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Diploma in Nursing · 2022
UGANDA NURSES AND MIDWIVES EXAMINATIONS BOARD
Diploma in Nursing (Extension) – Paper Code: DNE 112
Medical Nursing III
SECTION A: OBJECTIVE QUESTIONS 20 Marks
1. The most common cause of glomerulonephritis is
Explanation: Acute glomerulonephritis is most commonly a post-infectious autoimmune response triggered specifically by Group A Beta-Hemolytic Streptococcus (GABHS), often following a throat or skin infection.
2. When planning a diet for a patient with renal failure, the nurse remembers to include
Explanation: In renal failure (pre-dialysis), the kidneys cannot excrete nitrogenous wastes (urea). Therefore, dietary protein must be strictly limited. However, to prevent the body from breaking down its own muscles for energy (which would release more nitrogenous waste), the diet must provide adequate overall calories primarily sourced from high carbohydrates.
3. The nurse suspects a client who complains of excessive thirst and passing a large volume of very dilute urine to be suffering from
Explanation: A deficiency of Anti-Diuretic Hormone (ADH) leads to Diabetes Insipidus, characterized by the kidneys’ absolute inability to concentrate urine. This results in extreme polyuria (passing massive amounts of very dilute urine) and severe compensatory polydipsia (excessive thirst).
4. The goal of care when treating a patient with diabetes mellitus is to
Explanation: Regardless of whether a patient has Type 1 or Type 2 Diabetes, or which specific medications are used (insulin vs. oral hypoglycemics), the ultimate, overarching clinical goal of all treatment regimens is to achieve and strictly control blood glucose levels to prevent long-term systemic complications.
5. Which of the following findings does a nurse expect to find on assessment of a patient with rheumatoid arthritis?
Explanation: A classic, hallmark symptom of Rheumatoid Arthritis is severe early morning joint pain and stiffness that uniquely lasts for more than 1 hour after waking up. It causes decreased range of motion and severe joint swelling, invalidating the other options.
6. Which of the following is NOT associated with osteoporosis?
Explanation: Osteoporosis causes fragile bones, leading to fractures (c) and severe back pain from spinal compression (b). A sedentary lifestyle (a) is a massive risk factor. Urinary stones (d) are associated with gout or primary hyperparathyroidism, but are not a direct, classical feature or association of osteoporosis itself.
7. Which of the following is NOT true about stroke?
Explanation: Strokes (Cerebrovascular Accidents) present with sudden neurological deficits: facial drooping, arm/leg numbness, aphasia (trouble speaking), and sudden vision loss. Sudden epigastric (abdominal) pain is highly indicative of gastrointestinal issues or atypical Myocardial Infarction, not a stroke.
8. A nurse records a blood clot, fat globule or gas bubble created in part of the body that circulates in the blood stream as
Explanation: A thrombus is a blood clot that forms and remains attached to the wall of a blood vessel. When a piece of that clot (or a fat globule/air bubble) breaks off and freely circulates through the bloodstream, it is medically termed an embolus.
9. Dwarfism is an inherited deficiency of growth hormone with the absence of
Explanation: Somatotropin is the medical term for human Growth Hormone (GH), which is secreted by the anterior pituitary gland. Pituitary dwarfism specifically results from an absolute absence or severe deficiency of this specific hormone.
10. Which of the following nursing actions is specific to a patient with meningococcal meningitis?
Explanation: Meningococcal meningitis (caused by Neisseria meningitidis) is highly contagious and spreads rapidly via respiratory droplets. Therefore, instantly placing the patient in a private isolation room on droplet precautions is the most specific, critical priority action to protect staff and the public.
11. Unusual vaginal discharge, pelvic and abdominal pain, pain during intercourse, frequency of micturition may be found in patients suspected of
Explanation: These localized urogenital symptoms—unusual vaginal discharge, dyspareunia (painful sex), and dysuria/frequency—are classic presentations of lower genital tract infections like Gonococcal/Chlamydial Urethritis or Cervicitis. Renal failure and glomerulonephritis present with systemic fluid issues, and pyelonephritis presents with flank pain and high fever.
12. Which of the following findings is associated with glomerulonephritis?
Explanation: Glomerulonephritis is inflammation of the glomerular capillaries, making them highly permeable to red blood cells. This results in gross or microscopic Haematuria (cola-colored urine). It also causes high BUN and hypertension, invalidating the other options.
