INSTITUTE OF NURSING EDUCATION

PRILIMINARY EXAMINATION 4TH SEMESTER. B.Sc (N), BATCH, XIX, 2024-2025

SUBJECT: ADULT HEALTH NURSING-II

TOTAL MARKS: 75 MARKS

DURATION: 3 HOURS

Q. NO I. MULTIPLE CHOICE QUESTIONS (12X 1=12MARKS)

1. While triaging the wounded from a disaster. You note that one of the wounded is not
breathing, radial pulse is absent, capillary refill > 2 seconds, and does not responds to your
commands. What color tag is assigned?

A. Green
B. Red
C. yellow
D. Black
2. The normal range for intracranial pressure (ICP) in an adult patient is -----------
A) 1-5 mmHg
B) 7-15 mmHg
C) 20-25 mmHg
D) 30-35 mmHg
3. Which among the following is an essential criterion to begin weaning patient from Mechanical
ventilator?
A) Heart rate > 130bpm
B) Patient is sedated and unresponsive
C) Spontaneous breathing trial tolerated
D) FiO2 requirement is 40%
4. A group of ocular condition characterized by optic nerve damage is termed as ------------
A) Cataract
B) Age related Macular degeneration
C) Optic neuritis
D) Glaucoma
5. Lower Urinary Tract symptoms (LUTS) are the cardial sign of ---------------
A) Phimosis
B) Benign prostatic hyperplasia
C) Epididymitis
D) Orchitis
6. Which of the following best describes the effect of a hearing aid for the client with
sensorineural hearing loss?
A) It makes sounds louder but not clear
B) It has no effect on hearing
C) It makes sounds louder and clear
D) It improves the client’s ability to separate words from background noise
7. ---------------- is a surgical incision made in the tympanic membrane?
A) Tympanoplasty
B) Myringotomy
C) Ossiculoplasty
D) Myringoplasty
8. Proliferation of cells in an organ that may result in gross enlargement is termed as ---------
A) Neoplasm
B) Hyperplasia
C) Hypertrophy
D) Dystrophy
9. You receive a patient who has experienced a burn on the right leg, you note the burn contains
small blisters and is extremely pinkish red and shiny/moist . the patient reports severe pain. You
document this burns as -----------
A) 1st degree (superficial)
B) 2nd degree (partial- thickness)
C) 3rd degree (full-thickness)
D) 4th degree (deep full-burns)
10. India’s first National AIDS control programme was launched in ----------
A) 1992
B) 1990
C) 1997
D) 1995
11. A formal, legal endorsed document that provides instructions for care or names a proxy
decisions maker is called-----------?
A) End of life care
B) Advance directives
C) Informed consent
D) DNR orders
12. The factories act was formulated in the year ------------
A) 1938
B) 1948
C) 1947
D) 1952
Q. NO. II: VERY SHORT ANSWERS QUESTIONS (4X 2=8MARKS)

Q.1. Name the antidotes used for opioids and carbon mono-oxide poisoning?

Answer. Opioids- Naloxone and Carbon Mono-oxide - Oxygen therapy

Q.2. Explain briefly on Anthracosis?

Answer: It also called as coal miner’s pneumoconiosis.

phases: simple pneumoconiosis- little ventilatory impairment, requires at least 12 years of

exposure.
Progressive massive- severe respiratory disability and results in premature death.

Notifiable disease under mines act 1952 and compensatable in workmen’s compensation act of
1959

Q.3. Difference between Epididymitis and Orchitis?

Features Epididymitis Orchitis

Definition Inflammation of epididymis Inflammation of testis
Onset Gradual Sudden
Pain Location Posterior of testis Whole of testis
Cause Bacterial STI, UTI Viral, Mumps, Bacterial
Prehn’s Sign Positive Negative
Fever May be present More common

Q.4. Give reason why Attico- Antral chronic suppurative otitis media is also called as dangerous otitis
media

Answer: It is characterized by the presence of destructive cholesteatoma in the attic and the
antrum which may spread beyond the middle ear cleft causing life threatening complications.
Hence also called as dangerous otitis media

Q.NO. III: SHORT ANSWERS QUESTIONS (5X5=25MARKS)

Q.1. Explain the principles of emergency Nursing?

