Kennex Midwives and Nurses Revision, Chavuma, Kamwala (2026)

03/06/2026

Kennex Midwives and Nurses Revision
SCENARIO
Mrs is admitted at Chavuma Mission Hospital Labour ward with prolonged first stage of labour. After some hours she progresses into Second stage of labor and the baby's head is now on the v***a but progress of labour stops witnessed by reverse traction of the head. Upon your examination, you make a provision diagnosis of shoulder dystocia.

QUESTIONS
A. What is shoulder dystocia? 5%
B. State the 5 predisposing factors to Mrs Mulenga's condition? 20%
C. State the 3 signs that can help you diagnose shoulder dystocia? 15%
D. Explain at least 5 non invasive and invasive maneuvers that can be used to manage Mrs Mulenga's condition. 40%
E. Discuss 5 Complications associated with shoulder dystocia. 20%

ANSWERS
A. DEFINITION
The term shoulder dystocia means or describes failure of the shoulders to traverse or pass through the pelvis spontaneously after delivery of the head Inspite of appropriate management.

B. PREDISPOSING FACTORS
1. Post maturity
📌 Post maturity makes the baby not able to negotiate well through the birth canal due to it being big than the pelvis

2. Fetal macrosomia
📌 ( birth weight of over 4 kg) has been associated with an increased risk of shoulder dystocia.

3. Diabetes mellitus
📌Maternal diabetes mellitus and gestational diabetes have also been identified as important risk factors as their babies tend to be macrosomic.

4. Prolonged second stage of labour

5. Incordinated rotation
📌The main cause is failure of the shoulders to rotate into the antero-posterior diameter following delivery of the head.

C. DIAGNOSIS OF SHOULDER DYSTOCIA
📌The delivery may have been uncomplicated initially but the head may have advanced slowly and the chin may have had difficulty in sweeping over the perineum.

📌Once the head is delivered, it may look as if it is trying to return into the va**na, which is caused by reverse traction.

📌It is diagnosed also when manouvres normally used by the midwife fail to accomplish delivery.

D. MANEUVERS USED IN THE MANAGEMENT OF SHOULDER DYSTOCIA

1. THE McROBERTS MANOUVRES
📌This involves helping the woman to lie flat and to bring her knees up to her chest as far as possible.
📌This will rotate the angle of the symphysis p***s superiorly and use the weight of the mother’s legs to create gentle pressure on her abdomen, releasing the impaction of the anterior shoulder.
📌The manouvre is associated with the lowest level of morbidity and requires the least force to accomplish delivery.

2. SUPRAPUBIC PRESSURE
📌Pressure should be exerted on the side of the fetal back and towards the fetal chest.
📌This manouvre may help to adduct the shoulders and push the anterior shoulder away from the symphysis p***s.

3. RUBIN’S MANOUVRE
📌This manouvre requires the midwife to identify the posterior shoulder on va**nal examination, then to push the posterior shoulder in the direction of the fetal chest, thus rotating the anterior shoulder away from the symphysis p***s.
📌By adducting the shoulders, this manouvre reduces the boisacromial diameter.

4. WOOD’S MANOUVRE
📌This requires the midwife to insert her hand into the va**na and identify the fetal chest. Then by exerting pressure onto the posterior fetal shoulder, rotation is achieved.

📌Although this manouvre does abduct the shoulders, it will rotate the shoulders into a more favorable diameter and enable the midwife to complete the delivery.

5. ZAVANELLI MANOUVRE
📌If the manouvres described above have been unsuccessful, the obstetrician may consider the Zavanelli manouvre as a last hope for delivery of a live infant.
📌The manouvre requires the reversal of the mechanisms of delivery so far and reinsertion of the fetal head into the va**na. Delivery is then completed by caesarean section.
📌The head is returned to its pre-restitution position.
📌Pressure is then exerted onto the occiput and the head is returned to the va**na.
Prompt delivery by caesarean section is then required.

E. COMPLICATIONS ASSOCIATED WITH SHOULDER DYSTOCIA

1. POSTPARTUM HAEMORRHAGE
✅Approximately two-thirds will have a blood loss of more than 1,000 mls from injury associated with delivery.

2. UTERINE RUPTURE
✅Due to maneuvers such as fundal pressure

3. MATERNAL DEATH
✅Maternal death from uterine rupture has been reported following the use of fundal pressure and from haemorrhage during and after delivery.

