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MOSA UNIVERSITY
SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF NURSING SCIENCES
______________________________________________________________________
ZAMBIA REGISTERED NURSES’ SURGERY SURGICAL NURSING.
REVISION QUESTIONS.BY MP 2018 MOSA 15MILES LSK
INDEX NUMBER OF CANDIDATE: __________________________________
TIME ALLOWED: 3 HOURS (14 – 17:00 HOURS)
INSTRUCTIONS TO CANDIATES:
1. This paper has four (4) sections.

2. Answer all questions in SECTION A, B, and C in the examination booklet as
instructed. (Each question carries one (1) mark )
3. Answer two (2) questions only from Section D in the provided answer booklet. Each
question carries 100 marks. Essay question number one (1) is COMPULSORY
4. Write your index numbers on ALL sheets of paper used in the examination.
5. No name of candidates should appear in the examination booklet
6. MOBILE PHONES or ANY ELECTRONIC DEVICES are not allowed in the
examination room.
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SURGERY AND SURGICAL NURSING MOCK EXAMINATION FOR JULY 2015 INTAKE
7. Involvement in any form of examination malpractice will warrant disqualification from
the examination.
SECTION A: MULTIPLE CHOICE QUESTIONS (50 marks)

Encircle the most appropriate answer
1. Opening the abdominal wall surgically is termed as:
a. Laparostomy
b. Laparectomy
c. Laparotomy
d. Laparatomy
2. Bacteria may reach the peritoneum to use peritonitis through ALL the following
EXCEPT:
a. Local spread
b. Direct spread
c. Infection
d. Haematogenously
3. __________________________________ Surgery presents greater risk to life.

a. Major Surgery
b. Minor Surgery
c. Optional Surgery
d. Orthopedic Surgery
4. _____________________ surgery may be performed in clinic, OPD and it is usually
done under local anaesthesia.
a. Major Surgery
b. Minor Surgery
c. Optional Surgery
d. Orthopedic Surgery
5. It is a type of hernia which rarely protrude into the scrotum.

a. Indirect inguinal hernia
b. Direct inguinal hernia
c. Femoral hernia
d. Scrotal hernia
6. Wounds that result from a sharp pointed object are termed as________ wounds.
a. Contused
b. Lacerated
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c. Braised
d. Punctured
7. _________________ is the direct cause of liver cirrhosis.

a. Prehepatic
b. Intrahepatic
c. Posthepatic
d. Biliary obstruction.
8. A surgical procedure done to repair a hernia is called:

a. Herniectomy
b. Herniography
c. Herniorrhaphy
d. Herniostomy
9. ____________________________is an increase in the number of cells of a tissue
a. Hyperplasia
b. Hypertrophy
c. Anaplasia
d. Metastasis
10. Resolution as an outcome of inflammation is likely to occur in the presence of most

of the following factors excluding:
a. Minimal cell death and tissue damage occurred
b. Extensive tissue damage occurred
c. Rapid elimination of causal agent
d. Local conditions favour removal of fluid and debris
11. ALL the following are mechanical causes of intestinal obstruction EXCEPT:
a. Food bolus
b. Volvulous
c. Paralytic ileus
d. Strangulation
12. Surgeons in Kenya (Nairobi) performed brain surgery to remove a blood clot. Upon
examining the brain carefully, they could not find the blood clot. They then
discovered that the procedure was done on a wrong patient. Which part of
preoperative care was possibly lightly taken?
a. Local site preparation
b. Patient labelling
c. Bowel preparation
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d. Patient identification
13. The type of surgery done with the view of improving otherwise a normal organ is:
a. Palliative surgery
b. Curative surgery
c. Reconstructive
d. Reparative surgery
14. The failure of the esophageal muscle to relax leaving the proximal portion dilated is
called:
a. Esophageal deserticolous
b. Esophageal Varices
c. Esophageal achalasia
d. Esophageal stricture
15. Early ambulation for post-operative patients is important for ALL the following
reasons EXCEPT:
a. To prevent hypostatic pneumonia
b. To prevent deep vein thrombosis
c. To improve blood circulation and expedite wound healing
d. To prevent haemorrhage
16. Which ONE of the following is NOT a systemic factor that CAN enhance wound
healing?
a. Good nutrition
b. Improved metabolic rate
c. Systemic antibiotics
d. Presence foreign bodies
17. The following is a NOT specific complication of colostomy on the stoma?

a. Stoma retraction
b. Stoma prolapse
c. Stoma stenosis
d. Stoma injury
18. The type of bleeding occurring at the time or within the first 24 hours of operation or
injury is termed as:
a. Reactionary haemorrhage
b. Arteriole haemorrhage
c. Primary haemorrhage
d. Secondary haemorrhage
19. The immediate reason for adequate bowel preparation in an elective procedure is:
a. To prevent accidental injury to the colon
b. To prevent faecal incontinence
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c. To prevent aspiration
d. Prevent contamination of the surgical field
20. ______________ is an example of palliative surgery used to control peptic ulcers?

a. Total gastrectomy
b. Selective vagotomy
c. Bilroth I surgery
d. Bilroth II surgery
21. The type of intestinal obstruction where the proximal intestines invaginates into the
distal portion is called:
a. Volvulus intestinal obstruction
b. Intussusception intestinal obstruction
c. Diverticular intestinal obstruction
d. Paralytic intestinal obstruction
22. Which ONE of the following is NOT a local sign of inflammation?
a. Hyperaemia
b. Loss of function
c. Fever
d. Oedema
23. __________ are wounds whose top infected dead tissue has been removed
surgically by a procedure called sloughectomy.
a. Clean wounds
b. Debrided wounds
c. Contaminated wounds
d. Infected wounds
24. ALL the following are types of wound healing EXCEPT:

a. Healing by first intention
b. Healing by granulation
c. Healing by tertiary intention
d. Proliferative healing
25. For an elective surgical procedure, the patient is kept nil orally
a. For 2 – 3 hours
b. 3 – 4 hours
c. 4 hours only
d. 6 – 8 hours
26. ______________ is the physiological process of responding to an injury or infection.

