COMPETENCY OPTIMIZING REVIEW (CORe) GUIDED NLE REVIEW DIAGNOSTIC EXAMINATION II

SITUATION: Nursing Process always must be implemented with an awareness of the interrelationship, during childbearing, of the maternal and fetal needs and their manifestations. The nurse needs to keep in mind that interventions for the mother may have an impact on the developing fetus and vice versa. 1. Knowledge of sexual functioning is defined as the extent of understanding conveyed about sexual development and responsible sexual practices. The following are specific indicators that suggest that this outcome has been achieved except: a. Ability of the client to describe effective contraception b. The client was able to describe the societal influences on sexual behavior c. The client was able to describe the inner sense of his/her identity d. The client was able to describe measures to prevent sexually transmitted diseases ANSWER: C Gender identity or sexual identity is the inner sense a person has of being male or female, which may be the same as or different from biologic gender. Options A, B and D are all indicators that the outcome had been achieved if the clients has the ability to describe the following Reference: Adelle Pillitteri. Maternal and Child Health Nursing. 5th Edition. Page 88. 2. To preserve the reproductive health of the woman and man, guidelines for safer sex practices were established. Which of the following statements is not included? a. The use of condoms is the best protection against infection. Condoms are latex, use oil-based lubricant rather than water-based lubricant because it can weaken the rubber b. Be selective in choosing sexual partners c. For safer oral-vaginal sex, a condom split in two or a plastic dental dam covering the mouth should be used to protect against the exchange of body fluids d. Use oil lubricants for anal penetration to keep bleeding and condom resistance to a minimum ANSWER: A Condoms should be latex; the chance of the condom tearing is less if it is a pre-lubricated brand. Use of water-based lubricants such as KY jelly on condoms made aid its smooth penetration, the use of oil-based lubricant may cause weakening of the rubber making condom lose it strength and may tear eventually. Options B, C and D are all correct safe sex practices Reference: Adelle Pillitteri. Maternal and Child Health Nursing. 5th Edition. Page 91.

3. A 22-year old woman has missed two of her regular menstrual periods. Her doctor confirms an early, intrauterine pregnancy. To determine her expected due date, which of the following assessments is most important? a. Date of her first menstrual period c. Date of last normal menstrual period b. Date of sexual intercourse d. Age of menarche ANSWER: C The dates of the last menstrual period, especially the first day of that period, will be used in applying Naegeles rule to determine the estimated date of delivery. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed. 4. A primigravid client asks Nurse Isabelle how the action of hormones during pregnancy affects her body. Nurse Isabelle responds on the basis that hormones: a. Raises resistance to insulin c. Prevents the liver from metabolizing glycogen b. Blocks the release of insulin from the pancreas d. Enhances the conversion of food to glucose ANSWER: A Hormonal influences during pregnancy cause a resistance to insulin utilization at the cellular level. It allows sufficient glucose for placental transport to the fetus, and also prevents the blood sugar in the nondiabetic client from falling to dangerous levels. In the diabetic client, it requires increase in her insulin doses. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed. 5. Nurse Hannah is caring for a young diabetic woman who is in her first trimester of pregnancy. As the pregnancy continues Nurse Hannah should anticipate which change in her medication needs? a. A decrease in the need for short-acting insulins b. A steady increase in insulin requirements c. Oral hypoglycemic drugs will be given several times daily d. The variable pattern of insulin absorption throughout the pregnancy requires constant adjustment ANSWER: B During the first trimester of pregnancy, there is little change in insulin requirements. In the second trimester, gradually increasing amounts of insulin are needed, with the insulin dose doubling by the end of pregnancy. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed. 6. As early as the 3rd week of intrauterine life, fetal blood begins to exchange nutrients with the maternal circulation across the chorionic villi. Fetal circulation differs from extrauterine circulation in all but one of the following aspects: a. The blood that enters the lungs is oxygenated in fetal circulation while it is unoxygenated in an adult circulation b. Fetal oxygen in the blood is derived from the placenta while in adult the oxygen is from the lungs

c. The vein (carrying oxygenated blood) in the umbilicus of the fetus carries blood away from the heart and the artery (carrying unoxygenated blood) carries blood toward the fetus. In an adult, it is the vein which carries unoxygentaed blood toward the heart and the arteries that carry oxygenated blood away from the heart d. In fetal circulation, shunting of blood is present while in an adult circulation, there is normally no shunting of blood. ANSWER: C In a fetal circulation, the umbilical vein (carrying oxygenated blood) carries blood toward the heart of the fetus and the artery (carrying unoxygenated blood) carries blood away from the heart. In an adult, it is the vein that carries unoxygenated blood toward the heart and the arteries that carry oxygenated blood away from the heart. The others choices are true when it comes to fetal circulation. The blood entering the blood vessels of the lungs is not for oxygen exchange but to supply cells of the lungs themselves. During the fetal life, the lungs are not yet mature enough to function as that during birth. Therefore, specialized structures present in the fetus shunt blood flow to supply the most important organs of the body; brain, liver, heart and kidneys. Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition. Page 190-191. 7. Maricar asks Nurse Sarah at what age of gestation is the product of conception prone to teratogenic insults to the cardiovascular system? a. 4th week b. 8th week c. 12th week d. 16th week ANSWER: A At the end of 4th week of gestation the human embryo is a rapidly growing formation of cells and the rudimentary heart appears as a prominent bulge on the anterior surface; chambers at this time is already visible and major veins are formed thus teratogenic insults at this time may cause future congenital heart defect/s. At the end of 8th week is the completion of the organogenesis the heart will now develop septum and valves, and is beating rhythmically. At the 12th week the heart beat is now audible with the use of a Doppler and the completion of the first trimester. At the end of the 16th week fetal heart sounds are audible to a fetoscope. Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition. Page 195-196. 8. Nurse Mian discusses the fetal circulation to the students. To check whether the student understands her teaching she asks, What is the fetal structure that carries oxygenated blood from the umbilical cord to the inferior vena cava. The student correctly answers, It is the: a. Ductus Venosus b. Ductus Arteriosus c. Pulmonary Artery d. Formane Ovale ANSWER: A The ductus venosus carries oxygenated blood from the umbilical vein to the inferior vena cava which allows oxygenated blood to be supplied directly to the fetal liver. Oxygenated blood then empties into the IVC and is carried to right side of the heart. Because there is no need for the bulk of the blood to pass through the lungs, it is shunted,

as it enters the right atrium, into the left atrium through the opening in the atrial septum, called foramen ovale. From the left atrium, it follows the course of normal circulation into the left ventricle and into the aorta. A small amount of blood that returns to the heart via the vena cava does leave the right atrium by the adult circulatory route; that is the tricuspid valve into the right ventricle and the n into the pulmonary artery and lungs to service the lung tissue. However, the larger portion of this blood is shunted away from the lungs through additional structure, the ductus areteriosus, directly into the descending aorta. Pulmonary artery arises from the right ventricle of the heart and caries unoxygenated blood to the lungs. Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition. Page 190. 9. The day after a client has cesarean birth, the indwelling catheter is removed. The nurse can best evaluate that the clients urinary function has returned to normal when: a. Clients urinalysis indicates no bacteria present b. Client has residual urine of 90 ml after voiding c. Clients daily urinary output is at least 1000 ml d. Client voids at least 300 ml four hours after catheter removal ANSWER: D This would indicate that the urinary sphincter tone has not been affected by the catheter and urinary retention with overflow is not present. Option A the absence of bacteria indicates the absence of infection but does not portend the return of urinary function, urine culture may be ordered to check for the possibility of a urinary tract infection after catheter removal Option B this indicates retention with overflow; the client urinates small amounts but does not completely empty the bladder, this voiding pattern is potentially dangerous because it means that the womans bladder is held continuously under tension Option C it indicates that urine retention is present Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition. Page 580-581. 10. A nurse is working with a particular cultural group in which it is not uncommon for grandparents to live with their married children and to assist with child rearing and discipline issues. This is an example of which of the following? a. Blended family b. Traditional family c. Two-career family d. Intragenerational family Answer: D In some cultures and as people live longer, more than two generations may live together in an intragenerational setting, as described. A two-career family is one where both partners are employed. A blended family occurs when existing family units join together to form new families. A traditional family is viewed as an autonomous unit in which both parents reside in the home. Reference: Kozier and Erbs Fundamentals of Nursing 8th edition Page 430

