DIAGNOSTIC 5

SITUATION: The DOH developed and promotes various programs in addressing major health problems. Nurses responsibility is in the implementation of these programs. 1. Comprehensive postabortion care services should include both medical and preventive healthcare. The following except one are key elements of postabortion care: a. Emergency treatment of incomplete abortion and potentially lifethreatening complications b. Postabortion family planning counseling and services c. Links between postabortion emergency services and the reproductive healthcare system d. Psychological and spiritual counseling ANSWER: D Comprehensive postabortion care services should include both medical and preventive healthcare. The key elements of postabortion care are: Emergency treatment of incomplete abortion and potentially lifethreatening complications Postabortion family planning counseling and services Links between postabortion emergency services and the reproductive healthcare system Reference: Adapted from WHO 2. WHO has identified the prompt treatment of incomplete abortion as an essential element of obstetric care that should be available at every district-level hospital. Emergency treatment for postabortion complications does not include: a. Uterine evacuation to remove retained products of conception (POC) c. Provision for family planning b. An initial assessment to confirm the presence of abortion complications d. Prompt referral and transfer ANSWER: C Emergency treatment for postabortion complications includes: An initial assessment to confirm the presence of abortion complications Talking to the woman regarding her medical condition and the treatment plan Medical evaluation (brief history, limited physical and pelvic examinations) Prompt referral and transfer if the woman requires treatment beyond the capability of the facility where she is seen Stabilization of emergency conditions and treatment of any complications (both complications present before treatment and complications occurring during or after the treatment procedure) Uterine evacuation to remove retained products of conception (POC) Option C is done after emergency treatment. Reference: Adapted from WHO 3. A number of factors limit provision of family planning services to women who have experienced an abortion. The following except one are factors that increase a woman's risk of repeated unwanted pregnancies:

a. Lack of understanding of and attention to women's reproductive health needs on the part of providers b. Lack of services for some groups of women c. Misinformation among providers about appropriate postabortion contraceptive methods d. Peer influences ANSWER: D Because a woman seeking treatment for incomplete abortion already may have experienced an unwanted pregnancy either as the result of not using contraception or method failure, she may be in need of effective contraception. A number of factors limit provision of family planning services to women who have experienced an abortion. These factors, which increase a woman's risk of repeated unwanted pregnancies, include: Lack of understanding of and attention to women's reproductive health needs on the part of providers Lack of services for some groups of women (e.g., adolescents, single women) Separation of emergency postabortion care services and family planning services Misinformation among providers about appropriate postabortion contraceptive methods Lack of acknowledgment of the problem of unsafe abortion and the resulting need for contraceptive services Reference: Adapted from WHO 4. Which of the following statements made by Nurse Hannah correctly describe the implementing rules and regulations of RA 9288? a. All communicable diseases should be reported to the nearest health station b. To acquire a marriage license, couple should receive instructions on family planning and responsible parenthood c. Newborn screening should be performed after 24 hours following delivery of the newborn d. All children below 8 years of age requires compulsory immunization against childhood immunizable diseases ANSWER: C Under Sec. 6 of RA 9288, Newborn screening shall be performed after twenty-four (24) hours of life but not later than three (3) days from complete delivery of the newborn. A newborn that must be placed in intensive care in order to ensure survival may be exempted from the 3-day requirement but must be tested by seven (7) days of age. A parent or legal guardian may refuse testing on the grounds of religious beliefs, but shall acknowledge in writing their understanding that refusal for testing places their newborn at risk for undiagnosed heritable conditions. The DOH shall be the lead agency in implementing this Act. Option A: RA 3573. Option B: PD 965. Option D: PD 996 Reference: RA 9288 5. A postpartum client asks the nurse, What are the disorders tested in newborn screening? The nurse accurately responds by stating: a. These are Congenital Hypothyroidism, Congenital Adrenal Hyperplasia, Galactosemia, PKU, and G6PD deficiency

b. These are Down syndrome, Cretinism, PKU and Galactosemia c. These are mental retardation, hypothyroidism, and PKU d. All of the disorders known to man ANSWER: A Disorder Screened Effect if NOT SCREENED Effect if SCREENED and treated CH (Congenital Hypothyroidism) Severe Mental Retardation Normal CAH (Congenital Adrenal Hyperplasia) Death Alive and normal GAL (Galactosemia) Death or Cataracts Alive and normal PKU (Phenylketonuria) Severe Mental Retardation Normal G6PD Deficiency Severe Anemia, Kernicterus Normal

a. Right source, right preparation, right cooking, right storage b. Right source, right temperature, right people, right amount c. Right source, right preparation, right temperature, right storage d. Right source, right food handlers, right utensils, right preparation ANSWER. A There are the four rights in food safety which involves the chain in food processing from the source in the market until the food reaches the table. They mainly encompass the following: right source, right preparation, right cooking and right storage. Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. Manila 9. There has been a steady increase in the number of household having access to safe water supply resources. The following are the approved types of water supply facilities by the DOH except: a. Point source b. Stand-posts c. Open dug wells d. Water works system ANSWER. C Based on the DOH policies, the approved types of water supply facilities are point source, communal faucets, standposts and water works system. The unapproved types of water facilities are those that come from doubtful sources such as open dug wells, unimproved springs, wells that need priming, etc. Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. Manila 10. Under the ENTREPRENURSE Project, unemployed nurses: a. Seek financial assistance from DOLE to organize a home healthcare cooperative under the supervision of a trained or experienced nurse b. Can borrow money from the DOLE to start a health care related business such as: Pharmacy store c. Can seek financial assistance when applying abroad d. Can work at any DOH hospital for 1 year with pay. ANSWER: A Implementing strategy for ENTREPRENURSE PROJECT: Organize unemployed nurses into home health-acre cooperatives on a per city or per province basis. The DOLEs (initial funding) assistance shall be in a form of grants to these cooperatives, which shall use the money to get the home health care business started. The cooperatives will run nursemanaged clinics under the supervision of trained and experienced nurses which will deploy newly licensed nurses to poor rural communities with big populations of sick, elderly and disabled patients who have little or no access to basic health care. Reference: DOLE 11. One of the essential elements of primary health care which involves controlling all the factors in mans environment that may form links in disease transmission is: a. Immunization c. Environmental sanitation b. Treatment of locally endemic diseases d. Control of communicable diseases ANSWER: C

6. School entrants are injected with BCG vaccine. The site of administration is: a. Upper outer portion of the thigh c. Vastus lateralis b. Upper outer portion of the gluteal muscle d. Right deltoid region of the arm ANSWER: D The site of administration of BCG for school entrants is the right deltoid region of the arm. Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. Manila 7. It is known as the certification recognition program that develops and promotes a standard for quality health care, services and facilities. a. FOURmula One b. EPI c. Sentrong Sigla d. Healthy Lifestyle ANSWER: C Quality Assurance through Sentrong Sigla is a way of engaging local government units and communities in assuring quality health services at the local level through a certification recognition program. FOURmula ONE for Health is the implementation framework for health sector reforms in the Philippines for the medium term covering 2005-2010. The Expanded Program on Immunization (EPI) is one of the DOH Programs to reduce infant mortality and morbidity through decreasing the prevalence of six (6) immunizable diseases (TB, diphtheria, pertussis, tetanus, polio and measles). And lastly, Healthy Lifestyle (HL) or the National Healthy Lifestyle Program of the DOHs has a goal to reduce the toll of morbidity, disability and premature deaths due to lifestyle related diseases. Department of Health. URL: http://www.doh.gov.ph and DOH Flyer about Sentrong Sigla 8. Food establishments are already subject to sanitary inspection. Which of the following are the four rights in food safety?