a. Infection
b. Immunity
c. Cellulitis
d. Inflammation
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27. The first phase of a surgical patient during his treatment while in the hospital is:
a. Preoperative care
b. Perioperative phase
c. Post operative phase
d. Preoperative phase
28. ALL the following are general post operative complications EXCEPT:
a. Haemorrhage
b. Deep vein thrombosis
c. Dumping syndrome
d. Cardiac arrhythmias
29. Outcomes of acute inflammation include most of the following EXCEPT:
a. Resolution
b. Granulation
c. Suppuration
d. Chronic inflammation
30. Which one of the following is not a mechanical cause of acute abdomen?
a. Volvulus
b. Intususception
c. Acute cholecystitis
d. Heavy intestinal worm infestation
31. About full thickness burns:

a. They involve the epidermis and the upper layers of the dermal cells remain.
b. They are characterized by the destruction of the whole skin and its appendages.
c. They involve the whole skin depth, underlying fat tissue, muscle, tendons
and even bones.
d. They involve the destruction of only the superficial epidermal tissue.
32. The main reason for starving a patient before surgery even if the procedure has
nothing to do with the gastrointestinal tract or the abdomen is:
a. To prevent vomiting during surgery
b. To avoid aspiration when the patient is under general anaesthesia.
c. To prevent accidental injury to intraabdominal organs.
d. To prevent surgical errors
33. A condition characterized by excessive dilation of veins of the anal region is called:
a. Varicose veins
b. Haemorrhage
c. Ano fissure
d. Haemorrhoids
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34. _____________________________ the movement or realignment of a body part to
its normal position
a. Adduction
b. Abduction
c. Reduction
d. Circumduction
35. Which ONE of the following is NOT an advantage of the recovery room?
a. One nurse may care for two or three patients at a time.
b. Equipment necessary for resuscitation is concentrated in the area.
c. Nurses are found in the recovery room for 24 hours
d. Constant observation is provided by staff experienced in immediate post
operative care and who attention is undivided.
36. Infection prevention is achieved through _____________instruments before use

a. High level disinfection (HLD)
b. Autoclaving
c. Sterilization
d. Washing
37. ALL the following are the causes of acute inflammation EXCEPT:
a. Trauma which can be blunt or penetrating
b. Physical and chemical agents
c. Prolonged exposure to a rough surface causing friction
d. Immune reactions like swelling due to a bee sting
38. Burns which affect the subcutaneous tissues are called;

a. First degree burns
b. Second degree burns
c. Third degree burns
d. Fourth degree burns
39. Anaemia as a complication of burns may result from:

a. Excessive bleeding from the burn wound
b. Haemolysis resulting from sluggish blood flow caused by haemoconcentration.
c. Altered nutrition leading to the patient not taking enough iron containing foods
d. Lack of production of red blood cells when one has severe burn wounds
40. Which ONE of the following is NOT a type of bleeding named on the basis of the
source of the bleeding?
a. Secondary haemorrhage
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b. Arterial haemorrhage
c. Venous haemorrhage
d. Capillary haemorrhage
41. Pallor in a patient with severe haemorrhage results from:

a. Higher concentration of carbon dioxide in tissues
b. Reduced stroke volume
c. Loss of effective blood volume
d. Low cardiac output
42. Exudation in the process of inflammation occurs as a result of most of the following
EXCEPT:
a. Increased capillary permeability
b. Increased capillary pressure
c. Increased tissue osmotic /oncotic pressure
d. Extra vascular loss of fluid
43. Which ONE of the following is NOT a systemic sign of inflammation?

a. General body malaise
b. Fever
c. Oliguria
d. Loss of function
44. The patient with septic shock is given:

a. 5% Dextrose
b. 0.9% Sodium chloride solution
c. Antihistamine and steroids
d. Antibiotics
45. Which ONE of the following is NOT a possible complication of diverticuli?

a. Malnutrition resulting from impaired food intake
b. Aspiration as a result of collected food in the diverticuli
c. Intestinal obstruction resulting from adhesions from the healing process.
d. Perforation if surgical intervention is delayed to correct the deformity.
46. ALL of the following are nursing diagnoses of oral disorders EXCEPT:
a. Impaired oral mucous membrane related to infection or trauma to the mouth
evidenced by patient complaining of oral pain.
b. Imbalanced nutrition less than body requirements related to inability to ingest
food evidenced by inability to food orally.
c. Impaired gaseous exchange related to oedema of the pulmonary system
evidenced by dyspnoea.
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d. Anxiety related to fear of oral pain related to the patient’s inability to verbally
communicate effectively.
47. Steatorrhoea is a complication that results when a patient undergoes:

a. Amputation of a limb
b. Herniorrhaphy
c. Total gastrectomy
d. Appendicectomy
48. Which ONE of the following is NOT a specific cause of acute abdomen?
a. Peritonitis
b. Inflammatory conditions
c. Acute appendicitis
d. Dynamic intestinal obstruction
49. A chronic inflammatory disease of the mucosa of the large bowel is called:
a. Haemorrhoids
b. Ulcerative colitis
c. Peptic ulcers
d. Diverticuli
50. Which ONE of the following is NOT an example of a type of abdominal pain?
a. Visceral pain
b. Chronic pain
c. Referred pain
d. Somatic pain
SECTION B: CROSSMATCHING ITEMS (20 marks)
Match the words in column I with their corresponding meaning in column II

COLUM I COLUM II
51. G oscopy A Repair or reconstruction
52. F orraphy B Removal of organ.
53. B ectomy C Swelling of a neoplastic but sometimes a non-neoplastic
54. D Pexy D Fixing an organ
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55. C Oma E cutting or dividing
F) Inflammatory condition.
G) Looking into the interior of an organ using an instrument
Match the types of shock in column I with their causes in column II
COLUMN I COLUMN II
56. E Hemorrhagic Shock A. Usually results from extreme pain

