Health Assessment Solved Past paper 2019

Q1) define interview and explain the principles of interviewing

Interview Definition:

The interview is a process of communication or interaction in which the subject or interviewee gives the needed information verbally in a face to face situation.

Principles Of Interviewing:

  1. Interviewing is a special kind of conversation
  2. Has a definite purpose
  3. More structured
  4. Strong element of control
  5. Two parties only: interviewer and respondent
  6. Different amounts of speaking (30/70)
  7. A significant aspect of daily business

Q2) describe the component of health history that should be produced during the assessment of skin, head and neck

Subjective Data:

  1. Any previous skin disease or problem (infection, rashes, lesions, itching).
  2. How was it treated?
  3. Skin allergic problem
  4. precipitating factors (stress, weather, drugs)
  5. Any birth marks or tattoos.
  6. Change in skin color, pigmentation and lesions
  7. Any recent hair loss
  8. Amount of sun exposure

Examination of Skin:

1. Color
2.Temperature
3.Texture
4.Mobility
5.Turgor
6.Moisture
7.Sensation
8.Integrity

Lesions

  1. lLocation/ distribution
  2. lMorphology
  3. –Primary
  4. –Secondary
  5. –Vascular
  6. –Cancerous

Q3) classify the structure landmarks of the nose mouth and pharynx

Nose

  1. The nose is the first segment of the respiratory system.
  2. It is the sensory organ of smell
  3. External nose (It shaped like a triangle with one side attached to the face on its leading edge.
  4. The superior part is the bridge and the free corner is the tip.
  5. The oval openings at the base of the triangle are the nares just inside, each nares widen into the vestibule.
  6. The upper third of the external nose is made of bone, the rest is cartilage. The parts of the nose are:
  7. Nasal cavity
  8. Septum
    iii.        Turbinate
    Paranasal sinuses
    Frontal
    Maxillary
    vii.       Ethmoid
    VIII. Sphenoid

Mouth

  1. Mouth is the first segments of the digestive system and the airway of the respiratory system.
  2. The oral cavity is the short passage boarded by the lips, palate, checks, and tongue.
  3. It continues the teeth, gums, tongue and salivary glands.
  4. The arching roof of the mouth is the palate, it is divided into two parts.
  5. The interior, hard palate; Posterior to this is the soft palate.
  6. The uvula is the free projection hanging down from the middle of the soft palate.
  7. The cheeks are the side walls of the oral cavity.
  8. Floor of the mouth is tongue and horse shoe shaped mandible bone.
  9. Parotid
  10. Submandibular gland
  11. Sublingual fold, duct and gland
  12. Teeth

Pharynx:

  1. Oropharynx
  2. Tonsils
  3. Nasopharynx

Q4) describe the specific assessment to be made during the physical examination of abdomen

Assessment

1. Inspect
a. Shape and contour
i. Look across abdomen left to right
ii. Can use pen light to look for visible bulging or masses
iii. Look for distention
b. Umbilicus – discoloration, inflammation, or hernia
c. Skin texture and color
d. Lesions or scars
i. Note details – length, color, drainage, etc.
e. Visible pulsations
f. Respiratory movements (belly breather)
2. Auscultate
a. Start in RLQ → RUQ → LUQ → LLQ
i. This follows the large intestine
b. Use diaphragm of stethoscope to listen for 1 full minute per quadrant
i. Active – Should hear 5-30 clicks per minute
ii. Hypoactive
iii. Hyperactive
iv. Absent – must listen for 5 minutes per quadrant to confirm this
c. Use bell of stethoscope to listen for bruits
i. Aorta – over the epigastrium
ii. Iliac and femoral arteries – Inguinal are
iii. Renal arteries – A few cm above and to the side of the umbilicus
1. Press firmly
iv. The presence of a bruit could indicate narrowing of the arteries – if this is a new finding, report to provider
3. Percuss
a. Percuss x 4 quadrants, starting in RLQ as with auscultation
b. Expect to hear tympany
c. Dullness could indicate a mass, fluid-filled bladder, blood in the belly, or significant adipose tissue
i. Exception – dullness over the liver is expected
d. CVA tenderness
i. Place nondominant hand flat over the costovertebral angle (flank).
ii. Strike your hand with the ulnar surface of your dominant hand
iii. Should be nontender
iv. Repeat bilaterally
4. Palpate
a. Light palpation – small circles in all 4 quadrants
i. Can do 4 small areas in each quadrant to be thorough
b. Deep palpation – deeper circles in all areas
c. Palpating for masses – make note of size, location, consistency, tenderness, and mobility
d. Make note of any guarding or tenderness
e. Assess for rebound tenderness
i. Press down slowly and deeply
ii. Release quickly
iii. Ask patient which hurt most (down or up)
iv. Rebound tenderness over RLQ could indicate appendicitis
f. If distended, perform Fluid-Wave test to look for ascites:
i. Place patient’s hand over umbilicus
ii. Place your hand on right flank, then tap or push on the left flank with your other hand
iii. If you feel the tap/push on the opposite hand, that’s a Positive Fluid-Wave test
1. Indicates Ascites
iv. You may also see the patient’s hand ‘wave’ with the fluid

Q5) define breast examination and discuss the steps of self-breast examination

 Definition

A physical exam of the breast performed by a health care provider to check for lumps or other changes. Also called CBE.

steps of self-breast examination

 Step 1: stand up before the mirror and Start by looking for differences between your breasts

  1. Good breast self-exams should be concerned with both the look and feel of breasts. The look element should be performed while either standing or sitting in front of a mirror, with your clothes removed. Examine both breasts and look for:
  2. Visible lumps
  3. Any unusual differences between the two breasts

iii.  Dimpling or indentations in the breast tissue

  1. Redness, scaliness, or other changes to the skin or nipples that appear abnormal
  2. Changes to your nipples, for example a nipple that is newly inverted or pulling in

Step 2: Put your hands on your hips, pull your elbows forward

  1. Look for the same changes in the breasts from Step 1 — such as redness, lumps and indentations — this time with your hands resting on your hips

while squeezing your elbows forward since this might bring out lumps that might not appear otherwise. Keep your hands on your hips and slowly swivel from side to side to catch possible abnormalities from more angles.

