REPUBLIC DU CAMEROUN REPUBLIC OF CAMEROON

Paix-Travail-Patrie Peace-Work-Fatherland
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MINISTERE DE MINISTERE DE
L’ENSIGNEMENT SUPERIEUR L’ENSIGNEMENT SUPERIEUR
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COMMISSION NATIONALE d’ORGANISATION DES EXAMENS NATIONAL COMMISSION FOR THE ORGANISATION OF THE
DU HND HIGHER NATIONAL DIPLOMA (HND) EXAM
NATIONAUX
HIGHER NATIONAL DIPLOMA (HND) EXAM

JUNE-JULY 2021 SESSION Examination Date……..………………….

OPTION NURSING

SPECIALTIES NURSING

COURSE TITLE CASE STUDY

COURSE CODE NUS14

TYPE OF EXAMINATION WRITTEN

CREDIT VALUE 10

DURATION: 5 HOURS

GENERAL INSTRUCTIONS

You are reminded of the necessity of orderly presentation of your material and good English

Where calculations are required, clearly show your working and be chronological in your answer

SPECIFIC INSTRUCTION

THE MARKS ALL SUM UP TO 100

The different Case Study are represented in this paper in the mentioned percentages.

The questions are structured into MCQs, Short Answers and Essay

ATTEMPT ALL QUESTIONS

SECTION A: MCQ (50 mks)

1) This antibiotic must not be given together with calcium

a) Penicillin c) tetracycline

b) Gentamycin b) chloramphenicol

2) Which of these drugs causes Steven Johnson’s syndrome?

a) Azithromycin c) amoxicillin

b) Bactrim d) doxycycline

3) Samson was diagnosed with gastric ulcer with Helicobacter pylori being the cause. Which

one of these is the best antibiotic that will be included in his treatment?

a) Clarithromycin c) azithromycin

b) Cloxacillin d) cefixime

4) Which of these antacids also has laxative properties

a) Magnesium trisilicate c) sodium bicarbonate

b) Magnesium sulphate d) all of the above

5) Corticosteroids are used in the management of asthma because it has----------------properties.

a) Antimicrobial c) anti-inflammatory

b) Antispasmodic d) antitussive

6) Mr. Tom was rushed in the hospital by the family into the emergency department where the

physician suggest the patient suffered from myocardial infarction (MI). In assessing a patient

with MI the most prominent symptom is

a) Chest pain

b) Dyspnoea

c) Insomnia
 d) Restlessness

7) Abdominal pain that intensifies twenty minutes after meal and radiates to the neck and back,

followed by vomiting of acidic content maybe as a result of;

a) Peptic ulcer disease

b) Gastroesophageal reflux disease

c) Hepatitis B

d) Colon cancer

8) The most important nursing diagnosis for a patient with asthma will be;

a) Ineffective airway clearance related to increased production of mucus and

bronchospasm

b) Risk of dehydration related to loss of fluid as mucus

c) Impaired gaseous exchange as evident by difficulty in breathing

d) All of the above

9) Mrs. Ngum comes to your clinic complaining of unusual discharge from the vagina, pain

during sexual intercourse in women, bleeding following sexual intercourse, pain and burning

during urination and pain in the lower abdomen after a swab analysis, the bacterium

Chlamydia trachomatis was found to be causing the symptoms. Which of the following drugs

will you use to best treat this infection?

a) Azithromycin

b) Penicilin

c) Ceftriaxone

d) Erythromycin
10) At this stage of pneumonia, the consistency of the lungs resembles that of the liver. The lungs

become hyperemic. Alveolar capillaries are engorged with blood .Fibrinous exudates fill the

alveoli .This stage is "characterized by the presence of many erythrocytes, neutrophils,

desquamated epithelial cells, and fibrin within the alveoli"

a) Consolidation

b) Resolution

c) Grey Hepatization

d) Red Hepatization

11) The physician after consultation reviews to the patient that he is suffering from a condition

resulting from an adrenocortical insufficiency. You understand that the patient is suffering

from

a) Addison’s disease

b) Cushing’s disease

c) Conn’s disease

d) Pheochromotoma

12) A patient was diagnosed of suffering from Pheomocytoma; you explain to the patient that the

best and main management option for the condition is

a) Drug administration

b) Radiation therapy

c) Surgery

d) It is not manageable
13) You are on a morning duty in a surgical ward of a regional hospital. Four patients are in front

of you with different conditions, Which of them will require immediate/emergency surgical

intervention

a) Orchitis

b) Testicular torsion

c) Hydrocele

d) Crytorchidism

14) A patient is admitted in the medical ward with complaints of abdominal pains, vomiting,

distension and belching. During history taking the nurse discovers that one of the aggravating

factors is NSAIDS. What is the patient diagnosis?

