ROYAL CIVIL SERVICE COMISSION

CIVIL SERVICE COMMON EXAMINATION (CSCE) 2009

EXAMINATION CATEGORY: TECHNICAL

PAPER III: SUBJECT SPECIALIZATIONPAPER for B.Sc. NURSING

Date: 8th November, 2009

Total Marks: 100
Examination Time: 2.5 Hours
Reading Time: Min. 5 minutes (Prior to exam. Time)

1. Read the questions carefully before proceeding to answer.

2. This paper consists of nine (9) pages.
3. All the answer must be written on the answer sheet provided.
4. You are required to answer all the questions in Section A.
5. The section A consists of two parts; Part I consists of objective type
questions, 30 questions of 1 mark each. Part II consists of four short
answer questions of 5 marks each.
6. The section B consists of two case studies. You are required to answer
only one case study which carries 50 marks.
7. For the objective type question write down the question number and the
correct answer against it.
Example
22. b
23. c
24. a
8. Answer the short question in part II of section A in brief and to the point.
9. Before submitting the paper mention the number of answer sheets
attached to ensure that the papers are not lost or tampered with.
10. Number of answer sheets attached

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 CIVIL SERVICE COMMON EXAMINATION (CSCE) 2009
TECHNICAL GRADUATE SELECTION EXAMINATION
PAPER III: SUBJECT SPECIALIZATION

SECTION A (50 Marks)

I. Multiple choice question: Answer in separate sheet as per the above
instruction (1x30= 30 marks)
1) The nurse practices nursing in conformity with the code of ethics for
professional registered nurse. This code:
a. Improves self-health care
b. Protects the client from harm
c. Ensures identical care to all clients
d. Defines the principles by which nurses’ provide care to their clients
2) An 18-year-old woman is in the emergency department with fever and cough.
The physician asks the nurse to measure vital signs, auscultate lung sounds,
listen to heart sounds, determine the level of comfort, and collect blood and
sputum samples for analysis. The nurse is performing what aspect of practice?
a. Diagnosis
b. Evaluation
c. Assessment
d. Implementation
3) The nurse is caring for a client with end-stage lung disease. The client wants
to go home on oxygen therapy and be comfortable. The family wants the client
to undergo a new surgical procedure. The nurse explains the risk and benefits
of the surgery to the family and discusses the client’s wishes with the family.
The nurse is acting as the client’s:
a. Manager
b. Educator
c. Advocate
d. Caregiver
4) Evidence-based practice is defined as:
a. Nursing care based on tradition
b. Scholarly inquiry embodied in the nursing and biomedical research literature
c. A problem-solving approach to clinical practice based on best practices
d. Quality nursing care provided in an efficient and economically sound manner

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5) Contemporary nursing requires that the nurse possess knowledge and skills to
carry out a variety of professional roles and responsibilities. Examples include
which of the following? (Select all that apply.)
a. Autonomy and accountability
b. Advocacy
c. Provision of bedside care
d. Health promotion and illness prevention
6) Nursing practice in the twenty-first century is an art and science that is
centered on:
a. The client
b. The nursing process
c. Cultural diversity
d. The health care facility
7) Which of the following statements is true about evidence-based practice?
(Select all that apply.) Evidence-based practice:
a. Is based only on the results of research
b. Assists nurses in meeting standards of practice
c. Helps nurses solve dilemmas in the clinical setting
d. Requires nurses to review and critique research and practice findings
8) Healthy People 2010’s overall goals are to:
a. Assess the health care needs of individuals, families, or communities
b. Develop and implement public health policies and improve access to care
c. Gather information on incident rates of certain diseases and social problems
d. Increase life expectancy and quality of life and eliminate health disparities
9) Substance abusers frequently avoid health care providers because of:
a. Fear of the cost of health care
b. Fear of institutions and people
c. Fear of being turned in to criminal authorities
d. Fear of being without the recreational drug of choice
10) Nursing’s paradigm includes:
a. Health, person, environment, and theory
b. Concepts, theory, health, and environment
c. Nurses, physicians, models, and client needs
d. The person, health, environment/situation, and nursing

