UGANDA HEALTH PROFESSIONS ASSESSMENT BOARD
Medical Nursing II and Pharmacology II (Paper Code: CN 221)
Certificate in Nursing - Year 2, Semester 2
SECTION A: OBJECTIVE QUESTIONS
20 Marks
1. Which of the following findings is associated with glomerulonephritis?
Glomerulonephritis typically presents with hypertension, edema, hematuria, and proteinuria due to sodium/fluid retention and renin-angiotensin system activation.
2. The most common risk factor for urethritis is
Urethritis is predominantly infectious in origin, most commonly caused by sexually transmitted pathogens like Neisseria gonorrhoeae and Chlamydia trachomatis.
3. Which of the following is a priority nursing action for a patient with meningitis?
Due to altered mental status, confusion, and a high risk of sudden seizures from increased intracranial pressure, ensuring physical safety (protecting from falls/injury) is a paramount nursing priority.
4. Which of the following interventions does the nurse perform first, after receiving a patient who is unconscious?
Following the fundamental ABCs of emergency resuscitation (Airway, Breathing, Circulation), establishing and maintaining a patent airway is always the absolute first step.
5. The most important predisposing cause of stroke is
Chronic hypertension is universally recognized as the single most critical and modifiable risk factor for both ischemic and hemorrhagic strokes.
6. The purpose of a diet therapy in the management of type 1 diabetes is to
In Type 1 Diabetes, medical nutrition therapy aims to balance food intake with insulin therapy to achieve near-normal glucose metabolism and prevent acute complications.
7. The most important intervention for prevention of hyperglycaemia involves
Infections induce a physiological stress response, releasing cortisol and epinephrine, which profoundly raise blood glucose levels and can easily precipitate Diabetic Ketoacidosis (DKA).
8. The most appropriate nursing intervention for exophthalmos is to
Severe exophthalmos prevents full eyelid closure. Taping the lids shut at night and providing artificial tears protects the exposed sclera and cornea from drying and dangerous ulceration.
9. While managing a patient with acute thyrotoxicosis, the nurse prioritises administering medication that
A thyrotoxic crisis (thyroid storm) is life-threatening. The definitive, prioritized pharmacological action is administering antithyroid drugs to halt the synthesis and release of toxic hormone levels.
10. In which of the following conditions will the patient definitely present with anasarca?
Nephrotic syndrome causes massive proteinuria leading to profound hypoalbuminemia. The resulting drop in oncotic pressure causes fluid to shift into tissues, creating generalized massive edema (anasarca).
11. Which of the following interventions does the nurse implement when she/he notes coolness and edema at the patient's intravenous access site?
Coolness, pallor, and swelling indicate IV infiltration. The immediate primary action is to stop the infusion and remove the catheter to prevent further tissue distension or necrosis.
12. Which of the following symptoms is typical of gastric ulcer?
Unlike duodenal ulcers which are often relieved by eating, gastric ulcer pain is typically exacerbated 30-60 minutes after meals due to the increased production of stomach acid irritating the raw lesion.
13. Exophthalmos is a cardinal sign in
Protruding, bulging eyeballs (exophthalmos) are a classic hallmark sign of Graves' disease, which is the leading autoimmune cause of thyrotoxicosis (hyperthyroidism).
14. Which of the following medications is used in the management of a patient in diabetic coma?
Soluble (Regular) insulin is the only formulation that is safe and effective to administer intravenously to rapidly lower dangerously high blood glucose levels during a diabetic crisis.
15. The drug of choice nurses administer in the management of thyrotoxicosis is
Carbimazole is an antithyroid agent widely used as the primary pharmacological treatment to decrease thyroid hormone synthesis in patients with hyperthyroidism.
16. The antidote nurses administer in a patient who has suffered an opioid overdose is
Naloxone (Narcan) is a fast-acting opioid receptor antagonist that rapidly reverses the deadly respiratory and central nervous system depression caused by opioid toxicity.
