ZAMBIA REGISTERED NURSE PROGRAMME

PAPER III – SURGERY AND SURGICAL NURSING

SECTION A: MULTIPLE CHOICE QUESTIONS

IN EACH OF THE FOLLOWING QUESTIONS ENCIRCLE THE LETTER

CORRESPONDING WITH THE MOST APPROPRIATE ANSWER.

ONE (1) MARK EACH

1. The three ossicles include:

a. Malleolus,tympanic and stapes
b. Stapes, malleus and mastoid
c. Stapes , malleus and incus
d. Mastoid, incus and stapes
2. Fractures can be prevented by:
a. Plaster immobilization of fracture
b. Cast brace treatment of fracture
c. Internal fixation of fracture
d. Physiotherapy
3. One of the following nerves originates in the organ of corti in the inner ear
and is responsible for conveying impulses to the hearing area in the cerebral
cortex.
a. Auditory nerve
b. Vestibulocochlear nerve
c. Cochlear nerve
d. Vestibular nerve
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 4. Commonest complication while using external fixator is:
a. Pin tract infection
b. Compartment syndrome
c. Loosening of pins
d. Fixation of muscles
5. Chemically plaster of Paris is:
a. Calcium carbonate
b. Calcium sulphate
c. Anhydrous calcium sulphate
d. Hemihydrated calcium sulphate
6. The true organ of hearing is the:
a. Organ of corti
b. Auditory nerve
c. Trochlear
d. Tympanic membrane
7. The colour of the cylinder in which oxygen is stored is:
a. Grey
b. Orange
c. Blue
d. Black and white
8. The anterior and posterior lamellae of the lid can be separated at the level of
the lid margin by the:
a. Lash line
b. Line of meibomian gland orifices
c. Gray line
d. Mucocutaneous junction
9. Tylosis refers to:
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 a. Loss of lashes
b. Misdirection of lashes
c. Blocked meibomian orifices
d. Hypertrophied drooping lid
10.Which of the following is commonest complication of Colles’ fracture:
a. Stiffness of fingers
b. Stiffness of wrist
c. Stiffness of shoulder
d. Subluxation of inferior radio ulnar joint with pain
11.Infection in the nose may spread upwards to the middle ear through:
a. Naso pharynx
b. Eustachian tube
c. External auditory meatus
d. Oval window
12.Which of the following is NOT the cause of pleural effusion?
a. Pulmonary tuberculosis
b. Acute pancreatitis
c. Systemic lupus erythematosus
d. Meningitis
13.A condition in which there are multiple rib fractures, with or without
fracture of sternum is known as:
a. Fractured rib
b. Cardiac tamponade
c. Pulmonary injury
d. Flail chest
14.An injury to the lung tissue resulting in seepage of blood and /or fluids into
the interstitial space on the lung is called:
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 a. Haemopneumothorax
b. Pulmonary contusion
c. Pleural effusion
d. Penetrating trauma
15.Which of the following is NOT a complication of constrictive pericarditis?
a. Cardiac tamponade
b. Damage to the coronary arteries
c. Heart failure
d. Pericardial effusion
16.Which of the following is NOT a complication of gangrene?
a. Heart failure
b. Hip flexion contracture
c. Delirium
d. Haematoma
17.Which of the following is NOT a complication of Cardiac surgery?
a. Cerebral injury
b. Renal failure
c. Low cardiac output
d. Angina pectoris
18.During the removal of the chest tubes, the patient is asked to:
a. Exhale deeply and the tube is removed
b. Inhale deeply and the tube is removed
c. Swallow as the tube is being removed
d. Hold a breath as the tube is being removed.
19.Which of the following brain tumours is highly vascular in nature such that
it may resemble an arteriovenous malfunction?
a. Meningiomas
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 b. Pituitary Adenoma
c. Glioblastoma
d. C P angle epidermoid
20.Which of the following sites is most common in spinal injuries?
a. Sacral spine
b. Upper cervical spine
c. Thoraco-lumber segment
d. Lower cervical spine
21.The three phases of management of the patient undergoing surgery are:
a. Preoperative, supraoperative and postoperative phases
b. Early operative, intraoperative and late operative phases
c. Preoperative, intraoperative and postoperative phases
d. Preoperative, perioperative and postoperative phases
22.Which of the following is NOT a characteristic of gastric ulcer?
a. Predominantly allocated in the pylorus of the stomach
b. Pain is usually 1-2 hours after meals
c. Gastric secretion is usually normal or decreased
d. Usually the lesion is superficial as compared to duodenal ulcer
23.Which type of ulcers is relieved by ingestion of food?
a. Gastric ulcers
b. Duodenal ulcers
c. Both A and B
d. None of the above
24.A twisting of the intestines at least 180 degrees of itself is called:
a. Volvulus
b. Intussusception
c. Strangulated hernia
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 d. Diverticulum
25.An irregular tear-like wound caused by some blunt trauma is known as:
a. Laceration
b. Abrasion
c. Contusion
d. Puncture
26.Which of the following factors do NOT aid in wound healing?
a. Adequate nutrition
b. Obesity
c. Elevation of the affected part
d. Exercises
27.The non-modifiable risk factor for atherosclerosis is:
a. Cigarette smoking
b. Hyperlipidemia
c. Female over 55 years of age
d. Sedentary lifestyle
28.John has just returned from the post anesthesia care unit from a
hemorrhoidectomy. His postoperative orders include sitz baths in order to:
a. Promote healing
b. Relieve tension
c. Lower body temperature
d. Cause swelling
29.A nurse is providing discharge information to a patient with peripheral
vascular disease. Which of the following information should be included in
instructions?
a. Walk barefoot whenever possible
b. Use a heating pad to keep feet warm
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 c. Avoid crossing the legs
d. Use antibacterial ointment to treat skin lesions at risk of infections
30.Claudication is a well-known effect of peripheral artery disease. Which of
the following facts about claudication is NOT correct?
a. It result when there is increased blood supply
b. It is characterized by pain that often occurs during rest
c. It is a result of tissue hypoxia
d. It is characterized by cramping and weakness
31.After thoracentesis, the nurse should observe the client for:
a. Period of confusion
b. Expectoration of blood
c. Increased breath sound
d. Decreased respiratory rate
32.If an open pneumothorax of the right lung occurred what would be the effect
on the left lung?
a. No anatomic change to the left lung would occur
b. The left lung would expand towards the chest wall
c. The left lung would expand into the right lung space
d. The left lung would develop atelectasis
33.The patient recovering from a CVA asks the purpose of the warfarin. The
best response by the nurse is that warfarin :
a. Dissolves the clot
b. Prevents formation of new clots
c. Dilates the vessels to improve blood flow
d. Suppresses the formation of platelets

