Adult health Nursing-I Solved past paper -2018

Q1) a) define Folic acid deficiency anemia.

Folate-deficiency anemia is a decrease in red blood cells (anemia) due to a lack of folate. Folate is a type of vitamin B. It is also called folic acid. Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

b) write down the dietary sources of Folic acid

  1. Legumes (beans, peas, lentils)
  2. Asparagus
  3. Eggs
  4. Leafy greens
  5. Beets
  6. Citrus fruits
  7. Brussels sprouts
  8. Broccoli
  9. Nuts and seeds
  10. Beef liver
  11. Wheat germ
  12. Papaya
  13. Bananas
  14. Avocado
  15. Fortified grains

c) write down the importance of Folic acid in human body

1)Folic acid helps your body produce and maintain new cells.

2)It helps prevent changes to DNA that may lead to cancer.

3)As a medication, folic acid is used to treat folic acid deficiency and certain types of anemia (lack of red blood cells) caused by folic acid deficiency.

Q2) a) define appendicitis

It is an acute inflammation of vermiform appendix (a small finger like appendage attached to caecum just below the ileocecal valve)

  1. write down the sign and symptoms of appendicitis
  • progressively worsening pain
  • painful coughing or sneezing
  • nausea
  • vomiting
  • diarrhea
  • inability to pass gas (break wind)
  • fever
  • constipation
  • loss of appetite
  1. write down the nursing management of appendicitis
    1. Maintain NPO status.
    2. Administer fluids intravenously to prevent dehydration.
    3. Monitor for changes in level of pain.
    4. Monitor for signs of ruptured appendix and peritonitis.
    5. Position right-side lying or low to semi fowler position to promote comfort.
    6. Monitor bowel sounds.

Q3) define ovarian cyst

Ovarian cysts are fluid-filled sacs or pockets in an ovary or on its surface. Women have two ovaries, each about the size and shape of an almond on each side of the uterus.

  1. write down the causes and management of ovarian cyst
    1. Hormonal problems. Functional cysts usually go away on their own without treatment.
    2. Women with endometriosis can develop a type of ovarian cyst called an endometrioma.
    3. Severe pelvic infections.


▪ Functional/physiologic cysts usually resolve spontaneously


  • Uncomplicated cyst rupture (hemodynamically stable) ▫Pain management (e.g., NSAIDs)



  • Ongoing hemorrhage, hemodynamic instability, torsion/rupture risk
  • Ovarian cystectomy ▫Removal of abnormal tissue only
  • Unilateral/bilateral oophorectomy ▫Removal of entire ovary(ies); recommended for menopausal/ postmenopausal individuals, if malignancy confirmed

Q4) define polycythemia

Polycythemia refers to an increase in the number of red blood cells in the body. The extra cells cause the blood to be thicker, and this, in turn, increases the risk of other health issues, such as blood clots.

  1. discuss types of polycythemia

Primary Polycythemia occurs when excess red blood cells are produced as a result of an abnormality of the bone marrow. Often, excess white blood cells and platelets are also produced.


Secondary polycythemia is usually due to increased erythropoietin (EPO) production either in response to chronic hypoxia (low blood oxygen level) or from an erythropoietin secreting tumor.


Relative erythrocytosis is an increase in RBC numbers without an increase in total RBC mass. Usually, this is caused by loss of plasma volume with resultant hemo-concentration, as seen in severe dehydration related to vomiting and diarrhea.


Stress polycythemia is a term applied to a chronic (long standing) state of low plasma volume, which is seen commonly in active, hardworking, anxious, middle-aged men. In these people, the red blood cell volume is normal, but the plasma volume is low.

  1. write down the nursing intervention of polycythemia
    1. Monitor for peripheral and cerebral thrombosis.
    2. Assist the patient for ambulation
    3. Perform phlebotomy as per doctor’s order
  2. Administer iv fluids and encourage to take oral fluids
  3. Administer pain management measures
  4. Advice to do regular exercise
  5. Instruct to avoid tobacco
  6. Advise to maintain skin hygiene
  7. Avoid extreme temperatures
  8. Provide psychological support to the patient.

Q5) a) define infertility

Inability to achieve pregnancy with limited intercourse for at least 1 year

  1. write down the causes of infertility in male and female Causes of infertility in females

1)​The most common overall cause of female infertility is the failure to ovulate.

2)Problems with the menstrual cycle, the process that prepares the female body for pregnancy, can lead to infertility.

3)Structural problems usually involve the presence of abnormal tissue in the fallopian tubes or uterus.

4)Infections can also cause infertility in men and women.

