In The Pre-Hospital Setting

SITUATION: Every day, millions of parents seek health care for their sick children, taking them to
hospitals, health centers, pharmacists, doctors and traditional healers. Surveys reveal that many sick
children are not properly assessed and treated by these health care providers, and that their parents are
poorly advised. These factors make providing quality care to sick children a serious challenge. WHO
and UNICEF have addressed this challenge by developing a strategy called the Integrated Management
of Childhood Illness (IMCI).
1. The core of the IMCI strategy is integrated case management of the most common childhood
problems, with a focus on the most important causes of death. The components of the IMCI strategy
include:
I.
Improvements in the case-management skills of health staff through the provision of locally
adapted guidelines on IMCI and through activities to promote their use
II.
Improvement of the publics acceptance of IMCI.
III.
Improvements in the health system required for effective management of childhood Illness
IV.
Improvements in family and community practices

1. I,II,III,IV
B. I,III,IV
C. I,II,III
D. II,III,IV
ANSWER: B
RATIONALE: The strategy includes three main components: Improvements in the case-management
skills of health staff through the provision of locally adapted guidelines on IMCI and through activities
to promote their use, Improvements in the health system required for effective management of
childhood illness, and Improvements in family and community practices (IMCI Handbook WHO
2005).
CONCEPT: Integrated Management of Childhood Illness (IMCI)
SUBJECT: Community Health Nursing
REFERENCE:
http://www.who.int/child_adolescent_health/topics/prevention_care/child/imci/en/index.html
2. All but one are reasons why IMCI is better than single-condition approaches:
1. Children brought for medical treatment in the developing world are often suffering from more
than one condition, making a single diagnosis impossible.
2. IMCI is an integrated strategy, which takes into account the variety of factors that put children
at serious risk.
3. It ensures the combined treatment of the major childhood illnesses, emphasizing prevention of
disease through immunization and improved nutrition.
4. D. IMCI provides an avenue in advancing the health care practice among health workers
in the pre-hospital setting.
ANSWER: D
RATIONALE: Why is IMCI better than single-condition approaches?
Children brought for medical treatment in the developing world are often suffering from more than one
condition, making a single diagnosis impossible. IMCI is an integrated strategy, which takes into
account the variety of factors that put children at serious risk. It ensures the combined treatment of the
major childhood illnesses, emphasizing prevention of disease through immunization and improved
nutrition.
REFERENCE:
http://www.who.int/child_adolescent_health/topics/prevention_care/child/imci/en/index.html
3. The clinical guidelines, which are based on expert clinical opinion and research results, are designed
for the management of :
1.
1.
2.
3.
4.
Sick children aged 1 week up to 5 years