Environmental sanitation is one element of primary health care which encompasses adequate supply of safe water and proper waste disposal and controlling all the factors in the environment that may form links in the transmission of disease. Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. Manila 12. Tuberculosis is considered as the worlds deadliest disease and remains as a major public health problem in the Philippines. Which statement is true regarding tuberculosis? a. The risk of developing the disease is low among adolescents b. A positive Mantoux Test indicates positive infection c. Domiciliary treatment is the preferred mode of care d. Xray examinations alone is sufficient to make the diagnosis of TB ANSWER: C The preferred mode of care, according to National Tuberculosis Program of the DOH, is Domiciliary treatment through DOTS. Option A: The risk of developing the disease is highest in children under 3 years old, lower in later adulthood and high again among adolescents, young adults and the very old. Option B: A positive mantoux test indicates exposure to the disease. Option D: DSSM is the primary diagnostic tool in NTP case finding. No TB diagnosis shall be made based on the results of Xray examinations alone. Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. Manila 13. Who among the following TB patients is included in Category 1 of treatment regimen? a. A patient who failed in the treatment c. New smear positive PTB b. Relapsed patient d. New smear-negative PTB with minimal parenchymal lesions on CXR ANSWER: C Category 1: New smear positive PTB; New smear negative PTB with extensive parenchymal lesions on CXR; EPTB; and severe concomitant HIV disease. Category 2: Treatment failure; relapse; return after default. Category 3: New smear-negative PTB with minimal parenchymal lesions on CXR. Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. Manila 14. A child shall be clinically confirmed of having TB is he has three of the following conditions except one: a. Positive history of exposure to an adult TB case c. Abnormal chest radiograph suggestive of TB b. Positive tuberculin test d. Unexplained fever for 2 weeks or more ANSWER: D A child shall be clinically confirmed of having TB is he has any three of the following conditions: 1. Positive history of exposure to an adult TB case 2. Positive tuberculin test 3. Abnormal chest radiograph suggestive of TB 4. Presence of signs and symptoms suggestive of TB 5. Laboratory findings indicative or suggestive of TB Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. Manila

15. Treatment regimen for children with PTB includes: a. Intensive phase of Isoniazid, Rifampicin and Pyrazinamide for 2 months; Continuation phase of Isoniazid and Rifampicin for 4 months b. Intensive phase of Isoniazid, Rifampicin ,Pyrazinamide and Ethambutol or Streptomycin for 2 months; Continuation phase of Isoniazid and Rifampicin for 4 months c. Intensive phase of Isoniazid, Rifampicin and Pyrazinamide for 4 months; Continuation phase of Isoniazid and Rifampicin for 2 months d. Intensive phase of Isoniazid, Rifampicin ,Pyrazinamide and Ethambutol or Streptomycin for 4 months; Continuation phase of Isoniazid and Rifampicin for 2 months ANSWER: A Treatment regimen for children with PTB according to NTP: Pulmonary TB: Intensive phase of Isoniazid, Rifampicin and Pyrazinamide for 2 months Continuation phase of Isoniazid and Rifampicin for 4 months Extra-pulmonary TB: Intensive phase of Isoniazid, Rifampicin ,Pyrazinamide and Ethambutol or Streptomycin for 2 months Continuation phase of Isoniazid and Rifampicin for 4 months Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. Manila 16. Rural sanitary inspectors and midwives compose what level of primary health care workers? a. Intermediate level health workers c. Grassroots health workers b. Village health workers d. Barangay health workers ANSWER: A There are two levels of primary health care workers, the first is the village/barangay/grassroots health workers including community workers and traditional birth attendants. The other one is the intermediate level health workers that comprise the general medical practitioners, public health nurses, rural sanitary inspectors and midwives. Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. Manila 17. The core strategy of the Primary Health Care concept is characterized by: a. Partnership with the private sector c. Centralized delivery of health care services b. Essential health care services d. People empowerment ANSWER: D The concept of PHC is characterized by partnership and empowerment of the people that shall permeate as the core strategy in the provision of essential health care services. Reference: Cuevas, Frances P., et. al. (2007) DOHs Public health nursing in the Philippines. 10th edition, Page 30 18. Community development advocates the principles of self-help and the voluntary participation of the people of community. Community development rests upon certain assumptions, this does not include: a. Everyone has something to contribute to the community

b. People have limited ability to learn c. Community development provides the opportunity by which the worth of an individual is revealed d. Worth and dignity of individual are the basic values in a democratic society ANSWER: B Community development rests upon certain assumptions: Worth and dignity of individual are the basic values in a democratic society. Community therefore is rooted in human development Everyone has something to contribute to the life of the community. Even the poorest member can share something, maybe not monetary, nut in terms of talents and skills People have the ability to learn and grow. As long as a person is ready and willing to learn, his/her potentials can be enhanced Community development provides the opportunity and the means by which the worth of an individual is revealed, his/her contribution can be made and learning can take place Reference: Carmen Jimenez. Community Organizing Participatory Action Research for Community Health Development Page 5 19. Mr. Tibe came to the health center clinic for his daily medication for TB. This condition falls under: a. Heath deficit b. Health threat c. Foreseeable crisis d. Stress point ANSWER: A A health deficit occurs when there is a gap between actual and achievable health status and occurs when there are instances of failure in health maintenance. The presence of a disease falls under this category: Reference: Cuevas, Frances P., et. al. (2007) DOHs Public health nursing in the Philippines. 10th edition, Page 44 20. These are conditions that promote disease or injury and prevent people from realizing their health potential: a. Heath deficit b. Health threat c. Foreseeable crisis d. Stress point ANSWER: B 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 SITUATION: Nurses today are actively generating, publishing and applying research to be able to improve client care and enhance nursings scientific knowledge base. 21. She is known as the first nurse researcher as well as the first modern nurse. a. Hildegard Peplau b. Martha Rogers c. Florence Nightingale d. Callista Roy Answer: C

Florence Nightingale is credited as being the first nurse researcher, as well as the first modern nurse. In her work, Notes In Nursing, What It Is and What It Is Not, she illustrated her environmental approach in the care of the sick, thus, considered as the first nursing theorist. Reference: Venzon, L.M.(2004) Introduction To Nursing Research 22. The researcher may be guided by the following steps when doing research studies: 1. Statement of the problem and hypothesis 3. Data collection and methodology 2. Results, interpretation and conclusion 4. Theoretical framework and definition of terms a. 1,2,3,4 b. 1,4,3,2 c. 1,3,4,2 d. 1,2,4,3 ANSWER: B Doing a research follows the order of: Statement of the problem and hypothesis, giving the theoretical framework and definition of terms, collecting, presenting and analyzing data and providing the results, interpretation, conclusion and recommendations. Reference: Beck, C.T. & Polit, D. F. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice. 8th Edition. 23. Nurse Risa wants to study the effect of Metformin in lowering glucose level among diabetic clients admitted at the hospital. The independent variable is the: a. Metformin b. Glucose level c. Diabetic clients d. Hospital ANSWER: A Independent variable, the one being manipulated is the presumed cause while the dependent variable is the presumed effect. Here, Metformin is the I.V. while glucose level is the D.V. Reference: Beck, C.T. & Polit, D. F. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice. 8th Edition. Page 59 24. What is an example of a null hypothesis among the following statements? a. Students who enrolled in a review center will pass the NLE b. The negative attitudes of the caregivers affect the help seeking behavior of the patients c. Exercise will lower the blood cholesterol d. There is no significant relationship between smoking and glucose level ANSWER: D The null hypothesis asserts that there is no significant difference between two variables or relationship among variables. In this case, it is best exemplified by Choice D. Reference: Beck, C.T. & Polit, D. F. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice. 8th Edition. Page 66 25. If a researcher asks the subject to refer other potential subjects as samples in the study. She is utilizing which type of sampling: a. Purposive sampling b. Snow-ball sampling c. Convenience sampling d. Quota sampling

