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SECTION A

Multiple Choices (50 marks)

Instructions: Kindly circle the most appropriate response to the following questions

Scenario I

Diabetes Mellitus is defined as a group of disorders characterized by abnormal metabolism of


glucose, protein and fats. It is caused by an absence of insulin production in type I and a
reduction or resistance to insulin in type II. Classical signs and symptoms include frequent
urination, thirst and hunger.

Question 1-10 relate to the scenario above

1. A client has been diagnosed with Diabetes Mellitus type I. He ask the nurse what this means.
_____________would be the nurse’s best response (select all that apply)

a) “It means your pancreas cannot secrete insulin”


b) “Without insulin you will develop ketoacidosis (DKA)”
c) “The exocrine function of your pancreas is to secrete insulin”
d) “The endocrine function of your pancreas is to secrete insulin”

2. During the planning phase, the doctor prescribes medications for a patient’s Diabetes
Mellitus. The doctor’s order of_______________ would be questioned by the nurse.

a) Lantus 20 units BID


b) Humalog insulin for sliding scale as per protocol
c) Administer regular insulin 30 minutes before meals
d) Metformin (Glucophage) 1000 mg per day in divided dosages

3. A student nurse has just taught a newly diagnosed Diabetic Mellitus client about her illness.
The student would expect the patient response to be_____________________.

a) “my cells cannot use the insulin my pancreas make”


b) “my beta cells cannot produce enough insulin for my cells”
c) “my peripheral cells have increased susceptibility to insulin”
d) “ my cells have increased their receptors, but there is not enough insulin”
4. The nurse in assessing a client who gave himself insulin as prescribed, but forgot to eat,
would expect to find a client ___________________.

a) complaining of frequent thirst


b) with moist and diaphoretic skin
c) complaining of frequent urination
d) complaining of nausea and vomiting

5. A Diabetic client is preparing to do a diagnostic test; however, he is scheduled to be NPO


prior to the test.___________________ would be the nurse’s best plan in regard to
administration of the patient’s oral administration.

a) Notifying the physician and request orders


b) Giving the medications immediately after the test
c) Notifying the X-ray department and request orders
d) Administer oral agents with a sip of water before the test

6. A client with Diabetes Mellitus type I was found unresponsive in the clinical setting by a
final year nursing student. The student determines that _______________ would be the
priority nursing action.

a) calling a code
b) assessing the client’s vital signs
c) treating the client for hypoglycemia
d) calling the doctor as soon as possible

7. The doctor prescribes 10 units of Lispro (Humalog) for a Diabetic client. The nurse decides
that the best time for its administration would be _________________.

a) when the patient is eating


b) thirty minutes before meal
c) fifteen minutes before meals
d) When the meal trolley arrives on the ward

8. The student in educating a group of pregnant mothers about Gestational Diabetes, knows that
__________________ of them will be diagnosed with type II Diabetes Mellitus.

a) 25-30%
b) 5-10%
c) 20-25%
d) Less than 5%
9. The ward sister is educating a group of third year nursing students about the various types of
Diabetes Mellitus. The students would expect these to include______________.

a) genetic, no production, secondary, insulin resistance,


b) no production, genetic, pregnancy related, hereditary
c) insulin resistance, no production, pregnancy related, genetic
d) pregnancy related, insulin resistance, no production, secondary

10. The doctor prescribes 0.5cc of Regular Insulin for a Diabetic patient. As the nurse assigned
to this client you determine that the patient will receive________________.

a) 5 units
b) 50 units
c) 0.5 units
d) 500 units

11. Doctor’s prescription for a diabetic client reads: Regular Insulin I. V infusion at 20 units/hr.
The solution is 250 mls of Normal Saline with 100 units of Insulin. The correct flow rate
would be____________________.

a) 50 ml/hr
b) 20 ml/hr
c) 25 ml/hr
d) 13.5 ml/hr

Scenario II

Mrs. Julian has been admitted to Ward 2A at St. John Hospital with Chronic Renal Failure. Her
history reveals that she had Acute Renal Failure some years ago, but did not follow her medical
regime. She reported that she has not pass any urine for three days now. On assessment her
abdomen and feet were swollen and her breath had a fruity odour.

