LUMHS Post RN BSN – Semester II Solved Papers
 |
| Solved LUMHS Post RN BSN Semester II past papers (regular examination 2017, session 2015-17). Use as a revision guide and verify with your course notes. |
1. Advance Nursing Concept – II
BSN Past Paper Year – 2016 · Solved
B.Sc NURSING (POST-RN), FIRST YEAR, SEMESTER-II
REGULAR EXAMINATION 2016 (SESSION 2015-17)
ADVANCE NURSING CONCEPT-II (SEQs)
NOTE:
- Attempt any FOUR questions.
- All questions carry equal marks.
Q.1. What is CA bladder and its causes? Write the alteration in the bladder functions due to CA and management of CA bladder patients.
Definition
Cancer (CA) of the bladder is the uncontrolled growth of abnormal cells in the lining (urothelium) of the urinary bladder. About 90% are urothelial (transitional cell) carcinomas; the rest are squamous cell carcinoma and adenocarcinoma.
Causes and risk factors
- Cigarette smoking – the most important cause.
- Occupational chemicals: aromatic amines and dyes (rubber, leather, paint, textile and chemical workers).
- Chronic bladder irritation: long-term catheters, bladder stones, recurrent urinary tract infection.
- Schistosoma haematobium infection in endemic areas (squamous cell type).
- Previous treatment: pelvic radiation or cyclophosphamide.
- Age above 55 years, male sex, and family history.
Alteration in bladder function
- Painless hematuria (visible blood in urine) – the commonest and earliest sign.
- Frequency, urgency, dysuria and nocturia from irritation of the bladder wall.
- Urinary retention when the tumour or blood clots block the outlet.
- Reduced bladder capacity and loss of wall elasticity when the muscle is invaded; urge incontinence.
- Ureteric obstruction leading to hydronephrosis, flank pain and kidney damage; recurrent infection.
Management
Diagnosis: history, urine cytology, ultrasound, CT or MRI, and cystoscopy with biopsy (confirms the diagnosis and stage).
| Stage | Treatment |
|---|---|
| Superficial (non-muscle-invasive) | Transurethral resection of the bladder tumour (TURBT), followed by intravesical BCG or chemotherapy (e.g. mitomycin C); regular cystoscopy follow-up |
| Muscle-invasive | Radical cystectomy with urinary diversion (ileal conduit or neobladder), chemotherapy and/or radiotherapy |
| Advanced or metastatic | Systemic chemotherapy, immunotherapy, palliative radiotherapy and pain control |
Nursing management
- Before surgery: explain the procedure and the stoma, mark the stoma site, bowel preparation, emotional support, treat anaemia and infection.
- After surgery: monitor vital signs, urine output (at least 30 mL/hour), drains and stoma (should be pink-red and moist), manage pain, prevent infection, give 2-3 litres of fluid daily, and encourage early mobilisation.
- Stoma and skin care: teach pouch emptying and changing, skin protection and odour control.
- After intravesical therapy: explain that the drug is retained for the prescribed time, then voided; follow hospital instructions for safe disposal of urine.
- Education: stop smoking, report haematuria, fever or flank pain, attend follow-up cystoscopy, and support body-image and sexual concerns.
Q.2. Write down the nursing intervention of patient with angina?
Angina pectoris is chest pain or pressure caused by temporary myocardial ischaemia, when oxygen demand is greater than supply. The aims of nursing care are to relieve pain, reduce oxygen demand, prevent myocardial infarction and teach the patient to prevent attacks.
During an attack
- Stop activity and make the patient sit or lie in a semi-Fowler position; stay with the patient and stay calm.
- Record vital signs, check SpO2 and give oxygen if SpO2 is low or as ordered.
- Give nitroglycerin 0.4 mg sublingual as ordered (check blood pressure first; it may be repeated every 5 minutes up to 3 doses). If the pain is not relieved, call the doctor or emergency team at once.
- Record a 12-lead ECG, start IV access and send cardiac enzymes (troponin) to exclude myocardial infarction.
- Assess pain with PQRST (provoking, quality, region/radiation, severity, time).
- Give aspirin, beta-blocker or other drugs as prescribed and monitor for side effects (headache, hypotension, bradycardia).
- Reassure the patient to reduce anxiety, which increases the heart rate.
Between attacks and health education
- Identify and avoid triggers: heavy exertion, large meals, cold weather, emotional stress, smoking.
- Teach to rest at the first sign of pain, pace activities and take nitroglycerin while sitting down.
- Keep nitroglycerin tablets in the original dark glass container, carry them always and replace as the label advises.
- Diet: low in fat, cholesterol and salt; reduce weight; stop smoking and limit caffeine and alcohol.
- Control blood pressure, diabetes and cholesterol; take medicines regularly (antiplatelets, beta-blockers, statins).
- Regular graded exercise or cardiac rehabilitation as advised; sleep and stress management.
- Teach warning signs for emergency help: pain lasting more than 15-20 minutes, or not relieved by rest and nitroglycerin, or with sweating, breathlessness or fainting.
Q.3. List down the difference between acute and chronic renal failure.
Acute renal failure (now called acute kidney injury, AKI) is a sudden loss of kidney function over hours to days. Chronic renal failure (chronic kidney disease, CKD) is a gradual, permanent loss of function over at least three months.
| Point | Acute renal failure | Chronic renal failure |
|---|---|---|
| Onset | Sudden (hours to days) | Gradual (months to years) |
| Causes | Prerenal (shock, dehydration, bleeding), intrarenal (acute tubular necrosis, nephrotoxic drugs, glomerulonephritis) and postrenal (stones, prostate enlargement) | Diabetes mellitus, hypertension, chronic glomerulonephritis, polycystic kidney disease, recurrent infection |
| Reversibility | Usually reversible if the cause is treated early | Irreversible and progressive |
| Course | Oliguric, diuretic and recovery phases | Five stages by GFR, ending in end-stage renal disease |
| Urine output | Often oliguria or anuria (may be normal) | Polyuria and nocturia early; oliguria late |
| Kidney size | Normal or enlarged | Small and shrunken |
| Anaemia and bone disease | Absent or mild | Present (anaemia, renal osteodystrophy) |
| Blood tests | Rapid rise of urea, creatinine and potassium | Slowly rising creatinine, low calcium, high phosphate |
| Treatment | Treat the cause, fluid and electrolyte balance, temporary dialysis if needed | Diet and drug control, long-term dialysis or kidney transplant |
| Prognosis | Good if treated early; high mortality in critical illness | Poor without dialysis or transplant |
Q.4. Write the pathophysiology of MI with its sign and symptoms and first line treatment in the emergency room.
Pathophysiology
Myocardial infarction (MI) is the death of heart muscle caused by prolonged ischaemia.
- An atherosclerotic plaque in a coronary artery ruptures or erodes.
- Platelets stick and a thrombus forms, which suddenly blocks the artery.
- The blocked area gets no oxygen; the muscle shifts to anaerobic metabolism, lactic acid collects and contractility falls within seconds.
- After about 20-40 minutes the injury becomes irreversible, and necrosis spreads from the inner to the outer layer of the wall; troponin and CK-MB leak into the blood.
- Loss of pumping function reduces cardiac output and can cause arrhythmias, heart failure and cardiogenic shock.
- Over weeks the necrotic area is replaced by a fibrous scar.
MI is classed as STEMI (ST-segment elevation, complete occlusion) or NSTEMI (partial occlusion).
Signs and symptoms
- Severe, crushing chest pain or pressure behind the sternum, lasting more than 20 minutes, radiating to the left arm, jaw, neck or back, not relieved by rest or nitrates.
- Sweating (diaphoresis), pallor, cold clammy skin, nausea and vomiting.
- Shortness of breath, weakness, palpitations, anxiety and a feeling of impending doom.
- Tachycardia or bradycardia, irregular pulse, low or high blood pressure, S3 or S4 sound.
- Women, elderly and diabetic patients may have atypical or silent MI (breathlessness, fatigue, epigastric pain).
First-line treatment in the emergency room
- Put the patient on bed rest with continuous cardiac monitoring and IV access; take vital signs.
- Record a 12-lead ECG within 10 minutes of arrival; send troponin, CBC, electrolytes, creatinine and blood sugar.