17. Which of the following medicines is an angiotensin converting enzyme inhibitor?
Drugs ending in the suffix "-pril" (like Captopril, Enalapril, Lisinopril) belong to the ACE inhibitor class, used primarily to treat hypertension and heart failure.
18. For which of the following administered drugs does the nurse warn the patient of nephrotoxicity and ototoxicity?
Gentamicin is an aminoglycoside antibiotic. This entire class carries severe, well-documented risks of causing permanent hearing loss (ototoxicity) and kidney damage (nephrotoxicity).
19. Which of the following drugs do nurses specifically administer while caring for patients with cryptococcal meningitis?
Cryptococcal meningitis is caused by a fungus, frequently affecting immunocompromised (HIV/AIDS) patients. It requires aggressive intravenous antifungal therapy, primarily Amphotericin B.
20. Which of the following drugs is used in management of malignant diseases?
Methotrexate is a potent antimetabolite chemotherapeutic agent used to aggressively treat various cancers, including leukemias, lymphomas, and breast cancer.
SECTION A: FILL IN THE BLANK SPACES
10 Marks
21. Inflammation of the stomach is referred to as:
→ GASTRITIS
→ GASTRITIS
22. Formation of stones in the gall bladder is referred to as:
→ CHOLELITHIASIS
→ CHOLELITHIASIS
23. A positive Bruzinski's sign is seen in a condition called:
→ MENINGITIS
→ MENINGITIS
24. Patients complaining of pelvic and abdominal pain, frequency of urination and dyspareunia may be suffering from:
→ PELVIC INFLAMMATORY DISEASE (PID) / CYSTITIS
→ PELVIC INFLAMMATORY DISEASE (PID) / CYSTITIS
25. Diabetic patients experience loss of energy due to:
→ LACK OF INSULIN (INABILITY TO UTILIZE GLUCOSE)
→ LACK OF INSULIN (INABILITY TO UTILIZE GLUCOSE)
26. The drug that causes discolouring and displacement of calcium from the teeth and bones is called:
→ TETRACYCLINE
→ TETRACYCLINE
27. The most feared complication of isoniazid is:
→ HEPATOTOXICITY (LIVER DAMAGE)
→ HEPATOTOXICITY (LIVER DAMAGE)
28. Penicillins are mostly contra indicated in patients due to:
→ HYPERSENSITIVITY / ALLERGY
→ HYPERSENSITIVITY / ALLERGY
29. Drugs given to induce defecation are called:
→ LAXATIVES / CATHARTICS
→ LAXATIVES / CATHARTICS
30. Yellowing of the skin and mucous membrane is referred to as:
→ JAUNDICE / ICTERUS
→ JAUNDICE / ICTERUS
SECTION B: SHORT ESSAY QUESTIONS
10 Marks
Question 31: Nephrotic Syndrome & Analgesics
(a) Outline five (5) clinical features of Nephrotic syndrome (5 marks):
- Massive Proteinuria: The hallmark sign, characterized by large amounts of protein (specifically albumin) leaking into the urine.
- Severe Generalized Edema (Anasarca): Swelling that often starts in the periorbital area (around the eyes) in the morning and progresses to the extremities and abdomen.
- Hypoalbuminemia: Low levels of albumin in the blood serum caused by the excessive urinary losses, directly triggering the fluid shift into tissues.
- Hyperlipidemia: Elevated blood cholesterol and triglycerides as the liver ramps up lipid production in response to falling protein levels.
- Lipiduria / Frothy Urine: The presence of fats in the urine and high protein content gives the patient's urine a distinctively frothy or foamy appearance.
(b) List five (5) examples of analgesics (5 marks):
- Paracetamol (Acetaminophen): A widely used non-opioid analgesic and antipyretic for mild to moderate pain.
- Ibuprofen: A Non-Steroidal Anti-Inflammatory Drug (NSAID) effective for pain, fever, and inflammation.
- Diclofenac: A potent NSAID frequently prescribed for joint, muscle, or post-operative inflammatory pain.
- Morphine: A strong opioid narcotic used to treat severe, acute, or chronic pain (such as in trauma or cancer).
