Past Papers RN Solved ACCN 2019.pdf

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Solved Past Papers

Shalamar Nursing College, Lahore

Submitted as Assignment to:

Tanzeel Ul Rahman

Nursing Instructor

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Copyright © 2019 by Tanzeel Ul Rahman

All rights reserved. This Presentation or any portion thereof may not be

reproduced or used in any manner whatsoever without the proper

acknowledgment of the owner.

Tanzeel Ul Rahman

Nursing Instructor







Time Allowed 2hours

Max Marks 45

Date: 19/03/2015

Health Assessment

Q.1. In pain assessment, what dose pain mnemonic “OLD CART” means? #06 Ans. “O” Onset: ask patient to describe the pain began.

“L” Location: where does it hurt?

“D” Duration: how long the pain has been going on for? “C” Characteristics: patient description about the pain.

“A” Aggravating factors what make the pain worse, or cause the pain. “R” Reliving factors: what has patient done to relive the pain.

“T” Treatment: what can I do to relive pain.

( Q.2. Give at least five teqniques of skilled interviewing? #06

Ans. 1. Active listening. 2. Guided questioning.

3. Nonverbal communication. 4. Empathic response.

5. Validation. 6. Reassurance. 7. Summarization.

8. Empowering the patient.

(“BATES” Chapter 2 page #35)

Q. 3. Briefly explain the four types of health histories, and when they are used? #06 Ans. 1. Complete Health History.

2. Interval Health History

3. Problem – Focused Health History. 4. Emergency Health History.

1. Complete Health History.

It is taken on initial visits to health care facilities. 2. Interval health history.


3 3. Problem-Focused health history.

Collecting data about a specific problem. 4. Emergency Health History.

Emergency assessment is a very rapid assessment performed in life-threatening situations. (Janet R. Weber page#) Q.4. Enumerate the component of adult Health History? #06

Ans. 1. Biographical.

2. Reason for seeking health care. 3. Present health/ illness.

4. Past health. 5. Family health. 6. Review of system. 7. Psychological history. 8. Functional assessment.

(Bedside Techniques. pag#03)


Q.5. a) what are types of Diabetes Mellitus? #02 Ans. Types of diabetes mellitus:

1. Type 1 diabetes mellitus/ insulin dependent DM. Onset any age, but usually young <30 years.

2. Type 2 diabetes mellitus/ non-insulin depend DM. Onset any age but usually over 30 years.

3. Gestational diabetes. Onset during pregnancy usually 2nd and 3rd trimester. 4. DM associated with other condition/syndromes, e.g.

Pancreatic disease, Hormonal abnormalities, medication such as corticosteroids and estrogen containing preparations.

(Brunner & Siddhartha’s page# 1198) b) Give its clinical manifestations. #02

Ans. 1. Polyuria (increase urination) 2. polydipsia (increase thirst) 3. polyphagia (increase appetite) 4. Fatigue and weakness.

5. Sudden vision changes.

6. Tingling and numbness in hands and feet. 7. Recurrent infections.

8. Dry skin, skin lesions or wounds that are slowly heal.



Ans. The late symptomatic stage of chronic disease caused by Human Immunodeficiency Virus infection which progressively impairs the body’s cell- mediated immune responses to infection and cancers.

(Baillie’s nurse’s dictionary pag#13) b) How is it transmitted? #02

Ans. 1. Sharing infected injection drug use equipment.

2. Having sexual relations with infected individuals. (both male and female) 3. people at risk who received HIV infected blood and blood products. 4. Infants born to mother with HIV infection.

(Brunner @ Siddhartha’s pag#1574)

Advanced Concepts in Clinical Nursing

Q.7. what are the complication of IV therapy? #05 Ans. Systemic complication,

1. Fluid overload. 2. Air embolism. 3. Infection. Local complication,

1. Infiltration and extravasation. 2. Phlebitis

3. Thrombophlebitis. 4. Hematoma.

5. Clotting and obstruction.

(Brunner & Suddarth′s pag#281) Q.8. Discus the nursing intervention of pain? #05

Ans. 1. Perform and document a comprehensive pain assessment.

a. Use a reliable and valid tool to determine pain intensity. b. Accept the patient′s report of pain.

c. Apply the hierarchy of pain measures in patient who are unable to report their pain

1. Administer analgesic agent as prescribed.

2. Offer and educate patient how to use appropriate non pharmacological interventions. 3. Reassess for degree of pain relief and presence of adverse effect at peak effect time of


4. Obtain additional prescription as needed. 5. prevent and treat adverse effects.

6. Educate patient and family about the effect of analgesic and goals of care.



Is an inflammation of lung parenchyma caused by various micro−organism, including bacteria, mycobacterium, fungi and viruses?


1. Sudden onset of chills. 2. Fever (101°F to 105°F) 3. Pleuritic chest pain. 4. Coughing.

5. Deep breathing. 6. Tachypnea.

7. Respiratory distress.

(Brunner & Siddhartha’s pag#573,577) Prepared by:

Huraira Batool Iram shehzadi

Paper of 10-04-2017

Health assessment

Q: 1 A 20 years old female came to you for her breast examination and you found a mass in her left breast.

Q: 1 (A) What else to you would look for related to mass? (Write at least 4 items)


 Tenderness  Painful/painless  Fixed

 Moveable

Reference: Susan Wilson and Jean Giddens (2013) health assessment in nursing practice: Published by Mosby and affiliate of Elsevier 5th Edition: Pg.366.

Q: 1 (B) Define meiosis?

Ans: Reflex contraction of the sphincter muscles of the iris in the response to a bright light (or certain dryness) causing the pupil to become smaller.


Q: 2 Write the three normal finding of inspection of nasal mucosa? Ans: Normal finding of inspection of nasal mucosa are:

 Color slight darker as compare to oral mucosa  Nasal septum should be straight, intact and midline



Q: 3 A 50 years old man came to you and complaining of numbness of his both legs you plan for complete neurological examination. Enlist the number of equipment you are going to use for this purpose?

Ans: Enlist the number of equipment use for neurological examination  Penlight

 Tongue depressor  Hammer

 Cotton ball  Measuring tap  Gloves

Reference: Susan Wilson and Jean Giddens (2013) health assessment in nursing practice: Published by Mosby and affiliate of Elsevier 5th Edition: Pg. 336.

Q: 4 (A) Define the Glasgow Coma Scale?

Ans: GCS (Glasgow coma scale) is the most common scoring system used to described the level of consciousness in a person following and traumatic brain injury. Basically it use to help gauge the severity of an acute injury

Reference: Susan Wilson and Jean Giddens (2013) health assessment in nursing practice: Published by Mosby and affiliate of Elsevier 5th Edition: Pg. 556.

Q: 4 (B) How would you describe level of consciousness?

