Primary Health Care PHC

 

PRIMARY HEALTH CARE

Stuation: The primary function of the Department of Health is the promotion, protection, preservation or restoration of the health of the people though the provision and delivery of health services. a.  What is the vision of the Department of Health a.  Responsible for the formulation, planning, implemented, and coordination of policies and programs in the field of health b.  Regulates health goods and services c.  Health as Right. Health for all Filipinos by the year 2000 and Health in the hands of the People by the year 2020 d.   All of the above b.  DOH should work to make enjoyment of the right to health a reality. What is the mission of DOH? a.  by promoting the means to better health b.  by planning the programs in the field of health c.  by encouraging providers of health goods and services d.  d none of the above c.  What is the normal temperature of a child who is 1-3 year of age? a.  39.1 C b.  35 C c.  37 C d.  38 C d.  To convert the body temperature of 38 C to F, what’s the answer?  answer?   a.  107.9 F b.  106.2 F c.  95 F d.  100.4 F e.  The Rural Health Doctor orders Dextran 12% 1000 ml within 8 hours for a client. Drop factor is 12 gtt/ml. Solve for the gtt/min. a.  24-5 gtts/min b.  25 gtts/min c.  25.5 gtts/min d.  26 gtts/min f.  Baby Boy Noel was admitted and the doctor ordered D5NSS 1L x KVO. The MIDWIFE should calibrate the IVF to: a.  5 gtts/min b.  10 gtts/min c.  15 gtts/min d.  20 gtts/min g.  Baby Girl Lee, the neighbor of Baby Boy Noel was brought also to the clinic by her mother for the immunization. What immunization will be given if Baby Girl Lee is 9 months old? a.  BCG b.  Measles c.  DPT d.  Polio 2 h.  ORESOL has been introduced to the barangay for dehydration. To prepare for the solution, what will be the desired amount? a.  2 glasses of water + ½ tbsp. of salt b.  ½ glass of water+1 tbsp. of salt + 3 tbsp. of sugar c.  2 ½ glasses of :water + 2 tbsp. of salt + ½ tbsp. of sugar d.  1 glass of water + 1 pinch of salt + 1 tbsp. of sugar Situation: A place in Brgy. Canla has a common cause of Iodine deficiency where their main products are "Goitrogenics." i.  Which of the following are considered goitrogenics? a.  mandarins b.  kangkong c.  tomato d.  cassava  j.  Which of the following are rich source of Iodine? a.  talaba b.  liver c.  lean meat d.  gizzard 11. What area of CHN bag is considered sterile? a.  outside b.  sheath c.  inside d.  sides Situation: These are nutritional needs of the mother during her pregnancy. 12. Nancy who just delivered a baby boy works as an executive for a big company. Which of these should the MIDWIFE first encourage? a.  Mixed feeding b.  Bottle feeding c.  Leave the baby in the Nursery d.  Breastfeeding

 

  Situation: Mr. Reyes, 59 years old is a frequent visitor of Lions Club. Lately, he became inefficient with his work and complaining of dizziness. 13.  You stressed to him and to the finally the importance of the following food that will help in the production of RBC, EXCEPT: a.  kangkong b.  egg yolk c.  broccoli d.  ampalaya 14.  Your health teaching to his family is to serve food rich In Iron and this is: a.  egg yolk b.  ampalaya c.  liver d.  lean meat

Cacabdcbdaacdcd Situation: The following questions pertain to the MIDWIFE and responsibilities. 15.  Concerned with the care of school-children, the MIDWIFE does the following. EXCEPT:   a. provides for a safe environment b. detects, diagnose, and treats children with health problems c. identifies and refers children with eye problems d. conducts health education classes 16.  An important reason why erasures In the patient's chart should be avoided is:  a. chart would look dirty and reflects, the MIDWIFE personality b. recording maybe illegible c. chart is a legal document d. chartings are essential for endorsement and follow-up care of patient Situation: This pertains to human anatomy and physiology. 17.  The principal factor-causing vaginal pH to be acidic:   a. Action of Doderlein's bacillus b. Cervical mucus changes c. Secretions from Skene's glands d. Secretions from the Bartholin’s glands  glands  Situation: In one of your conference with the midwives, you answered the question pertaining to computation and presentation of statistical data at the Rural' Health Unit. Some of the questions are the following among others. 18.  The following measures is used as a numerator to capture for the infant mortality rate:   a. Total number of deaths from maternal causes in same year b. Total number of registered live births of a given year c. Total number of deaths less than 1 year of age registered in same calendar year d. Total number of deaths registered in same calendar year 19.  In order to present the frequency of occurrence of new cases of PNA In the municipality you have to t o compute for the:   a. prevalence rate b. case fatality rate c. proportionate mortality rate d. incidence rate  Situation: Nursing as a profession benefits from the use of nursing diagnosis process in professional clinical practice. 20.  The most important values of the use of nursing diagnosis in care planning is:  a. highlights your critical thinking and decision-making b. focuses in cause of the illness c. helps to define what is health d. identifies what the MIDWIFE can prescribe Situation: The following questions pertain to nursing care of child with cardiovascular, disorders. 21.  Amy, 6 years old, Is admitted with an impression of rheumatic fever. To help establish the diagnosis of rheumatic fever, which of these questions should the MIDWIFE ask?  a. Did Amy travel abroad recently? b. Did Amy remark of fatigability? c. Did Amy have sore throat recently? d. Did Amy have viral infections? 22.  MIDWIFE Jo reviews the laboratory data of Amy. Of these data, one would be supportive of a diagnosis of rheumatic fever?  a. low hematocrit b. increased leukocyte count c. high erythrocyte sedimentation rate d. elevated antibody level 23.  Bob who is diagnosed with rheumatic fever is prescribed with Aspirin. The purpose of this medication is to:   a. reduce inflammation b. relieve anxiety c. control headache d. decrease fever

Situation: Professional nursing practice primarily aims to promote health and prevent illness. 24. The meet basic goal of health promotion is:  a. healthy b. absence of disease c. no illness d. wellness

 

25. You are a factory MIDWIFE in a bottling industry. What priority health promotion program can you undertake?   a. Physical fitness program b. Accident prevention program   c. Formulating work strategy d. Relaxation exercises Situation: Your 13 year old daughter tells you that she is having her menarche and that she fees awful. To comfort her, you would explain the menstrual cycle. 26. You start by defining menstruation is:   a. Expelling of the unfertilized egg which causes the bleeding b. Soughing off the perimetrium c. Sign of an aborted pregnancy d. Monthly sloughing off of the uterine tiring that had been prepared to nurture a fertilized egg. 27. Ovulation usually occurs on the:   a. 28th day of a 28 day menstrual cycle b. 1st week of a 28 day menstrual cycle c. last week of a 28 day menstrual cycle d. 14th ay of a 28 day menstrual cycle 28. The secretory phase is characterized by the secretion or storage nutrients, glycogen and mucin. This is due to the th e action of: o f:  a. prolactin b. estrogen c. androgen d. progesterone 29. To allay the fears f ears of your daughter regarding losing too much blood during menses, you would tell her that the average blood lost per cycle is: a. 80ml b. lOOml c. 120 ml d. 30 ml 

Situation: Mrs. Mia Sandoval, a newly-married couple, plan to start a family planning clinic to choose the most appropriate contraceptive method for them: 30. Mrs. Sandoval is Interested in IUD. The MIDWIFE tells her that its insertion is usually done at this period of the menstrual cycle:   a. 7th to 10th days b. 18th to 20th days c. 12th to 16th days d. 1st 104th days 31. Upon further discussion, the MIDWIFE talks about the diaphragm which after intercourse must be kept in place for:  a. 6-8 hours b. 12-24 hours c. 11-20 hours d. 9-10 hours 32. Mrs. Sandoval talks about friend's infertility problem that was prescribed with Clomid by her physician. The MIDWIFE informs her that a side effect of this medication may be:  a. multiple gestation b. headache c. transitory depression d. hypertension Situation: The following pertains to some concepts and principles of community health nursing (CHN) that a MIDWIFE must apply in carrying out CHN services. 33. Community health Nursing is a service that is provided in an environment that is constantly changing. This implied that the community health MIDWIFE to be able to provide relevant services.   a. must involve other disciplines In carrying out health care services in various settings b. must provide a service that is community-based c. must provide a service that is integrated and comprehensive d. must update her knowledge on the current and evolving characteristics of health care system 34. Promotion of health is a major responsibility of the CHN, This refers to; a. Activities that seek to protect clients from potential or actual health threats and their harmful consequences b. Activities directed toward developing the resources of clients that maintain or enh ance well-being c. Activities directed toward decreasing the probability of specific illness or dysfunctions in individuals d. Activities aimed to prevent to spread of microorganisms to Individual

Situation: The public health MIDWIFE performs varied functions and activities in her place of work. 35. In dealing with a primigravida who is afraid of childbirth due to her beliefs and misconceptions. The first thing that the MIDWIFEs should do is:  a. help woman recognize the sign of abnormalities in pregnancy to enable her to report to the midwife b. identify the beliefs and misconceptions and their source c. immediately correct the beliefs and misconceptions

 

 

d. refer to midwife for regular follow-up visit

36. Kwashiorkor is a condition usually seen among pre- school children. This is characterized by which of the following signs? 

a. all these signs b. retarded growth and hairs c. loss of appetite d. edema 37. Vitamin A deficiency will lead to which of the following conditions?   a. high blood pressure b. swollen face, body and limb c. inability to see in the dark d. enlargement of the neck 38. Grace was referred to you by a midwife. In order to determine whether Grace is suffering from severe calorie deficiency, wh which ich of the following condition will you take note of?  a. thin, sparse hair b. an extreme wasting away of fat muscle c. paleness of the inner side of the lips d. generalized swelling of the body Situation: You are the new Public Health MIDWIFE in the Municipality of Pontevedra. This municipality has the following data in 2003: Population - 30,000 Total infants death - 11 Total number of cases examined for PTB - 200 Total births - 500  All causes -74 Number of confirmed positive of PTB cases - 5 39. You need to gather a lot of data about the community. Which of these can be g given iven least priority?  a. community's belief and practice b. community s political leadership c. community's knowledge in health d. community's way of life

40. You studied the figures of disease and accidents that occurred in Pontevedra for the last 2 years. These figures are referred to as:  a. mortality statistics b. mortality and morbidity statistics c. rates and ratios d. morbidity statistics 41. Which of the following f ollowing gives a good reflection of the state of health of Pontevedra?   a. maternal morbidity rate b. age-specific death rate c. infant mortality rate d. crude death rate  Situation: In one of your home visits you discovered that Tristan, 2 years old who lives with Mang Tero his lolo is still on bottle feeding. No supplementary feeding given: 42. Supplementary feeding should be started:  a. at the age of 8 -12 months b. at the age of 8 months c. not earlier than 2 months but not later than 4 months d. not earlier than 4 ninths but and later than 6 moths 43. You're Interested to know whether Tristan has signs of malnutrition. Hence, you will:   a. weigh the child and perform physical assessment b. weigh the child c. perform a physical assessment d. refer to physician or nearest health facility Situation: Atypical teenager, Susan, 17 years old, is in her 3rdyear high school. Besides sports and other school activities, she volunteers for community outreach programs in her school, among them going to the slums of Tondo. 44. Susan wears contact lenses. But she claims that these are so comfortable she forgets to removes them at night. As the school schoo l MIDWIFE, you caution that she should not sleep with her soft contact lens because the y can damage one of these:   a. sciera b. optic nerve c. cornea d. pupil

45. In one of her information- sharing, Susan mentions that her mother was taking diethyistijbestrd (DES) when she was pregnant withjier. The MIDWIFE feels that she must suggest 'to Susan one ofthese. \Wch os correct?  a. "I wiH take your Pap smear for laboratory exams." b. "Do nd use the pi!! for contraception." c. "Please see a gynecologist as soon as possible."  

 

 

d. "Avoid us! ng lampoons during menstruation."

Situation: Miss Go is a clinical instructor in Community Health Nursing discussing about vital statistics, epidemiology and laws affecting Public Health and practice of Community Health Nursing. 46. It is concerned with the t he study of factors that influence the occurrence and distribution of diseases, defects disability or deaths. This is:  a. Epidemiology b. Statistics c. Public Health d. Community Health Nursing 47. The Republic Act that refers to the Magna Carta of Public Health Workers:   a. R.A 2382 b. R.A 1062 c. R.A 7305 d. R.A 6425

t he Philippines. A 48. Republic Act 7164 known as the "Philippine Nursing Act of 1991" embodies the regulation of Practice of Nursing in the member of the Board of Nursing must be:  a. Citizen of the Philippines b. RN and holder of Master's Degree c. 10 years of continuous practice of the profession d. All of the above Situation: Mr. Laurel, a public MIDWIFE is conducting community class in Brgy. Kawayan about pulmonary tuberculosis. 49. Category 3 treatment regimen for TB is prescribed p rescribed to:  a. New pulmonary TB patients whose sputum is positive b. Previously treated patients who are on relapse c. New pulmonary TB patients whose sputum is serum-negative for 3x and a chest x-ray of PTB minimal d. Previously treated patients who are failures 50. What TB drug is net given to children under age 6 who are too young to report visual disturbances?  a. INH b. Rifampicin c. Ethambutol d. PZA 51. Category treatment regimen for TB Is prescribed. This is given:   a. 2 months Intensive phase, 4 months maintenance phase b. 3 months intensive phase, 5 months maintenance phase c. 2 months intense phase, 2 months maintenance phase d. 3 months Intensive phase,6 months maintenance phase Situation: Cancer ranks third in leading cause of morbidity and mortality in the Philippines. Early detection Increases the survival rate of those afflicted. You are a MIDWIFE in a cancer-prevention and screening clinic and are for health education. 52. The following are warning signs of cancer. Which one is not?  a. Change In bladder and bowel habits b. Indigestion or difficulty in swallowing c. Weight gain d. Nagging cough or hoarseness 53. Monthly examination (BSE) can help in early detection of breast CA. When do you perform BSE? a. once a month after menstruation b. once a month before menstruation c. every ether month after menstruation d. every other month before menstruation 54. There are several risk factors with developing cancer. The following are risk factors of cancer, except:  a. age b. race c. ordinal petition In the family d. lifestyle 55. A form of cancer therapy wherein a beam of high-energy electromagnetic radiation desires the cancer ceils?  a. surgery b. radiation therapy c. chemotherapy d. pallitive treatment Situation: Mental health covers the psychosocial concerns of daily living covering the stages of life. Efforts to train manpower have been done by the government through the National Mental Health Programs. Situation: The following questions are concerned with nutrition. 56. Which one is not a function of calcium a. Bone and teeth mineralization b. Absorption of iron and the formation of hgb c. Blood clothing

 

 

d. Muscle relaxation and contraction

57. Xerophthalmia is characterized by:   a. Tunnel vision b. Floaters c. Night blindness d. Window vision 58. A deficiency in protein leads to:   a. Kwashiorkor b. Ricketts c. Beri-beri d. Hemorrhage 59. Nutrients are classified according to their structures. Which among these is not a micronutrient?  a. Vitamin A b. Iron c. Iodine d. Amino acids 60. What mineral works with Vitamin E to protect body compounds from oxidation?   a. Sodium b. Selenium c. Zinc d. Manganese Situation: Osteoporosis is considered a major health and economic problem. One in every four women over age 50 is believed to have this disease. 61. What is the main reason why Asian women are more in developing o osteoporosis steoporosis than African-American women?  a. There are more post menopausal aged Asian women b. Banes of Asian women are 30-40% less dense than that of African-American women c. African-American women eat more compared to Asian women d. Asian women have lesser bone mass compared to African-American women 62. There are factors that predispose an individual for osteoporosis. What factor is least associated with the disease?  a. Decreased level of oxygen b. Calcium deficiency c. Exposure to sunlight d. Lack of exercise

63. Women over 50 years are very much at risk for fractures. Where Is the most common site of fractures to osteoporosis?  a. femur b. forearm c. vertebrae d. hips Situation: Mrs. M. has been given a copy of her diet. He consulted you about her prescribed diet. 64. Which of the following diseases results from niacin deficiency?  a. diabetes b. beriberi c. pellagra d. megaloblastjc anemia 65. He also asked about Vitamin E. The richest source of Vitamin E is:   a. vegetable oil b. milk c. fish d. cereals 66. The most common vitamin deficiency seen in alcoholics is:  a. Thiamne b. Riboflavin c. Pyridoxine d. Pantothenic acid Situation: Mr. S., a patient in MS ward, wants to increase his Vitamin C intake. He also asks you several questions about nutrition. 67. Which of the following foods is not well-known source of Vitamin C?  a. tomatoes b. grapefruits c. green and yellow vegetables d. oranges 68. Vitamin C deficiency is characterized by the following except:  a. redness and edema of the gums b. pinpoint peripheral hemorrhages c. pernicious anemia d. bones that fracture easily

 

  Situation 1. The following pertains to some concepts and principles of community health nursing that a MIDWIFE must apply in carry out CHN services.

69. Community heatlth nursing is a field of nursing which utilize   1. Knowledge about the history and philosophy of public health practices 2. Concepts of epidemiology and bio-statistics 3. Principles of leadership and management 4 Principles of social change a. 1, 2, 3 & 4 b. 1 & 2 C. 2 & 3 d. 1,2 & 3 70. Which of the following features should the MIDWIFE incorporate in her practice of community health nursing (CHN)?   1. CHN is oriented to population 2. CHN emphasize health 3. CHN involves interdisciplinary collaboration 4. CHN promotes client participation in determining their own health

a. 1, 2, 3 & 4 b. 3 & 4 only c. 1 & 2 only d. 1, 2 & 3 71. In order to strengthen community participation in health activities in the community, which of this following should be done by the Public Health MIDWIFE?  1. Identify the existing and potential leaders of the community 2. Form a core group for health 3. Formulate action program for health 4. Tell the community leaders what to do for their health problems a.1 & 3 b.3 & 4 c.1 & 2 d.2 & 3 72. Which of the following characterize Primary Health Care?   1. Essential health care accessible and acceptable to individual and families in the community 2. The cost of care is affordable to community and country 3. The setting is in tertiary hospitals 4. Require; health personnel and specializ specialized ed training a. 1 & 4 b. 3 & 4 c. 1 & 2 d. 2 & 3 73. Which of the following statements about the PHN’s role in the community is/are correct?  correct?   1. The PHN will only enjoy her work if she accepts her role and is able to perform that role 2. The PHN is a community health MIDWIFE if she is able to establish rapport with the community officials and members 3. The PHN wish only give bedside nursing care 4. The PHN can walkthrough mud, work under stress and eat with the people in the barangay a.1 & 2 b.3 & 4 C. 2 & 3 d. 1, 2 & 4 Situation 2. Cynthia Payas at 30 weeks of gestation has been admitted to the labor room. She says she been having moderate contractions every 3-5 minutes lasting almost a minute. Her membranes are placed. 74. From the MIDWIFE's assessment findings of Leopold maneuvers TS revealed a soft, rounded mass, irregular nodules nodule s on Cynthia's right side and a hard prominence on her right, just above the symphisis. Which of the following best describe the fetal presentation prese ntation and position?  a. ROP b. LOA c. LSA d. RSP 75. Health teaching during the prenatal period emphasize the expectant mother's need to go to the hospital when: a. Contractions are 5-10 min, apart lasting 30 seconds and are felt as strong as menstrual cramp. b. Contractions are 5 min. apart lasting 60 seconds and in increasing intensity c. Contractions are 3-5 min. apart with rectal pressure and bloody show d. contractions are 2-3 min apart lasting 90 seconds and membranes have ruptured 76. The MIDWIFE continues with her admission assessment. Which location should the MIDWIFE anticipate finding the t he fetal heart tones?  a. above the umbilicus on her left side b. above the umbilicus on her right side c. below the umbilicus of Mona's left side d. below the umbilicus of Mona’s right side  side  

 

77. The MIDWIFE assessed the frequency, duration and intensity of Cynthia's contractions. Which of the following techniques should the MIDWIFE use?  a. Holding the finger and palm over the area below the umbilicus b. Moving of her ringers of one hand over the uterus pressing into the muscle c. Spreading the ringers of one hand tightly over the hand d. Indenting the uterus in several places during and between contractions 78. During labor, when positioning a client on lithotomy, the MIDWIFE should  a. Make sure the legs are safety strapped on the stirrups b. Put her on semi-ceiling position first c. Gradually lift one legs after the other d. Put up hef client's leg together Situation 3. An early childhood febrile syndrome affecting the lymphodes was identified by the Public Health Nuse(PHN) 79. Cristina a three years old girl came to RHU due to fever unresponsive to antibiotics. During assessment, the MIDWIFE noticed that she has "strawberry tongue ". Which the following syndrome her diagnosis?   a. Karachi fever b. Igarashi fever c. Kawasaki fever d. Nagasaki fever 80. Upon assessment, you have observed that Cristina was irritable with mood changes and cervical lymphadenopalhy. What would you do to her?  a. Blame the mother b. Give medication c. Divert bar attention d. Spank her 81. When the doctor arrived, the mother wanted to bring her child to a tertiary hospital. Which level of bars would you put Cristina in? a. fourth b. first c. second d. third 82. Which among the treatment below was ordered by the physician for Cristina's mother to b buy uy from the "Botika sa barangay"?  a. Immunoglobuline b. Antihistamine c. Paracetamol d. Salicylatea  83. Susceptibility of the syndrome that Cristina was affected with, is from what ancestry?   a. Aryan b. Caucasian c. Asian d. America Situation 6. MIDWIFEs provide care to individuals in the various stages of health & illness. 84. Which of the following are internal factors that influence health practices? a. Family practices b. Norms of society c. Religious beliefs d. Developmental stage 85. Health-illness continuum refers to which of the following statements? A person a. Can both be healthy or ill b. Is either healthy or sick c. Can be at the level of health & illness   d. Is either not healthy or not ill 86. One's ideas convictions and attitudes which influence his level of health is referred to as his:   a. Health beliefs b. Health habits c. health practice d. health perceptions 87. Health Beliefs Model states that one on e takes health action if:  a. Is consistent of his health beliefs b. Get support from family c. Agree with the society's norms d. Will prevent his getting sick   88. Health action that keeps one's present level of health is referred to as:  a. Health enhancement b. Health promotion c. Death prevention d. Health maintenance Situation 7.Cathy is in the early first trimester of her first pregnancy. ,

 

nursin g history, she states that her last menstrual period 89. Cathy visits her gynecologist to confirm a suspected pregnancy. During the nursing began April 11. Cathy states that some spotting occurred in May 8. The MIDWIFE calculates that her due date is:   a. January 10 b. January 18 c. February 12 d. February 15 90. Cathy asks the MIDWIFE why menstruation ceases once pregnancy occurs. The MIDWIFE's best response would be that this t his occurs because of the  a. Reduction in the secretion of hormones by the ovaries b. Production of estrogen and progesterone by the ovaries. c. Secretion of luteinizing hormone produced by the pituitary d. Secretion of follicle-stimulating hormone produced by the pituitary. 91. The MIDWIFE is aware that the nausea and vomiting commonly experienced by many women during the first trimester of pregnanc y is an adaptation to the increased level of a. Estrogen b. Progesterone c. Luteinizing hormone d. Chorionic gonadothropin 92. The MIDWIFE in the prenatal clinic should provide nutritional counseling to all newly pregnant women because:   a. Most weight gain during pregnancy is fluid retention b. Dietary allowance should not increase during pregnancy c. Pregnant women must adhere to a specific pregnancy diet d. Different sources of essential nutrients are favored by different cultural groups 93. Cathy is now in her 8 weeks of pregnancy and complains of having to go to the bathroom often to urinate. The MIDWIFE explains to her that urinary frequency often occurs because the capacity of the bladder during pregnancy is diminished by:   a. Atony of the detrusor muscle b. Compression by the ascending uterus c. Compromise of the autonomic reflexes d. Constriction of the ureteral entrance at the trigone Situation 8. AIDS cases has been all over the country and yet only few are reported cases due to the stigma attach to it. 94. What is the causative agent in HIV/AIDS?   a. trichomonas vaginalis b. Human, T-cell lymphotrophio virus c. Treponema pallidum d. Chlamydia tranchomatis 95. A classic full blown AIDS case is identified by clinical manifestations such as:   a. Persistent generalized lymphadenopathy b. Sudden loss of weight, afternoon fever and general malaise c. Tumors and opportunistic infections d. Fever, weight loss, night sweats and diarrhea 96. Pulmonary complications are the most common problem in caring for AIDS patients. This is caused:   a. Kaposi's Sarcoma b. Filterable Virus c. Pneumonia Carnii d. Staphylococcus bacteria

infec tions is/are the following:  97. The cause of death of most AIDS patients who develop multiple opportunistic infections a. Weakened immune system impairs response to therapy b. AH of these (a, b, c) c. Weakened immune system impairs resistance to infection d. Infection cannot be treated effectively 98. Implementation of the following activities can help prevent the transmission of AIDS through the blood.   1. Conduct public education campaign, with the aim of implementation self-deferral of blood donate who are risk of HIV infection 2. Educate health care workers on the correct use of blood 3. Conduct surveillance of women attending anti-natal clinics 4. Use of condoms of those found to be infected with HIV a. 1 & 2 b. 3 & 4 C. 1 & 3 d. 2 & 3 Situation 10. You are assigned as a public health MIDWIFE to oversee the different health activities in your community. 99. While you were going over the record of Mrs. Uy who missed her prenatal appointment date. Her review of tthe he family folder sshowed howed the following: GR-II, PARA II; with w ith slight edema; BP=150/100. Mra. Uy eldest son in underweight is sick of H-fever. MIDWIFE Linda

planned a home visit. Which of the t he following would you give priority in planning her for the family?   a. Mrs. Uy's eldest son who is sick with H-fever b. Mrs. Uy pre-eclampsia c. Nutritional status of Mrs. Uy’s Uy’s eldest son d. Family potential threat of cross-infection from H-fever 100. The midwife refers to you a family who fails to take action regarding a sick member of the family despite her suggestions. In helping h elping

 

the family decide on what actions to take you will.   1. Explain the consequences of inaction 2. Identify the courses of action open to the family and resources needed for each 3. Discuss the consequences of each course of action available 4. Influence me family to act on what you think is best for the situation a. 1 & 4 b. 2, 3 & 1 c. 2 & 3 d. 4 only 101. Elisa is on her 1 1/2 month pregnancy. Her first child 3 1/2 month monthss old. She asked you if she should stop breastfeeding her first baby since she is now pregnant. Your response should be the following. EXCEPT:  a. Breastfeeding during pregnancy is not harmful to either of the babies. b. Sudden weaning can be harmful and can make the older child ill c. Breast milk is only valuable until the child is 4 months old d. She can start giving solid foods in preparation for weaning when her child is 4 to 6 months old

f ollowing statements is correct regarding Community Health Nursing (CHN)? 102. Which of the following a. Professional growth and development of the PHN is the responsibility of the Department health b. Provision of CHN care is not any way affected by policies of the agency where the MIDWIFE work c. The PHN worked with community 19 for 6 years can solely determine the health needs of the community d. Evaluation of the health status of individuals and families should be done in consultation with them  103. In developing capability of people to assume more responsibility for their health, which of the following statements would you consider most important? a. Lead-lag in the health activities b. Organizing me community for health c. Identifying health problems with the people d. Making medicine available Situation 11. Demographic profile of the elderly population is important in the nursing profession and it is therefore important to know the basic facts about it 104. According to the definition of UN and WHO elderly people are who belong to the age bracket of   a. 60 years old and above   b. 65 to 74 years old c. 85 years old and above d. 75 to 84 years old

g roup do old-old person, belong   105. There are four classifications of elderly, which age group a. 55 to 60 years old b. 65 to 74 years old c. 75 to 84 years old d. 85 years old and above 106. Factors that affect Reproductive health includes, except, a. Socio-economic b. Status of Women c. Status of Men d. Social and Gender Issues 107. Element of Reproductive Hearth is responsible for the sex education for students, a. Men's Reproductive Health b. Adolescent Reproductive Health c. Family Planning d. V.A.W 108. Essential Tool used in Community Health Nursing, that saves time and effort, a. Bag technique b. Public Health Bag c. BP Apparatus d. Thermometer Technique 109. Principles in Home Visit include, except  a. Home visit should have an objective or purpose. b. Planning of Home Visit should be flexible and practical. c. Planning revolves around the needs of the MIDWIFE.   d. Planning should revolve around the essential needs of the family, 110. Steps in Home Visit, which should be done initially?  a. Wash hands b. Greet Client or household c. Explain purpose of visits d. Ask about client's health status. 111. After home delivery, the MIDWIFE should include in her health teaching a. Circumcision of the Infant b. Immunization c. Starting the infant on bottle feeding d. Breast feeding of infant

 

112. In giving tetanus toxoid immunization for pregnant women, the first dose should be given.   a. Second Trimester b. 3rd Trimester c. 1 year after delivery d. as early as possible during pregnancy 113. The legal mandate that supports the PHC act  a. LOI 949  b. PD 996 c. E.O 51 d. RA7180 114. Requirements to be a Public Health MIDWIFE Includes   1. Filipino citizen 2. BSN, RN 3. Masters degree in Nursing 4. 3 years as a C. I a. 1, 3 b. 3, 4 c. 1, 2 d. 2, 4 115. Which of the following f ollowing statements best explain the concept of people empowerment?   a. People are the health beneficiaries b. People themselves are health resources c. People can demand health services d. People are our partners in health 116. As a PHN you also have an active role in disease surveillance sod epidemiology of disease in the community. Among others you also do the following.  1. Immediately inform the rural health physician of any unusual increases cases in the community disease. 2. Conduct epidemiological investigation on all reported outbreaks 3. Request the midwife to graph weekly disease incidence cases in the municipality 4. Assist in the planning and implementing disease control measures during outbreak a. 1, 2 & 4 b. 2 & 4 c. 1 & 4 d. 3 & 4 117. The habitual presence of a disease or infectious agent within a given geographic area is:   a. Epidemic b. Endemic c. Pandemic d. Sporadic 118. Measures the frequency of occurrence of new cases of a certain disease during a given period of time   a. Prevalence rate b. Endemic c. Fatality rate d. Mortality rate Situation 13. Theories regarding the aging process were formulated in order to guide the health care profession in their care of the elderly patient. 119. Theories proposed to explain aging are organized as:   a. Fully explanatory and partially explanatory b. Complete and incomplete c. Genetic, biochemical and sociopsychological d. Known and unknown 120. In the "Wear and Tear" theory of aging continued use of the body is supposed to lead to worn out parts, similar to the breakdown and wearing out ®f old machinery. This could not explain aging because:   a. Continued use has little effect b. Nothing over wears out completely c. The human body can’t be compared to machinery   d. Greater use leads to improvement in some systems such as muscles 121. The "Somatic Mutation Theory" states that low doses of radiation accelerate aging. The theory has been criticized for three reasons. Which of the following is not of the reasons why this theory explains little about the aging process. a. Sunscreens are now available to block out fee harmful ultraviolet rays b. The effect of the sun occurs mainly in dividing cells while the effects of aging are seen mainly in calls that no longer divide c. The number of cells that undergo mutation is too small to account for overall aging. d. Most cells contain mechanisms for the repair of DNA

122. Which of the following f ollowing explains that the critical factor in framing old age concerns is how well persons function in regards regard s to activities of daily living? a. The functional capacity theory b. The activity theory c. the disengagement theory d. the personal meaning theory

 

123. The view of the older people "Withdraw" from the soclety is:   a. The adics theory b. The disengagement theory c. The parling theory d. The absence theory Situation 14. Mrs. Castro is one-week post partum. She visits health center because of fever and intense pain over the episiotomy site. 124. What will be first action of the MIDWIFE?  a. Assess for signs of anemia b. Determine nutritional status c. Ask for the possibility of sexual intercourse d. Elici: history of delivery 125. Upon inspection the MIDWIFE observes an edematous episiotomy site. Which of the following intervention will you first apply ?  a. Administer antimicrobials as ordered b. Expose the wound to perilight c. Cleanse the episiotomy with iodine solution d. Give oral analgesic 126. Upon inspection the MIDWIFE observes an edematous episiotomy site. Which of the following herbal plants can be used to related perineal infection?  a. Lagundi b. Banana Leaves c. Herba Buena d. Guava Leaves 127. Breast engorgement can also cause temperature elevation, but does not last longer than how many hours?   a. 48 hours b. 12 hours c. 10 hours d. 24 hours  128. Which of the following is an anti-inflammatory drug?  a. Metoprotol succinate

b. Mefenamic Acid  c. Meperidine hydrochloride d. Mefhylergonovine oaaleate Situation 15. The Department of Health implements various health programs and projects in order to achieve its goals and objectives. As a Public Health MIDWIFE you are one of the implementers of these programs at the municipal level. 129. The primary function of the t he Department of Health is the promotion, preservation or restoration of the health of the people through.  a. Regulation and encouragement of providers of health goods and services b. Provision and delivery of health services c. All of these except reduction of morbidity and mortality d. Reduction of morbidity and mortality 130. In recent years, the government have given more emphasis of which of the following.   a. Rehabilitation b. Treatment of disease c. Prevention of illness d. Treatment and rehabilitation

t hese groups are your target audience for health education? 131. In your campaign against sexually transmitted disease which of these a. Commercial social workers b. All of these groups c. General population d. Health workers and private practitioners 132. Knowing the policies if the National Family Planning Program which of these is the best contraceptive method to use for a couple who have already four children? a. Use of IUD since she is still on her postpartum period b. Natural family planning method since her menstruation is still regular c. A method they will choose and use d. Tubal ligation as this is more permanent method 133. Under the National Center Control Program, the following are primary prevention measures implemented cancer of the mouth except  a. Avoidance of inverted cigarette smoking b. None of these c. Improved dental hygiene d. Avoidance of smoking and betel chewing

Situation 16. The Community Health MIDWIFE prepares/participate in the preparation of the community health care plan. 134. In order to plan effectively, the MIDWIFE needs a -working knowledge on the following, except a. None of these  b. The way people view health and how they are using health care services c. Health status profile of the community

 

 

d. Data on quality assurance

135. In a rural health unit with full man po power wer complement, the MIDWIFE's main contribution in the preparation of the total health care plan is the.  a. Preparation of the nursing component of the plan b. Collation of the data on Health Statistics e. Identification of health problem of the barangays d. Analysis of the community survey data 136. Which of the following f ollowing statement would serve as a guide in the preparation, of the community health care plan?   a. Recommendation for action should be stated in quantifiable terms b. The formulation of criteria for evaluating the effectiveness of the plans must be an aspect of planning c. All of these statements d. Problems goals and objectives should be stated in quantifiable terms 137. Which of the following f ollowing is a well-stated objective of a community health nursing care plan a. To increase the number of mothers coming for prenatal check-up by 25% in 6 months time. b. To increase the number of home visits by 50% c. To increase the coverage for immunization in 1 year time d. To increase the number of children receiving food assistance 138. If the objectives o bjectives of the health care plan is to decrease the number of children with parasitism: by 50% by the end of 2 yea rs, which of these would be an appropriate evaluation indicator? a. Number of children found positive for ascaris/ amebiasis/ hookworm, infection b. Number of children examined for parasitism c. Number of children who consulted for abdominal pain and anemia d. Number of children who were dewormed Situation 17. Your head MIDWIFE participated a 2-weeks seminar. You were designated to be an officer-in-charge of your nursing unit. 139. In unit planning p lanning which of the following questions initiate the process?  a. How to schedule the activities? b. Who will do the planning? c. What is to be accomplished? d. Where to get unit supplies? 140. This is an example of data that should be analyzed when identifying missing needs.  a. Number of nursing staff b. Medical diagnosis of patient c. Ward supplies and materials d. Patient classification 141. To accomplish the nursing unit work, you should first get information about:   a. Objectives of the unit c. Nursing budget b. Nursing service organizational chart d. Mission of the hospital 142 This is an example of a patient care unit objective a. To ensure adequate unit supplies/materials b. To use the kardex system of charting c. To determine the number of nursing staff needed d. To provide safe nursing

f ollowing tools can be most helpful h elpful in the evaluation of staff performance? 143. Which of the following a. Performance assessment b. Performance standard c. Performance audit d. Performance appraisal Situation 18. Rebecca, a 2 year old and her Mother are consulting the community health MIDWIFE 144. The MIDWIFE observes Rebecca at play in the clinic. She realizes that at this age, Rebecca could be expected to exhibit which of the following?  a. Build houses with blocks b. Is extremely possessive of toys c. Attempts to stay within the hue when coloring d. Amuses herself with a picture book of 15 minutes 145. When observing Rebecca, the MIDWIFE would expect her to engage in which type of play? a. Parallel play b. Solitary play c. Competitive play d. tumbling play

b e appropriate to take her to the t he dentist for dental prophylaxis. What is t he 146. Rebecca's mother asks the MIDWIFE when it would be MIDWIFE most appropriate response? a. Before starting school b. Between 2 and 3 years of age c. When Rebecca begins to lose deciduous teeth d. The next time another family member goes to the dental

 

  147.. Rebecca's mother say's that Rebecca consistently says "no” every time she is offered fluids. Considering Rebecca's devel opment, 147 how could the MIDWIFE assist the mother to increase Rebecca's fluid intake?  a. Distract her with some food b. Be firm and hand her the glass c. Offer her a choice of two things to drink d. Let Rebecca see that she is making her mother angry 148. Rebecca is well and is to t o be discharged- Her mother asks the MIDWIFE why Rebecca persists in saying ''no'' to everything. The MIDWIFE explains to Rebecca's mother that this negativism is helping Rebecca to meet a 2 year old need for which of the following? a. Trust b. Attention c. Discipline d. Independence Situation 19. You are the MIDWIFE assigned in the MIDWIFEry unit and your patients are of various ages. 149. Assessment an infant, the MIDWIFE knows that a pincer grasp nornally appears  a. At the same time as the palmar grasp b. Between 9 & 12 month of age c. Between 5 & 7 month of age d. Along with the ability to "rake" objects toward themselves 150. In a child development, the period of negativism begins when the child  a. Can manipulate his or her parents b. Copies negative behavior of sibling. c. Is struggling between dependence and independence d. Is learning manual skills 151. The MIDWIFE is caring for a hospitalized toddler who was toilet trained home. He wets his pants. The best response to this situation is to say?  a. "Its okay, try not to wet your pants next time”   b. "That's okay. Now lets get you cleaned up”   c. "I know you understand how to use the toilet; what happened?" d. "Your mom told me you don't wet anymore; what's wrong?" 152. Which of the following behavior would a normal 18 moths old be likely to exhibit during the first few hours of hospitalization?  a. Crying loudly when parents leave b. Readily accepting the MIDWIFE caring for him c. Showing considerable interest in new toy d. Sitting quietly in the comer of the cab, showing little or no interest in his surrounding 153. Evaluating a 1 month old infant normal developmental skills, the MIDWIFE should observe that the infant a. Actively follow movement of familiar persons with her eyes b. Responds to "No-No" c. Turns her head to a familiar noise d. Discriminates between family and strangers 154. The MIDWIFE knows which of the following indicates protein deficiency?  a. Hypoalbuminemia and pot belly b. Koionychia (spoon-shaped nails) c. Beefy red tongued. d. Bleeding gums 155. Before administering a tube feeding the MIDWIFE knows to perform which of the following assessments? a. The GI tract including bowel sound, last BM and distention b. The clients neurologic status, especially gag reflex c. The amount of air in the stomach d. The formula used directly from the refrigerator 156. An adult is being taught about a healthy diet. The MIDWIFE can offer:  a. Milk b. Jello c. Freshly squeezed orange juice d. Ice cream 157. An adult has received an injection of immunoglobulin. The MIDWIFE knows that the client will develop which of the following types of immunity:  a. Active natural immunity b. Active artificial immunity c. Passive natural immunity d. Passive artificial immunity

158. Which of these groups should a MIDWIFE target when planning a community education presentation about testicular cancer?  a. Day care providers b. Senior citizens c. Middle - aged men d. High - school students 159. A woman reports all of the following data when giving his history to a MIDWIFE. Which one would indicate a risk factor for developing cancer of cervix?  

 

 

a. Diet high in fat b. Exposure to pesticides c. "What does your family want you to do." d. "I wouldn't have the t he surgery done without a second opinion."

160. A MIDWIFE is planning a community education presentation about testicular cancer. The large groups should be b e men aged:   a. 20 to 39 years b. 40 to 49 years c. 50 to 64 years d. 65 years and older 161. A 10-year-old boy who is in the terminal stages of Duchenne muscular dystrophy is being cared fo forr at home. When evaluating for major complications of this disease, a MIDWIFE would give priority to assessing which of the following body systems?   a. Integumentary b. Neurological c. Respiratory d. Gastrointestinal

Br uce. Which of the following is part 162. The physician asks the MIDWIFE to describe the laparoscopy procedure for sterilization to Ms. Bruce. of a correct explanation of this procedure?   a. Two small abdominal incisions are made to introduce the instrument b. Hospitalization for 4 to 5 days is normally required c. This procedure is performed vaginally d. This procedure requires the consent of the sexual partner 163. The MIDWIFE is asked to plan a health teaching program for women of child -bearing age with genital herpes. Which one of the following should the MIDWIFE include in a teaching session?  a. The physician will prescribe an antiviral drug as a pregnancy is confirmed b. Genital herpes in the mother-has no effect on the infant c. Wait until the infection has been cured before becoming pregnant d. If pregnant, in form the physician of a history of genital herpes 164. Ms. Manning is scheduled for Papanicolaou test (Pap Smear) at the time of the next visit to the physician's office. Which one o ne of the following instructions should the MIDWIFE give to Ms. Manning?   a. Do not douche for 2 to 3 days before this test b. Do not drink coffee or alcoholic beverages for 2 days before this test c. It will be necessary to fast from midnight the night before the test d. Bring a sanitary napkin with you because bleeding usually occurs after this week 165. The MIDWIFE obtains a health history from Ms. Reeves who states that she usually has symptoms when she ovulates. If Ms. Reeves has a normal menstrual cycle, how many days after ovulation should menstruation begin?  a. 3 days b. 7 days c. 14 days d. 21 days 166. The physician asks the MIDWIFE to discuss the use of an oral contraceptive with Ms. Sheppard. The MIDWIFE should instruct M s. Sheppard that oral contraceptive:  a. Are taken at the same time t ime each day, preferably in the evening b. Must be taken on an empty stomach c. Are started on the first day of menstruation d. Are best taken in the morning before breakfast 167. Ms. Dodd has been told by her physician that she has genital warts, which are caused by a human .papilloma.papilloma-virus-infection. virus-infection. She asks the MIDWIFE if there is any danger or problems associated with this t his condition. The most correct response-is based on the fact that genital warts:  a. Can be treated with an antibiotic, such as penicillin or tetracycline b. Appear to increase the risk of cancer of the vulva, vagina, and cervix c. Can be prevented of the individual takes birth control pills d. Are of no danger and need not be treated 168. Which of the following f ollowing are included in the instructions for a client h having aving a pelvic examination?  a. Self-administer an enema or take a laxative for 2 nights prior to the examination b. Void immediately before the examination c. Douche the day before the examination d. Do not eat or drink fluids after midnight 169. The MIDWIFE is assigned to teach young women attending a gynecology clinic. The physician suggests that the MIDWIFE include explaining ways to prevent toxic shock syndrome. Which one of the th e following suggestions can be included in this teaching session?  a. Avoid using super absorbed tampons b. Take a diuretic at the onset of menstruation c. Avoid the use of large sanitary pads d. Use a tampon only during the night PART 2

1. Which is the primary goal of community health nursing?   A. To support and supplement supp lement the efforts of the me medical dical profession iinn the promotion of hea health lth and prevention ooff B. To enhance the capacity of individuals, families and communities to cope with their health needs C. To increase the productivity of the people by providing them with services that will increase their level of health

 

 

D. To contribute to national development through promotion of family welfare, focusing particularly on mothers and children

2. CHN is a community-based practice. Which best explains this statement? state ment?  A. The service is provided in the natural environment e nvironment of peopl peoplee B. The MIDWIFE has to conduct community diagnosis to determine nursing needs and problems   C. The service are based on the available resources within the community D. Priority setting is based on the magnitude of the health problems identified 3. Population- focused nursing practice requires which of the following processes? p rocesses?   A. Community organizing organizin g . B. Nursing, process C. Community diagnosis  diagnosis  D. Epidemiologic process

4. RA 1054 is also known as the Occupational Health Act. Aside from the number of employees, what other factor must be considered in determining the occupational health privileges to which the workers will be entitled?    A. Type of occupation,: agriculture, agricu lture, commercia commercial,l, industrial B. Location of the workplace in relation to health facilities   C. Classification of the business enterprise based on net profit D. Sex and age compositio compositionn of eemployees mployees

5. A business firm must employ an occupational health MIDWIFE when it has at least how many employees.   A. 21 B. 101  101  C. 201 D. 301

6. When the occupational health MIDWIFE employs ergonomic principles, she is performing which of her roles?  A. Health care provider B. Health educator C. Health care coordinator D. Environment manager  

7. A garment factory does not have an occupational MIDWIFE. Who shall provide the occupational health needs of the factory workers?   A. Occupational health heal th MIDWIFE at the Provincial Health Office B. Physician employed by the factory C. Public Health MIDWIFE of the RHU of their municipality D. Rural Sanitary inspector of the RHU in their municipality

8. "Public health services are given free of charge". Is this statement true or false?   A. The statement is true; it is the responsibility re sponsibility of government gove rnment to provide ha haste ste services B. The statement is false; people pay indirectly for public health services   C. The statement may be true or false; depending on the Specific service required D. The statement may be true or false; depending on policies of the government concerned.

