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Concept:

• Needlestick injuries are wound caused by accidental puncture of the skin by a needle.
• Needlestick injuries can cause blood transmitted diseases such as HIV and Hepatitis B. Both of the diseases are life-threatening. Therefore, needle stick injuries are taken care of immediately without any delay.

Explanation:

Protocol of Needlestick Injury:

• Cleaning with running water and soap.
• Cross-check with patient's virology result.
• Management
  • Vaccination for Hepatitis B and tetanus.
  • Nucleoside reverse transcriptase inhibitors.
  • Initiate Antiretroviral therapy within 72 hours of exposure.
• Reporting

Preventive measures:

• Use disposable syringes and needles.
• Discard needles carefully and according to biomedical waste management.
• Don't perform recapping of needles.
• Always use a sharp container.

• A needle stick injury with HIV contamination causes a chance of 1/160 chance to get the disease.
• According to CDC, around 385000 needle stick injuries occur per year. 

Concept:

About the Calories: 

> Calories are the amount of energy released when the body breaks down food. 

> Calories are a way of keeping track of the body's energy budget 

> If we consistently put more energy into our bodies than we burn the excess will gradually be stored as fat in our cells and we'll gain weight 

> If we burn off more energy than we replenish, we'll lose weight.

Daily calorie needs based on Age, Gender and the  Activity level

Calorie rich food : 

Proteins: Red meats, pork, chicken with skin on (roast or broil don’t deep fry for your health), salmon or other oily fish, beans, whole milk, eggs, cheese, full-fat yogurt.

Carbohydrates: potatoes, brown rice, whole grain pasta, whole grains, whole grain breads.

Fats: Nuts and nut butters, olives, avocado, butter, salad dressings, mayonnaise, high-fat cheeses.

Explanation:

• Graphic Rating Scales: On some sort of relative scale (usually 1-5 or 1-7), employees are assessed on specific characteristics, accomplishments and behaviors.
• This is a useful method to observe improvements over time.

• The ethical principles that nurses must adhere to are the principles of justice, beneficence, nonmaleficence, accountability, fidelity, autonomy, and veracity.
• Justice is fairness.
• Nurses must be fair when they distribute care, for example, among the patients in the group of patients that they are taking care of.

Concept:

• Electroconvulsive treatment refers to the electrical stimulation of the brain in depressive disorder under anesthesia.
• Atropine is given before ECT. Atropine is an anticholinergic medication.

Explanation:

• Anticholinergic medication minimizes secretion of the body.
• Atropine also acts to prevent transient post-ictal bradyarrhythmias. Bradyarrhythmias is a slow heart rate that is less than 60 beats per minute.
• Atropine reduces gastric motility and lowers esophageal sphincter tone as an anticholinergic agent.
• Anticholinergic medication does not provide prevent aspiration.

Concept:

• During the fluid replacement therapy for a burn patient, hourly urine output is monitored through the indwelling catheter.
• Urine output helps to adjust the fluid resuscitation.
• Urine output is a physiologic response and therefore is an indicator for hypovolemia.

Explanation:

• The resuscitation phase is the time between initial injury and 48 hours after injury.
• The aim of the resuscitation phase is to assess the severity of the burn, monitor airway and breathing, and prevent hypovolemic shock.
• The burn injury leads to the loss of the majority of the body water. That causes hypovolemic shock.
• Therefore, fluid resuscitation is required.
• The fluid resuscitation is calculated through= RL's solution 2 to 4ml * body weight (kg) * percent burn.
• The formula act as a guide and urine output help to adjust the infusion rate.

Concept:

• Cord presentation refers to the condition of cord slipping down below the presenting part in the intact bag of membranes.
• It is identified by pulsation in the intact membrane.
• Management:
  • Do not replace the cord as it can lead to rupture of membrane.
  • Immadiate vaginal delivery. If vaginal delivery is not possible, cesaren section is performed.
  • While preparing for cesarean section, women is kept in exaggerated Sim's position or traditionally used trendelenburg or knee-chest position. Trendelenburg can be tirsome for the patient.

