REPUBLIC OF CAMEROON

REPUBLIC DU CAMEROUN
Peace-Work-Fatherland
Paix-Travail-Patrie
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MINISTERE DE
MINISTERE DE
L’ENSIGNEMENT SUPERIEUR
L’ENSIGNEMENT SUPERIEUR
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NATIONAL COMMISSION FOR THE ORGANISATION OF THE
COMMISSION NATIONALE d’ORGANISATION DES EXAMENS
HIGHER NATIONAL DIPLOMA (HND) EXAM
DU HND
NATIONAUX

HIGHER NATIONAL DIPLOMA (HND) EXAM

JUNE-JULY 2021 SESSION Examination Date……..………………….

OPTION NURSING

SPECIALTIES NURSING

COURSE TITLE NURSING SCIENCE

COURSE CODE NUS18

TYPE OF EXAMINATION WRITTEN

CREDIT VALUE 8

DURATION: 3 HOURS

GENERAL INSTRUCTIONS

You are reminded of the necessity of orderly presentation of your material and good English

Where calculations are required, clearly show your working and be chronological in your answer

SPECIFIC INSTRUCTION

THE MARKS ALL SUM UP TO 100

The different Nursing Science subjects: fundamentals of nursing, medico-surgical specialties,

emergency nursing, geriatric and psychiatric nursing are represented in this paper in the
mentioned percentages.

The questions are structured into MCQs, Short Answers and Essay

ATTEMPT ALL QUESTIONS

SECTION A: MULTIPLE CHOICE QUESTIONS (30MKS)

1. Your grandfather who is ill is said to be in a geriatric home where he will have the

opportunity to see a geriatrician. Who is a geriatrician?

a) A doctor who specialises in the diagnosis of diseases of older adult

b) One who specialises in the treatment of disease of older adult

c) One who specialises in the prevention of diseases and disabilities of older adults

d) All of the above

2. The nurse is performing an assessment on an older client who is having difficulty

sleeping at night. Which statement by the client indicates the need for further teaching

regarding measures to improve sleep?

a) “I swim three times a week.”

b) “I have stopped smoking cigars.”

c) “I drink hot coffee before bedtime.”

d) “I read for 40 minutes before bedtime.”

3. A visiting nurse observes that the older male client is confined by his daughter-in-law to

his room. When the nurse suggests that he walk to the den and join the family, he says, “I’m

in everyone’s way; my daughter-in-law needs me to stay here.” Which is the most important

action for the nurse to take?

a) Say to the daughter-in-law, “Confining your father-in-law to his room is inhumane.”

b) Suggest to the client and daughter-in-law that they consider a nursing home for the client.

c) Say nothing, because it is best for the nurse to remain neutral and wait to be asked for

help.
 d) Suggest appropriate resources to the client and daughter-in-law, such as respite care and a

senior citizens center.

4. The nurse is performing an assessment on an older adult client. Which assessment data

would indicate a potential complication associated with the skin?

a) Crusting

b) wrinkling

c) Deepening of expression lines

d) Thinning and loss of elasticity in the skin

5. The home health nurse is visiting a client for the first time. While assessing the client’s

medication history, it is noted that there are 19 prescriptions and several over-the-counter

medications that the client has been taking. Which intervention should the nurse take first?

a) Check for medication interactions.

b) Determine whether there are medication duplications.

c) Call the prescribing health care provider (HCP) and report polypharmacy.

d) Determine whether a family member supervises medication administration.

6. With your expertise in emergency nursing which of the following do you think could be

the underlying cause of shock?

A) Hypovolemia,

B) Cardiogenic,

C) Neurogenic, or septic

D) All of the above are correct.

7. When carrying out management of a patient with hypovolemia the emergency nurse

should____________

A) ensure a patent airway

B) Maintain breathing

C) provide ventilatory assistance

D) All of the above are correct

The following questions should be answered using the statement below.

In order to get some rest after a hectic week at the emergency department where you work at

the General Hospital Douala, you decided to go for a picnick Seme Beach resort Limbe with

your family. But your quiet enjoyment was unceremoniously cut-off when you met a panicking

couple at the pool whose 16 year old daughter was near-drowning in the beach. You

immediately go into action in order to assist the rescue team. You should have at the back of

your mind the following.