Ans: Level of consciousness (Definition need to be mentioned as well)  Alert (quick to response)

 Lethargic (laziness or lack of energy, sluggish)  Obtunded (Dull, Blunt)

 Stupor (Not aware about surrounding)  Coma (prolong state of unconsciousness)

Reference: Susan Wilson and Jean Giddens (2013) health assessment in nursing practice: Published by Mosby and affiliate of Elsevier 5th Edition: Pg. 556.


Q: 5 (A) What are types of diabetes mellitus?

Ans: Types of diabetes mellitus

 Types 1 Diabetes :( referred to as insulin dependent diabetes mellitus)  Types 2 Diabetes :( referred to as non-insulin dependent diabetes mellitus)

 Gestational diabetes mellitus: any degree of glucose intolerance with its onset during pregnancy

Reference: Brunner & Suddarth (2015) Medical-surgical Nursing: Published by Wolter Kluwer health 13th Edition: Vol-2, Pp- 1163.

Q: 5 (B) Give its clinical manifestation?


7  Polyphagia, Fatigue

 Weakness, Sudden Vision problem  Tingling or numbness in hands or feet

 Dry skin, skin lesion or wound (slow to heal) and recurrent infections.

Reference: Brunner & Suddarth (2015) Medical-surgical Nursing: Published by Wolter Kluwer health 13th Edition Vol-2 Pp- 1165.

Q: 6 (A) What is acquired immune deficiency syndrome? Ans: Definition of AIDS

It is retroviral disease characterized by profound immunosuppression associated with opportunistic infection secondary to neoplasms and neurological manifestation.

Reference: Muhammad Inam Danish (2016) short textbook of Pathophysiology: Published by: Paramount Bools 2nd-Edition: Pp-94.

Q: 6 (B) How it is transmitted? Ans: AIDS is transmitted by

 Body fluid containing HIV  Blood and blood product

 Having sexual relationship with infected individual  Vaginal fluid/seminal fluid

 Amniotic fluid

 Breast fed by HIV infected mother

Reference: Brunner & Suddarth (2015) Medical-surgical Nursing: Published by Wolter Kluwer health 13 th Edition Vol-1, Pp- 1000.

Advance Critical Care Nursing

Q: 7 what are the causes of Bell’s palsy?

Ans: Causes of Bell’s palsy

 Inflammation of the seventh nerve, which results in weakness or paralysis of facial muscles.

 Vascular ischemia

 Viral disease (herpes simplex and herpes zoster)  Autoimmune disease

 The inflamed/edematous nerve become compressed to the point of damage  Blood supply is occluded

 Producing ischemia necrosis of nerve

Reference: Brunner & Suddarth (2015) Medical-surgical Nursing: Published by Wolter Kluwer health 13th Edition: Vol-2, Pp- 2047.

Q: 8. what are the complication and side effects of epidural analgesia? Ans: Complication and side effects of epidural analgesia


8  Inadequate pain relief

 Headache  Slow breathing

 Temporary nerve damage  Infection

 Permanent nerve damage  Haematoma

Reference: Brunner & Suddarth (2015) Medical-surgical Nursing: Published by Wolter Kluwer health 13th Edition: Vol-1, Pp- 429.

Q: 9. Enlist the signs of early septic shock? Ans: Signs of early septic shock are:

 Hypotension  Tachycardia  Tachypnea  Low urine output

 Skin become cool or pale

 Temperature normal or below normal  Feeble pulse

 Altered conscious level

Reference: Brunner & Suddarth (2015) Medical-surgical Nursing: Published by Wolter Kluwer health 13th Edition: Vol: 1, Pp- 301-302.

Prepared By: Shamsa Kanwal Faryad Masih

Paper of 23-06-2012

Paper A: Health Assessment

Question-1 During the health history taking as a part of nursing assessment of the client writes complain regarding sense of hearing. The nurse asks “have you recently noticed any different hearing in one or both ears”? What is the rational in asking this question?

Answer: When Nurse taking history of patient about sense of hearing. He/she most focus on infection (otitis media), wax and tumor in the ear. Though they are quite uncommon, tumors can cause differences in hearing between ears. They affect hearing by growing on the nerve leading from the brain to the inner ear. Because those nerves account for both balance and hearing, audio neuromas may cause both dizziness and hearing loss

(Reference: Brunner& Suddarth’s Text book of Medical and surgical 13ed vol) Question-2 While assessing a client in the abdomen, which are the focus question to be asked for a subjective data collection?

Answer: In assessment of the abdomen must focused on Change in appetite • Weight gain or loss


9 • Intolerance to certain foods

• Nausea and vomiting Change in bowel habits • Abdominal pain

(Reference: Question-3 How do you begin respiratory assessment? What are landmark lines key for assessment?

Answer: Observe respiratory rate and rhythm. Begin the respiratory assessment by counting patient's respiratory rate and simply observing his breathing pattern. Check oxygen saturation. Inspect chest configuration and the work of breathing. Palpation for chest cavity. Percussion abnormality. Auscultation for fluid in lungs.

Anterior Thoracic Landmarks 1. Suprasternal notch 2. Sternum

3. Sternal Angle 4. Costal Angle

Posterior Thoracic Landmarks 1. Vertebral prominence 2. Spinous processes

3. Inferior border of scapulae 4. Twelfth rib

(Reference: Brunner& Suddarth’s Text book of Medical and surgical 13ed vol) Question-4 What are the description and clinical significant of “hyper-resonance” and “tympanic” as percussion sound?

Answer: Tympanitic percussion , drum-like sounds heard over air filled structures during the abdominal examination.

Hyperresonant (pneumothorax) percussion said to sound similar to percussion of puffed up cheeks. Paper B: Pathophysiology


a) Describe circulation shock?

Answer: Circulatory shock, commonly known as shock, is a life-threatening medical condition of low blood perfusion to tissues resulting in cellular injury and inadequate tissue function.

(Reference: b) What are its types?

Answer: There are several types of shock:

1. Septic shock caused by bacteria,

2. Anaphylactic shock caused by hypersensitivity or allergic reaction, 3. Cardiogenic shock from heart damage,

4. Hypovolemic shock from blood or fluid loss, 5. Neurogenic shock from spinal cord trauma.


10 c) Give four features of hypovolemic shock?

Answer: Hypovolemic shock, the most common type of shock, is characterized by a decreased intravascular volume. Body fluid is contained in the intracellular and extracellular compartments. Intracellular fluid accounts for about two thirds of the total body water.

 bleeding from serious cuts or wounds

 bleeding from blunt traumatic injuries due to accidents

 internal bleeding from abdominal organs or ruptured ectopic pregnancy  bleeding from the digestive tract

 significant vaginal bleeding



a) What is AIDS?

Answer: AIDS is a medical condition. AIDS (acquired immunodeficiency syndrome) is a syndrome caused by a virus called HIV (human immunodeficiency virus). The disease alters the immune system, making people much more vulnerable to infections and diseases. This susceptibility worsens as the syndrome progresses.


b) How its transmit from one to another person?