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11) Maslow’s hierarchy of needs is useful to nurses, who must continually
prioritize a client’s nursing care needs. The most basic or first-level needs
include:
a. Self-actualization
b. Love and belonging
c. Air, water, and food
d. Esteem and self-esteem
12) A number of strategies have the potential for creating work environments that
enable nurses to demonstrate more caring behaviors. Some of these include:
a. Increasing working hours
b. Raising monetary compensation
c. Providing flexibility, autonomy, and improved staffing
d. Increasing input from physicians concerning nursing functions
13) The caring aspect of nursing may be negatively affected in clinical practice
today primarily because of:
a. Lack of time constraints in nursing care
b. Increased emphasis on the nurse-client relationship
c. Prevalence of chronic conditions that slow the pace of nursing
d. Rise in technology that takes nurses’ attention away from clients
14) During the day the nurse spends time instructing a client in how to self-
administer insulin. After discussing the technique and demonstrating an
injection, the nurse asks the client to try it. After the client makes two attempts
it is clear that the client does not understand how to prepare the correct dose.
The nurse discusses the situation with the charge nurse and asks for
suggestions. This is and example of:
a. Reflection
b. Risk taking
c. Problem solving
d. Client assessment
15) A nurse uses an institution’s procedure manual to confirm how to insert a
Foley catheter. The level of critical thinking the nurse is using is:
a. Commitment
b. Scientific method
c. Basic critical thinking

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d. Complex critical thinking
16) What techniques encourage a client to tell his or her full story? (Select all that
apply.)
a. Active listening
b. Back channeling
c. Use of open-ended questions
d. Use of closed-ended questions
17) A nursing diagnosis is:
a. The diagnosis and treatment of human responses to health and illness
b. The advancement of the development, testing, and refinement of a common
nursing language
c. A clinical judgment about individual, family, or community responses to
actual and potential health problems or life processes
d. The identification of a disease condition based on a specific evaluation of
physical signs, symptoms, the client’s medical history, and the results of
diagnostic tests
18) In the examples given below, which nurse is acting to avoid a data collection
error?
a. The nurse asks her colleague to chart her assessment data.
b. The nurse considers conflicting cues in deciding on the correct nursing
diagnosis.
c. The nurse who assesses the edema in a client’s lower leg is unsure of its
severity and asks her co-worker to check it with her.
d. After performing an assessment the nurse critically reviews his level of
comfort and competence with interviewing and physical assessment skills.
19) A client-centered goal is a specific and measurable behavior or response that
reflects:
a. The physician’s goal for the specific client
b. The client’s desire for specified health care interventions
c. The client’s response compared to that of another client with a similar problem
d. The client’s highest possible level of wellness and independence in function

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20) Nurses agree to be advocates for their clients. The practice of advocacy calls
for the nurse to do which of the following?
a. Seek out the nursing supervisor in conflicting situations
b. Work to understand the law as applies to the client’s clinical condition
c. Assess the client’s point of view and prepare to articulate this point of view
d. Document all clinical changes in the medical record in a timely manner
21) A client tells the nurse, “I have stomach cramps and feel nauseous.” This is an
example of what type of data?
a. Objective
b. Historical
c. Subjective
d. Biographical
22) Clients frequently request copies of their medical records. The nurse
understands that:
a. Only the families may read the records
b. Clients have the right to read those records
c. Clients are not allowed to read those records
d. Only health care workers have access to the records
23) Which of the following values for vital signs would the nurse address first?
a. Heart rate = 72 beats per minute
b. Respiration rate = 28 breaths per minute
c. Blood pressure = 160/86
d. Oxygen saturation by pulse oximetry = 89%
e. Temperature = 37.2 degrees centigrade, tympanic
24) The nurse decides to take an apical pulse instead of a radial pulse. Which of
the following client conditions influenced the nurse’s decision?
a. The client is in shock
b. The client has an arrhythmia
c. The client underwent surgery 18 hours earlier
d. The client showed a response to orthostatic changes
25) If an infectious disease can be transmitted directly from one person to another,
it is:
a. A susceptible host
b. A communicable disease

