Download Model answer Medical Surgical Nursing (NUR 201) Final Semester

Model answer Medical Surgical Nursing (NUR 201)
Final Semester Exam
Second Year- First Term
Date: 10 /1/2016
Questions parts: 5
Time allowed: 3 hours
No. of papers:12
Total marks: 80 marks
Section I: Multiple Choice Questions: ( 20 marks)
*Please circle the correct answer only :
1- A male elderly client is admitted to an acute care facility with influenza. The
nurse monitors the client closely for complications. What is the most common
complication of influenza?
a) Septicemia
b) Pneumonia
c) Meningitis
d) Pulmonary edema
2- A male client is admitted to the health care facility for treatment of chronic
obstructive pulmonary disease. Which nursing diagnosis is most important for
this client?
a) Risk for infection related to retained secretions
b) Activity intolerance related to fatigue
c) Anxiety related to actual threat to health status.
d) Impaired gas exchange related to airflow obstruction.
3- The amount of air inspired and expired with each breath is called:
a) Tidal volume
b) Residual volume
c) Vital capacity.
d) Dead-space volume
1
4- The scrubbing nurse performs one of the following:
a) perform surgical hand scrub
b) check suction apparatus&O2 supply
c) documents operative record &nurse notes
d) Arranges sterile & unsterile supplies
5 - After abdominal surgery, the circulating and scrub nurses have critical
responsibility
about
sponge
and
instrument
count.
Counting is performed thrice: during the pre-incision phase, the operative phase
and closing phase. Who counts the sponges, needles and instruments?
a) The scrub nurse only
b) The surgeon and the assistant surgeon
c) The circulating nurse only
d) The scrub nurse and circulating nurse
6- In Spinal surgery the nurse put the patients in…………
a) Lateral position
b) Prone position
c) Supine position
d) Semi-fowlers position
7- The client with cancer is receiving chemotherapy and develops
thrombocytopenia. The nurse identifies which intervention as the highest
priority in the nursing plan of care?
a) Ambulation three times a day
b) Monitoring temperature
c) Monitoring the platelet count
d) Monitoring for pathological factor
2
8-For a female client with newly diagnosed cancer, the nurse formulates a
nursing diagnosis of anxiety related to the threat of death secondary to cancer
diagnosis. Which expected outcome would be appropriate for this client
a) Client doesn’t guess at prognosis
b) Client verbalizes feelings of anxiety
c) Client uses any effective method to reduce tension
d) Client stops seeking information
9- The nurse is caring for a male client with cancer and the client is complaining
of pain. The nurse assess the client’s intensity of pain would include
a) Simple descriptive pain intensity scale
b) Numeric pain intensity scale (0-10)
c) Visual analogue scale
d) All of the above
10- The physical assessment of a 55 y/o female with end-stage cirrhosis abdomen
with bulging flanks and dullness to the dependent side while lying on the right.
The appropriate terminology for documentation of this assessment is what?
a) Fluid overloads
b) Ascities
c) Distension
d) None of the above
11- Testicular and ovarian function can be affected by chemotherapeutic agents,
resulting in ……….
a) Possible sterility
b) Early menopause
c) Permanent sterility may result
d) All the above
12- The nurse is planning care for a patient with fluid volume overload &
hyponatremia. Which of the following should be included in this patient's plan
of care?
a) Restrict fluids
b) Administer intravenous fluids
c) Provide Kayexalate
d) Administer intravenous normal saline with furosemide
3
13- The nurse is caring for a patient who is anxious & dizzy following a
traumatic experience. The arterial blood gas findings include: pH 7.48, PaO2
110, PaCO2 25, & HCO3 24. The nurse would anticipate which initial
intervention to correct this problem
a) Encourage the patient to breathe in & out slowly into a paper bag.
b) Immediately administers oxygen via a mask & monitor oxygen saturation
c) Prepare to start an intravenous fluid bolus using isotonic fluids.
d) Anticipate the administration of intravenous sodium bicarbonate
14- When assessing a patient for signs of fluid overload, the nurse would expect
to observe:
a) A vesicular breathing sound
b) Bounding pulse
c) Poor skin turgor
d) Flat neck veins
15- In compensating for respiratory alkalosis, the body excretes more:
a) Bicarbonate ions
b) Dehydrogenase phosphate ions
c) Carbonic acid
d) Hydrogen ions.
16- One of the long term complications of diabetes mellitus is:
a) Kato acidosis
b) Neuropathy
c) Hypo & hyperclacimias
d) hypoglycemia
17- If a nurse is counseling a patient with high blood glucose level regarding diet
modifications, the nurse should instruct the patient to:
a) Limit potassium intake to less than 50 mEq/L per day
b) Ensure that the diet contains 2500 mg of calcium per day
c) Keep total dietary fats at 30% or less of the daily caloric intake
d) Consistency is required in maintaining calories and carbohydrate consumed
at different meals
4
18- Causes of increase blood glucose level in Insulin dependent diabetes mellitus
include one of the following:
a) Decrease cardiac output