57. A Neurogenic shock B. Usually results from extra vascular fluid loss
58. F Septic shock C. Usually results from an allergic reaction
59. G Cardiogenic shock D. Usually results from rapid plasma loss
60. C Anaphylactic shock E. Usually results from loss of whole blood or plasma
F. Usually results from presence of toxins from organisms
G. Usually results from interference with the
pumping of the heart.
Match the types of wounds in column I with their causes in column II
COLUMN I COLUMN II
61. C Lacerated wounds A. They are usually caused by blunt surfaces

62. D Incised wounds B. They are usually caused by severe head shaking.
63. B Contused wounds C. They are usually caused by rough objects.
64. G Poisoned wounds D. They are usually caused by sharp objects
65. F Punctured wounds E. They are usually caused by introduction of infection
F. They are usually caused by sharp pointed object.
G. They are usually caused by contamination by the
source of injury
Match the types of casts in column I with their best descriptions in column II.
COLUMN I COLUMN II
66. C Long arm cast A. Encases the trunk.
67. D Thumb spica B. A body cast that encases the trunk, shoulder, and
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elbow.
68. B Shoulder spica C. Extends from axilla to palm, with the elbow
normally
69. E Walking cast-a D. Extends from below the elbow to the palm
and includes the thumb.
70. A Body cast E. A short or long leg cast with a rubber or metal
walking device attached to the foot.
F. A body cast that encases the trunk and one

or both lower extremities.
SECTION C: COMPLETION (30 marks)
Complete the following sentences with an appropriate word or

words where applicable
71. A LAPAROTOMY is a surgical procedure involving a large incision through the

abdominal wall to gain access into the abdominal cavity. It is also known as a
CELIOTOMY.
72. ESOPHAGEAL VARICES are extremely dilated sub-mucosal veins in the lower third
of the esophagus.
73. COLOSTOMY is a surgical creation of an opening into the colon.
74. During wound healing FIBRIN in the clot binds the wound edges together.
75. SHOCK is when there is loss of effective circulating blood volume and inadequate
organ and tissue perfusion resulting in derangement of cellular functions.
76. TUMOUR / NEOPLASM is a mass of new tissue which develops from normal tissue
but has no useful function for the body.
77. PERIOPERATIVE PHASE is a total surgical experience period from the time a
decision is made that surgery should be done until the patient is admitted to the
theatre department.
78. A BENIGN tumor is a well-defined tumor and resembles the parent cell.
79. The type of surgery done within 24 – 36 hours to prevent complications is called
URGENT surgery
80. Surgical removal of poorly vascularised tissue and dead bone as part of
management of osteomyelitis is known as SEQUESTERCTOMY
81. ENTROPION is the turning of the eye lids in wards.
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82. The CORNEA is the transparent front part of the eye that covers the iris, pupil, and
anterior chamber
83. A tissue which is collected for investigations is called a BIOPSY
84. The classification of burns which involves the epidermis only is called 1ST DEGREE
OR SUPERFICIAL BURN
85. TNM is used in staging and grading of cancer. T stands for TUMOUR
86. Patients with liver cirrhosis are advised to stop taking PARACETAMOL / ALCOHOL
87. A chronic inflammatory disease of the mucosa and less frequently submucosa of the
distal ileum, colon and rectum is called ULCERATIVE COLITIS
88. When bile is supersaturated it forms BILE/GALL stones.
89. An abnormality in which, part of the stomach protrudes through the diaphragmatic is
called HIATUS hernia
90. End to end ANASTOMOSIS is the term used to denote the surgical connection of
two ends of body structures
91. Anaphylactic Shock is also known as HISTAMINE shock.
92. Wounds that involve direct contamination by the source of the injury such as snake
bites, insect stings, dog bites are known as POISONED wounds
93. Peritonsillar abscess one of the indications for tonsillectomy is also known as
QUINSY
94. INTUSUSSEPTION is the invagination of the proximal intestine into the distal part.
95. CONSENT FORM is a document which empowers the surgeon and the theatre team
to conduct a procedure on the patient.
96. A LENSMETER is an instrument that measures the power of a patient's spectacles
during an eye examination.
97. SUPPURATIVE otitis media is caused by conditions that allow nasopharyngeal flora
to reflux through the Eustachian tube and colonize the middle ear, such as
respiratory tract infection and allergic reaction.
98. TRACHEOSTOMY is an emergency or elective life saving surgical procedure where

an opening is created in the anterior wall of the trachea between the second and
third tracheal rings for the purpose of establishing an airway to facilitate breathing
which may be either temporary or permanent.
99. Nose bleeding which originates further back and higher up the nose where artery
branches supply blood to the nose is called POSTERIOR epistaxis.
100. MASTOIDECTOMY is a surgical procedure that removes an infected portion of
the mastoid bone when medical treatment is not effective.
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SECTION D: ESSAY QUESTIONS
ANSWER TWO (2) QUESTIONS ONLY. QUESTION ONE (1) IS COMPULSORY
Mr. Mark Kamwendo aged 36 one of the casualties of RTA and has sustained a
ruptured spleen and has been brought to casualty department where you are working.
Splenectomy is indicated.
a) State five (5) functions of the human spleen 15%
b) Outline five (5) indications for splenectomy other than the one mentioned in the
stem 20%
c) Discuss how you will prepare Mr. Kamwendo for surgery 50%
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d) State any five (5) specific complications of splenectomy 15%
ANSWERS/DISCUSSION
a) State five (5) functions of the human spleen 10%
i. Haemopoeisis: The spleen is a source of red blood cells and granulocytes in
foetal life.
ii. Filtration of blood cells: Normal blood cells pass through the spleen
unchanged. Abnormal and ageing cells are trapped and destroyed in the spleen.
It is the largest lymphatic tissue in the body.
iii. Immunological Function: The spleen is an important site for affecting both cell
mediated (T cells) and humoral (B cells) immunity.
iv. Particulate antigens are filtered off and immunoglobulins particularly IgM are
produced in the spleen.
v. Endocrine Effects: On the bone marrow the spleen stimulates erythropoeisis
and depressing white blood cell and platelet counts.
vi. Storage of blood
The spleen contains up to 350 ml of blood, and in response
to sympathetic stimulation can rapidly return a large part
of this volume to the circulation, e.g. in haemorrhage.
b) Explain five (5) indications for splenectomy other than the one mentioned in
the stem
Hereditary Spherocytosis
This is an inherited blood disorder in which there are abnormal red blood cells known as
spherocytes
Spherocytes are erythrocytes which are spherical rather than biconcave.
The RBCs are fragile and are easily haemolysed by the spleen. To prevent anemia,
pleenectomy is indicated.
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Thrombocytopenic Purpura:
It is a bleeding disorder that is caused by reduction of circulating platelets. In this case
the spleen is removed as it is the site of platelet consumption to try and improve the
number of circulating platelets.
Leukaemia
• In this conditions the spleen breaks down the RBCs faster than the rate of
manufacture leading to anaemia.
• Spleenectomy helps to control the situation.
ACQUIRED HAEMOLYTIC ANAEMIAS