ANSWER: B Snow-ball sampling involves the subjects suggesting or referring other subjects who meet the researchers criteria. For example, a researcher wants to study the post traumatic stress disorders in patients who reportedly had been raped. Looking for subjects is quite tedious since almost all would not admit being subject to such violence. The snowball type of sampling is best for this kind of research. Reference: Beck, C.T. & Polit, D. F. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice. 8th Edition. Page341 SITUATION: IMCI is a strategy developed by the World Health Organisation and UNICEF. It has been introduced to address morbidity and mortality in children. 26. A mother with her sick child comes to the health center. The health worker should first: a. Ask the mother about the child c. Check if the childs weight and temperature were recorded b. Greet the mother appropriately d. Assess the child ANSWER: B When the nurse sees the mother, or the childs caretaker, with the sick child, the nurse should first: GREET THE MOTHER APPROPRIATELY AND ASK ABOUT THE CHILD; LOOK TO SEE IF THE CHILDS WEIGHT AND TEMPERATURE HAVE BEEN RECORDED Reference: IMCI 2009 27. After asking the mother what the childs problems are, what is the next thing that the nurse should do based on the IMCI? a. Classify the condition b. Assess for main symptoms c. Check for danger signs d. Refer the mother ANSWER. C Based on the IMCI case management in the outpatient care facility, the nurse should first check/assess the presence of danger signs. The danger signs include: convulsions, lethargy, inability to eat/drink and vomiting. After the danger signs, the occurrence of main symptoms such as cough, difficulty of breathing, diarrhea, fever and ear problems should be checked. After performing the assessment, the childs condition can be classified and an appropriate treatment action can be identified. Reference: IMCI 2009 28. The IMCI clinical guidelines focus on five main symptoms. Which is not included? a. Diarrhea b. Cough c. Ear Problems d. Constipation ANSWER. D The IMCI guidelines focus on the five main symptoms. These are the following: a) cough, b) difficulty of breathing, c) fever, d) diarrhea, and e) ear problems. Constipation is not included as a main symptom. Reference: IMCI 2009 SITUATION: Tuti is 11 months old. His temperature is 37.5 degree C. His mother says he has had a dry cough for

the last week. He has no GDS. The health worker counted 42 bpm, does not see chest indrawing and no stridor when the he is calm. No visible severe wasting. There is some palmar pallor. There is no edema of both feet. 29. Tutis sign is classified under: a. VERY SEVERE MALNUTRITION OR VERY SEVERE ANEMIA c. ANEMIA OR VERY LOW WEIGHT b. SEVERE MALNUTRITION OR SEVERE ANEMIA d. NO ANEMIA AND NOT VEY LOW WEIGHT ANSWER: C SEVERE MALNUTRITION OR SEVERE ANEMIA: Visible severe wasting, has edema of both feet, severe palmar pallor ANEMIA OR VERY LOW WEIGHT: Some palmar pallor, very low weight for age NO ANEMIA AND NOT VEY LOW WEIGHT: Not very low weight for age and no other signs of malnutrition Reference: IMCI 2009 edition Page 6 30. Feeding recommendations for infants 6 months up to 12 months would include: a. Exclusive breastfeeding c. Breastfeeding plus lugaw with added pulverized roasted dilis b. Breastfeeding plus plain lugaw d. Breastfeeding plus adequate amounts family foods ANSWER: C The feeding recommendations are appropriate both when the child is sick and when the child is healthy. During illness, children may not want to eat much. However, they should be offered the types of food recommended for their age, as often as recommended, even though they may not take much at each feeding. Up to 6 months: Exclusive breastfeedeing, at least 8 times in 24 hours; do not give other foods or fluids 6 months to 12 months: Breastfeeding plus any of the following: Lugaw with added oil, mashed vegetables or beans, steamed tokwa, flaked fish, pulverized roasted dilis, finely ground meat, egg yolk, bite sized fruits 12 months to 2 years: Breastfeed plus give adequate amounts of family foods 2 years and older: Give adequate amounts of family foods at 3 meals a day; Give nutritious snack twice daily between meals such as boiled yellow camote, boiled yellow corn, boiled saba, fresh banana, taho, fruits and fruit juices. Reference: IMCI 2009 edition Page 21 31. Signs of good attachment in breastfeeding include all but one: a. Mouth wide open c. More areola visible below than above the mouth b. Chin touching the breast d. Lower lip turned outward ANSWER: C More areola visible below than above the mouth There is good attachment if the baby is CALM C chin touching the breast or chin very close to breast A areola is more visible above than below the mouth L lower lip is turned outward M mouth wide open

Reference: IMCI resource Manual Page 95 SITUATION: Leticia is 3 years old. She weighs 10 kg. Her axillary temperature is 38 degrees C. Her mother brought her to the health center because she has cough. She also has a rash: 32. Leticia has measles and displays severe stomatitis with deep and extensive mouth ulcers. This is classified as: a. UNCOMPLICATED FEVER c. SEVERE COMPLICATED MEASLES b. POSSIBLE BACTERIAL INFECTION d. MEASLES WITH MOUTH COMPLICATIONS ANSWER: C Deep and extensive mouth ulcers classified as Option C. Reference: IMCI 2009 edition Page 4 33. Leticias classification is under which color? a. Pink b. Red c. Yellow d. Green ANSWER: A Severe Complicated Measles has a color classification of Pink Yellow Measles with Eye or Mouth Complications Green - Measles Reference: IMCI 2009 edition Page 4 34. Clinical signs manifested by Leticia are as follows, except: a. Any danger sign b. Clouding of the cornea c. Deep Mouth ulcers d. Pus draining from the eye ANSWER: D Option D is not included in Severe Complicated Measles signs.(Measles with eye complications) Reference: IMCI 2009 edition Page 4 35. IMCI recommends the following in soothing the throat and relieving cough. Which is not included? a. Calamansi b. Ginger c. Breastmilk d. Cough syrups ANSWER: D Rationale: To soothe the throat and relieve cough with a safe remedy the ff are recommended: breastmilk for exclusively breastfed infant, tamarind, calamansi and ginger. On the other hand, the nurse should discourage the ff harmful remedies: Codeine cough syrups other cough syrups and oral and nasal decongestants. Reference: IMCI 2009 edition SITUATION: Todays pediatric nurse faces an array of challenges in providing care for children and their families. A nurse requires competent skills form wide spectrum of both technological and psychosocial disciplines. 36. Nurse Hannah is assessing a healthy neonate upon admission to the nursery. Which characteristic would the admitting nurse record as normal? a. Hypertonia c. Head circumference measuring 31 cm b. Irregular respiratory rate of 50 bpm d. High-pitched or shrill cry ANSWER: B The normal respiratory rate is between 30 and 60, characterized by shallow, irregular breaths, often interrupted by short periods of apnea lasting 5 to 15 seconds. Hypertonia or a high pitched/shrill cry may indicate neurologic

