1. Gwazo is brought to the hospital by police. They found him lying down at Geza bus stand. He is in unconscious state. Outline FIVE possible causes of his condition :(5 Marks)



· Cerebral tumor

· Cerebral haemorrhage

· Head injury

· Epilepsy

· Metabolic disorder e.g. acidosis, hypoglycemia, uremia and liver disease.

· Over dose of some drugs, such as sedative narcotics, anesthetics, alcohol, chemical & gas poisoning.


2. Outlines five Components of pre-operative care.





Pre-surgery Examination (Physicals, Vitals signs)

Fasting (Nil per oral)

Set up of pre-op area and Operation room


Aseptic preparation




3. Mention Five levels of consciousness.



1. Alert

2. Confusion

3. Responding to voice

4. Responding to pain

5. Stupor/Coma




4. Outline FIVE procedures for providing first aid to a person with clothing on fire.



1. Place burn area under cold running water.

2. Cut/Lift away clothing covering the burned area

3. Leave Clothing that sticks to burned area

4. Remove jewellery from burned limb

5. Apply a sterile dressing

6. Raise the limb to reduce swelling


5.  Outline FIVE issues to be communicated when seeking for help of emergency care to assist clients.   


Answers.  (5marks)

1. Location,

2. Type of injury or problem,

3. Victim’s condition,

4. Sequence of events leading to emergency,

5. Type of assistance given


6. Mention five ( 5) conditions which require emergency care        (5 Marks)


Answers. Any five


1. Epileply

2. Convulsion

3. Hypoglycaemia

4. Head injury, cerebral hemorrhage, stroke

5. Heart attack, Heart failure

6. Shock

7. Acidosis/Uremia

8. Burn

9. Asthma

10. Allergic reactiion


7. Enumerate five (5) Rationale for providing intra-operative care to the patient.


· To maintain safety and comfort for the patient until he/she is admitted to the recovery room.

· To prevent complications occurring during and after surgery.

· To maintain the physiological monitoring.

· To provide psychological support (prior to induction of anesthesia).

· To prevent surgical errors.


8. Outline five (5) procedures for providing first aid to a person with chemical and biological spill on the body.   (5marks)



1. Remove any contaminated cloth

2. Cool the injured site

3. If chemical splashes on the body wash with water

4. Do not rub area affected by the spill

5. Take the patient to the hospital for medical assistance

9. It is a Saturday Morning and you are in the surgical ward for a service ward round. You passed through a patient who has been in the ward for three days with the diagnosis of diabetic ulcer. Your plan is sloughectomy and wound dressing. List five (5) equipments for wound dressing.  :(5 Marks)


Answers: Any five


Clean gloves

Sterile gloves

Moisture- proof bag

Sterile dressing set

Culture tube with swab and culture medium

Completed label for each container


1. List five (5) equipment contained in a tray for instillation of ear drops:


Prescribed ear drops.

Sterile ear dropper.

Galipot with sterile swabs.

Clean gloves.

Cotton- tipped applicator.

Kidney dish for used swab.

Sterile pipette if the medicine bottle has no dropper


2. Mention five (5) indications for Catheterization. (5marks)



Relieving retention of urine when other nursing measures have failed.

Emptying the bladder before giving a bladder irrigation or instillation.

Ensuring that the bladder is empty before, during and after pelvic surgery.

Obtaining a sterile urine specimen when collection of ‘Mid–stream’ specimen of urine is impractical, for example when a woman is menstruating or when the patient is incontinent.

Splinting the urethra following urethral surgery or trauma.


3. A 45 years old man was admitted in the ward due to severe malaria, Intramuscular quinine injection was prescribed by doctor on call. Outline FIVE advantages of this route (5 Marks):


Advantages of Parental Route

The drug acts quicker than by the oral route

It is a route of choice when a patient is unconscious

It is also useful in emergence

The route is useful for uncooperative patient who refuses to take drug orally e.g. (psychiatric patient)

Desired dosage can be determined more accurately

Some patients  get psychological satisfaction with injection


4. Write down five  (5 ) purposes for performing wound  dressing.        (5 Marks)


· To protect the wound from further injury or infection.