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 34.The nurse explains that a patient who has been determined to have had a
complete stroke as a result of a ruptured vessel in the left hemisphere would
be classified as:
a. Ischemic, embolic
b. Hemorrhagic, subarachnoid
c. Hemorrhagic, intracelebral
d. Ischemic, thrombotic
35.Immediately after CVA , a major nursing priority is ensuring:
a. Preservation of motor function
b. Airway maintenance
c. Adequate hydration
d. Control of elimination
36.Which of the following findings is typical of cardiac tamponade?
a. A pulse rate of 60 per minute
b. Flat neck veins
c. Muffed or distant heart sounds
d. A pulse pressure of 18/82 mmHg
37.The inflammation of the peritoneum is known as:
a. Peritonitis
b. Ulcerative colitis
c. Peritoneulitis
d. Crohns disease
38.A plolonged gasping inspiration followed by very short usually inefficient
expiration, associated with central nervous system disorders is called:
a. Chyne stroke
b. Kussmaul
c. Biot’s
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 d. Apneustic
39.Local anaesthesia which is given directly to the nerve that supplies the
operated area is termed:
a. Spinal anaesthesia
b. Infiltration anaesthesia
c. Epidural anaesthesia
d. Nerve block anaesthesia
40.Which of th following anatomical regions of the abdomen lies just distal to
the sternum?
a. Epigastric
b. Hypochondriac
c. Hypogastric
d. Lumbar
41.A patient has a fracture in which the radius is bent but not displaced and the
skin is intact. This type of fracture is known as:
a. Closed greenstick
b. Complex, comminuted
c. Compound , transverse
d. Open, spiral
42.Which of the following should be part of your care for a severely bleeding
open wound without broken bones?
a. Allow the wound to bleed in order to minimize infection
b. Apply direct pressure and elevate the injured area
c. Use tourniquet to stop all blood flow
d. Position the patient to allow free flow
43.Which of the following positions is ideal for perineal examination?
a. Supine
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 b. Lithotomy
c. Lateral
d. Sims or semi prone
44.Which of the following is the single most important infection prevention
procedure?
a. Sterilizing equipment
b. Hand washing
c. Decontamination
d. High level disinfection
45.One of the following is not an agent of sterilization:
a. Moist heat
b. Dry heat
c. Cetrimide
d. Gluteraldehyde
46.There is pooling of blood through the dressing on a patient in the recovery
room. What is the first action to take?
a. Check vital signs
b. Call the surgeon to look at the wound
c. Reinforce the dressing
d. Remove soiled dressing and apply a fresh one
47.Anterior colporrhaphy is done for:
a. Cystocele
b. Rectocele
c. Urethrocele
d. Enterocele
48.The type of colostomy where the bowel is cut and both ends are brought out
onto the abdomen is called:
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 a. End colostomy
b. Double barrel colostomy
c. Loop colostomy
d. Brook colostomy
49.In which of the following procedures is a pyloroplasty done?
a. Vagotomy
b. Ramsedt’s
c. Gasrectomy
d. Hemicololectomy
50.While examining a client’s leg, the nurse notes an open ulceration with
visible granulation tissues in the wound. Until the wound specialist can be
contacted, which type of dressings is most appropriate for the nurse to
apply?
a. Dry sterile dressing
b. Sterile petroleum gauze
c. Moist, sterile saline gauze
d. Povidine-iodine soaked gauze