b) Heart failure
c) Decrease mount of insulin production
d) Destruction of the pancreatic beta -cells
19- When performing physical assessment for patient diagnosed with arterial
disorder you should assess:
a) Skin colour
b) Temperature
c) Character of peripheral pulses
d) All of the above
20-For a patient with peripheral vascular disorders, you should assess all of the following Except:
a) Popliteal artery
b) Dorsalis pedis artery
c)Posterior tibial artery
d)Radial pulse
Section II: Please, read the statement carefully and write the letter (T) if the
statement is true and the letter (F) if the statement is false. ( 10 marks)
Item
1-The position of patient post upper ureters surgery is lateral position
2- Pulmonary embolism is one of post-operative complication
3-Teach patient in post-operative to select foods low in protein &
vitamins C
4-From causes of liver cirrhosis alcoholism ,chronic hepatitis, toxins
and infection
5-Wide excision means removal of the primary tumor, regional lymph
nodes, lymphatic channels, and neighboring structures (e.g.) radical
mastectomy
6- Needle biopsy means removal of small portions of tumor with
forceps
5
True/False
7- Increase intracranial pressure caused by tumor growth may cause
headache, lethargy, nausea, and vomiting
8- A person can only become infected with hepatitis D if they are
already infected with hepatitis B.
9-Early postoperative ambulation affect in prevention of paralytic ileus
10-Patient with COPD complain of edema in lower limb due to enlarged
in the liver
11-when assessing a patient with venous thromboembolism it can be
observed that patient's skin is pale, cold, and cyanosed
12- A patient with dialysis catheter, hypercoagulability is more liable to
have upper extremity venous thromboembolism.
13-A patient with phlebitis is not at risk of thrombus formation
14-Diabetus mellitus is a group of metabolic disorders characterized by
lower levels of blood glucose
15-Stenosis is persistent pain in the foot when the patient is resting
indicating a severe degree of arterial insufficiency
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
T
T
F
T
T
F
T
T
T
T
F
T
F
F
F
6
Section III: Matching Type Questions (20 marks)
Part 1
Match the term in column A with the correct definition in column B
Column A
Column B
1-Hepatitis A
A-A condition in which the liver slowly deteriorates and
malfunctions due to chronic injury
2-Hepatitis E
B-Commonly spread via direct contact with the blood of a person
who has the disease.
3-Cirrhosis
C-A collective term describing a large group of diseases
characterized by uncontrolled growth and spread of abnormal
cells.
4-Cancer
D-Person can become infected with by drinking contaminated
water
5-Hepatitis C
E-Caused by consuming contaminated food or water
1
2
3
4
5
DD
E
D
C
A
B
DD
Column A
Column B
6- COPD.
A-The cells of lung tissues grow uncontrollably and
form tumors
7- Emphysema
B-Pulmonary hypertension will lead to right
ventricular hypertrophy followed by right ventricular
failure
8- Cor - pulmonal
C- A multisystem,
unknown etiology.
9- Sarcoidosis
D-Nonreversible process of airway narrowing and
loss of supporting tissue
10- Lung cancer
E- Enlargement of the airspaces due to dilatation and/
or destruction of the alveolar walls
7
granulomatous
disease
of
6
E
7
C
8
D
9
A
10
B
Part (2) Match the description in column I with the correct word in columnII
Column I
Column II
1- Assist scrub nurse
A- this nurse is responsible for check &
record all drugs required during the
operation
B - Assist with surgical draping of patient
2- Scrub Nurse
3- Anesthesia nurse
C- Put patient in positions on operating
room table according to the type of
procedure &surgeons preference
D -Monitor of level of consciousness,
airway and vital signs
4- Postoperative phase
5- Reception nurse
1
C
E- Confirm that the patient has signed the
operative consent
2
B
3
A
Column I
4
D
5
E
Column II
A- Sound produced by turbulent blood flow
through an irregular, tortuous, stenosis, or
dilated vessel.
B-Reddish blue discoloration of the extremities
indicative of severe peripheral arterial damage.
6- Psychogenic
pain
7- Referred pain
C – Muscular, cramp like pain in the extremities
reproduced with the same degree of exercise or
activity and relieved by rest
D-The pain where no physical pathology has
been found or where the pain appears to have a
greater psychologic basis than a physical one
8- Rubor
9 - Intermittent
claudication
10- Bruit
E-It is felt in areas other than those
stimulated
6
D
7
E
8
B
8
9
C
10
A
Section IV: Short notes questions
(15 marks)
1-Factors that influence patient's responses to pain (2 marks)
- Cultural factors
-Previous pain experiences
-Meaning of the pain
-Patient's responses to pain relief strategies
2- Causes of chronic bronchitis (3 marks)
1-Bronchial irritation:a- cigarette smoking.
b- occupational exposure to dust a fumes .
c- Atmospheric pollution .
2- Infection :- especially with strept – pneumoniae
3- Predisposing factors:a- pulmonary congestion in cases of left sided heart failure.
b –Bronchiectasis
c – chonic sinusitis
3- Diet recommendations for liver cirrhosis patients ( 2 marks )

diet should be low in sodium (salt), high in carbohydrates.