- Aspirin 162-325 mg chewed (unless allergic).
- Nitroglycerin sublingual or IV for pain (avoid in hypotension, right ventricular infarction or recent use of sildenafil-type drugs).
- Morphine IV in small doses for severe pain not relieved by nitrates, as ordered.
- Oxygen only if SpO2 is below 90% or the patient is in distress.
- Second antiplatelet (clopidogrel or ticagrelor) and anticoagulant (heparin) as ordered.
- Reperfusion: primary PCI within 90 minutes of arrival, or thrombolysis (streptokinase or alteplase) within 30 minutes if PCI is not available.
- Then beta-blocker, ACE inhibitor and statin; treat arrhythmias; reassure the patient and keep the family informed.
Q.5. Describe pathophysiology of osteoarthritis, list the diagnostic criteria, clinical features of osteoarthritis.
Osteoarthritis (OA) is a degenerative, non-inflammatory joint disease with progressive loss of articular cartilage and changes in the underlying bone. It mainly affects the knees, hips, spine and small joints of the hand.
Pathophysiology
- Ageing, obesity, injury, overuse and genetic factors damage the cartilage.
- Breakdown of cartilage exceeds repair: enzymes (matrix metalloproteinases) and cytokines (IL-1, TNF) destroy proteoglycans and collagen, and the chondrocytes cannot keep up.
- The cartilage becomes soft, fibrillated, cracked and thin, and the joint space narrows.
- The exposed subchondral bone becomes hard (sclerosis) and forms cysts.
- The bone edges form osteophytes (bone spurs); the synovium shows mild inflammation and produces extra fluid.
- The result is pain, stiffness, deformity and loss of movement.
Diagnostic criteria (ACR, knee OA)
Clinical: knee pain plus at least 3 of: age over 50 years, morning stiffness under 30 minutes, crepitus, bony tenderness, bony enlargement, no palpable warmth.
Clinical and radiographic: knee pain plus osteophytes on X-ray plus at least one of: age over 50 years, stiffness under 30 minutes, crepitus.
- X-ray: narrowed joint space, osteophytes, subchondral sclerosis and cysts.
- ESR and CRP normal or only slightly raised, rheumatoid factor negative; synovial fluid is non-inflammatory (low white cell count).
- MRI is used only when the diagnosis is doubtful.
Clinical features
- Joint pain that is worse with activity and weight-bearing and relieved by rest; later, pain at night.
- Morning stiffness lasting less than 30 minutes; stiffness after rest (gelling).
- Crepitus (grating sound), reduced range of movement, swelling and joint instability.
- Bony enlargements: Heberden's nodes (distal finger joints) and Bouchard's nodes (middle finger joints).
- Muscle wasting, deformity (e.g. bow-leg), limping and difficulty climbing stairs.
- No fever or other general symptoms, which separates it from rheumatoid arthritis.
Q.6. Define peptic ulcer, its causes, sign and symptoms, medical and nursing management.
Definition
A peptic ulcer is a break in the mucosal lining of the stomach (gastric ulcer) or duodenum (duodenal ulcer) that reaches the muscle layer and is caused by the action of acid and pepsin.
Causes
- Helicobacter pylori infection – the most common cause.
- Long-term use of NSAIDs and aspirin; corticosteroids.
- Excess acid secretion (Zollinger-Ellison syndrome), smoking, alcohol, caffeine.
- Severe physical stress (burns, head injury, major surgery) causing stress ulcers; family history; blood group O.
Signs and symptoms
- Burning or gnawing epigastric pain. Duodenal ulcer: pain 2-3 hours after meals and at night, relieved by food. Gastric ulcer: pain soon after eating, weight loss.
- Nausea, vomiting, bloating, belching, heartburn, loss of appetite.
- Haematemesis (vomiting of blood), melaena (black stool) and anaemia from bleeding.
- Complications: haemorrhage, perforation (sudden severe pain and a rigid, board-like abdomen), gastric outlet obstruction.
Medical management
- Eradicate H. pylori: triple therapy for 14 days – a proton-pump inhibitor (omeprazole) with clarithromycin and amoxicillin (or metronidazole); bismuth quadruple therapy if needed.
- Acid suppression: PPIs or H2-receptor blockers (ranitidine-type drugs), antacids, sucralfate; misoprostol for NSAID users.
- Stop NSAIDs, smoking and alcohol; endoscopy with biopsy for diagnosis and treatment of bleeding.
- Surgery (vagotomy, pyloroplasty, partial gastrectomy or repair) for perforation, bleeding that cannot be controlled, or obstruction.
Nursing management
- Relieve pain and give medicines on time; explain the purpose of each drug and the need to finish the full course.
- Diet: small, frequent, bland meals; avoid spicy food, tea, coffee, alcohol and very hot food.
- Advise to stop smoking, avoid NSAIDs, reduce stress and get adequate rest.
- Watch for bleeding (vomit, stools, pulse, blood pressure) and perforation; if bleeding, keep NPO, give IV fluids and blood as ordered, and prepare for endoscopy.
- Record intake and output, weight and haemoglobin; arrange follow-up.
2. Epidemiology
BSN Past Paper Year – 2016 · Solved
B.Sc NURSING (POST-RN), FIRST YEAR, SEMESTER-II
REGULAR EXAMINATION 2016 (SESSION 2015-17)
EPIDEMIOLOGY (SEQs)
NOTE:
- Attempt any FOUR questions.
- All questions carry equal marks.
Q.1. Define "surveillance", describe the methods of surveillance.
Surveillance is the continuous, systematic collection, analysis and interpretation of health data, and the timely distribution of the results to those who need them so that action can be taken to prevent and control disease.
Cycle of surveillance
Data collection → analysis → interpretation → dissemination (feedback) → action (control measures) → evaluation.
Methods of surveillance
- Passive surveillance: health facilities send routine reports of notifiable diseases to the health department (cheap and wide, but under-reporting is common).
- Active surveillance: health staff actively search for cases by visiting facilities and communities (e.g. acute flaccid paralysis surveillance for polio); more accurate but costly.
- Sentinel surveillance: selected hospitals or clinics report on a particular disease; gives quick trends at low cost.
- Syndromic surveillance: monitors symptom groups (fever with rash, acute watery diarrhoea) before a diagnosis is confirmed, for early warning of outbreaks.
- Laboratory-based surveillance: uses laboratory test results to follow organisms and resistance patterns.
- Event-based and community-based surveillance: rumours, media reports and community reports of unusual events.
- Population surveys and registries: health surveys, birth and death registration, cancer registry.
Q.2. Define cross sectional study. Explain advantages and disadvantages of cross sectional study.
A cross-sectional study is an observational study in which exposure and outcome (disease) are measured at the same point in time in a defined population. It gives a "snapshot" and measures the prevalence of a disease or risk factor, so it is also called a prevalence study. Example: a survey of the blood pressure and body weight of 1,000 adults in a village.
| Advantages | Disadvantages |
|---|---|
| Quick, simple and inexpensive | Cannot prove cause and effect, because exposure and disease are measured together (no time sequence) |
| No follow-up of participants is needed | Not suitable for rare diseases or diseases of short duration |
| Measures prevalence and describes the burden of disease | Prevalence is affected by duration of disease (long-lasting cases are over-represented) |
| Many exposures and outcomes can be studied at once | Recall bias and non-response bias are common |
| Useful for health planning and for generating hypotheses | Confounding factors are hard to control |
| Ethical, as no one is given an intervention | Needs a large sample for reliable results |
Q.3. Define primary, secondary and tertiary prevention with examples.
| Level | Definition | Examples |
|---|---|---|
| Primary prevention | Action taken before disease occurs, to prevent it from starting. It includes health promotion and specific protection. | Immunisation, health education, safe water and sanitation, good nutrition, condom use, seat belts, not smoking, handwashing |
| Secondary prevention | Early detection and prompt treatment of disease in its early or pre-symptomatic stage, to stop it from progressing. | Screening: Pap smear, mammography, blood pressure and blood sugar checks, sputum test for TB; early treatment such as DOTS |
| Tertiary prevention | Reducing disability, complications and relapse after the disease is established, and rehabilitation. | Physiotherapy after stroke, artificial limbs, foot care in diabetes, cardiac rehabilitation, vocational training for the disabled |
Q.4. Describe the natural history of the disease in the process of epidemiological triad.
