MCN

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 44

Situation 1: Mariah is a 31 year old lawyer who has

A. Fetal development are felt by Mariah

been married for 6 moths. She consults you for

B. Vernix caseosa covers the entire body

guidance in relation with her menstrual cycle and her

C. Viable if delivered within this period

desire to get pregnant.

D. Braxton Hicks contractions are observed

1. She wants to know the length of her menstrual

7. The nurse palpates the abdomen of Mariah.

cycle. Her periodic menstrual period is October

Now at 5 month gestation, what level of the

22 to 26. Her LMB is November 21. Which of the

abdomen can be the fundic height be palpated?

following number of days will be your correct

A. Symphysis pubis

response?

B. Midpoint between the umbilicus and the xiphoid

A. 29

process

B. 28

C. Midpoint between the symphysis pubis the umbilicus

C. 30

D. Umbilicus

D. 31

8. She worries about her small breast, thinking

2. You advised her to observe and record the

that she probably will incapable to breastfeed

signs of ovulation. Which of the following signs

her baby. Which of the following responses of the

will she likely note down?

nurse is correct?

1. A 1 degree Fahrenheit rise in basal body temperature

A. The size of your breast will not affect your

2. Cervical mucus becomes copious and clear

lactation.

3. One pound increase in weight

B. You can switch to bottle feeding.

4. Mittelschmerz

C. You can try to have exercise to increase the size of

A. 1,2,4

your breast.

B. 1,2,3

D. Manual expression of milk is possible.

C. 2,3,4

9. She tells the nurse that she does not take milk

D. 1,3,4

regularly. She claims that she does not want to

3. You instruct Mariah to keep record of her basal

gain too much weight during her pregnancy.

temperature everyday, which of the following

Which of the following nursing diagnosis is a

instructions is incorrect?

priority?

A. If coitus has occurred, this should be reflected in the

A. Potential self-esteem disturbance related to

chart

physiologic changes in pregnancy

B. It is best to have coitus on the evening following a

B. Ineffective individual coping related to physiologic

drop in BBT to become pregnant

changes in pregnancy

C. Temperature should be taken immediately after

C. Fear related to the effects of pregnancy

waking and before getting put of bed

D. Knowledge deficit regarding nutritional requirements

D. BBT is lowest during the secretory phase

pregnancies related to lack of information sources.

4. She reports an increase in BBT on December

10. Which of the following interventions will

16. Which hormone brings about this change in

likely ensure compliance of Mariah?

her BBT?

A. Incorporate her food preferences that are adequately

A. Estrogen

nutritious in her meal plan.

B. Progesterone

B. Consistently counsel toward optimum nutritional

C. Gonadootrophine

intake

D. Follicle Stimulating Hormone

C. Respect her right to reject dietary information if she

5. The following month, Mariah suspects she is

chooses

pregnant. Her urine is positive for Human

D. Information of the adverse effects of inadequate

Chorionic Gonadotrophin. Which structure

nutrition to her fetus

produce HCG?

Situation 3: Susan is a patient in the clinic where you

A. Pituitary Gland

work. She is inquiring about pregnancy.

B. Trophoblastic cells of the embryo

11. Susan tells you she is worried because she

C. Uterine deciduas

develops breast later than most of her friends.

D. Ovarian follicles

Breast development is termed as:

Situation 2: Mariah came back and she is now

A. Adrenarche

pregnant.

B. Mamarche

6. At 5 months gestation, which of the following

C. Thelarche

fetal development would probably be expected:

D. Menarche

12. Kevin, Susans husband, tells you that he is

D. She should assess whether her breast feel sensitive

considering vasectomy. After the birth of their

to cool air.

new child. Vasectomy involves the incision of

17. Dana chooses to use COC as her family

which organ?

planning method, what is the danger sign of COC

A. The testes

you would ask her to report?

B. The vas deferens

A. A stuffy or runny nose

C. The epididymis

B. Arthritis like symptoms

D. The scrotum

C. Slight weight gain

13. On examination, Susan has been found of

D. Migraine headache

having a cystocele. A cystocele is:

18. Dana asks about subcutaneous implants and

A. A sebaceous cyst arising from the vulvar fold.

she asks how long will these implants be

B. Protrusion of intestines into the vagina

effective. Your best answer is:

C. Prolapse of the uterus into the vagina

A. One month

D. Herniation of the bladder into the vaginal wall.

B. Twelve month

14. Susan typically has menstrual cycle of 34

C. Five years

days. She told you she had a coitus on days 8, 10

D. 10 years

and 20 of her menstrual cycle. Which is the day

19. Dana asks about female condoms. Which of

on which she is most likely to conceive?

the following is true with regards to female

A. 8th day

condoms?

B. 10th day

A. The hormone the condom releases might cause mild

C. Day 15

weight gain.

D. Day 20

B. She should insert the condom before any penile

15. While talking with Susan, 2 new patients

penetration

arrived and they are covered with large towels

C. She should coat the condom with spermicide before

and the nurse noticed that there are many

use

cameraman and news people outside of the OPD.

D. Female condoms unlike male condoms are reusable.

Upon assessment the nurse noticed that both of

20. Dana has asked about GIFT procedure. What

them are still nude and the male clients penis is

makes her a good candidate for GIFT?

still inside the female clients vagina and the

A. She has patent fallopian tubes, so fertilized ova can

male client said that I cant pull it. Vaginismus

be implanted on them.

was your first impression. You know that the

B. She is RH negative, a necessary stipulation to rule

psychological cause of Vaginismus is related to:

out RH incompatibility.

A. The male client inserted the penis too deeply that it

C. She has normal uterus, so the sperm can be injected

stimulates vaginal closure

through the cervix into it.

B. The penis was too large thats why the vagina

D. Her husband is taking sildenafil (Viagra), so all

triggered its defense to attempt to close

sperms will be motile.

C. The vagina do not want to be penetrated

Situation 5 Nurse Lorena is a Family Planning and

D. It is due to learning patterns of the female client

Infertility Nurse Specialist and currently attends to

where she views sex as bad or sinful.

FAMILY PLANNING CLIENTS AND INFERTILE COUPLES.

Situation 4: Overpopulation is one problem in the

The following conditions pertain to meeting the nursing

Philippines that case economic drain. Most Filipinos are

needs of this particular population group.

against in legalizing abortion. As a nurse, Mastery of

21. Dina, 17 years old, asks you how a tubal

contraception is needed to contribute to the society

ligation prevents pregnancy. Which would be the

and economic growth.

best answer?

16. Supposed that Dana, 17 years old, tells you

A. Prostaglandins released from the cut fallopian tubes

she wants to use fertility awareness method of

can kill sperm

contraception. How will she determine her fertile

B. Sperm can not enter the uterus because the cervical

days?

entrance is blocked.

A. She will notice that she feels hot as if she has an

C. Sperm can no longer reach the ova, because the

elevated temperature

fallopian tubes are blocked

B. She should assess whether her cervical mucus is thin

D. The ovary no longer releases ova as there is

colour, clear and watery.

nowhere for them to go.

C. She should monitor her emotions fro sudden anger

22. The Dators are a couple undergoing testing

or crying

for infertility. Infertility is said to exist when:

A. a woman has no uterus

A. Increased glomerular filtration

B. a woman has no children

B. Diuretic use

C. a couple has been trying to conceive for 1 year

C. Decreased bladder capacity

D. a couple has wanted a child for 6 months

D. Decreased glomerular filtration

23. Another client named Lilia is diagnosed as

29. Which of the following is the MOST COMMON

having endometriosis. This condition interferes

sign of infection among the elderly?

with fertility because:

A. Decreased breath sounds with crackles

A. endometrial implants can block the fallopian tubes

B. Fever

B. the uterine cervix becomes inflamed and swollen

C. Pain

C. the ovaries stop producing adequate estrogen

D. Change in the mental status

D. pressure on the pituitary leads to decreased FSH

30. Priorities when caring for the elderly trauma

levels

patient:

24. Lilia is scheduled to have a

A. Circulation, airway, breathing

hysterosalpingogram. Which of the following

B. Disability(Neurologic), airway, breathing

instructions would you give her regarding this

C. Airway, Breathing, Disability(Neurologic),

procedure?

D. Airway, breathing, Circulation

A. She will not be able to conceive for 3 months after

31. Preschoolers are able to see things from

the procedure

which of the following perspectives?

B. The sonogram of the uterus will reveal any tumors

A. Their peers

present

B. Their own and their caregivers

C. Many women experience mild bleeding as an after

C. Their own and their mothers

effect

D. Only their own

D. She may feel some cramping when the dye is

32. In conflict management, the win-win

inserted

approach occurs when:

25. Lilias cousin on the other hand, knowing

A. There are two conflicts and the parties agree to each

nurse Lorenas specialization asks what artificial

one

insemination by donor entails. Which would be

B. Each party gives in on 50% of the disagreement

your best answer if you were Nurse Lorena?

making the conflict

A. Donor sperm are introduced vaginally into the uterus

C. Both parties involved are committed in solving the

or cervix

conflict

B. Donor sperm are injected intra-abdominally into

D. The conflict is settled out of court so the legal

each ovary

system mandates parties win.

C. Artificial sperm are injected vaginally to test tubal

33. According to the social-International

patency

perspective of child abuse and neglect, four

D. The husbands sperm is administered intravenously

factors place the family members at risk for

weekly

abuse, these risk factors are the family members

Situation 6: You are assigned to take care of a group of

at risk for abuse. These risk factors are the

patients across the lifespan.

family itself, the caregiver, the child and:

26. Pain in the elder persons require careful

A. The presence of a family crisis

assessment because they:

B. Genetics

A. Experienced reduce sensory perception

C. The national emphasis on sex

B. Have increased sensory perception

D. Chronic poverty

C. Are expected to experience chronic pain

34. Which of the following signs and symptoms

D. Have decreased pain threshold

would you most likely find when assessing an

27. Administration of analgesics to the older

infant with Arnold-Chiari malformation?

persons require careful patient assessment

A. Weakness of the leg muscles, loss of sensation in the

because older people:

legs, and restlessness

A. Are more sensitive drugs

B. Difficulty swallowing, diminished or absent gag reflex

B. Have increased hepatic, renal, and gastrointestinal

and respiratory distress

function

C. Difficulty sleeping, hypervigilant and an arching of

C. Have increased sensory perception

the back

D. Mobilize drugs more rapidly

D. Paradoxical irritability, diarrhea and vomiting

28. The elderly patient is at higher risk for

35. A parent calls you and frantically reports that

urinary incontinence because:

her child has gotten into her famous ferrous

sulfate pills and ingested a number of these pills.

stomachs or buttocks, the nurse would teach the

Her child is now vomiting, has bloody diarrhea

caregivers to:

and is complaining of abdominal pain. You will

A. Avoid covering the area of the topical medication

tell the mother to:

with the diaper

A. Call emergency medical services (EMS) and get the

B. Avoid the use of clothing on top of the diaper

child to the emergency room

C. Put the diaper on as usual

B. Relax because these symptoms will pass and the

D. Apply an icepack for 5 minutes to the outside of the

child will be fine

diaper

C. Administer syrup of ipecac

41. Which of the following factors is most

D. Call the poison control center

important in determining the success of

36. A client says she heard from a friend that you

relationships used in delivering nursing care?

stop having periods once you are on the pill.

A. Type of illness of the client

The most appropriate response would be:

B. Transference and countertransference

A. The pill prevents the uterus from making such

C. Effective communication

endometrial lining, that is why period may often be

D. Personality of the participants

scant or skipped occasionally.

42. Grace sustained a laceration on her leg from

B. If your friend has missed her period, she should

automobile accident. Why are lacerations of

stop taking the pills and get a pregnancy test.

lower extremities potentially more serious

C. The pill should cause a normal menstrual period

among pregnant women than other?

every month. It sounds like your friend has not been

A. lacerations can provoke allergic responses due to

taking the pills properly.

gonadotropic hormone release

D. Missed period can be very dangerous and may lead

B. a woman is less able to keep the laceration clean

to the formation of precancerous cells.

because of her fatigue

37. The nurse assessing newborn babies and

C. healing is limited during pregnancy so these will not

infants during their hospital stay notice which of

heal until after birth

the following symptoms as a primary

D. increased bleeding can occur from uterine pressure

manifestation of Hirschsprungs disorder?

on leg veins

A. A fine rash over the trunk

43. In working with the caregivers of a client

B. Failure to pass meconium during the first 24 hours

with an cute or chronic illness, the nurse would:

after birth

A. Teach care daily and let the caregivers do a return

C. The skin turns yellow and then brown over the first

demonstration just before discharge

24 hours to 46 hours after birth.

B. Difficulty swallowing, diminished or absent gag reflex

D. High grade fever.

and respiratory distress

38. A client is 7 months pregnant and has just

C. Difficulty sleeping, hypervigilant and arching of the

been diagnosed as having a partial placenta

back

previa. She is able and has minimal spotting and

D. Paradoxical irritability, diarrhea and vomiting

is being sent home. Which of these instructions

44. Which of the following roles BEST exemplifies

to the client may indicate a need for further

the expanded role of the nurse?

teaching?

A. Circulating nurse in surgery

A. Maintain bed rest with bathroom privileges

B. Medication nurse

B. Avoid intercourse for three days

C. Obstetrical nurse

C. Call if contractions occur.

D. Pediatric nurse practitioner

D. Stay on left side as much as possible when lying

45. According to De Rosa and Kochuras (2006)

down.

article entitled Implement Culturally Health

39. A woman has been rushed to the hospital

Care in your workplace, cultures have different

with ruptured membrane. Which of the following

patterns of verbal and nonverbal communication.

should the nurse check first?

Which difference does NOT necessarily belong?

A. Check for the presence of infarction.

A. Personal behaviour

B. Assess for Prolapse of the umbilical cord

B. Eye contact

C. Check the maternal heart rate

C. Subject Matter

D. Assess the color of the amniotic fluid

D. Conversational style

40. The nurse notes that the infant is wearing a

46. You are the nurse assigned to work with a

plastic-coated diaper. If a topical medication

child with acute glomerulonephritis. By following

were to be prescribed and it were to go on the

the prescribed treatment regimen, the child

experiences a remission. You are now checking

51. If a child with diarrhea registers two signs in

to make sure the child does not have a relapse.

the yellow row in the IMCI chart, we can classify

Which finding most lead you to the conclusion

the patient as:

that a relapse is happening?

A. Moderate dehydration

A. Elevated temperature, cough, sore throat, changing

B. Some dehydration

complete blood count (CBC) with differential count

C. Severe dehydration

B. A urine dipstick measurement of 2+ proteinuria or

D. No dehydration

more for 3 days or the child found to have 3-4+

52. Celeste has had diarrhea for 8 days. There is

proteinuria plus edema.

no blood in the stool, he is irritable, his eyes are

C. The urine dipstick showing glucose in the urine for 3

sunken, the nurse offers fluid to Celeste and he

days, extreme thirst, increase in urine output and a

drinks eagerly. When the nurse pinched the

moon face.

abdomen it goes back slowly. How will you

D. A temperature of 37.8 degrees (100 degrees F) flank

classify Celestes Illness?

pain, burning frequency, urgency on voiding and cloudy

A. Moderate dehydration

urine.

B. Some dehydration

47. The nurse is working with an adolescent who

C. Severe dehydration

complains of being lonely and having a lack of

D. No dehydration

fulfilment in her life. This adolescent shies away

53. A child who is 7 weeks has had diarrhea for

from intimate relationships at times yet at other

14 days but has no sign of dehydration is

times she appears promiscuous. The nurse will

classified as?

likely work with this adolescent in which of the

A. Persistent diarrhea

areas?

B. Severe dysentery

A. Isolation

C. Dysentery

B. Loneliness

D. Severe Persistent diarrhea

C. Lack of fulfilment

54. The child with no dehydration needs home

D. Identity

treatment. Which of the following is not included

48. The use of interpersonal decision making

in the rules for home treatment in this case?

psychomotor skills and application of knowledge

A. Forced fluids

expected in the role of a

B. When to return

licensed healthcare professional in the context of

C. Give Vitamin A supplement

public health welfare and safety as an example

D. Feeding more

of?

55. Fever as used in IMCI includes:

A. Delegation

A. Axillary temperature of 37.5 or higher

B. Supervision

B. Rectal temperature of 38 or higher

C. Responsibility

C. Feeling hot to touch

D. Competence

D. All of the above

49. The painful phenomenon known as back labor

E. A and C only

occurs in a client whose fetus in what position?

Situation: Prevention of Dengue is an important nursing

A. Brow position

responsibility and controlling its spread is priority once

B. Right occipito-Anterior Position

outbreak has been observed.

C. Breech position

56. An important role of the community health

D. Left occipito-Posterior Position

nurse in the prevention and control of Dengue H-

50. Focus methodology stands for?

fever includes:

A. Focus, Organize, Clarify, Understand and Solution

A. Advising the elimination of vectors by keeping water

B. Focus, Opportunity, Continuous, Utilize, Substantiate

containers covered

C. Focus, Organize, Clarify, Understand, Substantiate

B. Conducting strong health education drives/campaign

D. Focus, Opportunity, Continuous (process),

directed toward proper garbage disposal

Understand, Solution

C. Explaining to the individuals, families, groups and

Situation 7: The infant and child mortality rate in the

community the nature of the disease and its causation.

low to middle income countries is ten times higher than

D. Practicing residual spraying with insecticides

industrialized countries. In response to this the WHO

57. Community health nurses should be alert in

and UNICEF launched protocol Integrated Management

observing a Dengue suspect. The following is

of Childhood Illness to reduce the morbidity and

NOT an indicator for hospitalization of H-fever

mortality against childhood illnesses.

suspects?

A. Marked anorexia, abdominal pain and vomiting

64. If ever convulsion occurs after administering

B. Increasing hematocrit count

DPT, what should nurse best suggest to the

C. Cough of 30 days

mother?

D. Persistent headache

A. Do not continue DPT vaccination anymore

58. The community health nurses primary

B. Advise mother to come back aster 1 week

concern in the immediate control of hemorrhage

C. Give DT instead of DPT

among patients with dengue is:

D. Give pertussis of the DPT and remove DT

A. Advising low fiber and non-fat diet

65. These vaccines are given 3 doses at one

B. Providing warmth through light weight covers

month intervals:

C. Observing closely the patient for vital signs leading

A. DPT, BCG, TT

to shock

B. DPT, TT, OPV

D. Keeping the patient at rest.

C. OPV, Hep. B, DPT

59. Which of these signs may NOT be REGARDED

D. Measles, OPV, DPT

as a truly positive signs indicative of Dengue H-

Situation 10: With the increasing documented cases of

fever?

CANCER the best alternative to treatment still remains

A. Prolonged Bleeding Time

to be PREVENTION. The following conditions apply.

B. Appearance of at least 20 petechiae within 1 cm

66. Which among the following is the primary

square

focus of prevention of cancer?

C. Steadily increasing hematocrit count

A. Elimination of conditions causing cancer

D. Fall in the platelet count

B. Diagnosis and treatment

60. Which of the following is the most important

C. Treatment at early stage

treatment of patients with Dengue H-fever?

D. Early detection

A. Give aspirin for fever

67. In the prevention and control of cancer,

B. Replacement of body fluids

which of the following activity is the most

C. Avoid unnecessary movement

important function of the community health

D. Ice cap over abdomen in case of melena

nurse?

Situation 9: Health education and Health Promotion is

A. Conduct community assemblies

an important part of nursing responsibility in the

B. Referral to cancer specialist those clients with

community. Immunization is a form of health promotion

symptoms of cancer

that aims at preventing the common childhood

C. Use the nine warning signs of cancer as parameters

illnesses.

in our process of detection; control and treatment

61. In correcting misconceptions and myths

modalities.

about certain diseases and their management,

D. Teach women about proper/correct nutrition.

the health worker should first:

68. Who among the following are recipients of

A. Identify the myths and misconceptions prevailing in

the secondary level of care for cancer cases?

the community

A. Those under early case detection

B. Identify the source of these myths and

B. Those under supportive care

misconceptions

C. Those scheduled for surgery

C. Explain how and why these myths came about

D. Those under going treatment

D. Select the appropriate IEC strategies to correct

69. Who among the following are recipients of the

them.

tertiary level of care for cancer cases?

62. How many percent of measles are prevented

A. Those under early treatment

by immunization at 9 months age?

B. Those under supportive care

A. 80 %

C. Those under early detection

B. 90%

D. Those scheduled for surgery

C. 99 %

70. In Community Health Nursing, despite the

D. 95 %

availability and use of many equipment and

63. After TT3 vaccination a mother is said to be

devices to facilitate the job of the community

protected to tetanus by around?

health nurse, the nurse should be prepared to

A. 80 %

apply is a scientific approach. This approach

B. 85 %

ensures quality of care even at the community

C. 99 %

setting. This nursing parlance is nothing less

D. 90 %

than the:

A. Nursing diagnosis

abnormally sleepy or difficult to awaken. Her

B. Nursing protocol

temperature is 38.9 deg C. Using the integrated

C. Nursing research

management of childhood illness or IMCI

D. Nursing process

strategy, if you were the nurse in charge of

Situation 11 Two children were brought to you. One

Carol, how will you classify her illness?

with chest indrawing and the other had diarrhea. The

A. a child at a general danger sign

following questions apply:

B. very severe febrile disease

71. Using Integrated Management and Childhood

C. severe pneumonia

Illness (IMCI) approach, how would you classify

D. severe malnutrition

the 1st child?