a) Stomatitis

b) Heart burn

c) Gastritis

d) Typhoid

15) The Dr orders an upper GI series and a barium enema Xray for a patient. The patient wants

to know why. The nurse’s best response is “Barium:

a) Gives off visible light, illuminating the alimentary tract.”

b) Provides fluorescence, thereby lighting up the alimentary tract.”

c) Dyes the structures of the alimentary tract, making them more visible.”

d) Gives more contrast to the soft tissue of the alimentary tract, allowing absorption of x-

rays.”

16) Gastrointestinal conditions that often result in anaemia include all of these except:

a) Ulcers
 b) Haemorrhoids

c) Gastritis

d) Menstruation

17) The genes involved in cell division and tumour development are all except:

a) Oncogenes

b) Mutation genes

c) Tumour suppressor genes

d) Self destruction genes

18) An Adenocarcinoma is a malignant tumour of:

a) Connective tissue

b) Fibrous tissue

c) Bone

d) Glandular epithelium

19) A 22-year-old man awakens with periumbilical abdominal pain followed by vomiting. The

patient does not like to be moved.

What is the most likely Diagnosis?

a) Perforated ulcer

b) Acute appendicitis

c) Perforation following bowel obstruction

d) Cholecystitis

20) A female patient with a history of two past abdominal operations presents with abdominal

distension, colicky abdominal pain and no bowel function for 36 hours prior to admission.

Which of the following is the initial treatment plan for this patient?
 a) Immediate surgery is ordered when the diagnosis is made.

b) Nasogastric decompression for 24 hours allows spontaneous resolution in most

patients.

c) The presence of fever, tachycardia, localized pain, or leukocytosis suggests

strangulation and warrants prompt surgery.

d) A small bowel resection must be performed,

21) What effect of povidone-iodine (Betadine) does a nurse consider when using it on the client’s

skin before obtaining a specimen for a blood culture?

a) Makes the skin more supple

b) Avoids drying the skin as does alcohol

c) Eliminates surface bacteria that may contaminate the culture

d) Provides a cooling agent to diminish the feeling from the puncture wound

22) Which drug requires the nurse to monitor the client for signs of hyperkalemia?

a) Furosemide (Lasix)

b) Metolazone (Zaroxolyn)

c) Spironolactone (Aldactone)

d) Hydrochlorothiazide (HydroDIURIL)

23) A client receiving morphine is being monitored by the nurse for signs and symptoms of

overdose. Which clinical findings support a conclusion of overdose? Select all that apply.

a) Polyuria

b) Bradycardia

c) Dilated pupils

d) Slow respirations
24) Ceftriaxone (Rocephin) 2.5 g IV in a solution every 8 hours, is prescribed for a client with a

severe infection. The pharmacy sends a vial labelled 5 g per 10 ml. What volume of

ceftriaxone should the nurse add to the IV solution?

a) 5 ml

b) 3.5 ml

c) 4.0 ml

d) 2.5 ml

25) A client with a head injury has been receiving dexamethasone (Decadron). The Dr reduces

the dexamethasone dosage gradually and continues with a lower maintenance dosage. Why is

the dose usually tapered gradually?

a) Builds glycogen stores in the muscles

b) Produces antibodies by the immune system

c) Allows the increased intracranial pressure to return to normal

Promotes return of cortisone production by the adrenal glands

SECTION B: SHORT ANSWER QUESTIONS (25mks)

1. What are H2 receptor antagonists? Give at least 2 examples (2 mks)

2. Name at least 5 Signs of metabolic acidosis (5mks)

3. What General Nursing Care actions can be applied for clients with fluid and electrolyte

problems (5mks)

4. Corticosteroids

a) Corticosteroids are produced in the --------- 1mk.

b) One of its uses is during organ transplant explain 2mks

 c) Why are they never used together with NSAIDS 1mk?

d) Give 2 examples of corticosteroids 1mk.

