Surgical II and Paediatric II UHPAB 2025
UGANDA HEALTH PROFESSIONS ASSESSMENT BOARD (UHPAB)
Certificate in Nursing - Surgical Nursing II & Paediatric Nursing II (CN 222)
June 2025
Duration: 3 Hours
SECTION A: OBJECTIVE QUESTIONS
20 Marks
1. The manifestation of thyroid hyperfunction includes systolic
(a) hypertension. ✓
(b) hypotension.
(c) hypertrophy.
(d) hypotrophy.
Hyperthyroidism increases metabolic rate and sympathetic nervous system activity, directly causing increased cardiac output, resulting in isolated systolic hypertension.
2. Which of the following equipment is used to inspect the urinary bladder?
(a) Laparoscope.
(b) Uroscope.
(c) Cystoscope. ✓
(d) Urescope.
A cystoscope is a specialized endoscope passed through the urethra into the bladder (cysto = bladder, scope = to look) to directly visualize the bladder lining.
3. Treatment of advanced breast cancer falls under
(a) Palliative medicine. ✓
(b) Occupational therapy.
(c) Recreational therapy.
(d) Herbal therapy.
When cancer becomes advanced (metastatic) and is no longer curable, care transitions to palliative medicine to manage pain, symptoms, and improve quality of life.
4. Which of the following measures helps in preventing cancer of the prostate?
(a) Regular screening. ✓
(b) Using drugs.
(c) Circumcision.
(d) Avoiding multiple partners.
While technically secondary prevention, regular screening (PSA and Digital Rectal Exams) is the most clinically recognized measure for preventing the progression of prostate cancer by catching it early.
5. During physical examination the nurse who discovers an orange peel like appearance on the breast of her client records this as
(a) peel de orange.
(b) peau d'orange. ✓
(c) orange appearance.
(d) web like appearance.
"Peau d'orange" (French for skin of an orange) occurs due to cutaneous lymphatic edema and is a classic, ominous sign of inflammatory breast cancer.
6. In which of the following conditions does the nurse warn patients of a high risk of developing ano fistula?
(a) Chronic constipation.
(b) A foreign body in the rectum.
(c) Anorectal abscess. ✓
(d) Itching.
Almost all anal fistulas are the direct consequence of a previous, poorly healed or surgically drained anorectal abscess that leaves a persistent infectious tract.
7. Which of the following features does a nurse closely monitor a patient for following a thyroidectomy?
(a) Hypotension.
(b) Headache.
(c) Urinary retention.
(d) Respiratory distress. ✓
Post-thyroidectomy patients are at extremely high risk for airway compromise due to localized tissue edema, hemorrhage/hematoma formation, or bilateral recurrent laryngeal nerve damage.
8. Twisting of intestines is medically referred to as
(a) intussusception.
(b) volvulus. ✓
(c) obstruction.
(d) herniation.
A volvulus occurs when a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction and life-threatening ischemia.
9. Which of the following activities is most appropriate for a child with severe heart disease?
(a) Playing video games.
(b) Reading a book. ✓
(c) Riding a bicycle.
(d) Dancing gently.
Reading a book is a quiet, sedentary activity that imposes the least amount of metabolic demand and cardiac workload on a child with severe heart disease.
10. While assessing for consciousness, the nurse is aware that the highest motor response is scored
(a) 3.
(b) 4.
(c) 5.
(d) 6. ✓
In the Glasgow Coma Scale (GCS), the best motor response is scored from 1 (no response) to 6 (obeys verbal commands perfectly).
11. While on ward round the student nurse learns that the patient has blood in the pleural cavity, and records this in her note book as
(a) empyema.
(b) haemothorax. ✓
(c) pleural effusion.
(d) pneumothorax.
Haemo = blood, thorax = chest. A haemothorax is a collection of blood within the pleural space, often secondary to chest trauma or surgery.
12. Bone fragility arises from
(a) Fractures.
(b) Osteogenesis imperfecta. ✓
(c) Osteomyelitis.
(d) Sickle cells.
Osteogenesis imperfecta (Brittle Bone Disease) is a genetic disorder characterized by defective collagen synthesis, leading to severe bone fragility and frequent fractures.
13. The WHO classification of dehydration excludes .............................. dehydration.
(a) no.
(b) some.
(c) moderate. ✓
(d) severe.