• Excess haemolysis may occur secondary to exposure to agents such as
chemicals, drugs, infection or extensive burns or it may be an autoimmune
phenomena. Autoimmune anaemia affects predominantly middle aged women
and causes severe haemolytic crises, super imposed background of mild
anaemia. If steroids fail to control the disease, excess sequestration of red blood
cells has been demonstrated. Splenectomy may be required
HYPERSPLENISM
• This syndrome consists of splenomegally and pancytopaenia (reduced blood
cells) in the presence of an apparent normal bone marrow as briefly discussed
above. There is sequestration and destruction of blood cells in the spleen
affecting predominantly white blood cells and platelets.
• Hypersplenism may complicate a number of inflammatory conditions e.g.
rheumatoid arthritis, infection e.g. malaria, myeloproliferative and
lymphoproliferative disorders.
PORTAL HYPERTENSION:
• In which case the spleen is severely enlarged, warranting it’s removal.
• In portal hypertension, splenic congestion frequently leads to splenomegally and
hypersplenism.
Other possible indications include

 Splenic cancer to prevent spread of the cancer
 Splenic abscess where other means of treatment fail
 Slenomegally to prevent spontaneous rapture of the spleen
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c) Discuss how you will prepare Mr. Kamwendo for surgery 50%
I will prepare Mr.Kamwendo for emergency surgery because his condition

is immediately life threatening .
Note that in an emergency the preoperative preparation is limited to basic

essentials.
OBJECTIVES/AIMS
1. To prepare Mr. Kamwendo physiologically and psychologically for emergency
surgery
2. To resuscitate Mr. Kamwendo before surgery
3. To relieve pain
4. To prevent complications such as intestinal necrosis
PATIENT ASSESSMEMT AND RESUSCITATION

I will do a quick assessment on the level of consciousness and Get ONLY relevant
history for the patient’s present condition that is useful for resuscitation and approach
for surgery. I will assess and intervene in the following to resuscitate the patient
AIRWAY
I will assess the airway for patency and ensure that it is patent by positioning the
patient in a recumbent position with head turned to one side to promote drainage of the
oral secretions
BREATHING
I will assess the breathing status by observing the rate and depth of respirations,
checking oxygen saturation by doing pulse oximetry and checking for presence of
cyanosis. I will commence supplemental oxygen therapy by nasal catheter or mask at 5
Litres per minute to improve tissue oxygenation. I will Insert an NG tube to decompress
the abdomen in cases of abdominal distension which may interfere with breathing. This
promotes full lung expansion since distension tends to push abdominal organs to the
thoracic cage
CIRCULATION:
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I will check the pulse and blood pressure to rule out shock and assess the level of
dehydration by checking for skin turgor and sunken eyes or dry lips.
I will quickly cannulate the patient and commence fluids intravenous infusion to restore
intravascular volume and correct shock
I will elevate the foot end of the bed to promote blood flow to the vital organs of the
body such as lungs, brain and the heart and I will cover the patient is with extra linen to
keep him warm.
PAIN RELIEF
Most patients with acute abdomen or requiring emergency surgery are usually in
severe pain. (Check stem of the question). I will nurse the patient in the most
comfortable position to avoid pressure against the painful site and I give strong
analgesic such as Pethidine 1mg/kg/bwt to block pain sensation and prevent
neurogenic shock from severe pain.
NB: For a patient who in not passing urine, catheterize the patient to empty the bladder
and relieve pain arising from a full bladder.
OBSERVATIONS:
I will observe general condition of the patient to determine level of consciousness
I will check vital signs: Temperature, Pulse, Respiration and Blood Pressure to monitor
the conditions of the patient.
I will monitor the flow rate the IV line to ensure that the fluid is flowing at the correct rate
to improve the intravascular volume
INVESTIGATIONS:
Investigations are done at the same time with resuscitative measures and are limited to
essentials. I will ensure that they are done quickly so that surgery is not delayed.
I will quickly collect blood for :
1. Haemoglobin estimation to rule out anaemia
2. Grouping and cross matching to identify the patient’s blood group in case of the
need for blood transfusion.
3. Random blood sugar to rule out hypoglycaemia
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Other investigations that will/may be done include
• Plain abdominal X-ray to Evaluate the state of the abdominal cavity
• Abdominal ultra sounds- sound waves are used to show abdominal pictures
PSYCHOLOGICAL CARE
The patient who is conscious will be anxious because of severe abdominal pain and not
knowing the outcome of the condition. I will explain the condition and disease process to
the patient and relatives to increase awareness about the condition and allay anxiety. I
will also explain the need for emergency surgery as the only alternative to correct the
condition to gain the patient’s and family cooperation. I will also discuss the benefits and
risks of surgery to help the patient and his family make an informed decision
OBTAINING CONSENT:
An informed consent is a legal document signed by the patient or his relative to signify
that he/she has understood the process of the operation and is willing be operated on.
Once the patient has agreed that surgery be performed on him, I will provide a consent
form to either the patient or next of kin to sign to legalize the surgical operation or to
allow the surgeon and his team perform surgery.
PHYSICAL PREPARATION
This involves the following areas of preparation for surgery
GASTRIC PREPARATION
I will immediately put the patient nil per oral and If the patient has eaten a meal within
2hours I will pass a nasogastric tube to empty the stomach content to prevent aspiration
of stomach contents during surgery when patient is under the effects of General
anaesthesia. This may lead to aspirational pneumonia. The nasogastric tube is left in-
situ for continuous drainage. Intravenous fluids are given as prescribed to maintain fluid
and electrolyte balance and prevent shock (hypovolemic) as well as dehydration.
BLADDER PREPARATION
I will empty the urinary bladder by catheterizing the patient to prevent urinary retention
during induction and operation. A full bladder may interfere with a surgical procedure
by making the site less accessible and it may increase the risk of accidental injury to the
bladder wall. This will also help in preventing urine incontinency and monitoring kidney
function which may be affected by general anaesthesia.
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BOWEL PREPARATION
If ordered and necessary I will administer an enema to cleanse the colon of fecal
material.Bowel preparation helps to reduces the possibility of fecal incontinency during
surgery as the muscles will be paralyzed by anesthesia and contaminate the surgical
field.
SKIN PREPARATION:
Preoperative skin care is given in order to have the skin as free as possible of dirty
particles, hair, cells, secretions and organisms .since this is an emergency I will quickly
wipe the skin with antiseptic soap and shave or trim the hair of the skin from nipple line
to mid-thigh to remove hairs that might harbor microbes.
PREMEDICATION
I will administer the following drugs;
1. Atropine 0.6mg IM or IV to reduce over production body secertions
2. Promethazine 12.5 mg to control nausea and vomiting induced by general
anesthesia
3. Diazepam 15mg IM/IV to relax muscles and calm the patient
PATIENT IDENTIFICATION
I will give an identity band containing the patient’s details:-
name, age, diagnosis, type of operation, type of Anaesthesia
This is done to prevent surgical errors.
REMOVAL OF JEWELRY AND OTHER ITEMS