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c. A portal of entry to a host
d. A portal of exit from reservoir
26) The most effective way to break the chain of infection is by:
a. Practicing good hand hygiene
b. Wearing gloves
c. Placing clients in isolation
d. Providing private rooms for clients
27) The client has an order for 2 tablespoons of milk of magnesia. The nurse
converts this dose to the metric system and gives the client:
a. 2ml
b. 5 ml
c. 16 ml
d. 30 ml
28) Most medication errors occur when the nurse:
a. Is caring for too many clients
b. Fails to follow routine procedures
c. Is administering unfamiliar medications
d. Is responsible for administering numerous medications
29) A client is to receive Cephalexin 500 mg by mouth. The pharmacy has sent
250 mg tablets. The nurse gives:
a. Half a tablet
b. 1 tablet
c. 1 and half tablet
d. 2 tablets
30) The nurse is obtaining a client’s medication history. Which of the following
medications may cause gastrointestinal bleeding? (Select all that apply.)
a. Aspirin
b. Cathartics
c. Antidiarrheal opiate agents
d. Nonsteriodal anti-inflammatory drugs (NSAIDs)

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 II. Short answer question (5x 4=20 Marks)
a) List down the five steps in nursing process model
b) Define the following terms:
i. Cyanosis
ii. Nosocomial infection
iii. Bradycardia
iv. Tracheostomy
v. Pyuria
c) What are the five “Rs” followed when administering medications?
d) List five pieces of specific preliminary information the nurse needs before a
patient is prepared for surgery.

SECTION B: Answer any one of the case study (1x 50= 50 Marks)

CASE STUDY 1:
Mr. Dorji, a 22 year old male is to undergo surgery for Crohn’s disease. He will have
a new, pouching colostomy. He and his family/ care giver need teaching about what
this means for his future elimination needs.
a) Explain three common bowel elimination problems. (6)
b) List and explain four factors which affect normal bowel function. (8)
c) What is colostomy? (1)
d) List the different types of colostomy. (4)
e) Explain the care of colostomy to Mr. Dorji and his family. (10)
f) What health education would you provide Mr. Dorji and his family members
regarding the care of colostomy?(5)
g) List and explain three nursing measures which will promote normal bowel
function (6)
h) Write two nursing diagnosis and their interventions for Mr. Dorji. (10)

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CASE STUDY 2:
Mr. Sonam, a 70 year old male, was admitted to the hospital with fever, dehydration,
malaise, and weakness. He was restless and confused and did not know where he was
or the time of the day. Mr. Sonam has a history of cardiac disease, for which he takes
digitalis preparation.
a. What method should the nurse use to assess Mr. Sonam’s body temperature?
Why?(2)
b. What is the normal range of temperature in a normal adult?(1)
c. On assessing Mr. Sonam’s temperature, it was 104 degree Fahrenheit. Convert
Fahrenheit scale to Celsius scale.(2)
d. What changes would you expect to find in Mr. Sonam’s pulse and respiratory
rate?(1)
e. Explain the five different types of fever. (5)
f. Explain the care of a client with fever. (5)
g. What pulse site should the nurse use to assess Mr. Sonam’s pulse rate, rhythm,
and volume?(1)
h. Other than the respiratory rate, what other assessment data does the nurse need
to collect in relation to Mr. Sonam’s respiratory status?(6)
i. When taking Mr. Sonam’s blood pressure, the nurse:
1. measures the systolic pressure at which sound?(1)
2. Measures the diastolic pressure at which sound?(1)
j. Mr. Sonam’s blood pressure indicates that he has hypertension. This means
that his:
1. Systolic blood pressure is above which pressure?(1)
2. Diastolic pressure is above which pressure?(1)
k. Explain factors which influence blood pressure. (5)
l. Explain the guidelines for taking vital signs. (5)
m. Explain the procedure for taking pulse and respiration. (10)
n. What are vital signs? Mention the normal vitals signs of a normal human
being. (3)

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