Questions 12-21 relates to the scenario above

12. Mrs. Julian’s Chronic Renal Failure is in the early stage. ____________________would be
an expected assessment finding by the nurse.

a) Anuria
b) Polyuria
c) Oliguria
d) Polydypsia
13. In planning care for Mrs. Julian, the nurse understands that End Stage Renal Failure diseases
(ERSD) will eventually occur. ESRD takes place when glomerular filtration rate is less than
____________ per minute

a) 5 ml
b) 10 ml
c) 15 ml
d) 25 ml

14. Mrs. Julian tells the nurse that she dislikes the thought of dialysis; however, she states it will
help her to eat and drink anything she likes. Given this information the student nurse caring
for her identifies a nursing diagnosis of____________________.

a) self esteem disturbance related to dependence on dialysis


b) anxiety related to perceive stress on health status and role functioning
c) risk for imbalanced nutrition more than body requirement related to increased
dietary intake
d) ineffective management of therapeutic regimen related to insufficient knowledge
regarding treatment

15. Mrs. James serum blood urea nitrogen level was done. The nurse expects the diagnostic
findings to reveal a/an ______________________.

a) high levels of c-reactive protein


b) ability of the kidneys to concentrate urine
c) serum levels of the end products of protein
d) concentration of urine osmolarity and electrolytes

16. The doctor on duty has decided that Mrs. James needs to have an internal access for
hemodialysis. The student nurse determines that an appropriate action after the access is
insitu is to________________.

a) protect the arm from blood pressure readings


b) irrigate with heparin and normal saline q8 hourly
c) keep the arm elevated above the level of the heart
d) apply warm moist packs to the area after hemodialysis

17. On reviewing Mrs. Julian medical records the charge nurse discovers that Mrs. James had
Influenza when she was admitted for Acute Renal Failure. One nursing measure that should
have been carried out for Mrs. James on her first admission was a/an ___________________.

a) catheterization for residual volume


b) encouraging fluids to 2000 ml in 24 hours
c) observation for signs of a secondary infection
d) providing a high protein, low carbohydrate diet
18. Based on Mrs. Julian condition, the charge nurse decided to have a teaching session for a
group of patients on Acute Renal Failure. She ask a student to classify Acute Renal
failure.___________________ would be an appropriate response

a) Left of the capsule, inside the capsule, beside the capsule


b) Before the capsule, inside the capsule, outside the capsule
c) Outside the capsule, beside the capsule, inside the capsule
d) Inside the capsule, the right of the capsule, before the capsule

19. The dietician in conjunction with the doctor decided to place Mrs. Julian on a strict renal diet.
The student nurse anticipates that this diet will include _______________ meals.

a) high protein, high carbohydrate, low calorie


b) low calorie, limited protein, low carbohydrate
c) limited protein, low carbohydrate, adequate calorie intake
d) adequate calorie intake, high carbohydrate, limited protein

20. In making arrangement to administer Mrs. Julian’s medication, student nurse O’Connor
noticed that a new order was made. Utilizing his knowledge of renal medications he with-
held _____________ because he knows they are nephrotoxic.

a) diuretics
b) sodium and potassium bicarbonate
c) nonsteriodal anti-inflammatory drugs
d) angiotensin converting enzymes (ACE) inhibitors

21. From sister’s teaching session, a patient politely asks what does the terms, “Too few
nephrons to excrete metabolic waste and fluid and electrolyte balance refer to?” As a
knowledgeable student your best response would be_________________.

a) dialysis
a) renal insufficiency
b) acute tubular necrosis
c) end stage renal disease
Scenario III
A client Mrs. Judas is admitted to the medical-surgical floor at UHWI with a diagnosis of Acute
Pancreatitis. Her blood pressure is 136/76 mm Hg, pulse 96 beats/minute, respirations 22
breaths/minute, temperature 99°F (38.3°C), and she has been experiencing severe vomiting and
nausea, for 24 hours. She also reported abdominal pain and distention. Her past medical history
reveals hyperlipidemia and alcohol abuse.