Do not eat raw shellfish.

Five small meals per day with starches and protein are important, avoid red
meat, and avoid fat.

Avoiding Certain Medications: Patients with cirrhosis should
take Non-Steroidal, Anti-Inflammatory Drugs (NSAID) such as Advil
(Ibuprofen), Motrin (Ibuprofen), or aspirin-type drugs.. Because cirrhosis
9
not
patients are at increased risk of ulcer disease, the patient should discuss with his
doctor about taking an anti-ulcer drug.
4 –Contraindication of anticoagulant therapy: (2 marks)
• Lack of patient cooperation
• Bleeding from the following systems: Gastrointestinal, Genitourinary, Respiratory,
and Reproductive.
• Aneurysms
• Hemorrhagic blood dyscrasias
• Alcoholism
• Open ulcerative wounds
• Severe trauma
• Severe hepatic or renal disease • Recent childbirth
• Recent surgery of the eye, spinal cord, or brain
• Infections
• Recent cerebrovascular hemorrhage• Occupations that involve a significant hazard
for injury
5-Seven tips for managing diabetes mellitus(3.5 marks)
healthy eating, being active, monitoring, taking medication, problem solving, healthy
coping,and reducing risks
6- Long term care (continuous care) for patient with heart failure (2.5 marks)
• Warning signals of cardiac decompensation that require treatment Desired and adverse effects
of prescribed drugs; monitoring for effects; importance of compliance with drug regimen to
prevent acute and long-term complications of heart failure
• Prescribed diet and sodium restriction; practical suggestions for reducing salt intake;
recommend American Heart Association materials and recipes
• Exercise recommendations to strengthen the heart muscle and improve aerobic capacity
•
The importance of keeping scheduled follow-up appointments to monitor disease
progression and effects of therapy. Provide referrals for home healthcare and household
assistance (shopping, transportation, personal needs, and housekeeping) as indicated.
Referrals to community agencies, such as local cardiac rehabilitation programs, heart
support groups, or the AHA, can provide additional materials and psychosocial support
Section V: case study question
(10 marks)
10
A 65 year old female is admitted to medical unit complaining of nausea, vomiting
and diarrhea for 3 days. Her history is unremarkable except hypertension for which
she takes hydrochlorothiazide. She relates feeling exhausted and having leg cramps
which interfere with her sleeping. Notable assessment findings include T. 38.6 C,
apical pulse 102 and irregular, B.P. 90/50; absent bowel tones, poor muscle tone and
skin turgor. Laboratory data includes K+ 2.9 mEq/L, Na+ 137 mEq/L, Cl- 97 mEq/L,
and WBC 20,000/ul. ECG shows cardiac arrhythmias (frequent PVCs) Physician's
orders include:

IV D50.9%NaCl with 20 mEqKCl/L to infuse at 90cc/hr.

40 mEq of KCl IV over the next 2 hours

K+ level 30 minutes after 40 mEq IV KCl has infused

Bed rest: May use bathroom

NPO
1- Which electrolyte disturbance is of most concern with this client?
(1mark)
-……… Hypokalemia ……………………………………………
2- Underline the signs and symptoms that can result from this electrolyte
disturbance.(3 marks)
exhausted,
leg cramps,
AP 102 and irregular,
absent bowel tones,
poor muscle tone and
skin turgor
3- What do you suspect as the cause(s) of this electrolyte disturbance?(1.5)
Vomiting,
K+ wasting diuretic therapy,
and no K+ replacement
5- What type of solution is D5NS (glucose & normal saline) with 20mEq KCl /L?
(1marks)
-………………… Hypertonic
6-What are your primary nursing responsibilities for this client? (3.5marks)
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‫‪Diuretic‬‬
‫‪End of questions‬‬
‫‪Good Luck‬‬
‫المسؤل عن المادة ‪:‬‬
‫د‪ /‬صفاء محمد السيد‬
‫د‪ /‬سماح السيد غنيم‬
‫د‪ /‬رشا فتحي محمد‬
‫د‪ /‬ايمان صبحي عمران‬
‫د‪ /‬مروة مسعد علي مهدي‬
‫د‪ /‬نهال محمود ابو الفضل‬
‫‪12‬‬