4. ASPHYXIA
✅Neonatal asphyxia may occur following shoulder dystocia.

5. BIRTH INJURIES
Brachial plexus injury with damage to cervical nerve roots 5 and 6 may result in an Erb’s palsy, commonly associated with shoulder dystocia when the head and neck have been twisted.

03/06/2026

Every exam you are going to write this year will be a step toward being successful. 🤗

02/06/2026

*MEDICAL SURGICAL NURSING*

1. Tuberculosis
2. Pneumonia
3. Asthma
4. Anaemia
5. Sickle cell anaemia
6. Malaria
7. Leukemia
8. Hypertension
9. Heart Failure
10. Ebola
11. Corona virus
12. Rheumatic heart disease
13. Coronary artery disease
14. Meningitis
15. Cerebral vascular accident
16. Leprosy
17. Epilepsy
18. Cholera
19. Diarrhoea
20. Dysentery
21. Typhoid fever
22. Peptic ulcer
23. Renal failure
24. Diabetes mellitus
25. Rabbies → _Rabies_
26. Migraine headache
27. HIV
28. Toxoplasmosis
29. Trypanosomiasis
30. Gastritis
31. Hyperthyroidism
32. Hepatitis
33. Liver cirrhosis
34. Cholelithiasis
35. Schistosomiasis

36. Burns
37. Wounds
38. Intestinal obstruction
39. Hyperthyroidism
40. Head injuries
41. Chest injuries
42. Acute abdomen
43. Haemorrhoids
44. Appendicitis
45. Spleen
46. Benign prostate hypertrophy
47. Amputation
48. Theatre nursing
49. Breast cancer
50. Fractures
51. Pancreas
52. Cataract
53. Tonsillitis
54. Glaucoma
55. Trachoma
56. Retinal detachment
57. Orthopaedics
58. Hearing impairment
59. Blindness
60. Tracheostomy
61. Epistaxis
62. Otitis media
63. Shock
64. Gangrene
65. Colostomy
66. Cholelithiasis
67. Ileostomy
68. Laryngitis
69. Pharyngitis
70. Hernia
71. Unconsciousness
72. EN
Kennex Midwives and Nurses Revision

