1. 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. With regards to Women’s Health and Safe Motherhood Project, the following strategies are included to prevent maternal mortality, except one:

Establishment of BEmoNC and CEmoNC networksTBA facilitated home deliveriesImproved Family Planning counsellingEmphasis on Facility based deliveries

Question 1 Explanation: 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.

2. The following qualifications reflect possible delivery in the Rural Health Unit, except for one:Cephalic presentationAdequate pelvisHistory of ceasarian section deliveryLess than five pregnancies

Question 2 Explanation: 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.

3. You are assigned to provide baby care to the newly delivered healthy baby. What procedure are you going to do first?

Examine the newborn and check for defects, deformities and birth injuries.Provide warmth to the newborn and have a quick check for breathingClamp and cut the cord after cord pulsations have stopped.Facilitate the bonding between the mother and the newborn through early skin – to - skin contact

Question 3 Explanation: Rationale: Within the first 30 seconds, the objective of the nurse is to dry and provide warmth to the newborn to prevent from hypothermia.

4. The basis for the improvement in strategies in maternal and neonatal care is on Millennium Development Goals, which are:

MDGs 1 & 2MDGs 2 & 4MDGs 3 & 5MDGs 4 & 5

Question 4 Explanation: 

Rationale: MDG 4 focuses on reducing child mortality and MDG 5 corresponds to the improvement of maternal health.

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:

Every delivery is facility- based and managed by skilled birth attendantsEvery pregnancy is adequately managed during pre and post partum coursesEvery pregnancy is wanted, planned and supportedOnly answers A & C

Question 5 Explanation: Rationale: Only A & C are correct; Every pregnancy is adequately managed throughout its course, not only during pre natal and post partum periods.

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. Which is the best preventive measure for dengue hemorrhagic fever?

Frequent fogging in the vicinity to kill mosquitoesUse of mosquito nets and mosquito coilsUse of mosquito repellent lotionsCleaning of surroundings and proper disposal of coconut shells, tires, and containers

Question 6 Explanation: 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.

7. What are the signs and symptoms of DHF assessed as Grade II?Herman’s signs, bone and joint pains, fever with headache, and abdominal painHypotension, anorexia, nausea and vomiting, fever, and rapid weak pulseHerman’s signs, fever with headache, epistaxis, and melenaNarrowing pulse pressure, restlessness, and cold clammy perspiration

Question 7 Explanation: 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.

8. For planning and implementation during the course of DHF, the following are the necessary nursing considerations:

Educate client to avoid dark colored foods and the use of hard bristled toothbrush, razor and other sharp objectsMonitoring the intake and output of clientEncouraging client to increase fluid intake

All of the aboveQuestion 8 Explanation: 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.

9. What diagnostic procedure will confirm that the client is having DHF?Blood smearUrine and Stool examinationsCerebrospinal fluid examinationSputum examination

Question 9 Explanation: 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.

10. Dengue hemorrhagic fever can be fatal. The following manifestations are present in DHF, except for one.

ThrombocytosisProlonged bleeding timeThrombocytopeniaPositive Rumpel Leade test

Question 10 Explanation: 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

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. What should you look for in assessing the child’s condition?

Does the child vomit everything?Is the child able to breastfeed or drink?Is the child lethargic or unconscious?Is the child having some breathing difficulties?

Question 11 Explanation: 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.

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?

GreenYellowPinkViolet

Question 12 Explanation: Rationale: Pink, since the child is suggested to be having very severe febrile disease under the high malaria risk management.

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?

ButtocksAbdomenEyelidsArms

Question 13 Explanation: Rationale: Abdomen is assessed for signs of dehydration in children; the rest do not give hints of dehydration.

14. Child Isabel is already 12 weeks old. What immunizations should Isabel have received?BCG, OPV-0, DPT+HIB-1, Hepatitis B1, and OPV-1BCG, OPV-0, DPT+HIB-1, Hepatitis B1, DPT+HIB-2, Hepatitis B2, OPV-1 and OPV-2BCG, OPV-0, DPT+HIB-1, Hepatitis B1, OPV-1, and MeaslesBCG, OPV-0, DPT+HIB-1, and OPV-1

Question 14 Explanation: 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.