9. According to C.E. Winslow, which of the following is the goal of Public Health?  A. For people to attain their thei r birthrights and longevity  long evity   B. For promotion of health and prevention and diseases C. For people to have access to basic health services D. For people to be organized in their health efforts

10. We say that a Filipino has attained longevity when he is able to reach the average life span of Filipinos. What other sta tistic may be used to determine attainment of longevity?    A. Age-specific mortality rate B. Proportionate mortality rate C. Swaroop's index   D. Case fatality rate

11. Which of the following is the most prominent feature of public health nursing?   A. It involves providing home h ome care to sick peop people le who are not confi confined ned in the hospital B. Services are provided free of charge to people within the catchment area C. The public health MIDWIFE functions as part of a team providing a public health nursing service D. Public health nursing focuses on preventive, not curative services  services 

12. According to Margaret Shetland, the philosophy of public health nursing is based on which of the following?   A. Health and longevity longe vity as birthrights B. The mandate of the state to protect the birthrights of its citizens C. Public health nursing as a specialized field of nursing D. The worth and dignity of man

13. Which of the following is the mission of the Department of Health?  

 

 

A. Health for all Filipinos B. Ensure the accessibility and quality of health C. Improve the general health status of the population D. Health in the hands of the Filipino people by the year 2020

14. Region IV Hospital is classified as what level of facility?  A. Primary B. Secondary C. Intermediate D. Tertiary   15. What is true of primary p rimary facilities?   A. They are usually government-run gove rnment-run B. Their services are provided on an out-patient basis C. They are training facilities for health professionals D. A community hospital is an example of this level of health facilities 16. Which is an example of the school MIDWIFE's health care provider function?   A. Requesting for BCG from the RHU for school entrance immunization i mmunization B. Conducting random classroom inspection during measles epidemic   C. Taking remedial action on an accident hazard in the school playground D. Observing places in the school where pupils spend their free times

17. When the MIDWIFE determines whether resources were maximized in implementing Ligtas Tigdas, she is evaluating:    A. Effectiveness B. Efficiency   C. Adequacy D. Appropriateness

18. You are a new B.S.N. graduate. You want to become a Public Health MIDWIFE. Where will you apply?    A. Department of Health B. Provincial Health Office  Office   C. Regional Health Office D. Rural Health Unit

19. RA 7160 mandates devolution of basic services from the national government to local government units. Which of the follow following ing is the major goal of devolution?    A. To strengthen local government go vernment units B. To allow greater autonomy to local government units. C. To empower the people and promote their self-reliance  self-reliance  D. To make basic services more accessible to the people

20. Who is the Chairman of the Municipal Health Board?   A. Mayor   B. Municipal Health Officer C. Public Health MIDWIFE D. Any qualified physician

21. Which level of health facility is the usual point of entry of a client into the health care delivery system?   A. Primary   B. Secondary C. Intermediate D. Tertiary

22. The public health MIDWIFE is the supervisor of rural health midwives. Which of the following is a supervisory function of the pubic health MIDWIFE?   A. Referring cases or patients patie nts to the midwife B. Providing technical guidance to the midwife  midwife   C. Proving nursing care to cases referred by the midwife D. Formulating and implementing training programs for midwives

23. One of the participants in a hilot training class asked you to whom she should refer a patient in labor who develops a complication.  You will answer, to the;   A. Public health MIDWIFE B. Rural health midwife C. Municipal health officer   D. Any of these health professionals 24. You are the public health MIDWIFE in a municipality with a total population of about 20,000. There are3 health midwives among the RHU personnel. How many more midwife items will the RHU need?   A. 1  1  B. 2 C. 3

 

 

D. 4

25. If the RHU needs additional midwife items, you will submit the request for additional midwife items for approval to the:   A. Rural Health Unit B. District Health Office C. Provincial Health Office D. Municipal Health Board  

26. As an epidemiologist, the MIDWIFE is responsible for reporting cases or notifiable n otifiable diseases. What law mandates reporting cases of notifiable diseases?   A. Act 3573  3573  B. RA.3753 C. RA 1054 D. RA 1082

27. According to Freeman and Heinrich, community health nursing is a developmental service. Which of the following best illustrates this statement?   A. The community health MIDWIFE M IDWIFE continuously develops de velops himself ppersonally ersonally and professionally pro fessionally B. Health education and community organizing are necessary in providing community health services   C. Community health nursing in intended primarily for health promotion and prevention and treatment of disease. D. The goal of community health nursing is to provide nursing services to people in their own place of .residence

28. Which disease was declared through Presidential Proclamation No. 4 as a target for, eradication in the Philippines?   A. Pioliomyelitis B. Measles  Measles  C. Rabies D. Neonatal Tetanus

29. The public health MIDWIFE is responsible for presenting the municipal health statistics using graphs and tables. To compare the frequency of the leading causes of mortality in the municipality, which graph will you prepare?    A. Line B. Bar   C. Pie D. Scatter diagram

30. Which step in community organizing involves training of potential leaders in the community?    A. Integration B. Community organization C. Community study D. Core group formation  formation 

31. In which step are plans p lans formulated for solving community problems?   A. Mobilization B. Community organization  organization  C. Follow-up/extension D. Core group formation

32. The public health MIDWIFE takes an active role in community participation. What is the primary goal of community organizing?    A. To educate the people peopl e regarding community com munity health prob problems lems B. To mobilize the people to resolve community health problems   C. To maximize the community's resources in dealing with health problems  problems 

33. An indicator of success in community organizing is when people are able to:    A. Participate in community commun ity activities for the solutio solutionn of a community problem pro blem   B. Implement activities for the solution of the community problem C. Plan activities for the solution of the community problem D. Identify the health problem as a common concern

34. Tertiary prevention is needed in which stage of the natural history of disease?  A. Pre-pathogenesis B. Pathogenesis C. Predromal D. Terminal  

35. Isolation of a child with measles belongs to what level of p prevention? revention?   A. Primary   B. Secondary C. Intermediate D. Tertiary

 

36. On the other hand, h and, Operation Timbang is_____ prevention?   A. Primary B. Secondary   C. Intermediate D. Tertiary

37. Which type of family-MIDWIFE contact will provide you with the best opportunity to observe family dynamics?    A. Clinic consultation B. Group conferences C. Home visit   D. Written communication

38. The typology of family f amily nursing problems is used in the statement of nursing diagnosis in the care of families. The youngest child of the delos Reyes family has been diagnosed as mentally retarded. This is classified as:   A. Health threat B. Health deficit C. Foreseeable crisis D. Stress point

39. The delos Reyes coupled have 6-year old child entering school for the first time. The delos Reyes family has a:   A. Health threat B. Health deficit C. Foreseeable crisis  crisis   D. Stress point 40. Which of the following is an advantage of a home visit?   A. It allows the MIDWIFE to provide provi de nursing care to a greater g reater number of pe people ople B. It provides an opportunity to do first hand appraisal of the home situation   C. It allows sharing of experience among people with similar health problems D. It develops the family's initiative in providing for health needs of its members

41. Which is CONTRARY to the principles in planning a home visit?    A. A home visit should have ha ve a purpose of objective ob jective B. The plan should revolve around the family health .needs C. A home visit should be conducted in the manner prescribed by RHU   RHU   D. Planning of continuing care should involve a responsible-family member

42. The PHN bag is an important tool in providing nursing care during a home visit. The most important principle in bag technique states that it;   A. Should save time and effort B. Should minimize if not totally prevent the spread of infection   C. Should not overshadow concern for the patient and his family D. May be done in variety of ways depending on the home situation, etc.

43. To maintain the cleanliness of the bag and its contents, which of the following must the MIDWIFE do?   A. Wash his/her hands before be fore and after providing pro viding nursing care to the family members members   B. In the care of family member's, as much as possible, use only articles taken from the bag C. Put on an apron to protect her uniform and fold it with the right side out before putting it back into the bag. D. At the end of the visit, fold the lining on which the bag was placed, ensuring that the contaminated side is on the outside.

44. The public health conducts a study on the factors contributing to the high morality rate due to heart diseases i n the municipality where she works. Which branch of epidemiology does the MIDWIFE practice practice in this situation?    A. Descriptive B. Analytical   C. Therapeutic D. Evaluation

45. Which of the following is a function of epidemiology?    A. Identifying the disease disea se condition base basedd on manifestations pr presented esented by a clien clientt B. Determining factors that contributed to the occurrence of pneumonia in a 3 year old C. Determining the efficacy of the antibiotic used in the treatment of the 3 year old client with pneumonia D. Evaluating the effectiveness of the implementation of the Integrated Management of Childhood Illness Illness   46. Which of the following is an epidemiologic function of the MIDWIFE during an epidemic?  A Conducting assessment assess ment of suspected case casess to detect the communica communicable ble diseases B. Monitoring the condition of the cases affected by the communicable disease C. Participating in the investigation to determine the source of epidemic   D. Teaching the community on preventive measures against the disease

47. The primary purpose of conducting an epidemiologic investigation is to;   A. Delineate the etiology etiol ogy of the epidemi epidemicc

 

 

B. Encourage cooperation and support of the community C. Identify groups who are at risk of contracting the disease D. Identify geographical location of cases of the disease in the community   community  

48. Which is a characteristic of person-to-person propagated epidemic?   A. There are more cases of o f the disease than expected expec ted B. The disease must necessarily be transmitted through a vector C. The spread of the disease can be attributed to a common vehicle D. There is gradual build up of cases before we epidemic becomes easily noticeable  

49. In the investigation of an epidemic, you compare the present frequency of the disease with the usual frequency at this time of the year in this community. This is done during which stage of the investigation?    A. Establishing the epidemic  epi demic   B. Testing the hypothesis C. Formulation of the hypothesis D. Appraisal of facts

50. The number of cases of Dengue fever usually increases towards the end of the rainy season. This pattern of occurrence of Dengue fever is best described as;   A. Epidemic occurrence B. Cyclical variation  variation  C. Sporadic occurrence D. Secular occurrence

51. In the year 1980, the World Health Organization declared the Philippines, together with some other countries in the Western Pacific Region, “free" of which disease?  disease?    A. Pneumonic plaque plaqu e B. Poliomyelitis C. Small pox   D. Anthrax

52. In the census of the Philippines in 1995, there were about 35,299,000 males and about 34,968,000 females. What is the sex ratio?   A. 99.06:100 B. 100.94:100   C. 50.23% D. 49.76%

53. Primary health care is a total approach to t o community development. Which of the following is an indicator of success in the use of the primary health care approach?   A. Health services are provided p rovided free of charge to individuals and families fa milies B. Local officials are empowered as the major decision makers in matters of health C. Health workers are able too provide care based on identified health needs of the people D. Health programs are sustained according to the level of development of the community   community  

54. Sputum examination is the major screening tool for pulmonary tuberculosis. Clients would sometimes get false negative results in this exam. This means that the test is not perfect in terms of which characteristic of a diagnostic examination?   A. Effectiveness B. Efficacy C. Specificity D. Sensitivity  

55. Use of appropriate technology requires knowledge of indigenous technology. Which medical herb is given for fever, headach e and cough?   A. Sambong B. Tsaang gubat C. Akapulko D. Lagundi  

56. What law created the Philippine institute of Traditional and Alternative Health Care?   A. RA 8483  8483   B. RA4823 C. RA 2483 D. RA 3482

57. In traditional Chinese medicine, the yielding, negative and feminine force is termed:   A. Yin  Yin  B. Yang C. Qi D. Chai

58. What is the legal basis b asis of Primary Health Care approach in the Philippines? 

 

   A. Alma Ata Declaration of o f PHC B. Letter of Instruction No 949  949  C. Presidential Decree No. 147 D. Presidential Decree 996

59. Which of the following demonstrates inter-sectoral linkages?   A. Two-way referral system B. Team approach C. Endorsement done by a midwife to another midwife D. Cooperation between PHN and public school teacher  

60. The municipality assigned to you has a population of about 20/000. Estimate the number of 1-4 year old children who be given Retinol capsule 200.000 every 6 months.   A. 1,500 B. 1,800 C. 2,000 D. 2,300  

61. Estimate the number of pregnant women who will be given tetanus toxoid during an immunization outreach activity in a barangay with a population of about 1,500.   A. 265   B. 300 C. 375 D. 400 62. To describe the sex composition of the population, which demographic tool may be used?    A. Sex ratio B. Sex proportion C. Population pyramid D. Any of these maybe used  

63. Which of the following is a natality rate?  A. Crude birth rate  rate   B. Neonatal mortality rate C. Infant mortality rate D. General fertility rate

64. You are computing the crude rate of your municipality, with a total population o about 18,000 for last year. There were 94 deaths. Among those who died, 20 died because of diseases of the heart and 32 were aged 50 years or older. What is the crude death rate?    A. 4.1/1000 B. 5.2/1000   C. 6.3/1000 D. 7.3/1000

65. Knowing that malnutrition is a frequent community health problem, you decided to conduct nutritional assessment. What population is particularly susceptible to protein p rotein energy malnutrition (PEM)?   A. Pregnant women and the th e elderly B. Under 5 year old children C. 1-4 year old children  children   D. School age children

66. Which statistic can give the most accurate reflection of the t he health status of a community?    A. 1-4 year old age-specific age-s pecific mortality rate B. Infant mortality rate C. Swaroop's index D. Crude death rate  rate 

67. In the past year, Barangay A had an average population of 1655. 46 babies were born in that year, 2 of whom died less than 4 weeks after they were born. They were 4 recorded stillbirths. What is the neonatal mortality rate?    A. 27.8/1000   B. 43.5/1000 C. 86.9/1000 D. 130.4/1000

68. Which statistic best reflects the nutritional status of a population?   A. 1-4 year old age-specific age-s pecific mortality rate rate   B. Proportionate mortality rate C. Infant mortality rate D. Swaroop's index

69. What numerator is used in computing general fertility rate? 

 

   A. Estimated midyear population pop ulation B. Number of registered live births  births   C. Number of pregnancies in the year D. Number of females of reproductive age

70. You will gather data for nutritional assessment of a purok. You will g gather ather information only from families with members who belong to the target population for PEM. What method of delta gathering is best for this purpose?   A. Census B. Survey   C. Record Review D. Review of civil registry

71. In the conduct of a census, the method of population assignment based on the actual physical location of the people is termed;    A. De jure B. De locus C. De facto  facto  D. De novo

72. The Field Health Services and information System (FHSIS) is the recording and a nd reporting system in public health) care in the Philippines. The monthly field health service activity report is a form used in which of the components of the FHSIS?   A. Tally report   B. Output report C. Target/client list D. Individual health record

73. To monitor clients registered in long-term regimens, such as the Multi-Drug Therapy, which component will be most mo st useful?   A. Tally report B. Output report C. Target/client list   D. Individual health record

74. Civil registries are important sources of data. Which law requires registration of births within 30 days from the occurrence of the birth?   A. PD 651  651  B. Act 3573 C. RA 3753 D. RA 3375

75. Which of the following professionals can sign the birth certificate?   A. Public health MIDWIFE B. Rural health midwife C. Municipal health officer D. Any of these health professionals  professionals 

76. Which criterion in priority setting of health problems is used only in community health care?    A. Modifiability of the problem pro blem B. Nature of the problem presented C. Magnitude of the health problem  problem  D. Preventive potential of the health problem

77. The Sentrong Sigla Movement has been launched to improve health service delivery. Which of the following is/are true of this t his movement?   A. This is a project spearheaded spearhe aded by local government go vernment units B. It is a basis for increasing funding from local government units C. It encourages health centers to focus on disease prevention and control D. Its main strategy is certification of health centers able to comply with standards  

78. Which of the following women should be considered as special targets for family planning?    A. Those who have two children ch ildren or more B. Those with medical conditions such as anemia C. Those younger than 20 years and older than 35 years D. Those who just had a delivery within the past 15 months  months   79. Freedom of choice in one of the policies of the Family Planning Program of the Philippines. Which of the following illust rates this principle?   A. Information dissemination dissemina tion about the need nee d for family planning B. Support of research and development in family planning methods C. Adequate information for couples regarding the different methods  methods   D. Encouragement of couples to take family planning as a joint responsibility

80. A woman, 6 months pregnant, came to the center for consultation. Which of the following substances is contraindicated? 

 

   A. Tetanus toxoid B. Retinol 200,000 IU   C. Ferrous sulfate 200mg D. Potassium iodate 200 mg, capsule

81. During prenatal consultation, a client asked you if she can have her delivery at home. After history taking and physical examination, you advised her against a home delivery. Which of the th e following findings disqualifies her for a home delivery?   A. Her OB score is G5P3  G5P3   B. She has some palmar pallor C. Her blood pressure is 130/80 D. Her baby is in cephalic presentation

82. Inadequate intake by the pregnant woman of which vitamin may cause neural tube defects?    A. Niacin B. Riboflavin C. Folic Acid   D. Thiamine

83. You are in a client's home to attend to a delivery. Which of the following will you do first?   A. Set up a sterile area B. Put on a clean gown and apron C. Cleanse the client's vulva with soap and water D. Note the interval, duration and intensity of labor and contractions  

84. In preparing a primigravida for breastfeeding, which of the following will you do?    A. Tell her that lactation begins beg ins within a day aafter fter delivery B. Teach her nipple stretching exercises if her nipples are everted C. Instruct her to wash her nipples before and after each breastfeeding D. Explain to her that putting the baby to breast will lessen blood loss after delivery   delivery  

85. A primigravida is instructed to offer her breast to the baby for the first time within 30 minutes after delivery. What is the purpose of offering the breast this early?   A. To initiate the occurrence of milk letdown B. To stimulate milk production by the mammary acini   C. To make sure that the baby is able to get the colustrum D. To allow the woman to practice breastfeeding in the presence of the health worker

86. In a mother's class, you discuss proper breastfeeding technique. Which of these is a sign that the baby has "lactated on" the breast property?   A. The baby takes shallow, shallo w, rapid sucks B. The mother does not feel nipple pain  pain   C. The baby's mouth is only partly open D. Only the mother's nipple is inside the baby's mouth

87. You explain to a breastfeeding mother that breastmilk is sufficient for all of the baby's nutrient needs only up to:   A. 3 months B. 6 months  months   C. 1 year D. 2 years

88. What is given to a woman within a month after the delivery of a baby?    A. Malunggay capsule B. Ferrous sutfate l00mg O.D. C. Retinol 200.000 IU 1 capsule  capsule   D. Potassium Iodate 200 mg, 1 capsule

89. Which biological used in EPI is stored in the freezer?   A. DPT B. Tetanus toxoid C. Measles vaccine  vaccine  D. Hepatitis B vaccine

90. Unused BCG should be discarded how many hours after reconstitution?   A. 2 B. 4  4  C. 6 D. At the end of the day

91. In immunity school entrants with BCG, you not obliged to secure parental consent. This is b because ecause of which legal document document? ? 

 

 

A. PD 996   B. RA 7864 C. Presidential Proclamation No. 6 D. Presidential Proclamation No. 46

92. Which immunization produces a permanent scar?   A. DPT B. BCG  BCG  C. Measles vaccination D. Hepatitis B vaccination

93. A 4 week old baby was brought to the health center for his first immunization. Which can be given to him?   A. DPT1 B. OPV1 C. Infant BCG  BCG   D. Hepatitis B Vaccin

94. You will not give DPT 2 if the mother says that the infant had?   A. Seizures a day after DPT1  DPT1   B. Fever for 3 days after DPT1 C. Abscess formation after DPT1 D. Local tenderness for 3 days after DPT1

95. A 2-month old infant inf ant was brought to the health center for immunization. During assessment, the infant's temperature registered at 38.1 C. Which is the best course of action that you will take?   A. Go on with the infants immunization immu nization   B. Give paracetamol and wait for his fever to subside C. Refer the infant to the physician for further assessment D. Advise the infant's mother to bring him back for immunization when he is well

96. A pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will have protection against tetanus for how long?   A. 1 year   B. 3 years C. 10 years D. Lifetime

97. A 4-month old infant inf ant was brought to the health center of cough. Her respiratory rate is 42/minute. Using the IMCI guidelines of assessment, her breathing is considered;    A. Fast B. Slow C. Normal   D. Insignificant

98. Which of the following signs will indicate that a young child is suffering from severe pneumonia?    A. Dyspnea B. Wheezing C. Fast breathing D. Chest indrawing  

99. Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management for the child?    A. Prescribe antibiotic B. Refer him urgently to the hospital   C. Instruct the mother to increase fluid intake D. Instruct the mother to continue breastfeeding

100. A 5-month old infant was brought by his mother to the health center because of diarrhea occurring 4 to 5 times a day. His skin go es back slowly after a skin pinch and his eyes are sunken. Using the IMCI guidelines, you will classify this infant in which category?    A. No signs of dehydration dehydratio n B. Some dehydration  dehydration  C. Severe dehydration D. The data is insufficient

101. Based on the assessment, you classified a 3-month 3- month old infant with the chief complaint of diarrhea in the category of SOME DEHYDRATION. Based on the IMCI management guidelines, which of the following will you do?   A. Bring the infant to the nearest near est facility where IV fluids can ca n be given B. Supervise the mother in giving 200 to 400ml of Oresol in 4 hours  hours   C. Give the infant's mother instructions on home management D. Keep the infant in your health center for close observation

102. A mother is using Oresol' in the management of diarrhea of her 3-year 3 -year old child. She asked you what to do if her child vomits. You

 

will tell her to:   A. Bring the child to the nearest ne arest hospital for furthe furtherr assessment B. Bring the child to the health center for IV therapy C. Bring the child to the health center for assessment by the physician D. Let the child rest for 10 minutes then continue giving Oresol more slowly   slowly  

103. A 1 1/2 year old child was classified as having 3rd degree of protein energy malnutrition, kwashjorkor. Which of the following signs will be most apparent in this t his child?   A. Voracious appetite B. Wasting C. Apathy D. Edema  Edema 

104. Assessment of a 2-year old child revealed "baggy pants". Using the IMCI guidelines, how will you manage this child?    A. Refer the child urgently urgentl y to a hospital for confinement  confin ement   B. Coordinate with the social worker to enroll the child in a feeding program C. Make a teaching plan for the mother, focusing on the menu planning for her child D. Assess and treat the child for health problems like infections and intestinal parasitism 105. During the physical examination of a young child, what is the earliest sign of xerophthalmia that may observe?   A. Keratomalacia B. Corneal opacity C. Night blindness D. Conjunctival xerosis  xerosis 

106. To prevent xerophthalmia, young children are given Retinol capsule every 6 months. What is the dose given to preschoolers?    A. 10, 000 IU B. 20, 000 IU C. 100, 000 IU D. 200, 000 IU  

107. The major sign of iron deficiency anemia is pallor. What part is best examined for pallor?   A. Palms  Palms  B. Nailbeds C. Around the lips D. Lower conjunctival sac

108. Food fortification is one of the strategies to prevent micronutrient deficiency conditions. RA 8976 mandates fortification of certain food items. Which of the following f ollowing is among these food items?    A. Sugar   B. Bread C. Margarine D. Filled milk 109. What is the best course of action when there is a measles epidemic in a nearby municipality?   A. Give measles vaccine to babies ba bies aged 6 to 3 months m onths   B. Give babies aged 6 to 11 months one dose of 100,000 IU of Retinol C. Instruct mother to keep their babies at home to prevent disease transmission D. Instruct mothers to feed their babies adequately to enhance their babies resistance

110. A mother brought her daughter, 4 years old, to the RHU because of cough and colds. Following the IMCI assessment guide, which of the following is a danger sign that indicates the need for urgent referral to a hospital?    A. Inability to drink   B. High grade fever C. Signs of severe dehydration D. Cough for more than 30 days

111. Management of a child with measles includes the administration of which of the following?    A. Gentian violet on mouth mou th lesions B. Antibiotic to prevent pneumonia C. Tetracycline eye ointment for corneal opacity D. Retinol capsule regardless of when the last dose was given  

112. A mother brought her 10 month old infant for consultation because of fever which started 4 days prior to consultation. To T o determine malaria risk, what will you do?    A. Do a tourniquet test B. Ask where the family resides  resides  C. Get a specimen for blood smear D. Ask if the fever is present everyday

113. The following are strategies implemented by the DOH to t o prevent mosquito-borne diseases. Which of these is most effective in the control of Dengue fever? 

 

   A. Stream seeding with larva-eating la rva-eating fish B. Destroying breeding places of mosquitoes  mosquitoes   C. Chemoprophylaxis of non-immune persons going to endemic areas D. Teaching people in endemic areas to use chemically treated mosquito nets

114. Secondary prevention for malaria includes?    A. Planting of neem or eucalyptus eu calyptus trees B. Residual spraying of insecticides at night C. Determining whether a place is endemic or not   not   D. Growing larva-eating fish in mosquito breeding places

115. Scotch tape swab is done to check for which intestinal parasite?   A. Ascaris B. Pinworm  Pinworm  C. Hookworm D. Schistosoma

116. Which of the following signs indicates the t he need for sputum examination for AFB?    A. Hematemesis B. Fever for 1 week C. Cough for 3 weeks  weeks  D. Chest pain for 1 week

117. Which clients are considered targets t argets for DOTS category?    A. Sputum negative cavitary cavi tary cases B. Clients returning after default C. Relapses and failures of previous PTB treatment regimens D. Clients diagnosed for the first time through a positive sputum exam  

118. To improve compliance to treatment, what innovation is being implemented in DOTS?   A. Having the health worker w orker follow up the client at home B. Having the health worker or a responsible family member monitor drug intake   C. Having the patient come to the health center every month to get his medications D. Having a target list to check on whether the patient has collected his monthly supply of drugs

119. Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of leprosy?    A. Macular lesions B. Inability to close eyelids C. Thickened painful nerves  nerves   D. Sinking of the nose bridge

120. Which of the following clients should be b e classified as a case of mutibacillary leprosy?    A. 3 skin lesions, negative nega tive slit skin smear B. 3 skin lesions, positive slit skin smear C. 5 skin lesions, negative slit skin smear   D. 5 skin lesions, positive slit skin smear

121. In the Philippines, which condition is the t he most frequent cause of death associated by schistosomiasis?    A. Liver cancer B. Liver cirrhosis  cirrhosis  C. Bladder cancer D. Intestinal perforation

122. What is the most effective way of controlling schistosomiasis in an endemic area?   A. Use of molluscicides molluscicide s B. Building of foot bridges C. Proper use of sanitary toilets  toilets   D. Use of protective footwear, such as rubber boots

123. When residents obtain water from an artesian well in the neighborhood, the level of this approved type of water facility is:    A. I B. II   C. III D. IV

124. For prevention of Hepatitis A, you decided d ecided to conduct health education activities. Which of the following is Irrelevant?   A. Use of sterile syringes and an d needles needles   B. Safe food preparation and food handling by vendors C. Proper disposal of human excreta and personal hygiene

 

 

D. Immediate reporting of water pipe leaks and illegal water connections

125. Which biological used in EPI should not be stored in the freezer?    A. DPT   B. OPV C. Measles vaccine D. MMR

126. You will conduct outreach immunization in a barangay with a population of about 1500. Estimate the number of infants in the barangay.   A. 45   B. 50 C. 55 D. 60

127. In IMCI, severe conditions generally require urgent referral to a hospital. Which of the following severe conditions Does not always require urgent referral to hospital?   A. Mastoiditis B. Severe dehydration  dehydration  C. Severe pneumonia D. Severe febrile disease.

128. A client was diagnosed as having Dengue Fever. You will say that there is slow capillary refill when the color of the na ilbed that you pressed does not return within how many seconds?   A. 3  3  B. 5 C. 8 D. 10

129. A 3-year old child was brought by his mother to the health center because of fever of 44-day -day duration. The child had a positive tourniquet test result. In the absence of other signs, which of the most appropriate measure that the PHN may carry out to prevent Dengue shock syndrome?   A. Insert an NGT and give fluids flu ids per NGT B. Instruct the mother to give the child Oresol   C. Start the patient on IV Stat D. Refer the client to the physician for appropriate management

130. The pathognomonic sign of measles is Koplik’s spot. You may see Koplik’s spot by inspecting the:    A. Nasal Mucosa B. Buccal mucosa  mucosa  C. Skin on the abdomen D. Skin on the antecubital surface

131. Among the following diseases, which is airborne?    A. Viral conjunctivitis B. Acute poliomyelitis C. Diptheria D. Measles  Measles 

132. Among children aged 2 months to 3 years, the most prevalent form of meningitis is caused by which microorganism?   A. Hemophilus Influenzae Influe nzae   B. Morbillivirus C. Streptococcus Pneumoniae D. Neisseria meningitides

133. Human beings are the major reservoir of malaria. Which of the following strategies in malaria control is based on this f act?   A. Stream seeding B. Stream clearing C. Destruction of breeding places D. Zooprophylaxis  Zooprophylaxis 

134. The use of larvivorous fish in malaria control is the basis for which strategy of malaria control?   A. Stream seeding   B. Stream clearing C. Destruction of breeding places D. Zooprophylaxis .

135. Mosquito-borne diseases are prevented mostly with the use of mosquito control measures. Which of the following is NOT appropriate for malaria control?    A. Use of chemically treated mosquito nets

 

 

B. Seeding of breeding places with larva-eating fish C. Destruction of breeding places of the mosquito vector   vector   D. Use of mosquito-repelling soaps, such as those with basil or citronella

136. A 4-year old client was brought to the health center with chief complaint of severe diarrhea and the passage of “rice water”. The   client is most probably suffering from which condition?   A. Giardiasis B. Cholera  Cholera  C. Amebiasis D. Dysentery

137. In the Philippines, which specie of schistosoma is endemic in certain regions?   A. S. mansoni B. S. japonicum  japonicum  C. S. malayensis D. S. haematobium

138. A 32 year old client came for f or consultation at the health center with tthe he chief complaint of fever for a week. Accompanyi ng symptoms were muscle pains and body malaise. A week after the start of fever, the client noted yellowish discoloration of his sclera. History showed that he waded in flood waters about 2 weeks before the o onset nset of symptoms. Based on this history/ which disease condition will you suspect?   A. Hepatitis A B. Hepatitis B C. Tetanus D. Leptospirosis  Leptospirosis 

139. MWSS provides water to Manila and other cities in Metro Manila. This is an example of which level of water facility?   A. I B. II C. III   D. IV

140. You are the PHN in the city health center. A client underwent screening for AIDS using ELISA. His result was positive. What is the best course of action that you may take?   A. Get a thorough history of the client, cl ient, focusing on the practice p ractice of high risk beh behavior avior B. Ask the client to be accompanied by a significant person before revealing the result. C. Refer the client to the physician since he is the best person to reveal the result to the client D. Refer the client for a supplementary test, such as Western blot, since the ELISA result maybe false  

141. Which is the BEST control measure for AIDS?    A. Being faithful to a single singl e sexual partner  partne r   B. Using a condom during each sexual contact C. Avoiding sexual contact with commercial sex workers D. Making sure that one's sexual partner does not have signs of AIDS

142. The most frequent causes of death deat h among clients with AIDS are opportunistic diseases. Which of the following f ollowing opportunistic infections is characterized by tonsilllopharyngitis?   A. Respiratory candidiasis candid iasis B. Infectious mononucleosis C. Cytomegalovirus disease D. Pneumocystis carinii pneumonia 143. To determine the possible sources of sexually transmitted infections, which is the BEST method that may be undertaken by the public health MIDWIFE?   A. Contact tracing   B. Community survey C. Mass screening tests D. Interview suspects

144. Antiretroviral agents, such as AZT are used in the management of AIDS. Which of the following is not an action expected of these drugs?   A. They prolong the life of o f the client with AIDS B. They reduce the risk of opportunistic infections C. They shorten the period of communicability of the disease D. They are able to bring about a cure of the disease condition  condition  

145. A barangay had an outbreak of German measles. To prevent congenital rubella, what is the BEST advice that you can give to women in the first trimester of pregnancy in the barangay?  a. Advice them on the sign of German Measles b. Avoid crowded places, such as markets and moviehouses c. Consult at the health center where rubella vaccine may be given d. Consult a physician who may give them rubella immunoglobulin immunoglobulin  

 

  Situation 1: The Department of Health is strengthening its programs regarding maternal and child health nursing. As a newly appointed community health nurse in town, you are oriented and well verse on these. 1. With regards to Women’s Health and Safe Motherhood Project, the following strategies are included to prevent maternal mortality, mort ality, except one:  A. Establishment of BEmoNC BEmoN C and CEmoNC networks ne tworks B. TBA facilitated home deliveries C. Improved Family Planning counselling D. Emphasis on Facility based deliveries 2. The following qualifications reflect possible delivery in the Rural Health Unit, except for one:  A.  Cephalic presentation B.   Adequate pelvis C.  History of ceasarian section delivery D.  Less than five pregnancies 3. You are assigned to provide baby care to the newly delivered healthy baby. What procedure are you going to do first?  A. Examine the newborn newbor n and check for defects, defe cts, deformities and bir birth th injuries. B. Provide warmth to the newborn and have a quick check for breathing C. Clamp and cut the cord after cord pulsations have stopped. D. Facilitate the bonding between the mother and the newborn through early skin – skin – to  to - skin contact 4.The basis for the improvement in strategies in maternal and neonatal care is on Millennium Development Goals, which are:  A. MDGs 1 & 2 B. MDGs 2 & 4 C. MDGs 3 & 5 D. MDGs 4 & 5 5. The following are the intermediate results that can lower the risk for dying from pregnancy and childbirth with the integration of the MNCHN services in the community:  A. Every delivery is facilityfacility - based and managed man aged by skilled birth aattendants ttendants B. Every pregnancy is adequately managed during pre and post partum courses C. Every pregnancy is wanted, planned and supported D. Only answers A & C 6. Situation II: You have observed that there are reports of dengue hemorrhagic fever in the barangay. You are to perform community awareness lecture about the said disease. 6. Which is the best preventive measure for dengue hemorrhagic fever?  A. Frequent fogging in the vicinity to kill mosq mosquitoes uitoes B. Use of mosquito nets and mosquito coils C. Use of mosquito repellent lotions D. Cleaning of surroundings and proper disposal of coconut shells, tires, and containers 7. What are the signs and symptoms of DHF assessed as Grade II?  A Herman’s signs, bone and joint pains, fever with headache, and abdominal pain  pain   B Hypotension, anorexia, nausea and vomiting, fever, and rapid weak pulse C Herman’s signs, fever with headache, epistaxis, and melena  melena   D Narrowing pulse pressure, restlessness, and cold clammy perspiration 8.For planning and implementation during the course of DHF, the following are the necessary nursing considerations:  A Educate client to avoid dark colored foods and the use of hard bristled toothbrush, razor and other sharp objects B Monitoring the intake and output of client C Encouraging client to increase fluid intake D  All of the above 9.What diagnostic procedure will confirm that the client is having DHF?  A Blood smear B Urine and Stool examinations C Cerebrospinal fluid examination D Sputum examination 10. Dengue hemorrhagic fever can be fatal. The following manifestations are present in DHF, except for one.  A Thrombocytosis B Prolonged bleeding time C Thrombocytopenia D Positive Rumpel Leade test 11.Situation III: IMCI or the Integrated Management for Childhood Illnesses is an important tool for public health nurses for managing cases of children seeking health care. 11. What should you look for in assessing the child’s condition?  condition?  

 

 A Does the child vomit everything? B Is the child able to breastfeed or drink? C Is the child lethargic or unconscious? D Is the child having some breathing difficulties? 12. If the child is having fever for 9 days everyday and has stiff neck but without runny nose, what color health management will it suggest?  A Green B Yellow C Pink D Violet 13.In a child reported to having diarrhea, assessment is an essential guide for knowing if the child is experiencing dehydration. What body part should you assess?  A Buttocks B  Abdomen C Eyelids D  Arms 14. Child Isabel is already 12 weeks old. What immunizations should Isabel have received?  A. BCG, OPV-0, DPT+HIB-1, Hepatitis Hepati tis B1, and OPV-1 B. . CG, OPV-0, DPT+HIB-1, Hepatitis B1, DPT+HIB-2, Hepatitis B2, OPV-1 and OPV-2 C. BCG, OPV-0, DPT+HIB-1, Hepatitis B1, OPV-1, and D. BCG, OPV-0, DPT+HIB-1, and OPV-1 15. In preparing sugar water for the treatment of low blood sugar in a child, includes the following proportion: a. b.   c.  d. 

200 ml of clean water plus 2 level tbsp. of sugar 400 ml of clean water plus 4 level tsp of sugar 200 ml of clean water plus 4 level tsp of sugar 200 ml of clean water plus 4 level tbsp of sugar

Situation IV: The Aquino Health Agenda (AHA) is focusing on the achievement of Universal Health Care for All Filipinos. 16. The AHA strategic thrusts are the keys for ensuring that all Filipinos especially the poor will receive the benefits of the health reform. These involve: a.   Attainment of Millennium Development Developmen t Goals 2 and 3. b.  Financial risk protection through expansion in National Health Insurance Program enrolment and benefit c.  Improved service delivery for health care needs through upgraded quality health care facilities d.  B & C only e.  17. Last April 2011, the Department of Health together with the LGUs conducted a nationwide campaign on: a.  Reproductive Health Bill b.  Disaster and Preparedness c.  Measles- Rubella d.  Isang Milyong Sepilyo 18. Which is incorrect regarding the training and deployment of unemployed nurses as “RNHeals” to the rural area? A area? A a.  To supply the needs of poor Filipino people in far flung areas b.  To contribute to the eradication of poverty and hunger c.  To assist in the promotion of gender and equality d.  To address the proliferation of “volunteer nurses”  nurses”   19. According to the AHA, the following instruments are vital in implementing the three strategic thrusts. Which one refers to the access to professional health providers capable in the provision of their health needs at the appropriate level of care? a.  Service Delivery b.  Governance for Health c.  Human Resources for Health d.  Health Information 20. Encouragement of community integration and self- reliance enhancement in the community is valued, too in this health agenda. Which of these statements indicate the correct meaning of community health team? a.  It is a group of people composed of NGOs and private organizations b.  It is led by the midwife in the priority population areas c.  The rural health physician is the one who directly tracks the eligible population d. None of the above e.   21. It refers to the description of disease occurrence which is constantly present in a given area. a.  Pandemic b.  Sporadic c.  Endemic d.  Epidemic

 

22. Mang Ernie came to the RHU because he was bitten by their dog. What nursing consideration is your priority? a.   Administration of Anti- rabies ra bies vaccine b.  Provision of dim, quiet and non- stimulating room for the client c.   Assessment of wound for classification, cl assification, severity, and other signs and symptoms symp toms d.  Provision of isolation precautions 23. You are about to provide health teachings about pulmonary tuberculosis in your area of assignment. What diagnostic procedure is usually done early in the morning to confirm PTB? a.  Chest X- ray b.  Sputum Examination c.  Bronchoscopy d.   All of the above 24. Scarlet fever is a febrile contagious condition. Which laboratory procedure is not included in confirming scarlet fever? a.   ASO titer b.  Sputum Examination c.  Throat culture d.  Differential count of white blood cells 25. What skin manifestation can be observed to a child having the 3- day measle? a.  Generalized flushing of the skin b.  Rashes that appears on chest spreading gradually upward and downward c.  Macupapular rashes on the cheeks (slightly elevated) d.  Rose- red papules on the face *Rationale: Home deliveries are not recommended by the government even it is assisted by a health professional or a trained hilot nowadays. Maternal complications leading to maternal mortality has been found to be due to this. *Rationale: Rural health units do not have the capacity and the facilities to facilitate CS delivery. Aside from that women with history of CS deliveries usually have previous history of serious or potentially serious complications, thus they are usually advised to seek consult to the nearest hospital during their prenatal period to prepare them for their delivery. *Rationale: Within the first 30 seconds, the objective of the nurse is to dry and provide warmth to the newborn to prevent from hypothermia. *Rationale: MDG 4 focuses on reducing child mortality and MDG 5 corresponds to the improvement of maternal health. *Rationale: Only A & C are correct; Every pregnancy is adequately managed throughout its course, not only during pre natal and post partum periods. *Rationale: Fogging is not recommended for it only scares away mosquito and it even causes some respiratory consequences; use of mosquito nets, coils and repellants are options but the best preventive measure is through searching and destroying of breeding sites by cleaning the surroundings. *Rationale: DHF Grade II includes the signs of Grade I plus spontaneous bleeding. Choice A refers only to signs and symptoms found in Grade I, while options B and D correspond to signs and symptoms of Grade III. *Rationale: All the above options should be included in plan of care for a client with DHF to easily identify and prevent bleeding, and to prevent the occurrence of dehydration. *Rationale: By testing through blood smear DHF will be confirmed. The rest diagnostic procedures are not relevant to the confirmation process of this said disease. *Rationale: Thrombocytosis is not a manifestation of DHF instead there is depletion of thrombocytes in the system referring to as thrombocytopenia; which can be evidenced by prolonged bleeding time and petechial rashes. *Rationale: Options A and B refers to what you should ask for during assessment, but what you really need to look for is if the child is lethargic  –  –   which is a danger sign. It also refers to as objective data instead of subjective one as verbalized by mother. Option D is asked if you are querying the child to have pneumonia or not. *Rationale: Pink, since the child is suggested to be having very severe febrile disease under the high malaria risk management. *Rationale: Abdomen is assessed for signs of dehydration in children; the rest do not give hints of dehydration. *Rationale: At birth the child should have received BCG and OPV-0; at 6 weeks, the child can receive DPT+HIB-1, Hepatitis B1, OPV-1 already; and at 10 weeks, DPT+HIB-2, Hepatitis B2 and OPV-2 can be given to the child. The next immunization is when the child reached the age of 14 weeks. *Rationale: The right proportion in making sugar water is 200 ml of clean water with 4 tsp of sugar. *Rationale: There are three strategic thrusts involving financial risk protection, improved access to health care delivery, and attainment of health related MDGs which are MDGs 4 and 5. *Rationale: Measles Rubella Campaign was conducted last 2011 to decrease the incidence of MR in the country and to coincide with the MDGs goal of reducing child mortality *Rationale: It is only to improve the access of poor communities to quality healthcare and services, not to supply their needs; Take note also that community health nursing is focusing on the development of self- reliance of the community. *Rationale: Human Resources for Health refer to health professionals such as midwives, nurses and the like which could provide their needs in the community. They will be skilfully trained to be competent in the provision of health care in every family’s door steps as muc h as possible. *Rationale: It is a group of health volunteers led by the midwife in the barangay. The midwife tracks the eligible population for health care services while the rural health physician only supervises the community health team. family’s door steps as much as possible.  possible.   *Rationale: The constant presence of an infectious agent within a specific area is called endemic. Pandemic refers to an epidemic which has widely spread in different places; epidemic is the occurrence of a disease condition more than as expected; and sporadic is defined as occurrence of disease in occasional periods only. *Rationale: Assessment is always prioritized in doing nursing care. There are guidelines from which the assessment of type, size, and appearance of bite is classified prior to referral to Animal Bite Center. This classification is the basis for the treatment of anti- rabies vaccine as indicated by the physician. Provision of dim and non- stimulating room and isolation precautions are only given during the later stages of rabies virus invasion in the system. *Rationale: Sputum Examination is usually done early in the morning to detect presence of Mycobacterium Tuberculosis. Chest X- ray is another confirmatory procedure but could be done anytime of the day. On the other hand, bronchoscopy is an invasive procedure that confirms the extent of PTB. *Rationale: An elevated ASO titer, positive throat culture for strep, and an increase in WBC differential count especially the eosinophils conclude the presence of scarlet fever in the system. *Rationale: Option A refers to DHF, B for Scarlet fever, and C for Measles.

1. In immunizing school entrants with BCG, you are not obliged to secure parental consent. This is because of which legal document? a.  P.D. 996 b.  R.A. 7846

 

c.  Presidential Proclamation No. 6 d.  Presidential Proclamation No. 46 2. Which immunization produces a permanent scar? a.  DPT b.  BCG c.  Measles vaccination d.  Hepatitis B vaccination 3. A 4-week old baby was brought to the health center for his first immunization. Which can be given to him? a.  DPT1 b.  OPV1 c.  Infant BCG d.  Hepatitis B vaccine 1 e.  4. You will not give DPT 2 if the mother says that the infant had a.  b.  c.  d. 

Seizures a day after DPT 1. Fever for 3 days after DPT 1.  Abscess formation after DPT 1. Local tenderness for 3 days after DPT 1.

5. A 2-month old infant was brought to the health center for immunization. During asses sment, the infant’s temperature registered at 38.1°C. Which is the best course of action that you will take? a.  Go on with the infant’s immunizations.  immunizations.  b.  Give Paracetamol and wait for his fever to subside. c.  Refer the infant to the physician for further assessment. d.   Advise the infant’s mother moth er to bring him back for immunization im munization when he is well. well.   6. A pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will have protection against tetanus for how long? a.  1 year b.  3 years c.  10 years d.  Lifetime 7. A 4-month old infant was brought to the health center because of cough. Her respiratory rate is 42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines of assessment, her breathing is considered a.  Fast b.  Slow c.  Normal d.  Insignificant 8. Which of the following signs will indicate that a young child is suffering from severe pneumonia? a.  Dyspnea b.  Wheezing c.  Fast breathing d.  Chest indrawing 9. Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management for the child? a.  Prescribe an antibiotic. b.  Refer him urgently to the hospital. c.  Instruct the mother to increase fluid intake. d.  Instruct the mother to continue breastfeeding. 10. A 5-month old infant was brought by his mother to the health center because of diarrhea occurring 4 to 5 times a day. His skin goes back slowly after a skin pinch and his eyes are sunken. Using the IMCI guidelines, you will classify this infant in which category? a.  No signs of dehydration b.  Some dehydration c.  Severe dehydration d.  The data is insufficient. 11. Based on assessment, you classified a 3-month old infant with the chief complaint of diarrhea in the category of SOME DEHYDRATION. Based on IMCI management guidelines, which of the following will you do? a.  Bring the infant to the nearest facility where IV fluids can be given. b.  Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours. c.  Give the infant’s mother instructions on home management.  management.   d.  Keep the infant in your health center for close observation. 12. A mother is using Oresol in the management of diarrhea of her 3-year old child. She asked you what to do if her child vomits. You will tell her to a.  Bring the child to the nearest hospital for further assessment. b.  Bring the child to the health center for intravenous fluid therapy. c.  Bring the child to the health center for assessment by the physician. d.  Let the child rest for 10 minutes then continue giving Oresol more slowly. 13. A 1 ½ year old child was classified as having 3rd degree protein energy malnutrition, kwashiorkor. Which of the following signs will be most apparent in this child? a.  Voracious appetite b.  Wasting c.   Apathy d.  Edema

 

14. Assessment of a 2-year 2-year old child revealed “baggy pants”. Using the IMCI guidelines, how will you manage this child?   a.  Refer the child urgently to a hospital for confinement. b.  Coordinate with the social worker to enroll the child in a feeding program. c.  Make a teaching plan for the mother, focusing on menu planning for her child. d.   Assess and treat the child chil d for health problems problem s like infections an andd intestinal para parasitism. sitism. 15. During the physical examination of a young child, what is the earliest sign of xerophthalmia that you may observe? a.  Keratomalacia b.  Corneal opacity c.  Night blindness d.  Conjunctival xerosis 16. To prevent xerophthalmia, young children are given Retinol capsule every 6 months. What is the dose given to preschoolers? a.  b.  c.  d. 

