MAASAI MARA UNIVERSITY

REGULAR UNIVERSITY EXAMINATIONS

2022/2023 ACADEMIC YEAR
THIRD YEAR SECOND SEMESTER

SCHOOL OF PURE, APPLIED AND HEALTH

SCIENCES
BACHELOR OF SCIENCE IN NURSING (BSc. N)

COURSE TITLE:NUR 3305

COURSE CODE: MEDICAL-SURGICAL NURSING
IV
DATE: 21/4/2023 TIME: 0830-1030 HRS
INSTRUCTION TO CANDIDATES
Section A: Multiple Choice Questions. Answer ALL Questions
Section B: Short Answer Questions. Answer ALL Questions
Section C: Long Answer Questions. Answer Question ONE and any other ONE
question.
 SECTION A: MULTIPLE CHOICE QUESTION (20 MARKS)
1. A nurse is reviewing discharge instructions with a client who has a new diagnosis of
migraine headaches. Which of the following instructions should the nurse include?
A. Use music therapy for relaxation with the onset of the headache.
B. Increase physical activity when a headache is present.
C. Drink sugar-free beverages to prevent headaches.
D. Apply a cool cloth to the face during a headache.
2. The nurse is caring for a client diagnosed with an autoimmune disorder characterized by
antibody-mediated loss of acetylcholine receptors at the neuromuscular junction,
interfering with communication between motor neurons and innervated muscles. This
BEST describes which disorder?
A. Multiple sclerosis

B. Myasthenia gravis

C. Parkinson’s disease

D. Amyotrophic lateral sclerosis

3. During physical assessment, the nurse observes paralysis of both lower extremities and the
lower trunk. How should the nurse document this finding in the client’s record?
A. Hemiplegia
B. Paraplegia
C. Quadriplegia
D. Quadriparesis
4. When completing a neurological assessment, the nurse determines that a client has a
positive Romberg test. Which finding supports the nurse’s conclusion?
A. Inability to stand with feet together when eyes are closed
B. Fanning of toes when the sole of the foot is firmly stroked
C. Dilation of pupils when focusing on an object in the distance
D. Movement of eyes toward the opposite side when head is turned

3. A nurse is assessing a client whose mouth is drawn over to the left. The nurse should
consider damage to which cranial nerve to be the MOST LIKELY explanation for this clinical
finding?
A. Left facial nerve
B. Right facial nerve
C. Right abducens nerve
D. Left abducens nerve
4. A client has a craniotomy for a meningioma. For what response should the nurse assess the
client in the postanesthesia care unit?
A. Dehydration
B. Blurred vision
C. Wound infection
D. Narrowing pulse pressure
5. A nurse is reviewing the laboratory results for a client with suspected acute
glomerulonephritis. Which of the following findings should the nurse report to the
provider?
A. Urine specific gravity of 1.022
B. BUN of 16 mg/dL
C. Creatinine clearance of 48 mL/min/m2
D. Potassium level of 4.2 mEq/L
6. A client diagnosed with Guillain-Barre syndrome is being admitted in a medical ward. When
selecting the equipment to place in the client’s room, the nurse is MOST correct to include
items that facilitate which of the following?
A. Supplemental oxygen
B. Cardiac monitoring
C. Nasogastric suction
D. Intravenous therapy
7. A nurse is assessing a client who reports severe headache and a stiff neck. The nurse’s
assessment reveals positive Kernig’s and Brudzinski’s signs. Which of the following actions
should the nurse perform FIRST?
A. Administer antibiotics
B. Implement droplet isolation precautions
C. Initiate IV access
D. Decrease bright lights
8. A client arrives at the headache center for an initial evaluation. The client describes flashing
lights before the headache begins. The nurse is MOST correct in documenting the presence
of which of the following?
A. A premonition of a migraine headache
B. An aura prior to a migraine headache
C. A papillary response creating the headache
D. Intense photophobia prior to the headache onset
9. A nurse is providing discharge instructions to a female client who has a prescription for
phenytoin (Dilantin). Which of the following information should the nurse include?
A. Consider taking oral contraceptives when on this medication.
B. Watch for receding gums when taking the medication.
C. Take the medication at the same time every day.
D. Provide a urine sample to determine therapeutic levels of the medication.
10. A nurse working in a long-term care facility is planning care for a client in stage 5 of
Alzheimer’s disease. Which of the following interventions should be included in the plan of
care?
A. Use a gait belt for ambulation.
B. Thicken all liquids.
C. Provide protective undergarments.
D. Assist with ADLs.
11. The physician orders a 24-hour urine collection for a client who develops signs and
symptoms that resemble Cushing’s syndrome. The nurse is MOST accurate in instructing
the client that the urine collection will begin at what time?
A. At noontime
B. With the client’s next voiding
C. After the client’s next voiding
D. At midnight
12. A client who has intact function of the lower urinary tract but cannot identify the need to
void or ambulate to the toilet is likely to be experiencing which type of incontinence?
A. Functional incontinence
B. Urge incontinence
C. Reflex incontinence
D. Stress incontinence
13. A nurse is assessing a client who is scheduled for kidney transplantation surgery for risk
factors of surgery. Which of the following findings lowers the client’s risk of surgery?
A. Older than 70 years of age.
B. Has a BMI of 41
C. Administers NPH insulin each morning
D. Blood pressure averages 120/70 mm Hg
14. Which nursing intervention is most important to add to the plan for care following the
removal of a suprapubic catheter?
A. Reposition the client every 2 hours.
B. Change abdominal dressing when wet.
C. Ambulate the client with assistance.
D. Encourage deep breathing hourly.
15. A client who is symptomatic after having been stung by a bee is brought to the emergency
department. Which of the following is the initial PRIORITY nursing assessment?
A. Respiratory status
B. Level of consciousness
C. Heart rate
D. Urinary output
16. The physician orders several laboratory tests for a client suspected of having AIDS. Which
laboratory test is most significant for diagnosing antibodies to the human
immunodeficiency virus (HIV)?
A. Venereal disease research laboratory (VDRL) test
B. Schick test
C. Dick test
D. Enzyme-linked immunosorbent assay (ELISA) test
17. A client with AIDS comes into the clinic with a suspected case of candidiasis. Which of the
following signs and symptoms would the nurse observe in the client that would likely
confirm a diagnosis of candidiasis?
A. Serious loss of fluids
 B. Inadequate pulmonary function
C. Red, swollen eyes
D. White plaque that may bleed when mobilized
18. A client who undergoes litholapaxy for removing bladder stones is anxious to know how
long the urethral catheter should be kept in place. The nurse most correctly responds that
catheters generally remain in place for how long?
A. 6 to 7 days
B. 1 to 2 days
C. 2 to 3 days
D. 3 to 4 days