5)Implantation failure refers to the failure of a fertilized egg to implant in the uterine wall to begin pregnancy.

6)Polycystic Ovary Syndrome (PCOS) is one of the most common causes of female infertility.

7)Primary Ovary Insufficiency (POI) is a condition in which a woman’s ovaries stop producing hormones and eggs at a young age.

8)​Autoimmune disorders cause the body’s immune system to attack normal body tissues it would normally ignore. Autoimmune disorders, such as lupus, Hashimoto’s and other types of thyroiditis, or rheumatoid arthritis, may affect fertility.

Causes of infertility in Males

1)​Sperm Disorders

The most common problems are with making and growing sperm. Sperm may:

  • not grow fully
  • be oddly shaped
  • not move the right way
  • be made in very low numbers (oligospermia)
  • not be made at all (azoospermia)


Varicoceles are swollen veins in the scrotum. ​They harm sperm growth by blocking proper blood drainage.

3)​Retrograde Ejaculation

Retrograde ejaculation is when semen goes backwards in the body. They go into your bladder instead of out the penis. This happens when nerves and muscles in your bladder don’t close during orgasm (climax). Semen may have normal sperm, but the semen cannot reach the vagina.

4)​Immunologic Infertility

Sometimes a man’s body makes antibodies that attack his own sperm.


Sometimes sperm can be blocked. Repeated infections, surgery (such as vasectomy), swelling or developmental defects can cause blockage. Any part of the male reproductive tract can be blocked. With a blockage, sperm from the testicles can’t leave the body during ejaculation.


Hormones made by the pituitary gland tell the testicles to make sperm. Very low hormone levels cause poor sperm growth.


Sperm carries half of the DNA to the egg. Changes in the number and structure of chromosomes can affect fertility. For example, the male Y chromosome may be missing parts.


Certain medications can change sperm production, function and delivery. These medications are most often given to treat health problems like:

  • arthritis
  • depression
  • digestive problems
  • infections
  • high blood pressure
  • cancer

Q6) a) define peritonitis

Inflammation of the peritoneum (The peritoneum is the tissue layer of cells lining the inner wall of the abdomen and pelvis). Peritonitis can result from infection (such as bacteria or parasites), injury and bleeding, or diseases (such as systemic lupus erythematosus).

  1. discuss the causes of peritonitis
    1. a burst stomach ulcer.
    2. a burst appendix.
    3. digestive problems, such as Crohn’s disease or diverticuliti
    4. injury to the stomach.
    5. pelvic inflammatory disease
  1. write down the nursing management of peritonitis
    1. Blood pressure monitoring. The patient’s blood pressure is monitored by arterial line if shock is present
    2. Administration of analgesic and anti-emetics can be done as prescribed.
    3. Pain management. Analgesics and ​positioning​could help in decreasing pain.
      I&O monitoring.
    4. Accurate recording of all ​intakes and output​could help in the assessment of fluid replacement.
    5. IV fluids​. The ​nurse​administers and closely monitors IV fluids.
    6. Drainage monitoring. The nurse must monitor and record the character of the drainage postoperatively.

Q7) write the short note on the following

1)CT scan

A computerized tomography (CT) scan combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside your body. CT scan images provide more-detailed information than plain X-rays do.

2) upper and lower endoscopies

Endoscopy is a procedure in which the gastrointestinal (GI) tract is viewed through a fiber-optic camera known as an endoscope, inserted either through the mouth (upper) to scan the esophagus, stomach and small intestines, or through the anus (lower) to examine the large intestine, colon and rectum.

3) parenthesis

Parenthesis​refer to punctuation marks “(” and “)” used to separate relevant information or a comment from the rest of the text, or to enclose mathematical symbols, or the text inside of these marks. The punctuation marks in the math equation 2x (4+6) are an example ​of ​parenthesis​.

4) cystoscopy

Cystoscopy (sis-TOS-kuh-pee) is a procedure that allows your doctor to examine the lining of your bladder and the tube that carries urine out of your body (urethra). A hollow tube (cystoscope) equipped with a lens is inserted into your urethra and slowly advances into your bladder.

5) metabolic acidosis

Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body’s acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids.

The most common causes of hyperchloremic metabolic acidosis are gastrointestinal bicarbonate loss, renal tubular acidosis, drugs-induced hyperkalemia, early renal failure, and administration of acids.


Adult Health Nursing-I solved past paper- 2019

Q1) a) describe cirrhosis of liver

Cirrhosis of the liver is a chronic, progressive disease characterized by widespread fibrosis(scarring) and nodule formation.