impairment or a drug withdrawal and normal head circumference is 33-35 cm Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition 37. The nurse is caring for a child with hemophilia who is actively bleeding. Which nursing action is most important in the prevention of the crippling effects of bleeding? a. Active range of motion c. Encourage genetic counseling b. Avoidance of all dental care d. Elevate and immobilize the affected extremity ANSWER: D Repeated Hemarthrosis may result in flexion contractures andjoint fixations. During bleeding episodes, the affected joint must be elevated and immobilized to prevent the crippling effects of bleeding. Active range of motion is contraindicated during a bleeding episode. Dental care and genetic counseling are both appropriate, but neither is a priority action during a bleeding episode. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition 38. An infant is being treated for talipes equinovarus. Which statement by the childs mother indicates the best understanding of the casting process? a. My child will have successive casts until the desired results are achieved b. Wearing cast is very painful, so Ill need to medicate her every 4 hours c. Once the cast is on, it will remain on until the deformity is corrected d. My child will be immobilized and confined to an infant seat ANSWER: A Cast changes will be repeated throughout the course of treatment, usually every 1-2 week period. Although casts may feel heavy, continuous pain would need to be reported to the physician. Age appropriate activity should be encouraged. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition 39. A young child is admitted with acute epiglotittis. Which is of the highest priority as the nurse plans care? a. Assessing the airway frequently c. Administering cough medicine as ordered b. Turning, coughing, and deep breathing d. Encouraging the child to eat ANSWER: A Airway occlusion frequently occurs with epiglotittis. No liquid medications or food should be administered at this time, because of the swelling of the infected tissue in the throat which may block the airway and cut off breathing. Turning, coughing and deep breathing are not a priority at this time as for a client with a lung condition, such as pheumonia. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition 40. A young child with high bronchial asthma is admitted for the second time in 1 month. Cystic fibrosis is suspected. Which physiological assessment is most likely to be seen in the child with cystic fibrosis? a. Expectoration of large amounts of thin, frothy mucus with coughing, and bubbling rhonchi for lung sounds

b. High serum NaCl levels and low NaCl levels in the sweat c. Large, loose, foul-smelling stools with normal frequency or a chronic diarrhea of unformed stools d. Obesity from malabsorption of fats and polycythemia from poor oxygenation of tissues ANSWER: C The obstruction of the pancreatic duct with thick mucus prevents digestive enzymes from entering the duodenum, thus preventing digestion of food. Undigested food (mainly fats and proteins) are excreted in the stool, increasing the bulk to twice the normal amount. Expectoration is very difficult because the excess mucus produced is tenacious and viscous. Elevated sweat chloride above 60 mmol/L is consistent with the diagnosis of cystic fibrosis Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition 41. Which finding would alert the nurse to potential problems in a newly delivered term infant of a mother whose blood type is O negative? a. Pallor c. Infants blood type is O negative b. Negative direct Coombs d. Resting heart rate is 155 ANSWER: A When maternal sensitization occurs, maternal antibodies destroy the fetus red blood cells, leading to anemia and pallor. Negative direct Coombs indicates no development of maternal antibodies; O negative would not present an incompatibility; HR of 155 is a normal finding. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition 42. A 10-year old child is admitted to the hospital with sickle cell crisis. Which client goal is most appropriate for this child? a. The client will participate in daily aerobic exercises b. The client will take an antibiotic until the temperature is within normal limits c. The client will increase fluid intake d. The client will utilize cold compress to control pain ANSWER: C Adequate hydration prevents sickling and delays the stasis thrombosis-ischemic cycle. Exercise should be avoided because it causes cellular metabolism; antibiotics are given only for 7-10 days; and cold enhances vasoconstriction. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition

44. A child has cerebral palsy and is hospitalized for corrective surgery for muscle contractures. What is the most important immediate postoperative goal? a. Ambulate using adaptive devices c. Verbalize pain control b. Demonstrate optimal oxygenation d. Complete daily self-care needs ANSWER: B Oxygenation is the most important immediate goal. Remember the ABCs of client care. The other choices are appropriate goals, but not as important as oxygenation Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition 45. The nurse is teaching the parents of a child who is being treated in clinic for otitis media. Which of the following statements is essential to include in the teaching? a. Do not take acetaminophen as this is contraindicated c. Do not apply heat to the ear b. Take the medication until the pain and fever are gone d. Take all of the medication as ordered ANSWER: D To prevent reinfection, the entire prescribed antibiotic needs to be taken, with a course of treatment lasting 7 to 10 days. Acetaminophen is the drug of choice instead of aspirin; heat helps to decrease pain. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition 46. The nurse is assessing a newborn 5 minutes after birth. He has full flexion of the extremities, is acrocyanotic, has a heart rate of 124, a full, lust cry, and resists the suction catheter. The nurse should record the Apgar score as: a. 6 b. 7 c. 8 d. 9 ANSWER: D Nine is the correct answer. The baby gets 2 points for full flexion of the extremities, 1 point for being acrocyanotic, 2 points for heart rate, 2 points for respirations (full, lust cry), and 2 points for resisting suction catheter. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition 47. The mother of a newborn learns that her infant son has lost 8 oz since birth 2 days ago. The nurse explains that this weight loss is normal. What explanation will the nurse provide for the weight loss result? a. Feeding infants every 4 hours instead of every 3 hours c. Limited food intake since birth b. Loss of fluid from the cord stump d. Regurgitation of feedings ANSWER: C Weight loss occurs through excessive extracellular fluid loss, meconium loss, and limited food intake. Infants take in small amounts of feedings and energy expenditure exceeds intake. 48. A 4-week-old premature infant has been receiving epoetin alfa (Epogen) for the last three weeks. Which assessment finding indicates to the nurse that the drug is effective? a. Slowly increasing urinary output over the last week. c. Changes in apical heart rate from the 180s to the 140s. b. Respiratory rate changes from the 40s to the 60s. d. Change in indirect bilirubin from 12 mg/dl to 8 mg/dl. ANSWER: C

43. The nurse has been instructing the parents of a toddler about nutrition. Which of the following statements best indicates the parents understanding of an appropriate diet for a toddler? a. Its unusual for a toddler to be a picky eater b. A multivitamin each day will meet my childs nutritional needs c. Toddler needs servings from each food group daily d. Toddlers should still be eating prepared junior foods ANSWER: C Toddlers present a challenge to parents because they are picky eaters, so food choices would include a variety of food servings from all food groups. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition

Epogen, given to prevent or treat anemia, stimulates erythropoietin production, resulting in an increase in RBCs. Since the body has not had to compensate for anemia with an increased heart rate, changes in heart rate from high to normal is one indicator that Epogen is effective. Option A is not related to Epogen administration. Respiratory rate should decrease rather than increase (Option B) with Epogen administration. Option D is usually related to resolution of hyperbilirubinemia, treated with phototherapy or increased oral intake in the infant. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition 49. Immediately after birth a newborn infant is suctioned, dried, and placed under a radiant warmer. The infant has spontaneous respirations and the nurse assesses an apical heart rate of 80 beats/minute and respirations of 20 breaths/minute. What action should the nurse perform next? a. Initiate positive pressure ventilation. c. Initiate CPR on the infant. b. Intervene after the one minute Apgar is assessed. d. Assess the infant's blood glucose level. ANSWER: A The nurse should immediately begin positive pressure ventilation because this infant's vital signs are not within the normal range, and oxygen deprivation leads to cardiac depression in infants. (The normal newborn pulse is 100 to 160 beats/minute and respirations are 40 to 60 breaths/minute.) Waiting until the infant is 1 minute old to intervene may worsen the infant's condition. According to neonatal resuscitation guidelines, CPR is not begun until the heart rate is 60 or below or between 60 and 80 and not increasing after 20 to 30 seconds of PPV. Option D can be checked after treating the respiratory rate. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition 50. A newborn, whose mother is HIV positive, is scheduled for follow-up assessments. The nurse knows that the most likely presenting symptom for a pediatric client with AIDS is: a. Shortness of breath b. Joint pain c. A persistent cold d. Organomegaly ANSWER: C Respiratory tract infections commonly occur in the pediatric population. However, the child with AIDS has a decreased ability to defend the body against these infections and often the presenting symptom of a child with AIDS is a persistent cold. Options A, B, and D are symptoms of complications which may occur later in the disease process. 51. The nurse in a well baby clinic is assessing a 12-month old child. He is 30 inches tall and weighs 30 lb. His birth weight is 8 lbs. How does the nurse interpret this data? a. Normal height, increased weight c. Small for age, normal weight b. Normal height, decreased weight d. Tall for age, but weight appropriate for height ANSWER: A Normal height is 29-32 inches; weight is tripled by the age of 1 year. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition

52. The mother of an infant who has had a cleft lip repair has been taught the postoperative care needed. What does the nurse hope to see when evaluating this mothers understanding of this care? a. Positioning the child on his abdomen to facilitate drainage of oral secretions b. Comforting the child as soon as he starts to fuss, to prevent his crying c. Using a regular bottle nipple to feed the infant in a semi-reclining position d. Cleaning the suture line with warm water and washcloth once a day ANSWER: B Crying pulls the edges of suture line and may widen the scar line. The baby should be prevented from crying as much as possible by keeping the infants needs met and providing postoperative analgesia. Prone position is avoided as the infant can move back and forth on the bed, putting tension on the sutures and Logan bar. Drainage secretions are suctioned by a bulb syringe or placing the infant on his side. Special nipples are available to allow closure of the jaw without damaging the lip repair. Cleaning is performed as a sterile procedure with the use of cotton applications dipped in saline (as ordered). Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition SITUATION: Because pregnancy is a physiologic process, the health sector aims to make pregnancy for the women and gestation for the fetus as safe and medically uneventful as far as possible. 53. The 2000 Philippine Health Statistics revealed that the main cause of reported maternal deaths is due to: a. Postpartum hemorrhage b. Pregnancy with abortive outcomes c. Hypertension d. None of the above ANSWER: C The 2000 Philippine Health Statistics revealed that the main cause of reported maternal deaths is due to hypertension accounting for 25%. This is closely followed by postpartum hemorrhage with 20.3% and pregnancy with abortive outcomes which are neither preventable nor non predictable with a percentage of 9%. Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. 54. Every woman has the right to visit the nearest health care facility for antenatal registration and to avail prenatal care services. How often should the expectant mother visit the health center when she is on her 8th month of pregnancy? a. Every other day after the 8th month of pregnancy till delivery b. Every week after the 8th month of pregnancy till delivery c. Every 2 weeks after the 8th month of pregnancy till delivery d. None of the above ANSWER: C The expectant mother should visit the barangay health center every 2 weeks after the 8th month of pregnancy until delivery. The first visit should be done early in the pregnancy as possible before four months or during the first

trimester. The 2nd visit should be during the 2nd trimester and the third visit on the 3rd trimester. Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. 55. Tetanus toxoid vaccination is important for pregnant women and child bearing women to prevent them and their baby from acquiring tetanus. How many doses of Tetanus Toxoid vaccine should be given to the mother in order to protect the baby from acquiring neonatal tetanus? a. One dose b. Two doses c. Three doses d. Four doses ANSWER: B When two doses of Tetanus Toxoid injection are given at one month interval between each dose during pregnancy or even before pregnancy period, the baby is protected against neonatal tetanus. Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. 56. How many doses of Tetanus Toxoid vaccine are needed to protect a mother and her baby against the disease, during her pregnancy and for lifetime immunity? a. Three doses b. Four doses c. Five doses d. Six doses ANSWER: C When five doses of Tetanus Toxoid injection are given, the mother and her baby is protected against the disease, during her pregnancy and for lifetime immunity. Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. 57. Micronutrient supplementation is vital for pregnant women. To prevent Vitamin A deficiency, pregnant women should receive vitamin A 10,000 IU starting: a. First trimester c. 2 weeks before delivery b. Second trimester onwards d. 1 month after delievry ANSWER: B Vitamin A supplementation is only given during the 4th month of pregnancy onwards. It is not given before the 4th month of pregnancy because it might cause congenital problems in the baby. Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. 58. A pregnant woman with hypertension is suffering from postpartum hemorrhage. The following are the first aid measures to be done by the community health nurse, except: a. Massage uterus and expel clots b. Give Ergometrine 0.2 mg IM and another dose after 15 minutes c. Place cupped palmed hands on the uterine fundus and feel for the state of contraction d. Apply bimanual uterine compression if postpartum bleeding still persists ANSWER: B Ergometrine 0.2 mg IM is only given when the pregnant woman is not suffering from pre-eclampsia, eclampsia or hypertension. Options A, C and D are all first aid measures treatment for postpartum bleeding that the community heath nurse should perform.

Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. 59. The community health nurse should give supportive care to the pregnant mother during labor. The nurse should do the following, except: a. Encourage the mother to take a bath during the onset of labor b. Encourage the mother to drink and eat when she feels hungry c. Remind the mother to empty the bladder every 2 hours d. Encourage the mother to do breathing exercises for her to have energy in pushing the baby out of her birth canal. ANSWER: B Options A, C and D are all supportive care the nurse can give to the mother. This will help her deliver clean, safe and free from fatigue. Option B is the answer because the nurse should encourage the mother to drink but not to eat as this may interfere with surgery in case needed. Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. 60. The nurse should assess the progress of labor. She knows that the pregnant woman is in false labor if: a. The cervix is dilated 4 cm c. The membranes are not ruptured b. There is an increase in contractions d. All of the above ANSWER: C The nurse knows it is false labor when there is no cervical dilatation, there is no increase in uterine contractions after 8 hours and the membranes have not ruptured. Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. 61. The community health nurse should counsel the mother on the recommended schedule of her first postpartum visit, which is: a. 3-5 days after delivery b. 6 weeks after delivery c. A day after delivery d. 3 weeks after delivery ANSWER: A The recommended schedule for the first visit should be the 1st week post partum preferably 3-5 days after delivery. The second visit should be done six (6) weeks postpartum. Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. 62. During family planning counseling sessions, the nurse should include which topic in the discussion? a. Birth control methods b. Birth spacing c. Ideal number of children d. All of the above ANSWER: D The nurse should discuss the following about Family Planning (FP): 1) family planning methods, 2) proper spacing of births it has been said that the birth spacing of 3 to 5 years interval will help the mother completely recover from previous pregnancy and childbirth and 3) the right number of children Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The Philippines.10th ed. 63. It is the nurses responsibility to give the couple enough information about the different methods of contraception.

What are the factors that should be considered in method selection? a. The age of the woman c. The effectiveness of a method b. The woman's reproductive stage d. All of the above ANSWER: D All of the following factors should be considered when helping the couples choose the best method of contraception. a) The age of the woman- there are methods that are appropriate to use according to a womans age, b) The woman's reproductive stage- there are methods that are appropriate to use according to a womans reproductive stage c) The effectiveness of a method, and d) The womans health status. Reference: Department of Health. URL: http://www.doh.gov.ph 64. A population pyramid is a graphical illustration that shows the distribution of various age groups in a human population which normally forms the shape of a pyramid. A population pyramid with a broad base indicates: a. Higher proportion of children and a low proportion of older people b. Higher proportion of older people and a low proportion of children c. Higher female populations d. Higher male populations ANSWER: A A population pyramid showing a broad base, indicating a high proportion of children, a rapid rate of population growth, and a low proportion of older people. This wide base indicates a large number of children. A steady upwards narrowing shows that more people die at each higher age band. This type of pyramid indicates a population in which there is a high birth rate, a high death rate and a short life expectancy. This is the typical pattern for less economically developed countries, due to little access to and incentive to use birth control, negative environmental factors (for example, lack of clean water) and poor access to health care. Reference: http://en.wikipedia.org/wiki/Population_pyramid 65. A mother who wishes to use Lactation Amenorrhea method as a form of family planning method should be instructed: a. To use other forms of FP methods after 3 months b. About the potential side effects c. To wait for at least 1 month to be more effective as a FP method d. Alternate breastfeeding with formula feeding to be more effective ANSWER: C Lactating Amenorrhea Method or LAM is a temporary postpartum method of postponing pregnancy based on physiological infertility experienced by breast feeding women. As a rule, after 3 months of breastfeeding, the woman should be advised to choose another method of contraception. Reference: Pillitteri, A..Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 6th Edition, Vol. 1 Page 123 66. In providing guidance for a couple wishing to avoid pregnancy, the nurse reviews the record of a client who has a

