DIAGNOSTIC 5
Lack of understanding of and attention to women's reproductive
SITUATION: The DOH developed and promotes various programs in
addressing major health problems. Nurse’s
responsibility is in the implementation of these programs.
1. Comprehensive postabortion care services should include both
medical and preventive healthcare. The following
except one are key elements of postabortion care:
a. Emergency treatment of incomplete abortion and potentially life-
threatening complications
b. Postabortion family planning counseling and services
c. Links between postabortion emergency services and the
reproductive healthcare system
d. Psychological and spiritual counseling
ANSWER: D
Comprehensive postabortion care services should include both
medical and preventive healthcare. The key elements
of postabortion care are:
•Emergency treatment of incomplete abortion and potentially life-
threatening complications
•Postabortion family planning counseling and services
•Links between postabortion emergency services and the
reproductive healthcare system
Reference: Adapted from WHO
2. WHO has identified the prompt treatment of incomplete abortion
as an essential element of obstetric care that
should be available at every district-level hospital. Emergency
treatment for postabortion complications does not
include:
a. Uterine evacuation to remove retained products of conception
(POC) c. Provision for family planning
b. An initial assessment to confirm the presence of abortion
complications d. Prompt referral and transfer
ANSWER: C
Emergency treatment for postabortion complications includes:
•An initial assessment to confirm the presence of abortion
complications
•Talking to the woman regarding her medical condition and the
treatment plan
•Medical evaluation (brief history, limited physical and pelvic
examinations)
•Prompt referral and transfer if the woman requires treatment
beyond the capability of the facility where she is seen
•Stabilization of emergency conditions and treatment of any
complications (both complications present before
treatment and complications occurring during or after the treatment
procedure)
•Uterine evacuation to remove retained products of conception
(POC)
Option C is done after emergency treatment.
Reference: Adapted from WHO
3. A number of factors limit provision of family planning services to
women who have experienced an abortion. The
following except one are factors that increase a woman's risk of
repeated unwanted pregnancies:
a.
health needs on the part of providers
b. Lack of services for some groups of women
c. Misinformation among providers about appropriate postabortion
contraceptive methods
d. Peer influences
ANSWER: D
Because a woman seeking treatment for incomplete abortion
already may have experienced an unwanted pregnancy
either as the result of not using contraception or method failure, she
may be in need of effective contraception.
A number of factors limit provision of family planning services to
women who have experienced an abortion. These
factors, which increase a woman's risk of repeated unwanted
pregnancies, include:
• Lack of understanding of and attention to women's reproductive
health needs on the part of providers
• Lack of services for some groups of women (e.g., adolescents,
single women)
• Separation of emergency postabortion care services and family
planning services
• Misinformation among providers about appropriate postabortion
contraceptive methods
• Lack of acknowledgment of the problem of unsafe abortion and
the resulting need for contraceptive services
Reference: Adapted from WHO
4. Which of the following statements made by Nurse Hannah
correctly describe the implementing rules and
regulations of RA 9288?
a. All communicable diseases should be reported to the nearest
health station
b. To acquire a marriage license, couple should receive instructions
on family planning and responsible parenthood
c. Newborn screening should be performed after 24 hours following
delivery of the newborn
d. All children below 8 years of age requires compulsory
immunization against childhood immunizable diseases
ANSWER: C
Under Sec. 6 of RA 9288, Newborn screening shall be performed
after twenty-four (24) hours of life but not later than
three (3) days from complete delivery of the newborn. A newborn
that must be placed in intensive care in order to
ensure survival may be exempted from the 3-day requirement but
must be tested by seven (7) days of age. A parent
or legal guardian may refuse testing on the grounds of religious
beliefs, but shall acknowledge in writing their
understanding that refusal for testing places their newborn at risk
for undiagnosed heritable conditions. The DOH shall
be the lead agency in implementing this Act. Option A: RA 3573.