1. Sharing needles or syringes, rinse water, or other equipment (works) used to prepare drugs for injection with someone who has HIV.

2. From mother to child during pregnancy, birth, or breastfeeding.

3. Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV.

4. Eating food that has been pre-chewed by an HIV-infected person.

5. Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids.

6. Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV.



11 Question-7 Enlist the FIVE risk factor of tuberculosis?

Answer: The following factors increase the risk that latent disease will develop into active disease.

 Close contact with someone who has active TB. Inhalation of airborne nuclei from an infected person is proportional to the amount of time spent in the same air space, the proximity of the person, and the degree of ventilation.

 Immunocompromised status (eg, those with HIV infection,cancer, transplanted organs, and prolonged high-dose corticosteroidtherapy)

 Substance abuse (IV or injection drug users and alcoholics)

 Any person without adequate health care (the homeless; impoverished; minorities, particularly children under age 15 years and young adults between ages 15 and 44 yrs)

 Preexisting medical conditions or special treatment (eg, diabetes, chronic renal failure, malnourishment, selected malignancies, hemodialysis, transplanted organ, gastrectomy, or jejunoileal bypass)

 Immigration from countries with a high prevalence of TB (southeastern Asia, Africa, Latin America, Caribbean)

 Institutionalization (eg, long-term care facilities, psychiatric institutions, prisons)

 Living in overcrowded, substandard housing

 Being a health care worker performing high-risk activities: administration of aerosolized pentamidine and other medications, sputum induction procedures, bronchoscopy, suctioning, coughing procedures, caring for the immunosuppressed patient, home care with the high-risk population, and administering anesthesia and related procedures (eg, intubation, suctioning)

(Reference: Brunner& Suddarth’s Text book of Medical and surgical 13ed vol, p.p-533)

Question-8 A patient is intensive care because he suffered a sever myocardial infarction three days ago. In Lab reports the following values from a arterial blood sample pH7.3, HCO3:20mEq/l(22-26), pCO2: 33mmHg(35-45). What is most possible medical diagnosis?

Answer: Possible medical diagnosis metabolic acidosis

(Reference:Brunner& Suddarth’s Text book of Medical and surgical 13ed vol)

Question-9 Write down the cause of acute condition of respiratory acidosis.

Answer: Respiratory acidosis is usually caused by a lung disease or condition that affects normal breathing or impairs the lungs’ ability to remove CO2. Some common causes of the acute form are:

 lung disorders (COPD, emphysema, asthma, pneumonia)  conditions that affect the rate of breathing

 muscle weakness that affects breathing or taking a deep breath  obstructed airways (due to choking or other causes)

 sedative overdose  cardiac arrest


12 Fozia Ali

Ayshea Bibi

Past Paper of


Health Assessment

Question no1. What are the steps in assessment of a client with respiratory excursion? 06

Respiratory excursion: It is an estimation of thoracic expansion and may disclose

significant information about thoracic movement during breathing. The nurse assesses the patient for range and symmetry of excursion.

Anterior assessment

 The nurse places the thumbs along the costal margin of the chest wall and instructs the patient to inhale deeply.

 The nurse observes the movement of the thumbs during inspiration and expiration.

 This movement is normally symmetric.

Posterior assessment

 It is performed by placing the thumbs adjacent to the spinal column at the level of the 10th rib.

 The hands lightly grasp the lateral rib cage.

 Sliding the thumbs medially about 2.5cm raises a small skin fold between the thumbs.

 The patient instructed to take full inspiration and to exhale fully.

 The nurse observes for normal flatting of the skin fold and feels the symmetric movement of the thorax.

Reference: Brunner & suddarths, Medical-Surgical Nursing, 13th edition volume#1,

page# 478.

Question#2: what are the descriptions of bronchovesicular breath sound

heard during auscultation? 06

Bronchovesicular is the normal breath sound heard during auscultation.

 It has moderate pitch.

 It has mixed quality.

 It has moderate amplitude.

 It has same duration inspiration and expiration.

 Its location over major bronchi.

Anterior: around the upper sternum in the first and second intercostals spaces.

Posterior: Between the scapula.


13 These are most common abnormal breath sounds:

1. Rales or crackles 2. Wheezes

3. Rhonchi 4. Stridor

Location of abnormal breath sounds



are heard on inspiration, they may also heard on expiration.



are usually heard on expiration but may be heard on inspiration depending on the cause.



heard on chest auscultation.



heard on inspiration, usually without need of a stethoscope, secondary to upper airway obstruction.

Reference: Brunner & suddarths, Medical-Surgical Nursing, 13th edition volume#1,

page# 463,482.

Question no4. Adventitious breath sounds are extra sounds indicating a

disease or disorder. What does this sound may indicate? 06

Adventitious breath sounds are the abnormal sound on auscultation.

These are main four types of abnormal breath sounds.

1. Discontinous sound

a. Crackles [fine] b.Crackles [course]

2. Continuous sound

a. Pleural friction rub b.Wheeze [sibilant] c.Wheeze [sonorous]

3. Ronchi

4. Stridor

1. Discontinuous sound

a. Crackles [fine]:

these are occurring late in inspiration are associated with restrictive diseases such as pneumonia and congestive heart failure.

These sound are occurring early in inspiration are associated with obstructive diseases such as bronchitis, asthma, or emphysema.

b.Crackles [course]:

May indicate pneumonia, pulmonary edema and pulmonary fibrosis.

2. Continuous sound

a. Pleural friction rub: These are sound may indicate in pleuritis.



c.Wheeze [sonorous]:

Sonorous wheezes are indicate in cases of bronchitis or single obstructions and snoring before a sleep apnea.

3. Ronchi: Ronchi is indicate on expiration in chronic bronchitis and severe asthma.

4. Stridor: It is indicate in partial obstruction of larynx and trachea.



Health assessment in nursing: 5


edition, Janet, page# 389.


Bedside techniques methods of clinical examination, page# 99.


Question#5: Explain the briefly the inflammatory pthophysiology of gouty arthritis. 04 Gout is the most common form of inflammatory arthritis.

It is caused by hyperuricemia. Uric acid is a by –product of purine metabolism; puriens are basic chemicals compounds found in high concentrations in meat products. Urate levels are affected by diet, medications overproduction in the body, and inadequate excretion by the kidneys.

Hyperuricemia can, but does not always, cause urate crystals increase, the risk becomes greater. The initial cause for the gout attack occurs when macrophages in the joint space phagocytize urate crystals.

Through a series of immunologic steps, interleukin 1 beta is secreted, increasing the

inflammation. This process is exacerbated by the presence of free fatty acids. Both alcohol and consumption of a large meal, especially with red meat, can lead to increases in free fatty acid concentrations; they also are implicated as triggers to acute gout attacks.