8. Near-drowning is____________________

A) survival for at least 24 hours after submersion.

B) survival for at least 48 hours after submersion.

C) survival for at least 72 hours after submersion.

D) None of the above

9. The most common consequence of near-drowning is_________

A) Tachycardia

B) Hypoxemia.

C) Bradycardia

D) All of the above

10. As concerns triage in the emergency department, the priorities of emergency care for the

patient with an emergent or urgent health problem include_____________

A) stabilization,

B) provision of critical treatments,

C) prompt transfer to the appropriate setting (intensive care unit, operating room,

general care unit)

D) All the above are correct

11. Which of the following statements would indicate that family teaching about

schizophrenia had been effective?

a. “If our son takes his medication properly, he won’t have another psychotic episode.”

b. “I guess we’ll have to face the fact that our daughter will eventually be institutionalized.”

c. “It’s a relief to find out that we did not cause our son’s schizophrenia.”

d. “It is a shame our daughter will never be able to have children.”

12. The overall goal of psychiatric rehabilitation is for the client to gain

a) Control of symptoms

b) Freedom from hospitalization

c) Management of anxiety

d) Recovery from the illness

13. Which of the following are considered to be positive signs of schizophrenia? Select all

that apply

a. Anhedonia
 b. Delusions

c. Hallucinations

d. Disorganized thinking

e. Illusions

f. Social withdrawal

14. The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly

and rapidly, and using elaborate hand gestures. The nurse concludes that the client is

demonstrating which of the following?

a. Aggression

b. Anger

c. Anxiety

d. Psychomotor agitation

15. A client with bipolar disorder begins taking lithium carbonate (lithium), 300 mg four

times a day. After 3 days of therapy, the client says, “My hands are shaking.” The best

response by the nurse is

a. “Fine motor tremors are an early effect of lithium therapy that usually subsides in a few

weeks.”

b. “It is nothing to worry about unless it continues for the next month.”

b. “Tremors can be an early sign of toxicity, but we’ll keep monitoring your lithium level to

make sure you’re okay.”

c. “You can expect tremors with lithium. You seem very concerned about such a small

tremor.”

16. The nursing process is utilized to:

a. Provide a systemic, organized and comprehensive approach to meeting the needs

of the client.

b. Encourage the family to make decisions regarding parients care

c. Increase involvement of allied healthcare professionals in decision-making

d. None of the above.

17. Objective data might include

a. Chest pain b. complaint of dizziness

c. an evaluation of blood pressure d. none of the above.

18. According to maslow’s heirarchy of human needs, the highest level is

a. Physiologic needs

b. Safety and security

c. Belongingness and affection and esteem and self-respect

d. Self actualization

19. All the following are indicative physical signs of poor nutrition, except

a. Dental caries, mottled appearance (flourosis), malpositioned

b. Brittle, depigmented, easily plucked;thin and sparse hair.

c. Tongue- deep red in appearance; surface papillae present

d. Spongy, Tongue- deep red in appearance; surface papillae present

e. Spongy, bleed easily, marginal redness, recession gums

20. The nurse is to administer an iron injection to an adult. How should this be administered?
 a. Subcutaneous in the arm

b. Intradermal in the forarm

c. Intramuscular in the deltoid

d. Z track intramuscular in the gluteal

21. A client has been admitted to a nurse home, and the nurse completes an assessment.

Which finding might lead to suspect a nutritional alteration>

a. eye clear

b. shiny hair

c. ridged nails

d. moist conjunctiva

22. A patient ask you wh you wh you wh you what vitamin is best for er eye sight. Your

response is:

a. Vitamin C

b. Vitamin A

c. Vitamin B6

d. Vitamin B12

23. The assessment of immobilized patient focus on the following except

a. Range of motion

b. Inactivity tolerance\

c. Body alignment

d. Psychological condition.

