PART I: MULTIPLE CHOICE QUESTIONS (MCQs) 20 MARKS
1. Which one of the following statements best describes pulmonary embolism?
a. It is a thrombus originating from arterial circulation that has occluded a bronchiole
b. It is a thrombus originating from arterial circulation that has occluded a pulmonary vessel
c. It is a thrombus originating from venous circulation that has occluded a pulmonary vessel
d. It is a blood clot that has developed in the pulmonary vessel
2. Which of the following symptoms would suggest a tension pneumothorax?
a. Haemoptysis
b. Sucking sounds made on inspiration
c. Collapsed neck vein
d. Deviation of the trachea
3. Which of the following nursing interventions can prevent or reduce the risk of atelectasis in a post operative patient?
a. Frequent turning
b. Steam inhalation
c. Use of an incentive spirometer
d. Coughing exercise
4. Which of the following treatments would the nurse recommend for a patient with spontaneous pneumothorax?
a. Insertion of chest tube
b. Thoracentesis
c. Antibiotic
d. Mechanical ventilation
5. Pleural effusion is defined as:-
a. The collapse of alveoli
b. The inflammation of pleura
c. The accumulation of fluid in the alveoli
d. The accumulation of fluid in the pleural space
6. Which one of the following methods is employed for removal of pleural fluid in pleural effusion?
a. Insertion of a chest tube in the pleural space
b. Perform paracentesis
c. Perform thoracentesis
d. Diuretic therapy
7. Which of the following diagnostic procedures most accurately confirms diagnosis of lung cancer?
a. Chest X-Ray
b. Bronchoscopy
c. Cytologic studies of early morning sputum specimen
d. Surgical biopsy
8. What diagnostic test for hematologic disorder measures the size of erythrocytes and the hemoglobin content?
a. Red blood cell counts
b. Hemoglobin level
c. Hematocrit level
d. Red blood cell indices
9. The nurse is assessing a patient with sickle cell anemia. During assessment she is expected to find all of the following except:
a. Paleness of hands and feet
b. Tachycardia and cardiomegaly
c. Petechiae on abdomen and thigh
d. Bone pain
10. Which one of the following signs and symptoms a patient with thrombocytopenia may exhibit?
a. Fatigue, weakness, and dyspnea
b. Tachycardia, hypotension, and fainting
c. Nausea, vomiting and dizziness
d. Epistaxis, gingival bleeding and petechiae
11. Which client is most at risk for sustaining devastating effects of dehydration related to diarrhea?
a. A 25 year old male athlete
b. A 35 year old female executive
c. A 4 year old female
d. A 56 year old accountant
12. Which one of the following reflects pain and bowel elimination pattern associated with irritable bowel syndrome?
a. Colic-like pain with spasms, mucous in stool, and a sensation of incomplete evacuation
b. Dull cramping and hard, tarry stools
c. Blood-tinged stools with watery liquid and no pain
d. Abdominal pain that worsens with defecation and feces formed greenish in color
13. Which of the following clinical manifestations would alert the nurse that a perforation of an appendix has occurred?
a. Sudden intense, burning pain
b. Slow relief of pain initially, followed by pain radiating back to both kidneys
c. Sudden relief of pain, followed by increased generalized pain and abdominal distension
d. Intense pain that radiates into the groin area
14. Which client description most accurately resembles the classical clinical pattern seen with peritonitis?
a. A 76 year old chronically debilitated male with confusion, restlessness, vague abdominal complaints, and decreased bowel sounds
b. A 36 year old immunosuppressed male who is confused, has decreased urinary output, fever and tachycardia and complains of diffuse abdominal pain
c. A 44 year old female with abdominal distension who guards her abdomen and demonstrates abdominal rigidity, fever, malaise, and confusion
d. A 66 year old female with anorexia, borborygmi, orthostatic hypotension, diarrhea, and abdominal pain with cramping
15. The most common cause of acute appendicitis is:
a. A fecalith
b. Kinking of the appendix
c. Tumor of the cecum
d. External occlusion of the bowel by adhesions
16. Which one of the following best describes the information a nurse would provide for a client with chronic ulcerative colitis?
a. That this disease is self-limiting and usually goes away in several years
b. That s/he must remove any form of stress in life since stress usually precipitates exacerbation of symptoms
c. That s/he is at increased risk for colorectal cancer and s/he should have periodic medical check ups
d. That s/he will most likely need to have surgery if symptoms persist over the ensuing years
17. J.K. has been diagnosed with rectal polyps. He is at risk of the development of:
a. Ulceration and bleeding of the polyps
b. An obstruction
c. A malignancy
d. Fibrosis
18. An intrinsic cause of hemolytic anemia is:
a. Red blood count (RBC) cell membrane defects
b. Hemoglobin structure defects
c. Inherited enzyme defects
d. Trauma
19. An example of anemia which depresses the bone marrow is:
a. Iron-deficiency anemia
b. Acquired hemolytic anemia
c. Aplastic anemia
d. Thalassemia
20. Which clinical manifestation is most accurately indicative of hemophilia?
a. Ulcerations occurring anywhere on the body
b. Pain or paralysis resulting from the pressure of hematomas on nerves
c. Shortness of breath related to lung parachymal bleeding
d. Pain in the joints accentuated by movement
PART II: SHORT ANSWER QUESTIONS (SAQs) 40 MARKS
1. Explain the pathophysiological changes that occur in pulmonary embolism (5 marks)
2. Outline the rationale for performing the following investigation tests in a TB patient: (4 marks)
a. Sputum culture
b. Blood culture
c. Chest X-Ray Study
d. Arterial Blood Gas (ABG) analysis
3. Explain the three (3) most important warning signs that signal lung cancer. (6 marks)
4. Differentiate between acute myeloid leukemia and acute lymphocytic leukemia (4marks)
5. Outline the symptoms experienced by a patient with a pharyngoesophageal diverticulum (4 marks)
6. Describe the relationship of stress, anxiety and depression with irritable bowel syndrome (4 marks)
7. State any five (5) signs that may be indicating the presence megacolon disease? (5 marks)
8. Describe the clinical stages of Hodgkin’s disease? (8 marks)
PART III: LONG ANSWER QUESTIONS (LAQs) 40 MARKS
1. A patient with emphysema is admitted in the medical unit of a Hospital with resting hypoxemia
a. Formulate four (4) priority nursing diagnoses for this condition (8 marks)
b. Discuss the interventions for each nursing diagnosis formulated in question (a) above (12 marks)
2. Mr. K.D. arrives at the Out patient department with nose and gingival bleeding. Physical examination reveals signs of petechiae. Her platelets count is below 20,000 (<20,000). The doctor diagnoses Thrombocytopenia.
a. Explain the three major factors that might lead to low platelet levels (Thrombocytopenia) (6 marks)
b. Describe the specific nursing management the nurse should plan for Mr. K.D. (14 marks)