Answer: Core Principles of Emergency Nursing:

1. Airway, Breathing, Circulation (ABCs):Prioritizing airway patency, breathing effectiveness,
and circulatory function as the foundation of initial assessment and intervention.

2. Triage: A systematic process for prioritizing patients based on the severity of their condition,
determining the order of treatment, and resource allocation.

3. Basic Life Support (BLS):Essential skills to maintain life-sustaining functions, including

airway management, breathing support, and cardiac resuscitation.

4. Rapid Assessment: Quickly evaluating a patient's condition to identify immediate threats and
guide interventions.

5. Stabilization: Implementing measures to improve the patient's physiological state and prevent
further deterioration.
6.Communication:Effective communication with patients, families, and other healthcare
providers to ensure accurate information exchange and coordinate care.

7.Teamwork: Collaborating with a multidisciplinary team to provide comprehensive care and

leverage the skills of each member.

8. Ethical Considerations: Addressing ethical dilemmas, such as resource allocation during mass
casualty situations, and upholding principles of beneficence, non-maleficence, autonomy, and
justice.

9.Adaptability: Adjusting care plans and interventions based on the changing needs of the patient
and the evolving nature of the emergency.

10.Documentation: Accurate and timely documentation of all assessments, interventions, and

patient responses.

Q. 2. Write short note on infection control measures in Intensive care unit?

Answer:

1. Hand hygiene
2. Use of PPE
3. Aseptic technique
4. Environmental cleaning and disinfection
5. Surveillance and isolation

All the above points to be explained in brief

Q.3. Fluid replacement therapy for burns patients? Fluid replacement therapy:

Answer: Combination of fluid categories may be used

1. Colloids
2. Crystalloids/electrolytes
3. Adequate fluid resuscitation results in slightly decreased blood volume levels during the first 24 post
burn hours and restoration of plasma levels to normal by the end of 48 hours.

Oral and enteral resuscitation can be successful in adults with less than 20% TBSA and in children with
less than 10% to 15%

Fluid replacement depends on Percentage of burned TBSA and the weight of the patient.

Formulas must be adjusted so that initiation of fluid replacement reflects the time of injury.

1. CONSENSUS FORMULA
 2. EVANS FORMULA
3. BROOKS ARMY FORMULA
4. PARKLAND/BAXTER FORMULA
5. HYPERTONIC SALINE SOLUTION

1. CONSENSUS FORMULA

Lactated Ringer's solution (or other balanced saline solution):

2-4 mL × kg body weight × % total body surface area (TBSA) burned.

Half to be given in first 8h; remaining half to be given over next 16 h.

2. EVANS FORMULA

Colloids: 1 mL × kg body weight x% TBSA burned

Electrolytes (saline): 1 mL. × body weight × % TBSA burned

Glucose (5% in water): 2000 mL. for insensible loss

Day 1: Half to be given in first 8 h; remaining half over next 16 h.

Day 2: Half of previous day's colloids and electrolytes; all if insensible fluid replacement.

Maximum of 10,000 mL. over 24 h.

Second- and third-degree (partial- and full-thickness) burns exceeding 50% TSA are calculated on the
basis of 50% TBSA.
3. BROOKS ARMY FORMULA

Colloids: 0.5 mL × kg body weight × % TBSA

Electrolytes (lactated Ringer's solution):1.5 mL × kg body weight X% TBSA burned

Glucose (5% in water): 2000 mL for insensible loss

Day 1: Half to be given in first 8 h; remaining half over next 16 h

Day 2: Half of colloids; half of electrolytes; all of insensible fluid replacement.

