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 MOTHER AND CHILD HEALTH

COURSE CODE NUS17

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 Mother and Child Health subjects: Paediatric pathologies and child care,
obstetrics care and pathology and reproductive health are represented in this paper in the
mentioned percentages.

The questions are structured into MCQs, Short Answers and Essay

ATTEMPT ALL QUESTIONS

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SECTION A: MCQ 30 marks

Pediatric Nursing (1 mark each)

1. The average number of days that symptoms of tetanus usually appear are:

A. 3 days B. 5 days C. 6 days D. 10 days

2. The different forms of tetanus include the following EXCEPT?

A. Generalized tetanus

B. Neonatal tetanus

C. Adult tetanus

D. Local tetanus

3. Generalized tetanus is the most common type representing about

A. 80%of cases

B. 50 % of cases

C. 30% of cases

D. 25% of cases

4. The generalized for of tetanus usually presents with a descending pattern and the first sign

is?

A. Trismus (lock jaw)

B. Facial spasm

C. Stiffness of the neck

D. Rigidity of calf muscle

5. The form of generalized that affects or occurs in new born is known as?

A. Infant tetanus

B. Prenatal tetanus

C. Neonatal tetanus

D. Childhood tetanus

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6. The infants at risk of acquiring neonatal tetanus include the following EXCEPT?

A. Children who have not received passive immunity from their mothers

B. Infants with umbilical cord infection

C. Children living in developing countries

D. Common in children in many developed countries

7. Neonatal tetanus is responsible to what percentage of all neonatal deaths in many

developing countries?

A. 14%

B. 16%

C. 17%

D. 15%

8. An uncommon form of the disease, in which patients have persistent contraction of

muscles in the same anatomic area as the injury is called?

A. Local tetanus

B. Cephalic tetanus

C. Umbilical tetanus

D. Neonatal tetanus

9. Tetanus is caused by an orgasm known as?

A. Clostridium vibra

B. Clostridium tetani

C. Clostridium tetanus

D. Clostridium weachice

10. Which of these objects is tetanus often associated with?

A. Rust

B. Rusty nails

C. Outdoor rusty objects

D. All of the above

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11. During the first year of life, the infant experiences a rapid period of growth and

development. At the end o the first year, it is expected that the infant’s weight in

comparison to birth weight has

A. Doubled

B. Tripled

C. Quadrupled

D. Multiplied

12. When assessing six-month-old baby girls, the nurse should expect the infant to exhibit

which one of the following abilities indicative of normal development?

A. Creeping on her hands and knees

B. Pulling herself to a standing position

C. Waving bye- bye

D. Turning over completely

Reproductive Health (1 Mark each)

1. What day of a typical 28-day menstrual cycle is a woman likely to ovulate?

a. 4

b. 10

c. 14

d. 22

2. Approximately how many sperm are in the typical ejaculate?

a. .300

b. 300,000

c. 3 million

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 d. 300 million

3. The egg can be fertilized until about _______ after ovulation.

a. 6 hours

b. 24 hours

c. 72 hours

d. 1 week

4. In order to improve the chances of conception:

a. intercourse should take place twice daily during the week of ovulation

b. a woman should use douches with acidic solution

c. lubricants should be used before intercourse

d. none of the above

5. For purposes of conception, the best position for intercourse is:

a. woman-on-top

b. man-on-top

c. rear entry

d. side-to-side

6. The placenta does all of the following except:

a. supplies oxygen to the fetus

b. supplies nutrients to the fetus

c. supplies blood to the fetus

d. secretes hormones

Obstetric Care 1 mark each

1. Which of the following is not a clinical manifestation of breast abscess?

A. Area is very sensitive, appears dusky red

B. Pus maybe expressed from nipple

C. Visible sore on the nipple of the affected breast

D. Mass is palpable
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2. The treatment of stage 2 of cancer of the breast is:

A. Radical mastectomy with or without post-operative irradiation

B. Simple mastectomy

C. Simple mastectomy with radiations

D. Total mastectomy with radiation therapy

3. Domestic accidents are preventable but some children are vulnerable to hazards such

as the following EXCEPT?

A. Aggressiveness

B. Stubbornness

C. Poor concentration

D. Alertness

4. Esophageal atresia is failure of the esophagus to form a continuous passage to the

stomach during embryonic development. When do the clinical manifestations appear

after birth?