  1. Next, lift your arms above your head to see if there’s any puckering or dimpling of the skin when you elevate them. “When you raise your arms, the mass, if there is one, stays there and the skin pulls in,” says Kruper.

Step 3: Use 3 fingers when examining your breasts

  1. The feel part of the breast self-exam should be done while lying down, with a pillow propping up your head and your arm resting behind it. With the opposite hand, take the first three fingers — index, middle and ring fingers — and use them to press down around the breast and surrounding area using circular motions. Using three fingers, rather than just one, keeps you from mistaking normal breast tissue for lumps. Increase the pressure you use with each pass around the breasts to ensure you are not just feeling superficial tissue.

Step 4: Examine the areas surrounding the breast

  1. After examining your breasts, it is important to perform a check of the areas around them. Continue to use circular motions and increasing pressure as you move from the collarbone to the sternum and down below the breast. From the lower part of the breast, travel up to the area under your arm to look for any swelling in the lymph nodes. “What you’re looking for is something that stands out — something that feels like a pea, or a marble or a walnut,” says Kruper. “Something that definitely feels different than the surrounding breast tissue.”

Step 5: Perform the test at the same time each month

A, Be sure to do the breast self-examination the same time every month. If you are still menstruating, Kruper recommends you do the exam about seven to 10 days after your menstrual cycle, since at that time there will likely be fewer cycle-related changes in the breast tissue. Women who are postmenopausal can do the exam at any time of the month, as long it is around the same time each month.

B, Keep in mind that there is some debate about whether women should perform routine breast self-exams to find potentially cancerous lumps.

According to current research, some of the issues depend on the possibility of false positives and the possibility that the screenings might not really increase a woman’s probability of survival.

Q6) classify the equipment needed to perform a physical examination

 The equipment needed to perform a physical examination

  1. Within reach and ready
  2. Arranged as per need
  3. Required equipment
  4. Extra supplies/equipment
  5. Clean or sterile equipment
  6. Warm metallic piece

The following are the more common but essential medical tools that are used during physical health exam.

  1. Medical Weighing Scale
  2. Sphygmomanometer
  3. Stethoscope
  4. Thermometer
  5. Ophthalmoscope
  6. OTOSCOPE
  7. TUNING FORK
  8. NASAL SPECULUM
  9. PERCUSSION HAMMER
  10. VAGINAL SPECULUM
  11. PROTOSCOPE
  12. GLOVES

Q7) define health assessment and identify types of health assessment

Definition

A health assessment is a plan of treatment that outlines a person’s unique requirements and how those needs will be met. A is provided by the hospital system or a skilled nursing facility. Health assessment is the evaluation of one’s health status through a physical exam and a health history. It is done to detect diseases in people who appear to be healthy.
There are four types of Health Assessment

1)   Comprehensive Initial Assessment:

  1. The initial assessment, also known as triage assessment.
  2. Performed shortly after admittance to hospital
  3. Performed by the nurse to collect data on all aspects of patient’s health
  4. It helps to determine the nature of the problem and prepares the way for the ensuing assessment stages.
  5. The initial assessment is used more than the other assessments used by nurses.
  6. Components may include obtaining a patient’s medical history or putting him/her through a physical exam, or preparing a psychosocial assessment for a mental health patient.
  7. Other components may include obtaining a patient’s vital signs and taking subjective statements from the patient, as well as double-checking the subjective symptoms with the objective signs of the condition.

2)   Focused Assessment:

  1. The focused assessment is the stage in which the problem is exposed and treated.
  2. Due to the importance of vital signs and their ever-changing nature, they are continuously monitored during all parts of the assessment.
  3. May be performed during initial assessment or as routine ongoing data collection
  4. Performed to gather data about a specific problem already identified, or to identify new or overlooked problems
  5. Performed by the nurse to collect data about the specific problem
  6. Depending on the problem, initial treatment for pain and long-term treatment for the root cause of the trouble is administered and monitored.
  7. Part of the goal of the focused assessment is to diagnose and treat the patient in order to stabilize her condition.
  8. Focused assessments may also include X Rays or other types of tests.

3)   Time-Lapsed Assessment:

  1. Once treatment has been implemented, a time-lapsed assessment must be conducted to ensure that the patient is recovering from his problem and his condition has stabilized.
  2. Depending on the nature of the problem, the time-lapsed assessment may span the length of one or two hours or a couple of months.
  3. Performed to compare a patient’s current status to baseline data obtained earlier
  4. Performed to reassess health status and make necessary revisions in plan of care
  5. Performed by the nurse to collect data about current health status of patient
  6. During the time-lapsed assessment, the current status of the patient is compared to the previous baseline during and prior to treatment.
  7. Similar to the focused assessment, the time lapsed assessment may also include lab work, X-rays or other diagnostic medical testing.