Second- and third-degree (partial- and full-thickness) burns exceeding 50% TBSA are calculated

4. PARKLAND/BAXTER FORMULA

Lactated Ringer's solution: 4 mL × kg body weight × % TBSA

Day 1: Half to be given in first 8 h; half to be given over next 16 hrs

Day 2: Varies. Colloid is added

5. HYPERTONIC SALINE SOLUTION

Goal: Increase serum sodium level and osmolarity to reduce edema and prevent pulmonary
complications.

Concentrated solutions of sodium chloride (NaCl) and lactate with concentration of 250-300 mEq of
sodium per litre, administered at a rate sufficient to maintain a desired volume of urinary output.

Do not increase the infusion rate during the first 8 post burn hours.

Serum sodium levels must be monitored closely.

Q. 4. Nursing management of a patient suffering from retinal detachment?

Answer: Nursing Management of a patient suffering from Retinal detachment.

1 .Perform nursing assessment through history taking ,physical examination of eye and assessing the
results of various general and specific tests to know about the causes and clinical manifestations of
retinal detachment.

2. Explain and assist the client to undergo various test like split lamp examination, tonometry,
ophthalmoscopy, A scan, B scan etc

3. Administer drugs such as Mydriatrics and cycloplegics as ordered by the physician

4. Prepare the patients for surgeries such as Cryopexy and Laser Photocoagulation, Scleral Buckle
Surgery, Pneumatic Retinopexy, Vitrectomy.

Pre operative management:

1. Assess the visual acuity of client’s both eyes
2. Prior to surgery assess the client’s support systems and the possible effect of impaired vision
on lifestyle and ability to perform ADLS in the post-operative period
3. Safety measures such as installing hand rails , especially if the client has limited vision in the
unaffected eye.
4. Remove all eye makeup and contact lenses or glasses prior to surgery
Mydriatrics (pupil-dilating) or cycloplegic (ciliary- paralytic) drops and drops to lower
intraocular pressure may be prescribed preoperatively.

Post operative management

1. Monitor status of the eye dressing following surgery.

2. Assess dressings for the presence of bleeding or drainage
3. Maintain the eye patch or eye shield in place.
4. Place the client in a semi-fowler’s or fowler’s position. Having the client lie on the unaffected
side. These positions reduce intraocular pressure in the affected eye.
5. Assess the client and medicate or assist to avoid vomiting coughing, sneezing or straining as
needed. These activities increase intraocular pressure
6. After surgery for a detached retina, the client is positioned so that the detachment is dependent
or inferior. for example, if the outer portion of the left retina is detached, the client is positioned
on the left side. Positioning so that the detachment is inferior maintains pressure on that area of
the retina, improving its contact with the choroid.
7. Assess comfort and medicate as necessary for complaints of an aching or scratchy sensation in
affected eye. Immediately report any complaint of sudden, sharp eye pain to the physician.
8. Place all personal articles and the call bell within easy reach. These measures prevent
stretching and straining by the client
9.Assist with ambulation and personal care activities asneeded. Assistance may be necessary to
maintain safety
10.Administer antibiotic anti-inflammatory and other systemic and eye medications as
prescribed. Medications are prescribed post operatively to prevent infection or inflammation of
the operative site, maintain pupil constriction, and control intraocular pressure
11.Monitor and prevent complications like Double vision
 Glaucoma
 Bleeding into the vitreous, within the retina, Or behind the retina
 Cataract
 Drooping of the eyelid
 Infection around the scleral buckle
 Endophthalmitis
12. Assess evidence of any of the below manifestations or unusual complaints by the client and report to
the physician at once:

 Pain in or drainage from the affected eye

 Hemorrhage with blood in the anterior chamber eye

 Flashes of light, floaters, or the sensation of a curtain being drawn over the eye (indicators of
retinal detachment)

 Cloudy appearance to the cornea (corneal edema)

13. Approach the client on the unaffected side. This Approach facilitates eye contact and
communication.

Q.5. Define and list down the purposes of laryngoscopy. Explain the procedure steps and after care of a
patient who has undergone an indirect laryngoscopy?

