Microsoft word - exam mid-year 08 sq 2009.docx

QUESTION PAPER

Faculty of Social and Health Science
Department of Nursing

NURS6021 NURSING PRACTICE – MEDICAL
END OF COURSE EXAMINATION – November, 2009
Group: Mid-year 08 - Class Number - 5045
Weighting – 70% of Total Grade
Time Allowed: 2 ½ Hours
Write your student ID number on every page of the answer
Write in ink only
This paper consists of TWO (2) sections
You are required to answer all questions in both sections
Section B:
Short Answer Questions. Write only on the lines provided.
Read the following scenario carefully and answer the related questions.
Mr D, a 70yr old patient with type 2 diabetes is admitted to hospital with a 2 day
history of feeling unwell.
Subjective data (supplied by daughter)
• History of a lower respiratory tract infection for the past week • Diagnosed with type 2 diabetes 20yrs ago • Very depressed since death of wife 3 months ago • Has been non-compliant with his oral medications which include • Has not been eating or drinking adequately • Has been passing very large quantities of urine
Objective data
• Skin flushed and very dry with dry mucous membranes • Drowsy and confused as to time and place
Diagnostic studies
• Urinalysis – glucose: +++++, ketones: neg/trace
Question 1: (6 marks)
Mr D is experiencing an acute complication of his diabetes diagnosed as HONK
(Hyperosmolar non-ketotosis). From the above data, describe the clinical
manifestations of HONK and the related pathophysiology.
Question 2: (4 marks -2 marks each)

The two main problems related to type 2 diabetes are insulin resistance and
impaired insulin secretion. Discuss what is meant by these two factors.
Question 3: (2 marks)

Explain what you would tell Mr. D’s daughter when she asks what is meant by the
HbA1c.
Question 4: (6 marks – 3 marks each)
Discuss 2 (two) microvascular complications of diabetes mellitus with reference
to pathophysiology and clinical manifestations.
Question 5: (6 marks – 2 marks each)
Discuss how the following components of management of diabetes mellitus will
assist in achieving optimum control of the disease.

Question 6: (4 marks – 2marks each)
Discuss the action and side effects of the following classes of drugs in the
treatment of type 2 diabetes mellitus. Give 1 (one) example of each.

Read the following scenario carefully and answer the related questions.
Mrs P, a 67yr old retired teacher, is admitted to hospital with chest pain radiating
down both arms. She had a myocardial infarction 5 years ago and has been fairly well and active since then. States that pain is less severe than that experienced with her MI but has concerns because of her past history. Subjective data:
• Both parents died of cardiovascular disease and a brother of a MI aged 55
• Pain started at 8am after her shower and subsided when she rested but
reoccurred 2 hrs later after a short walk • Has smoked 1 packet of cigarettes a day for 30 yrs.
• Her husband has recently been diagnosed with prostate cancer and she is
• She has a 10 year history of hypertension treated with antihypertensive • Takes lipex to control her cholesterol Objective data:
• Central chest pain on exertion radiating to arms and jaw accompanied by • No nausea or vomiting
• Is
• Vital signs: BP 180/90 , Apex beat 100, Resp. 28 and Temp 37.8oC
• Pulse oximetry 92% on room air

Diagnostic studies:
• No rise in troponin and cardiac enzymes on admission and 8 hrs later • 12- lead ECG shows no significant acute changes
Interventions:
• 1 dose of nitroglycerin (GTN) sublingually, which relieved her chest pain • Oxygen via nasal prongs at 2 litres /min Question 7: (3 marks)
Mrs P is experiencing an episode of angina pectoris which is attributed to her
CAD (coronary artery disease). From your assessment, discuss the data that would indicate that angina and not a myocardial infarction (MI) is occurring. Question 8: (6 marks)
Differentiate between the basic pathophysiology of angina pectoris and MI Question 9: (8 marks – 2 marks each)
Identify 4 (four) modifiable risk factors for Mrs P and discuss how these would Question10: (3 marks)
Briefly describe what is meant by the following? Question 11: (3 marks)
Describe the nursing education you would give to Mrs P with regard to self - administration of glyceryl trinitrate (GTN) spray. Include at least 6 (six) points in Question 12: (5 marks)
Long standing CAD and hypertension can eventually lead to CHF (congestive heart failure) Describe the pathophysiology and clinical manifestations of right – Question 13: (4 marks- 2 marks each)
Describe the mechanism of action and side effects of the following medications Question 14: (8 marks)
Chronic obstructive respiratory disease (CORD) is characterised by airflow obstruction caused by chronic bronchitis and emphysema. Differentiate between the two disease processes in terms of pathophysiology. Question 15: (4 marks)
Discuss the nursing considerations when administering oxygen to the patient with Question 16: (4marks – 2 marks each)
Discuss how the following will help in improving breathing patterns in the patient Question 17: (6 marks)
Pneumonia is a frequent complication of CORD and accounts for numerous admissions to hospital each year. Describe how this develops in the patient with chronic bronchitis who continues to smoke. Question 18: (4 marks)
Describe the education you would give to the CORD patient with reference to the advantages of using a spacer when administering medications Question 19: (4 marks – 2 marks each)
Discuss the action of the following medications in the management of CORD.

Source: http://www.unitec.ac.nz/library2/Exam%20papers/health/nursing_practice_medical_6021_2009_s2_gm.pdf