Sick children aged 1 month up to 5 years
Sick children aged 1 year up to 5 years
Sick children aged 1 day up to 5 years
ANSWER: A
RATIONALE: The clinical guidelines, which are based on expert clinical opinion and research results,
are designed for the management of sick children aged 1 week up to 5 years. (IMCI Handbook WHO
2005).
4. Which of the following is wrong about IMCI?
1.
1. Integrated case management relies on case detection
2. The treatments are developed according to action oriented classifications rather than
exact diagnosis.
3. The guidelines give instructions for how to routinely assess a child for general danger
signs
4. The treatments are developed according to diagnosis rather than action oriented
classifications
ANSWER: D
RATIONALE: The treatments are developed according to action oriented classifications rather than
exact diagnosis. (IMCI Handbook WHO 2005 p. 3).
5. In the IMCI clinical guidelines, this measures the proportion or percentage of those with the disease
who are correctly identified by the sign.
1.
1. Specificity
2. Sensitivity
3. True positives
4. False positives
ANSWER: B
RATIONALE: Sensitivity measures the proportion or percentage of those with the disease who are
correctly identified by the sign. In other words, it measures how sensitive the sign is in detecting the
disease. (Sensitivity = true positives / [true positives + false negatives]) (IMCI Handbook WHO 2005
p. 3).
6. This measures the proportion of those without the disease who are correctly called free of the
disease by using the IMCI sign guidelines.
1.
1.
2.
3.
4.
Specificity
Sensitivity
True positives
False positives
ANSWER: A
RATIONALE: Specificity measures the proportion of those without the disease who are correctly
called free of the disease by using the sign. (Specificity = true negatives / [true negatives + false
positives]). Sensitivity and specificity measure the diagnostic performance of a clinical sign compared
with that of the gold standard, which by definition has a sensitivity of 100% and a specificity of 100%.
(IMCI Handbook WHO 2005 p. 3).
SITUATION: When assessing a sick child, a combination of individual signs leads to one or more
classifications, rather than to a diagnosis. IMCI classifications are action oriented and allow nurses and
other health care providers to determine if a child should be urgently referred to another health facility.
7. IMCI is a case management process for a first-level facility such as the following,
except:
1.
1.
2.
3.
4.
ANSWER: C
A health center
An outpatient department of a hospital
Hospital pediatric ward
A clinic
RATIONALE: It is a case management process for a first-level facility such as a clinic, a health centre
or an outpatient department of a hospital. Hospital pediatric ward is already classified under secondlevel health care facility (IMCI Handbook WHO 2005 p. 3).
8. The complete IMCI case management process involves the following elements:
I. Assess a child by checking first for danger signs
II. Classify a childs illnesses using a colour-coded triage system.
III. identify specific treatments for the child.
IV. Provide practical treatment instructions
1.
1.
2.
3.
4.
I, II, III
II, III, IV
I, II, IV
I, II, III, IV
ANSWER: D
RATIONALE: All of these are elements of IMCI case management process (IMCI Handbook WHO
2005 p. 4).
9. FOR ALL SICK CHILDREN age 1 week up to 5 years who are brought to the clinic, what is the first
information that you need to ask?
1.
1.
2.
3.
4.
Ask why the child was brought to the clinic

Ask for specific signs and symptoms
Ask the childs age
Ask for danger signs
ANSWER: C
RATIONALE: FOR ALL SICK CHILDREN age 1 week up to 5 years who are brought to the clinic
ask for the childs age first to identify the appropriate IMCI case chart to use in assessment. (IMCI
Handbook WHO 2005 p. 4).
10. The case management process for sick children age 2 months up to 5 years is presented on three
charts. Which chart title is not included?
1.
1.
2.
3.
4.
ASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANT

ASSESS AND CLASSIFY THE SICK CHILD
COUNSEL THE MOTHER
TREAT THE CHILD
ANSWER: A
RATIONALE: If the child is not yet 2 months of age, the child is considered a young infant.
Management of the young infant age 1 week up to 2 months is somewhat different from older infants
and children. It is described on a different chart titled: ASSESS, CLASSIFY AND TREAT THE SICK
YOUNG INFANT (IMCI Handbook WHO 2005).
CONCEPT: Integrated Management of Childhood Illness (IMCI p.5)
11. The IMCI case management charts and recording forms guide you through the following
steps:
1.
1. Assess the sick child or sick young infant; Classify the illness; Identify treatment;
Treat the child or young infant; Counsel the mother; Give follow-up care
2. Assess the sick child or sick young infant; Classify the illness; Identify treatment;
Treat the child or young infant; Give follow-up care Counsel the mother;
3. Assess the sick child or sick young infant; Classify the illness; Treat the child or young
infant; Identify treatment; Give follow-up care ; Counsel the mother;
4. Assess the sick child or sick young infant; Treat the child or young infant ; Classify the
illness; Identify treatment; Counsel the mother; Give follow-up care
ANSWER: A
RATIONALE: The IMCI case management charts and recording forms guide you through the
following steps: Assess the sick child or sick young infant; Classify the illness; Identify
treatment; Treat the child or young infant; Counsel the mother; Give follow-up care (IMCI
Handbook WHO 2005 p.6).
SITUATION: Signs, classifications, treatments and counseling differ between sick young infants and
sick children. It is essential to start the case management process by selecting the appropriate set of
IMCI charts.
12. The ASSESS AND CLASSIFY chart describes how to assess the child, classify the childs illnesses
and identify treatments. This column on the left side of the chart describes how to take a history and do
a physical examination.
1.
1.
2.
3.
4.
Assess and classify column