Answer: Definition: Laryngoscopy is a direct examination of the larynx done with a flexible
fiberoptic laryngoscope

Purposes:
a)Diagnostic:
1. Examination of tissue
2. Evaluation of a tumor for potential surgical resection.
3.Collect tissue specimen for diagnosis
4. Evaluate bleeding sites

b).Therapeutic:
1. Remove foreign bodies
2. Remove thick, viscous secretions
3. Treat postoperative atelectasis
4. Remove and destroy lesions

Indirect Laryngoscopy:
Procedure:
1.Indirect laryngoscopy mirror is warmed on a spirit lamp or in hot water to prevent fogging of
the mirror caused by condensation of water vapour from the breathe of the patient.
The warmth of the mirror is tested on the back of the hand of the surgeon.
2.The patient opens his mouth and protrudes his tongue.
The tongue is held with a piece of gauge by a finger and thumb of the left hand while another
finger retracts the upper lip.
3.The patient breathes gently.
4.The indirect laryngoscopy mirror is held like a pen with the mirror facing downwards.
It is gently introduced in the oral cavity and it rests against the soft palate without touching the
posterior pharyngeal wall.
By holding the tongue, larynx is pulled upwards and the mass of the tongue moves forwards
which makes examination possible.
The tongue is not depressed for indirect laryngoscopy.

AFTER CARE:
1. Patient is kept under close supervision.
2. Following the laryngoscopy the head of bed is elevated
3. The patient is encouraged to breathe deeply.
4. Keep the patient NPO until gag reflex returns
5. Patient is encouraged to cough, talk, or clear the throat
6. Observe the client for signs of respiratory distress

Q.NO. IV: LONGANSWERSLSITUATION TYPE QUESTIONS (2X15=30MARKS)

1. During your posting in nephrology unit, you come across a patient with decreased urine
output, increased serum creatine level, and serum potassium, on observation you identify patient
has breathing difficulty, and pedal edema, identify patients condition and Define acute renal
failure, list the pre renal, intra renal and post renal causes of ARF, commonly performed
diagnostic investigations and explain medical, nursing management of patient with chronic Renal
Failure? (2+5+2+2+4)

Answer: Patient is case of Renal failure

Definition of Acute Renal Failure

Acute renal failure is an clinical syndrome characterized by rapid loss of renal function with progressive
Azotemia or accumulation of nitrogenous waste product (urea, nitrogen, creatinine)in the body.

Pre-renal causes

1. Hypovolemia: Dehydration, Hemorrhage, Diarrhea and vomiting (G I losses), Excessive diuresis,

Hypoalbuminia, Burns

2. Decreased cardiac output: cardiac dysrhythmias, cardiogenic shock, heart failure, Myocardial
infarction

3. Decreased peripheral vascular resistance: anaphylaxis, Neurogenic injury, septic shock

4. Decreased renovascular blood flow: bilateral renal vein thrombosis, embolism, hepatorenal
syndrome, renal artery thrombosis

Intra-renal causes

1. Prolonged renal ischemia

2. Nephrotic injury

3. Drugs (amino glycosides)

4. Radiolucent agents

5. Hemolytic blood transfusion reaction

6. Severe crush injury

7.Chemical exposure ( ethylene, glycol, arsenic, carbon tetrachloride)

8. Interstitial nephritis

9. Allergies: antibiotics, NSAIDS, Ace inhibitors

10. Infections

11. Acute glomerulonephritis, thrombotic disorders

12. Toxemia of pregnancy, malignant hypertension, SLE

Post-renal causes

1. Benign prostatic hyperplasia BEP

2. Bladder cancer

3. Calculi formation
4. Neuromuscular disorders

5. Prostate cancer

6. Spinal cord disorders

7. Strictures

8. Trauma: back, pelvis, perineum

Diagnostic tests

Clinical assessment: Noting symptoms, history, and physical examination.