· To absorb exudates such as pus or serum.

· To immobilize and support the injured part.

· To apply pressure on the wound to control bleeding or approximate the wound edges.

· To provide psychological and physical comfort for the patient


5. Mention five ( 5) Sites for Intravenous Injection.     (5 Marks)


The basilic and cephalic veins located at the inner aspect of the elbow.

The accessory cephalic or the median ante-brachial veins in the forearm.

The dorsal metacarpal veins at the back of the hand.

The commonly used leg veins are the saphenous and femoral veins in the thigh and saphenous at the ankle.

 In children scalp veins may be used.




6. List five (5) equipments for urethral catheterization. (5marks)


        Equipment. Any five

Sterile catheter of the appropriate size

Sterilization kit containing

Water proof drape

Antiseptic solution

Cleansing cotton wool balls

Sterile gloves

Dissecting forceps

Water soluble lubricant

Urine receiver

Specimen container




7. Outline five (5) routes of drugs administration(5 Marks):


· Oral

· Parental

· Topical

· Inhalational

· Rectal


8. Mention Components of Vital or Cardinal Signs


o Body temperature

o Pulse

o Respiration

o Blood pressure

o Pain (recently added as a component of cardinal sign.


9. Mention the five Clinical Signs of Hypothermia


Decreased body temperature, pulse, and respirations

Severe shivering (initially)

Feelings of cold and chills

Pale cool waxy skin


Decrease urinary output

Lack of muscle coordination


Drowsiness progressing to coma

SECTION E: ESSAY QUESTIONS                              


· This section consists of three 3) questions which are supposed to be answered in a narrative way

· Write your answer on a separate sheet of paper provided; each question should start on a new page.

· Write your examination number on each answer sheet you are using

1.A 30-year old man is admitted to the hospital due to loss of consciousness. A community health worker who brought this patient reports that he has been unconscious for three days. Describe how you are going to care this patient in the ward (10 Marks)


(Five points, 2 marks each)

i. Maintaining the ABC i.e. Airway, Breathing and Circulation

Position the patient in a lateral or semi- prone position to prevent tongue from falling back and obstruct the airway.  

The position also facilitates drainage of oral secretions.

Insert oral airway if the tongue is obstructing the airway.

However, an oral airway is a short term measure.

For long term measure a cuffed endotracheal tube will be inserted.  

This tube facilitates the removal of tracheobronchial secretions.

Aspirate oral secretions by suctioning as necessary.

If an endotracheal tube is in place, follow the usually instructions for suctioning the tracheo-bronchial secretions.   

Administer humidified oxygen as indicated.


ii. Assessment of Vital Signs

Check the vital signs – Temperature, pulse, respiration and blood pressure 2 hourly.

Establish a baseline data with the initial readings.

Report promptly any significant deviation from the baseline readings.

Rectal temperatures are more recommended for unconscious patients than axiliary temperature.


iii. Assessment of the Level of Consciousness

Assess the level of responsiveness every 60 minutes for the first 4 hours and then as the condition improves assess 4 hourly.

When recording the condition of consciousness do not use sweeping statements, such as the patient is still unconscious or stuporous.

 Record in the terms of the patient’s responses to the stimulus required to cause them, for example, ‘opens his eye when called loudly or ‘moves his limbs when pricked’.

 Examine pupils of eyes for size, shape and reaction to light.


iv. Positioning and Exercises

Prevent complications by proper positioning of patient.  

Maintain proper body alignment and use proper devices and exercises to prevent foot drops, wrist drop and joint contractures.

Turn the patient every 2 hours.  

Use a turning sheet to help maintain the patient’s body alignment and reduce the strain on the nurses back.

Carry out passive range of motion exercises on all joints at least three times a day, and whenever you turn the patient.  

Use all available devices to prevent pressure sores.

Carry out physical chest therapy as directed by the physiotherapist.

Put up side-rails of the bed whenever the patient is not being attended.  

