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UNIVERSITY OF GHANA

(All Rights Reserved)

SCHOOL OF NURSING

COLLEGE OF HEALTH SCIENCES

BSC NURSING, FIRST SEMESTER EXAMINATIONS, 2016/2017 ACADEMIC YEAR

NURS 333: SURGICAL CONDITIONS OF RESPIRATORY, CARDIOVASCULAR AND

GENITOURINARY SYSTEMS (2 CREDITS)

INSTRUCTIONS: ANSWER ALL QUESTIONS IN SECTIONS A AND B (ANSWER

SECTION A ON THE QUESTION PAPER AND SECTION B IN THE ANSWER
BOOKLET)

TIME ALLOWED - TWO (2) HOURS

SECTION A (CIRCLE THE MOST APPROPRIATE ANSWER)

] . Doctors who specialize in transplants and will be performing kidney transplant are known as
a. Transplant coordinator
b. Nephrologist
c. Transplant surgeon
d. Physical therapist

2. A doctor who specializes in disorders of the kidneys and helps manage the condition before
and after the surgery is called
a. Transplant coordinator
b. Nephrologist
c. Transplant surgeon
d. Physical therapist

3. Professionals who will help meet nutritional needs of patients before and after kidney
transplant are called
a. Dietitian
b. Physical therapi sts
c. Pastoral Care
d. Meal planners

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4. The kidney transplant team include the following EXCEPT

a. Anesthesiologist
b. Hematologist
c. infectious disease specialist
d. laboratory technician

5. In kidney transplantation post operatively, in what position is the patient placed?

a. Semi-prone
b. Prone
c. Recumbent
d. Sim' s position

6. The nurse should be careful when changing postoperative dressing not to introduce
microorganism into the wound. This is an example of
a. Concurrent asepsis
b. Medical asepsis
c. Surgical asepsis
d. Wound asepsis

7. The main complaint of a patient with cancer of the prostate gland would be
a. Dysuria
b. Oliguria
c. Retention of urine
d. Suppression of urine

8. Patient going for abdominal operation should urinate immediately before the operation in
order to
a. Eliminate one source of post-operative discomfort
b. Permit better visualisation of other viscera
c. Prevent voiding on the operating table
d. Prevent injury to the bladder during surgery

9. The main reason for administering atropine sulphate preoperatively is to

a. Accelerate the effect of anaesthesia
b. Decrease secretion
c. Improve cardiac contraction
d. Prevent depression of the respiratory centre

10. Vitamin K is associated with which of the fo llowing function

a. Anabolism of protein
b. Blood clotting
c. Respiratory gas exchange
d. Wound healing

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11. A major postoperative nursing responsibility is assessing for cardiovascular function by
monitoring:
a. Arterial blood gases.
b. Central nervous pressure.
c. Vital signs
d. All of the above.

12. Patients remain in the recovery room or post anaesthesia care unit (P ACU) until they are
fully recovered from anaesthesia. This is evidenced by:
a. A patient's airway
b. A reasonable degree of consciousness
c. A stable blood pressure
d. Indication that all of the above have occurred

13. One of the most common postoperative respiratory complications in the elderly patient is:
a. Pleurisy
b. Pneumonia
c. Hypoxemia
d. Pulmonary oedema

14. Which of the following is a symptom of Ventricular Septal Defect?

a. Rapid breathing
b. Irritability
c, Poor weight gain
d. All of the above

15 . Which of the following is true about patent ductus arteriosus?

a. Children with small patent ductus are usually asymptomatic
b. Large left to right shunts develop symptoms of congestive heart failure
c. Continuous murmur is heard best at the left sternal border during auscultation
d. All of the above.

16. The following are true about Tetralogy of Fallot EXCEPT

a. Stenosis of the pulmonary artery
b. Interventricular communication
c. Hypertrophy of the left ventricle
d. Hypertrophy of the right ventricle

17. Suctioning of the patient with tracheostomy must be brief. It should not exceed
a. 5 seconds
b. 10 seconds
c. 15 seconds
d. 20 seconds

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18. Which patient is at the greatest risk for surgical and anaesthetic complications? AI An
a. Three-year old boy scheduled for a hernia repair
b. Forty-two year old scheduled for a breast cancer
c. Eighteen- year old scheduled for emergency appendectomy
d. Eighty- year old lady scheduled for exploratory laparotomy

19. Which of the following characteristics of the operating room environment facilitates the
prevention of infection in the surgical patient?
a. Adjustable lightening
b. Conductive furniture
c. Explosion proof electrical plugs
d. Filters in the ventilating system