77. Why are small for gestational age newborns

A. Bronchopneumonia

at risk for difficulty maintaining body

B. No pneumonia: cough or cold

temperature?

C. Severe pneumonia

A. their skin is more susceptible to conduction of cold

D. Pneumonia

B. they are preterm so are born relatively small in size

72. The 1st child who is 13 months has fast

C. they do not have as many fat stored as other infants

breathing using IMCI parameters he has:

D. they are more active than usual so they throw off

A. 40 breaths per minute or more

comes

B. 50 breaths per minute

78. Oxytocin is administered to Rita to augment

C. 30 breaths per minute or more

labor. What are the first symptoms of water

D. 60 breaths per minute

intoxication to observe for during this

73. Nina, the 2nd child has diarrhea for 5 days.

procedure?

There is no blood in the stool. She is irritable and

A. headache and vomiting

her eyes are sunken. The nurse offered fluids and

B. a swollen tender tongue

the child drinks eagerly. How would you classify

C. a high choking voice

Ninas illness?

D. abdominal bleeding and pain

A. Some dehydration

79. Which of the following treatment should NOT

B. Dysentery

be considered if the child has severe dengue

C. Severe dehydration

hemorrhagic fever?

D. No dehydration

A. use plan C if there is bleeding from the nose or gums

74. Ninas treatment should include the following

B. give ORS if there is skin petechiae, persistent

EXCEPT:

vomiting, and positive tourniquet test

A. Reassess the child and classify him for dehydration

C. give aspirin

B. For infants under 6 months old who are not

D. prevent low blood sugar

breastfed, give 100-200 ml clean water as well during

80. In assessing the patients condition using the

this period.

Integrated Management of Childhood Illness

C. Give in the health center the recommended amount

approach strategy, the first thing that a nurse

of ORS for 4 hours.

should do is to:

D. Do not give any other foods to the child for home

A. ask what are the childs problem

treatment

B. check the patients level of consciousness

75. While on treatment, Nina 18 months old

C. check for the four main symptoms

weighed 18 kgs and her temperature registered

D. check for the general danger signs

at 37 degrees C. Her mother says she developed

81. A child with diarrhea is observed for the

cough 3 days ago. Nina has no general danger

following EXCEPT:

signs. She has 45 breaths/minute, no chest

A. how long the child has diarrhea

indrawing, no stridor. How would you classify

B. skin petechiae

Ninas manifestation.

C. presence of blood in the stool

A. No pneumonia

D. signs of dehydration

B. Severe pneumonia

82. The child with no dehydration needs home

C. Pneumonia

treatment. Which of the following is NOT

D. Bronchopneumonia

included in the care for home management at

76. Carol is 15 months old and weighs 5.5 kgs

this case?

and it is her initial visit. Her mother says that

A. give drugs every 4 hours

Carol is not eating well and unable to breastfeed,

B. continue feeding the child

he has no vomiting, has no convulsion and not

C. give the child more fluids

When the nurse asks the boy his tiredness, he

D. inform when to return to the health center

talks of playing outside until midnight. The nurse

83. Ms. Jordan, RN, believes that a patient should

will suspect that this child is:

be treated as individual. This ethical principle

A. Being raised by a parent of low intelligence (IQ)

that the patient referred to:

B. An orphan

A. beneficence

C. A victim of child neglect

B. nonmaleficence

D. The victim of poverty

C. respect for person

90. Which of the following indicates the type(s)

D. autonomy

of acute renal failure?

84. When patients cannot make decisions for

A. Four types: hemorrhagic with and without clotting,

themselves, the nurse advocate relies on the

and nonhemorrhagic with and without clotting

ethical principle of:

B. One type: Acute

A. justice and beneficence

C. Three types: Prerenal, intrarenal, postrenal

B. fidelity and nonmaleficence

D. Two types: Acute and subacute

C. beneficence and nonmaleficence

Situation 13: Milo 16 y/o has been diagnosed to have

D. fidelity and justice

AIDS, he worked as entertainer in a cruise ship:

85. Being a community health nurse, you have

91. Which method of transmission is common to

the responsibility of participating in protecting

contract AIDS:

the health of people. Consider this situation:

A. Syringe and needles

Vendors selling bread with their bare hands.

B. Body fluids

They receive money with these hands. You do not

C. Sexual contact

see them washing their hands. What should you

D. Transfusion

say or do?

92. Causative organism in AIDS is one of the

A. Miss, may I get the bread myself because you have

following:

not washed your hands

A. Fungus

B. All of these

B. Bacteria

C. Miss, it is better to use a pick up forceps/ bread

C. Retrovirus

tong

D. Parasites

D. Miss, your hands are dirty. Wash your hands first

93. You are assigned in a private room of Milo.

before getting the bread

Which procedure should be of utmost

Situation 12: The following questions refer to common

importance:

clinical encounters experienced by an entry level nurse.

A. Alcohol wash

86. A female client asks the nurse about the use

B. Universal precaution

of cervical cap. Which statement is correct

C. Washing isolation

regarding the use of the cervical cap?

D. Gloving technique

A. It may affect Pap smear results

94. What primary health teaching would you give

B. It does not need to be fitted by the physician

to Milo?

C. It does not require the use of spermicide

A. Daily exercise

D. It must be removed within 24 hours

B. Prevent infection

87. The major components of the communication

C. Reversal Isolation

process are?

D. Proper nutrition

A. Verbal, written, and nonverbal

95. Exercise precaution must be taken to protect

B. Speaker, Listener and reply

health worker dealing with the AIDS patients,

C. Facial expression, tone of voice and gestures

which among these must be done as priority?

D. Message, sender, channel, Receiver and Feedback

A. Boil used syringes and needles

88. The extent of burns in children are normally

B. Use gloves when handling specimen

assessed and expressed in terms of:

C. Label personal belonging

A. The amount of body surface that is unburned

D. Avoid accidental wound

B. Percentages of total body surface area (TBSA)

Situation 14: Michelle is a 6 year old preschooler. She

C. How deep the deepest burns are

was reported by her sister to have measles but she was

D. The severity of the burns on a 1 to 5 burn scale

at home because of fever, upper respiratory problem

89. The school nurse notices a child who is

and white sports in her mouth.

wearing old, dirty, poor-fitting clothes; is always

96. Rubeola is an Arabic term meaning Red, the

hungry; has no lunch money; and is always tired.

rash appears on the skin in invasive stage prior

to eruption. As a nurse, your physical

2. Nurse Reese is reviewing the record of a

examination must determine complication

pregnant client for her first prenatal visit. Which

especially:

of the following data, if noted on the clients

A. Otitis media

record, would alert the nurse that the client is at

B. Bronchial pneumonia

risk for a spontaneous abortion?

C. Inflammatory conjunctiva
D. Membranous laryngitis

a. Age 36 years

97. To render comfort measure is one of the

b. History of syphilis

priorities, which includes care of the skin, eyes,

c. History of genital herpes

ears, mouth and nose. To clean the mouth, your

d. History of diabetes mellitus

antiseptic is in some form of which one below?


A. Water
B. Sulfur
C. Alkaline
D. Salt
98. As a public health nurse, you teach mother
and family members the prevention of
complication of measles. Which of the following
should be closely watched?
A. Temperature fails to drop
B. Inflammation of the conjunctiva
C. Inflammation of the nasopharynx
D. Ulcerative stomatitis
99. Source of infection of measles is secretion of
nose and throat of infection person. Filterable of
measles is transmitted by:
A. Water supply
B. Droplet
C. Food ingestion

3. Nurse Hazel is preparing to care for a client


who is newly admitted to the hospital with a
possible diagnosis of ectopic pregnancy. Nurse
Hazel develops a plan of care for the client and
determines that which of the following nursing
actions is the priority?
a. Monitoring weight
b. Assessing for edema
c. Monitoring apical pulse
d. Monitoring temperature
4. Nurse Oliver is teaching a diabetic pregnant
client about nutrition and insulin needs during
pregnancy. The nurse determines that the client
understands dietary and insulin needs if the
client states that the second half of pregnancy
require:

D. Sexual contact

a. Decreased caloric intake

100. Method of prevention is to avoid exposure

b. Increased caloric intake

to an infection person. Nursing responsibility for

c. Decreased Insulin

rehabilitation of patient includes the provision

d. Increase Insulin

of:
A. Terminal disinfection

5. Nurse Michelle is assessing a 24 year old client

B. Injection of gamma globulin

with a diagnosis of hydatidiform mole. She is

C. Immunization

aware that one of the following is unassociated

D. Comfort measures

with this condition?

1. May arrives at the health care clinic and tells

a. Excessive fetal activity.

the nurse that her last menstrual period was 9

b. Larger than normal uterus for gestational age.

weeks ago. She also tells the nurse that a home

c. Vaginal bleeding

pregnancy test was positive but she began to

d. Elevated levels of human chorionic gonadotropin.

have mild cramps and is now having moderate


vaginal bleeding. During the physical

6. A pregnant client is receiving magnesium

examination of the client, the nurse notes that

sulfate for severe pregnancy induced

May has a dilated cervix. The nurse determines

hypertension (PIH). The clinical findings that

that May is experiencing which type of abortion?

would warrant use of the antidote , calcium


gluconate is:

a. Inevitable
b. Incomplete

a. Urinary output 90 cc in 2 hours.

c. Threatened

b. Absent patellar reflexes.

d. Septic

c. Rapid respiratory rate above 40/min.


d. Rapid rise in blood pressure.

7. During vaginal examination of Janna who is in

c. Encourage the mother to hold the child.

labor, the presenting part is at station plus two.

d. Ignore the crying and screaming.

Nurse, correctly interprets it as:


12. Baby Tina a 3 month old infant just had a
a. Presenting part is 2 cm above the plane of the ischial

cleft lip and palate repair. What should the nurse

spines.

do to prevent trauma to operative site?

b. Biparietal diameter is at the level of the ischial


spines.

a. Avoid touching the suture line, even when cleaning.

c. Presenting part in 2 cm below the plane of the ischial

b. Place the baby in prone position.

spines.

c. Give the baby a pacifier.

d. Biparietal diameter is 2 cm above the ischial spines.

d. Place the infants arms in soft elbow restraints.

8. A pregnant client is receiving oxytocin

13. Which action should nurse Marian include in

(Pitocin) for induction of labor. A condition that

the care plan for a 2 month old with heart

warrant the nurse in-charge to discontinue I.V.

failure?

infusion of Pitocin is:

a. Feed the infant when he cries.

a. Contractions every 1 minutes lasting 70-80

b. Allow the infant to rest before feeding.

seconds.

c. Bathe the infant and administer medications before

b. Maternal temperature 101.2

feeding.

c. Early decelerations in the fetal heart rate.

d. Weigh and bathe the infant before feeding.

d. Fetal heart rate baseline 140-160 bpm.

14. Nurse Hazel is teaching a mother who plans

9. Calcium gluconate is being administered to a

to discontinue breast feeding after 5 months.

client with pregnancy induced hypertension

The nurse should advise her to include which

(PIH). A nursing action that must be initiated as

foods in her infants diet?

the plan of care throughout injection of the drug


is:

a. Skim milk and baby food.


b. Whole milk and baby food.

a. Ventilator assistance

c. Iron-rich formula only.

b. CVP readings

d. Iron-rich formula and baby food.

c. EKG tracings
d. Continuous CPR

15. Mommy Linda is playing with her infant, who


is sitting securely alone on the floor of the clinic.

10. A trial for vaginal delivery after an earlier

The mother hides a toy behind her back and the

caesareans, would likely to be given to a gravida,

infant looks for it. The nurse is aware that

who had:

estimated age of the infant would be:

a. First low transverse cesarean was for active herpes

a. 6 months

type 2 infections; vaginal culture at 39 weeks

b. 4 months

pregnancy was positive.

c. 8 months

b. First and second caesareans were for cephalopelvic

d. 10 months

disproportion.
c. First caesarean through a classic incision as a result
of severe fetal distress.
d. First low transverse caesarean was for breech
position. Fetus in this pregnancy is in a vertex
presentation.
11. Nurse Ryan is aware that the best initial
approach when trying to take a crying toddlers
temperature is:
a. Talk to the mother first and then to the toddler.
b. Bring extra help so it can be done quickly.

16. Which of the following is the most prominent


feature of public health nursing?
a. It involves providing home care to sick people who
are not confined in the hospital.
b. Services are provided free of charge to people within
the catchments area.
c. The public health nurse functions as part of a team
providing a public health nursing services.
d. Public health nursing focuses on preventive, and not
curative, services.

17. When the nurse determines whether

22. Nurse Tina is aware that the disease declared

resources were maximized in implementing

through Presidential Proclamation No. 4 as a

Ligtas Tigdas (Measles Prevention), she is

target for eradication in the Philippines is?

evaluating:
a. Poliomyelitis
a. Effectiveness

b. Measles

b. Efficiency

c. Rabies

c. Adequacy

d. Neonatal tetanus

d. Appropriateness
23. May knows that the step in community
18. Vangie is a new B.S.N. graduate. She wants

organizing that involves training of potential

to become a Public Health Nurse. Where should

leaders in the community is:

she apply?
a. Integration
a. Department of Health

b. Community organization

b. Provincial Health Office

c. Community study

c. Regional Health Office

d. Core group formation

d. Rural Health Unit


24. Beth a public health nurse takes an active
19. Tony is aware the Chairman of the Municipal

role in community participation. What is the

Health Board is:

primary goal of community organizing?

a. Mayor

a. To educate the people regarding community health

b. Municipal Health Officer

problems

c. Public Health Nurse

b. To mobilize the people to resolve community health

d. Any qualified physician

problems
c. To maximize the communitys resources in dealing

20. Myra is the public health nurse in a

with health problems.

municipality with a total population of about

d. To maximize the communitys resources in dealing

20,000. There are 3 rural health midwives among

with health problems.

the RHU personnel. How many more midwife


items will the RHU need?

25. Tertiary prevention is needed in which stage


of the natural history of disease?

a. 1
b. 2

a. Pre-pathogenesis

c. 3

b. Pathogenesis

d. The RHU does not need any more midwife item.

c. Prodromal
d. Terminal

21. According to Freeman and Heinrich,


community health nursing is a developmental

26. The nurse is caring for a primigravid client in

service. Which of the following best illustrates

the labor and delivery area. Which condition

this statement?

would place the client at risk for


disseminated intravascular coagulation (DIC)?

a. The community health nurse continuously develops


himself personally and professionally.

a. Intrauterine fetal death.

b. Health education and community organizing are

b. Placenta accreta.

necessary in providing community health services.

c. Dysfunctional labor.

c. Community health nursing is intended primarily for

d. Premature rupture of the membranes.

health promotion and prevention and treatment of


disease.

27. A full term client is in labor. Nurse Betty is

d. The goal of community health nursing is to provide

aware that the fetal heart rate would be:

nursing services to people in their own places of


residence.

a. 80 to 100 beats/minute
b. 100 to 120 beats/minute

c. 120 to 160 beats/minute

c. Mastitis

d. 160 to 180 beats/minute

d. Physiologic anemia

28. The skin in the diaper area of a 7 month old

34. Nurse Lynette is working in the triage area of

infant is excoriated and red. Nurse Hazel should

an emergency department. She sees that several

instruct the mother to:

pediatric clients arrive simultaneously. The client


who needs to be treated first is:

a. Change the diaper more often.


b. Apply talc powder with diaper changes.

a. A crying 5 year old child with a laceration on his

c. Wash the area vigorously with each diaper change.

scalp.

d. Decrease the infants fluid intake to decrease

b. A 4 year old child with a barking coughs and flushed

saturating diapers.

appearance.
c. A 3 year old child with Down syndrome who is pale

29. Nurse Carla knows that the common cardiac

and asleep in his mothers arms.

anomalies in children with Down Syndrome

d. A 2 year old infant with stridorous breath sounds,

(trisomy 21) is:

sitting up in his mothers arms and drooling.

a. Atrial septal defect

35. Maureen in her third trimester arrives at the

b. Pulmonic stenosis

emergency room with painless vaginal bleeding.

c. Ventricular septal defect

Which of the following conditions is suspected?

d. Endocardial cushion defect


a. Placenta previa
30. Malou was diagnosed with severe

b. Abruptio placentae

preeclampsia is now receiving I.V. magnesium

c. Premature labor

sulfate. The adverse effects associated with

d. Sexually transmitted disease

magnesium sulfate is:


36. A young child named Richard is suspected of
a. Anemia

having pinworms. The community nurse collects

b. Decreased urine output

a stool specimen to confirm the diagnosis. The

c. Hyperreflexia

nurse should schedule the collection of this

d. Increased respiratory rate

specimen for:

31. A 23 year old client is having her menstrual

a. Just before bedtime

period every 2 weeks that last for 1 week. This

b. After the child has been bathe

type of menstrual pattern is bets defined by:

c. Any time during the day

a. Menorrhagia

d. Early in the morning

b. Metrorrhagia

37. In doing a childs admission assessment,

c. Dyspareunia

Nurse Betty should be alert to note which signs

d. Amenorrhea

or symptoms of chronic lead poisoning?

32. Jannah is admitted to the labor and delivery

a. Irritability and seizures

unit. The critical laboratory result for this client

b. Dehydration and diarrhea

would be:

c. Bradycardia and hypotension

a. Oxygen saturation

d. Petechiae and hematuria

b. Iron binding capacity

38. To evaluate a womans understanding about

c. Blood typing

the use of diaphragm for family planning, Nurse

d. Serum Calcium

Trish asks her to explain how she will use the

33. Nurse Gina is aware that the most common


condition found during the second-trimester of
pregnancy is:
a. Metabolic alkalosis
b. Respiratory acidosis

appliance. Which response indicates a need for


further health teaching?
a. I should check the diaphragm carefully for holes
every time I use it
b. I may need a different size of diaphragm if I gain or

lose weight more than 20 pounds

a. Stable blood pressure

c. The diaphragm must be left in place for at least 6

b. Patent fontanelles

hours after intercourse

c. Moros reflex

d. I really need to use the diaphragm and jelly most

d. Voided

during the middle of my menstrual cycle.


44. Nurse Carla should know that the most
39. Hypoxia is a common complication of

common causative factor of dermatitis in infants

laryngotracheobronchitis. Nurse Oliver should

and younger children is:

frequently assess a child with


laryngotracheobronchitis for:

a. Baby oil
b. Baby lotion

a. Drooling

c. Laundry detergent

b. Muffled voice

d. Powder with cornstarch

c. Restlessness
d. Low-grade fever

45. During tube feeding, how far above an


infants stomach should the nurse hold the

40. How should Nurse Michelle guide a child who

syringe with formula?

is blind to walk to the playroom?


a. 6 inches
a. Without touching the child, talk continuously as the

b. 12 inches

child walks down the hall.

c. 18 inches

b. Walk one step ahead, with the childs hand on the

d. 24 inches

nurses elbow.
c. Walk slightly behind, gently guiding the child

46. In a mothers class, Nurse Lynnette discussed

forward.

childhood diseases such as chicken pox. Which of

d. Walk next to the child, holding the childs hand.

the following statements about chicken pox is


correct?

41. When assessing a newborn diagnosed with


ductus arteriosus, Nurse Olivia should expect

a. The older one gets, the more susceptible he

that the child most likely would have an:

becomes to the complications of chickenpox.


b. A single attack of chickenpox will prevent future

a. Loud, machinery-like murmur.

episodes, including conditions such as shingles.

b. Bluish color to the lips.

c. To prevent an outbreak in the community, quarantine

c. Decreased BP reading in the upper extremities

may be imposed by health authorities.

d. Increased BP reading in the upper extremities.

d. Chicken pox vaccine is best given when there is an


impending outbreak in the community.

42. The reason nurse May keeps the neonate in a


neutral thermal environment is that when a

47. Barangay Pinoy had an outbreak of German

newborn becomes too cool, the neonate

measles. To prevent congenital rubella, what is

requires:

the BEST advice that you can give to women in


the first trimester of pregnancy in the Barangay

a. Less oxygen, and the newborns metabolic rate

Pinoy?

increases.
b. More oxygen, and the newborns metabolic rate

a. Advise them on the signs of German measles.

decreases.

b. Avoid crowded places, such as markets and movie

c. More oxygen, and the newborns metabolic rate

houses.

increases.

c. Consult at the health center where rubella vaccine

d. Less oxygen, and the newborns metabolic rate

may be given.

decreases.

d. Consult a physician who may give them rubella


immunoglobulin.

