P.O. Box 6215700200 Nairobi - KENYATelephone: 891601 …



-114300-114300 THE CATHOLIC UNIVERSITY OF EASTERN AFRICAP.O. Box 6215700200 Nairobi - KENYATelephone: 891601-6Fax: 254-20-891084E-mail:academics@cuea.eduA. M. E. C. E. A REGINA PACIS INSTITUTE OF HEALTH SCIENCES MAIN EXAMINATIONAUGUST – DECEMBER 2018 TRIMESTER FACULTY OF SCIENCES DEPARTMENT OF NURSINGREGULAR PROGRAMME NUR 206: MEDICAL SURGICAL IIDate: DECEMBER 2018 Duration: 3 HoursINSTRUCTIONS: Answer ALL Questions PART I MULTIPLE QUESTIONS (MCQs) 20 MARKSQ1.The nurse is caring for a client diagnosed with gastroesophageal reflux disease (GERD). Which nursing interventions should be implemented?Place the client prone in bed and administer non-steroidal anti-inflammatory medications.Have the client remain upright at all times and walk for 30 minutes three (3) times a week.Instruct the client to maintain a right lateral side-lying position and take antacids before meals.Elevate the head of the bed 30 degrees and discuss lifestyle modifications with the client.Q2.The nurse is performing an admission assessment on a client diagnosed with gastroesophageal reflux disease (GERD).Which signs and symptoms would indicate GERD?Pyrosis, water brash, and flatulence.Weight loss, dysarthria, and diarrhea.Decreased abdominal fat, proteinuria, and constipation.Mid-epigastric pain, positive H. pylori test, and melena.Q3.Which of the following definitions best describes diverticulosis?The partial impairment of the forward flow of intestinal contentsA non-inflamed out-pouching of the intestineAn abnormal protrusion of an organ through the structure that usually holds it.An inflamed out-pouching of the intestineQ4.Which sign/symptom should the nurse expect to find in a client diagnosed with ulcerative colitis?Twenty bloody stools a dayOral temperature of 39?C.Hard, rigid abdomenChronic constipationQ5.What characteristics would the nurse find on the skin of a client with cirrhosis of the liver?Spider angiomas on the chest, yellow-tinted skin color, bruises.Cyanosis, red- to pink-colored extremities, glassy eyes.Dusky blue color, fruity breath, yellow-tinted skin color.Yellow-tinted skin color, varicose veins, glassy eyes.Q6.In diabetes mellitus there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which symptom is caused by the osmotic effect of glucose?Fatigue PolyphagiaPolydipsia Recurrent infectionsQ7.The two hormones adrenaline and noradrenalin are produced by:-Pituitary glandParathyroidAdrenal cortexAdrenal medullaQ8.Lispro insulin (Humalog) is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin should be administered:At mealtime or within 15 minutes of mealsOnly once a day1 hour before meals30 to 45 minutes before mealsQ9.A patient with diabetes is learning to mix regular insulin (short-acting) and NPH insulin (intermediate-acting) in the same syringe. The nurse determines that additional teaching is needed when the patient does what?Withdraws the NPH dose into the syringe firstInjects air equal to the NPH dose into the NPH vial firstRemoves any air bubbles after withdrawing the first insulinAdds air equal to the insulin dose into the regular vial and withdraws the doseQ10.Which one of the following is not an action of the catecholamines: Increased heart rateDilation of the small passages of the lungsc)Stimulation of the sympathetic nervous systemd)Decreased blood pressureQ11.What disorders and diseases are related to macrovascular complications of diabetes?Chronic kidney disease and retinopathyCoronary artery disease and ulcerationMicroaneurysms and destruction of retinal vesselsAmputation of the lower extremities and microaneurysmsQ12.During physical examination the senior nurse notices carpopedal spasm after inflating a blood pressure cuff on the upper arm of a patient. This is also called:Kerning’s signTrousseau's signChovstek’s signBabinski’s sign Q13.When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient?Pull back on the plunger after inserting the needle to check for blood.Consistently use the same size of insulin syringe to avoid dosing errors.c)Clean the skin at the injection site with an alcohol swab before each injection.d)Rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies.Q14.Narcolepsy is a disorder characterized by:Narcotic abuse Grand mal seizures Reliance on soporific drugsInability to regulate sleep-wake cyclesQ15.Huntington's disease is a heritable disorder that involves:Sudden paralysis Chorea, loss of cognitive abilities, and emotional disturbance Uncontrollable swearing and repetitive actionsInability to recognize facesQ16. The most common form of transient facial paralysis is:Alzheimer's disease Transient ischemic attack Bell's palsy Erb's palsy?Q17. Gradually increasing pain and weakness and numbness in the hand or wrist that radiates up the arm suggest:Amyotrophic lateral sclerosis Carpal tunnel syndromeBloch-Sulzberger SyndromeDystoniaQ18. The most common inherited neurological disorder is:Bloch-Sulzberger SyndromeCharcot-Marie-Tooth diseaseAlper's diseaseAsperger SyndromeQ19. A severe form of epilepsy that appears during the first year of life is called:Dandy-Walker syndrome Devic's syndromeDravet syndromeFabry diseaseQ20.The nurse is assessing a client experiencing motor loss as a result of left-sided cerebrovascular accident. (CVA) Which critical manifestations would the nurse document?Hemiparesis of the client’s left arm amd apraxia.Paralysis of right side of the body and ataxiaHomonymous hemianopsia and diplopiaImplulsive behaviour and hostility towards familyPART II SHORT ANSWER QUESTIONS (SAQ’S) 40 MARKSQ1.State three (3) differences between Crohn’s disease and Ulcerative Colitis(6 marks)Q2.Outline four (4) conservative measures for managing peritonitis(4 marks) Q3.State four (4) clinical manifestations that may suggest Colorectal cancer(4marks)Q4.Outline the regimen in triple therapy of H. pylori associated Duodenal ulcers (3 marks)Q5.State three (3) specific nursing interventions for a patient with a Parkinson's disease (3 marks)Q6.In a table, outline THREE (3) clinical differences between hyperosmolar non-ketoic syndrome and diabetic ketoacidosis (4 marks)Q7.Describe the pathophysiology of Celebral Vascular Accident (CVA) (6 marks)Q8.Explain how to assess the first six (6) cranial nerve (6 marks)Q9.State FOUR (4) postoperative complications of thyroidectomy (4 marks)PART III LONG ANSWER QUESTIONS (LAQs) 40 MARKSQ1.Mrs. C an 65 year-old woman presents with complains of nausea, vomiting and severe abdominal pain. Physical examination reveals distended abdomen that is tender on palpation. Bowel sounds are present on all quadrants but hyperactive in right, lower quadrant (RLQ). She is admitted with a diagnosis of query small bowel obstruction.Discuss how Mrs. C can be managed conservatively(5 marks)Write the Nursing care plan (with 2 actual nursing diagnoses) for Mrs C (10 marks) Explain the specific post-operative nursing care for her within the first day (5 marks)Q2.After running in a short race, Mrs K, a 24 year old woman with type 1 diabetes, is brought to the first aid tent. She states that she foos cold and has a headache; her fingers feel numb. On physical examination, she has slurred speech and unsteady gait; HR: 120 bpm; confused. Shortly after she becomes unconscious with capillary blood glucose level of 1.7mmol/L.Explain how the body controls blood glucose levels. ( 5 marks)Citing specific examples, describe the immediate management of Mrs. K (10 marks)Outline FIVE (5) priority teaching needs for this patient once her condition has stabilized. (5 marks)*END* ................
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