Indicate whether the following statements regarding the assessment of reflexes are True or
False
19. When the head of a comatose client is turned to the side, eyes should move in opposite
direction; absence of this reflex suggests brainstem injury.
20. When performing the caloric test, warm or ice water instilled into the ear of a comatose
client causes nystagmus to occur; eyes should deviate toward stimulated ear if ice water is
used and away with warm water; absence of reflex suggests brainstem damage.

SECTION B: SHORT ANSWER QUESTIONS (40 MARKS)

ANSWER ALL QUESTIONS
1. Regarding Parkinson’s disease,
a) Explain the pathophysiology. (4 Marks)
b) Describe the pharmacologic therapy. (4 Marks)
2. a) Differentiate between pyelonephritis and glomerulonephritis. (4 Marks)
b) State four (4) problems the nurse manages when caring for clients with
glomerulonephritis. (4 Marks)
3. A nurse caring for a client with spinal trauma formulates the nursing diagnosis ‘Impaired
physical mobility and Risk for disuse syndrome related to loss of motor function’. State
eight specific nursing interventions that should be performed. (8 Marks)
4. Clients with HIV/AIDS have multisystem manifestations of AIDS.
a) Describe the criteria of diagnosing AIDS according to CDC. (2 Marks)
b) Enumerate six (6) common gastrointestinal problems in clients with AIDS. Include the
etiology for each. (6 Marks)
5. Regarding renal calculi,
a) Describe the pathophysiology of urolithiasis. (4 Marks)
b) Define any four therapeutic procedures in the management of clients with urolithiasis.
(4 Marks)
 SECTION C: LONG ANSWER QUESTIONS (40 MARKS)
QUESTION 1 IS COMPULSORY, THEN CHOOSE EITHER QUESTION 2 OR 3.
1. A client diagnosed with end-stage renal failure is scheduled for dialysis.
a) Describe the etiopathogenesis of acute kidney failure. (6 Marks)
b) State four (4) priority nursing diagnoses in a patient diagnosed with kidney failure.
(4 Marks)
c) Discuss the nursing pre-, intra-, and post-procedure assessments performed when
caring for clients undergoing hemodialysis. (10 Marks)

2. A nurse is caring for a patient who was admitted with a seizure disorder.
a) Describe the clinical features of the various stages of a tonic-clonic seizure. (8 Marks)
b) Discuss the nursing process for a client with a seizure disorder. (12 Marks)

3. A client who suffered a head injury during a road traffic accident is receiving care at the
emergency unit. The patient sustained a skull fracture with cerebral hematomas.
a) Distinguish between a coup and a contrecoup injury. (2 Marks)
b) Define any three types of cerebral hematomas. (3 Marks)
c) Discuss the specific nursing care for a client undergoing intracranial surgery. Following
a logical sequence, be sure to include the preoperative and postoperative care.
(15 Marks)

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