Epidemiological triad
Disease results from the interaction of three factors:
- Agent: the cause (bacteria, virus, parasite, chemical, physical force, nutrient lack).
- Host: the person (age, sex, immunity, nutrition, behaviour, genetic make-up).
- Environment: external conditions (climate, water, sanitation, crowding, vectors, social and economic conditions).
When the balance between them is disturbed, disease develops.
Natural history of disease
The natural history is the progress of disease in a person over time, without treatment.
| Stage | What happens | Level of prevention |
|---|---|---|
| 1. Stage of susceptibility (pre-pathogenesis) | Agent, host and environment interact; risk factors are present but disease has not started | Primary (health promotion, specific protection) |
| 2. Stage of subclinical disease (incubation or latency) | Agent enters and multiplies; pathological changes begin but there are no symptoms | Secondary (screening, early diagnosis) |
| 3. Stage of clinical disease | Signs and symptoms appear; disease can be diagnosed and may be mild or severe | Secondary (prompt treatment) |
| 4. Stage of recovery, disability or death | The disease ends in cure, chronic illness, disability or death | Tertiary (rehabilitation) |
Example – typhoid: the agent is Salmonella Typhi, the host is a non-immune person, and the environment is contaminated water and poor sanitation. After an incubation period of 1-3 weeks, fever and abdominal symptoms appear; the patient recovers, becomes a carrier, or develops complications.
Q.5. Describe the advantages of using an epidemiological approach with special perspective for the nursing.
The epidemiological approach studies the distribution and determinants of health problems in groups of people. For the nurse it provides a scientific way of thinking about health in the community. Its advantages are:
- Identifies the causes and risk factors of disease, so prevention can be planned.
- Community diagnosis: shows the size and nature of health problems and which groups are at highest risk.
- Planning and priority setting: helps nurses decide where to put limited staff and resources.
- Disease surveillance and outbreak investigation: early detection and control of epidemics (e.g. dengue, cholera, measles).
- Evaluation: measures whether nursing programmes such as immunisation or health education are effective.
- Evidence-based practice: gives reliable data for clinical decisions, protocols and research.
- Infection control: tracks hospital-acquired infections and the effect of preventive measures.
- Health education and promotion: targets messages to the groups that need them most.
- Prediction of trends and support for health policy and advocacy.
- Improves the nurse's role in all three levels of prevention and in family and community care.
Q.6. Define any FIVE of the followings: a. Epidemiology b. Incubation period c. Latent period d. Carrier e. Case f. Control g. Pathogen
All seven terms are defined below.
- Epidemiology: the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control health problems.
- Incubation period: the time between the entry of an infectious agent into the body and the appearance of the first symptoms (e.g. about 10 days for measles).
- Latent period: the time between exposure to a disease agent and the point when the disease becomes detectable or, in an infection, when the person becomes infectious; in chronic disease it is the interval from exposure to onset (e.g. years between radiation exposure and cancer).
- Carrier: a person who harbours an infectious agent without showing signs of disease and can pass it to others (e.g. a typhoid or hepatitis B carrier).
- Case: a person in the population who has the particular disease or condition under study, according to a defined case definition.
- Control: in a case-control study, a person without the disease who is compared with the cases; in an experiment, the group that does not receive the intervention.
- Pathogen: a micro-organism (bacterium, virus, fungus, protozoan or parasite) that is able to cause disease.
3. Integrated Sciences – II
Including: a) Chemistry & b) Physics · BSN Past Paper Year – 2016 · Solved
B.Sc NURSING (POST-RN), FIRST YEAR, SEMESTER-II
REGULAR EXAMINATION 2016 (SESSION 2015-17)
INTEGRATED SCIENCES-II (SEQs)
NOTE:
- Attempt any FOUR questions.
- All questions carry equal marks.
Q.1. Define hydrocarbons. Explain classification of hydrocarbons.
Hydrocarbons are organic compounds made up of only two elements, carbon and hydrogen. They are the parent compounds of organic chemistry and the main components of petroleum and natural gas.
Classification
A. Open-chain (aliphatic) hydrocarbons – carbon atoms form straight or branched chains.
- Saturated – only single bonds: alkanes (CnH2n+2), e.g. methane, ethane, propane.
- Unsaturated – have double or triple bonds: alkenes (CnH2n), e.g. ethene; alkynes (CnH2n−2), e.g. ethyne.
B. Closed-chain (cyclic) hydrocarbons – atoms form rings.
- Alicyclic – ring compounds that behave like aliphatic ones: cyclopropane, cyclohexane.
- Aromatic – contain the benzene ring with delocalised electrons: benzene, toluene, naphthalene.
| Class | Bond | General formula | Example |
|---|---|---|---|
| Alkanes | All single (C–C) | CnH2n+2 | Methane CH4 |
| Alkenes | At least one double (C=C) | CnH2n | Ethene C2H4 |
| Alkynes | At least one triple (C≡C) | CnH2n−2 | Ethyne C2H2 |
| Cycloalkanes | Single bonds in a ring | CnH2n | Cyclohexane C6H12 |
| Aromatic | Benzene ring | – | Benzene C6H6 |
Q.2. Define enzymes. Give the classification of enzymes.
Enzymes are biological catalysts, mostly proteins, that speed up chemical reactions in living cells by lowering the activation energy, without being used up. Each enzyme is specific for its substrate, acts at an optimum temperature (about 37 °C in the body) and optimum pH (pepsin about 2, trypsin about 8), and is affected by inhibitors, activators and substrate concentration.
Classification (International Union of Biochemistry – six classes)
| Class | Reaction catalysed | Examples |
|---|---|---|
| 1. Oxidoreductases | Oxidation and reduction (transfer of electrons or hydrogen) | Lactate dehydrogenase, oxidases |
| 2. Transferases | Transfer of a group from one molecule to another | AST and ALT (transaminases), kinases |
| 3. Hydrolases | Breaking of bonds by adding water | Amylase, lipase, pepsin, trypsin |
| 4. Lyases | Removal of a group without water, forming a double bond | Aldolase, decarboxylases |
| 5. Isomerases | Rearrangement within a molecule | Phosphoglucose isomerase, mutases |
| 6. Ligases | Joining of two molecules using ATP | DNA ligase, synthetases |
Nursing relevance: raised serum enzymes help diagnosis (troponin and CK-MB in MI, amylase in pancreatitis, ALT in liver disease), and many drugs act as enzyme inhibitors.
Q.3. Explain the organic chemistry with special reference to alkanes, alkenes and alkynes.
Organic chemistry is the branch of chemistry that deals with compounds of carbon (apart from simple oxides, carbonates and cyanides). Carbon forms four covalent bonds and can join to itself in long chains and rings, so millions of organic compounds exist, including carbohydrates, proteins, fats, drugs and plastics.
| Point | Alkanes | Alkenes | Alkynes |
|---|---|---|---|
| Bond | Single C–C | Double C=C | Triple C≡C |
| General formula | CnH2n+2 | CnH2n | CnH2n−2 |
| Hybridisation and shape | sp3, tetrahedral, 109.5° | sp2, planar, 120° | sp, linear, 180° |
| Type | Saturated | Unsaturated | Unsaturated |
| Name ending | -ane | -ene | -yne |
| First members | Methane, ethane, propane, butane | Ethene, propene, butene | Ethyne, propyne, butyne |
| Main reactions | Combustion and substitution (e.g. CH4 + Cl2 → CH3Cl + HCl in light) | Addition (hydrogen, halogens, HX, water) and polymerisation (ethene → polyethylene) | Addition (two steps) |
| Reactivity | Low | High | High |
| Test | Do not decolourise bromine water | Decolourise bromine water | Decolourise bromine water |
| Uses | Fuels (LPG, petrol), solvents, wax | Plastics, ripening of fruits, alcohol manufacture | Welding fuel, chemical industry |
Addition: CH2=CH2 + H2 → CH3–CH3 (alkene to alkane)
Q.4. Explain Boyle's Law, and its application in nursing practice.
Boyle's law: at constant temperature, the volume of a fixed mass of gas is inversely proportional to its pressure. If pressure rises, volume falls, and the reverse.