A. Appear soon after birth

B. Hours after birth

C. A few days after birth

D. Seven days (1 week) after birth

5. Which of the following conditions is characterized with projectile vomiting

A. Esophageal atresia

B. Hypertrophic pyloric stenosis

C. Enteric fever

D. Food poisoning

6. Family planning aims at helping couples achieve all of these EXCEPT?

A. Space birth

B. Limit number of children

C. Avoid unwanted pregnancies

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 D. Improve the health of mother and child

7. The following are methods of family planning EXCEPT?

A. Natural methods

B. Hormonal methods

C. Sexual abstinence method

D. Barrier methods

8. Injectable contraceptives have the following advantages EXCEPT?

A. High effectiveness (99%)

B. Prolonged action

C. No effect on lactation

D. Protection against STIs/HIV

9. The following are types of hormonal methods EXCEPT?

A. The monophasic high dose

B. Monophasic low dose

C. Cervical mucus

D. Biphasic

10. Combined oral contraceptives work as follows EXCEPT?

A. Modify the cervical mucus

B. Block ovulation through the inhibition of hypophyseal FSH and LH

C. Modify the trophicity of the endometrium

D. Does not modify the cervical mucus

11. The following are some of the advantages of combined oral contraceptives EXCEPT?

A. Irreversible

B. Very effective (98-99%)

C. Easy to prescribe

D. Regular menstrual periods

12. One of combined oral contraceptives disadvantages is?

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 A. Must be taken every day

B. Decrease menstrual bleeding

C. Decrease risk of anemia

D. Not expensive

SECTION B: SHORT ANSWER QUESTIONS (40 MARKS)

Reproductive Health (8 marks)

Define the following with short notes; 3 marks

a. Menstrual cycle

b. Abortion

c. Family planning

d. Bring out the signs and symptoms of pregnancy (5marks)

Obstetric Care and Pathology (16 Marks)

Write short noteson the following (3, 3, 3 marks)

a) Management of Ante- partum hemorrhage

b) Hygiene in pregnancy

c) Benefits of breast feeding

2. Maternal and foetal distress is often life threatening both to the child and the mother.

Enumerate the

a) Causes

b) Clinical manifestations

c) Clinical management (2, 2,3 marks)

Pediatric and child health (16 marks)

1. Discuss pre, intra and post operation nursing care peculiar to a child with esophageal

atresia (16mks)

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SECTION C: ESSAY 30 marks

Pediatrics Nursing 12 marks

1 Discuss pre, intra and post op nursing care management specific to hypertrophic pyloric

stenosis. (12marks)

Obstetric Care 12 marks

2 a. What are the signs of preceding labour

b) What is the time taken for the 1 st, 2nd and 3rd stage of Labour, for both primigravida and

a multigravida?

c) Explain the mechanism of Labour.(6,7MARK

Reproductive Health 6 marks

3 Define family planning and Outline the advantages and disadvantages of the natural

family planning method (2 mks)

State and briefly explain factors that influence adolescent health in your community

(4mks)

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MARKING GUIDE

PEDIATRIC NURSING

PART I 30 Marks

MCQ

1. D

2. C

3. A

4. A

5. C

6. D

7. A

8. A

9. B

10. D

11. A

12. D

REPRODUCTIVE HEALTH

1. C

2. D

3. B

4. D

5. B

6. C

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OBSTETRIC CARE

1. D

2. C

3. C

4. D

5. D

6. A

7. C

8. D

9. D

10. B

11. C

12. A

SHORT QUESTION ANSWER 40 Marks

REPRODUCTIVE HEALTH 8 marks

a) Menstrual cycle: This is the regular natural change that occurs in the female reproductive

system (especially the uterus and Ovaries) that makes pregnancy possible. The cycle is

required for the production of Ovocytes and for the preparation of the uterus for

pregnancy. It is divided into menstrual phase, proliferative phase and secretary phase. It

occurs with influence of the following hormones. TSH, LH, Oestrogen and progesterone.

b) Abortion: This is the termination of a human pregnancy, most often performed during the

first 28 weeks. Abortion can either induced or spontaneous.

c) Family planning: WHO defies family planning as something that allows individuals and

couples to anticipate and attain their desired number of children and the spacing and

timing of their birth? It is achieved through use of contraceptive methods and the

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 treatment of involuntary infertility, example of family planning methods include Barrier

method, Hormonal intra uterine devices (IUD), Natural methods and Permanent methods.

