MERU UNIVERSITY OF SCIENCE AND TECHNOLOGY

P.O. Box 972-60200 – Meru-Kenya

Tel: +254(0) 799 529 958, +254(0) 799 529 959, + 254 (0) 712 524 293,
Website: info@must.ac.ke Email: info@must.ac.ke

University Examinations 2021/2022

SECOND YEAR FIRST SEMESTER EXAMINATION FOR THE DEGREE OF BACHELOR

OF SCIENCE IN NURSING

NWD 3211: MEDICAL SURGICAL NURSING I

DATE: FEBRUARY 2022 TIME: 3 HOURS

INSTRUCTIONS:
Answer All questions
Ensure that all your answers are properly numbered
Part I multiple Choice Questions (MCQ): Write the correct answer on the space provided
in the answer booklet. Each MCQ is one mark
Part II: Short Answer Questions – Answer questions following each other on the answer
booklet
Part III: Long Answer Questions – Answer each question on the

SECTION I MULTIPLE CHOICE (20 MARKS)

1. An inappropriate intervention for a patient who has just had a bronchoscopy is?
a. Taking client’s pulse oximeter reading
b. Offering the patient some water
c. Raising the head of the bed of the patient
d. Taking the client’s tympanic temperature
2. Which of the following instructions should be included in the teaching plan for a client
with chronic sinusitis?
a. Avoid the use of caffeinated beverage
b. Perform postural drainage every day
Meru University of Science & Technology is ISO 9001:2015 Certified
Foundation of Innovations Page 1
 c. Take hot showers twice daily
d. Report a temperature of 38.90C or higher
3. A priority assessment for a patient who underwent posterior nasal packing for epistaxis
is?
a. Patient’s temperature
b. Level of the patient’s pain
c. Drainage on the nasal dressing
d. Oxygen saturation by pulse oximetry
4. Which of the following procedures should the nurse follow when suctioning a
tracheostomy or laryngectomy tube?
a. Use a sterile catheter each time the client is suctioned
b. Clean the catheter in sterile water after each use and reuse for no longer than 8 hours
c. Protect the catheter in sterile packaging between suctioning episodes
d. Use a clean catheter with each suctioning, and disinfect it in hydrogen peroxide
between uses
5. A patient with acute pharyngitis is seen at the clinic with fever and dysphagia. On
inspection, the throat is reddened and edematous with patchy yellow exudates.
Collaborative management for this patient includes?
a. Treatment with antibiotics
b. Treatment with antifungal agents
c. Throat culture or rapid strep antigen test
d. Treatment with medication only if the pharyngitis does not resolve in 3 to 4 days
6. Associate these clinical manifestations in column A with their complications in column B
Column A Column B
a) Muffled distant heart sounds, hypotension i) Flail chest
b) Deviation of the trachea, air hunger ii) Hemothorax
c) Paradoxical movement of the chest wall iii) Tension pneumothorax
d) Shock, dullness on percussion iv) Cardiac tamponade
v) Pulmonary contusion

Meru University of Science & Technology is ISO 9001:2015 Certified

Foundation of Innovations Page 2
7. A patient is admitted to the emergency department with an acute asthma attack. Which
patient assessment is of greatest concern to the nurse?
a. The presence of a pulsus paradoxus
b. Markedly diminished breath sounds with no wheezing
c. Use of accessory muscles of respiratory and a feeling of suffocation
d. A respiratory rate of 34 and increased pulse and blood pressure
8. Which of the following would be a significant intervention to help prevent lung cancer
a) Encourage cigarette smokers to have yearly chest x-rays
b) Instruct people about techniques for smoking cessation
c) Recommend that people have their houses checked for asbestos leakage
d) Encourage people to install air cleaners in their homes
9. Which of the following interventions would be most likely to prevent the development of
acute respiratory distress syndrome (ARDS)?
a. Teaching cigarette smoking cessation
b. Maintaining adequate serum potassium levels
c. Monitoring clients for signs of hypercapnia
d. Replacing fluids adequately during hypovolemic states
10. Which of the following should the nurse monitor for in a patient after a barium meal
procedure?
a. Patient’s ability to eat
b. The passage of stool
c. The color of the patient’s urine
d. Patient’s swallowing ability
11. What are characteristics of gingivitis?
a. Formation of abscesses with loosening of teeth
b. Caused by upper respiratory tract viral infection
c. Shallow, painful vesicular ulcerations of lips and mouth
d. Infectious ulcers of mouth and lips as a result of systematic disease