02/06/2026

*NURSING MANAGEMENT OF PSYCHIATRIC EMERGENCY*
*AIMS*
✅To maintain safety of the patient and others.
✅To control agitation and violent behavior.
✅To restore calmness and cooperation.
✅To promote recovery and prevent relapse.
*SECLUSION*
✅ I will place the patient in a quiet, well-lit observation room to minimize external stimulation.
✅ I will keep the patient under close supervision to prevent escape or self-harm.
✅ I will limit unnecessary visitors to reduce confusion and agitation.
✅ I will provide essential items only, such as bedding, avoiding sharp or breakable objects.
*PREVENTION OF INJURY (TO PATIENT AND OTHERS)*
✅ I will remove all potential weapons or harmful objects from the environment.
✅ I will maintain a safe distance and use a calm tone when communicating.
✅ I will call for assistance from other staff when handling an aggressive patient.
✅ I will ensure staff are trained in safe restraint techniques to prevent harm.
*CONTROL*
✅ I will administer prescribed sedatives or antipsychotics to reduce agitation.
✅ I will apply physical restraint only when absolutely necessary and with team assistance.
✅ I will monitor the patient’s level of consciousness and cooperation frequently.
✅ I will document all measures taken and the patient’s response accurately.
*ENVIRONMENT*
✅ I will remove any dangerous objects from the room to prevent self-harm or harm to others.
✅ I will ensure the room is well ventilated and supervised at all times.
✅ I will keep the bed low and free from sharp items.
✅ I will provide a calm and non-threatening environment to reduce fear and suspicion.
*PSYCHOLOGICAL CARE*
✅ I will speak calmly and clearly, avoiding arguments or sudden movements.
✅ I will offer reassurance to reduce anxiety and fear.
✅ I will involve him in simple activities once agitation decreases.
✅ I will encourage trust and communication when stable.
*PHYSICAL CARE*
✅ I will monitor vital signs regularly to detect side effects of drugs like hypotension or sedation.
✅ I will maintain personal hygiene by assisting with bathing and grooming.
✅ I will provide adequate rest and sleep by minimizing disturbances.
✅ I will offer fluids and food when he becomes calm.
*RESTRAINT*
✅ I will apply physical restraint only when absolutely necessary and with team assistance.
✅ I will explain the reason for restraint to the patient once calm to maintain dignity.
✅ I will check circulation, comfort, and positioning during restraint.
✅ I will document the duration and reason for restraint use.
*OBSERVATION*
✅ I will observe behavior changes such as reduced agitation or improved cooperation.
✅ I will monitor for side effects of medications like tremors or excessive drowsiness.
✅ I will watch for suicidal or violent tendencies.
✅ I will report progress to the psychiatrist.
*PHARMACOLOGICAL CARE*
✅ I will administer prescribed psychotropic medications such as haloperidol and diazepam.
✅ I will observe therapeutic response and side effects.
✅ I will educate the patient and family on adherence to medication.
✅ I will not stop medication abruptly to prevent relapse.
*COUNSELING*
✅ I will provide supportive counseling to help the patient understand his condition.
✅ I will encourage expression of feelings and fears once stable.
✅ I will involve the family in counseling sessions for better support.
✅ I will emphasize coping strategies and stress management.
*REHABILITATION*
✅ I will plan for gradual reintegration into family and community settings.
✅ I will encourage participation in occupational and recreational therapy.
✅ I will link the patient to community mental health resources.
✅ I will support long-term follow-up to maintain recovery.
*SOCIAL SKILLS TRAINING*
✅ I will teach the patient basic interpersonal and communication skills.
✅ I will encourage appropriate social interaction during therapy sessions.
✅ I will reinforce positive behaviors and self-care habits.
✅ I will help the patient rebuild confidence for community living.
*HEALTH EDUCATION*
✅ I will educate the family about the nature of the illness and importance of medication adherence.
✅ I will teach early warning signs of relapse such as restlessness or isolation.
✅ I will encourage avoidance of alcohol and drugs.
✅ I will emphasize the need for follow-up at the mental health clinic.

02/06/2026

BREAKING NEWS..🎉
40,000 health workers recruitment in second term.

02/06/2026

*RN's NMCZ 2025 DECEMBER POST EXAMS*

*IRH 2021 CURRICULUM*

*1*. First Stage of Labour
*2*. Ectopic Pregnancy
*3*. Puerperium (Pelvic Floor)

02/06/2026

*c) With the aid of a diagram explain the steps that are involved in the communication process*

*Sender (Source)*
* This is the person who initiates the communication. The sender has an idea, information, or message they want to share.
*Encoding*
* The sender converts the idea into a message using words, symbols, gestures, or written form.
*Message*
* This is the actual information being communicated.
*Channel*
* The medium used to transmit the message, such as speech, phone, email, letters, or gestures.
*Receiver*
* The person or group for whom the message is intended.
*Decoding*
* The receiver interprets or translates the message to understand its meaning.
*Feedback*
* The response from the receiver back to the sender, showing whether the message was understood or not. It completes the communication loop.
Kennex Midwives and Nurses Revision

02/06/2026

*Dear Students*

Keep pushing forward, even when the journey feels difficult. Every lesson you learn and every hour you spend studying is an investment in your future. Success does not come from being the smartest person in the room, it comes from consistency, determination, and the willingness to keep going when things get tough.

Believe in your ability to learn and improve. Stay focused on your goals, manage your time wisely, and never compare your progress to someone else's. Everyone has their own journey and pace.

Stay disciplined, stay positive, and keep moving forward. Your dedication today will open doors to opportunities tomorrow. You are capable of achieving more than you think so just keep studying hard, keep believing in yourself, and keep striving for excellence. 📚💪✨

Remember, as I always say: if I believe in all of you, why shouldn't you believe in yourself?

I love you all, and may a Clear Pass locate each and every one of you..

IT SHALL BE WELL
Kennex Midwives and Nurses Revision

01/06/2026

*2017 to 2024 questions for mental health nursing examinations:*

2017
Question 1:
Mrs. Katebe went through various stages of the grieving process after losing her husband and made several attempts to take her life. She is admitted to the acute ward following suicidal attempts.

a) Explain three (3) significant losses that may lead to grieving.
b) State five (5) stages of grieving.
c) Explain three (3) types of su***de.
d) What are some of the circumstances that may complicate grieving.
e) Outline the management of a client who has had two previous attempts of Su***de while on the ward.