10,000 IU 20,000 IU 100,000 IU 200,000 IU

17. The major sign of iron deficiency anemia is pallor. What part is best examined for pallor? a.  Palms b.  Nailbeds c.   Around the lips d.  Lower conjunctival sac 18. Food fortification is one of the strategies to prevent micronutrient deficiency conditions. R.A. 8976 mandates fortification of certain food items. Which of the following is among these food items? a.  Sugar b.  Bread c.  Margarine d.  Filled milk 19. What is the best course of action when there is a measles epidemic in a nearby municipality? a.  Give measles vaccine to babies aged 6 to 8 months. b.  Give babies aged 6 to 11 months one dose of 100,000 I.U. of Retinol c.  Instruct mothers to keep their babies at home to prevent disease transmission. d.  Instruct mothers to feed their babies adequately to enhance their babies’ resistance.  resistance.   20. A mother brought her daughter, 4 years old, to the RHU because of cough and colds. Following the IMCI assessment guide, which of the following is a danger sign that indicates the need for urgent referral to a hospital? a.  Inability to drink b.  High grade fever c.  Signs of severe dehydration d.  Cough for more than 30 days 21. Management of a child with measles includes the administration of which of the following? a.  Gentian violet on mouth lesions b.   Antibiotics to prevent pneumonia pn eumonia c.  Tetracycline eye ointment for corneal opacity d.  Retinol capsule regardless of when the last dose was given 22. A mother brought her 10 month old infant for consultation because of fever, which started 4 days prior to consultation. To determine malaria risk, what will you do? a.  Do a tourniquet test. b.   Ask where the family resides. resi des. c.  Get a specimen for blood smear. d.   Ask if the fever is present everyday. eve ryday. 23. The following are strategies implemented by the Department of Health to prevent mosquito-borne diseases. Which of these is most effective in the control of Dengue fever? a.  Stream seeding with larva-eating fish b.  Destroying breeding places of mosquitoes c.  Chemoprophylaxis of non-immune persons going to endemic areas d.  Teaching people in endemic areas to use chemically treated mosquito nets 24. Secondary prevention for malaria includes a.  Planting of neem or eucalyptus trees b.  Residual spraying of insecticides at night c.  Determining whether a place is endemic or not d.  Growing larva-eating fish in mosquito breeding places 25. Scotch tape swab is done to check for which intestinal parasite? a.   Ascaris b.  Pinworm c.  Hookworm d.  Schistosoma 26. Which of the following signs indicates the need for sputum examination for AFB? a.  Hematemesis b.  Fever for 1 week c.  Cough for 3 weeks d.  Chest pain for 1 week

 

  27. Which clients are considered targets for DOTS Category I? a.  Sputum negative cavitary cases b.  Clients returning after a default c.  Relapses and failures of previous PTB treatment regimens d.  Clients diagnosed for the first time through a positive sputum exam 28. To improve compliance to treatment, what innovation is being implemented in DOTS? a.  Having the health worker follow up the client at home b.  Having the health worker or a responsible family member monitor drug intake c.  Having the patient come to the health center every month to get his medications d.  Having a target list to check on whether the patient has collected his monthly supply of drugs 29. Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of leprosy? a.  Macular lesions b.  Inability to close eyelids c.  Thickened painful nerves d.  Sinking of the nosebridge 30. Which of the following clients should be classified as a case of multibacillary leprosy? a.  3 skin lesions, negative slit skin smear b.  3 skin lesions, positive slit skin smear c.  5 skin lesions, negative slit skin smear d.  5 skin lesions, positive slit skin smear  Answers and Rationales Ratio nales  Answer: (A) P.D. 996. Presidential Presi dential Decree 9996, 96, enacted in 1976 1976,, made immuniza immunization tion in the EPI compulso compulsory ry for children under unde r 8 years of age. Hepatitis B vaccination was made compulsory for the same age group by R.A. 7846.  Answer: (B) BCG. BCG causes cause s the formation of a superficial supe rficial absces abscess, s, which begins 2 weeks wee ks after immunization immunization.. The abscess heals without wi thout treatment, with the formation of a permanent scar.  Answer: (C) Infant BCG. Infant BCG BC G may be given at birth. All the other immunizations mentioned m entioned can be given at 6 weeks of age.  Answer: (A) Seizures a day da y after DPT 1. Seizures with within in 3 days after administration ad ministration of DPT is an ind indication ication of hypersensitivity hypersens itivity to pertu pertussis ssis vaccine, a component of DPT. This is considered a specific contraindication to subsequent doses of DPT.  Answer : (A) Go on with the infant’s immunizations. In the EPI, fever up to 38.5°C is not a contraindication to immunization. Mild a cute respiratory tract infection, simple diarrhea and malnutrition are not contraindications either.  Answer: (A) 1 year. The baby bab y will have pa passive ssive natural immunity immuni ty by placental tran transfer sfer of antibodies. The m mother other will have active aartificial rtificial immunity lasting for about 10 years. 5 doses will give the mother lifetime protection.  Answer: (C) Normal. In IMCI, a respiratory re spiratory rate of 50/minute 50/mi nute or more is fast brea breathing thing for an infant ag aged ed 2 to 12 months.  Answer: (D) Chest indrawing. indra wing. In IMCI, chest indra indrawing wing is used as the positive sign of dyspn dyspnea, ea, indicating severe seve re pneumonia.  Answer: (B) Refer him urgently urge ntly to the hospital. Severe Seve re pneumonia requires r equires urg urgent ent referral to a hospi hospital. tal. Answers A, C and D are done do ne for a client classified as having pneumonia.  Answer: (B) Some dehydration. deh ydration. Using the ass assessment essment guidelines guidelin es of IMCI, a child (2 month monthss to 5 years old) with dia diarrhea rrhea is classified cla ssified as having havin g SOME DEHYDRATION if he shows 2 or more of the following signs: restless or irritable, sunken eyes, the skin goes back slow after a skin pinch.  Answer: (B) Supervise the th e mother in giving 2200 00 to 400 ml. of Oresol iinn 4 hours. In the IMCI manag management ement guidelin guidelines, es, SOME DEH DEHYDRATION YDRATION is treated with the administration of Oresol within a period of 4 hours. The amount of Oresol is best computed on the basis of t he child’s weight (75 ml/kg body weight). If the weight is unknown, the amount of Oresol is based on the child’s age.  Answer: (D) Let the child rest r est for 10 minutes then continue co ntinue giving Oresol Ore sol more slowly. If the child vomits v omits persistently, that is, he vomits everythin everythingg that he takes in, he has to be referred urgently to a hospital. Otherwise, vomiting is managed by letting the child rest for 10 minutes and then continuing with Oresol administration. Teach the mother to give Oresol more slowly.  Answer: (D) Edema. Edema, Ede ma, a major sign of kwa kwashiorkor, shiorkor, is cause causedd by decreased collo colloidal idal osmotic pr pressure essure of the blood br brought ought about ab out by hypoalbuminemia. Decreased blood albumin level is due a protein-deficient diet.  Answer: (A) Refer the child chi ld urgently to a hospita hospitall for confinement. “Baggy “Bagg y pants” is a sign of severe seve re marasmus. The be best st management mana gement is urgent referral to a hospital.  Answer: (D) Conjunctival Conjunct ival xerosis. The earliest ea rliest sign of Vitamin A def deficiency iciency (xerophthalmia) (xerophthal mia) is night blind blindness. ness. However, this iiss a functional change, chan ge, which is not observable during physical examination.The earliest visible lesion is conjunctival xerosis or dullness of the conjunctiva due to inadequate tear production.  Answer: (D) 200,000 IU. IU . Preschoolers are ggiven iven Retinol 200,0 200,000 00 IU every 6 months. 10 100,000 0,000 IU is given on once ce to infants aged 6 to 12 months. The dose for pregnant women is 10,000 IU.  Answer: (A) Palms. The anatomic an atomic characteristics ooff the palms allow a reliable and conve convenient nient basis for examination e xamination for pallor. pallo r.  Answer: (A) Sugar. R.A. 8976 mandates m andates fortification of rice, wheat flour, suga sugarr and cooking oil with wi th Vitamin A, iron and/o and/orr iodine iodine..  Answer: (A) Give measles measl es vaccine to babi babies es aged 6 to 8 months. Or Ordinarily, dinarily, measles vacc vaccine ine is given at 9 months mon ths of age. During an impending impend ing epidemic, however, one dose may be given to babies aged 6 to 8 months. The mother is instructed that the baby needs another dose when the baby is 9 months old.  Answer: (A) Inability to drink. dr ink. A sick child aged 2 months to 5 years must be referred urgently to a hospital h ospital if he/she has o ne or more of the following signs: not able to feed or drink, vomits everything, convulsions, abnormally sleepy or difficult to awaken.  Answer: (D) Retinol capsule ca psule regardl regardless ess of when the last dose was given. An infant 6 to 12 1 2 months classified classifie d as a case of meas les is given Retinol 100,000 IU; a child is given 200,000 IU regardless of when the last dose was given.  Answer: (B) Ask where the family fa mily resides. Because malaria m alaria is endemic, ende mic, the first question to deter determine mine malaria risk ri sk is where the t he client’s family resides. If the area of residence is not a known endemic area, ask if the child had traveled within the past 6 months, where he/she was brought and whether he/she stayed overnight in that area.  Answer: (B) Destroying breeding pla places ces of mosquitoes. Aedes aaegypti, egypti, the vector of Dengue Den gue fever, breed breedss in stagnant, clear wa ter. Its feeding time is usually during the daytime. It has a cyclical pattern of occurrence, unlike malaria which is endemic in certain parts of the country.  Answer: (C) Determining Determinin g whether a place plac e is endemic or not. This is diagnostic and ther therefore efore secondary secondar y level prevention. The o ther choices are for primary prevention.  Answer: (B) Pinworm. Pinworm Pin worm ova are deposited depo sited around the an anal al orifice.  Answer: (C) Cough for 3 weeks. A client is con considered sidered a PTB suspect suspe ct when he has cough fo forr 2 weeks or more, plus plu s one or more of o f the following signs: fever for 1 month or more; chest pain lasting for 2 weeks or more not attributed to other conditions; progressive, unexplained weight loss; night sweats; and hemoptysis.  Answer: (D) Clients diagnosed di agnosed for the first time through a positive ssputum putum exam. Category I is for new clients diagnosed diagn osed by sputum examination ex amination and clients diagnosed to have a serious form of extrapulmonary tuberculosis, such as TB osteomyelitis.

 

 Answer: (B) Having the health worker or a responsible family member monitor dru drugg intake. Directly O Observed bserved Treatment Short Shor t Course is so-called so-call ed because a treatment partner, preferably a health worker accessible to the client, monitors the client’s compliance to the tre atment.  Answer: (C) Thickened painful p ainful nerves. The lesion l esion of leprosy is not macular. It is chara characterized cterized by a change chang e in skin color (either reddish re ddish or whitish) and loss of sensation, sweating and hair growth over the lesion. Inability to close the eyelids (lagophthalmos) and sinking of the nosebridge are late symptoms.  Answer: (D) 5 skin lesions, lesi ons, positive slit skin sm smear. ear. A multibacilla multibacillary ry leprosy case is one who has a positive slit sl it skin smear and at least lea st 5 skin lesions.

1. A client asks the nurse what a third degree laceration is. She was informed that she had one. The nurse explains that this is: that extended their anal sphincter through the skin and into the muscles that involves anterior rectal wall that extends through the perineal muscle. 2. Betina 30 weeks AOG discharged with a diagnosis of placenta previa. The nurse knows that the client understands her care at home when she says: a.  b.  c.  d. 

I am happy to note that we can have sex occasionally when I have no bleeding. I am afraid I might have an operation when my due comes I will have to remain in bed until my due date comes I may go back to work since I stay only at the office.

3. The uterus has already risen out of the pelvis and is experiencing farther into the abdominal area at about the: a.  b.  c.  d. 

8th week of pregnancy 10th week of pregnancy 12th week of pregnancy 18th week of pregnancy

4. Which of the following urinary symptoms does the pregnant woman most frequently experience during the first trimester: a.  frequency b.  dysuria c.  incontinence d.  burning 5. Mrs. Jimenez went to the health center for pre-natal check-up. the student nurse took her weight and revealed 142 lbs. She asked the student nurse how much should she gain weight in her pregnancy. a.  20-30 lbs b.  25-35 lbs c.  30- 40 lbs d.  10-15 lbs 6. The nurse is preparing Mrs. Jordan for cesarean delivery. Which of the following key concept should the nurse consider when implementing nursing care? a.  Explain the surgery, expected outcome and kind of anesthetics. b.  Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth. c.   Arrange for a staff member of the th e anesthesia department depa rtment to explai explainn what to expect post-op post-operatively. eratively. d.  Instruct the mother’s support person to remain in the family lounge until after the delivery.   7. Bettine Gonzales is hospitalized for the treatment of severe preecplampsia. Which of the following represents an unusual finding for this condition? a.  generalize generalizedd edema b.  proteinuria 4+ c.  blood pressure of 160/110 d.  convulsions 8. Nurse Geli explains to the client who is 33 weeks pregnant and is experiencing vaginal bleeding that coitus: a.  Need to be modified in any way by either partner b.  Is permitted if penile penetration is not deep. c.  Should be restricted because it may stimulate uterine activity. d.  Is safe as long as she is in side-lying position. 9. Mrs. Precilla Abuel, a 32 year old mulripara is admitted to labor and delivery. Her last 3 pregnancies in short stage one of labor. The nurses decide to observe her closely. The physician determines that Mrs. Abuel’s cervix is dilated to 6 cm. Mrs. Abuel states that s he is extremely uncomfortable. To lessen Mrs. Abuel’s discomfort, the nurse the nurse can advise her to: a.  lie face down b.  not drink fluids c.  practice holding breaths between contractions d.  assume Sim’s position  position   10. Which is true regarding the fontanels of the newborn? a.  The anterior is large in shape when compared to the posterior fontanel. b.  The anterior is triangular shaped; the posterior is diamond shaped. c.  The anterior is bulging; the posterior appears sunken. d.  The posterior closes at 18 months; the anterior closes at 8 to 12 months. 11. Mrs. Quijones gave birth by spontaneous delivery to a full term baby boy. After a minute after birth, he is crying and moving actively. His birth weight is 6.8 lbs. What do you expect baby Quijones to weigh at 6 months?

 

a.  b.  c.  d. 

13 -14 lbs 16 -17 lbs 22 -23 lbs 27 -28 lbs

12. During the first hours following delivery, the post partum client is given IVF with oxytocin added to them. The nurse understands the primary reason for this is: a.  To facilitate elimination b.  To promote uterine contraction c.  To promote analgesia d.  To prevent infection 13. Nurse Luis is assessing the newborn’s heart rate. Which of the following would be considered normal if the newborn is sleeping?  sleeping?   a.  80 beats per minute b.  100 beats per minute c.  120 beats per minute d.  140 beats per minute 14. The infant with Down Syndrome should go through which of the Erikson ’s developmental stages first?  first?  a.  Initiative vs. Self doubt b.  Industry vs. Inferiority c.   Autonomy vs. Shame and doubt d oubt d.  Trust vs. Mistrust 15. The child with phenylketonuria (PKU) must maintain a low phenylalanine diet to prevent which of the following complications? a.  Irreversible brain damage b.  Kidney failure c.  Blindness d.  Neutropenia 16. Which age group is with imaginative minds and creates imaginary friends? a.  Toddler b.  Preschool c.  School d.   Adolescence 17. Which of the following situations would alert you to a potentially developmental problem with a child? a.  Pointing to body parts at 15 months of age. b.  Using gesture to communicate at 18 months. c.  Cooing at 3 months. d.  Saying “mama” or “dada” for the first time at 18 months of age.  age.   18. Isabelle, a 2 year old girl loves to move around and oftentimes manifests negativism and temper tantrums. What is the best way to deal with her behavior? a.  Tell her that she would not be loved by others is she behaves that way.. b.  Withholding giving her toys until she behaves properly. c.  Ignore her behavior as long as she does not hurt herself and others. d.   Ask her what she wants and an d give it to pacify her. 19. Baby boy Villanueva, 4 months old, was seen at the pediatric clinic for his scheduled check-up. By this period, baby Villanueva has already increased his height by how many inches? a.  3 inches b.  4 inches c.  5 inches d.  6 inches 20. Alice, 10 years old was brought to the ER because of Asthma. She was immediately put under aerosol administration of Terbutaline. After sometime, you observe that the child does not show any relief from the treatment given. Upon assessment, you noticed that both the heart and respiratory rate are still elevated and the child shows difficulty of exhaling. You suspect: a.  Bronchiectasis b.   Atelectasis c.  Epiglotitis d.  Status Asthmaticus 21. Nurse Jonas assesses a 2 year old boy with a tentative diagnosis of nephroblastoma. Symptoms the nurse observes that suggest this problem include: a.  Lymphedema and nerve palsy b.  Hearing loss and ataxia c.  Headaches and vomiting d.   Abdominal mass and weakness 22. Which of the following danger sings should be reported immediately during the antepartum period? a.  blurred vision b.  nasal stuffiness c.  breast tenderness d.  constipation 23. Nurse Jacob is assessing a 15 month old child with acute otitis media. Which of the following symptoms would the nurse anticipate finding? a.  periorbital edema, absent light reflex and translucent tympanic membrane b.  irritability, purulent drainage in middle ear, nasal congestion and cough c.  diarrhea, retracted tympanic membrane and enlarged parotid gland

 

d.  Vomiting, pulling at ears and pearly white tympanic membrane 24. Which of the following is the most appropriate intervention to reduce stress in a preterm infant at 33 weeks gestation? a.  Sensory stimulation including several senses at a time b.  tactile stimulation until signs of over stimulation develop c.   An attitude of extension when w hen prone or side si de lying d.  Kangaroo care 25. The parent of a client with albinism would need to be taught which preventive healthcare measure by the nurse: a.  Ulcerative colitis diet b.  Use of a high-SPF sunblock c.  Hair loss monitoring d.  Monitor for growth retardation  Answers and Rationales Ratio nales (A) that extended their anal sphincter. Third degree laceration involves all in the second degree laceration and the external sphincter of the rectum. Options B, C and D are under the second degree laceration. (C) I will have to remain in bed until my due date comes. Placenta previa means that the placenta is the presenting part. On the first and second trimester there is spotting. On the third trimester there is bleeding that is sudden, profuse and painless. (D) 18th week of pregnancy. On the 8th week of pregnancy, the uterus is still within the pelvic area. On the 10th week, the uterus is still within the pelvic area. On the 12th week, the uterus and placenta have grown, expanding into the abdominal cavity. On the 18th week, the uterus has already risen out of the pelvis and is expanding into the abdominal area. (A) frequency. Pressure and irritation of the bladder by the growing uterus during the first trimester is responsible for causing urinary frequency. Dysuria, incontinence and burning are symptoms associated with urinary tract infection. (B) 25-35 lbs. A weight gain of 11. 2 to 15.9 kg (25 to 35 lbs) is currently recommended as an average weight gain in pregnancy. This weight gain consists of the following: fetus- 7.5 lb; placenta- 1.5 lb; amniotic fluid- 2 lb; uterus- 2.5 lb; breasts- 1.5 to 3 lb; blood volume- 4 lb; body fat- 7 lb; body fluid- 7 lb. (B) Modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth. A key point to consider when preparing the client for a cesarean delivery is to modify the preoperative teaching to meet the needs of either planned or emergency cesarean birth, the depth and breadth of instruction will depend on circumstances and time available. (D) convulsions. Options A, B and C are findings of severe preeclampsia. Convulsions is a finding of eclampsia —an obstetrical emergency. (C) Should be restricted because it may stimulate uterine activity.. Coitus is restricted when there is watery discharge, uterine contraction and vaginal bleeding. Also those women with a history of spontaneous miscarriage may be advised to avoid coitus during the time of pregnancy when a previous miscarriage occurred. (D) assume Sim’s position. When the woman is in Sim’s position, this puts the weight of the fetus on bed, not on the woman an d allows good circulation in the lower extremities. (A) The anterior is large in shape when compared to the posterior fontanel.. The anterior fontanel is larger in size than the posterior fontanel.  Additionally, the anterior a nterior fontanel, whic whichh is diamond shaped shape d closes at 18 mon month, th, whereas the posterio posteriorr fontanel, which is triangular tri angular in shape sh ape closes at 8 to 12 weeks. Neither fontanel should appear bulging, which may indicate increases ICP or sunken, which may indicate hydration. (A) 13 -14 lbs. The birth weight of an infant is doubled at 6 months and is tripled at 12 months. (B) To promote uterine contraction. Oxytocin is a hormone produced by the pituitary gland that produces intermittent uterine contractions, helping to promote uterine involution. (B) 100 beats per minute. The normal heart rate for a newborn that is sleeping is approximately 100 beats per minute. If the newborn was awake, the normal heart rate would range from 120 to 160 beats per minute. (D) Trust vs. Mistrust. The child with Down syndrome will go through the same first stage, trust vs. mistrust, only at a slow rate. Therefore, the nurse should concentrate on developing on bond between the primary caregiver and the child. (A) Irreversible brain damage. The child with PKU must maintain a strict low phenylalanine diet to prevent central nervous system damage, seizures and eventual death. (B) Preschool. During preschool, this is the time when children do imitative play, imaginative play— play —the occurrence of imaginative playmates, dramatic play where children like to act, dance and sing. (D) Saying “mama” or “dada” for the  the  first time at 18 months of age.. A child should say “mama” or “dada” during 10 to 12 months of age. Options A, B and C are all normal assessments of language development of a child. (C) Ignore her behavior as long as she does not hurt herself and others.. If a child is trying to get attention or trying to get something through tantrums— tantrums —ignore his/her behavior. (B) 4 inches. From birth to 6 months, the infant grows 1 inch (2.5 cm) per month. From 6 to 12 months, the infant grows ½ inch (1.25 cm) per month. (D) Status Asthmaticus. Status asthmaticus leads to respiratory distress and bronchospasm despite of treatment and interventions. Mechanical ventilation maybe needed due to respiratory failure. (D) Abdominal mass and weakness. Nephroblastoma or Wilm’s tumor tumo r is caused by chromosomal abnormalities, most common kidney cancer among children characterized by abdominal mass, hematuria, hypertension and fever. (A) blurred vision. Danger signs that require prompt reporting are leaking of amniotic fluid, blurred vision, vaginal bleeding, rapid weight gain and elevated blood pressure. Nasal stuffiness, breast tenderness, and constipation are common discomforts associated with pregnancy. (B) irritability, purulent drainage in middle ear, nasal congestion and cough. Irritability, purulent drainage in middle ear, nasal congestion and cough, fever, loss of appetite, vomiting and diarrhea are clinical manifestations of otitis media. Acute otitis media is common in children 6 months to 3 years old and 8 years old and above. Breast fed infants have higher resistance due to protection of Eustachian tubes and middle ear from breast milk. (D) Kangaroo care. Kangaroo care is the use of skin-to-skin contact to maintain body heat. This method of care not only supplies heat but also encourages parent-child interaction. (B) Use of a high-SPF sunblock. Without melanin production, the child with albinism is at risk for severe sunburns. Maximum sun protection should be taken, including use of hats, long sleeves, minimal time in the sun and high-SPF sunblock, to prevent any problems.

1. In the Philippines, which condition is the most frequent cause of death associated with schistosomiasis? a.  Liver cancer b. Liver cirrhosis c.   Bladder cancer d.  Intestinal perforation 2. What is the most effective way of controlling schistosomiasis in an endemic area? a.  Use of molluscicides b.  Building of foot bridges

 

c.  Proper use of sanitary toilets d.  Use of protective footwear, such as rubber boots 3. When residents obtain water from an artesian well in the neighborhood, the level of this approved type of water facility is a.  I b.  II c.  III d.  IV 4. For prevention of hepatitis A, you decided to conduct health education activities. Which of the following is IRRELEVANT? a.  Use of sterile syringes and needles b.  Safe food preparation and food handling by vendors c.  Proper disposal of human excreta and personal hygiene d.  Immediate reporting of water pipe leaks and illegal water connections 5. Which biological used in Expanded Program on Immunization (EPI) should NOT be stored in the freezer? a.  DPT b.  Oral polio vaccine c.  Measles vaccine d.  MMR 6. You will conduct outreach immunization in a barangay with a population of about 1500. Estimate the number of infants in the barangay. a.  45 b.  50 c.  55 d.  60 7. In Integrated Management of Childhood Illness, severe conditions generally require urgent referral to a hospital. Which of the following severe conditions DOES NOT always require urgent referral to a hospital? a.  Mastoiditis b.  Severe dehydration c.  Severe pneumonia d.  Severe febrile disease 8. A client was diagnosed as having Dengue fever. You will say that there is slow capillary refill when the color of the nailbed that you pressed does not return within how many seconds? a.  3 b.  5 c.  8 d.  10 9. A 3-year old child was brought by his mother to the health center because of fever of 4-day duration. The child had a positive tourniquet test result. In the absence of other signs, which is the most appropriate measure that the PHN may carry out to prevent Dengue shock syndrome? a.  Insert an NGT and give fluids per NGT. b.  Instruct the mother to give the child Oresol. c.  Start the patient on intravenous fluids STAT. d.  Refer the client to the physician for appropriate management. 10. The pathognomonic sign of measles is Koplik’s spot. You may see Koplik’s spot by inspecting the _____.   a.  Nasal mucosa b.  Buccal mucosa c.  Skin on the abdomen d.  Skin on the antecubital surface 11. Among the following diseases, which is airborne? a.  Viral conjunctivitis b.   Acute poliomyelitis c.  Diphtheria d.  Measles 12. Among children aged 2 months to 3 years, the most prevalent form of meningitis is caused by which microorganism? a.  Hemophilus influenzae b.  Morbillivirus c.  Steptococcus pneumoniae d.  Neisseria meningitidis 13. Human beings are the major reservoir of malaria. Which of the following strategies in malaria control is based on this fact? a.  Stream seeding b.  Stream clearing c.  Destruction of breeding places d.  Zooprophylaxis 14. The use of larvivorous fish in malaria control is the basis for which strategy of malaria control? a. Stream seeding b.   Stream clearing c.  Destruction of breeding places d.  Zooprophylaxis 15. Mosquito-borne diseases are prevented mostly with the use of mosquito control measures. Which of the following is NOT appropriate for malaria control?

 

a.  Use of chemically treated mosquito nets b.  Seeding of breeding places with larva-eating fish c.  Destruction of breeding places of the mosquito vector d.  Use of mosquito-repelling soaps, such as those with basil or citronella 16. A 4-year 4-year old client was brought to the health center with the chief complaint of severe diarrhea and the passage of “rice water” stools. The client is most probably suffering from which condition? a.  Giardiasis b.  Cholera c.   Amebiasis d.  Dysentery 17. In the Philippines, which specie of schistosoma is endemic in certain regions? a.  S. mansoni b.  S. japonicum c.  S. malayensis d.  S. haematobium 18. A 32-year old client came for consultation at the health center with the chief complaint of fever for a week. Accompanying symptoms were muscle pains and body malaise. A week after the start of fever, the client noted yellowish discoloration of his sclera. History showed that he waded in flood waters about 2 weeks before the onset of symptoms. Based on his history, which disease condition will you suspect? a.  Hepatitis A b.  Hepatitis B c.  Tetanus d.  Leptospirosis 19. MWSS provides water to Manila and other cities in Metro Manila. This is an example of which level of water facility? a.  I b.  II c.  III d.  IV 20. You are the PHN in the city health center. A client underwent screening for AIDS using ELISA. His result was positive. What is the best course of action that you may take? a.  Get a thorough history of the client, focusing on the practice of high risk behaviors. b.   Ask the client to be accompanied accompa nied by a significant significa nt person before re revealing vealing the resul result.t. c.  Refer the client to the physician since he is the best person to reveal the result to the client. d.  Refer the client for a supplementary test, such as Western blot, since the ELISA result may be false. 21. Which is the BEST control measure for AIDS? a.  Being faithful to a single sexual partner b.  Using a condom during each sexual contact c.   Avoiding sexual contact con tact with commercia commerciall sex workers d.  Making sure that one’s sexual partner does not have signs of AIDS   22. The most frequent causes of death among clients with AIDS are opportunistic diseases. Which of the following opportunistic infections is characterized by tonsillopharyngitis? a.  Respiratory candidiasis b.  Infectious mononucleosis c.  Cytomegalovirus disease d.  Pneumocystis carinii pneumonia 23. To determine possible sources of sexually transmitted infections, which is the BEST method that may be undertaken by the public health nurse? a.  Contact tracing b.  Community survey c.  Mass screening tests d.  Interview of suspects 24. Antiretroviral agents, such as AZT, are used in the management of AIDS. Which of the following is NOT an action expected of these drugs. a.  They prolong the life of the client with AIDS. b.  They reduce the risk of opportunistic infections c.  They shorten the period of communicability of the disease. d.  They are able to bring about a cure of the disease condition. 25. A barangay had an outbreak of German measles. To prevent congenital rubella, what is the BEST advice that you can give to women in the first trimester of pregnancy in the barangay? a.   Advice them on the signs sign s of German measles. b.   Avoid crowded places, pla ces, such as markets and moviehouses. m oviehouses. c.  Consult at the health center where rubella vaccine may be given. d.  Consult a physician who may give them rubella immunoglobulin. 26. You were invited to be the resource person in a training class for food handlers. Which of the following would you emphasize regarding prevention of staphylococcal food poisoning? a.  All cooking and eating ea ting utensils must be tho thoroughly roughly washed. b.   Food must be cooked properly to destroy staphylococcal microorganisms. c.  Food handlers and food servers must have a negative stool examination result. d.  Proper handwashing during food preparation is the best way of preventing the condition. 27. In a mothers’ class, you discussed childhood diseases such as chicken pox. Which of the following statements about chicke n pox is correct? a.  The older one gets, the more susceptible he becomes to the complications of chicken pox.

 

b.   A single attack of chicken pox will prevent future futur e episodes, inclu including ding conditions ssuch uch as shingles. c.  To prevent an outbreak in the community, quarantine may be imposed by health authorities. d.  Chicken pox vaccine is best given when there is an impending outbreak in the community. 28. Complications to infectious parotitis (mumps) may be serious in which type of clients? a.  Pregnant women b.  Elderly clients c.  Young adult males d.  Young infants  Answers and Rationales Ratio nales  Answer: (B) Liver cirrhosis. cirrho sis. The etiologic age agent nt of schistosomiasis in the Philippine Philippiness is Schistosoma japo japonicum, nicum, which affects the sma smallll intestine and the liver. Liver damage is a consequence of fibrotic reactions to schistosoma eggs in the liver.  Answer: (C) Proper use of sanitary toilets. The ova of the parasite get ou outt of the human body tog together ether with feces. Cutting the cycle c ycle at this stage stag e is the most effective way of preventing the spread of the disease to susceptible hosts.  Answer: (B) II. A communal faucet fauc et or water standpost standp ost is classified as Le Level vel II.  Answer: (A) Use of sterile syringes syr inges and needles. nee dles. Hepatitis A is transm transmitted itted through the fecal oral o ral route. Hepatitis B is tran smitted through infected infe cted body secretions like blood and semen.  Answer: (A) DPT. DPT is sensitive sensiti ve to freezing. The appropriate ap propriate storage temperature of DPT is 2 to 8° C on only. ly. OPV and measles vacc vaccine ine are highly sensitive to heat and require freezing. MMR is not an immunization in the Expanded Program on Immunization.  Answer: (A) 45. To estimate the th e number of infan infants, ts, multiply total popul population ation by 3%.  Answer: (B) Severe dehydration. deh ydration. The order ord er of priority in the mana management gement of severe deh dehydration ydration is as follow follows: s: intravenous flui d therapy, referral referra l to a facility where IV fluids can be initiated within 30 minutes, Oresol/nasogastric tube, Oresol/orem. When the foregoing measures are not possible or effective, tehn urgent referral to the hospital is done.  Answer: (A) 3. Adequate blood supply to the area allows the retur returnn of the color of the nai nailbed lbed within 3 seconds.  Answer: (B) Instruct the mother to give the child Oresol Oresol.. Since the child doe doess not manifest any other danger sign, mainte maintenance nance of o f fluid balance and an d replacement of fluid loss may be done by giving the client Oresol.  Answer: (B) Buccal mucosa. mucosa . Kopli Koplik’s k’s spot may be seen on the mucosa of the mouth or the throat.  throat.    Answer: (D) Measles. Viral Vira l conjunctivitis is tran transmitted smitted by direct or in indirect direct contact with discha discharges rges from infected eyes. ey es. Acute poliomyelitis pol iomyelitis is spread through the fecal-oral route and contact with throat secretions, whereas diphtheria is through direct and indirect contact with respiratory secretions.  Answer: (A) Hemophilus Hemophi lus influenzae. Hemophilus He mophilus mening meningitis itis is unusual over ove r the age of 5 years. In developing d eveloping countries, countri es, the peak incidence i ncidence is in children less than 6 months of age. Morbillivirus is the etiology of measles. Streptococcus pneumoniae and Neisseria meningitidis may cause meningitis, but age distribution is not specific in young children.  Answer: (D) Zooprophylaxis. Zooprop hylaxis. Zooprophylaxis Zooproph ylaxis is done by pu putting tting animals lilike ke cattle or dogs close to w windows indows or doorways doorway s just before nightfall nightfall.. The  Anopheles mosquito mosqu ito takes his blood bloo d meal from the anima animall and goes back to its bree breeding ding place, thereby there by preventing infectio infectionn of huma humans. ns.  Answer: (A) Stream seeding. seedi ng. Stream seeding seedin g is done by putting titilapia lapia fry in streams or oother ther bodies of water identified id entified as breeding breedin g places of the  Anopheles mosquito mosqu ito  Answer: (C) Destruction of o f breeding places place s of the mosquito vector. Ano Anopheles pheles mosquitoe mosquitoess breed in slow slow-moving, -moving, clear wate water, r, such as mountain streams.  Answer: (B) Cholera. Passage Pa ssage of profuse wa watery tery stools is the major symp symptom tom of cholera. Both amebic ameb ic and bacillary dysentery d ysentery are characterized by the presence of blood and/or mucus in the stools. Giardiasis is characterized by fat malabsorption and, therefore, steatorrhea.  Answer: (B) S. japonicum. japonicum . S. mansoni is found mostly m ostly in Africa and Sou South th America; S. haematobium haematobiu m in Africa and the Middl Middlee East; and an d S. malayensis only in peninsular Malaysia.  Answer: (D) Leptospirosis. Leptospir osis. Leptospirosis Leptospiro sis is transmitted through co contact ntact with the skin or mucous me membrane mbrane with water or m moist oist soil contaminate contaminatedd with urine of infected animals, like rats.  Answer: (C) III. Waterworks systems, syste ms, such as MWSS, are classified classifie d as level III.  Answer: (D) Refer the client cli ent for a supplemen supplementary tary test, such as Western bblot, lot, since the ELISA result may bbee false. A client having a rreactive eactive ELISA result must undergo a more specific test, such as Western blot. A negative supplementary test result means that the ELISA result was false and that, most probably, the client is not infected.  Answer: (A) Being faithful faithfu l to a single sexual ppartner. artner. Sexual fideli fidelity ty rules out the possibi possibility lity of getting the disea disease se by sexual sexua l contact with another anothe r infected person. Transmission occurs mostly through sexual intercourse and exposure to blood or tissues.  Answer: (B) Infectious mononucleosis. mon onucleosis. Cytome Cytomegalovirus galovirus disea disease se is an acute viral di disease sease characterize characterizedd by fever, sore throat a nd lymphadenopathy.  Answer: (A) Contact tracing. tracin g. Contact tracing is th thee most practical and rreliable eliable method of fin finding ding possible sources so urces of person person-to-person -to-person transmitted infections, such as sexually transmitted diseases.  Answer: (D) They are able ab le to bring abou aboutt a cure of the disease con condition. dition. There is no know knownn treatment for AIDS. AI DS. Antiretroviral agents agen ts reduce the risk of opportunistic infections and prolong life, but does not cure the underlying immunodeficiency.  Answer: (D) Consult a physician ph ysician who may give th them em rubella immunoglobulin. immu noglobulin. Rub Rubella ella vaccine is ma made de up of attenuated German measles mea sles viruses. This is contraindicated in pregnancy. Immune globulin, a specific prophylactic against German measles, may be given to pregnant women.  Answer: (D) Proper handwashing han dwashing during du ring food prepar preparation ation is the best way of preve preventing nting the condition. condition . Symptoms of this food foo d poisoning are a re due to staphylococcal enterotoxin, not the microorganisms themselves. Contamination is by food handling by persons with staphylococcal skin or eye infections.  Answer: (A) The older one on e gets, the more susceptible suscep tible he beco becomes mes to the complications complicatio ns of chicken pox. Ch Chicken icken pox is usually more m ore severe in adults than in children. Complications, such as pneumonia, are higher in incidence in adults.  Answer: (C) Young adult adu lt males. Epididymitis Epididymi tis and orchitis are po possible ssible complicatio complications ns of mumps. In ppost-adolescent ost-adolescent males, ma les, bilateral inflammation infla mmation of the testes and epididymis may cause sterility. 1. Which is the primary goal of community health nursing? a.  To support and supplement the efforts of the medical profession in the promotion of health and prevention of illness b.  To enhance the capacity of individuals, families and communities to cope with their health needs c.  To increase the productivity of the people by providing them with services that will increase their level of health d.  To contribute to national development through promotion of family welfare, focusing particularly on mothers and children. 2. CHN is a community-based practice. Which best explains this statement? a. The service is provided in the natural environment of people. b.   The nurse has to conduct community diagnosis to determine nursing needs and problems. c.  The services are based on the available resources within the community. d.  Priority setting is based on the magnitude of the health problems identified. 3. Population-focused nursing practice requires which of the following processes? a.  Community organizing

 

b.  Nursing process c.  Community diagnosis d.  Epidemiologic process 4. R.A. 1054 is also known as the Occupational Health Act. Aside from number of employees, what other factor must be considered in determining the occupational health privileges to which the workers will be entitled? a.  Type of occupation: agricultural, commercial, industrial b.  Location of the workplace in relation to health facilities c.  Classification of the business enterprise based on net profit d.  Sex and age composition of employees 5. A business firm must employ an occupational health nurse when it has at least how many employees? a.  21 b.  101 c.  201 d.  301 6. When the occupational health nurse employs ergonomic principles, she is performing which of her roles? a.  Health care provider b.  Health educator c.  Health care coordinator d.  Environm Environmental ental manager 7. A garment factory does not have an occupational nurse. Who shall provide the occupational health needs of the factory workers? a.  Occupational health nurse at the Provincial Health Office b.  Physician employed by the factory c.  Public health nurse of the RHU of their municipality d.  Rural sanitary inspector of the RHU of their municipality 8. “Public health services are given free of charge.” Is this statemen t true or false? a.  The statement is true; it is the responsibility of government to provide basic services. b.  The statement is false; people pay indirectly for public health services. c.  The statement may be true or false, depending on the specific service required. d.  The statement may be true or false, depending on policies of the government concerned. 9. According to C.E.Winslow, which of the following is the goal of Public Health? a.  For people to attain their birthrights of health and longevity b.  For promotion of health and prevention of disease c.  For people to have access to basic health services d.  For people to be organized in their health efforts 10. We say that a Filipino has attained longevity when he is able to reach the average lifespan of Filipinos. What other statistic may be used to determine attainment of longevity? a.   Age-specific mortality rate ra te b.  Proportionate mortality rate c.  Swaroop’s index  index  d.  Case fatality rate 11. Which of the following is the most prominent feature of public health nursing? a.  It involves providing home care to sick people who are not confined in the hospital. b.  Services are provided free of charge to people within the catchment area. c.  The public health nurse functions as part of a team providing a public health nursing services. d.  Public health nursing focuses on preventive, not curative, services. 12. According to Margaret Shetland, the philosophy of public health nursing is based on which of the following? a.  Health and longevity as birthrights b.  The mandate of the state to protect the birthrights of its citizens c.  Public health nursing as a specialized field of nursing d.  The worth and dignity of man 13. Which of the following is the mission of the Department of Health? a.  Health for all Filipinos b.  Ensure the accessibility and quality of health care c.  Improve the general health status of the population d.  Health in the hands of the Filipino people by the year 2020 14. Region IV Hospital is classified as what level of facility? a.  Primary b.  Secondary c.  Intermediate d.  Tertiary 15. Which is true of primary facilities? a.  They are usually government-run. b. Their services are provided on an out-patient basis. c.   They are training facilities for health professionals. d.   A community hospital is an a n example of this level leve l of health facilities. 16. Which is an example of the school nurse’s health care provider functions? a.  Requesting for BCG from the RHU for school entrant immunization b.  Conducting random classroom inspection during a measles epidemic

 

c.  Taking remedial action on an accident hazard in the school playground d.  Observing places in the school where pupils spend their free time 17. When the nurse determines whether resources were maximized in implementing Ligtas Tigdas, she is evaluating a.  Effectiveness b.  Efficiency c.   Adequacy d.   Appropriateness 18. You are a new B.S.N. graduate. You want to become a Public Health Nurse. Where will you apply? a.  Department of Health b.  Provincial Health Office c.  Regional Health Office d.  Rural Health Unit 19. R.A. 7160 mandates devolution of basic services from the national government to local government units. Which of the following is the major goal of devolutio devolution? n? a.  To strengthen local government units b.  To allow greater autonomy to local government units c.  To empower the people and promote their self-reliance d.  To make basic services more accessible to the people 20. Who is the Chairman of the Municipal Health Board? a.  Mayor b.  Municipal Health Officer c.  Public Health Nurse d.   Any qualified physician physi cian 21. Which level of health facility is the usual point of entry of a client into the health care delivery system? a.  Primary b.  Secondary c.  Intermediate d.  Tertiary 22. The public health nurse is the supervisor of rural health midwives. Which of the following is a supervisory function of the public health nurse? a. Referring cases or patients to the midwife b.   Providing technical guidance to the midwife c.  Providing nursing care to cases referred by the midwife d.  Formulating and implementing training programs for midwives 23. One of the participants in a hilot training class asked you to whom she should refer a patient in labor who develops a complication. You will answer, to the a.  Public Health Nurse b.  Rural Health Midwife c.  Municipal Health Officer d.   Any of these health professionals profess ionals 24. You are the public health nurse in a municipality with a total population of about 20,000. There are 3 rural health midwives among the RHU personnel. How many more midwife items will the RHU need? 1 2 3 The RHU does not need any more midwife item. 25. If the RHU needs additional midwife items, you will submit the request for additional midwife items for approval to the Rural Health Unit District Health Office Provincial Health Office Municipal Health Board 26. As an epidemiologist, the nurse is responsible for reporting cases of notifiable diseases. What law mandates reporting of cases of notifiable diseases?  Act 3573 R.A. 3753 R.A. 1054 R.A. 1082 27. According to Freeman and Heinrich, community health nursing is a developmental service. Which of the following best illustrates this statement? The community health nurse continuously develops himself personally and professionally. Health education and community organizing are necessary in providing community health services. Community health nursing is intended primarily for health promotion and prevention and treatment of disease. The goal of community health nursing is to provide nursing services to people in their own places of residence. 28. Which disease was declared through Presidential Proclamation No. 4 as a target for eradication in the Philippines? Poliomyelitis Measles Rabies Neonatal tetanus 29. The public health nurse is responsible for presenting the municipal health statistics using graphs and tables. To compare the frequency of the leading causes of mortality in the municipality, which graph will you prepare?

 

  Line Bar Pie Scatter diagram 30. Which step in community organizing involves training of potential leaders in the community? Integration Community organization Community study Core group formation  Answers and Rationales Ratio nales  Answer: (B) To enhance the th e capacity of individ individuals, uals, families and communities to cope with their hea health lth needs  Answer: (B) The nurse has ha s to conduct community communi ty diagnosis to determ determine ine nursing need needss and problems.  Answer: (C) Community diagnosis. d iagnosis. Population-focused Popul ation-focused nursing nu rsing care mean meanss providing care ba based sed on the greater greate r need of the majority of the population. The greater need is identified through community diagnosis.  Answer: (B) Location of the workplace in relation re lation to health facil facilities. ities. Based on R.A. 105 1054, 4, an occupationa occupationall nurse must be emp loyed when there ther e are 30 to 100 employees and the workplace is more than 1 km. away from the nearest health center.  Answer: (B) 101. Again, Again , this is based on R.A. 1054 1054..  Answer: (D) Environmental Environm ental manager. Ergo Ergonomics nomics is improving effi efficiency ciency of workers by impr improving oving the worker’s worker’ s environment throug h appropriately designed furniture, for example.  Answer: (C) Public health he alth nurse of the RHU of o f their municipality. You’re right! This que question stion is based on R.A.10 R.A.1054. 54.    Answer: (B) The statement is false; fal se; people pay in indirectly directly for public hhealth ealth services. Commun Community ity health services, servic es, including public pub lic health services, are pre-paid services, though taxation, for example.  Answer: (A) For people to attain their birthrig birthrights hts of health and long longevity. evity. According to Winsl Winslow, ow, all public health hea lth efforts are for ppeople eople to realize their the ir birthrights of health and longevity.  Answer: (C) Swaroop’s Swaroop ’s index. Swaroop’s Swaroop ’s index is the percenta percentage ge of the deaths aged ag ed 50 years or older older.. Its inverse represents t he percentage of untimely deaths (those who died younger than 50 years).  Answer: (D) Public health he alth nursing focuses focu ses on preventive, not curative, cu rative, services.The catchment catchm ent area in PHN consists con sists of a residential community, co mmunity, many of whom are well individuals who have greater need for preventive rather than curative services.  Answer: (D) The worth and an d dignity of man. This is a direct quote from Dr. Margaret Shetland’s statements on Public Health Nursing.    Answer: (B) Ensure the accessibility acc essibility and quality qu ality of health care  Answer: (D) Tertiary. Regional Regi onal hospitals ar aree tertiary facilities beca because use they serve as training train ing hospita hospitals ls for the region.  Answer: (B) Their services are a re provided on an a n out-patient bbasis. asis. Primary facilities gove government rnment and non-government non -government facilities facil ities that provide basic bas ic outpatient services.  Answer: (B) Conducting Conducti ng random classroo classroom m inspection during a measles ep epidemic. idemic. Random cl classroom assroom inspection inspectio n is assessment of pupils/students pu pils/students and teachers for signs of a health problem prevalent in the community.  Answer: (B) Efficiency. Efficiency Efficie ncy is determining whether the goals w were ere attained at the lea least st possible cost.  Answer : (D) Rural Health Unit. R.A. 7160 devolved basic health services to local government units (LGU’s ). The public health nurse  is an employee of the LGU.  Answer: (C) To empower empowe r the people an andd promote their self self-reliance. -reliance. People eempowerment mpowerment is the ba basic sic motivation behind behi nd devolution of basic services to LGU’s.  LGU’s.   Answer: (A) Mayor. The local loca l executive serves as the chairman c hairman of the Municipal Mun icipal Health Boar Board. d.  Answer: (A) Primary. The entry en try of a person into the health he alth care delivery system sys tem is usually through a consultation consultat ion in out-patient out-patie nt services.  Answer: (B) Providing technical te chnical guida guidance nce to the midwife. The nurse nu rse provides technical techn ical guidance to tthe he midwife in the care of o f clients, client s, particularly in the implementation of management guidelines, as in Integrated Management of Childhood Illness.  Answer: (C) Municipal Municipa l Health Officer. A public hhealth ealth nurse and rur al health midwife can pprovide rovide care during du ring normal childbirth. childb irth. A physician physi cian should attend to a woman with a complication during labor.  Answer: (A) 1. Each rural health h ealth midwife iiss given a popula population tion assignment of aabout bout 5,000.  Answer: (D) Municipal Municipa l Health Board. As man mandated dated by R.A. 7160, bbasic asic health services ha have ve been devolved devo lved from the national gover g overnment nment to local government units.  Answer: (A) Act 3573. Act 3573, 357 3, the Law on Rep Reporting orting of Communi Communicable cable Diseases, ena enacted cted in 1929, mandated man dated the reporting of diseases listed in the law to the nearest health station.  Answer: (B) Health education edu cation and community comm unity organizing ar aree necessary in pro providing viding community hea health lth services. The community commu nity health nurse develops the health capability of people through health education and community organizing activities.  Answer: (B) Measles. Presidential Presi dential Proclamation Proclamati on No. 4 is on the Ligt Ligtas as Tigdas Program.  Answer: (B) Bar. A bar graph grap h is used to present co comparison mparison of val values, ues, a line graph for fo r trends over time or age age,, a pie graph for population popu lation composition or distribution, and a scatter diagram for correlation of two variables.  Answer: (D) Core group grou p formation. In core grou groupp formation, the nurse is i s able to transfer transfe r the technology of community com munity organizing to the potential or informal community leaders through a training program.

