KANO STATE SCHOOL OF NURSING

COLLEGE OF NURSING & MIDWIFERY, KANO STATE

HOSPITAL FINAL EXAMINATION

PAPER 1 (Section A) DATE: July 26th, 2021

SECTION A: Objective Questions – 40%

MARKING GUIDE

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Questions Answers 36 B 72 A

1 B 37 D 73 D

2 B 38 D 74 C

3 B 39 A 75 A

4 B 40 C 76 C

5 A 41 B 77 B

6 A 42 A 78 D

7 A 43 D 79 D

8 D 44 B 80 A

9 C 45 C 81 B

10 B 46 A 82 C

11 D 47 A 83 D

12 D 48 D 84 A

13 C 49 C 85 A

14 B 50 B 86 A

15 A 51 C 87 C

16 D 52 A 88 D

17 D 53 A 89 D

18 A 54 B 90 A

19 B 55 D 91 A

20 B 56 A 92 B

21 D 57 C 93 C

22 D 58 C 94 A

23 C 59 B 95 A

24 C 60 B 96 C

25 A 61 A 97 A

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 26 C 62 D 98 C

27 A 63 B 99 B

28 B 64 A 100 C

29 D 65 A

30 B 66 D

31 C 67 C

32 D 68 A

33 C 69 D

34 C 70 B

35 B 71 C

SECTION B: Essay Questions – 60%

QUSTION 1

1a.

a. Structure of the Nephron

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Well and clearly labeled diagram with full descriptions. Maximum 4 marks
(Diagram=1 mark, Labelling = 1 mark, Description = 2 marks)

3b. Functions of the Kidneys

1. Removal of metabolic waste

2. Regulation of blood pressure

3. Regulation of Acid-base balance

4. Regulation of electrolytes

5. Secretion of Vitamin D

6. Regulation of water

7. Secretion of Homrmone

8. Etc

Any 6 functions well explained. Maximum 6marks

3c. Pathophysiology of Nephrotic Syndrome

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 Maximum Score: 4 Marks

3d. Nursing Care Plan for a Pateint with Nephrotic Syndrome

3 marks each for a well identified and well solved nursing diagnosis related to the condition in accordance
with the NANDA list using the Nursing care plan format.

SN Nursing Nursing Objectives Nursing Scientific Rationale Evaluation

Diagnosis Actions

Maximum Mark: 9 marks

1. Fluid volume excess

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 2. Parental anxiety related to diagnosis, prognosis, evidenced by facial Expression or verbalization
or by asking questions.
3. Deficient knowledge related to ignorance evidenced by non-compliance
4. Disturbed sensory perception related to edema over the skin periphery evidenced
5. Risk for impaired skin integrity related to accumulation fluid over the skin

Nursing Diagnosis: ½ mark for correct diagnosis from current NANDA list

Objective: ½ mark x 1 correct point = ½ mark

Nursing Intervention: ½ mark each x 4 correct points= 1 mark

Scientific Rationale: 1/8 mark each x 4 correct points = ½ mark

Evaluation: ½ mark x 1 correct point = ½ mark

Total: 3 correctly developed nursing diagnosis = 9marks

NB: Wrong Nursing diagnosis invalidates the corresponding objective, nursing intervention, etc.

Question 2

2ai. Definition of mental health

Mental health as a state of mind in which one is free to make use of his capacities in an effective and
satisfying manner.

OR

Mental health implies a moderate amount of self-understanding, the capacity to be creative, the ability to
love and accept love, and to think in terms of other people rather than on oneself only.

OR

“the quality of personal health resulting from the individual’s satisfaction of human needs through
personal and social adjustments in his environment”

(2 marks for any correct definition)

2aii. Elements of mental health

When the human brain is working at its best, it is capable of doing 9 things that contribute to what
we might commonly consider, “good mental health.” They are:

1. Body Regulation—the ability to keep the organs of the body and the autonomic nervous
system (e.g, heart rate, respiration, body temperature) coordinated and balanced. Body regulation
isn’t just about physical health. Emotions begin as an embodied experience. For example; a racing

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heart and shallow respiration often precipitate feelings of panic/anxiety. Feelings of exhaustion or
under-stimulation often precipitate depression.

2. Attuned Communication—the ability to pick up on the meaning of subtle, non-verbal, physical

cues (facial expressions, tones of voice, posture) that indicate another person’s emotional states and
degree of well-being. People with Autism spectrum disorders especially have a difficult time with
this.

3. Emotional Balance—the ability to maintain optimal emotional functioning. That is, I know how
to be emotionally stimulated enough to be aware and engaged in my circumstances and relationships
but not so emotionally stimulated that I am regularly flooded by my feelings and carried away by
them.