Explanation:

• The positioning is done to minimize cord compression.
• Cord prolapse is different from the cord presentation.
• Cord prolapse refers to the cord lying inside or outside the vulva following rupture of membranes.
• First aid management for cord prolapse:
  • Minimize the pressure on the cord.
  • Bladder is filled with 400-750ml of normal saline to raise the presenting part off the compressed cord.
  • Presenting part is lifted off the cord by gloved fingers.
  • Exgaggerated and elevated Sim's position with a pillow under thigh. Trendeleburg or knee-chest position has been traditionally used.
  • Replace the cord to minimize vasospasm due to irritation.

"Correct Answer - Option 4 : 14 & 18

CONCEPT:

• Fetal movement refers to the motion of a fetus caused by its own muscle activity.
• Fetal movements are the kicks, rolls, and hiccups of your unborn baby. Fetal movements show that your unborn baby is getting the oxygen and nutrients he needs before birth.  

EXPLANATION:  

• Women who have already given birth have more relaxed uterine muscles that are consequently more sensitive to fetal motion, and for them, fetal motion can sometimes be felt as early as 14 weeks. By about week 21, the fetus begins to develop a regular schedule of movement.
• The movements grow stronger and more frequent as your baby grows.

"

Concept:

• Delphi technique refers to the process of making decisions by surveying panellists. Several rounds of questionnaires are given to the panel of experts.
• Every panellist is allowed to adjust their answers according to the answers of the last round.
• Delphi's technique involves expert analysis and wisdom of the crowd.

Explanation:

Concept:

• Resilience refers to the ability to recover from stressful situations. A stressful situation may involve trauma, the death of a loved one, the transition phase, unexpected change, chronic illness, accident, or any other stressor.
• It is the process of adapting to an adverse situation.

Explanation:

Concept:

• The deficiency of folic acid causes neural tube detection.
• 400 mcg of folic acid is necessary for pregnancy.
• A neural tube defect is a congenital malformation of the brain and spine. There are two types of neural tube defects anencephaly and spina bifida.

Explanation:

• Niacin, thiamine, and riboflavin are not necessary for pregnancy.

Concept:

• Sanguinarine is a major alkaloid of Argemone oil.
• Epidemic dropsy occurs when edible oils are adultered by Argemone oil.
• Sanguinarine acts on capillaries. There is capillary dilatation, proliferation, and increased capillary permeability. It leads to edema and hypovolemia.

• Epidemic dropsy is characterized by gastroenteric symptoms followed by cutaneous erythema and pigmentation. Respiratory and cardiac symptoms may also be present.

Explanation:

• Ergot is a fungus that grows on wheat. The reaction associated with ergot is St. Anthony's fire.
• BOAA that is beta-N-oxalylamino-L-alanine is associated with lathyrism.
• Aflatoxins can be responsible for the poisoning in humans. The toxins are produced by fungi found on crops such as maize, cottonseed, and tree nuts.

Explanation:

• Phlebitis is an inflammation of a vein.
• The vein is hot, red and lumpy.
• The lump is tubular in shape and it is tender to touch, it may throb and walking may be painful.
• The cause of phlebitis in the leg is most often a clot in the vein just under the skin.

Concept:

About Meningitis: It is an inflammation of the fluid and membranes (meninges) surrounding your brain and spinal cord.

Causes:

1. Viral infection, bacterial infections fungal and parasitic infections.

2. Cancer

3. Drug Allergy

Epilepsy: It is a disorder in which nerve cell activity in the brain is disturbed, causing seizures.              

•  Bacterial meningitis is a preventable cause of epilepsy.

Symptoms of Epilepsy:

• Temporary confusion
• Uncontrollable jerking movements of the arms and legs.
• Loss of consciousness or awareness.
• Memory lapses.

Causes of Epilepsy:

• Lack of oxygen during birth
• Stroke
• Brain tumour
• Severe head injury
• Brain infection
• Alcohol misuse

Concept:

Newborn babies are less able to regulate their body temperature.

About the Thermoregulation:

• Thermal care is central to reducing morbidity and mortality in newborns.
• Thermoregulation is the ability to balance heat production and heat loss in order to maintain body temperature within a certain normal range.
• The average “normal” axillary temperature is considered to be 37°C.

Radiant Warmer:

1. It is a body warming device to provide heat to the body.

2. This device helps to maintain the body temperature of the baby and limit the metabolism rate.

Apgar Score: It is a quick test performed on a baby at 1 and 5 minutes after birth. The Apgar score is based on a total score of 1 to 10. The higher the score, the better the baby is doing after birth.

