UGANDA NURSES AND MIDWIVES EXAMINATIONS BOARD
Medical Nursing III - Paper Code: DNE 112 (Diploma in Nursing Extension)
June 2022
Duration: 3 Hours
SECTION A: OBJECTIVE QUESTIONS 20 Marks
1. The most common cause of glomerulonephritis is
Group A beta-hemolytic streptococcus is the primary pathogen causing post-streptococcal glomerulonephritis.
2. When planning a diet for a patient with renal failure, the nurse remembers to include
Patients with renal failure need restricted protein to prevent nitrogenous waste buildup, but require high carbohydrates/adequate calories to spare protein and prevent tissue catabolism.
3. The nurse suspects a client who complains of excessive thirst and passing a large volume of very dilute urine to be suffering from
Excessive thirst (polydipsia) and large volumes of dilute urine (polyuria) are hallmark signs of Diabetes Insipidus due to ADH deficiency.
4. The goal of care when treating a patient with diabetes mellitus is to
The ultimate therapeutic goal of all DM management (Type 1 and 2) is to maintain tight control over blood glucose levels.
5. Which of the following findings does a nurse expect to find on assessment of a patient with rheumatoid arthritis?
Rheumatoid Arthritis typically presents with severe joint stiffness and pain in the morning lasting longer than an hour.
6. Which of the following is NOT associated with osteoporosis?
Osteoporosis directly causes fractures and back pain, and is worsened by a sedentary lifestyle. Urinary stones are not a characteristic consequence of the disease itself.
7. Which of the following is NOT true about stroke?
Sudden epigastric pain is a gastrointestinal or cardiac symptom (e.g., atypical MI), but is not a neurological symptom of 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
A traveling mass in the bloodstream is an embolus, whereas a stationary clot attached to the vessel wall is a thrombus.
9. Dwarfism is an inherited deficiency of growth hormone with the absence of
Somatotropin is the medical term for Growth Hormone (GH), secreted by the anterior pituitary.
10. Which of the following nursing actions is specific to a patient with meningococcal meningitis?
Meningococcal meningitis is highly contagious. Implementing strict droplet isolation immediately is the most crucial, specific nursing priority.
11. Unusual vaginal discharge, pelvic and abdominal pain, pain during intercourse, frequency of micturition may be found in patients suspected of
These are classic symptoms of ascending lower urogenital tract infections (like Gonococcal/Chlamydial urethritis and cervicitis/PID).
12. Which of the following findings is associated with glomerulonephritis?
Glomerulonephritis presents with Nephritic Syndrome, characterized by hematuria (red blood cells in urine), hypertension, and elevated BUN.
13. Nurses advise the patients undergoing dialysis to have a special diet and drugs because
Because failed kidneys cannot excrete normally, patients accumulate toxic waste products, potassium, and phosphorus between sessions, necessitating strict diets and binders.
14. Which of the following type of headache presents with one sided, throbbing intense pain?
Migraines are classically unilateral (one-sided) and described as having a throbbing or pulsating character.
15. A nervous disorder characterised by tremors at rest, sluggish initiation of movements and muscle rigidity is
Parkinson's is defined by the classic triad: resting tremors, bradykinesia (sluggish initiation/movement), and lead-pipe or cogwheel rigidity.
16. A disorder where the nerves of the eyes, brain and spinal cord lose patches of myelin is
Multiple Sclerosis (MS) is an autoimmune demyelinating disease of the Central Nervous System (brain, optic nerves, spinal cord).
17. The degenerative disease of the neck discs and vertebrae is referred to as cervical
Cervical spondylosis is age-related wear and tear (osteoarthritis) affecting the spinal disks and vertebrae in the neck.
18. Total blockage of nerve impulse transmission up and down the spinal cord is referred to as
Acute transverse myelitis involves inflammation completely across one level of the spinal cord, blocking sensory and motor transmission below that level.
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
Spinal cord compression is an emergency requiring intense neurological monitoring and pain management to prevent permanent paralysis.