SECTION B: MATCHING ITEMS

Match the following procedures in column I with their corresponding

meaning in Column II. Responses in Column II should be used once only.

Column I Column II

51.……Pneumonectomy A. This is the removal of one or two

segments of the lungs when the disorder is limited to only the
segment(s)resected
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 52.….. Lobectomy B. This is the removal of a small localized
area of disease
53.…..Segmentectomy C. This is the removal of the entire lung
54.……Wedge Resection D. This is the removal of a lobe of a lung
55.…..Thoracotomy E. Surgical removal of or stripping of a thick
fibrous membrane
F. This is a plastic operation on the thorax in
which ribs or portions of the ribs are
removed to reduce the size of the thoracic
space
G. Repair of one lobe of the lung
H. Removal of the thorax

Match the following operations in column I with their meaning in Column II.
Responses in Column II should be used once only.

Column I Column II

56.…….vagotomy A. The surgical removal of the lower

portion of the stomach and anastomosis of its remaining portion to the
duodenum.
57.…..Antrectomy B. The surgical dilatation of the pyloric
sphincter to increase the rate of gastric emptying
58.…..Gastroduodenostomy C. The surgical procedure involving the
anastomosis of the inferior part of the oesophagus to the jejunum
59.….Gastrojejunostomy D. Surgical removal of the duodenum

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 60.…..oesophagojejunostomy E. Surgical removal of the stomach antrum
and its distal portion and duodenum with anastomosis of the remaining
stomach portion to jejunum
F. The surgical removal of antrum of the
stomach
G. The surgical ligation of the vagus nerve to
decrease the secretion of gastric acid
H. Surgical repair of the vagus nerve

Match the types of Shock in Column I with their corresponding names in

Column II. Responses in Column II should be used once only.

Column I Column II

61.…….Haemorrhage schock A. Vaso vagal shock

62.…….Neurogenic shock B. cardiac shock
63.……Bactereamia shock C. Oligaemic shock
64.……Cardiogenic shock D. Septic shock
65.……Histamine shock E. Toxic shock
F. Anaphylactic shock
G. pulmonary Shock
H. Hypovolemic shock

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Match the following drugs in Column I with the group they belong to in
Column II. Responses in Column II should be used once only.

Column I Column II

66.…..Betamethasone A. Urinary antiseptics

67.…..Nitrofurantoin B. Digitalis
68.…..Glibenclamide C. Amoebicides
69.…..Niridazole D. Vasodilator
70.……Apresoline HCL E. Schistosomides
F. Oral hypoglycaemics
G. Corticosteroids
H. Glycosides

SECTION C: COMPLETION

COMPLETE TH FOLLOWING SENTENCES USING ONE, TWO OR

MORE WORDS ONLY

71.The type of forceps which must be available during intubation is the

…………………………………………………………………
72.A process of supporting respiration by manual or mechanical means when
normal breathing is inefficient or has stopped is known as
………………………………………………………………
73.The other name for activated glutaraldehyde is ……………………………
74.The incision of choice for an appendectomy is the
………………………….........................................................