Example: 4 litres of gas at 1 atmosphere is compressed to 2 atmospheres: V2 = (1 × 4) / 2 = 2 litres.
Applications in nursing practice
- Breathing: in inspiration the diaphragm contracts, the chest volume increases, lung pressure falls below atmospheric pressure and air flows in; in expiration the reverse occurs.
- Syringes: pulling the plunger increases the volume, lowers the pressure and draws liquid in; pushing it raises the pressure and expels the liquid.
- Chest drainage (pneumothorax, pleural effusion): restoring negative pressure in the pleural space re-expands the lung.
- Mechanical ventilators and suction machines: change of pressure moves air and secretions.
- Vacuum blood-collection tubes: the low pressure in the tube draws blood in.
- Oxygen cylinders: gas stored at high pressure in a small volume is released through a regulator at low pressure.
- IV infusion: the air vent lets air enter the bottle so that fluid can flow out; air bubbles are compressible, so they must be removed from syringes.
Q.5. Explain three Newton's laws of motion.
| Law | Statement | Example in nursing |
|---|---|---|
| First law (law of inertia) | A body stays at rest, or keeps moving in a straight line at constant speed, unless an external unbalanced force acts on it. | A patient on a trolley or in a moving ambulance lurches forward when it stops suddenly; this is why belts and side rails are used. |
| Second law | The acceleration of a body is directly proportional to the net force and inversely proportional to its mass: F = m × a. | A heavier patient or loaded bed needs more force to move it; a light wheelchair is easier to push. |
| Third law | For every action there is an equal and opposite reaction. | Crutches push on the ground and the ground pushes back; a nurse pushing on the floor with her feet moves forward when pulling a patient. |
The unit of force is the newton (1 N = 1 kg · m/s2). Good body mechanics for nurses (wide base, bent knees, keeping the load close) uses these laws to reduce injury.
Q.6. Discuss advantages and disadvantages of friction. How to reduce the friction?
Friction is the force that opposes the relative motion, or attempted motion, between two surfaces in contact. Its types are static, sliding (kinetic) and rolling friction.
| Advantages | Disadvantages |
|---|---|
| We can walk without slipping | Wears away surfaces and machine parts |
| Allows gripping of objects such as syringes and instruments | Produces unwanted heat |
| Brakes on beds, trolleys and wheelchairs work because of friction | Wastes energy and reduces the efficiency of machines |
| Knots, screws and nails hold in place; writing is possible | Causes skin abrasion and pressure injuries from friction and shear in bed-bound patients |
| Bandages and dressings stay in place | Makes it hard to move heavy objects or to slide a patient up the bed |
Methods of reducing friction
- Lubricants: oil, grease, and in the body synovial fluid in joints; lubricating jelly for catheters and examinations.
- Making surfaces smooth by polishing.
- Using wheels and ball bearings, which replace sliding friction with rolling friction (beds, trolleys, wheelchairs).
- Streamlined shapes to lower fluid friction.
- Nursing practice: lift the patient or use a slide sheet instead of dragging, keep the sheets smooth and dry, use barrier creams and cushions.
4. Community Health Nursing
BSN Past Paper Year – 2016 · Solved
B.Sc NURSING (POST-RN), FIRST YEAR, SEMESTER-II
REGULAR EXAMINATION 2016 (SESSION 2015-17)
COMMUNITY HEALTH NURSING (SEQs)
NOTE:
- Attempt any FOUR questions.
- All questions carry equal marks.
Q.1. Discuss the development of community health nursing.
Community health nursing is the care of individuals, families and groups in the community, with the aim of promoting health, preventing disease and giving care at home. It developed in stages:
| Period | Development |
|---|---|
| Early period | Care of the sick at home was given by family members, religious groups and charity workers, without training. |
| 1850s-1860s | Florence Nightingale founded modern nursing (training school at St Thomas' Hospital, 1860) and stressed sanitation, health teaching and home care. |
| 1859 | William Rathbone, a Liverpool merchant, started district nursing and, with Florence Nightingale's advice, trained nurses to care for the poor at home. |
| 1893 | Lillian Wald and Mary Brewster opened the Henry Street Settlement in New York; Wald is credited with the term "public health nurse". |
| 1912 | The National Organisation for Public Health Nursing was formed in the USA. |
| 1978 | The Alma-Ata Declaration adopted primary health care and "Health for All", making community-based nursing central. |
| From the 1970s | The term "community health nursing" came into wide use, covering prevention, treatment and rehabilitation for both individuals and populations. |
| Pakistan | Community nursing grew with primary health care services, basic health units, the Lady Health Worker Programme (1994), immunisation and maternal and child health services. |
Today community health nurses work in homes, clinics, schools, factories and health centres, and they take part in health education, surveillance, family planning, immunisation and disaster response.
Q.2. Define occupational health, what do you know about occupational hazards.
Occupational health (WHO/ILO) is the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; the prevention of ill health caused by working conditions; protection of workers from risks; and placing each worker in a job suited to his or her ability.
Occupational hazards
An occupational hazard is any condition at work that can cause injury, disease or death.
| Type | Examples |
|---|---|
| Physical | Noise (hearing loss), heat, radiation, vibration, poor lighting, high or low pressure |
| Chemical | Dusts causing pneumoconiosis (silicosis, asbestosis, byssinosis); lead, mercury, pesticides, solvents, gases |
| Biological | Hepatitis B and C, HIV, tuberculosis, needle-stick injuries, zoonoses |
| Mechanical / ergonomic | Machinery accidents, falls, back pain, repetitive strain injury |
| Psychosocial | Stress, long hours, shift work, violence, harassment |
Prevention and role of the nurse
- Engineering controls, safe work practices and personal protective equipment (gloves, masks, ear protection).
- Pre-employment and periodic medical examination, immunisation, first aid and treatment of workers.
- Health education, rest breaks, safe lifting, good ventilation and sanitation.
- Keeping records of accidents and diseases; following labour and compensation laws.
Q.3. Differentiate between community health nursing and public health nursing.
| Point | Community health nursing | Public health nursing |
|---|---|---|
| Meaning | Nursing care of individuals, families and groups within a community, combining health promotion, treatment and rehabilitation | Nursing practice that applies nursing and public health science to protect and improve the health of the whole population |
| Focus | Individuals, families and groups; the community as client | Entire population, with stress on prevention and policy |
| Scope | Broader: preventive, curative and rehabilitative care | Mainly preventive and promotive |
| Setting | Homes, clinics, schools, workplaces, health centres | Health departments, public health programmes, communities |
| Employer | Government, voluntary agencies, private organisations | Usually government or official health agencies |
| Examples | Home visits, care of chronic patients at home, school health | Immunisation campaigns, disease surveillance, sanitation programmes |
Similarity: both use the nursing process, work for the health of the community, and emphasise health promotion and disease prevention.
Q.4. Discuss the causes of maternal mortality.
Maternal mortality is the death of a woman while pregnant or within 42 days of the end of pregnancy, from any cause related to or made worse by the pregnancy or its care (not accidental causes).
A. Direct (obstetric) causes
- Haemorrhage – antepartum and postpartum (the leading cause).
- Sepsis (puerperal infection).
- Hypertensive disorders – pre-eclampsia and eclampsia.
- Obstructed labour and ruptured uterus.
- Unsafe abortion and complications of anaesthesia or embolism.
B. Indirect causes
Anaemia, malaria, hepatitis, tuberculosis, HIV, heart disease and diabetes, made worse by pregnancy.
C. Contributing social and health-system factors (the "three delays")
- Delay in deciding to seek care: low education, poverty, early marriage, lack of knowledge of danger signs, and low status of women.
- Delay in reaching a facility: poor roads and transport, long distance, cost.
- Delay in receiving care: shortage of staff, blood, drugs and emergency obstetric services.
- No or poor antenatal care, deliveries by untrained birth attendants at home, malnutrition.
- Too many, too early, too late and too closely spaced pregnancies; lack of family planning.
Q.5. List the causes high growth rate of Pakistan.
- High birth rate with a falling death rate because of better health services and immunisation.
- Low use of contraception and unmet need for family planning; weak family planning services in rural areas.
- Early marriage and a long reproductive period.