20. Bradycardia, decreased cardiac output, cool skin and cold intolerance are symptoms commonly seen in patients suffering from
These are classic manifestations of a slowed basal metabolic rate due to a lack of thyroid hormones.
SECTION A: FILL IN THE BLANK SPACES 10 Marks
21. The type of arthritis that causes joint pain especially in the great toe is...
→ GOUTY ARTHRITIS (Gout)
→ GOUTY ARTHRITIS (Gout)
22. A metabolic disorder in which there is low bone mass and deterioration of bone structure is...
→ OSTEOPOROSIS
→ OSTEOPOROSIS
23. Tingling sensations of the fingers and feet in a diabetic patient is termed as...
→ DIABETIC NEUROPATHY (or Peripheral Neuropathy)
→ DIABETIC NEUROPATHY (or Peripheral Neuropathy)
24. The auto immune disorder where the body attacks the thyroid gland and stops it from producing T3 and T4 is...
→ HASHIMOTO'S THYROIDITIS
→ HASHIMOTO'S THYROIDITIS
25. A tumour of the adrenal medulla that increases blood pressure is...
→ PHEOCHROMOCYTOMA
→ PHEOCHROMOCYTOMA
26. An acute and rare condition in which all manifestations of hyperthyroidism are heightened is...
→ THYROID STORM (or Thyrotoxic Crisis)
→ THYROID STORM (or Thyrotoxic Crisis)
27. A patient becomes comatose during retention of ketones and glucose as a result of...
→ DIABETIC KETOACIDOSIS (DKA)
→ DIABETIC KETOACIDOSIS (DKA)
28. A paroxysmal discharge of cerebral neurons accompanied by an apparent clinical phenomenon is called a...
→ SEIZURE (or Convulsion)
→ SEIZURE (or Convulsion)
29. A part from maintaining a fluid balance chart, salt and water status of the patient may be monitored carefully by accurate...
→ DAILY WEIGHT MEASUREMENT
→ DAILY WEIGHT MEASUREMENT
30. The nurse should prevent dehydration in a patient with excessive fluid loss to avoid a complication known as...
→ HYPOVOLEMIC SHOCK
→ HYPOVOLEMIC SHOCK
SECTION B: SHORT ESSAY QUESTIONS 10 Marks
Q31: Urethritis (5 Marks)
Outline five (5) signs and symptoms of urethritis:
- Dysuria: Burning sensation or pain during urination.
- Frequent Urination: Increased urgency and frequency of micturition.
- Urethral Discharge: Unusual purulent, yellow, or clear discharge from the urethra.
- Meatal Irritation: Itching, redness, or swelling at the urethral opening.
- Dyspareunia: Pelvic pain or discomfort during sexual intercourse.
Q32: Parkinson's Disease (5 Marks)
Outline five (5) complications of Parkinson's disease:
- Dysphagia: Difficulty swallowing, which can lead to aspiration pneumonia.
- Physical Injuries: High risk of falls and bone fractures due to postural instability.
- Cognitive Decline: Parkinson's disease dementia and severe memory issues in late stages.
- Psychological Issues: Severe depression, anxiety, and sleep disorders (insomnia).
- Gastrointestinal/Genitourinary Issues: Severe constipation and urinary incontinence.
SECTION C: LONG ESSAY QUESTIONS 60 Marks
Q33: Diabetes Mellitus & Glomerulonephritis (20 Marks)
(a) Explain five (5) benefits of physical exercises in the management of diabetes mellitus (10 marks): 1. Lowers blood glucose: Muscle contraction increases cellular glucose uptake independent of insulin. 2. Improves insulin sensitivity: Reduces cellular insulin resistance, lowering the dosage of exogenous insulin needed. 3. Promotes weight loss: Helps maintain an ideal Body Mass Index (BMI), crucial for managing Type 2 DM. 4. Improves lipid profiles: Lowers LDL (bad cholesterol) and triglycerides while increasing HDL (good cholesterol). 5. Enhances cardiovascular health: Lowers blood pressure and improves circulation, preventing micro/macro-vascular complications.