If the bed has not side –rails, one nurse or attendant must be at the bedside all the time.


v. Maintaining Fluid and Nutritional Balance

The unconscious patient cannot swallow.

He is therefore never given fluids or food by mouth.

His fluid and electrolyte needs are met by intravenous infusion, naso-gastrict tube feeding.

Give frequent oral care and apply petroleum jelly to the lips prevent cracking.

Keep an accurate fluid balance chart.


vi. Bladder and Bowel Elimination

Most unconscious patients have both urinary and fecal incontinence.

For urinary incontinence, an indwelling Foley’s catheter is introduced and kept in situ.

For fecal incontinence, the doctor may prescribe a supporting enema to be given after every 2 or 3 days.  

This will prevent incontinence as well as faecal impaction.


vii. Care of the Eyes


§ Inspect the eyes using a flash light, irrigate the eyes with physiologic saline and instill prescribed eye drops or ointment.  

§ Use eye shield if available or eye pads and protect by adhesive strip.


viii. Self Care Needs

perform faithfully all the self-care activities of daily living for the patient.  

Allow him to ask questions and explain him what has happened.


ix. Emotional Support for the Patient’s Family

Family members need emotional support as they may be very anxious about the patient’s condition.  

Seeing a close member of the family in an unconscious state is frightening to many people.  

The medical care provider should reassure them by keeping the patient tidy, comfortable and in attractive appearance.  

Care should be taken when discussing with the family members about the patient’s condition.  

              The patient may hear what you talk without your knowledge



2.An adult man brought at Emergency department suffering from acute heart attack. He needs emergency care including cardiopulmonary resuscitation Describe the steps of performing cardiopulmonary resuscitation to this patient.



Intro of CPR---1mark

Steps……..1mrk @


Airway assessment

Breathing assessment

Circulation assessment

Chest compression

Rescue breathing ( Mouth-to-mouth)

Repeat Chest compression

Re-assess ABCs




3.You have been called to attend victims of train accident at Nzega village who have suffered from minor cuts and puncture wounds. Describe procedures for providing first aid to these individuals.


Answers. (2marks each)

Wash your hands

Stop bleeding

Clean the wound

Apply the antibiotics

Cover the wounds

Take to the hospital


1. Describe the factors Affecting Wound Healing


Extent of the wound: A small superficial wound heals more quickly than bigger and

deeper wounds.

Nutritional status: Poor nutrition delays wound healing.Provision of adequate amounts of protein, vitamin C and calories hastens the healing process.

Location of the wound: Wounds on the feet and legs or less clean heal more slowly than wounds on the face or head.

Age of the patient: Healing is more rapid in children and young adults than in elderly people.

Foreign bodies: Healing will not take place until foreign bodies are removed from the wound.These foreign bodies may be in the form of damaged tissues, imbedded fragments of wood, and metals of drainage tubes.

Hemorrhage and haematoma: These prolong the healing time since they provide a good culture medium for the growth of micro-organisms.

Presence of other diseases: Diseases such as diabetes mellitus prolong the healing time of wounds owing to a high amount of glucose in the blood.

Certain drugs: Drugs that may alter healing rate include anti-inflammatory drugs, such as

cortisone, and some immune-suppressive and cancer drugs.


4.A 70-year old man is admitted to the hospital due to urine retention. A community health worker who brought this patient reported that he has been diagnosed with prostate cancer for three years. Describe how you are going to catheterize this Mzee. (10 Marks)


Answer 1mark @

· Wash hands and wear gloves

· Expose the genital area and swabs the glans of penis

· Add lubricants to the urethral penis

· Take off the catheter from its sterile packet

· Hold the penis straight and insert the catheter to the urethra

· Connect the foley catheter with the urine bag

· Take Syringe and draw water of injection or normal saline

· Ballon the catheter

· Cover the patient and leave at good state

· Take off gloves and wash hands


5.Yuri is 12 year old boy, admitted in paediatric ward after sustained burn injury at the abdomen. Explain step-by-step procedure on how are you going to dress his wound.               (10 Marks)


Answers: intro wound dressing ………….1mark

Procedure  ……..1marks @

1- Explain procedure to the client .

