2nd Year GNM Nursing KARNATAKA MEDICAL SURGICAL NURSING - I FEBRUARY 2025
KARNATAKA STATE DIPLOMA IN NURSING EXAMINATION BOARD
GNM THEORY EXAMINATION – FEBRUARY 2025
2nd YEAR - MEDICAL SURGICAL NURSING - I
I. Give the meaning of the following
Answer :
1) Gout
Gout is a
metabolic disorder in which uric acid levels in blood become high and
crystals of uric acid get deposited in joints – causing sudden severe joint
pain, swelling and redness (mostly in big toe).
2) Urinary Incontinence
Urinary
incontinence is the inability to control urine discharge – patient
passes urine involuntarily.
3) Epilepsy
Epilepsy
is a chronic neurological disorder in which there are repeated
seizures / fits due to abnormal electrical activity in the brain.
4) Arthritis
Arthritis
is an inflammation of joints which leads to joint pain, swelling,
stiffness and reduced movement.
II. Fill in the blanks
Answer :
5. Damage
to the air sacs in the lungs is called as Emphysema
6. Inflammation
and infection of the salivary gland is known as Sialadenitis
7. Esophageal
varices are abnormal enlarged veins in the lower part of the esophagus
8. Formation
of stone in gall bladder is known as Cholelithiasis
III. Write short notes for any FOUR of the following
Answer :
9) Steps of Nursing Process
Nursing process is a systematic problem–solving method used by nurses to provide quality care. Steps:
1. Assessment
– collect data (history, physical examination, investigations).
2. Nursing
Diagnosis – identify actual/potential patient problems.
3. Planning
– set goals, priorities, and plan nursing care.
4. Implementation
– carry out the planned nursing interventions.
5. Evaluation
– check whether goals are achieved; modify care if needed.
10) Post-operative Care
Care given after surgery to promote recovery, prevent complications.
Important points:
·
Receive patient in recovery room, maintain
airway & breathing.
·
Monitor vital signs, oxygen saturation, urine
output.
·
Pain management – analgesics.
·
Prevent complications: deep breathing exercises
to prevent atelectasis, early ambulation to prevent DVT.
·
Wound care – observe drainage, bleeding,
infection.
·
Maintain IV fluids, monitor I/O.
·
Provide psychological support & patient
education.
11) Caring for the Patient on a Ventilator
Ventilator is used when patient cannot maintain adequate breathing.
Care includes:
·
Maintain airway patency (suctioning secretions).
·
Check ventilator settings regularly (mode, FiO₂,
tidal volume).
·
Monitor ABG, SpO₂, respiratory rate.
·
Prevent infection – strict aseptic suction,
mouth care.
·
Prevent ventilator associated pneumonia (VAP) –
elevate head 30–45°.
·
Secure endotracheal tube.
·
Give sedation as ordered.
·
Provide communication methods.
12) Portal Hypertension
Portal hypertension means increased blood pressure in the portal
venous system.
Causes:
·
Cirrhosis (most common)
·
Portal vein obstruction
·
Liver fibrosis
Effects / Complications:
·
Esophageal varices
·
Ascites
·
Splenomegaly
·
Hemorrhoids
Management:
·
Low salt diet
·
Diuretics (spironolactone)
·
Beta-blockers to reduce portal pressure
·
Endoscopic banding for varices
13) Neurogenic Bladder
Neurogenic bladder is loss of normal bladder control due to nerve
damage.
Causes:
·
Spinal cord injury
·
Stroke
·
Diabetic neuropathy
·
Multiple sclerosis
Features:
·
Urinary retention or incontinence
·
Frequent UTIs
·
Dribbling of urine
Management:
·
Bladder training
·
Intermittent catheterization
·
Anticholinergic drugs
·
Adequate fluid intake & skin care
IV. Answer the following
Answer :
14. Define COPD (1 mark)
COPD (Chronic Obstructive Pulmonary Disease) is a chronic,
progressive respiratory disorder caused by airflow obstruction
due to inflammation and damage of airways and alveoli — mainly seen in chronic
bronchitis and emphysema.
15. List the stages and clinical manifestations of COPD
(3 marks)
Stages of COPD (based on severity):
1. Mild
– chronic cough, occasional sputum
2. Moderate
– shortness of breath on exertion, increased sputum
3. Severe
– dyspnoea on minimal activity, frequent infections
4. Very
Severe – respiratory failure, cor-pulmonale, poor quality of life
Clinical manifestations:
·
Chronic cough with sputum
·
Dyspnoea on exertion
·
Wheezing / chest tightness
·
Barrel–shaped chest (emphysema)
·
Pursed-lip breathing
·
Cyanosis (chronic bronchitis type)
16. Explain the medical and nursing management of COPD
(3 marks)
Medical management:
·
Bronchodilators (salbutamol, ipratropium)
·
Corticosteroids to reduce inflammation
·
Antibiotics if infection present
·
Oxygen therapy (low flow)
·
Pulmonary rehabilitation exercises
·
Stop smoking
Nursing management:
·
Position patient in high-Fowler’s position
·
Teach pursed-lip breathing exercises
·
Monitor SpO₂, respirations
·
Maintain fluid intake (to thin secretions)
·
Suction if needed
·
Advise small frequent meals
·
Provide psychological support
17. Define inflammation and mention the causes and types of inflammation (4 marks)
Definition:
Inflammation is a protective response of tissues to injury or
infection resulting in redness, heat, swelling, pain and loss of
function.