Option B: PD 965. Option D: PD 996
Reference: RA 9288
5. A postpartum client asks the nurse, “What are the disorders
tested in newborn screening?” The nurse accurately
responds by stating: a. “These are Congenital Hypothyroidism,
Congenital Adrenal Hyperplasia, Galactosemia, PKU, and G6PD
deficiency”
b. “These are Down syndrome, Cretinism, PKU and Galactosemia”
c. “These are mental retardation, hypothyroidism, and PKU”
d. “All of the disorders known to man”
ANSWER: A
Disorder Screened Effect if NOT SCREENED Effect if SCREENED and
treated
CH (Congenital Hypothyroidism) Severe Mental
Retardation
Normal
CAH (Congenital Adrenal
Hyperplasia)
Death Alive and normal
GAL (Galactosemia) Death or Cataracts Alive and normal
PKU (Phenylketonuria) Severe Mental
Retardation
Normal
G6PD Deficiency Severe Anemia,
Kernicterus
Normal
6. School entrants are injected with BCG vaccine. The site of
administration is:
a. Upper outer portion of the thigh c. Vastus lateralis
b. Upper outer portion of the gluteal muscle d. Right deltoid region
of the arm
ANSWER: D
The site of administration of BCG for school entrants is the right
deltoid region of the arm.
Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health
Nursing In The Philippines.10th ed. Manila
7. It is known as the certification recognition program that develops
and promotes a standard for quality health care,
services and facilities.
a. FOURmula One b. EPI c. Sentrong Sigla d. Healthy
Lifestyle
ANSWER: C
Quality Assurance through Sentrong Sigla is a way of engaging local
government units and communities in assuring
quality health services at the local level through a certification
recognition program. FOURmula ONE for Health is the
implementation framework for health sector reforms in the
Philippines for the medium term covering 2005-2010. The
Expanded Program on Immunization (EPI) is one of the DOH
Programs to reduce infant mortality and morbidity
through decreasing the prevalence of six (6) immunizable diseases
(TB, diphtheria, pertussis, tetanus, polio and
measles). And lastly, Healthy Lifestyle (HL) or the National Healthy
Lifestyle Program of the DOH’s has a goal to
reduce the toll of morbidity, disability and premature deaths due to
lifestyle related diseases.
Department of Health. URL: http://www.doh.gov.ph and DOH Flyer
about Sentrong Sigla
8. Food establishments are already subject to sanitary inspection.
Which of the following are the four rights in food
safety?
a. Right source, right preparation, right cooking, right storage
b. Right source, right temperature, right people, right amount
c. Right source, right preparation, right temperature, right storage
d. Right source, right food handlers, right utensils, right preparation
ANSWER. A
There are the four rights in food safety which involves the chain in
food processing from the source in the market until
the food reaches the table. They mainly encompass the following:
right source, right preparation, right cooking and
right storage.
Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The
Philippines.10th ed. Manila
9. There has been a steady increase in the number of household
having access to safe water supply resources. The
following are the approved types of water supply facilities by the
DOH except:
a. Point source b. Stand-posts c. Open dug wells d. Water works
system
ANSWER. C
Based on the DOH policies, the approved types of water supply
facilities are point source, communal faucets, stand-
posts and water works system. The unapproved types of water
facilities are those that come from doubtful sources
such as open dug wells, unimproved springs, wells that need
priming, etc.
Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The
Philippines.10th ed. Manila
10. Under the ENTREPRENURSE Project, unemployed nurses:
a. Seek financial assistance from DOLE to organize a home health-
care cooperative under the supervision of a trained
or experienced nurse
b. Can borrow money from the DOLE to start a health care related
business such as: Pharmacy store
c. Can seek financial assistance when applying abroad
d. Can work at any DOH hospital for 1 year with pay.
ANSWER: A
Implementing strategy for ENTREPRENURSE PROJECT:
Organize unemployed nurses into home health-acre cooperatives on
a per city or per province basis. The DOLE’s
(initial funding) assistance shall be in a form of grants to these
cooperatives, which shall use the money to get the
home health care business started. The cooperatives will run nurse-
managed clinics under the supervision of trained
and experienced nurses which will deploy newly licensed nurses to
poor rural communities with big populations of
sick, elderly and disabled patients who have little or no access to
basic health care.
Reference: DOLE
11. One of the essential elements of primary health care which
involves controlling all the factors in man’s
environment that may form links in disease transmission is:
a. Immunization c. Environmental sanitation
b. Treatment of locally endemic diseases d. Control of
communicable diseases ANSWER: C
Environmental sanitation is one element of primary health care
which encompasses adequate supply of safe water and
proper waste disposal and controlling all the factors in the
environment that may form links in the transmission of
disease.
Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The
Philippines.10th ed. Manila
12. Tuberculosis is considered as the world’s deadliest disease and
remains as a major public health problem in the
Philippines. Which statement is true regarding tuberculosis?
a. The risk of developing the disease is low among adolescents
b. A positive Mantoux Test indicates positive infection
c. Domiciliary treatment is the preferred mode of care
d. Xray examinations alone is sufficient to make the diagnosis of TB
ANSWER: C
The preferred mode of care, according to National Tuberculosis
Program of the DOH, is Domiciliary treatment through
DOTS. Option A: The risk of developing the disease is highest in
children under 3 years old, lower in later adulthood
and high again among adolescents, young adults and the very old.
Option B: A positive mantoux test indicates
exposure to the disease. Option D: DSSM is the primary diagnostic
tool in NTP case finding. No TB diagnosis shall be
made based on the results of Xray examinations alone.
Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The
Philippines.10th ed. Manila
13. Who among the following TB patients is included in Category 1
of treatment regimen?
a. A patient who failed in the treatment c. New smear positive PTB
b. Relapsed patient d. New smear-negative PTB with minimal
parenchymal lesions on CXR
ANSWER: C
Category 1: New smear positive PTB; New smear negative PTB with
extensive parenchymal lesions on CXR; EPTB;
and severe concomitant HIV disease. Category 2: Treatment failure;
relapse; return after default. Category 3: New
smear-negative PTB with minimal parenchymal lesions on CXR.
Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The
Philippines.10th ed. Manila
14. A child shall be clinically confirmed of having TB is he has three
of the following conditions except one:
a. Positive history of exposure to an adult TB case c. Abnormal
chest radiograph suggestive of TB
b. Positive tuberculin test d. Unexplained fever for 2 weeks or
more
ANSWER: D
A child shall be clinically confirmed of having TB is he has any three
of the following conditions:
1. Positive history of exposure to an adult TB case
2. Positive tuberculin test
3. Abnormal chest radiograph suggestive of TB
4. Presence of signs and symptoms suggestive of TB
5. Laboratory findings indicative or suggestive of TB
Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The
Philippines.10th ed. Manila
15. Treatment regimen for children with PTB includes:
a. Intensive phase of Isoniazid, Rifampicin and Pyrazinamide for 2
months; Continuation phase of Isoniazid and
Rifampicin for 4 months
b. Intensive phase of Isoniazid, Rifampicin ,Pyrazinamide and
Ethambutol or Streptomycin for 2 months; Continuation
phase of Isoniazid and Rifampicin for 4 months
c. Intensive phase of Isoniazid, Rifampicin and Pyrazinamide for 4
months; Continuation phase of Isoniazid and
Rifampicin for 2 months
d. Intensive phase of Isoniazid, Rifampicin ,Pyrazinamide and
Ethambutol or Streptomycin for 4 months; Continuation
phase of Isoniazid and Rifampicin for 2 months
ANSWER: A
Treatment regimen for children with PTB according to NTP:
Pulmonary TB:
• Intensive phase of Isoniazid, Rifampicin and Pyrazinamide for 2
months
• Continuation phase of Isoniazid and Rifampicin for 4 months
Extra-pulmonary TB:
• Intensive phase of Isoniazid, Rifampicin ,Pyrazinamide and
Ethambutol or Streptomycin for 2 months
• Continuation phase of Isoniazid and Rifampicin for 4 months
Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The
Philippines.10th ed. Manila
16. Rural sanitary inspectors and midwives compose what level of
primary health care workers?
a. Intermediate level health workers c. Grassroots health workers
b. Village health workers d. Barangay health workers
ANSWER: A
There are two levels of primary health care workers, the first is the
village/barangay/grassroots health workers
including community workers and traditional birth attendants. The
other one is the intermediate level health workers
that comprise the general medical practitioners, public health
nurses, rural sanitary inspectors and midwives.
Cuevas, F. P. et. al. (2007) DOH Book: Public Health Nursing In The
Philippines.10th ed. Manila
17. The core strategy of the Primary Health Care concept is
characterized by:
a. Partnership with the private sector c. Centralized delivery of
health care services
b. Essential health care services d. People empowerment
ANSWER: D
The concept of PHC is characterized by partnership and
empowerment of the people that shall permeate as the core
strategy in the provision of essential health care services.