1. Nurse Bella explains to a 28 year old pregnant woman undergoing a non-stress test that the test is a way of evaluating the condition of the fetus by comparing the fetal heart rate with: Fetal lie Fetal movement Maternal blood pressure Maternal uterine contractions 2. During a 2 hour childbirth focusing on labor and delivery process for primigravida. The nurse describes the second maneuver that the fetus goes through during labor progress when the head is the presenting part as which of the following: Flexion Internal rotation Descent External rotation 3. Mrs. Jovel Diaz went to the hospital to have her serum blood test for alpha-fetoprotein. The nurse informed her about the result of the elevation of serum AFP. The patient asked her what was the test for: Congenital Adrenal Hyperplasia PKU

 

Down Syndrome Neural tube defects 4. Fetal heart rate can be auscultated with a fetoscope as early as: 5 weeks of gestation 10 weeks of gestation 15 weeks of gestation 20 weeks of gestation 5. Mrs. Bendivin states that she is experiencing aching swollen, leg veins. The nurse would explain that this is most probably the result of which of the following: Thrombophlebitis PIH Pressure on blood vessels from the enlarging uterus The force of gravity pulling down on the uterus 6. Mrs. Ella Santoros is a 25 year old primigravida who has Rheumatic heart disease lesion. Her pregnancy has just been diagnosed. Her heart disease has not caused her to limit physical activity in the past. Her cardiac disease and functional capacity classification is: Class I Class II Class III class IV 7. The client asks the nurse, “When will this soft spot at the top of the head of my baby will close?” The nurse should instr uct instr uct the mother that the neonate’s anterior fontanel will normally close by age:  age:   2-3 months 6-8 months 10-12 months 12-18 months 8. When a mother bleeds and the uterus is relaxed, soft and non-tender, you can account the cause to:  Atony of the uterus Presence of uterine scar Laceration of the birth canal Presence of retained placenta fragments 9. Mrs. Pichie Gonzales’s Gonzales’s LMP began April 4, 2010. Her EDD should be which of the following:   February 11, 2011 January 11, 20111 December 12, 2010 Nowember 14, 2010 10. Which of the following prenatal laboratory test values would the nurse consider as significant? Hematocrit 33.5% WBC 8,000/mm3 Rubella titer less than 1:8 One hour glucose challenge test 110 g/dL 11. Aling Patricia is a patient with preeclampsia. You advise her about her condition, which would tell you that she has not really understood your instructions? “I will restrict my fat in my diet.”  diet.”   “I will limit my activities and rest more frequently throughout the day.”   “I will avoid salty foods in my diet.”  diet.”   “I will come more regularly for checkcheck -up.” up.”   12. Mrs. Grace Evangelista is admitted with severe preeclampsia. What type of room should the nurse select this patient?  A room next to the elevator. elevato r. The room farthest from the nursing station. The quietest room on the floor. The labor suite. 13. During a prenatal check-up, the nurse explains to a client who is Rh negative that RhoGAM will be given: Weekly during the 8th month because this is her third pregnancy. During the second trimester, if amniocentesis indicates a problem. To her infant immediately after delivery if the Coomb’s test is positive.   Within 72 hours after delivery if infant is found to be Rh positive. 14. A baby boy was born at 8:50pm. At 8:55pm, the heart rate was 99 bpm. She has a weak cry, irregular respiration. She was moving all extremities and only her hands and feet were still slightly blue. The nurse should enter the APGAR score as: 5 6 7 8 15. Billy is a 4 year old boy who has an IQ of 140 which means: average normal very superior above average genius 16. A newborn is brought to the nursery. Upon assessment, the nurse finds that the child has short palpebral fissures, thinned upper lip. Based on this data, the nurse suspects that the newborn is MOST likely showing the effects of:

 

  Chronic toxoplasmosis Lead poisoning Congenital anomalies Fetal alcohol syndrome 17. A priority nursing intervention for the infant with cleft lip is which of the following: Monitoring for adequate nutritional intake Teaching high-risk newborn care  Assessing for respiratory respira tory distress Preventing injury 18. Nurse Jacob is assessing a 12 year old who has hemophilia A. Which of the following assessment findings would the nurse anticipate? an excess of RBC an excess of WBC a deficiency of clotting factor VIII a deficiency of clotting factor IX 19. Celine, a mother of a 2 year old tells the nurse that her child “cries and has a fit when I have to leave him with a sitter or someone else.” Which of the following statements would be the nurse’s most accurate analysis of the mother’s comment?   The child has not experienced limit-setting or structure. The child is expressing a physical need, such as hunger. The mother has nurtured overdependence in the child. The mother is describing her child’s separation anxiety.  anxiety.   20. Mylene Lopez, a 16 year old girl with scoliosis has recently received an invitation to a pool party. She asks the nurse how she can disguise her impairment when dressed in a bathing suit. Which nursing diagnosis can be justified by Mylene’s statement? statement?    Anxiety Body image disturbance Ineffective individual coping Social isolation 21. The foul-smelling, frothy characteristic of the stool in cystic fibrosis results from the presence of large amounts of which of the following: sodium and chloride undigested fat semi-digested carbohydrates lipase, trypsin and amylase 22. Which of the following would be a disadvantage of breast feeding? involution occurs rapidly the incidence of allergies increases due to maternal antibodies the father may resent the infant’s demands on the mother’s body   there is a greater chance of error during preparation 23. A client is noted to have lymphedema, webbed neck and low posterior hairline. Which of the following diagnoses is most appropriate? Turner’s syndrome  syndrome  Down’s syndrome  syndrome  Marfan’s syndrome  syndrome  Klinefelter’s syndrome  syndrome  24. A 4 year old boy most likely perceives death in which way:  An insignificant event ev ent unless taugh taughtt otherwise Punishment for something the individual did Something that just happens to older people Temporary separation from the loved one. 25. Catherine Diaz is a 14 year old patient on a hematology unit who is being treated for sickle cell crisis. During a crisis such as that seen in sickle cell anemia, aldosterone release is stimulated. In what way might this influence Catherine’s fluid and electrolyte balance?   sodium loss, water loss and potassium retention sodium loss, water los and potassium loss sodium retention, water loss and potassium retention sodium retention, water retention and potassium loss  Answers and Rationales Ratio nales (B) Fetal movement. Non-stress test measures response of the FHR to the fetal movement. With fetal movement, FHR increase by 15 beats and remain for 15 seconds then decrease to average rate. No increase means poor oxygenation perfusion to fetus. (A) Flexion. The 6 cardinal movements of labor are descent, flexion, internal rotation, extension, external rotation and expulsion. (D) Neural tube defects. Alpha-fetoprotein is a substance produces by the fetal liver that is present in amniotic fluid and maternal serum. The level is abnormally high in the maternal serum if the fetus has an open spinal or abdominal defect because the open defect allows more AFP to appear. (D) 20 weeks of gestation. The FHR can be auscultated with a fetoscope at about 20 weeks of gestation. FHR is usually auscultated at the midline suprapubic region with Doppler ultrasound at 10 to 12 weeks of gestation. FHR cannot be heard any earlier than 10 weeks of gestation. (C) Pressure on blood vessels from the enlarging uterus. Pressure of the growing fetus on blood vessels results in an increase risk for venous stasis in the lower extremities. Subsequently, edema and varicose vein formation may occur. (A) Class I. Clients under class I has no physical activity limitation. There is a slight limitation of physical activity in class II, ordinary activity causes fatigue, palpitation, dyspnea or angina. Class III is moderate limitation of physical activity; less than ordinary activity causes fatigue. Unable to carry on any activity without experiencing discomfort is under class IV. (D) 12-18 months. Anterior fontanel closes at 12-18 months while posterior fontanel closes at birth until 2 months. (A) Atony of the uterus. Uterine atony, or relaxation of the uterus is the most frequent cause of postpartal hemorrhage. It is the inability to maintain the uterus in contracted state. (B) January 11, 20111. 201 11. Using the Nagel’s rule, he use this formula ( -3 calendar months + 7 days).

 

(C) Rubella titer less than 1:8. A rubella titer should be 1:8 or greater. Thus, a finding of a titer less than 1:8 is significant, indicating that the client may not possess immunity to rubella. A hematocrit of 33.5%, WBC of 8,000/mm3, and a 1 hour glucose challenge test of 110 g/dL are within normal parameters. (B) “I will limit my activities and rest more frequently throughout the day.”Pregnant woman with preeclampsia should be in a complete bed rest. When body is in recumbent position, sodium tends to be excreted at a faster rate. It is the best method of aiding increased excretion of sodium and encouraging diuresis. Rest should always be in a lateral recumbent position to avoid uterine pressure on the vena cava and prevent supine hypotension. (C) The quietest room on the floor.A loud noise such as a crying baby, or a dropped tray of equipment may be sufficient to trigger a seizure initiating eclampsia, a woman with severe preeclampsia should be admiotted to a private room so she can rest as undisturbed as possible. Darken the room if possible because bright light can trigger seizures. (D) Within 72 hours after delivery if infant is found to be Rh positive. RhoGAM is given to Rh-negative mothers within 72 hours after birth of Rhpositive baby to prevent development of antibodies in the maternal blood stream, which will be fata to succeeding Rh-positive offspring. (B) 6. Heart rate of 99 bpm-1; weak cry-1; irregular respiration-1; moving all extremities-2; extremities are slightly blue-1; with a total score of 6. (D) genius. IQ= mental age/chronological age x 100. Mental age refers to the typical intelligence level found for people at a give chronological age. OQ of 140 and above is considered genius. (D) Fetal alcohol syndrome. The newborn with fetal alcohol syndrome has a number of possible problems at birth. Characteristics that mark the syndrome include pre and postnatal growth retardation; CNS involvement such as cognitive challenge, microcephally and cerebral palsy; and a distinctive facial feature of a short palpebral fissure and thin upper lip. (A) Monitoring for adequate nutritional intake. The infant with cleft lip is unable to create an adequate seal for sucking. The child is at risk for inadequate nutritional intake as well as aspiration. (C) a deficiency of clotting factor VIII. Hemophillia A (classic hemophilia) is a deficiency in factor VIII (an alpha globulin that stabilizes fibrin clots). (D) The mother is describing her child’s separation anxiety. Before coming to any conclusion, the nurse should ask the mother  focused mother   focused questions; however, based on initial information, the analysis of separation anxiety would be most valid. Separation anxiety is a normal toddler response. When the child senses he is being sent away from those who most provide him with love and security. Crying is one way a child expresses a physical need; however, the nurse would be hasty in drawing this as first conclusion based on what the mother has said. Nurturing overdependence or not providing structure for the toddler are inaccurate conclusions based on the information provided. (B) Body image disturbance. Mylene is experiencing uneasiness about the curvative of her spine, which will be more evident when she wears a bathing suit. This data suggests a body image disturbance. There is no evidence of anxiety or ineffective coping. The fact that Mylene is planning to attend a pool party dispels a diagnosis of social isolation. (B) undigested fat. The client with cystic fibrosis absorbs fat poorly because of the think secretions blocking the pancreatic duct. The lack of natural pancreatic enzyme leads to poor absorption of predominantly fats in the duodenum. Foul-smelling, frothy stool is termed steatorrhea. (C) the father may resent the infant’s demands on the mother’s body. With breast feeding, the father’s body is not capable of providing the milk for the newborn, which may interfere with feeding the newborn, providing fewer chances for bonding, or he may be jealous of the i nfant’s demands on his wife time and body. Breast feeding is advantageous because uterine involution occurs more rapidly, thus minimizing blood loss. The presence of maternal antibodies in breast milk helps decrease the incidence of allergies in the newborn. A greater chance for error is associated with bottle feeding. No preparation required for breast feeding. (A) Turner’s syndrome. Lymphedema, webbed neck and low posterior hairline, these are the 3 key assessment features in Turner’ s syndrome. If the child is diagnosed early in age, proper treatment can be offered to the family. All newborns should be screened for possible congenital defects. (D) Temporary separation from the loved one. The predominant perception of death by preschool age children is that death is temporary separation. Because that child is losing someone significant and will not see that person again, it’s inaccurate to infer death is insignificant, regardless of the child’s response.  response.   (D) sodium retention, water retention and potassium loss. Stress stimulates the adrenal cortex to increase the release of aldosterone. Aldosterone promotes the resorption of sodium, the retention of water and the loss of potassium. 1. Which is the primary goal of community health nursing?  A. To support and supplement supp lement the efforts of the me medical dical profession iinn the promotion of hea health lth and prevention pre vention of B. To enhance the capacity of individuals, families and communities to cope with their health needs C. To increase the productivity of the people by providing them with services that will increase their level of health D. To contribute to national development through promotion of family welfare, focusing particularly on mothers and children 2. CHN is a community-based practice. Which best explains this statement?  A. The service is provided provide d in the natural environment of peop people le B. The nurse has to conduct community diagnosis to determine nursing needs and problems C. The service are based on the available resources within the community D. Priority setting is based on the magnitude of the health problems identified 3. Population- focused nursing practice requires which of the following processes?  A. Community organizing organizi ng . B. Nursing, process C. Community diagnosis D. Epidemiologic process 4. RA 1054 is also known as the Occupational Health Act. Aside from the number of employees, what other factor must be considered in determining the occupational health privileges to which the workers will be entitled?  A. Type of occupation,: agriculture, agri culture, commercial, commercia l, industrial B. Location of the workplace in relation to health facilities C. Classification of the business enterprise based on net profit D. Sex and age composition of employees 5. A business firm must employ an occupational health nurse when it has at least how many employees.  A. 21 B. 101 C. 201 D. 301 6. When the occupational health nurse employs ergonomic principles, she is performing which of her roles?

 

 A. Health care provider provi der B. Health educator C. Health care coordinato coordinatorr D. Environment manager 7. A garment factory does not have an occupational nurse. Who shall provide the occupational health needs of the factory workers?  A. Occupational health hea lth nurse at the Provinci Provincial al Health Office B. Physician employed by the factory C. Public Health nurse of the RHU of their municipality D. Rural Sanitary inspector of the RHU in their municipality 8. “Public health services are given free of charge”. Is this statement true or false?    A. The statement is true; it is the responsibility r esponsibility of government gove rnment to provide ha haste ste services B. The statement is false; people pay indirectly for public health services C. The statement may be true or false; depending on the Specific service required D. The statement may be true or false; depending on policies of the government concerned. 9. According to C.E. Winslow, which of the following is the goal of Public Health?  A. For people to attain their the ir birthrights and lo longevity ngevity B. For promotion of health and prevention and diseases C. For people to have access to basic health services D. For people to be organized in their health efforts 10. We say that a Filipino has attained longevity when he is able to reach the average life span of Filipinos. What other statistic may be used to determine attainment of longevity?  A. Age-specific mortality mortali ty rate B. Proportionate mortality rate C. Swaroop’s index  index  D. Case fatality rate 11. Which of the following is the most prominent feature of public health nursing?  A. It involves providing home care to sick peo people ple who are not con confined fined in the hospi hospital tal B. Services are provided free of charge to people within the catchment area C. The public health nurse functions as part of a team providing a public health nursing service D. Public health nursing focuses on preventive, not curative services 12. According to Margaret Shetland, the philosophy of public health nursing is based on which of the following?  A. Health and longevity longe vity as birthrights B. The mandate of the state to protect the birthrights of its citizens C. Public health nursing as a specialized field of nursing D. The worth and dignity of man 13. Which of the following is the mission of the Department of Health?  A. Health for all Filipinos Filipi nos B. Ensure the accessibility and quality of health C. Improve the general health status of the population D. Health in the hands of the Filipino people by the year 2020 14. Region IV Hospital is classified as what level of facility?  A. Primary B. Secondary C. Intermediate D. Tertiary 15. What is true of primary facilities?  A. They are usually government-run gove rnment-run B. Their services are provided on an out-patient basis C. They are training facilities for health professionals D. A community hospital is an example of this level of health facilities 16. Which is an example of the school nurse’s health care provider function?    A. Requesting for BCG from the th e RHU for school entrance entra nce immunization immuniza tion B. Conducting random classroom inspection during measles epidemic C. Taking remedial action on an accident hazard in the school playground D. Observing places in the school where pupils spend their free times 17. When the nurse determines whether resources were maximized in implementing Ligtas Tigdas, she is evaluating:  A. Effectiveness B. Efficiency C. Adequacy

 

D. Appropriateness 18. You are a new B.S.N. graduate. You want to become a Public Health Nurse. Where will you apply?  A. Department of Health B. Provincial Health Office C. Regional Health Office D. Rural Health Unit 19. RA 7160 mandates devolution of basic services from the national government to local government units. Which of the following is the major goal of devolutio devolution? n?  A. To strengthen local government g overnment uni units ts B. To allow greater autonomy to local government units. C. To empower the people and promote their self-reliance D. To make basic services more accessible to the people 20. Who is the Chairman of the Municipal Health Board?  A. Mayor B. Municipal Health Officer C. Public Health Nurse D. Any qualified physician 21. Which level of health facility is the usual point of entry of a client into the health care delivery system?  A. Primary B. Secondary C. Intermediate D. Tertiary 22. The public health nurse is the supervisor of rural health midwives. Which of the following is a supervisory function of the pubic health nurse?  A. Referring cases or patients pa tients to the midwife B. Providing technical guidance to the midwife C. Proving nursing care to cases referred by the midwife D. Formulating and implementing training programs for midwives 23. One of the participants in a hilot training class asked you to whom she should refer a patient in labor who develops a complication. You will answer, to the;  A. Public health nurse nur se B. Rural health midwife C. Municipal health officer D. Any of these health professionals 24. You are the public health nurse in a municipality with a total population of about 20,000. There are3 health midwives among the RHU personnel. How many more midwife items will the RHU need?  A. 1 B. 2 C. 3 D. 4 25. If the RHU needs additional midwife items, you will submit the request for additional midwife items for approval to the:  A. Rural Health Unit Uni t B. District Health Office C. Provincial Health Office D. Municipal Health Board 26. As an epidemiologist, the nurse is responsible for reporting cases or notifiable diseases. What law mandates reporting cases of notifiable diseases?  A. Act 3573 B. RA.3753 C. RA 1054 D. RA 1082 27. According to Freeman and Heinrich, community health nursing is a developmental service. Which of the following best illustrates this statement?  A. The community health nurse n urse continuou continuously sly develops himse himselflf personally and pprofessionally rofessionally B. Health education and community organizing are necessary in providing community health services C. Community health nursing in intended primarily for health promotion and prevention and treatment of disease. D. The goal of community health nursing is to provide nursing services to people in their own place of .residence 28. Which disease was declared through Presidential Proclamation No. 4 as a target for, eradication in the Philippines?  A. Pioliomyelitis B. Measles

 

C. Rabies D. Neonatal Tetanus 29. The public health nurse is responsible for presenting the municipal health statistics using graphs and tables. To compare the frequency of the leading causes of mortality in the municipality, which graph will you prepare?  A. Line B. Bar C. Pie D. Scatter diagram 30. Which step in community organizing involves training of potential leaders in the community?  A. Integration B. Community organization C. Community study D. Core group formation 31. In which step are plans formulated for solving community problems?  A. Mobilization B. Community organization C. Follow-up/extension D. Core group formation 32. The public health nurse takes an active role in community participation. What is the primary goal of community organizing?  A. To educate the people peop le regarding co community mmunity health problems prob lems B. To mobilize the people to resolve community health problems C. To maximize the community’s resources in dealing with health problems  problems   33. An indicator of success in community organizing is when people are able to:  A. Participate in community commu nity activities for the solu solution tion of a community problem pr oblem B. Implement activities for the solution of the community problem C. Plan activities for the solution of the community problem D. Identify the health problem as a common concern 34. Tertiary prevention is needed in which stage of the natural history of disease?  A. Pre-pathogenesis Pre-pathogene sis B. Pathogenesis C. Predromal D. Terminal 35. Isolation of a child with measles belongs to what level of prevention?  A. Primary B. Secondary C. Intermediate D. Tertiary 36. On the other hand, Operation Timbang is_____ prevention?  A. Primary B. Secondary C. Intermediate D. Tertiary 37. Which type of family-nurse contact will provide you with the best opportunity to observe family dynamics?  A. Clinic consultation B. Group conferences C. Home visit D. Written communication 38. The typology of family nursing problems is used in the statement of nursing diagnosis in the care of families. The youngest child of the delos Reyes family has been diagnosed as mentally retarded. This is classified as:  A. Health threat B. Health deficit C. Foreseeable crisis D. Stress point 39. The delos Reyes couple have 6-year old child entering school for the first time. The delos Reyes family has a:  A. Health threat B. Health deficit C. Foreseeable crisis D. Stress point

 

40. Which of the following is an advantage of a home visit?  A. It allows the nurse to provide pr ovide nursing ca care re to a greater numbe numberr of people B. It provides an opportunity to do first hand appraisal of the home situation C. It allows sharing of experience among people with similar health problems D. It develops the family’s initiative in providing for health needs of its members   41. Which is CONTRARY to the principles in planning a home visit?  A. A home visit should have ha ve a purpose of objective ob jective B. The plan should revolve around the family health .needs C. A home visit should be conducted in the manner prescribed by RHU D. Planning of continuing care should involve a responsible-family member 42. The PHN bag is an important tool in providing nursing care during a home visit. The most important principle in bag technique states that it;  A. Should save time and an d effort B. Should minimize if not totally prevent the spread of infection C. Should not overshadow concern for the patient and his family D. May be done in variety of ways depending on the home situation, etc. 43. To maintain the cleanliness of the bag and its contents, which of the following must the nurse do?  A. Wash his/her hands before b efore and after provi providing ding nursing care to th thee family members B. In the care of family member’s, as much as possible, use only articles taken from the bag   C. Put on an apron to protect her uniform and fold it with the right side out before putting it back into the bag. D. At the end of the visit, fold the lining on which the bag was placed, ensuring that the contaminated side is on the outside. 44. The public health conducts a study on the factors contributing to the high morality rate due to heart diseases in the municipality where she works. Which branch of epidemiology does the nurse practice in this situation?  A. Descriptive B. Analytical C. Therapeutic D. Evaluation 45. Which of the following is a function of epidemiology?  A. Identifying the disease disea se condition ba based sed on manifestations ppresented resented by a client clien t B. Determining factors that contributed to the occurrence of pneumonia in a 3 year old C. Determining the efficacy of the antibiotic used in the treatment of the 3 year old client with pneumonia D. Evaluating the effectiveness of the implementation of the Integrated Management of Childhood Illness 46. Which of the following is an epidemiologic function of the nurse during an epidemic?  A Conducting assessment asse ssment of suspected cases c ases to detect the commu communicable nicable diseases B. Monitoring the condition of the cases affected by the communicable disease C. Participating in the investigation to determine the source of epidemic D. Teaching the community on preventive measures against the disease 47. The primary purpose of conducting an epidemiologic investigation is to;  A. Delineate the etiology etio logy of the epide epidemic mic B. Encourage cooperation and support of the community C. Identify groups who are at risk of contracting the disease D. Identify geographical location of cases of the disease in the community 48. Which is a characteristic of person-to-person propagated epidemic?  A. There are more cases case s of the disease than exp expected ected B. The disease must necessarily be transmitted through a vector C. The spread of the disease can be attributed to a common vehicle D. There is gradual build up of cases before we epidemic becomes easily noticeable 49. In the investigation of an epidemic, you compare the present frequency of the disease with the usual frequency at this time of the year in this community. This is done during which stage of the investigation?  A. Establishing the epidemic ep idemic B. Testing the hypothesis C. Formulation of the hypothesis D. Appraisal of facts 50. The number of cases of Dengue fever usually increases towards the end of the rainy season. This pattern of occurrence of Dengue fever is best described as;  A. Epidemic occurrence occurren ce B. Cyclical variation C. Sporadic occurrence D. Secular occurrence

 

51. In the year 1980, the World Health Organization declared the Philippines, together with some other countries in the Western Pacific Region, “free” of which disease?  disease?    A. Pneumonic plaque plaq ue B. Poliomyelitis C. Small pox D. Anthrax 52. In the census of the Philippines in 1995, there were about 35,299,000 males and about 34,968,000 females. What is the sex ratio?  A. 99.06:100 B. 100.94:100 C. 50.23% D. 49.76% 53. Primary health care is a total approach to community development. Which of the following is an indicator of success in the use of the primary health care approach?  A. Health services are provided p rovided free of charge charg e to individuals and families B. Local officials are empowered as the major decision makers in matters of health C. Health workers are able too provide care based on identified health needs of the people D. Health programs are sustained according to the level of development of the community 54. Sputum examination is the major screening tool for pulmonary tuberculosis. Clients would sometimes get false negative results in this exam. This means that the test is not perfect in terms of which characteristic of a diagnostic examination?  A. Effectiveness B. Efficacy C. Specificity D. Sensitivity 55. Use of appropriate technology requires knowledge of indigenous technology. Which medical herb is given for fever, headache and cough?  A. Sambong B. Tsaang gubat C. Akapulko D. Lagundi 56. What law created the Philippine institute of Traditional and Alternative Health Care?  A. RA 8483 B. RA4823 C. RA 2483 D. RA 3482 57. In traditional Chinese medicine, the yielding, negative and feminine force is termed:  A. Yin B. Yang C. Qi D. Chai 58. What is the legal basis of Primary Health Care approach in the Philippines?  A. Alma Ata Declaration Declaratio n of PHC B. Letter of Instruction No 949 C. Presidential Decree No. 147 D. Presidential Decree 996 59. Which of the following demonstrates inter-sectoral linkages?  A. Two-way referral system B. Team approach C. Endorsement done by a midwife to another midwife D. Cooperation between PHN and public school teacher 60. The municipality assigned to you has a population of about 20/000. Estimate the number of 1-4 year old children who be given Retinol capsule 200.000 every 6 months.  A. 1,500 B. 1,800 C. 2,000 D. 2,300 61. Estimate the number of pregnant women who will be given tetanus toxoid during an immunization outreach activity in a barangay with a population of about 1,500.  A. 265 B. 300 C. 375 D. 400

 

  62. To describe the sex composition of the population, which demographic tool may be used?  A. Sex ratio B. Sex proportion C. Population pyramid D. Any of these maybe used 63. Which of the following is a natality rate?  A. Crude birth rate B. Neonatal mortality rate C. Infant mortality rate D. General fertility rate 64. You are computing the crude rate of your municipality, with a total population o about 18,000 for last year. There were 94 deaths. Among those who died, 20 died because of diseases of the heart and 32 were aged 50 years or older. What is the crude death rate?  A. 4.1/1000 B. 5.2/1000 C. 6.3/1000 D. 7.3/1000 65. Knowing that malnutrition is a frequent community health problem, you decided to conduct nutritional assessment. What population is particularly susceptible to protein energy malnutrition (PEM)?  A. Pregnant women and an d the elderly B. Under 5 year old children C. 1-4 year old children D. School age children 66. Which statistic can give the most accurate reflection of the health status of a community?  A. 1-4 year old age-specific age -specific mortality rate B. Infant mortality rate C. Swaroop’s index  index  D. Crude death rate 67. In the past year, Barangay A had an average population of 1655. 46 babies were born in that year, 2 of whom died less than 4 weeks after they were born. They were 4 recorded stillbirths. What is the neonatal mortality rate?  A. 27.8/1000 B. 43.5/1000 C. 86.9/1000 D. 130.4/1000 68. Which statistic best reflects the nutritional status of a population?  A. 1-4 year old age-specific age -specific mortality rate B. Proportionate mortality rate C. Infant mortality rate D. Swaroop’s index  index  69. What numerator is used in computing general fertility rate?  A. Estimated midyear population po pulation B. Number of registered live births C. Number of pregnancies in the year D. Number of females of reproductive age 70. You will gather data for nutritional assessment of a purok. You will gather information only from families with members who belong to the target population for PEM. What method of delta gathering is best for this purpose?  A. Census B. Survey C. Record Review D. Review of civil registry 71. In the conduct of a census, the method of population assignment based on the actual physical location of the people is termed;  A. De jure B. De locus C. De facto D. De novo 72. The Field Health Services and information System (FHSIS) is the recording and reporting system in public health) care in the Philippines. The monthly field health service activity report is a form used in which of the components of the FHSIS?  A. Tally report B. Output report C. Target/client list

 

D. Individual health record 73. To monitor clients registered in long-term regimens, such as the Multi-Drug Therapy, which component will be most useful?  A. Tally report B. Output report C. Target/client list D. Individual health record 74. Civil registries are important sources of data. Which law requires registration of births within 30 days from the occurrence of the birth?  A. PD 651 B. Act 3573 C. RA 3753 D. RA 3375 75. Which of the following professionals can sign the birth certificate?  A. Public health nurse nu rse B. Rural health midwife C. Municipal health officer D. Any of these health professionals 76. Which criterion in priority setting of health problems is used only in community health care?  A. Modifiability of the problem p roblem B. Nature of the problem presented C. Magnitude of the health problem D. Preventive potential of the health problem 77. The Sentrong Sigla Movement has been launched to improve health service delivery. Which of the following is/are true of this movement?  A. This is a project spearheaded spearh eaded by local government units B. It is a basis for increasing funding from local government units C. It encourages health centers to focus on disease prevention and control D. Its main strategy is certification of health centers able to comply with standards 78. Which of the following women should be considered as special targets for family planning?  A. Those who have two children or more B. Those with medical conditions such as anemia C. Those younger than 20 years and older than 35 years D. Those who just had a delivery within the past 15 months 79. Freedom of choice in one of the policies of the Family Planning Program of the Philippines. Which of the following illustrates this principle?  A. Information dissemination dissemin ation about the ne need ed for family plan planning ning B. Support of research and development in family planning methods C. Adequate information for couples regarding the different methods D. Encouragement of couples to take family planning as a joint responsibility 80. A woman, 6 months pregnant, came to the center for consultation. Which of the following substances is contraindicated?  A. Tetanus toxoid B. Retinol 200,000 IU C. Ferrous sulfate 200mg D. Potassium iodate 200 mg, capsule 81. During prenatal consultation, a client asked you if she can have her delivery at home. After history taking and physical examination, you advised her against a home delivery. Which of the following findings disqualifies her for a home delivery?  A. Her OB score is G5P3 B. She has some palmar pallor C. Her blood pressure is 130/80 D. Her baby is in cephalic presentation 82. Inadequate intake by the pregnant woman of which vitamin may cause neural tube defects?  A. Niacin B. Riboflavin C. Folic Acid D. Thiamine 83. You are in a client’s home to attend to a to  a delivery. Which of the following will you do first?  A. Set up a sterile area B. Put on a clean gown and apron C. Cleanse the client’s vulva with soap and water   water   D. Note the interval, duration and intensity of labor and contractions 84. In preparing a primigravida for breastfeeding, which of the following will you do?

 

 A. Tell her that lactation begins within a da dayy after delivery B. Teach her nipple stretching exercises if her nipples are everted C. Instruct her to wash her nipples before and after each breastfeeding D. Explain to her that putting the baby to breast will lessen blood loss after delivery 85. A primigravida is instructed to offer her breast to the baby for the first time within 30 minutes after delivery. What is the purpose of offering the breast this early?  A. To initiate the occurrence occurren ce of milk letdown B. To stimulate milk production by the mammary acini C. To make sure that the baby is able to get the colustrum D. To allow the woman to practice breastfeeding in the presence of the health worker 86. In a mother’s class, you discuss proper breastfeeding technique. Which of these is a sign that the baby has “lactated on”  the breast property?  A. The baby takes shallow, shal low, rapid sucks B. The mother does not feel nipple pain C. The baby’s mouth is mouth  is only partly open D. Only the mother’s nipple is inside the baby’s mouth   87. You explain to a breastfeeding mother that breastmilk is sufficient for all of the baby’s nutrient needs only up to:    A. 3 months B. 6 months C. 1 year D. 2 years 88. What is given to a woman within a month after the delivery of a baby?  A. Malunggay capsule capsu le B. Ferrous sutfate l00mg O.D. C. Retinol 200.000 IU 1 capsule D. Potassium Iodate 200 mg, 1 capsule 89. Which biological used in EPI is stored in the freezer?  A. DPT B. Tetanus toxoid C. Measles vaccine D. Hepatitis B vaccine 90. Unused BCG should be discarded how many hours after reconstitution?  A. 2 B. 4 C. 6 D. At the end of the day 91. In immunity school entrants with BCG, you not obliged to secure parental consent. This is because of which legal document?  A. PD 996 B. RA 7864 C. Presidential Proclamation No. 6 D. Presidential Proclamation No. 46 92. Which immunization produces a permanent scar?  A. DPT B. BCG C. Measles vaccination D. Hepatitis B vaccination 93. A 4 week old baby was brought to the health center for his first immunization. Which can be given to him?  A. DPT1 B. OPV1 C. Infant BCG D. Hepatitis B Vaccin 94. You will not give DPT 2 if the mother says that the infant had?  A. Seizures a day after DPT1 D PT1 B. Fever for 3 days after DPT1 C. Abscess formation after DPT1 D. Local tenderness for 3 days after DPT1 95. A 2-month 2-month old infant was brought to the health center for immunization. During assessment, the infant’s temperature registered at 38.1 at  38.1 C. Which is the best course of action that you will take?  A. Go on with the infants immunization imm unization B. Give paracetamol and wait for his fever to subside

 

C. Refer the infant to the physician for further assessment D. Advise the infant’s mother to bring him back f or or immunization when he is well 96. A pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will have protection against tetanus for how long?  A. 1 year B. 3 years C. 10 years D. Lifetime 97. A 4-month old infant was brought to the health center of cough. Her respiratory rate is 42/minute. Using the IMCI guidelines of assessment, her breathing is considered;  A. Fast B. Slow C. Normal D. Insignificant 98. Which of the following signs will indicate that a young child is suffering from severe pneumonia?  A. Dyspnea B. Wheezing C. Fast breathing D. Chest indrawing 99. Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management for the child?  A. Prescribe antibiotic antibio tic B. Refer him urgently to the hospital C. Instruct the mother to increase fluid intake D. Instruct the mother to continue breastfeeding 100. A 5-month old infant was brought by his mother to the health center because of diarrhea occurring 4 to 5 times a day. His skin goes back slowly after a skin pinch and his eyes are sunken. Using the IMCI guidelines, you will classify this infant in which category?  A. No signs of dehydration dehydra tion B. Some dehydration C. Severe dehydration D. The data is insufficient 101. Based on the assessment, you classified a 3-month old infant with the chief complaint of diarrhea in the category of SOME DEHYDRATION. Based on the IMCI management guidelines, which of the following will you do?  A. Bring the infant to the nearest nea rest facility where IV fluids fluid s can be given B. Supervise the mother in giving 200 to 400 ml of Oresol in 4 hours C. Give the infant’s mother instructions on home management  management   D. Keep the infant in your health center for close observation 102. A mother is using Oresol’ in the management  of diarrhea of her 3-year old child. She asked you what to do if her child vomits. You will tell her to:  A. Bring the child to the nearest n earest hospital for fur further ther assessment B. Bring the child to the health center for IV therapy C. Bring the child to the health center for assessment by the physician D. Let the child rest for 10 minutes then continue giving Oresol more slowly 103. A 1 1/2 year old child was classified as having 3rd degree of protein energy malnutrition, kwashjorkor. Which of the following signs will be most apparent in this child?  A. Voracious appetite appeti te B. Wasting C. Apathy D. Edema 104. Assessment of a 2-year 2-year old child revealed “baggy pants”. Using the IMCI guidelines, how will you manage this child?  child?    A. Refer the child urgently urgen tly to a hospital for confinement con finement B. Coordinate with the social worker to enroll the child in a feeding program C. Make a teaching plan for the mother, focusing on the menu planning for her child D. Assess and treat the child for health problems like infections and intestinal parasitism 105. During the physical examination of a young child, what is the earliest sign of xerophthalmia that may observe?  A. Keratomalacia B. Corneal opacity C. Night blindness D. Conjunctival xerosis 106. To prevent xerophthalmia, young children are given Retinol capsule every 6 months. What is the dose given to preschoolers?  A. 10, 000 IU B. 20, 000 IU

 

C. 100, 000 IU D. 200, 000 IU 107. The major sign of iron deficiency anemia is pallor. What part is best examined for pallor?  A. Palms B. Nailbeds C. Around the lips D. Lower conjunctival sac 108. Food fortification is one of the strategies to prevent micronutrient deficiency conditions. RA 8976 mandates fortification of certain food items. Which of the following is among these food items?  A. Sugar B. Bread C. Margarine D. Filled milk 109. What is the best course of action when there is a measles epidemic in a nearby municipality?  A. Give measles vaccine to babies aged 6 to 3 months B. Give babies aged 6 to 11 months one dose of 100,000 IU of Retinol C. Instruct mother to keep their babies at home to prevent disease transmission D. Instruct mothers to feed their babies adequately to enhance their babies resistance 110. A mother brought her daughter, 4 years old, to the RHU because of cough and colds. Following the IMCI assessment guide, which of the following is a danger sign that indicates the need for urgent referral to a hospital?  A. Inability to drink B. High grade fever C. Signs of severe dehydration D. Cough for more than 30 days 111. Management of a child with measles includes the administration of which of the following?  A. Gentian violet on mouth mo uth lesions B. Antibiotic to prevent pneumonia C. Tetracycline eye ointment for corneal opacity D. Retinol capsule regardless of when the last dose was given 112. A mother brought her 10 month old infant for consultation because of fever which started 4 days prior to consultation. To determine malaria risk, what will you do?  A. Do a tourniquet test B. Ask where the family resides C. Get a specimen for blood smear D. Ask if the fever is present everyday 113. The following are strategies implemented by the DOH to prevent mosquito-borne diseases. Which of these is most effective in the control of Dengue fever?  A. Stream seeding with wi th larva-eating fis fishh B. Destroying breeding places of mosquitoes C. Chemoprophylaxis of non-immune persons going to endemic areas D. Teaching people in endemic areas to use chemically treated mosquito nets 114. Secondary prevention for malaria includes?  A. Planting of neem or eucalyptus trees B. Residual spraying of insecticides at night C. Determining whether a place is endemic or not D. Growing larva-eating fish in mosquito breeding places 115. Scotch tape swab is done to check for which intestinal parasite?  A. Ascaris B. Pinworm C. Hookworm D. Schistosoma 116. Which of the following signs indicates the need for sputum examination for AFB?  A. Hematemesis B. Fever for 1 week C. Cough for 3 weeks D. Chest pain for 1 week 117. Which clients are considered targets for DOTS category?  A. Sputum negative cavitary ca vitary cases B. Clients returning after default

 

C. Relapses and failures of previous PTB treatment regimens D. Clients diagnosed for the first time through a positive sputum exam 118. To improve compliance to treatment, what innovation is being implemented in DOTS?  A. Having the health heal th worker follow up the client at home B. Having the health worker or a responsible family member monitor drug intake C. Having the patient come to the health center every month to get his medications D. Having a target list to check on whether the patient has collected his monthly supply of drugs 119. Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of leprosy?  A. Macular lesions B. Inability to close eyelids C. Thickened painful nerves D. Sinking of the nose bridge 120. Which of the following clients should be classified as a case of mutibacillary leprosy?  A. 3 skin lesions, negative nega tive slit skin smear B. 3 skin lesions, positive slit skin smear C. 5 skin lesions, negative slit skin smear D. 5 skin lesions, positive slit skin smear 121. In the Philippines, which condition is the most frequent cause of death associated by schistosomiasis?  A. Liver cancer B. Liver cirrhosis C. Bladder cancer D. Intestinal perforation 122. What is the most effective way of controlling schistosomiasis in an endemic area?  A. Use of molluscicides molluscicide s B. Building of foot bridges C. Proper use of sanitary toilets D. Use of protective footwear, such as rubber boots 123. When residents obtain water from an artesian well in the neighborhood, the level of this approved type of water facility is:  A. I B. II C. III D. IV 124. For prevention of Hepatitis A, you decided to conduct health education activities. Which of the following is Irrelevant?  A. Use of sterile syringes and a nd needles B. Safe food preparation and food handling by vendors C. Proper disposal of human excreta and personal hygiene D. Immediate reporting of water pipe leaks and illegal water connections 125. Which biological used in EPI should not be stored in the freezer?  A. DPT B. OPV C. Measles vaccine D. MMR 126. You will conduct outreach immunization in a barangay with a population of about 1500. Estimate the number of infants in the barangay.  A. 45 B. 50 C. 55 D. 60 127. In IMCI, severe conditions generally require urgent referral to a hospital. Which of the following severe conditions Does not always require urgent referral to hospital?  A. Mastoiditis B. Severe dehydration C. Severe pneumonia D. Severe febrile disease. 128. A client was diagnosed as having Dengue Fever. You will say that there is slow capillary refill when the color of the nailbed that you pressed does not return within how many seconds?  A. 3 B. 5 C. 8 D. 10

 

  129. A 3-year old child was brought by his mother to the health center because of fever of 4-day duration. The child had a positive tourniquet test result. In the absence of other signs, which of the most appropriate measure that the PHN may carry out to prevent Dengue shock syndrome?  A. Insert an NGT and give fluids flu ids per NGT B. Instruct the mother to give the child Oresol C. Start the patient on IV Stat D. Refer the client to the physician for appropriate management 130. The pathognomonic sign of measles is Koplik’s spot. You may see Koplik’s spot by inspecting the:    A. Nasal Mucosa B. Buccal mucosa C. Skin on the abdomen D. Skin on the antecubital surface 131. Among the following diseases, which is airborne?  A. Viral conjunctivitis conjunctiviti s B. Acute poliomyelitis C. Diphtheria D. Measles 132. Among children aged 2 months to 3 years, the most prevalent form of meningitis is caused by which microorganism?  A. Hemophilus Influenzae Influ enzae B. Morbillivirus C. Streptococcus Pneumoniae D. Neisseria meningitides 133. Human beings are the major reservoir of malaria. Which of the following strategies in malaria control is based on this fact?  A. Stream seeding B. Stream clearing C. Destruction of breeding places D. Zooprophyla Zooprophylaxis xis 134. The use of larvivorous fish in malaria control is the basis for which strategy of malaria control?  A. Stream seeding B. Stream clearing C. Destruction of breeding places D. Zooprophylaxis . 135. Mosquito-borne diseases are prevented mostly with the use of mosquito control measures. Which of the following is NOT appropriate for malaria control?  A. Use of chemically treated trea ted mosquito nets B. Seeding of breeding places with larva-eating fish C. Destruction of breeding places of the mosquito vector D. Use of mosquito-repelling soaps, such as those with basil or citronella 136. A 4-year 4-year old client was brought to the health center with chief complaint of severe diarrhea and the passage of “rice water”. The  client is most probably suffering from which condition?  A. Giardiasis B. Cholera C. Amebiasis D. Dysentery 137. In the Philippines, which specie of schistosoma is endemic in certain regions?  A. S. mansoni B. S. japonicum C. S. malayensis D. S. haematobium 138. A 32 year old client came for consultation at the health center with the chief complaint of fever for a week. Accompanying symptoms were muscle pains and body malaise. A week after the start of fever, the client noted yellowish discoloration of his sclera. History showed that he waded in flood waters about 2 weeks before the onset of symptoms. Based on this history/ which disease condition will you suspect?  A. Hepatitis A B. Hepatitis B C. Tetanus D. Leptospirosis 139. MWSS provides water to Manila and other cities in Metro Manila. This is an example of which level of water facility?  A. I B. II C. III

 

D. IV 140. You are the PHN in the city health center. A client underwent screening for AIDS using ELISA. His result was positive. What is the best course of action that you may take?  A. Get a thorough history of the client, focusing on the practice of high risk be behavior havior B. Ask the client to be accompanied by a significant person before revealing the result. C. Refer the client to the physician since he is the best person to reveal the result to the client D. Refer the client for a supplementary test, such as Western blot, since the ELISA result maybe false 141. Which is the BEST control measure for AIDS?  A. Being faithful to a single sing le sexual partn partner er B. Using a condom during each sexual contact C. Avoiding sexual contact with commercial sex workers D. Making sure that one’s sexual partner does not have signs of AIDS   142. The most frequent causes of death among clients with AIDS are opportunistic diseases. Which of the following opportunistic infections is characterized by tonsilllopharyngitis?  A. Respiratory candidiasis candid iasis B. Infectious mononucleosis C. Cytomegalovirus disease D. Pneumocystis carinii pneumonia 143. To determine the possible sources of sexually transmitted infections, which is the BEST method that may be undertaken by the public health nurse?  A. Contact tracing B. Community survey C. Mass screening tests D. Interview suspects 144. Antiretroviral agents, such as AZT are used in the management of AIDS. Which of the following is not an action expected of these drugs?  A. They prolong the life li fe of the client with AIDS B. They reduce the risk of opportunistic infections C. They shorten the period of communicability of the disease D. They are able to bring about a cure of the disease condition 145. A barangay had an outbreak of German measles. To prevent congenital rubella, what is the BEST advice that you can give to women in the first trimester of pregnancy in the barangay? a. Advice them on the sign of German Measles b. Avoid crowded places, such as markets and moviehouses c. Consult at the health center where rubella vaccine may be given d. Consult a physician who may give them rubella immunoglobulin  Answers and Rationale Ratio nale Gauge your performance by counter-checking your answers to those below. If you have disputes or further questions, please direct them to the comments section. 1. Answer: (B) To enhance the capacity of individuals, families and communities to cope with their health needs. To contribute to national development through promotion of family welfare, focusing particularly on mothers and children. 2. Answer: (B) The nurse has to conduct community diagnosis to determine nursing needs and problems. Community-based practice means providing care to people in their own natural environments: the home, school and workplace, for example. 3. Answer: (C) Community diagnosis Population-focused nursing care means providing care based on the greater need of the majority of the population. The greater need is identified through community diagnosis. 4. Answer: (B) Location of the workplace in relation to health facilities Based on R.A. 1054, an occupational nurse must be employed when there are 30 to 100 employees and the workplace is more than 1 km. away from the nearest health center. 5. Answer: (B) 101 6. Answer: (D) Environmental manager Ergonomics is improving efficiency of workers by improving the worker’s environment through appropriately designed furniture,  for example. 7. Answer: (C) Public health nurse of the RHU of their municipality 8. Answer: (B) The statement is false; people pay indirectly for public health services. Community health services, including public health services, are prepaid paid services, through taxation, for example. 9. Answer: (A) For people to attain their birthrights of health and longevity  According to Winslow, Winslow , all public hea health lth efforts are for people to realize their birthrights birthrig hts of health and lo longevity. ngevity. 10. Answer: (C) Swaroop’s index  index  Swaroop’s index is the percentage of the deaths aged 50 years or older. Its inverse represents the percentage of untimely deaths (those who died younger than 50 years).