24. The phases of the nursing process includes the following except

a. Assessment
 b. Diagnosis

c. Planning

d. Education

25. A triage nurse in the emergency department determines that a patient with dyspnea and

dehydration is not in a life-threatening situation. The triage category that the nurse would

choose is:

a) Delayed

b) Emergent

c) Immediate

d) Urgent

26. A nurse at the scene of an industrial explosion uses “field triage’’ to categorize victims for

treatment. A patient in need of emergent care would be tagged using the color:

a) Blue

b) Green

c) Red

d) Yellow

27. John, 16years old, is brought to the emergency department after a vehicular accident. He is

pronounced death on arrival (DOA). When his parents arrive the hospital, the nurse

should:

a) Ask them to sit down in the waiting room until she canspend time alone with them

b) Speak to both parents together and encourage them to support each other and express

their emotions freely

 c) Speak to one parent at a time in a private setting so that each can ventilate feelings of

loss without upsetting the other

d) Ask the emergency physician to medicate the parents so that they can handle their

own son’s unexpected death quietly and without hysteria

28. The first priority in treating any patient in the emergency department is:

a) Controlling hemorrhage

b) Establishing airway

c) Obtaining consent for treatment

d) Restoring cardiac output

29. Clinical indicators for emergency endotracheal intubation include:

a) Airway obstruction

b) Respiratory arrest

c) Respiratory insufficiency

d) All of the above

30. The most common cause of shock in emergency situations is:

a) Cardiac failure

b) Decreased arterial resistance

c) Hypovolemia

d) Septicemia

SECTION B: SHORT ANSWER QUESTIONS (40mks)

1) What is the difference between geriatrics and gerontology? 2mrks

2) What is the effect of medication on the elderly. 2mks

3) Management of falls in geriatric. 3mks

 4) What is rescue breathing (2 marks?)

5) Name three microorganisms that most commonly causes conjunctivitis and one

characteristic sign of viral conjunctivitis (4mks)

6) List two significant changes in the optic nerve in glaucoma (2mks)

7) List four clinical symptoms indicative of a detached retina (4mks)

8) When is mouth to nose breathing performed (3 marks)

9) What is the primary cause of age related vision loss in the elderly? (1mk)

10) Compare and contrast the two sociologic theories of aging: the activity and continuity

theory. (5mks)

11) Nurses monitor vital signs of patients as first priority in practice. What is the importance

of this action in nursing practice?

12) In nursing planning, who are those involved? 2mks

13) In the nursing process, what is meant by implementation stage? 2mks

14) a. Define schizophrenia (1mk)

b. Outline three causes of schizophrenia (3mk)

c. List three positive and three negative signs of schizophrenia each (3mk)

SECTION C: ESSAY (30mks)

1. a) Differentiate between dementia and delirum(5 marks)

b) Give 5 functions or typical work activities of the psychiatric nurse (5 marks

2. Give two causes of postpartum haemorrhage and five nursing interventions with four nursing

diagnosis. (10 Marks )

 3.Mr Ambe Is a 74 years old man feels he has been neglected by his family, he refuses to eat,

and always looking sad. Mr Ambe is later brought to you. Using your knowledge of geriatric

nursing;

e. Define geriatric nursing.2mks

f. State and briefly explain your role as a geriatric nurse to mr Ambe.8mks

SECTION A: MARKING GUIDE

1. A 2. C 3. D 4.A 5.B

6.D 7.D 8.A 9.B 10.D

11.A,C 12.A 13.B,C,D,E,F 14.D 15.A

16. A 17. C 18. D 19. B 20. D

21.C 22. B 23.D 24. D 25. D

26.C 27. B 28. A 29. C 30. C

SECTION B: SHORT ANSWER

1) Geriatric is care of the of the elderly.

Gerontology is the study of the aging process.

2) Patients who smoke should be counselled to stop and, if they continue, not to smoke in

bed because the elderly are more likely to fall asleep while doing so. Patients should be

checked for signs of alcohol use disorders, which are underdiagnosed in the elderly. Such

signs include confusion, anger, hostility, alcohol odor on the breath, impaired balance and

gait, tremors, peripheral neuropathy, and. nutritional deficiencies. Screening

questionnaires and questions about quantity and. frequency of alcohol consumption can

help.

