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