 

  11. Answer: (D) Public health nursing focuses on preventive, not curative, services. The catchment area in PHN consists of a residential community, many of whom are well individuals who have greater need for preventive rather than curative services. 12. Answer: (D) The worth and dignity of man This is a direct quote from Dr. Margaret Shetland’s statements on Public Health Nursing.   13. Answer: (B) Ensure the accessibility and quality of health care 14. Answer: (D) Tertiary Regional hospitals are tertiary facilities because they serve as training hospitals for the region. 15. Answer: (B) Their services are provided on an out-patient basis. Primary facilities government and non-government facilities that provide basic out-patient services. 16. Answer: (B) Conducting random classroom inspection during a measles epidemic Random classroom inspection is assessment of pupils/students and teachers for signs of a health problem prevalent in the community. 17. Answer: (B) Efficiency Efficiency is determining whether the goals were attained at the least possible cost. 18. Answer: (D) Rural Health Unit R.A. 7160 devolved basic health services to local government units (LGU’s). The public health nurse is an employee of the LGU.   19. Answer: (C) To empower the people and promote their self-reliance People empowerment is the basic motivation behind devolution of basic services to LGU’s.  LGU’s.   20. Answer: (A) Mayor The local executive serves as the chairman of the Municipal Health Board. 21. Answer: (A) Primary The entry of a person into the health care delivery system is usually through a consultation in out-patient services. 22. Answer: (B) Providing technical guidance to the midwife The nurse provides technical guidance to the midwife in the care of clients, particularly in the implementation of management guidelines, as in Integrated Management of Childhood Illness. 23. Answer: (C) Municipal Health Officer  A public health nurse nur se and rural hea health lth midwife can provid providee care during normal no rmal childbirth. A phys physician ician should atten attendd to a woma womann with a complication complicatio n during labor. 24. Answer: (A) 1 Each rural health midwife is given a population assignment of about 5,000. 25. Answer: (D) Municipal Health Board  As mandated by R.A. 7160, 716 0, basic health services servi ces have been devo devolved lved from the natio national nal government to lo local cal government units. uni ts. 26. Answer: (A) Act 3573  Act 3573, the Law on Reporting of Commun Communicable icable Diseases, enacted in 1929, 192 9, mandated the rep reporting orting of diseases listed in the law to the near nearest est health station. 27. Answer: (B) Health education and community organizing are necessary in providing community health services. The community health nurse develops the health capability of people through health education and community organizing activities. 28. Answer: (B) Measles Presidential Proclamation No. 4 is on the Ligtas Tigdas Program. 29. Answer: (B) Bar  A bar graph is used to present p resent comparison compariso n of values, a line ggraph raph for trends ov over er time or age, a pie gra graph ph for population composition or distribution, dis tribution, and a scatter diagram for correlation of two variables. 30. Answer: (D) Core group formation In core group formation, the nurse is able to transfer the technology of community organizing to the potential or informal community leaders through a training program. 31. Answer: (B) Community organization Community organization is the step when community assemblies take place. During the community assembly, the people may opt to formalize the community organization and make plans for community action to resolve a community health problem. 32. Answer: (D) To maximize the community’s resources in dealing with health problems  problems   Community organizing is a developmental service, service, with the goal of developing the people’s self -reliance self -reliance in dealing with community health problems. A, B and C are objectives of contributory objectives to this goal. 33. Answer: (A) Participate in community activities for the solution of a community problem Participation in community activities in resolving a community problem may be in any of the processes mentioned in the other choices. 34. Answer: (D) Terminal Tertiary prevention involves rehabilitation, prevention of permanent disability and disability limitation appropriate for convalescents, the disabled, complicated cases and the terminally ill (those in the terminal stage of a disease)

 

35. Answer: (A) Primary The purpose of isolating a client with a communicable disease is to protect those who are not sick (specific disease prevention). 36. Answer: (B) Secondary Operation Timbang is done to identify members of the susceptible population who are malnourished. Its purpose is early diagnosis and, subsequently, prompt treatment. 37. Answer: (C) Home visit Dynamics of family relationships can best be observed in the family’s natural environment, which is the home.   38. Answer: (B) Health deficit Failure of a family member to develop according to what is expected, as in mental retardation, is a health deficit. 39. Answer: (C) Foreseeable crisis Entry of the 6-year old into school is an anticipated period of unusual demand on the family. 40. Answer: (B) It provides an opportunity to do first hand appraisal of the home situation. Choice A is not correct since a home visit requires that the nurse spend so much time with the family. Choice C is an advantage of a group conference, while choice D is true of a clinic consultation. 41. Answer: (C) A home visit should be conducted in the manner prescribed by the RHU. The home visit plan should be flexible and practical, depending on factors, such as the family’s needs and the resources avai lable to the nurse and the family. 42. Answer: (B) Should minimize if not totally prevent the spread of infection. Bag technique is performed before and after handling a client in the home to prevent transmission of infection to and from the client. 43. Answer: (A) Wash his/her hands before and after providing nursing care to the family members. Choice B goes against the idea of utilizing the family’s resources, which is encouraged in CHN. Choices C and D goes against the principle of asepsis of confining the contaminated surface of objects. 44. Answer: (B) Analytical  Analytical epidemiology epide miology is the stud studyy of factors or determinants determin ants affecting the patterns of o f occurrence and distribution distri bution of disease in a community. 45. Answer: (D) Evaluating the effectiveness of the implementation of the Integrated Management of Childhood Illness Epidemiology is used in the assessment of a community or evaluation of interventions in community health practice. 46. Answer: (C) Participating in the investigation to determine the source of the epidemic Epidemiology is the study of patterns of occurrence and distribution of disease in the community, as well as the factors that affect disease patterns. The purpose of an epidemiologic investigation is to identify the source of an epidemic, i.e., what brought about the epidemic. 47. Answer: (A) Delineate the etiology of the epidemic Delineating the etiology of an epidemic is identifying its source. 48. Answer: (D) There is a gradual build up of cases before the epidemic becomes easily noticeable.  A gradual or insidious insid ious onset of the epidemic epi demic is usually obs observable ervable in perso person-to-person n-to-person propagated epidemics. epid emics. 49. Answer: (A) Establishing the epidemic Establishing the epidemic is determining whether there is an epidemic or not. This is done by comparing the present number of cases with the usual number of cases of the disease at the same time of the year, as well as establishing the relatedness of the cases of the disease. 50. Answer: (B) Cyclical variation  A cyclical variation is i s a periodic fluctuation fluctua tion in the number of ca cases ses of a disease in the co community. mmunity. 51. Answer: (C) Smallpox The last documented case of Smallpox was in 1977 at Somalia. 52. Answer: (B) 100.94:100 Sex ratio is the number of males for every 100 females in the population. 53. Answer: (D) Health programs are sustained according to the level of development of the community. Primary health care is essential health care that can be sustained in all stages of development of the community. 54. Answer: (D) Sensitivity Sensitivity is the capacity of a diagnostic examination to detect cases of the disease. If a test is 100% sensitive, all the cases tested will have a positive result, i.e., there will be no false negative results. 55. Answer: (D) Lagundi Sambong is used as a diuretic. Tsaang gubat is used to relieve diarrhea. Akapulko is used for its antifungal property. 56. Answer: (A) R. A.  A. 8423 or “AN ACT CREATING THE PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE ALT ERNATIVE HEALTH CARE (PITAHC) TO ACCELERATE THE DEVELOPMENT OF TRADITIONAL AND ALTERNATIVE HEALTH CARE IN THE PHILIPPINES, PROVIDING FOR A TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT DE VELOPMENT FUND AND FOR OTHER PURPOSES” signed to a law on December 9, 1997. 57. Answer: (A) Yin Yang is the male dominating, positive and masculine force. 58. Answer: (B) Letter of Instruction No. 949 Letter of Instruction 949 was issued by then President Ferdinand Marcos, directing the formerly called Ministry of Health, now the Department of Health, to utilize Primary Health Care approach in planning and implementing health programs.

 

  59. Answer: (D) Cooperation between the PHN and public school teacher Intersectoral linkages refer to working relationships between the health sector and other sectors involved in community development. 60. Answer: (D) 2,300 Based on the Philippine population composition, to estimate the number of 1-4 year old children, multiply total population by 11.5%. 61. Answer: (A) 265 To estimate the number of pregnant women, multiply the total population by 3.5%. 62. Answer: (D) Any of these may be used. Sex ratio and sex proportion are used to determine the sex composition of a population. A population pyramid is used to present the composition of a population by age and sex. 63. Answer: (A) Crude birth rate Natality means birth. A natality rate is a birth rate. 64. Answer: (B) 5.2/1,000 To compute crude death rate divide total number of deaths (94) by total population (18,000) and multiply by 1,000. 65. Answer: (C) 1-4 year old children Preschoolers are the most susceptible to PEM because they have generally been weaned. Also, this is the population who, unable to feed themselves, are often the victims of poor intrafamilial food distribution. 66. Answer: (C) Swaroop’s index  index  Swaroop’s index is the proportion of deaths aged 50 years and above. The higher the Swaroop’s index of a population, the grea ter the proportion of the deaths who were able to reach the age of at least 50 years, i.e., more people grew old before they died. 67. Answer: (B) 43.5/1,000 To compute for neonatal mortality rate, divide the number of babies who died before reaching the age of 28 days by the total number of live births, then multiply by 1,000. 68. Answer: (A) 1-4 year old age-specific mortality rate Since preschoolers are the most susceptible to the effects of malnutrition, a population with poor nutritional status will most likely have a high 1-4 year old age-specific mortality rate, also known as child mortality rate. 69. Answer: (B) Number of registered live births To compute for general or total fertility rate, divide the number of registered live births by the number of females of reproductive age (15-45 years), then multiply by 1,000. 70. Answer: (B) Survey  A survey, also called sample s ample survey, is data ggathering athering about a sample sa mple of the popul population. ation. 71. Answer: (C) De facto The other method of population assignment, de jure, is based on the usual place of residence of the people. 72. Answer: (A) Tally report  A tally report is prepared prepar ed monthly or qua quarterly rterly by the RHU person personnel nel and transmitted to the Provincial Health He alth Office. 73. Answer: (C) Target/client list The MDT Client List is a record of clients enrolled in MDT and other relevant data, such as dates when clients collected their monthly supply of drugs. 74. Answer: (A) P.D. 651 P.D. 651 amended R.A. 3753, requiring the registry of births within 30 days from their occurrence. 75. Answer: (D) Any of these health professionals R.A. 3753 states that any birth attendant may sign the certificate of live birth. 76. Answer: (C) Magnitude of the health problem Magnitude of the problem refers to the percentage of the population affected by a health problem. The other choices are criteria considered in both family and community health care. 77. Answer: (D) Its main strategy is certification of health centers able to comply with standards. Sentrong Sigla Movement is a joint project of the DOH and local government units. Its main strategy is certification of health centers that are able to comply with standards set by the DOH. 78. Answer: (D) Those who just had a delivery within the past 15 months The ideal birth spacing is at least two years. 15 months plus 9 months of pregnancy = 2 years. 79. Answer: (C) Adequate information for couples regarding the different methods To enable the couple to choose freely among different methods of family planning, they must be given full information regarding the different methods that are available to them, considering the availability of quality services that can support their choice. 80. Answer: (B) Retinol 200,000 IU Retinol 200,000 IU is a form of megadose Vitamin A. This may have a teratogenic effect. 81. Answer: (A) Her OB score is G5P3. Only women with less than 5 pregnancies are qualified for a home delivery. It is also advisable for a primigravida to have delivery at a childbirth facility.

 

82. Answer: (C) Folic acid It is estimated that the incidence of neural tube defects can be reduced drastically if pregnant women have an adequate intake of folic acid. 83. Answer: (D) Note the interval, duration and intensity of labor contractions.  Assessment of the woman woma n should be do done ne first to determine wheth whether er she is having true labor and, if so so,, what stage of labor she is in. in . 84. Answer: (D) Explain to her that putting the baby to breast will lessen blood loss after delivery. Suckling of the nipple stimulates the release of oxytocin by the posterior pituitary gland, which causes uterine contraction. Lactation begins 1 to 3 days after delivery. Nipple stretching exercises are done when the nipples are flat or inverted. Frequent washing dries up the nipples, making them prone to the formation of fissures. 85. Answer: (B) To stimulate milk production by the mammary acini Suckling of the nipple stimulates prolactin reflex (the release of prolactin by the anterior pituitary gland), which initiates lactation. 86. Answer: (B) The mother does not feel nipple pain. When the baby has properly latched on to the breast, he takes deep, slow sucks; his mouth is wide open; and much of the areola is inside his mouth. And, you’re right! The mother does not feel nipple pain.   87. Answer: (B) 6 months  After 6 months, the baby’s nutrient n utrient needs, especially esp ecially the baby’ baby’ss iron requireme requirement, nt, can no longer be pprovided rovided by mother’s mother’ s milk alone.  alone.   88. Answer: (C) Retinol 200,000 I.U., 1 capsule  A capsule of Retinol 200,000 IU is given w within ithin 1 month after deli delivery. very. Potassium ioda iodate te is given durin duringg pregna pregnancy; ncy; malunggay capsule caps ule is not routinely administered after delivery; and ferrous sulfate is taken for two months after delivery. 89. Answer: (C) Measles vaccine  Among the biologicals biolog icals used in the Expanded Exp anded Program on Immunization, measl measles es vaccine and OPV are highly sensitive sensi tive to heat, requirin requiringg storage in the freezer. 90. Answer: (B) 4 While the unused portion of other biologicals in EPI may be given until the end of the day, only BCG is discarded 4 hours after reconstitution. This is why BCG immunization is scheduled only in the morning. 91. Answer: (A) P.D. 996 Presidential Decree 996, enacted in 1976, made immunization in the EPI compulsory for children under 8 years of age. Hepatitis B vaccination was made compulsory for the same age group by R.A. 7846. 92. Answer: (B) BCG BCG causes the formation of a superficial abscess, which begins 2 weeks after immunization. The abscess heals without treatment, with the formation of a permanent scar. 93. Answer: (C) Infant BCG Infant BCG may be given at birth. All the other immunizations mentioned can be given at 6 weeks of age. 94. Answer: (A) Seizures a day after DPT 1. Seizures within 3 days after administration of DPT is an indication of hypersensitivity to pertussis vaccine, a component of DPT. This is considered a specific contraindication to subsequent doses of DPT. 95. Answer: (A) Go on with the infant’s immunizations.   In the EPI, fever up to 38.5°C is not a contraindication to immunization. Mild acute respiratory tract infection, simple diarrhea and malnutrition are not contraindications either. 96. Answer: (A) 1 year The baby will have passive natural immunity by placental transfer of antibodies. The mother will have active artificial immunity lasting for about 10 years. 5 doses will give the mother lifetime protection. 97. Answer: (C) Normal In IMCI, a respiratory rate of 50/minute or more is fast breathing for an infant aged 2 to 12 months. 98. Answer: (D) Chest indrawing In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating severe pneumonia. 99. Answer: (B) Refer him urgently to the hospital. Severe pneumonia requires urgent referral to a hospital. Answers A, C and D are done for a client classified as having pneumonia. 100. Answer: (B) Some dehydration Using the assessment guidelines of IMCI, a child (2 months to 5 years old) with diarrhea is classified as having SOME DEHYDRATION if he shows 2 or more of the following signs: restless or irritable, sunken eyes, the skin goes back slow after a skin pinch. 101. Answer: (B) Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours. In the IMCI management guidelines, SOME DEHYDRATION is treated with the administration of Oresol within a period of 4 hours. The amount of Oresol is best computed on the basis of the child’s weight (75 ml/kg body weight). If the weight is unknown, the amount of Oresol is based on the child’s age.  age.  102. Answer: (D) Let the child rest for 10 minutes then continue giving Oresol more slowly. If the child vomits persistently, that is, he vomits everything that he takes in, he has to be referred urgently to a hospital. Otherwise, vomiting is managed by letting the child rest for 10 minutes and then continuing with Oresol administration. Teach the mother to give Oresol more slowly. 103. Answer: (D) Edema Edema, a major sign of kwashiorkor, is caused by decreased colloidal osmotic pressure of the blood brought about by hypoalbuminemia. Decreased blood albumin level is due a protein-deficient diet.

 

  104. Answer: (A) Refer the child urgently to a hospital for confinement. “Baggy pants” is a sign of severe marasmus. The best management is urgent referral to a hospital.   105. Answer: (D) Conjunctival xerosis The earliest sign of Vitamin A deficiency (xerophthalmia) is night blindness. However, this is a functional change, which is not observable during physical examination.The earliest visible lesion is conjunctival xerosis or dullness of the conjunctiva due to inadequate tear production. 106. Answer: (D) 200,000 IU Preschoolers are given Retinol 200,000 IU every 6 months. 100,000 IU is given once to infants aged 6 to 12 months. The dose for pregnant women is 10,000 IU. 107. Answer: (A) Palms The anatomic characteristics of the palms allow a reliable and convenient basis for examination for pallor. 108. Answer: (A) Sugar R.A. 8976 mandates fortification of rice, wheat flour, sugar and cooking oil with Vitamin A, iron and/or iodine. 109. Answer: (A) Give measles vaccine to babies aged 6 to 8 months. Ordinarily, measles vaccine is given at 9 months of age. During an impending epidemic, however, one dose may be given to babies aged 6 to 8 months. The mother is instructed that the baby needs another dose when the baby is 9 months old. 110. Answer: (A) Inability to drink  A sick child aged 2 months to 5 years must be rreferred eferred urgently to a hhospital ospital if he/she has on onee or more of the following follo wing signs: not able to feed or drink, vomits everything, convulsions, abnormally sleepy or difficult to awaken. 111. Answer: (D) Retinol capsule regardless of when the last dose was given  An infant 6 to 12 months classified cl assified as a case of m measles easles is given Re Retinol tinol 100,000 IU; a child chil d is given 200,000 200,0 00 IU regardless of when the last dose was given. 112. Answer: (B) Ask where the family resides. Because malaria is endemic, the first question to determine malaria risk is where the client’s family resides. If the area of residence is not a  known endemic area, ask if the child had traveled within the past 6 months, where he/she was brought and whether he/she stayed overnight in that area. 113. Answer: (B) Destroying breeding places of mosquitoes  Aedes aegypti, the vector ve ctor of Dengue feve fever, r, breeds in stagnant, cle clear ar water. Its feeding time is uusually sually during the daytime. d aytime. It has a cyclical cyc lical pattern of occurrence, unlike malaria which is endemic in certain parts of the country. 114. Answer: (C) Determining whether a place is endemic or not This is diagnostic and therefore secondary level prevention. The other choices are for primary prevention. 115. Answer: (B) Pinworm Pinworm ova are deposited around the anal orifice. 116. Answer: (C) Cough for 3 weeks  A client is considered considere d a PTB suspect when hhee has cough for 2 wee weeks ks or more, plus one oorr more of the following ssigns: igns: fever for fo r 1 month or more; chest pain lasting for 2 weeks or more not attributed to other conditions; progressive, unexplained weight loss; night sweats; and hemoptysis. 117. Answer: (D) Clients diagnosed for the first time through a positive sputum exam Category I is for new clients diagnosed by sputum examination and clients diagnosed to have a serious form of extrapulmonary tuberculosis, such as TB osteomyelitis. 118. Answer: (B) Having the health worker or a responsible family member monitor drug intake Directly Observed Treatment Short Course is so-called because a treatment partner, preferably a health worker accessible to the client, monitors the client’s compliance to the treatment.  treatment.  119. Answer: (C) Thickened painful nerves The lesion of leprosy is not macular. It is characterized by a change in skin color (either reddish or whitish) and loss of sensation, sweating and hair growth over the lesion. Inability to close the eyelids (lagophthalmos) and sinking of the nosebridge are late symptoms. 120. Answer: (D) 5 skin lesions, positive slit skin smear  A multibacillary leprosy le prosy case is one who has a positive slit sl it skin smear and at a t least 5 skin lesions. 121. Answer: (B) Liver cirrhosis The etiologic agent of schistosomiasis in the Philippines is Schistosoma japonicum, which affects the small intestine and the liver. Liver damage is a consequence of fibrotic reactions to schistosoma eggs in the liver. 122. Answer: (C) Proper use of sanitary toilets The ova of the parasite get out of the human body together with feces. Cutting the cycle at this stage is the most effective way of preventing the spread of the disease to susceptible hosts. 123. Answer: (B) II  A communal faucet or water wa ter standpost is classified classifi ed as Level II. 124. Answer: (A) Use of sterile syringes and needles Hepatitis A is transmitted through the fecal oral route. Hepatitis B is transmitted through infected body secretions like blood and semen. 125. Answer: (A) DPT DPT is sensitive to freezing. The appropriate storage temperature of DPT is 2 to 8° C only. OPV and measles vaccine are highly sensitive to heat and require freezing. MMR is not an immunization in the Expanded Program on Immunization.

 

126. Answer: (A) 45 To estimate the number of infants, multiply total population by 3%. 127. Answer: (B) Severe dehydration The order of priority in the management of severe dehydration is as follows: intravenous fluid therapy, referral to a facility where IV fluids can be initiated within 30 minutes, Oresol/nasogastric tube, Oresol/orem. When the foregoing measures are not possible or effective, tehn urgent referral to the hospital is done. 128. Answer: (A) 3  Adequate blood supply to the area allows a llows the return of the col color or of the nailbed w within ithin 3 seconds. 129. Answer: (B) Instruct the mother to give the child Oresol. Since the child does not manifest any other danger sign, maintenance of fluid balance and replacement of fluid loss may be done by giving the client Oresol. 130. Answer: (B) Buccal mucosa Koplik’s spot may be seen on the mucosa of the mouth or the throat.  throat.   131. Answer: (D) Measles Viral conjunctivitis is transmitted by direct or indirect contact with discharges from infected eyes. Acute poliomyelitis is spread through the fecal-oral route and contact with throat secretions, whereas diphtheria is through direct and indirect contact with respiratory secretions. 132. Answer: (A) Hemophilus influenzae Hemophilus meningitis is unusual over the age of 5 years. In developing countries, the peak incidence is in children less than 6 months of age. Morbillivirus is the etiology of measles. Streptococcus pneumoniae and Neisseria meningitidis may cause meningitis, but age distribution is not specific in young children. 133. Answer: (D) Zooprophylaxis Zooprophylaxis is done by putting animals like cattle or dogs close to windows or doorways just before nightfall. The Anopheles mosquito takes his blood meal from the animal and goes back to its breeding place, thereby preventing infection of humans. 134. Answer: (A) Stream seeding Stream seeding is done by putting tilapia fry in streams or other bodies of water identified as breeding places of the Anopheles mosquito. 135. Answer: (C) Destruction of breeding places of the mosquito vector  Anopheles mosquitoes mosqu itoes breed in slow-moving, s low-moving, clear clea r water, such as mounta mountain in streams. 136. Answer: (B) Cholera Passage of profuse watery stools is the major symptom of cholera. Both amebic and bacillary dysentery are characterized by the presence of blood and/or mucus in the stools. Giardiasis is characterized by fat malabsorption and, therefore, steatorrhea. 137. Answer: (B) S. japonicum S. mansoni is found mostly in Africa and South America; S. haematobium in Africa and the Middle East; and S. malayensis only in peninsular Malaysia. 138. Answer: (D) Leptospirosis Leptospirosis is transmitted through contact with the skin or mucous membrane with water or moist soil contaminated with urine of infected animals, like rats. 139. Answer: (C) III Waterworks systems, such as MWSS, are classified as level III. 140. Answer: (D) Refer the client for a supplementary test, such as Western blot, since the ELISA result may be false.  A client having a reactive re active ELISA result must und undergo ergo a more specific specif ic test, such as Western blot. A negative neg ative supplementary supplementa ry test result means m eans that the ELISA result was false and that, most probably, the client is not infected. 141. Answer: (A) Being faithful to a single sexual partner Sexual fidelity rules out the possibility of getting the disease by sexual contact with another infected person. Transmission occurs mostly through sexual intercourse and exposure to blood or tissues. 142. Answer: (B) Infectious mononucleosis Cytomegalovirus disease is an acute viral disease characterized by fever, sore throat and lymphadenopathy. 143. Answer: (A) Contact tracing Contact tracing is the most practical and reliable method of finding possible sources of person-to-person transmitted infections, such as sexually transmitted diseases. 144. Answer: (D) They are able to bring about a cure of the disease condition. There is no known treatment for AIDS. Antiretroviral agents reduce the risk of opportunistic infections and prolong life, but does not cure the underlying immunodeficiency. 145. Answer: (D) Consult a physician who may give them rubella immunoglobulin. Rubella vaccine is made up of attenuated German measles viruses. This is contraindicated in pregnancy. Immune globulin, a specific prophylactic against German measles, may be given to pregnant women. 1. May arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. She also tells the nurse that a home pregnancy test was positive but she began to have mild cramps and is now having moderate vaginal bleeding. During the physical examination of the client, the nurse notes that May has a dilated cervix. The nurse determines that May is experiencing which type of abortion? Inevitable Incomplete Threatened

 

Septic 2. Nurse Reese is reviewing the record of a pregnant client for her first prenatal visit. Which of the following data, if noted on the client’s record, would alert the nurse that the client is at risk for a spontaneous abortion?  Age 36 years History of syphilis History of genital herpes History of diabetes mellitus 3. Nurse Hazel is preparing to care for a client who is newly admitted to the hospital with a possible diagnosis of ectopic pregnancy. Nurse Hazel develops a plan of care for the client and determines that which of the following nursing actions is the priority? Monitoring weight  Assessing for edema edem a Monitoring apical pulse Monitoring temperature 4. Nurse Oliver is teaching a diabetic pregnant client about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that the second half of pregnancy require: Decreased caloric intake Increased caloric intake Decreased Insulin Increase Insulin 5. Nurse Michelle is assessing a 24 year old client with a diagnosis of hydatidiform mole. She is aware that one of the following is unassociated with this condition? Excessive fetal activity. Larger than normal uterus for gestational age. Vaginal bleeding Elevated levels of human chorionic gonadotropin. 6. A pregnant client is receiving magnesium sulfate for severe pregnancy induced hypertension (PIH). The clinical findings that would warrant use of the antidote , calcium gluconate is: Urinary output 90 cc in 2 hours.  Absent patellar reflexes. refle xes. Rapid respiratory rate above 40/min. Rapid rise in blood pressure. 7. During vaginal examination of Janah who is in labor, the presenting part is at station plus two. Nurse, correctly interprets it as: Presenting part is 2 cm above the plane of the ischial spines. Biparietal diameter is at the level of the ischial spines. Presenting part in 2 cm below the plane of the ischial spines. Biparietal diameter is 2 cm above the ischial spines. 8. A pregnant client is receiving oxytocin (Pitocin) for induction of labor. A condition that warrant the nurse in-charge to discontinue I.V. infusion of Pitocin is: Contractions every 1 ½ minutes lasting 70-80 seconds. Maternal temperature 101.2 Early decelerations in the fetal heart rate. Fetal heart rate baseline 140-160 bpm. 9. Calcium gluconate is being administered to a client with pregnancy induced hypertension (PIH). A nursing action that must be initiated as the plan of care throughout injection of the drug is: Ventilator assistance CVP readings EKG tracings Continuous CPR 10. A trial for vaginal delivery after an earlier caesareans, would likely to be given to a gravida, who had: First low transverse cesarean was for active herpes type 2 infections; vaginal culture at 39 weeks pregnancy was positive. First and second caesareans were for cephalopelvic disproportion. First caesarean through a classic incision as a result of severe fetal distress. First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex presentation. 11.Nurse Ryan is aware that the best initial approach when trying to take a crying toddler’s temperature is:   Talk to the mother first and then to the toddler. Bring extra help so it can be done quickly. Encourage the mother to hold the child. Ignore the crying and screaming. 12.Baby Tina a 3 month old infant just had a cleft lip and palate repair. What should the nurse do to prevent trauma to operative site?  Avoid touching the suture line, even w when hen cleaning. Place the baby in prone position. Give the baby a pacifier. Place the infant’s arms in soft elbow restraints.  restraints.   13. Which action should nurse Marian include in the care plan for a 2 month old with heart failure? Feed the infant when he cries.  Allow the infant to rest before be fore feeding. Bathe the infant and administer medications before feeding. Weigh and bathe the infant before feeding. 14.Nurse Hazel is teaching a mother who plans to discontinue breast feeding after 5 months. The nurse should advise her to include which foods in her infant’s diet?  diet?   Skim milk and baby food. Whole milk and baby food. Iron-rich formula only. Iron-rich formula and baby food. 15.Mommy Linda is playing with her infant, who is sitting securely alone on the floor of the clinic. The mother hides a toy behind her back and the infant looks for it. The nurse is aware that estimated age of the infant would be: 6 months 4 months 8 months 10 months 16.Which of the following is the most prominent feature of public health nursing?

 

It involves providing home care to sick people who are not confined in the hospital. Services are provided free of charge to people within the catchments area. The public health nurse functions as part of a team providing a public health nursing services. Public health nursing focuses on preventive, not curative, services. 17.When the nurse determines whether resources were maximized in implementing Ligtas Tigdas, she is evaluating Effectiveness Efficiency  Adequacy  Appropriateness 18.Vangie is a new B.S.N. graduate. She wants to become a Public Health Nurse. Where should she apply? Department of Health Provincial Health Office Regional Health Office Rural Health Unit 19.Tony is aware the Chairman of the Municipal Health Board is: Mayor Municipal Health Officer Public Health Nurse  Any qualified physician ph ysician 20.Myra is the public health nurse in a municipality with a total population of about 20,000. There are 3 rural health midwives among the RHU personnel. How many more midwife items will the RHU need? 1 2 3 The RHU does not need any more midwife item. 21.According to Freeman and Heinrich, community health nursing is a developmental service. Which of the following best illustrates this statement? The community health nurse continuously develops himself personally and professionally. Health education and community organizing are necessary in providing community health services. Community health nursing is intended primarily for health promotion and prevention and treatment of disease. The goal of community health nursing is to provide nursing services to people in their own places of residence. 22.Nurse Tina is aware that the disease declared through Presidential Proclamation No. 4 as a target for eradication in the Philippines is? Poliomyelitis Measles Rabies Neonatal tetanus 23.May knows that the step in community organizing that involves training of potential leaders in the community is: Integration Community organization Community study Core group formation 24.Beth a public health nurse takes an active role in community participation. What is the primary goal of community organizing? To educate the people regarding community health problems To mobilize the people to resolve community health problems To maximize the community’s resources in dealing with health problems.  problems.   To maximize the community’s resources in dealing with health problems.  problems.   25.Tertiary prevention is needed in which stage of the natural history of disease? Pre-pathogenesis Pathogenesis Prodromal Terminal 26.The nurse is caring for a primigravid client in the labor and delivery area. Which condition would place the client at risk for disseminated intravascular coagulation (DIC)? Intrauterine fetal death. Placenta accreta. Dysfunctional labor. Premature rupture of the membranes. 27.A fullterm client is in labor. Nurse Betty is aware that the fetal heart rate would be: 80 to 100 beats/minute 100 to 120 beats/minute 120 to 160 beats/minute 160 to 180 beats/minute 28.The skin in the diaper area of a 7 month old infant is excoriated and red. Nurse Hazel should instruct the mother to: Change the diaper more often.  Apply talc powder with diaper changes. chang es. Wash the area vigorously with each diaper change. Decrease the infant’s fluid intake to decrease saturating diapers.  diapers.   29.Nurse Carla knows that the common cardiac anomalies in children with Down Syndrome (tri-somy 21) is:  Atrial septal defect Pulmonic stenosis Ventricular septal defect Endocardial cushion defect 30.Malou was diagnosed with severe preeclampsia is now receiving I.V. magnesium sulfate. The adverse effects associated with magnesium sulfate is:  Anemia Decreased urine output Hyperreflexia Increased respiratory rate 31.A 23 year old client is having her menstrual period every 2 weeks that last for 1 week. This type of menstrual pattern is bets defined by: Menorrhagia Metrorrhagia

 

Dyspareunia  Amenorrhea 32. Jannah is admitted to the labor and delivery unit. The critical laboratory result for this client would be: Oxygen saturation Iron binding capacity Blood typing Serum Calcium 33.Nurse Gina is aware that the most common condition found during the second-trimester of pregnancy is: Metabolic alkalosis Respiratory acidosis Mastitis Physiologicc anemia Physiologi 34.Nurse Lynette is working in the triage area of an emergency department. She sees that several pediatric clients arrive simultaneously. The client who needs to be treated first is:  A crying 5 year old child chi ld with a laceratio lacerationn on his scalp.  A 4 year old child with w ith a barking coug coughs hs and flushed app appearance. earance.  A 3 year old child with w ith Down syndrom syndromee who is pale and asl asleep eep in his mother mother’s ’s arms. arms.    A 2 year old infant with stridorous brea breath th sounds, sitting up in his m mother’s other’s arms and drooling. dr ooling.   35.Maureen in her third trimester arrives at the emergency room with painless vaginal bleeding. Which of the following conditions is suspected? Placenta previa  Abruptio placentae placenta e Premature labor Sexually transmitted disease 36.A young child named Richard is suspected of having pinworms. The community nurse collects a stool specimen to confirm the diagnosis. The nurse should schedule the collection of this specimen for: Just before bedtime  After the child has been bathe  Any time during the day da y Early in the morning 37.In doing a child’s admission assessment, Nurse Betty should be alert to note which signs or symptoms of chronic lead poiso ning? Irritability and seizures Dehydration and diarrhea Bradycardia and hypotension Petechiae and hematuria 38.To evaluate a woman’s understanding about the use of diaphragm for family planning, Nurse Trish asks her to explain how she will use the appliance. Which response indicates a need for further health teaching? “I should check the diaphragm carefully for holes every time I use it”   “I may need a different size of diaphragm if I gain or lose weight more than 20 pounds”   “The diaphragm must be left in place for atleast 6 hours after intercourse”   “I really need to use the diaphragm and jelly most during the middle of my menstrual cycle”.   39.Hypoxia is a common complication of laryngotracheobronchitis. Nurse Oliver should frequently assess a child with laryngotracheobronchitis for: Drooling Muffled voice Restlessness Low-grade fever 40.How should Nurse Michelle guide a child who is blind to walk to the playroom? Without touching the child, talk continuously as the child walks down the hall. Walk one step ahead, with the child’s hand on the nurse’s elbow.   Walk slightly behind, gently guiding the child forward. Walk next to the child, holding the child’s hand.  hand.   41.When assessing a newborn diagnosed with ductus arteriosus, Nurse Olivia should expect that the child most likely would have an: Loud, machinery-like murmur. Bluish color to the lips. Decreased BP reading in the upper extremities Increased BP reading in the upper extremities. 42.The reason nurse May keeps the neonate in a neutral thermal environment is that when a newborn becomes too cool, the neonate requires: Less oxygen, and the newborn’s metabolic rate increases.  increases.   More oxygen, and the newborn’s metabolic rate decreases.  decreases.   More oxygen, and the newborn’s metabolic rate increases.  increases.   Less oxygen, and the newborn’s metabolic rate decreases.  decreases.   43.Before adding potassium to an infant’s I.V. line, Nurse Ron must be sure to assess whet her this infant has: Stable blood pressure Patant fontanelles Moro’s reflex  reflex  Voided 44.Nurse Carla should know that the most common causative factor of dermatitis in infants and younger children is: Baby oil Baby lotion Laundry detergent Powder with cornstarch 45.During tube feeding, how far above an infant’s stomach should the nurse hold the syringe with formula? formula?   6 inches 12 inches 18 inches 24 inches 46. In a mothers’ class, Nurse Lhynnete discussed Lhynnete  discussed childhood diseases such as chicken pox. Which of the following statements about chicken pox is correct? The older one gets, the more susceptible he becomes to the complications of chicken pox.  A single attack of chicken pox will preven preventt future episodes, episodes , including condi conditions tions such as shingles. shingle s. To prevent an outbreak in the community, quarantine may be imposed by health authorities. Chicken pox vaccine is best given when there is an impending outbreak in the community.

 

47.Barangay Pinoy had an outbreak of German measles. To prevent congenital rubella, what is the BEST advice that you can give to women in the first trimester of pregnancy in the barangay Pinoy?  Advice them on the signs sig ns of German measle measles. s.  Avoid crowded places, pla ces, such as markets and movie m ovie houses. Consult at the health center where rubella vaccine may be given. Consult a physician who may give them rubella immunoglobulin immunoglobulin.. 48.Myrna a public health nurse knows that to determine possible sources of sexually transmitted infections, the BEST method that may be undertaken is: Contact tracing Community survey Mass screening tests Interview of suspects 49.A 33-year old female client came for consultation at the health center with the chief complaint of fever for a week. Accompanying symptoms were muscle pains and body malaise. A week after the start of fever, the client noted yellowish discoloration of his sclera. History showed that he waded in flood waters about 2 weeks before the onset of symptoms. Based on her history, which disease condition will you suspect? Hepatitis A Hepatitis B Tetanus Leptospirosis 50.Mickey a 3-year 3-year old client was brought to the health center with the chief complaint of severe diarrhea and the passage of “rice water” stools. The client is most probably suffering from which condition? Giardiasis Cholera  Amebiasis Dysentery 51.The most prevalent form of meningitis among children aged 2 months to 3 years is caused by which microorganism? Hemophilus influenzae Morbillivirus Steptococcus pneumoniae Neisseria meningitidis 52.The student nurse is aware that the pathognomonic sign of measles is Koplik’s spot and you may see Koplik’s spot by inspec ting the: Nasal mucosa Buccal mucosa Skin on the abdomen Skin on neck 53.Angel was diagnosed as having Dengue fever. You will say that there is slow capillary refill when the color of the nailbed that you pressed does not return within how many seconds? 3 seconds 6 seconds 9 seconds 10 seconds 54.In Integrated Management of Childhood Illness, the nurse is aware that the severe conditions generally require urgent referral to a hospital. Which of the following severe conditions DOES NOT always require urgent referral to a hospital? Mastoiditis Severe dehydration Severe pneumonia Severe febrile disease 55.Myrna a public health nurse will conduct outreach immunization in a barangay Masay with a population of about 1500. The estimated number of infants in the barangay would be: 45 infants 50 infants 55 infants 65 infants 56.The community nurse is aware that the biological used in Expanded Program on Immunization (EPI) should NOT be stored in the freezer? DPT Oral polio vaccine Measles vaccine MMR 57.It is the most effective way of controlling schistosomiasis in an endemic area? Use of molluscici molluscicides des Building of foot bridges Proper use of sanitary toilets Use of protective footwear, such as rubber boots 58.Several clients is newly admitted and diagnosed with leprosy. Which of the following clients should be classified as a case of multibacillary leprosy? 3 skin lesions, negative slit skin smear 3 skin lesions, positive slit skin smear 5 skin lesions, negative slit skin smear 5 skin lesions, positive slit skin smear 59.Nurses are aware that diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of leprosy? Macular lesions Inability to close eyelids Thickened painful nerves Sinking of the nosebridge 60.Marie brought her 10 month old infant for consultation because of fever, started 4 days prior to consultation. In determining malaria risk, what will you do? Perform a tourniquet test.  Ask where the family resides. re sides. Get a specimen for blood smear.  Ask if the fever is present everyday. ev eryday.