Question 2:
A patient was admitted to your ward for three (3) weeks with a diagnosis of schizophrenia. He has now been discharged on chlorpromazine 100mg twice a day and will need to come for review after one month.

a) Explain the health education you will give to the client about the medication and his condition.
b) Describe the roles of a nurse in the community.
c) Explain four (4) ethical consideration that the nurse should consider in the community.
d) Outline four (4) objectives of the first visit by the community health nurse.

Question 3:
Esther Chileshe, is a schizophrenic patient admitted in Chainama hospital for the past 6 years. She is observed to have developed the symptoms of being institutionalized.
a) Define Institutionalization.
b) Explain five (5) features of institutionalization on the patient and how you would manage them.
c) Explain five (5) measures you would take to prevent patients developing symptoms of institutionalisation.
d) Describe ten (10) points you would include in the rehabilitation programme for Mrs. Chileshe who is institutionalized.

Question 1:
The issue of Child Abuse has raised concern among the Government and Stake Holders.
a) Define the term 'Child Abuse'.
b) Outline five (5) factors that contribute to Child Abuse.
c) Explain five (5) effects of abuse on a Child.
d) Discuss the role of the community Mental Health Nurse in preventing and dealing with abuse.

Question 2:
You are working in an acute male psychiatric ward and you admit Mr Chalwe, aged 35 years from Mtendere compound shouting and threatening violence to his fellow patients and members of staff. He is a known case of Schizophrenia.
a) Define aggression.
b) Discuss the three (3) types of aggression.
c) Outline five (5) causes of aggression in psychiatric patients.
d) How would you manage Mr Chalwe during the episode of aggression.

Question 3:
Mrs Tokozile Gondwe aged 60 years is brought to Chainama Hospital ward B with history of self-neglect and wandering about for the past 2 months. On admission the Doctor does a Mental State Examination and a diagnosis of Dementia is made.
a) Define Dementia.
b) Explain five (5) causes/predisposing factors of Dementia.
c) Describe five (5) cardinal signs of Dementia.
d) Discuss how you are going to nurse Mrs Gondwe during her stay in hospital.

Question 1:
Diana a young female adolescent is brought to the psychiatric hospital amidst talking and shouting on top of her voice non-stop. The father had accompanied her saying this was of sudden onset. The daughter cannot sleep claims she is the newly crowned queen of England, and feels she has some special powers to save the world. The staff on the ward decides to manage this client accordingly.
a) i. Define Mania.
ii. Outline five (5) predisposing factors to Mania.
b) State five (5) clinical manifestation of mania.
c) Mention three (3) drugs that may be given to Diana stating the dose, frequency and two (2) side effects of each drug.
d) Discuss the Nursing Management you would give Diana.

Question 2:
Aggression is one of the common signs that are exhibited by mentally ill patients.
a) Define aggression.
b) Explain the risk factors of aggression.
c) Discuss the nursing intervention of aggression.
d) Discuss how you would prevent episodes of aggression in the ward.

Question 3:
The issue of Child Abuse has raised concern among the Government and Stake Holders.
a) State five (5) types of Child Abuse.
b) Outline five (5) factors that contribute to Child Abuse.
c) Explain five (5) effects of abuse on a Child.
d) Discuss the role of the community Mental Health Nurse in preventing and dealing with abuse.

Question 1:
Mrs. Katebe reports to you that their 9-year-old boy has difficulties in learning and the boy delayed in walking and talking. Upon assessment, you suspect the boy has mental retardation.
a) Define mental retardation.
b) State five causes of mental retardation.
c) Explain four types of mental retardation.
d) Discuss the management of mental retardation in terms of primary prevention, secondary prevention and tertiary prevention.
e) Explain the health education you will give to Mrs. Katebe before allowing them to go home.

Question 2:
Mr. Tembo went through various stages of the grieving process after losing his husband and made several attempts to take his life. He is admitted to the acute ward following suicidal attempts.
a) Explain three (3) significant losses that may lead to grieving.
b) Outline five (5) stages of grieving.
c) Explain four (4) types of su***de.
d) Discuss the management of Mr. Tembo while on the ward.