15. In preparing sugar water for the treatment of low blood sugar in a child, includes the following proportion:

200 ml of clean water plus 2 level tbsp. of sugar400 ml of clean water plus 4 level tsp of sugar200 ml of clean water plus 4 level tsp of sugar200 ml of clean water plus 4 level tbsp of sugar

Question 15 Explanation: Rationale: The right proportion in making sugar water is 200 ml of clean water with 4 tsp of sugar.

16. Situation IV: The Aquino Health Agenda (AHA) is focusing on the achievement of Universal Health Care for All Filipinos. 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:

Attainment of Millennium Development Goals 2 and 3.Financial risk protection through expansion in National Health Insurance Program enrolment and benefitImproved service delivery for health care needs through upgraded quality health care facilities

B & C onlyQuestion 16 Explanation: 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.

17. Last April 2011, the Department of Health together with the LGUs conducted a nationwide campaign on:

Reproductive Health BillDisaster and PreparednessMeasles- RubellaIsang Milyong Sepilyo

Question 17 Explanation: 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.

18. Which is incorrect regarding the training and deployment of unemployed nurses as “RNHeals” to the rural area?

To supply the needs of poor Filipino people in far flung areasTo contribute to the eradication of poverty and hungerTo assist in the promotion of gender and equalityTo address the proliferation of “volunteer nurses”

Question 18 Explanation: 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.

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?

Service DeliveryGovernance for HealthHuman Resources for HealthHealth Information

Question 19 Explanation: 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 much as possible.

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?

It is a group of people composed of NGOs and private organizationsIt is led by the midwife in the priority population areas

The rural health physician is the one who directly tracks the eligible populationNone of the above

Question 20 Explanation: 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.

21. It refers to the description of disease occurrence which is constantly present in a given area.PandemicSporadicEndemicEpidemic

Question 21 Explanation: 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.

22. Mang Ernie came to the RHU because he was bitten by their dog. What nursing consideration is your priority?

Administration of Anti- rabies vaccineProvision of dim, quiet and non- stimulating room for the clientAssessment of wound for classification, severity, and other signs and symptomsProvision of isolation precautions

Question 22 Explanation: 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.

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?

Chest X- raySputum ExaminationBronchoscopyAll of the above

Question 23 Explanation: 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.

24. Scarlet fever is a febrile contagious condition. Which laboratory procedure is not included in confirming scarlet fever?

ASO titerSputum ExaminationThroat cultureDifferential count of white blood cells

Question 24 Explanation: 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.

25. What skin manifestation can be observed to a child having the 3- day measle?Generalized flushing of the skinRashes that appears on chest spreading gradually upward and downwardMacupapular rashes on the cheeks (slightly elevated)Rose- red papules on the face

Question 25 Explanation: Rationale: Option A refers to DHF, B for Scarlet fever, and C for Measles.

Chn and Ob 2

1. Answer: (A) Inevitable

Rationale: An inevitable abortion is termination of pregnancy that cannot be prevented. Moderate to severe bleeding with mild cramping and cervical dilation would be noted in this type of abortion.

2. Answer: (B) History of syphilis

Rationale: Maternal infections such as syphilis, toxoplasmosis, and rubella are causes of spontaneous abortion.

3. Answer: (C) Monitoring apical pulse

Rationale: Nursing care for the client with a possible ectopic pregnancy is focused on preventing or identifying hypovolemic shock and controlling pain. An elevated pulse rate is an indicator of shock.

4. Answer: (B) Increased caloric intake

Rationale: Glucose crosses the placenta, but insulin does not. High fetal demands for glucose, combined with the insulin 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 diabetogenic effect of pregnancy.

5. Answer: (A) Excessive fetal activity.

Rationale: The most common signs and symptoms of hydatidiform mole includes elevated levels of human 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.

6. Answer: (B) Absent patellar reflexes

Rationale: Absence of patellar reflexes is an indicator of hypermagnesemia, which requires administration of calcium gluconate.

7. Answer: (C) Presenting part in 2 cm below the plane of the ischial spines.

Rationale: Fetus at station plus two indicates that the presenting part is 2 cm below the plane of the ischial spines.

8. Answer: (A) Contractions every 1 ½ minutes lasting 70-80 seconds.

Rationale: Contractions every 1 ½ minutes lasting 70-80 seconds, is indicative of hyperstimulation of the uterus, which could result in injury to the mother and the fetus if Pitocin is not discontinued.