normal 29-day cycle. On which of the following days would the nurse expect the client to ovulate? a. Day 5 or 6 b. Day 13 or 14 c. Day 15 or 16 d. Day 28 or 29 ANSWER: C Ovulation occurs most commonly 14 days before the next menstrual period. In a 29-day cycle, this would be day 15 or 16. Option A and B are incorrect because it describes a time prior to normal ovulation. Option D is incorrect because ovulation occurs before the last week of the menstrual cycle. Reference: Pillitteri, A.. (2007). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 5th Edition, Vol. 1 Page 110 67. A client who is taking oral contraceptives should immediately report which symptom associated with the adverse effect of OCs? a. Blurred vision b. Nausea c. Breakthrough bleeding d. Breast tenderness ANSWER: A Options B, C and D are the common side-effects of OCs. They usually subside after a few months of use or may be managed by a different routine or brand of contraceptive. Option A is an adverse effect of OCs. It might indicate a cerebrovascular accident occurring and thus must be reported immediately to their health care provider. Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 6th Edition, Vol. 1 Page 125 68. A mother asks Nurse Basyang about subcutaneous implants and how long will the implants be effective. Her best response is: a. It is effective for one month c. It is effective for up to 5 years b. It is effective for twelve months d. It is effective for ten years ANSWER: C Subcutaneous implants or Norplant consists of six nonbiodegradable Silastic implants that are filled with synthetic progesterone and embedded just under the skin on the inside of the upper arm. Once embedded, the implants appear only as irregular lines, simulating small veins. Over the next three (3) to five (5) years, the implants slowly release the hormone, suppressing ovulation, stimulating thick cervical mucus and changing the endometrium so that the ovulation is difficult. Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 6th Edition, Vol. 1 Page 129 69. A client who gave birth to a healthy 8 pound infant 3 hours ago is admitted to the postpartum unit. Which nursing plan is best in assisting this mother to bond with her newborn infant?

a. Encourage the mother to provide total care for her infant. b. Provide privacy so the mother can develop a relationship with the infant. c. Encourage the father to provide most of the infant's care during hospitalization. d. Meet the mother's physical needs and demonstrate warmth toward the infant. ANSWER: D It is most important to meet the mother's requirement for attention to her needs so that she can begin infant caretaking (option D). Nurse theorist Reva Rubin describes the initial postpartal period as the "taking-in phase," which is characterized by maternal reliance on others to satisfy the needs for comfort, rest, nourishment, and closeness to families and the newborn. Option A could impede development of maternal bonding. Option B is important but not the priority. Option C might encourage paternal bonding, but does not specifically encourage maternal bonding. Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 6th Edition 70. Which maternal behavior is the nurse most likely to see when a new mother receives her infant for the first time? a. She eagerly reaches for the infant, undresses the infant, and examines the infant completely. b. Her arms and hands receive the infant and she then traces the infant's profile with her fingertips. c. Her arms and hands receive the infant and she then cuddles the infant to her own body. d. She eagerly reaches for the infant and then holds the infant close to her own body. ANSWER: B Attachment/bonding theory indicates that most mothers will demonstrate behaviors described in option B during the first visit with the newborn, which may be at delivery or later. After the first visit, the mother may exhibit greater affection such as eagerly reaching, hugging, etc. 71. A client who is attending antepartum classes asks the nurse why her healthcare provider has prescribed iron tablets. The nurse's response is based on what knowledge? a. Supplementary iron is more efficiently utilized during pregnancy. b. It is difficult to consume 18 mg of additional iron by diet alone. c. Iron absorption is decreased in the GI tract during pregnancy. d. Iron is needed to prevent megaloblastic anemia in the last trimester. ANSWER: B Consuming enough iron-containing foods to facilitate adequate fetal storage of iron and to meet the demands of pregnancy is difficult so iron supplements are often recommended. Dietary iron is just as "good" as iron in tablet form. Iron absorption occurs readily during pregnancy, and is not decreased within the GI tract. Megaloblastic anemia is caused by folic acid deficiency. Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 6th Edition

72. When educating a pregnant client about home safety, which of the following information is least appropriate for the nurse to include in the teaching plan? a. When taking a shower, place a non-skid mat on the floor of the tub or shower. b. Avoid climbing stairs c. Avoid wearing high heels. d. Use non-slip rugs on the floors. ANSWER: B A woman's center of gravity changes during pregnancy, increasing her risk of falls. She should use a non-skid mat in the tub or shower. Wearing high heels will increase unbalance and can contribute to falls. Non-slip rugs will prevent tripping and falling. There is no reason that a pregnant woman in good health should avoid climbing stairs; in fact, stair climbing is good exercise. Reference: Pilliteri, A. (2007). Maternal & Child Health Nursing: Care of the Childbearing & Childbearing Family. 5th Edition, Vol. 1. Page 364. 73. A woman comes to the health clinic because she thinks she is pregnant. Tests are performed and the pregnancy is confirmed. The clients last menstrual period began on September 8 and lasted for 6 days. The nurse calculates that her expected date of confinement (EDC) is: a. May 15 b. June 15 c. June 21 d. July 8 ANSWER: B EDC is calculated according to Nageles rule (first day of the last normal menstrual period -3 months and +7 days and 1 year). Assumes that every woman has a 28 day cycle and pregnancy occurred on fourteenth day. Most women deliver within period extending from 7 days before to 7 days after the EDC. September 8 - 3 months = June 8 + 7 days = June 15 of next year. Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 6th Edition 74. A woman comes to the clinic for routine prenatal check-up at 34 weeks gestation. Abdominal palpation reveals the fetal position as right occipital anterior (ROA). At which of the following sites would the nurse expect to find the fetal heart tone? a. Below the umbilicus, on the mothers left side c. Above the umbilicus, on the mothers left side b. Below the umbilicus, on the mothers right side d. Above the umbilicus, on the mothers right side ANSWER: B Describing fetal position is the practice of defining position of baby relative to mothers pelvis. The point of maximum intensity (PMI) of the fetus is a point on mothers abdomen where FHT is the loudest, usually over the fetal back. Divide mothers pelvis into 4 parts or quadrants: right and left anterior (front), and right and left posterior (back). Abbreviated as R and L for right and left, and A and P for anterior and posterior. The head, particularly the occiput, is the most common presenting part, and is abbreviated O. LOA is most common fetal presentation and FHT heard on