Classify column
Assess column
Identify column
ANSWER: C
RATIONALE: The ASSESS column on the left side of the chart describes how to take a history and do
a physical examination. You will note the main symptoms and signs found during the examination in
the ASSESS column of the case recording form. (IMCI Handbook WHO 2005 p.8).
13. This column means to make a decision about the severity of the illness.
1.
1.
2.
3.
4.
Treatment column
Classify column
Assess column
Identify column
ANSWER: B
RATIONALE: The CLASSIFY column on the ASSESS AND CLASSIFY chart lists clinical signs of
illness and their classifications. Classify means to make a decision about the severity of the illness. For
each of the childs main symptoms, you will select a category, or classification, that corresponds to
the severity of the childs illnesses. You will then write your classifications in the CLASSIFY column
of the case recording form. (IMCI Handbook WHO 2005 p.9).
14. This part of the assess and classify chart helps you to quickly identify treatment for the
classifications written on your case recording form. Appropriate treatments are recommended for each
classification.
1.
1.
2.
3.
4.
Treatment column
Classify column
Identify Treatment column
Identify column
ANSWER: C
RATIONALE: The IDENTIFY TREATMENT column of the ASSESS AND CLASSIFY chart helps
you to quickly identify treatment for the classifications written on your case recording form.
Appropriate treatments are recommended for each classification. When a child has more than one
classification, you must look at more than one table to find the appropriate treatments. You will write
the treatments identified for each classification on the reverse side of the case recording form. (IMCI
Handbook WHO 2005 p. 10).
15. TREAT means giving treatment in clinic, prescribing drugs or other treatments to be given at home,
and also teaching the caretaker how to carry out the treatments. What IMCI chart shows how to do the
treatment steps identified on the first chart?
1.
1.
2.
3.
4.
Treat the child chart

Assess and classify chart
Treatment chart
Intervention chart
ANSWER: A
RATIONALE: The IMCI chart titled TREAT THE CHILD shows how to do the treatment steps
identified on the ASSESS AND CLASSIFY chart. TREAT means giving treatment in clinic,
prescribing drugs or other treatments to be given at home, and also teaching the caretaker how to carry
out the treatments. (IMCI Handbook WHO 2005 p.11).
16. Recommendations on feeding, fluids and when to return are given on the chart titled:
1.
1.
2.
3.
4.
ASSESS AND CLASSIFY CHART

TREAT THE CHILD CHART
COUNSEL THE MOTHER CHART
FOLLOW-UP CARE CHART
ANSWER: C
RATIONALE: Recommendations on feeding, fluids and when to return are given on the chart titled
COUNSEL THE MOTHER. For many sick children, you will assess feeding and counsel the mother
about any feeding problems found. For all sick children who are going home, you will advise the
childs caretaker about feeding, fluids and when to return for further care. (IMCI Handbook WHO 2005
p.12).

SITUATION: The nurse needs to understand the basic charts, tables and recording forms for the sick
child in IMCI.
17. In IMCI protocol, you can best see if the child is improving on the drug or other treatment that was
prescribed through this activity:
1.
1.
2.
3.
4.
Home visit
Follow-up visit
Clinic visit
RHU visit
ANSWER: B
RATIONALE: At a follow-up visit you can see if the child is improving on the drug or other treatment
that was prescribed. (IMCI Handbook WHO 2005 p.10).
18. What section of the chart in IMCI describes the steps for conducting each type of visit to follow-up
the childs condition?
1.
1.
2.
3.
4.
GIVE FOLLOW-UP CARE section