11. Nurse Isabel is conducting a family assessment to a pregnant client and asks the following question: "How, as a family, do you deal with disappointments or stressful changes that occur and affect the members of your family?" The nurse is trying to identify: a. Health beliefs c. Family coping mechanisms b. Family communication patterns d. Potential family problems ANSWER: C Family coping mechanisms are behaviors that families use to deal with stress or changes imposed from either within or without. The coping mechanisms families and individuals develop reflect their individual resourcefulness. The assessment of coping mechanisms is a way to determine how families relate to stress. Reference: Kozier and Erbs Fundamentals of Nursing 8th edition Page 434-435 12. Regardless of whether someone is planning on childbearing, everyone is wiser by being familiar with reproductive anatomy and physiology and his or her own bodys reproductive and sexual health. Which of the following is true about the reproductive development? a. Male and female reproductive systems arise from the same embryonic origin b. The sex of an individual is determined 10 weeks after conception c. If testosterone is not present at 5 weeks, the gonadal tissue differentiates into ovaries d. Estrogen influences the enlargement of the labia majora and clitoris ANSWER: A Although the structures of the female and male reproductive systems differ greatly in both appearance and function, they are homologousthat is, they arise from the same or matched embryonic origin. Option B: The sex of an individual is determined at the moment of conception by the chromosome information supplied by the particular ovum and sperm. Option C: If testosterone is not present at 10 weeks, the gondola tissue differentiates into ovaries. Option D: Testosterone, not estrogen, influences the enlargement of the labia majora and clitoris and formation of axillary and pubic hair. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed. Page 86 13. During the secretory phase of menstrual cycle, the glands of the uterine endometrium becomes corkscrew in appearance and dilated with quantities of glycogen and mucin. This activity is stimulated by which hormone? a. Progesterone b. Estrogen c. Glycogen d. Prolactin ANSWER: A After ovulation, the formation of progesterone in the corpus luteum (under the direction of LH) causes the glands of the uterine endometrium to become corkscrew or twisted in appearance and dilated with quantities of glycogen and mucin (a protein). Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed. Page 101

14. A client expresses concern about his son who is a homosexual. He states, "Nag-aalala ako sa kanya, alam ko sa impyerno ang tuloy nya. In responding to this client, the nurse should consider which of the following important information? a. Sexual development is genetically determined and not affected by environment. b. What constitutes normal sexual expression varies among cultures and religions. c. Normal sexuality is described as whatever behaviors give pleasure and satisfaction to those adults involved. d. Since alternative lifestyles are now so well accepted in society, this parent should not feel so much concern. ANSWER: B This nurse should remember that culture and religion have a big impact upon what a person believes to be normal sexual behavior. Even though many consider whatever activity gives pleasure and satisfaction to the involved adults to be normal, some cultures and religions do not hold that belief. While alternative lifestyles are well accepted in some cultures, apparently that is not true in this parent's belief patterns. Sexual development has both genetic and environmental components. Reference: Kozier and Erbs Fundamentals of Nursing 8th edition page 1025-1026 15. The nurse working in a family planning clinic is aware that oral contraceptives are not contraindicated for which of the following patients? a. A 30-year old woman who smokes more than 15 cigarettes a day b. A 30-year old diabetic woman c. A 10 week postpartum client who is not breastfeeding d. A client who experiences migraine with aura ANSWER: C One contraindication for OCs use is those who are breastfeeding and those clients who are less than 6 weeks postpartum. Therefore option C is the correct answer since the client is at 10 weeks postpartum and does not breastfeed. Other options are contraindicated. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed. Page 125 16. An Intrauterine device is being fitted to a client. The nurse understands that IUD prevents pregnancy by: a. Creating a sterile inflammatory process that prevents implantation b. Suppressing secretion of FSH and LH c. Blocking the fallopian tube to prevent entry of the ovum d. Killing the spermatozoa before they can enter the cervix ANSWER: A The intrauterine device (IUD) is a small plastic object that is inserted into the uterus through the vagina. Today, the IUD is thought to be preventing fertilization as well as creating a local sterile inflammatory condition that prevents implantation. When copper is added to the device, sperm mobility appears to be affected. These decrease the possibility that the sperm will successfully cross the uterine space and reach the ovum. In some IUDs (not copper

based) there is a drug reservoir of progesterone in the stem. This drug reservoir gradually diffuses into the uterus through the plastic. It both prevents endometrium proliferation and thickens cervical mucus. Option B: COCs. Option C: Incorrect. Option D: Action of the spermicides. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed. Page 129-130 17. The nurse will advise a pregnant client, who is scheduled for amniocentesis, to perform which of the following? a. Increase the fluid intake to help aspirate more amniotic fluid during the procedure b. Lie in side lying-position to avoid supine hypotension during the procedure c. Ask the client to take a deep breath and hold it during insertion of needle d. Rest for 30 minutes after the procedure ANSWER: D Amniocentesis is a technically easy procedure, but it can be frightening to a woman. In preparation for amniocentesis, ask the woman to void to reduce the size of the bladder and prevent an inadvertent puncture. Place her in supine position with a folded towel under her right buttock to tip her body slightly to the left and move the uterus off the vena cava to prevent supine hypotension. Do not suggest to the client to take a deep breath and hold it as a distraction against discomfort during insertion; this lowers the diaphragm against the uterus and shifts intrauterine contents. After the needle is removed, the woman rests quietly for about 30 minutes. The nurse monitors the fetal heart rate during and for 30 minutes afterward. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed. Page 213-214 18. A high-risk pregnant client will go through a non-stress test. The result indicates a reactive non-stress test. The client asks the nurse what it means. The nurse aptly replies by saying: a. The fetus is receiving adequate oxygen b. The fetal heart rate is decreasing, instead of increasing, with every contraction c. There is no fetal movement during stimulation d. You are at risk for premature labor; the doctor may prescribe tocolytic drug ANSWER: A A non-stress test measures the response of fetal heart rate to fetal movement. When the fetus moves, the FHR should increase about 15 beats per minute and remain elevated for 15 seconds. It should decrease to its average rate again as the fetus quiets. If no increase in beats per minute is noticeable on fetal movement, poor oxygen perfusion of the fetus is suggested. The test is said to be reactive if two accelerations of fetal heart rate (by 15 beats or more) lasting for 15 seconds occur after movement within chosen time period. The test is non-reactive if no accelerations occur with the fetal movements. Other options are incorrect statement. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed.

Page 208 19. Which of the following common emotional reactions to pregnancy would the nurse expect to occur during the first trimester? a. Introversion, egocentrism, narcissism c. Anxiety, passivity, extroversion b. Awkwardness, clumsiness, and unattractiveness d. Ambivalence, fear, fantasies ANSWER: D During the first trimester, common emotional reactions include ambivalence, fear, fantasies, or anxiety. The second trimester is a period of well-being accompanied by the increased need to learn about fetal growth and development. Common emotional reactions during this trimester include narcissism, passivity, or introversion. At times the woman may seem egocentric and self-centered. During the third trimester, the woman typically feels awkward, clumsy, and unattractive, often becoming more introverted or reflective of her own childhood. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed. Page 221-225 20. Which of the following statements, if made by a woman who is 12 weeks pregnant, would be essential for a nurse to further evaluate? a. I thought I wanted to be pregnant, but now I dont know b. My husband is angry because I got pregnant c. Being pregnant makes me feel very tried d. I dont want to get too fat while Im pregnant ANSWER: B The most important person to the pregnant woman is generally the father of the child. A major need during a womans pregnancy is to secure her partners acceptance of the child and assimilate the child into the family. Option A: Ambivalence is a normal response to pregnancy. Even woman who are please to be pregnant may experience feelings of hostility toward the pregnancy or unborn child from time to time. It these feelings intensify and persist through the third trimester, this may indicate unresolved conflict with the motherhood role. Option C: Fatigue is common in early pregnancy. Option D: For most women the feeling of liking or not liking their bodies during pregnancy is temporary and does not cause permanent changes in their perceptions of themselves. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed. Page 21. Mrs. Selena complains of morning sickness during the first trimester of pregnancy. A nurse would suggest that she take which of the following measures to help alleviate the symptoms? a. Consume a clear liquid diet c. Eat foods that are low in protein b. Take prenatal vitamins with milk d. Avoid exposure to noxious odors ANSWER: D