I will remove the following
Dentures to prevent choking, glasses or artificial lenses if any to prevent infection as
they habour microbes, Jewelry to prevent electric shock where the diathermy machine
is used and nail polish since it can mask cyanosis.
GOWNING
Before the patient goes to the theatre, I will provide clean gown as this will reduce
chances of infection, will allow easy access to the operation site, keep the patient warm
and maintain the patient’s privacy
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PATIENT TRANSFER
I will do final observations, collect all patient’s records and do check listing to be sure
that everything has been done. I will explain to the patient that he is being taken to
theatre and while escorting him explain the expectation of the theatre department.
POST OPERATIVE BED: (1%)
Upon return from theatre I will make post-operative bed and tray in readiness for the
patient after surgery. I will assemble all the emergency equipment and drugs on the
acute bay
d) State any five (5) specific complications of splenectomy 20%

Haemorrhage:- If Some blood vessels were not well closed during the operation,
they will cause continued internal bleeding. This if not managed early enough
can proceed to anaemia or shock
• Over whelming life- threatening post Spleenectomy infection caused by

streptococcus, pneumococus, Nesselia meningitides or Haemophilus influenza.
• These bacteria take advantage of the large raw area from which the spleen was
removed and if poor aseptic techniques are used on the ward during dressings
or in theatre during the operation
• Pancreatitis and fistula formation: due to its proximity to the spleen, the
pancreas may end up with an infection or fistula from the spleen site.
This may later end into diminished insulin production causing diabetes mellitus.
Atelectasis may al develop due to the proximity of the lower lobe of the left lung to the
spleen.
These may occur as a result of surgical manouver
Pneumonia This will be secondary to atelectasis
2. Mr. Eaten Handyabantu has sustained major head injury following road
traffic accident. He has been brought to your surgical ward for treatment.
a) i. Define head injury 5%
ii.List five (5) causes of head injury 10%
b) Outline three (3) types of intracranial haemorrhage/heamatoma 15%
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c) Identify any (5) five nursing problems that Mr. Handyabantu may present with and
using a nursing care plan describe the nursing management 50%
d) Outline any five (5) members of the rehabilitation team and their roles in the
rehabilitation program for a patient with head injury 20%
ANSWERS/DISCUSSION
a) i. Define Head injury 5%

Head injury defined as injury to the scalp, skull, or brain caused by trauma instead of
disease
List five (5) causes of head injury 10%
1. Road traffic accidents involving the head
2. Industrial accidents involving the head
3. Falling off from a height
4. Diving or swimming
5. Fighting with blows on the head
6. Military accidents e.g. gun shots involving the head
b) Outline three (3) types of intracranial haemorrhage 15%