The modern WHO IMCI (Integrated Management of Childhood Illness) guidelines classify dehydration into exactly three categories: No dehydration, Some dehydration, and Severe dehydration. "Moderate" is excluded.
14. Protrusion of meninges with brain substance through a bony defect in the skull is referred to as
(a) anencephaly.
(b) spinal bifida.
(c) encephalocele. ✓
(d) hydrocephalus.
An encephalocele is a rare neural tube defect characterized by sac-like protrusions of the brain and the membranes that cover it through openings in the skull.
15. Children reporting with temporary cessation of breathing for 20 minutes or more are recorded to have
(a) Tarchycardia.
(b) Apnoea. ✓
(c) Hypoxia.
(d) Asphyxia.
Correction Note: The exam paper states "20 minutes", which is a typographical error. Clinically, apnea is defined as the cessation of breathing for 20 seconds or longer, or accompanied by bradycardia/cyanosis.
16. Which of the following is the most appropriate nursing intervention for a new born with difficulty in breathing?
(a) Suctioning and ventilation. ✓
(b) Kangaroo care.
(c) Keeping the baby warm.
(d) Drying the baby.
According to neonatal resuscitation guidelines (HBB), if a newborn is not breathing well after initial drying and stimulation, clearing the airway (suctioning if meconium/secretions) and providing positive pressure ventilation is the priority.
17. The most wide spread condition affecting the health of children in Uganda is
(a) low birth weight.
(b) parasitic infections. ✓
(c) poisoning.
(d) malnutrition.
While malnutrition is extremely prevalent, parasitic infections (specifically Malaria and soil-transmitted helminths) are the absolute leading cause of outpatient visits and widespread morbidity among children in Uganda.
18. Which of the following interventions is ideal for managing an eye of a 5 year old with chemical splashes?
(a) Flush the eye with clean water. ✓
(b) Let the eye tear to wash the chemical out.
(c) Cover the eye with a loose moist dressing.
(d) Apply tetracycline eye ointment.
Immediate, copious, and prolonged irrigation (flushing) with clean water or saline is the critical first-aid treatment to dilute and remove the chemical before irreversible corneal damage occurs.
19. Which of the following signs and symptoms is seen in patients with bronchial asthma disease?
(a) Expiratory wheezing. ✓
(b) Inspiratory wheezing.
(c) Crackles.
(d) Stridor.
Asthma causes lower airway bronchoconstriction. Since the airways naturally narrow during expiration, air forced through these narrowed passages produces a classic expiratory wheeze.
20. The priority nursing intervention for a baby admitted in a painful sickle cell crisis is administering
(a) antibiotics.
(b) analgesics. ✓
(c) relaxants.
(d) sedatives.
A vaso-occlusive sickle cell crisis causes excruciating, ischemic pain. Immediate and aggressive pain management (analgesics) alongside hydration and oxygenation is the absolute priority.
SECTION A: FILL IN THE BLANK SPACES
10 Marks
21. Coughing up blood is known as...
→ HAEMOPTYSIS
→ HAEMOPTYSIS
22. Injuries caused by hot liquids are referred to as...
→ SCALDS
→ SCALDS
23. A congenital absence of the cranial vault is called...
→ ANENCEPHALY
→ ANENCEPHALY
24. Inflammation of the middle ear in children is known as...
→ OTITIS MEDIA
→ OTITIS MEDIA
25. The commonest type of fracture in children characterised by cracks on only one side of the bone is called...
→ GREENSTICK FRACTURE
→ GREENSTICK FRACTURE
26. A collection of pus in the pleural cavity is called...
→ EMPYEMA
→ EMPYEMA
27. Excessive thickening of scar tissue is known as...
→ KELOID (OR HYPERTROPHIC SCAR)
→ KELOID (OR HYPERTROPHIC SCAR)
28. Surgical removal of a thrombus is called...
→ THROMBECTOMY
→ THROMBECTOMY
29. Surgical removal of necrotic tissue in the bone is referred to as...
→ SEQUESTRECTOMY
→ SEQUESTRECTOMY
30. Gall stone formation is known as...
→ CHOLELITHIASIS
→ CHOLELITHIASIS
SECTION B: SHORT ESSAY QUESTIONS
20 Marks
Question 31: Breast Cancer and Surgical Oncology (10 Marks)
(a) List five (5) signs and symptoms of breast cancer (5 marks):
- Palpable Lump: A painless, hard, and irregular mass or thickening in the breast or underarm tissue.