The nurse should instruct the patient to avoid odorous food if morning sickness occurs. Options A, B and C: Morning sickness is due to fluctuating hormone levels. Dry foods such as crackers before arising seem to alleviate some of the nausea. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed. Page 311 22. Nurse Heart is caring for a woman who is admitted to the hospital in active labor. What information is most important for Nurse Heart to assess to avoid respiratory complications during labor and delivery? a. Family history of lung disease c. Number of cigarettes smoked daily b. Food or drug allergies d. When the client last ate ANSWER: D Gastric motility is decreased during pregnancy. Food eaten several hours prior to the onset of labor may still be in the stomach undigested. This will influence the type of anesthesia the client may receive. Inhalation of vomitus from pressure of the uterus on the stomach can be fatal if a womans airway becomes occluded by the foreign matter. Some anesthesiologists may order IV ranitidine or an oral antacid such as cimetidine to be given before general anesthesia is administered, to reduce the level of acid in stomach contents should aspiration occur. Reference: A. Pillitteri. Maternal and Child Health Nursing 6th edition Page 408 23. Mrs. Pilapil is admitted to the hospital in labor. Vaginal examination reveals that she is 8 cm dilated. At this point in her labor, which of the following statements would the nurse expect her to make? a. I cant decide what to name my baby c. Take your hand off my stomach when I have a contraction b. It feels good to push with each contraction d. This isnt as bad as I expected ANSWER: C At 8 cm dilated is in the transition stage of her labor. Many women experience hyperesthesia of the skin at this time and would not want to be touched during a contraction. Reference: A. Pillitteri. Maternal and Child Health Nursing 6th edition Page 361 24. A postpartum client has a temperature of 101.4F, 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? a. Lochia b. Breasts c. Incision d. Urine ANSWER: A The data suggests an infection of the endometrial lining of the uterus. The lochia may be decreased or copious, dark brown in appearance, and foul smelling, providing further evidence of a possible infection. All the clients data indicate a uterine problem, not a breast problem. Typically, transient fever, usually 101F, 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 the clients urine. Reference: A. Pilliteri. Maternal and Child Health Nursing 6th edition Page 425, 432 25. Nurse Hannah is assessing a postpartum client whose uterus is palpable 6 days after delivering the baby. Nurse Hannah documents this as: a. An expected finding c. Abnormal finding that needs further assessment b. Possible uterine atony d. Possible retained placenta ANSWER: A The uterus decreases in size at a predictable rate during postpartal period. On the first postpartal day, it will be palpable one fingerbreadth below the umbilicus; on the second day, two fingerbreadths below the umbilicus; and so on. After 10 days, it recedes under the pubic bone and is no longer palpable. Reference: A. Pilliteri. Maternal and Child Health Nursing 6th edition Page 422 26. A nurse observes a new mother breast feeding her newborn. Which of the following actions would indicate to a nurse that the mother has a correct understanding of breastfeeding techniques? a. Cleansing the breast with soap and water prior to feeding the newborn b. Scheduling the newborn to feed every six hours around the clock c. Initiating the newborns feeding on the same breast for each feeding d. Placing the nipple and areola into the newborns mouth ANSWER: D The baby should be put to breast by guiding the nipple and areolar tissue into the infants mouth and over the tongue. Compress the breast with fingers above and thumb below the areola to permit the infant to latch on effectively. Option A: Daily washing of the breast with water is sufficient for cleanliness. Option B: Newborns need to be fed every two to three hours for a total of eight to 12 minutes each 24 hours for at least one month. Option C: The mother will be able to tell which breast to start with next time by feeling the weight of the breast. The heaviest one has the most milk and should be used for that feeding. Reference: A. Pilliteri. Maternal and Child Health Nursing 6th edition Page 493-500 27. A newborn who is being cared for in an open warming unit has an axillary temperature of 96.2deg F (35.7 deg C). It is essential that the nurse take which of the following actions? a. Wrap the newborn in a blanket c. Increase the heat- control setting on the warming unit b. Notify the parents of the findings d. Perform a heel stick to check the capillary blood glucose ANSWER: C Increasing the temperature of the warming unit is the action of choice. Option A: An infant in a warming unit should

not be wrapped because the blanket will interrupt the thermal environment. Option B: Parents are not routinely informed of the temperature instability of an infant under a radiant warmer. Option D: Glucose is needed for increased energy but a heelstick is not the priority nursing action. Reference: A. Pilliteri. Maternal and Child Health Nursing 6th edition Page 474 28. Signs of imminent miscarriage are noted by Nurse Hannah in a woman at 8 weeks gestation. Which of the following would be an appropriate medical management approach for this woman? a. The woman will undergo sonogram c. Teach her the need for bedrest for 2 weeks b. Prepare her for D&C d. Increase fluid intake ANSWER: B A threatened miscarriage becomes an imminent miscarriage if uterine contractions and cervical dilation occur. If no fetal heart tones are detected, the physician may perform D and C to ensure all products of conception are removed. Sonogram is used to determine the integrity of the gestational sac and the viability of the fetus. Reference: Pilliterri, A.(2003) Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 4th ed. Page 384 29. Ectopic pregnancy is the second most frequent cause of bleeding early in the pregnancy. It occurs more frequently in the following women. Which is not included? a. Woman who smokes c. Woman who uses IUDs b. Woman who douches d. Woman who uses oral contraceptives ANSWER: D Ectopic pregnancy occurs more frequently in women who smoke compared to those who not. It also occurs more frequently in women who douche, possibly due to the risk of introducing an infection. There is also evidence that the use of intrauterine devices used for contraception may slow down the transport of the zygote and lead to ovarian or tubal implantation. Oral contraceptives may reduce the possibility of ectopic pregnancy. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed. Page 559 30. Nurse Mara is caring for a client with suspected pregnancy induced hypertension (PIH). She expects to find which findings if PIH is present? a. Edema, obesity, ketonuria c. Edema, proteinuria, hypertension b. Edema, tachycardia, ketonuria d. Hyportension, edema, hyperalbunemia ANSWER: C Pregnancy-induced hypertension is the most common hypertensive disorder in pregnancy. It is characterized by the development of hypertension, proteinuria, and edema. Glycosuria and ketonuria occur in diabetes mellitus. Tachycardia and obesity are not specifically related to diagnosing PIH. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed.

Page 575 31. Because a woman who is confirmed to be at 30 weeks gestation has sudden painless bright red vaginal bleeding, a nurse would suspect the woman is experiencing: a. Abruption placenta b. An ectopic pregnancy c. Placenta previa d. A molar pregnancy ANSWER: C Manifestations of placenta previa include minimal to severe bright red blood from the vagina and absence of pain. Option A: Abruptio placentae is manifested by uterine tenderness or pain and dark red or absent bleeding. Option B: Pain and dark red or no vaginal bleeding also is associated with a ruptured tubal pregnancy. Option D: Molar pregnancy is a uterine growth that contains no fetus, placenta or amniotic sac vaginal bleeding occurs in 45% of patients. The vaginal discharge may be dark brown or bright red, either scant or profuse. It may continue for a few days, or continue intermittently for weeks. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed. Page 563 32. A woman who frequently abuses cocaine during pregnancy is at risk for developing which of the following complications? a. Incompetent cervix c. Gestational diabetes b. Abruptio placenta d. Hyperremesis gravidarum ANSWER: B With cocaine abuse during pregnancy uterine blood vessels are maximally dilated but vasoconstrict rapidly in the face of catecholamines, placing the woman at risk for separation of the placenta (abruption) or acute onset of preterm labor. The patient also is put at risk for precipitous birth. Women who abuse cocaine during pregnancy are not at risk for incompetent cervix, gestational diabetes or hyperemesis gravidarum. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 6th ed. Page 564 33. The nurse is planning for the care of a 30-year-old primigravida with pre-gestational diabetes. What is the most important factor affecting this client's pregnancy outcome? a. Mother's age. c. Degree of glycemic control during pregnancy. b. Amount of insulin required prenatally. d. Number of years since diabetes was diagnosed. ANSWER: C Clients with tight glucose control and no blood vessel disease should have positive pregnancy outcomes (C). Risk assessment is best done by evaluating the woman's blood glucose and blood vessels, not by evaluating mother's age (A), number of years since diabetes was diagnosed (D), or the amount of insulin required prenatally (B). Reference: A. Pillitteri. Maternal and Child Health Nursing 6th edition Page 538

34. While caring to a postpartal client, nurse Hannah noticed an increase in her respirations and the client is complaining of chest pain. Nurse Hannah should first: a. Notify the physician c. Obtain an order for antianxiety b. Assess vital signs d. Provide supportive care ANSWER: A The woman is experiencing pulmonary embolism, the nurse should promptly notify the physician. Pulmonary embolism is an emergency. A woman needs oxygen administered immediately and is at high-risk for cardiopulmonary arrest. Other signs of PE are tachycardia, orthopnea, and cyanosis. Because of the seriousness of the condition, a woman with PE is transferred immediately to an ICU for continuing care. Reference: Adele Pilitteri. Maternal and Child Health Nursing 5th edition Page 689 35. The nurse is assessing Nancy who is now in her third trimester with known maternal hypertenstion. She was scheduled to have her ultrasonography today. Based on her health history, what could be the possible defect brought about by her condition may be manifested by her fetus? a. Hypoglycemia b. Fetal lung maturity delays c. Small for gestational age d. All of the above ANSWER: C The mothers nutrition during pregnancy plays a major role in fetal growth, so lack of adequate nutrition may be a major contributor to intrauterine growth restriction. Pregnancy induced hypertension is a common cause of late pregnancy fetal growth retardation. Vasoconstriction reduces placental exchange of oxygen and nutrients. Option A is not a caused by the womans condition Option B for an unexplained reason, fetal lung maturity appears to advance rapidly with PIH, (possibly from the intrauterine stress), so even though the fetus is younger than 36 weeks, the lecithin-sphingomyelin ration may indicate fetal lung maturity Reference: Pilliteri, A. (2007). Maternal & Child Health Nursing: Care of the Childbearing & Childbearing Family. 5th Edition, Vol. 1. Page 432-433, 757-758. 36. A client was admitted to the maternity unit with symptoms of preeclampsia. The nurse is concerned that the client may be developing HELLP syndrome if which of the following are noted? a. Deep tendon reflex (4+) c. Decrease in AST b. Decrease in platelet count d. Sudden increase in weight ANSWER: B HELLP is a laboratory diagnosis for a variant of severe preeclampsia and is characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). One of the signs of HELLP syndrome is a decrease in the platelet count. Other laboratory findings are: hemolysis of red blood cells and elevated liver enzymes due to hemorrhage and necrosis of the liver. Therapy for this condition is to improve the platelet count by transfusion of fresh frozen plasma or platelets. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed.