Questions 22-31 refers to the scenario above

22. For Mrs. Judas’ signs and symptoms the nurse would expect the diagnosis of Pancreatitis to
be confirmed with laboratory testing that reveals elevated ___________________serum.

a) calcium
b) bilirubin
c) amylase*
d) potassium

23. Doctor orders for Mrs. Judas are: strict nil per os (NPO) and Nasogastric tube (NGT) to low
intermittent suction. The nurse recognizes that these interventions
will_____________________.

a) eliminate the need for analgesic


b) prevent secretion of gastric acid
c) decrease the client's need for insulin
d) reduce the secretion of pancreatic enzymes

24. Student nurse Meikle asked a registered nurse on the ward what was the major reason for the
prescription of the NGT. The expected response would be to____________________.

a) remove bile from the gallbladder


b) prevent spasms at the sphincter of Oddi.
c) empty the stomach of fluids and gas to relieve vomiting.
d) prevent air from forming in the small and large intestines.

25. The ward sister is planning dietary changes for Mrs. Judas following her episode of
Pancreatitis. Student nurse Jarrett applies her knowledge when she gives
a_____________________ diet to the client.

a) high calorie, low fat


b) high protein, high fat
c) low calorie, low carbohydrate
d) low protein, high carbohydrate
26. Student Nurse Crew is obtaining assessment data from Mrs. Judas Pancreatitis. She
determines that _____________________ is an important part of the health history.

a) smoking
b) alcohol use
c) diabetes mellitus
d) high-fat dietary intake

27. The nurse identifies the collaborative problem of potential complication: electrolyte
imbalance for a patient with severe Acute Pancreatitis. Assessment findings that alert the
nurse to electrolyte imbalances associated with Acute Pancreatitis include ______________.

a) hypotension.
b) hyperglycemia
c) muscle twitching and finger numbness.
d) paralytic ileus and abdominal distention.

28. A patient with Chronic Pancreatitis is complaining of pain. Doctor prescribes Morphine grain
1/10, in stock is Morphine 10 mg/ml. The nurse is expected to give____________________.

a) 6 mls
b) 60 mls
c) 0.6 mls
d) 0.66 mls

29. The nurse in collecting information from a client with Acute Pancreatitis understands that the
illness is_________________.

a) self limiting
b) insidious in nature
c) caused by stones in the gall bladder
d) affects persons in the 10-20 age group

30. In drawing data from different sources student nurse Danville recognizes that a patient with
Pancreatitis will exhibit__________________.

a) intermittent pain in the abdomen


b) pain that is stationary in the abdomen
c) pain that goes to the back from the abdomen
d) pain that goes to the iliac region from the abdomen
31. In assessing a client with Pancreatitis who has fever and pain the most appropriate nursing
needs would be__________________.

a) psychosocial, safety, oxygen


b) Rest, Comfort & Activity, safety, fluids
c) oxygen, psychosocial, Rest, Comfort & Activity
d) safety, Rest, Comfort & Activity, psychological

Scenario IV

Acquired Immunodeficiency Syndrome (AIDS) is the late stage of a continuum of symptoms


resulting from infection with the Human Immunodeficiency Virus (HIV). HIV/AIDS is generally
transmitted through:
 body fluids (semen) during sexual contact with an infected person
 use of hyperdermic needles with an infected person who share the same needle
 blood, blood products, body fluids of an infected person, intra-placentally or through
breast milk of an infected
mother

Questions 32-43 relates to the scenario above

32.Ms. Ximines is diagnosed with Acquired Immunodeficiency Syndrome (AIDS). The student
nurse caring for this patient is aware that for a patient to be diagnosed with HIV she should
have_______________________.