Meru University of Science & Technology is ISO 9001:2015 Certified

Foundation of Innovations Page 3
12. Nursing management of the patient with chronic gastritis includes teaching the patient to?
a. Take antacids before meals to decrease stomach acidity
b. Maintain a nonirritating diet with six small meals a day
c. Eliminate alcohol and caffeine from the diet when symptoms occur
d. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of aspirin for minor pain
relief
13. Symptoms of perforation in a patient with a history of peptic ulcer disease include?
a. Vomiting of bright-red blood
b. Projectile vomiting of undigested food
c. Sudden, severe upper abdominal swelling
d. Hyperactive stomach sounds and upper abdominal swelling
14. A patient with a gastric outlet obstruction is being treated with nasogastric tube(NG)
decompression. After the first 24 hours, the patient develops nausea and increased upper
abdominal bowel sounds. The best action by the nurse is?
a. Check the patency of the NG tube
b. Place the patient in a recumbent position
c. Assess the patient’s vital signs and circulatory status
d. Encourage the patient to deep breathe and consciously relax
15. Correct instructions for a patient with a hiatal hernia or GERD to control symptoms
include?
a. Drink 2-3 glasses of water with each meal
b. Space six small meals a day between breakfast and bedtime
c. Sleep with the head of the bed elevated
d. Perform daily exercises of toe-touching, sit-ups, and weight lifting
16. A patient with acute pacreatitis has a blood pressure of 88/40 heart rate of 128
beats/minute, respirations of 28/minute and grey turner’s sign. The nurse should first?
a. Assess the urine output
b. Place an intravenous line
c. Position patient on the left side

Meru University of Science & Technology is ISO 9001:2015 Certified

Foundation of Innovations Page 4
 d. Insert an nasogastric tube
17. Cobalamin and iron injections are prescribed for patients with inflammatory bowel
disease in order to?
a. Alleviate stress
b. Correct malnutrition
c. Combat infection
d. Improve quality of life
18. Appropriate nursing intervention for an 82-year-old man admitted with an acute attack of
diverticulitis is?
a. Monitor for signs of peritonitis
b. Treat with daily medicated enemas
c. Prepare for surgery to resect the involved colon
d. Provide a heating pad to apply to the left lower quadrant
19. The appropriate time for a sitz bath for a patient who has had rectal surgery is?
a. First thing each morning
b. As needed for discomfort
c. After a bowel movement
d. At bedtime
SECTION II: Short Answer Questions (40 marks)
1. Outline six nursing interventions when caring for a patient with a chest tube connected to
under water seal drainage (6 marks)
2. Enumerate five health messages for a patient diagnosed with pulmonary TB on discharge
(5 marks)
3. A patient with COPD has a nursing diagnosis of “imbalanced nutrition: less than body
requirements related to dyspnea, excessive sputum, nausea and poor appetite as
evidenced by weight loss and lack of interest in food. Outline two nursing assessment
interventions and two three therapeutic interventions for the patient (5 marks)
4. Outline two risk factors for pulmonary embolism and management for each (4 marks)

Meru University of Science & Technology is ISO 9001:2015 Certified

Foundation of Innovations Page 5
 5. State five pre-procedure preparations for a patient undergoing an
esophagogastroduodenoscopy (5 marks)
6. Describe the pathophysiology of peptic ulcer disease (5 marks)
7. State five post-operative nursing interventions for a patient with a newly created
ileostomy (6 marks)
8. Contrast ulcerative colitis and Crohn’s disease (5 marks)

SECTION III: Long Answer Questions (40 marks)

1. Mrs Ziwa is a 70 year old patient admitted in the female medical ward. Her vital signs are
temperature, 39.40C; pulse 92 beats/min; respirations 30/min; and blood pressure, 122/80
mmHg; Sp0280. Her skin is dry and auscultation reveals inspiratory crackles with
dimished breath sounds in the right lung. She also complains of shortness of breath upon
exertion. She is diagnosed with pneumonia and is put on ceftriaxone 1gm, BD and
paracetamol, 1 gm, TDS
a) Outline four risk factors for pneumonia (2 marks)
b) Identify three actual nursing diagnosis and develop a 48 hour care plan for Mrs Ziwa.
For each problem/ diagnosis, outline two priority nursing interventions. (18 marks)
2. Mr. Kali is as adult patient who is diagnosed with appendicitis. An appendectomy is
conducted
a) Enumerate any four clinical features of appendicitis (4 marks)
b) Explain post-operative nursing care of Mr kali in the first 48 hours in the surgical
ward (16 marks)

Meru University of Science & Technology is ISO 9001:2015 Certified

Foundation of Innovations Page 6