20. Which of the following nursing actions is NOT desirable during recovery from anaesthesia?
a. Auscultating the patient chest bilaterally
b. Encouraging deep breathing and coughing
c. Placing the patient in a supine position
d. Suctioning to remove excess respiratory secretions

21. Septal involvement occurs in which type of cardiomyopathy?

a. Congestive
b. Dilated
c. Hypertrophic
d. Restrictive

22. Dyspnoea, cough, expectoration, weakness, and oedema are classic signs and symptoms of
which of the following conditions?
a. Pericarditis
b. Hypertension
c. Myocardial Infarction
d. Heart failure

23 . What is the most common complication of a Myocardial Infarction?

a. Cardiogenic shock
b. Heart failure
c. Arrhythmias
d. Pericarditis

24. What is the first intervention for a client experiencing Myocardial Infarction?
a. Administer morphine
b. Administer oxygen
c. Administer sublingual nitroglycerin
d. Obtain an ECG

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25. Which of the following blood gas abnormalities is initially most suggestive of pulmonary
oedema?
a. Anoxia
b. Hypercapnia
c. Hyperoxygenation
d. Hypocapnia

26. After an anterior wall myocardial infarction, which of the following problems is indicated by
auscultation of crackles in the lungs?
a. Left-sided heart failure
b. Pulmonic valve malfunction
c. Right-sided heart failure
d. Tricupsid valve malfunction

27 . Which of the following conditions is the predominant cause of angina?

a. Increased preload
b. Decreased afterload
c. Coronary artery spasm
d. Inadequate oxygen supply to the myocardium

28. Stimulation ofthe sympathetic nervous system produces which of the following responses?
a. Bradycardia
b. Tachycardia
c. Hypotension
d. Decreased myocardial contractility

29. Myocardial oxygen consumption increases as which of the following parameters increase?
a. Preload, afterload , and cerebral blood flow
b. Preload, afterload, and renal blood flow
c. Preload, afterload, contractility, and heart rate
d. Preload, afterload, cerebral blood flow, and heart rate

30. Excessive alcohol use while on warfarin (Coumadin) therapy leads to:
a. Decreased anticoagulation effect.
b. Decreased international normalized ratio.
c. Increased anticoagulation effect.
d. Increased vitamin K absorption

31. A patient who underwent coronary artery bypass surgery demonstrates effective
understanding of discharge teaching by:
a. Asking whether smoking one cigarette per day is acceptable.
b. Clarifying when cardiac rehabilitation will begin.
c. Describing plans to relax in a hot tub during recovery.
d. Planning to resume driving his or her spouse to work next week

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32. Palliative treatment surgery is perform to :

a. Cure of the condition
b. Provide therapy
c. Relieve pain
d. Treat a disease

33. Which of the following would a nurse use when removing an old dressing from a wound?
a. Cheatle forceps
b. Examination glove
c. Surgical glove
d. Utility glove

34. Informed consent from the patient is necessary for:

a. Admission procedure
b. Discharge procedure
c. Invasive procedures such as surgery
d. Personal hygiene procedures such as bed bathing

35 . The role of the circulating nurse in the theatre is to assist the:

a. Anaesthetist to prepare anaesthetics
b. Nurse to set up trolleys
c. Pharmacist selects analgesics for patient
d. Surgeon to perform operation

36. Pre-operative preparation include the following EXCEPT

a. Physical
b. Physiological
c. Psychosocial
d. Psychoanalytical

37. Deep-Breathing exercise is effectively taught:

a. Intra operatively
b. Peri-operatively
c. Post operatively
d. Pre operatively

38. Kwame is receiving analgesics after surgery. How often would it be given?
a. As often as patient request for it
b. According to Surgeon' s prescription
c. Every 30 minutes
d. Whenever necessary

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39. A patient with chest tube insertion should assume which position?
a. Low Fowler' s
b. High Fowler' s
c. Prone
d. Recumbent

40. A woman is taught to catheterize herself by inserting the catheter into the urethra:
a. 0.5 to 1 inch
b. 2 inches
c. 3 inches
d. 5 inches

41. A major clinical manifestation of renal stones is:

a. dysuria
b. Haematuria
c. Infection
d. Pain

42. The most common symptom of cancer of the bladder is:

a. back pain
b. dysuria
c. painless haematuria
d. infection

43. The predominant cause of bladder cancer is

a. chronic renal failure
b. cigarette smoking
c. environmental pollution
d. metastasis from a primary site

44. The urinary diversion whereby the patient will void from his rectum for the rest of his life
is known as a:
a. cutaneous ureterostomy
b. nephrostomy
c. ureterosigmoidostomy
d. suprapubic cystotomy

45 . A patient chose Continuous Ambulatory Peritoneal Dialysis (CAPD) as a way of

managing his end-stage renal disease because it helped him:
a. have control over his daily activities
b. avoid severe dietary restrictions
c. control his blood pressure
d. do all of the above

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46. Nurse Mensah will go through the following in sequential order to prepare a patient skin for
surgery.

