PART I: MULTIPLE CHOICE QUESTIONS (MCQs) 20 MARKS
1. Pretibial myxedema is associated with
a. Grave’s disease
b. Iodine-induced hyperthyroidism
c. Choricarcinoma
d. Toxic multinodular goiter
2. Thyrotoxicosis and uniformly increased radioactive iodine uptake in the thyroid can occur without any thyrotropin receptor antibodies or any thyroid autoimmunity in:
a. Struma ovarii
b. Iodine-induced hyperthyroidism
c. Choricarcinoma
d. Toxic multinodular goiter
3. High levels of thyroidal peroxidase antibody are found with:
a. Iodine deficiency
b. Hashimotto’s thyroiditis
c. Propylthiouracil
d. Toxic multinodular goiter
4. The pattern of normal TSH, normal T4, and low T3 is most consistent with:
a. Hyperthyroidism
b. Subclinical hypothyroidism
c. Nonthyroidal illness
d. Estrogen therapy
5. A 47 year old man complains of headache, impotance, and galactorrhea for the past two months. A likely hormonal profile on this patient would be:
a. Low testosterone, high LH, and low prolactin
b. Low testosterone, low LH, and low prolactin
c. Low testosterone, high LH, and high prolactin
d. Low testosterone, low LH, and high prolactin
6. Untreated acromegaly exhibits a decreased life expectancy from:
a. Prognatism
b. Renal hypertrophy
c. Colon carcinoma
d. Cervical arthropathy
7. Which of the following clinical manifestations will be seen in a patient with hypoglycemia?
a. Dry skin, hypotension, bradycardia, deep rapid respiration
b. Polyuria, polydipsia, hypernatremia, hypotension
c. Polyuria, polydipsia, hunger and weight loss
d. Anxiety, palpitation, tachycardia, cool moist skin, headache
8. Which of the following conditions can differentiate hyperosmolar hyperglycemic nonketotic syndrome from diabetic ketoacidosis?
a. Hyperglycemia
b. Hyperosmolality
c. Absence of ketonuria
d. Electrolyte imbalance
9. An important nursing intervention when caring for a patient with cushing’s syndrome is to:
a. Provide a low protein diet
b. Observe for signs of hypotension
c. Provide extra blankets to prevent hypothermia
d. Encourage good grooming and use of attractive clothing
10. Which of the following disorders causes secondary adrenal insufficiency?
a. Hyposecretion of somatotropin by pituitary gland
b. Hyposecretion of corticotrophin by the pituitary gland
c. Hypersecretion of cortisol by the adrenal gland
d. Hypersecretion of corticotrophin by the pituitary gland
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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
PART II: SHORT ANSWER QUESTIONS (SAQs) 40 MARKS
1. Differentiate between acute myeloid leukemia and acute lymphocytic leukemia (4 marks)
2. Outline the symptoms experienced by a patient with a pharyngoesophageal diverticulum (5 marks)
3. Differentiate between Cushing’s syndrome and Addison’s disease (8 marks)
4. Describe the relationship of stress, anxiety and depression with irritable bowel syndrome (6 marks)
5. State six (6) signs that may be indicating the presence megacolon disease? (6 marks)
6. Explain the three (3) major clinical manifestations of myxedema coma? (6 Marks)
7. Describe the clinical stages of Hodgkin’s disease? (8 marks)
PART III: LONG ANSWER QUESTIONS (LAQs) 40 MARKS
1. Your patient is started on antithyroid medication to control hyperthyroidism. Her husband has been very concerned about her irritability, rapid mood swings, and weight loss.
a. What explanation should the nurse give the husband about his wife’s symptoms? (8 marks)
b. Discuss the appropriate nursing care for this patient (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)