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 75.The space of the spinal cord in which the spinal anaesthesia drug is directed
is referred to as
the……………………………………………………….space
76.Concerning inflammation ……………………………………………are the
second cells to arrive within 3 to 7 days.
77.The type of surgery which is usually planned and whereby failure to do it
has no immediate catastrophic end is known as
……………………………………………………………..
78.The separation of all the tissue layers of the abdominal wound and the
protrusion of a loop of the intestine onto the surface is referred to as
………………………………………………………………………..
79.An abnormality in which the opening of the urethral meatus lies on the
dorsal surface of the penis is called
……………………………………………………………………………..
80.What percentage of fluid does prostatic fluid contribute to the total quantity
of semen? …………………………………………………………………..
81.The procedure of blocking the production of testosterone by use of drugs
like Zoladex is called
…………………………………………………………………
82.A medical personnel who is specialized in the treatment of cancers is called
………………………………………………………………………
83.An incision made in the bladder and closed up without a drainage tube is
called ………………………………………………………………
84.Skin care around the cystostomy tube critical in order to prevent
………………………………………………………………………

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 85.The drug of choice for pain management in the first 48 hours following
urinary bladder surgery is
……………………………………………………………………….
86.The presence of stones in the ureter is called
…………………………………………………………………..
87.The presence of stones in the urinary bladder is called
………………………………………………………..
88.A ……………………………………………….is a strand of material used
for apposing tissue together.
89.……………………………………………………….is a procedure to
remove joint fluid that is often performed in the treatment room or theatre in
arthritis.
90.…………………………………………………………..is the term given to
the new bone laid down over the infected bone by oesteoblasts in
Osteomyelitis.
91.………………………………………………………….is the term that
describes the complete or partial loss of all movements and sensation from
the chest downward, affecting the lower limbs.
92.The vertebral column consists of ……………………………………….
Separate movable joints.
93.Grade …………………………..indicates an “incomplete” spinal cold injury
where sensory but not motor function is preserved below the neurological
level and includes the sacral segments S4 S5.
94.……………………………………….is the inflammation of the gums.
95.……………………………………………………is the surgical operation
that allows for cold expansion from oedema if neurologic deterioration fails
to be controlled by conversional measures in spinal cord injury.
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 96.Recurrence of kidney stones can be prevented by increasing fluid intake and
maintaining daily urine output of ………………………………. Litres.
97.High consumption of sugars found in food or drink can predispose to kidney
stones as the urine will contain increased amounts of uric acid, calcium and
…………………………………………………….
98.In bladder tumours, an investigation that is done to identify obstruction or
defects of the urinary system is
………………………………………………………………………………
99.Early detection of prostate cancer in men between 40 and 50 years can be
achieved by yearly screening using PSA and
…………………………………………………………………………….
100. ………………………………………………….involves the injection
of a radiographic contrast medium into the leg veins so that vein anatomy
can be visualized during various leg movements.

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SECTION D: ESSAY QUESTIONS

ANSWER TWO QUESTIONS ONLY. QUESTION ONE(1) IS

COMPULSORY

1. Miss Catherine Chanda aged 28 years old sustained burns of the anterior
trunk, posterior trunk and left leg. She has developed some inflammation
and the attending Doctor admitted her to Female surgical ward where you
work from.
a. Explain two (2) types of inflammation 10%
b. Explain the pathophysiology of inflammation 20%
c. Discuss the care of Ms. Chanda during her stay in hospital 50%
d. Outline five(5) complications that Ms. Chanda may develop. 20%

2. Mrs. Malingose Tembo, a 38 year old house wife from Chiboma village
comes to the Ear, Nose and Throat clinic with history of hearing impairment
and speech problems. After thorough examination by the Doctor, a diagnosis
of deafness is made.
a. Draw a well labeled diagram of the ear 15%
b. State five (5) common causes of hearing impairment and/or deafness

15%
c. Describe the care of Mrs. Tembo under the following headings:
i. Medical management 15%
ii. Rehabilitation measures which will assist her cope with the hearing
impairment and speech problems 35%

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 d. Discuss five (5) ways through which hearing impairment and deafness
can be prevented 20%

3. Mrs. Agness Mangilazi a 65 year old widow, narrates to you as a nurse in

the eye clinic that her vision has become poor of late and the
ophthalmoscopy examination shows leucorrhoea in both eyes and that the
leucorrhoea is more marked in the right eye.
a. i. Define cataract 5%
ii. Draw a well labeled diagram of the eye 15%
b. state five (5) predisposing factors to cataract formation 15%
c. Describe the postoperative nursing management of Mrs. Mangilazi
50%
d. Discuss five points you would include in your Information Education
and Communication (IEC) to Mrs. Mangilazi and her relatives on
discharge 15%

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