Staff Nurse 2nd paper solution PDF

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Section A (Marks: 50)


1. Define sterilization and write about the autoclave. [2+3=5]

Sterilization is the process by which all forms of microbial life, including bacteria, viruses, spores, and fungi, are completely destroyed. It is a critical process in healthcare to ensure that surgical instruments, dressings, and other medical items are free of pathogens.

Autoclave:
An autoclave is a pressure chamber used to perform sterilization by applying high-pressure saturated steam. It is the most effective and commonly used method for sterilizing surgical instruments, dressings, syringes, and glassware.

Principle: Uses moist heat under pressure. Steam at 121°C and 15 pounds per square inch (psi) for 15–30 minutes kills all microbes including spores.

  • Types: Gravity displacement autoclave, pre-vacuum autoclave.
  • Uses in Nursing:
    • Sterilization of dressing sets, surgical instruments, and linen.
    • Ensures asepsis in operating rooms and wards.

Nurses play a key role in preparing, loading, and monitoring autoclave processes, as well as ensuring that sterile supplies remain uncontaminated until use.

2. Name the cranial nerves and explain their functions. [2+3=5]

There are 12 pairs of cranial nerves, each with specific sensory, motor, or mixed functions.

Names (Mnemonic: “Oh Oh Oh To Touch And Feel Very Good Velvet AH”):

  1. Olfactory (I)
  2. Optic (II)
  3. Oculomotor (III)
  4. Trochlear (IV)
  5. Trigeminal (V)
  6. Abducens (VI)
  7. Facial (VII)
  8. Vestibulocochlear (VIII)
  9. Glossopharyngeal (IX)
  10. Vagus (X)
  11. Accessory (XI)
  12. Hypoglossal (XII)

Functions:

  • Sensory Nerves: I (smell), II (vision), VIII (hearing and balance)
  • Motor Nerves: III, IV, VI (eye movement), XI (shoulder movement), XII (tongue movement)
  • Mixed Nerves:
    • V: Facial sensation and chewing
    • VII: Facial expressions, taste
    • IX: Taste, swallowing
    • X: Autonomic functions (heart, lungs, digestive tract)

Understanding these nerves helps nurses assess neurological function in patients with head injuries, strokes, or brain infections.

3. Write signs and symptoms of the patient with cirrhosis of liver. [2+3=5]

Cirrhosis is a chronic, progressive liver disease characterized by fibrosis and regenerative nodules that impair liver function.

Early Signs:

  • Fatigue, loss of appetite
  • Nausea, indigestion
  • Weight loss

Advanced Signs and Symptoms:

  1. Jaundice: Yellowing of skin and sclera due to bilirubin accumulation.
  2. Ascites: Accumulation of fluid in the peritoneal cavity, leading to abdominal distension.
  3. Hepatic Encephalopathy: Confusion, altered consciousness due to toxin accumulation (esp. ammonia).
  4. Esophageal Varices: Dilated veins that may rupture and bleed.
  5. Spider Angiomas & Palmar Erythema: Due to hormonal imbalance and vascular changes.

Nurses monitor vital signs, measure abdominal girth, manage dietary restrictions (low sodium, high protein), and educate patients on avoiding alcohol and hepatotoxic substances.

4. Write down the signs and symptoms of myocardial infarction and its emergency management. [5]

Myocardial infarction (MI), or heart attack, occurs due to sudden blockage of coronary arteries, leading to necrosis of heart muscle.

Signs and Symptoms:

  • Severe chest pain or pressure, often described as “crushing” or “tight,” radiating to the left arm, neck, or jaw.
  • Shortness of breath
  • Sweating (diaphoresis), cold and clammy skin
  • Nausea and vomiting
  • Feeling of impending doom or restlessness
  • Hypotension or arrhythmias in severe cases

Emergency Management:

  1. MONA Protocol:
    • Morphine: Pain relief and anxiety reduction.
    • Oxygen: To enhance oxygen delivery to ischemic myocardium.
    • Nitroglycerin: Vasodilation and reduction of myocardial workload.
    • Aspirin: Antiplatelet effect to prevent further clot formation.
  2. IV Access and ECG Monitoring: For immediate diagnosis and preparation for thrombolysis or percutaneous intervention.
  3. Thrombolytic Therapy: If available and no contraindications.
  4. Psychological Support: Reassurance and calming the patient.

Nurses are responsible for rapid recognition of MI signs, immediate action, and monitoring post-intervention.