Question 3:
Stephen Njovu, aged 43 years, married with 6 children is admitted to a hospital ward with a history of alcohol abuse. The wife said that he sometimes experiences tremors. He is on suspension at work for absenteeism. The wife explained that he has impaired thinking and hallucinations. On examination a provisional diagnosis of alcoholism was made.
a) Define alcohol abuse.
b) Explain five (5) social effects of alcohol abuse.
c) Discuss five (5) ways of how alcohol abuse can be prevented.
d) Describe in detail the management of Mr. Njovu.

November 2019 Qualifying Examination
Question 1:
From time in memorial, Mental illness has been considered to be contagious and patients with mental illness have therefore been stigmatized and shunned.
a) Define mental Illness.
b) Outline five (5) causes of mental illness.
c) Discuss any five (5) signs and symptoms of mental illness.
d) As a nurse working in the mental health unit, what measures would you put in place to try and reduce stigma against the mentally ill patients.

Question 2: You work in a community where there are a lot of defilement cases. Most of these cases go unreported to the police and as a community mental health nurse you are concerned about this situation and you decide to intervene.
a) i. Define defilement.
ii. Outline five (5) factors that could have contributed to the development of this problem in this community.
b) Explain five (5) signs and symptoms that you could observe in a child that has been defiled.
c) As a community mental health nurse what could be your role in addressing the situation in the community.
d) Explain measures that Government could put in place to prevent child defilement.

Question 3:
Mr. Andrew Kaira aged 30 years has been referred to your outpatient department with a history of increasing anxiety. This follows a positive HIV test results a few weeks before his wedding day. Mr Kaira needs crisis intervention.
a) Define a crisis.
b) Describe the four (4) phases of a crisis.
c) Outline three (3) types of crisis.
d) Discuss the immediate intervention to help Mr. Kaira resolve the crisis.

Question 1:
Mr. Andrea Kalonde was brought to the Hospital in unconscious state with the history of taking pesticide (doom) after a quarrel with the wife. Upon arrival at the Out Patient Department (OPD), the Nurse In-charge ordered other nurses and clinicians on duty that quick response should be done to save the life of Mr. Kalonde.
a) Define the term psychiatric emergency.
b) Outline five (5) psychiatric emergencies.
c) Discuss five (5) roles of the nurse in su***de prevention.
d) Explain five (5) points you will give to Mr. Kalonde and the family before discharge.

Question 2:
It has been observed that the incidence of mental illness in Zambia is on the increase in the general population as can be seen by statistics in many mental health units.
a) i. Define substance abuse.
ii. State five (5) sign and symptoms of alcohol intoxication.
b) Outline five (5) factors that have led to an increase of mental illness in Zambia.
c) For each factor in (b) explain steps that can be taken to remedy the situation.
d) Describe six (6) health problems of substance abuse.

Question 3:
The minister of Health issued the ministerial statement in parliament, that the Government has set some funds to improve mental health service delivery in the provinces throughout the country. The priority of the utilization of funds is set to support mental health advocacy.
a) Define mental health advocacy.
b) Outline five (5) types of advocacy.
c) Discuss three (3) roles of mass media in advocacy.
d) As an advocator, discuss five (5) services you will provide to reduce stigma against mental patients among the general public.

May 2021 Qualifying Examination
Question 1:
The Minster of Health gave a statement when he addressed the co-operating partners. In his statement, he stated that primary healthcare should be supported and should not be left out.
a) Define the term mental health promotion.
b) State five barriers to mental health promotion.
c) Explain five (5) roles of the community mental health nurse in mental health promotion.
d) Outline three levels of disease prevention, in relation to mental health, and give examples of services offered at each level.

Question 2:
Bwalya Mwenya, is a community mental health nurse. During her community diagnosis she discovers children with mental retardation.
a) Define the term mental retardation.
b) Explain 5 (five) causes of mental retardation.
c) Outline five (5) preventive measures of mental retardation.
d) Outline eight (8) measures you would take in the rehabilitation programme of a child with mental retardation in the community.

Question 3:
Mrs. Mwale, aged 46 years, lost a husband two (2) weeks ago in a motor vehicle accident. She is brought to your ward and a diagnosis of Depression is made.
a) Define the term Depression.
b) Explain five (5) signs and symptoms of Depression.
c) State five (5) predisposing factors to developing depression.
d) Outline the management of Mrs. Mwale during hospitalization.