Presumptive signs and symptoms

I. Amenorrhea

 Implantation bleeding

 Serious illness

 Menopause

II. Breast changes

 Surface veins becomes visible

 Appearance of the Montgomery’s tarbushes

 Tinkling sensation

 Appearance of the darkening of the primary areola

 Clear fluid can be expressed

 Colostrum can be expressed

 Secondary appearance of darkening on the secondary areola

III. Morning Sickness

 Bladder irritability

 Aspect of chloasma

 Linear nigra

 Striaegravidarum

 Nausea and vomiting

IV. Quickening (16th -20th week of pregnancy)

Probable signs and symptoms

a) Hegais sign

b) Jacquemiers sign
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 c) Oslander’s sign

d) Changes in the uterus

e) Presence of Braxton hicks contractions

Positive signs and symptoms

 The foetal heart is heard with a haetuscope

 The foetal parts can be palpated

 Foetal movements

 An echography or ultrasound will reveal a foetus

OBSTETRIC CARE 16 marks

1. (A) Management of Ante- partum hemorrhage

The victim may be admitted to hospital for observation and assessment of the cause of

bleeding. She will have an ultrasound scan and the baby may have a cardiotocograph

(CTG) which checks your baby's heart beat. Depending on how much bleeding has

occurred, client may need to have an intravenous (IV) drip inserted and may require IV

fluids. In severe circumstances you may require a blood transfusion or your baby may

need to be born early. Initially client will be encouraged to rest in bed.

At this point in time, we recommend that you:

 change sanitary pads at least every four hours while you have any blood loss (personal

hygiene is very important to reduce the risk of infection)

 do not use tampons

 wipe from front to back after going to the toilet

 do not go swimming

 do not have baths or use a spa—please shower

 do not have sexual intercourse

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  do not use any vaginal medications/creams

(b) Hygiene in pregnancy

 Brush and floss your teeth at least twice daily.

 Use a good quality toothbrush with soft bristles and a toothpaste containing fluoride.

 Brush your teeth with your fingers after every meal. Rinse your mouth vigorously to flush

out all food particles.

 Limit the sweets and snacks you eat during the day, or at least try to switch to hard fruits

like apples that have a rubbing action on your teeth.

 Increase your intake of milk and other dairy products to get more calcium in your diet.

 Have a thorough dental checkup. Contact your dentist immediately if you have toothache,

loose teeth, bleeding gums.

 If your breasts are very sore in early pregnancy, wear a soft seamless cotton bra or a

cropped top. A sports bra will also prevent excessive movement and cause less breast

soreness. Invest in a sleep bra if the soreness of your breasts are causing sleeplessness.

 Keep a breast pad or a fine cotton handkerchief inside your bra to absorb any milk that

may leak from your breasts.

 If the colostrum dries into a crust on your breast, rinse it off with warm water. Do not

apply soap as it may cause irritation.

 If your nipples are retracted, draw them out gently every time you bathe or take a shower.

Alternatively, you can buy nipple shields which can be worn inside your bra. They keep the

nipples erect and cause them to protrude from the areola.

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 If you are on the larger side, wear plus-sized nursing bras, specially made for large

women. These have wide straps that help to support the breasts better.

 A cool shower once or twice daily will decrease the temperature of your body and help

you feel refreshed and relaxed. It also keeps your body, especially your vaginal area clean and

free from infection.

 Do not douche your vagina unless your doctor specifically advises you to do so. It is also

wiser to settle for a shower rather than a tub bath as soapy and dirty water can enter your

vagina in a tub bath.

Do not bathe in very hot water (above 101 degrees). The heat can cause damage to the

umbilical cord and lead to abortions.

 Do not use bubble baths as the perfume and other chemicals in them may enter your vagina

and cause irritation. A cool shower once or twice daily will decrease the temperature of your

body and help you feel refreshed and relaxed. It also keeps your body, especially your vaginal

area clean and free from infection.

 Do not douche your vagina unless your doctor specifically advises you to do so. It is also

wiser to settle for a shower rather than a tub bath as soapy and dirty water can enter your

vagina in a tub bath.

 Do not bathe in very hot water (above 101 degrees). The heat can cause damage to the

umbilical cord and lead to abortions.

 Do not use bubble baths as the perfume and other chemicals in them may enter your

vagina and cause irritation.