(b) Outline ten (10) specific nursing interventions for a patient with Glomerulonephritis in the first 24 hours (10 marks):
- Enforce strict bed rest to reduce metabolic waste accumulation.
- Monitor vital signs regularly, specifically tracking hypertension.
- Maintain a strict Intake and Output (I&O) chart to assess oliguria.
- Weigh the patient daily on the same scale to monitor fluid retention.
- Assess urine regularly for hematuria (color) and volume.
- Provide a prescribed low-sodium, fluid-restricted diet.
- Restrict dietary protein if BUN and creatinine levels are highly elevated.
- Administer prescribed loop diuretics to manage edema.
- Administer prescribed anti-hypertensives to control blood pressure.
- Auscultate lungs to detect crackles indicative of fluid overload.
Q34: Hyperthyroidism Care & Complications (20 Marks)
(a) With rationale, explain ten (10) specific nursing interventions for hyperthyroidism for the first 48 hours (15 marks):
- 1. Provide a cool environment:
Rationale: Reduces heat intolerance and metabolic demand. - 2. Provide a high-calorie/protein diet:
Rationale: Meets the hypermetabolic state demands and prevents weight loss. - 3. Administer anti-thyroid drugs (e.g., PTU):
Rationale: Blocks the synthesis of excessive thyroid hormones. - 4. Administer Beta-blockers (e.g., Propranolol):
Rationale: Relieves sympathetic symptoms like tachycardia and tremors. - 5. Monitor vital signs strictly:
Rationale: To detect life-threatening spikes in heart rate or temperature (Thyroid Storm). - 6. Enforce bed rest / limit visitors:
Rationale: Reduces physical and emotional stress which exacerbates symptoms. - 7. Provide eye care (dark glasses/tears):
Rationale: Protects the corneas from drying out due to exophthalmos. - 8. Weigh the patient daily:
Rationale: Helps monitor nutritional status and fluid balance. - 9. Replace fluids (IV or Oral):
Rationale: Compensates for fluid loss due to excessive diaphoresis and diarrhea. - 10. Provide emotional support:
Rationale: Reassures the patient that extreme anxiety and mood swings are part of the disease process.
(b) List five (5) complications of hyperthyroidism (5 marks): 1. Thyroid Storm (Thyrotoxic crisis). 2. Cardiac arrhythmias (e.g., Atrial Fibrillation). 3. Congestive Heart Failure. 4. Osteoporosis (due to rapid bone turnover). 5. Vision loss or corneal ulceration (from severe exophthalmos).
Q35: Rheumatoid Arthritis & Ergonomics (20 Marks)
(a) State ten (10) signs and symptoms of Rheumatoid Arthritis (5 marks):
- Morning joint stiffness lasting >1 hour.
- Symmetrical joint swelling and pain.
- Joints that are warm and tender to touch.
- Presence of subcutaneous rheumatoid nodules.
- Severe fatigue and generalized malaise.
- Low-grade fever.
- Unintended weight loss (anorexia).
- Visible joint deformities (e.g., Swan-neck).
- Decreased range of motion.
- Muscle atrophy around affected joints.
(b) Outline five (5) complications of Rheumatoid Arthritis (5 marks): 1. Permanent joint destruction and crippling deformity. 2. Osteoporosis. 3. Carpal tunnel syndrome. 4. Cardiovascular disease (increased risk of atherosclerosis). 5. Systemic nodule formation in internal organs (like the lungs and heart).
(c) Explain ten (10) measures that nurses should implement to prevent low back pain (10 marks):
- Use correct body mechanics (bend knees, keep back straight when lifting).
- Utilize mechanical lifting devices (hoists) for heavy patients.
- Seek assistance from colleagues when moving heavy loads.
- Push objects rather than pulling them.
- Maintain a healthy body weight to reduce lumbar strain.
- Perform regular core and back strengthening exercises.
- Wear comfortable, flat shoes with good arch support.
- Avoid sudden twisting or jerking movements of the spine.
- Elevate the height of the patient's bed to waist level before performing care.
- Avoid prolonged standing; take stretch breaks.