1. Epidural (Extra Dural) Haemorrhage/Haematoma
In this type of bleeding haemorrhage occurs between the dura mater and the skull.
It is commonly due to rupture of the meningeal artery which runs beneath and is closer
to the temporal bone of the skull. There being no much space between the bone and
brain, the brain tissue is compressed and this leads to increased intracranial pressure.
The whole brain shifts and this can be seen on an x - ray film.
2. Subdural Haemorrhage/Haematoma
This is bleeding below the dura mater (i.e. between the dura mater and arachnoid mater
– subdural space). The bleeding is usually venous in nature and mostly involves the
21
cerebral vein. There is slow development of the haematoma.
However, after a period of time, the bleeding eventually causes increased intracranial
pressure and leads to symptoms similar to those seen in an epidural haematoma.
3. Subarachnoid haemorrhage/Haematoma
This is bleeding of cerebral vessels into the space beneath the arachnoid mater.
This is rarely seen in trauma and is more likely to be due to cerebral aneurysms.
It may occur in combination with other types of bleeding stated above. Bleeding is
usually associated with spillage of cerebral spinal fluid as this space connects with the
spinal canal and hence even pressure does not commonly occur.
4. Intracerebral Haemorrhage/Haematoma
Intracerebral haemorrhage occurs within the brain tissue itself. The bleeding may be
small but like bruising in any other part of the body, swelling or oedema may occur over
a period of time causing progressive decrease in the level of consciousness and other
symptoms of head injury in the patient.
c) Identify any five (5) nursing problems that Mr. Handyabantu may present with and
using a nursing care plan describe the nursing management 50%
Nursing care plan for Mr. Handyabantu
Nursing Nursing Goal/objective Intervention and Evaluation
22
Problem Diagnosis rationale
Ineffective Ineffective Patient will I will position patient in Patient had normal
breathing breathing related have normal semi prone position or breathing within 2
pattern to compression of breathing recumbent position with hours of
the respiration within 2 hours head turned to one side hospitalization
Centre evidenced of to promote drainage of evidenced by normal
by rapid hospitalization oral secretions. respirations of 14
respirations of 22 I will insert an oral breaths per minute.
breaths per minute pharyngeal airway to
prevent the tongue from
falling backward
I will administer
supplemental oxygen at
the rate of 4-
5/litres/minute to improve
tissue oxygenation
I will do pulse oximetry to
assess oxygen saturation
and monitor patient’s
response to oxygen
therapy
Risk for Risk for Patient will I will insert a nasogastric Patient nutritional
Imbalanced Imbalanced have adequate tube to provide an status was
nutrition less nutrition less than nutrition alternative way of feeding. maintained within
than body body requirements throughout I will provide nutritious normal throughout
23
requirement due to decreased hospitalization fluid based feeds via hospitalization
s alertness, chewing nasogastric tube to meet evidenced by
and swallowing the patient’s daily absence of signs of
difficulties nutritional requirements. malnutrition.
resulting from I will administer
altered level of prescribed intravenous
consciousness. fluids to replace lost fluids
and electrolytes.
I will record intake and
output on a fluid balance
chart to prevent fluid
overload which may
worsen cerebral oedema
and rise the intracranial
pressure.
Self care Self care deficit Patient will I will bath the patient in Patient had
deficit related to altered have improved bed to remove dead improved comfort
consciousness comfort epithelial tissue throughout
evidenced by through out I will do oral care to hospitalization.
patient’s inability hospitalization. prevent halitosis
to do self care I will do nail care to
activities. prevent harboring of
bacteria in the nails.
I will change soiled linen
to promote patient’s
comfort
Risk of Risk of pressure Patient will be I will turn the patient 2 Patient was
pressure sore formation prevented from hourly to prevent prevented from
24
sore related to developing prolonged pressure on developing pressure
formation prolonged pressure sores bony prominences. sores through out
immobility through out I will do pressure area hospitalization
hospitlization care to increase blood evidenced by an
flow to bony prominences intact skin.
I will change soiled linen
to maintain skin integrity
I will put an air ring below
the patient’s buttocks to
relieve sacral pressure.
Risk of Risk of hypostatic Patient will be I will turn the patient 2 Patient was
hypostatic pneumonia related prevented from hourly to prevent stasis of prevented from
pneumonia to prolonged developing tracheobronchial developing
immobility hypostatic secretions. hypostatic
pneumonia I will involve pneumonia through
throughout physiotherapist in out hospitalization.
hospitalization. performing chest
exercises to mobilize
trachea bronchial
secretions for suctioning
I will gently suction out
bronchial secretions to
prevent their
accumulation
d) Outline any five (5) members of the rehabilitation team and their roles in the
rehabilitation program for a patient with head injury 20%
25
Occupational therapist
He/she helps the patient learn, relearn or improve skills to perform everyday activities
Physical therapist
He/she helps with mobility and relearning movement patterns, balance and walking
Speech and language pathologist
He/she helps the person improve communication skills and use assistive
communication devices if necessary
Neuropsychologist or psychiatrist
He/she helps the patient manage behaviors or learn coping strategies, provides talk
therapy as needed for emotional and psychological well-being, and prescribes
medication as needed
Social worker
He/she facilitates access to service agencies, assists with care decisions and planning,
and facilitates communication among various professionals, care providers and family
members
Rehabilitation nurse
He/she provides ongoing rehabilitation care and services and who helps with discharge
planning from the hospital or rehabilitation facility
Vocational counselor
He/she assesses the ability to return to work and appropriate vocational opportunities,
and provides resources for addressing common challenges in the workplace
3. Mr. Justine Changwe, a 61 year man a known heavy smoker is admitted to the
eye ward with bilateral senile cataract. He is scheduled for cataract extraction.
a. Draw a well labeled diagram of the cross section of the human eye 20%
b. State five types of cataract 15%
c. Describe the preoperative care you will give to Mrs. Changwe
50%
26
d. State five (5) complications of cataract surgery 15%
ANSWERS/DISCUSSION
a. Draw a well labeled diagram of the cross section of the human eye 20%
b. State five types of cataract 15%

Types of cataract according to cause include
27
1. TRAUMATIC CATARACT
This results from both penetrating and none penetrating injuries can cause cataract by
disrupting the consistency of the lens material.
2. SECONDARY/ PATHOLOGICAL-
It cataract due to existing eye and other systemic conditions e.g glaucoma, uveitis
Diabetes Mellitus
3. CONGENITAL
This is cataract which presents at birth and may this may be idiopathic, genetic (familial)
or due to infection of the fetus during early pregnancy (rubella, toxoplasmosis,
cytomegalovirus (CMV) and herpes simplex infections.
4. DRUG INDUCED CATARACT

This type of cataract is caused by prolonged use of phototoxic medication such as
corticosteroids. These medications cause pigment deposits in the anterior lens capsule
making it loose its transparency.
5. SENILE CATARACT
This type of cataract is due to old age and is the commonest type of cataract. The
pathogenesis of age related cataract is multifactorial. As lens ages, it increases in its
weight and thickness and decreases in accommodation power of the lens. This results
into reducing transparency as the lens takes a yellow or brownish appearnce with
advancing age.
SUMMARY OF AETIOLIGICAL CLASSIFICATION OF CATARACT
• Age-related cataract (common).