Reference: Brunner & suddarths, Medical-Surgical Nursing, 13th edition volume#1,

page# 1079. Question#6: What is heart failure? Explain briefly.04

Heart Failure is a clinical syndrome resulting from structural or functional cardiac discords that impair the ability of the ventricles to fill or eject blood.

Heart failure is recognized as a clinical syndrome characterized by sign and symptoms of fluid overload or inadequate tissue perfusion. Fluid overload and decreased tissue perfusion result when the heart cannot generate cardiac output sufficient to meet the body demands for oxygen and nutrients.



Reference: Brunner & suddarths, Medical-Surgical Nursing, 13th edition volume#1,

page# 795.

Advanced critical care nursing

Questions#7: a sixteen year old boy is brought to an accident and emergency department, after having a motorcycle accident. He was received in gasping condition, emergency tracheotomy is done. As a nurse which interventions will prevent patient from

complications associated with tracheotomy? Write at least five interventions. 05

These are following interventions for preventing complications associated with tracheotomy;

 Administer oxygen as prescribed. Monitor oxygen saturation

 Monitor for cyanosis.

 Administer adequate warmed humidity.

 Maintain cuff pressure at appropriate level.

 Suction as needed per assessment findings.

 Maintain skin integrity. Change tape and dressing as per needed.

 Auscultator lung sounds.

 Monitor for sign and symptoms of infection, including temperature and wbcs count.

 Maintain adequate hydration of the patient.

Reference: Brunner & suddarths, Medical-Surgical Nursing, 13th edition volume#1, page# 507. Question#8 A 40 year old lady and come to oncology department for chemotherapy. What occupational safety measures an oncology nurse should know while preparing and handling of antineoplastic agents. 05

When preparing chemotherapy for administration, use the following safety equipment to prevent exposure through inhalation, direct contact, and ingestion:

 Closed system transfer devices

 Puncture and leak-proof containers, IV bags

 Needleless system i.e. IV tubing and syringes

 Surgical N-95 respirator to provide respiratory and splash protection

 Eye and face protection[face shield and goggles]

When preparing, administering chemotherapy or handling linens and other materials contaminated with chemotherapy or blood and body fluids of patients receiving chemotherapy, wear the following for personal protection:

 Double layer powder-free gloves specially designated for chemotherapy handling

 Long sleeve, disposable gowns

Linens contaminated with chemotherapy or blood and body fluids of patients receiving chemotherapy should in placed the following:

 Closed system, puncture and leak-proof containers labeled [hazardous: chemotherapy contaminated linens]



Reference: Brunner & suddarths, Medical-Surgical Nursing, 13th edition volume#1, page# 336. Question#9 A patient come to emergency department. He was in shock on admission

B.P50/30, pulses feeble, skin is very cold and clammy.


Enlist the stages of shock. 02


What steps or management a nurse could take in all types of shock.



Stages of shock

 Compensatory stage

 Progressive stage

 Irreversible stage


Management of all types of shock

Management in all types and all phases of shock includes the following:

 Support of the respiratory system with supplemental oxygen or mechanical ventilation to provide optimal oxygenation.

 Fluid replacement to restore intravascular volume.

 Vasoactive medications to restore vasomotor tone and improve cardiac function.

 Nutritional support to address the metabolic requirements that are often dramatically increased in shock.

Reference: Brunner & suddarths, Medical-Surgical Nursing, 13th edition

volume#1, page# 293. Prepared by

Mahtab Illyas, Samina Aslam

Saida Waheed FMH College of Nursing

PART – A Health Assessment

Q1: Describe briefly the three phases of nursing intervention? (5 marks) Ans PHASES OF INTERVENTION:

 Put the plan of nursing care into action

 Coordinate the activities of the patient, family or significant others, nursing team members and other team members

 Record the patient ‘s responses to the nursing actions

(BRUNNER & SUDDARTH (Pg # 61) Q2: When auscultating the thorax, the nurses systematically asses breathe sounds.

What is the description of normal vesicular sounds? (5 marks) Ans: Description of Normal Vesicular Sounds

 Low pitched, contnious sounds with no gap between inspiration and expiration. Similar to the sound of wind rustling in the tree leaves.



 Audible throughout inspiration but during only initial one third of expiration.

 Normally audible all over the lung field.

 Vesicular breathing with prolonged expiration is present in chronic bronchitis, emphysema and bronchial asthma.

(BEDSIDE TECHNIQUE BY /INAYYAT ULLAH) (Pg # 97) Q: 3 The nursing health history provides subjective data about the patient as a person. What are the components of a comprehensive nursing health history? Explain each component briefly? Ans: Component of Subjective Data

 Biographical Data

 Reason for seeking health care

 Past health history/Illness

 Family health or Family history (current health)

 Review of systems

 Psychological history

 Functional assessment

 Perception of heath


PART-B PATHOPHYSIOLOGY Q1: What is metaplasia? Give an example? (1+1)

Ans: Metaplasia:

A cell transformation in which there is conversion of one type of mature cell into another type of cell.

Example: The change from columnar to squamous cells in the respiratory tract, from squamous to columnar

in Barrett Esophagitis.

(BRUNNER AND SUDDARTH) (Pg # 77) Q2: Define atrophy. Relate 2 causes of pathologic atrophy? (1+1)

Ans : Atrophy

A decrease in the size of an organ or tissue resulting from a decrease in mass of preexisting cells

Cause 1: Tissue atrophy in the period of prolonged starvation results into malnutrition atrophy. Cause 2: tissue atrophy in the period of prolonged ischemia results into ischemic atrophy.

(INAM DANISH-Pg # 3) Q3: Differentiate between benign and malignant neoplasm. Write only four points? (4 marks)



 Well differentiated cells resemble normal cell of the tissue from which the tumor is originated.

 Tumor grows by expansion and does not infiltrate the surrounding tissues: usually encapsulated.

 Rate of growth is usually slow

 Does not spread by metastasis

 Cells are undifferentiated and may bear little resemblance to the normal cell

 Grows at the periphery and overcomes contact inhibition to invade and infiltrate surrounding tissues

 Rate of growth is variable and depends on level of differentiation: the more anaplastic the tumor, the faster is growth.

 Gains accesses to the blood and lymphatic channels and metastasize to areas of the body.


Q1: What is the main symptom of COPD? (2 marks) Ans : Clinical Manifestations:

 Generally a progressive disease characterized by three primary symptoms :chronic cough, sputum production and dyspnea

 Weight loss

 Loss of lung elasticity and Chest tightness

 Shortness of breath

(BRUNNER AND SUDDARTH) (Pg # 621) Q2: What is the nursing management of ASTHMA? (3 marks

Ans: Nursing Management of Asthma:

The nurse generally performs the following interventions:

 Obtains a history of allergic reactions to medications before administering medications

 Identifies medications the patient is taking

 Administers medications as prescribed and monitors the patient ‘s responses to those medications

 Administers fluids if the patient is dehydrated

(BRUNNER AND SUDDARTH) (Pg # 644) Q3: Enlist the five risk factors which are predisposing to pneumonia? (3 marks)

Ans: You are more likely to get pneumonia if you:

 Smoke: cigarette smoking in healthy young people

 Are younger than 1 year of age or older than 65

 Have an impaired immune system

 Have another medical condition ,especially lung diseases such as COPD or Asthma

 Drink excessive amount of alcohol

(Google –webMD) Q.4:A 25 year old female patient admit in medical ward with complain of fluid volume excess and clinical manifestations of edema ,distended weak veins ,crackles ,tachycardia ,increase blood pressure and increase weight.