433. 37. Oyo Hermosa, 24-year old, comes to the clinic because she thinks she is pregnant. Which of the following is a probable sign of pregnancy that the nurse would expect the client to have? a. Fetal heart tone b. Nausea and vomiting c. Amenorrhea d. Chadwicks sign ANSWER: D Probable signs of pregnancy are the result of physiologic changes in the pelvic organs and hormonal influences; for example, the mucous membranes of the vulva, vagina and cervix becomes bluish (Chadwicks sign) as a result of hyperemia and proliferation of cells Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed. 38. A woman, 30 weeks gestation, is being discharged to home care with a diagnosis of placenta previa. What statement by the client indicates she understands her care at home? a. As I get closer to my due date I will have to remain in bed b. I can continue with my office job because its mostly sitting c. My husband wont be too happy with this no sex order d. Im disappointed that will need a caesarean section ANSWER: C In placenta previa, any sexual arousal is contraindicated because it can cause the release of oxytocin, which can cause the cervix to pull away from the low-lying placenta; this results in bleeding and potential bleeding and potential jeopardy to the fetus. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed. 39. Which nursing action should be included in the care of the infant with caput succedaneum? a. Aspiration of the trapped blood under the periosteum c. Gentle rubbing in a circular motion to decrease size b. Explanation to the parents about the cause/prognosis d. Application of cold to reduce size ANSWER: B Caput succedaneum (scalp edema) will regress in a few days without interventions and without residual damage Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed. 40. The nursery nurse carries a newborn baby into his mothers room. The mother states, I think my babys afraid of me, everytime I make a loud noise, he jumps. What should be the nurses initial action? a. Encourage her not to be so nervous with her baby b. Reassure her that this is normal reflexive reaction for her baby c. Take the baby back to the nursery for neurologic evaluation d. Wrap the baby more lightly in warm blankets ANSWER: B The startle reflex, normally present in neonates, is characterized by symmetric extension and abduction of the arms with fingers extended. The parent perceives the response as jumping

Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed. 41. The nurse should refer the parents of an 8-month-old child to a health care provider if the child is unable to do which of the following? a. Stand momentarily without holding onto furniture. c. Stoop to recover an object. b. Stand alone well for long period of time. d. Sit without support for long periods of time. ANSWER: D An 8-month-old child can sit without additional support for long periods of time. This is a major milestone in development that should always be considered in assessment. Children with delayed cognitive or motor development may not accomplish this step at this time. Option A - An 8-month-old child does not have the ability to stand without hanging on to a stationary object for support. This development is observed in a child who is 12-months old. Option B - His muscles are not developed enough to support all his weight without assistance, at 12-months, a child stands alone at least momentarily Option D - His balance has not developed to the point that he can stand and stoop over to reach an object. Reference: Pillitteri, A. (2007). Maternal and Child Health Nursing: Care of the childbearing and childrearing family. Volume. 5th edition. Lippincot William & Wilkins. Page 830831. 42. A mother comes to the clinic complaining about her 7-month-old son having colic. Nurse Hannah should not include which teaching? a. I should avoid over feeding my child. b. "this discomfort is more common in infants who are formula fed. c. I should let my infant burp after every feeding. d. I should try to place hot water bottle on my infants abdomen for comfort. ANSWER: D A basic rule for any abdominal discomfort is to avoid heat in case appendicitis is developing. Although it is highly unlikely to young infant, doing this often may give the wrong notion that it always help to relieve discomforts in the abdomen and used it again when the child is older. In addition, hot water bottles and heating pads also might burn the delicate skin of the infants. The cause of colic is unclear. It may occur in susceptible infants from overfeeding or from swallowing too much air while feeding. Formula-fed babies are morel likely to have colic than breast-fed babies, possibly because they swallow more air while drinking or because formula is harder to digest. Having the baby burp every after feeding may expel the air ingested. Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition Page 852. 43. A baby undergoes surgery to correct an esophageal atresia and tracheoesophageal fistula. Which nursing

diagnosis has the highest priority during the first 24 hours postoperatively? a. Ineffective airway clearance c. Interrupted breast-feeding b. Imbalanced nutrition: Less than body requirements d. Hypothermia ANSWER: A Ineffective airway clearance is the priority nursing diagnosis in the immediate postoperative period. The infant's airway must be carefully assessed and frequent suctioning may be necessary to remove mucus while taking care not to pass the catheter as far as the suture line. Assess breath sounds, respiratory rate, skin color, and ease of breathing. Because of the risk of edema and airway obstruction, keep a laryngoscope and endotracheal intubation equipment readily available. Imbalanced nutrition, Interrupted breastfeeding, and Hypothermia are also important during the postoperative period but only after a patent airway is ensured. Reference: Wongs Nursing Care of Infants and Children 8th edition Page 44. It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which of the following may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome ANSWER: C The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs. Option A: Cough is prevented by inhaled steroids. Option B: No evidence exists that inhaled steroids cause osteoporosis. Option D: Cushing syndrome is caused by longterm systemic steroids. Reference: Wongs Nursing care for Infants and Children 8th edition Page 45. Which of the following explains why iron-deficiency anemia is common during toddlerhood? a. Milk is a poor source of iron. c. Fetal iron stores are depleted by age 1 month. b. Iron cannot be stored during fetal development. d. Dietary iron cannot be started until age 12 months. ANSWER: A Children between the ages of 12 to 36 months are at risk for anemia, because cows milk is a major component of their diet, and it is a poor source of iron. Option B: Iron is stored during fetal development, but the amount stored is dependent on maternal iron stores. Option C: Fetal iron stores are usually depleted by age 5 to 6 months. Option D: Dietary iron can be introduced by breast-feeding, iron-fortified formula, and cereals during the first 12 months of life. Reference: Wongs Nursing Care of Infant and children 8th edition 46. A 6-month-old infant is receiving digoxin (Lanoxin). The nurse should notify the practitioner and withhold the medication if the apical pulse is less than which of the following? a. 60 b. 70 c. 90 to 110 d. 110 to 120 ANSWER: C

If the 1-minute apical is below 90 to 110, the digoxin should not be given to a 6-month-old. Option A: This is the cutoff for holding the digoxin dose in an adult. Option B: This is the determining heart rate to hold a dose of digoxin for an older child. Option D: This is an acceptable heart rate to administer digoxin to a 6-month-old. Reference: Wongs Nursing care for Infants and Children 8th edition Page 47. The nurse is discharging from the hospital a 7-month-old who weighs 15 lb. The parents have put the child in the back seat of the car with the car seat facing the front seat. Upon seeing the parents action, what should the nurse prioritize to do? a. Ask the parents to wait while the nurse obtains the correct car seat. b. Complete the discharge with the child sitting facing the front seat. c. Give the parents a manual on proper car seat placement. d. Show the parents proper placement of the car seat facing the back seat. ANSWER: D The proper placement for a car seat for a child less than 20 lb and younger than 1 year is in the back seat, facing the rear of the car because inflating front-seat airbag could suffocate an infant. Demonstrating proper car seat placement and explaining the reason for this position reinforces correct car seat positioning and may motivate the parents to continue this practice the next time they place the child in a vehicle. Option A - The car seat is not in question and does not need to be replaced. Option B - Keeping the child in an improperly installed car seat while the nurse continues the discharge only reinforces incorrect placement of the car seat. Option C - The parents are not likely to read a manual, especially since the child is 7 months old already and they have probably been placing the child in this position since birth. Reference: Pillitteri, A. (2007). Maternal and Child Health Nursing: Care of the childbearing and childrearing family. Volume. 5th edition. Lippincot William & Wilkins. Page 839. 48. Which nursing intervention is appropriate when caring for this childs surgical incision one day after the cleft lip repair? a. Clean the incision only when serous exudates forms b. Rub the incision gently with a sterile cotton-tipped swab c. Rinse the incision with sterile water after feeding d. Replace the Logan Bar carefully after cleaning the incision ANSWER: C The incision should be rinsed with sterile water after every feeding. Rubbing alters the integrity of the suture line. Rather, the incision should be patted or dabbed. The purpose of the Logan bar is to maintain the integrity of the suture line. Removing the Logan bar on the first postoperative day would increase tension on the surgical incision. Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition. Page 1187. 49. When taking a diet history from the mother of a 7-year-old child with phenylketonuria, a report of an intake of