• Congenital cataract.
• Traumatic cataract.
• Drug-induced cataract e.g. corticosteroids.
• Metabolic cataract e.g. Diabetes Mellitus.
• Secondary cataract e.g. iritis.
OTHER CAUSES OF CATARACT
28
RADIATION
Ultraviolet light, specifically UV-B, has been shown to cause cataracts, and some
evidence indicates sunglasses worn at an early age can slow its development in later
life.The lens filters UV light; so once it is removed via surgery, one may be able to see
UV light. Microwave radiation has also been found to cause cataracts. The mechanism
is unclear, but may include changes in heat-sensitive enzymes that normally protect cell
proteins in the lens.
Another possible mechanism is direct damage to the lens from pressure waves induced
in the aqueous humor.
Cataracts have also been associated with ionizing radiation such as X-rays. The
addition of damage to the DNA of the lens cells also has been considered. Finally,
electric and heat injuries denature and whiten the lens as a result of direct protein
coagulation.This same process makes the clear albumin of an egg become white and
opaque after cooking. Cataracts of this type are often seen in glassblowers and furnace
workers.
SKIN DISEASES
• The skin and the lens have the same embryological origin and can be affected by
similar diseases.
• Those with atopic dermatitis and eczema occasionally develop shield ulcers
cataracts. Ichthyosis is an autosomal recessive disorder associated with
cuneiform cataracts and nuclear sclerosis.
• Basal-cell nevus and pemphigus have similar associations.
MEDICATIONS
• Some drugs, such as corticosteroids, can induce cataract development.
• Patients with schizophrenia often have risk factors for lens opacities (such as
diabetes, hypertension, and poor nutrition) but antipsychotic medications are
unlikely to contribute to cataract formation.
• Miotics and triparanol may increase the risk.
29
Types of cataract according to zones or part of the lens affected include:
1. NUCLEAR CATARACT/SCLEROSIS
It is the most common type of cataract, involves the central or 'nuclear' part of the
lens. Over time, this becomes hard or 'sclerotic' due to condensation of lens
nucleus and deposition of brown pigment within the lens. In advanced stages, it
is called brunescent cataract.
2. CORTICAL CATARACT
It involves the lens cortex. Cortical cataracts are due to the lens cortex (outer
layer) becoming opaque. They occur when changes in the water content of the
periphery of the lens causes fissuring.
3. SUBCAPSULAR CATARACT
It Involve the lens capsulePosterior subcapsular cataracts are cloudy at back of
the lens adjacent to the capsule (or bag) in which the lens sits. Because light
becomes more focused toward the back of the lens, they can cause
disproportionate symptoms for their size.
Types of cataract according to development of the cataract include
1. MATURE CATARACT- Totally opacified lens.(all the lens protein is opaque)

2. IMMATURE CATARACT- an immature cataract has some transparent protein,
but with a mature cataract,Cataract with a clear cortex.
30
c. Describe the preoperative care you will give to Mrs. Changwe
50%
AIMS
1. To educate the patient about his eye condition and the surgical procedure to be
performed.
2. To prepare the patient for surgery physically and psychologically
3. To reduce/prevent intraoperative and post-operative complications.
ADMISSION/ENVIRONMENT
I will admit the patient to ophthalmology ward for bed rest, preoperative care and to
enable him familiarize with the ward environment. I will do a thorough orientation to his
immediate hospital environment to help the patient during the postoperative period,
since he will not be able to see as a result of the procedure or the need for the eyes to
be patched. I will assist the patient to learn details of his room such as the location of
furniture, doors, windows, and so forth.I will also enable the patient to familiarize with
the voices of those who will care for him after surgery and familiarize him with the daily
sounds and noises in the environment, since he will be more aware of sound without his
vision. I will ensure that there is dim light in the environment to reduce eye irritation.I
will ensure that the ward is clean, dust to prevent eye irritation and infection and free
from injurious objects to prevent injury since the patient has visual impairment.
PSYCHOLOGICAL CARE
Mr. Changwe is likely to be anxious due to blurred vision and fear of complete loss of
vision. I will explain to him about his condition and the need for surgery to improve his
sight. I will explain to him that there is no medical treatment for cataract to enable him
appreciate the need for surgery. I will explain the benefits and possible risks of eye
surgery to enable the patient make an informed decision about surgery.
I will also explain all the medical and nursing procedures including investigations to be
done on her before surgery to gain his cooperation and I will allow him to express his
fears and concerns about surgery to relieve psychological tension.
31
PREOPERATIVE TEACHING
Mr. Chalwe has the right to information about pre and post-surgery requirements. I will
teach him about what is expected of him before and after surgery. I will educate him on
the Dos and DONTs of surgery and the objective of resting the eyes and avoiding
actions that increase intraocular pressure such keeping the head still, no bending over
the waist, no lifting of heavy objects to prevent rise in intraocular pressure. I will advise
him not be reading until when the patient fully recovers from surgery. I will also educate
him that he should not to chew hard food nor squeeze his eye not lie on the operated
side and to avoid kissing as these activities involve use of facial muscles and may
cause strain on the operated eye. I will advise the patient to minimise smoking as it
induces coughing and development of muscle spasmswhich may increase intraocular
pressure. I will also educate him that he should not to chew hard food nor squeeze his
eye not lie on the operated side and to avoid kissing as these activities involve use of
facial muscles and may cause strain on the operated eye.
OBTAINING CONSENT FOR SURGERY
An informed consent is a legal document signed by the patient or his relative to signify
that he/she has understood the process of the operation and is willing be operated on.
Once Mr. Changwe has agreed that surgery be performed on him, I will provide a
written consent to him to sign so as to allow the surgeon and his team operate on him.
OBSERVATIONS
On admission I will take the patient’s vital signs to obtain base line information and
detect any deviations from normal. I will do subsequent observations at least 12 hourly
to monitor the patient’s condition. I will observe the patient for tendencies to cough or
sneeze as such violent movements of the head during the postoperative course may
cause increased intraocular pressure, leading to hemorrhage or rupture of incisions.
32
INVESTIGATIONS
The following investigations will be done:
1. Visual Acuity test to establish degree of visual impairment