A. what are the possible nursing diagnoses? (2) B .Make two nursing goals?(2)

A.Ans: Nursing Diagnoses:



 Risk for decreased cardiac output related to peripheral edema. B.Ans: Nursing Goals:

 Preventing hypervolemia

 Educate patient about edema and excessive intake.

(BRUNNER AND SUDDARTH) ( Pg#250) Q.5: A 70 year old patient has been admitted in ward with diagnoses of pneumonia.

He has a persistent cough and complains of SOB, temperature 101 F, heart rate 100bpm, and respiratory rate is 30/min. what are your most likely nursing diagnoses? (3)

Ans: Nursing diagnoses related to pneumonia:

 Ineffective airway related to bronchial inflammation

 Activity intolerance related to exertion

 Hyperthermia related to infection (BRUNNER AND SUDDARTH) ( Pg#582)

Prepared by: Mehwish Gill Ghazala Shaheen

Paper of 27.9.9 Health Assessment

Q # 01: The nursing health histpry provides subjective data about the patient as a person. What are the components of a comprehensive nursing health history and explain each component briefly? 06


Definition of Nursing Health History

Nursing health history can be defined as data collected about a patient’s level of wellness, changes in life, patterns , sociocultural role and mental and emotional reaction to illness.

Components of Comprehensive Nursinh Helth History

The nursing health history has following eight components.

1. Biographic Data

2. Reasons for seeking health care

3. History of present health concerns

4. Past health history

5. Family health history

6. Review of system

7. Life style and health practices profile

8. Developmental Level

Biographic Data

Full Name Address

Telephone Number Birth Date & Place Gender


20 Religion & Race

Occupation Source of referral Educational Level

Usual source of health care

Source & reliability of information Date of interview

Reasons for seeking health care

Major health problem or concerns

Document the onset, duration & precipitating factors Document frequency, duration of complaint

Associated symptoms i.e Nausia/Vomiting Alleviating/Aggrevating factors

History of Present Health Concerns Using COLDSPA

C Character

O Onset

L Location

D Duration

S Severity

P Pettern

A Associated Factors

Past Health History

Problem act birth Childhood illness Accident/ Injuries Adult illness Surgeries Hospitalization Allergies Medication Transfusion

Acute & Chronic illness Obstetric history

Physical, emotional, social or spiritual weakness Physical, emotional, social or spiritual strengths

Family Health History

Age of prents(Living, Deceased date) Parents illness & longevity


21 Aunt’s and Uncle’s age and illness and longevity Children’s age & illness or handicaps & longevity

Review of System

Review past and present health status of each body system Review of health maintenance

A head to toe approach May elect new information

Lifestyle & Health Practices Profile

Nutrition and weight management 24 hours dietry intake

Activities on a typical day Excercise, habit & patterns Sleep & rest habits & patterns

Use of medicines & other substances Relationship with family

Type of work Level of Job

Development Level

Young adult : intimacy versus isolation Middlescent : Generativity versus stagnation Older Adult : Ego integ

References ,

Health Assesment in Nursing Janet R.Weber Jane H. Kelly Fifth Edition Page # 19

Q# 02: Therapeutic use of self sometimes used as a tool in approaching a client for assesment, Explain briefly “Therapetic use of Self”



Definition of Therapeutic use of Self

Therapeutic use of self can be defined as important therapeutic tool or by some as a core skills of occupational therapy. It is also known as concious use of self.



2. It involves a planned interaction with another person in order to alleviate fear or anxiety, provide reassurance, obtain necessary information, provide information and give advice.

3. The exploitation of personal characteristics which are of benefit to the therapeutic relationship e.g insight, patience, humour, energy, honesty, voice and body language etc.

4. The complete being of an indvidual, comprising both physical psychological

characteristics and including both concious and unconcious compnents.

5. Therapeutic use of self the ability to use theory, experimental knowledge and self awareness and to explain one’s impact on other.


Hegedorn, R(2000) Tools of Practice in Occupational

Therapy : A Structured approach to core skills and processes.

Edinburg : Churchill Livingstone

Kielhofner G & Forsyth, K (2000): A model of human occupation. Theory and application(3rd Edi)

Baltimore : Lippincott William & Wikins.

Q# 03: when assessing a patient with a symptom of health concern, the symptom analysis is easy to remember with mnemonic device called PQRST, what are the question guidelines of the assessment analysis device? 06



 Where is the pain? Can you point it?  What makes the pain better or worse?  What were you doing when the pain started?  Does the pain change with repositioning?


 Is it sharp, dull, constant,intermittent? Can you describe it?


 Does any the pain radiate to any other areas? Can you point it?


 Can you rate the pain out of 10?

 Does it interfere with activities?


 How long have you had the pain for?

 Is the pain intermittent (starts and stops) or is it continues?

Refrence: Health



Q# 04: when assessing a patient,s health and illness pattern, the nurse asks selected questions about the functions. What are the selected questions while

assessing the cardiovascular system? 06 Answer:

Question assessing the cardiovascular system:

 Question to ask about chest pain  Onset, location, character, type of pain  What brings it on, associated symptoms.  What aggrevates it? what relieve it?

 Question to ask about dyspnea

 How would you assess for otrhopnea?

 Number of pillows patient uses when sleeping or lying down

 Question to ask about coughing

 Question to ask about fatigue

 Question about edema

 Question to ask about nocturial dyspnea


Q # 05

Explain briefly the Pathophysiological changes of “ After Load” in Heart Failure? (04)


Myocardial Dysfunction

Ischemic heart discease Hyperthyroidsm

Value Discease

Alchohol, coccaine abuse Hypertention

Leads to

Cardiac output

Systemic blood pressure Perfusion to kidney

Leads Activation of Baroceptors

Left ventride Aortic arch Carotid Sinus


24 Leads to

Activation of Sympathetic Nervous System

Catecholamines (epinephrine &norepinephrine leads vasoconstruction) Afterload

Blood Pressure Heart Rate


Medical Surgical Nursing(Brunner & Suddarths’s) Page # 798


Q # 06: Explain briefly the Pathophysiologic changes of Malignant Melanoma 04 Answer:

Pathophysiology of Malignant Melanoma

Sunlight Exposure

Formation of thymine climes

DNA repair removes most UV Induced damage

Cumulative DNA Damage Leads to mutation

Sunligt depresses the local immune system

Decreasing immune surveillance for new tumor cells




Advance Concepts In Clinical Nursing

Q# 07: A twenty year old boy brought to an emergency department with chief complaint of severe diarrhea and vomiting since last one day. He is severely

dehydrated, as a nurse what sign and symptoms she will observe in this case? 05


Sign and symptoms of dehydration:

 Nausea and vomiting

 Dry mouth

 Increase thirst

 Sunkens eyes

 Dry mucous membrane

 Low blood pressure

 Poor skin turgor

 Headache

 Dizziness

 Lethargy,confusion

 Decrease urine out put


Notes: Fluid volume deficit

Q# 08: A 60 year old female came to an emergency department, Her chief complaint was acute chest pain and dyspne, she was also having fever, cough, hemoptysis and syncope. She was diagnose with pulmonary embolism. As a nurse what emergency

management you will give to her? Write five important steps of management? 05


Emergency Management of pulmonary Embolism:

1. Administered nasal oxygen immediately to relieve hypoxemia, respiratory distress and central cyanosis.

Severe hypoxemia may necessitate emergency endo tracheal tube (ETT) and mechanical ventilator.

2. Administered iv fluid that will be needed

3. Vasopressor therapy for hypotension that does not resolve with iv fluid

4. Perfusion scan, hemodynamic measurement, evaluation for hypoxia and spiral CT or pulmonary angiography

5. Monitor ECG for dysrhythmias and right ventricular failure



Refrence: Medical Surgical Nursing (Brunner & Suddarth)

Page No: 601

Q# 09: Mr. “y” 65 year admitted to an oncology department, diagnosed case of lung cancer. At this time he is in very critical condition, nurse has complete all

documentations regarding his life preferences .What method she can use in stating his end of life preferences?

05 Answer:

Stating End of Life preference:-

 DNR orders  Advance directives

 Living will or durable power of attorney  Nutrition/hydration at the end of life  Cardiopulmonary Resuscitation  Ventilator

 Assisted suicide or euthanasia  Desired location of dying

 Spiritual/religious practices and rituals

 Care of body after death


Medical Surgical Nursing BRUNNER & SUDDARTH Page No:- 385

Prepared By Saima Parveen

Sadaf Afzal

Paper of 01/03/2012


You are assessing a patient for chronic bronchitis as a nurse what signs and symptoms you will find in your assessment? (6marks)


SIGN AND SYMPTOMS 1: Persistent cough with sputum. 2: airway obstruction.

3: Dysnea and hypoxemia. 4: Fatigue, wheezing.


27 7: ankle, foot and legs are swollen.

8: pulmonary function test shows obstructive lung disease. Reference: pathology (mohd inam Danish p no 203) QUESTION NO 2:

What do you look for during skin lesion assessment? (6marks) ANSWER:


During assessment we see the type or structure of skin lesions.

A: Primary skin lesion (those that appear initially in response to some change in the external or internal environment of the skin).

B: Secondary skin lesion (those that do not appear initially but result from modification such as chronicity, trauma, or infection of the primary lesion) e.g a vesicle (primary lesion) may rupture and can cause an erosion (secondary lesion).


A:note size in millimeters and whether the lesion is circumscribed or irregular, round, or oval shaped, flat, elevated, depressed, solid, soft, or hard, rough or thickened fluid filled or has flakes. 3: COLOUR:

There may be no discoloration, one discrete color (e.g red, brown, or black).several colors as with ecchymosis(a bruise)in which an initial dark color fades to yellow color. When color changes are limited to the edges of a lesion, they are described as circumscribed, when spread over a large area, they are described as diffuse.


It is described according to the location of the lesions on the body and symmetry or asymmetry of findings in comparable body areas.


It refers to the arrangement of lesions in relation to each other. Configuration of lesions may be annular (arrange in a circle) may be clustered (group) may be linear (in a line) may be arch or bow shaped may be merged together or indiscrete.

Reference: QUESTION NO3:

During assessment you are interviewing a client regarding health history. What are the recommended tips for conducting an interview? (6marks)


Recommended tips for conducting an interview are as following. 1: Environment should be conducive. And provide privacy



4: The interviewer should collect all background information from the previous chart. 5: Introduction should be done prior to interview.

6: Explain the purpose of interview. 7: Ensure confidentiality of information. 8: Provide for patient needs prior to interview. 9: Excellent communication skills are needed. 10: Active listening must be present.

11: Use eye contact.

12: Ask open ended question.

Reference: notes of health assessment by sir Farhan QUESTION NO 4:

Differentiate the following, light and deep palpation. (6marks) ANSWER:


1: It is used to feel the abnormalities that are on the surface.

2: To perform light palpation place your dominant hand lightly on the surface of the structure about less than 1cm, there should be very little or no depression.

3: It helps to identify pulses, tenderness, surface skin texture, temperature, moisture, elasticity and masses.

4: Feel the surface structure using circular motion. 5: All areas must be palpated systemically.


1: Deep palpation is used to feel the internal organs and masses.

2: Place your dominant hand on the skin surface and your non dominant hand on the tip of your dominant hand to apply pressure.

3: This should result in a surface depression between 2.5cm-5cm (1-2inches). 4: It helps to identify the size, shape, tenderness, symmetry and mobility.

5: Deep palpation can be painful and uncomfortable for patients while examining abdomen. Reference: janet r waber health assessment 5th edition( p no 47)

PATHOPHYSIOLOGY QUESTION NO 5: A: define anemia? (1marks)



Reduction below normal levels of hemoglobin concentration and RBC’s mass is called anemia. Anemia is present in adults if hemoglobin is less than 13.5g/dl in males or 12g/dl in females.

B: What are its types? (2marks)

More than 400 types of anemia but some common types are following. 1: Iron deficiency anemia.

2: Thalassemia. 3: Aplastic anemia. 4: Hemolytic anemia. 5: Sickle cell anemia.

6: Vitamin deficiency anemia.

7: Anemia of chronic diseases (e.g renal failure) 8: Pernicious anemia.

C: Which type of anemia is common in Pakistan? (1marks) Most common type of anemia in Pakistan is iron deficiency anemia. Reference: pathology by inam Danish 2nd edition (p no157) QUESTION NO 6: A: what is diabetes mellitus? (1marks) ANSWER:

A disease in which the body’s ability to produce and respond to the hormone insulin is impaired resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in blood.

B: There are following types of diabetes mellitus (1marks).

1: Insulin dependent diabetes mellitus/type 1/juvenile diabetes mellitus. 2: Non-insulin dependent diabetes mellitus/type 2/adult diabetes mellitus. 3: Gestational diabetes mellitus.

C: Give four important symptoms of diabetes mellitus (2marks) 1: Polyuria.

2: Polydipsia. 3: Polyphagia. 4: Asthenia. 5: Nocturia.