43. Before adding potassium to an infants I.V.


line, Nurse Ron must be sure to assess whether

48. Myrna a public health nurse knows that to

this infant has:

determine possible sources of sexually


transmitted infections, the BEST method that
may be undertaken is:

a. Contact tracing

a. 3 seconds

b. Community survey

b. 6 seconds

c. Mass screening tests

c. 9 seconds

d. Interview of suspects

d. 10 seconds

49. A 33-year old female client came for

54. In Integrated Management of Childhood

consultation at the health center with the chief

Illness, the nurse is aware that the severe

complaint of fever for a week. Accompanying

conditions generally require urgent referral to a

symptoms were muscle pains and body malaise.

hospital. Which of the following severe

A week after the start of fever, the client noted

conditions DOES NOT always require urgent

yellowish discoloration of his sclera. History

referral to a hospital?

showed that he waded in flood waters about 2


weeks before the onset of symptoms. Based on

a. Mastoiditis

her history, which disease condition will you

b. Severe dehydration

suspect?

c. Severe pneumonia
d. Severe febrile disease

a. Hepatitis A
b. Hepatitis B

55. Myrna a public health nurse will conduct

c. Tetanus

outreach immunization in a barangay Masay with

d. Leptospirosis

a population of about 1500. The estimated


number of infants in the barangay would be:

50. Mickey a 3-year old client was brought to the


health center with the chief complaint of severe

a. 45 infants

diarrhea and the passage of rice-watery stools.

b. 50 infants

The client is most probably suffering from which

c. 55 infants

condition?

d. 65 infants

a. Giardiasis

56. The community nurse is aware that the

b. Cholera

biological used in Expanded Program on

c. Amebiasis

Immunization (EPI) should NOT be stored in the

d. Dysentery

freezer?

51. The most prevalent form of meningitis among

a. DPT

children aged 2 months to 3 years is caused by

b. Oral polio vaccine

which microorganism?

c. Measles vaccine
d. MMR

a. Hemophilus influenzae
b. Morbillivirus

57. It is the most effective way of controlling

c. Streptococcus pneumoniae

schistosomiasis in an endemic area?

d. Neisseria meningitidis

a. Use of molluscicides

52. The student nurse is aware that the

b. Building of foot bridges

pathognomonic sign of measles is Kopliks spot

c. Proper use of sanitary toilets

and you may see Kopliks spot by inspecting the:

d. Use of protective footwear, such as rubber boots

a. Nasal mucosa

58. Several clients is newly admitted and

b. Buccal mucosa

diagnosed with leprosy. Which of the following

c. Skin on the abdomen

clients should be classified as a case of

d. Skin on neck

multibacillary leprosy?

53. Angel was diagnosed as having Dengue fever.

a. 3 skin lesions, negative slit skin smear

You will say that there is slow capillary refill

b. 3 skin lesions, positive slit skin smear

when the color of the nail bed that you pressed

c. 5 skin lesions, negative slit skin smear

does not return within how many seconds?

d. 5 skin lesions, positive slit skin smear

59. Nurses are aware that diagnosis of leprosy is

d. Let the child rest for 10 minutes then continue giving

highly dependent on recognition of symptoms.

Oresol more slowly.

Which of the following is an early sign


of leprosy?

64. Nikki a 5-month old infant was brought by his


mother to the health center because of diarrhea

a. Macular lesions

for 4 to 5 times a day. Her skin goes back slowly

b. Inability to close eyelids

after a skin pinch and her eyes are sunken. Using

c. Thickened painful nerves

the IMCI guidelines, you will classify this infant in

d. Sinking of the nosebridge

which category?

60. Marie brought her 10 month old infant for

a. No signs of dehydration

consultation because of fever, started 4 days

b. Some dehydration

prior to consultation. In determining malaria risk,

c. Severe dehydration

what will you do?

d. The data is insufficient.

a. Perform a tourniquet test.

65. Chris a 4-month old infant was brought by

b. Ask where the family resides.

her mother to the health center because of

c. Get a specimen for blood smear.

cough. His respiratory rate is 42/minute. Using

d. Ask if the fever is present everyday.

the Integrated Management of Child Illness


(IMCI) guidelines of assessment, his breathing is

61. Susie brought her 4 years old daughter to the

considered as:

RHU because of cough and colds. Following the


IMCI assessment guide, which of the following is

a. Fast

a danger sign that indicates the need for urgent

b. Slow

referral to a hospital?

c. Normal
d. Insignificant

a. Inability to drink
b. High grade fever

66. Maylene had just received her 4th dose of

c. Signs of severe dehydration

tetanus toxoid. She is aware that her baby will

d. Cough for more than 30 days

have protection against tetanus for

62. Jimmy a 2-year old child revealed baggy

a. 10 year

pants. As a nurse, using the IMCI guidelines,

b. 5 years

how will you manage Jimmy?

c. 3 years
d. Lifetime

a. Refer the child urgently to a hospital for


confinement.

67. Nurse Ron is aware that unused BCG should

b. Coordinate with the social worker to enroll the child

be discarded after how many hours of

in a feeding program.

reconstitution?

c. Make a teaching plan for the mother, focusing on


menu planning for her child.

a. 2 hours

d. Assess and treat the child for health problems like

b. 4 hours

infections and intestinal parasitism.

c. 8 hours
d. At the end of the day

63. Gina is using Oresol in the management of


diarrhea of her 3-year old child. She asked you

68. The nurse explains to a breastfeeding mother

what to do if her child vomits. As a nurse you will

that breast milk is sufficient for all of the babys

tell her to:

nutrient needs only up to:

a. Bring the child to the nearest hospital for further

a. 5 months

assessment.

b. 6 months

b. Bring the child to the health center for intravenous

c. 1 year

fluid therapy.

d. 2 years

c. Bring the child to the health center for assessment


by the physician.

69. Nurse Ron is aware that the gestational age

75. Which symptom would indicate the Baby

of a conceptus that is considered viable (able to

Alexandra was adapting appropriately to extra-

live outside the womb) is:

uterine life without difficulty?

a. 8 weeks

a. Nasal flaring

b. 12 weeks

b. Light audible grunting

c. 24 weeks

c. Respiratory rate 40 to 60 breaths/minute

d. 32 weeks

d. Respiratory rate 60 to 80 breaths/minute

70. When teaching parents of a neonate the

76. When teaching umbilical cord care for

proper position for the neonates sleep, the

Jennifer a new mother, the nurse Jenny would

nurse Patricia stresses the importance of placing

include which information?

the neonate on his back to reduce the risk of


which of the following?

a. Apply peroxide to the cord with each diaper change


b. Cover the cord with petroleum jelly after bathing

a. Aspiration

c. Keep the cord dry and open to air

b. Sudden infant death syndrome (SIDS)

d. Wash the cord with soap and water each day during

c. Suffocation

a tub bath.

d. Gastroesophageal reflux (GER)


77. Nurse John is performing an assessment on a
71. Which finding might be seen in baby James a

neonate. Which of the following findings is

neonate suspected of having an infection?

considered common in the healthy neonate?

a. Flushed cheeks

a. Simian crease

b. Increased temperature

b. Conjunctival hemorrhage

c. Decreased temperature

c. Cystic hygroma

d. Increased activity level

d. Bulging fontanelle

72. Baby Jenny who is small-for-gestation is at

78. Dr. Esteves decides to artificially rupture the

increased risk during the transitional period for

membranes of a mother who is on labor.

which complication?

Following this procedure, the nurse Hazel checks


the fetal heart tones for which the following

a. Anemia probably due to chronic fetal hypoxia

reasons?

b. Hyperthermia due to decreased glycogen stores


c. Hyperglycemia due to decreased glycogen stores

a. To determine fetal well-being.

d. Polycythemia probably due to chronic fetal hypoxia

b. To assess for prolapsed cord


c. To assess fetal position

73. Marjorie has just given birth at 42 weeks

d. To prepare for an imminent delivery.

gestation. When the nurse assessing the


neonate, which physical finding is expected?

79. Which of the following would be least likely


to indicate anticipated bonding behaviors by new

a. A sleepy, lethargic baby

parents?

b. Lanugo covering the body


c. Desquamation of the epidermis

a. The parents willingness to touch and hold the

d. Vernix caseosa covering the body

newborn.
b. The parents expression of interest about the size of

74. After reviewing the Myrnas maternal history

the newborn.

of magnesium sulfate during labor, which

c. The parents indication that they want to see the

condition would nurse Richard anticipate as a

newborn.

potential problem in the neonate?

d. The parents interactions with each other.

a. Hypoglycemia

80. Following a precipitous delivery, examination

b. Jitteriness

of the clients vagina reveals a fourth-degree

c. Respiratory depression

laceration. Which of the following would be

d. Tachycardia

contraindicated when caring for this client?

a. Applying cold to limit edema during the first 12 to 24

c. Monitor partial pressure of oxygen (Pao2) levels.

hours.

d. Humidify the oxygen.

b. Instructing the client to use two or more peri pads to


cushion the area.

85. Which of the following is normal newborn

c. Instructing the client on the use of sitz baths if

calorie intake?

ordered.
d. Instructing the client about the importance of
perineal (kegel) exercises.
81. A pregnant woman accompanied by her
husband, seeks admission to the labor and
delivery area. She states that shes in labor and
says she attended the facility clinic for prenatal
care. Which question should the nurse Oliver ask
her first?
a. Do you have any chronic illnesses?
b. Do you have any allergies?
c. What is your expected due date?
d. Who will be with you during labor?
82. A neonate begins to gag and turns a dusky
color. What should the nurse do first?
a. Calm the neonate.
b. Notify the physician.
c. Provide oxygen via face mask as ordered
d. Aspirate the neonates nose and mouth with a bulb
syringe.
83. When a client states that her water broke,
which of the following actions would be
inappropriate for the nurse to do?
a. Observing the pooling of straw-colored fluid.
b. Checking vaginal discharge with nitrazine paper.
c. Conducting a bedside ultrasound for an amniotic
fluid index.
d. Observing for flakes of vernix in the vaginal
discharge.
84. A baby girl is born 8 weeks premature. At
birth, she has no spontaneous respirations but is
successfully resuscitated. Within several hours
she develops respiratory grunting, cyanosis,
tachypnea, nasal flaring, and retractions. Shes
diagnosed with respiratory distress syndrome,
intubated, and placed on a ventilator. Which
nursing action should be included in the babys
plan of care to prevent retinopathy of
prematurity?
a. Cover his eyes while receiving oxygen.
b. Keep her body temperature low.

a. 110 to 130 calories per kg.


b. 30 to 40 calories per lb of body weight.
c. At least 2 ml per feeding
d. 90 to 100 calories per kg
86. Nurse John is knowledgeable that usually
individual twins will grow appropriately and at
the same rate as singletons until how many
weeks?
a. 16 to 18 weeks
b. 18 to 22 weeks
c. 30 to 32 weeks
d. 38 to 40 weeks
87. Which of the following classifications applies
to monozygotic twins for whom the cleavage of
the fertilized ovum occurs more than 13 days
after fertilization?
a. conjoined twins
b. diamniotic dichorionic twins
c. diamniotic monochorionic twin
d. monoamniotic monochorionic twins
88. Tyra experienced painless vaginal bleeding
has just been diagnosed as having a placenta
previa. Which of the following procedures is
usually performed to diagnose placenta previa?
a. Amniocentesis
b. Digital or speculum examination
c. External fetal monitoring
d. Ultrasound
89. Nurse Arnold knows that the following
changes in respiratory functioning during
pregnancy is considered normal:
a. Increased tidal volume
b. Increased expiratory volume
c. Decreased inspiratory capacity
d. Decreased oxygen consumption
90. Emily has gestational diabetes and it is
usually managed by which of the following
therapy?
a. Diet
b. Long-acting insulin

c. Oral hypoglycemic

c. Pyelonephritis

d. Oral hypoglycemic drug and insulin

d. Urinary tract infection (UTI)

91. Magnesium sulfate is given to Jemma with

96. Rh isoimmunization in a pregnant client

preeclampsia to prevent which of the following

develops during which of the following

condition?

conditions?

a. Hemorrhage

a. Rh-positive maternal blood crosses into fetal blood,

b. Hypertension

stimulating fetal antibodies.

c. Hypomagnesemia

b. Rh-positive fetal blood crosses into maternal blood,

d. Seizure

stimulating maternal antibodies.


c. Rh-negative fetal blood crosses into maternal blood,

92. Cammile with sickle cell anemia has an

stimulating maternal antibodies.

increased risk for having a sickle cell crisis

d. Rh-negative maternal blood crosses into fetal blood,

during pregnancy. Aggressive management of a

stimulating fetal antibodies.

sickle cell crisis includes which of the following


measures?

97. To promote comfort during labor, the nurse


John advises a client to assume certain positions

a. Antihypertensive agents

and avoid others. Which position may cause

b. Diuretic agents

maternal hypotension and fetal hypoxia?

c. I.V. fluids
d. Acetaminophen (Tylenol) for pain

a. Lateral position
b. Squatting position

93. Which of the following drugs is the antidote

c. Supine position

for magnesium toxicity?

d. Standing position

a. Calcium gluconate (Kalcinate)

98. Celeste who used heroin during her

b. Hydralazine (Apresoline)

pregnancy delivers a neonate. When assessing

c. Naloxone (Narcan)

the neonate, the nurse Lynnette expects to find:

d. Rho (D) immune globulin (RhoGAM)


a. Lethargy 2 days after birth.
94. Marlyn is screened for tuberculosis during

b. Irritability and poor sucking.

her first prenatal visit. An intradermal injection

c. A flattened nose, small eyes, and thin lips.

of purified protein derivative (PPD) of the

d. Congenital defects such as limb anomalies.

tuberculin bacilli is given. She is considered to


have a positive test for which of the following

99. The uterus returns to the pelvic cavity in

results?

which of the following time frames?

a. An indurated wheal under 10 mm in diameter

a. 7th to 9th day postpartum.

appears in 6 to 12 hours.

b. 2 weeks postpartum.

b. An indurated wheal over 10 mm in diameter appears

c. End of 6th week postpartum.

in 48 to 72 hours.

d. When the lochia changes to alba.

c. A flat circumcised area under 10 mm in diameter


appears in 6 to 12 hours.

100. Maureen, a primigravida client, age 20, has

d. A flat circumcised area over 10 mm in diameter

just completed a difficult, forceps-assisted

appears in 48 to 72 hours.

delivery of twins. Her labor was unusually long


and required oxytocin (Pitocin) augmentation.

95. Dianne, 24 year-old is 27 weeks pregnant

The nurse whos caring for her should stay alert

arrives at her physicians office with complaints

for:

of fever, nausea, vomiting, malaise, unilateral


flank pain, and costovertebral angle tenderness.

a. Uterine inversion

Which of the following diagnoses is most likely?

b. Uterine atony
c. Uterine involution

a. Asymptomatic bacteriuria
b. Bacterial vaginosis

d. Uterine discomfort

Situation : Nurse Macarena is a Family Planning and


Infertility Nurse Specialist and currently attends to
FAMILY PLANNING CLIENTS AND INFERTILE COUPLES.
The following conditions pertain to meeting the nursing
needs of this particular population group.
1. Daphne, 19 years old, asks nurse Macarena how can
pregnancy be prevented through tubal ligation. Which
would be the best answer?
A. Prostaglandins released from the cut fallopian tubes
will lead to permanent closure of the vagina.
B. Sperm can not enter the uterus because the cervical
entrance is blocked.
C. Sperm can no longer reach the ova, because the
fallopian tubes are blocked
D. The ovary no longer releases ova as there is no
where for them to go.
2. The Stevens are a couple undergoing testing for
infertility. Infertility is said to exist when:
A. A woman has no uterus
B. A woman has no children
C. A couple has been trying to conceive for 1 year
D. A couple has wanted a child for 6 months
3. Another client named Cindy is diagnosed as having
endometriosis. This condition interferes with fertility
because:
A. Endometrial implants can block the fallopian tubes
B. The uterine cervix becomes inflamed and swollen
C. The endometrial lining becomes inflamed leading to
narrowing of the cervix.
D. Inflammation of the endometrium causes release of
substance P which kills the sperm.
4. Cindy submits herself to Fatima Medical Center and
is scheduled to have a hysterosalpingogram. Which of
the following instructions would you give her regarding
this procedure?
A. Menstruation will be irregular for few months as an
effect of the dye but it is just normal
B. The sonogram of the uterus will reveal any tumors
present
C. The women may experience some itchiness in the
vagina as an after effect.
D. Cramping may be felt when the dye is inserted
5. Cindys cousin on the other hand, knowing nurse
Macarenas specialization asks what artificial
insemination by donor entails. Which would be your
best answer if you were Nurse Macarena?
A. Donor sperm are introduced vaginally into the uterus
or cervix
B. Donor sperm are injected intra-abdominally into
each ovary
C. Artificial sperm are injected vaginally to test tubal
patency
D. The husbands sperm is administered intravenously
weekly
6. Pain in geriatric clients require careful assessment
because they:
A. experienced reduce sensory perception
B. have increased sensory perception
C. are expected to experience chronic pain
D. have a increased pain sensitivity
7. Administration of aminoglycosides to the older
persons requires careful patient assessment because
older people:
A. are more sensitive to drugs
B. have increased hepatic, renal and gastrointestinal
function
C. have increased sensory perception

D. mobilize drugs more rapidly


8. Elder clients are often at risk of having impaired skin
integrity. One factor is that they often experience
urinary incontinence. The elderly patient is at higher
risk for urinary incontinence because of:
A. increased glomerular filtration
B. decrease elasticity of blood vessels
C. decreased bladder capacity
D. dilated urethra
9. Which of the following is the MOST COMMON sign of
infection among the elderly?
A. decreased breath sounds with crackles
B. Increase body temperature
C. pain
D. Restlessness, confusion, irritability
10. Prioritization is important to test a nurses good
judgment towards different situations. Priorities when
caring for the elderly trauma patient:
A. circulation, airway, breathing
B. disability (neurologic), airway, breathing
C. airway, breathing, disability (neurologic)
D. airway, breathing, circulation
11. The nurse assessing newborn babies and infants
during their hospital stay after birth will notice which of
the following symptoms as a primary manifestation of
Achalasia?
A. Olive shaped mass on abdomen
B. Failure to pass meconium during the first 24 to 48
hours after birth
C. The skin turns yellow and then brown over the first
48 hours of life
D. Effortless and non-projectile vomiting
12. A client is 7 months pregnant and has just been
diagnosed as having a partial placenta previa. She is
stable and has minimal spotting and is being sent
home. Which of these instructions to the client may
indicate a need for further teaching?
A. Maintain bed rest with bathroom privileges
B. Avoid intercourse for three days.
C. Call if contractions occur.
D. Stay on left side as much as possible when lying
down.
13. Ms. Anna has been rushed to the hospital with
ruptured membrane. Which of the following should the
nurse check first?
A. Check for the presence of infection
B. Assess for Prolapse of the umbilical cord
C. Check the maternal heart rate
D. Assess the color of the amniotic fluid
14. The nurse notes that the infant is wearing a plasticcoated diaper. If a topical medication were to be
prescribed and it were to go on the stomachs or
buttocks, the nurse would teach the caregivers to:
A. avoid covering the area of the topical medication
with the diaper
B. avoid the use of clothing on top of the diaper
C. put the diaper on as usual
D. apply an icepack for 5 minutes to the outside of the
diaper
15. Which of the following factors is most important in
determining the success of relationships used in
delivering nursing care?
A. Type of illness of the client
B. Transference and countertransference
C. Effective communication
D. Personality of the participants