2. Tonometry to check intra ocular pressure to rule out elevated IOP or glaucoma
3. Refraction is performed to calculate the approximate intra ocular lens power
implantation.
4. Conjunctival swab is taken for culture to rule out conjunctival infection
5. Chest X ray to rule out chest infections such as pneumonia
6. Full blood count to rule out blood disorders and infection
7. Urinalysis to rule out kidney disorders
NUTRITION
I will assess Mr. Changwe’s nutritional status to detect any nutritional deficiencies. I will
encourage the patient to eat diet rich in calories, proteins, vitamins, and mineral salts to
build his immunity and meet his nutritional demands. I will also encourage adequate
intake of fluids to prevent dehydration and constipation.
IMMEDIATE PREOPERATIVE CARE
This is the care I will give to Mr. Changwe a few hours before surgery and it will involve
the following physical preparation.
SKIN PREPARATION
I will advise patient to clean his eyelashes to remove debris and minimize the risk of
infection. Shaving of eyebrows, cutting of eyelashes, and shaving of face will be done if
ordered by surgeon.
PREMEDICATION
1. In the morning of the operation, pupils are dilated with mydriatics eye drops in
readiness for surgery
2. IOP should be lowered by acetazolamide 500mg stat 2 hours before surgery.
3. Diazepam 10 mg IM is given to patients who are anxious to help them to relax
and calm.
33
PATIENT IDENTIFICATION
I will label the patient using an identity band containing the patient’s details:-
Name, age, diagnosis, type of operation, type of Anaesthesia
This is done to prevent surgical errors.
The eye to operated on must be clearly marked
REMOVAL OF JEWELRY AND OTHER ITEMS

I will remove the following
Glasses or artificial lenses if any to facilitate smooth eye surgery.
GOWNING
Before the patient goes to the theatre, I will provide clean gown as this will reduce
chances of infection, will allow easy access to the operation site, keep the patient warm
and maintain the patient’s privacy
PATIENT TRANSFER
I will do final observations, collect all patient’s records and do check listing to be sure
that everything has been done. I will explain to the patient that he is being taken to
theatre. While escorting him explain the expectation of the theatre department.
POST OPERATIVE BED:
Upon return from theatre I will make post-operative bed and tray in readiness for the
patient after surgery. I will assemble all the emergency equipment and drugs on the
acute bay. I will ensure that the bed is equipped with side rails. I will assemble sand
bags should for use in immobilizing the head.
34
d. State five (5) complications of cataract surgery 15%
Complications
1. Acute angle glaucoma- the lens may become swollen and because of its
increased size, it will make the anterior chamber shallow, leading to acute angle
glaucoma.
2. Phacolytic uveitis- the fluid lens protein may leak out through the capsule into
the anterior chamber. This causes inflammation in the eye and acute uveitis.
3. Severe corneal oedema- this is due to loss of corneal endothelial cells so that
the cornea becomes waterlogged
4. Endophthalmitis- infection inside the eye. Disastrous complication occurring
within the first 48 hours after surgery
5. Secondary glaucoma- this may occur due to remains of cortical matter, blood or
not removing the viscoelastic material.
35

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MOSA UNIVERSITY

SCHOOL OF HEALTH SCIENCES

INDEX NUMBER OF CANDIDATE: __________________________________

TIME ALLOWED: 3 HOURS (14 – 17:00 HOURS)

1. This paper has four (4) sections.

SECTION A: MULTIPLE CHOICE QUESTIONS (50 marks)

3. __________________________________ Surgery presents greater risk to life.

5. It is a type of hernia which rarely protrude into the scrotum.

7. _________________ is the direct cause of liver cirrhosis.

8. A surgical procedure done to repair a hernia is called:

10. Resolution as an outcome of inflammation is likely to occur in the presence of most

17. The following is a NOT specific complication of colostomy on the stoma?

20. ______________ is an example of palliative surgery used to control peptic ulcers?

24. ALL the following are types of wound healing EXCEPT:

26. ______________ is the physiological process of responding to an injury or infection.

31. About full thickness burns:

36. Infection prevention is achieved through _____________instruments before use

38. Burns which affect the subcutaneous tissues are called;

39. Anaemia as a complication of burns may result from:

41. Pallor in a patient with severe haemorrhage results from:

43. Which ONE of the following is NOT a systemic sign of inflammation?

44. The patient with septic shock is given:

45. Which ONE of the following is NOT a possible complication of diverticuli?

47. Steatorrhoea is a complication that results when a patient undergoes:

SECTION B: CROSSMATCHING ITEMS (20 marks)

Match the words in column I with their corresponding meaning in column II

Match the types of shock in column I with their causes in column II

56. E Hemorrhagic Shock A. Usually results from extreme pain

Match the types of wounds in column I with their causes in column II

61. C Lacerated wounds A. They are usually caused by blunt surfaces

and includes the thumb.

F. A body cast that encases the trunk and one

SECTION C: COMPLETION (30 marks)

Complete the following sentences with an appropriate word or

71. A LAPAROTOMY is a surgical procedure involving a large incision through the

98. TRACHEOSTOMY is an emergency or elective life saving surgical procedure where

ANSWER TWO (2) QUESTIONS ONLY. QUESTION ONE (1) IS COMPULSORY

ACQUIRED HAEMOLYTIC ANAEMIAS

Other possible indications include

I will prepare Mr.Kamwendo for emergency surgery because his condition

Note that in an emergency the preoperative preparation is limited to basic

PATIENT ASSESSMEMT AND RESUSCITATION

REMOVAL OF JEWELRY AND OTHER ITEMS

POST OPERATIVE BED: (1%)

d) State any five (5) specific complications of splenectomy 20%

• Over whelming life- threatening post Spleenectomy infection caused by

a) i. Define Head injury 5%

2. Industrial accidents involving the head

3. Falling off from a height

5. Fighting with blows on the head

6. Military accidents e.g. gun shots involving the head

b) Outline three (3) types of intracranial haemorrhage 15%

Nursing Nursing Goal/objective Intervention and Evaluation

Speech and language pathologist

b. State five types of cataract 15%

4. DRUG INDUCED CATARACT

SUMMARY OF AETIOLIGICAL CLASSIFICATION OF CATARACT

• Age-related cataract (common).

OTHER CAUSES OF CATARACT

Types of cataract according to development of the cataract include

1. MATURE CATARACT- Totally opacified lens.(all the lens protein is opaque)

OBTAINING CONSENT FOR SURGERY