3) All adults older than 65 years be screened annually for a history of falls or balance

impairment. An individualized risk assessment should be performed, with corresponding

multifactorial intervention, for those who report a single fall and have unsteadiness; who

report two or more falls; who report difficulties with gait or balance; or who seek medical

attention because of a fall. The following components should be included in

multifactorial interventions: exercise, particularly balance, strength, and gait training;

modification of the home environment; minimization of medications, especially

 psychoactive medications; management of postural hypotension; and management of foot

problems and footwear. These interventions are effective

4) The process of ventilating the lungs through the victim’s mouth, nose, or stoma is called

rescue breathing

5) Streptococcus pneumonia, Hemophilus influenza, and staphylococcus aureus

6) “Pink eye” (dilation of the conjunctival blood vessels)

7) Pallor and cupping of the optic nerve disc

8) Patients report the sensation of a shade or curtain coming across the eye, cobwebs, bright

flushing lights, or the onset of floaters. Pain is not reported.

9) Mouth-to-nose breathing is performed when the client is an infant or small child, or when

mouth to-mouth breathing is impossible or unsuccessful

10) Macular degeneration

11) The activity theory proposes that life satisfaction in normal aging requires maintaining

the active lifestyle of middle age. The continuity theory proposes that successful

adjustment to old age requires continuing life patterns across a lifetime.

12) The activity theory proposes that life satisfaction in normal aging requires maintaining

the active lifestyle of middle age. The continuity theory proposes that successful

adjustment to old age requires continuing life patterns across a lifetime.

13) Vital signs reflect changes in body function that otherwise may not be observed.

14) The nurse, patient, family and other care provider.

15) Implementation means outing planned nursing strategies into action.

 16)

a. Schizophrenia is a serious psychiatric disorder characterized by impaired communication

with loss of contact with reality and deterioration from a previous level of functioning in

work, social relations or self-care.

b. The cause of schizophrenia is still unclear. Some theories about the cause of this disease

include:

Genetics (Heredity): Scientists recognize that the disorder tends to run in families and

that a person inherits a tendency to develop the disease. Close relatives of schizophrenic

patients are up to 50 times more likely to develop the condition and the closer the degree

of biological relatedness, the higher the risk

Schizophrenia may also be triggered by environmental events such as viral infections or

highly stressful situations or a combination of both.

Similar to some other genetically-related illnesses, schizophrenia appears when the body

undergoes hormonal and physical changes like those that occur during puberty in the teen

and young adult years.

Biochemical hypothesis: People with schizophrenia have a chemical imbalance of brain

chemicals that is neurotransmitters (serotonin and especially dopamine). The imbalance

of these neurotransmitters/chemicals affects the way a person’s brain reacts to stimuli;

which explains why a person with schizophrenia may be overwhelmed by sensory

information (loud music or bright lights) which other people can easily handle. This
 problem in processing different sounds, sights, smells and tastes can also lead to

hallucinations or delusions.

Psychosociocultural causes can be linked to disturbed family and interpersonal patterns.

This is common in the lower socioeconomic group, social failure, high stress level. Some

incidence have been reported for those with low birth weight and congenital deafness

c. Positive symptoms are disturbances that are “added” to the person’s personality.

- Delusions

- Hallucinations –The most common experience is hearing imaginary voices

- Disordered thinking and speech

Negative symptoms are capabilities that are “lost” from the person’s personality.

- Social withdrawal

- Extreme apathy

- Lack of drive or initiative

- Emotional unresponsiveness

ESSAY

QUESTION 1.

Factors Delicium Demantia

Nature acuteness Acute Chronic

State of neurone Altered Death

 Reversibility Reversible Irreversible

Organic brain disease Absent Present

Structural changes Absent Present

– Develop a relationship with the person based on empathy and trust

- Promote the persons sense of positive self-regard

- Promote the persons engagement with their social and support network

- Promote effective coping and problem solving skills in a way empowering

- Promote positive health behaviour including medication compliance

QUESTION 2

Excessive blood loss (more than 500ml or 1000ml) after delivery within the first 24 hours

following delivery. It is considered early PPH also called immediate or primary PPH when it

happens days or weeks after delivery it is known as late, delayed or secondary PPH can be

caused by:

1. Uterine atony (uterus isn’t contracting effectively after delivery.

2. It can be as a result of fibroids or any kind of infection and from pregnancy complications

like placenta previa or placenta accrete, cervical lacerations, deep vagina or perineum tear.