4. Response Flexibility—the ability to pause before acting on my impulses and willfully change the
direction of my actions if doing so suits me better than my initial impulses. People with ADHD,
pathological anger, addictions, and other impulse control problems struggle with this skill.

5. Fear Modulation—reducing fear. Self-explanatory. People with anxiety and panic disorders,
especially, have a difficult time modulating the brain’s fear responses. They become easily flooded
with anxiety where others might just experience nervousness or even excitement.

6. Insight—the ability to reflect on my life experiences in a way that links my past, present, and
future in a coherent, cohesive, compassionate manner. In sight helps me make sense of both the
things that have happened to me in the past and the things that are happening to me now.

7. Empathy—Essentially, empathy is the ability to have insight (as defined above) into other
people. Empathy is the ability to imagine what it is like to be another person, and to reflect on their
experiences in a way that links their past, present, and future in coherent, cohesive.
compassionate manner. Empathy helps you make sense of other people’s lives, the way they think,
and their feelings.

8. Morality—the ability to imagine, reason, and behave from the perspective of the greater good.
Includes the ability to delay gratification and find ways to get my needs met while understanding
and accommodating the needs of others.

9. Intuition—having access to the input from the body and its non-rational ways of knowing that
fuel wisdom. One’s “gut sense” of things is actually based on a complex process by which one’s
right brain makes ”quick and dirty” global assessments of one’s feelings and circumstances.

OR

1. Autonomy
Autonomy is the ability to make your own decisions about how to think and behave, rather than over-
relying on others’ opinions or approval. Autonomous people resist social pressures that are inconsistent
with their inner standards or preferences. They pursue freely chosen goals that they genuinely value.

2. Competence
Competence means having knowledge, skills, and abilities and using them to solve problems and
accomplish worthwhile tasks. Competent people can manage the responsibilities and demands of daily

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life and get things done. They make good use of their opportunities and arrange their living environments
in ways that suit them.

3. Healthy relationships
Most people need connections with others. Some enjoy large circles of friends, family, and coworkers;
others prefer more solitude and independence. The ability to develop caring, trusting, and supportive
relationships is an important element of psychological health, whether you seek many relationships or
only a few.

4. Self-acceptance
Self-accepting people understand that, like everyone else, they have strengths and weaknesses. They
recognise that life has ups and downs; that everyone makes mistakes, misses opportunities, and feels
regret, disappointment, and other unpleasant emotions. They are understanding and nonjudgmental of
themselves and how their lives have gone so far.

5. Personal growth
People who value personal growth are open to learning and new experiences. They recognise that
perspectives change with time and see themselves as maturing and developing. They are interested in
broadening their horizons and fulfilling their potential.

6. Purpose in life
People with purpose have a sense of direction in life. They understand what they value most deeply, such
as being a loving parent, supportive friend, productive professional, or contributing member of a
community. They find satisfaction in setting goals and working to achieve them and feel that their lives
have meaning.

Cultivating these elements of wellbeing can be challenging. Standing on our own principles can be
difficult, especially when others disapprove. Managing daily demands can be stressful. Even the
healthiest relationships have delicate, uncomfortable moments. It is painful to face up to our failures and
imperfections, to feel awkward and nervous while learning new skills.
(Any four (4) correct points, 1 mark each = 4 marks)

2b. factors that influence mental health

Risk factors

 Academic failure and scholastic demoralization

 Attention deficits
 Caring for chronically ill or dementia patients
 Child abuse and neglect

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  Chronic insomnia
 Chronic pain
 Communication deviance
 Early pregnancies
 Elder abuse
 Emotional immaturity and dyscontrol
 Excessive substance use
 Exposure to aggression, violence and trauma
 Family conflict or family disorganization
 Loneliness
 Low birth weight
 Low social class
 Medical illness
 Neurochemical imbalance
 Parental mental illness
 Parental substance abuse
 Perinatal complications
 Personal loss – bereavement
 Poor work skills and habits
 Reading disabilities
 Sensory disabilities or organic handicaps
 Social incompetence
 Stressful life events
 Substance use during pregnancy

Protective factors

 Ability to cope with stress

 Ability to face adversity
 Adaptability
 Autonomy

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  Early cognitive stimulation
 Exercise
 Feelings of security Feelings of mastery and control
 Good parenting
 Literacy
 Positive attachment and early bonding
 Positive parent–child interaction
 Problem-solving skills
 Pro-social behaviour
 Self-esteem
 Skills for life Social and conflict management skills
 Socioemotional growth
 Stress management
 Social support of family and friends

(Any six (6 correct points, ½ marks each = 3 marks)