Reference: Cuevas, Frances P., et. al. (2007) DOH’s Public health
nursing in the Philippines. 10th
edition, Page 30
18. Community development advocates the principles of self-help
and the voluntary participation of the people of
community. Community development rests upon certain
assumptions, this does not include:
a. Everyone has something to contribute to the community
b. People have limited ability to learn
c. Community development provides the opportunity by which the
worth of an individual is revealed
d. Worth and dignity of individual are the basic values in a
democratic society
ANSWER: B
Community development rests upon certain assumptions:
• Worth and dignity of individual are the basic values in a
democratic society. Community therefore is rooted in
human development
• Everyone has something to contribute to the life of the
community. Even the poorest member can share
something, maybe not monetary, nut in terms of talents and skills
• People have the ability to learn and grow. As long as a person is
ready and willing to learn, his/her potentials
can be enhanced
• Community development provides the opportunity and the means
by which the worth of an individual is
revealed, his/her contribution can be made and learning can take
place
Reference: Carmen Jimenez. Community Organizing Participatory
Action Research for Community Health Development
Page 5
19. Mr. Tibe came to the health center clinic for his daily medication
for TB. This condition falls under:
a. Heath deficit b. Health threat c. Foreseeable crisis d. Stress
point
ANSWER: A
A health deficit occurs when there is a gap between actual and
achievable health status and occurs when there are
instances of failure in health maintenance. The presence of a disease
falls under this category:
Reference: Cuevas, Frances P., et. al. (2007) DOH’s Public health
nursing in the Philippines. 10th
edition, Page 44
20. These are conditions that promote disease or injury and prevent
people from realizing their health potential:
a. Heath deficit b. Health threat c. Foreseeable crisis d. Stress
point
ANSWER: B
Health threats are conditions that promote disease or injury and
prevent people from realizing their health potential.
Reference: Cuevas, Frances P., et. al. (2007) DOH’s Public health
nursing in the Philippines. 10th
edition, Page 44
SITUATION: PEDIA
Situation: Nurses today are actively generating, publishing and
applying research to be able to improve client care and enhance
nursing’s scientific knowledge base.
21. She is known as the first nurse researcher as well as the first
modern nurse.
a. Hildegard Peplau b. Martha Rogers c. Florence Nightingale d.
Callista Roy
Answer: C
Florence Nightingale is credited as being the first nurse researcher,
as well as the first modern nurse. In her work,
“Notes In Nursing, What It Is and What It Is Not,” she illustrated her
environmental approach in the care of the sick,
thus, considered as the first nursing theorist.
Reference: Venzon, L.M.(2004) Introduction To Nursing Research
22. The researcher may be guided by the following steps when doing
research studies:
1. Statement of the problem and hypothesis 3. Data collection
and methodology
2. Results, interpretation and conclusion 4. Theoretical
framework and definition of terms
a. 1,2,3,4 b. 1,4,3,2 c. 1,3,4,2 d. 1,2,4,3
ANSWER: B
Doing a research follows the order of: Statement of the problem and
hypothesis, giving the theoretical framework and
definition of terms, collecting, presenting and analyzing data and
providing the results, interpretation, conclusion and
recommendations.
Reference: Beck, C.T. & Polit, D. F. (2008). Nursing Research:
Generating and Assessing Evidence for Nursing
Practice. 8th Edition.
23. Nurse Risa wants to study the effect of Metformin in lowering
glucose level among diabetic clients admitted at the
hospital. The independent variable is the:
a. Metformin b. Glucose level c. Diabetic clients d. Hospital
ANSWER: A
Independent variable, the one being manipulated is the presumed
cause while the dependent variable is the presumed
effect. Here, Metformin is the I.V. while glucose level is the D.V.
Reference: Beck, C.T. & Polit, D. F. (2008). Nursing Research:
Generating and Assessing Evidence for Nursing
Practice. 8th
Edition. Page 59
24. What is an example of a null hypothesis among the following
statements?
a. Students who enrolled in a review center will pass the NLE
b. The negative attitudes of the caregivers affect the help seeking
behavior of the patients
c. Exercise will lower the blood cholesterol
d. There is no significant relationship between smoking and glucose
level
ANSWER: D
The null hypothesis asserts that there is no significant difference
between two variables or relationship among
variables. In this case, it is best exemplified by Choice D.