67: Acetone breath.

Reference: notes by sir Mehdi hadayat khan


QUESTION NO 7: Write down at least five risk factors that prescipitate cardiac dysrhythmias to post-operative period. (5marks)


30 4: Electrolyte disturbances.

5: Structural heart disease. 6: Previous stroke.

7: H/O chronic obstructive pulmonary disease. Reference:

QUESTION NO 8: Explain complications of pacemaker and two collaborative problems (nursing diagnosis) for the patient with a pacemaker. (5marks)


COMPLICATIONS 1: Bleeding, swelling. 2: Phlebitis.

3: Lead dislodgment. 4: Infection.

5: Pneumothorax. 6: Hemothorax.

7: Myocardial perforation. 8: Collapsed lung.


1: Risk for infection related to direct access to blood stream.

2: Risk for impaired home maintenance related to lack knowledge of catheter management. Reference:

QUESTION NO 9: Explain classification of shock and give detail physical findings of hypovolemic shock (5marks)



1: Hypovolemic shock (hemorrhagic shock). 2: Cardiogenic shock.

3: Distributive shock. A: Neurogenic shock. B: Anaphylactic shock. C: Septic shock.

4: Obstructive shock. HYPOVOLEMIC SHOCK:

It is a result of inadequate circulating blood volume when you loss more than 20 percent of your body’s blood or fluid supply.




The mechanism underlying all distributive shock states is vasodilation that causes pool in peripheral blood vessels.


Vasodilation result from a loss of sympthatic innervation to the blood vessels. ANAPHYLACTIC SHOCK AND SEPTIC SHOCK:

Vasodilation result from the presence of vasodilating substances in the blood. OBSTRUCTIVE SHOCK:

It is associated with physical obstruction of the great vessels of heart itself. Pulmonary embolism and cardiac temponade

are considered forms of obstructive shock.


2: Cool clammy skin. 3: Anxiety.

4: Tachycardia. 5: Oliguria. 6: Pale skin. 7: Weakness.

8: Blue lips and finger nails. 9: Lightheadedness.

10: Headach, nausea, profuse, sweating. 11: Decrease blood pressure.

Reference: notes by sir Tanzeel-ul-Rehman


Paper of 10-07-2017

Part A Health Assessment

Q;-Write a characteristics of breast lump. (Mark 6)

Normal Finding;-

Fibrocystic breast tissue that feels roly lumps or bumpy in texture is referred to as noduler or glandular breast tissue .

Benign breast disease consist of bilateral, multiple ,firm , regular rubbery mobile nodules with well demarcated borders pain and fullness occur just before menses.

Abnormal Finding;-

Fibro adenomas :- Are usually 1-5 cm round ao oval mobile ,firm, solid elastic ,nontender ,single or multiple benign masses found in one or both breast.

Milk Cysts ;- (Sacs Filled with milk) and infections (mastits) may turn into an abscess and occur if breast feeding a recently given birth



Reference ;-Health Assesment Nursing Fifth Editio Jantet R .Webe jane H. Kelley Page no 408

Q;2 If you suspected a client who has meningeal irritation or inflammation from infection which two tests you will perform during assessment to confirm that client has meningeal inflammation also given its normal and abnormal findings.? (Mark 6)

These two test mostely perform to confirm that client has meningeal inflammation Test

Test for brudzinski`s sign .as you flex the neck ,watch the hips and knees in reaction to your maneuver .

Normal Finding

Hips and knees remain relaxed and motion less. Abnormal Finding

Pain and flexion hips and knees are positive brudzinski`s signs ,suggesting meningeal inflamation.

Test for kerning’s sign flex the clients leg at both the hips and knee ,then straighten the knee Normal finding

No pain is felt discomfort behind the knee during full extension occurs in many normal people Abnormal Finding

Pain and increase resistance to extending the knee are a possive kernings sign when kernig`s is bilateral the examiner suspected the meningeal irritation

Refrence; Health Assesment Nursing Fifth Editio Jantet R .Webe jane H. Kelley Page no 573

Q;3Note on buerger test and capillary refill test along with normal and abnormal findings.? (Mark 3,3)

“Buerger test” with the patient supine raise his legs to about 45 degree at the hip and hold for 2-3 minutes ,the blood will drain from the legs and will turn pale .

 After two minutes ask the patient to sit up and lower the leg by hanging it off the side of the bed .

 Note the time it for colour to return ,Normaly it takes less than one minutes .

 If it takes longer ,the test is positive for arterial compromise to the lower extremity. Palpate to assess capillary Refill Time :-

Compress the nailbed until it blanches ,release the pressure and calculate the time it taken for color to return .this test indicates peripheral perfusion and reflected cardic out put .

Normal finding :-

capillary beds refill ( and ,therefore ,color returns) in 2 seconds or less AbNormal Finding ;-

Caapillary refill time excesding 2 second may indicate vasoconstriction , decreased cardic out put ,shock ,arterial occlusions or hypothermic

Refrence ;-Health Assesment Nursing Fifth Editio Jantet R .Webe jane H. Kelley Page no 457



The client who wear glasses should keep them on for this test .to perform the confrontation test . Procedure;-

Position yourself approximately 2 Feet away from the client at eye level . have the client cover the left eye while you cover you right eye .Look directly at each other with you un-covered ,fully extend your left arm at midline and slowly move one finger ( or a pencil) up ward from below until the client see`s you finger or Pencil .test the remaining three visual fields of the clients right eye .( i.e Superior temporal and nasal ) Repeat the test for the opposite eye . Normla Finding ;-

With normal peripheral vision ,the clients should see the exmaminer finger at the same time the examiner see it . Normal Visual Field degree are approximately as follows

Inferior ; 70 degree Superior : 50 Tempora : 90 Nasal ; 60

Abnormal Findings ;- A delayed or absent perception of the examiner finger indicates reduced peripheral vision . abnormal findings refer the client for further evolution .

Refrence Health Assesment Nursing Fifth Editio Jantet R .Webe jane H. Kelley Page no 309

Part B : pathophysiology

Q:5 Mr.”A” admitted to the medical department with the complaint of uncontrolled diabetes mellitu. Physician advised for glycated hemoglobin (HbA1c or A1c) testing. What is hemoglycated hemoglobin test? 04 marks

Ans: The glycated hemoglobin test is also referred to as hemoglobin A1c test.It is a measure of the amount of “suger coating” is on the red blood cells as a result of diabetes mellitus because Red Blood Cells live for about 3 months.The test is a good measure of the average blood suger values over that previous three months.

This is test is some time used to diagnose diabetes mellitus but is more commonly used to see how the blood suger level have been in patients already diagnosed With diabetes.

The glycated hemoglobin test can b used to diagnose prediabetes and type 2 diabetes. According to expert on diabetes the hemoglobin A1c test can b used to diagnose type 1 and type 2 diabetes.