The development of cirrhosis is an insidious, prolonged course, usually after decades of chronic liver disease.

b) enlist its signs and symptoms

Some of the more common symptoms and signs of cirrhosis include:

    1. Yellowing of the skin (jaundice) due to the accumulation of bilirubin in the blood
    2. Fatigue
    3. Weakness
    4. Loss of appetite
    5. Itching
    6. Easy bruising from decreased production of blood clotting factors by the diseased liver.
  1. list 10 points of nursing intervention
    1. Promoting rest ​to conserve energy
    2. Improving nutritional status
    3. Providing skin care
    4. Reducing risk of injury
    5. Monitoring & managing Potential complication
  • Bleeding & hemorrhage
  • Hepatic encephalopathy
  • Fluid Volume excess
  1. Promoting home & self care
  2. Client teaching like deep breathing techniques.
  3. Provide adequate nutrition and education, encourage lifestyle changes
  4. Provide a quiet and calm environment.
  5. Provide comfort measures such as back rubbing and changing position to relieve pain.

Q2) a) define intestinal obstruction and its types

This obstruction can involve only the small intestine (small bowel obstruction), the large intestine (large bowel obstruction), or via systemic alterations, involving both the small and large intestine (generalized ileus). The “obstruction” can involve a mechanical obstruction or, in contrast, may be related to ineffective motility without any physical obstruction, so-called functional obstruction, “pseudo-obstruction,” or paralytic ileus

There are two main types

  1. Mechanical
    1. It is caused by physical barrier
      1. Adhesions
        1. Cause Tissue and organ stick together
      2. Tumor
      3. Hernia
      4. Intussusception
      5. Volvulus
      6. Fecal impaction
  2. Functional
    1. Lack or absence of peristalsis
      1. Lack of muscular contractions to move food contents

b) describe its management and nursing care

1)Collaborative Care

a. Relieving pressure and obstruction

b. Supportive care

2)Gastrointestinal Decompression

a. Treatment with nasogastric or long intestinal tube provides bowel rest and removal of air and fluid

b. Successfully relieves many partial small bowel obstructions


a. Treatment for complete mechanical obstructions, strangulated or incarcerated obstructions of small bowel, persistent incomplete mechanical obstructions

b. Preoperative care

1.Insertion of nasogastric tube to relieve vomiting, abdominal distention, and to prevent aspiration of intestinal contents

2.Restore fluid and electrolyte balance; correct acid and alkaline imbalances

3.Laparotomy: inspection of intestine and removal of infarcted or gangrenous tissue

4.Removal of cause of obstruction: adhesions, tumours, foreign bodies, gangrenous portion of intestines and anastomosis or creation of colostomy depending on individual case

4)Nursing Care

a. Prevention includes healthy diet, uid intake

b. Exercise, especially in clients with recurrent small bowel obstructions

Q3) a) define renal failure and its causes


A condition in which the ​kidneys​stop working and are not able to remove waste and extra water from the blood or keep body chemicals in balance. Acute or severe renal failure​happens suddenly (for example, after an injury) and may be treated and cured.

The most common causes are:

    1. high blood pressure
    2. chronic glomerulonephritis (kidney damage)
    3. high blood sugar (diabetes)
    4. polycystic kidney disease
    5. blocked urinary tract
    6. kidney infection
  1. describe acute renal failure along with nursing care

Acute kidney failure​happens when your ​kidneys​suddenly lose the ability to eliminate excess salts, fluids, and waste materials from the blood. This elimination is the core of your ​kidneys​’main function. Body fluids can rise to dangerous levels when ​kidneys lose their filtering ability.

Nursing Interventions:

  1. Monitor 24-hour urine volume to follow clinical course of the disease.
  2. Monitor BUN, creatinine, and electrolyte.
  3. Monitor ABG levels as necessary to evaluate acid-base balance.
  4. Weigh the patient to provide an index of fluid balance.
  5. Measure blood pressure at various times during the day with patients in supine, sitting, and standing positions.
  6. Adjust fluid intake to avoid volume overload and dehydration.
  7. Watch for cardiac dysrhythmias and heart failure from hyperkalaemia, electrolyte imbalance, or fluid overload. Have resuscitation equipment available in case of cardiac arrest.
  8. Watch for urinary tract infection and remove bladder catheter as soon as possible.
  9. Employ intensive pulmonary hygiene because incidence of pulmonary oedema and infection is high.

10.Provide meticulous wound care.

11.Offer high-carbohydrate feedings because carbohydrates have a greater protein-sparing power and provide additional calories.

12.Institute seizure precautions. Provide padded side rails and have airway and suction equipment at the bedside.

13.Encourage and assist the patient to turn and move because drowsiness and lethargy may reduce activity.