4)   Emergency Assessments:

  1. During emergency procedures, a nurse is focused on rapidly identifying the root causes of concern for the patient and assessing the airway, breathing and circulation (ABCs) of the patient.
  2. Once the ABCs are stabilized, the emergency assessment may turn into an initial or focused assessment, depending on the situation.
  3. If the nurse is not in a health care setting, emergency assessments must also include an assessment for scene safety so that no other individuals, including the nurse himself/herself are hurt during the rescue and emergency response process.
  4. Performed by the nurse to gather data about the life-threatening problem

 

Health Assessment Paper- MCQs/BCQs

1) When doing an assessment on a client’s eyes the very first thing that a nurse should look at is?
A. Eye internal structures
B. Eye external structures
C. The pupils reactivity to light
D. Color of the irises of the eye
2) While the nurse is inspecting the throat of a client with a tongue blade, the client begins to gag. What does this response indicate to the nurse?
A. The client is nauseated.
B. The client has nerve damage to his tongue.
C. The client has a functioning response.
D. The client has a malfunctioning response
3) During the health history, a client begins to talk about her dog and the trouble she is having housebreaking the new pet. To help the client return to the health interview, the nurse could use the communication skill:
A. Listening
B. Reflecting
C. Questioning
D. Focusing
4) After inspecting a client’s abdomen, which assessment technique should the nurse use next?
A. Light Palpation
B. Percussion
C. Auscultation
D. Deep Palpation
5) Nurse Tara asks her client Farhan to clench his jaw as she continues to palpate his head. When she asks him to do this what is Nurse Tara most likely trying to palpate?
A. Faran’s submandibular joint
B. Farhan’s submental joint
C. Farhan’s temporomandibular joint
D. Faran’s temporal artery
6) The nurse is planning to palpate a client’s bladder. Which area of the abdomen should this palpation be done?
A. Hypogastric region
B. Right hypochondriac region
C. Right Lower Quadrant
D. Left lumbar region
7) A 70-year-old male client comes into the clinic with weight loss and difficulty swallowing. Which of the following should the nurse document for this client?
A. Odynophagia
B. Bulimia
C. Dysphagia
D. Aphasia
8) A 15-year-old high school student came to the clinic with a 1-day history of nausea and anorexia. He describes the pain as generalized yesterday, but today it has localized to the right lower quadrant. You palpate the left lower quadrant and the patient experiences pain in the right lower quadrant. What is the name of this sign?
A. Murphy’s sign
B. Psoas sign
C. Grey Turner’s sign
D. Rovsing’s sign
9) During eye assessment when you asked the patient to follow your finger or pencil as you move it in toward the bridge of the nose. Which of the following test you are performing?
A. Visual acuity
B. Visual Fields by Confrontation
C. Test for convergence
D. Visual fields
10) A nurse doing her assessment proceeds to palpate a client’s frontal and maxillary sinuses. What should she make sure she checks for?
A. Tactile signs of carcinoma
B. Swelling
C. Lesions
D. Tenderness
11) A nurse would use either a Snelling chart or the finger wiggle test to assess a client’s what?
A. Hearing
B. Vision
C. Consensual light reflex
D. Bone conduction
12) During assessment of pharynx you as the client to say “Ah” and uvula and soft palate rise centrally. It determines the function of which cranial nerve:
A. Spinal accessory
B. Vagus
C. Trochlear
D. Trigeminal
13) During the assessment of a client, the nurse gently touches the tip of a sterile cotton swab in the client’s eye. Which of the following would be considered an expected response for the client to make?
A. Begin sneezing.
B. Blink.
C. Scream in pain.
D. Swat the nurse’s hand away.
14) If assessing a client for kidney tenderness, where would you begin?
A. External Oblique Angle
B. Left Upper Quadrant
C. Right Upper Quadrant
D. Costovertebral Angle
15) The three things a nurse needs to check for when doing an examination on the eyes regarding the external structures is?
A. Eyelash texture, shape of eyes, redness
B. Shape of eyes, pupils reactivity, iris’s color
C. Drainage, possible tumors, irritation
D. Eyelash distribution, coloring, drainage
16) A 40-year-old female came for evaluation of abdominal pain. She stated that it is worse after eating, especially if she has a meal that is spicy or high in fat. She has taken antacids, but they have not helped the pain. After examining her abdomen, you strongly suspect cholecystitis. Which sign on examination increases your suspicion for this diagnosis?
A. Murphy’s sign
B. Psoas sign
C. Grey Turner’s sign
D. Rovsing’s sign
17) During the percussion of a client’s abdomen, the nurse hears a loud high-pitched drum like tone. The nurse would document this sound as being:
A. Resonance
B. Tympany
C. Hyper-resonance
D. Flatness
18) What could the nurse assess based solely on the way the client walks into the room?
A. Signs of illness, well nourished
B. Dress and signs of illness
C. Gender and age
D. Gait and posture
19) Which of the following is a clinical manifestation of Bell’s palsy?
A. Asymmetry of the mouth
B. Asymmetry of the entire side of the face
C. Asymmetry of the lower face
D. Involuntary movements of the face
20) The nurse notices that a client walks with a limp and has long legs. Which of the following aspects of the general survey is this nurse assessing?
A. Physical appearance
B. Behavior
C. Mental status
D. Mobility
21) Test for shifting dullness is performed to assess:
A. Liver abscess
B. Ascites
C. Cholecystitis
D. Peritonitis
22) When a nurse performing the eye examinations, which piece of equipment does she/he use to inspect the eye structures?
A. Ultrasonic stethoscope
B. Sphygmomanometer
C. Ophthalmoscope
D. Otoscope
23) The normal liver span of an adult is:
A. 7-12 cm
B. 5-12 cm
C. 6-12 cm
D. 4-12 cm
24) A client comes into the clinic for a routine breast and axilla exam. Which assessment technique does the nurse use first during this examination?
A. Palpation
B. Auscultation
C. Inspection
D. Percussion
25) The clinic is sponsoring a client education session for breast cancer awareness month. Which of the following considerations should be included to support cultural differences about breast health?
A. Refer all clients to the American Cancer Society if they have questions.
B. Inform all about the low-cost breast cancer screening program…
C. A:
D. Encourage all females to increase their intake of vitamins A and E
26) Grade +2 pitting edema is:
A. 4 mm deep
B. 6 mm deep
C. 2 mm deep
D. 8 mm deep
27) The nurse is going to assess a client’s blood pressure. To do this, the nurse will need to have:
A. A stethoscope and sphygmomanometer
B. A tongue blade and tuning fork
C. A flashlight and gloves
D. A stethoscope and thermometer
28) The clinic is sponsoring a client education session for breast cancer awareness month. Which of the following considerations should be included to support cultural differences about breast health?
A. Refer all clients to the American Cancer Society if they have questions.
B. Encourage all females to increase their intake of vitamins A and E.
C. Inform all about the low-cost breast cancer screening program.
D. Encourage all females to complete monthly breast exams
29) After auscultating the bowel sounds of a client, the nurse realizes the sounds were long. Which of the following would be appropriate for the nurse to use to document this finding?
A. Intensity
B. Pitch
C. Quality
D. Duration
30) During the physical assessment of Mr. Ahsan’s skin, the nurse observed that Mr. Ahsan’s skin color is pale, the nurse expect that Mr. Ahsan may has:
A. Jaundice
B. Anemia
C. Heart failure
D. Pulmonary edema
31) The nurse assesses a client’s vision to be 20/150. The client asks for an explanation of the numbers. Which of the following would be a correct explanation for the nurse to say to the client?
A. You might need surgery to correct the nystagmus
B. You see at 20 feet what a person with normal vision sees at 150 feet.
C. You see at 150 feet what a person with normal vision sees at 20 feet.
D. You have impaired vision
32) A nurse conducting an assessment on a client’s head would do what first?
A. Inspect and palpate hair
B. Look at patient’s prior medical history
C. Inspect and palpate scalp
D. Inspect and palpate sinuses to control spread of germs
33) The nurse is planning to assess the abdomen of an adult male.
A. Place the client in side-lying position
B. Ask client to empty bladder
C. Tell client to raise arms above the head
D. Ask client to hold his breath for a few seconds
34) Normal angle at nail base is:
A. 10 degrees
B. 160 degrees
C. 180 degrees
D. 30 degrees
35) When performing an ear assessment, the nurse notes tenderness of the pinna and tragus to movement and the presence of drainage in the external canal. The nurse suspects which of the following?
A. Otitis Media
B. Otitis Externa
C. An inner ear infection
D. A negative rmberg’s sign
36) The nurse asks the client to move his eyes in the shape of an H and then in a large X. The portion of the physical assessment the nurse is completing with this client is:
A. Assessing the optic nerve
B. Assessing extra ocular muscle movements
C. Assessing the eyelids
D. Assessing the red reflex
37) As the nurse introduces the otoscope into a client’s ear, the client starts to jerk his head and complains of pain. Which of the following should the nurse do?
A. Remove the otoscope and reinsert taking care not to touch the sides of the ear canal.
B. Begin to remove the embedded cerumen.
C. Instill ear drops.
D. Document “unable to complete the examination.
38) Which cranial nerve is affected by Bell’s palsy?
A. Facial (CN VII)
B. Trigeminal (CN V)
C. Vagus (X)
D. Abducens (CN VI)
39) In medical which term is used for “impaired near vision”?
A. Amblyopia
B. Myopia
C. Presbyopia
D. Diplopia
40) During the physical examination of a male client’s scrotum, the nurse palpates a mass. What should the nurse do next with this information?
A. Perform transillumination to further assess the finding.
B. Nothing. This is a normal finding.
C. Document mass palpated, left testicle.
D. Ask the client how long he’s had a tumor in his testicle.
41) During the breast exam, the nurse asks the client to raise her arms over her head. Why did the nurse change the client’s position?
A. The client has small breasts.
B. The client has large breasts.
C. The nurse couldn’t palpate the axillae correctly.
D. Skin dimpling is accented in this position

