Nursing science 1

SECTION A: MULTIPLE CHOICE QUESTIONS. ENCIRCLE ONLY ONE CORRECT

ANSWER. EACH CORRECT ANSWER IS ARKS (30MKS).

1. One of the following endoscopic exams may not be used to diagnose

hemorrhoids:
a) Anuscopy
b) Sigmoidoscopy
c) Colonoscopy
d) Gastroscopy
e) Proctoscopy
b) Encouraged adequate intake of fiber MBER CHRISTOPHER
2. The following advice is given to a patient suffering from hemorrhoid on
discharge, except one:
Carry out good hygiene practices.
Encouraged adequate intake of fiber
Inform about the risk factors e.g hemorrhoid, infection.
Increase fluid intake and diet rich in fruits and vegetables to aid elimination.
Report to the hospital only if there is bleeding.
3. And acute abdomen is and abdominal condition of abrupt onset resulting
from any of the following, except
a) Inflammation
b) Trauma
c) Obstruction
d) Infarction
e) Perforation
4. Chemical irritants that can cause peritonitis include all of these, except
a) Bile
b) Blood
c) Urine
d) Streptococcus
e) Gastric or pancreatic juices
5. Activities of daily living (ADL) include all of these, except
a) Shooping
b) Movement
c) Bathing
d) Sleeping
c) Eliminating
6.Aging is all of these, except
a) Universal
b) Progressive
c) Instrinsic
d) Unavoidable
e) Unreliable
7. After a fracture MR Bill is hospitalized pop is applied on his leg. The nurse
frequency check the toes for
a) Change in temperature
b) Change in colour
c) Oedema
d) All of the above
e) None of the above
8. A patient come into the hospital with a diagnosis of and internal pile which
prolapsed and can only be push back with a finger. Which state grade of
internal hemorrhoid does he have?
a) Furst degree internal hemorrhoid
b) Second degree internal hemorrhoid e) Third degree internal hemorrhoid
d) Fourth degree internal hemorrhoid Which virus is responsible for causing
cancer of the cervix?
a) Hepatitis b) Hepatitis C
c) HIV
d) Human papilloma virus
e) Cytomegalovirus
10. A patient with burns is examined depending on the extent of the burns.
Bums of both lower limbs represent which percentage?
a) 36%
b) 26%
c) 16%
d) 18%
11. One of the following is the most contagious form of leprosy.
a) Tuberculoid leprosy
b) Borderline leprosy c) Lepromatous leprosy
d) Unspecified leprosy
c) None of the above
12. Clinical and acute infection and enlargement of the adenoid may ENT
physiology
a) Difficulty in swallowing, loss of appetite
b) Obstructs Eustachian tube, otitis media, and deafness
c) Sinusitis, nasal discharge, blockage
d) All the above
13. Pedophilia is
a) The norm in some in cultures
b) A situation to be treated with confident
c) Legally required to be reported as child abuse
d) Curable with psychotherapy
14. And abnormal or pathological, they to exaggerates or tell lies is known as
a) Pyromania
b) Mythomanin
c) Kleptomania
15. And older adult with diagnosis of dementia of the Alzheimer's type likes to
talk about older days and time has a tendency to confabulate. The nurse should
recognize that confabulation serves to
Prevent regression
Prevent embarrassment
Attract the attention of others
Reminisce about achievements
SECTION B: SHORT ANSWER QUESTIONS (40MKS)
1. If a patient has been burnt over his entire back, both legs, and right arm,
what percentage of his body is considered to be burned? (5marks)
2. What is the procedure for emergency treatment of burns victim? (5mks)
3. What are the signs and symptoms of a pneumothorax? (5mks)
4. What are the sign of tension pneumothorax? (at least 5) (10mks)
5. What are the stages of developing bedsores? (10mks)
6. Complete bed rest in and elderly patient can cause...? (5mks)
ESSAY QUESTIONS (30MARKS)
GASTRICT INTUBATION
a. What is it and through which routes can it be done? (4mks)
b. Name at least 6 reasons why it is done; (6nks)
c. What advice can be given to the patient before the procedure? (5marks)
d. Enumerates any 5 precautions that need to be taken before inserting the
tube; (5marks)
e. What is the preferred way to determine if a nasogastric tube has been
correctly inserted? (3mks)
f. What type of solution should be used to irrigate a nasogastric and why?
(2mks).
g. Why should you be concern if a patient with nasogastric complains of
nausea, vomiting, and abdominal distention? (5mks)

Nursing sciences 2
SECTION A: MCQ (30MARKS)