1. Cover skin with sterile towel

II. Clean skin with antiseptic lotion
III. Shave skin according to institution protocol
IV . Wash skin with soap and water

a. I, II, III and IV

b. II, III, IV and I
c. III, IV I and II
d. IV, III, II and I

47 . The nurse will do all the following in case a patient has dehiscence with evisceration (burst
abdomen) EXCEPT
a. Call the Surgeon
b. Instruct patient to stay calm
c. Prepare patient for theatre
d. Try and push back contents of abdomen

48. The following may contribute to prostate enlargement EXCEPT

a. Androgen
b. Testosterone
c. Aging
d. Radiation therapy

49. Surgical procedures required for Benign Prostatic Hypertrophy include the following
EXCEPT
a. Transurethral surgery
b. Microwave therapy
c. Transurethral microwave therapy (TUMT)
d. Simple prostatectomy

50. Kidneys are harvested after these adults are pronounced either brain dead or cardiac dead .
This type of transplant is called:
a. Cadaveric transplant
b. Manual transplant
c. Kidney transplant
d. Nephrotic transplant

51 . In kidney transplantation post operatively, in what position is the patient placed?

a. Semi-prone
b. Prone
c. Recumbent
d. Sim's position

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Examiner: Dr. Lydia Aziato

Index Number _ _ _ _ _ _ _ _ _ __ Signature _ _ _ _ _ _ _ _ _ _ __

52. The most common form of lung cancer in both and women is
a. Epidermoid carcinoma
b. Adenocarcinoma
c. Secondary lung cancer
d. Small cell lung cancer

53 . The following are extrathoracic symptoms of lung cancer EXCEPT

a. Jaundice
b. Scleroderma
c. Haemoptysis
d. Hypercalcaemia

54. Which of the following states best describes pleural effusion?

a. The collapse of alveoli
b. The collapse of a bronchiole
c. The fluid in the alveolar space
d. The accumulation of fluid between the linings of the pleural space

55 . If a pleural effusion occurs, which of the following actions best described how fluid can be
removed from the pleural space?
a. Inserting a chest tube
b. Performing thoracentesis
c. Performing paracentesis
d. Allowing pleural effusion to drain by itself

56. The following are included in cardiac bed and its accessories EXCEPT:
a. Vomit bowl
b. Pen and paper
c. Sputum mug
d. Pillows

57. The drug digoxin is not given if pulse is less than

a. 90 bpm
b. 80 bpm
c. 70 bpm
d. 60 bpm

58 . Obstruction to blood flow includes the following EXCEPT:

a. Pulmonary stenosis
b. Pulmonary coarctation
c. Aortic stenosis
d. Aortic coarctation

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59 . The three major types of atrial septal defect include all EXCEPT:
a. Sinoatrial venosus
b. Ostium secundum
c. Ostium primum
d. Sinus venosus

60. Which of the following is the single most common congenital heart malformation,
accounting for almost 30% of all Congenital Heart Diseases?
a. Atrial septal defect
b. Patent ductus arteriosus
c. Ventricular Septal defect
d. Tetralogy of Fallot

60 marks

SECTION B - ANSWER ALL QUESTIONS IN THE ANSWER BOOKLET

1. Mr Mensah 30 years has cancer of the lower lobe of the right lung and is scheduled for a sub-
total lobectomy.
a. Outline 5 pre-operative nursing diagnoses that would guide your care BEFORE
surgery (5marks).
b. Describe the pre-operative care you will give him (10 marks).
c. What advice will you give him and family on discharge? (5 marks).

2. Madam Oko 55 years old has undergone a replacement of a defective aortic valve 72 hours
ago and has been brought from the intensive care unit to your cardio-thoracic ward.
a. Describe the care you will give specific to her under-water sealed drainage (chest tube)
(10 marks).
b. Describe the nursing intervention you will give with regards to the following nursing
diagnoses
1. Activity intolerance (5 marks)
ii. Altered body comfort (pain) (5 marks)

111 -40 MARKS

BESTI WISHES

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Examiner: Dr. Lydia Aziato