2- Wash hands.

3- Provide for client privacy

4- Remove binder and tape

-remove binder if used and place them aside .

- If adhesive tape used ,remove it by holding down the skin and pulling the tape toward the wound .

- Use solvent to loose the tape if required

5- Remove and dispose of soiled dressing .

- Put on clean gloves to remove outer dressing or surgipad .

- Place outer dressing away from client .Place the soiled dressing in moisture proof bag without touch the outside the bag .

- Remove the under dressing , taking care not to dislodge any drains , if the gauze sticks to the drains , support the drain with one hand and remove the gauze with other.


6- Setup sterile supplies .

- Open the sterile dressing set using aseptic technique .

- Place the sterile drape beside the wound .

- Open the sterile cleaning solution pour it over the gauze sponges .

- Put on sterile gloves

7- Irrigate the wound :

-Instill a steady  stream of irrigating solution into the wound .

- Position the basin below the wound to receive the irrigating

-Use either a syringe with a catheter attached or with irrigating tip to flush the wound

-Continue irrigating until the solution becomes clear.

-Dry the area around the wound

8- Clean the wound .

- Clean the wound using your gloved hands or forceps and gauze swabs moisture with cleaning solutions.

Use the cleaning method .

 Use a separate swab for each stroke and discard each swab after use .

9- Apply dressing to the drain site and incision.

-Place a precut 4 in 4 gauze around drain .

 -Apply the sterile dressing one at a time over the drain and incision .

-Apply surgipad , remove gloves and dispose of them .

-Secure the dressing with tape or tie.

- Wash your hands.

-Document the procedure and all nursing assessment


6.The important interventions that aim to promote client recovery and prevent

complications during surgery.


a. Introduction 2marks

b. Main body (6 points @2marks )

· Pain Management

· Positioning

· Deep-Breathing and Coughing Exercises

· Leg Exercises

· Moving and Hydration

· Hydration

· Diet.

· Urinary Elimination

· Suction

· Communicative Aspect

· Teaching aspect

     c . conclusion (1 mark)

6.Describe the Factors Affecting Blood Pressure



1.Peripheral Resistance

Blood cells and plasma encounter resistance when they contact blood vessel walls.

If resistance increases, then more pressure is needed to keep blood moving.

Three main sources of peripheral resistance:


2.Blood vessel diameter

As the diameter of a tube gets smaller, a greater proportion of the fluid is in

contact with the wall of the tube.

Therefore resistance to flow is increased and pressure rises. Larger diameter, same volume, less pressure. Smaller diameter, same volume, more pressure. Constriction of blood vessels raises blood pressure. Vessel diameter is actively regulated by vasomotor fibers, sympathetic nerve fibers that innervate the vessel's smooth muscle layer.


3.Blood viscosity

Viscosity is related to the thickness of a fluid.

The greater the viscosity, the less easily molecules slide past one another and the

more difficult it is to get the fluid moving and keep it moving. Because of this greater resistance to flow, a greater pressure is required to pump the same volume of viscous fluid.


4.Total vessel length

Total vessel length affects peripheral resistance. Increased fatty tissue requires more blood vessels to service it and adds to the total vessel length in the body.

The longer the total vessel length, the greater the resistance encountered, and the

greater the blood pressure


5.Vessel Elasticity

Besides peripheral resistance, blood vessel elasticity also affects blood pressure.

A healthy elastic artery expands, absorbing the shock of systolic pressure.

The elastic recoil of the vessel then maintains the continued flow of blood during diastole.

When an individual has arteriosclerosis, arteries become calcified and rigid, so they can't

expand when the pulse wave of systolic pressure passes through them.


6.Blood Volume

Blood volume affects blood pressure.

When there is a greater volume of fluid, more fluid presses against the walls of the

arteries resulting in a greater pressure.

When there is less volume there is less pressure.


7.Cardiac Output

Anything that decreases cardiac output also decreases blood pressure, because there is

less pressure on the vessel walls.

An increase in cardiac output results in increased blood pressure.

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