1. Question 1, 2 and 3 are based on the following case scenario: Mr Jankowicz,

a veteran of the Vietnam war, has been hospitalized with symptoms of
depression, nightmares, suicidal thinking, anger and hopelessness. He has
experience marital discord, alcohol nabuse, and inability to hold a job. The
nurse will expect which of the following medical diagnosis?
a) Post-traumatic stress disorder
b) Agoraphobia RISTORNER
c) Conversion disorder
d) Dissociative disorder
2. Which nursing diagnosis should have the highest priority early in Mr.
Jankowicz's hospitalization?
a) Knowledge deficit
b) Ineffective individual coping
c) Social isolation
d) Potential for violence
3. Mr. Jankowicz will experience the most lasting relief of his symptoms when
he is able to?
a) Comply with the prescribed medication program
b) Receive more symptomatic support from his wife and family
c) Discuss his sad and bitter memories with sympathetic listeners
d) Understand the negative effects of alcohol in his bady.
4. One of the main causes of delirium in our society today is
a) Drug intoxication
b) Food poisoning
c) Alcoholism
d) None of the above
5. The first thing to do in drowning persons is
a) Resuscitate the persons
b) Take the persons out of the water
c) Clear the air airways and give oxygen
d) All of the above
6. Healing process of wounds can take place in the presence of
a) Carbohydrate and oxygen
b) Proteins and minerals
c) Proteins only
(d) Proteins and vitamin c
7. The causes of ageing may stem from one of the following theories
a) Wear and tear theory
b) Fundamental theory
c) Accumulation theory
d) None of the above
8. Geontological nursing is.
a) Nursing that cares for the c
b) Effective nursing care of the old
c) Assessing, diagnosing implementing care to meet identified needs
9. An older adult is considered to be good at
a) 40 years to 45 years
b) 65 and above
c) 40 years to about 50 years
10. Photophobia means
a) Love for images from the lighted objects
b) Irrational fear for darkness
c) Irrational fear for light
d) None of the above
11. Blurred vision means
a) The object is blue
b) The image is blue
c) The eye is inflamed
d) The patient cannot see objects or their image well.
12. Ocular emergencies include:
a) Foreign bodies in the eye
b) Diplopia
c) Injury to the eye
d) (a) and (b)
13. A cataract is
a) A tumor of the eye
b) Transparencies of the lens of the eye
c) Opacity of the cornea
d) Opacity of the lens of the eye
14. An auriscope is another name for
a) Laryngoscope
b) Electrocardiograph
c) A fundoscope
d) Otoscope
15. Ophthalmic neonatorum.
a) A hereditary condition of the new born
b). A congenital eye disease of the neonate
c) Yellowish eyes
d) Blurred vision
16. First treatment priority in patients with my
a) Airway maintenance b) Bleeding control