5. State the health indicators of children of Nepal and its uses. [5]

Health indicators provide measurable data on the health status of populations. For children in Nepal, key indicators include:

  1. Infant Mortality Rate (IMR): Number of deaths of infants under one year per 1,000 live births.
  2. Under-Five Mortality Rate (U5MR): Number of deaths of children under five years per 1,000 live births.
  3. Immunization Coverage: Percentage of children receiving vaccines like BCG, DPT, polio, measles.
  4. Nutritional Status:
    • Stunting (low height for age)
    • Wasting (low weight for height)
    • Underweight (low weight for age)
  5. Prevalence of Childhood Diseases: Incidence of diarrhea, pneumonia, anemia, etc.

Uses:

  • Assess effectiveness of maternal and child health (MCH) programs.
  • Guide health policy and resource allocation.
  • Monitor progress toward Sustainable Development Goals (SDGs).
  • Identify priority areas for intervention (e.g., malnutrition hotspots).
  • Evaluate health inequalities across regions or ethnic groups.

Nurses use these indicators for community assessments, planning health camps, and targeting health education.

6. Describe the principles of primary health care. [5]

The Alma-Ata Declaration of 1978 introduced the concept of Primary Health Care (PHC) as essential, accessible, and affordable care for all individuals.

Principles of PHC:

  1. Equitable Distribution: Health services should be available to all regardless of socioeconomic status, geography, or ethnicity.
  2. Community Participation: Involvement of individuals and families in planning, implementation, and maintenance of health programs ensures sustainability.
  3. Intersectoral Coordination: Health development requires coordinated efforts with sectors like education, agriculture, water, and sanitation.
  4. Appropriate Technology: Health interventions must be culturally acceptable, cost-effective, and adaptable to local settings (e.g., oral rehydration salts, clean delivery kits).
  5. Preventive and Curative Services: Emphasizes health promotion, disease prevention, treatment, and rehabilitation.

As nurses, we uphold PHC by promoting immunization, conducting health education, managing common illnesses, and referring complicated cases to higher centers.

7. Describe the role of nurses while administering drugs by different routes. [5]

Nurses play a pivotal role in safe and effective medication administration through various routes:

  1. Oral Route:
    • Ensure the patient is conscious and able to swallow.
    • Verify drug compatibility with food or other medications.
    • Educate the patient on timing and side effects.
  2. Intramuscular (IM) Route:
    • Select appropriate site (e.g., deltoid, gluteus).
    • Use correct technique to avoid nerve damage or abscess.
    • Monitor for allergic reactions.
  3. Intravenous (IV) Route:
    • Prepare aseptically, check for vein patency.
    • Monitor infusion rate, fluid balance, and side effects.
    • Observe for phlebitis, infiltration, or anaphylaxis.
  4. Subcutaneous Route:
    • Used for insulin or heparin.
    • Rotate sites to prevent tissue damage.
  5. Topical and Rectal Routes:
    • Apply only on intact skin or mucosa.
    • Provide privacy and explain the procedure.

General Responsibilities:

  • Follow the “Five Rights” of drug administration: right patient, drug, dose, route, and time.
  • Maintain documentation and report adverse effects.

8. Define meningitis. Write its signs, symptoms and management. [2+2+6=10]

Definition:
Meningitis is the inflammation of the meninges, the protective membranes covering the brain and spinal cord. It can be bacterial, viral, or fungal. Bacterial meningitis is a medical emergency.

Signs and Symptoms:

  1. In Adults:
    • High fever, headache, stiff neck
    • Photophobia, nausea, vomiting
    • Seizures, altered consciousness
  2. In Infants:
    • Bulging fontanelle
    • Poor feeding, irritability
    • Lethargy, high-pitched cry

Management:

  1. Medical Management:
    1. Immediate administration of empirical IV antibiotics (e.g., ceftriaxone + vancomycin).
    1. Antipyretics for fever, anticonvulsants for seizures.
    1. Dexamethasone to reduce inflammation in bacterial cases.
  2. Nursing Management:
    1. Isolate the patient to prevent spread (in bacterial cases).
    1. Monitor vital signs, neurological status, and fluid balance.
    1. Maintain a quiet, dimly lit room to reduce stimulation.
    1. Ensure hydration and nutritional support.
    1. Support the family emotionally and educate them about the illness.
  3. Preventive Measures:
    1. Vaccination (e.g., Hib, meningococcal, pneumococcal vaccines).
    1. Prophylactic antibiotics for close contacts in some cases.