Reference: Beck, C.T. & Polit, D. F. (2008). Nursing Research:
Generating and Assessing Evidence for Nursing
Practice. 8th Edition. Page 66
25. If a researcher asks the subject to refer other potential subjects
as samples in the study. She is utilizing which
type of sampling:
a. Purposive sampling b. Snow-ball sampling c. Convenience
sampling d. Quota sampling
ANSWER: B Snow-ball sampling involves the subjects suggesting or
referring other subjects who meet the researcher’s criteria.
For example, a researcher wants to study the post traumatic stress
disorders in patients who reportedly had been
raped. Looking for subjects is quite tedious since almost all would
not admit being subject to such violence. The snow-
ball type of sampling is best for this kind of research.
Reference: Beck, C.T. & Polit, D. F. (2008). Nursing Research:
Generating and Assessing Evidence for Nursing
Practice. 8th Edition. Page341
SITUATION: IMCI is a strategy developed by the World Health
Organisation and UNICEF. It has been introduced to
address morbidity and mortality in children.
26. A mother with her sick child comes to the health center. The
health worker should first:
a. Ask the mother about the child c. Check if the child’s weight and
temperature were recorded
b. Greet the mother appropriately d. Assess the child
ANSWER: B
When the nurse sees the mother, or the child’s caretaker, with the
sick child, the nurse should first: GREET THE
MOTHER APPROPRIATELY AND ASK ABOUT THE CHILD; LOOK TO SEE
IF THE CHILD’S WEIGHT AND TEMPERATURE
HAVE BEEN RECORDED
Reference: IMCI 2009
27. After asking the mother what the child’s problems are, what is
the next thing that the nurse should do based on
the IMCI?
a. Classify the condition b. Assess for main symptoms c. Check
for danger signs d. Refer the mother
ANSWER. C
Based on the IMCI case management in the outpatient care facility,
the nurse should first check/assess the presence
of danger signs. The danger signs include: convulsions, lethargy,
inability to eat/drink and vomiting. After the danger
signs, the occurrence of main symptoms such as cough, difficulty of
breathing, diarrhea, fever and ear problems
should be checked. After performing the assessment, the child’s
condition can be classified and an appropriate
treatment action can be identified.
Reference: IMCI 2009
28. The IMCI clinical guidelines focus on five main symptoms. Which
is not included?
a. Diarrhea b. Cough c. Ear Problems d. Constipation
ANSWER. D
The IMCI guidelines focus on the five main symptoms. These are the
following: a) cough, b) difficulty of breathing, c)
fever, d) diarrhea, and e) ear problems. Constipation is not included
as a main symptom.
Reference: IMCI 2009
SITUATION: Tuti is 11 months old. His temperature is 37.5 degree C.
His mother says he has had a dry cough for
the last week. He has no GDS. The health worker counted 42 bpm,
does not see chest indrawing and no stridor when
the he is calm. No visible severe wasting. There is some palmar
pallor. There is no edema of both feet.
29. Tuti’s sign is classified under:
a. VERY SEVERE MALNUTRITION OR VERY SEVERE ANEMIA c.
ANEMIA OR VERY LOW WEIGHT
b. SEVERE MALNUTRITION OR SEVERE ANEMIA d. NO ANEMIA AND
NOT VEY LOW WEIGHT
ANSWER: C
SEVERE MALNUTRITION OR SEVERE ANEMIA: Visible severe wasting,
has edema of both feet, severe palmar pallor
ANEMIA OR VERY LOW WEIGHT: Some palmar pallor, very low
weight for age
NO ANEMIA AND NOT VEY LOW WEIGHT: Not very low weight for
age and no other signs of malnutrition
Reference: IMCI 2009 edition Page 6
30. Feeding recommendations for infants 6 months up to 12 months
would include:
a. Exclusive breastfeeding c. Breastfeeding plus lugaw with added
pulverized roasted dilis
b. Breastfeeding plus plain lugaw d. Breastfeeding plus adequate
amounts family foods
ANSWER: C
The feeding recommendations are appropriate both when the child
is sick and when the child is healthy. During
illness, children may not want to eat much. However, they should be
offered the types of food recommended for their
age, as often as recommended, even though they may not take
much at each feeding.