16. Grace sustained a laceration on her leg from


automobile accident. Why are lacerations of lower
extremities potentially more serious among pregnant
women than other?
A. lacerations can provoke allergic responses due to
gonadotropic hormone release
B. a woman is less able to keep the laceration clean
because of her fatigue
C. healing is limited during pregnancy so these will not
heal until after birth
D. increased bleeding can occur from uterine pressure
on leg veins
17. You are the nurse assigned to work with a child with
acute glomerulonephritis. By following the prescribed
treatment regimen, the child experiences a remission.
You are now checking to make sure the child does not
have a relapse. Which finding would most lead you to
the conclusion that a relapse is happening?
A. Elevated temperature, cough, sore throat, changing
complete blood count (CBC) with differential
B. A urine dipstick measurement of 2+ proteinuria or
more for 3 days, or the child found to have 3-4+
proteinuria plus edema.
C. The urine dipstick showing glucose in the urine for 3
days, extreme thirst, increase in urine output, and a
moon face.
D. A temperature of 37.8 degrees (100 degrees F),
flank pain, burning frequency, urgency on voiding, and
cloudy urine.
18. The painful phenomenon known as back labor
occurs in a client whose fetus in what position?
A. Brow position
B. Right Occipito-Anterior Position
C. Breech position
D. Left Occipito-Posterior Position
19. Which among the following is the primary focus of
prevention of cancer?
A. Elimination of conditions causing cancer
B. Diagnosis and treatment
C. Treatment at early stage
D. Early detection
20. In the prevention and control of cancer, which of
the following activities is the most important function of
the community health nurse?
A. Conduct community assemblies.
B. Referral to cancer specialist those clients with
symptoms of cancer.
C. Use the nine warning signs of cancer as parameters
in our process of detection, control and treatment
modalities.
D. Teach women about proper/correct nutrition.
21. Who among the following are recipients of the
secondary level of care for cancer cases?
A. Those under early case detection
B. Those under post case treatment
C. Those scheduled for surgery
D. Those undergoing treatment
22. Who among the following are recipients of the
tertiary level of care for cancer cases?
A. Those under early treatment C. Those under early
detection
B. Those under supportive care D. Those scheduled for
surgery
23. Being a community health nurse, you have the
responsibility of participating in protecting the health of
people. Consider this situation: Vendors selling bread
with their bare hands. They receive money with these

hands. You do not see them washing their hands. What


should you say/do?
A. Miss, may I get the bread myself because you have
not washed your hands
B. All of these
C. Miss, it is better to use a pick up forceps/ bread
tong
D. Miss, your hands are dirty. Wash your hands first
before getting the bread
24. A female client asks the nurse about the use of a
cervical cap. Which statement is correct regarding the
use of the cervical cap?
A. It may affect Pap smear results.
B. It does not need to be fitted by the physician.
C. It does not require the use of spermicide.
D. It must be removed within 24 hours.
25. The major components of the communication
process are:
A. Verbal, written and nonverbal
B. Speaker, listener and reply
C. Facial expression, tone of voice and gestures
D. Message, sender, channel, receiver and feedback
26. The school nurse notices a child who is wearing old,
dirty, poor-fitting clothes is always hungry, has no
lunch money, and is always tired. When the nurse asks
the boy his tiredness, he talks of playing outside until
midnight. The nurse will suspect that this child is:
A. Being raised by a parent of low intelligence quotient
(IQ)
B. An orphan
C. A victim of child neglect
D. The victim of poverty
Situation: Milo, a 16-year-old male, has been diagnosed
to have AIDS. He worked as entertainer in a cruise ship.
27. Which method of transmission is common to
contract AIDS:
A. Syringe and needles
B. Body fluids
C. Sexual contact
B. Transfusion
28. Causative organism in AIDS is one of the following:
A. Fungus
B. Bacteria
C. retrovirus
D. Parasites
29. You are assigned in a private room of Milo. Which
procedure should be of utmost importance?
A. Alcohol wash
B. Universal precaution
C. Washing Isolation
D. Gloving technique
30. What primary health teaching would you give to
Milo?
A. Daily exercise
B. Prevent infection
C. Reverse isolation
D. Proper nutrition
31. Exercise precaution must be taken to protect health
worker dealing with the AIDS patients. Which among
these must be done as priority:
A. Boil used syringe and needles
B. Use gloves when handling specimen
C. Label personal belonging
D. Avoid accidental wound
Situation: Michelle is a 6 year old preschooler. She was
reported by her sister to have measles but she is at

home because of fever, upper respiratory problem and


white sports in her mouth.
32. Rubeola is an Arabic term meaning Red, the rash
appears on the skin in invasive stage prior to eruption
behind the ears. As a nurse, your physical examination
must determine complication especially:
A. Otitis media
B. Bronchial pneumonia
C. Inflammatory conjunctiva
D. Membranous laryngitis
33. To render comfort measure is one of the priorities,
Which includes care of the skin, eyes, ears, mouth and
nose. To clean the mouth, your antiseptic solution is in
some form of which one below?
A. Water
B. Sulfur
C. Alkaline
D. Salt
34. As a public health nurse, you teach mother and
family members the prevention of complication of
measles. Which of the following should be closely
watched?
A. Temperature fails to drop
B. Inflammation of the conjunctiva
C. Inflammation of the nasopharynx
D. Ulcerative stomatitis
35. Source of infection of measles is secretion of nose
and throat of infection person. Filterable virus of
measles is transmitted by:
A. Water supply
B. Droplet
C. Food ingestion
D. Sexual contact
36. Method of prevention is to avoid exposure to an
infected person. Nursing responsibility for rehabilitation
of patient includes the provision of:
A. Terminal disinfection
B. Injection of gamma globulin
C. Immunization
D. Comfort measures
SITUATION: Sexually Transmitted Diseases are
important to identify during pregnancy because of their
potential effect on the pregnancy, fetus, or newborn.
The following questions pertain to STDs.
37. Ms. Reynaldita is a promiscuous woman in Manila
submits herself to the clinic for certain examinations.
She is experiencing vaginal irritation, redness, and a
thick cream cheese vaginal discharge. As a nurse, you
will suspect that Ms. Reynaldita is having what disease?
A. Gardnerella Vaginalis
B. Candida Albicans
C. Treponema Pallidum
D. Moniliasis
38. As a knowledgeable nurse, you know that the
doctor may prescribe a certain medications for Ms.
Reynaldita. What is the drug of choice for Reynalditas
infection?
A. haloperidol
B. miconazole
C. benzathine penicillin
D. metronidazole
39. Based on your learnings, you know that the
causative agent of Reynalditas infection is:
A. Monistat Candida
B. Candida Albicans
C. Albopictus Candidiasis
D. Monakiki

40. The microorganism that causes Reynalditas


infection is a:
A. Bacteria
B. Protozoa
C. Fungus
D. Virus
41. Another client in the Maternal Clinic was Ms.
Celbong. Her doctor examined Ms. Celbongs vaginal
secretions and found out that she has a Trichomoniasis
infection. Trichomoniasis is diagnosed through which of
the following method?
A. Vaginal secretions are examined on a wet slide that
has been treated with potassium hydroxide.
B. Vaginal speculum is used to obtain secretions from
the cervix.
C. A litmus paper is used to test if the vaginal
secretions are infected with trichomoniasis.
D. Vaginal secretions are examined on a wet slide
treated with zephiran solution.
42. Daphne who is on her first trimester of pregnancy is
also infected with trichomoniasis. You know that the
drug of choice for Daphne is:
A. Flagyl
B. Clotrimazole (topical)
C. Monistat
D. Zovirax
43. Syphilis is another infection that may impose risk
during pregnancy. Since we are under the practice of
health science, you know that Syphilis is caused by:
A. Treponema Syphilis
B. Neisseria gonorrhoeae
C. Chlamydia Trachomatis
D. Treponema Pallidum
44. What type of microorganism is the causative agent
of syphilis?
A. Spirochete
B. Fungus
C. Bacteria
D. Protozoan
45. Under the second level of prevention, you know
that one of the focuses of care is the screening of
diseases. What is the screening test for syphilis?
A. VDRL
B. Western blot
C. PSA
D. ELISA
46. Jarisch-Herxheimer reaction may be experienced by
the client with syphilis after therapy with benzathine
penicillin G. The characteristic manifestations of
Jarisch-Herxheimer reaction are:
A. Rashes, itchiness, hives and pruritus
B. Confusion, drowsiness and numbness of extremities
C. sudden episode of hypotension, fever, tachycardia,
and muscle aches
D. Episodes of nausea and vomiting, with bradypnea
and bradycardia
47. A pregnant woman is in the clinic for consultation
with regards to STDs. She inquires about Venereal
warts and asks you about its specific lesion
appearance. Which of the following is your correct
response to the client?
A. Why are you asking about it? You might be a
prostitute woman.
B. The lesions appear as cauliflower like lesions.
C. It appears as pinpoint vesicles surrounded by
erythema.
D. The lesions can possibly obstruct the birth canal.

48. Based on your past learnings in communicable


diseases, you know that the causative agent of
venereal warts is:
A. Chlamydia Trachomatis
B. Candida Moniliasis
C. Human Papillomavirus
D. Staphylococcus Aureus
49. As a nurse in charge for this woman, you anticipate
that the doctor will prescribe what medication for this
type of infection?
A. Podophyllum (Podofin)
B. Flagyl
C. Monistat
D. Trichloroacetic acid
50. Cryocautery may also be used to remove large
lesions. The healing period after cryocautery may be
completed in 4-6 weeks but may cause some
discomforts to the woman. What measures can
alleviate these discomforts?
A. Kegels Exercise
B. Cool air
C. Topical steroids
D. Sitz baths and lidocaine cream
51. In order to prevent acquiring sexually transmitted
diseases, what is the BEST way to consider?
A. Condom use
B. Withdrawal
C. vasectomy
D. Abstinence
SITUATION: The Gastrointestinal System is responsible
for taking in and processing nutrients for all parts of the
body, any problem can quickly affect other body
systems and, if not adequately treated, can affect
overall health, growth, and development. The following
questions are about gastrointestinal disorders in a
child.
52. Mr. & Mrs. Alcaras brought their son in the hospital
for check up. The child has failure to thrive and was
diagnosed with pyloric stenosis. Which among the
following statements are the characteristic
manifestations of pyloric stenosis?
A. Vomiting in the early morning
B. Bile containing vomitus immediately after meal
C. sausage shaped mass in the abdomen
D. Projectile vomiting with no bile content
53. The exact cause of pyloric stenosis is unknown, but
multifactorial inheritance is the likely cause. Being
knowledgeable about this disease, you know that
pyloric stenosis is more common in which gender?
A. Male
B. Female
C. Incidence is equal for both sexes
D. None of the above
54. To rule out pyloric stenosis, the definitive diagnosis
is made by watching the infant drink. After the infant
drinks, what will be the characteristic sign that will
describe pyloric stenosis?
A. An olive-size lump can be palpated
B. There is gastric peristaltic waves from left to right
across the abdomen
C. A hypertrophied sphincter can be seen on
ultrasound.
D. A tingling sensation is felt on the lower extremities
55. Shey a 10 months old infant was admitted to the
hospital for severe abdominal pain. The doctor found
out that the distal ileal segment of the childs bowel

has invaginated into the cecum. The nurse will suspect


what disease condition?
A. Intussusception
B. Pyloric stenosis
C. Hirschsprungs disease
D. Vaginismus
56. In intussusceptions, children suddenly draw up their
legs and cry as if they are in severe pain and possibly
vomit. Another manifestation of such disease is the
presence of blood in the stool. What is the
characteristic stool of client with intussusception?
A. Coffee ground
B. Black and Tarry
C. Currant jelly stool
D. Watery stool
57. A 4-year-old child is hospitalized because of
persistent vomiting. As a nurse, you must monitor the
child closely for:
A. Diarrhea
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Hyperactive bowel sounds
58. A nurse is monitoring for signs of dehydration in a
1-year-old child who has been hospitalized for diarrhea.
The nurse prepares to take the childs temperature and
avoids which method of measurement?
A. Tympanic
B. Axillary
C. Rectal
D. Electronic
59. A home care nurse provides instructions to the
mother of an infant with cleft palate regarding feeding.
Which statement if made by the mother indicates a
need for further instructions?
A. I will use a nipple with a small hole to prevent
choking.
B. I will stimulate sucking by rubbing the nipple on the
lower lip.
C. I will allow the infant time to swallow.
D. I will allow the infant to rest frequently to provide
time for swallowing what has been placed in the
mouth.
60. An infant has just returned to the nursing unit
following a surgical repair of a cleft lip located at the
right side of the lip. The nurse places the infant in
which most appropriate position?
A. On the right side
B. On the left side
C. Prone
D. Supine
61. A clinic nurse reviews the record of an infant seen
in the clinic. The nurse notes that a diagnosis of
esophageal atresia with tracheoesophageal fistula
(TEF) is suspected. The nurse expects to note which
most likely sign of this condition documented in the
record?
A. Severe projectile vomiting
B. Coughing at night time
C. Choking with feedings
D. Incessant crying
SITUATION: Human development is one of the
important concepts that a nurse should learn to be able
to deal appropriately with their clients of different
developmental stages.
62. Which statement best describes when fertilization
occurs?

A. When the spermatozoon passes into the ovum and


the nuclei fuse into a single cell.
B. When the ovum is discharged from the ovary near
the fimbriated end of the fallopian tube.
C. When the embryo attaches to the uterine wall.
D. When the sperm and ova undergo developmental
changes resulting in a reduction in the number of
chromosomes.
63. A pregnant client asks you about fetal
development. At approximately what gestational age
does the fetuss single chambered heart begin to pump
its own blood cells through main blood vessels?
A. 10 weeks
B. 8 weeks
C. 5 weeks
D. 3 weeks
64. At 17 weeks gestation, a fetus isnt considered to
be ballotable. Ballottement means that:
A. The examiner feels rebound movement of the fetus.
B. The examiner feels fetal movement.
C. The client feels irregular, painless uterine
contractions.
D. The client feels fetal movement.
65. Which hormone stimulates the development of the
ovum?
A. Follicle stimulating hormone (FSH)
B. Human Chorionic Gonadotropin (HCG)
C. Luteinizing Hormone (LH)
D. Gonadotropin Releasing Hormone (GnRH)
66. How long is the gestational period of a full term
pregnancy?
A. Ranging from 245 days to 259 days
B. around 5,554 hours to 5,880 hours
C. More than 294 days
D. Averaging of 266 to 294 days
67. An 18 year old woman in her 18th week of
pregnancy is being evaluated. Which positive sign of
pregnancy should the nurse expect to be present?
A. Fetal heart tones detectable by Doppler stethoscope
B. Fetal movement detectable by palpation
C. Visualization of the fetus by ultrasound examination.
D. Fetal heart tones detectable by a fetoscope.
68. During her prenatal visit, a 28 year old client
expresses concern about nutrition during pregnancy.
She wants to know what foods she should be eating to
ensure the proper growth and development of her baby.
Which step should the nurse take first?
A. Give the client a sample diet plan for a 2,400 calorie
diet.
B. Emphasize the importance of avoiding salty and
fatty foods.
C. Instruct the client to continue to eat a normal diet.
D. Assess the clients current nutritional status by
taking a diet history.
69. A nurse is teaching a class about the reproductive
system. She explains that fertilization most often takes
place in the:
A. Ovary
B. Fallopian tubes
C. Uterus
D. vagina
70. A large number of neural tube defects may be
prevented if a pregnant woman includes which
supplement in her diet?
A. Vit. A
B. Vit. E
C. Vit. D

D. Vit. B9
71. A 22 year old client is at 20 weeks gestation. She
asks the nurse about the development of her fetus at
this stage. Which of the following developments occurs
at 20 weeks gestation?
A. The pancreas starts producing insulin and the
kidneys produce urine.
B. The fetus follows a regular schedule of turning,
sleeping, sucking, and kicking.
C. Swallowing reflex has been mastered, and the fetus
sucks its thumb.
D. Surfactant forms in the lungs.
SITUATION: Developing countries such as the
Philippines suffer from high infant and child mortality
rates. Thus, as a management to the existing problem,
the WHO and UNICEF launched the IMCI.
72. A 6 month old baby Len was brought to the health
center because of fever and cough for 2 days. She
weighs 5 kg. Her temperature is 38.5 taken axillary.
Further examination revealed that she has general
rashes, her eyes are red and she has mouth ulcers non
deep and non extensive, There was no pus draining
from her eyes. Most probably Baby Len has:
a. Severe complicated measles
b. Fever: No MALARIA
c. Very severe febrile disease
d. Measles
e. Measles with eye or mouth complications
73. The dosage of Vit. A supplement given to Baby Len
would be:
a. 100,000 IU
b. 10,000 IU
c. 200,000 IU
d. 20,000 IU
74. Using IMCI Chart, this child can be manage with:
a. Treat the child with paracetamol and follow up in 2
days if the fever persist
b. Give the first dose of antibiotic, give Vit. A, apply
Gentian Violet for mouth ulcers and refer urgently to
hospital
c. Give100, 000 international units of Vit. A
d. Give 200, 000 international units of Vit. A
e. Give Vit. A, apply Gentian violet for mouth ulcers and
follow up in 2 days
75. The following are signs of severe complicated
measles:
a. Clouding of the cornea
b. Deep or extensive mouth ulcers
c. Pus draining from the eyes
d. A and b only
e. All of the above
76. If the child is having 2 weeks ear discharges, how
would you classify and treat the child:
1. Green
2. Yellow
3. Pink
4. Red
5. Dry the ear by wicking
6. 5 days antibiotic
7. Urgent referral with first dose of antibiotic
a. 4,7
b. 2,5,6
c. 1,5
d. 3,7
e. 2,5
77. The following are treatments for acute ear
infections:

a. Dry the ear by wicking


b. Give antibiotics for 5 days
c. Follow up in 5 days
d. A and c only
e. All of the above
78. A child with ear problem should be assessed for the
following, except:
a. Ear pain
b. If discharge is present for how long?
c. Ear discharge
d. Is there any fever?
e. None of the above
79. If the child does not have ear problem, using IMCI,
what should you do as a nurse?
a. Go to the next question, check for malnutrition
b. Check for ear pain
c. Check for tender swelling behind the ear
d. Check for ear discharge
80. An ear discharge that has been present for more
than 14 days can be classified as:
a. Complicated ear infection
b. Acute ear infection
c. Chronic ear infection
d. Mastoiditis
81. An ear discharge that has been present for less
than 14 days can be classified as:
a. Complicated ear infection
b. Acute ear infection
c. Chronic ear infection
d. Mastoiditis
82. If the child has severe classification because of ear
problem, what would be the best thing that you should
do as a nurse?
a. Dry the ear by wicking
b. Give an antibiotic for 5 days
c. Refer urgently
d. Instruct mother when to return immediately
Situation: Primary Health Care (PHC) is defined by the
WHO as essential health care made universally
accessible to individuals, families and communities.
83. The WHO held a meeting in this place where
Primary health Care was discussed. What is this place?
A. Alma Ata
B. Russia
C. Vienna
D. Geneva
Situation: The national objective for maintaining the
health of all Filipinos is a primary responsibility of the
DOH.
84. The following are mission of the DOH except:
a. Ensure accessibility
b.Quality of health care
c.Health for all Filipinos
d.Quality of Life of all Filipinos
e. None of the above
85. The basic principles to achieve improvement in
health include all BUT:
a. Universal access to basic health services must be
ensured
b. The health and nutrition of vulnerable groups must
be prioritized
c. Performance of the health sector must be enhanced
d. Support the frontline workers and the local health
system
e. None of the above
86. Which of the following is not a primary strategy to
achieve health goals:

a. Support of local health system development


b. Development of national standards for health
c. Assurance of health care for all
d. Support the frontline workers
e. None of the above
87. According to the WHO health is:
A. state of complete physical, mental and social well
being not merely the absence of disease
B. A science and art of preventing disease and
prolonging life
C. A science that deals the optimum level of
functioning of the Individual, family and community
D. All of the above
88. Assistance in physical therapy of a trauma patient
is a:
A. Primary level of prevention
B. Secondary level of prevention
C. Tertiary level of prevention
D. Specialized level of prevention
89. Local health boards were established at the
provincial, city and municipal levels. At the municipal
level,the chairman of the board is the:
A.Rural Health physician
B.Governor
C.Mayor
D.Chairman of the Committee on Health
90. The emphasis of community health nursing is on:
A. Treatment of health problems
B. Preventing health problems and promoting optimum
health
C. Identification and assessment of health problems
D. Illness end of the wellness-illness continuum.
91. In asking the mother about her childs problem the
following communication skills should be used except:
a. Use words that the mother understand
b. Give time for the mother to answer the questions
c. Listen attentively
d. Ask checking questions
e. None of the above
92. Which of the following is the principal focus of the
CARI program of the Department of Health?
a. Teach other community health workers how to assess
patients
b. Mortality reduction through early detection
c. Teach mothers how to detect signs and where to
refer
d. Enhancement of health team capabilities
93. You were able to identify factors that lead to
respiratory problems in the community where your
health facility serves. Your primary role therefore in
order to reduce morbidity due to pneumonia is to?
a. Seek assistance and mobilize the BHWs to have a
meeting with mothers
b. Refer cases to hospitals
c. Make home visits to sick children
d. Teach mothers how to recognize early signs and
symptoms of pneumonia
94. Which of the following is the most important
responsibility of a nurse in the prevention of
unnecessary deaths from pneumonia and other severe
disease?
a. Weighing of the child
b. Provision of careful assessment
c. Taking of the temperature of the sick child
d. Giving of antibiotics

95. A 4-month-old child was brought to your clinic


because of cough and colds. Which of the following is
your primary action?
a. Teach the mother how to count her childs breathing?
b. Refer to the doctor
c. Assess the patient using the chart on management
of children with cough
d. Give cotrimoxazole tablet or syrup
e. All of the above
96. In responding to the care concerns to children with
severe disease, referral to the hospital is of the essence
especially if the child manifests which of the following?
a. Stopped feeding well
b. Fast breathing
c. Wheezing
d. Difficulty to awaken
SITUATION: Elvira is a 26 year old woman you admit to
a birthing room. Shes been having contractions 45
seconds long and 3 minutes apart for the last 6 hours.
She tells you she wants to have her baby naturally
without any analgesia or anesthesia. Her husband is in
the Army and assigned overseas, so he is not with her.
Although her sister lives only two blocks from the
hospital, Elvira doesnt want her called. She asks if she
can talk to her mother on the telephone instead.
97. Elvira didnt recognize for over an hour that she
was in labor. A sign of true labor is:
A. Sudden increase energy from epinephrine release
B. Nagging but constant pain in the lower back.
C. Urinary urgency from increased bladder pressure.
D. Show or release of the cervical mucus plug.
98. Elvira asks you which fetal position and
presentation are ideal. Your best answer would be:
A. Right occipitoanterior with full flexion.
B. Left transverse anterior in moderate flexion.
C. Right occipitoposterior with no flexion.
D. Left sacroanterior with full flexion.
99. Elvira is having long and hard uterine contractions.
What length of contraction would you report as
abnormal?
A. Any length over 30 seconds.
B. A contraction over 70 seconds in length.
C. A contraction that peaks at 20 seconds.
D. A contraction shorter than 60 seconds.
100. You assess Elviras uterine contractions. In relation
to the contraction, when does a late deceleration
begin?
A. Forty-five seconds after the contraction is over.
B. Thirty seconds after the start of a contraction.
C. After every tenth or more contraction.
D. After a typical contraction ends.
Situation 1 Nurse Minette is an independent nurse
practitioner following-up referred clients in their
respective homes. Here she handles a case of
POSTPARTUM MOTHER AND FAMILY focusing on HOME
CARE.
1. Nurse Minette needs to schedule a first home visit to
OB client Leah. When is a first home-care visit typically
made?
a. Within 4 days after discharge
b. Within 24 hours after discharge
c. Within 1 hour after discharge
d. Within 1 week of discharge
2. Leah is developing constipation from being on bed
rest. What measures would you suggest she take to
help prevent this?