- Skin Changes (Peau d'orange): Dimpling, puckering, or an orange-peel texture on the skin over the breast.
- Nipple Abnormalities: Sudden nipple inversion, retraction, or persistent pain/scaling of the nipple.
- Abnormal Discharge: Spontaneous, clear, or bloody discharge originating from the nipple.
- Breast Asymmetry: A sudden or unexplained change in the size, shape, or contour of one breast compared to the other.
(b) List five (5) surgical procedures performed in the treatment of cancer (5 marks):
- Mastectomy: Surgical removal of the entire breast tissue to eradicate malignant breast tumors.
- Prostatectomy: Surgical excision of the prostate gland to treat localized prostate cancer.
- Colectomy: Resection of a portion of the large intestine (colon) to remove bowel malignancies.
- Lobectomy: Removal of an entire lobe of the lung to treat early-stage lung carcinomas.
- Hysterectomy: Complete surgical removal of the uterus to treat uterine or cervical cancers.
Question 32: Paediatric Apnoea (10 Marks)
(a) List five (5) causes of apnoea in neonates (5 marks):
- Prematurity: Immaturity of the central nervous system respiratory center is the leading cause (Apnea of Prematurity).
- Hypoxia/Asphyxia: Lack of oxygen before, during, or immediately after birth depressing the respiratory drive.
- Neonatal Sepsis: Systemic bacterial infections causing metabolic collapse and respiratory depression.
- Hypoglycemia: Dangerously low blood sugar levels depriving the brain of essential energy to stimulate breathing.
- Intracranial Hemorrhage: Bleeding within the brain (often trauma or prematurity-related) increasing pressure on the respiratory centers.
(b) Outline five (5) signs and symptoms of apnoea in children (5 marks):
- Cessation of Breathing: Complete lack of respiratory effort for 20 seconds or longer.
- Cyanosis: A bluish discoloration of the lips, face, and extremities due to severe oxygen desaturation.
- Bradycardia: A sudden, dangerous drop in heart rate corresponding to the lack of oxygen.
- Hypotonia: The child becomes completely limp or floppy, indicating loss of muscle tone from hypoxia.
- Unresponsiveness: The infant fails to respond to tactile stimulation (like rubbing the back or flicking the soles).
SECTION C: LONG ESSAY QUESTIONS
60 Marks
Question 33: Thyrotoxicosis & Thyroidectomy Care (25 Marks)
(a) List five (5) clinical features a 60-year-old admitted with thyrotoxicosis may present with (5 marks):
- Tachycardia and Palpitations: A rapid, irregular resting heart rate or bounding pulse.
- Severe Heat Intolerance: Excessive sweating and feeling uncomfortably hot in normal climates.
- Paradoxical Weight Loss: Rapid and unexplained loss of body mass despite an increased, voracious appetite.
- Neurological Tremors: Noticeable fine trembling of the hands and fingers at rest.
- Exophthalmos: Bulging of the eyes resulting in a wide-eyed, staring appearance (specific to Graves' disease).
(b) List five (5) predisposing factors to thyrotoxicosis (5 marks):
- Autoimmune Disorders: Conditions like Graves' disease where antibodies overstimulate the thyroid.
- Genetic/Family History: A strong familial link to thyroid disorders increases susceptibility.
- Excessive Iodine Intake: Consuming too much iodine (dietary or via contrast media) triggering hypersecretion.
- Toxic Multinodular Goiter: The presence of autonomously functioning nodules within the thyroid gland.
- Female Gender: Women are significantly more susceptible to developing hyperthyroidism than men.
(c) Outline fifteen (15) post-operative nursing care interventions implemented for a patient within 24 hours of thyroidectomy (15 marks):
- Airway Maintenance: Keep a tracheostomy tray and suction equipment at the bedside at all times in case of sudden airway collapse.
- Positioning: Nurse the patient in a Semi-Fowler’s position to decrease edema and promote venous drainage from the neck.
- Head/Neck Support: Use pillows/sandbags to support the head, avoiding hyperextension which strains the suture line.
- Monitor Respiratory Status: Assess continuously for stridor, dyspnea, or oxygen desaturation indicating airway obstruction.
- Assess for Bleeding: Check the anterior dressing and physically palpate behind the patient's neck/shoulders for dependent blood pooling.
- Voice Assessment: Ask the patient to speak every 2 hours to assess for hoarseness (indicating recurrent laryngeal nerve damage).