MOTHERS COUNSELING section
ASSESS AND CLASSIFY section
TREAT THE CHILD section
ANSWER: A
RATIONALE: The GIVE FOLLOW-UP CARE section of the TREAT THE CHILD chart describes
the steps for conducting each type of follow-up visit. Headings in this section correspond to the childs
previous classification(s). (IMCI Handbook WHO 2005 p.10).
19. According to this chart, you should ask the mother about the childs problem and check the child
for general danger signs.
1.
1.
2.
3.
4.
ASSESS AND CLASSIFY THE SICK CHILD CHART

CASE RECORDING FORM
ASSESSMENT CHART
CLASSIFY AND TREAT THE CHILD CHART
ANSWER: A
RATIONALE: The chart ASSESS AND CLASSIFY THE SICK CHILD AGE 2 MONTHS UP TO 5
YEARS describes how to assess and classify sick children so that signs of disease are not overlooked.
The chart then helps you to identify the appropriate treatments for each classification. According to the
chart, you should ask the mother about the childs problem and check the child for general danger
signs. (IMCI Handbook WHO 2005 p.13).
20. Check the child for general danger signs, common symptoms of the sick child and the main
problem. Which of the following is a not included in the IMCI four main symptoms of a sick
child?
1.
1.
2.
3.
4.
cough or difficult breathing

diarrhea
fever
easy bruising
ANSWER: D
RATIONALE: According to the chart, you should ask the mother about the childs problem and check
the child for general danger signs. Then ask about the four main symptoms: cough or difficult
breathing, diarrhea, fever and ear problem. (IMCI Handbook WHO 2005 p.13).
21. Which of the following is not routinely checked in a sick child using the IMCI charts?
1.
1.
2.
3.
4.
malnutrition
anemia
Immunization status
bleeding
ANSWER: D
RATIONALE: The child is checked for immunization status, respiratory problems, anemia, ear
problems, diarrhea, infections. (IMCI Handbook WHO 2005 p.13).
SITUATION: A child who has one or more of the main symptoms could have a serious illness. The
serious diseases can cause death or disability in young children if they are not treated.
22. In assessing the child, the nurse observes good communication skills. One of these statements
violated the guidelines in the use of therapeutic communication:
1.
1.
2.
3.
4.
Listen carefully to what the mother tells you

Use words the mother understands
Give the mother time to answer the questions
Do not ask additional questions when the mother is not sure about her answer
ANSWER: D
RATIONALE: Ask additional questions when the mother is not sure about her answer to clarify
concerns (IMCI Handbook WHO 2005 p. 14).
23. A mother brings her child to the clinic. The nurse determines if this is an initial visit or a follow-up
visit. If it is an initial visit for an identified problem:
1.
1.
2.
3.
4.
GIVE FOLLOW-UP CARE

ASSESS and TREAT the child
ASSESS and CLASSIFY the child
ASSESS and GIVE HEALTH TEACHINGS
ANSWER: C
RATIONALE: if it is an initial visit for the problem, assess and classify the child. (IMCI Handbook
WHO 2005 p. 15).
24. If this is a follow-up visit for the problem:
1.
1.
2.
3.
4.
GIVE FOLLOW-UP CARE

ASSESS and TREAT the child
ASSESS and CLASSIFY the child
ASSESS and GIVE HEALTH TEACHINGS
ANSWER: A
RATIONALE: GIVE FOLLOW-UP CARE according to the guidelines of the IMCI handbook if this is
a follow-up visit for the problem (IMCI Handbook WHO 2005 p. 15).