Laboratory tests:

Serum creatinine and blood urea nitrogen (BUN) levels to assess kidney function.

Electrolyte levels (sodium, potassium, calcium, phosphorus).

Urinalysis to detect protein, blood, or casts

Imaging studies

Ultrasound can be used to evaluate kidney size, obstruction, and overall anatomy.

CT scans or MRI

Chronic Renal Failure

Slowing disease progression
Managing complications
Preventing and treating cardiovascular disease
Preparing for renal replacement therapy (dialysis or transplant)
MEDICAL MANAGEMENT
1. Slowing Progression of CKD
Control blood pressure
Target: <130/80 mmHg
First-line: ACE inhibitors (e.g., enalapril) or ARBs (e.g., losartan), especially in proteinuric
patients
Glycemic control in diabetics
Target HbA1c: ~7%
Use SGLT2 inhibitors (e.g., Empagliflozin) for additional renal protection
Lipid control
Statins (e.g., atorvastatin) in all CKD patients with cardiovascular risk
Proteinuria management
Use of ACE inhibitors/ARBs
Low-protein diet (0.6–0.8 g/kg/day), but ensure adequate nutrition

2. Managing Complications
a) Anemia
Common in stages 3–5
Caused by erythropoietin deficiency and iron deficiency
Management:
Iron supplementation (oral or IV if ferritin <100 ng/mL. or TSAT <20%)
Erythropoietin-Stimulating Agents (ESAs) (e.g., epoetin alfa) if Hb <10 g/dL
Monitor for hypertension and thrombosis
b) Mineral and Bone Disorder (CKD-MBD)
Imbalance of calcium, phosphate, PTH, and vitamin D
Management:
Phosphate binders: Calcium carbonate, sevelamer
Vitamin D analogs: Calcitriol
Calcimimetics: Cinacalcet (if secondary hyperparathyroidism)
Dietary phosphate restriction
c) Metabolic Acidosis
Treat if serum bicarbonate <22 mEq/L
Oral sodium bicarbonate supplementation
d) Hyperkalemia
Common in advanced CKD
Management:
Dietary potassium restriction
Use of potassium binders (e.g., patiromer)
Avoid drugs that increase potassium (e.g., NSAIDs, potassium-sparing diuretics)
e) Fluid Overload
Sodium and fluid restriction
Loop diuretics (e.g., furosemide)
Monitor for pulmonary edema and heart failure
3. Cardiovascular Risk Reduction
CKD is a major risk factor for CVD
Measures:
Blood pressure control
Statins
Smoking cessation
Low-dose aspirin if indicated
Weight and glycemic control
4. Lifestyle and Dietary Modifications
Diet : Low sodium (<2 g/day)
Low potassium and phosphate (stage 4–5)
Moderate protein intake
Physical activity: Encourage moderate exercise
Avoid Nephrotoxins: NSAIDs, contrast agents, certain antibiotics (amino glycosides)
5. Preparation for Renal Replacement Therapy (Stage 4–5)
Education on dialysis and transplant options
Timely referral to nephrologists

Access creation:
AV fistula (hemodialysis)
Peritoneal dialysis catheter
Transplant evaluation (if eligible)
MONITORING
Parameter Frequency
Serum creatinine, GFR Every 3–6 months
Urine albumin/protein Every 6–12 months
Electrolytes, calcium, phosphate Every 3–6 months
Hemoglobin, iron studies Every 3–6 months
PTH, vitamin D Annually or as needed
BP, weight Every visit

REFERRAL TO NEPHROLOGIST
 GFR <30 mL./min
 Persistent hyperkalemia or acidosis
 Resistant hypertension
 Rapidly progressive disease
 Planning for dialysis or transplant