- Illiteracy, especially among women, and low status and decision-making power of women.
- Poverty: children are seen as a source of income and old-age security.
- Preference for sons leading to repeated pregnancies.
- Cultural and religious misconceptions about family planning, and the joint family system.
- Population momentum: a large young population entering the reproductive age.
- Lack of awareness and weak implementation of population policy; migration and refugee inflow.
Q.6. Attempt any two of the followings: a. Epidemiologic process b. Occupational hazard c. Health educator d. Basic health unit e. Millennium development goals
All five are written below.
- Epidemiologic process: the interaction of agent, host and environment that leads to the occurrence of disease. In infectious disease it follows the chain of infection: agent → reservoir → portal of exit → mode of transmission → portal of entry → susceptible host. Understanding the process shows where the chain can be broken.
- Occupational hazard: any condition, substance or activity in the workplace that may harm the health or safety of the worker, e.g. noise, dust, chemicals, infections, machinery, stress.
- Health educator: a person who plans, carries out and evaluates programmes that teach people and communities how to protect and improve their health. The community health nurse is a health educator when she teaches about hygiene, nutrition, immunisation and family planning.
- Basic health unit (BHU): the first-level health facility of primary health care in rural Pakistan, usually at union council level. Its staff (medical officer, lady health visitor, health technician, dispenser) provide outpatient care, mother and child health, immunisation, family planning, health education and referral to the rural health centre or tehsil hospital.
- Millennium Development Goals (MDGs): eight goals set by the United Nations for 2015: (1) eradicate extreme poverty and hunger; (2) achieve universal primary education; (3) promote gender equality and empower women; (4) reduce child mortality; (5) improve maternal health; (6) combat HIV/AIDS, malaria and other diseases; (7) ensure environmental sustainability; (8) develop a global partnership for development. They were succeeded by the Sustainable Development Goals (2016-2030).
5. Introduction to Management
BSN Past Paper Year – 2016 · Solved
B.Sc NURSING (POST-RN), FIRST YEAR, SEMESTER-II
REGULAR EXAMINATION 2016 (SESSION 2015-17)
INTRODUCTION TO MANAGEMENT (SEQs)
NOTE:
- Attempt any FOUR questions.
- All questions carry equal marks.
Q.1. Discuss the basic functions of modern management.
Management is the process of getting things done through people, by using resources (men, money, material, machines, time) to achieve the goals of an organisation efficiently. Its basic functions are:
| Function | Meaning | Example in a ward or hospital |
|---|---|---|
| 1. Planning | Setting objectives and deciding in advance what to do, how, when and by whom | Making the monthly duty roster; planning an immunisation drive |
| 2. Organising | Arranging work, resources and authority; dividing tasks and establishing relationships | Assigning nurses to wards and shifts; preparing the organisation chart |
| 3. Staffing | Recruiting, selecting, orienting, training, appraising and promoting the right people | Appointing and orienting new staff nurses |
| 4. Directing (leading) | Guiding, motivating, supervising and communicating with staff to get the work done | Giving instructions at handover, motivating the team |
| 5. Controlling | Measuring performance against standards and taking corrective action | Nursing audits, checking infection rates, performance appraisal |
Some authors add coordinating, reporting and budgeting (POSDCORB: planning, organising, staffing, directing, coordinating, reporting, budgeting). The functions are linked: planning comes first, and control feeds back into the next plan.
Q.2. State the leadership styles.
Leadership is the ability to influence people to work willingly towards a common goal. The main styles are:
| Style | Features | Advantage | Disadvantage |
|---|---|---|---|
| Autocratic (authoritarian) | The leader makes all decisions and gives orders; staff have no say | Quick decisions; useful in emergencies and with inexperienced staff | Low morale, little creativity, dependence on the leader |
| Democratic (participative) | Decisions are made with the group; two-way communication | High morale and commitment, good ideas | Slow; not suitable in emergencies |
| Laissez-faire (free-rein) | The leader gives little direction; staff decide for themselves | Good for skilled, self-motivated staff | Confusion, lack of direction, poor accountability |
Other styles: bureaucratic (follows rules strictly), transactional (rewards and punishments), transformational (inspires and develops followers), charismatic, servant and situational leadership (the style is changed according to the situation and the maturity of the staff). A good nurse manager uses the style that fits the situation.
Q.3. Describe the managerial skills of a good manager.
According to Robert Katz, a manager needs three basic skills:
- Technical skill: knowledge and ability in a specific field, such as clinical nursing procedures. It matters most for first-line managers (ward in-charge).
- Human (interpersonal) skill: the ability to work with, motivate, communicate with and understand people and to build teams. It is needed at all levels.
- Conceptual skill: the ability to see the organisation as a whole, think strategically and solve complex problems. It matters most for top managers (nursing director).
Other skills of a good manager: communication, decision making and problem solving, planning and time management, delegation, leadership, conflict handling, negotiation, financial and resource management, and ethical behaviour.
Q.4. List techniques for resolving conflict and managing it.
Conflict is a disagreement between two or more people or groups because of differences in goals, values, ideas or resources. Techniques (Thomas-Kilmann styles):
- Avoiding (withdrawal): staying out of the issue; useful when the matter is trivial or people need time to cool down.
- Accommodating (smoothing): giving in to keep peace; useful when the relationship is more important than the issue.
- Competing (forcing): using authority to win; useful in emergencies or when a quick decision is needed.
- Compromising: each side gives up something; useful when both are equally strong and time is limited.
- Collaborating (problem solving, win-win): working together to find a solution that satisfies all; the best long-term method.
Other methods: negotiation, mediation by a neutral person, arbitration, setting a common (superordinate) goal, clear communication, changing the structure or reassigning staff, and training in conflict management.
Steps in managing conflict: identify the problem and its cause → listen to all sides → discuss options → agree on a solution → implement it → follow up and evaluate.
Q.5. Define supervision and list the basic skills needed for good supervision.
Supervision is the process of overseeing, guiding, teaching and evaluating the work of staff, so that tasks are done correctly and according to standards. In nursing, the supervisor makes sure patients get safe, quality care and helps the staff to grow professionally.
Basic skills for good supervision
- Technical (clinical) skill – knowledge of the work being supervised.
- Human relations and communication skill – listening, giving clear instructions and feedback.
- Leadership and motivation skill – encouraging and guiding the staff.
- Planning and organising skill – scheduling work, delegating, using resources well.
- Decision making and problem solving.
- Teaching and training skill – on-the-job teaching and orientation.
- Observation and evaluation skill – checking performance fairly and recording it.
- Conflict management, time management and fairness without favouritism.
Q.6. Describe any TWO of the following: a) centralized and decentralized structure b) functional and divisional structure c) recruitment, selection and orientation
All three parts are answered.
a) Centralised and decentralised structure
| Point | Centralised | Decentralised |
|---|---|---|
| Decision making | Concentrated at the top | Delegated to lower levels |
| Speed of decisions | Slower for local issues | Faster, close to the problem |
| Uniformity and control | High; policies are the same everywhere | Less; units may differ |
| Staff morale and initiative | Lower | Higher; develops future managers |
| Burden on top managers | Heavy | Reduced |
| Suitable for | Small organisations, crises, routine matters | Large, complex, spread-out organisations |
b) Functional and divisional structure
| Point | Functional structure | Divisional structure |
|---|---|---|
| Grouping | By function or specialty (nursing service, pharmacy, laboratory, administration) | By service, product, patient group or location (medical, surgical, paediatric divisions) |
| Strength | Specialisation and efficient use of skills; clear career path | Focus on the service; quick response; accountability for results |
| Weakness | Poor coordination between departments; slow decisions | Duplication of resources and higher cost; rivalry between divisions |
| Control | Top management coordinates | Each division head has more authority |
c) Recruitment, selection and orientation
| Term | Meaning | Main steps or methods |
|---|---|---|
| Recruitment | The process of searching for and attracting qualified candidates to apply for vacant posts | Job analysis, advertisement, internal promotion, campus visits, employment agencies, references |
| Selection | The process of choosing the most suitable candidate from those who applied | Screening of applications, written test, interview, reference and background check, medical examination, final decision and appointment letter |
| Orientation (induction) | Introducing the new employee to the organisation, the job, policies, colleagues and facilities, so that he or she settles in quickly | Tour of the hospital, explanation of rules, job description, safety and infection control, introduction to the team, a preceptor |
Recruitment attracts applicants, selection chooses among them, and orientation helps the chosen person to start work well.
