CLARKE INTERNATIONAL UNIVERSITY

SCHOOL OF NURSING AND MIDWIFERY

MEDICAL NURSING I END OF SEMESTER ONLINE EXAMINATION
BNS DIRECT II AND TU II AUGUST INTAKE
Date: 23rd May 2023 Time: 2:00pm – 5.00pm
____________________________________________________________________________
____________________________________________________________________________
SECTION 1 (62.5 MARKS)

This section consists of multiple­choice questions. Answer questions 1 ­ 35 by

selecting the appropriate and correct answer. Each correct answer carries 1.5
marks.

Qn 1. What do you understand by a communicable or infectious disease? It is a

disease that is:
(a) caused by a pathogen and its products
(b) caused by all bacteria
(c) spread from person to person
(d) transferred by mosquitoes
(e) always caused by the patient’s diet and life style
Qn 2. Which of the following factors play a key role in likelihood of infectious
disease acquisition?
(a) Genetic profile
(b) Human behavior
(c) Environmental conditions
(d) a and b. above
(e) All of the above
Qn 3. Virulence of a microorganism refers to the:
(a) Ability to cause clinical disease
(b) Ability to cause severe disease
(c) The ability to evoke an immune response
(d) All of the above
(e) a and b. above

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

1
Qn 4.The following statements about Universal precautions are true except:
(a) Universal precautions apply to everyone in the healthcare setting regardless
of whether or not they are thought or known to be infectious
(b) Universal precautions prevent or reduce the risk of transmission from person
to person, even in high­risk populations
(c) Universal precautions strictly apply to those individuals who are thought or
known to be infectious
(d) Universal precautions should be used when coming into contact with blood
and all other body secretions even if they do not contain visible blood
(e) None of the above
Qn 5. Ebola and Marburg fevers are two forms of Viral Hemorrhagic fevers (VHF).
How do the diseases spread from human to human?
a) Spreads through direct contact with blood and bodily fluids
b) Spreads through inhaling infected droplets
c) Spreads through contaminated water
d) Spreads through inoculation of the skin
e) None of the above
Qn 6. There are four types of human malaria. Which is most common type and also
most deadly?
(a) Plasmodium Malariae
(b) Plasmodium Ovale
(c) Plasmodium Anopheles
(d) Plasmodium falciparum
(e) Plasmodium Vivax

Qn 7. The primary vector of malaria is the female Anopheles mosquito which has the
following characteristics apart from:
(a) It is bigger in size than the ordinary mosquito.
(b) is brown in color.
(c) is a night­biting mosquito.
(d) usually does not bite a person who is in motion.
(e) breeds in unclear, flowing streams usually in the mountains.

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

2
Qn 8. Effective malaria control interventions include all the following except:
a) Blood donors should be properly screened.
b) Massive use of Fansidar chemoprophylaxis on all the population
c) Destruction of Mosquito breeding places
d) Insect repellents must be applied to the exposed portion of the body.
e) Use of Insecticide­mosquito nets
Qn 9. An infection of the valves and endothelial surface of the heart is known as:
(a) Acute Infective pericarditis
(b) Rheumatic endocarditis
(c) Myocarditis
(d) Infective endocarditis
(e) Endocardial valvular disease
Qn 10. One of the following is not a clinical feature of infective endocarditis:
(a) Janeway Lesions
(b) Itching of fingers
(c) Splinter Hemorrhages
(d) Enlarged Spleen
(e) Osler’s Nodes
Qn 11. The condition associated with the highest risk of developing infective
endocarditis (IE) is
(a) mitral valve prolapse with regurgitation
(b) the presence of a prosthetic heart valve.
(c) rheumatic fever without valvular defects.
(d) intravenous drug abuse.
(e) None of the above
Qn 12. The ideal management for the above infective condition involves one of the
following interventions:
(a) No need for culture, just Treat It Early
(b) Use Bactericidal Agents and low dosages
(c) Use Adequate Dosage but avoid parenteral Route
(d) Sufficient Duration: 4­6 Weeks Or Longer using Parenteral Route
(e) None of the above

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

3
Qn 13. A client with pneumonia develops dyspnoea with a respiratory rate of 32
breaths/minute and difficulty expelling his secretions. The nurse auscultates his
lung fields only to hear abnormal sounds in the left lower lobe. The nurse
determines that the patient requires which of the following treatments first?
(a) Antibiotics
(b) Bed rest
(c) Oxygen
(d) Nutritional intake
(e) Spiritual care
Qn 14. The cyanosis that accompanies bacterial pneumonia is primarily caused by:
(a) Decreased cardiac output
(b) Pleural effusion
(c) Inadequate peripheral circulation
(d) Decreased oxygenation of the blood
(e) Anaemia
Qn 15. All the following are factors known to cause MDR Tuberculosis except:
(a) Health­care provider inadequate regimens
(b) Inadequate supply and stock­out of drugs
(c) High cost of anti­TB drugs in Uganda
(d) Inadequate drug intake by patients
(e) Poor monitoring of treatment
Qn 16. Collections of bacteria that adhere to the surfaces of the teeth are called
(a) dental caries.
(b) dental plaque.
(c) Halitosis
(d) periodontal disease
(e) septic gums.