 

Pathophysiology MCQs/BCQs

1) Total body water is:
1. 14L
2. 42L
3. 20 L
4. 28 L

2) All of the following are benign tumors, the most unlikely is:
1. Adenocarcinoma
2. Meningioma
3. Fibroma
4. Leiomyoma

3) Neutrophils predominate in acute inflammatory infiltrate during:
1. First 06 -24 hours
2. First 08 hours
3. First 04- 06 hours
4. First 24-48 hours

4) Most effective Bactericidal system in neutrophils is:
1. Halideion
2. MPOsystem (Myeloperoxidase)
3. NADPHoxidasesystem
4. MP0-H202Halidesystem

5) What is the most important prognostic factor for human cancer is proved to be of greater clinical value:
1. Stage
2. Vascular invasion.
3. Lymphocytic infiltration
4. Grade.

6) Most reliable feature that differentiates malignant tumor from benign is:
1. Local invasion
2. Metastasis
3. Irregular surface
4. Capsule

7) Regarding type – I hypersensitity:
1. Initial response is characterized by vasoconstriction
2. Late phase reaction occurs after few minutes
3. Develop after few days
4. Characterized by release of mast cell mediators

8) Reaction due to injection of horse serum (serum sickness) is example of:
1. Type – IV hypersensitivity
2. Type – Il hypersensitivity
3. Type – Ill hypersensitivity
4 Type – I hypersensitivity

9) Antibody mediated hypersensitivity does not occur in:
1. Erythroblastosis fetalis
2. Autoimmune Hemolytic anemia
3. Arthus reaction
4. Transfusion reaction

10) A 50 years old male develops sudden severe abdominal pain radiating to back. His lab values shows raised Amylase level. Regarding this case fat necrosis may occur in which of the following organ:
1. Brain
2. Skeletal muscle
3. Pancrease
4. Heart

 

11) Regarding Necrosis, which of the following statement is true:
1. Pancreas shows coagulative necrosis
2. Heart shows coagulative necrosis
3. Brain shows coagulation Necrosis
4. Heart shows liquefactive necrosis

12) In full term pregnancy, which one of the following cell adaptation has maximum contribution to increase in the size of uterus?
1. Dystrophy
2. Hyperplasia
3. Anaplasia
4. Atrophy

13) AIDS can be transferred through following factors except:

1.Inhalation
2. Blood
3. Direct contact
4. Saliva
14) All of the following are malignant tumors, the most unlikely is
1. Adenocarcinoma
2. Fibrosarcoma
3. Teratoma
4. Leukemia