14.Explain that the patient may experience residual defects in kidney function for a long time after acute illness.

15.Encourage the patient to report routine urinalysis and follow-up examinations.

16.Recommend resuming activity gradually because muscle weakness will be present from excessive catabolism.

Q4) a) what is abortion and describe its causes and types

Abortion is the termination of pregnancy before viability of the featus before 22 weeks or if the fetal weight is less than 500gm.


Interruption of pregnancy or expulsion of the product of conception before the fetus is viable is called abortion. The fetus is generally considered to be viable any time after the fifth to sixth month of gestation.

There are three main types

    1. Spontaneous Abortion
      1. It is caused by
        1. abnormality in the fetus
        2. systemic diseases
        3. hormonal imbalance
        4. anatomic abnormalities
    2. Habitual Abortion
      1. It is caused by
        1. chromosomal anomalies
    3. Induced Abortion
      1. It is caused by
        1. A voluntary induced termination of pregnancy is performed by skilled health care providers
  1. right management of habitual abortion

Medical Management

After a spontaneous abortion, all tissue passed vaginally is saved for examination, if possible. The patient and all personnel who care for her are alerted to save any discharged material. In the rare case of heavy bleeding,the patient may require blood component transfusions and fluid replacement. An estimate of the bleeding volume can be determined by recording the number of perineal pads and the degree of saturation over 24 hours. When an incomplete abortion occurs, oxytocin may be prescribed to cause uterine contractions before D&E or uterine suctioning.

Nursing management

Because patients experience loss and anxiety, emotional support and understanding are important aspects of nursing care. Women may be grieving or relieved, depending on their feelings about the pregnancy. Providing opportunities for the patient to talk and express her emotions is helpful and also provides clues for the nurse in planning more specific care.

Q5) a) what is your understanding about infertility

Infertility is defined as a couple’s inability to achieve pregnancy after 1 year of unprotected intercourse

b) describe its pathophysiology and its management


  1. Age
  2. Weight
  3. Genetic causes ; turner syndrome
  4. Hypothalamic pituitary disorder
  5. Anatomical disorders


  1. Assist in reducing stress in relationship
  2. Encourage cooperation
  3. Protect privacy
  4. Foster understanding and refer the couple to appropriate resources when necessary . Because infertility workups are expensive, time consuming , invasive , stressful, and not always successful .
  5. Couples need support in working together to deal with endeavor
  6. Smoking is strongly discouraged because it has an adverse effect on the success of assisted reproduction
  7. Diet, exercise , stress reduction techniques, health maintenance ,and disease prevention are being emphasized in many infertility programs .

Q6) a) define anaemia

Anaemia​is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body’s tissues. Having ​anaemia​can make you feel tired and weak. There are many forms of ​anaemia​, each with its own cause.

b) enlist its types

The seven types of anaemia

  1. Iron deficiency anaemia​.
  2. Thalassaemia.
    1. Aplastic ​anaemia​.
    2. Haemolytic ​anaemia​.
    3. Sickle cell ​anaemia​.
    4. Pernicious ​anaemia​.
    5. Fanconi ​anaemia​.
  3. describe iron deficiency anemia in detail

As the name implies, ​iron deficiency anemia​is due to insufficient ​iron​. Without enough ​iron​, your body can’t produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin). As a result, ​iron deficiency anemia​may leave you tired and short of breath.

Iron-Deficiency Anemia: Signs, Symptoms, and Treatment

  • Fatigue.
  • Weakness.
  • Pale skin.
  • Shortness of breath.
  • Dizziness.
  • Swollen, sore tongue.
  • Abnormal heart rate.

To treat iron deficiency anemia, your doctor may recommend that you take ​iron supplements​.

Iron supplements

  • Take ​iron​tablets on an empty stomach.
  • Don’t take ​iron​with antacids.
  • Take ​iron​tablets with vitamin C.

Q7) differentiate between palliative care and hospice care

Hospice care Palliative care
1) It is mainly based on comfortable care without any intention of curing a patient It targets on patient comfort and care with or without the presence of curative
2) Requires physician certification Does not require physician certification
3) Patient is not seeking curative measures or return to the hospital Patient may be seeking curative measures or return to the hospital
4) Patient has a terminal or untreatable illness with fewer than 6 months to live in the normal course of the disease Patient has a serious chronic or life limiting illness
5) Focus on symptoms management and quality of life Address goals of care focus on symptoms management and quality of life
6) Usually takes place in a home or home like environment Usually takes place in a hospital or medical facility
7) Patient has agreed to stop active/curative treatment Can be provided with active/curative treatment