9. Answer: (C) EKG tracings

Rationale: A potential side effect of calcium gluconate administration is cardiac arrest. Continuous monitoring of cardiac activity (EKG) throught administration of calcium gluconate is an essential part of care.

10. Answer: (D) First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex presentation.

Rationale: This type of client has no obstetrical indication for a caesarean section as she did with her first caesarean delivery.

11. Answer: (A) Talk to the mother first and then to the toddler.

Rationale: When dealing with a crying toddler, the best approach is 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.

12. Answer: (D) Place the infant’s arms in soft elbow restraints.

Rationale: Soft restraints from the upper arm to the wrist prevent the infant 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.

13. Answer: (B) Allow the infant to rest before feeding.

Rationale: Because feeding requires so much energy, an infant with heart failure should rest before feeding.

14. Answer: (C) Iron-rich formula only.

Rationale: The infants at age 5 months should receive iron-rich formula and that they shouldn’t receive solid food, even baby food until age 6 months.

15. Answer: (D) 10 months

Rationale: A 10 month old infant can sit alone and understands object permanence, so he would look for the hidden 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 permanence of objects.

16. Answer: (D) Public health nursing focuses on preventive, not curative, services.

Rationale: The catchments area in PHN consists of a residential community, many of whom are well individuals who have greater need for

preventive rather than curative services.

17. Answer: (B) Efficiency

Rationale: Efficiency is determining whether the goals were attained at the least possible cost.

18. Answer: (D) Rural Health Unit

Rationale: 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: (A) Mayor

Rationale: The local executive serves as the chairman of the Municipal Health Board.

20. Answer: (A) 1

Rationale: Each rural health midwife is given a population assignment of about 5,000.

21. Answer: (B) Health education and community organizing are necessary in providing community health services.

Rationale: The community health nurse develops the health capability of people through health education and community organizing activities.

22. Answer: (B) Measles

Rationale: Presidential Proclamation No. 4 is on the Ligtas Tigdas Program.

23. Answer: (D) Core group formation

Rationale: 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.

24. Answer: (D) To maximize the community’s resources in dealing with health problems.

Rationale: Community organizing is a developmental service, with the goal of developing the people’s self-reliance in dealing with community

health problems. A, B and C are objectives of contributory objectives to this goal.

25. Answer: (D) Terminal

Rationale: 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).

26. Answer: (A) Intrauterine fetal death.

Rationale: Intrauterine fetal death, abruptio placentae, septic shock, and amniotic fluid embolism may trigger 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.

27. Answer: (C) 120 to 160 beats/minute

Rationale: A rate of 120 to 160 beats/minute in the fetal heart appropriate for filling the heart with blood and pumping it out to the system.

28. Answer: (A) Change the diaper more often. 

Rationale: Decreasing the amount of time the skin comes contact with wet soiled diapers will help heal the irritation.

29. Answer: (D) Endocardial cushion defect

Rationale: Endocardial cushion defects are seen most in children with Down syndrome, asplenia, or polysplenia.

30. Answer: (B) Decreased urine output

Rationale: Decreased urine output may occur in clients receiving I.V. magnesium and should be monitored 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.

31. Answer: (A) Menorrhagia

Rationale: Menorrhagia is an excessive menstrual period.

32. Answer: (C) Blood typing

Rationale: Blood type would be a critical value to have because the risk of blood loss is always a potential complication during the labor and delivery process. Approximately 40% of a woman’s cardiac output is delivered to the uterus, therefore, blood loss can occur quite rapidly in the event of uncontrolled bleeding.

33. Answer: (D) Physiologic anemia

Rationale: Hemoglobin values and hematocrit decrease during pregnancy as the increase in plasma volume exceeds the increase in red blood cell production.

34. Answer: (D) A 2 year old infant with stridorous breath sounds, sitting up in his mother’s arms and drooling.

Rationale: The infant with the airway emergency should be treated first, because of the risk of epiglottitis.

35. Answer: (A) Placenta previa

Rationale: Placenta previa with painless vaginal bleeding.

36. Answer: (D) Early in the morning

Rationale: Based on the nurse’s knowledge of microbiology, the specimen should be collected early in the 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.

37. Answer: (A) Irritability and seizures

Rationale: Lead poisoning primarily affects the CNS, causing increased intracranial pressure. This condition results in irritability and changes in level of consciousness, as well as seizure disorders, hyperactivity, and learning disabilities.