5. Mammy Susan is experiencing urgency, dysuria with abnormal urinary constituents. She

was diagnosed of cystitis.

a) Identify the causes of this condition. (1 marks)

b) Why is cystitis common in females than males? (2 marks)

c) Give with rationale for your action the nursing interventions to put in place. (3 marks)

6. Define Cirrhosis of the liver 2 mks

SECTION C: ESSAY (25mks)

1) Chief Kajifu is admitted in the male medical ward with a stiff neck, severe headache,

photophobia and drowsiness.

a) What is his diagnosis? (2 marks)

b) How will you diagnose this condition? (5 marks)

c) Identify the medical management for this condition (3 marks)

d) What is the nursing intervention for this condition? Give your points with

rationale for your action. (5 marks)

2) A 50 years old man was admitted in the hospital because of urinary stagnation, bladder

distention and hesitates to urinate.

a) What is the patient’s diagnosis? (2 marks)

b) How will you diagnose his condition? (3 marks)

c) What are the aetiologies of this condition? (5 marks)

 d) With the use of a nursing process draw a comprehensive care plan for this patient. (8

marks)

3) Mrs. Salome is a 56 year old mother with three children. The husband died last year and

because of that she has been under a lot of stress to take care of the children and she turns

to drink much alcohol to manage the stress. She was brought to the hospital where you

work and at the OPD, the following were recorded; temperature 38 0c, B.P 150/100

mmHg, p = 92 b/m, RR = 22c/m and weight 85 kg. She complains of headache,

backache, muscle weakness and fatigue, polydipsia and polyuria. Upon physical

examination, the physician noted a moon-shaped face and buffalo hump and purple bands

on the thigh and breast

i. State the medical diagnosis of Mrs. Salome (2mks)

ii. Outline four other causes or risk factors associated with this condition (4mks)

iii. State a definite diagnostic test for this condition (3mk)

iv. Outline four specific patient teaching you will render to Mrs. Salome upon discharge (4 mks)

v. State any four complications that can result if her case is not well manage (4mks)
 PROPOSED MARKING GUIDE

SECTION A

1. 1) C 2) b 3) a 4) b 5) c 6) a 7) b 8) a 9) c 10) a 12) a 13) c 14. c 15.d 16)

d 17, b 18, d 19, b 20, b 21, c 22, a 23, b and d 24, a 25, d

SECTION B

1) These are drugs that block histamine stimulated gastric secretions or block the H2

receptors of parietal cells thus inhibiting the secretion of acid e.g. Cimetidine and

Ranitidine (Zantac). (3 mks)

2) Any 5 of the following (1 mkeach) 5 mks

weakness, headache, disorientation, deep and rapid breathing (Kussmaul’s

respirations), fruity odor to the breath, nausea and vomiting, coma

3) Any 5 of the following (1mk each) 5mks

• Monitor the Vital signs

• Check for Skin turgor, hydration, and temperature and Breath sounds for abnormalities

• Daily weight measurements and document

• Monitor the patient for Changes in behavior, energy level, and level of consciousness

• Laboratory tests (e.g., urine specific gravity; serum pH and arterial blood gases; serum

electrolytes; haematocrit; blood urea nitrogen; creatinine clearance)

• Administer IV therapy. Fluids may be encouraged to correct deficit (usually 3000

mL/day); may be restricted to prevent excess

• Nutritional intake can be increased or restricted to correct electrolyte disturbances (e.g.,

sodium, potassium, calcium)

• Monitor intake and output and Maintain the I&O chart

• Monitor client for complications such as infiltration phlebitis, signs of infection and

circulatory overload

4)

a) Adrenal cortex

b) They suppress the immune system hence will prevent rejection of the transplanted

organ

c) Both have the side effect of intestinal bleeding so this will be aggravated

d) Prednisolone, cortisol, betamethasone, triamcinolone

5) It is a condition in which the resting systolic blood pressure reading is constantly 140 –

159 mmHg and above diastolic pressure of 90- 99mmHg and above.

b) Severe Headache

Increase pressure in the ears leading to ringing in the ears an sometime epistaxis

Convulsions and paralysis

Dyspnoea

c)

 Educate the patient on the importance of long life medication

 Instruct the client about the action, side effects and scheduling of medication
  Advise the patient that if uncomfortable side effects occurs he/she should contact

the physician and not stop the medication

 It is a condition in which the resting systolic blood pressure reading is constantly

140 – 159 mmHg and above diastolic pressure of 90- 99mmHg and above.

 It is a condition in which the resting systolic blood pressure reading is constantly

140 – 159 mmHg and above diastolic pressure of 90- 99mmHg and above.

