REPUBLIQUE DU CAMEROON REPUBLIC OF CAMEROON
Paix-Travail-Patrie Peace-Work-Fatherland
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MINISTERE DE L’ENSEINEMENT SUPERIEUR MINISTRY OF HIGHER EDUCATION
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COMISSION NATIONALE D’ORGANISATION DE L’EXAMEN NATIONAL COMMISSION FOR THE
ORGANISATION DU HND OF THE HIGHER NATIONAL DIPLOMA (HND)
EXAM
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HIGHER NATIONAL DIPLOMA (HND) EXAMINATION
June- July session 2023
SPECIALITY/OPTION: NU COEFFICENT: 5
PAPER: CASE STUDY SETTING II DURATION: 6 HOURS
PROPOSED MARKING GUIDE
SECTION A: MULTIPLE CHOICE QUESTIONS
1. D
2. D
3. A
4. B
5. C
6. C
7. A
8. B
9. C
10. C
11. B
12. D
13. B
14. A
15. D
16. A
17. A
18. D
19. C
20. A
SECTION B
1. a. It is legally implicating to the nurse whose duty it is to turn the patient in bed
b. The position of problem and aetiology in the diagnositic state is reversed
c. It is written in terms of patient’s need rather than patient’s problem
d. Grieving is a normal reaction when someone loses a loved one, hence cannot be
diagnosed as a problem. (NB: It is instead abnormal if the person does not grieve however
grieving is only a problem if it maladaptive)
2. Effects of Sympathomimetics on the following organs include
a. Liver: Break down fats (lipolysis) and glycogen (glycogenolysis) to produce sugar
b. Bladder: Relax detrusor muscles and constrict sphincter (leading to urine retention)
c. Gastrointestinal tract: Constrict sphincters and reduce peristalsis
d. Pupils: Dilate pupils (Mydriasis)
SECTION C: CRITICAL THINKING
1. a. Some patient’s problems include
i. urinary incontinence
ii. bowel incontinence
iii. inability to turn self in bed
iv. inability to move lower limbs
v. fear of losing out on his athletic competition
vi. refusal to eat
b. Possible Nursing diagnoses
i. Ineffective coping related to inability to attend competition as evidenced by refusal to
eat
ii. Risk for impaired skin integrity (bed sore) r/t inability to turn self in bed
iii. Risk for disuse syndrome related inability to move lower limbs
iv. Situational low self-esteem (risk for)
v. Bathing/hygiene self-care deficit (risk for)
c. Draw a care plan
2. a. Bronchial asthma crisis (asthmatic crisis, acute asthma)
Group Sub group Examples
Adrenergic drugs (adrenergic Catecholamine Adrenaline etc.
agonists
Non Ephedrine,
catecholamine salbutamol,
albuterol,
formoterol etc.
OR
Alpha-adrenergic
agonists
Beta-adrenergic
agonists
Anticholinergic Antimuscarinics Atropine,
drugs ipratropium
Antinicotinics
b. Mechanism of action
i. Anticholinergics
Decrease vagal tone to airways resulting in vasodilation and reduction of secretion
Others include dilation of pupils; increase force and rate of cardiac contration; constrict
smooth muscles of blood vessels, etc
ii. Adrenergic agonists
Dilate smooth muscles of bronchioles and reduce secretion
Others include decrease motility of GIT, and decrease GI secretions; relax muscles of
bladder and ureters decreasing voiding; suppress sweating; cause pupillary dilation
etc.
c. Other indications include
i. Anticholinergics
Used as preanaesthetic medication to dry secretion
Used as antispasmodic
Heart block
Hyperhidrosis
Organophospate poisoning
etc
ii. Adrenergic agonists
Anaphylaxis
Epistaxis as local hemostatic agent
Used to prolong effects of local anaesthetics
Cardiac arrest
Nasal congestion
Nocturnal enuresis
etc
d. Possible Nursing Diagnoses
Ineffective tissue perfusion related to vasoconstriction secondary to drug use
Risk for imbalance nutrition: less than body requirement related to anorexia
Disturbed sleep pattern: insomnia, nervousness
Risk for injury related to cardiac stimulation (arrhythmias, hypertension)
Deficient knowledge: drug effects and safe used
Decrease bladder elimination: decreased bladder tone and urine retension
Constipation related to slow GI function
Disturbed thought process: confusion, disorientation, especially in older adults
Risk for injury related to drug – induced blurred vision and photophobia
Risk for noncompliance related to adverse drug effects
Risk for altered body temperature (hyperthermia) related to impaired sweating
Etc.