(c)Benefits of breastfeeding

Health benefits of breastfeeding for the baby

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Breastfeeding has long-term benefits for your baby, lasting right into adulthood.

Any amount of breast milk has a positive effect. The longer you breastfeed, the longer the

protection lasts and the greater the benefits.

Breastfeeding reduces your baby's risk of:

 infections, with fewer visits to hospital as a result

 diarrhoea and vomiting, with fewer visits to hospital as a result

 sudden infant death syndrome (SIDS)

 childhood leukaemia

 type 2 diabetes

 obesity

 cardiovascular disease in adulthood .Breast milk adapts as your baby grows to meet

your baby's changing needs.

Health benefits of breastfeeding for the mother

Giving nothing but breast milk is recommended for about the first six months (26 weeks) of

baby's life. After that, giving the baby breast milk alongside family foods for as long as

mother and baby want will help them grow and develop healthily.The more mother

breastfeed, the greater the benefits.

Breastfeeding lowers mother risk of:

 breast cancer

 ovarian cancer

 osteoporosis (weak bones)

 cardiovascular disease

 obesity

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 2 maternal and foetal distress

(a) Causes

Uteroplacental insufficiency is considered as the main cause for antepartal fetal distress. The

placenta is an important organ with a role in providing the enough amount of oxygen and

nutrients through the umbilical cord going to the fetus.

Other causes of fetal distress are:

 Reduced uterine perfusion

 Breathing problems

 Multiple births

 Fetal abnormal position or presentation

 Shoulder dystocia noted during delivery

 Uteroplacental vascular disease

 Reduced fetal reserves

 Fetal sepsis during the pregnancy

 Nuchal cord

 Umbilical cord prolapse

 Abruptio placenta during labor

 Cases of uterine rupture

 Premature closure of the fetal ductus arteriosus

 Maternal hypovolemia

 Fetal growth restriction

 Reduced liquor volume

Clinical manifestations

 Decreased fetal movement felt by the pregnant woman

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  Presence of meconium in the amniotic fluid

 Intrauterine growth restriction

 Decreased variability noted in the monitoring of the fetal heart rate

 Fetal tachycardia or bradycardia

 Repetitive variable decelerations

 Late decelerations are noted

 Low biophysical profile

 Fetal metabolic acidosis present

 Elevation of fetal blood lactate levels

(c) Clinical management

The treatment done is usually based on the different clinical manifestations of the patient

during the assessment and evaluation done by members of the health team.

 Intrauterine resuscitation is considered as the primary treatment needed for a non-

reassuring fetal status

 Rapid delivery by instrumental delivery is highly recommended among obstetricians

 Emergency cesarean birth in cases where vaginal delivery is not advised for the

patient, or in cases of severe fetal distress and the presence of a cord prolapse

 Encouraging the mother to change position when lying down, specifically on a left

lateral side-lying position

 The woman has to be well hydrated

 The woman has to be monitored for adequate oxygen supply

 Tocolysis to delay preterm labor of the woman by means of temporarily putting a stop

to contractions

 Intravenous hypertonic dextrose fluid has to be started

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  Amnioinfusion which involves fluid insertion into the amniotic cavity for the purpose

of alleviating the compression of the umbilical cord

PEDIATRICS NURSING 16 marks

1. Nursing care management of a child with esophageal atresia

A. Pre-op care peculiar to condition

- Position infant with head and chest elevated 20-30degrees to prevent or decrease

reflux of gastric juices into the tracheobronchial tree

- Intermittent nasopharyngeal suctioning or indwelling replogle tube (double lumen

tube) used to remove secretions

- Administer oxygen as need arises

- Accompany infant to the x-ray or theater in isolate (special incubator) with

portable oxygen and suction equipment.