a) infection with Tuberculosis, HIV and cytomegalovirus


b) infection with HIV, history of HIV infection and T-cell count below 200
cells/microliter
c) infection of HIV, have a CD4+ T-cell count of 500 cells/microliter, history of
acute HIV infection
d) infection of HIV, have a CD4+ T-cell count of less than 200 cells/microliter,
history of acute HIV infection
33. Sister Gray is giving an injection to Ms. Ximines. After giving the injection, she accidentally
pricked her finger with the needle when the client became very agitated. To determine if
sister became infected with HIV, she should _______________ .

a) take the test after a week and repeat in 4 months


b) take the test after a week and repeat in 6 months
c) immediately take the test and repeat after 4 weeks
d) immediately take the test and repeat after 12 weeks

34. The blood test first used to identify a response to HIV infection is __________________.

a) CBC
b) ELISA test
c) Western blot
d) CD4+ T-cell count

35. The nurse demonstrates her knowledge of HIV/AIDS when she states that
________________ is used definitively to confirmed the disease

a) CBC
b) ELISA test
c) Western blot
d) CD4+ T-cell count

36. In preparation of care for Mrs. Ximines, Sister Gray points out to a group of students that
_______________________ , therefore it is difficult to develop a vaccine against it.

a) HIV matures easily


b) HIV mutates easily
c) HIV is still unknown to human
d) HIV spreads rapidly throughout the body

37. Student nurse Johnson in collecting data from Mrs. Ximines who has the Human
Immunodeficiency Virus knows that the causative organism can be classified as
a________________________.

a) rotavirus
b) retrovirus
c) rhinovirus
d) rhabdovirus
38. The nurse observes precaution in caring for Mr. Ximines as HIV is most easily transmitted
in______________________.

a) feces and saliva


b) blood and semen
c) breast milk and tears
d) vaginal secretions and urine

39. In Mrs. Ximines who has advanced AIDS, a nursing diagnosis of __________________
would indicate that she has signs and symptoms of loose watery stools and wasting
syndrome.

a) diarrhea related to opportunistic infection


b) risk for fluid volume related to excess fluid loss
c) risk for infection related to compromised immune system
d) risk for impaired skin integrity related to poor nutrition and diarrhea

40. Mrs. Ximines has a nursing diagnosis of disturbed thought processes related to neurological
changes. The highest priority for her would be________________________.

a) providing a quiet environment


b) maintaining a safe environment
c) providing written instructions of directions to promote orientation
d) using memory cues such as calendar and clocks to promote orientation

41. The nurse administers antiretroviral medications to Mrs. Ximines. The effectiveness of
antiretroviral therapy is measured by_______________________

a) a rise in plasma HIV antibodies level


b) a reduction in opportunistic infections
c) a rise in the red blood cell count and hemoglobin level
d) a fall in the plasma viral load and an increase in the CD4 count

42. Cambivir 25 mg is prescribed for Mrs. Ximines, on hand is Cambivir 75 mgs. The nurse will
give___________________ which is expected to slow the progression of the disease.

a) 3 mgs
b) 33 mgs
c) 3.3 mgs
d) 0.33 mgs
43. Mrs. Ximines becomes lethargic and weak; doctor prescribes 6000 mls of Lactated Ringers
to run over a 24 hr period. The drop factor for the intravenous tubing is 10 gtts/ml. You
would give_________ gtts/min.

a) 42 gtt/min
b) 41 gtt/min
c) 41.66gtt/min
d) 42.66 gtt/min

Scenario V

Ms. Ingram is a 35 year old para 3/gravida 10, who was admitted to ward 10 at UHWI, with a
history of back pain, dysmenorrhia, yellow blood tinged vaginal discharge and bleeding between
periods. On examination, her papsmear showed abnormal cervical tissues. A Colposcopy and
biopsy was done. Preliminary findings indicate Cancer of the Cervix

Questions 44-50 relates to the scenario above

44. For Mrs. Ingram, newly diagnosed Cervical Cancer, the nurse formulates a nursing diagnosis
of Anxiety related to the threat of death secondary to cancer. An expected outcome
of_________________ would be appropriate for this client.

a) client stops seeking information


b) client doesn’t guess at prognosis
c) client verbalizes feelings of anxiety
d) client uses any effective method to reduce tension