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

4
Qn 17.Which of the following diseases of the gastrointestinal system is transmitted
by the respiratory route?
(a) Staphylococcal enterotoxicosis
(b) Mumps
(c) Vibrio gastroenteritis
(d) Bacillary dysentery
(e) Traveler's diarrhea
Qn 18. Part of the ability of Streptococcus Mutans to produce dental caries depends
on its ability to:
(a) invade plaque and dissolve the gums.
(b) convert sucrose to lactic acid.
(c) convert proteins to sugars.
(d) attach to the gums
(e) none of the above
Qn 19. The chronic inflammatory process involving the gums and tissues around
the teeth is called
(a) Dental caries.
(b) Periodontal disease.
(c) Dental formulae
(d) Dental plaque.
(e) Root caries.
Qn 20. Helicobacter pylori, a causative agent for gastric ulcers is, in part, able to
survive in the stomach by its ability to produce
(a) lactic acid from sugar.
(b) fatty acids from sebum.
(c) neutralizing proteins from glucans.
(d) ammonia from urea.
(e) stomach cancer

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

5
Qn 21. The major nursing concern associated with pancreatitis is:
(a) Pain in the abdominal area
(b) Electrolyte and fluid loss
(c) Presence of excessive flatus
(d) Irritation of the periumblical area
(e) Frequency to the toilet by the patient
Qn 22. One of these statements is not true regarding nutritional management of a
patient with pancreatitis:
(a) Parenteral nutrition is usually an important part of therapy
(b) Between acute attacks, the patient receives a diet high in carbohydrates and
low in fat and proteins
(c) Oral intake is encouraged to encourage pancreatic stimulation and secretion
of pancreatic enzymes
(d) The patient should avoid heavy meals and alcoholic beverages
(e) None of the above
Qn 23. A male client who has just been diagnosed with Hepatitis A asks, “How
could I have gotten this disease? What is the nurses’ best response?
(a) “You must have received an infected blood transfusion”
(b) “You probably got it by engaging in unprotected sex”
(c) “You may have eaten contaminated restaurant food or water.”
(d) “You could have got it by using I/V drugs”
(e) All of the above.
Qn 24. Which of the following are spread by the faeco­oral route?
(a) Hep B & C
(b) Hep D & E
(c) Hep C & D
(d) Hep A & E
(e) Hep A & B

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

6
Qn 25. Which of the following factors does not cause Hepatitis B?
(a) Sexual contact with an infected person
(b) Mother to child transmission
(c) Contact with infected blood
(d) Blood transfusions with infected blood
(e) Eating contaminated shell fish
Qn 26. The following forms of hepatitis are grouped as non­viral except:
(a) Hepatic cirrhosis
(b) Toxic hepatitis
(c) Fulminant hepatic failure
(d) Hepatitis E
(e) None of the above
Qn 27. What is the most common causative organism of Urinary tract infections
(UTI)?
a) Clamydia Trichomatis
b) Streptococcus Pyogens
c) Bacillus Anthracis
d) Staphylococcus aureus
e) Escherichia Coli
Qn 28.Which of the following is a risk factor for UTI among adults?
a) Diabetes
b) Enlarged prostate
c) Using a catheter
d) Bacterial spread from the bowel to the urinary tract
e) All of the above
Qn 29. The efficiency of transmission of any sexually transmitted infection (STI)
depends on all the following factors except:
(a) the virulence of the pathogen
(b) the susceptibility of the host
(c) the reproductive rate of the host
(d) the mode of spread (e.g. oral, anal or vaginal)
(e) the presence of other STDs.