INTERVENTIONS
 1. Assess and record the type, amount and site of the bleeding, count and weigh perineal

pads and if possible save blood clots to be evacuated by the Physician.

2. Assess the location of the uterus and the degree of the contractility of the uterus/massage

boggy hand above the symphysis pubis.

3. Review the records and note certain conditions such as retained placental fragments, any

lacerations abruption placenta etc.

4. Monitor vital signs including systolic and diastolic blood pressure. Check for capillary

refill and observe nail beds and mucous membrane.

5. Note for the presence of vulvar hematoma and apply an ice pack if indicated. Encourage

rest.

QUESTION 3

1) Supporting cognitive function: As the patient‘s cognitive ability declines, the nurse provides

a calm predictable environment that helps the person interpret his or

2) her surroundings and activities. Supporting cognitive function: As the patient‘s cognitive

ability declines, the nurse provides a calm predictable environment that helps the person

interpret his or her surroundings and activities.

3) - Promoting physical safety: A safe environment allows the patient to move about as freely as

possible and relieves the family of constant worry about safety

- Reducing anxiety and agitation: Despite profound cognitive losses, the patient will, at times, be

aware of his or her rapidly diminishing abilities. The patient still need constant emotional

support that reinforces a positive self-image. When losses of skills occur, goals are adjusted to fit

the patient‘s declining ability. The environment should be kept uncluttered, familiar, and noise
free. Excitement and confusion can be upsetting and may precipitate and combative, agitated

state known as a catastrophic reaction (over reaction to excessive stimulation).

-Improving communication: To promote the patient‘s interpretation of messages, the nurse

should remain unhurried and reduce noises and distractions. Use of clear, easy to understand

sentences to convey messages is essential because patients frequently forget the meaning of

words or have difficulty organizing and expressing thoughts. In the early stage, lists and simple

written instructions may be helpful. In the later stage, the patient may be able to point out at

objects or use nonverbal language to communicate.

-Providing for socialization and intimacy needs: Because socialization with friends and family

can be comforting, visits, letters and phone calls are encouraged.

Visits should be brief and non stressful; limiting visitors to one or two at a time helps reduce

overstimulation. Recreation is important, and people are encouraged to participate in simple

activities. Realistic goals for activities that provide satisfaction are appropriate. Hobbies and

activities such as walking, exercising and socializing can improve quality of life. The non-

judgemental friendliness of a pet can stimulate comfort and provide contentment. Care of plants

and pets can be satisfying and an outlet for energy.

Elderly with their spouses can continue their sexual activity. They must be encouraged to talk

regarding any sexual concerns. Simple expressions of love such as holding, touching are often

meaningful.

- Providing adequate nutrition: mealtime can be pleasant social occasion or a time of upset and

distress, and it should be kept simple, calm without confrontations.

People prefer foods that are appetizing and tastes good. To avoid playing with food, serve one

dish at a time. Food is cut into small pieces to avoid choking. Liquids may be easier to swallow

if they are converted to gelatine. Hot foods and beverages are served warm to prevent burns.

-Promoting balanced activity and rest: Many people complain with sleep disturbances and

wandering behaviours that may be inappropriate. These behavioursare most likely to occur when

there are unmet physical or psychological needs.

Caregivers must identify the needs of the patient who are exhibiting these behavioursbecause

further health decline may occur if these are not corrected. During the day time physical activity

can be encouraged and long durations of sleep during the day time are discouraged.

-Supporting home and community based care: The emotional burden on the families of elderly

are enormous. The physical health is often stable and mental degeneration is gradual. Family

members may be faced with difficult decisions.

Anger and agitation exhibited by the older adults are often misunderstood by the family

members. Abuse and neglect of the older adults must be avoided and they have to be constantly

supervised on the minor and major ailments for immediate medical help is mandatory