9. Explain the birth preparedness and complication readiness. [5]

Birth Preparedness and Complication Readiness (BPCR) is a strategic approach to reduce maternal and neonatal mortality by ensuring that a pregnant woman and her family are ready for childbirth and can handle emergencies effectively.

Components of Birth Preparedness:

  1. Identification of Skilled Birth Attendant: Choosing a nearby facility with skilled staff to ensure safe delivery.
  2. Selection of Delivery Site: Preferably a government birthing center or hospital equipped to handle emergencies.
  3. Transportation Arrangement: Planning for transport ahead of labor to avoid delays, especially in rural or hard-to-reach areas.
  4. Saving Money: Setting aside funds for delivery-related expenses, emergencies, and medicines.
  5. Essential Supplies: Preparing clean clothes, sanitary pads, baby clothes, and other delivery materials.

Complication Readiness Includes:

  • Recognizing danger signs such as severe bleeding, convulsions, high fever, and labor lasting more than 12 hours.
  • Identifying nearby emergency facilities and blood donors in case of postpartum hemorrhage or surgical need.

Nurses educate mothers during antenatal care (ANC) visits about BPCR and motivate families to plan and prepare in advance to reduce delays in care-seeking.

10. Discuss about use of partograph during second stage of labour in details. [3+2=5]

Partograph is a graphical tool used to monitor the progress of labor and assess fetal and maternal well-being.

Use in Second Stage of Labor (From full cervical dilation to delivery of the baby):

  1. Monitoring Descent and Expulsion:
    1. Although the partograph mainly tracks the first stage, continued monitoring during the second stage is essential.
    1. Documentation includes duration of second stage, fetal descent, and maternal pushing efforts.
  2. Fetal Monitoring:
    1. Fetal heart rate (FHR) is recorded every 5–15 minutes to detect fetal distress.
    1. Meconium-stained liquor may indicate fetal compromise.
  3. Maternal Condition:
    1. Maternal pulse, BP, and uterine contractions are monitored every 30 minutes.
    1. Frequency, duration, and strength of contractions are observed.

Importance of Partograph:

  • Early detection of prolonged labor.
  • Helps in timely decision-making (e.g., referral, cesarean).
  • Reduces risk of maternal exhaustion, obstructed labor, and neonatal asphyxia.

In summary, while its primary use is in the first stage, partograph supports safe monitoring throughout labor, including second stage, by prompting timely interventions.

11. List the major causes of infertility in male and female in Nepal. [5]

Infertility is a growing concern in Nepal and can result from various physiological, behavioral, and environmental factors.

Female Causes:

  1. Tubal Blockage: Due to infections like PID or STIs, previous surgeries, or ectopic pregnancy.
  2. Anovulation: Caused by PCOS, thyroid disorders, excessive stress, or malnutrition.
  3. Endometriosis: Endometrial tissue outside the uterus interferes with ovum release and implantation.
  4. Uterine Abnormalities: Congenital anomalies, fibroids, or adhesions.
  5. Poor Menstrual Hygiene and Reproductive Tract Infections (RTIs).

Male Causes:

  1. Low Sperm Count or Motility: Due to genetic factors, infections (mumps orchitis), or hormonal imbalance.
  2. Varicocele: Swelling of veins in the scrotum leading to poor sperm quality.
  3. Lifestyle Factors: Smoking, alcohol, stress, exposure to toxins, poor nutrition.
  4. STIs and Genital Infections.
  5. Ejaculation Problems or Testicular Injury.

Nurses must educate couples on healthy reproductive behaviors and promote timely medical evaluation.

12. Discuss about development milestone of pre-school age child in brief. [5]

Preschool age refers to children aged 3–5 years. It is a crucial phase for physical, cognitive, social, and emotional development.

Physical Milestones:

  • Walks and runs with coordination.
  • Climbs stairs alternating feet.
  • Draws basic shapes, uses scissors, begins writing letters.

Cognitive Development:

  • Understands cause and effect.
  • Counts up to 10; recognizes colors and shapes.
  • Begins to understand the concept of time and sequences.

Language Development:

  • Speaks in full sentences with increasing vocabulary (900–2,000 words).
  • Asks questions and tells stories.
  • Can follow 2–3 step instructions.

Social and Emotional Development:

  • Plays cooperatively with peers.
  • Shows affection, expresses a wide range of emotions.
  • Begins to develop self-control and independence.

Nurses assess these milestones during immunization or school health visits to identify early signs of developmental delays.