which of the following foods should cause the nurse to become concerned? a. Coke Zero b. Carrots c. Orange juice d. Bananas ANSWER: A As children grow older and have solid foods added to their meals, these foods also must be low in phenylalanine so that the phenylalanine level of the childs blood stays below 8 mg/dl. Foods with low phenylalanine levels include vegetables, fruits, and juices. Foods high in phenylalanine include meats and dairy products, which must be restricted or eliminated. Cola (like Coke zero) contain more phenylalanine than the fruits listed. Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition Page 1535. 50. A toddler who has been treated for a foreign body aspiration begins to fuss and cry when the parents attempt to leave the hospital for an hour. The parents will be returning to take the toddler home. As the nurse tries to take the child out of the crib, the child pushes the nurse away. The nurse interprets this behavior as indicating separation anxiety involving which of the following? a. Protest b. Despair c. Regression d. Detachment ANSWER: A Young children have specific reactions to separation and hospitalization. In the protest stage, the toddler physically and verbally attacks anyone who attempts to provide care. Here, the child is fussing and crying and visibly pushes the nurse away. In the despair stage, the toddler becomes withdrawn and obviously depressed (for example, not engaging in play activities and sleeping more than usual). Regression is a return to a developmentally earlier phase because of stress of crisis (for example, a toddler who could feed himself before this event is not doing so now). Denial or detachment occurs if the toddlers stay in the hospital without the parent is prolonged because the toddler settles in to the hospital life and denies the parents existence (for example, not reacting when the parent come to visit). Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition Page 1078t. 51. Which of the following foods should the nurse encourage the mother to offer to her child with iron deficiency anemia? a. Rice cereal, whole milk, and yellow vegetables c. Macaroni, cheese, and ham b. Potato, peas, and chicken d. Pudding, green vegetables, and rice ANSWER: B Potatoes, peas, chicken, green vegetables and rice cereal contain significant amounts of iron and therefore would be recommended. Milk and yellow vegetables are not good source of iron sources. Rice by itself also is not a good source of iron. Macaroni, cheese, and ham are not high in iron. While pudding (made with fortified milk) and green vegetables contain some iron, the better diet has protein and iron from the chicken and potato.

Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition Page 1394. 52. The mother asks the nurse why her childs hemoglobin was normal at birth but now the child has S hemoglobin. Which of the following responses by the nurse would be most appropriate? a. The placenta bars passage of the hemoglobin S from the mother to the fetus. b. The red bone marrow does not begin to produce hemoglobin S until several months after birth. c. Antibodies transmitted from you to the fetus provide the newborn with temporary immunity. d. The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth. ANSWER: D Sickle cell disease is an inherited disease that is present at birth. However, 60% to 80% of a newborns hemoglobin is fetal hemoglobin, which has a structure different from that of hemoglobin S or hemoglobin A. Sickle cell symptoms usually occur about 4 months after birth, when hemoglobin S begins to replace the fetal hemoglobin. Option A - The gene for sickle cell disease is transmitted at the time of conception, not passed through the placenta. Some hemoglobin S is produced by the fetus near term. Option B - The fetus produces all its own hemoglobin from the earliest production in the first trimester. Option C - Passive immunity conferred by maternal antibodies is not related to sickle cell disease, but this transmission of antibodies is important to protect the infant from various infections during early infancy. Reference: Pillitteri, A. (2007) Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family. 5th Edition. Vol. 2. Page 1396. 53. The child was confirmed to have UTI and was confined to the hospital. The father tells Nurse Joey, My wife and I are concerned because our child refuses to obey us concerning the preventions of UTI. Our child refuses to take her medication unless we buy her a present. We dont want to use discipline because of the illness, but were worried about the behavior. Which response by the nurse is best? a. I sympathize with your difficulties, but just ignore the behaviour for now. b. I understand its hard to discipline a child who is ill, but things need to be kept as normal as possible. c. I understand that things are difficult for you right now, but your child is ill and deserves a special treatment. d. I understand your concern, but this type of behaviour happens all the time, your child will get over it when feeling better. ANSWER: B To ensure appropriate psychosocial development, a child needs to have normal patterns maintained as much as possible during illness. It is tempting to give ill children special treatment and to relax discipline. However, family routines and discipline should be kept as normal as possible. The child needs to know the limits to ensure feelings of

security. When they are ill, children commonly attempt to stretch the rules and limits. If this occurs, returning to the previous well-behavior patterns will take time. Reference: Hockenberry/Wilson. Nursing Care of Infants and Children. 8th Edition. Wongs. Page 1240. SITUATION: CHN 54. Public health systems are operating within a context of ongoing changes. Which of the following exerts a number of pressures on the public health system? a. Shifts in demographic and epidemiological trends in diseases. c. New technologies b. Health reforms d. All of the above ANSWER: D Public health systems are operating based on ongoing changes brought by option A that includes emergence and reemergence of new diseases and prevalence of risk and protective factor; option B health reforms or new programs; option C new technologies for health care, communication, and information; additionally is the existing and emerging environmental hazards and some of this is related to globalization. Reference: Public Health Nursing in the Philippines by DOH, p. 2 55. In response to above trends, the global community, represented by UN General Assembly, decided to adopt a common vision exemplified by the Millennium Development Goal that includes: i. eradicate extreme poverty and hunger v. improve maternal health ii. achieve universal primary education vi. combat HIV iii. promote gender equality vii. ensure environmental sustainability iv. reduce child mortality viii. develop global partnership a. i, ii, iii, iv b. v, vi, vii, viii c. i, iii, iv, vii, viii d. all of the above ANSWER: D Millennium developmental goals are based on fundamental values of freedom, equality, solidarity, tolerance, health, and respect for nature and shared responsibility. All of the above are included in this goal. Reference: Public Health Nursing in the Philippines by DOH, p. 3 56. Nurse should remember which of the following as essential in the achievement of the Millennium Development Goal and stand as the major overarching goal of poverty reduction? a. Health b. Health-related c. Participation of all members of society d. FOURmula one ANSWER: A The 8 Millennium Development Goal are all health related except for gender equality and achievement of universal primary education. Health is essential to the achievement of these goals and is a major contributor to the overarching goal of poverty reduction. Option B: Participation of all members of society from both developing and developed countries is required to achieve the goals but not the essential or the major contributor in poverty reduction. FOURmula One is an initiative from various countries to implement cost-effective health care services. Reference: Public Health Nursing in the Philippines by DOH, p. 3 57. Community Health Nursing is responsible to:

a. Individuals c. Families b. Local government units (LGUs) d. Individuals, families, population groups, community ANSWER: D Choose the answer that encompasses all answers The primary goal of community health nursing is the promotion and preservation of health of its different clients the individual, family, population groups and the community. It deals with individuals sick or well on a daily basis. A population group is a group of people who share common characteristics, developmental stage or common exposure to a particular environmental factor and consequently, common health problems. Example of population groups are children, men, women, farmers, military men, elderly, etc. A community is a group of people sharing common geographic boundaries and/or common values and interests. Reference: Maglaya, Araceli S. (2004). Nursing Practice in the Community. 4th ed. Page 10 58. What is the basic principle in Community Health Nursing? a. Promote a self-reliant community c. Control of communicable diseases b. Eradicate the immunizable diseases d. Rehabilitation to the previous level of functioning the clients ANSWER: A The primary goal of community health nursing is the promotion, prevention and preservation of health of its different clients. Priority is placed over the health promotive and disease preventive strategies over curative or rehabilitative interventions and to be able to promote a self-reliant community. Reference: Cuevas, Frances P., et. al. (2007) DOHs Public Health Nursing in the Philippines. 10th Ed., page 3- 5 59. The goal of conceptual framework for Primary Health Care (PHC) is: a. 2020Health Promotion for all Filipinos by year 2020 b. Health services readily made available to the Filipinos in the year 2020 c. To promote self-reliant community d. Health for All Filipinos and Health in the hands of the people by the year ANSWER: D Primary Health Care was declared during the First International Conference on Primary Health Care held in Alma Ata, USSR on September 6-12, 1978 by WHO. The goal was Health for All by the year 2000. This was adopted in the Philippines through Letter of Instruction 949 signed by President Marcos on October19, 1979 and has an underlying them of Health in the Hands of the People by 2020. Reference: Cuevas, Frances P., et. al. (2007) DOHs Public Health Nursing in the Philippines. 10th Ed., page 30 60. What is the legal basis of Primary Health Care? a. RA 9173 b. EO 2009 c. LOI 949 d. EO 51 ANSWER: C Through Letter of Instruction 949 signed by President Marcos on October19, 1979 and has an underlying theme of Health in the Hands of the People by 2020.