2c. Types of hospital admissions in mental health nursing

Types Details
Voluntary admission The patient is admitted of his or her own volition after a
doctor at this hospital has decided that inpatient treatment
is necessary. However, discharge within 72 hours can be
restricted at the discretion of a designated mental health
doctor.
Admission for medical care and protection The patient is admitted even without their consent if a
designated doctor regards their admission as necessary
and the patient’s guardian consents. In the case of if the
patient has a legal guardian: the legal guardian, If the
patient is a minor: the parents, If the patient has a spouse:
or in the absence of any of the above:

Emergency admission The patient is admitted for up to 72 hours even without

their consent or that of their guardian or person with a
duty to support them, if a designated mental health doctor
regards emergency admission as necessary.
Involuntary admission The patient is admitted on the authority of the governor if
two designated mental health doctors ordered by the
governor to examine the patient determine that the
patient’s admission is necessary as a result of
examination because of a risk of self-harm or hurting
others.

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 Emergency involuntary admission The patient is admitted for up to 72 hours on the authority
of the governor as a result of examination by a single
designated mental health doctor if a hospital cannot
complete the official procedures for involuntary
admission and speed is required.

(2 marks each for any three (3) correct point well described, Total = 6 marks)

2d. preventive strategies of mental illness

In mental health nursing, patient or client may be dealt as an individual, family, group, organization or
community. In a variety of settings, various direct and indirect functions based on concepts of primary,
secondary and tertiary preventions are discussed below.

1. Primary Prevention: Primary prevention is a community concept that involves lowering the
incidence. a. Health teaching regarding principles of mental health.

b. Improved living conditions, freedom from poverty and better education.

c. Consumer education in such areas like normal growth development and sex education.

d. Initiating appropriate referrals before mental disorder occurs based on assessment of potential
stressors and life changes.

e. Assisting patients in a general hospital setting to avoid future psychiatric problems.

f. Working with families to support family members and group functioning.

g. Becoming active in community and political activities related to mental health.

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2. Secondary Prevention involved the reduction of actual illness by early detection and treatment of the
problem.

a. Screening and evaluation service

b. Home visits for preadmission and treatment service.

c. Emergency treatment and psychiatric service in the general hospital.

d. Providing a therapeutic Millieu.

e. Supervising patients for receiving medication.

f. Suicide prevention services.

g. Counselling on a time limited basis

h. Crisis intervention.

i. Psychotherapy with individuals.

Families and groups of various ages ranging from children to older adults. Intervening with communities
and organizations based on an identified problem.

3. Tertiary Prevention involves reducing residual impairment or disable laities resulting from the illness.
Direct nursing care functions include the followings:

a. Promoting vocational training and rehabilitation.

b. Organization after care programs for patient discharged from psychiatric facilities to facilitate their
transition from the hospital to the community.

c. Providing partial hospitalised options for patients. In addition to these direct nursing care functions,
psychiatric nurses engage in indirect activities that affect all three levels of prevention.

These activities includes educating nursing personal, continuing, generic or advanced educational
programs, administrating in mental health setting to facilities the provision of optimal nursing care,
supervising nursing personnel to improve the quality of nursing services, professional, consumers groups.
Community care gives local and national agencies and researching clinical nursing problems.

(1 marks for each state point, total 4 marks)

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Question 3.

3a. Definition of traction

Traction is the application of pulling force type out of the body to minimize muscle spasm reduce, align
an immobilize fracture, reduce deformity and to increase space between opposing fractures.

OR

It is the application of force to a part of the body.

3b. Types of traction

1 fix traction

2 balanced traction

3 skin traction

4 skeletal fraction

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5 buck extension traction

6 Hamilton Russell traction

7 packin's traction

8. Dunlop traction

9. Gallow's structure

3c. Management of Traction

Management-of Mr. Thomas on traction

1. Physical assessment and preparation - Before traction is applied, check orthopaedic bed if the
mattress is firm and level. Explain the procdure to the patient.

2. Positioning — the patient is nursed flat with his back on (dorsal position) and remain so, otherwise
immobilization of the fracture would be prevented.

*Explain to the patient and the family members the reasons proper position.

A firm mattress or fracture board will help in maintai.håifib Vlödy alignment.

Use accessories to prevent foot drop (eg. foot support)}

3 skin care — the skin over bony prominence such as the malleoli, elbow, sacrum and ischea should be
observed for signs of pressure sore Turn patient 2 hourly.

Treatment of pressure areas should be out at least 2 hourly

Remove crumples from the bed.

4. Nutrition/Fluid: Ensure adequate nutrition rich in protein, vitamins, mineral e.g. increase fluid
intake.

5. Elimination - Assist patient to make use of bedpan to evacuate rectum as reduced GIT mobility results
in constipation

Ensure a diet highly diet in fibre to stimulate gastric motility.