38. Answer: (D) “I really need to use the diaphragm and jelly most during the middle of my menstrual cycle”.

Rationale: The woman must understand that, although the “fertile” period is approximately 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.

39. Answer: (C) Restlessness

Rationale: In a child, restlessness is the earliest sign of hypoxia. Late signs of hypoxia in a child are associated with a change in color, such as pallor or cyanosis.

40. Answer: (B) Walk one step ahead, with the child’s hand on the nurse’s elbow.

Rationale: This procedure is generally recommended to follow in guiding a person who is blind.

41. Answer: (A) Loud, machinery-like murmur.

Rationale: A loud, machinery-like murmur is a characteristic finding associated with patent ductus arteriosus.

42. Answer: (C) More oxygen, and the newborn’s metabolic rate increases.

Rationale: When cold, the infant requires more oxygen 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.

43. Answer: (D) Voided

Rationale: Before administering potassium I.V. to any client, the nurse must first check 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.

44. Answer: (c) Laundry detergent

Rationale: Eczema or dermatitis is an allergic skin reaction caused by an offending allergen. The topical allergen that is the most common causative factor is laundry detergent.

45. Answer: (A) 6 inches

Rationale: This distance allows for easy flow of the formula by gravity, but the flow will be slow enough not to overload the stomach too rapidly.

46. Answer: (A) The older one gets, the more susceptible he becomes to the complications of chicken pox.

Rationale: Chicken pox is usually more severe in adults than in children. Complications, such as pneumonia, are higher in incidence in adults.

47. Answer: (D) Consult a physician who may give them rubella immunoglobulin.

Rationale: 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.

48. Answer: (A) Contact tracing

Rationale: Contact tracing is the most practical and reliable method of finding possible sources of person-to-person transmitted infections, such as sexually transmitted diseases.

49. Answer: (D) Leptospirosis

Rationale: Leptospirosis is transmitted through contact with the skin or mucous membrane with water or moist soil contaminated with urine of infected animals, like rats.

50. Answer: (B) Cholera

Rationale: 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.

51. Answer: (A) Hemophilus influenzae

Rationale: 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.

52. Answer: (B) Buccal mucosa

Rationale: Koplik’s spot may be seen on the mucosa of the mouth or the throat.

53. Answer: (A) 3 seconds

Rationale: Adequate blood supply to the area allows the return of the color of the nailbed within 3 seconds.

54. Answer: (B) Severe dehydration

Rationale: 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 or nasogastric tube. When the foregoing measures are not possible or effective, then urgent referral to the hospital is done.

55. Answer: (A) 45 infants

Rationale: To estimate the number of infants, multiply total population by 3%.

56. Answer: (A) DPT

Rationale: 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.

57. Answer: (C) Proper use of sanitary toilets

Rationale: 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.

58. Answer: (D) 5 skin lesions, positive slit skin smear

Rationale: A multibacillary leprosy case is one who has a positive slit skin smear and at least 5 skin lesions.

59. Answer: (C) Thickened painful nerves

Rationale: 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.

60. Answer: (B) Ask where the family resides.

Rationale: 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 she was brought and whether she stayed overnight in that area.

61. Answer: (A) Inability to drink

Rationale: A sick child aged 2 months to 5 years must be referred urgently to a hospital if he/she has one or more of the following signs: not able to feed or drink, vomits everything, convulsions, abnormally sleepy or difficult to awaken.

62. Answer: (A) Refer the child urgently to a hospital for confinement.

Rationale: “Baggy pants” is a sign of severe marasmus. The best management is urgent referral to a hospital.

63. Answer: (D) Let the child rest for 10 minutes then continue giving Oresol more slowly.

Rationale: 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.

64. Answer: (B) Some dehydration

Rationale: 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.

65. Answer: (C) Normal

Rationale: In IMCI, a respiratory rate of 50/minute or more is fast breathing for an infant aged 2 to 12 months.

66. Answer: (A) 1 year

Rationale: 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.

67. Answer: (B) 4 hours

Rationale: 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.

68. Answer: (B) 6 months

Rationale: After 6 months, the baby’s nutrient needs, especially the baby’s iron requirement, can no longer be provided by mother’s milk

alone.