Option A Philippine Nursing Act 2002 Option B Family Code of the Philippines Option D Milk Code Reference: Cuevas, Frances P., et. al. (2007) DOHs Public Health Nursing in the Philippines. 10th Ed., page 140,342 61. Framework for implementation of Health Sector Reform Agenda (HSRA) is: a. Rationalization for Health c. Primary Health Care (PHC) b. National Objective for Health (NOH) d. Fourmula One for Health (F1) ANSWER: D The framework for implementation of HSRA is FOURmula One for Health. Goals of FOURmula ONE for Health: 1) Better health outcomes 2) More responsive health systems. 3) Equitable health care financing. Reference: Cuevas, Frances P., et. al. (2007) DOHs Public Health Nursing in the Philippines. 10th Ed., page 26 62. Nurse Isabelle will conduct teaching regarding Family Planning Program. Which of the following statements is true regarding family planning? a. All contraceptives causes sterility c. Tubal ligation can be irreversible b. Some Family Planning methods causes abortion d. Using contraceptive methods will result to loss of sexual desire ANSWER: C Vasectomy and tubal ligation in women are considered permanent methods and chosen by couples who have completed their desired family size. Option A: Contraceptive such as pills, IUD, injectables and condoms which are used for birth spacing, when pregnancy is desired, a couple can stop using the contraceptive method and they can have children again. Option B: This is not true. Abortion is termination of pregnancy, while family planning prevents pregnancy through the use of contraceptives, and abstinence during fertile periods, blocking of tubes, all of which prevent the meeting of egg and sperm. It prevents induced abortion by preventing unplanned pregnancies. Option D: Sexual desires are not affected by contraceptive use. In fact, the use of contraceptives frees the couple from the fear of unwanted pregnancies. This enhances the couples sexual relationship Reference: Cuevas, Frances P., et. al. (2007) DOHs Public health nursing in the Philippines. 10th edition, Page 133 63. Nurse Sinka, a community health nurse, motivates the people to share their ideas on how to manage their concerns during which phase of COPAR? a. Pre-entry phase b. Entry phase c. Organization-building phase d. Sustenance Phase ANSWER: B Option A is more on project site selection, C is more on immersion and its activities, and D is more on the transfer of KAS and community self-reliance. Reference: Jimenez, Carmen, E.. (2002). Community Organizing Participatory Action Research (CO-PAR) for Community Health Development.

64. Upon entry to the community, the organizer can start the following, except: a. Social preparation b. Deepening social investigation c. Core-group formation d. Community integration ANSWER: C Core group formation is done on the later part of entry. Reference: Jimenez, Carmen, E.. (2002). Community Organizing Participatory Action Research (CO-PAR) for Community Health Development. 65. Integration to the community is best done through: a. House-to-house visits c. Visits to where people are b. Participation in work setting d. Attending community occasions ANSWER: C It presents a broader concept where most people will listen to your advocacy. Reference: Jimenez, Carmen, E.. (2002). Community Organizing Participatory Action Research (CO-PAR) for Community Health Development. 66. The delivery of basic health services was devolved to the local government units. The legal basis for this is embodied in: a.RA 7610 b. EO 119 c. RA 7160 d. EO 226 ANSWER: C Under the RA 7160, the LGU now is the responsible in the implementation of health programs. Non-government organizations participate in the local health systems development. Reference: Public Health Nursing in the Philippines by DOH, p. 24 67. The components of FHSIS are the following except: a. Family treatment record b. Reporting forms c. Target client listing d. Input forms Answer: D Option A, B and C are components of FHSIS. Option D should be output form not input form. Reference: Cuevas, Frances P., et. al. (2007) DOHs Public health nursing in the Philippines. 10th edition, Page 80 68. Alvira brought her 2-month old infant to the clinic for immunization. She asks you when will her child can be considered fully immunized. A child is said to be Fully Immunized Child when a child receives: a. One dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HB and one dose of measles before a childs first birthday. b. One dose of BCG, 3 doses of OPV, 3 doses of DPT, 2 doses of HB and one dose of measles before a childs first birthday c. One dose of BCG, 4 doses of OPV, 3 doses of DPT, 2 doses of HB and one dose of MMR before a childs first birthday d. One dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HB and one dose of measles before five years old. ANSWER: A A child is said to be Fully Immunized Child when a child receives One dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HB and one dose of measles before a childs first birthday.

Reference: Cuevas, Frances P., et. al. (2007) DOHs Public health nursing in the Philippines. 10th edition, Page 149 69. The student nurse is investigating different types of practice settings. In looking at community health nursing, the student recognizes that it: a. Requires a Masters degree to become a Public Health Nurse b. Is the same as public health nursing c. Focuses on the incidence of disease d. Includes direct care and services to subpopulations ANSWER: D Community health nursing strives to safeguard and improve the health of populations in the community as well as providing direct care services to subpopulations within a community. Option A: Nurses who become expert in community health practice may have advanced nursing degrees; BSN degree and a RN can become quite competent in formulating and applying population-focused assessments and interventions. Option B: Public health nursing focuses on the needs of populations. Community health nursing has a broader focus, with an emphasis on the health of a community. The community health nurse merges public health knowledge with nursing theory. The community health nurse considers the needs of populations and is prepared to provide direct care services to subpopulations within a community. Option C: Public health nursing is concerned with trends and patterns influencing the incidence of disease within populations. A community health nurse may be involved in direct client care for disease within a community. Reference: Cuevas. Public Health Nursing in the Philippines 10th edition page 7, 365 70. There are different ways to look on health and illness. When formulating a definition of health, a person should consider that health, within its current definition, is: a. The absence of disease c. A state of well being involving the whole person b. A function of the physiological state d. The ability to pursue activities of daily living ANSWER: C When formulating a definition of health, a person should consider the total person, as well as the environment in which the person lives. Health generally implies a state of well being, which is ultimately defined in terms of the individual. Option A: Health is considered to be more than merely the absence of disease. Option B: The definition of health has broadened beyond the physiological state to include mental, social, and spiritual well being. Option D: An individual who has the ability to pursue activities of daily living may not define himself or herself as being healthy. Life conditions such as environment, diet and lifestyle practices may negatively affect ones health long before one is unable to perform activities of daily living. Reference: Potter and Perry Fundamentals of Nursing 6th edition page 91 71. When working as a community health nurse, the nurse works to improve the health of:

a. Infants and preschool children c. Mothers and children b. Elderly clients in an aggregate d. The entire community ANSWER: D Nurses who work in the community make a commitment to improving the health of the entire community and not just infants, preschool children, mothers, or elderly clients. Reference: Cuevas. Public Health Nursing in the Philippines 10th edition 72. There are three major roles of the Department of Health as a national authority in health. Which one is not included? a. Decision-maker of peoples health c. Administrator of specific services b. Enabler and Capacity builder d. Leader in health ANSWER: A The three major roles of the Department of Health as a national authority in health are the following: Leadership in health, Enabler and Capacity builder, and Administrator of specific services. Reference: Cuevas, Frances P., et. al. (2007) DOHs Public health nursing in the Philippines. 10th edition, Page 24 73. PHC is based on which of the following concept? a. Empowerment of the private health care service providers c. Effective provision of essential health services b. Partnership with the people d. All of the above ANSWER: B The concept of PHC is characterized by partnership and empowerment of the people that shall permeate as the core strategy in the effective provision of essential health services that are community based, accessible, acceptable and sustainable at a cost which the community and government can afford. Reference: Public Health Nursing in the Philippines by DOH, p. 30 74. Type of nursing assessment whereby existing problems of the family are determined: a. First- level assessment c. On-going assessment b. Second-level assessment d. Third-level assessment ANSWER: A First-level assessment is a process whereby existing and potential health conditions or problems of the family are determined. Second-level assessment defines the nature or type of nursing problems that the family encounters in performing the health tasks with respect to a given health condition or problem, and the etiology or barriers to the familys assumption of these tasks. Reference: Maglaya. Nursing Practice in the Community 4th edition page 54 75. Baby Monmon, 12 months old, did not receive his scheduled measles vaccine at 9 months. Nurse Jaika identifies categorize this health problem as: a. Health threat b. Health deficit c. Stress points d. Foreseeable crisis ANSWER: A