A score of 7, 8, or 9 is normal and is a sign that the newborn is in good health.

Inspecting the newborn's umbilical cord: It is important that you keep the umbilical cord stump and surrounding skin clean and dry. This basic care helps prevent infection.

Suctioning with a bulb syringe: A bulb syringe is used to remove mucus from your baby's mouth or nose.

Explanation:

• Glutaraldehyde is used as a cold sterilant to disinfect a variety of heat-sensitive instruments, such as endoscopes, dialysis equipment, and more.
• It is used as a high-level disinfectant for those surgical instruments that cannot be heat sterilized.
• Common instruments used during laparoscopic procedures include a: laparoscope, needle driver for suturing, trocar, bowel grasper and surgical mesh are also disinfect by Glutaraldehyde solution.
• Disinfectant and sterilization of surfaces and equipment.

Explanation:

• Grief is a natural response to losing something important.
• Grief is universal.
• There are five stages of grief.
• Denial, Anger, Bargaining, Depression, and Acceptance are the stages.
• Denial is the primary stage in the process of grief.

Stages of grief

Denial

• Refuses to believe the loss has occurred.
• Act as a defence mechanism to give a chance to understand the event.

Anger

• Experiencing anger after lose.
• May blame self or others.
• Anger is necessary stage of healing process.

Bargaining

• Making promises to change if the lose is returned.
• Often accompanied by guilt.

Depression

• Feeling of sadness, regret, fear, uncertainty, loneliness, and loss of interest.
• There may be no hope.

Acceptance 

• Accepting the reality.
• Accepting the permanent change.

Concept:

• The gown is an important part of personal protective equipment.
• It protects the health care provider from the spread of infection, and a splash of blood and body fluids.
• A gown should be discarded after use.

Explanation:

• Other personal protective equipments are:
  • Gloves
  • Goggles
  • Mask
  • Shoe cover

Concept:

• The most common cause of medication is a lack of pharmacology knowledge.
• Lack of pharmacology knowledge includes:
  • Improper dose administration
  • Sound-alike and look-alike drugs
  • Improper route of drug administration
  • Administration of unfamiliar medication

Explanation:

• To prevent drug errors, the nursing staff should follow the ten rights of medication.
• A nurse must follow only written orders.
• If there is any query or doubt, it should be clarified first before drug administration.

Explanation

• Proteins are very essential in wound repair.
• Proteins are polymer chain made up of amino acids.
• Muscles and tissues are mainly made up of proteins.

Sources of Protein

• Legume
• Cereals
• Whole grains
• Nuts and seeds
• Animal meat

Clinical significance 

• PEM (Protein energy malnutrition)

Concept:

• An ileostomy can cause dehydration.
• The colon is responsible for absorbing water.
• After the ileostomy, the stool passes from the ileum, and less water is absorbed for the body.
• This leads to dehydration.
• Therefore, a nurse must emphasize increasing fluid intake to prevent dehydration.

Explanation:

• Other important health teachings on discharge:
  • Consumption of a low-fiber diet.
  • Avoid enteric-coated medicine because of partial absorption of the medicine.
  • Avoid carbonated drinks and food.
  • Avoid gas-producing food.
  • Assess for any redness, swelling, or drainage in the stoma and inform the health care provider.

Explanation

• Uterine hyperstimulation is a potential complication due to induction of labor.
• Commonly used drug for induction is Pitocin(Oxytocin).

Dangers associated with uterine hyper stimulation

• Blood flow to placenta reduces or may even stops.
• Hypoxia
• Ischemia
• Acidosis
• Uterine rupture
• Birth injuries to baby.

Treatment 

• Prostaglandin E2
• Tocolytic treatment.
• Beta 2 adrenergic drugs.

Explanation

• Tongue thrust reflux is a reflex that automatically pushes food out from mouth.

 Tongue thrust

• Trigger by touching something like rice cereal in to the lip or gently introducing in to the mouth.

Response

• The tongue thrusts forward automatically, preventing the food from entering.

​Importance

• Tongue thrust preventing the baby from choking.