6. Fundamentals of Counseling & Guidance – II
BSN Past Paper Year – 2016 · Solved
B.Sc NURSING (POST-RN), FIRST YEAR, SEMESTER-II
REGULAR EXAMINATION 2016 (SESSION 2015-17)
FUNDAMENTALS OF COUNSELING & GUIDANCE-II (SEQs)
NOTE:
- Attempt any FOUR questions.
- All questions carry equal marks.
Q.1. Explain how guidance differs from counseling.
Guidance is the process of helping a person with information, advice and direction so that he or she can choose wisely and adjust to life. Counseling is a professional, one-to-one helping relationship in which a trained counselor helps a person to understand his or her feelings and solve personal problems, and to make his or her own decisions.
| Point | Guidance | Counseling |
|---|---|---|
| Scope | Broad; covers education, career, health and personal life | Narrow and specialised; focuses on a particular personal or emotional problem |
| Approach | Often directive: advice and information are given | Non-directive or client-centred: the client finds his or her own solution |
| Who gives it | Teacher, parent, nurse, elder, guidance worker | Trained and qualified counselor |
| Setting | Individual or group | Usually individual, private and confidential |
| Depth | General and preventive | Deep; deals with feelings, attitudes and behaviour change |
| Time | May be brief or occasional | Planned sessions over time |
| Main aim | To inform and direct | To help the person to understand, accept and change |
Q.2. List the principles of what to do and what to avoid in counseling.
| What to do (Do's) | What to avoid (Don'ts) |
|---|---|
| Build trust and rapport, and welcome the client warmly | Do not judge, criticise or blame |
| Keep everything confidential (explain the limits, such as risk to life) | Do not break confidentiality without a valid reason |
| Listen actively with full attention and good eye contact | Do not interrupt, or finish the client's sentences |
| Show empathy and unconditional respect | Do not show shock, anger or disgust |
| Respect the client's values, culture, religion and right to decide | Do not impose your own values or moralise |
| Use open-ended questions and allow silence | Do not interrogate or ask too many questions |
| Be genuine, honest and patient; give enough time | Do not give false promises or false reassurance |
| Help the client to find his or her own solutions and set goals | Do not give quick advice or make decisions for the client |
| Provide a private, quiet place | Do not argue or get distracted (mobile phone, noise) |
| Know your limits and refer when necessary; keep records | Do not discuss your own problems or make the client dependent |
Q.3. Identify the problems and issues nursing students face in hospitals, and briefly describe any two of the following:
Problems and issues of nursing students in hospitals
- Anxiety and fear of making mistakes, of the first clinical day, and of handling serious patients.
- Poor attitude of seniors and staff: scolding, lack of respect, little cooperation and favouritism.
- Misuse as workforce: given non-nursing or routine tasks rather than learning experiences.
- Lack of supervision and absence of clinical instructors; weak guidance during procedures.
- Gap between theory and practice and lack of clear learning objectives.
- Long duty hours, night shifts and fatigue, with little time to study.
- Shortage of equipment, supplies and facilities (rest rooms, transport, hostel).
- Poor image of nursing and lack of respect from doctors, patients and attendants.
- Safety risks: needle-stick injury, infection, violence by attendants, harassment.
- Emotional stress from patient suffering and death; communication and language barriers with patients.
- Financial difficulties, peer competition and an unfair evaluation system.
How to help
Proper orientation, trained preceptors, regular feedback, counseling services for students, fair duty rosters, safe working conditions and respect from the hospital team.
Q.4. Draw the Johari Window.
The Johari Window was created by the psychologists Joseph Luft and Harrington (Harry) Ingham in 1955. It is a model for understanding self-awareness and communication between a person and others, shown as a window with four panes.
| Known to self | Not known to self | |
|---|---|---|
| Known to others | 1. Open area (Arena) Known to me and to others | 2. Blind area (Blind spot) Known to others, not to me |
| Not known to others | 3. Hidden area (Façade) Known to me, hidden from others | 4. Unknown area Unknown to me and to others |
Meaning of each pane
- Open area: shared information such as name, behaviour and skills; it grows as trust increases.
- Blind area: habits or effects on others that the person is unaware of; reduced by receiving feedback.
- Hidden area: private feelings, fears and secrets; reduced by self-disclosure.
- Unknown area: hidden talents, unconscious feelings and untested abilities; revealed by new experiences, counseling and self-discovery.
Use in counseling and nursing: the aim is to enlarge the open area through honest feedback and appropriate self-disclosure, which improves communication, trust and self-awareness.
Q.5. Discuss the importance of verbal and nonverbal communication in nursing.
Verbal communication uses spoken or written words. Nonverbal communication conveys messages without words, through the body, face, eyes, touch, voice quality and appearance. In practice both are used together.
Importance of verbal communication
- Taking the patient's history and giving clear, accurate information and instructions.
- Health teaching and counseling; explaining procedures and obtaining informed consent.
- Building a therapeutic relationship and reducing fear.
- Reports, handover (e.g. SBAR) and documentation, which keep care safe and continuous.
- Communicating with doctors and other team members.
Importance of nonverbal communication
- Shows feelings and attitude: a smile, eye contact, open posture and gentle touch show care and respect.
- Helps to understand patients who cannot speak: unconscious, speech-impaired, children, elderly, or those with a language barrier.
- Signs such as grimacing, guarding, restlessness, pallor and sweating reveal pain and distress.
- Checks whether words and body language agree (congruence); when they differ, people trust the body language.
- Voice tone, pace and silence can calm or upset the patient.
- Personal space and privacy must be respected according to culture.
Tips for the nurse: face the patient, keep eye contact appropriate to culture, use simple words, listen actively, avoid crossed arms and looking at the clock, and confirm that the message is understood.
Q.6. Identify the most common characteristics of middle-age school children.
| Area | Common characteristics |
|---|---|
| Physical | Slow, steady growth (about 2-3 kg and 5-6 cm a year); permanent teeth appear; better coordination and strength; high energy and love of active games; generally healthy but prone to accidents, dental caries and infections |
| Cognitive (Piaget: concrete operational stage) | Logical thinking about real objects; understands conservation, classification and numbers; reading, writing and arithmetic develop; less egocentric; longer attention span |
| Psychosocial (Erikson: industry versus inferiority) | Wants to learn skills and be productive; success gives confidence, repeated failure gives feelings of inferiority |
| Social | Peer group becomes important; friendships mostly with the same sex; team games, clubs and rules; need for acceptance and belonging |
| Emotional | Developing self-concept and self-esteem; fears (failure, school, ridicule); can control emotions better; sensitive to criticism |
| Moral | Learns right and wrong from rules and authority (Kohlberg: from pre-conventional to conventional); sense of fairness |
| Language and interests | Larger vocabulary and better speech; hobbies, collecting, reading and curiosity |
Implications for nurses and counselors
Encourage achievement and praise effort, explain procedures in simple concrete terms, allow choices, protect from accidents, watch for bullying, school phobia and learning problems, and involve parents and teachers in guidance.
7. English – II
BSN Past Paper Year – 2016 · Solved
LIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCES, JAMSHORO
B.S NURSING (POST-RN) 1st YEAR, SEMESTER-II
(SESSION 2015-2017) REGULAR EXAMINATION 2016
ENGLISH-II
INSTRUCTIONS:
- Attempt any FIVE questions including question no. 1, which is compulsory.
Q-1. (Compulsory) Read the passage about carrier pigeons and answer the questions: a. How many pigeons are named in the text, what are their names? b. "Croix de Guerre" was awarded to which pigeon? c. Nathan Rothschild was earning his livelihood by? d. What is the difference between carrier pigeons and street pigeons? e. How old was the Kaiser when he died?
The passage explains how carrier pigeons have been used to deliver messages for hundreds of years, how Nathan Rothschild profited from early news of Waterloo, how the armies of World War I and II used them, and how a few famous birds were honoured.
- Pigeons named in the text: four pigeons are named: the Kaiser (the German-trained bird captured by American forces in 1918), Cher Ami, President Wilson and Colonel's Lady.