NURSING MANAGEMENT OF A PATIENT WITH

CHRONIC RENAL FAILURE
I. Assessment
A thorough nursing assessment includes:
Domain Key Aspects
Subjective Fatigue, anorexia, nausea, itching, decreased urine output, headache, muscle
Data cramps, sleep disturbances
 Domain Key Aspects
Objective Edema, pallor, hypertension, weight gain, changes in urine output/color, signs of
Data uremia (confusion, asterixis), skin changes (dry, flaky skin)
Elevated BUN, creatinine, potassium; low GFR; metabolic acidosis; anemia;
Lab Values
hypocalcemia; hyperphosphatemia

II. Nursing Diagnoses (NANDA-I)

1. Excess fluid volume related to impaired kidney function
2. Imbalanced nutrition: Less than body requirements related to anorexia and dietary
restrictions
3. Risk for electrolyte imbalance
4. Fatigue related to anemia and metabolic waste accumulation
5. Risk for infection due to immune suppression and dialysis access
6. Disturbed body image related to physical changes and dialysis
7. Knowledge deficit regarding disease process and self-care
8. Risk for impaired skin integrity due to pruritus and edema

III. Nursing Interventions and Rationales

1. ✅ Fluid and Electrolyte Management
Intervention Rationale
Monitor daily weight and I&O Detects fluid retention or loss
Assess for signs of fluid overload (edema, crackles, Prevents complications like pulmonary
hypertension) edema
Reduces fluid retention and
Restrict fluids and sodium as ordered
hypertension
Monitor lab values (K⁺, Na⁺, Ca²⁺, PO₄³⁻) Guides electrolyte correction
Manages fluid and electrolyte
Administer diuretics or potassium binders as prescribed
imbalance

2. Nutritional Support
Intervention Rationale
Collaborate with dietitian Ensures individualized, safe renal diet
Monitor appetite and weight trends Detects malnutrition or weight gain
Educate patient on low-protein, low-sodium, low- Reduces kidney workload and prevents
potassium, and low-phosphate diet complications

3. Anemia Management
Intervention Rationale
Monitor hemoglobin and hematocrit Detects anemia severity
Administer iron supplements and ESAs (e.g., epoetin alfa) as
Stimulates RBC production
ordered
Encourage iron- and folate-rich foods if permitted Supports hematopoiesis
4. Skin Care
Intervention Rationale
Provide skin care using non-irritating soap and Prevents skin breakdown and relieves
lotion pruritus
Maintain short nails, use mitts if necessary Reduces scratching and infection risk

5. Psychosocial Support
Intervention Rationale
Assess coping mechanisms and emotional status Identifies need for psychological support
Provide education about disease and treatment Promotes empowerment and adherence
Encourage support group participation Reduces anxiety, promotes adjustment

6. Infection Prevention
Intervention Rationale
Use aseptic technique when handling dialysis
Prevents sepsis
access
Monitor for signs of infection (fever, chills,
Enables early intervention
redness)
Promotes self-monitoring and timely care-
Educate on hygiene and signs of infection
seeking

7. Dialysis Care (If Applicable)

Hemodialysis:
 Monitor AV fistula site: check for bruit/thrill
 Avoid BP/IV on fistula arm
 Monitor pre- and post-dialysis vitals and weight
Peritoneal Dialysis:
 Maintain sterile technique during exchanges
 Monitor for signs of peritonitis: cloudy effluent, abdominal pain, fever

8. Education and Health Promotion

Topic Key Points
Diet Renal diet, fluid restriction
Medications Purpose, side effects, adherence
Signs to report SOB, edema, decreased output, confusion, infection
Dialysis When to start, what to expect, access care
Lifestyle Smoking cessation, exercise, follow-up appointments

IV. Evaluation
 Goal Expected Outcome
Maintain fluid/electrolyte balance Stable weight, normal BP, no edema
Maintain adequate nutrition Stable weight, no signs of malnutrition
Prevent complications No infections, normal electrolyte levels
Improved understanding Patient verbalizes understanding of CKD care
Emotional adaptation Expresses concerns, participates in care

Special Considerations
Elderly patients may present with nonspecific symptoms (fatigue, confusion)
Pediatric patients require family-centered education and growth monitoring
Cultural beliefs and literacy levels may impact dietary and treatment compliance