left side. In a vertex presentation, FHT is heard below the umbilicus. In a breech presentation, FHT is heard above umbilicus. Occiput and back are pressing against right side of mothers abdomen; FHT would be heard below umbilicus on right side. Reference: Pilliteri, A. (2007). Maternal & Child Health Nursing: Care of the Childbearing & Childbearing Family. 5th Edition, Vol. 2. Page 475-476. 75. Mrs. Dimaano complains about her morning sickness. The nurse provides health teachings to the client. Which of the following statements made by the client indicates a need for further instruction by the nurse? a. I will avoid spicy or fatty foods c. I will eat small frequent meals b. I will postpone eating until supper d. I will eat crackers and dry toast before arising ANSWER: B Standard measures for control of morning sickness include eating crackers or toast before arising from bed in the morning, eating small frequent meals, avoiding fatty and spicy foods, and arising slowly to avoid orthostatic hypotension. Delaying eating until suppertime does not promote proper nutrition for the pregnant woman and fetus. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed. 76. Nurse Mian is preparing to assist in performing Leopolds maneuver to a pregnant client. Which of the following should the nurse include in preparing the client for this procedure? a. Tell the client to drink a glass of water before the procedure b. Locate the fetal heart tones c. Tell the client to void before beginning the examination d. Advise the client not to eat anything 4 hours before the exam ANSWER: C An empty bladder contributes to a womans comfort during the examination. Drinking water to fill the bladder may be performed before a sonogram but are not applicable to performing Leopold maneuvers. Often the Leopold maneuvers are performed to aid the examiner in locating the fetal heart tones. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed. 77. Mrs. Makiss is scheduled for a nonstress test. After the test, the result documented on the chart is no accelerations during the 40 minute observation. The nurse interprets these findings as: a. A reactive stress test c. An unsatisfactory stress test b. A nonreactive stress test d. The results are inconclusive ANSWER: B A reactive nonstress test (normal/negative) indicates a healthy fetus. It is described as two or more fetal heart rate (FHR) accelerations of at least 15 beats or more lasting at least 15 seconds from the beginning of the acceleration to the end in association with fetal movement, during a 20 minute period. A nonreactive nonstress test (abnormal) is described as no accelerations or accelerations of less than 6 beats per minute or lasting less than 15 seconds in

duration for a chosen time period. An unsatisfactory test cannot be interpreted because of the poor quality of the FHR. The results are conclusive as nonreactive. Reference: Pilliterri, A Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed. 78. Another client had a nonstress tests for the past few weeks and the results were reactive. A few minutes ago, the results were nonreactive. The nurse anticipates that the client will be prepared for: a. A return appointment in 2 to 7 days to repeat the nonstress test b. A contraction stress test c. Hospital admission with continuous fetal monitoring d. Immediate induction of labor ANSWER: B A nonreactive nonstress test needs further assessment. There is not enough data in the question to indicate that the procedures in options c and d are necessary at this time. To send the client home for 2 to 7 days may place the fetus in jeopardy as in option a. A contraction stress test is the next test needed to further assess the fetal status. Reference: Pilliterri, A Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed. 79. A pregnant woman is having a contraction stress test (CST) preformed. Which of the following shows a negative test result? a. 50% or more contractions cause a late deceleration b. No FHR decelerations occur with contractions c. Decrease in FHR that occurs toward the end of a contraction and continues after the contraction d. All of the options indicate a negative result ANSWER: B The CST is negative or normal if no fetal heart rate decelerations occur with contractions. Options a and c indicates that the CST is positive or abnormal. Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th ed page 204 80. During her first trimester, a woman experiences many physiologic changes that lead her to think she is pregnant. Which of the following changes will the nurse likely tell her are normal changes for an 8 week pregnancy? a. Dysuria b. Colostrum secretion c. Nosebleeds d. Dependent edema ANSWER: C Epistaxis occurs in the 1st trimester. It is related to capillary dilation. Dysuria is an abnormal condition with urinary tract infection; colostrums occurs at 16 weeks gestation; and dependent edema may occur in the third trimester 81. Following her babys birth, the womans uterine fundus is soft, midline, 2 cm above the umbilicus, and she has saturated two pads within 30 minutes. Which immediate need by the client should be addressed? a. Be cleaned and have another pad change c. Have an increase in her IV fluids of Ringers Lactate

b. Empty her bladder d. Have her fundus massaged ANSWER: D Massaging the fundus is most important because her uterus is soft and higher than normal. Fundal massage causes uterine contraction leading to vasoconstriction, which will lead to decreased bleeding. Cleaning and pad change along with replacing IV fluid are important, but not before an action to decrease bleeding. Information given does not indicate the bladder is full. 82. Nurse Junifer is caring for a woman who is having labor induced with an oxytocin (Pitocin) drip. Which assessment of the client indicates there is a problem? a. The fetal heart rate is 160 beats per minute c. Contraction duration is 60 seconds b. The woman has three contractions in 5 minutes d. Early fetal rate decelerations are occurring ANSWER: B If the woman has more than three contractions in 5 minutes, the oxytocin should be discontinued. Normal fetal heart rate is 120-160 bpm; normal contraction is 40-90 seconds; early decelerations indicate fetal head compression but not distress. 83. Mrs. Fortalejo is in labor and taking three cleansing breaths followed by four, slow, deep breaths with each contraction. She is experiencing much discomfort with her contractions. What action is most appropriate for the nurse to take? a. Demonstrate to Mrs. Fortalejo a different breathing pattern during contractions b. Ask the physician for an order of pain medication c. Have the man take a break and instruct Mrs. Fortalejo in another breathing pattern d. Leave the couple alone as they have their routine established ANSWER: A Appropriate demonstration does not belittle the man or diminish his wifes confidence in him. This allows the man to maintain continued control in the situation. 84. Nurse Kristine is teaching childbirth education classes. What topic should be included during the second trimester? a. Overview of the conception c. Infant care b. Medication and breastfeeding d. Strategies to relieve the discomforts of pregnancy ANSWER: D Many discomforts arise during the second trimester and information regarding relief will make pregnancy much more comfortable. The other topics would be discussed at other periods of pregnancy. 85. Nurse Esther is caring for a woman in labor who suddenly complains of dizziness, becomes pale, and has a 30point drop in her BP with an increase in pulse rate. What is the most appropriate initial nursing action? a. Turn her to her left side c. Notify her physician b. Have her breathe into a paper bag d. Increase her IV fluids ANSWER: A

The signs and symptoms described are those of vena caval syndrome. It is most important to remove the gravid uterus from the inferior vena cava and aorta. Turning the woman to the left side will accomplish this. 86. A woman is 25% over her ideal weight of 140 pounds. She would like to lose weight before becoming pregnant. The woman is 2 months into her weight loss program. Which indicates she is following proper weight management principles? a. Carefully selects only carbohydrate and fat choices for meals b. Has lost a total of 4 pounds c. Is now 5% over her ideal weight d. Goes to beginning aerobics for three times a week ANSWER: D Traditional weight loss programs combine dieting, exercise, psychosocial support, and behavior modification. Protein should be included in the diet; a 4 lb weight is inadequate for 2 months; or has occurred too quickly, respectively. 87. A 38-week primigravida who works as a secretary and sits at a computer 8 hours each day tells the nurse that her feet have begun to swell. Which instruction would be most effective in preventing pooling of blood in the lower extremities? a. Wear support stockings c. Move about every hour b. Reduce salt in her diet d. Avoid constrictive clothing ANSWER: C Pooling of blood in the lower extremities results from the enlarged uterus exerting pressure on the pelvic veins. Moving about every hour (C) will straighten out the pelvic veins and increase venous return. (A) increase venous return from varicose veins in the lower extremities, but are little help with swelling. (B) might be helpful with generalized edema (which could be an indication of PIH) but is not specific for edematous lower extremities. (D) does not specifically address venous return in this particular case. Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 6th Edition 88. A client receiving epidural anesthesia begins to experience nausea and becomes pale and clammy. What intervention should the nurse implement first? a. Raise the foot of the bed c. Evaluate the fetal heart rate b. Assess for vaginal bleeding d. Take the client's blood pressure ANSWER: A These symptoms are suggestive of hypotension which is a side effect of epidural anesthesia. Raising the foot of the bed will increase venous return and provide blood to the vital areas. Increasing the IV fluid rate using a balanced nondextrose solution and ensuring that the client is in a lateral position are also appropriate interventions. Options B and C will not raise the maternal blood pressure. Since the symptoms are common side effects of epidural anesthesia and suggest hypotension, option D can wait until option A is implemented. Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 6th Edition