- Croix de Guerre: the French "Croix de Guerre" was awarded to Cher Ami, for carrying a message in World War I, although wounded, that saved the lives of 194 American soldiers.
- Rothschild's livelihood: Nathan Rothschild was an English banker who made his fortune by dealing in government bonds. In 1815 his carrier pigeons brought him news of the Duke of Wellington's victory over Napoleon at Waterloo before anyone else knew it. He bought the bonds cheaply while others were selling in panic, and their value soared when the truth became known.
- Carrier pigeons and street pigeons: carrier pigeons are a slightly different breed from the pigeons seen on city streets. They are thinner and taller with longer legs and have a large wattle (a knobby build-up of skin on the beak), which many people find ugly, although pigeon keepers like it. Street pigeons lack these features.
- The Kaiser's age: he was taken to America and lived to the age of 32 years.
Q-2. Write an essay on one of the following topics: a. Value of science in everyday life b. Uses and abuses of internet c. Nurse: angel or devil d. My ideal of happy life
All four essays are written below.
a) Value of Science in Everyday Life
Science is the systematic study of nature, and it has become part of every moment of our lives. From the time we wake up to the time we sleep, we use the gifts of science, often without noticing them.
At home, electricity gives us light, fans, refrigerators and washing machines, which save time and effort. Gas stoves, water pumps and mobile phones have made daily work easier. In transport, cars, trains and aeroplanes carry people over long distances in hours, which once took weeks. In communication, the telephone, television and internet connect us with the whole world within seconds.
In medicine, science has been a great blessing. Vaccines protect children from polio and measles, and antibiotics cure infections that once killed millions. X-rays, ultrasound and CT scans help doctors to find disease early, and anaesthesia and sterile techniques have made surgery safe. As nurses we see every day how thermometers, monitors, infusion pumps and ventilators save lives.
Science also improves agriculture through better seeds, fertilisers, tractors and cold storage, so more food reaches more people. Education has changed through computers and online classes, and industry produces cheap clothes, tools and medicines for everyone. Even simple habits, such as boiling water, washing hands and storing food in a refrigerator, rest on scientific knowledge and protect our health.
However, science can be harmful when it is misused. Weapons of mass destruction, pollution from factories and vehicles, and global warming threaten our survival, and too many machines may make people lazy. Science must therefore be guided by ethics and a sense of responsibility.
In conclusion, science is a faithful servant of humanity when it is used wisely. We should learn it, respect it and use it for peace, health and progress. A nation that ignores science stays behind, while a nation that values it moves ahead.
b) Uses and Abuses of the Internet
The internet is a worldwide network of computers that has changed the way we live, learn and work. Like every invention, it is a good servant but a bad master, and it has both uses and abuses.
The first great use of the internet is education. Students can find books, journals, lectures and videos on any subject in a few minutes. Nurses use online databases to read the latest research, and many universities now offer online courses. Secondly, the internet is a fast and cheap means of communication. E-mail, video calls and messaging apps connect families and colleagues across the globe in seconds.
Thirdly, it has changed business and services. People can shop, pay bills, bank and book tickets from home, and online work has created new jobs. In health care, telemedicine and electronic records help doctors and nurses to give better care, especially to patients in remote areas. The internet also provides news, entertainment and a platform to express opinions.
On the other hand, the internet is often abused. Many young people waste hours on games and social media, which harms their studies, sleep and health. Some websites spread false news, rumours and hate. Cyber crimes such as hacking, online fraud and theft of personal information are increasing, and children can reach harmful content. Cyber-bullying causes stress and even depression. Students may copy assignments from the web instead of learning, and constant screen use causes eye strain and weakens real relationships.
To use the internet wisely, parents and teachers should guide children, strong passwords and privacy settings should be used, and we should check information before believing or sharing it. Time limits and healthy habits are also needed.
In conclusion, the internet is a powerful tool. Used properly, it brings knowledge, convenience and progress; abused, it brings harm. The choice is ours.
c) Nurse: Angel or Devil
The nurse is the person who stays closest to the patient, day and night. People have called her an "angel of mercy" ever since Florence Nightingale carried her lamp among the wounded soldiers. Yet some patients complain that certain nurses are cold or careless, and call them devils. The truth lies in the way a nurse practises her profession.
In most cases the nurse is truly an angel. She gives medicines on time, checks vital signs, dresses wounds and watches over the patient when the doctor is away. She comforts frightened families, holds the hand of a dying person and teaches patients how to protect their health. She works long hours, in night duty and during epidemics, risking her own health from infections. In wars and disasters nurses have saved countless lives, often with little thanks. Such devotion truly deserves the title of angel.
Nevertheless, a few nurses disappoint the patients. Some are rude, impatient or lazy, ignore the call bell, or make mistakes through carelessness. They may break confidentiality or neglect patients because of fatigue and stress. Such behaviour harms the patients and spoils the good name of the whole profession, and it is this behaviour that gives rise to the word "devil".
We must also remember that many nurses work in difficult conditions: low pay, shortage of staff, heavy workload and little respect. A tired and unsupported nurse cannot always show the best behaviour. Better training, fair pay, safe workplaces and supportive supervision can bring out the angel in every nurse.
In conclusion, a nurse is not an angel or a devil by birth, but by her conduct. A kind, honest and skilled nurse is an angel to her patients. If we train and respect our nurses properly, the number of "devils" will fall to nothing, and the nursing profession will shine.
d) My Ideal of a Happy Life
Every human being wants to be happy, but each person understands happiness in a different way. For some it means wealth and luxury; for me, it is a simple, peaceful and useful life.
First of all, my ideal of a happy life is based on good health. A healthy body and a calm mind are the greatest riches, because without them no comfort can be enjoyed. I would keep myself healthy through a balanced diet, regular exercise, enough sleep and a clean environment.
Secondly, I believe that a happy life needs honest earning. I want a respectable profession in which I can use my knowledge to serve others. As a nurse, I find real joy in easing the pain of patients and seeing them recover. Money is necessary to meet our needs, but contentment is more important than a large income. A person who is satisfied with what Allah has given him is always happy.
Thirdly, a happy life depends on good relationships. A loving family, caring parents and true friends give strength in difficulty. I would spend time with my family, respect my elders and be kind to my neighbours. I would also try to forgive others, for hatred and jealousy destroy peace.
Moreover, I would continue to learn throughout my life, because knowledge makes a person confident and wise. I would also keep time for prayer, reading and good hobbies, and I would help the poor and needy, for there is a special happiness in giving.
Finally, I would avoid bad habits and wasteful spending, and I would be grateful for my blessings.
In conclusion, my ideal of happiness is a life of good health, honest work, love, service and gratitude. Such a life may not make a person rich, but it makes him peaceful and respected.
Q-2. (second) Do as directed: a. She says, "She is working hard." (Change into indirect speech) b. The teacher said, "do not be noisy." (Change into indirect speech) c. I said that I had not been in the class. (Change into direct speech) d. My dog was being beaten by the man. (Make active) e. He could not hit the ball. (Make passive)
| # | Given sentence | Answer | Rule |
|---|---|---|---|
| a | She says, "She is working hard." | She says that she is working hard. | The reporting verb "says" is in the present tense, so the tense of the reported speech does not change. |
| b | The teacher said, "do not be noisy." | The teacher told them not to be noisy. | A negative command becomes "told/ordered ... not to + verb". |
| c | I said that I had not been in the class. | I said, "I was not in the class." | Past perfect in indirect speech goes back to the simple past (or present perfect: "I have not been in the class") in direct speech. |
| d | My dog was being beaten by the man. | The man was beating my dog. | Past continuous passive "was being + V3" becomes "was + V-ing"; the agent becomes the subject. |
| e | He could not hit the ball. | The ball could not be hit by him. | Modal passive: modal + be + V3. (The paper prints "He could not be hit the ball", which is a typing error for "He could not hit the ball".) |
Q-3. Choose the correct one from the given options.
| # | Question and options | Correct answer |
|---|---|---|
| i | Almost everyone ______ heard of them. (a) has (b) have (c) having (d) done | (a) has – "everyone" is singular and takes "has". |
| ii | We are planning to go to ______ Spain ______ England during the holidays. (a) either...nor (b) either...or (c) neither...and (d) both...nor | (b) either...or – "either" is paired with "or". |
| iii | The sentence that states the main idea is called ______. (a) Supporting detail (b) Transitional sentence (c) Thesis statement (d) Plan of development | (c) Thesis statement – it states the main idea of an essay (in a paragraph the same job is done by the topic sentence). |
| iii (second) | Plays were a popular form of entertainment in Shakespeare's time; ______ they continue to be a popular form of entertainment today. (a) however (b) while (c) as (d) because | (a) however – a conjunctive adverb after a semicolon: "...; however, they continue...". |
| iv | An effective paragraph or essay: (a) makes a point (b) provides specific support (c) a & b (d) does none of the above | (c) a & b – it makes a point and supports it with specific details. |
Q-4. Define the following terms (any three) with at least two examples each: a. Run-on sentence b. Subject-verb agreement c. Fragment d. Parallel structure e. Misplaced modifier f. Dangling modifier
All six terms are defined below.
a. Run-on sentence
A run-on sentence joins two or more independent clauses without correct punctuation or a joining word. A fused sentence has no punctuation; a comma splice uses only a comma.
