KMTC/QP-08EPS KENYA MEDICAL TRAINING COL! FACULTY OF NURSING SCIENCI DEPARTMENT OF NURSING FINAL QUALIFYING EXAMINATION FOR LTH NURSING DIPLOMA IN COMMUNIT" PAPER: MEDICAL-SURGICAL NURSING TIME: 3 HOURS (9:00 A.M - 12 NOON) January, 2023 INSTRUCTIONS 1. This paper consists of: ‘© Section | (40 Multiple Choice Questions) Section 2 (8 Short Answer Questions) ‘* Section 3 (1 Long Answer Question) 2. Attempt ALL Questions Multiple Choice Questions should be answered in CAPITAL LETTERS Write the EXAMINATION NUMBER given on all the answer sheets provided and on the question paper. 45, Ensure that all examination answer scripts are handed in at the end of the examination 6. Ensure you sign the examination register provided (Both in and out) EXAMINATION NUMBER sinus sista Page 1017KMTC/QP-08/EPS CTION 1, The laboratory test that evaluates the blood PH is A. Hemoglobin level B. Red blood cell count C. Arterial blood gases (ABG) analysis D. Blood culture 2. The cause of circulatory insufficiency that can lead te shock as a result of decreased plasma volume is: A. Penetrating trauma with blood loys, B. Gastrointestinal bleeding. C. Anaphylaxis because of medications D. All of the above 3. The mitral valve in the heart is located in: A. Between right ventricle and pulmonary artery B. Where left ventricle meets the aorta C. Between left atrium and left ventricle D. Between right atrium and right ventricle 4. The blood test most indicative of cardiac damage is: A. Complete blood count B. Haemoglobin AIC C. Lactate dehydrogenase D. Creatinine kinase 5. The condition caused by long term exposure to high levels of cortisol ts A. Addison's disease B. Crohn's disease C. Adrenal insufficiency D. Cushing's syndrome 6. Hashimoto's disease is: A. Chronic inflammation of the thyroid gland BW. Adrenal insufficiency C. Cushing's syndrome D. Hyperpituitarism 7. Amethod of management of genital organ prolapse is ‘A. Oophorectomy B, Sacro colpopexy C. Culdocentesis D, Salpingoscopy Page 2 ot?KMIC/IQP-OWEPS: 8. A condition in which the endometrial cavity undergoes fibrosis and adhesions is referred to as: A. Adenomyosis B Endometriosis C.Asherman's syndrome D. Shechan's disease 9. The indication for Cholecystogram is: A. Urinary bladder stones B. Gall bladder stones C. Kidney stones D. Ureteric stones 10. A Scopic procedure used to examine the petitoncal cavity, pelvis and abdomen is referred to as A. Endoscopy B. Laparoscopy C. Cystoscopy D. Pycloscopy UL The nurse is monitoring the patient wha is 24 hours post-operation ftom surgery Which findings requires immediate intervent ABP of 10030 mmHg. 124 hours urine output of 300 ml C. Pain rating of 4 on 1-10 scale D. Temperature of 99,3° F 12. A potential postoperative concern regarding a patient wno has already resumed solid diet is: A. Failure to pass stool within 12 hours of eating solid food 1B. Failure to pass stoo! within 48 hours of eating solid food C. Passage of excessive Matus D. Patient repons a decreased diet 13. You are completing taking the history of a patient who ts scheduled for surgery. What health history increases the risk for surgery for the patient A. Urinzry tract infections B. History of premature ventricle beats C. Abuse of street drugs D. Hypothyroidism 14, The patient has the right to refuse a medication despite the explanation of the nurse How de we refer this ethical principle A. Beneficence B. Veracity C. Autonomy D. Respondeat Superior Page Sot?KMTC/QP-O8/EPS 22. The acidity of a solution is measured by the concentration of; A. Oxygen ions B_ Hydrogen ions C. Water molecules D. Nitrogen ions 23. Stress Ulcer (Acute mucosal ulceration of duodenal or gastric area) occurs after: A. Starvation, alcoholism, shock B. Bums, shock, severe sepsis C. Spicy foods, Cigarettes smoking, starvation D. Alcoholism, shock, severe sepsis 24. The preferred diagnostic procedure that allows direct visualization of peptic ulcers and aids in obtaining biopsy is: A. Colonoscopy C. Sigmoidoscopy D. Barium study 2, Other less invasive measures for detecting Helicobacter Pylori include: A. Full blood count B, Gastric analysis to elucidate pathologic changes C. Serologic testing for antibodies against H. pylori D. Ultrasound sean 26. The end products of protein metabolism excreted by kidneys arc: A. Blood Urea Nitrogen and Magnesium B. Creatinine, Calcium and Phosphate C. Blood Urea Nitrogen and Creatinine D. Creatinine, Potassium and Sodium 27, During physical exam, pain and tenderness elicited in the area of Costovertebral angle is indicative of ‘A. Nephrotie Syndrome B. Acute Pyelonephritis, C. Renal failure D. Cystitis 28, The elevated levels of urea and other compounds in the blood is known as: A. Polyuria B. Azotemia C. Oliguria D. Urolythiasis 29, A skin condition characterized