 

61.Susie brought her 4 years old daughter to the RHU because of cough and colds. Following the IMCI assessment guide, which of the following is a danger sign that indicates the need for urgent referral to a hospital? Inability to drink High grade fever Signs of severe dehydration Cough for more than 30 days 62.Jimmy a 2-year 2-year old child revealed “baggy pants”. As a nurse, nu rse, using the IMCI guidelines, how will you manage Jimmy? Refer the child urgently to a hospital for confinement. Coordinate with the social worker to enroll the child in a feeding program. Make a teaching plan for the mother, focusing on menu planning for her child.  Assess and treat the child chi ld for health proble problems ms like infections and intestinal parasi parasitism. tism. 63.Gina is using Oresol in the management of diarrhea of her 3-year old child. She asked you what to do if her child vomits. As a nurse you will tell her to: Bring the child to the nearest hospital for further assessment. Bring the child to the health center for intravenous fluid therapy. Bring the child to the health center for assessment by the physician. Let the child rest for 10 minutes then continue giving Oresol more slowly. 64.Nikki a 5-month old infant was brought by his mother to the health center because of diarrhea for 4 to 5 times a day. Her skin goes back slowly after a skin pinch and her eyes are sunken. Using the IMCI guidelines, you will classify this infant in which category? No signs of dehydration dehydration Some dehydration Severe dehydration The data is insufficient. 65.Chris a 4-month old infant was brought by her mother to the health center because of cough. His respiratory rate is 42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines of assessment, his breathing is considered as: Fast Slow Normal Insignificant 66.Maylene had just received her 4th dose of tetanus toxoid. She is aware that her baby will have protection against tetanus for 1 year 3 years 5 years Lifetime 67.Nurse Ron is aware that unused BCG should be discarded after how many hours of reconstitution? 2 hours 4 hours 8 hours  At the end of the day 68.The nurse explains to a breastfeeding mother that breast milk is sufficient for all of the baby’s nutrient needs only up t o: 5 months 6 months 1 year 2 years 69.Nurse Ron is aware that the gestational age of a conceptus that is considered viable (able to live outside the womb) is: 8 weeks 12 weeks 24 weeks 32 weeks 70.When teaching parents of a neonate the proper position for the neonate’s sleep, the nurse Patricia stresses the importance  of placing the neonate on his back to reduce the risk of which of the following?  Aspiration Sudden infant death syndrome (SIDS) Suffocation Gastroesophageal reflux (GER) 71.Which finding might be seen in baby James a neonate suspected of having an infection? Flushed cheeks Increased temperature Decreased temperature Increased activity level 72.Baby Jenny who is small-for-gestation is at increased risk during the transitional period for which complication?  Anemia probably probabl y due to chronic fetal hhyposia yposia Hyperthermia due to decreased glycogen stores Hyperglycemia due to decreased glycogen stores Polycythemia probably due to chronic fetal hypoxia 73.Marjorie has just given birth at 42 weeks’ gestation. When the nurse assessing the neonate, which physical finding is expected? is  expected?  A sleepy, lethargic baby ba by Lanugo covering the body Desquamation of the epidermis Vernix caseosa covering the body 74.After reviewing the Myrna’s maternal history of magnesium sulfate during labor, which condition would nurse Richard antici pate as a potential problem in the neonate? Hypoglycemia Jitteriness Respiratory depression Tachycardia 75.Which symptom would indicate the Baby Alexandra was adapting appropriately to extra-uterine life without difficulty? Nasal flaring Light audible grunting Respiratory rate 40 to 60 breaths/minute Respiratory rate 60 to 80 breaths/minute

 

76. When teaching umbilical cord care for Jennifer a new mother, the nurse Jenny would include which information?  Apply peroxide to the cord with each diaper di aper change Cover the cord with petroleum jelly after bathing Keep the cord dry and open to air Wash the cord with soap and water each day during a tub bath. 77.Nurse John is performing an assessment on a neonate. Which of the following findings is considered common in the healthy neonate? Simian crease Conjunctival Conjunctiv al hemorrhage Cystic hygroma Bulging fontanelle 78.Dr. Esteves decides to artificially rupture the membranes of a mother who is on labor. Following this procedure, the nurse Hazel checks the fetal heart tones for which the following reasons? To determine fetal well-being. To assess for prolapsed cord To assess fetal position To prepare for an imminent delivery. 79.Which of the following would be least likely to indicate anticipated bonding behaviors by new parents? The parents’ parents’ willingness to touch and hold the new born.  born.  The parent’s expression of interest about the size of the new born.   The parents’ indication that they want to see the newborn.   The parents’ interactions with each other.  other.   80.Following a precipitous delivery, examination of the client’s vagina reveals  reveals   a fourth-degree laceration. Which of the following would be contraindicated when caring for this client?  Applying cold to limit l imit edema durin duringg the first 12 to 24 hours. Instructing the client to use two or more peripads to cushion the area. Instructing the client on the use of sitz baths if ordered. Instructing the client about the importance of perineal (kegel) exercises. 81. A pregnant woman accompanied by her husband, seeks admission to the labor and del ivery area. She states that she’s in labor and says she attended the facility clinic for prenatal care. Which question should the nurse Oliver ask her first? “Do you have any chronic illnesses?”  illnesses?”   “Do you have any allergies?”  allergies?”   “What is your expected due date?”  date?”  “Who will be with you during labor?”  labor?”  82.A neonate begins to gag and turns a dusky color. What should the nurse do first? Calm the neonate. Notify the physician. Provide oxygen via face mask as ordered  Aspirate the neonate’s neona te’s nose and mouth mou th with a bulb syr inge. inge. 83. When a client states that her “water broke,” which of the following actions would be inappropriate for the nurse to do?   Observing the pooling of straw-colored fluid. Checking vaginal discharge with nitrazine paper. Conducting a bedside ultrasound for an amniotic fluid index. Observing for flakes of vernix in the vaginal discharge. 84. A baby girl is born 8 weeks premature. At birth, she has no spontaneous respirations but is successfully resuscitated. Within several hours she develops respiratory grunting, cyanosis, tachypnea, nasal flaring, and retractions. She’s diagnosed with respiratory distress syndrome, intubated,   and placed on a ventilator. Which nursing action should be included in the baby’s plan of care to prevent retinopathy of prem aturity? Cover his eyes while receiving oxygen. Keep her body temperature low. Monitor partial pressure of oxygen (Pao2) levels. Humidify the oxygen. 85. Which of the following is normal newborn calorie intake? 110 to 130 calories per kg. 30 to 40 calories per lb of body weight.  At least 2 ml per feeding 90 to 100 calories per kg 86. Nurse John is knowledgeable that usually individual twins will grow appropriately and at the same rate as singletons until how many weeks? 16 to 18 weeks 18 to 22 weeks 30 to 32 weeks 38 to 40 weeks 87. Which of the following classifications applies to monozygotic twins for whom the cleavage of the fertilized ovum occurs more than 13 days after fertilization? conjoined twins diamniotic dichorionic twins diamniotic monochorionic twin monoamniotic monochorionic twins 88. Tyra experienced painless vaginal bleeding has just been diagnosed as having a placenta previa. Which of the following procedures is usually performed to diagnose placenta previa?  Amniocentesis Digital or speculum examination External fetal monitoring Ultrasound 89. Nurse Arnold knows that the following changes in respiratory functioning during pregnancy is considered normal: Increased tidal volume Increased expiratory volume Decreased inspiratory capacity Decreased oxygen consumption 90. Emily has gestational diabetes and it is usually managed by which of the following therapy? Diet Long-actingg insulin Long-actin Oral hypoglycemic

 

Oral hypoglycemic drug and insulin 91. Magnesium sulfate is given to Jemma with preeclampsia to prevent which of the following condition? Hemorrhage Hypertension Hypomagnesemia Seizure 92. Cammile with sickle cell anemia has an increased risk for having a sickle cell crisis during pregnancy. Aggressive management of a sickle cell crisis includes which of the following measures?  Antihypertensive agents ag ents Diuretic agents I.V. fluids  Acetaminophen (Tylenol) (Ty lenol) for pain 93. Which of the following drugs is the antidote for magnesium toxicity? Calcium gluconate (Kalcinate) Hydralazine (Apresoline) Naloxone (Narcan) Rho (D) immune globulin (RhoGAM) 94. Marlyn is screened for tuberculosis during her first prenatal visit. An intradermal injection of purified protein derivative (PPD) of the tuberculin bacilli is given. She is considered to have a positive test for which of the following results?  An indurated wheal whe al under 10 mm in diameter appear appearss in 6 to 12 hours.  An indurated wheal whe al over 10 mm in diameter di ameter appears in 4488 to 72 hours.  A flat circumcised area under 10 mm in dia diameter meter appears in 6 to 1122 hours.  A flat circumcised area are a over 10 mm in diame diameter ter appears in 48 to 7722 hours. 95. Dianne, 24 year-old year-old is 27 weeks’ pregnant arrives at her physician’s office with complaints of fever, nausea, vomiting, malaise, unilateral f lank f  lank pain, and costovertebral angle tenderness. Which of the following diagnoses is most likely?  Asymptomatic bacteriuria bacteriuri a Bacteriall vaginosis Bacteria Pyelonephritis Urinary tract infection (UTI) 96. Rh isoimmunization in a pregnant client develops during which of the following conditions? Rh-positive maternal blood crosses into fetal blood, stimulating fetal antibodies. Rh-positive fetal blood crosses into maternal blood, stimulating maternal antibodies. Rh-negative fetal blood crosses into maternal blood, stimulating maternal antibodies. Rh-negative maternal blood crosses into fetal blood, stimulating fetal antibodies. 97. To promote comfort during labor, the nurse John advises a client to assume certain positions and avoid others. Which position may cause maternal hypotension and fetal hypoxia? Lateral position Squatting position Supine position Standing position 98. Celeste who used heroin during her pregnancy delivers a neonate. When assessing the neonate, the nurse Lhynnette expects to find: Lethargy 2 days after birth. Irritability and poor sucking.  A flattened nose, small smal l eyes, and thin lip lips. s. Congenital defects such as limb anomalies. 99. The uterus returns to the pelvic cavity in which of the following time frames? 7th to 9th day postpartum. 2 weeks postpartum. End of 6th week postpartum. When the lochia changes to alba. 100. Maureen, a primigravida client, age 20, has just completed a difficult, forceps-assisted delivery of twins. Her labor was unusually long and required oxytocin (Pitocin) augmentation. The nurse who’s caring for her should stay alert for : Uterine inversion Uterine atony Uterine involution Uterine discomfort  Answers and Rationales Ratio nales  Answer: (A) Inevitable. Inevitable . An inevitable ab abortion ortion is termination ooff pregnancy that canno cannott be prevented. Moderate Mod erate to severe bleeding blee ding with mild cramping and cervical dilation would be noted in this type of abortion.  Answer: (B) History of syphilis. syphi lis. Maternal infections infectio ns such as syphilis syphilis,, toxoplasmosis, and rub rubella ella are causes of sp spontaneous ontaneous abortion. a bortion.  Answer: (C) Monitoring Monitorin g apical pulse. pulse . Nursing care for the clie client nt with a possib possible le ectopic pregnan pregnancy cy is focused on pre preventing venting or identifying identifyi ng hypovolemic shock and controlling pain. An elevated pulse rate is an indicator of shock.  Answer: (B) Increased caloric cal oric intake. Glucose crosses c rosses the placenta, placenta , but insulin does no not.t. High fetal ddemands emands for glucose, glucose , combined with the insulin in sulin resistance caused by hormonal changes in the last half of pregnancy can result in elevation of maternal blood glucose levels. This increases the mother’s demand for insulin and is referred to as the diabetog enic effect of pregnancy.  Answer: (A) Excessive fetal activity. The most common signs s igns and symptoms of hyd hydatidiform atidiform mole inc includes ludes elevated levels leve ls of hum human an chorionic gonadotropin, vaginal bleeding, larger than normal uterus for gestational age, failure to detect fetal heart activity even with sensitive instruments, excessive nausea and vomiting, and early development of pregnancy-induced hypertension. Fetal activity would not be noted.  Answer: (B) Absent patellar patell ar reflexes. Absence of patellar p atellar reflexes is an indicator ooff hypermagnesemi hypermagnesemia, a, which requires administration a dministration of calcium cal cium gluconate.  Answer: (C) Presenting part p art in 2 cm below the plane pl ane of the ischial spines. Fetus at station plus ttwo wo indicates that the ppresentin resentingg part is 2 cm below the plane of the ischial spines.  Answer: (A) Contractions Contraction s every 1 ½ minutes lasting lasti ng 70-80 seco seconds. nds. Contractions eve every ry 1 ½ minutes lasting 770-80 0-80 seconds, is in indicative dicative of hyperstimulation of the uterus, which could result in injury to the mother and the fetus if Pitocin is not discontinued.  Answer: (C) EKG tracings. A potential po tential side effect of calcium cal cium gluconate administration ad ministration is cardiac cardia c arrest. Continuous m monitorin onitoringg of cardiac activity (EKG) throught administration of calcium gluconate is an essential part of care.  Answer: (D) First low transverse transv erse caesarean w was as for breech positio position. n. Fetus in this pregnan pregnancy cy is in a vertex presen presentation. tation. This type of client ha s no obstetrical indication for a caesarean section as she did with her first caesarean delivery.

 

 Answer: (A) Talk to the mother moth er first and then to the toddler. tod dler. When dealing with a crying toddl toddler, er, the best approach is i s to talk to the mother and ignore the toddler first. This approach helps the toddler get used to the nurse before she attempts any procedures. It also gives the toddler an opportunity to see that the mother trusts the nurse.  Answer: (D) Place the infant’s in fant’s arms in soft elbow restraints. r estraints. Soft restraints from the upper u pper arm to the wrist pre prevent vent the inf ant ant from touching her lip but allow him to hold a favorite item such as a blanket. Because they could damage the operative site, such as objects as pacifiers, suction catheters, and small spoons shouldn’t be placed in a baby’s mouth after cleft repair. A baby in a prone position may rub her face on the sheets and traumatize the operative site. The suture line should be cleaned gently to prevent infection, which could interfere with healing and damage the cosmetic appearance of the repair.  Answer: (B) Allow the infant infa nt to rest before feeding. feedin g. Because feeding rrequires equires so much ene energy, rgy, an infan infantt with heart failure should shou ld rest before feeding.  Answer: (C) Iron-rich formula fo rmula only. The infa infants nts at age 5 months sho should uld receive ironiron -rich formula and that they shouldn’t receive solid food, even baby food until age 6 months.  Answer: (D) 10 months. A 10 month old infant can ca n sit alone and un understands derstands object per permanence, manence, so he wo would uld look for the hidden hidde n toy. At age 4 to 6 months, infants can’t sit securely alone. At age 8 months, infants can sit securely alone but cannot understand the permanenc e of objects.  Answer: (D) Public health he alth nursing focuses focuse s on preventive, not cura curative, tive, services. The catchments catchmen ts area in PHN consists consi sts of a resid residential ential community, many of whom are well individuals who have greater need for preventive rather than curative services.  Answer: (B) Efficiency. Efficiency Efficie ncy is determining whether the goals were attained at the lea least st possible cost.  Answer: (D) Rural Health Hea lth Unit. R.A. 7160 devo devolved lved basic health se services rvices to local governm government ent units (LGU’s ). The public pu blic health health nurse  nurse is an employee of the LGU.  Answer: (A) Mayor. The local loca l executive serves as the chairman c hairman of the Municipal Mun icipal Health Boar Board. d.  Answer: (A) 1. Each rural health h ealth midwife is give givenn a population assignment of abo about ut 5,000.  Answer: (B) Health education edu cation and community comm unity organizing ar aree necessary iinn providing commun community ity health services. The community c ommunity health nu nurse rse develops the health capability of people through health education and community organizing activities.  Answer: (B) Measles. Presidential Presi dential Proclamation Proclamati on No. 4 is on the Ligt Ligtas as Tigdas Progra Program. m.  Answer: (D) Core group grou p formation. In core grou groupp formation, the nurse is i s able to transfer the technology techno logy of community organizi or ganizing ng to the potential oorr informal community leaders through a training program.  Answer: (D) To maximize the community’s resources resour ces in dealing with health problems. Community organizing is a developmental service, with the goal of developing the people’s self -reliance -reliance in dealing with community health problems. A, B and C are objectives of contributory objectives to this goal.  Answer: (D) Terminal. Terminal . Tertiary prevention involves inv olves rehabilitatio rehabilitation, n, prevention of permanent pe rmanent disabili disability ty and disability lim limitation itation approp riate for convalescents, the disabled, complicated cases and the terminally ill (those in the terminal stage of a disease).  Answer: (A) Intrauterine fetal fe tal death. Intrauterin Intrauterinee fetal death, abruptio placentae, septic shoc shock, k, and amniotic fluid eembolism mbolism may trigger tri gger normal clotting mechanisms; if clotting factors are depleted, DIC may occur. Placenta accreta, dysfunctional labor, and premature rupture of the membranes aren’t associated with DIC.  DIC.    Answer: (C) 120 to 160 beats/minute. A rate of 12 1200 to 160 beats/minu beats/minute te in the fetal heart appro appropriate priate for filling the heart he art with blood blo od and pumping pumpi ng it out to the system.  Answer: (A) Change the diaper d iaper more often. o ften. Decreasing the am amount ount of time the skin comes contact co ntact with wet soiled diapers d iapers will help hheal eal the irritation.  Answer: (D) Endocardial Endocardi al cushion de defect. fect. Endocardial cushi cushion on defects are seen most in children with D Down own syndrome, asple asplenia, nia, or po polysplenia. lysplenia.  Answer: (B) Decreased urine u rine output. Decreased Decrea sed urine output ma mayy occur in clients recei receiving ving I.V. magnesium aand nd should be monitored mon itored closely to keep urine output at greater than 30 ml/hour, because magnesium is excreted through the kidneys and can easily accumulate to toxic levels.  Answer: (A) Menorrhagia. Menorrha gia. Menorrhagia is an excessive menstru menstrual al period.  Answer: (C) Blood typing. typin g. Blood type would wou ld be a critical value to have because the risk of blood loss iiss always a potential c omplication during the labor and delivery process. Approximately 40% of a woman’s cardiac output is delivered to the uterus, therefore, blood loss can occur q uite rapidly in the event of uncontrolled bleeding.  Answer: (D) Physiologic Physiolog ic anemia. Hem Hemoglobin oglobin values and an d hematocrit decre decrease ase during pregnancy as the iincrease ncrease in plasma volume vo lume exceeds the increase in red blood cell production.  Answer: (D) A 2 year old infant with stridorous bbreath reath sounds, sitting up u p in his mother’s arms aand nd drooling. The infant in fant with the airway emergency should be treated first, because of the risk of epiglottitis.  Answer: (A) Placenta previa. pr evia. Placenta pre previa via with painless vag vaginal inal bleedin bleeding. g.  Answer: (D) Early in the morning. m orning. Based on the nnurse’s urse’s knowledge knowledg e of microbiology, microbiolog y, the specimen shoul shouldd be collected early in t he morning. The rationale for this timing is that, because the female worm lays eggs at night around the perineal area, the first bowel movement of the day will yield the best results. The specific type of stool specimen used in the diagnosis of pinworms is called the tape test.  Answer: (A) Irritability and seizures. Lead ppoisoning oisoning primarily primari ly affects the CNS, causing in increased creased intracra intracranial nial pressure. Thi s condition results resul ts in irritability and changes in level of consciousness, as well as seizure disorders, hyperactivity, and learning disabilities.  Answer: (D) “I really need nee d to use the diaphr diaphragm agm and jelly most dur during ing the middle of my m y menstrual cycle”. The woman woma n must under stand under stand that, although the “fertile” period is approximately mid-cycle, mid -cycle, hormonal variations do occur and can result in early or late ovulation. To be effective, the diaphragm should be inserted before every intercourse.  Answer: (C) Restlessness. Restlessne ss. In a child, restlessness is i s the earliest sign ooff hypoxia. Late signs of hyp hypoxia oxia in a child are associated associate d with a change in color, such as pallor or cyanosis.  Answer: (B) Walk one step ahead, a head, with the child child’s ’s hand on the nu nurse’s rse’s elbow. This proce procedure dure is generally genera lly recommended to follo fol low w in guiding a person who is blind.  Answer: (A) Loud, machinery-like machi nery-like mu murmur. rmur. A loud, machinery-like machiner y-like murmur is a ch characteristic aracteristic finding aassociated ssociated with patent du ductus ctus arteriosus.  Answer: (C) More oxygen, oxyge n, and the newbo newborn’s rn’s metabolic rate in increases. creases. When cold, the in infant fant requires more ooxygen xygen and there is an increase in metabolic rate. Non-shievering thermogenesis is a complex process that increases the metabolic rate and rate of oxygen consumption, therefore, the newborn increase heat production.  Answer: (D) Voided. Before Befo re administering administerin g potassium I.V. to any clie client, nt, the nurse must first che check ck that the client’s kidneys are functioning and that the client is voiding. If the client is not voiding, the nurse should withhold the potassium and notify the physician.  Answer: (C) Laundry Laundr y detergent. Eczema or de dermatitis rmatitis is an allergic skin reaction ca caused used by an offending offend ing allergen. The topical to pical allergen that th at is the most common causative factor is laundry detergent.  Answer: (A) 6 inches. This Thi s distance allows for ea easy sy flow of the formula by gravity, but the flow will be b e slow enough not no t to overload th thee stomach too rapidly.  Answer: (A) The older one on e gets, the more susceptible suscep tible he becomes to the complications of chi chicken cken pox. Chicken ppox ox is usually more m ore severe in adults than in children. Complications, such as pneumonia, are higher in incidence in adults.  Answer: (D) Consult a physician ph ysician who may give them rubella immu immunoglobulin. noglobulin. Rub Rubella ella vaccine is ma made de up of attenuated German measles viruses. This is contraindicated in pregnancy. Immune globulin, a specific prophylactic against German measles, may be given to pregnant women.  Answer: (A) Contact tracing. tracin g. Contact tracing is the most mo st practical and reliable reli able method of findin findingg possible source sourcess of person person-to-person -to-person transmitted infections, such as sexually transmitted diseases.  Answer: (D) Leptospirosis. Leptospir osis. Leptospirosis is transmitted t ransmitted through contact c ontact with the skin or muco mucous us membrane with wi th water or moist soil contaminated con taminated with urine of infected animals, like rats.

 

 Answer: (B) Cholera. Cholera . Passage of profuse wate watery ry stools is the major symptom symp tom of cholera. Both amebic ame bic and bacillary dysentery aare re characterized by the presence of blood and/or mucus in the stools. Giardiasis is characterized by fat malabsorption and, therefore, steatorrhea.  Answer: (A) Hemophilus Hemophi lus influenzae. Hemophilus He mophilus mening meningitis itis is unusual over ove r the age of 5 years. In developin d evelopingg countries, the peak in incidence cidence is in children less than 6 months of age. Morbillivirus is the etiology of measles. Streptococcus pneumoniae and Neisseria meningitidis may cause meningitis, but age distribution is not specific in young children.  Answer:  Answ er: (B) Buccal mucosa. Koplik’s spot may be seen on the mucosa of the mouth or the throat.    Answer: (A) 3 seconds. seconds . Adequate blood su supply pply to the area allow allowss the return of the colo colorr of the nailbed within 3 seconds.  Answer: (B) Severe dehydration. deh ydration. The order ord er of priority in the m management anagement of severe dehydration is aass follows: intravenous flfluid uid therapy, referral referr al to a facility where IV fluids can be initiated within 30 minutes, Oresol or nasogastric tube. When the foregoing measures are not possible or effective, then urgent referral to the hospital is done.  Answer: (A) 45 infants. To estimate estima te the number of infants, multiply mu ltiply total population populati on by 3%.  Answer: (A) DPT. DPT is sensitive sensiti ve to freezing. The appropriate ap propriate storage tem temperature perature of DPT is 2 to 8° C on only. ly. OPV and mea measles sles vaccine are highly h ighly sensitive to heat and require freezing. MMR is not an immunization in the Expanded Program on Immunization.  Answer: (C) Proper use of o f sanitary toilets. The ova of o f the parasite get out of the human body togeth together er with feces. Cutting the t he cycle at this stage is the most effective way of preventing the spread of the disease to susceptible hosts.  Answer: (D) 5 skin lesions, lesi ons, positive slit skin sme smear. ar. A multibacillary multibacillar y leprosy case is one w who ho has a positive slit skin s kin smear and a nd at least 5 skin lesions.  Answer: (C) Thickened painful p ainful nerves. The lesion l esion of leprosy is not macular. It is characterized by b y a change in skin color co lor (either (eithe r reddish or whitish) whi tish) and loss of sensation, sweating and hair growth over the lesion. Inability to close the eyelids (lagophthalmos) and sinking of the nosebridge are late symptoms.  Answer: (B) Ask where the family fa mily resides. Because malaria m alaria is endemic, ende mic, the first question to deter determine mine malaria risk ri sk is where the t he client’s family resides. If the area of residence is not a known endemic area, ask if the child had traveled within the past 6 months, where she was brought and whether she stayed overnight in that area.  Answer: (A) Inability to drink. dr ink. A sick child aged 2 months to 5 years must be referred urgently to a hospital h ospital if he/she has o ne or more of the following signs: not able to feed or drink, vomits everything, convulsions, abnormally sleepy or difficult to awaken.  Answer: (A) Refer the child chi ld urgently to a hospita hospitall for confinement. “Baggy “Bagg y pants” is a sign of severe seve re marasmus. The be best st management  management is urgent referral to a hospital.  Answer: (D) Let the child rest r est for 10 minutes then continue co ntinue giving Oresol Ore sol more slowly. If the child vomits v omits persistently, that is, he vomits everythin everythingg that he takes in, he has to be referred urgently to a hospital. Otherwise, vomiting is managed by letting the child rest for 10 minutes and then continuing with Oresol administration. Teach the mother to give Oresol more slowly.  Answer: (B) Some dehydration. deh ydration. Using the ass assessment essment guidelines guidelin es of IMCI, a child (2 mont hs to 5 years old) wi with th diarrhea is classified classifi ed as having SOME DEHYDRATION if he shows 2 or more of the following signs: restless or irritable, sunken eyes, the skin goes back slow after a skin pinch.  Answer: (C) Normal. In IMCI, a respiratory re spiratory rate of 50/minute 50/mi nute or more is fast breathin breathingg for an infant aged age d 2 to 12 months.  Answer: (A) 1 year. The baby bab y will have passi passive ve natural immunity bbyy placental transfer ooff antibodies. The mo mother ther will have act ive artificial immunity immun ity lasting for about 10 years. 5 doses will give the mother lifetime protection.  Answer: (B) 4 hours. While Whil e the unused por portion tion of other biologica biologicals ls in EPI may be given uuntil ntil the end of the da day, y, only BCG is discarded dis carded 4 hours after reconstitution. This is why BCG immunization is scheduled only in the morning.  Answer: (B) 6 months. After 6 months, mo nths, the baby’s nutrient needs, n eeds, especially the baby’s iron req requirement, uirement, can no longer long er be provided pro vided by mother’s milk alone.  Answer: (C) 24 weeks. At approximately ap proximately 23 to 24 weeks’ gestation, the lungs are devel developed oped en enough ough to sometimes maintain extrauterine life. The lungs are the most immature system during the gestation period. Medical care for premature labor begins much earlier (aggressively (aggress ively at 21 weeks’ gestation)  Answer: (B) Sudden infant in fant death syndrom syndromee (SIDS). Supine po positioning sitioning is recomm recommended ended to reduce the rrisk isk of SIDS in infancy. The risk of o f aspiration is slightly increased with the supine position. Suffocation would be less likely with an infant supine than prone and the position for GER requires the head of the bed to be elevated.  Answer: (C) Decreased temperature. Temp Temperature erature instability, espe especially cially when it resul results ts in a low temperature in the neonate, m ay be a sign of infection. The neonate’s color often changes with an infection process but generally becomes ashen or mottled. The neonate with an infection will usually show a decrease in activity level or lethargy.  Answer: (D) Polycythemia Polycythemi a probably due to chronic fetal hypoxi hypoxia. a. The small-for small-for-gestation -gestation neonate iiss at risk for developing developin g polycythemia during d uring the transitional period in an attempt to decreasehypoxia. The neonates are also at increased risk for developing hypoglycemia and hypothermia due to decreased glycogen stores.  Answer: (C) Desquamation Desquama tion of the epidermis. epider mis. Postdate fetuses lose the vernix caseosa, aand nd the epiderm epidermis is may become desquamated. desqu amated. These neonates are usually very alert. Lanugo is missing in the postdate neonate.  Answer: (C) Respiratory Respirator y depression. Mag Magnesium nesium sulfate crosses th thee placenta and adverse ad verse neonatal eeffects ffects are respiratory dep depression ression,, hypotonia, and bradycardia. The serum blood sugar isn’t affected by magnesium sulfate. The neonate would be floppy, not jittery.    Answer: (C) Respiratory Respirator y rate 40 to 60 brea breaths/minute. ths/minute. A respiratory rate 40 4 0 to 60 breaths/minute iiss normal for a neona neonate te during durin g the transitional period. Nasal flaring, respiratory rate more than 60 breaths/minute, and audible grunting are signs of respiratory distress.  Answer: (C) Keep the cord dry and open to air. a ir. Keeping the cord dr dryy and open to air he helps lps reduce infection infectio n and hastens has tens drying. Infants aren’t given tub bath but are sponged off until the cord falls off. Petroleum jelly prevents the cord from drying and encourages infection. Peroxide could be painful and isn’t recommended.  recommended.    Answer: (B) Conjunctival Conjun ctival hemorrhag hemorrhage. e. Conjunctival he hemorrhages morrhages are commonly seen in ne neonates onates secondar secondaryy to the cranial pressure aapplied pplied during the birth process. Bulging fontanelles are a sign of intracranial pressure. Simian creases are present in 40% of the neonates with trisomy 21. Cystic hygroma is a neck mass that can affect the airway.  Answer: (B) To assess for prolapsed prol apsed cord. After a client clien t has an amniotomy, the nurse n urse should assur assuree that the cord isn’t prolap prol apsed sed and that the baby tolerated the procedure well. The most effective way to do this is to check the fetal heart rate. Fetal well-being is assessed via a nonstress test. Fetal position is determined by vaginal examination. Artificial rupture of membranes doesn’t indicate an imminent delivery.    Answer: (D) The parents’ paren ts’ interactions with ea each ch othe other. r. Parental interaction will provide the nurse with a good assessment of the stability of the family’s home life but it has no indication for parental bonding. Willingness to touch and hold the newborn, expressing interest about the newborn’s size, and indicating a desire to see the newborn are behaviors indicat indicating ing parental bonding.  Answer: (B) Instructing the client c lient to use two or more peripads to cushion the area. Using two or mo more re peripads would wou ld do little to reduce r educe the pain or or promote perineal healing. Cold applications, sitz baths, and Kegel exercises are important measures when the client has a fourth-degree laceration.  Answer: (C) “What is your expected exp ected due date?” date ?” When obtaining th thee history of a client who m may ay be in labor, labor , the nurse’s highest  priority is to determine her current status, particularly her due date, gravidity, and parity. Gravidity and parity affect the duration of labor and the potential for labor complications. Later, the nurse should ask about chronic illnesses, allergies, and support persons.  Answer: (D) Aspirate the neonate’s nose an andd mouth with a bulb ssyringe. yringe. The nurse’s first acti action on should be to cle clear ar the neonat e’s airway with a bulb bu lb syringe. After the airway is clear and the neonate’s color improves, the nurse should comfort and cal m the neonate. If the problem recurs or the neonate’s color doesn’t improve readily, the nurse should notify the physician. Administering oxygen when the airway isn’t cl clear ear would be ineffective.  Answer: (C) Conducting Conductin g a bedside uultrasound ltrasound for an amn amniotic iotic f luid luid index. It isn’t within a nurse’s scope of practice to perform and interpret a bedside ultrasound under these conditions and without specialized training. Observing for pooling of straw-colored fluid, checking vaginal

 

discharge with nitrazine paper, and observing for flakes of vernix are appropriate assessments for determining whether a client has ruptured membranes.  Answer: (C) Monitor partial pa rtial pressure of oxyg oxygen en (Pao2) levels. Mon Monitoring itoring PaO2 levels an andd reducing the oxygen o xygen concentration to keep PaO2 within normal limits reduces the risk of retinopathy of prematurity in a premature infant receiving oxygen. Covering the infant’s ey es and humidifying the oxygen don’t reduce the risk of retinopathy of prematurity. Because cooling increases the risk of acido sis, the infant should be kept warm so that his respiratory distress isn’t aggravated.  aggravated.   Answer: (A) 110 to 130 calories ca lories per kg. Calo Calories ries per kg is the accepted accep ted way of determined aappropriate ppropriate nutritional nutri tional intake for a newborn. The recommended calorie requirement is 110 to 130 calories per kg of newborn body weight. This level will maintain a consistent blood glucose level and provide enough calories for continued growth and development.  Answer: (C) 30 to 32 weeks. wee ks. Individual twins twin s usually grow at the sa same me rate as singletons until 30 to 32 weeks’ gestation, then twins don’t’ gain weight as rapidly as singletons of the same gestational age. The placenta can no longer keep pace with the nutritional requirements of both fetuses after 32 weeks, so there’s some growth retardation growth  retardation in twins if they remain in utero at 38 to 40 weeks.  Answer: (A) conjoined conjoin ed twins. The type of place placenta nta that develops in monozygotic twins depe depends nds on the time at a t which cleavage of the ovum occurs. Cleavage in conjoined twins occurs more than 13 days after fertilization. Cleavage that occurs less than 3 day after fertilization results in diamniotic dicchorionic twins. Cleavage that occurs between days 3 and 8 results in diamniotic monochorionic twins. Cleavage that occurs between days 8 to 13 result in monoamniotic monochorionic twins.  Answer: (D) Ultrasound. Ultrasound . Once the mother and a nd the fetus are stabilize stabilized, d, ultrasound evaluation evalu ation of the placen placenta ta should be done to determine d etermine the cause of the bleeding. Amniocentesis is contraindicated in placenta previa. A digital or speculum examination shouldn’t be do ne as this may lead to severe bleeding or hemorrhage. External fetal monitoring won’t detect a placenta previa, although it will detect fetal distress, distre ss, which may result from blood loss or placenta separation.  Answer: (A) Increased tidal tida l volume. A pregnant pregn ant client breathes deeper, which increases the tidal vo volume lume of gas moved in i n and out of the respiratory resp iratory tract with each breath. The expiratory volume and residual volume decrease as the pregnancy progresses. The inspiratory capacity increases during pregnancy. The increased oxygen consumption in the pregnant client is 15% to 20% greater than in the nonpregnant state.  Answer: (A) Diet. Clients with gestational di diabetes abetes are usually ma managed naged by diet al alone one to control their gglucose lucose intolerance. intoleranc e. Oral hypog hypoglycemic lycemic drugs are contraindicated in pregnancy. Long-acting Long- acting insulin usually isn’t needed for blood glucose control in the client with gestational diabetes.  diabetes.    Answer: (D) Seizure. The anticonvulsant me mechanism chanism of magnesiu magnesium m is believes to depres depresss seizure foci in the brain b rain and peripheral periph eral ne neuromuscular uromuscular blockade. Hypomagnesemia isn’t a complication of preeclampsia. Antihypertensive drug other than magnesium are preferred for s ustained hypertension. Magnesium doesn’t help prevent hemorrhage in preeclamptic clients.  clients.    Answer: (C) I.V. fluids. A sickle cell crisis during pregnancy is usu usually ally managed by eexchange xchange transfusion transfusi on oxygen, and L.V. Fluids. Flu ids. The client usually needs a stronger analgesic than acetaminophen to control the pain of a crisis. Antihypertensive drugs usually aren’t necessar y. necessar y. Diuretic Diuretic wouldn’t be used unless fluid overload resulted.  Answer: (A) Calcium gluconate gl uconate (Kalcinate (Kalcinate). ). Calcium gluconate glucona te is the antidote for ma magnesium gnesium toxicity. Ten mi milliliters lliliters of 10% ccalcium alcium gluconate is given L.V. push over 3 to 5 minutes. Hydralazine is given for sustained elevated blood pressure in preeclamptic clients. Rho (D) immune globulin is given to women with Rh-negative blood to prevent antibody formation from RH-positive conceptions. Naloxone is used to correct narcotic toxicity.  Answer: (B) An indurated indurat ed wheal over 1100 mm in diameter app appears ears in 48 to 72 hou hours. rs. A positive PPD result wo would uld be an indurated indura ted wheal over 10 mm in diameter that appears in 48 to 72 hours. The area must be a raised wheal, not a flat circumcised area to be considered positive.  Answer: (C) Pyelonephritis. Pyelone phritis. The symptoms in indicate dicate acute pyelone pyelonephritis, phritis, a serious con condition dition in a pregn pregnant ant client. UTI symptoms in clude dysuria, urgency, frequency, and suprapubic tenderness. Asymptomatic bacteriuria doesn’t cause symptoms. Bacterial vaginosis causes milky white vaginal discharge but no systemic symptoms.  Answer: (B) Rh-positive Rh-posit ive fetal blood crosse crossess into maternal blood blood,, stimulating materna maternall antibodies. Rh iso isoimmunization immunization occurs when Rh-positive Rh -positive fetal blood cells cross into the maternal circulation and stimulate maternal antibody production. In subsequent pregnancies with Rh-positive fetuses, maternal antibodies may cross back into the fetal circulation and destroy the fetal blood cells.  Answer: (C) Supine position. po sition. The supine po position sition causes compr ession compr ession of the client’s aorta and inferior vena cava by the fetus. This, in turn, inhibits maternal circulation, leading to maternal hypotension and, ultimately, fetal hypoxia. The other positions promote comfort and aid labor progress. For instance, the lateral, or side-lying, position improves maternal and fetal circulation, enhances comfort, increases maternal relaxation, reduces muscle tension, and eliminates pressure points. The squatting position promotes comfort by taking advantage of gravity. The standing position also takes advantage of gravity and aligns the fetus with the pelvic angle.  Answer: (B) Irritability and poor p oor sucking. Neon Neonates ates of heroin-addicted heroin- addicted mothers aare re physically depen dependent dent on the drug and experience withdrawal w ithdrawal when the drug is no longer lon ger supplied. Signs of heroin withdrawal include irritability, poor sucking, and restlessness. Lethargy isn’t associated with   neonatal heroin addiction. A flattened nose, small eyes, and thin lips are seen in infants with fetal alcohol syndrome. Heroin use during pregnancy hasn’t been linked to specific congenital anomalies.    Answer: (A) 7th to 9th day postpartum. po stpartum. The normal involutional i nvolutional proce process ss returns the uterus to the pelvic pe lvic cavity in 7 to 9 days . A significant involutional complication is the failure of the uterus to return to the pelvic cavity within the prescribed time period. This is known as subinvolution.  Answer: (B) Uterine atony. atony . Multiple fetuses, extended exten ded labor stimulat stimulation ion with oxytocin, and traumatic deliver deliveryy commonly are associated as sociated with uterine uteri ne atony, which may lead to postpartum hemorrhage. Uterine inversion may precede or follow delivery and commonly results from apparent excessive traction on the umbilical cord and attempts to deliver the placenta manually. Uterine involution and some uterine discomfort are normal after delivery. 1. A pregnant woman who is at term is admitted to the birthing unit in active labor. The client has only progressed from 2cm to 3 cm in 8 hours. She is diagnosed with hypotonic dystocia and the physician ordered Oxytocin (Pitocin) to augment her contractions. Which of the following is the most important aspect of nursing intervention at this time? Timing and recording length of contractions. Monitoring. Preparing for an emergency cesarean birth. Checking the perineum for bulging. 2. A client who hallucinates is not in touch with reality. It is important for the nurse to: Isolate the client from other patients. Maintain a safe environment. Orient the client to time, place, and person. Establish a trusting relationship. 3. The nurse is caring to a child client who has had a tonsillectomy. The child complains of having dryness of the throat. Which of the following would the nurse give to the child? Cola with ice Yellow noncitrus Jello Cool cherry Kool-Aid  A glass of milk 4. The physician ordered Phenylephrine (Neo-Synephrine) nasal spray to a 13-year-old client. The nurse caring to the client provides instructions that the nasal spray must be used exactly as directed to prevent the development of:

 

  Increased nasal congestion. Nasal polyps. Bleeding tendencies. Tinnitus and diplopia. 5. A client with tuberculosis is to be admitted in the hospital. The nurse who will be assigned to care for the client must institute appropriate precautions. The nurse should: Place the client in a private room. Wear an N 95 respirato respiratorr when caring for the client. Put on a gown every time when entering the room. Don a surgical mask with a face shield when entering the room. 6. Which of the following is the most frequent cause of noncompliance to the medical treatment of open-angle glaucoma? The frequent nausea and vomiting accompanying use of miotic drug. Loss of mobility due to severe driving restrictions. Decreased light and near-vision accommodation due to miotic effects of pilocarpine. The painful and insidious progression of this type of glaucoma. 7. In the morning shift, the nurse is making rounds in the nursing care units. The nurse enters in a client’s room and notes that the client’s tube has become disconnected from the Pleurovac. What would be the initial nursing action?  Apply pressure directly dire ctly over the incision ssite. ite. Clamp the chest tube near the incision site. Clamp the chest tube closer to the drainage system. Reconnect the chest tube to the Pleurovac. 8. Which of the following complications during a breech birth the nurse needs to be alarmed?  Abruption placenta. placen ta. Caput succedaneum. Pathological hyperbilirubinemia. Umbilical cord prolapse. 9. The nurse is caring to a client diagnosed with severe depression. Which of the following nursing approach is important in depression? Protect the client against harm to others. Provide the client with motor outlets for aggressive, hostile feelings. Reduce interpersonal contacts. Deemphasizing preoccupation with elimination, nourishment, and sleep. 10. A 3-month-old client is in the pediatric unit. During assessment, the nurse is suspecting that the baby may have hypothyroidism when mother states that her baby does not: Sit up. Pick up and hold a rattle. Roll over. Hold the head up. 11. The physician calls the nursing unit to leave an order. The senior nurse had conversation with the other staff. The newly hired nurse answers the phone so that the senior nurses may continue their conversation. The new nurse does not knowthe physician or the client to whom the order pertains. The nurse should:  Ask the physician to call cal l back after the nur nurse se has read the hospi hospital tal policy manual. Take the telephone order. Refuse to take the telephone order.  Ask the charge nurse or o r one of the other sen senior ior staff nurses to take the telephone orde order. r. 12. The staff nurse on the labor and delivery unit is assigned to care to a primigravida in transition complicated by hypertension. A new pregnant woman in active labor is admitted in the same unit. The nurse manager assigned the same nurse to the second client. The nurse feels that the client with hypertension requires one-to-one care. What would be the initial actionof the nurse?  Accept the new assignment assig nment and comple complete te an incident repo report rt describing a sho shortage rtage of nursing sta staff. ff. Report the incident to the nursing supervisor and request to be floated. Report the nursing assessment of the client in transitional labor to the nurse manager and discuss misgivings about the new assignment.  Accept the new assignment assig nment and provid providee the best care. 13. A newborn infant with Down syndrome is to be discharged today. The nurse is preparing to give the discharge teaching regarding the proper care at home. The nurse would anticipate that the mother is probably at the: 40 years of age. 20 years of age. 35 years of age. 20 years of age. 14. The emergency department has shortage of staff. The nurse manager informs the staff nurse in the critical care unit that she has to float to the emergency department. What should the staff nurse expect under these conditions? The float staff nurse will be informed of the situation before the shift begins. The staff nurse will be able to negotiate the assignments in the emergency department. Cross training will be available for the staff nurse. Client assignments will be equally divided among the nurses. 15. The nurse is assigned to care for a child client admitted in the pediatrics unit. The client is receiving digoxin. Which of the following questions will be asked by the nurse to the parents of the child in order o rder to assess the client’s risk for digoxin toxicity?  toxicity?   “Has he been exposed to any childhood communicable diseases in the past 22 -3 weeks?”  weeks?”  “Has he been taking diuretics at home?”  home?”  “Do any of his brothers and sisters have history of cardiac problems?”   “Has he been going to school regularly?”  regularly?”  

 

16. The nurse noticed that the signed consent form has an error. The form states, “Amputation of the right leg” instead of th e left leg that is to be amputated. The nurse has administered already the preoperative medications. What should the nurse do? Call the physician to reschedule the surgery. Call the nearest relative to come in to sign a new form. Cross out the error and initial the form. Have the client sign another form. 17. The nurse in the nursing care unit checks the fluctuation in the water-seal compartment of a closed chest drainage system. The fluctuation has stopped, the nurse would: Vigorously strip the tube to dislodge a clot. Raise the apparatus above the chest to move fluid. Increase wall suction above 20 cm H2O pressure.  Ask the client to cough and a nd take a deep bbreath. reath. 18. The pediatric nurse in the neonatal unit was informed that the baby that is brought to the mother in the hospital room is wrong. The nurse determines that two babies were placed in the wrong cribs. The most appropriate nursing action would be to: Determine who is responsible for the mistake and terminate his or her employment. Record the event in an incident/variance report and notify the nursing supervisor. Reassure both mothers, report to the charge nurse, and do not record. Record detailed notes of the event on the mother’s medical record.   19. Before the administration of digoxin, the nurse completes an assessment to a toddler client for signs and symptoms of digoxin toxicity. Which of the following is the earliest and most significant sign of digoxin toxicity? Tinnitus Nausea and vomiting Vision problem Slowing in the heart rate 20. Which of the following treatment modality is appropriate for a client with paranoid tendency?  Activity therapy. Individual therapy. Group therapy. Family therapy. 21. The client with rheumatoid arthritis is for discharge. In preparing the client for discharge on prednisone therapy, the nurse should advise the client to: Wear sunglasses if exposed to bright light for an extended period of time. Take oral preparations of prednisone before meals. Have periodic complete blood counts while on the medication. Never stop or change the amount of the medication without medical advice. 22. A pregnant client tells the nurse that she is worried about having urinary frequency. What will be the most appropriate nursing response? “Try using Kegel (perineal) exercises and limiting fluids before bedtime. If you have frequency associated with fever, pain o n voiding, or blood in the urine, call your doctor/nurse-midwife. “Placental progesterone causes irritability of the bladder sphincter. Your symptoms will go away after the baby comes.”  comes.”   “Pregnant women urinate frequently to get rid of fetal wastes. Limit fluids to 1L/daily.”   “Frequency is due to bladder irritation from concentrate urine and is normal in pregnancy. Increase your daily fluid intake to 3L.”  3L.”  23. Which of the following will help the nurse determine that the expression of hostility is useful? Expression of anger dissipates the energy. Energy from anger is used to accomplish what needs to be done. Expression intimidates others. Degree of hostility is less than the provocation. 24. The nurse is providing an orientation regarding case management to the nursing students. Which characteristics should the nurse include in the discussion in understanding case management? Main objective is a written plan that combines discipline-specific processes used to measure outcomes of care. Main purpose is to identify expected client, family and staff performance against the timeline for clients with the same diagnosis. Main focus is comprehensive coordination of client care, avoid unnecessary duplication of services, improve resource utilization and decrease cost. Primary goal is to understand why predicted outcomes have not been met and the correction of identified problems. 25. The physician orders a dose of IV phenytoin to a child client. In preparing in the administration of the drug, which nursing action is not correct? Infuse the phenytoin into a smaller vein to prevent purple glove syndrome. Check the phenytoin solution to be sure it is clear or light yellow in color, never cloudy. Plan to give phenytoin over 30-60 minutes, using an in-line filter. Flush the IV tubing with normal saline before starting phenytoin. 26. The pregnant woman visits the clinic for check – check  –up. up. Which assessment findings will help the nurse determine that the client is in 8-week gestation? Leopold maneuvers. Fundal height. Positive radioimmunoassay test (RIA test).  Auscultation of fetal heart he art tones. 27. Which of the following nursing intervention is essential for the client who had pneumonectomy? Medicate for pain only when needed. Connect the chest tube to water-seal drainage. Notify the physician if the chest drainage exceeds 100mL/hr. Encourage deep breathing and coughing.

 

28. The nurse is providing a health teaching to a group of parents regarding Chlamydia trachomatis. The nurse is correct in the statement, “Chlamydia trachomatis is not only an intracellular bacterium that causes neonatal conjunctivitis, but it also can cause: Discoloration of baby and adult teeth. Pneumonia in the newborn. Snuffles and rhagades in the newborn. Central hearing defects in infancy. 29. The nurse is assigned to care to a 17-year-old 17-year- old male client with a history of substance abuse. The client asks the nurse, “Have you ever tried or used drugs?” The most correct response of the nurse would be:   “Yes, once I tried grass.”  grass.”  “No, I don’t think so.”  so.”  “Why do you want to know that?”  that?”  “How will my answer help you?”  you?”  30. Which of the following describes a health care team with the principles of participative leadership? Each member of the team can independently make decisions regarding the client’s care without necessarily consult ing the other members. The physician makes most of the decisions regarding the client’s care.  care.   The team uses the expertise of its members to influence the decisions regarding the client’s care.   Nurses decide nursing care; physicians decide medical and other treatment for the client. 31. A nurse is giving a health teaching to a woman who wants to breastfeed her newborn baby. Which hormone, normally secreted during the postpartum period, influences both the milk ejection reflex and uterine involution? Oxytocin. Estrogen. Progesterone. Relaxin. 32. One staff nurse is assigned to a group of 5 patients for the 12-hour shift. The nurse is responsible for the overall planning, giving and evaluating care during the entire shift. After the shift, same responsibility will be endorsed to the next nurse in charge. This describes nursing care delivered via the: Primary nursing method. Case method. Functional method. Team method. 33. The ambulance team calls the emergency department that they are going to bring a client who sustained burns in a house fire. While waiting for the ambulance, the nurse will anticipate emergency care to include assessment for: Gas exchange impairment. Hypoglycemia. Hyperthermia. Fluid volume excess. 34. Most couples are using “natural” family planning methods. Most accidental pregnancies in couples preferred to use this method have been related to unprotected intercourse before ovulation. Which of the following factor explains why pregnancy may be achieved by unprotected intercourse during the preovulatory period? Ovum viability. Tubal motility. Spermatozoal viability. Secretory endometrium. 35. An older adult client wakes up at 2 o’clock in the morning and comes to the nurse’s station saying, “I am having difficulty in sleeping.” What i s the best nursing response to the client? “I’ll give you a sleeping pill to help you get more sleep now.”   “Perhaps you’d like to sit here at the nurse’s station for a while.”  while.”   “Would you like me to show you where the bathroom is?”   “What woke you up?”  up?”  36. The nurse is taking care of a multipara who is at 42 weeks of gestation and in active labor, her membranes ruptured spontaneously 2 hours ago. While auscultating for the point of maximum intensity of fetal heart tones before applying an external fetal monitor, the nurse counts 100 beats per minute. The immediate nursing action is to: Start oxygen by mask to reduce fetal distress. Examine the woman for signs of a prolapsed cord. Turn the woman on her left side to increase placental perfusion. Take the woman’s woman’s radial pulse while still auscultating the FHR.  FHR.  37. The nurse must instruct a client with glaucoma to avoid taking over-the-counter medications like:  Antihistamines. NSAIDs.  Antacids. Salicylates. 38. A male client is brought to the emergency department due to motor vehicle accident. While monitoring the client, the nurse suspects increasing intracranial pressure when: Client is oriented when aroused from sleep, and goes back to sleep immediately. Blood pressure is decreased from 160/90 to 110/70. Client refuses dinner because of anorexia. Pulse is increased from 88-96 with occasional skipped beat. 39. The nurse is conducting a lecture to a class of nursing students about advance directives to preoperative clients. Which of the following statement by the nurse js correct?