13. Nurses advise the patients undergoing dialysis to have a special diet and drugs because
Explanation: Once a patient transitions to active hemodialysis or peritoneal dialysis, amino acids and proteins are heavily washed out and lost into the dialysate fluid. Because they also suffer from uremia-induced anorexia (poor appetite), they require highly specialized dietary interventions to actively replace this continuous protein loss.
14. Which of the following type of headache presents with one sided, throbbing intense pain?
Explanation: A classic Migraine is characterized by severe, unilateral (one-sided), pulsating or throbbing pain, often accompanied by photophobia, phonophobia, and nausea. (Cluster headaches are one-sided but are piercing/stabbing behind the eye, not typically throbbing).
15. A nervous disorder characterised by tremors at rest, sluggish irritation of movements and muscle rigidity is
Explanation: The clinical triad of Parkinson’s Disease consists of resting tremors (pill-rolling), bradykinesia (sluggish/slow movements), and lead-pipe or cogwheel muscle rigidity, caused by the severe depletion of dopamine in the substantia nigra.
16. A disorder where the nerves of the eyes, brain and spinal code lose patches of myelin is
Explanation: Multiple Sclerosis (MS) is an autoimmune demyelinating disease strictly confined to the Central Nervous System (the brain, spinal cord, and optic nerves). The immune system attacks the myelin sheath, leaving behind hard sclerotic plaques (patches).
17. The degenerative disease of the neck discs and vertebrae is referred to as cervical
Explanation: Cervical Spondylosis is the specific medical term for the age-related “wear and tear” (osteoarthritis) affecting the spinal disks and vertebrae in the neck region.
18. Total blockage of nerve impulse transmission up and down the spinal cord is referred to as
Explanation: Transverse myelitis is an inflammatory condition that completely spans the entire width (transversely) of the spinal cord at a specific level. This inflammation destroys myelin, causing a total blockage of both sensory and motor nerve impulse transmission below the level of the lesion.
19. Providing a safe environment, assisting with activity and watching for changes in the neurological status and intensity of the pain are nursing measures for patients with
Explanation: Spinal cord compression (often due to tumors, trauma, or severely herniated discs) constitutes a neurological emergency. The priority nursing management involves strict safety, preventing further mechanical compression during movement, and aggressively monitoring for rapidly worsening neurological deficits or escalating severe localized pain.
20. Bradycardia, decreased cardiac output, cool skin and cold intolerance are symptoms commonly seen in patients suffering from
Explanation: These are the classic systemic manifestations of severe Hypothyroidism. A lack of circulating thyroid hormones (T3/T4) drastically lowers the basal metabolic rate, causing the heart to beat extremely slowly (bradycardia), reducing heat production (cold intolerance), and reducing peripheral perfusion (cool skin).
SECTION A: FILL IN THE BLANK SPACES 10 Marks
GOUT / GOUTY ARTHRITIS
OSTEOPOROSIS
DIABETIC NEUROPATHY / PERIPHERAL NEUROPATHY
HASHIMOTO’S THYROIDITIS
PHEOCHROMOCYTOMA
THYROID STORM / THYROTOXIC CRISIS
DIABETIC KETOACIDOSIS (DKA)
SEIZURE / CONVULSION
DAILY WEIGHING
HYPOVOLEMIC SHOCK / ACUTE RENAL FAILURE
SECTION B: SHORT ESSAY QUESTIONS 10 Marks
Question 31: Signs and Symptoms of Urethritis (5 Marks)
Outline the five (5) signs and symptoms of urethritis:
- Dysuria: A severe burning, painful sensation experienced specifically during the passage of urine.
- Urethral Discharge: Presence of thick, purulent (yellow/green) or mucopurulent discharge emanating directly from the urethral meatus.
- Urinary Frequency and Urgency: The constant, overwhelming feeling of needing to urinate, even immediately after the bladder is emptied.
- Meatal Erythema: Visible, localized redness, swelling, and inflammation around the urethral opening.
- Hematuria / Pelvic Pain: Microscopic or gross blood present in the urine, occasionally accompanied by a dull, aching pain in the lower pelvis or lower abdomen.
Question 32: Complications of Parkinson’s Disease (5 Marks)
Outline five (5) complications of Parkinson’s disease:
- Aspiration Pneumonia: Advanced Parkinson’s severely compromises the swallowing muscles (dysphagia), frequently causing food and liquids to enter the lungs, leading to fatal pulmonary infections.
- Traumatic Injuries / Fractures: Severe postural instability, shuffling gait, and delayed reflexes inevitably lead to frequent, devastating falls resulting in hip or skull fractures.