 It is a condition in which the resting systolic blood pressure reading is constantly

140 – 159 mmHg and above diastolic pressure of 90- 99mmHg and above.

 It is a condition in which the resting systolic blood pressure reading is constantly

140 – 159 mmHg and above diastolic pressure of 90- 99mmHg and above.

6) Cirrhosis of the liver is the late stage of scarring of the liver caused by many forms of

liver disease eg, chronic alcoholism or hepatitis

SECTION C

1)

a) Meningitis

b) Cerebrospinal fluid indicates elevated proteins higher in bacterial meningitis than viral

meningitis

 Decrease cerebrospinal glucose is common in bacterial meningitis and may be normal in

viral meningitis

 The cerebrospinal fluid is purulent in bacterial meningitis and may be clear in viral

meningitis

 FBC will indicate elevated WBC

 Differential count indicates elevated neutrophils in bacterial meningitis and lymphocytes

elevation will indicate viral meningitis.

c) Lumbar puncture for CSF analysis

 Ampicillin, gentamycin and ceftriaxone are the drugs of choice for meningitis

 Analgesics e.g. tramadol may be prescribed

 Mannitol to alleviate cerebral oedema

d) Monitor vital signs

 Do neurologic assessment i.e. reflexes

 Monitor fluid intake and output

 Place patient on semi recumbent position after lumbar puncture

 Encourage gentle range of motion and leg exercises to reduce joint stiffness and promote

circulation

 Tepid sponge to reduce temperature

 Administer medications as prescribed

2)

a) Benign Prostatic hyperplasia

b) Rectal examination (palpation of the prostate through the rectum) may reveal a

markedly enlarged prostate

- Ultrasound examination of the prostate to rule out malignancy

- Urinary flow rates

- Prostate-specific antigen (PSA) to eliminate diagnosis of carcinoma in selected patients

- Renal function test

- Cystoscopy and FBC

c)

Prostate gland usually increases in size with age

- Cause is unknown but is thought to be associated with

Endocrine diseases associated with aging

Stimulation by estrogen after its conversion to androgens

Increase concentration of androgens (testosterone and related hormones) in the prostate.

Dihydrotestosterone (DHT, a metabolite of testosterone) synthesized in the prostate by

the enzyme 5α-reductase causing rapid growth and multiplication of epithelial and

stromal cells

- Other factors include diet, race, lifestyle

d) CARE PLAN

Assesment

Nursing diagnosis

Objectives/goals

Intervention

Rationale

Evaluation

NB. Should be represented on a table

3)

i. Cushing's Disease
ii. Causes/Risk Factors

 The most common cause of Cushing syndrome is the use of corticosteroid

medications,such as prednisone, in high doses for a long period. High doses of injectable

steroids for treatment of back pain can also cause this syndrome.

 High stress levels, including stress related to an acute illness, surgery, injury, or

pregnancy especially in the final trimester, depression, panic disorders, or high levels of

emotional stress and Athletic training

 Malnutrition and Alcoholism

 A pituitary gland tumor in which the pituitary gland releases too much

adrenocorticotropic hormone

 Ectopic ACTH syndrome, which causes tumors that usually occur in the lung, pancreas,

thyroid, or thymus gland

 An adrenal gland abnormality or tumor

 Familial Cushing syndrome is another possible cause. Cushing syndrome isn’t typically

inherited, but it’s possible to have an inherited tendency to develop tumors of the

endocrine glands.

iii. Definitive diagnostic test is A 24-hour urinary free cortisol test

iv. Teach patient on drugs

On disease condition

On rendevvous

Recognition of complications and/or S/E of drugs

v. Complications include

 Bone fractures
  Muscle loss and weakness

 High blood pressure

 Type 2 diabetes

 Infections

 Enlargement of a pituitary tumor

 Kidney stones

 Cushing syndrome due to pituitary tumors can interfere with the production of other

hormones.

TREATMENT

There are three possibilities: irradiation; drug therapy; or surgery. The type of treatment selected

depends on the condition of the individual patient.

Drug therapy: Some medications decrease cortisol production in the adrenal glands or

decrease ACTH production in the pituitary gland while others medications block the

effect of cortisol on your tissues. A change in medication or dosage of corticosteroids

may be necessary.

Surgical removal may be necessary since the tumors can be malignant or benign

May also recommend radiation therapy or chemotherapy