​Usual time

• 4-6 months​

Concept:

• Auguste Comte is the father of Sociology.
• He is considered the father of Sociology as he reinvented the term Sociology in 1838.
• He developed a scientific method to study sociology.

Explanation:

• According to Auguste, Sociology is the most important branch of natural science.
• He believed the study of Sociology will lead to the betterment of society.

Concept:

• The human immunoglobulin system has 5 major classes.
• IgG, IgM, IgA, IgD, and IgE are five immunoglobulins.
• IgM appears first in exposure to antigen, followed by IgA.
• The presence of IgM signifies a recent infection.
• It has high agglutinating properties.

Explanation:

• IgM is produced by vertebrates.
• IgM is one of the isotypes of immunoglobulin.
• IgG is the smallest antibody in the human body. It is also the most common immunoglobulin.

A fetus can also produce IgM.

Concept:

• When the insulin is low in the body, the liver starts to break fat into ketones. Increased ketones in the urine are termed ketonuria.
• Hyperglycemia or low insulin levels → lipolysis and oxidation of free fatty acids → ketones in the body → metabolic acidosis.

Explanation:

• Starvation ketoacidosis occurs in deprivation of glucose. The body starts to use fat for metabolism that results in the production of ketones.
• Alcohol ketoacidosis occurs because of alcohol abuse, and liver disease.

Concept:

• The complication of radiation therapy includes:
  • skin irritation
  • xerostomia (dry mouth because of decreased production of saliva)
  • mucositis
  • laryngeal edema
  • delayed healing

Explanation:

• Laryngeal edema leads to dyspnoea which is difficulty in breathing.
• The edema causes airway obstruction.
• It can lead to a life-threatening situation.

During radiation therapy patients are regularly assessed for the above side-effects such as airway distress and ability to eat.

Explanation

• The modern type of examination assesses the skills like communication, clinical examination, medical and nursing procedures.
• It is a performance-based test used to assess clinical competence. 

 Objective

• Use of checklist for evaluation.

Structured

• Trainee sees the same problem and performs the same tasks in the same time frame.

Clinical

• The tasks are representative of real clinical situations.

History

• Developed by the University of Dundee, Scotland in 1975 by Dr. Harden.
• It was a subject in an international conference in Ottawa in 1985.
• More than 50 countries accepted it.
• Globally using now.

Advantages and Disadvantages

Explanation

• Learning is the modification of behavior.
• The psychomotor domain is skill based.

 It is steeped in a demonstration and three practical instructional levels.

• Imitation
• Practice
• Habit

Levels according to Francis M Quinn

• Perception
• Set
• Guided response
• Mechanisms
• Complex overt response
• Adaptation
• Origination

Explanation

• Teach the patients only when the patient is fully conscious, alert and in a good cooperative mood.
• If the patient suffers from pain, or in an irritable mood, the nurse must focus to reduce the pain and stressor.
• Because all other stressors cause inability to concentrate.

 Strategies to provide good teaching

• Appropriate educational technology.
• Determine the patient's learning style.
• Arouse interest.
• Consider the strength and limitations.
• Include family members.

Concept:

• Gonorrhea is caused by the bacteria Neisseria gonorrhoeae.
• The bacteria infects the mucous membrane of the reproductive tract.
• It may also affect the mucous membrane of the mouth, throat, and rectum.

Explanation:

• It is a sexually transmitted disease (STD).
• Symptoms of gonorrhea include:
  • dysuria
  • urethral discharge in men
  • increased vaginal discharge in women
  • itching
  • soreness
  • bleeding
  • painful bowel movements

• Streptococcus pneumonia causes infection of the respiratory tract.

Concept:

• Widal test detects antibodies against the antigens of Salmonella. Typhi.
• It assesses the antibodies against flagellar (H) and somatic (O) antigens.
• Salmonella typhi causes enteric fever or typhoid.

Explanation:

• The test was developed by Georges Ferdinand Widal in 1896.
• It is an indirect agglutination test.

• Salmonella typhi spreads through oral-fecal route.
• Incubation period: 10-14 days.

Explanation

• Chemical injuries to the eyes are considered an ophthalmological emergency.
• The chemical injuries can be from acid or alkali compounds.