 

“The spouse, but not the rest of the family, may override the advance directive.”   “An advance directive is required for a “do not resuscitate” order.”   “A durable power of attorney, a form of advance directive, may only be held by a blood relative.”   “The advance directive may be enforced even in the face of opposition by the spouse.”   40. A client diagnosed with schizophrenia is shouting and banging on the door leading to the outside, saying, “I need to go to an appointment.” What is the appropriate nursing intervention? Tell the client that he cannot bang on the door. Ignore this behavior. Escort the client going back into the room.  Ask the client to move away awa y from the door. 41. Which of the following action is an accurate tracheal suctioning technique? 25 seconds of continuous suction during catheter insertion. 20 seconds of continuous suction during catheter insertion. 10 seconds of intermittent suction during catheter withdrawal. 15 seconds of intermittent suction during catheter withdrawal. 42. The client’s jaw and cheekbone is sutured and wired. The nurse anticipates that the most important thing that must be rea dy at the bedside is: Suture set. Tracheostomy set. Suction equipment. Wire cutters. 43. A mother is in the third stage of labor. Which of the following signs will help the nurse determine the signs of placental separation? The uterus becomes globular. The umbilical cord is shortened. The fundus appears at the introitus. Mucoid discharge is increased. 44. After therapy with the thrombolytic alteplase (t-PA), what observation will the nurse report to the physician? 3+ peripheral pulses. Change in level of consciousness consciousness and headache. Occasional dysrhythmias. Heart rate of 100/bpm. 45. A client who undergone left nephrectomy has a large flank incision. Which of the following nursing action will facilitate deep breathing and coughing? Push fluid administration to loosen respiratory secretions. Have the client lie on the unaffected side. Maintain the client in high Fowler’s position. Coordinate breathing and coughing exercise with administration of analgesics. 46. The community nurse is teaching the group of mothers about the cervical mucus method of natural family planning. Which characteristics are typical of the cervical mucus mucus during the “fertile” period of the menstrual cycle?    Absence of ferning. Thin, clear, good spinnbarkeit. Thick, cloudy. Yellow and sticky. 47. A client with ruptured appendix had surgery an hour ago and is transferred to the nursing care unit. The nurse placed the client in a semiFowler’s position primarily to:  to:   Facilitate movement and reduce complications from immobility. Fully aerate the lungs. Splint the wound. Promote drainage and prevent subdiaphragmatic abscesses. 48. Which of the following will best describe a management function? Writing a letter to the editor of a nursing journal. Negotiating labor contracts. Directing and evaluating nursing staff members. Explaining medication side effects to a client. 49. The parents of an infant client ask the nurse to teach them how to administer Cortisporin eye drops. The nurse is correct in advising the parents to place the drops: In the middle of the lower conjunctival sac of the infant’s eye.   Directly onto the infant’s sclera.  sclera.   In the outer canthus of the infant’s eye.  eye.  In the inner canthus of the infant’s eye.  eye.   50. The nurse is assessing on the client who is admitted due to vehicle accident. Which of the following findings will help the nurse that there is internal bleeding? Frank blood on the clothing. Thirst and restlessness.  Abdominal pain. pain . Confusion and altered of consciousness. 51. The nurse is completing an assessment to a newborn baby boy. The nurse observes that the skin of the newborn is dry and flaking and there are several areas of an apparent macular rash. The nurse charts this as: Icterus neonatorum Multiple hemangiomas

 

Erythema toxicum Milia 52. The client is brought to the emergency department because of serious vehicle accident. After an hour, the client has been declared brain dead. The nurse who has been with the client must now talk to the family about organ donation. Which of the following consideration is necessary? Include as many family members as possible. Take the family to the chapel. Discuss life support systems. Clarify the family’s family’s understanding of brain death.  death.   53. The nurse is teaching exercises that are good for pregnant women increasing tone and fitness and decreasing lower backache. Which of the following should the nurse exclude in the exercise program? Stand with legs apart and touch hands to floor three times per day. Ten minutes of walking per day with an emphasis on good posture. Ten minutes of swimming or leg kicking in pool per day. Pelvic rock exercise and squats three times a day. 54. A client with obsessive-compulsive behavior is admitted in the psychiatric unit. The nurse taking care of the client knows that the primary treatment goal is to: Provide distraction. Support but limit the behavior. Prohibit the behavior. Point out the behavior. 55. After ileostomy, the nurse expects that the drainage appliance will be applied to the stoma: When the client is able to begin self-care procedures. 24 hours later, when the swelling subsided. In the operating room after the ileostomy procedure.  After the ileostomy begins begin s to function. 56. A female client who has a 28-day menstrual cycle asks the community health nurse when she get pregnant during her cycle. What will be the best nursing response? It is impossible to determine the fertile period reliably. So it is best to assume that a woman is always fertile. In a 28-day cycle, ovulation occurs at or about day 14. The egg lives for about 24 hours and the sperm live for about 72 hours. The fertile period would be approximately between day 11 and day 15. In a 28- day cycle, ovulation occurs at or about day 14. The egg lives for about 72 hours and the sperm live for about 24 hours. The fertile period would be approximately between day 13 and 17. In a 28-day cycle, ovulation occurs 8 days before the next period or at about day 20. The fertile period is between day 20 and the beginning of the next period. 57. Which of the following statement describes the role of a nurse as a client advocate?  A nurse may override clients’ wishes for the theirir own good. good.    A nurse has the moral obligation o bligation to prevent p revent harm and do well w ell for clients.  A nurse helps clients clien ts gain greater ind independence ependence and sself-determina elf-determination. tion.  A nurse measures the risk r isk and benefits of vari various ous health situatio situations ns while factoring in cost. 58. A community health nurse is providing a health teaching to a woman infected with herpes simplex 2. Which of the following health teaching must the nurse include to reduce the chances of transmission of herpes simplex 2? “Abstain from intercourse until lesions heal.”  heal.”   “Therapy is curative.”  curative.”  “Penicillin is the drug of choice for treatment.”  treatment.”   “The organism is associated with later development of hydatidiform mole.  mole.   59. The nurse in the psychiatric ward informed the male client that he will be attending the 9:00 AM group therapy sessions. The client tells the nurse that he must wash his hands from 9:00 to 9:30 AM each day and therefore he cannot attend. Which concept does the nursing staff need to keep in mind in planning nursing intervention for this client? Depression underlines ritualistic behavior. Fear and tensions are often expressed in disguised form through symbolic processes. Ritualistic behavior makes others uncomfortable. Unmet needs are discharged through ritualistic behavior. 60. The nurse assesses the health condition of the female client. The client tells the nurse that she discovered a lump in the breast last year and hesitated to seek medical advice. The nurse understands that, women who tend to delay seeking medical advice after discovering the disease are displaying what common defense mechanism? Intellectualization. Suppression. Repression. Denial. 61. Which of the following situations cannot be delegated by the registered nurse to the nursing assistant?  A postoperative client clien t who is stable needs nee ds to ambulate. Client in soft restraint who is very agitated and crying.  A confused elderly woman who nee needs ds assistance with eatin eating. g. Routine temperature check that must be done for a client at end of shift. 62. In the admission care unit, which of the following client would the nurse give immediate attention?  A client who is 3 days postoperative p ostoperative with le leftft calf pain.  A client who is postoperative postop erative hip pinn pinning ing who is complaining compla ining of pain. New admitted client with chest pain.  A client with diabetes diabete s who has a gluco glucoscan scan reading of 18 180. 0.

 

63. A couple seeks medical advice in the community health care unit. A couple has been unable to conceive; the man is being evaluated for possible problems. The physician ordered semen analysis. Which of the following instructions is correct regarding collection of a sperm specimen? Collect a specimen at the clinic, place in iced container, and give to laboratory personnel immediately. Collect specimen after 48-72 hours of abstinence and bring to clinic within 2 hours. Collect specimen in the morning after 24 hours of abstinence and bring to clinic immediately. Collect specimen at night, refrigerate, and bring to clinic the next morning. 64. The physician ordered Betamethasone to a pregnant woman at 34 weeks of gestation with sign of preterm labor. The nurse expects that the drug will: Treat infection. Suppress labor contraction. Stimulate the production of surfactant. Reduce the risk of hypertension. 65. A tracheostomy cuff is to be deflated, which of the following nursing intervention should be implemented before starting the procedures? Suction the trachea and mouth. Have the obdurator available. Encourage deep breathing and coughing. Do a pulse oximetry reading. 66. A client is diagnosed with Tuberculosis and respiratory isolation is initiated. This means that: Glovess are worn when handling the client’s tissue, excretions, and linen.  Glove linen.   Both client and attending nurse must wear masks at all times. Nurse and visitors must wear masks until chemotherapy is begun. Client is instructed in cough and tissue techniques. Full isolation; that is, caps and gowns are required during the period of contagion. 67. A client with lung cancer is admitted in the nursing care unit. The husband wants to know the condition of his wife. How should the nurse respond to the husband? Find out what information he already has. Suggest that he discuss it with his wife. Refer him to the doctor. Refer him to the nurse in charge. 68. A hospitalized client cannot find his handkerchief and accuses other cient in the room and the nurse of stealing them. Which is the most therapeutic approach to this client? Divert the client’s attention.  attention.   Listen without reinforcing the client’s belief.  belief.   Inject humor to defuse the intensity. Logically point out that the client is jumping to conclusions. 69. After a cystectomy and formation of an ileal conduit, the nurse provides instruction regarding prevention of leakage of the pouch and backflow of the urine. The nurse is correct to include in the instruction to empty the urine pouch: Every 3-4 hours. Every hour. Twice a day. Once before bedtime. 70. Which telephone call from a student’s mother should the school nurse take care of at once?    A telephone call notifying no tifying the school nurse that the child’ ped pediatrician iatrician has informed info rmed the mother that the ch child ild will need car diac car diac repair surgery within the next few weeks.  A telephone call notifying no tifying the school nurse that the child’s ped pediatrician iatrician has informed info rmed the mother that the ch child ild has head lic e.  A telephone call notifying no tifying the school nurse that a child has a tem temperature perature of 102ºF 102 ºF and a rash co covering vering the trunk and upper up per extremities of the body. bod y.  A telephone call notifying no tifying the school nurse that a child unde underwent rwent an emergency emerge ncy appendectom appendectomyy during the previous previou s night. 71. Which of the following signs and symptoms that require immediate attention and may indicate most serious complications during pregnancy? Severe abdominal pain or fluid discharge from the vagina. Excessive saliva, “bumps around the areolae, and increased vaginal mucus.   Fatigue, nausea, and urinary frequency at any time during pregnancy.  Ankle edema, enlarging enla rging varicositi varicosities, es, and heartburn. 72. The nurse is assessing the newborn boy. Apgar scores are 7 and 9. The newborn becomes slightly cyanotic. What is the initial nursing action? Elevate his head to promote gravity drainage of secretions. Wrap him in another blanket, to reduce heat loss. Stimulate him to cry,, to increase oxygenation.  Aspirate his mouth and an d nose with bul bulbb syringe. 73. The nurse is formulating a plan of care to a client with a somatoform disorder. The nurse needs to have knowledge of which psychodynamic principle? The symptoms of a somatoform disorder are an attempt to adjust to painful life situations or to cope with conflicting sexual, aggressive, or dependent feelings. The major fundamental mechanism is regression. The client’s symptoms are imaginary and the suffering is faked.    An extensive, prolonged prolon ged study of the sympto symptoms ms will be reassuring to the client, who seeks seek s sympathy, attention an andd love. 74. An infant is brought to the health care clinic for three immunizations at the same time. The nurse knows that hepatitis B, DPT, and Haemophilus influenzae type B immunizations should: Be drawn in the same syringe and given in one injection. Be mixed and inject in the same sites. Not be mixed and the nurse must give three injections in three sites. Be mixed and the nurse must give the injection in three sites.

 

75. A female client with cancer has radium implants. The nurse wants to maintain the implants in the correct position. The nurse should position the client: Flat in bed. On the side only. With the foot of the bed elevated. With the head elevated 45-degrees (semi-Fowler’s). (semi- Fowler’s).   76. The nurse wants to know if the mother of a toddler understands the instructions regarding the administration of syrup of ipecac. Which of the following statement will help the nurse to know that the mother needs additional teaching? “I’ll give the medicine if my child gets into some toilet bowl cleaner.”   “I’ll give the medicine if my child gets into some aspirin.”   “I’ll give the medicine if my child gets into some plant bulbs.”   “I’ll give the medicine if my child gets into some vitamin pills.”   77. To assess if the cranial nerve VII of the client was damaged, which changes would not be expected? Drooling and drooping of the mouth. Inability to open eyelids on operative side. Sagging of the face on the operative side. Inability to close eyelid on operative side. 78. The community health nurse makes a home visit to a family. During the visit, the nurse observes that the mother is beating her child. What is the priority nursing intervention in this situation?  Assess the child’s injuries. in juries.   Report the incident to protective agencies. Refer the family to appropriate support group.  Assist the family to identify stressors and use of other othe r coping mechanisms mech anisms to prevent furthe furtherr incidents. 79. The nurse in the neonatal care unit is supervising the actions of a certified nursing assistant in giving care to the newborns. The nursing assistant mistakenly gives a formula feeding to a newborn that is on water feeding only. The nurse is responsible for the mistake of the nursing assistant:  Always, as a representative represe ntative of the institution.  Always, because nurses nu rses who super supervise vise less-trained individuals i ndividuals are responsible r esponsible for their m mistakes. istakes. If the nurse failed to determine whether the nursing assistant was competent to take care of the client. Only if the nurse agreed that the newborn could be fed formula. 80. The nurse is assigned to care for a client with urinary calculi. Fluid intake of 2L/day is encouraged to the client. the primary reason for this is to: Reduce the size of existing stones. Prevent crystalline irritation to the ureter. Reduce the size of existing stones Increase the hydrostatic pressure in the urinary tract. 81. The nurse is counseling a couple coupl e in their mid 30’s who have been unable to conceive for about 6 months. They are concerned that one or both of them may be infertile. What is the best advice the nurse could give to the couple? “it is no unusual to take 6-12 6 -12 months to get pregnant, especially when the partners are in their mid- 30s. Eat well, exercise, and avoid stress.”  stress.”   “Start planning adoption. Many couples get pregnant when they are trying to adopt.”  adopt.”   “Consult a fertility specialist and start testing before you get any older.”   “Have sex as often as you can, especially around the time of ovulation, to increase your chances of pregnancy.”   82. The nurse is caring for a cient who Is a retired nurse. A 24-hour urine collection for Creatinine clearance is to be done. The client tells the nurse, “I can’t remember what this test is for.” The best response by the nurse is:  is:   “It provides a way to see if you are passing any protein in your urine.”   “It tells how well the kidneys filter wastes from the blood.”  blood.”   “It tells if your renal insufficiency has affected your heart.”   “The test measures the number of particles the kidney filters.”   83. The nurse observes the female client in the psychiatric ward that she is having a hard time sleeping at night. The nurse asks the client about it and the client says, “I can’t sleep at night because of fear of dying.” What is the best initial nursing response?   “It must be frightening for you to feel that way. Tell me more about it.”  it.”   “Don’t worry, you won’t die. You are just here for some test.”  test.”   “Why are you afraid of dying?”  dying?”   “Try to sleep. You need the rest before tomorrow’s test.”  test.”   84. In the hospital lobby, the registered nurse overhears a two staff members discussing about the health condition of her client. What would be the appropriate action for the registered nurse to take? Join in the conversation, giving her input about the case. Ignore them, because they have the right to discuss anything they want to. Tell them it is not appropriate to discuss such things. Report this incident to the nursing supervisor. 85. The client has had a right-sided cerebrovascular accident. In transferring the client from the wheelchair to bed, in what position should a client be placed to facilitate safe transfer? Weakened (L) side of the cient next to bed. Weakened (R) side of the client next to bed. Weakened (L) side of the client away from bed. Weakened (R) side of the cient away from bed. 86. The child client has undergone hip surgery and is in a spica cast. Which of the following toy should be avoided to be in the child’s bed?  bed?   A toy gun.  A stuffed animal.  A ball.

 

Legos. 87. The LPN/LVN asks the registered nurse why oxytocin (Pitocin), 10 units (IV or IM) must be given to a client after birth fo the fetus. The nurse is correct to explain that oxytocin: Minimizes discomfort from “afterpains.” “afterpains.”   Suppresses lactation. Promotes lactation. Maintains uterine tone. 88. The nurse in the nursing care unit is aware that one of the medical staff displays unlikely behaviors like confusion, agitation, lethargy and unkempt appearance. This behavior has been reported to the nurse manager several times, but no changes observed. The nurse should: Continue to report observations of unusual behavior until the problem is resolved. Consider that the obligation to protect the patient from harm has been met by the prior reports and do nothing further. Discuss the situation with friends who are also nurses to get ideas .  Approach the partner partn er of this medical staff memb member er with these concerns. concer ns. 89. The physician ordered tetracycline PO qid to a child client who weights 20kg. The recommended PO tetracycline dose is 25-50 mg/kg/day. What is the maximum single dose that can be safely administered to this child? 1g 500 mg 250 mg 125 mg 90. The nurse is completing an obstetric history of a woman in labor. Which event in the obstetric history will help the nurse suspects dysfunctional labor in the current pregnancy? Total time of ruptured membranes was 24 hours with the second birth. First labor lasting 24 hours. Uterine fibroid noted at time of cesarean delivery. Second birth by cesarean for face presentation. 91. The nurse is planning to talk to the client with an antisocial personality disorder. What would be the most therapeutic approach? Provide external controls. Reinforce the client’s self -concept. -concept. Give the client opportunities to test reality. Gratify the client’s inner needs.  needs.  92. The nurse is teaching a group of women about fertility awareness, the nurse should emphasize that basal body temperature: Can be done with a mercury thermometer but no a digital one. The average temperature taken each morning. Should be recorded each morning before any activity. Has a lower degree of accuracy in predicting ovulation than the cervical mucus test. 93. The nursing applicant has given the chance to ask questions during a job interview at a local hospital. What should be the most important question to ask that can increase chances of securing a job offer? Begin with questions about client care assignments, advancement opportunities, and continuing education. Decline to ask questions, because that is the responsibility of the interviewer.  Ask as many questions question s about the facility as po possible. ssible. Clarify information regarding salary, benefits, and working hours first, because this will help in deciding whether or not to take the job. 94. The nurse advised the pregnant woman that smoking and alcohol should be avoided during pregnancy. The nurse takes into account that the developing fetus is most vulnerable to environment teratogens that cause malformation during: The entire pregnancy. The third trimester. The first trimester. The second trimester. 95. A male client tells the nurse that there is a big bug in his bed. The most therapeutic nursing response would be: Silence. “Where’s the bug? I’ll kill it for you.”  you.”   “I don’t see a bug in your bed, but you seem afraid.”  afraid.”   “You must be seeing things.”  things.”  96. A pregnant client in late pregnancy is complaining of groin pain that seems worse on the right side. Which of the following is the most likely cause of it? Beginning of labor. Bladder infection. Constipation. Tension on the round ligament. 97. The nurse is conducting a lecture to a group of volunteer nurses. The nurse is correct in imparting the idea that the Good Samaritan law protects the nurse from a suit for malpractice when: The nurse stops to render emergency aid and leaves before the ambulance arrives. The nurse acts in an emergency at his or her place of employment. The nurse refuses to stop for an emergency outside of the scope of employment. The nurse is grossly negligent at the scene of an emergency. 98. A woman is hospitalized with mild preeclampsia. The nurse is formulating a plan of care for this client, which nursing care is least likely to be done? Deep-tendon reflexes once per shift. Vital signs and FHR and rhythm q4h while awake.  Absolute bed rest.

 

Daily weight. 99. While feeding a newborn with an unrepaired cardiac defect, the nurse keeps on assessing the condition of the client. The nurse notes that the newborn’s respiration is 72 breaths per minute. What would would be the initial nursing action? Burp the newborn. Stop the feeding. Continue the feeding. Notify the physician. 100. A client who undergone appendectomy 3 days ago is scheduled for discharge today. The nurse notes that the client is restless, picking at bedclothes and saying, “I am late on my appointment,” and calling the nurse by the wrong name. The nurse suspects:   Panic reaction. Medication overdose. Toxic reaction to an antibiotic. Delirium tremens.  Answers and Rationales Ratio nales  A. The oxytocic effect of Pitocin increases i ncreases the intensity and an d durations of contractions; contr actions; prolonged co contractions ntractions will jeo jeopardi pardize ze the safetyof the fetus and necessitate discontinuing the drug. B. It is of paramount importance to prevent the client from hurting himself or herself or others. B. After tonsillectomy, clear, cool liquids should be given. Citrus, carbonated, and hot or cold liquids should be avoided because they may irritate the throat. Red liquids should be avoided because they give the appearance of blood if the child vomits. Milk and milk products including pudding are avoided because they coat the throat, cause the child to clear the throat, and increase the risk of bleeding.  A. Phenylephrine, Phenylephrine , with frequent and continued co ntinued use, can caus causee rebound ccongestion ongestion of mucou mucouss membranes. B. The N 95 respirator is a high-particulate filtration mask that meets the CDC performance criteria for a tuberculosis respirator. C. The most frequent cause of noncompliance to the treatment of chronic, or open-angle glaucoma is the miotic effects of pilocarpine. Pupillary constriction impedes normal accommodation, making night driving difficult and hazardous, reducing the client’s ability to rea d for extended periods and making participation in games with fast-moving objects impossible. B. This stops the sucking of air through the tube and prevents the entry of contaminants. In addition, clamping near the chest wall provides for some stability and may prevent the clamp from pulling on the chest tube. D. Because umbilical cor dd’s ’s insertion site is born before the fetal head, the cord may be compressed by the after -coming after -coming head in a breech birth. B. It is important to externalize the anger away from self. D. Development normally proceeds cephalocaudally; so the first major developmental milestone that the infant achieves is the ability to hold the head up within the first 8-12 8-12 weeks of life. In hypothyroidism, the infant’s muscle tone would be poor and the infant would not be able to achieve this milestone. D. Get a senior nurse who know s the policies, the client, and the doctor. Generally speaking, a nurse should not accept telephone orders. However, if it is necessary to take one, follow the hospital’s policy regarding telephone orders. Failure to followhospital p olicy could be considered negligence. In this case, the nurse was new and did not know the hospital’s policy concerning telephone orders. The nurse was  also unfamiliar with the doctor and the client. Therefore the nurse should not take the order unless a) no one else is available and b) it is an emergency situation. C. The nurse is obligated to inform the nurse manager about changes in the condition of the client, which may change the decision made by the nurse manager.  A. Perinatal risk factors for the development d evelopment of Do Down wn syndrome in include clude advanced maternal age, esp especially ecially with the first pregnancy. pre gnancy. B. Assignments should be based on scope of practice and expertise. B. The child who is concurrently taking digoxin and diuretics is at increased risk for digoxin toxicity due to the loss of potassium. The child and parents should be taught what foods are high in potassium, and the child should be encouraged to eat a high- potassium diet. In addition, the child’s serum potassium level should be carefully monitored.  A. The responsible for fo r an accurate infor informed med consent is the physic physician. ian. An exception to this thi s answer would be a life-threatening life-threa tening emergency, but b ut there are no data to support another response. D. Asking the client to cough and take a deep breath will help determine if the chest tube is kinked or if the lungs has reexpanded. B. Every event that exposes a client to harm should be recorded in an incident report, as well as reported to the appropriate supervisors in order to resolve the current problems and permit the institution to prevent the problem from happening again. D. One of the earliest signs of digoxin toxicity is Bradycardia. For a toddler, any heart rate that falls below the norm of about 100-120 bpm would indicate Bradycardia and would necessitate holding the medication and notifying the physician. B. This option is least threatening. D. In preparing the client for discharge that is receiving prednisone, the nurse should caution the client to (a) take oral preparations after meals; (b) remember that routine checks of vital signs, weight, and lab studies are critical; (c) NEVER STOP OR CHANGE THE AMOUNT OF MEDICATION WITHOUT MEDICAL ADVICE; (d) store the medication in a light-resistant container.  A. Progesterone also reduces re duces smooth muscle mu scle motility in the urinar urinaryy tract and predisposes pre disposes the pregn pregnant ant woman to urinary urinar y tract infections. Women should contact their doctors if they exhibit signs of infection. Kegel exercise will help strengthen the perineal muscles; limiting fluids at bedtime reduces the possibility of being awakened by the necessity of voiding. B. This is the proper use of anger. C. There are several models of case management, but the commonality is comprehensive coordination of care to better predict needs of high-risk clients, decrease exacerbations and continually monitor progress overtime.  A. Phenytoin should be infused or inj injected ected into larger vein veinss to avoid the discolo discoloration ration know as purple glove syndrome; infusi ng into a smaller vein ve in is not appropriate. C. Serum radioimmunoassay (RIA) is accurate within 7days of conception. This test is specific for HCG, and accuracy is not compromised by confusion with LH. D. Surgery and anesthesia can increase mucus production. Deep breathing and coughing are essential to prevent atelectasis and pneumonia in the client’s only remaining lung. B. Newborns can get pneumonia (tachypnea, mild hypoxia, cough, eosinophilia) and conjunctivitis from Chlamydia. D. The client may perceive this as avoidance, but it is more important to redirect back to the client, especially in light of the manipulative behavior of drug abusers and adolescents. C. It describes a democratic process in which all members have input in the client’s care.    A. Contraction of the milk mil k ducts and let-do let-down wn reflex occur under th thee stimulation of oxytocin re released leased by the posterior pituitar pituitaryy gland. B. In case management, the nurse assumes total responsibility for meeting the needs of the client during the entire time on duty.  A. Smoke inhalation affects gas exchange. C. Sperm deposited during intercourse may remain viable for about 3 days. If ovulation occurs during this period, conception may result. B. This option shows acceptance (key concept) of this age-typical sleep pattern (that of waking in the early morning). D. Taking the mother’s pulse while listening to the F HR will differentiate between the maternal and fetal heart rates and rule out fetal Bradycardia.  A. Antihistamines cause pupil dilatio dilationn and should be aavoided voided with gla glaucoma. ucoma.  A. This suggests that the level le vel of consciousness is decreasing.

 

D. An advance directive is a form of informed consent, and only a competent adult or the holder of a durable power of attorney has the right to consent or refuse treatment. If the spouse does not hold the power of attorney, the decisions of the holder, even if opposed by the spouse, are enforced. C. Gentle but firm guidance and nonverbal direction is needed to intervene when a client with schizophrenic symptoms is being disruptive. C. Suctioning is only done for 10 seconds, intermittently, as the catheter is being withdrawn. D. The priority for this client is being able to establish an airway.  A. Signs of placental separation sep aration include includ e a change in the sha shape pe of the uterus from ovo ovoid id to globular. B. This could indicate intracranial bleeding. Alteplase is a thrombolytic enzyme that lyses thrombi and emboli. Bleeding is an adverse effect. Monitor clotting times and signs of any gastrointestinal or internal bleeding. D. Because flank incision in nephrectomy is directly below the diaphragm, deep breathing is painful. Additionally, there is a greater incisional pull each time the person moves than there is with abdominal surgery. Incisional pain following nephrectomy generally requires analgesics administration every 3-4 hours for 24-48 hours after surgery. Therefore, turning, coughing and deep-breathing exercises should be planned to maximize the analgesic effects. B. Under high estrogen levels, during the period surrounding ovulation, the cervical mucus becomes thin, clear, and elastic (spinnbarkeit), facilitating sperm passage. D. After surgery for a ruptured appendix, the client should be placed in a semi- Fowler’s position to promote drainage and to prevent possible complications. C. Directing and evaluation of staff is a major responsibility of a nursing manager.  A. The recommended procedure for ad administering ministering eyedro eyedrops ps to any client calls for th thee drops to be place placedd in the middle of the lower lo wer conjunctival sa sac. c. B. Thirst and restlessness indicate hypovolemia and hypoxemia. Internal bleeding is difficult to recognized and evaluate because it is not apparent. C. Erythema toxicum is the normal, nonpathological macular newborn rash. D. The family needs to understand what brain death is before talking about organ donation. They need time to accept the death of their family member. An environment conducive to discussing an emotional issue is needed.  A. Bending from the waist wa ist in pregnancy ten tends ds to make backache worse. B. Support and limit setting decrease anxiety and provide external control. C. The stoma drainage bag is applied in the operating room. Drainage from the ileostomy contains secretions that are rich in digestive enzymes and highly irritating to the skin. Protection of the skin from the effects of these enzymes is begun at once. Skin exposed to these enzymes even for a short time becomes reddened, painful and excoriated. B. It is the most accurate statement of physiological facts for a 28-day menstrual cycle: ovulation at day 14, egg life span 24 hours, sperm life span of 72 hours. Fertilization could occur from sperm deposited before ovulation. C. An advocate role encourage freedom of choice, includes speaking out for the client, and supports the client’s best interes ts.  A. Abstinence will eliminate e liminate any unn unnecessary ecessary pain durin duringg intercourse and will reduce the poss possibility ibility of transmitting infection to one’s sexual partner.  partner.   B. Anxiety is generated by group therapy at 9:00 AM. The ritualistic behavioral defense of hand washing decreases anxiety by avoiding group therapy. D. Denial is a very strong defense mechanism used to allay the emotional effects of discovering a potential threat. Although denial has been found to be an effective mechanism for survival in some instances, such as during natural disasters, it may in greater pathology in a woman with potential breast carcinoma. B. The registered nurse cannot delegate the responsibility for assessment and evaluation of clients. The status of the client in restraint requires further assessment to determine if there are additional causes for the behavior. C. The client with chest pain may be having a myocardial infarction, and immediate assessment and intervention is a priority. B. Is correct because semen analysis requires that a freshly masturbated specimen be obtained after a rest (abstinence) period of 48-72 hours. C. Betamethasone, a form of cortisone, acts on the fetal lungs to produce surfactant.  A. Secretions may have pooled p ooled above the th e tracheostomy cuff. If these are nnot ot suctioned before ddeflation, eflation, the secretions secretio ns may be aspirated. a spirated. C. Proper handling of sputum is essential to allay droplet transference of bacilli in the air. Clients need to be taught to cover their nose and mouth with tissues when sneezing or coughing. Chemotherapy generally renders the client noninfectious within days to a few weeks, usually before cultures for tubercle bacilli are negative. Until chemical isolation is established, many institutions require the client to wear a mask when visitors are in the room or when the nurse is in attendance. Client should be in a well-ventilated room, without air recirculation, to prevent air contamination.  A. It is best to establish baseline basel ine information informatio n first. B. Listening is probably the most effective response of the four choices.  A. Urine flow is continuous. continu ous. The pouch ha hass an outlet valve for easy ddrainage rainage every 3 -4 hours. (the pouch should s hould be changed change d every 3-5 da days, ys, or sooner if the adhesive is loose). C. A high fever accompanied by a body rash could indicate that the child has a communicable disease and would have exposed other students to the infection. The school nurse would want to investigate this telephone call immediately so that plans could be instituted to control the spread of such infection.  A. Severe abdominal pain may indi indicate cate complications of pre pregnancy gnancy such as ab abortion, ortion, ectopic pregn pregnancy, ancy, or abruption placenta; p lacenta; fluid flu id discharge from the vagina may indicate premature rupture of the membrane. D. Gentle aspiration of mucus helps maintain a patent airway, required for effective gas exchange.  A. Somatoform disorders disorder s provide a way of copi coping ng with conflicts. C. Immunization should never be mixed together in a syringe, thus necessitating three separate injections in three sites. Note: some manufacturers make a premixed combination of immunization that is safe and effective.  A. Clients with radioactive radioa ctive implants sho should uld be positioned flflat at in bed to pr prevent event dislodgeme dislodgement nt of the vaginal pac packing. king. The client may roll rol l to the side for meals but the upper body should not be raised more than 20 degrees.  A. Syrup of ipecac is not administered ad ministered when wh en the ingested substa substances nces is corrosive in nature. na ture. Toilet bo bowl wl cleaners, as a collective colle ctive whole, are highly h ighly corrosive substances. If the ingested substance “burned” the esophagus going down, it will “burn” the esophagus coming back up u p when the child begins to vomit after administration of syrup of ipecac. B. Inability to open eyelids on operative side is seen with cranial nerve III damage.  A. Assessment of physical injuries (like bru bruises, ises, lacerations, ble bleeding eding and fractu fractures) res) is the first priority. C. The nurse who is supervising others has a legal obligation to determine that they are competent to perform the assignment, as well as legal obligation to provide adequate supervision. D. Increasing hydrostatic pressure in the urinary tract will facilitate passage of the calculi.  A. Infertility is not diagnosed diagno sed until atleas atleastt 12months of unprotected intercourse has failed fai led to produce a pre pregnancy. gnancy. Older couples couple s will experien experience ce a longer time to get pregnant. B. Determining how well the kidneys filter wastes states the purpose of a Creatinine clearance test.  A. Acknowledging a feeling tone iiss the most therapeutic re response sponse and pr provides ovides a broad op opening ening for the client to eelaborate laborate feeling feelings. s. C. The behavior should be stopped. The first is to remind the staff that confidentiality maybe violated. C. With a right-sided cerebrovascular accident the client would have left-sided left- sided hemiplegia or weakness. The client’s good side should be closest to the bed to facilitate the transfer. D. Legos are small plastic building blocks that could easily slip under the child’s cast and l ead to a break in skin integrity and even infection. Pencils, backscratchers, and marbles are some other narrow or small items that could easily slip under the child’s cast and l ead to a break in skin integrity and infection. D. Oxytocin (Pitocin) is used to maintain uterine tone.

 

B. The submission of reports about incidents that expose clients to harm does not remove the obligation to report ongoing behavior as long as the risk to the client continues. C. The recommended dosage of tetracycline is 25-50mg/kg/day. If the child weighs 20kg and the maximum dose is 50mg/kg, this would indicate a total daily dose of 1000mg of tetracycline. In this case, the child is being given this medication four times a day. Therefore the maximum single dose that can be given is 250mg (1000 mg of tetracycline divided by four doses.) C. An abnormality in the uterine muscle could reduce the effectiveness of uterine contractions and lengthen the duration of subsequent labors.  A. Personality disorders disord ers stem from a weak supe superego, rego, implying implyin g a lack of adequate adequa te controls. C. The basal body temperature is the lowest body temperature of a healthy person that is taken immediately after waking and before getting out of bed. The BBT usually varies from 36.2 ºC to 36.3ºC during menses and for about 5-7 days afterward. About the time of ovulation, a slight drop in temperature may be seen, after ovulation in concert with the increasing progesterone levels of the early luteal phase, the BBT rises 0.2-0.4 ºC. This elevation remains until 2-3 days before menstruation, or if pregnancy has occurred.  A. This choice implies implie s concern for client car caree and self-impro self-improvement. vement. C. The first trimester is the period of organogenesis, that is, cell differentiation into the various organs, tissues, and structures. C. This This response does not contradict the client’s perception, is honest, and shows empathy.   D. Tension on round ligament occurs because of the erect human posture and pressure exerted by the growing fetus. D. The Good Samaritan Law does not impose a duty to stop at the scene of an emergency outside of the scope of employment, therefore nurses who do not stop are not liable for suit. C. Although reducing environment stimuli and activity is necessary for a woman with mild preeclampsia, she will most probably have bathroom privileges. B. A normal respiratory rate for a newborn is 30-40 breaths per minute. D. The behavior described is likely to be symptoms of delirium tremens, or alcohol withdrawal (often unsuspected on a surgical unit.) 1. For the client who is using oral contraceptives, the nurse informs the client about the need to take the pill at the same time each day to accomplish which of the following? Decrease the incidence of nausea Maintain hormonal levels Reduce side effects Prevent drug interactions 2. When teaching a client about contraception. Which of the following would the nurse include as the most effective method for preventing sexually transmitted infections? Spermicides Diaphragm Condoms Vasectomy 3. When preparing a woman who is 2 days postpartum for discharge, recommendations for which of the following contraceptive methods would be avoided? Diaphragm Female condom Oral contraceptives Rhythm method 4. For which of the following clients would the nurse expect that an intrauterine device would not be recommended? Woman over age 35 Nulliparous woman Promiscuous young adult Postpartum client 5. A client in her third trimester tells the nurse, “I’m constipated all the time!” Which of the following should the nurse r ecommend? r ecommend? Daily enemas Laxatives Increased fiber intake Decreased fluid intake 6. Which of the following would the nurse use as the basis for the teaching plan when caring for a pregnant teenager concerned about gaining too much weight during pregnancy? 10 pounds per trimester 1 pound per week for 40 weeks ½ pound per week for 40 weeks  A total gain of 25 to 30 pounds po unds 7. The client tells the nurse that her last menstrual period started on January 14 and ended on January 20. Using Nagele’s ru le, the nurse determines her EDD to be which of the following? September 27 October 21 November 7 December 27 8. When taking an obstetrical history on a pregnant client who states, “I had a son born at 38 weeks gestation, a daughter bo rn at 30 weeks gestation and I lost a baby at about 8 weeks,” the nurse should nurse  should record her obstetrical history as which of the following? G2 T2 P0 A0 L2 G3 T1 P1 A0 L2 G3 T2 P0 A0 L2 G4 T1 P1 A1 L2 9. When preparing to listen to the fetal heart rate at 12 weeks’ gestation, the nurse would use which of the following?   Stethoscope placed midline at the umbilicus Doppler placed midline at the suprapubic region Fetoscope placed midway between the umbilicus and the xiphoid process External electronic fetal monitor placed at the umbilicus 10.When developing a plan of care for a client newly diagnosed with gestational diabetes, which of the following instructions would be the priority? Dietary intake Medication Exercise Glucose monitoring 11.A client at 24 weeks gestation has gained 6 pounds in 4 weeks. Which of the following would be the priority when assessing the client? Glucosuria Depression

 

Hand/face edema Dietary intake 12. A client 12 weeks’ pregnant come to the emergency department with abdominal cramping and moderate vaginal bleeding. Specu lum examination reveals 2 to 3 cms cervical dilation. The nurse would document these findings as which of the following? Threatened abortion Imminent abortion Complete abortion Missed abortion 13.Which of the following would be the priority nursing diagnosis for a client with an ectopic pregnancy? Risk for infection Pain Knowledge Deficit  Anticipatory Grieving Grievin g 14.Before assessing the postpartum client’s uterus for firmness and position in relation to the umbilicus and midline, which of the following should the nurse do first?  Assess the vital signs  Administer analgesia analge sia  Ambulate her in the hall h all  Assist her to urinate 15.Which of the following should the nurse do when a primipara who is lactating tells the nurse that she has sore nipples? Tell her to breast feed more frequently  Administer a narcotic narco tic before breast feed feeding ing Encourage her to wear a nursing brassiere Use soap and water to clean the nipples 16.The nurse assesses the vital signs of a client, 4 hours’ postpartum that are as follows: BP 90/60; temperature 100.4ºF; pu lse 100 weak, thready; R 20 per minute. Which of the following should the nurse do first? Report the temperature to the physician Recheck the blood pressure with another cuff  Assess the uterus for firmness firmne ss and position Determine the amount of lochia 17.The nurse assesses the postpartum vaginal discharge (lochia) on four clients. Which of the following assessments would warrant notification of the physician?  A dark red discharge on a 2-day postpartum po stpartum client  A pink to brownish discharge d ischarge on a cli client ent who is 5 days postpa postpartum rtum  Almost colorless to creamy crea my discharge on a client 2 weeks after deli delivery very  A bright red discharge discharg e 5 days after delive delivery ry 18.A postpartum client has a temperature of 101.4ºF, with a uterus that is tender when palpated, remains unusually large, and not descending as normally expected. Which of the following should the nurse assess next? Lochia Breasts Incision Urine 19.Which of the following is the priority focus of nursing practice with the current early postpartum discharge? Promoting comfort and restoration of health Exploring the emotional status of the family Facilitating safe and effective self-and newborn care Teaching about the importance of family planning 20. Which of the following actions would be least effective in maintaining a neutral thermal environment for the newborn? Placing infant under radiant warmer after bathing Covering the scale with a warmed blanket prior to weighing Placing crib close to nursery window for family viewing Covering the infant’s head with a knit stockinette   21.A newborn who has an asymmetrical Moro reflex response should be further assessed for which of the following? Talipes equinovarus Fractured clavicle Congenital hypothyroidism Increased intracranial pressure 22.During the first 4 hours after a male circumcision, assessing for which of the following is the priority? Infection Hemorrhage Discomfort Dehydration 23.The mother asks the nurse. “What’s wrong with my son’s breasts? Why are they so enlarged?” Whish of the following would be  the best response by the nurse? “The breast tissue is inflamed from the trauma experienced with birth”   “A decrease in material hormones present before birth causes enlargement,”  enlargement,”   “You should discuss this with your doctor. It could be a malignancy”   “The tissue has hypertrophied while the baby was in the uterus”  uterus”  24. Immediately after birth the nurse notes the following on a male newborn: respirations 78; apical hearth rate 160 BPM, nostril flaring; mild intercostal retractions; and grunting at the end of expiration. Which of the following should the nurse do? Call the assessment data to the physician’s attention attention   Start oxygen per nasal cannula at 2 L/min. Suction the infant’s mouth and nares  nares  Recognize this as normal first period of reactivity 25.The nurse hears a mother telling a friend on the telephone about umbilical cord care. Which of the following statements by the mother indicates effective teaching? “Daily soap and water cleansing is best”  best”  ‘Alcohol helps it dry and kills germs”  germs”  “An antibiotic ointment applied daily prevents infection”  infection”  “He can have a tub bath each day”  day”  

 

26.A newborn weighing 3000 grams and feeding every 4 hours needs 120 calories/kg of body weight every 24 hours for proper growth and development. How many ounces of 20 cal/oz formula should this newborn receive at each feeding to meet nutritional needs? 2 ounces 3 ounces 4 ounces 6 ounces 27.The postterm neonate with meconium-stained amniotic fluid needs care designed to especially monitor for which of the following? Respiratory problems Gastrointestinal problems Integumentary problems Elimination problems 28.When measuring a client’s fundal height, which of the following techniques denotes the correct method of measurement used by the nurse? From the xiphoid process to the umbilicus From the symphysis pubis to the xiphoid process From the symphysis pubis to the fundus From the fundus to the umbilicus 29.A client with severe preeclampsia is admitted with of BP 160/110, proteinuria, and severe pitting edema. Which of the following would be most important to include in the client’s plan client’s plan of care? Daily weights Seizure precautions Right lateral positioning Stress reduction 30. A postpartum primipara asks the nurse, “When can we have sexual intercourse again?” Which of the following would be the nurse’s best response? “Anytime you both  both want to.”  to.”  “As soon as choose a contraceptive method.”  method.”  “When the discharge has stopped and the incision is healed.”  healed.”   “After your 6 weeks examination.”  examination.”  31.When preparing to administer the vitamin K injection to a neonate, the nurse would select which of the following sites as appropriate for the injection? Deltoid muscle  Anterior femoris muscle Vastus lateralis muscle Gluteus maximus muscle 32.When performing a pelvic examination, the nurse observes a red swollen area on the right side of the vaginal orifice. The nurse would document this as enlargement of which of the following? Clitoris Parotid gland Skene’s gland  gland  Bartholin’s gland  gland  33.To differentiate as a female, the hormonal stimulation of the embryo that must occur involves which of the following? Increase in maternal estrogen secretion Decrease in maternal androgen secretion Secretion of androgen by the fetal gonad Secretion of estrogen by the fetal gonad 34.A client at 8 weeks’ gestation calls complaining of slight nausea in the morning hours. Which of t he following client interventions should the nurse question? Taking 1 teaspoon of bicarbonate of soda in an 8-ounce glass of water Eating a few low-sodium crackers before getting out of bed  Avoiding the intake inta ke of liquids in the morning hours Eating six small meals a day instead of thee large meals 35.The nurse documents positive ballottement in the client’s prenatal record. The nurse understands that this indicates which of which  of the following? Palpable contractions on the abdomen Passive movement of the unengaged fetus Fetal kicking felt by the client Enlargement and softening of the uterus 36.During a pelvic exam the nurse notes a purple-blue tinge of the cervix. The nurse documents this as which of the following? Braxton-Hicks sign Chadwick’s sign  sign  Goodell’s sign McDonald’s sign  sign  37.During a prenatal class, the nurse explains the rationale for breathing techniques during preparation for labor based on the understanding that breathing techniques are most important in achieving which of the following? Eliminate pain and give the expectant parents something to do Reduce the risk of fetal distress by increasing uteroplacental perfusion Facilitate relaxation, possibly reducing the perception of pain Eliminate pain so that less analgesia and anesthesia are needed 38.After 4 hours of active labor, the nurse notes that the contractions of a primigravida client are not strong enough to dilate the cervix. Which of the following would the nurse anticipate doing? Obtaining an order to begin IV oxytocin infusion  Administering a light li ght sedative to allow all ow the patient to rest for sever several al hour Preparing for a cesarean section for failure to progress Increasing the encouragement to the patient when pushing begins 39.A multigravida at 38 weeks’ gestation is admitted with painless, bright bright red bleeding and mild contractions every 7 to 10 minutes. Which of the following assessments should be avoided? Maternal vital sign Fetal heart rate Contraction monitoring Cervical dilation

 

40.Which of the following would be the nurse’s most appropriate appropriat e response to a client who asks why she must have a cesarean delivery if she has a complete placenta previa? “You will have to ask your physician when he returns.”   “You need a cesarean to prevent hemorrhage.”  hemorrhage.”   “The placenta is covering most of your cervix.”  cervix.”   “The placenta is covering the opening of the uterus and blocking your baby.”   41.The nurse understands that the fetal head is in which of the following positions with a face presentation? Completely flexed Completely extended Partially extended Partially flexed 42.With a fetus in the left-anterior breech presentation, the nurse would expect the fetal heart rate would be most audible in which of the following areas?  Above the maternal umbilicus u mbilicus and to the th e right of midline In the lower-left maternal abdominal quadrant In the lower-right maternal abdominal quadrant  Above the maternal umbilicus u mbilicus and to the th e left of midline 43.The amniotic fluid of a client has a greenish tint. The nurse interprets this to be the result of which of the following? Lanugo Hydramnio Meconium Vernix 44.A patient is in labor and has just been told she has a breech presentation. The nurse should be particularly alert for which of the following? Quickening Ophthalmia neonatorum Pica Prolapsed umbilical cord 45.When describing dizygotic twins to a couple, on which of the following would the nurse base the explanation? Two ova fertilized by separate sperm Sharing of a common placenta Each ova with the same genotype Sharing of a common chorion 46.Which of the following refers to the single cell that reproduces itself after conception? Chromosome Blastocyst Zygote Trophoblast 47.In the late 1950s, consumers and health care professionals began challenging the routine use of analgesics and anesthetics during childbirth. Which of the following was an outgrowth of this concept? Labor, delivery, recovery, postpartum (LDRP) Nurse-midwifery Clinical nurse specialist Prepared childbirth 48.A client has a midpelvic contracture from a previous pelvic injury due to a motor vehicle accident as a teenager. The nurse is aware that this could prevent a fetus from passing through or around which structure during childbirth? Symphysis pubis Sacral promontory Ischial spines Pubic arch 49.When teaching a group of adolescents about variations in the length of the menstrual cycle, the nurse understands that the underlying mechanism is due to variations in which of the following phases? Menstrual phase Proliferative phase Secretory phase Ischemic phase 50.When teaching a group of adolescents about male hormone production, which of the following would the nurse include as being produced by the Leydig cells? Follicle-stimulating hormone Testosterone Leuteinizing hormone Gonadotropin releasing hormone  Answers and Rationales Ratio nales B . Regular timely ingestion of oral contraceptives is necessary to maintain hormonal levels of the drugs to suppress the action of the hypothalamus and anterior pituitary leading to inappropriate secretion of FSH and LH. Therefore, follicles do not mature, ovulation is inhibited, and pregnancy is prevented. The estrogen content of the oral site contraceptive may cause the nausea, regardless of when the pill is taken. Side effects and drug interactions may occur with oral contraceptives regardless of the time the pill is taken. C . Condoms, when used correctly and consistently, are the most effective contraceptive method or barrier against bacterial and viral sexually transmitted infections. Although spermicides kill sperm, they do not provide reliable protection against the spread of sexually transmitted infections, especially intracellular organisms such as HIV. Insertion and removal of the diaphragm along with the use of the spermicides may cause vaginal irritations, which could place the client at risk for infection transmission. Male sterilization eliminates spermatozoa from the ejaculate, but it does not eliminate bacterial and/or viral microorganisms that can cause sexually transmitted infections.  A . The diaphragm must m ust be fitted individua individually lly to ensure effectiven effectiveness. ess. Because of the chan changes ges to the repro reproductive ductive structures during pregnancy pregnan cy and following delivery, the diaphragm must be refitted, usually at the 6 weeks’ examination following childbirth or after a weight weig ht loss of 15 lbs or more. In addition, for maximum effectiveness, spermicidal jelly should be placed in the dome and around the rim. However, spermicidal jelly should not be inserted into the vagina until involution is completed at approximately 6 weeks. Use of a female condom protects the reproductive system from the introduction of semen or spermicides into the vagina and may be used after childbirth. Oral contraceptives may be started within the first postpartum week to ensure suppression of ovulation. For the couple who has determined the female’s fertile period, using the rhythm method, avoidance of intercourse during this period, is safe and effective.