69. Answer: (C) 24 weeks

Rationale: At approximately 23 to 24 weeks’ gestation, the lungs are developed enough 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 at 21 weeks’ gestation)

70. Answer: (B) Sudden infant death syndrome (SIDS)

Rationale: Supine positioning is recommended to reduce the risk of SIDS in infancy. The risk of 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.

71. Answer: (C) Decreased temperature

Rationale: Temperature instability, especially when it results in a low temperature in the neonate, may 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.

72. Answer: (D) Polycythemia probably due to chronic fetal hypoxia

Rationale: The small-for-gestation neonate is at risk for developing polycythemia during the transitional period in an attempt to decrease

hypoxia. The neonates are also at increased risk for developing hypoglycemia and hypothermia due to decreased glycogen stores.

73. Answer: (C) Desquamation of the epidermis

Rationale: Postdate fetuses lose the vernix caseosa, and the epidermis may become desquamated. These neonates are usually very alert. Lanugo is missing in the postdate neonate.

74. Answer: (C) Respiratory depression

Rationale: Magnesium sulfate crosses the placenta and adverse neonatal effects are respiratory depression, hypotonia, and bradycardia. The serum blood sugar isn’t affected by magnesium sulfate. The neonate would be floppy, not jittery.

75. Answer: (C) Respiratory rate 40 to 60 breaths/minute

Rationale: A respiratory rate 40 to 60 breaths/minute is normal for a neonate during the transitional period. Nasal flaring, respiratory rate more than 60 breaths/minute, and audible grunting are signs of respiratory distress.

76. Answer: (C) Keep the cord dry and open to air

Rationale: Keeping the cord dry and open to air helps reduce infection and hastens 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.

77. Answer: (B) Conjunctival hemorrhage

Rationale: Conjunctival hemorrhages are commonly seen in neonates secondary to the cranial pressure applied 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.

78. Answer: (B) To assess for prolapsed cord

Rationale: After a client has an amniotomy, the nurse should assure that the cord isn't prolapsed 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.

79. Answer: (D) The parents’ interactions with each other.

Rationale: 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 indicating parental bonding.

80. Answer: (B) Instructing the client to use two or more peripads to cushion the area

Rationale: Using two or more peripads would do little to reduce the pain or promote perineal healing. Cold applications, sitz baths, and Kegel

exercises are important measures when the client has a fourth-degree laceration.

81. Answer: (C) “What is your expected due date?”

Rationale: When obtaining the history of a client who may be in 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.

82. Answer: (D) Aspirate the neonate’s nose and mouth with a bulb syringe.

Rationale: The nurse's first action should be to clear the neonate's airway with a bulb syringe. After the airway is clear and the neonate's color improves, the nurse should comfort and calm 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 clear would be ineffective.

83. Answer: (C) Conducting a bedside ultrasound for an amniotic fluid index.

Rationale: 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.

84. Answer: (C) Monitor partial pressure of oxygen (Pao2) levels.

Rationale: Monitoring PaO2 levels and reducing the oxygen concentration to keep PaO2 within normal limits reduces the risk of retinopathy of prematurity in a premature infant receiving oxygen. Covering the infant's eyes and humidifying the oxygen don't reduce the risk of retinopathy of prematurity. Because cooling increases the risk of acidosis, the infant should be kept warm so that his respiratory distress

isn't aggravated.

85. Answer: (A) 110 to 130 calories per kg.

Rationale: Calories per kg is the accepted way of determined appropriate nutritional 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.

86. Answer: (C) 30 to 32 weeks

Rationale: Individual twins usually grow at the same 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 in twins if they remain in utero at 38 to 40 weeks.

87. Answer: (A) conjoined twins

Rationale: The type of placenta that develops in monozygotic twins depends on the time at 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.

88. Answer: (D) Ultrasound

Rationale: Once the mother and the fetus are stabilized, ultrasound evaluation of the placenta should be done to determine the cause of the bleeding. Amniocentesis is contraindicated in placenta previa. A digital or speculum examination shouldn’t be done as this may lead to severe bleeding or hemorrhage. External fetal monitoring won’t detect a placenta previa, although it will detect fetal distress, which may result from blood loss or placenta separation.

89. Answer: (A) Increased tidal volume

Rationale: A pregnant client breathes deeper, which increases the tidal volume of gas moved in and out of the respiratory 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.