November/December 2023 Competence Examination
Question 1:
Mr. Mumbi was brought to the Hospital in unconscious state with the history of taking pesticide (doom) after a quarrel with the wife. Upon arrival at the Out Patient Department (OPD), the Nurse In-change ordered other nurses and clinicians on duty that quick response should be done to save the life of Mr. Mumbi.
a) Define the term psychiatric emergency.
b) Explain five (5) psychiatric emergencies.
c) Describe five (5) roles of the nurse in su***de prevention.
d) Explain five (5) points you will give to Mr. Mumbi and the family before discharge.

Question 2: Mrs. Pearson is admitted to your psychiatric facility and she is severely anxious.
a) Define Anxiety.
b) Outline four (4) levels of Anxiety.
c) Describes the Nursing management of Mrs. Pearson during hospitalization.
d) Explain five (5) differences between Neurosis and Psychosis.

Question 3:
Mr. Jones aged 40 years; a well-known Schizophrenic patient has been admitted to your Psychiatric facility for the fourth time in 4 months. The wife admits that he has not been taking his medication regularly.
a) Define Schizophrenia.
b) State five (5) positive signs of Schizophrenia.
c) Explain five (5) types of Schizophrenia.
d) Describe Mr. Jones management from admission until discharge.

May 2024 Competence Examination
Question 1:
Mr. Kalobwe aged 45 years has been admitted to your psychiatric facility with history of extreme sadness, mutism and neglect in his physical appearance. After a thorough mental state examination, a diagnosis of depression is made. The psychiatrist has indicated that Mr. Kalobwe is suicidal as well.
a) Define depression.
b) State five (5) differences between Reactive depression and Endogenous.
c) Discuss the management of Mr. Kalobwe from admission to discharge paying particular attention to his suicidal ideas.
d) Mr. Kalobwe will undergo intensive counseling sessions to help manage his depression. Discuss five (5) counseling principles that you will observe.

Question 2:
Mrs. Madiba a retired University lecturer aged 85 years old has been admitted to your psychiatric facility with a diagnosis of Dementia.
a) Define dementia.
b) State five (5) Clinical features of Dementia.
c) Explain five (5) types of Dementia and their causes other than the one mentioned in the stem.
d) Describe The Nursing Management of Mrs Madiba while in the hospital.

Question 3:
Mulenga Kangwa, a 6-year-old girl has been brought to your Centre with history of being sexually abused. You realize as a Mental Health Nurse that cases of child abuse have been on the increase in the community.
a) Define child abuse.
b) Explain five (5) factors that may contribute to child abuse in the community.
c) Explain five (5) effects of child abuse on a child.
d) Discuss five (5) roles of a Community Health Nurse in preventing and dealing with child abuse.
Kennex Midwives and Nurses Revision

01/06/2026

HENRY FAYOL'S 14 PRINCIPLES OF MANAGEMENT

Unity of Command
Each employee should receive orders from only one manager to avoid confusion and conflict.

Unity of Direction
All activities in an organization should be directed toward a single common goal.

Division of Work
Work should be divided among individuals and groups based on specialization to improve efficiency.

Discipline
Employees must obey rules and show respect for authority and organizational agreements.

Authority
Managers have the right to give orders, but they also carry responsibility for their actions and decisions.

Equity
Employees should be treated fairly and justly to promote loyalty and commitment.

Scalar Chain
There should be a clear chain of command from top management to the lowest level, ensuring proper communication flow.

Subordination of Individual Interest
The interests of the organization should come before personal interests.

Remuneration
Employees should be fairly compensated for their work to ensure motivation and productivity.

Centralization
Decision-making authority should be appropriately balanced between top management and lower levels (centralization vs decentralization).

Order
Everything (people and materials) should be in the right place at the right time to ensure efficiency.

Stability of Tenure of Personnel
Employees should have job security to reduce turnover and improve experience and productivity.

Initiative
Employees should be encouraged to suggest and implement new ideas.

Esprit de Corps
Promotes teamwork, unity, and strong group spirit within the organization.
Kennex Midwives and Nurses Revision

Kennex Midwives and Nurses Revision

03/06/2026

03/06/2026

02/06/2026

02/06/2026

02/06/2026

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