 

C . An IUD may increase the risk of pelvic inflammatory disease, especially in women with more than one sexual partner, because of the increased risk of sexually transmitted infections. An UID should not be used if the woman has an active or chronic pelvic infection, postpartum infection, endometrial hyperplasia or carcinoma, or uterine abnormalities. Age is not a factor in determining the risks associated with IUD use. Most IUD users are over the age of 30. Although there is a slightly higher risk for infertility in women who have never been pregnant, the IUD is an acceptable option as long as the risk-benefit ratio is discussed. IUDs may be inserted immediately after delivery, but this is not recommended because of the increased risk and rate of expulsion at this time. C . During the third trimester, the enlarging uterus places pressure on the intestines. This coupled with the effect of hormones on smooth muscle relaxation causes decreased intestinal motility (peristalsis). Increasing fiber in the diet will help fecal matter pass more quickly through the intestinal tract, thus decreasing the amount of water that is absorbed. As a result, stool is softer and easier to pass. Enemas could precipitate preterm labor and/or electrolyte loss and should be avoided. Laxatives may cause preterm labor by stimulating peristalsis and may interfere with the absorption of nutrients. Use for more than 1 week can also lead to laxative dependency. Liquid in the diet helps provide a semisolid, soft consistency to the stool. Eight to ten glasses of fluid per day are essential to maintain hydration and promote stool evacuation. D . To ensure adequate fetal growth and development during the 40 weeks of a pregnancy, a total weight gain 25 to 30 pounds is recommended: 1.5 pounds in the first 10 weeks; 9 pounds by 30 weeks; and 27.5 pounds by 40 weeks. The pregnant woman should gain less weight in the first and second trimester than in the third. During the first trimester, the client should only gain 1.5 pounds in the first 10 weeks, not 1 pound per week.  A weight gain of ½ pound pou nd per week wou would ld be 20 pounds for th thee total pregnancy, less than the recom recommended mended amount. B . To calculate the EDD by Nagele’s rule, add 7 days to the first day of the last menstrual period and count back 3 months, changing the year appropriately. To obtain a date of September 27, 7 days have been added to the last day of the LMP (rather than the first day of the LMP), plus 4 months (instead of 3 months) were counted back. To obtain the date of November 7, 7 days have been subtracted (instead of added) from the first day of LMP plus November indicates counting back 2 months (instead of 3 months) from January. To obtain the date of December 27, 7 days were added to the last day of the LMP (rather than the first day of the LMP) and December indicates counting back only 1 month (instead of 3 months) from January. D. The client has been pregnant four times, including current pregnancy (G). Birth at 38 weeks’ gestation is considered full ter m ter m (T), while birth form 20 weeks to 38 weeks is considered preterm (P). A spontaneous abortion occurred at 8 weeks (A). She has two living children (L). B. At 12 weeks gestation, the uterus rises out of the pelvis and is palpable above the symphysis pubis. The Doppler intensifies the sound of the fetal pulse rate so it is audible. The uterus has merely risen out of the pelvis into the abdominal cavity and is not at the level of the umbilicus. The fetal heart rate at this age is not audible with a stethoscope. The uterus at 12 weeks is just above the symphysis pubis in the abdominal cavity, not midway between the umbilicus and the xiphoid process. At 12 weeks the FHR would be difficult to auscultate with a fetoscope. Although the external electronic fetal monitor would project the FHR, the uterus has not risen to the umbilicus at 12 weeks.  A . Although all of the choices ch oices are importan importantt in the managemen managementt of diabetes, diet therapy iiss the mainstay of the treatme treatment nt plan and a nd should always alwa ys be the priority. Women diagnosed with gestational diabetes generally need only diet therapy without medication to control their blood sugar levels. Exercise, is important for all pregnant women and especially for diabetic women, because it burns up glucose, thus decreasing blood sugar. However, dietary intake, not exercise, is the priority. All pregnant women with diabetes should have periodic monitoring of serum glucose. However, those with gestational diabetes generally do not need daily glucose monitoring. The standard of care recommends a fasting and 2- hour postprandial blood sugar level every 2 weeks. C. After 20 weeks’ gestation, when there is a rapid weight gain, preeclampsia should be suspected, which may be caused by flu id retention manifested by edema, especially of the hands and face. The three classic signs of preeclampsia are hypertension, edema, and proteinuria.  Although urine is checked ch ecked for glucos glucosee at each clinic visit, this iiss not the priority. Depre Depression ssion may cause either eithe r anorexia or excessive food intake, inta ke, leading to excessive weight gain or loss. This is not, however, the priority consideration at this time. Weight gain thought to be caused by excessive food intake would require a 24-hour diet recall. However, excessive intake would not be the primary consideration for this client at this time. B. Cramping and vaginal bleeding coupled with cervical dilation signifies that termination of the pregnancy is inevitable and cannot be prevented. Thus, the nurse would document an imminent abortion. In a threatened abortion, cramping and vaginal bleeding are present, but there is no cervical dilation. The symptoms may subside or progress to abortion. In a complete abortion all the products of conception are expelled. A missed abortion is early fetal intrauterine death without expulsion of the products of conception. B . For the client with an ectopic pregnancy, lower abdominal pain, usually unilateral, is the primary symptom. Thus, pain is the priority. Although the potential for infection is always present, the risk is low in ectopic pregnancy because pathogenic microorganisms have not been introduced from external sources. The client may have a limited knowledge of the pathology and treatment of the condition and will most likely experience grieving, but this is not the priority at this time. D. Before uterine assessment is performed, it is essential that the woman empty her bladder. A full bladder will interfere with the accuracy of the assessment by elevating the uterus and displacing to the side of the midline. Vital sign assessment is not necessary unless an abnormality in uterine assessment is identified. Uterine assessment should not cause acute pain that requires administration of analgesia. Ambulating the client is an essential component of postpartum care, but is not necessary prior to assessment of the uterus.  A. Feeding more fr equently, equently, about every 2 hours, will decrease the infant’s frantic, vigorous sucking from hunger and will decrease breast engorgement, soften the breast, and promote ease of correct latching-on for feeding. Narcotics administered prior to breast feeding are passed through the breast milk to the infant, causing excessive sleepiness. Nipple soreness is not severe enough to warrant narcotic analgesia. All postpartum clients, especially lactating mothers, should wear a supportive brassiere with wide cotton straps. This does not, however, prevent or reduce nipple soreness. Soaps are drying to the skin of the nipples and should not be used on the breasts of lactating mothers. Dry nipple skin predisposes to cracks and fissures, which can become sore and painful. D. A weak, thready pulse elevated to 100 BPM may indicate impending hemorrhagic shock. An increased pulse is a compensatory mechanism of the body in response to decreased fluid volume. Thus, the nurse should check the amount of lochia present. Temperatures up to 100.48F in the first 24 hours after birth are related to the dehydrating effects of labor and are considered normal. Although rechecking the blood pressure may be a correct choice of action, it is not the first action that should be implemented in light of the other data. The data indicate a potential impending hemorrhage. Assessing the uterus for firmness and position in relation to the umbilicus and midline is important, but the nurse should check the extent of vaginal bleeding first. Then it would be appropriate to check the uterus, which may be a possible cause of the hemorrhage. D. Any bright red vaginal discharge would be considered abnormal, but especially 5 days after delivery, when the lochia is typically pink to brownish. Lochia rubra, a dark red discharge, is present for 2 to 3 days after delivery. Bright red vaginal bleeding at this time suggests late postpartum hemorrhage, which occurs after the first 24 hours following delivery and is generally caused by retained placental fragments or bleeding disorders. Lochia rubra is the normal dark red discharge occurring in the first 2 to 3 days after delivery, containing epithelial cells, erythrocyes, leukocytes and decidua. Lochia serosa is a pink to brownish serosanguineous discharge occurring from 3 to 10 days after delivery that contains decidua, erythrocytes, leukocytes, cervical mucus, and microorganisms. Lochia alba is an almost colorless to yellowish discharge occurring from 10 days to 3 weeks after delivery and containing leukocytes, decidua, epithelial cells, fat, cervical mucus, cholesterol crystals, and bacteria.  A. The data suggests an infection i nfection of the end endometrial ometrial lining of the uterus. The lochia ma mayy be decreased oorr copious, dark brown in appearance, appearan ce, and foul smelling, providing further evidence evid ence of a possible infection. All the client’s data indicate a uterine problem, not a breast problem. Typically, transient fever, usually 101ºF, may be present with breast engorgement. Symptoms of mastitis include influenza-like manifestations. Localized infection of an episiotomy or C-section incision rarely causes systemic symptoms, and uterine involution would not be affected. The client data do not include dysuria, frequency, or urgency, symptoms of urinary tract infections, which would necessitate assessing asse ssing the client’s urine.  urine.   C. Because of early postpartum discharge and limited time for teaching, the nurse’s priority is to facilitate the safe and ef fective ef fective care of the client and newborn. Although promoting comfort and restoration of health, exploring the t he family’s emotional status, and teaching about family planning are important in postpartum/newborn nursing care, they are not the priority focus in the limited time presented by early post-partum discharge.

 

C. Heat loss by radiation occurs when the infant’s infan t’s crib is placed too near cold walls or windows. Thus placing the newborn’s crib close to the viewing window would be least effective. Body heat is lost through evaporation during bathing. Placing the infant under the radiant warmer after bathing will assist the infant to be rewarmed. Covering the scale with a warmed blanket prior to weighing prevents heat loss through conduction. A knit cap prevents heat loss from the head a large head, a large body surface area of the newborn’s body.   B. A fractured clavicle would prevent the normal Moro response of symmetrical sequential extension and abduction of the arms followed by flexion and adduction. In talipes equinovarus (clubfoot) the foot is turned medially, and in plantar flexion, with the heel elevated. The feet are not involved with the Moro reflex. Hypothyroiddism has no effect on the primitive reflexes. Absence of the Moror reflex is the most significant single indicator of central nervous system status, but it is not a sign of increased intracranial pressure. B. Hemorrhage is a potential risk following any surgical procedure. Although the infant has been given vitamin K to facilitate clotting, the prophylactic dose is often not sufficient to prevent bleeding. Although infection is a possibility, signs will not appear within 4 hours after the surgical procedure. The primary discomfort of circumcision occurs during the surgical procedure, not afterward. Although feedings are withheld prior to the circumcision, the chances of dehydration are minimal. B . The presence of excessive estrogen and progesterone in the maternal fetal blood followed by prompt withdrawal at birth precipitates breast engorgement, which will spontaneously resolve in 4 to 5 days after birth. The trauma of the birth process does not cause inflammation of the newborn’s breast tissue. Newborns do not have breast malignancy. This reply by the nurse would cause the mother to have undue  anxiety. Breast tissue does not hypertrophy in the fetus or newborns. D . The first 15 minutes to 1 hour after birth is the first period of reactivity involving respiratory and circulatory adaptation to extrauterine life. The data given reflect the normal changes during this time period. The infant’s assessment data reflect normal adaptation. Thus, the physician does not need to be notified and oxygen is not needed. The data do not indicate the presence of choking, gagging or coughing, which are signs of excessive secretions. Suctioning is not necessary. B. Application of 70% isopropyl alcohol to the cord minimizes microorganisms (germicidal) and promotes drying. The cord should be kept dry until it falls off and the stump has healed. Antibiotic ointment should only be used to treat an infection, not as a prophylaxis. Infants should not be submerged in a tub of water until the cord falls off and the stump has completely healed. B. To determine the amount of formula needed, do the following mathematical calculation. 3 kg x 120 cal/kg per day = 360 calories/day feeding q 4 hours = 6 feedings per day = 60 calories per feeding: 60 calories per feeding; 60 calories per feeding with formula 20 cal/oz = 3 ounces per feeding. Based on the calculation. 2, 4 or 6 ounces are incorrect.  A. Intrauterine anoxia may cause relaxatio relaxationn of the anal sphincter aand nd emptying of mecon meconium ium into th thee amniotic fluid. At birth some som e of the meconium fluid may be aspirated, causing mechanical obstruction or chemical pneumonitis. The infant is not at increased risk for gastrointestinal problems. Even though the skin is stained with meconium, it is noninfectious (sterile) and nonirritating. The postterm meconiumstained infant is not at additional risk for bowel or urinary problems. C . The nurse should use a nonelastic, flexible, paper measuring tape, placing the zero point on the superior border of the symphysis pubis and stretching the tape across the abdomen at the midline to the top of the fundus. The xiphoid and umbilicus are not appropriate landmarks to use when measuring the height of the fundus (McDonald’s measurement).   B . Women hospitalized with severe preeclampsia need decreased CNS stimulation to prevent a seizure. Seizure precautions provide environmental safety should a seizure occur. Because of edema, daily weight is important but not the priority. Preclampsia causes vasospasm and therefore can reduce utero-placental perfusion. The client should be placed on her left side to maximize blood flow, reduce blood pressure, and promote diuresis. Interventions to reduce stress and anxiety are very important to facilitate coping and a sense of control, but seizure precautions are the priority. C. Cessation of the lochial discharge signifies healing of the endometrium. Risk of hemorrhage and infection are minimal 3 weeks after a normal vaginal delivery. Telling the client anytime is inappropriate because this response does not provide the client with the specific information she is requesting. Choice of a contraceptive method is important, but not the specific criteria for safe resumption of sexual activity. Culturally, the 6weeks’ examination has been used been used as the time frame for resuming sexual activity, but it may be resumed earlier. C . The middle third of the vastus lateralis is the preferred injection site for vitamin K administration because it is free of blood vessels and nerves and is large enough to absorb the medication. The deltoid muscle of a newborn is not large enough for a newborn IM injection. Injections into this muscle in a small child might cause damage to the radial nerve. The anterior femoris muscle is the next safest muscle to use in a newborn but is not the safest. Because of the proximity of the sciatic nerve, the gluteus maximus muscle should not be until the child has been walking 2 years. D . Bartholin’s glands are the glands on either side of the vaginal orifice. The clitoris is  female erectile tissue found in the perineal area above the urethra. The parotid glands are open into the mouth. Skene’s glands open into the posterior wall of the female urinary meatus . D . The fetal gonad must secrete estrogen for the embryo to differentiate as a female. An increase in maternal estrogen secretion does not effect differentiation of the embryo, and maternal estrogen secretion occurs in every pregnancy. Maternal androgen secretion remains the same as before pregnancy and does not effect differentiation. Secretion of androgen by the fetal gonad would produce a male fetus.  A . Using bicarbonate bicarbon ate would increase increa se the amount of sodium iingested, ngested, which can cause ca use complication complications. s. Eating low-so low-sodium dium crackers would wo uld be appropriate. Since liquids can increase nausea avoiding them in the morning hours when nausea is usually the strongest is appropriate. Eating six small meals a day would keep the stomach full, which often decrease nausea. B . Ballottement indicates passive movement of the unengaged fetus. Ballottement is not a contraction. Fetal kicking felt by the client represents quickening. Enlargement and softening of the uterus is known as Piskacek’s sign.  sign.   B . Chadwick’s sign refers to the purple-blue purple -blue tinge of the cervix. Braxton Hicks contractions are painless contractions beginning around the 4th month. Goodell’s sign indicates softening of the cervix. Flexibility of the uterus against the cervix is known as McDonald’s sign. C . Breathing techniques can raise the pain threshold and reduce the perception of pain. They also promote relaxation. Breathing techniques do not eliminate pain, but they can reduce it. Positioning, not breathing, increases uteroplacental perfusion.  A . The client’s labor is hypotonic. The nurse should call the physical and obtain an order for an infusion of oxytocin, which will a ssist the uterus to contact more forcefully in an attempt to dilate the cervix. Administering light sedative would be done for hypertonic uterine contractions. Preparing for cesarean section is unnecessary at this time. Oxytocin would increase the uterine contractions and hopefully progress labor before a cesarean would be necessary. It is too early to anticipate client pushing with contractions. D . The signs indicate placenta previa and vaginal exam to determine cervical dilation would not be done because it could cause hemorrhage.  Assessing maternal materna l vital signs can he help lp determine matern maternal al physiologic sta status. tus. Fetal heart rate is impo rtant to assess fetal well-be well-being ing and should shou ld be done. Monitoring the contractions will help evaluate the progress of labor. D . A complete placenta previa occurs when the placenta covers the opening of the uterus, thus blocking the passageway for the baby. This response explains what a complete previa is and the reason the baby cannot come out except by cesarean delivery. Telling the client to ask the physician is a poor response and would increase the patient’s anxiety. Although a cesarean would help to prevent pre vent hemorrhage, the statement does not explain why the hemorrhage could occur. With a complete previa, the placenta is covering all the cervix, not just most of it. B . With a face presentation, the head is completely extended. With a vertex presentation, the head is completely or partially flexed. With a brow (forehead) presentation, the head would be partially extended. D . With this presentation, the fetal upper torso and back face the left upper maternal abdominal wall. The fetal heart rate would be most audible above the maternal umbilicus and to the left of the middle. The other positions would be incorrect. C. The greenish tint is due to the presence of meconium. Lanugo is the soft, downy hair on the shoulders and back of the fetus. Hydramnios represents excessive amniotic fluid. Vernix is the white, cheesy substance covering the fetus. D . In a breech position, because of the space between the presenting part and the cervix, prolapse of the umbilical cord is common. Quickening is the woman’s first perception perception of fetal movement. Ophthalmia neonatorum usually results from maternal gonorrhea and is conjunctivitis. Pica refers to the oral intake of nonfood substances.

 

 A . Dizygotic (fraternal) (fraterna l) twins involve two ova fertilized by separate separa te sperm. Monozygotic (identical) twins in involve volve a common pla placenta, centa, same genotype, and common chorion. C . The zygote is the single cell that reproduces itself after conception. The chromosome is the material that makes up the cell and is gained from each parent. Blastocyst and trophoblast are later terms for the embryo after zygote. D . Prepared childbirth was the direct result of the 1950’s challenging of the routine use of analgesic and anesthetics durin g childbirth. The LDRP was a much later concept and was not a direct result of the challenging of routine use of analgesics and anesthetics during childbirth. Roles for nurse midwives and clinical nurse specialists did not develop from this challenge. C . The ischial spines are located in the mid-pelvic region and could be narrowed due to the previous pelvic injury. The symphysis pubis, sacral promontory, and pubic arch are not part of the mid-pelvis. B . Variations in the length of the menstrual cycle are due to variations in the proliferative phase. The menstrual, secretory and ischemic phases do not contribute to this variation. B . Testosterone is produced by the Leyding cells in the seminiferous tubules. Follicle-stimulating hormone and leuteinzing hormone are released by the anterior pituitary gland. The hypothalamus is responsible for releasing gonadotropin-releasing hormone. 1. Estimate the number of pregnant women who will be given tetanus toxoid during an immunization outreach activity in a barangay with a population of about 1,500. 265 300 375 400 2. To describe the sex composition of the population, which demographic tool may be used? Sex ratio Sex proportion Population pyramid  Any of these may be used. used . 3. Which of the following is a natality rate? Crude birth rate Neonatal mortality rate Infant mortality rate General fertility rate 4. You are computing the crude death rate of your municipality, with a total population of about 18,000, for last year. There were 94 deaths. Among those who died, 20 died because of diseases of the heart and 32 were aged 50 years or older. What is the crude death rate? 4.2/1,000 5.2/1,000 6.3/1,000 7.3/1,000 5. Knowing that malnutrition is a frequent community health problem, you decided to conduct nutritional assessment. What population is particularly susceptible to protein energy malnutrition (PEM)? Pregnant women and the elderly Under-5 year old children 1-4 year old children School age children 6. Which statistic can give the most accurate reflection of the health status of a community? 1-4 year old age-specific mortality rate Infant mortality rate Swaroop’s index  index  Crude death rate 7. In the past year, Barangay A had an average population of 1655. 46 babies were born in that year, 2 of whom died less than 4 weeks after they were born. There were 4 recorded stillbirths. What is the neonatal mortality rate? 27.8/1,000 43.5/1,000 86.9/1,000 130.4/1,000 8. Which statistic best reflects the nutritional status of a population? 1-4 year old age-specific mortality rate Proportionate mortality rate Infant mortality rate Swaroop’s index  index  9. What numerator is used in computing general fertility rate? Estimated midyear population Number of registered live births Number of pregnancies in the year Number of females of reproductive age 10. You will gather data for nutritional assessment of a purok. You will gather information only from families with members who belong to the target population for PEM. What method of data gathering is best for this purpose? Census Survey Record review Review of civil registry 11. In the conduct of a census, the method of population assignment based on the actual physical location of the people is termed

 

De jure De locus De facto De novo 12. The Field Health Services and Information System (FHSIS) is the recording and reporting system in public health care in the Philippines. The Monthly Field Health Service Activity Report is a form used in which of the components of the FHSIS? Tally report Output report Target/client list Individual health record 13. To monitor clients registered in long-term regimens, such as the Multi-Drug Therapy, which component will be most useful? Tally report Output report Target/client list Individual health record 14. Civil registries are important sources of data. Which law requires registration of births within 30 days from the occurrence of the birth? P.D. 651  Act 3573 R.A. 3753 R.A. 3375 15. Which of the following professionals can sign the birth certificate? Public health nurse Rural health midwife Municipal health officer  Any of these health professionals pro fessionals 16. Which criterion in priority setting of health problems is used only in community health care? Modifiability of the problem Nature of the problem presented Magnitude of the health problem Preventive potential of the health problem 17. The Sentrong Sigla Movement has been launched to improve health service delivery. Which of the following is/are true of this movement? This is a project spearheaded by local government units. It is a basis for increasing funding from local government units. It encourages health centers to focus on disease prevention and control. Its main strategy is certification of health centers able to comply with standards. 18. Which of the following women should be considered as special targets for family planning? Those who have two children or more Those with medical conditions such as anemia Those younger than 20 years and older than 35 years Those who just had a delivery within the past 15 months 19. Freedom of choice is one of the policies of the Family Planning Program of the Philippines. Which of the following illustrates this principle? Information dissemination about the need for family planning Support of research and development in family planning methods  Adequate information informa tion for couples reg regarding arding the differen differentt methods Encouragement of couples to take family planning as a joint responsibility 20. A woman, 6 months pregnant, came to the center for consultation. Which of the following substances is contraindicated? Tetanus toxoid Retinol 200,000 IU Ferrous sulfate 200 mg Potassium Potassiu m iodate 200 mg. capsule 21. During prenatal consultation, a client asked you if she can have her delivery at home. After history taking and physical examination, you advised her against a home delivery. Which of the following findings disqualifies her for a home delivery? Her OB score is G5P3. She has some palmar pallor. Her blood pressure is 130/80. Her baby is in cephalic presentation. 22. Inadequate intake by the pregnant woman of which vitamin may cause neural tube defects? Niacin Riboflavin Folic acid Thiamine 23. You are in a client’s home to attend to a delivery. Which of the following will you do first?  first?   Set up the sterile area. Put on a clean gown or apron. Cleanse the client’s vulva with soap and water.  water.   Note the interval, duration and intensity of labor contractions. 24. In preparing a primigravida for breastfeeding, which of the following will you do? Tell her that lactation begins within a day after delivery.

 

Teach her nipple stretching exercises if her nipples are everted. Instruct her to wash her nipples before and after each breastfeeding. Explain to her that putting the baby to breast will lessen blood loss after delivery. 25. A primigravida is instructed to offer her breast to the baby for the first time within 30 minutes after delivery. What is the purpose of offering the breast this early? To initiate the occurrence of milk letdown To stimulate milk production by the mammary acini To make sure that the baby is able to get the colostrum To allow the woman to practice breastfeeding in the presence of the health worker 26. In a mothers’ class, you discuss proper breastfeeding technique. Which is of these is a sign that the baby has “latched on” to the breast properly? The baby takes shallow, rapid sucks. The mother does not feel nipple pain. The baby’s mouth baby’s mouth is only partly open. Only the mother’s nipple is inside the baby’s mouth.   27. You explain to a breastfeeding mother that breast milk is sufficient for all of the baby’s nutrient needs only up to ____ . 3 months 6 months 1 year 2 years 28. What is given to a woman within a month after the delivery of a baby? Malunggay capsule Ferrous sulfate 100 mg. OD Retinol 200,000 I.U., 1 capsule Potassium iodate 200 mg, 1 capsule 29. Which biological used in Expanded Program on Immunization (EPI) is stored in the freezer? DPT Tetanus toxoid Measles vaccine Hepatitis B vaccine 30. Unused BCG should be discarded how many hours after reconstitution? 2 4 6  At the end of the day  Answers and Rationales Ratio nales  Answer: (A) 265. To estimate the th e number of pregnant preg nant women, mu multiply ltiply the total popula population tion by 3.5%.  Answer: (D) Any of these may ma y be used. Sex ratio and sex proportion are a re used to determine th thee sex composition of a population. po pulation. A population pyramid is used to present the composition of a population by age and sex.  Answer: (A) Crude birth rate. r ate. Natality means birth birth.. A natality rate is a birth rate. ra te.  Answer: (B) 5.2/1,000. To compute com pute crude death rate divide total num number ber of deaths (94) by tota totall population (18,0 (18,000) 00) and multip ly by 1,000.  Answer: (C) 1-4 year old o ld children. Presch Preschoolers oolers are the most susce susceptible ptible to PEM because they the y have generally general ly been weaned. Also, Al so, this is the population who, unable to feed themselves, are often the victims of poor intrafamilial food distribution.  Answer: (C) Swaroop’s Swaroop ’s index. Swaroop’s Swaroop ’s index is is  the proportion of deaths aged 50 years and above. The higher the Swaroop’s index of a population, the greater the proportion of the deaths who were able to reach the age of at least 50 years, i.e., more people grew old before they died.  Answer: (B) 43.5/1,000. 43.5/1,000 . To compute for neon neonatal atal mortality rate, divide th thee number of babies babie s who died before reaching the age of o f 28 days by the total number of live births, then multiply by 1,000.  Answer: (A) 1-4 year old ol d age-specific mo mortality rtality rate. Since prescho preschoolers olers are the mos mostt susceptible to the effects of ma malnutrition, lnutrition, a popul population ation with poor nutritional status will most likely have a high 1-4 year old age-specific mortality rate, also known as child mortality rate.  Answer: (B) Number of registered reg istered live births. To co compute mpute for gene general ral or total fertility rate, divid dividee the number of reg registered istered live births by the number n umber of females of reproductive age (15-45 years), then multiply by 1,000.  Answer: (B) Survey. A survey, surve y, also called sample survey, is data gath gathering ering about a sampl samplee of the population. popu lation.  Answer: (C) De facto. The other othe r method of population popu lation assignment assignment,, de jure, is based on the uusual sual place of residence resid ence of the people. peo ple.  Answer: (A) Tally report. A tally tal ly report is prepar prepared ed monthly or quarte quarterly rly by the RHU personne personnell and transmi transmitted tted to the Provincial Health He alth Office.  Answer: (C) Target/client Target/clien t list. The MDT Client List is a record reco rd of clients enrolled enro lled in MDT and othe otherr relevant data, such as d ates when clients cli ents collected their monthly supply of drugs.  Answer: (A) P.D. 651. P.D. 651 amended a mended R.A. 3753, requiring re quiring the reg registry istry of births within 30 days fr from om their occurrence. occurrence .  Answer: (D) Any of these health he alth professiona professionals. ls. D. R.A. 3753 states that any bbirth irth attendant may sign the certificate of live birth.  Answer: (C) Magnitude Magnitud e of the health pr problem. oblem. Magnitude ooff the problem refers to the ppercentage ercentage of the pop population ulation affected by a health he alth problem. The other choices are criteria considered in both family and community health care.  Answer: (D) Its main strategy is certification of health heal th centers able to comply with standards. Sentrong Sigla Move Movement ment is a joint proje project ct of the DOH and local government units. Its main strategy is certification of health centers that are able to comply with standards set by the DOH.  Answer: (D) Those who just j ust had a delive delivery ry within the past 15 mon months. ths. The ideal birth spa spacing cing is at least two years. 15 months plus 9 months month s of pregnancy = 2 years.  Answer: (C) Adequate information i nformation for couples coup les regarding the ddifferent ifferent methods. To ena enable ble the couple to cho choose ose freely among different d ifferent methods meth ods of family planning, they must be given full information regarding the different methods that are available to them, considering the availability of quality services that can support their choice.  Answer: (B) Retinol 200,000 20 0,000 IU. Retinol 20 200,000 0,000 IU is a form of m megadose egadose Vitamin A. This m may ay have a teratogenic teratoge nic effect.  Answer: (A) Her OB score is G5P3. G5 P3. Only women with less le ss than 5 pregna pregnancies ncies are qualified fo forr a home delivery. It is also advisab a dvisable le for a primigravida to have delivery at a childbirth facility.  Answer: (C) Folic acid. It is estimated esti mated that the incidence incide nce of neural tube defects can be reduce reducedd drastically if pregn pregnant ant women have an adequate adequ ate intake of folic acid.  Answer: (D) Note the interval, inter val, duration and intensity of labor contra contractions.. ctions.. Assessmen Assessmentt of the woman should shoul d be done first to determine determi ne whether she is having true labor and, if so, what stage of labor she is in.

 

 Answer: (D) Explain to her that putting the baby ba by to breast will lessen blood loss after delivery. de livery. Suckling of the nipple n ipple stimu stimulates lates the release ooff oxytocin by the posterior pituitary gland, which causes uterine contraction. Lactation begins 1 to 3 days after delivery. Nipple stretching exercises are done when the nipples are flat or inverted. Frequent washing dries up the nipples, making them prone to the formation of fissures.  Answer: (B) To stimulate milk mil k production by the mammary mam mary acini. Suckling of o f the nipple stimulate stimulatess prolactin reflex (the release of prolactin by the anterior pituitary gland), which initiates lactation.  Answer: (B) The mother does do es not feel nipple pain.. When the bab babyy has properly latch latched ed on to the breast, he takes take s deep, slow sucks; his mouth is wide open; and much of the areola is inside his mouth. And, you’re right! The mother does not feel nipple pain.    Answer:  Answe r: (B) 6 months. After 6 months, the baby’s nutrient needs, especially the baby’s iron requirement, can no longer be provided  by mother’s milk alone.  Answer: (C) Retinol 200,000 20 0,000 I.U., 1 capsule capsule.. A capsule of Retinol 2200,000 00,000 IU is given within wi thin 1 month after delivery. Potassium iodate io date is given during pregnancy; malunggay capsule is not routinely administered after delivery; and ferrous sulfate is taken for two months after delivery.  Answer: (C) Measles vaccine. va ccine. Among the biologicals b iologicals used in the Expanded Program on Immuniza Immunization, tion, measles vaccine and a nd OPV are highly hig hly sensitive to heat, requiring storage in the freezer.  Answer: (B) 4. While the unused un used portion of other oth er biologicals in EPI may be given until the end e nd of the day, only BCG BC G is discarded discard ed 4 hours after reconstitution. This is why BCG immunization is scheduled only in the morning. 1. In which step are plans formulated for solving community problems? Mobilization Community organization Follow-up/extension Core group formation 2. The public health nurse takes an active role in community participation. What is the primary goal of community organizing? To educate the people regarding community health problems To mobilize the people to resolve community health problems To maximize the community’s resources in in dealing with health problems To maximize the community’s resources in dealing with health problems  problems   3. An indicator of success in community organizing is when people are able to Participate in community activities for the solution of a community problem Implement activities for the solution of the community problem Plan activities for the solution of the community problem Identify the health problem as a common concern 4. Tertiary prevention is needed in which stage of the natural history of disease? Pre-pathogenesis Pathogenesis Prodromal Terminal 5. Isolation of a child with measles belongs to what level of prevention? Primary Secondary Intermediate Tertiary 6. On the other hand, Operation Timbang is _____ prevention. Primary Secondary Intermediate Tertiary 7. Which type of family-nurse contact will provide you with the best opportunity to observe family dynamics? Clinic consultation Group conference Home visit Written communication 8. The typology of family nursing problems is used in the statement of nursing diagnosis in the care of families. The youngest child of the de los Reyes family has been diagnosed as mentally retarded. This is classified as a: Health threat Health deficit Foreseeable crisis Stress point 9. The de los Reyes couple have a 6-year old child entering school for the first time. The de los Reyes family has a: Health threat Health deficit Foreseeable crisis Stress point 10. Which of the following is an advantage of a home visit? It allows the nurse to provide nursing care to a greater number of people. It provides an opportunity to do first hand appraisal of the home situation. It allows sharing of experiences among people with similar health problems. It develops the family’s initiative in providing for health needs of its memb ers. 11. Which is CONTRARY to the principles in planning a home visit?  A home visit should have h ave a purpose or o r objective. The plan should revolve around family health needs.

 

 A home visit should be conducted in the manner prescribe prescribedd by the RHU. Planning of continuing care should involve a responsible family member. 12. The PHN bag is an important tool in providing nursing care during a home visit. The most important principle of bag technique states that it Should save time and effort. Should minimize if not totally prevent the spread of infection. Should not overshadow concern for the patient and his family. May be done in a variety of ways depending on the home situation, etc. 13. To maintain the cleanliness of the bag and its contents, which of the following must the nurse do? Wash his/her hands before and after providing nursing care to the family members. In the care of family members, as much as possible, use only articles taken from the bag. Put on an apron to protect her uniform and fold it with the right side out before putting it back into the bag.  At the end of the visit, fold the lining l ining on which the th e bag was placed placed,, ensuring that the con contaminated taminated side is oonn the outside. 14. The public health nurse conducts a study on the factors contributing to the high mortality rate due to heart disease in the municipality where she works. Which branch of epidemiology does the nurse practice in this situation? Descriptive  Analytical Therapeutic Evaluation 15. Which of the following is a function of epidemiology? Identifying the disease condition based on manifestations presented by a client Determining factors that contributed to the occurrence of pneumonia in a 3 year old Determining the efficacy of the antibiotic used in the treatment of the 3 year old client with pneumonia Evaluating the effectiveness of the implementation of the Integrated Management of Childhood Illness 16. Which of the following is an epidemiologic function of the nurse during an epidemic? Conducting assessment of suspected cases to detect the communicable disease Monitoring the condition of the cases affected by the communicable disease Participating in the investigation to determine the source of the epidemic Teaching the community on preventive measures against the disease 17. The primary purpose of conducting an epidemiologic investigation is to Delineate the etiology of the epidemic Encourage cooperation and support of the community Identify groups who are at risk of contracting the disease Identify geographical location of cases of the disease in the community 18. Which is a characteristic of person-to-person propagated epidemics? There are more cases of the disease than expected. The disease must necessarily be transmitted through a vector. The spread of the disease can be attributed to a common vehicle. There is a gradual build up of cases before the epidemic becomes easily noticeable. 19. In the investigation of an epidemic, you compare the present frequency of the disease with the usual frequency at this time of the year in this community. This is done during which stage of the investigation? Establishing the epidemic Testing the hypothesis Formulation of the hypothesis  Appraisal of facts 20. The number of cases of Dengue fever usually increases towards the end of the rainy season. This pattern of occurrence of Dengue fever is best described as Epidemic occurrence Cyclical variation Sporadic occurrence Secular variation 21. In the year 1980, the World Health Organization declared the Philippines, together with some other countries in the Western Pacific Region, “free” of which disease?  disease?   Pneumonic plague Poliomyelitis Small pox  Anthrax 22. In the census of the Philippines in 1995, there were about 35,299,000 males and about 34,968,000 females. What is the sex ratio? 99.06:100 100.94:100 50.23% 49.76% 23. Primary health care is a total approach to community development. Which of the following is an indicator of success in the use of the primary health care approach? Health services are provided free of charge to individuals and families. Local officials are empowered as the major decision makers in matters of health. Health workers are able to provide care based on identified health needs of the people. Health programs are sustained according to the level of development of the community. 24. Sputum examination is the major screening tool for pulmonary tuberculosis. Clients would sometimes get false negative results in this exam. This means that the test is not perfect in terms of which characteristic of a diagnostic examination?

 

  Effectiveness Efficacy Specificity Sensitivity 25. Use of appropriate technology requires knowledge of indigenous technology. Which medicinal herb is given for fever, headache and cough? Sambong Tsaang gubat  Akapulko Lagundi 26. What law created the Philippine Institute of Traditional and Alternative Health Care? R.A. 8423 R.A. 4823 R.A. 2483 R.A. 3482 27. In traditional Chinese medicine, the yielding, negative and feminine force is termed Yin Yang Qi Chai 28. What is the legal basis for Primary Health Care approach in the Philippines?  Alma Ata Declaration on PHC Letter of Instruction No. 949 Presidential Decree No. 147 Presidential Decree 996 29. Which of the following demonstrates intersectoral linkages? Two-way referral system Team approach Endorsement done by a midwife to another midwife Cooperation between between the PHN and public school teacher 30. The municipality assigned to you has a population of about 20,000. Estimate the number of 1-4 year old children who will be given Retinol capsule 200,000 I.U. every 6 months. 1,500 1,800 2,000 2,300  Answers and Rationales Ratio nales  Answer: (B) Community organization. o rganization. Community Com munity organization is the step when commu community nity assemblies take ta ke place. During the com communi munity ty assembly, the people may opt to formalize the community organization and make plans for community action to resolve a community health problem.  Answer: (D) To maximize the community’s resources resour ces in dealing wi with th health problems. proble ms. Community organ organizing izing is a developmental developme ntal service, se rvice, with the goal of developing the people’s self -reliance -reliance in dealing with community health problems. A, B and C are objectives of contributory objectives to this goal.  Answer: (A) Participate in community c ommunity activities for the solution of a community comm unity problem. Participa Participation tion in community activities acti vities in resolving res olving a community problem may be in any of the processes mentioned in the other choices.  Answer: (D) Terminal. Tertiary Te rtiary prevention invo involves lves rehabilitatio rehabilitation, n, prevention of permanent pe rmanent disability and disability limitation lim itation app appropriate ropriate for convalescents, the disabled, complicated cases and the terminally ill (those in the terminal stage of a disease)  Answer: (A) Primary. The purpose pu rpose of isolating a client cli ent with a communicable commun icable disease is to pprotect rotect those who are not n ot sick (specific (spec ific disease prevention).  Answer: (B) Secondary. Secondar y. Operation Timbang is done to identify me members mbers of the susceptible ppopulation opulation who are malnourished malnourished.. Its purpose is early diagnosis and, subsequently, prompt treatment.  Answer: (C) Home visit. visi t. Dynamics of family relation relationships ships can best be observed in the family’s natural environment, which is the home.    Answer: (B) Health deficit. def icit. Failure of a family mem member ber to develop according a ccording to what is expecte expected, d, as in mental retardation, reta rdation, is a health deficit.  Answer: (C) Foreseeable Foreseea ble crisis. Entry of the 66-year -year old into school schoo l is an anticipated pperiod eriod of unusual demand on the fami family. ly.  Answer: (B) It provides an opportunity op portunity to do first hand han d appraisal of the home situation.. Choice A is not correct since a home ho me visit req requires uires that the nurse spend so much time with the family. Choice C is an advantage of a group conference, while choice D is true of a clinic consultation.  Answer: (C) A home visit visi t should be condu conducted cted in the manner pre prescribed scribed by the RHU.The home ho me visit plan sho should uld be flexible and practi practical, cal, depending on factors, such as the family’s needs and the resources available to the nurse and the family.    Answer: (B) Should minimize min imize if not totally prevent pr event the spread of infection. inf ection. Bag technique is performed befor beforee and after handl ing a client in the home h ome to prevent transmission of infection to and from the client.  Answer: (A) Wash his/her hands h ands before and an d after providing nu nursing rsing care to the family mem members. bers. Choice B goes against ag ainst the idea of utilizing the family’s resources, which is encouraged in CHN. Choices C and D goes against the principle of asepsis of confining the contaminated surface of objects.  Answer: (B) Analytical. Analytical An alytical epidem epidemiology iology is the study of factors facto rs or determinants aaffecting ffecting the patterns of occurr occurrence ence an andd distribution of disease in a community.  Answer: (D) Evaluating Evaluatin g the effectiveness of the implementation im plementation of the Integrated Manage Management ment of Childhood Ill Illness. ness. Epidemiolog y is used in the assessment of a community or evaluation of interventions in community health practice.  Answer: (C) Participating Participa ting in the investigation investiga tion to determine the so source urce of the epidemic. epidem ic. Epidemiology is the study of patterns of occurrence occurre nce and distribution of disease in the community, as well as the factors that affect disease patterns. The purpose of an epidemiologic investigation is to identify the source of an epidemic, i.e., what brought about the epidemic.  Answer: (A) Delineate Delinea te the etiology of the eepidemic. pidemic. Delineat Delineating ing the etiology of aann epidemic is iden identifying tifying its source.  Answer: (D) There is a gradual gr adual build uupp of cases before the epidemic e pidemic become becomess easily noticeabl noticeable. e. A gradual or in insidious sidious onset of the epidemic ep idemic is usually observable in person-to-person propagated epidemics.

 

 Answer: (A) Establishing Establishin g the epidemic. Establishing Estab lishing the epid epidemic emic is determinin determiningg whether there is an epidemic or not. n ot. This is done by compar comparing ing the present number of cases with the usual number of cases of the disease at the same time of the year, as well as establishing the relatedness of the cases of the disease.  Answer: (B) Cyclical variation. va riation. A cyclical vari variation ation is a periodi periodicc fluctuation in the nnumber umber of cases of a di disease sease in the community.  Answer: (C) Small pox. The Th e last documented ca case se of Small pox was iinn 1977 at Somalia.  Answer: (B) 100.94:100. 100.94:100 . Sex ratio is the number numb er of males for every 100 fe females males in the po population. pulation.  Answer: (D) Health programs pro grams are sustaine sustainedd according to the leve levell of developmen developmentt of the community. Primary he health alth care is essential esse ntial health care ca re that can be sustained in all stages of development of the community.  Answer: (D) Sensitivity. Sensitivity is the capaci capacity ty of a diagnostic exa examination mination to detect cases of the disease. If a test is 100% sensi sensitive, tive, all the cases tested will have a positive result, i.e., there will be no false negative results.  Answer: (D) Lagundi. Lagund i. Sambong is use usedd as a diuretic. Tsaang gubat is used to rel relieve ieve diarrhea. Akap Akapulko ulko is used for its antifungal antifung al property.  Answer: (A) R.A. 8423  Answer: (A) Yin. Yang is the male dominatin dominating, g, positive and masculine mascu line force.  Answer: (B) Letter of Instruction No. 949. Letter of Instruction In struction 949 was issu issued ed by then Presiden Presidentt Ferdinand Marco Marcos, s, directing the formerly called ca lled Ministry of Health, now the Department of Health, to utilize Primary Health Care approach in planning and implementing health programs.  Answer: (D) Cooperation Coopera tion between the PHN and public scho school ol teacher. Inters Intersectoral ectoral linkages refer to working relationships relationsh ips between the health sector and other sectors involved in community development.  Answer: (D) 2,300. Based on the Philippin Philippinee population ccomposition, omposition, to estimate the number of 11-4 -4 year old children, childre n, multiply total popu population lation by 11.5%.