16) Which of the following complement proteins may act as Opsonins:
1. c3b
2. C3a
3 C5b 9 complex
4. C3a & C5a

17) All of the following are malignant tumors, the most unlikely is:
1. Leukemia
2. Adenocarcinoma
3. Fibrosarcoma
4. Osteoma

18) Which one of the following mediator causes, chemotaxis of the leukocytes?
1. C1
2. C5a
3. c2a
4. C4

19) Granuloma with caseous necrosis is seen in:
1. Lymphoma
2. Tuberculosis
3. Sarcoidosis
4. Foreign body granuloma

20) Which of the following lab diagnostic technique is most convenient and suitable for the initial diagnosis and management of the patient suffering from swelling infront of neck (goiter)?
1 Smear
2. FNAC
3. Immunohistochemistry
4. Biopsy

 

21) ———— is also called Cytotoxic Hypersensitivity because it utilizes antibodies that can destroy normal cells by complement lysis or by antibody-dependent cellular cytotoxicity
1. Type-ll hypersensitivity
2. Type-l hypersensivitiy
3. Type-IV hypersensivitiy
4. Type-ll hypersensivitiy

22) Most common chornic inflammatory cells are:
1. Neutrophils
2. Macrophages
3. Eosinophils
4. Plasma cells

23) Malignant tumor arising from mesenchymal tissue is most likely called as:
1. Adenomna
2. Sarcoma
3. Hepatoma
4. Fibroma

24) Metastasis of cancer most unlikely occur by:
1. Lymphatic spread
2. Direct seeding of body cavities
3. Aerosol droplet
4. Hematogenous spread

25) Regarding anaplasia which of the following statement is true:
1. Nuclear to cytoplasmic ratio 1:6
2. Increase mitosis
3. Well differentiated cells
4. Normal size of shape of cells

26) Laboratory test most commonly used for diagnosis of AIDS is:
1. ELISA
2. EASTERN BLOT
3. RIBA
4. WESTERN BLOT

27) Multiple sclerosis is example of:
1. Type – l hypersensitivity
2. Type- IV hypersensitivity
3. Type-Ill hypersensitivity
4. Type – I hypersensitivity

28) Generalized edema through the body is termed as:
1. Anasarca
2. Anaplasia
3. Sarcoma
4. Pitting edema

29) Major component of innate immunity are all of following, the most unlikely is:
1. Epithelial barrier
2. B-lymphocyte
3. Complement proteins
4. NK cells

30) A 40 years old male suffering from cervical lymphadenopathy. Biopsy report shows granuloma with caseous necrosis. The most likely diagnosis will be
1. Tuberculosis
2. Sarcoidosis
3. Lymphoma
4 Foreign body granuloma

 

31) Pathological hyperplasia of thyroid gland occurs in:
1. Thyroid connective tissue
2. Thyroid follicles
3. Whole thyroid tissue
4. Thyroid stroma

32) A 55 years old female with ovarian Carcinoma developed ascities. Cytological analysiss of ascitic fluid show malignant cells. Which of the following pathway best explaining the spreading of tumor to the peritonium:
1. Seeding of body cavity
2. Lymphatic spread
3. Hematogenous spread
4. Direct Extension

33) Weakness and wasting of the body due to severe chronic illness is referred to:
1. Neoplasm
2. Cachexia
3. Anorexia
4. Fatigue

34) Which of the following is earliest stage of vascular events of acute inflammation?
1. Vasodilation
2. Initial vasoconstriction
3. Redness
4. Leukocytic migration

35) Increased concentration of potassium in the blood is termed as:
1. Hypernatremia
2. Hyperkalemia
3. Hypokalemia
4. Hyponatremia

36) Loss of uniformity of cells & Ioss of arachitectural orientation is most likely called as:
1. Desmoplasia
2. Metaplasia
3. Dysplasia
4. Anaplasia

37) Arthus reaction is example of:
1. Type – lll hypersensitivity
2. Type – II hypersensitivity
3. Type- IV hypersensitivity
4. Type – I hypersensitivity

38) All are causes of atrophy, the most unlikely is:
1. Diminished blood supply
2. Denervation
3. Decrease workload
4. Increase workload

39) Excessive intake of acid containing foods and beverages may lead to development of:
1. Metabolic acidosis
2. Respiratory alkalosis
3. Metbolic alkalosis
4. Respiratory acidosis

40) In full term pregnancy, which one of the following cell adaptations has maximum contribution to increase in the size of uterus?
1. Dystrophy
2. Hyperplasia
3. Anaplasia
4 Atrophy

41) Goodpasture syndrome is example of:
1. Type -Ill hypersensitivityy
2. Type – I hypersensitivity
3. Type-ll hypersensitivity
4. Type – IV hypersensitivity

 

Adult health Nursing-I Solved past papers- 2019

Q1) Explain Strategies for managing patient with urinary stress incontinence

Ans :- The nurse instructs the patient to:

1)Avoid bladder irritants, such as caffeine, alcohol, and aspartame (NutraSweet).

2)Avoid taking diuretic agents after 4 pm.

3)increased awareness of the amount and timing of all fluid intake.

4)Perform all pelvic floor muscle exercises as prescribed, every day.

5)Stop smoking (smokers usually cough frequently, which increases incontinence).

6)Take steps to avoid constipation: Drink adequate fluids, eat a well-balanced diet high in fiber, exercise regularly, and take stool softeners if recommended.

7)Void regularly, 5–8 times a day (about every 2–3 hours):

  • First thing in the morning
  • Before each meal
  • Before retiring to bed
  • Once during the night if necessary

Q2) a) difference between AIDS and HIV

  1. b) explain the prevention of HIV

HIV:

HIV (Human Immunodeficiency Virus)

HIV is the acronym for human deficiency virus

Virus that invades the immunity system

Patient may suffer minor difficulties; symptoms will be similar to flu

AIDS:

AIDS (acquired immunodeficiency syndrome)

AIDS is the acronym for acquired immune deficiency syndrome

Large stage of spectrum of conditions, initially caused by the infection of (HIV)

Patient will experience severe sign and symptoms, disrupting the quality of life

Prevention of HIV

Individuals can reduce the risk of HIV infection by limiting exposure to risk factors.