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

7
Qn 30. A 20 year old woman who reports unprotected sex with a new partner 2
weeks previously develops fever and left lower quadrant abdominal pain with onset
in association with her menstrual period. Neisseria gonorrhoeae is cultured from
her endocervix. The diagnosis is gonococcal pelvic inflammatory disease. What is
the common complication of this infection?
(a) Cancer of the cervix
(b) Infertility
(c) Urethral stricture
(d) uterine fibriod tumors
(e) Vaginal­rectal fistula
Qn 31. A 42 year old woman presents with a 2 cm ulcer on her labia majora. The
lesion is painless and has a raised border. The differential diagnosis of this lesion
includes:
(a) Adenovirus infection
(b) Chlamydia trachomatis infection
(c) Neisseria gonorrhoeae infection
(d) Papilloma virus infection
(e) Treponema pallidum infection
Qn 32. Which major organ(s) can be affected by untreated syphilis?
(a) Heart
(b) Brain
(c) Liver
(d) Kidneys
(e) a and b

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

8
Qn 33. A client who tested HIV positive 3 years ago and declined Antiretroviral
treatment comes to the ART clinic today looking very emaciated. He expresses
concern that “ I must be having too much virus in my body because I refused to
take HIV drugs all this while”. Which test will you carry out in order to help this
client effectively?
(a) CD4 Count
(b) Viral Load Count
(c) HB level estimation
(d) Full Blood Count
(e) PCR
Qn 34. Dissemination of Sexually Transmitted Infections (STIs) can be reduced by
all of these strategies except:
(a) Screening of risk groups, pregnant women, and their partners
(b) Treating all infections
(c) Behavior modification through increasing partners & condom use
(d) Health education and risk reduction counseling
(e) Partner notification
Qn 35. Meningitis refers to the inflammation of the meninges covering the brain
and the spinal cord. During a physical examination of a patient suspected to have
meningitis, a flexion of the patient’s neck produces a flexion of the neck and hips.
In addition, when passive flexion of the lower extremity is made, a similar
movement is seen in the opposite extremity. This sign is known as
(a) Kening’s sign
(b) Involuntary spasms
(c) Hemiplegic spasms
(d) Brudzinski’s sign
(e) None of the above

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

9
Part B: TRUE/ FALSE QUESTIONS

For each of the following statements, state True (T) or False (F) as appropriate. (1
Mark Each)

36. The portal of entry and exit for most infectious diseases is the
same
37. Antibiotics are ineffective against viral myocarditis and do not
always benefit patients with bacterial pericarditis.
38. Air bone transmission of infection is when one gets infection by
touching an infectious person or contact with contaminated
material

39. People’s endogenous flora includes pathogens which can

become infections to themselves or other people

40 Early detection and treatment of infection reduces the average

length of time individuals are infectious, reduces the rate of
spread of the infection and the probability that infected
individuals will develop complications

41. Intravenous routes of fluid administration can cause serious

infection in patients
42. Myocarditis is an infection of the valves and endothelial surface
of the heart
43. A.I.D.S. stands for Auto Immuno Deficiency Syndrome

44 Acquiring HIV infection and development of AIDS is a most

likely circumstance to reactivate latent TB.

45. Ebola was named after the first man to have died from the
disease in Africa

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

10
SECTION 2

PART A ­ Fill in the blank spaces below (2 Marks each)

Qn 46. A patient presents with a persistent hoarseness of the voice. The most
probable diagnosis is…………………………………………………….
Qn 47. The elevation of serum………………………………………....enzyme is a
confirmatory finding for acute pancreatitis.
Qn 48. In the management of pancreatitis, it is a goal to inhibit pancreatic
stimulation together with secretion of pancreatic enzymes. What measure is
undertaken to achieve this goal? .....................................................................

PART B – Write short notes on the following questions:

Qn 49. State five priority nursing diagnoses of a patient with severe pneumonia.
(5 Marks)
Qn 50. Why is it important to make an individualised teaching plan for each patient
admitted on the Ward with Infective Endocarditis (mention 5 reasons). (5 Marks)

Qn 51. Outline five factors contributing to high occurrence of sexually transmitted

infections (STIs) in Uganda. (5 Marks)

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

11
SECTION 3 (20 Marks)
Qn 52. Emerging infectious diseases is a term that refers to newly identified
infectious agents that cause public health problems either locally or internationally.
Among them are:
 Multi­drug resistant (MDR) Tuberculosis
 Ebola fever;
 HIV/AIDS
 Prion and Prion diseases.
 Complicated (& Drug resistant) Malaria

(a) Select only one of the above diseases. State the major and specific clinical
features of the disease. (In the case of HIV/AIDS, reference must be on Stage IV of
the disease (AIDS)). (5 Marks)

(b) Using only three priority nursing diagnoses (eg ……………..related to……….
…….as evidenced by………………..…), make a nursing care plan for this patient.
Present your answers in a tabular form as indicated below:
(10 Marks)

Nursing diagnosis Nursing intervention Rationale

(c) List important things would you emphasize in health education of the
patient, family, and public.
(5 Marks)

End of Semester Exams, Office of the Academic Registrar, MAY-JUNE 2013

12