B. Post-operative care(specific for the condition)

- Request that the physician should mark a suction catheter indicating how far the

catheter can be safely inserted without disturbing the anastomosis

- Head and shoulders elevated 20-30 degrees

- Be prepared to function in an emergency

- Oral feeding may begin 6-14 days post op

- Feed slowly to allow infant time to swallow

- Use upright sitting position

- Burp frequently

- Be aware of impending complications and act

Leakage at site of operation

- Stricture at site

- Recurrent fistula

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 - Pneumonitis

- Provide opportunities for the parents to learn all aspects of care of their baby

SECTION C: ESSAY

PEDIATRIC NURSING 12 Marks

1 Nursing care of a child with Hypertrophic Pyloric Stenosis

a. Pre op care (specific to condition)

- Restore hydration and electrolyte balance

- Initiate IV therapy and monitor accordingly

- Prevent or decrease the likelihood of vomiting

- Ensure proper functioning of nasogastric tube

- Careful observation of output, amount and characteristics

- Proper positioning

- Elevate head of bed, mattress or infant’s seat at an angle of 75-80 degrees

- Place infant slightly on right side, to in gastric emptying

- Make frequent, accurate observation of the infant’s condition

- Provide support to parents

b. Post op care

- Give good post op care and observe for the usual post op complications

- Monitor parenteral fluids in order to maintain hydration

- Assist in resuming oral feedings

- Usually resumed 2-8hrs after surgery

- Start with small, frequent feedings of glucose and slowly advance to full strength

formula

- Burp baby frequently

- Report any vomiting

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 - Ensure head of bed remains elevated

- Place on right side to aid gastric emptying

- Encourage parents to resume care of their baby especially feeding, this will help

restore their confidence in caring for their baby

- If the mother was breast feeding, resume this as soon as possible

- Explain to parents that surgery has corrected the Pyloric Stenosis

- After discharge parents should ensure follow up appointments are kept and any

worries reported accordingly

- Arrange for any help that may be needed by a young mother on discharge home

with her baby.

REPRODUCTIVE HEALTH 6 Marks

Family Planning is an approach used to prevent, space and plan the number of children any

family wants to have in their family

1. Advantages

- No side effects

- Inexpensive

- Used to achieve pregnancy

- Couples have a better understanding of their reproductive system

- Consolidate bonding between partners

- Accepted by churches

- Readily available

Disadvantages

- Less effective than modern method

- Requires training and motivation

- Daily monitoring

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 - Abstinence may cause marital problems

- Short coitus (sometimes)

- Fear of unplanned pregnancy

2. Factors that influence adolescent health: 2 main groups

Environmental Factors include

- Family

- Peer group

- Television

- School and community characteristics

All these contribute to adolescent’s health and risk behavior

Societal influences

- Government agencies

- Community organizations

- Opinion leaders including schools and other community members

If they work in a comprehensive approach and providing a safe and nurturing environment for

Nations Youths can help, ensure that the adolescents will be healthy and productive members

of the society

OBSTETRIC CARE 12 Marks

a)

1) AN increase in Braxton hicks contractions

2) Baby dropping (lightening)

3) Nausea, or loose stools…………………….

4) Lose or release of the show the mucus plug or the cervix.

5) Dilating cervix

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 6) Rupture of membranes

7) Rhythmic back pain

8) Frequent contractions which are progressive

9) Thinning of the cervix

10) An increase urge to urinate

b) Approximate time for each stage of labour

1st stage 2nd stage 3rd stage

Primi gravida 12-14 hours ½ -1 ½ hours 5-15 mins

Multigravida 6-10 hours 15-30 mins 5-15 mins

c) Mechanism of labour

This mechanism is dutired as the force which act on the foetus including it to make turns and

twist during labour. It is divided into the following steps.

 Descent

 Ilexion

 Internal rotation ahead

 Crowning of the head

 Extension

 Restitution

 Internal rotation of the foetus (shoulder)

 Lateral flexion

2. Nursing care management of a child with esophageal atresia

2 Pre-op care peculiar to condition

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 - Position infant with head and chest elevated 20-30degrees to prevent or decrease

reflux of gastric juices into the tracheobronchial tree

- Intermittent nasopharyngeal suctioning or indwelling replogle tube (double lumen

tube) used to remove secretions

- Administer oxygen as need arises

- Accompany infant to the x-ray or theater in isolate (special incubator) with

portable oxygen and suction equipment.

3 Post-operative care(specific for the condition)

- Request that the physician should mark a suction catheter indicating how far the

catheter can be safely inserted without disturbing the anastomosis

- Head and shoulders elevated 20-30 degrees

- Be prepared to function in an emergency

- Oral feeding may begin 6-14 days post op

- Feed slowly to allow infant time to swallow

- Use upright sitting position

- Burp frequently

- Be aware of impending complications and act

Leakage at site of operation

- Stricture at site

- Recurrent fistula

- Pneumonitis

- Provide opportunities for the parents to learn all aspects of care of their baby

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