90. Answer: (A) Diet

Rationale: Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Oral hypoglycemic drugs are contraindicated in pregnancy. Long-acting insulin usually isn’t needed for blood glucose control in the client with gestational diabetes.

91. Answer: (D) Seizure

Rationale: The anticonvulsant mechanism of magnesium is believes to depress seizure foci in the brain and peripheral neuromuscular blockade. Hypomagnesemia isn’t a complication of preeclampsia. Antihypertensive drug other than magnesium are preferred for sustained hypertension. Magnesium doesn’t help prevent hemorrhage in preeclamptic clients.

92. Answer: (C) I.V. fluids

Rationale: A sickle cell crisis during pregnancy is usually managed by exchange transfusion oxygen, and L.V. Fluids. The client usually needs a stronger analgesic than acetaminophen to control the pain of a crisis. Antihypertensive drugs usually aren’t necessary. Diuretic wouldn’t be used unless fluid overload resulted.

93. Answer: (A) Calcium gluconate (Kalcinate)

Rationale: Calcium gluconate is the antidote for magnesium toxicity. Ten milliliters of 10% calcium 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.

94. Answer: (B) An indurated wheal over 10 mm in diameter appears in 48 to 72 hours.

Rationale: A positive PPD result would be an indurated 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.

95. Answer: (C) Pyelonephritis

Rational: The symptoms indicate acute pyelonephritis, a serious condition in a pregnant client. UTI symptoms include dysuria, urgency, frequency, and suprapubic tenderness. Asymptomatic

bacteriuria doesn’t cause symptoms. Bacterial vaginosis causes milky white vaginal discharge but no systemic symptoms.

96. Answer: (B) Rh-positive fetal blood crosses into maternal blood, stimulating maternal antibodies.

Rationale: Rh isoimmunization occurs when 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.

97. Answer: (C) Supine position

Rationale: The supine position causes compression 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.

98. Answer: (B) Irritability and poor sucking.

Rationale: Neonates of heroin-addicted mothers are physically dependent on the drug and experience withdrawal when the drug is no

longer 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.

99. Answer: (A) 7th to 9th day postpartum

Rationale: The normal involutional process returns the uterus to the pelvic 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.

100. Answer: (B) Uterine atony

Rationale: Multiple fetuses, extended labor stimulation with oxytocin, and traumatic delivery commonly are associated with uterine 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.

OB

1. A woman of 38 weeks AOG is experiencing true labor when her contraction pattern shows:

A occasional irregular contractionsB irregular contractions that increase in intensityC regular contractions that remain the sameD regular contractions that increase in frequency and duration

(Correct Answer)(No Answer)

2. The nurse should encourage her gravid patient to void frequency during labor, primarily to:

A prevent urinary infectionsB enhance fetal descent

(Correct Answer)C strengthen the vaginal and perineal musclesD assess urine specimens for albumin

(No Answer)

3. The placenta forms from the:

A chorionic villi and deciduas veraB chorionic villi and decidua capsularisC deciduas basalis and deciduas vera

D chorionic villi and decidua basalis(Correct Answer)(No Answer)

4. When performing Leopold's maneuvers, which of the following would the nurse ask the client to do to ensure optimal comfort and accuracy?

A breathe deeply for one minuteB empty her bladder

(Correct Answer)C drink a full glass of waterD lie on her left side

(No Answer)

5. The nurse instructs a primigravid patient to increase her intake of Magnesium because of its role with which of the following?

A prevention of demineralization of the mother's bonesB synthesis of proteins and nucleic acids and fats

(Correct Answer)C amino acid metabolismD synthesis of neural pathways in the fetus

(No Answer)

6. After instructing a primigravid client about the functions of the placenta, the nurse determines that the client needs additional teaching when she says that which of the following hormones is produced by the placenta:

A testosterone(Correct Answer)

B estrogenC progesteroneD HcG

(No Answer)

7. During a childbirth preparation class, a primigravid client at 36 weeks gestation tells the nurse, "My lower back has really been bothering me lately." Which of the following exercises suggested by the nurse would be most helpful?