Health threats are conditions that promote disease or injury and prevent people from realizing their health potential. Reference: Cuevas, Frances P., et. al. (2007) DOHs Public health nursing in the Philippines. 10th edition, Page 44 76. It is the model that scientists have developed for studying health problems. It can help students understand infectious diseases and how they spread: a. Epidemiology b. Vital statistics c. Epidemiologic triangle d. Health education ANSWER: C The Epidemiologic Triangle is a model that scientists have developed for studying health problems. It can help your students understand infectious diseases and how they spread. It also gives students a chance to apply a scientific model to a variety of circumstances and facts. The Triangle has three corners: Agent, or microbe that causes the disease (the what of the Triangle); Host, or organism harboring the disease (the who of the Triangle); Environment, or those external factors that cause or allow disease transmission (the where of the Triangle) Reference: Cuevas, Frances P., et. al. (2007) DOHs Public health nursing in the Philippines. 10th edition, Page 63 77. Nurse Hannah had documented an unusually large number of cases of measles in barangay Pito-pito from January to July. This is known as: a. Endemic b. Sporadic c. Pandemic d. Epidemic ANSWER: D In epidemiology, an epidemic is a classification of a disease that appears as new cases in a given human population, during a given period, at a rate that substantially exceeds what is "expected," based on recent experience. Reference: Cuevas, Frances P., et. al. (2007) DOHs Public health nursing in the Philippines. 10th edition, Page 67 78. Isabel, a new public health nurse, is evaluating the general health condition of Barangay Tralala. Which data will be most helpful to Nurse Isabel? a. Infant Mortality Rate (IMR) c. Maternal Mortality Rate (MMR) b. Crude Death Rate (CDR) d. Crude Birth Rate (CBR) ANSWER: A Infant Mortality Rate (IMR) measures the risk of dying during the first year of life. It is a good index of the general health condition of a community since it reflects the changes in the environment and medical condition of a community. Reference: Cuevas, Frances P., et. al. (2007) DOHs Public health nursing in the Philippines. 10th edition, Page 76 79. It is a major component of the work information sources developed by the Department of Health (DOH) to better manage nationwide health service delivery: a. Field health services and information system c. Public health surveillance b. Family treatment record d. Target client listing ANSWER: A

Field health services and information system has the objective of providing summary of data on health services delivery and selected program accomplished indicators at the barangay, municipality, provincial and national level. Reference: Cuevas, Frances P., et. al. (2007) DOHs Public health nursing in the Philippines. 10th edition, Page 80 80. A project launched by the DOH is the Project Entreprenurse which encourages nurses not only to seek but create jobs and engage in income augmentation programs. The underlying concept of this project is based on: a. Bringing into awareness of nurses the opportunity for wider horizon of the profession b. Bringing primary health care to the community thru home health care c. The fulfillment of the DOH millennium developmental goals for better health care services and healthy nation d. Maximizing employment opportunities for the countrys unemployed nurses ANSWER: B ENTREPRENURSE is rooted from the original concept of INTRODUCING A HOME HEALTH CARE INDUSTRY IN THE PHILIPPINES. This project aims to promote nurse entrepreneurship by introducing a home health care industry to reduce the cost of health care for the countrys indigent population by (1)bringing primary health care services to poor rural communities, (2) to maximize employment opportunities for the countrys unemployed nurses and (3) to utilize the countrys unemployed human resources for health for the delivery of public health services and the achievement of the countrys Millennium Development Goals on maternal and child health, consistent with the Fourmula One for Health framework of the Department of Health. Options B, C and D are components of the health care industry and the means to effectively achieve its goal of reducing the cost of health care. Reference: Souvenir Program. Oathtaking Ceremony for New Professional Nurses. March 2010. Page 227. : BON Newsletter. March 8, 2010, Volume 6. Page 10. 81. Mang Indoy, who is one of the attendees in your seminar, asks you what can be done to prevent the spread of a disease. Your appropriate response would be based on the easiest link to break, which is: a. Causative agent b. Reservoir c. Mode of transmission d. Portal of entry ANSWER: C The mode of transmission is the means by which the infectious agent passes from the portal of exit from the reservoir to the susceptible host. Of the six links in the chain of infection, the mode of transmission is the easiest link to break. Reference: David L. Longworth. Handbook of Infectious Diseases. Springhouse. Page 17-18. 82. Which statement is not true about infection and colonization? a. Infection is the invasion and multiplication of microorganisms in body tissue with cellular injury.

b. Colonization is the multiplication of microorganisms on or within a host that does not result in cellular injury. c. Colonies of microorganisms are incapable of ever causing infection to the host. d. There are two types of flora: resident and transient. ANSWER: C Infection is an invasion and multiplication of microorganisms in body tissue that results in cellular injury. Colonization is the multiplication of microorganisms on or within a host that does not result in cellular injury. However, microorganisms that are colonized on a host may be a potential source of infection. Flora are the vegetation of microorganisms on the human body. There are two types of flora: resident and transient. Reference: Rick Daniels Fundamentals of Nursing 83. A client asks Nurse Hannah, how can you say that a disease is communicable? Nurse Hannah correctly respond by saying that a disease is said to be communicable if: a. It is capable of producing s secondary infection c. It is transmitted directly from one person to another b. It persists for a long period of time d. Lifestyle factors contribute to the disease process ANSWER: C Infectious pathologies are usually qualified as communicable diseases due to their potentiality of transmission from one person or species to another. Reference: Kozier, B. et. al. (2008) Fundamentals of Nursing: Concepts, Process and Practice. 8th ed. Pearson Prentice Hall. Page :Potter and Perry Fundamentals of Nursing 6th edition Page 774 84. During an initial exposure to an antigen, the T cells stimulate the production of B cells, which then produce antibodies specific to the antigen. This process is collectively referred to as: a. Acquired immunity b. Humoral immunity c. Specific immune defense d. Vaccination ANSWER: B T cells are produced and moved to the injured area, releasing chemical substances and activating other cells to assist in destroying the antigen. T cells also stimulate production of B cells, which produce antibodies specific to the antigen; this process is known as humoral immunity. Reference: White. Foundations of Nursing 3rd edition 85. Which action indicates a break in handwashing technique? a. Removing jewelry b. Keeping hands and forearms in the down position when washing c. Rinsing with hands in the up position d. Drying in the direction of fingers to wrists and forearms ANSWER: C When handwashing, jewelry is to be removed. Keep hands and forearms in the down position when washing. Rinsing should be done with the hands in the down position, elbows straight. Drying should be done from the hands up to the forearms. Reference: White. Foundations of Nursing 3rd edition

86. An appropriate technique for Nurse Isabelle to implement for the client on isolation precautions is to: a. Double bag all disposable items and linens b. Put another gown over the one worn if it has become wet c. Place specimen containers in plastic bags for transport d. Hand items to be reused directly to a nurse standing outside of the room ANSWER: C Transfer specimen to container without soiling outside of container. Place container in a plastic bag and label the outside of the bag or as per agency policy- Specimens of blood and body fluids are placed in well-constructed containers with secure lids to prevent leaks during transport. A. Use single bags that are impervious to moisture and sturdy to contain soiled articles. Use double bag if necessary for heavily soiled linen or heavy wet trash. Linen or refuse should be totally contained to prevent exposure of personnel to infective material. B. Avoid allowing isolation gown to become wet; carry wash basin outward away from gown; avoid leaning against wet tabletop. Moisture allows organisms to travel through gown to uniform D. Remove all reusable pieces of equipment. Clean any contaminated surfaces with hospital approved disinfectant. All items must be properly cleaned, disinfected, or sterilized for reuse. Reference: Clinical Nursing Skills and technique 6th edition page 203, 204 87. In taking the history of a client suspected of having bacterial meningitis, which question is most important for the nurse to ask? a. Do you live in a crowded residence? c. Have you had any viral infections recently? b. When was your last tetanus vaccination? d. Have you traveled out of the country in the last month? ANSWER: A Meningococcal meningitis tends to occur in outbreaks. It is most likely to occur in areas of high-density population, such as college dormitories, prisons, and military barracks. Reference: Ignatavicius. Medical Surgical Nursing 7th edition 88. The causative agent for tetanus is: a. Bordetella b. Clostridium tetani c. Neisseria Gonorrheae d. Enterobius vermicularis ANSWER. B. Tetanus is an infectious disease caused by Clostridium tetani which produces potent exotoxin with prominent systemic neuromuscular efforts manifested by generalized spasmodic contractions of the skeletal musculator. Reference: Dionesia Mondejar-Navales. Handbook of Common Communicable and Infectious Diseases. Revised Edition. 274. 89. The disease is caused by four species of protozoa. The specie which is considered as the most serious malarial infection is known as: a. Plasmodium vivax b. Plasmodium falciparum c. Plasmodium malariae d. Plasmodium ovale