 Agents

• Alkali
  • Ammonia
  • Lye
  • Potassium hydroxide
  • Magnesium hydroxide
  • Lime
• Acids
  • Sulfuric acid
  • Nitric acid
  • Hydro fluoric acid

First aid

• Flush the eye with water in tap water for 20 minutes.
• Wash hands with soap and water.
• Remove contact lens.
• Seek medical help.

• Don't rub the eye.
• Don't put anything against eye except water.

Explanation

• Naloxone challenge test is used to assess physical dependency.

• It is administered via the IM or IV route.
• The dosage of naloxone is usually 0.2-0.8mg.
• A positive test shows physical dependence and typical withdrawal signs and symptoms.
• These signs and symptoms may last up to 20-30 minutes.
• This test is helpful in starting maintenance therapy using an opiate antagonist. 

Explanation

• Placenta is partially or completely attached to the lower uterine wall is called placenta previa.

​ Risk factors

• Multiparity
• Increased maternal age
• Higher altitude
• Smoking

Types

• Low lying
• Marginal
• Incomplete or partial central
• Central or total.

Indications for LSCS in Placenta Previa

• Bleeding at or after 37 weeks.
• Uncontrolled heavy bleeding.
• Absent FSH
• Gross fetal malformation
• Dead fetus.

Explanation:

• Data measured at the nominal level: Because all three measures of dispersion require data range to be ranked or summed, none of them are appropriate for data measured at the nominal level.
• Data measured at the ordinal level: The range and interquartile range are appropriate.

Concept:

• The most effective way to break the chain of infection is hand hygiene.
• Hand washing stops the spread of infection.
• Infections are easily spread through hands, aerosol, or contaminated equipment.
• Nursing staff should wash hands before and after coming in contact with the patient.
• In case wash can be washed, alcohol sanitizer should be used to clean the hands.

Explanation:

• The chain of infection includes six points.
  • Infectious agent
  • Reservoir
  • Portal of exit
  • Mode of transmission
  • Portal of entry
  • Susceptible host
• The chain of infection can be broken through the following steps:
  • Hand hygiene
  • Vaccination
  • Using masks and gloves
  • Isolation, if and when necessary
  • Cleaning and disinfecting the environment
  • Using sterile medical equipment.

Concept:

• Pulse deficit refers to the difference between a radial pulse and an apical pulse rate.
• The apical pulse is assessed through the stethoscope in a sitting or lying position of the patient.
• The radial pulse is assessed by palpating the radial artery.

The pulse deficit is seen in atrial fibrillation.

Explanation:

• Due to atrial fibrillation, there is electrical-mechanical disassociation.
• This leads to poor perfusion in the periphery arteries.
• It causes pulse deficit.

Explanation:

• Pulse oximetry is a test used to measure the oxygen level (oxygen saturation) of the blood.
• It is an easy, painless measure of how well oxygen is being sent to parts of your body furthest from your heart, such as the arms and legs.

Explanation

• Any other route of drug administration that is not oral.

 Importance of Parenteral route

• Speed and efficacy of drug action.
• Absorption and bioavailability.
• Rapid action.
• Minimal adverse reaction.
• Better tolerability.
• Rapid delivery of therapeutic concentrations of drug to the desired site of action.

Sites

• Intramuscular.
• Intravenous
• Subcutaneous.
• intradermal.
• Intracardiac.
• intrathecal.
• Intraocular.

Concept:

• Ego strength refers to the ability or behavior that helps them maintain good mental health in a crisis situation.
• According to Freud, the ego works as a mediator between the id and superego.
• The id is the primitive impulsive nature and the superego is the morale learned from society.
• The ego helps to create a balance between the id and the superego.

Explanation:

• Strengthening ego helps to develop attitude and behavior to get through a painful experience or crisis.
• For example, it helps to forgive someone or to fight destructive habits.

Explanation

• The helping relationship between a nurse and patient is also called therapeutic nurse-patient relationship.
• It focus on patient's ideas and feelings.

Components

• Rapport
• Empathy
• Warmth
• Genuineness 

Characteristics

• Mutual learning
• Mutual growth
• Nurse and patient work towards goal

Phases

• Pre interaction phase
• Orientation phase
• Working phase
• Termination phase

Explanation:

• Corn oil is high in omega-6 acids essentially, free of omega-3 acids, and contains less saturated fat than soybean and cottonseed oil.
• Omega-3 fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).
• Peanuts are an excellent source of plant-based protein, fibre, omega-3 and several other essential vitamins and minerals. 
• Mustard oil is also rich in omega-3 fatty acids, including alpha-linolenic acid ( 25 ).