- Tramadol: A centrally acting synthetic opioid analgesic used for moderate to moderately severe pain.
Question 32: Stomatitis & Renal Failure
(a) Outline five (5) causes of stomatitis (5 marks):
- Pathogenic Infections: Fungal infections like oral thrush (Candida albicans) or viral infections such as Herpes Simplex Virus causing cold sores.
- Nutritional Deficiencies: Lack of essential vitamins and minerals, specifically Vitamin B12, Folic acid, Vitamin C, or Iron, leading to mucosal breakdown.
- Mechanical Trauma or Poor Hygiene: Ill-fitting dentures, jagged teeth, accidental biting, or neglecting oral care leading to irritation and inflammation.
- Chemical Irritants: Frequent use of strong tobacco, excessive alcohol consumption, or eating overly spicy/acidic foods that burn the oral mucosa.
- Medication Side Effects: Cytotoxic chemotherapy drugs and head/neck radiation therapy frequently attack rapidly dividing mucosal cells, causing severe ulcers.
(b) Outline five (5) predisposing factors to renal failure (5 marks):
- Chronic Uncontrolled Hypertension: Prolonged high blood pressure damages the delicate blood vessels in the kidneys, reducing their filtering ability.
- Uncontrolled Diabetes Mellitus: Chronically high blood sugar damages the nephrons over time (Diabetic Nephropathy), making it a leading cause of renal disease.
- Severe Dehydration or Hemorrhage: Conditions leading to profound hypovolemia or shock drastically reduce renal perfusion, causing Acute Kidney Injury (AKI).
- Nephrotoxic Medications: Overuse of NSAIDs (like Ibuprofen), certain antibiotics (Aminoglycosides), or IV contrast dyes can directly poison renal tubules.
- Urinary Tract Obstruction: Conditions such as large kidney stones, tumors, or Benign Prostatic Hyperplasia (BPH) that block urine flow and cause backward pressure damage.
SECTION C: LONG ESSAY QUESTIONS
50 Marks
Question 33: Bacterial Meningitis (25 Marks)
(a) State five (5) signs and symptoms of meningitis (5 marks):
- Nuchal Rigidity: Extreme stiffness in the neck, making it painful or impossible to touch the chin to the chest.
- Sudden High Fever: A rapid onset of significantly elevated body temperature accompanied by chills.
- Severe, Unrelenting Headache: A massive, diffuse pain caused by the inflammation of the meninges and increased intracranial pressure.
- Photophobia: Extreme sensitivity to light, causing the patient to actively seek dark environments.
- Altered Mental Status: Ranging from mild confusion and irritability to extreme lethargy, stupor, or coma.
(b) Describe the management of a patient with bacterial meningitis for the first 48 hours of admission (15 marks):
- Immediate Isolation: The nurse must place the patient in respiratory/droplet isolation for at least the first 24 hours of antibiotic therapy to prevent disease transmission.
- Establish Airway and Oxygenation: Ensure the airway is patent, especially if the patient's sensorium is altered, and provide supplemental oxygen to meet high metabolic demands.
- Prompt Antibiotic Administration: Obtain blood and CSF cultures stat, then immediately administer broad-spectrum IV antibiotics (e.g., Ceftriaxone) without delay to cross the blood-brain barrier.
- Strict Neurological Monitoring: Assess the patient hourly using the Glasgow Coma Scale (GCS), evaluating pupil size and reactivity to catch early signs of brain herniation or rising Intracranial Pressure (ICP).
- Environmental Control: Keep the room dark, quiet, and restrict visitors to minimize sensory stimulation, which can aggravate the severe headache and photophobia.
- Seizure Precautions: Pad the side rails of the bed, maintain suction equipment at the bedside, and be prepared to administer anticonvulsants (like Diazepam) if a seizure occurs.
- Optimal Positioning: Elevate the head of the bed to 30 degrees and keep the patient's neck in a neutral midline position to promote cerebral venous drainage and lower ICP.