Normal Range of glycated hemoglobin

 hemoglobin Normal range of glycated hemoglobin is 4 to 6.4% Abnormal range

 If the person doe’s not have type 2 diabetes, the glycated hemoglobin level will be less then 5.7%.

 If the person has diabetes ,the glycated hemoglobin level will be between 5.7to 6.4%.

 If the person has diabetes, the glycated hemoglobin level will be 6.5 or higher.  The test should be repeated every year until the individual show a glycated



Reference diabetes library org/glycated

Q:6 Compare the chief characteristics of hypovolemic shock, obstructive and distributive shock? 04

Ans: Hypovolemic shock It is a life threatening condition that result when lose more then 20% of our blood or fluid supply. This type of shock can cause of many organ to stop.


• Cool, calamy skin • Anxiety • Confusion • Decrease urine output • Pale skin color • General weakness • Rapid breath • Sweating • Moist skin

Obstructive shock Its type of shock which circulatory collapse caused by condition that block flow of blood into or out of the heart.It is much common within Cardiogenic shock E.g Cardiac tampon add, cardiac rumors,massive pulmonary embolism or tention pneumothorasic

Charactersitics • Chest pain • Weak pulse • Decrease urine output • Unconscious • Confusion or lack of alertness • Excessive sweating • Rapid shallow breathing • Dyspnea • Light headed Distributive shock It is a medical condition in which abnormal distribution of blood flow in the smallest blood vessels result in the inadequate supply of blood to the body tissue and organ • Types of distributive shock • Neurogenic shock • Anaphylactic shock • Septic shock

Characterstic • Lack of oxygen to body tissue • Cardiac arrest • Low blood pressure • Rapid and weak pulse • Dull eyes • Unconsciousness • Hypothermia • Dry mouth • Fatigue • Rapid heart rat References Lippincott Williams & Wilkins page 295,300

Part C: Advance concepts in clinical nursing

QNO 7.write down the types of shock. Give nursing interventions of

cardiogenic shock? 05 marks

ANS 7 : Types of shock :

1 Hypovolemic shock

a) hemorrhagic shock 2 Cardiogenic shock

3 Distributive shock i) Neurogenic shock ii) Septic shock

iii) Anaphylactic shock Obstructive shock

Nursing Management of cardiogenic shock

1. Preventing cardiogenic shock.

2. Telemetery continuously (hemodynamic monitoring). 3. Administering medication &intravenous fluids.

Prevent both overload and fluid deficit.

4. Maintain Intra-Aortic Ballon Counter pulsation 5. Enhancing safety and comfort . (Proper postioning)



QNO 8.Write down any five nursing intervention of a client with metabolic

acidosis? 05marks

ANS : Nursing intervention of a client with metabolic acidosis

1. Treatment of metabolic Acidosis

2. Treat underlying cause 3. Monitor potassium level. 4. Insulin and diabetic ketosis.

5. With acidosis hyperkalemia may occur as potassium shift out of cell. So treat hyperkalemia

6. Iv bicarbonate or lactate.


Dialysis to treat hyperkalemia.

Reference: Bruner and Siddharth

Q NO 9 a. what is Nanda and its role in modern nursing? 02marks

Answer a. Nanda international (Nanda -1 formerly known as the north American

Nursing Diagnosis Association)

Role of Nanda in nursing

Is the official responsible for developing taxonomy of nursing diagnosis

b. Define nursing diagnosis Write down its types. 03 marks

Nursing diagnosis: The first taxonomy created in nursing have fostered autonomy and accountability in nursing and have helped to delineate the scope of practice

Types of nursing diagnosis:

Actual diagnosis

An actual diagnosis is a client problem that is present at the time of the nursing assessment. These diagnoses are based on the presence of associated signs and symptoms.

Wellness Diagnosis

Wellness Diagnoses describe human responses to levels of wellness in an individual, family or community that have a readiness for enhancement. Examples of wellness diagnosis would be Readiness for Enhanced spiritual Well Being or Readiness for Enhanced Family Coping.

Risk diagnosis

A risk nursing diagnosis is a clinical judgment that a problem does not exist, but the presence of risk factors indicates that a problem is likely to develop unless nurses intervene.

Syndrome Diagnosis



Reference: Brunner and Siddharth

Prepared By:

Nazia Gulshan Seemab

Paper of 7/3/14

Part a: Health Assessment

1. A 20 years old girl comes to you for her breast examination and you found a mass in her left breast.

A) What else you would look for related to mass? 4 Answer:

Focused assessment of breast mass

 Mass is palpable or non palpable

 Shape & size

 Pain redness , edema and any skin changes

 Palpate axillary, suparclavicular area for enlarge lymph node.

 Consistency and fixation of surrounding tissues

(Health assessment Janet R Weber p#413) a) Define miosis? 2


Also known as pinpoint pupils, miosis is characterized by constrictive and fixed pupils possibly a result of nicrotic drugs or brain damage.

(Health assessment Janet R Weber p#324) 2. Write three normal findings of inspection of nasal mucosa? 6


 No redness or inflammation

 Color of nasal mucosa

 Foreign body

 No nasal tenderness

 discharge

 Nose midline intact

 Septum without deviation tenderness , trauma, bleeding or lesions

 Sinus no swelling or mucoid drainage

 No bruising on nose

 no ulceration

 symmetry(centered nose ,right symmetry nose)



3. A 50 year old man comes to you and of numbness of his both legs you plan for a complete neurological assessment. Enlist the complaining six names equipment you are going to use for this purpose? 6


 cotton tipped applicator

 newsprint to read

 ophthalmoscope

 penlight

 snellen chart

 tongue depressor

 tunic fork

 substance to smell or taste

 tap measure

(Health assessment Janet R Weber p#557)

4 a) Define Glasgow comma scale? 2 Answer:

The Glasgow coma scale provides a practical method for assessment of impairment of conscious level in response to defined stimuli.

it include eye, verbal or motor response

Minimum score is 3 it indicate deep coma or brain dead state. Maximum is 15 which indicate a fully awake patient.

(Health assessment Janet R Weber p#85) b) How would you describe level of consciousness? 4


There are two level of consciousness

Full conscious: the normal stat of consciousness comprises either the stat of wakefulness, awareness, or alertness in which most human beings function while not asleep.

Unconscious / altered level of conscious

Lethargy: client open eyes, answers questions, and falls back asleep.

Obtunded: client open eyes to loud voice, response slowly with confusion and seems unaware of environment

Stupor: client awakens to vigorous shake or painful stimuli but returns to unresponsive sleep. Coma: client remains unresponsive to all stimuli, eyes stay closed.

(Health assessment Janet R Weber p#96) Part b: Pathophysiology

5 A) What is type of diabetes mellitus? 2 Answer:

Type 1 diabetes mellitus (beta cells destruction, combined genetic or insulin dependent)



Related subjects : 13th edition