89. A 37-week gestation neonate has just been born to a woman with insulin-dependent diabetes mellitus and is admitted to the nursery. Which of the following is most essential when planning immediate care for the infant? a. Glucose monitoring b. Daily weights c. Supplemental formula feedings d. An apnea monitor ANSWER: A Because the infant is no longer exposed to the mothers high circulating glucose levels and its own pancreas is still secreting insulin on response to the glucose, the infant is subject to hypoglycemia. Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 6th Edition 90. A 34 week pregnant client calls the clinic complaining of severe headache, blurred vision, and swollen feet. The nurse expects the physician to tell the client to: a. Have it checked in the hospital b. Come to the clinic tomorrow morning c. Decrease salt intake and increase fluids d. Rest for 4 hours a day for 3 days and come to the clinic if symptoms persist ANSWER: A Swelling feet, blurred vision and severe headache are danger signs of pregnancy. Delaying or dismissing these symptoms would endanger both the mother and the fetus. Reference: Adele Pillitteri. Maternal and Child Health Nursing 5th edition Page 287 91. Nurse Grasya went to give her morning care to a postpartum mother, she observed the mother talking to the baby, checking diaper, and asking infant care questions. Nurse Grasya determines that the client is in which postpartal phase of psychological adaptation? a. Taking in b. Taking on c. Taking hold d. Letting go ANSWER: C After a time of passive dependence, the woman begins to initiate action which signals that the client is in the taking hold phase with a demonstrated focus on the neonate and learning about and fulfilling infant care and needs. As a rule, therefore it is always best to give a woman brief demonstrations of baby care and then allow her to care for her child herself with watchful guidance Taking In phase is the first period after delivery where there is emphasis on reviewing and reliving the labor and delivery process, concern with self and needing to be mothered. Eating and sleeping are high priorities during this phase. Taking on- is not a phase of postpartum psychological adaptation Letting go is the process beginning about 6 weeks postpartum when the mother may be preparing to go back to work and defines her new role Reference: A. Pillitteri. Maternal and Child Nursing. 5th Edition. Page 624.

92. During an initial prenatal visit a pregnant client states she has had 2 miscarriages at 12 weeks and 13 weeks, one child delivered at 38 weeks, and another child delivered at 40 weeks. The nurse documents this as: a. G4P2/T2A2 b. G3P3/T2A1 c. G3P2/T2A2 d. G4P3/T3A0 ANSWER: A G4P2/T2A2 is accurate due to the current pregnancy, 2 term births, and 2 abortion. Reference: Adele Pillitteri. Maternal and Child Health Nursing 5th edition Page 253 93. A woman who is 24-hours postpartum and who has an episiotomy would be instructed to report which of the following findings immediately? a. Decrease in urine output c. Presence of lochia rubra b. Absence of a daily bowel movement d. Increase in perineal pain sensation ANSWER: D Signs of an infected episiotomy include pain, redness, warmth, swelling and discharge. Option A: Hormonal changes cause an increase in renal function during pregnancy. Decreased steroid levels may partially explain the reduction of renal function in the postpartum period. Option B: Spontaneous bowel evacuation may be delayed up to two to three days after childbirth. Option C: Lochia rubra begins to turn brown three to four days after childbirth. Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition. Page 94. A client in active labor is admitted with preeclampsia. Which assessment finding is most significant in planning this client's care? a. Patellar reflex 4+. c. Four-hour urine output 240 ml. b. Blood pressure 158/80. d. Respiration 12/minute. ANSWER: A A 4+ reflex in a client with pregnancy-induced hypertension indicates hyperreflexia, which is an indication of an impending seizure. Although option B is significant, some individuals have preeclampsia superimposed on chronic hypertension, and an elevated blood pressure alone is not as significant a finding as option A. Options C and D are important, but these findings are within normal range. Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th edition 95. When explaining "postpartum blues" to a client who is 1 day postpartum, which symptoms should the nurse include in the teaching plan? 1. Mood swings 3. Tearfulness 5. Disinterest in the infant 2. Panic attacks 4. Decreased need for sleep a. 1 and 3 b. 1, 3, 4 c. All except 2 d. All of the above ANSWER: A "Postpartum blues" is a common emotional response related to the rapid decrease in placental hormones after delivery and include mood swings (1), tearfulness (3), feeling low, emotional, and fatigued. Numbers 2, 4, and 5 are more characteristic of postpartum depression that typically occurs 3 to 7 days later than postpartum blues.

Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th edition 96. A primigravida client with severe preeclampsia is receiving magnesium sulfate via continuous IV infusion. Which assessment data indicates to the nurse that the client is experiencing magnesium sulfate toxicity? a. Deep tendon reflexes 2+. c. Respiratory rate 18/minute. b. Blood pressure 140/90. d. Urine output 90 ml/4 hours. ANSWER: D Urine outputs of less than 100 ml/4 hours, absent DTRs, and a respiratory rate of less than 12 breaths/minute are cardinal signs of magnesium sulfate toxicity. Options A, B, and C do not indicate a magnesium sulfate toxicity. Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th edition 97. A woman with severe PIH was delivered 2 hours ago. Which nursing action should be included in the plan of care for her postpartum hospital stay? a. Continuing to monitor blood pressure, respirations and reflexes b. Encouraging frequent family visits c. Keeping her NPO d. Maintain an IV access to the circulatory system ANSWER: A Post delivery management of the mother includes close observation for BP elevation, CNS irritability (visitors are limited), and respiratory function. The client is at risk for seizure for 24 hours after delivery. Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th edition 98. Discharge instructions are given to a woman who had been admitted with placenta previa. Which statement by the client to her husband best demonstrates she understands the teaching? a. We cant have sex b. I have to return in a few days for a vaginal exam c. I will have to have a caesarian delivery for this and other pregnancies d. I can go back to part-time work beginning tomorrow ANSWER: A Sexual intercourse is avoided as it causes uterine contractions, contributing to further placental separation or dislodge the placenta. The client will not have vaginal examination (as it can cause further separation of the placenta); cesarian will be evaluated at a later time; bed rest is recommended. Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th edition 99. The nurse is caring for a woman who is 35 weeks pregnant. She comes to the emergency room with painless, vaginal bleeding. This is her third pregnancy and she states that this has never happened before. What would be avoided in caring for this client? a. Allowing her husband to stay with her c. Shaving the perineum b. Keeping her at rest d. Performing vaginal examination ANSWER: D

Painless vaginal bleeding is symptomatic of placenta previa. Vaginal exams are contraindicated before 36 weeks unless done in the delivery room set up for emergency cesarian section if needed. Bed rest is essential and shaving is not necessary. Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th edition 100. Nurse Hannah is caring for a woman with a placenta previa who has been hospitalized for several weeks. She is now at 38 weeks gestation and her membranes have ruptured. The amniotic fluid has a greenish color and the woman has started to bleed again. What would the nurses first action? a. Administer oxygen c. Call the doctor and prepare for a cesarian birth b. Place her in trendelenburgs position d. Move her to the delivery room immediately ANSWER: C Green amniotic fluid is indicative of fetal distress. This combined with bleeding from the placenta previa may require a cesarian section. Oxygen and movement to the delivery room may be performed, but notifying the doctor would be a definite plan. Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th edition