Up to 6 months: Exclusive breastfeedeing, at least 8 times in 24
hours; do not give other foods or fluids
6 months to 12 months: Breastfeeding plus any of the following:
Lugaw with added oil, mashed vegetables or beans,
steamed tokwa, flaked fish, pulverized roasted dilis, finely ground
meat, egg yolk, bite sized fruits
12 months to 2 years: Breastfeed plus give adequate amounts of
family foods
2 years and older: Give adequate amounts of “family foods” at 3
meals a day; Give nutritious snack twice daily
between meals such as boiled yellow camote, boiled yellow corn,
boiled saba, fresh banana, taho, fruits and fruit
juices.
Reference: IMCI 2009 edition Page 21
31. Signs of good attachment in breastfeeding include all but one:
a. Mouth wide open c. More areola visible below than above
the mouth
b. Chin touching the breast d. Lower lip turned outward
ANSWER: C
More areola visible below than above the mouth
There is good attachment if the baby is CALM
C – chin touching the breast or chin very close to breast
A – areola is more visible above than below the mouth
L – lower lip is turned outward
M – mouth wide open
Reference: IMCI resource Manual Page 95
SITUATION: Leticia is 3 years old. She weighs 10 kg. Her axillary
temperature is 38 degrees C. Her mother brought
her to the health center because she has cough. She also has a rash:
32. Leticia has measles and displays severe stomatitis with deep and
extensive mouth ulcers. This is classified as:
a. UNCOMPLICATED FEVER c. SEVERE COMPLICATED MEASLES
b. POSSIBLE BACTERIAL INFECTION d. MEASLES WITH MOUTH
COMPLICATIONS
ANSWER: C
Deep and extensive mouth ulcers classified as Option C.
Reference: IMCI 2009 edition Page 4
33. Leticia’s classification is under which color?
a. Pink b. Red c. Yellow d. Green
ANSWER: A
Severe Complicated Measles has a color classification of Pink
Yellow – Measles with Eye or Mouth Complications
Green - Measles
Reference: IMCI 2009 edition Page 4
34. Clinical signs manifested by Leticia are as follows, except:
a. Any danger sign b. Clouding of the cornea c. Deep Mouth
ulcers d. Pus draining from the eye
ANSWER: D
Option D is not included in Severe Complicated Measles signs.
(Measles with eye complications)
Reference: IMCI 2009 edition Page 4
35. IMCI recommends the following in soothing the throat and
relieving cough. Which is not included?
a. Calamansi b. Ginger c. Breastmilk d. Cough syrups
ANSWER: D
Rationale: To soothe the throat and relieve cough with a safe
remedy the ff are recommended: breastmilk for
exclusively breastfed infant, tamarind, calamansi and ginger. On the
other hand, the nurse should discourage the ff
harmful remedies: Codeine cough syrups other cough syrups and
oral and nasal decongestants.
Reference: IMCI 2009 edition
SITUATION: Today’s pediatric nurse faces an array of challenges in
providing care for children and their families. A nurse requires
competent skills form wide spectrum of both technological and
psychosocial disciplines.
36. Nurse Hannah is assessing a healthy neonate upon admission to
the nursery. Which characteristic would the admitting nurse record
as normal?
a. Hypertonia c. Head circumference measuring 31 cm
b. Irregular respiratory rate of 50 bpm d. High-pitched or shrill cry
ANSWER: B
The normal respiratory rate is between 30 and 60, characterized by
shallow, irregular breaths, often interrupted by
short periods of apnea lasting 5 to 15 seconds. Hypertonia or a high
pitched/shrill cry may indicate neurologic
impairment or a drug withdrawal and normal head circumference is
33-35 cm
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
37. The nurse is caring for a child with hemophilia who is actively
bleeding. Which nursing action is most important in
the prevention of the crippling effects of bleeding?
a. Active range of motion c. Encourage genetic counseling
b. Avoidance of all dental care d. Elevate and immobilize the
affected extremity
ANSWER: D
Repeated Hemarthrosis may result in flexion contractures andjoint
fixations. During bleeding episodes, the affected
joint must be elevated and immobilized to prevent the crippling
effects of bleeding. Active range of motion is
contraindicated during a bleeding episode. Dental care and genetic
counseling are both appropriate, but neither is a
priority action during a bleeding episode.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
38. An infant is being treated for talipes equinovarus. Which
statement by the child’s mother indicates the best
understanding of the casting process?