1)Male and female condom use before sex

2)Testing and counselling for HIV and STIs

3)Testing and counselling, linkages to tuberculosis (TB) care

4)Avoid sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs

5)Elimination of mother-to-child transmission of HIV

Q3) enlist types of hypersensitivity and explain management of any one of them And :- Definition

Hypersensitivity is an excessive or aberrant immune response to any type of stimulus

Types of hypersensitivity

1)Anaphylactic (Type I) Hypersensitivity

2)Cytotoxic (Type II) Hypersensitivity

3)Immune Complex (Type III) Hypersensitivity

4)Delayed-Type (Type IV) Hypersensitivity

Anaphylactic (Type I) Hypersensitivity Management

1)​Antihistamines act​to block the effects of ​histamine​, which reduces ​vascular permeability ​and ​bronchoconstriction​.
2)Corticosteroids ​which can be used to reduce the inflammatory response, as well as epinephrine​, which is sometimes given during severe reactions via intramuscular injections through an EpiPen or ​intravenous​injection.
3)​Epinephrine​can help constrict blood vessels and prevent ​anaphylactic shock​.

Q4) enlist complication of chemotherapy

Ans :- ​Complication of chemotherapy

  • Hair loss.
  • Easy bruising and bleeding.
  • Anemia (low red blood cell counts)
  • Nausea and vomiting.
  • Appetite changes.

Q5) explain immediate post operative care of patient after appendectomy Ans :-

Post Operative care

1)Monitor vital sign.
2)Assess level of consciousness.
3)Assess bleeding at wound site.
4)Give clear fluid for first POD.
5)Monitor for infection and any complication at the wound incision.
6)Administer IV prophylaxis antibiotics as ordered.
7)Maintain aseptic technique during dressing.
8)Encourage patient to do ROM exercise.

Q6) English types of abortion and explain management of any one Ans :- Definition

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.

Types of abortion

1)Threatened abortion:-

The term threatened abortion is used when a pregnancy is complicated by vaginal bleeding before the 20th week. Pain may not be a prominent feature of threatened abortion, although a lower abdominal dull ache sometimes accompanies the bleeding. Vaginal examination at this stage usually reveals a closed cervix. 25% to 50% of threatened abortion eventually result in loss of the pregnancy.

Management

The patient is kept at rest in bed until 2 days after blood loss has ceased. Intercourse is forbidden. As soon as the initial bleeding has stopped an ultrasound scan is performed. This will reveal whether or not the pregnancy is intact. The prognosis is good when all abnormal signs and symptoms disappear and when the resumption of the progress of pregnancy is apparent.

2)Inevitable abortion:-

In case of inevitable abortion, a clinical pregnancy is complicated by both vaginal bleeding and cramp-like lower abdominal pain . The cervix is frequently partially dilated, attesting to the inevitability of the process.

Management

The uterus usually expels its contents unaided , and examination must be made with strict aseptic technique. If the abortion is not quickly completed, or if hemorrhage becomes severe, the contents of the uterus are removed with a suction curettege.

3)Incomplete Abortion:-

In addition to vaginal bleeding, cramp-like pain, and cervical dilatation , an incomplete abortion involves the passage of products of conception , often described by the women as looking like pieces of skin or liver.

Management

Patients require admission to the hospital. Treatment is aimed at preventing infection, controlling bleeding and obtaining an empty and involuting uterus. The chief risks associated with retained products are hemorrhage and sepsis.

4)Missed Abortion: –

The term missed abortion is used when the fetus has died but is retained in the uterus, usually for some weeks. After 16 weeks’ gestation, dilatation and curettage may become a problem. Fibrinogen levels should be checked weekly until the fetus and placenta are expelled.

Management

Once the diagnosis has been made the uterus should be emptied. Early in gestation evacuation of the uterus is usually accomplished by suction curettage. The prognosis for the mother is good. Serious complications are uncommon.

5) Recurrent Abortion: –

Recurrent abortion refers to any case in which there have been three consecutive spontaneous abortions. Possible causes are known to be genetic error, anatomic abnormalities of the genital tract, hormonal abnormalities, infection, immunologic factors, or systemic disease.

Management

Paternal and maternal chromosomes should be evaluated. The mother should be ruled out the presence of systemic disorders such as DM, SLE, and thyroid disease. It should rule out the presence of Mycoplasma, Listeria, Toxoplasma etc. infectious disease. Pelvic examination

Q7) English types of abortion and explain management of them

Types of abortion
1)Threatened abortion
2)Inevitable abortion
3)Incomplete Abortion
4)Missed Abortion
5)Recurrent Abortion

 

 

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.

Management

▪ Functional/physiologic cysts usually resolve spontaneously

MEDICATIONS

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

SURGERY

Laparoscopy/laparotomy

  • 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
    1. PRIMARY 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.

  1. SECONDARY POLYCYTHEMIA

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.

  1. RELATIVE POLYCYTHEMIA

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.

  1. STRESS POLYCYTHEMIA

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)

2)​Varicoceles

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.

5)​Obstruction

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.

6)Hormones

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

7)Chromosomes

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.

8)Medication

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

3)Surgery

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

Definition

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.

Or

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

Pathophysiology

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

Management

  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

 

Adult Health Nursing-I Solved past paper 2016-LUMHS

Q1) define first line defence /immune system

The ​first line​of ​defence​is your innate ​immune system​. Level one of this ​system consists of physical barriers like your skin and the mucosal lining in your respiratory tract. The tears, sweat, saliva and mucous produced by the skin and mucosal lining are part of that physical barrier.