25. This column on the left side of the chart describes how to take a history and do a physical
examination. The instructions in this column begin with ASK THE MOTHER WHAT THE CHILDS
PROBLEMS ARE:
1.
1.
2.
3.
4.
ASSESS COLUMN
CLASSIFY COLUMN
MOTHERS INTERVIEW COLUMN
ASK COLUMN
ANSWER: A
RATIONALE: The ASSESS column on the left side of the chart describes how to take a history and do
a physical examination. The instructions in this column begin with ASK THE MOTHER WHAT THE
CHILDS PROBLEMS ARE (IMCI Handbook WHO 2005 p. 15).
26. When you see the mother, or the childs caretaker, with the sick child, you first:
1.
1.
2.
3.
4.
Ask the mother about the child

Greet the mother appropriately
Check if the childs weight and temperature were recorded
Assess the child
ANSWER: B
RATIONALE: When you see the mother, or the childs caretaker, with the sick child: GREET THE
MOTHER APPROPRIATELY AND ASK ABOUT THE CHILD; LOOK TO SEE IF THE CHILDS
WEIGHT AND TEMPERATURE HAVE BEEN RECORDED (IMCI Handbook WHO 2005 p.15).
IMCI CASE MANAGEMENT PROCESS:
A. Arrange the following major activities in the IMCI case management process by numbering the
items from 1 to 6.
5_____Counsel the mother
3_____Identify treatment
1_____Assess the child or the young infant

4_____Treat the child
6_____Give follow-up care
2_____Classify the illness
ANSWER: 5-3-1-5-6-2
RATIONALE:
1.
2.
3.
4.
5.
6.
Assess the child or the young infant

Classify the illness
Identify treatment
Treat the child
Counsel the mother
Give follow-up care
B. Arrange the following activities using the guidelines for the ASSESS AND CLASSIFY SICK
CHILD AGE 2 MONTHS UP TO 5 YEARS
5_____Ask about the main symptoms.
8_____Assess other problems.
4_____Check for general danger signs.
2_____Record the childs data: e.g. name, age, weight, temperature
6_____Check for malnutrition and anemia.
3_____Ask the mother what the childs problems are.
1_____Determine which age group the child belongs.
7_____Check childs immunization, vitamin A and deworming status.
ANSWER: 5-8-4-2-6-3-1-7
RATIONALE:
1.Determine which age group the child belongs.
2.Record the childs data: e.g. name, age, weight, temperature
3.Ask the mother what the childs problems are.
4.Check for general danger signs.
5.Ask about the main symptoms.
6.Check for malnutrition and anemia.
7.Check childs immunization, vitamin A and deworming status.
8.Assess other problems.
REFERENCE: IMCI Chart booklet 2008. Philippine edition
C. Arrange the following activities using the guidelines for the ASSESS AND CLASSIFY THE SICK
YOUNG INFANT AGED UP TO 2 MONTHS
4_____Ask: Does the young infant have diarrhea?
6_____Check the young infants immunization and vitamin A status.
2_____Check for very severe disease and local infection.
7_____Assess other problems.
3_____Check for jaundice.
5_____Check for feeding problem or low weight.
1_____Ask the mother what the young infants problems are.
ANSWER: 4-6-2-7-3-5-1
RATIONALE:
1.
2.
3.
4.
5.
6.
7.
Ask the mother what the young infants problems are.

Check for very severe disease and local infection.
Check for jaundice.
Ask: Does the young infant have diarrhea?
Check for feeding problem or low weight.
Check the young infants immunization and vitamin A status.
Assess other problems.

In The Pre-Hospital Setting

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In The Pre-Hospital Setting

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SITUATION: Every day, millions of parents seek health care for their sick children, taking them to

Improvement of the publics acceptance of IMCI.

Improvements in family and community practices

Sick children aged 1 week up to 5 years

Ask why the child was brought to the clinic

ASSESS, CLASSIFY AND TREAT THE SICK YOUNG INFANT

Assess and classify column

Treat the child chart

ASSESS AND CLASSIFY CHART

SUBJECT: Community Health Nursing

GIVE FOLLOW-UP CARE section

ASSESS AND CLASSIFY THE SICK CHILD CHART

cough or difficult breathing

Listen carefully to what the mother tells you

GIVE FOLLOW-UP CARE

GIVE FOLLOW-UP CARE

CONCEPT: Integrated Management of Childhood Illness (IMCI)

Ask the mother about the child

1_____Assess the child or the young infant

Assess the child or the young infant

Ask the mother what the young infants problems are.

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