Q.2. Mr. Z is diagnosed of oral cancer and is undergoing radiation. What are the etiological factors,
explain pathophysiology and sign and symptoms of oral cancer. What health advice you will give to
patient undergoing external beam radiation therapy (EBRT) ( 3+3+3+6)

.Answer:

ETIOLOGY: Include tobacco use, alcohol use, sun exposure, and genetics:

1. Tobacco use
• Smoking cigarettes, cigars, pipes, or electronic cigarettes
• Chewing tobacco, snuff, or betel nut
• Using a water pipe

2. Alcohol
Drinking heavily and Using alcohol and tobacco together.

3. Sun exposure
• Chronic exposure to ultraviolet light from the sun or sunbeds
• Cancer of the lip is more likely to occur in areas that are exposed to more sunlight

4. Genetics
• Inherited defects in certain genes, such as Fanconi anemia and Dsykeratosiscongenita
• Having a close relative with head and neck cancer

5.Other risk factors

• Poor nutrition, especially a diet low in fruits and vegetables
• A weakened immune system, such as HIV or AIDS
• - Taking immunosuppressant medicine
A.Age
 • Risk increases with age, and oral cancers most often occur in people over the age of 40
• More men than women develop oral cancer
B. HPV
• Infection with the human papillomavirus (HPV), a common sexually transmitted disease

SIGN AND SYMPTOMS

• A lip or mouth sore that won't heal.

• A white or reddish patch on the inside of the mouth.

• Loose teeth.

•A growth or lump inside the mouth.

• Mouth pain.

• Ear pain.

• Difficult or painful swallowing

PATHOPHYSIOLOGY
HEALTH ADVICE FOR PATIENTS RECEVING EXTEERNAL BEAM RADIATION

Skin Care:

Avoid sun exposure on the treated area. If outdoors, use sunscreen as advised by your care
team.
Protect the skin from heat or cold. Avoid tanning beds, hot tubs, saunas, and hot pads.
Wear loose, soft clothing to minimize skin irritation.
Do not shave the treated area unless your doctor approves.
Be careful with tape or bandages on the treated area, and follow your doctor's instructions for
cleaning and wound care.

Hydration:
Drink plenty of fluids, aiming for 3-4 quarts per day.
Hydration helps flush out toxins, reduces side effects like nausea and fatigue, and can prevent
the need for intravenous hydration.
Consider adding fluids like Jello, popsicles, broth, or flavored teas if you don't like plain
water.
Managing Side Effects:
Report any unusual symptoms to your doctor or nurse, including coughing, sweating, fever, or
unusual pain.
Many side effects are mild and can be managed with medication or dietary adjustments.
Some side effects may appear later, so it's important to discuss both short-term and long-term
potential side effects with your doctor.
During Treatment:
Follow your radiation therapist's instructions regarding positioning and staying still during
treatment.
You may be asked to change into a gown and remove jewelry.
If you are receiving radiation to the head and neck area, you may be fitted with a mask to help
you stay still.
The treatment area may be marked with dots or tattoos to ensure accurate positioning.
Follow-up:
Attend all scheduled follow-up appointments with your radiation oncologist.
These appointments help monitor your progress and address any side effects.
Your doctor may order tests, such as blood tests, to check for any changes in your blood cell
counts.
General Advice:
Be aware that radiation therapy is a localized treatment, and patients do not become radioactive
after external beam radiation therapy.
However, if you are receiving internal or systemic radiation, your doctor may advise specific
precautions for a short time after treatment.

Q.3. Mr. D is admitted in the medicine ward, he is a known case of HIV infection since 9 years, presently
he is admitted with complaints of fever, malaise, abnormal gait, tingling sensation and numbness of hands
and feet. List the modes of transmission for HIV infection; explain the pathophysiology of HIV infection,
what is the diagnostic test done to detect HIV infection (3+7+5)