Provide urinal when the need arises.

6. Self-Care/Exercise

Assisted self-care /activities like deep breathing and coughing exercise should be encouraged.

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Active exercise in form of pulling up on the trapeze, flexing and extending the feet.

Passive exercise within the therapeutic limits of the traction should be ensured maintain muscle strength
and tone.

Patient would benefit from bed-bath.

7. Observation: observe of the affected site for sensitivity and circulation. Proper placement of traction.

Patient's comfort or pain should be assessed.

Observe the pin site for infection-

Observe the colour of the extremities

8. Pin Site care

Observe pin sites daily for reaction and infection e.g. purulent discharge, pin Ioosening and odour

For the first 48 •o after insertion, the site is covered with a sterile absorbent, nonstick dress and gauze

After 48 hours: apply loose cover dressing or no dressing.

9. Diversional Therapy- the patient Will likely experience boredom, depression e.t.c.
Occupational therapy and diversional therapy in form of handicraft, reading, material, radio and
television should be provided.

10.Elevate the head of the bird so that he may adjust to have his head and trunk in the upright position
after being flat with the head lower than the body for so long. The elevation is gradual passive and active
exercise are necessary to prevent deformity and to restore normal muscle function

11. Physiotherapy: Crotches are walking stick and are usually useful in regaining independent mobility
this is gradually withdrawn as the patient gains confidence in working

1 mark for any eight (8) correct points= 8 marks

3d. Physiology of Bone Healing

l. Haematoma stage immediately a fracture occurs there in bleeding from the injured vessels around the
fracture site. This is followed by aseptic inflammatory response (except the skin is broken). Later the
blood fill clot, the clot and inflammatory exudates fill the space between the fragments and around the
fracture line.

2. Cellular growth (Regeneration): the clot is not absorbed but becomes part of the bone itself as healing
progresses. From adjacent connective tissue blood vessels, fibroblast and capillaries invade the
haematoma and exudate forming and granulation tissue (cellular growth). 'The-granulation tissue formed

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is referred to as provisional callus. Almost at the same time, osteoblast cells from the inner surface of the
periosteum proliferate and invade the granulation tissue forming the

3. Callus formation stage — at this stage, osteoblast will start depositioning calcium salts in the
granulation tissue to form hard cement-like tissue called temporary callus. The temporary callus appears
like a collar around between the bone end of the site, making the site thicker than the original bone.

4. Callus Ossification stage - at first, tile callus is comparatively soft but later becomes harder and
converted into bone (permanent to more deposition of calcium salts by the osteoblasts. Medullary canal is
created by the osteoclast. Callus formation could usual be x-rayed around 10 th day of fracture.

5. Remodeling/Consolidation stage this involves re-organization of new bone into its former structural
arrangements.

1marks each for five correct points = 5 marks

3e Complication that may arise from traction

1. Malunion: his means healing Of fracture in position like angulation or of the bones over the Other site.
This alters the shape and• length of the bone with impaired function. This is usually caused by poor
reduction and or fixation during healing.

2: Delayed healing – means that the fracture is not healing rapidly.as expected. The cause may be due' to
a-wider gap between the fragments or presence of a tissue or foreign body 'between bone fragments or
due to poor blood supply to the site or due to surgical intervention or infection of the site or malnutrition,

3. Non-Union — this occurs when the granulation tissue which is formed between the fragment is
converted to dense fibrous tissue, instead of normal temporary callus to permanent callus.

4. Pressure Ulcer — skin breakdown result irritation caused by contact of the skin with the tape or foam
shearing forces,

5. Foot Drop may occur if pressure is applied to the peroneal area at the point at which it passes -around
the neck of the fibula just below the knee.

6. Circulatory Impairment — this may occur after skin traction is applied, the nurse assesses circulåtion
of the foot and hand within 15 — 30 minutes and every 1—2 hours.

7. Ateleetasis and Pheumonia — the nurse auscultates the patient's. lungs every 4 8 hours tm assess
respiratory status. The patient is taught deep-breathing and coughing exercises to-aid in full expansion of
lungs and moving pulmonary secretions.

8. Venous Thromboembolism —venous stasis that thromboembolism occurs with immobility.

9. Acute Compartment Syndrome (ACS) —.it's a condition in which increased pressure within one or
more compartment causes compromise of circulation to the area; common sites are the lower leg and the

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dorsal and volar compartment of the forearm. Infection, motor weakness, contracture and myoglobinuric
renal failure can occur.

10. Hypovolemic Shock — shock can occur as a result of haemorrhage

11. Infection — osteomyelitis is very common.

12. Avascular Necrosis - aseptic or ischaemic necrosis.

13. Gangrene.

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