A pelvic rocking

(Correct Answer)B deep breathingC tailor sittingD squatting

(No Answer)

8. What is a common endocrine response to pregnancy?

A decrease cortisol levelsB decrease production of prolactinC increase plasma parathyroid hormone

(Correct Answer)D increase maternal blood glucose level

(No Answer)

9. Combined oral contraceptives prevent pregnancy by inhibiting the production of:

A FSH & prolactinB LH & estrogenC FSH & LH

(Correct Answer)D Estrogen and progesterone

(No Answer)

10. The nurse should instruct her client to discontinue the oral contraceptive and call the physician immediately if she experiences:

A hypomenorrheaB dysmenorrheaC severe headache

(Correct Answer)D leucorrhea

(No Answer)

11. Assessment of primigravid client reveals cervical dilatation at 8cm and complete effacement. The client complains of severe back pain during this phase of labor. The nurse explains that the client's severe back pain is most likely caused by the fetal occiput being in a position that is identified as which of the following?

A breech

B transverseC posterior

(Correct Answer)D anterior

(No Answer)

12. While the nurse is caring for a multiparous client in active labor at 37 weeks gestation, the client tells the nurse, "I think my water just broke." Which of the following would the nurse do first?

A turn the client on the right sideB assess the fetal heart rate pattern

(Correct Answer)C assess the color, amount and odor of fluidD check the client's cervical dilation.

(No Answer)

13. The physician orders oxytocin to be added to the IVF of a 26-year old multigravid client at 38 weeks AOG after vaginal delivery. The nurse anticipates administering the oxytocin after delivery of which of the following

A first placentaB second placenta

(Correct Answer)C first twinD second twin

(No Answer)

14. While making a home visit to a postpartum client on day 10, the nurse would anticipate that the client's lochia would be:

A dark redB pinkC brownD white

(Correct Answer)(No Answer)

15. Which of the following forms the basis for the teaching plan about avoiding medication use unless prescribed for a primiparous client who is breastfeeding?

A breast milk quality and richness are decreasedB the mother's motivation to breastfeed is diminishedC medications may be excreted in breastmilk to the nursing neonate

(Correct Answer)D medication interfere with the mother's let-down reflex

(No Answer)

16. A client is admitted to the hospital with contractions that are about 1-2 minutes apart and last for 60 seconds. Vaginal exam reveals that her cervix is dilated 8cm. The client is in which stage labor?

A latent phaseB active phaseC third stageD transitional phase

(Correct Answer)(No Answer)

17. During the third postpartum day, which of the following would the nurse be most likely to find in the client:

A she's interested in learning more about newborn care(Correct Answer)

B she talks a lot about the birth experienceC she sleeps whenever the baby isn't presentD she requests help in choosing a name for the baby

(No Answer)

18. When assessing a client's episiotomy, the nurse should be especially careful to observe:

A locationB discharge and odorC edema and approximation

(Correct Answer)D subinvolution

(No Answer)

19. In performing a routine fundal assessment, the nurse finds that the client's fundus

is boggy. The nurse should first:

A call the physicianB massage the fundus

(Correct Answer)C assess the lochial flowD obtain an order for methelergonovine

(No Answer)

20. Which assessment of a woman in labor can be determined by vaginal examination?

A fetal weightB cervical dilatation

(Correct Answer)C strength of contractionD fetal head circumference

(No Answer)

21. The postovulation rise in BBT is due to the high blood level of which hormone?

A FSHB HPLC estrogenD progesterone

(Correct Answer)(No Answer)

22. A pregnant woman's history reveals one pregnancy, terminated by elective abortion at 10 weeks, birth of twins at 37 weeks and a spontaneous abortion at 12 weeks. According to TPAL system, which of the following describes her present parity.

A 0-2-2-2B 2-0-2-2C 0-1-2-2

(Correct Answer)D 1-0-2-2

(No Answer)

23. Which principal factor cause vaginal patient to be acidic?

A cervical mucus changesB secretion from skene's glandsC the action of doderlein's bacillus

(Correct Answer)D secretions from Bartholin's gland

(No Answer)

24. Which normal assessment finding can the nurse expect in the 34th week of pregnancy?

A Braxton-Hicks contractions, joint hypermobility and backache(Correct Answer)

B Dysuria, constipation, hemorrhoids and lighteningC Feeling of tranquility and heightened introspectionD Morning sickness, breast tenderness

(No Answer)

25. What are the 2 fetal membranes?

A ectoderm and mesodermB chorion and amnion

(Correct Answer)C chorion and endodermD amnion and chorionic villi