a. Eat more frequent small meals instead of three large


one daily
b. Walk for at least half an hour daily to stimulate
peristalsis
c. Drink more milk, increased calcium intake prevents
constipation
d. Drink eight full glasses of fluid such as water daily
3. If you were Minette, which of the following actions,
would alert you that a new mother is entering a
postpartum at taking-hold phase?
a. She urges the baby to stay awake so that she can
breastfeed him in her
b. She tells you she was in a lot of pain all during labor
c. She says that she has not selected a name for the
baby as yet
d. She sleeps as if exhausted from the effort of labor
4. At 6-week postpartum visit what should this
postpartum mothers fundic height be?
a. Inverted and palpable at the cervix
b. Six fingerbreadths below the umbilicus
c. No longer palpable on her abdomen
d. One centimeter above the symphysis pubis
5. This postpartum mother wants to lose the weight she
gained in pregnancy, so she is reluctant to increase her
caloric intake for breast-feeding. By how much should a
lactating mother increase her caloric intake during the
first 6 months after birth?
a. 350 kcal/day
b. 5CO kcal/day
c. 200 kcal/day
d. 1,000 kcal/day
Situation 2 As the CPES is applicable for all
professional nurse, the professional growth and
development of Nurses with specialties shall be
addressed by a Specialty Certification Council. The
following questions apply to these special groups of
nurses.
6. Which of the following serves as the legal basis and
statute authority for the Board of nursing to promulgate
measures to effect the creation of a Specialty
Certification Council and promulgate professional
development programs for this group of nurseprofessionals?
a. R.A. 7610
b. R.A. 223
c. R.A. 9173
d. R.A. 7164
7. By force of law, therefore, the PRC-Board of Nursing
released Resolution No. 14 Series of the entitled:
Adoption of a Nursing Specialty Certification Program
and Creation of Nursing Specialty Certification Council.
This rule-making power is called:
a. Quasi-Judicial Power
b. Regulatory Power
c. Quasi/Legislative Power
d. Executive/Promulgation Power
8. Under the PRC-Board of Nursing Resolution
promulgating the adoption of a Nursing SpecialtyCertification Program and Council, which two (2) of the
following serves as the strongest for its enforcement?
(a) Advances made in science and technology have
provided the climate for specialization in almost all
aspects of human endeavor and
(b) As necessary consequence, there has emerged a
new concept known as globalization which seeks to
remove barriers in trade, industry and services

imposed by the national laws of countries all over the


world; and
(c) Awareness of this development should impel the
nursing sector to prepare our people in the services
sector to meet .the above challenges; and
(d) Current trends of specialization in nursing practice
recognized by; the International Council of Nurses (ICN)
of which the Philippines is a member for the benefit of
the Filipino in terms of deepening and refining nursing
practice and enhancing the quality of nursing care.
a. b & c are strong justification
b. a & b are strong justification
c. a & c are strong justification
d. a & d are strong justification
9. Which of the following is NOT a correct statement as
regards Specialty Certification?
a. The Board of Nursing intended to create the Nursing
Specialty Certification Program as a means of
perpetuating the creation of an elite force of Filipino
Nurse Professionals.
b. The Board of Nursing shall oversee the
administration of the NSCP through the various Nursing
Specialty Boards which will eventually, be created.
c. The Board of Nursing at the time exercised their
powers under R.A. 7164 in order to adopt the creation
of the Nursing Specialty Certification /council and
Program.
d. The Board of Nursing consulted nursing leaders of
national nursing associations and other concerned
nursing groups which later decided to ask a special
group of nurses of the program for nursing specialty
certification
10. The NSCC was created for the purpose of
implementing the Nursing Specialty policy under the
direct supervision and stewardship of the Board of
Nursing. Who shall comprise the NSCC?
a. A Chairperson who is the current President of the
APO a member from .the Academe, and the last
member coming from the Regulatory Board
b. The Chairperson and members of the Regulatory
Board ipso facto acts as the CPE Council
c. A Chairperson, chosen from among the Regulatory
Board Members, a Vice Chairperson appointed by the
BON at-large; two other members also chosen at-large;
and one representing the consumer group
d. A Chairperson who is the President of the Association
from the Academe; a member from the Regulatory
Board, and the last member coming from the APO
Situation 3 Nurse Anna is a new BSEN graduate and
has just passed her Licensure Examination for Nurses in
the Philippines. She has likewise been hired as a new
Community Health Nurse in one of the Rural Health
Units in their City, which of the following conditions
may be acceptable TRUTHS applied to Community
Health Nursing Practice.
11. Which of the following is the primary focus of
community health nursing practice?
a. Cure of illnesses
b. Prevention of illness
c. Rehabilitation back to health
d. Promotion of health
12. In Community Health Nursing, which of the
following is our unit of service as nurses?
a. The community.
b. The extended members of every family.
c. The individual members of the Barangay.
d. The family.

13. A very important part of the Community Health


Nursing Assessment Process includes:
a. the application of professional judgment in
estimating importance of facts to family and
community.
b. evaluation structures arid qualifications of health
center team.
c. coordination with other sectors in relation to health
concerns.
d. carrying out nursing procedures as per plan of
action.
14. In community health nursing it is important to take
into account the family health with an equally
important need to perform ocular inspection of the
areas activities which are powerful elements of:
a. evaluation
b. assessment
c. implementation
d. planning
15. The initial step in the PLANNING process in order to
engage in any nursing project or parties at the
community level involves:
a. goal-setting
b. monitoring
c. evaluation of data
d. provision of data
Situation 4 Please continue responding as a
professional nurse in these other health situations
through the following questions.
16. Transmission of HIV from an infected individual to
another person occurs:
a. Most frequency in nurses with needlesticks.
b. Only if there is a large viral load in the blood.
c. Most commonly as a result of sexual contact.
d. In all infants born to women with HIV infection.
17. The medical record of a client reveals a condition in
which the fetus cannot pass through the maternal
pelvis. The nurse interprets this as:
a. Contracted pelvis
b. Maternal disproportion
c. Cervical insufficiency
d. Fetopelvic disproportion
18. The nurse would anticipate a cesarean birth for a
client who has which infection present at the onset of
labor?
a. Herpes simplex virus
b. Human papillomavirus
c. Hepatitis
d. Toxoplasmosis
19. After a vaginal examination, the nurse determines
that the clients fetus is in an occiput posterior position.
The nurse would anticipate that the client will have:
a. A precipitous birth
b. Intense back pain
c. Frequent leg cramps
d. Nausea and vomiting
20. The rationales for using a prostaglandin gel for a
client prior to the induction of labor is to:
a. Soften and efface the cervix
b. Numb cervical pain receptors
c. Prevent cervical lacerations
d. Stimulate uterine contractions
Situation 5 Nurse Lorena is a Family Planning and
Infertility Nurse Specialist and is currently attending to
a meeting. The following conditions pertain to meeting
the nursing of this particular population group.

21. Dina, 17 years old, asks you how a tubal ligation


prevents pregnancy. Which would be the best answer?
a. Prostaglandins released from the cut fallopian tubes
can kill sperm
b. Sperm cannot enter the uterus, because the cervical
entrance is blocked
c. Sperm can no longer reach the ova, because the
fallopian tubes are blocked
d. The ovary no longer releases ova, as there is no
where for them to go
22. The McMichaels are a couple undergoing testing for
infertility. Infertility is said to exist when:
a. a woman has no uterus
b. a woman has no children
c. a couple has been trying to conceive for 1 year
d. a couple has wanted a child for 6 months
23. Another client names Lilia is diagnosed as having
endometriosis. This condition interferes with the
fertility because:
a. endometrial implants can block the fallopian tubes
b. the uterine cervix becomes inflamed and swollen
c. ovaries stop producing adequate estrogen
d. pressure on the pituitary leads to decreased FSH
levels
24. Lilia is scheduled to have a hysterosalpingogram.
Which of the following, instructions would you give her
regarding this procedure?
a. She will not be able to conceive for 3 months after
the procedure
b. The sonogram of the uterus will reveal any tumors
present
c. Many women experience mild bleeding as an after
effect
d. She may feel some cramping when the dye is
inserted
25. Lilias cousin on the other hand, knowing nurse
Lorenas specialization asks what artificial insemination
by donor entails. Which would be your best answer if
you were Nurse Lorena?
a. Donor sperm are introduced vaginally into the uterus
or cervix
b. Donor sperm are injected intra-abdominally into each
ovary
c. Artificial sperm are injected vaginally to test tubal
patency
d. The husbands sperm is administered intravenously
weekly
Situation 6 There are other important basic
knowledge in the performance of our task as
Community Health Nurse in relation to IMMUNIZATION
these include:
26. The correct temperature to store vaccines in a
refrigerator is:
a. between -4 deg C and +8 deg C
b. between 2 deg C and +8 deg C
c. between -8 deg C and 0 deg C
d. between -8 deg C and +8 deg C
27. Which of the following vaccines is not done by
intramuscular (IM) injection?
a. Measles vaccine
b. DPT
c. Hepa B vaccines
d. DPT
28. This vaccine content is derived from RNA
recombinants:
a. Measles
b. Tetanus toxoids

c. Hepatitis B vaccines
d. DPT
29. This is the vaccine needed before a child reaches
one (1) year in order for him/her to qualify as a fully
immunized child.
a. DPT
b. Measles
c. Hepatitis B
d. BCG
30. Which of the following dose of tetanus toxoid is
given to the mother to protect her infant from neonatal
tetanus and likewise provide 10 years protection for the
mother?
a. Tetanus toxoid 3
b. Tetanus toxoid 2
c. Tetanus toxoid 1
d. Tetanus toxoid 4
Situation 7 Records contain those, comprehensive
descriptions of patients health conditions and needs
and at the same serve as evidences of every nurses
accountability in the, caregiving process. Nursing
records normally differ from institution to, institution
nonetheless they follow similar patterns of meeting
needs for specifics, types of information. The following
pertains to documentation/records management.
31. This special form used when the patient is admitted
to the unit. The nurse completes, the information in this
records particularly his/her basic personal data, current
illness, previous health history, health history of the
family, emotional profile, environmental history as well
as physical assessment together with nursing diagnosis
on admission. What do you call this record?
a. Nursing Kardex
b. Nursing Health History and Assessment Worksheet
c. Medicine and Treatment Record
d. Discharge Summary
32. These, are sheets/forms which provide an efficient
and time saving way to record information that must be
obtained repeatedly at regular and/or short intervals, of
time. This does not replace the progress notes; instead
this record of information on vital signs, intake and
output, treatment, postoperative care, postpartum
care, and diabetic regimen, etc., this is used whenever
specific measurements or observations are needed tobe documented repeatedly. What is this?
a. Nursing Kardex
b. Graphic Flowsheets
c. Discharge Summary
d. Medicine and Treatment Record
33. These records show all medications and treatment
provided on a repeated basis. What do you call this
record?
a. Nursing Health History and Assessment Worksheet
b. Discharge Summary
c. Nursing Kardex
d. Medicine and Treatment Record
34. This flip-over card is usually kept in a portable file
at the Nurses Station. It has 2-parts: the activity and
treatment section and a nursing care plan section. This
carries information about basic demographic data,
primary medical diagnosis, current orders of the
physician to be carried out by the nurse, written
nursing care plan, nursing orders, scheduled tests and
procedures, safety precautions in-patient care and
factors related to daily living activities/ this record is
used in the charge-of-shift reports or during the
bedside rounds or walking rounds. What record is this?

a. Discharge Summary
b. Medicine and Treatment Record
c. Nursing Health History and Assessment Worksheet
d. Nursing Kardex
35. Most nurses regard this as conventional recording
of the date, time and mode by which the patient leaves
a healthcare unit but this record includes importantly,
directs of planning for discharge that starts soon after
the person is admitted to a healthcare institution, it is
accepted that collaboration or multidisciplinary
involvement (of all members of the health team) in
discharge results in comprehensive care. What do you
call this?
a. Discharge Summary
b. Nursing Kardex
c. Medicine and Treatment Record
d. Nursing Health History and Assessment Worksheet
Situation 8 As Filipino Professional Nurses we must be
knowledgeable, about the Code of Ethics for Filipino
Nurses and practice these by heart. The next questions
pertain to this Code of Ethics.
36. Which of the following is TRUE about the Code of
Ethics of Filipino Nurses?
a. The Philippine Nurses Association for being the
accredited professional organization was given the
privilege to formulate a Code of Ethics which the Board
of Nurses promulgated
b. Code of Nurses was first formulated in 1982
published in the Proceedings of the Third Annual
Convention of the PNA House of Delegates
c. The present code utilized the Code of Good
Governance for the Professions in the Philippines
d. Certificate of Registration of registered nurses; may
be revoked or suspended for violations of any
provisions of the Code of Ethics
37. Based on the Code of Ethics for Filipino Nurses,
what is regarded as the hallmark of nursing
responsibility and accountability?
a. Human rights of clients, regardless of creed and
gender
b. The privilege of being a registered professional
nurses
c. Health, being a fundamental right of every individual
d. Accurate documentation of actions and outcomes
38. Which of the following nurses behavior is regarded
as a violation of the Code of Ethics of Filipino Nurses?
a. A nurse withholding harmful information to the
family members of a patient
b. A nurse declining commission sent by a doctor for
her referral
c. A nurse endorsing a person running for congress
d. Nurse Reviewers and/or nurse review center
managers who pays a considerable amount of cash for
reviewees who would memorize items from the
Licensure exams and submit these to them after the
examination
39. A nurse should be cognizant that professional
programs for specialty certification by the Board of
Nursing are accredited through the
a. Professional Regulation Commission
b. Nursing Specialty Certification Council
c. Association of Deans of Philippine Colleges of Nursing
d. Philippine Nurse Association
40. Mr. Santos, R.N. works in a nursing home, and he
knows that one of his duties is to be an advocate for his
patients. Mr. Santos knows a primary duty of an
advocate is to:

a. act as the patients legal representative


b. complete all nursing responsibilities on time
c. safeguard the wellbeing of every patient
d. maintain the patients right to privacy
Situation 9 Nurse Joanna works as an OB-Gyn Nurse
and attends to several HIGH-RISK PREGNANCIES:
Particularly women with preexisting or newly acquired
illness. The following conditions apply.
41. Bernadette is a 22-year old woman. Which
condition would make her more prone than others to
developing a Candida infection during pregnancy?
a. Her husband plays golf 6 days a week
b. She was over 35 when she became pregnant
c. She usually drinks tomato juice for breakfast
d. She has developed gestational diabetes
42. Bernadette develops a deep-vein thrombosis
following an auto accident and is prescribed heparin
sub-Q. What should Joanna educate her about in regard
to this?
a. Some infants will be born with allergic symptoms to
heparin
b. Her infant will be born with scattered petechiae on
his trunk
c. Heparin can cause darkened skin in newborns
d. Heparin does not cross the placenta and so does not
affect a fetus
43. The cousin of Bernadette with sickle-cell anemia
alerted Joanna that she may need further instruction on
prenatal care. Which statement signifies this fact?
a. Ive stopped jogging so I dont risk becoming
dehydrated
b. I take an iron pull every day to help grow new red
blood cells
c. I am careful to drink at least eight glasses of fluid
everyday
d. 1 understand why folic acid is important for red cell
formation
44. Bernadette routinely takes acetylsalicylic acid
(aspirin) for arthritis. Why should she limit or
discontinue this toward the end of pregnancy?
a. Aspirin can lead to deep vein thrombosis following
birth
b. Newborns develop a red rash from salicylate toxicity
c. Newborns develop withdrawal headaches from
salicylates
d. Salicylates can lead to increased maternal bleeding
at childbirth
45. Bernadette received a laceration on her leg from
her automotive accident. Why are lacerations of lower
extremities potentially more serious in pregnant
women than others?
a. Lacerations can provoke allergic responses because
of gonadotropic hormone
b. Increased bleeding can occur from uterine pressure
on leg veins
c. A woman is less able to keep the laceration clean
because o f her fatigue
d. Healing is limited during pregnancy, so these will not
heal until after birth
Situation 10 Still in your self-managed Child Health
Nursing Clinic, your encounter these cases pertaining
to the CARE OF CHILDREN WITH PULMONARY
AFFECTIONS.
46. Josie brought her 3-months old child to your clinic
because of cough and colds. Which of the following is
your primary action?
a. Give cotrimoxazole tablet or syrup

b. Assess the patient using the chart on management


of children with cough
c. Refer to the doctor
d. Teach the mother how to count her childs bearing
47. In responding to the care concerns of children with
severe disease, referral to the hospital of the essence
especially if the child manifests which of the following?
a. Wheezing
b. Stopped bleeding
c. Fast breathing
d. Difficulty to awaken
48. Which of the following is the most important
responsibility of a nurse in the prevention of necessary
deaths from pneumonia and other severe diseases?
a. Giving of antibiotics
b. Taking of the temperature of the sick child
c. Provision of Careful Assessment
d. Weighing of the sick child
49. You were able to identify factors that lead to
respiratory problems in the community where your
health facility serves. Your primary role therefore in
order to reduce morbidity due to pneumonia is to:
a. Teach mothers how to recognize early signs and
symptoms of pneumonia
b. Make home visits to sick children
c. Refer cases to hospitals
d. Seek assistance and mobilize the BHWs to have a
meeting with mothers
50. Which of the following is the principal focus on the
CARI program of the Department of Health?
a. Enhancement of health team capabilities
b. Teach mothers how to detect signs and where to
refer
c. Mortality reduction through early detection
d. Teach other community health workers how to assess
patients
Situation 11 You are working as a Pediatric Nurse in
your own Child Health Nursing Clinic, the following
cases pertain to ASSESSMENT AND CARE OF THE
NEWBORN AT RISK conditions.
51. Theresa, a mother with a 2 year old daughter asks,
At what are can I be able to take the blood pressure of
my daughter as a routine procedure since hypertension
is common in the family? Your answer to this is:
a. At 2 years you may
b. As early as 1 year old
c. When shes 3- years old
d. When shes 6 years old
52. You typically gag children to inspect the back of
their throat. When is it important NOT to solicit a gag
reflex?
a. when a girl has a geographic tongue
b. when a boy has a possible inguinal hernia
c. when a child has symptoms of epiglottitis
d. when children are under 5 years of age
53. Baby John was given a drug at birth to reverse the
effects of a narcotic given to his mother in labor. What
drug is commonly used for this?
a. Naloxone (Narcan)
b. Morphine Sulfate
c. Sodium Chloride
d. Penicillin G
54. Why are small-for-gestational-age newborns at risks
for difficulty maintaining body temperature?
a. They do not have as many fat stores as other infants
b. They are more active than usual so throw off covers
c. Their skin is more susceptible to conduction of cold

d. They are preterm so are born relatively small in size


55. Baby John develops hyperbilirubinemia. What is a
method used to treat hyperbilirubinemia in a newborn?
a. Keeping infants in a warm arid dark environment
b. Administration of a cardiovascular stimulant
c. Gentle exercise to stop muscle breakdown
d. Early feeding to speed passage of meconium
Situation 12 You are the nurse in the Out-PatientDepartment and during your shift you encountered
multiple childrens condition. The following questions
apply.
56. You assessed a child with visible severe wasting, he
has:
a. edema
b. LBM
c. kwashiorkor
d. marasmus
57. Which of the following conditions is NOT true about
contraindication to immunization?
a. do not give DPT2 or DPT3 to a child who has
convulsions within 3 days of DPT1
b. do not give BOG if the child has known hepatitis .
c. do not give OPT to a child who has recurrent
convulsion or active neurologic disease
d. do not give BCG if the child has known AIDS
58. Which of the following statements about
immunization is NOT true:
a. A child with diarrhea who is due for OPV should
receive the OPV and make extra dose on the next visit
b. There is no contraindication to immunization if the
child is well enough to go home
c. There is no contraindication to immunization if the
child is well enough to go home and a child should be
immunized in the health center before referrals are
both correct
d. A child should be immunized in the center before
referral
59. A child with visible severe wasting or severe palmar
pallor may be classified as:
a. moderate malnutrition/anemia
b. severe malnutrition/anemia
c. not very tow weight no anemia
d. anemia/very low weight
60. A child who has some palmar pallor can be
classified as:
a. moderate anemia/normal weight
b. severe malnutrition/anemia
c. anemia/very low weight
d. not very low eight to anemia
Situation 13 Nette, a nurse palpates the abdomen of
Mrs. Medina, a primigravida. She is unsure of the date
of her last menstrual period. Leopolds Maneuver is
done. The obstetrician told mat she appears to be 20
weeks pregnant. .
61. Nette explains this because the fundus is:
a. At the level the umbilicus, and the fetal heart can be
heard with a fetoscope
b. 18 cm, and the baby is just about to move
c. is just over the symphysis, and fetal heart cannot be
heard
d. 28 cm, and fetal heart can be heard with a Doppler
62. In doing Leopolds maneuver palpation which
among the following is NOT considered a good
preparation?
a. The woman should lie in a supine position with her
knees flexed slightly

