatectomy (2 marks)
(g) What could be the cause of Fiifi’s ulcer? (1 mark)

QUESTION TWO

Mr. Kofi Boateng, a 42 year old man is admitted to your to your ward with lymph edema of the
right leg. He is scheduled for an above knee amputation

(a) What is amputation (1 mark)

(b) List four indications for amputation (2 marks)
(c) How would he be prepared psychologically towards the impending surgery? (5 marks)
(d) List six (6) physiological preparations that would be carried out prior to the surgery
(3 marks)
 (e) Describe the post operative nursing management that would be given to Mr. Boateng
under the following:
(i) Care of the wound and the stump from the day of operation till discharge.
(5marks)
(ii) Helping the patient achieve physical mobility (3 marks)
(f) List two complications that might occur after amputation (1 mark)

QUESTION THREE

Mrs. Bimpong aged 62 years had road traffic accident and sustained fracture mid-shaft of femur.
She had traction applied after Steinmann’s pin surgery

(a) Mention four (4) types of skeletal traction (2 marks)

(b) What assessment would you make on Mrs. Bimpong before traction is applied? (3 marks)
(c) Describe the nursing care of a patient on traction (8 marks)
(d) Describe the nursing interventions after application of traction under the following
headings
(i) Prevention of constipation (3 marks)
(ii) Reducing the risk of urinary retention (2 marks)
(iii) Boredom and depression due to enforced immobility (2 marks)