Concept:

• Neurotransmitters refer to the chemical messengers in the brain. Neurotransmitters help to communicate between nerve cells. There are three types of neurotransmitters that play a vital role in depression.

1. Dopamine: It is responsible for motivation. Low levels of dopamine result in not being able to enjoy or have pleasure in activities.
2. Norepinephrine: Norepinephrine is responsible for fight and flight response. The deficiency results in depression and an excessive amount results in mania.
3. Serotonin: It also plays an important role in the body. It affects emotional processing.

Explanation:

• The deficiency of acetylcholine is associated with Alzheimer's and Parkinson's disease. Alzheimer's is characterized by dementia. Parkinson's disease is characterized by involuntary movements.
• GABA is a non-protein amino acid. It has a calming effect on the brain. The deficiency of GABA results in anxiety disorder.
• 5-HT, 5-hydroxytryptamine receptors are also known as serotonin receptors.

Concept: 

• Leadership is the ability to lead people. Theories of leadership explain why and who become leaders. 
• Thomas Carlyle gave the trait theory. According to trait theory, people inherit qualities of leadership. Therefore, they are well suited to become leaders. Some of the inherited traits are:

1. Extroversion
2. Confidence
3. Charisma
4. Cognitive skills

• Trait theory is similar to the Great Man Theory that believes people are born to lead. According to the Great man theory, leadership qualities are not learned, but some people are born to lead.

Explanation:

• The Situational theory believes in leadership according to variation in situations. Leaders adopt different leadership styles according to various circumstances.
• The Contingency theory believes there is no specific effective type of leadership. Leadership style depends on the particular variable of the environment.
• The Behavioral theory believes that leaders are trained and made. This theory is the opposite of the Great Man Theory.

Concept:

• Acid-fast bacillus refers to the bacteria with the property of acid fastness. Acid fastness refers to the property to resist decolorization during staining procedures. The most common bacteria with acid fastness is Genus Mycobacterium. 
• Mycobacterium tuberculosis shows the strongest property. 
• Mycobacterium leprae has the weak property of acid fastness. M. leprae causes leprosy.
• They are hydrophobic and impermeable to stain such as gram stain. 

Explanation:

• Bacillus pertussis belongs to the genus Bordetella, which causes whooping cough. It releases Pertussis toxin. It has hemagglutinating activity.
• Corynebacterium diphtheria is a pathogenic bacteria that can cause diphtheria. It belongs to the family Corynebacteriaceae. It is gram-positive and non-acid fast.
• Salmonella typhi refers to gram-negative, rod-shaped bacteria. It shows a positive test for lipopolysaccharide antigens and polysaccharide capsular antigen Vi.

• Another acid-fast bacterias are Genus Nocardia. 

Explanation

• Down's syndrome is the commonest chromosome abnormality.
• High maternity age is the major reason.
• 1978-2010 incidence is increased up to 30%.

Screening

Second-trimester Screening Test.

• AFP
• E3
• hCG

The triple test gives 70% accuracy.

• Inhibin A is also tested and the test is known as the quadruple test.
• Quadruple test reliability is up to 76%. 

"Correct Answer - Option 3 : Anterior fontanel assessment

CONCEPT: 

• VP (ventriculoperitoneal) shunting is a surgical procedure for treating a medical condition called hydrocephalus, which occurs due to excessive fluid accumulation in the ventricles of the brain.
• This fluid is called Cerebrospinal Fluid (CSF) and it is responsible for providing cushion to the brain and protecting from any internal injury to the skull. 
• Intracranial pressure is the pressure exerted by fluids such as cerebrospinal fluid inside the skull and on the brain tissue. This pressure can prevent blood from flowing to your brain, which deprives it of the oxygen it needs to function. 

EXPLANATION: 

• In children with an open anterior fontanelle (AF), where the skull sutures have not yet fused, an abnormal increase in the head circumference and bulging of the fontanelle are good indicators of raised ICP.
• In severely raised ICP, the sutures may often be separated and palpable.

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