b. The hands of the nurse should be cold so that


abdominal muscles would contract and tighten
c. Be certain that your hands are warm (by washing
them in warm water first if necessary)
d. The woman empties her bladder before palpation
63. In her pregnancy, she experienced fatigue and
drowsiness. This probably occurs because:
a. of high blood pressure
b. she is expressing pressure
c. the fetus utilizes her glucose stores and leaves her
with a Sow blood glucose
d. of the rapid growth of the fetus
64. The nurse assesses the woman at 20 weeks
gestation and expects the woman to report:
a. Spotting related to fetal implantation
b. Symptoms of diabetes as human placental lactogen
is released
c. Feeling fetal kicks
d. Nausea and vomiting related HCG production
65. If Mrs. Medina comes to you for check-up on June 2,
her EDO is June 11, what do you expect during
assessment?
a. Fundic ht 2 fingers below xyphoid process, engaged
b. Cervix close, uneffaced, FH-midway between the
umbilicus and symphysis pubis
c. Cervix open, fundic ht. 2 fingers below xyphoid
process, floating .
d. Fundal height at least at the level of the xyphoid
process, engaged
Situation 14: Please continue responding as a
professional nurse in varied health situations through
the following questions.
66. Which of the following medications would the nurse
expect the physician to order for recurrent convulsive
seizures of a 10-year old child brought to your clinic?
a. Phenobarbital
b. Nifedipine
c. Butorphanol
d. Diazepam
67. RhoGAM is given to Rh-negative women to prevent
maternal sensitization from occurring. The nurse is
aware that in addition to pregnancy, Rh-negative
women would also receive this medication after which
of the following?
a. Unsuccessful artificial insemination procedure
b. Blood transfusion after hemorrhage
c. Therapeutic or spontaneous abortion
d. Head injury from a car accident
68. Which of the following would the nurse include
when describing the pathophysiology of gestational
diabetes?
a. Glucose levels decrease to accommodate fetal
growth
b. Hypoinsulinemia develops early in the first trimester
c. Pregnancy fosters the development of carbohydrate
cravings
d. There is progressive resistance to the effects of
insulin
69. When providing prenatal education to a pregnant
woman with asthma, which of the following would be
important for the nurse to do?
a. Demonstrate how to assess her blood glucose
b. Teach correct administration of subcutaneous
bronchodilators
c. Ensure she seeks treatment for any acute
exacerbation

d. Explain that she should avoid steroids during her


pregnancy
70. Which of the following conditions would cause an
insulin-dependent diabetic client the most difficulty
during her pregnancy?
a. Rh incompatibility
b. Placenta previa
c. Hyperemesis gravidarum
d. Abruptio placentae
Situation 15 One important toot a community health
nurse uses in the conduct of his/her activities is the
CHN Bag. Which of the following BEST DESCRIBES the
use of this vital facility for our practice?
71. The Community/Public Health Bag is:
a. a requirement for home visits
b. an essential and indispensable equipment of the
community health nurse
c. contains basic medications and articles used by the
community health nurse
d. a tool used by the Community health nurse is
rendering effective nursing procedure during a home
visit
72. What is the rationale in the use of bag technique
during home visit?
a. It helps render effective nursing care to clients or
other members of the family
b. It saves time and effort of the nurse in the
performance of nursing procedures
c. It should minimize or prevent the spread of infection
from individuals to families
d. It should not overshadow concerns for the patient
73. Which among the following is important in the use
of the bag technique during home visit?
a. Arrangement of the bags contents must be
convenient to the nurse
b. The bag should contain all necessary supplies and
equipment ready for use
c. Be sure to thoroughly clean your bag especially when
exposed to communicable disease cases
d. Minimize if not totally prevent the spread of infection
74. This is an important procedure of the nurse during
home visits?
a. protection of the CHN bag
b. arrangement of the contents of the CHM bag
c. cleaning of the CHN bag
d. proper handwashing
75. In consideration of the steps in applying the bag
technique, which side of the paper lining of the CHN
bag is considered clean to make a non-contaminated
work area?
a. The lower lip
b. The outer surface
c. The upper lip
d. The inside surface
Situation 16 As a Community Health Nurse relating
with people in different communities, and in the
implementation of health programs and projects you
experience vividly as well the varying forms of
leadership and management from the Barangay Level
to the Local Government/Municipal City Level.
76. The following statements can correctly be made
about Organization and management?
A. An organization (or company) is people. Values make
people persons: values give vitality, meaning and
direction to a company. As the people of an
organization value, so the company becomes.

B. Management is the process by which administration


achieves its mission, goals, and objectives
C. Management effectiveness can be measured in
terms of accomplishment of the purpose of the
organization while management efficiency is measured
in terms of the satisfaction of individual motives
D. Management principles are universal therefore one
need not be concerned about people, culture, values,
traditions and human relations.
a. B and C only
b. A, B and D only
c. A and D only
d. B, A, and C only
77. Management by Filipino values advocates the
consideration of the Filipino goals trilogy according to
the Filipino priority-values which are:
a. Family goals, national goals, organizational goals
b. Organizational goats, national goals, family goals
c. National goals, organizational goals, family goals
d. Family goals, organizational goals, national goals
78. Since the advocacy for the utilization of Filipino
value-system in management has been encouraged,
the Nursing sector is no except, management needs to
examine Filipino values and discover its positive
potentials and harness them to achieve:
a. Employee satisfaction
b. Organizational commits .ants, organizational
objectives and employee satisfaction
c. Employee objectives/satisfaction, commitments and
organizational objectives
d. Organizational objectives, commitments and
employee objective/satisfaction
79. The following statements can correctly be made
about an effective and efficient community or even
agency managerial-leader.
A. Considers the achievement and advancement of the
organization she/he represents as well as his people
B. Considers the recognition of individual efforts toward
the realization of organizational goals as well as the
welfare of his people
C. Considers the welfare of the organization above all
other consideration by higher administration
D. Considers its own recognition by higher
administration for purposes of promotion and prestige
a. Only C and D are correct
b. A, C and D are correct
c. B, C, and D are correct
d. Only A and B are correct
80. Whether management at the community or agency
level, there are 3 essential types of skills managers
must have, these are:
A. Human relation skills, technical skills, and cognitive
skills
B. Conceptual skills, human relation/behavioral skills,
and technical skills
C. Technical skills, budget and accounting skills, skills in
fund-raising
D. Manipulative skills, technical skills, resource
management skills
a. A and D are correct
b. B is correct
c. A is correct
d. C and D are correct
Situation 17 You are actively practicing nurse who just
finished your Graduate Studies. You earned the value of
Research and would like to utilize the knowledge and

skills gained in the application of research to Nursing


service. The following questions apply to research.
81. Which type of research Inquiry investigates the
issue of human complexity (e.g. understanding the
human expertise)
a. Logical position
b. Naturalistic inquiry
c. Positivism
d. Quantitative Research
82. Which of the following studies is based on
quantitative research?
a. A study examining the bereavement process in
spouses of clients with terminal cancer
b. A study exploring factors influencing weight control
behavior
c. A study measuring the effects of sleep deprivation on
wound healing
d. A study examining clients feelings before, during
and after a bone marrow aspiration
83. Which of the following studies is based on
qualitative research?
a. A study examining clients reactions to stress after
open heart surgery
b. A study measuring nutrition and weight, loss/gain in
clients with cancer
c. A study examining oxygen levels after endotracheal
suctioning
d. A study measuring differences in blood pressure
before during and after a procedure
84. An 85 year old client in a nursing home tells a
nurse, I signed the papers for that research study
because the doctor was so insistent and I want: him to
continue taking care of me. Which client right is being
violated?
a. Right of self determination
b. Right to privacy and confidentiality
c. Right to full disclosure
d. Right not to be harmed
85. A supposition or system of ideas that is proposed
to explain a given phenomenon, best defines:
a. a paradigm
b. a concept
c. a theory
d. a conceptual framework
Situation 18 Nurse Michelle works with a Family
Nursing Team in Calbayog Province specifically handling
a UNICEF project for children. The following conditions
pertain, to CARE OP THE FAMILIES PRESCHOOLERS.
86. Ronnie asks constant questions. How many does a
typical 3-year-old ask in a days time?
a. 1,200 or more
b. Less than 50
c. 100-200
d. 300-400
87. Ronnie will need to change to a new bed because
his baby sister will need Ronnies old crib. What
measure would you suggest that his parents take to
help decrease sibling rivalry between Ronnie and his
new sister?
a. Move him to the new bed before the baby arrives
b. Explain that new sisters grow up to become best
friends
c. Tell him he will have to share with the new baby
d. Ask him to get his crib ready for the new baby
88. Ronnies parents want to know how to react to him
when he begins to masturbate while watching
television. What would you suggest?

a. They refuse to allow him to watch television


b. They schedule a health check-up for sex-related
disease
c. They remind him that some activities are private
d. They give him timeout when this begins
89. How many words does a typical 12-month-old infant
use?
a. About 12 words
b. Twenty or more words
c. About 50 words
d. Two, plus mama and dada
90. As a nurse. You reviewed infant safety procedures
with Bryans mother. What are two of the most
common types of accidents among infants?
a. Aspiration and falls
b. Falls and auto accidents
c. Poisoning and burns
d. Drowning and homicide
Situation 19 Among common conditions found in
children especially among poor communities are ear
infection/problems. The following questions apply.
91. A child with ear problem should be assessed for the
following EXCEPT:
a is there any fever?
b. ear discharge
c. if discharge is present for how long?
d. ear pain
92. If the child does not have ear problem, using IMCI,
what should you as the nurse do?
a. Check for ear discharge
b. Check for tender swellings, behind the ear
c. Check for ear pain
d. Go to the next question, check for malnutrition
93. An ear discharge that has been present for more
than 14 days can be classified as:
a. mastoiditis
b. chronic ear infection
c. acute ear infection
d. complicated ear infection
94. An ear discharge that has been present for less
than 14 days can be classified as:
a. chronic ear infection
b. mastoiditis
c. acute ear infection
d. complicated ear infection
95. If the child has severe classification because of ear
problem, what would be the best thing that you as the
nurse can do?
a. instruct mother when to return immediately
b. refer urgently
c. give an antibiotic for 5 days
d. dry the ear by wicking
Situation 20 If a child with diarrhea registers one sign
in the pink row and one in the yellow; row in the IMCI
Chart.
96. We can classify the patient as:
a. moderate dehydration
b. some dehydration
c. no dehydration
d. severe dehydration
97. The child with no dehydration needs home
treatment Which of the following is not included the
rules for home treatment in this case:
a. continue feeding the child
b. give oresol every 4 hours
c. know when to return to the health center
d. give the child extra fluids

98. A child who has had diarrhea for 14 days but has no
sign of dehydration is classified as:
a. severe persistent diarrhea
b. dysentery
c. severe dysentery b. dysentery
d. persistent diarrhea
99. If the child has sunken eyes, drinking eagerly,
thirsty and skin pinch goes back slowly, the
classification would be:
a. no dehydration
b. moderate dehydration
c. some dehydration
d. severe dehydration
100. Carlo has had diarrhea for 5 days. There is no
blood in the stool, he is irritable. His eyes are sunken
the nurse offers fluid to Carlo and he drinks eagerly.
When the nurse pinched the abdomen, it goes back
slowly. How will you classify Carlos illness?
a. severe dehydration
b. no dehydration
c. some dehydration
d. moderate dehydration
1. Postpartum Period:
The fundus of the uterus is expected to go down
normally postpartally about __ cm per day.
A. 1.0 cm
B. 2.0 cm
C. 2.5 cm
D. 3.0 cm
2. The lochia on the first few days after delivery is
characterized as
A. Pinkish with some blood clots
B. Whitish with some mucus
C. Reddish with some mucus
D. Serous with some brown tinged mucus
3. Lochia normally disappears after how many days
postpartum?
A. 5 days
B. 7-10 days
C. 18-21 days
D. 28-30 days
4. After an Rh(-) mother has delivered her Rh (+) baby,
the mother is given RhoGam. This is done in order to:
A. Prevent the recurrence of Rh(+) baby in future
pregnancies
B. Prevent the mother from producing antibodies
against the Rh(+) antigen that she may have gotten
when she delivered to her Rh(+) baby
C. Ensure that future pregnancies will not lead to
maternal illness
D. To prevent the newborn from having problems of
incompatibility when it breastfeeds
5. To enhance milk production, a lactating mother must
do the following interventions EXCEPT:
A. Increase fluid intake including milk
B. Eat foods that increases lactation which are called
galactagues
C. Exercise adequately like aerobics
D. Have adequate nutrition and rest
6. The nursing intervention to relieve pain in breast
engorgement while the mother continues to breastfeed
is
A. Apply cold compress on the engorged breast
B. Apply warm compress on the engorged breast
C. Massage the breast
D. Apply analgesic ointment

7. A woman who delivered normally per vagina is


expected to void within ___ hours after delivery.
A. 3 hrs
B. 4 hrs.
C. 6-8 hrs
D. 12-24 hours
8. To ensure adequate lactation the nurse should teach
the mother to:
A. Breast feed the baby on self-demand day and night
B. Feed primarily during the day and allow the baby to
sleep through the night
C. Feed the baby every 3-4 hours following a strict
schedule
D. Breastfeed when the breast are engorged to ensure
adequate supply
9. An appropriate nursing intervention when caring for
a postpartum mother with thrombophlebitis is:
A. Encourage the mother to ambulate to relieve the
pain in the leg
B. Instruct the mother to apply elastic bondage from
the foot going towards the knee to improve venous
return flow
C. Apply warm compress on the affected leg to relieve
the pain
D. Elevate the affected leg and keep the patient on
bedrest
10. The nurse should anticipate that hemorrhage
related to uterine atony may occur postpartally if this
condition was present during the delivery:
A. Excessive analgesia was given to the mother
B. Placental delivery occurred within thirty minutes
after the baby was born
C. An episiotomy had to be done to facilitate delivery of
the head
D. The labor and delivery lasted for 12 hours
11. According to Rubins theory of maternal role
adaptation, the mother will go through 3 stages during
the post partum perioD. These stages are:
A. Going through, adjustment period, adaptation period
B. Taking-in, taking-hold and letting-go
C. Attachment phase, adjustment phase, adaptation
phase
D. Taking-hold, letting-go, attachment phase
12. The neonate of a mother with diabetes mellitus is
prone to developing hypoglycemia because:
A. The pancreas is immature and unable to secrete the
needed insulin
B. There is rapid diminution of glucose level in the
babys circulating blood and his pancreas is normally
secreting insulin
C. The baby is reacting to the insulin given to the
mother
D. His kidneys are immature leading to a high tolerance
for glucose
13. Which of the following is an abnormal vital sign in
postpartum?
A. Pulse rate between 50-60/min
B. BP diastolic increase from 80 to 95mm Hg
C. BP systolic between 100-120mm Hg
D. Respiratory rate of 16-20/min
14. The uterine fundus right after delivery of placenta is
palpable at
A. Level of Xyphoid process
B. Level of umbilicus
C. Level of symphysis pubis
D. Midway between umbilicus and symphysis pubis

15. After how many weeks after delivery should a


woman have her postpartal check-up based on the
protocol followed by the DOH Philippines?
A. 2 weeks
B. 3 weeks
C. 6 weeks
D. 12 weeks
16. In a woman who is not breastfeeding, menstruation
usually occurs after how many weeks?
A. 2-4 weeks
B. 6-8 weeks
C. 6 months
D. 12 months
17. The following are nursing measures to stimulate
lactation EXCEPT
A. Frequent regular breast feeding
B. Breast pumping
C. Breast massage
D. Application of cold compress on the breast
18. When the uterus is firm and contracted after
delivery but there is vaginal bleeding, the nurse should
suspect
A. Laceration of soft tissues of the cervix and vagina
B. Uterine atony
C. Uterine inversion
D. Uterine hypercontractility
19. The following are interventions to make the fundus
contract postpartally EXCEPT
A. Make the baby suck the breast regularly
B. Apply ice cap on fundus
C. Massage the fundus vigorously for 15 minutes until
contracted
D. Give oxytocin as ordered
20. The following are nursing interventions to relieve
episiotomy wound pain EXCEPT
A. Giving analgesic as ordered
B. Sitz bath
C. Perineal heat
D. Perineal care
21. Postpartum blues is said to be normal provided that
the following characteristics are present. These are
1. Within 3-10 days only;
2. Woman exhibits the following symptoms- episodic
tearfulness, fatigue, oversensitivity, poor appetite;
3. Maybe more severe symptoms in primpara
A. All of the above
B. 1 and 2
C. 2 only
D. 2 and 3
22. The neonatal circulation differs from the fetal
circulation because
A. The fetal lungs are non-functioning as an organ and
most of the blood in the fetal circulation is mixed
blooD.
B. The blood at the left atrium of the fetal heart is
shunted to the right atrium to facilitate its passage to
the lungs
C. The blood in left side of the fetal heart contains
oxygenated blood while the blood in the right side
contains unoxygenated blooD.
D. None of the above
23. The normal respiration of a newborn immediately
after birth is characterized as:
A. Shallow and irregular with short periods of apnea
lasting not longer than 15 seconds, 30-60 breaths per
minute

B. 20-40 breaths per minute, abdominal breathing with


active use of intercostals muscles
C. 30-60 breaths per minute with apnea lasting more
than 15 seconds, abdominal breathing
D. 30-50 breaths per minute, active use of abdominal
and intercostal muscles
24. The anterior fontanelle is characterized as:
A. 3-4 cm antero-posterior diameter and 2-3 cm
transverse diameter, diamond shape
B. 2-3 cm antero-posterior diameter and 3-4 cm
transverse diameter and diamond shape
C. 2-3 cm in both antero-posterior and transverse
diameter and diamond shape
D. none of the above
25. The ideal site for vitamin K injection in the newborn
is:
A. Right upper arm
B. Left upper arm
C. Either right or left buttocks
D. Middle third of the thigh
26. At what APGAR score at 5 minutes after birth should
resuscitation be initiated?
A. 1-3
B. 7-8
C. 9-10
D. 6-7
27. Right after birth, when the skin of the babys trunk
is pinkish but the soles of the feet and palm of the
hands are bluish this is called:
A. Syndactyly
B. Acrocyanosis
C. Peripheral cyanosis
D. Cephalo-caudal cyanosis
28. The minimum birth weight for full term babies to be
considered normal is:
A. 2,000gms
B. 1,500gms
C. 2,500gms
D. 3,000gms
29. The procedure done to prevent ophthalmia
neonatorum is:
A. Marmets technique
B. Credes method
C. Ritgens method
D. Ophthalmic wash
30. Which of the following characteristics will
distinguish a postmature neonate at birth?
A. Plenty of lanugo and vernix caseosa
B. Lanugo mainly on the shoulders and vernix in the
skin folds
C. Pinkish skin with good turgor
D. Almost leather-like, dry, cracked skin, negligible
vernix caseosa
31. According to the Philippine Nursing Law, a
registered nurse is allowed to handle mothers in labor
and delivery with the following considerations:
1. The pregnancy is normal.;
2. The labor and delivery is uncomplicated;
3. Suturing of perineal laceration is allowed provided
the nurse had special training;
4. As a delivery room nurse she is not allowed to insert
intravenous fluid unless she had special training for it.
A. 1 and 2
B. 1, 2, and 3
C. 3 and 4
D. 1, 2, and 4
32. Birth Control Methods and Infertility:

In basal body temperature (BBT) technique, the sign


that ovulation has occurred is an elevation of body
temperature by
A. 1.0-1.4 degrees centigrade
B. 0.2-0.4 degrees centigrade
C. 2.0-4.0 degrees centigrade
D. 1.0-4.0 degrees centigrade
33. Lactation Amenorrhea Method(LAM) can be an
effective method of natural birth control if
A. The mother breast feeds mainly at night time when
ovulation could possibly occur
B. The mother breastfeeds exclusively and regularly
during the first 6 months without giving supplemental
feedings
C. The mother uses mixed feeding faithfully
D. The mother breastfeeds regularly until 1 year with
no supplemental feedings
34. Intra-uterine device prevents pregnancy by the ff.
mechanism EXCEPT
A. Endometrium inflames
B. Fundus contracts to expel uterine contents
C. Copper embedded in the IUD can kill the sperms
D. Sperms will be barred from entering the fallopian
tubes
35. Oral contraceptive pills are of different types. Which
type is most appropriate for mothers who are
breastfeeding?
A. Estrogen only
B. Progesterone only
C. Mixed type- estrogen and progesterone
D. 21-day pills mixed type
36. The natural family planning method called Standard
Days (SDM), is the latest type and easy to use methoD.
However, it is a method applicable only to women with
regular menstrual cycles between ___ to ___ days.
A. 21-26 days
B. 26-32 days
C. 28-30 days
D. 24- 36 days
37. Which of the following are signs of ovulation?
1. Mittelschmerz;
2. Spinnabarkeit;
3. Thin watery cervical mucus;
4. Elevated body temperature of 4.0 degrees
centigrade
A. 1 & 2
B. 1, 2, & 3
C. 3 & 4
D. 1, 2, 3, 4
38. The following methods of artificial birth control
works as a barrier device EXCEPT:
A. Condom
B. Cervical cap
C. Cervical Diaphragm
D. Intrauterine device (IUD)
39. Which of the following is a TRUE statement about
normal ovulation?
A. It occurs on the 14th day of every cycle
B. It may occur between 14-16 days before next
menstruation
C. Every menstrual period is always preceded by
ovulation
D. The most fertile period of a woman is 2 days after
ovulation
40. If a couple would like to enhance their fertility, the
following means can be done:

1. Monitor the basal body temperature of the woman


everyday to determine peak period of fertility;
2. Have adequate rest and nutrition;
3. Have sexual contact only during the dry period of the
woman;
4. Undergo a complete medical check-up to rule out
any debilitating disease
A. 1 only
B. 1 & 4
C. 1,2,4
D. 1,2,3,4
41. In sympto-thermal method, the parameters being
monitored to determine if the woman is fertile or
infertile are:
A. Temperature, cervical mucus, cervical consistency
B. Release of ovum, temperature and vagina
C. Temperature and wetness
D. Temperature, endometrial secretion, mucus
42. The following are important considerations to teach
the woman who is on low dose (mini-pill) oral
contraceptive EXCEPT:
A. The pill must be taken everyday at the same time
B. If the woman fails to take a pill in one day, she must
take 2 pills for added protection
C. If the woman fails to take a pill in one day, she needs
to take another temporary method until she has
consumed the whole pack
D. If she is breast feeding, she should discontinue using
mini-pill and use the progestin-only type
43. To determine if the cause of infertility is a blockage
of the fallopian tubes, the test to be done is
A. Huhners test
B. Rubins test
C. Postcoital test
D. None of the above
44. Infertility can be attributed to male causes such as
the following EXCEPT:
A. Cryptorchidism
B. Orchitis
C. Sperm count of about 20 million per milliliter
D. Premature ejaculation
45. Spinnabarkeit is an indicator of ovulation which is
characterized as:
A. Thin watery mucus which can be stretched into a
long strand about 10 cm
B. Thick mucus that is detached from the cervix during
ovulation
C. Thin mucus that is yellowish in color with fishy odor
D. Thick mucus vaginal discharge influence by high
level of estrogen
46. Vasectomy is a procedure done on a male for
sterilization. The organ involved in this procedure is
A. Prostate gland
B. Seminal vesicle
C. Testes
D. Vas deferens
47. Breast self examination is best done by the woman
on herself every month during
A. The middle of her cycle to ensure that she is
ovulating
B. During the menstrual period
C. Right after the menstrual period so that the breast is
not being affected by the increase in hormones
particularly estrogen
D. Just before the menstrual period to determine if
ovulation has occurred

48. A woman is considered to be menopause if she has


experienced cessation of her menses for a period of
A. 6 months
B. 12 months
C. 18 months
D. 24 months
49. Which of the following is the correct practice of self
breast examination in a menopausal woman?
A. She should do it at the usual time that she
experiences her menstrual period in the past to ensure
that her hormones are not at its peak
B. Any day of the month as long it is regularly observed
on the same day every month
C. Anytime she feels like doing it ideally every day
D. Menopausal women do not need regular self breast
exam as long as they do it at least once every 6
months
50. In assisted reproductive technology (ART), there is a
need to stimulate the ovaries to produce more than
one mature ovA. The drug commonly used for this
purpose is:
A. Bromocriptine
B. Clomiphene
C. Provera
D. Estrogen
1. Which of the following conditions will lead to a smallfor-gestational age fetus due to less blood supply to the
fetus?
A. Diabetes in the mother
B. Maternal cardiac condition
C. Premature labor
D. Abruptio placenta
2. The lower limit of viability for infants in terms of age
of gestation is:
A. 21-24 weeks
B. 25-27 weeks
C. 28-30 weeks
D. 38-40 weeks
3. Which provision of our 1987 constitution guarantees
the right of the unborn child to life from conception is
A. Article II section 12
B. Article II section 15
C. Article XIII section 11
D. Article XIII section 15
4. In the Philippines, if a nurse performs abortion on the
mother who wants it done and she gets paid for doing
it, she will be held liable because
A. Abortion is immoral and is prohibited by the church
B. Abortion is both immoral and illegal in our country
C. Abortion is considered illegal because you got paid
for doing it
D. Abortion is illegal because majority in our country
are catholics and it is prohibited by the church
5. The preferred manner of delivering the baby in a
gravido-cardiac is vaginal delivery assisted by forceps
under epidural anesthesiA. The main rationale for this
is:
A. To allow atraumatic delivery of the baby
B. To allow a gradual shifting of the blood into the
maternal circulation
C. To make the delivery effort free and the mother does
not need to push with contractions
D. To prevent perineal laceration with the expulsion of
the fetal head
6. When giving narcotic analgesics to mother in labor,
the special consideration to follow is:

A. The progress of labor is well established reaching the


transitional stage
B. Uterine contraction is progressing well and delivery
of the baby is imminent
C. Cervical dilatation has already reached at least 8 cm.
and the station is at least (+)2
D. Uterine contractions are strong and the baby will not
be delivered yet within the next 3 hours.
7. The cervical dilatation taken at 8:00 AM in a G1P0
patient was 6 centimeters. A repeat I.E. done at 10 A.
M. showed that cervical dilation was 7 cm. The correct
interpretation of this result is:
A. Labor is progressing as expected
B. The latent phase of Stage 1 is prolonged
C. The active phase of Stage 1 is protracted
D. The duration of labor is normal
8. Which of the following techniques during labor and
delivery can lead to uterine inversion?
A. Fundal pressure applied to assist the mother in
bearing down during delivery of the fetal head
B. Strongly tugging on the umbilical cord to deliver the
placenta and hasten placental separation
C. Massaging the fundus to encourage the uterus to
contract
D. Applying light traction when delivering the placenta
that has already detached from the uterine wall
9. The fetal heart rate is checked following rupture of
the bag of waters in order to:
A. Check if the fetus is suffering from head compression
B. Determine if cord compression followed the rupture
C. Determine if there is utero-placental insufficiency
D. Check if fetal presenting part has adequately
descended following the rupture
10. Upon assessment, the nurse got the following
findings: 2 perineal pads highly saturated with blood
within 2 hours post partum, PR= 80 bpm, fundus soft
and boundaries not well defineD. The appropriate
nursing diagnosis is:
A. Normal blood loss
B. Blood volume deficiency
C. Inadequate tissue perfusion related to hemorrhage
D. Hemorrhage secondary to uterine atony
11. The following are signs and symptoms of fetal
distress EXCEPT:
A. Fetal heart rate (FHR) decreased during a
contraction and persists even after the uterine
contraction ends
B. The FHR is less than 120 bpm or over 160 bpm
C. The pre-contraction FHR is 130 bpm, FHR during
contraction is 118 bpm and FHR after uterine
contraction is 126 bpm
D. FHR is 160 bpm, weak and irregular
12. If the labor period lasts only for 3 hours, the nurse
should suspect that the following conditions may occur:
1.Laceration of cervix
2.Laceration of perineum
3.Cranial hematoma in the fetus
4.Fetal anoxia
A. 1 & 2
B. 2 & 4
C. 2,3,4
D. 1,2,3,4
13. The primary power involved in labor and delivery is
A. Bearing down ability of mother
B. Cervical effacement and dilatation
C. Uterine contraction
D. Valsalva technique

14. The proper technique to monitor the intensity of a


uterine contraction is
A. Place the palm of the hands on the abdomen and
time the contraction
B. Place the finger tips lightly on the suprapubic area
and time the contraction
C. Put the tip of the fingers lightly on the fundal area
and try to indent the abdominal wall at the height of
the contraction
D. Put the palm of the hands on the fundal area and
feel the contraction at the fundal area
15. To monitor the frequency of the uterine contraction
during labor, the right technique is to time the
contraction
A. From the beginning of one contraction to the end of
the same contraction
B. From the beginning of one contraction to the
beginning of the next contraction
C. From the end of one contraction to the beginning of
the next contraction
D. From the deceleration of one contraction to the
acme of the next contraction
16. The peak point of a uterine contraction is called the
A. Acceleration
B. Acme
C. Deceleration
D. Axiom
17. When determining the duration of a uterine
contraction the right technique is to time it from
A. The beginning of one contraction to the end of the
same contraction
B. The end of one contraction to the beginning of
another contraction
C. The acme point of one contraction to the acme point
of another contraction
D. The beginning of one contraction to the end of
another contraction
18. When the bag of waters ruptures, the nurse should
check the characteristic of the amniotic fluiD. The
normal color of amniotic fluid is
A. Clear as water
B. Bluish
C. Greenish
D. Yellowish
19. When the bag of waters ruptures spontaneously,
the nurse should inspect the vaginal introitus for
possible cord prolapse. If there is part of the cord that
has prolapsed into the vaginal opening the correct
nursing intervention is:
A. Push back the prolapse cord into the vaginal canal
B. Place the mother on semifowlers position to improve
circulation
C. Cover the prolapse cord with sterile gauze wet with
sterile NSS and place the woman on Trendelenburg
position
D. Push back the cord into the vagina and place the
woman on sims position
20. The fetal heart beat should be monitored every 15
minutes during the 2nd stage of labor. The
characteristic of a normal fetal heart rate is
A. The heart rate will decelerate during a contraction
and then go back to its pre-contraction rate after the
contraction
B. The heart rate will accelerate during a contraction
and remain slightly above the pre-contraction rate at
the end of the contraction

C. The rate should not be affected by the uterine


contraction.
D. The heart rate will decelerate at the middle of a
contraction and remain so for about a minute after the
contraction
21. The mechanisms involved in fetal delivery is
A. Descent, extension, flexion, external rotation
B. Descent, flexion, internal rotation, extension,
external rotation
C. Flexion, internal rotation, external rotation, extension
D. Internal rotation, extension, external rotation, flexion
22. The first thing that a nurse must ensure when the
babys head comes out is
A. The cord is intact
B. No part of the cord is encircling the babys neck
C. The cord is still attached to the placenta
D. The cord is still pulsating
23. To ensure that the baby will breath as soon as the
head is delivered, the nurses priority action is to
A. Suction the nose and mouth to remove mucous
secretions
B. Slap the babys buttocks to make the baby cry
C. Clamp the cord about 6 inches from the base
D. Check the babys color to make sure it is not
cyanotic
24. When doing perineal care in preparation for
delivery, the nurse should observe the following
EXCEPT
A. Use up-down technique with one stroke
B. Clean from the mons veneris to the anus
C. Use mild soap and warm water
D. Paint the inner thighs going towards the perineal
area
25. What are the important considerations that the
nurse must remember after the placenta is delivered?
1.Check if the placenta is complete including the
membranes
2.Check if the cord is long enough for the baby
3.Check if the umbilical cord has 3 blood vessels
4.Check if the cord has a meaty portion and a shiny
portion
A. 1 and 3
B. 2 and 4
C. 1, 3, and 4
D. 2 and 3
26. The following are correct statements about false
labor EXCEPT
A. The pain is irregular in intensity and frequency.
B. The duration of contraction progressively lengthens
over time
C. There is no vaginal bloody discharge
D. The cervix is still closeD.
27. The passageway in labor and deliver of the fetus
include the following EXCEPT
A. Distensibility of lower uterine segment
B. Cervical dilatation and effacement
C. Distensibility of vaginal canal and introitus
D. Flexibility of the pelvis
28. The normal umbilical cord is composed of:
A. 2 arteries and 1 vein
B. 2 veins and 1 artery
C. 2 arteries and 2 veins
D. none of the above
29. At what stage of labor and delivery does a
primigravida differ mainly from a multigravida?
A. Stage 1
B. Stage 2

C. Stage 3
D. Stage 4
30. The second stage of labor begins with ___ and ends
with __?
A. Begins with full dilatation of cervix and ends with
delivery of placenta
B. Begins with true labor pains and ends with delivery
of baby
C. Begins with complete dilatation and effacement of
cervix and ends with delivery of baby
D. Begins with passage of show and ends with full
dilatation and effacement of cervix
31. The following are signs that the placenta has
detached EXCEPT:
A. Lengthening of the cord
B. Uterus becomes more globular
C. Sudden gush of blood
D. Mother feels like bearing down
32. When the shiny portion of the placenta comes out
first, this is called the ___ mechanism.
A. Schultze
B. Ritgens
C. Duncan
D. Marmets
33. When the babys head is out, the immediate action
of the nurse is
A. Cut the umbilical cord
B. Wipe the babys face and suction mouth first
C. Check if there is cord coiled around the neck
D. Deliver the anterior shoulder
34. When delivering the babys head the nurse
supports the mothers perineum to prevent tear. This
technique is called
A. Marmets technique
B. Ritgens technique
C. Duncan maneuver
D. Schultze maneuver
35. The basic delivery set for normal vaginal delivery
includes the following instruments/articles EXCEPT:
A. 2 clamps
B. Pair of scissors
C. Kidney basin
D. Retractor
36. As soon as the placenta is delivered, the nurse
must do which of the following actions?
A. Inspect the placenta for completeness including the
membranes
B. Place the placenta in a receptacle for disposal
C. Label the placenta properly
D. Leave the placenta in the kidney basin for the
nursing aide to dispose properly
37. In vaginal delivery done in the hospital setting, the
doctor routinely orders an oxytocin to be given to the
mother parenterally. The oxytocin is usually given after
the placenta has been delivered and not before
because:
A. Oxytocin will prevent bleeding
B. Oxytocin can make the cervix close and thus trap
the placenta inside
C. Oxytocin will facilitate placental delivery
D. Giving oxytocin will ensure complete delivery of the
placenta
38. In a gravido-cardiac mother, the first 2 hours
postpartum (4th stage of labor and delivery)
particularly in a cesarean section is a critical period
because at this stage

A. There is a fluid shift from the placental circulation to


the maternal circulation which can overload the
compromised heart.
B. The maternal heart is already weak and the mother
can die
C. The delivery process is strenuous to the mother
D. The mother is tired and weak which can distress the
heart
39. The drug usually given parentally to enhance
uterine contraction is:
A. Terbutalline
B. Pitocin
C. Magnesium sulfate
D. Lidocaine
40. The partograph is a tool used to monitor labor. The
maternal parameters measured/monitored are the
following EXCEPT:
A. Vital signs
B. Fluid intake and output
C. Uterine contraction
D. Cervical dilatation
41. The following are natural childbirth procedures
EXCEPT:
A. Lamaze method
B. Dick-Read method
C. Ritgens maneuver
D. Psychoprophylactic method
42. The following are common causes of dysfunctional
labor. Which of these can a nurse, on her own manage?
A. Pelvic bone contraction
B. Full bladder
C. Extension rather than flexion of the head
D. Cervical rigidity
43. At what stage of labor is the mother is advised to
bear down?
A. When the mother feels the pressure at the rectal
area
B. During a uterine contraction
C. In between uterine contraction to prevent uterine
rupture
D. Anytime the mother feels like bearing down
44. The normal dilatation of the cervix during the first
stage of labor in a nullipara is
A. 1.2 cm./hr
B. 1.5 cm./hr.
C. 1.8 cm./hr
D. 2.0 cm./hr
45. When the fetal head is at the level of the ischial
spine, it is said that the station of the head is
A. Station 1
B. Station 0
C. Station +1
D. Station +2
46. During an internal examination, the nurse palpated
the posterior fontanel to be at the left side of the
mother at the upper quadrant. The interpretation is
that the position of the fetus is:
A. LOA
B. ROP
C. LOP
D. ROA
47. The following are types of breech presentation
EXCEPT:
A. Footling
B. Frank
C. Complete
D. Incomplete

48. When the nurse palpates the suprapubic area of the


mother and found that the presenting part is still
movable, the right term for this observation that the
fetus is
A. Engaged
B. Descended
C. Floating
D. Internal Rotation
49. The placenta should be delivered normally within
___ minutes after the delivery of the baby.
A. 5 minutes
B. 30 minutes
C. 45 minutes
D. 60 minutes
50. When shaving a woman in preparation for cesarean
section, the area to be shaved should be from ___ to ___
A. Under breast to mid-thigh including the pubic area
B. The umbilicus to the mid-thigh
C. Xyphoid process to the pubic area
D. Above the umbilicus to the pubic area
1. For the client who is using oral contraceptives, the
nurse informs the client about the need to take the pill
at the same time each day to accomplish which of the
following?
A. Decrease the incidence of nausea
B. Maintain hormonal levels
C. Reduce side effects
D. Prevent drug interactions
2. When teaching a client about contraception. Which
of the following would the nurse include as the most
effective method for preventing sexually transmitted
infections?
A. Spermicides
B. Diaphragm
C. Condoms
D. Vasectomy
3. When preparing a woman who is 2 days postpartum
for discharge, recommendations for which of the
following contraceptive methods would be avoided?
A. Diaphragm
B. Female condom
C. Oral contraceptives
D. Rhythm method
4. For which of the following clients would the nurse
expect that an intrauterine device would not be
recommended?
A. Woman over age 35
B. Nulliparous woman
C. Promiscuous young adult
D. Postpartum client
5. A client in her third trimester tells the nurse, Im
constipated all the time! Which of the following should
the nurse recommend?
A. Daily enemas
B. Laxatives
C. Increased fiber intake
D. Decreased fluid intake
6. Which of the following would the nurse use as the
basis for the teaching plan when caring for a pregnant
teenager concerned about gaining too much weight
during pregnancy?
A. 10 pounds per trimester
B. 1 pound per week for 40 weeks
C. pound per week for 40 weeks
D. A total gain of 25 to 30 pounds

7. The client tells the nurse that her last menstrual


period started on January 14 and ended on January 20.
Using Nageles rule, the nurse determines her EDD to
be which of the following?
A. September 27
B. October 21
C. November 7
D. December 27
8. When taking an obstetrical history on a pregnant
client who states, I had a son born at 38 weeks
gestation, a daughter born at 30 weeks gestation and I
lost a baby at about 8 weeks,the nurse should record
her obstetrical history as which of the following?
A. G2 T2 P0 A0 L2
B. G3 T1 P1 A0 L2
C. G3 T2 P0 A0 L2
D. G4 T1 P1 A1 L2
9. When preparing to listen to the fetal heart rate at 12
weeks gestation, the nurse would use which of the
following?
A. Stethoscope placed midline at the umbilicus
B. Doppler placed midline at the suprapubic region
C. Fetoscope placed midway between the umbilicus
and the xiphoid process
D. External electronic fetal monitor placed at the
umbilicus
10. When developing a plan of care for a client newly
diagnosed with gestational diabetes, which of the
following instructions would be the priority?
A. Dietary intake
B. Medication
C. Exercise
D. Glucose monitoring
11. A client at 24 weeks gestation has gained 6 pounds
in 4 weeks. Which of the following would be the priority
when assessing the client?
A. Glucosuria
B. Depression
C. Hand/face edema
D. Dietary intake
12. A client 12 weeks pregnant come to the
emergency department with abdominal cramping and
moderate vaginal bleeding. Speculum examination
reveals 2 to 3 cms cervical dilation.The nurse would
document these findings as which of the following?
A. Threatened abortion
B. Imminent abortion
C. Complete abortion
D. Missed abortion
13. Which of the following would be the priority nursing
diagnosis for a client with an ectopic pregnancy?
A. Risk for infection
B. Pain
C. Knowledge Deficit
D. Anticipatory Grieving
14. Before assessing the postpartum clients uterus for
firmness and position in relation to the umbilicus and
midline, which of the following shouldthe nurse do first?
A. Assess the vital signs
B. Administer analgesia
C. Ambulate her in the hall
D. Assist her to urinate
15. Which of the following should the nurse do when a
primipara who is lactating tells the nurse that she has
sore nipples?
A. Tell her to breast feed more frequently
B. Administer a narcotic before breast feeding