The bodys first line of defense against pathogens uses mostly physical and chemical barriers such as

  1. Skin ​– acts as a barrier to invasion
  2. Sweat​– has chemicals which can kill different pathogens.
  3. Tears​- have lysozyme which has powerful digestive abilities that render antigens harmless.

Q2) define infertility and requirement for conception

In general, ​infertility​is ​defined​as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex.

The necessary requirements for conception to occur are the following:

  • The fallopian tubes must be unobstructed and functional to receive the egg from the ovary and allow it to meet with the sperm.
  • The sperm must have normal parameters of concentration, forward motility and viability to be able to reach the egg overcoming all the natural hurdles they meet in the way.
  • The passing of the sperm from the vagina to the fallopian tubes must be smooth with a friendly environment from the cervical mucus.ed from the follicle.
  • Ovulation must occur so that a mature egg is release
  • Sexual intercourse must take place during the fertile days.

Q3) describe types of 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.

Metabolic acidosis is classified into two types: Metabolic acidosis is classified into two types:

(a)metabolic acidosis with normal AG​ (with increased Cl ¯ ) and (a)metabolic acidosis with normal AG ( with increased Cl ¯ ) and (b) metabolic acidosis with high AG (with normal Cl ¯).

  1. metabolic acidosis with high AG​ (with normal Cl ¯). An increased AG means the accumulation of non-volatile acids in the body. An increased AG means the accumulation of non-volatile acids in the body.

Q4) define abortion and types of abortion

Definition

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.

Types of abortion

1)Threatened abortion:-

The term threatened abortion is used when a pregnancy is complicated by vaginal bleeding before the 20th week. Pain may not be a prominent feature of threatened abortion, although a lower abdominal dull ache sometimes accompanies the bleeding. Vaginal examination at this stage usually reveals a closed cervix. 25% to 50% of threatened abortion eventually result in loss of the pregnancy.

Management

The patient is kept at rest in bed until 2 days after blood loss has ceased. Intercourse is forbidden. As soon as the initial bleeding has stopped an ultrasound scan is performed. This will reveal whether or not the pregnancy is intact. The prognosis is good when all

abnormal signs and symptoms disappear and when the resumption of the progress of pregnancy is apparent.

2)Inevitable abortion:-

In case of inevitable abortion, a clinical pregnancy is complicated by both vaginal bleeding and cramp-like lower abdominal pain . The cervix is frequently partially dilated, attesting to the inevitability of the process.

Management

The uterus usually expels its contents unaided , and examination must be made with strict aseptic technique. If the abortion is not quickly completed, or if hemorrhage becomes severe, the contents of the uterus are removed with a suction curettege.

3)Incomplete Abortion:-

In addition to vaginal bleeding, cramp-like pain, and cervical dilatation , an incomplete abortion involves the passage of products of conception , often described by the women as looking like pieces of skin or liver.

Management

Patients require admission to the hospital. Treatment is aimed at preventing infection, controlling bleeding and obtaining an empty and involuting uterus. The chief risks associated with retained products are hemorrhage and sepsis .

4)Missed Abortion:-

The term missed abortion is used when the fetus has died but is retained in the uterus, usually for some weeks. After 16 weeks ’ gestation, dilatation and curettage may become a problem. Fibrinogen levels should be checked weekly until the fetus and placenta are expelled.

Management

Once the diagnosis has been made the uterus should be emptied. Early in gestation evacuation of the uterus is usually accomplished by suction curettage. The prognosis for the mother is good. Serious complications are uncommon .

5)Recurrent Abortion:-

Recurrent abortion refers to any case in which there have been three consecutive spontaneous abortions. Possible causes are known to be genetic error, anatomic

abnormalities of the genital tract, hormonal abnormalities, infection, immunologic factors, or systemic disease .

Management

Paternal and maternal chromosomes should be evaluated. The mother should be ruled out the presence of systemic disorders such as DM,SLE, and thyroid disease. It should rule out the presence of Mycoplasma, Listeria, Toxoplasma etc. infectious disease.Pelvic examination

Q5) define nursing intervention for patient with acute pancreatitis

Nursing Interventions

  1. relieving pain and discomfort
  2. restoring adequate fluid balance
  3. improving breathing pattern
  4. improving nutritional status
  5. improving skin integrity
  6. monitoring and managing potential complications
  7. Change in position
  8. Monitor pulse oximetry

Q6) describe stomatitis and its nursing management

Stomatitis Definition ​: Stomatitis is an inflammation of the mucous lining of the mouth , which may involve the cheeks, gums ,tongue ,lips , and roof or floor of the mouth. The word“ stomatitis “ literally means inflammation of the mouth.

Nursing Management

  1. Instruct the client to brush and floss his teeth and massage his gums several times daily.
  2. Advise the client to use gauze or a sponge toothette to clean the oral mucosa when pain prevents the use of a toothbrush.
  3. Recommend the use of water, saline, or a dilute solution of hydrogen peroxide instead of toothpaste or mouthwash.
  4. Advise the client to eat a bland diet.
  5. Suggest that the client consume lukewarm, or cold food and fluids, which may minimize discomfort and result in increased intake.

Q7) define Hernia and types of hernia

Define Hernia

A condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it (often involving the intestine at a weak point in the abdominal wall)

Types of hernia

1.) Inguinal hernia

i.) Indirect inguinal hernia

ii.) Direct inguinal hernia (in contrast)

2.) Hiatal Hernia

3.) Femoral hernias (protrude through the femoral ring)

4.) Umbilical hernia (congenital/acquire)

5.) Incisional/ventral hernias (occur at the site of previous surgical incision)

 

 

 

Adult health Nursing-I solved past paper -2015

Q1) a) define Folic acid deficiency anaemia

Folate​-​deficiency anaemia​is the lack of ​folic acid​in the blood. ​Folic acid​is a B vitamin that helps your body make red blood cells. If you don’t have enough red blood cells, you have ​anaemia​. Red blood cells carry oxygen to all parts of your body.