- Monitor for Hypocalcemia: Check for numbness/tingling around the mouth and perform Chvostek's/Trousseau's tests to detect parathyroid injury.
- Administer Calcium Gluconate: Have emergency IV calcium available to treat sudden tetany.
- Pain Management: Administer prescribed analgesics to manage surgical pain and ensure patient comfort.
- Vital Sign Monitoring: Check BP, HR, and temperature frequently to detect post-op hemorrhage or thyroid storm.
- Wound Care: Observe the surgical incision for signs of excessive swelling, hematoma formation, or tight dressing.
- Administer IV Fluids: Maintain continuous hydration until the patient can safely tolerate oral fluids without aspiration.
- Promote Calm Environment: Reduce sensory stimulation and strictly limit visitors to promote healing and reduce stress.
- Dietary Management: Introduce clear, cool liquids first once the swallowing reflex returns, progressing to soft foods.
- Emotional Support: Reassure the patient regarding transient voice changes and provide psychological support to alleviate anxiety.
Question 34: Childhood Pneumonia (25 Marks)
(a) List four (4) causative organisms of pneumonia in children (4 marks):
- Streptococcus pneumoniae: The leading bacterial cause of typical community-acquired pneumonia.
- Haemophilus influenzae type b (Hib): A significant bacterial pathogen, particularly in unimmunized populations.
- Respiratory Syncytial Virus (RSV): The most common viral cause of lower respiratory tract infections in early childhood.
- Staphylococcus aureus: A severe bacterial cause, often occurring secondary to a viral illness.
(b) Outline six (6) signs and symptoms of a four-year-old child with pneumonia (6 marks):
- Tachypnea (Fast Breathing): Respiratory rate significantly above normal for age (e.g., >40 breaths/min for a 4-year-old).
- Lower Chest Wall Indrawing: The lower rib cage pulls inwards during inspiration, indicating severe respiratory distress.
- Productive Cough: A persistent, wet cough often producing purulent or rust-colored sputum.
- High-Grade Fever: Sudden onset of high temperature, often accompanied by chills and rigors.
- Nasal Flaring and Grunting: Widening of the nostrils and a grunting sound on expiration as the child struggles to keep alveoli open.
- Lethargy and Poor Feeding: The child appears extremely exhausted, stops playing, and refuses food or drink.
(c) Outline fifteen (15) interventions implemented while managing a 4-year-old with pneumonia, within 12 hours of admission (15 marks):
- Administer Oxygen: Immediately apply humidified oxygen via nasal prongs or mask to correct hypoxia (maintaining SpO2 >94%).
- Prop up the Child: Nurse the child in a high-Fowler’s or propped-up position to maximize lung expansion and ease work of breathing.
- Administer IV Antibiotics: Promptly give the first dose of prescribed broad-spectrum antibiotics (e.g., Ceftriaxone) to halt bacterial replication.
- Monitor Vital Signs: Perform hourly checks of respiratory rate, heart rate, temperature, and oxygen saturation.
- Administer Antipyretics: Give Paracetamol to reduce high fever, lowering the child's metabolic and oxygen demands.
- Tepid Sponging: Apply lukewarm water to the forehead and armpits if the fever is dangerously high and unresponsive to drugs.
- Ensure Hydration: Initiate IV fluids cautiously to prevent dehydration while avoiding fluid overload that could worsen pulmonary edema.
- Clear the Airway: Perform gentle nasal suctioning if thick secretions are obstructing the upper airway.
- Encourage Oral Fluids: Once breathing stabilizes, offer small, frequent sips of water or breastmilk/formula to keep secretions thin.
- Maintain Warmth: Ensure the child is appropriately clothed and the ward is warm, as hypothermia exacerbates respiratory distress.
- Provide Nutritional Support: Offer a light, easily digestible, high-calorie meal once the child's respiratory rate drops and aspiration risk decreases.
- Promote Rest: Cluster nursing care and minimize painful procedures to allow the exhausted child uninterrupted sleep.
- Administer Bronchodilators: Give prescribed nebulized Salbutamol if significant wheezing or bronchospasm is auscultated.
- Monitor Fluid Balance: Accurately record intake and output (wet diapers) to assess renal perfusion and hydration status.
- Support the Parents: Explain the treatment plan clearly to the anxious parents, involving them in basic care to reduce their fear.