- Wrong: The nurse checked the pulse she recorded it. Correct: The nurse checked the pulse, and she recorded it.
- Wrong: The ward was quiet, the nurses took a break. Correct: The ward was quiet; the nurses took a break.
b. Subject-verb agreement
The verb must agree with its subject in number (singular or plural) and person.
- The nurse gives the injection. / The nurses give the injection.
- Each of the patients is resting. (Each is singular.) / Neither the doctor nor the nurses were present. (The verb agrees with the nearer subject.)
c. Fragment
A fragment is an incomplete sentence that lacks a subject, a verb, or a complete thought.
- Wrong: Because the patient was in pain. Correct: Because the patient was in pain, the nurse gave an analgesic.
- Wrong: Running down the corridor. Correct: The nurse was running down the corridor.
d. Parallel structure
Parallel structure means using the same grammatical form for items in a list or for paired ideas.
- Wrong: She likes reading, to write and swimming. Correct: She likes reading, writing and swimming.
- Wrong: The nurse is kind, patient and works hard. Correct: The nurse is kind, patient and hard-working.
e. Misplaced modifier
A misplaced modifier is placed too far from the word it describes, so the meaning becomes unclear or funny.
- Wrong: The patient was given tablets by the nurse that were bitter. Correct: The patient was given bitter tablets by the nurse.
- Wrong: The doctor examined the child with a stethoscope who had fever. Correct: The doctor examined the child who had fever with a stethoscope.
f. Dangling modifier
A dangling modifier describes a word that is missing from the sentence, so it seems to describe the wrong thing.
- Wrong: Walking into the ward, the bed was empty. Correct: Walking into the ward, the nurse saw that the bed was empty.
- Wrong: After finishing the dressing, the patient was shifted. Correct: After the nurse finished the dressing, the patient was shifted.
Q-5. Change the following into passive voice: a. People speak English in England b. We must learn our lesson c. They will watch a good movie d. Let's eat some fruit e. We can change the circumstances of Pakistan.
| # | Active | Passive |
|---|---|---|
| a | People speak English in England. | English is spoken in England (by people). |
| b | We must learn our lesson. | Our lesson must be learnt (by us). |
| c | They will watch a good movie. | A good movie will be watched by them. |
| d | Let's eat some fruit. | Let some fruit be eaten. |
| e | We can change the circumstances of Pakistan. | The circumstances of Pakistan can be changed by us. |
Q-6. What do you feel is the purpose of medical school?
In my opinion, the main purpose of medical school is to turn a student into a knowledgeable, skilled and caring health professional who can serve society safely.
First, medical school gives the scientific foundation of medicine. Students study anatomy, physiology, pathology, pharmacology and community medicine, so that they understand how the body works, how disease starts and how treatment acts. Without this base, no one can treat a patient safely.
Second, it develops practical skills. Through clinical rotations in wards, clinics and emergency departments, students learn to take a history, examine a patient, think about a diagnosis and carry out procedures under supervision. Learning at the bedside makes theory real.
Third, it teaches professionalism and ethics. A future doctor must be honest, respect confidentiality and patient dignity, work in a team with nurses and other staff, and communicate with compassion. These qualities are as important as technical skill.
Fourth, medical school trains students in research and lifelong learning, because medical knowledge changes quickly. A graduate must be able to find and judge new evidence throughout his or her career.
Finally, its purpose is to serve the community. Medical schools should produce doctors who care for the poor and the rural population, take part in prevention and health education, and respond to epidemics and disasters.
In short, medical school does not exist only to give a degree, but to prepare caring, competent and responsible doctors for the health of the nation.
Q-7. Write an essay on one of the following topics: a. Value of science in everyday life b. Injustice in the nursing profession c. Beggary in the cities of Sindh d. My ideal of a happy life
All four topics are answered. Topics (a) and (d) are the same as in Q-2, so use the essays given there.
a) Value of Science in Everyday Life
This topic is repeated from Q-2 (a). See the essay "Value of Science in Everyday Life" above.
b) Injustice in the Nursing Profession
Nursing is one of the noblest professions, yet nurses often face injustice in their work. Although they are the backbone of every hospital, their efforts are not always recognised or rewarded fairly.
The first form of injustice is low pay and poor benefits. Many nurses work long and tiring shifts, including nights and holidays, but receive salaries and allowances that are less than their responsibilities deserve. Overtime is often unpaid, and many do not get proper leave, transport or accommodation.
Secondly, there is a lack of respect and status. Nurses are sometimes treated as assistants of doctors, rather than as professionals in their own right. Patients' attendants may shout at them or even use violence, and some people look down upon the profession. Female nurses face harassment in some workplaces, and men in nursing face prejudice.
Thirdly, the career structure is weak. Promotions are slow, posts for senior nurses are few, and opportunities for higher education and training are limited. Nurses are seldom included in decision making on policy, even though they know patient care best.
Fourthly, shortage of staff means a heavy workload. One nurse may care for too many patients, which affects patient safety and causes burn-out. Nurses are also given non-nursing duties such as clerical work and arranging supplies.
This injustice has serious results. It lowers morale, encourages good nurses to go abroad, and discourages young people from entering the profession. In the end, the patients suffer.
The remedy is to raise salaries and benefits, to follow safe nurse-patient ratios, to provide security and a harassment-free workplace, to open clear promotion and education opportunities, and to give nurses a voice in policy. The public and the media should also give nursing the respect it deserves.
In conclusion, justice for nurses is justice for patients. A fair and respected nursing profession means better health for the whole nation.
c) Beggary in the Cities of Sindh
Beggary is a serious social problem in the cities of Sindh, such as Karachi, Hyderabad and Sukkur. At traffic signals, markets, shrines and hospitals, men, women and children can be seen asking for money. This sight shows the poverty and weaknesses of our society.
There are several causes of beggary. The first is poverty and unemployment. When families cannot earn enough to buy food, some members turn to begging. Secondly, floods, droughts and the lack of rural jobs push poor families to move to the cities, where many fail to find work. Thirdly, physical disability, old age, illness and the absence of a social safety net leave some people without any other means of survival. Another cause is that, in some cases, organised groups force children and weak persons to beg and take the earnings. Lack of education and the habit of easy income also make begging a profession for some.
Beggary has many bad effects. It damages the image of the city, increases the risk of crime and traffic accidents, and spreads disease among the poor in unhealthy conditions. Begging children are deprived of school and are exposed to abuse, and a generation grows up without skills. It also makes people dependent and kills self-respect.
The problem can be solved through joint effort. The government should create jobs, provide skills training and strengthen social support programmes for the poor and the disabled. Strong laws should be used against those who force children to beg, and shelters and rehabilitation centres should be opened. Free and compulsory education must reach every child. Citizens can help by giving zakat and charity through reliable organisations rather than to street beggars, and by teaching others to respect work.
In conclusion, beggary can only be ended by removing its causes. When every citizen has work, education and dignity, the streets of our cities will be free of beggars.
d) My Ideal of a Happy Life
This topic is repeated from Q-2 (d). See the essay "My Ideal of a Happy Life" above.
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