ANSWER: B Plasmodium falciparum is considered as the most serious malarial infection because of the development of high parasitic densities in blood (RBC) with tendency to agglutinate and form into microemboli. This is the most common in the Philippines. Option A this is nonlife threatening except for the very young and the old, it is manifested by chills every 48 hours on the 3rd day onward especially if untreated Option C it is less frequently seen, this specie is nonlife threatening Option D is the rare type of protozoan species and is rare in the Philippines Reference: Dionesia Mondejar-Navales. Handbook of Common Communicable and Infectious Diseases. Revised Edition. 185-186. 90. For paucibacillary type of leprosy, after taking how many months of doses of MDT, a person is considered cured and should be discharged at: a. 3 months b. 6 months c. 10 months d. 12 months ANSWER: B The drugs used in MDT are a combination of Rifampicin, clofazimine, and dapsone for Multibacillary leprosy and Rifampicin and dapsone for paucibacillary. For PB patients after taking 6 monthly doses of MDT this person may be declared cured and may be discharged. For MB patients after taking 12 monthly doses of MDT this person is cured and should be removed from the register. Reference: Dionesia Mondejar-Navales. Handbook of Common Communicable and Infectious Diseases. Revised Edition. Page 177. 91. As an RHU nurse, you are aware that the duration of treatment for patient classified under category 1 with tuberculosis meningitis or spinal disease with neurologic complication is: a. 9 months b. 7 months c. 8 months d. 4 months ANSWER: A The maintenance phase of Category 1 is extended from 4 months to 7 months in patients with this type of TB or complication Reference: Cuevas, Public Health Nursing in the Philippines. 10th Edition, 2007. Page 244. : Maria Loreto Evangelista-Sia. Community Health and Communicable Diseases. 2008 Edition. Page 163. 92. The following statements do not represent the nature of tuberculosis, except: a. Diagnosis of TB is confirmed by a positive tuberculin test, chest xray, and sputum culture b. TB is essentially not an airborne disease c. One negative sputum examination alone rules out active or inactive TB infection d. Reactivation of TB will not occur after being dormant for 5 years ANSWER: A All TB symptomatic identified shall be asked to undergo DSSM for diagnosis before start of treatment, regardless of

whether or not they have available X-ray results or whether or not they are suspected of having extra-pulmonary TB. Since DSSM is the primary diagnostic tool, no TB diagnosis shall be made based on the results of X-ray examinations alone. Likewise, results of the skin test for TB infection (PDD skin test) should not be used as bases for TB diagnosis in adults. TB is an airborne disease; the patient is placed on airborne precautions, in a negative air pressure room to avoid the spread of the disease. 3 positive sputum smear is used to confirm a diagnosis of TB Reactivation is possible even treatment if immunity level decreases and exposure to M. tubercle Reference: Cuevas, Public Health Nursing in the Philippines. 10th Edition, 2007. Page 243. : Dionesia-Mondejar-Navales, Handbook of Common Communicable and Infectious Diseases. Revised Edition. Page 284. 93. Hepatitis A is a liver disease cause by the hepatitis A virus. Lulu was concerned about the change in her skin color when she asks the nurse about the occurrence of this symptoms. The nurse can best respond by saying: a. The color change is due to the stimulation of the liver to produce an excess quantity of bile b. The color change is due to the increased destruction of the red blood cells during the acute phase of the disease c. The color change is due to the decreased prothrombin levels which lead to the multiple site of spontaneous bleeding d. The color change is due to the inability of the liver to remove normal amounts of bilirubin from the blood ANSWER: D Jaundice is a condition characterized by yellow colored skin due to the presence of bilirubin. Hepatitis causes hepatic jaundice which is due to the inability of the liver to remove normal amounts of bilirubin from the blood. Option B is an example of haemolytic jaundice. Reference: David L. Longworth. Handbook of Infectious Diseases. Springhouse. Page 131. 94. The strategy being implemented by the DOH in the fight against dengue is called: a. The 4 S b. Tapat Mo, Linis Mo c. Hithit -Buga d. L.A.M.O.K puksa ANSWER: A Efforts are continuously focused on the 4S strategy against dengue. 1. Search and destroy possible breeding places of dengue-causing mosquitoes like flower pots, vases, discarded plastic bags, bottles, old tires, cans, earthen jars, coconut husks, roof gutters, water drums, and other containers that might hold clean stagnant water. Preventing dengue can be easier achieved by doing your part in keeping the environment clean. Change water in vases frequently. Make sure all water containers are kept covered. 2. Self-protection measures include wearing long sleeves or long pants. It is also best to avoid dark-colored clothes like dark shades of blue and black, as dark clothing has been observed to attract mosquitoes. Apply mosquito

repellant on the skin to deter mosquito bites. Mosquito repellant lotions and liquid sprays are available on the market; however, parents are cautioned against using strong repellants on small children because of potentially harsh chemicals. There are organic mosquito repellant alternatives such as all-natural citronella bug spray. You can also use mosquito coils, electric vapour mats and mosquito spray during the daytime. Screens and mosquito nets are also good deterrents against mosquitoes. 3. Seek early consultation because dengue is crucial. See a doctor immediately if you show early signs and symptoms of dengue. 4. Say no to indiscriminate fogging. In the past, fogging was considered as a temporary solution against denguecarrying mosquitoes. At present, fogging is only advisable and recommended when outbreaks and epidemics are positively determined in a particular area. Fogging can only kill the adult infected mosquito; it cannot get rid of the larvae, locally known as kiti-kiti. Indiscriminate fogging will only drive away other mosquitoes to other places to find new breeding grounds. Reference: www.doh.gov.ph 95. Which of the following is true of the organism that causes malaria? a. It is transmitted by respiratory droplets. c. It causes symptoms within 24 hours after transmission. b. It is transmitted by sexual intercourse. d. It enters the body and destroys red blood cells. ANSWER: D This is what produces most of the clinical manifestations of malaria. Option A: It enters the bloodstream either by the bite of a mosquito or by the blood of an infected person. Option B: It is not a sexually transmitted disease. Option C: It usually does not cause symptoms until one-to-two weeks after transmission. Reference: http://www.who.int/topics/malaria/en/ 96. Dolor brought her 2-year-old daughter to the health center because of 2 days cough and 3 days colds. On assessment, the nurse counted the childs respiration to be 56 cycle/minute. Based on IMCI, the following statements are true and applicable: A. The child has pneumonia C. Soothe the throat and relieve cough with a safe remedy B. The child has to be referred to the hospital immediately D. The child can be treated at home a. A, B, C b. A, C, D c. B, C d. C, D ANSWER: B A child having fast breathing only is classified as having pneumonia. Management for a child with pneumonia: give an appropriate antibiotic for 3 days. If wheezing (even if it disappeared after rapid-acting bronchodilator), give an inhaled bronchodilator for 5 days. Soothe the throat and relieve the cough with a safe remedy that can be done at home. If coughing for more than 3 weeks or if having recurrent wheezing, refer for assessment for TB or asthma. Advise the mother when to return immediately. Follow-up in 2 days. Reference: WHO. IMCI Manual. 2009 Edition. Page 2.

97. Based on the IMCI guidelines, the following are safe remedies to soothe the throat of the client. This does not include: a. Cough syrups c. Calamansi b. Breastmilk especially to those exclusively breast fed d. Tamarind ANSWER: A Safe remedies recommended to soothe the sore throat are breastmilk for exclusively breastfed infants, tamarind, calamansi and ginger. Harmful remedies to discourage are the following: codeine cough syrup, and other cough syrups and oral and nasal decongestants. Reference: IMCI Manual. Page 9. 98. Which of the following findings indicate fast breathing? a. Respiratory rate of 30 or more breaths for a 15 months old child b. Respiratory rate of 40 or more breaths for a 2 months old child c. Respiratory rate of 50 or more breaths for a 2 weeks old infant d. Respiratory rate of 60 or more breaths for a 6 weeks old infant ANSWER: D There is fast breathing if a child whose age is: 1 week to 2 months old infant have 60 or more breaths per minute 2 to 12 months old child have 50 or more breaths per minute 12 months to 5 years old child have 40 or more breaths per minute Reference: WHO. IMCI Manual. 2009 Edition. Page 2. 99. A correlation coefficient of 0.80 between the number of hours studied for a test and the scores on the test indicates that: a. As the number of hours studied decreases, test scores increase. b. As the number of hours studied increases, test scores increase. c. There is a strong correlation between the number of hours studied for a test and test scores. d. The number of hours studied is correlated with test scores. ANSWER: A Students may have difficulty answering this question because they would expect a positive relationship, not a negative relationship, between the number of hours studied and test scores. However, the minus sign in front of the correlation coefficient indicates a negative relationship. The .80 correlation is a fairly strong correlation. Reference: Polit and Beck. Nursing Reseach. 8th edition Page 453 100. Probability sampling involves: a. The use of a random selection process c. Haphazardly selecting names from a telephone book b. Asking one subject to recommend three more d. The use of sequential lists ANSWER: A The term random seems haphazard but is actually a determined selection process with the goal to examine representative units of populations. Random sampling is a very systematic and scientific process. Reference: Polit and Beck. Nursing Reseach. 8th edition Page 344