- Parkinson’s Disease Dementia: In the late stages, profound cognitive decline, severe memory loss, and visual hallucinations occur as the neurodegeneration spreads to the cerebral cortex.
- Major Depression and Anxiety: The biochemical loss of dopamine, combined with the devastating loss of physical independence, triggers severe, refractory psychiatric distress.
- Chronic Constipation and Urinary Retention: Dysfunction of the autonomic nervous system drastically slows down gastrointestinal motility and impairs bladder emptying.
SECTION C: LONG ESSAY QUESTIONS 60 Marks
Question 33: Diabetes Management & Glomerulonephritis (20 Marks)
(a) Explain five (5) benefits of physical exercises in the management of diabetes mellitus (10 marks):
- Increases Cellular Insulin Sensitivity: Regular physical activity biologically upregulates insulin receptors on muscle cells, dramatically reducing insulin resistance and allowing glucose to enter cells effectively.
- Directly Lowers Blood Glucose: Contracting skeletal muscles act as metabolic engines, consuming massive amounts of circulating blood glucose for energy entirely independent of insulin action.
- Promotes Weight Loss: Exercise burns calories and helps patients reduce overall body fat and visceral adiposity, which is the primary driver of Type 2 Diabetes pathology.
- Improves Cardiovascular Health: Diabetics are at incredibly high risk for heart attacks. Aerobic exercise strengthens the heart muscle, lowers blood pressure, and improves peripheral circulation.
- Enhances Lipid Profiles: Routine exercise naturally lowers dangerous serum triglycerides and LDL (bad cholesterol) while actively raising HDL (good cholesterol), combating diabetic dyslipidemia.
(b) Outline ten (10) specific nursing interventions that should be implemented during management of a patient admitted with Glomerulonephritis in the first 24 hours (10 marks):
- Establish and strictly enforce absolute bed rest to drastically lower metabolic demands and preserve kidney function.
- Initiate a strict Intake and Output (I&O) chart to monitor for oliguria or anuria.
- Weigh the patient at exactly the same time daily (using the same scale and clothing) to objectively track fluid retention.
- Measure blood pressure frequently (every 2-4 hours) to immediately detect dangerous hypertensive spikes.
- Administer prescribed antihypertensive medications and loop diuretics exactly as scheduled.
- Restrict dietary sodium intake strictly to prevent further fluid accumulation and edema.
- Restrict total fluid intake accurately based on the previous day’s urine output plus insensible losses.
- Monitor urinalysis results closely, specifically looking for worsening hematuria (blood) or proteinuria.
- Assess the patient thoroughly for signs of pulmonary edema (e.g., listening for lung crackles, noting dyspnea).
- Provide a low-protein diet if laboratory results indicate rising Blood Urea Nitrogen (BUN) and creatinine (azotemia).
Question 34: Hyperthyroidism Nursing Care (20 Marks)
(a) With rationale for each, explain ten (10) specific nursing interventions for a patient with hyperthyroidism for the first 48 hours of admission (15 marks):
- Maintain a Cool Environment: Keep the room well-ventilated and provide light beddings.
Rationale: The patient suffers from extreme heat intolerance due to an abnormally high basal metabolic rate. - Provide a High-Calorie, High-Protein Diet: Serve 6 small, nutritionally dense meals a day.
Rationale: To meet the massive energy demands of the hypermetabolic state and prevent severe weight loss and muscle wasting. - Administer Prescribed Antithyroid Medications: Give drugs like Propylthiouracil (PTU) or Carbimazole strictly on time.
Rationale: To rapidly block the synthesis and release of excess thyroid hormones into the bloodstream. - Administer Beta-Blockers (e.g., Propranolol):
Rationale: To quickly block sympathetic nervous system overactivity, immediately relieving dangerous tachycardia, palpitations, and severe tremors. - Minimize Sensory Stimulation: Place the patient in a quiet, private room away from the busy nurses’ station.
Rationale: To reduce extreme neurological irritability, anxiety, and prevent triggering a fatal thyroid storm. - Provide Eye Care (Artificial Tears / Dark Glasses):
Rationale: To protect bulging eyes (exophthalmos) from intense light, severe drying, and irreversible corneal ulceration due to lid retraction. - Monitor Vital Signs Frequently: Specifically track core body temperature, heart rate, and blood pressure.