c) Circulatory volume restoration

d) Splinting of fractures
e) Reduction of dislocations
17. Which of the following is an example of a closed wound?
a) Gunshot wound
b) Amputated wound
c) Abrasion
d) Laceration
e) Hematoma.
18. Facial trauma. All of the following except one can lead to airway
compromise after facial
a) Blood in the airway
b) "Debris" in airway (vomitus, avulsed tissue, teeth or denture)
c) Foreign bodies in the airway
d) Pharyngeal or retropharyngeal swelling
e) Posterior tongue displacement from nasal fractures.
19. Which of the following is not a criterion to measure the severity of brain
injuries?
a) Duration of loss of consciousness
b) Initial score of Glasgow Coma Scale (GCS)
c) The length of post-traumatic amnesia (PTA)
d) The mechanism of injury
e) Rancho Los Angolos scale
20. Raised intracranial pressure (ICR) is a common finding in the patients who
sustain bra injury. Which of the following is a sign of raised intracranial
pressure?
a) Raised systolic blood pressure
b) Raised diastolic Blood pressure
c) Diplopia
d) Papilloedema
e) Deep coma
21. All of the following characterize extradural hematoma (EDH), excep
a) 90% of EDH is associated with skull fractures
b) The hematoma is disc-shaped and centrally thickened CHOCHUCHAY
c) Blood collects in the potential space between the inner and the Dura
d) No notion of lucid interval
e) Bleeding most from lacerated middle meningeal artery.
22. Which of the following type of intracranial hematoina presents with signs of
meningitis?
a) Extradural hematoma
b) Subdural hematoma
c) Subarachnoid hematoma
d) Intraparenchymal hematoma
e) None of the above
23. Which of the following is not part of the nursing care in a patient with head
injury?
a) Positioning of the patient
b) Nutritional support
c) Temperature management
d) Providing care for patient’s family
e) Evelation of the limbs of the patient
24. Which of the following is a late complication of fractures?
a) Hermorrhage
b) Nerve injury
c) Compartment syndrome
d) Mal-unions of bones
e) All of the above.
25. A 73 year old man missed his step without any significant trauma and
sustained a fracture of the femoral neck. What is the type of fracture he is
likely to sustain?
a) Traumatic fracture
b) Spiral fracture
c) Green-stick fracture
d) Pathological fracture
e) Fracture dislocation
26. All of the following will impair wound healing, except
a) Cigarette smoking
b) Immunosuppression
c) Age
d) Malnutrition
e) Unconscious state
27. A Glasgow Coma Scale of is said to be moderate
a) 4
b) 8
c) 15
d) 3
e) 6
A question 28 & 29 is based on the following case scenario: of a road traffic
accident is brought to General Hospital by the wife and the nurse is calle
evaluate the patient. The patient appeared to be sleeping but open his eyes
when tha hurse spoke to him. When he asked what happened, he said he was
brought to the General Hospital by his mother. He removed the nurse's hand
when he applied pressure on his sterqu NSHOCHUCHAYI
28. What is the GCS of this patient?
a) 9
b) 10
c) 11
d) 12
c) 13
29. What is the severit of his brain injury?
a) Mild injury
b) Moderate injury
c) Severe injury
d) Very severe injury
e) Average brain injury
30. The following are criterion to be admitted in the ICU except?
a) Urine output 0.5ml/kg/h
b) Cardiac arrest
c) Respiratory alkalosis
d) Prolonged seizure
e) None of the above
SECTION B: SHORT ESSAY QUESTIONS (40POINTS)
1. Write short notes on the following conditions.
i) Peptic ulcer disease
ii) Intestinal obstruction
ii) Head injury
iv) Edema (5 points cach=20pts)
2. A patient with urinary retention was ordered catheterization by a doctor.
a) What is catheterization?
b) List the materials needed for catheterization.
c) What are some of the indications for catheterization?
d) What precautions will you take when carrying out the procedure? (Spor cach
20pts)
SECTION C: LONG ESSAY QUESTIONS (30POINTS)
QUESTION 1:
A patient from a doctor's consultation with a diagnosis of acute your unit for
admission.
a) What do you understand by this condition? Um
b) Identify its clinical presentations (1mk)
c) Briefly explain its types (8mks)
d) Discuss the management under
i) Drug therapy (5mks}
ii) Nursing care
QUESTION 2:
A patient with urinary retention was ordered catheterization by the doctor.
a) What is catherization (2.5mks?)
b) List the materials needed for catheterization (2.5mks)
c) What are some indications for catheterization? (2.5mks)
d) What precautions will you take when carrying out the procedure? (2.5mks)

PROPOSED ANSWER PAPER 1

SECTION A:
1. C
2. E
3. A
4. E
5. A
6. E
7. B
8. C
9. D
 10.A
11.A
12.D
13.C
14.B
15.D
SECTION B:
1) Wallace Rule of nine (entire back-18%, both legs-36%, right arm-9)=63%.
2)
- Remove the patient from the source or cause e.g removing patient from
a burning room
- If the burnt area is limited immerse in cold water.
- A, B and C
- If the patient is going into shock or is already in shock position
- Reassure the patient by telling him that everything will de alright or ok or
he will be fine Cover burnt area with clean dry linen preferably sterile
ones
- Assist in transporting patient to the hospital.
3) A pneumothorax is an abdominal collection of air in the pleural space
between the lung and the chest wall. The s/s are:
- Sudden onset of sharp chest pain
- Shortness of breath
- Low oxygen in the tissue fast heart rate cough fatigue
4) A tension pneumothorax is a life threatening condition that develops when
air is trapped in the pleural cavity under positive pressure displacing media
sternal structures
- Chest pain usually of sudden onset.
 - The pain is sharp and may lead to felling of tightness in chest.
- Shortness of breath
- Rapid heart rate
- Fast breathing
- Cough
- Distended neck veins.
- Treachea deviation and hemodynamic instability
5)
- Stage 1. Sores are not open wounds, the shin maybe painful burit has no
breaks. The skin appears reddened. In darker skin people a different
color other than their skin color is observed
- Stage 2: the skin breaks open, wear away or form an u which is usually
tender and painful.
- Stage 3: the sore begins to expand into deeper the skin, tissues beneath
the skin forming a small crater. Damage to deeper tissues, tendons and
joints may occur.
- Stage 4: the pressure injury is very deep, reaching into muscle and bone
causing extensive damage. Damage to deeper tissues, tendons and joints
may occur.