45. Mrs. Ingram is reviewed by the gynecologist. After examining her, the physician diagnosed
her with stage II Cervical Cancer. The nurse reviews the client’s history for risk factors of
this disease. From the findings the nurse infers that _____________________ is a risk factor
for Cervical Cancer.

a) spontaneous abortion at age 19


b) human papillomavirus infection at age 32
c) onset of sporadic sexual activity at age 17
d) pregnancy complicated with eclampsia at age 27
46. In assessing Mrs. Ingram, the nurse found that she has radium implants for treatment of her
Cervical Cancer. As a knowledgeable student, you know that_________________ is the
order of activity for her.

a) bed rest
b) out of bed ad lib
c) out of bed in a chair only
d) ambulation to the bathroom only

47. While giving care, the nurse finds the radiation implant of the patient in the bed. A nursing
diagnosis that would be applicable to this situation is__________________.

a) Infection related to handling radiation implants


b) Risk for injury related to the effects of radiation
c) Knowledge deficit regarding the effects of iridium
d) Impaired skin integrity related to radiation implants

48. Two days post admission, sister collected information from Mrs. Ingram’s chart: it reads
Esophageal Reflux Disease, medicate with Rocephin 12 mg/kg p.o. q 12 hours. Available is
Rocephin 1g/10 ml. She currently weighs 110 lbs, from this assessment you would
give_____________________ of the drug.

a) 6 mLs
b) 3 mLs
c) 6.6 mLs
d) 0.6 mLs

49. When looking at the factors which would have contributed to Mrs. Ingram’s Cervical
Cancer, student nurse Brown recognizes that _____________________ would not have been
a factor in her diagnosis.

a) HIV infection, smoking


b) micronutrient deficiency
c) a history of genital warts
d) a high socioeconomic status

50. The ward manager asks you to plan an interactive session for Mrs. Ingram relating to her the
epidemiology and incidence of Cervical Cancer. You would inform Mrs. Ingram
that_______.

a) most cases occur in the developing world


b) worldwide it is the most common malignancy in women
c) it is most commonly diagnosed in the third to fourth decade of life
d) it is generally a problem that occurs predominantly in United State
SECTION B
Essay Questions (40 marks)

Instructions: Please write clearly on the ruled sheets provided, both questions are
compulsory

Scenario I

Eighteen year old Adonijah Nkrumah was rushed to the hospital by his mother with history of lower right
quadrant pain; same was crushing since 3 hours ago. On Assessment, young male lying on bed (in supine
position), conscious, responsive, coherent, not in respiratory distress, complained of abdominal pain to his
right lower quadrant, facial grimacing noted. His skin turgor felt moist, a bit diaphoretic, he was irritable and
his face flushed. Pain was rated at 8/10 and family member stated he could not walk because he was too
weak. He had an Intravenous Infusion of Dextrose 5% in Lactated Ringers 1L ( at 500 ml receiving level)
regulated @ 20 gtts/min infusing well @ left metacarpal vein and with the following vital signs: T 38.1C;
PR: 73bpm; RR19bpm, B/P 110/70mmHg. He was seen by doctor and a diagnosis of Ruptured
Appendicitis was made. He is scheduled to have surgery in 6 hours.

Utilizing the nursing process construct a Nursing Care Plan for Mr. Nkrumah under the
following headings:

a) Preoperatively: Pain reduction measures (8pts)


b) Post-operatively: Infection control (7pts)
c) Temperature regulation (5pts)

20 mark
Scenario II

Mrs. James a 45 year old mother of two children did a Total Mastectomy of the right breast four
(4) hours ago and returned to the ward with a dressing and hemovac draining system in place.
She is complaining of discomfort to the surgical area as well as an inability to use her right arm.
She is concerned about her ability to carry out her activities of daily living when she is
discharged from hospital.

Using the scenario above justify post-operative Nursing Interventions along with Rationales
under the following needs:

a) Comfort (8 pts)
b) Fluid Volume Deficit (7pts)
c) Discharge Teaching/Lifestyle (5pts)

20 marks

End of Examinations