- Fluid and Electrolyte Management: Carefully regulate IV fluid intake. Restrict fluids slightly to prevent exacerbating cerebral edema, and monitor for Syndrome of Inappropriate Antidiuretic Hormone (SIADH).
- Fever Management: Administer prescribed antipyretics (Paracetamol) and apply tepid sponging to safely bring down high fever, reducing the brain's metabolic oxygen requirement.
- Administer Corticosteroids: Give IV Dexamethasone, ideally shortly before or concurrent with the first antibiotic dose, to dramatically reduce meningeal inflammation and prevent sensorineural hearing loss.
(c) State five (5) complications of meningitis (5 marks):
- Sensorineural Hearing Loss: Permanent deafness due to damage to the 8th cranial nerve.
- Seizure Disorders: Development of chronic epilepsy resulting from cortical scarring.
- Hydrocephalus: Buildup of cerebrospinal fluid within brain ventricles due to blocked absorption pathways.
- Cognitive Impairment: Long-term mental retardation, learning disabilities, or memory deficits.
- Motor Deficits: Paralysis, hemiparesis, or the development of cerebral palsy due to brain tissue damage.
Question 34: Pharmacology - PUD, Bisacodyl, and Specific Drugs (25 Marks)
(a) With at least one example, state five classes of drugs used in management of peptic ulcer disease (5 marks):
- Proton Pump Inhibitors (PPIs): Block the final step of acid production. Example: Omeprazole, Pantoprazole.
- Histamine-2 (H2) Receptor Antagonists: Decrease acid secretion by blocking H2 receptors. Example: Ranitidine, Cimetidine.
- Antacids: Chemically neutralize existing stomach acid. Example: Magnesium hydroxide, Aluminum hydroxide.
- Mucosal Protectants: Form a protective physical barrier over the ulcer crater. Example: Sucralfate, Bismuth subsalicylate.
- Antibiotics: Eradicate the Helicobacter pylori bacteria causing the ulcer. Example: Amoxicillin, Clarithromycin, Metronidazole.
(b) Outline five (5) important pieces of information the nurse shares with a patient on bisacodyl (5 marks):
- Method of Administration: Instruct the patient to swallow the enteric-coated tablets completely whole; they must not be crushed, chewed, or broken to prevent severe stomach irritation.
- Interaction Warnings: Warn the patient strictly against taking the medication within 1 hour of consuming milk, dairy products, or antacids, as these dissolve the protective coating prematurely.
- Expected Onset of Action: Explain that bowel movements generally occur 6 to 12 hours after oral administration, so it is most practical to take the dose at bedtime for a morning effect.
- Risk of Dependency: Educate the patient that bisacodyl should only be used for short-term relief (less than 1 week); chronic use leads to laxative dependence and loss of normal bowel tone.
- Potential Side Effects: Inform the patient to expect possible mild abdominal cramping, nausea, or diarrhea, and advise them to increase water intake to prevent dehydration.
(c) State the class, average adult dose, two indications and two side effects of:
(i) Propranolol (5 marks):
- Class: Non-selective Beta-Adrenergic Blocker.
- Adult Dose: 40 mg to 160 mg daily (in divided oral doses, depending on condition).
- Indications: Management of Hypertension, Angina pectoris prophylaxis, control of Thyrotoxicosis tremors.
- Side Effects: Bradycardia, bronchospasm (dangerous in asthmatics), fatigue, hypotension.
- Class: Loop Diuretic.
- Adult Dose: 20 mg to 80 mg orally once or twice daily (or given IV in emergencies).
- Indications: Management of acute pulmonary edema, edema associated with Congestive Heart Failure, Hypertension.
- Side Effects: Hypokalemia (low potassium), severe dehydration, hypotension, ototoxicity.
- Class: Nitrate / Vasodilator.
- Adult Dose: Sublingual tablet: 0.3 to 0.6 mg every 5 minutes during an attack (up to a maximum of 3 doses).
- Indications: Acute relief of Angina pectoris attacks, prophylaxis of angina, acute decompensated heart failure.
- Side Effects: Severe throbbing headache, postural hypotension, reflex tachycardia, dizziness.