6) The following complications may arise from putting an elderly patient on

complete bed rest
i) Musculoskeletal difficulties
- Excessive bed rest can lead to contractures, muscle weakness and loss of
skeletal muscle mass, or muscle wasting
ii) Urologic problems bed rest can increase the risk of kidney stone when lying
down this weakens abdominal and pelvic floor muscle, incomplete implying of
the bladder and urinary stasis can occur leading to formation of kidney stones
and likelihood for infection
iii) GIT Problems:
- There is increased risk of constipation in bed ridden patients
iv) Cardiovascular system:
- Bed ridden patients may suffer from postural hypotension, decrease
cardiac function and deep vein thrombosis
v) Dermatological problems; there is increased risk of developing pressure sore
in bed ridden patients if their lying positions are not frequently changed to
relief pressure areas.
SHORT ESSAY QUESTIONS
1. Gl intubation is the insertion of a rubber or plastic tube into the gastric
reservoir, the duodenum which is the first part of the small intestine. The tube
maybe inserted through the mouth, the nose or through the abdominal wall.
The size and length of the tube depends on the intended s on the intended use.
For example: nasogastric tube are short, naso-duodenal tube are of medium
length and naso enteric tube are longer:
2. GI intubation may be done for the following reasons:
- To decompress a ballooned or distended abdomen
- For gastric lavage an remove ingested toxins
- To diagnose disorders of Gl motility and other disorders.
- For feeling and serving medication.
- To compress a bleeding site.
- To aspirate gastric content for analysis
- To treat an obstruction
3. Advice
 - Inform the patient of the procedure and the eventual complications that
may arise
- Ensure NPO before the procedure
- Encourage the patient to breathe through the mouth
4. Precautions
- The polystyrene tube is warmth to make it pliable and prevent
traumatizing the patient
- The tube should also be lubricated
- The nurse or healthcare provider should use aseptic technique to
prevent contamination
- The patient is place in a fowler position to ease descend of tube.
- Local anesthesia is administered (tetracain)
5. To ensure patient safety, it is essential to confirm that the tube has been
place correctly, particularly because tubes may be accidentally inserted in to
the lungs which may be undetected in high risk patients. To confirm correct
insertion of NG tube the following should be done:
- Visual assessment of the aspiration of the stomach content i.e a cloudy
green secretion
- Injection air through the tube while auscultating the epigastrium.
- An x-ray examination may confirm the position
- PH measurement of aspirated gastric secretions. The PH of gastric
secretion is 1-5
6. Normal saline (NaCl). This is because N/saline compensates for electrolyte
loss during NG drainage.
7. This could be a great sign that the drain flow is probably obstructed and
unclamp the tube will need to be irrigated.
 - Usually episodes of nausea, vomiting and abdominal distension could
also be noticed after abrupt attempt to move the NG tube. The nurse
may intermittently clamp and unclamp the tube for a trial period of 24
hours to ensure that the patient does not experience nausea, vomiting
and abdominal distension before the tube is removed.