  1. b) write down the dietary sources of Folic acid

Good sources include:

  1. broccoli
  2. brussels sprouts
  3. leafy green vegetables, such as cabbage, kale, spring greens and spinach
  4. peas
  5. chickpeas and kidney beans
  6. liver (but avoid this during pregnancy)
  7. breakfast cereals fortified with folic acid
  8. Okra
  9. Beets
  10. Orange juice
  1. write down the importance of Folic acid in human body
    1. Helps your body form red blood cells and DNA
    2. Promotes normal growth and development
    3. May play a role in prevention of certain cancers
    4. Reduces your risk for heart attack and stroke
    5. Can Prevent some Birth Defects

 

Q2) a) define renal failure

Renal failure is defined as a significant loss of renal function in both kidneys to the point where less than 10 to 20% of normal GFR remains.

  1. b) difference between acute and chronic renal failure
Acute renal failure Chronic renal failure
1) Onset – over days to weeks Onset 1) Onset – over weeks to months
2) Reversibility – Invariably reversible 2) Usually Irreversible
3) Cause – Pre-renal or post-renal 3) Mostly Renal.
4) Urinary volume – Oliguria & Anuria. 4) Polyuria & Nocturia.
5) Renal failure casts – Absent 5) Renal Failure casts – Present.
6) Specific Gravity – High. 6) Specific Gravity – Low & fixed.
7) Past history of renal disease – Absent 7) Present
8) Dialysis – Required for short period 8) Required repeatedly.
9) Renal transplantation – Not required 9) Required.

Q3) a) define leukemia

Definition It is a group of malignant disorder, affecting the blood and blood –forming tissue of the bone marrow lymph system and spleen.

  1. b) discuss the sign symptoms and diagnosis of Leukemia

Common leukemia signs and symptoms include:

  1. Fever or chills.
  2. Persistent fatigue, weakness.
  3. Frequent or severe infections.
  4. Losing weight without trying.
  5. Swollen lymph nodes enlarged liver or spleen.
  6. Easy bleeding or bruising.
  7. Recurrent nosebleeds.
  1. Tiny red spots in your skin (petechiae)

Diagnosis Of Leukemia

  1. History and physical examination
  2. Clinical features
  3. Blood Examination (work up)
  4. Peripheral blood examination
  5. Chest X ray
  6. Bone marrow studies: BM biopsy, imprint and aspiration.
  7. Flow cytometry
  8. Cytological differentiation and immunophenotyping: FISH, RTPCR, chromosome analysis

Q4) a) define ovarian cyst

ovarian cyst

An ovarian cyst is a semi-solid or fluid-filled sac within the ovary.

  1. b) discuss the causes and management of ovarian cyst

Cause Ovarian Cysts

  1. Polycystic ovary syndrome (PCOS) is a condition that causes lots of small, harmless cysts to develop on your ovaries. The cysts are small egg follicles that do not grow to ovulation and are the result of altered hormone levels.

Medical Management

  1. Watchful waiting (observation):​ An ultrasound scan will be carried out about a month or so later to check it, and to see whether it has gone.
  2. Hormonal birth control pills: prevent the development of new cysts in those who frequently get them.
  3. Analgesic (Pain relievers):​such as nonsteroidal ant-inflammatory drugs, opioids analgesic.

Surgical Management

  1. Laparoscopy (keyhole surgery)
  2. Laparotomy

 

Q5) a) define Fluid volume excess

Fluid overload or volume overload (hypervolemia) is a medical condition where there is too much fluid in the blood. Excess fluid, primarily salt and water, builds up throughout the body resulting in weight gain.

  1. enlist the clinical manifestation and nursing management of fluid volume excess

Signs of fluid overload may include:

  1. Rapid weight gain.
  2. Noticeable swelling (oedema) in your arms, legs and face.
  3. Swelling in your abdomen.
  4. Cramping, headache, and stomach bloating.
  5. Shortness of breath.
  6. High blood pressure.
  7. Heart problems, including congestive heart failure.

Nursing Management of Fluid Volume Excess

  1. I&O and daily weights; assess lung sounds, oedema, other symptoms; monitor responses to medications- diuretics
  2. Promote adherence to fluid restrictions, patient teaching related to sodium and fluid restrictions
  3. Monitor, avoid sources of excessive sodium, including medications
  4. Promote rest
  5. Semi-Fowler’s position for orthopnoea
  6. Skin care, positioning/turning

Q6) a) define colorectal cancer

Colorectal cancer​is cancer that occurs in the colon or rectum. Sometimes it is called colon cancer

  1. b) discuss the risk factors and nursing management of colorectal cancer

Risk factors

  1. Genetics
  2. Family history
  3. Obesity
  4. Race
  5. Irritable bowel syndrome
  6. Type 2 diabetes

Nursing Management of Colorectal Cancer

1.Prevention is primary issue

2.Client teaching

3.Diet: decrease amount of fat, refined sugar, red meat; increase amount of fiber; diet high in fruits and vegetables, whole grains, legumes

4.Screening recommendations

5.Seek medical attention for bleeding and warning signs of cancer

6.Risk may be lowered by aspirin or NSAID use

Q7) write a 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 GI 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 oesophagus, stomach, and small intestines, or through the anus (lower) to examine the large intestine, colon and rectum.

3) ultrasound

Ultrasound is sound that travels through soft tissue and fluids, but it bounces back, or echoes, off denser surfaces. This is how it creates an image. The term “ultrasound” refers to sound with a frequency that humans cannot hear. For diagnostic uses, the ultrasound is usually between 2 and 18 megahertz (MHz).

4) barium studies

Barium studies are specialized X-ray examinations of the gastrointestinal (GI) tract such as the oesophagus, stomach, small and large intestines using a solution containing barium.

5)Biopsy (liver)

A liver biopsy is a procedure to remove a small piece of liver tissue, so it can be examined under a microscope for signs of damage or disease.