Rationale: To immediately detect signs of cardiovascular collapse or a sudden temperature spike indicating a Thyroid Storm. - Weigh the Patient Daily:
Rationale: To accurately evaluate if the high-calorie nutritional interventions are effectively halting hypermetabolic weight loss. - Promote Strict Rest Periods: Group nursing procedures together to allow for uninterrupted sleep.
Rationale: To conserve the patient’s rapidly depleting energy reserves and reduce the severe workload on the heart. - Assess Mental Status: Talk to the patient calmly and evaluate for severe emotional lability or confusion.
Rationale: Severe hormone toxicity can cause acute psychosis or delirium requiring immediate psychiatric intervention.
(b) List five (5) complications of hyperthyroidism (5 marks):
- Thyroid Storm (Thyrotoxic Crisis): A sudden, massive release of hormones causing lethal hyperthermia and extreme tachycardia.
- Cardiac Arrhythmias: Specifically Atrial Fibrillation, leading to an incredibly high risk of stroke.
- Congestive Heart Failure: The heart eventually tires and fails from continuously pumping at an accelerated, high-output rate.
- Osteoporosis: Accelerated bone turnover from high hormone levels leads to brittle bones and spontaneous fractures.
- Permanent Vision Loss: Severe, untreated exophthalmos causes optic nerve compression or destruction of the cornea.
Question 35: Rheumatoid Arthritis & Low Back Pain (20 Marks)
(a) State ten (10) signs and symptoms of Rheumatoid Arthritis (5 marks):
- Symmetrical, bilateral joint pain.
- Morning joint stiffness lasting over 1 hour.
- Spongy, boggy swelling of affected joints.
- Joints feel hot and appear red.
- Swan-neck deformities in the fingers.
- Ulnar deviation (hands pointing outwards).
- Firm rheumatoid nodules under the skin.
- Profound, unrelenting fatigue.
- Unexplained, low-grade systemic fever.
- Severe weight loss and loss of appetite.
(b) Outline five (5) complications of Rheumatoid Arthritis (5 marks):
- Severe Joint Destruction: Chronic inflammation literally erodes the cartilage and bone, causing permanent, irreversible anatomical deformities.
- Rheumatoid Vasculitis: The autoimmune inflammation spreads to the blood vessels, severely restricting blood flow to nerves and organs.
- Cardiovascular Disease: Systemic inflammation causes pericarditis (inflammation of the heart sac) and massively accelerates atherosclerosis.
- Osteoporosis: Caused both directly by the disease limiting mobility and as a major side effect of chronic corticosteroid treatments.
- Carpal Tunnel Syndrome: Massive swelling of the wrist joints severely compresses the median nerve, causing excruciating neuropathic pain in the hands.
(c) Explain ten (10) measures that nurses should implement (and teach) to prevent low back pain (10 marks):
- Proper Lifting Body Mechanics: Teach the individual to strictly bend at the knees, keeping the back completely straight, and to lift using the powerful leg muscles rather than the weak lumbar spine.
- Weight Management: Encourage maintaining a healthy Body Mass Index (BMI) to prevent excess abdominal weight from pulling the pelvis forward and straining the lower back.
- Core Strengthening Exercises: Instruct the patient to perform daily exercises that strengthen the abdominal and paraspinal muscles, which act as a natural internal corset supporting the spine.
- Ergonomic Seating: Ensure the use of chairs with proper lumbar support, and advise against sitting in soft, deep couches that force the spine into a highly unnatural, “C”-shaped curve.
- Avoid Prolonged Positions: Instruct those who sit or stand for work to take mandatory micro-breaks every 30 minutes to stretch and relieve continuous mechanical tension on the intervertebral discs.
- Correct Footwear: Strongly discourage the use of high heels, which dramatically alter the body’s center of gravity and severely exaggerate the lumbar lordotic curve.
- Optimal Sleeping Posture: Advise sleeping on a firm mattress to maintain neutral spinal alignment, and suggest placing a pillow between the knees when sleeping on the side to prevent spinal twisting.
- Push, Do Not Pull: Educate the individual that when moving heavy objects (like a patient bed or a cart), pushing utilizes body weight efficiently, whereas pulling creates massive shear forces on the lumbar spine.
- Avoid Twisting While Lifting: Emphasize that pivoting the feet rather than violently twisting the waist while holding a heavy load prevents devastating tears to the spinal disc annulus.
- Stress Management: Explain that severe psychological stress and anxiety subconsciously cause chronic muscle tension in the back, and teach relaxation techniques to release this physical spasm.