PROPOSED ANSWERS paper 2

SECTION A: MCQ
1-A
2-B
3-C
4-C
5-B
6-D
7-A
8-A
9-B
10-C
12-D
13-D
14-D
15-D
16-A
17-E
18-E
19-D
20-D
21-D
22-C
23-D
24-D
25-E
26-E
27-B
28-C
29-A
30-A
SECTION B
1.
i) PEPTIC LCER DISEASE: peptic ulcers are open sore that develop on the inside
lining of your stomach and upper portion of your small intestines sometime
esophagus.
Peptic ulcer includes:
Gastric ulcers: that occurs at the inside of the stomach
Dueodenal ulcers: that occurs on die leide of the upper portion of your small
intestines (duodenum)
Esophageal ulcers: occurs on the mucosal lining of the esophagus. The most
common symptom peptic ulcer is pain (usually in the upper abdomen) the most
complan causeof peptic ulcer are infections with the bacterium helicobacter
and long term used of aspinne
ii) Intestinal obstruction: a gastrointestinal condition in which digested material
is prevented front passine normally through the bowel. It is cause by fibrous
bands of tissue (adhesions in the abdomen that form after surgery, an inflame
intestines, bernias, colon cancer, twisting of the intestine (volvulus), impacted
feces, impaired mobility of infestines (paralytic ileus). It is often manifested by
constipation, Vomiting, inability to have a bowel movement or pass gas,
swelling of the abdomen, of appetite, crampy abdominal pain that comes and
goes MBE In milder cases, the condition resolve on its own, but if it fails,
managements such as taking a lot of fluid, administration of laxative, manual
removal of fecal matter and surgery.
iii) Head injuries: it is any injury that results in trauma to the skull or brain. This
can range from mile bump or bruises to a traumatic brain injury. Common head
injuries include concussions, skull fractures and scalp wounds. Head injuries
may either be closed or open. A closed head injury is any injury that doesn't
break your skull. An open (penetrating) head injury is one in which something
breaks the scalp and skull and sometime enters your brain.
Head injuries can either be due to blows on the head or shaking/jarring of the
head Blows maybe from the motor vehicle accidents, falls, physical assault, ete
the major type of head injuries are hematoma, hemorrhage, concussions,
edema and diffused axonal injury.
iv) Edema: edema is swelling caused by excess fluid trapped in your body's
issues. Although edema can affect any part of your body, you may notice it
more in your hands arms, feet, ankle and legs. It can be the result of
medications, pregnancy or an underlying disease c.g CHF. Edema can be pitting
(when an indentation remains after the swollen skin pressed) or non-pitting
dependent (edema usually on the leg and lower body due to gravity). Base on
location edema can be classified as pulmonary cerebral peripheral, pedal etc
2. a) catheterization is a way to drain urine from the bladder by placing a small
tube called catheter into the urethra to the bladder. This is recommended
when the bladder doesn't empty on it own. Keeping the bladder and kidneys
healthy, prevent infection and control leakage. There are three main types of
catheters indwelling catheters external and short term catheters the condition
can be treated by identifying and eliminating the administration of diuretics.
- indwelling catheter is a catheter that rides in the bladder through the
urethra.
- An external catheter or condom catheter is a catheter place outside the
body.
- Short term catheters are catheters placed just for a short period of time
such as surgery,
b) catheterization tray (sterile consist of:
- Disposable sterile gloves sterile drapes, one fenestrated, lubricant, sterile
cotton balls. Sterile forceps (2), prefilled 10ce syringe with sterile water
to inflate the balloons, sterile water to inflate the loom Sterile catheter,
and sterile spacemen container for urine sample.
- Chlorhexidine (2%), catheter secure devices or adhesive tapes, urinary
drainage bag
c) Urinary retention: this is the inability to completely empty the bladder. It can
be due to blockage ofthe drethra, nerve problems, certain medications, weak
bladder muscle
- To monitor armary output in critically ill persons.
- To manage urination during surgery especially major operations of the
abdomen and pelvic cavity (such as CS)
- on patient with incontinence.
- During labour to prevent the progress of labour from be being
obstructed by a distended
- Following ureterectomy
 - on comatous patients.
d)
- Insert urinary catheter using sterile technique with sterile equipment. -
Ensure that no kinks or blockage occur in the tubing
- Secure the catheter tube to prevent urethral damage. -Avoid use of
antiseptic solutions on the urethral meatus and /or urinary bag.
- Urinary bag should be always be kept below the thigh.
- Privacy

SECTION C
Q1
a) It is a sudden onset inflammation and and/or of the outer membrane of the
eye balame inner eyelid (conjunctiva). b)-Redness of swelling of the white of
the eye or inside the eyelid.
b)
- Eye drainage which maybe clear, yellow. -Itchy irritated and or burning
eyes
- Increase amount of tears... e) According to the cause the following types
of conjunctivitis

i) Bacteria conjunctivitis: it is a common type cause by bacteria that infect the

eye through various sources of contamination. Common causative orga include
staph aureus, heamophilus influenza etc it usually produced by thick white
discharge.
1) viral conjunctivitis: this is another type that is highly contagious. It can also
accompany an
iii) Allergic conjunctivitis: this pink eye is cause by allergens that irritate the eye.
Eg pollen animal dander, dust and mites. The most common symptom is itchy
eye.
iv) Fungi conjunctivitis
d) i) Drug therapy: depending on the cause, bacterial conjunctivitis can be
managed with antibiotic eye drops and ointments eg erythromycin.
- For allergic conjunctivitis antihistamines such as patanol may be
prescribed to treat allergie symptoms such as itchy eye
- viral conjunctivius does not usually require specific antiviral treatment.
The treatment is mostly supportive.
- we give antipyretics to relief fever.
ii) Nursing care:
- rest: the patient should be nurse in a quite low intensity light room.
- isolate the patient if its infectious conjunctivitis.
- IEC: the patient should be educated on not sharing face cloths and
towels, try not to touch the eyes as it may bring infection and irritate the
eyes more, hand washing before/after touching the eye and also teach
the patient how to instilled eye drops on discharge.
- Instillation/administration of medications and ointments.
- Encourage patient to remain away from school and work for some time.