C. Encourage her to wear a nursing brassiere


D. Use soap and water to clean the nipples
16. The nurse assesses the vital signs of a client, 4
hours postpartum that are as follows: BP 90/60;
temperature 100.4F; pulse 100 weak, thready; R 20
per minute. Which of the following shouldthe nurse do
first?
A. Report the temperature to the physician
B. Recheck the blood pressure with another cuff
C. Assess the uterus for firmness and position
D. Determine the amount of lochia
17. The nurse assesses the postpartum vaginal
discharge (lochia) on four clients. Which of the
following assessments would warrant notification of the
physician?
A. A dark red discharge on a 2-day postpartum client
B. A pink to brownish discharge on a client who is 5
days postpartum
C. Almost colorless to creamy discharge on a client 2
weeks after delivery
D. A bright red discharge 5 days after delivery
18. A postpartum client has a temperature of 101.4F,
with a uterus that is tender when palpated, remains
unusually large, and not descending as normally
expected. Which of the following shouldthe nurse
assess next?
A. Lochia
B. Breasts
C. Incision
D. Urine
19. Which of the following is the priority focus of
nursing practice with the current early postpartum
discharge?
A. Promoting comfort and restoration of health
B. Exploring the emotional status of the family
C. Facilitating safe and effective self-and newborn care
D. Teaching about the importance of family planning
20. Which of the following actions would be least
effective in maintaining a neutral thermal environment
for the newborn?
A. Placing infant under radiant warmer after bathing
B. Covering the scale with a warmed blanket prior to
weighing
C. Placing crib close to nursery window for family
viewing
D. Covering the infants head with a knit stockinette
21. A newborn who has an asymmetrical Moro reflex
response should be further assessed for which of the
following?
A. Talipes equinovarus
B. Fractured clavicle
C. Congenital hypothyroidism
D. Increased intracranial pressure
22. During the first 4 hours after a male circumcision,
assessing for which of the following is the priority?
A. Infection
B. Hemorrhage
C. Discomfort
D. Dehydration
23. The mother asks the nurse. Whats wrong with my
sons breasts? Why are they so enlarged? Whish of the
following would be the best response by the nurse?
A. The breast tissue is inflamed from the trauma
experienced with birth
B. A decrease in material hormones present before
birth causes enlargement,

C. You should discuss this with your doctor. It could be


a malignancy
D. The tissue has hypertrophied while the baby was in
the uterus
24. Immediately after birth the nurse notes the
following on a male newborn: respirations 78; apical
hearth rate 160 BPM, nostril flaring; mild intercostal
retractions; and grunting at the end of expiration.
Which of the following shouldthe nurse do?
A. Call the assessment data to the physicians attention
B. Start oxygen per nasal cannula at 2 L/min.
C. Suction the infants mouth and nares
D. Recognize this as normal first period of reactivity
25. The nurse hears a mother telling a friend on the
telephone about umbilical cord care. Which of the
following statements by the mother indicates effective
teaching?
A. Daily soap and water cleansing is best
B. Alcohol helps it dry and kills germs
C. An antibiotic ointment applied daily prevents
infection
D. He can have a tub bath each day
26. A newborn weighing 3000 grams and feeding every
4 hours needs 120 calories/kg of body weight every 24
hours for proper growth and development. How many
ounces of 20 cal/oz formula should this newborn
receive at each feeding to meet nutritional needs?
A. 2 ounces
B. 3 ounces
C. 4 ounces
D. 6 ounces
27. The postterm neonate with meconium-stained
amniotic fluid needs care designed to especially
monitor for which of the following?
A. Respiratory problems
B. Gastrointestinal problems
C. Integumentary problems
D. Elimination problems
28. When measuring a clients fundal height, which of
the following techniques denotes the correct method of
measurement used by the nurse?
A. From the xiphoid process to the umbilicus
B. From the symphysis pubis to the xiphoid process
C. From the symphysis pubis to the fundus
D. From the fundus to the umbilicus
29. A client with severe preeclampsia is admitted with
of BP 160/110, proteinuria, and severe pitting edema.
Which of the following would be most important to
include in the clients plan of care?
A. Daily weights
B. Seizure precautions
C. Right lateral positioning
D. Stress reduction
30. A postpartum primipara asks the nurse, When can
we have sexual intercourse again? Which of the
following would be the nurses best response?
A. Anytime you both want to.
B. As soon as choose a contraceptive method.
C. When the discharge has stopped and the incision is
healed.
D. After your 6 weeks examination.
31. When preparing to administer the vitamin K
injection to a neonate, the nurse would select which of
the following sites as appropriate for the injection?
A. Deltoid muscle
B. Anterior femoris muscle
C. Vastus lateralis muscle

D. Gluteus maximus muscle


32. When performing a pelvic examination, the nurse
observes a red swollen area on the right side of the
vaginal orifice. The nurse would document this as
enlargement of which of the following?
A. Clitoris
B. Parotid gland
C. Skenes gland
D. Bartholins gland
33. To differentiate as a female, the hormonal
stimulation of the embryo that must occur involves
which of the following?
A. Increase in maternal estrogen secretion
B. Decrease in maternal androgen secretion
C. Secretion of androgen by the fetal gonad
D. Secretion of estrogen by the fetal gonad
34. A client at 8 weeks gestation calls complaining of
slight nausea in the morning hours. Which of the
following client interventions should the nurse
question?
A. Taking 1 teaspoon of bicarbonate of soda in an 8ounce glass of water
B. Eating a few low-sodium crackers before getting out
of bed
C. Avoiding the intake of liquids in the morning hours
D. Eating six small meals a day instead of thee large
meals
35. The nurse documents positive ballottement in the
clients prenatal record. The nurse understands that
this indicates which of the following?
A. Palpable contractions on the abdomen
B. Passive movement of the unengaged fetus
C. Fetal kicking felt by the client
D. Enlargement and softening of the uterus
36. During a pelvic exam the nurse notes a purple-blue
tinge of the cervix. The nurse documents this as which
of the following?
A. Braxton-Hicks sign
B. Chadwicks sign
C. Goodells sign
D. McDonalds sign
37. During a prenatal class, the nurse explains the
rationale for breathing techniques during preparation
for labor based on the understanding that breathing
techniques are most important in achieving which of
the following?
A. Eliminate pain and give the expectant parents
something to do
B. Reduce the risk of fetal distress by increasing
uteroplacental perfusion
C. Facilitate relaxation, possibly reducing the
perception of pain
D. Eliminate pain so that less analgesia and anesthesia
are needed
38. After 4 hours of active labor, the nurse notes that
the contractions of a primigravida client are not strong
enough to dilate the cervix. Which of the following
would the nurse anticipate doing?
A. Obtaining an order to begin IV oxytocin infusion
B. Administering a light sedative to allow the patient to
rest for several hour
C. Preparing for a cesarean section for failure to
progress
D. Increasing the encouragement to the patient when
pushing begins
39. A multigravida at 38 weeks gestation is admitted
with painless, bright red bleeding and mild contractions

every 7 to 10 minutes. Which of the following


assessments should be avoided?
A. Maternal vital sign
B. Fetal heart rate
C. Contraction monitoring
D. Cervical dilation
40. Which of the following would be the nurses most
appropriate response to a client who asks why she
must have a cesarean delivery if she has a complete
placenta previa?
A. You will have to ask your physician when he
returns.
B. You need a cesarean to prevent hemorrhage.
C. The placenta is covering most of your cervix.
D. The placenta is covering the opening of the uterus
and blocking your baby.
41. The nurse understands that the fetal head is in
which of the following positions with a face
presentation?
A. Completely flexed
B. Completely extended
C. Partially extended
D. Partially flexed
42. With a fetus in the left-anterior breech presentation,
the nurse would expect the fetal heart rate would be
most audible in which of the following areas?
A. Above the maternal umbilicus and to the right of
midline
B. In the lower-left maternal abdominal quadrant
C. In the lower-right maternal abdominal quadrant
D. Above the maternal umbilicus and to the left of
midline
43. The amniotic fluid of a client has a greenish tint.
The nurse interprets this to be the result of which of the
following?
A. Lanugo
B. Hydramnio
C. Meconium
D. Vernix
44. A patient is in labor and has just been told she has
a breech presentation. The nurse should be particularly
alert for which of the following?
A. Quickening
B. Ophthalmia neonatorum
C. Pica
D. Prolapsed umbilical cord
45. When describing dizygotic twins to a couple, on
which of the following would the nurse base the
explanation?
A. Two ova fertilized by separate sperm
B. Sharing of a common placenta
C. Each ova with the same genotype
D. Sharing of a common chorion
46. Which of the following refers to the single cell that
reproduces itself after conception?
A. Chromosome
B. Blastocyst
C. Zygote
D. Trophoblast
47. In the late 1950s, consumers and health care
professionals began challenging the routine use of
analgesics and anesthetics during childbirth. Which of
the following was an outgrowth of this concept?
A. Labor, delivery, recovery, postpartum (LDRP)
B. Nurse-midwifery
C. Clinical nurse specialist
D. Prepared childbirth

48. A client has a midpelvic contracture from a previous


pelvic injury due to a motor vehicle accident as a
teenager. The nurse is aware that this could prevent a
fetus from passing through or around which structure
during childbirth?
A. Symphysis pubis
B. Sacral promontory
C. Ischial spines
D. Pubic arch
49. When teaching a group of adolescents about
variations in the length of the menstrual cycle, the
nurse understands that the underlying mechanism is
due to variations in which of the following phases?
A. Menstrual phase
B. Proliferative phase
C. Secretory phase
D. Ischemic phase
50. When teaching a group of adolescents about male
hormone production, which of the following would the
nurse include as being produced by the Leydig cells?
A. Follicle-stimulating hormone
B. Testosterone
C. Leuteinizing hormone
D. Gonadotropin releasing hormone
1. While performing physical assessment of a 12
month-old, the nurse notes that the infants anterior
fontanel is still slightly open. Which of the following is
the nurses most appropriate action?
A. Notify the physician immediately because there is a
problem.
B. Perform an intensive neurological examination.
C. Perform an intensive developmental examination.
D. Do nothing because this is a normal finding for the
age.
2. When teaching a mother about introducing solid
foods to her child, which of the following indicates the
earliest age at which this should be done?
A. 1 month
B. 2 months
C. 3 months
D. 4 months
3. The infant of a substance-abusing mother is at risk
for developing a sense of which of the following?
A. Mistrust
B. Shame
C. Guilt
D. Inferiority
4. Which of the following toys should the nurse
recommend for a 5-month-old?
A. A big red balloon
B. A teddy bear with button eyes
C. A push-pull wooden truck
D. A colorful busy box
5. The mother of a 2-month-old is concerned that she
may be spoiling her baby by picking her up when she
cries. Which of the following would be the nurses best
response?
A. Let her cry for a while before picking her up, so you
dont spoil her
B. Babies need to be held and cuddled; you wont spoil
her this way
C. Crying at this age means the baby is hungry; give
her a bottle
D. If you leave her alone she will learn how to cry
herself to sleep

6. When assessing an 18-month-old, the nurse notes a


characteristic protruding abdomen. Which of the
following would explain the rationale for this finding?
A. Increased food intake owing to age
B. Underdeveloped abdominal muscles
C. Bowlegged posture
D. Linear growth curve
7. If parents keep a toddler dependent in areas where
he is capable of using skills, the toddle will develop a
sense of which of the following?
A. Mistrust
B. Shame
C. Guilt
D. Inferiority
8. Which of the following is an appropriate toy for an
18-month-old?
A. Multiple-piece puzzle
B. Miniature cars
C. Finger paints
D. Comic book
9. When teaching parents about the childs readiness
for toilet training, which of the following signs should
the nurse instruct them to watch for in the toddler?
A. Demonstrates dryness for 4 hours
B. Demonstrates ability to sit and walk
C. Has a new sibling for stimulation
D. Verbalizes desire to go to the bathroom
10. When teaching parents about typical toddler eating
patterns, which of the following should be included?
A .Food jags
B. Preference to eat alone
C. Consistent table manners
D. Increase in appetite
11. Which of the following suggestions should the nurse
offer the parents of a 4-year-old boy who resists going
to bed at night?
A. Allow him to fall asleep in your room, then move
him to his own bed.
B. Tell him that you will lock him in his room if he gets
out of bed one more time.
C. Encourage active play at bedtime to tire him out so
he will fall asleep faster.
D. Read him a story and allow him to play quietly in
his bed until he falls asleep.
12. When providing therapeutic play, which of the
following toys would best promote imaginative play in a
4-year-old?
A. Large blocks
B. Dress-up clothes
C. Wooden puzzle
D. Big wheels
13. Which of the following activities, when voiced by
the parents following a teaching session about the
characteristics of school-age cognitive development
would indicate the need for additional teaching?
A. Collecting baseball cards and marbles
B. Ordering dolls according to size
C. Considering simple problem-solving options
D. Developing plans for the future
14. A hospitalized schoolager states: Im not afraid of
this place, Im not afraid of anything. This statement is
most likely an example of whichof the following?
A. Regression
B. Repression
C. Reaction formation
D. Rationalization

15. After teaching a group of parents about accident


prevention for schoolagers, which of the following
statements by the group would indicate the need for
more teaching?
A. Schoolagers are more active and adventurous than
are younger children.
B. Schoolagers are more susceptible to home hazards
than are younger children.
C. Schoolagers are unable to understand potential
dangers around them.
D. Schoolargers are less subject to parental control
than are younger children.
16. Which of the following skills is the most significant
one learned during the schoolage period?
A. Collecting
B. Ordering
C. Reading
D. Sorting
17. A child age 7 was unable to receive the measles,
mumps, and rubella (MMR) vaccine at the
recommended scheduled time. When would the nurse
expect to administer MMR vaccine?
A. In a month from now
B. In a year from now
C. At age 10
D. At age 13
18. The adolescents inability to develop a sense of who
he is and what he can become results in a sense of
which of the following?
A. Shame
B. Guilt
C. Inferiority
D. Role diffusion
19. Which of the following would be most appropriate
for a nurse to use when describing menarche to a 13year-old?
A. A females first menstruation or menstrual periods
B. The first year of menstruation or period
C. The entire menstrual cycle or from one period to
another
D. The onset of uterine maturation or peak growth
20. A 14-year-old boy has acne and according to his
parents, dominates the bathroom by using the mirror
all the time.
Which of the following remarks by the nurse would be
least helpful in talking to the boy and his parents?
A. This is probably the only concern he has about his
body. So dont worry about it or the time he spends on
it.
B. Teenagers are anxious about how their peers
perceive them. So they spend a lot of time grooming.
C. A teen may develop a poor self-image when
experiencing acne. Do you feel this way sometimes?
D. You appear to be keeping your face well washed.
Would you feel comfortable discussing your cleansing
method?
21. Which of the following should the nurse suspect
when noting that a 3-year-old is engaging in explicit
sexual behavior during doll play?
A. The child is exhibiting normal pre-school curiosity
B. The child is acting out personal experiences
C. The child does not know how to play with dolls
D. The child is probably developmentally delayed.
22. Which of the following statements by the parents of
a child with school phobia would indicate the need for
further teaching?
A. Well keep him at home until phobia subsides.

B. Well work with his teachers and counselors at


school.
C. Well try to encourage him to talk about his
problem.
D. Well discuss possible solutions with him and his
counselor.
23. When developing a teaching plan for a group of
high school students about teenage pregnancy, the
nurse would keep in mind which of the following?
A. The incidence of teenage pregnancies is increasing.
B. Most teenage pregnancies are planned.
C. Denial of the pregnancy is common early on.
D. The risk for complications during pregnancy is rare.
24. When assessing a child with a cleft palate, the
nurse is aware that the child is at risk for more frequent
episodes of otitis media due to whichof the following?
A. Lowered resistance from malnutrition
B. Ineffective functioning of the Eustachian tubes
C. Plugging of the Eustachian tubes with food particles
D. Associated congenital defects of the middle ear.
25. While performing a neurodevelopmental
assessment on a 3-month-old infant, which of the
following characteristics would be expected?
A. A strong Moro reflex
B. A strong parachute reflex
C. Rolling from front to back
D. Lifting of head and chest when prone
26. By the end of which of the following would the
nurse most commonly expect a childs birth weight to
triple?
A. 4 months
B. 7 months
C. 9 months
D. 12 months
27. Which of the following best describes parallel play
between two toddlers?
A. Sharing crayons to color separate pictures
B. Playing a board game with a nurse
C. Sitting near each other while playing with separate
dolls
D. Sharing their dolls with two different nurses
28. Which of the following would the nurse identify as
the initial priority for a child with acute lymphocytic
leukemia?
A. Instituting infection control precautions
B. Encouraging adequate intake of iron-rich foods
C. Assisting with coping with chronic illness
D. Administering medications via IM injections
29. Which of the following information, when voiced by
the mother, would indicate to the nurse that she
understands home care instructions following the
administration of a diphtheria, tetanus, and pertussis
injection?
A. Measures to reduce fever
B. Need for dietary restrictions
C. Reasons for subsequent rash
D. Measures to control subsequent diarrhea
30. Which of the following actions by a community
health nurse is most appropriate when noting multiple
bruises and burns on the posterior trunk of an 18month-old child during a home visit?
A. Report the childs condition to Protective Services
immediately.
B. Schedule a follow-up visit to check for more bruises.
C. Notify the childs physician immediately.
D. Don nothing because this is a normal finding in a
toddler.

31. Which of the following is being used when the


mother of a hospitalized child calls the student nurse
and states, You idiot, you have no idea how to care for
my sick child?
A. Displacement
B. Projection
C. Repression
D. Psychosis
32. Which of the following should the nurse expect to
note as a frequent complication for a child with
congenital heart disease?
A. Susceptibility to respiratory infection
B. Bleeding tendencies
C. Frequent vomiting and diarrhea
D. Seizure disorder
33. Which of the following would the nurse do first for a
3-year-old boy who arrives in the emergency room with
a temperature of 105 degrees, inspiratory stridor, and
restlessness, who is learning forward and drooling?
A. Auscultate his lungs and place him in a mist tent.
B. Have him lie down and rest after encouraging fluids.
C. Examine his throat and perform a throat culture
D. Notify the physician immediately and prepare for
intubation.
34. Which of the following would the nurse need to
keep in mind as a predisposing factor when formulating
a teaching plan for child with a urinary tract infection?
A. A shorter urethra in females
B. Frequent emptying of the bladder
C. Increased fluid intake
D. Ingestion of acidic juices
35. Which of the following should the nurse do first for
a 15-year-old boy with a full leg cast who is screaming
in unrelenting pain and exhibiting right foot pallor
signifying compartment syndrome?
A. Medicate him with acetaminophen.
B. Notify the physician immediately
C. Release the traction
D. Monitor him every 5 minutes
36. At which of the following ages would the nurse
expect to administer the varicella zoster vaccine to
child?
A. At birth
B. 2 months
C. 6 months
D. 12 months
37. When discussing normal infant growth and
development with parents, which of the following toys
would the nurse suggest as most appropriate for an 8month-old?
A. Push-pull toys
B. Rattle
C. Large blocks
D. Mobile
38. Which of the following aspects of psychosocial
development is necessary for the nurse to keep in mind
when providing care for the preschool child?
A. The child can use complex reasoning to think out
situations.
B. Fear of body mutilation is a common preschool fear
C. The child engages in competitive types of play
D. Immediate gratification is necessary to develop
initiative.
39. Which of the following is characteristic of a
preschooler with mid mental retardation?
A. Slow to feed self
B. Lack of speech

C. Marked motor delays


D. Gait disability
40. Which of the following assessment findings would
lead the nurse to suspect Down syndrome in an infant?
A. Small tongue
B. Transverse palmar crease
C. Large nose
D. Restricted joint movement
41. While assessing a newborn with cleft lip, the nurse
would be alert that which of the following will most
likely be compromised?
A. Sucking ability
B. Respiratory status
C. Locomotion
D. GI function
42. When providing postoperative care for the child
with a cleft palate, the nurse should position the child
in which of the following positions?
A. Supine
B. Prone
C. In an infant seat
D. On the side
43. While assessing a child with pyloric stenosis, the
nurse is likely to note which of the following?
A. Regurgitation
B. Steatorrhea
C. Projectile vomiting
D. Currant jelly stools
44. Which of the following nursing diagnoses would be
inappropriate for the infant with gastroesophageal
reflux (GER)?
A. Fluid volume deficit
B. Risk for aspiration
C. Altered nutrition: less than body requirements
D. Altered oral mucous membranes
45. Which of the following parameters would the nurse
monitor to evaluate the effectiveness of thickened
feedings for an infant with gastroesophageal reflux
(GER)?
A. Vomiting
B. Stools
C. Uterine

D. Weight
46. Discharge teaching for a child with celiac disease
would include instructions about avoiding which of the
following?
A. Rice
B. Milk
C. Wheat
D. Chicken
47. Which of the following would the nurse expect to
assess in a child with celiac disease having a celiac
crisis secondary to an upper respiratory infection?
A. Respiratory distress
B. Lethargy
C. Watery diarrhea
D. Weight gain
48. Which of the following should the nurse do first
after noting that a child with Hirschsprung disease has
a fever and watery explosive diarrhea?
A. Notify the physician immediately
B. Administer antidiarrheal medications
C. Monitor child ever 30 minutes
D. Nothing, this is characteristic of Hirschsprung
disease
49. A newborns failure to pass meconium within the
first 24 hours after birth may indicate which of the
following?
A. Hirschsprung disease
B. Celiac disease
C. Intussusception
D. Abdominal wall defect
50. When assessing a child for possible
intussusception, which of the following would be least
likely to provide valuable information?
A. Stool inspection
B. Pain pattern
C. Family history
D. Abdominal palpation

You might also like