13. Write short notes on Electro-Convulsive Therapy (ECT). [5]

Electroconvulsive Therapy (ECT) is a medical treatment for severe psychiatric disorders where small electric currents are passed through the brain to trigger a controlled seizure.

Indications:

  • Major depressive disorder (resistant to medication).
  • Acute mania in bipolar disorder.
  • Schizophrenia with catatonic features or suicidal behavior.

Procedure:

  • Performed under general anesthesia.
  • Muscle relaxants (e.g., succinylcholine) are administered to prevent physical injury.
  • Electrodes are placed on the scalp; electric current induces seizure for 20–60 seconds.

Nursing Role:

  • Pre-ECT: Informed consent, NPO for 6 hours, remove jewelry/dentures, baseline vitals.
  • During ECT: Support anesthetist and psychiatrist, monitor airway and vitals.
  • Post-ECT: Monitor recovery, assess for confusion or memory loss, provide reassurance.

ECT is safe and effective when administered properly. Nurses play a vital role in preparation, monitoring, and post-procedure care.

14. Define leadership. Discuss the various leadership styles. [2+3=5]

Definition:
Leadership is the process of influencing, guiding, and directing individuals or teams to achieve common goals. In nursing, effective leadership enhances team collaboration, patient safety, and service quality.

Leadership Styles:

  1. Autocratic:
    • Leader makes decisions independently.
    • Useful in emergencies.
    • Disadvantage: May suppress team creativity and morale.
  2. Democratic (Participative):
    • Leader involves team in decision-making.
    • Encourages teamwork and satisfaction.
    • Disadvantage: Time-consuming.
  3. Laissez-faire:
    • Leader gives minimal direction.
    • Works with highly skilled and self-motivated teams.
    • Disadvantage: Can lead to confusion and lack of accountability.

A good nurse leader adapts styles based on situation, task urgency, and team competence.

15. Define Eclampsia. List the clinical features of Eclampsia. Explain the nursing management of a patient with Eclampsia. [1+3+6=10]

Definition:
Eclampsia is the occurrence of seizures (convulsions) in a pregnant woman with preeclampsia (hypertension + proteinuria), usually after 20 weeks gestation.

Clinical Features:

  1. Severe hypertension (BP > 160/110 mmHg)
  2. Edema, especially in face and hands
  3. Proteinuria
  4. Seizures (tonic-clonic type)
  5. Headache, visual disturbances
  6. Epigastric pain or right upper quadrant pain

Nursing Management:

  1. Emergency Care:
    • Position woman in left lateral to prevent aspiration.
    • Ensure airway patency and oxygenation.
    • Administer anticonvulsant: Magnesium Sulfate as per protocol.
    • Monitor deep tendon reflexes and urine output.
  2. Control Hypertension:
    • Administer antihypertensives (e.g., labetalol or hydralazine).
  3. Fetal Monitoring:
    • Monitor fetal heart rate and uterine activity.
  4. Fluid Balance:
    • Strict input-output charting.
    • Prevent fluid overload and pulmonary edema.
  5. Preparation for Delivery:
    • If seizures are controlled, delivery is the definitive treatment.
    • Prepare for cesarean section if required.
  6. Emotional Support:
    • Reassure and educate the patient and family.
    • Prevent recurrent seizures through regular ANC and early detection of preeclampsia.

16. Mention the principle of growth and development of children and explain clearly the factors which affect growth and development. [5+5=10]

Principles of Growth and Development:

  1. Cephalocaudal Principle: Development progresses from head to toe. For example, infants gain head control before they can walk.
  2. Proximodistal Principle: Development proceeds from the center of the body outward. Arm control comes before finger coordination.
  3. General to Specific Responses: Children respond to stimuli with generalized movement first, then with more specific responses.
  4. Continuity and Predictability: Growth and development follow a predictable sequence but vary in rate from child to child.
  5. Differentiation and Integration: Simple skills evolve into complex patterns. For instance, babbling leads to speaking in sentences.

Factors Affecting Growth and Development:

  1. Genetic Factors: Inherited characteristics such as height, body type, and intelligence.
  2. Nutrition: Adequate protein, vitamins, and minerals are essential for proper physical and mental development.
  3. Health and Illness: Frequent infections or chronic illnesses like tuberculosis can delay development.
  4. Environmental and Socioeconomic Status: Safe housing, clean environment, and access to healthcare positively influence growth.
  5. Parental Care and Stimulation: Emotional bonding, early education, and encouragement promote cognitive and emotional growth.

Nurses play a vital role in early screening, counseling parents, and implementing interventions in cases of developmental delay.

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