by a rash that develops in segmental distribution along affected nerve roots is called: ‘A. Chicken pox B. Small pox C. Herpes simplex D. Herpes Zoster Page Sof 7KMTC/QP-O8/EPS 15. The Valve that prevents the backflow of blood into the atria when the ventricles contract is the: A. Aortic B. Semitunar C. Atrio. ventricular D. Pulmonary 16, Withholding treatment: For example not carrying out a surgery that will extend life of the patient for a short time is: A. Active euthanasia B, Passive cuthanasia C. Indirect euthanasia D. Direct euthanasia 17. You are completing taking the history of a patient who is scheduled to have surgery. What health history increases the risk for surgery for the patient: A. Urinary tract infections B. History of premature ventricle beats C. Abuse of street drugs D, Hypothyroidism 18. The branches of the aorta include: A. Celiac trunk B. rachio-cephalic trunk C. Intercostal arteries D. Coronary Arteries 19, The protein that acts as a catalyst for biochemical reactions are referred to as A. Lysozymes B, Monoamines C. Enzymes D, Peptides 20. A Nursing student dressed the wound of a patient without the patiemt’s permission. his 1s referred to A. Battery B. Assault C. Invasion of Privacy D, Professional malpractice 21. The Largest Cell organelle that contains the body's genetic ma activities is called: A. Ribosomes B. Mitochondria C. Nucleus D. Lysosome rial which directs all metabolic Pace ot?KMTC/QP-08/EPS 30. The management of post herpetic Neuralgia includes: A. Analgesics, infiltration of the affected nerves with xylocaine in oll B. Application of calamine lotion, Corticosteroids C. Prednisone, short course of tetracycline D. Boric acid solution, acyclovir drops 31, The major cause of Iron deficiency anaemia in adults is: A. Decreased red blood cell production B. Hacmorthage C. Autoimmune reaction D. Mechanical damage of red blood cells 32. The food element that can inerease Iro1 n absorption in the body is: B12 (Cyanocobalaminy C. Vitamin D D. Vitamin C (Ascorbic acid) 33. In the diagnosis of anaemi A. Haematocrit B. Complete blood cet count C. Erythrocyte Sedimentation rate D. Haemogiobin level 44. For question 34 indicate whether the following statements are “TRUE! indicating the correct response in the space on the answer sheet provided. ‘A. Non-communicating hydrocephalus can be caused by obstruction in the cerebral aqueduct . B. Hydrocephalus generally results in decreased intracranial pressure. 35. The following is classified as a proton A. Ranitidine B, Omeprazole C. Magnesium triscillicate D. Sueralfate 36. The Classical clinical manifestations of diabetes inspidus include: A. Hypervolemia, B. Oliguria. C. Decreased serum osmolarity. D. Massive urine output. 37. One effect of nicotine in the body is: A. Decreases arterial lumen size and clevates blood pressure. B. Enhances plaque form: C. Creates excessive nitrogen in the tissues. D. Increases release of epinephrine. 's, the percentage of red blood cells in total volume of blood is called: or *FAL! Pump inhibitor used in managing peptic ulcers disease; Page 6of7KMTC/QP-08/EPS: 38, The ‘golden hour’ refers to the first hour after: A. A trauma patient arrives in hospital B. Trauma impact C. Initial emergency reseue D. Secondary survey 39. The following is a high ceiling diuretic: A. Mannitol B. Spironolactone C. Furosemide D. chlorothiazide 40. The first nursing intervention for a patient who has been sexually assaulted is to: A. Treat urgent medical conditions B. Contact support person for the patient to clean self C. Provide supplies and equipment for patient to take a bath D. Document bruises and lacerations of the perineum and cervix SECTION 2: SHORT ANSWER QUESTIONS: (40 MARKS) 41. Explain five (5) non-pharmacological ways of managing hypertension (S marks) 42. Explain five (5) nursing interventions used in prevention of pressure sores in a bed ridden patient, . (S marks) 43, State five (5) signs and symptoms suggestive of wound infection. (5 marks) 4. Outline five (5) important relevant healt’ messages you would share with a diabetic patient. (S marks) 45. Explain five (5) nursing consideration before a nasogastric feeding of a patient. (Smarks) 46. Briefly state the process of bone heali (S marks) 47. Explain the complications of Pneumoni (S marks) AB. State the responsibilities of a receiving nurse in theatre. (S marks) SECTION 3: LONG ANSWER QUESTION (20 MARKS) 49. Mr. Zee is admitted in the ward with a diagnosis of chronic renal failure. The doctor orders for immediate hemodialysis. a) Draw an illustrated diagram showing a kidney nephron (5 marks) b) Describe the role of a nurse during hemodialysis. (S marks) ©) State any five (5) complications of a patient with chronic renal failure. (10 marks) Page 7 of 7