Causes of inflammation:
·
Physical agents (heat, radiation, trauma)
·
Chemical agents (acids, alkalis)
·
Infective agents (bacteria, virus)
·
Immunological reactions / allergy
·
Ischemia & necrosis
Types of inflammation:
1. Acute
inflammation – sudden, short duration (hours to days)
2. Chronic
inflammation – long duration (weeks to years)
3. Subacute
inflammation – between acute & chronic
18. Stages of inflammatory reaction (3 marks)
Stages:
1. Vascular
response → vasodilation → increased blood flow (redness & heat)
2. Cellular
response → migration of WBCs (neutrophils, macrophages) to injury site
3. Phagocytosis
& healing → dead cells removed → tissue repair / scar formation
V. State the following statement is True / False
Answer :
19. Infectious
rhinitis caused by an upper respiratory tract infection — True
20. Absence of
enough calcium in blood is known as hypokalemia — False
(Low calcium = Hypocalcemia, Hypokalemia =
low potassium)
21. Collapse of
alveoli is known as atelectasis — True
22. Heller’s
myotomy is a surgical management for achalasia — True
VI. Write short notes for any THREE of the following
Answer :
23) Role of Nurse in Anaesthesia
·
Prepare patient pre-operatively (NPO status,
consent, IV line, allergy history).
·
Assist anaesthesiologist in giving drugs,
intubation, monitoring vitals.
·
Maintain airway patency and oxygenation.
·
Monitor vital signs (BP, pulse, RR, SpO₂)
throughout surgery.
·
Observe level of consciousness and pain relief.
·
Prevent complications – aspiration, hypotension,
arrhythmias.
·
Post–anaesthesia care in recovery room –
maintain airway, side-lying position, monitor for nausea, vomiting, hypoxia.
24) Types of Intestinal Obstruction
Intestinal obstruction = blockage that prevents passage of
intestinal contents.
Types:
1. Mechanical
obstruction
o
Due to physical blockage
o
Example: hernia, adhesions, tumor, volvulus,
intussusception.
2. Paralytic
ileus (non-mechanical)
o
Loss of peristalsis
o
Seen after abdominal surgery, peritonitis,
electrolyte imbalance.
3. Partial
or complete obstruction
o
Partial = some gas/fluid passes
o
Complete = total blockage.
25) Classification of Altered Immune Response
Altered immune response = abnormal response of immune system.
Types:
1. Hypersensitivity
reactions (Type I to Type IV)
o
Example: allergy, asthma, anaphylaxis.
2. Autoimmune
disorders
o
Body attacks its own cells.
o
Example: SLE, rheumatoid arthritis.
3. Immunodeficiency
o
Reduced immune function.
o
Example: AIDS, SCID.
4. Transplant
rejection
o
Immune reaction against transplanted organs.
26) Brain Abscess
Brain abscess is a localized collection of pus in
brain tissue because of infection.
Causes:
·
Spread from ear infection, sinusitis, dental
infection.
·
Trauma.
·
Bacteria most common.
Clinical features:
·
Headache, fever, vomiting
·
Seizures
·
Focal neurological deficits
Management:
·
IV antibiotics
·
Mannitol to reduce raised ICP
·
Surgical drainage if large
·
Monitor neurological status
VII. Answer the following
Answer :
27. Define Pancreatitis and mention the clinical
features of pancreatitis (3 marks)
Definition:
Pancreatitis is inflammation of the pancreas due to activation
of pancreatic enzymes inside the pancreas itself, leading to autodigestion of
pancreatic tissue.
Clinical features:
·
Severe abdominal pain (epigastric pain radiating
to back)
·
Nausea & vomiting
·
Abdominal distension
·
Fever
·
Tachycardia
·
Jaundice in some cases
·
Elevated serum amylase & lipase
28. Explain the medical, surgical and nursing management
of pancreatitis (5 marks)
Medical management
·
NPO (nothing by mouth) to rest pancreas
·
IV fluids to maintain hydration
·
Analgesics for pain (opioids)
·
Antibiotics if infection suspected
·
NG tube suction to relieve vomiting
·
Antacids / Proton pump inhibitors
Surgical management
·
Drainage of pseudocyst / abscess
·
ERCP for gallstone removal (if obstructive
pancreatitis)
·
Debridement of necrotic tissue (necrosectomy)
Nursing management
·
Monitor vital signs, pain level
·
Maintain NPO as ordered, slowly reintroduce oral
fluids
·
Strict I/O chart, daily weight
·
Provide adequate rest, semi-Fowler’s position
·
Monitor lab values (amylase, lipase,
electrolytes)
·
Psychological support
·
Educate patient to avoid alcohol & fatty
foods
29. Define Nephrotic Syndrome and explain the causes (3 marks)
Definition:
Nephrotic syndrome is a kidney disorder characterised by massive
protein loss in urine (proteinuria), hypoalbuminemia,
edema, and hyperlipidemia due to damage to
the glomerular membrane.
Causes:
·
Primary glomerular diseases (minimal change
disease, membranous nephropathy)
·
Secondary causes:
o
Diabetes mellitus
o
SLE (systemic lupus)
o
Infections (hepatitis, malaria)
o
Drugs (NSAIDs)
o
Allergies & immune disorders
30. Explain medical and Nursing management of Nephrotic
syndrome (4 marks)
Medical management
·
Corticosteroids (prednisolone)
·
Diuretics to reduce edema
·
ACE inhibitors to reduce proteinuria
·
Low salt diet
·
Albumin infusion in severe hypoalbuminemia
·
Statins to reduce hyperlipidemia
·
Antibiotics if infection present
Nursing management
·
Monitor I/O, daily weight, edema
·
Maintain low salt, moderate protein diet
·
Monitor BP and urine protein levels
·
Skin care to prevent breakdown (because of
oedema)
·
Infection prevention (immunity low)
·
Emotional support for patient & family