a. “My child will have successive casts until the desired results are
achieved”
b. “Wearing cast is very painful, so I’ll need to medicate her every 4
hours”
c. “Once the cast is on, it will remain on until the deformity is
corrected”
d. “My child will be immobilized and confined to an infant seat”
ANSWER: A
Cast changes will be repeated throughout the course of treatment,
usually every 1-2 week period. Although casts may
feel heavy, continuous pain would need to be reported to the
physician. Age appropriate activity should be
encouraged.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
39. A young child is admitted with acute epiglotittis. Which is of the
highest priority as the nurse plans care?
a. Assessing the airway frequently c. Administering cough
medicine as ordered
b. Turning, coughing, and deep breathing d. Encouraging the child
to eat
ANSWER: A
Airway occlusion frequently occurs with epiglotittis. No liquid
medications or food should be administered at this time,
because of the swelling of the infected tissue in the throat which
may block the airway and cut off breathing. Turning,
coughing and deep breathing are not a priority at this time as for a
client with a lung condition, such as pheumonia.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
40. A young child with high bronchial asthma is admitted for the
second time in 1 month. Cystic fibrosis is suspected.
Which physiological assessment is most likely to be seen in the child
with cystic fibrosis?
a. Expectoration of large amounts of thin, frothy mucus with
coughing, and bubbling rhonchi for lung sounds
b. High serum NaCl levels and low NaCl levels in the sweat
c. Large, loose, foul-smelling stools with normal frequency or a
chronic diarrhea of unformed stools
d. Obesity from malabsorption of fats and polycythemia from poor
oxygenation of tissues
ANSWER: C
The obstruction of the pancreatic duct with thick mucus prevents
digestive enzymes from entering the duodenum,
thus preventing digestion of food. Undigested food (mainly fats and
proteins) are excreted in the stool, increasing the
bulk to twice the normal amount. Expectoration is very difficult
because the excess mucus produced is tenacious and
viscous. Elevated sweat chloride above 60 mmol/L is consistent with
the diagnosis of cystic fibrosis
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
41. Which finding would alert the nurse to potential problems in a
newly delivered term infant of a mother whose
blood type is O negative?
a. Pallor c. Infant’s blood type is O negative
b. Negative direct Coombs d. Resting heart rate is 155
ANSWER: A
When maternal sensitization occurs, maternal antibodies destroy
the fetus’ red blood cells, leading to anemia and
pallor. Negative direct Coombs indicates no development of
maternal antibodies; O negative would not present an
incompatibility; HR of 155 is a normal finding.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
42. A 10-year old child is admitted to the hospital with sickle cell
crisis. Which client goal is most appropriate for this
child?
a. The client will participate in daily aerobic exercises
b. The client will take an antibiotic until the temperature is within
normal limits
c. The client will increase fluid intake
d. The client will utilize cold compress to control pain
ANSWER: C
Adequate hydration prevents sickling and delays the stasis
thrombosis-ischemic cycle. Exercise should be avoided
because it causes cellular metabolism; antibiotics are given only for
7-10 days; and cold enhances vasoconstriction.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
43. The nurse has been instructing the parents of a toddler about
nutrition. Which of the following statements best
indicates the parents’ understanding of an appropriate diet for a
toddler?
a. “It’s unusual for a toddler to be a picky eater”
b. “A multivitamin each day will meet my child’s nutritional needs”
c. “Toddler needs servings from each food group daily”
d. “Toddlers should still be eating prepared junior foods”
ANSWER: C
Toddlers present a challenge to parents because they are picky
eaters, so food choices would include a variety of food
servings from all food groups.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
44. A child has cerebral palsy and is hospitalized for corrective
surgery for muscle contractures. What is the most
important immediate postoperative goal?
a. Ambulate using adaptive devices c. Verbalize pain control
b. Demonstrate optimal oxygenation d. Complete daily self-care
needs
ANSWER: B
Oxygenation is the most important immediate goal. Remember the
ABC’s of client care. The other choices are
appropriate goals, but not as important as oxygenation
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
45. The nurse is teaching the parents of a child who is being treated
in clinic for otitis media. Which of the following
statements is essential to include in the teaching?
a. “Do not take acetaminophen as this is contraindicated” c. “Do
not apply heat to the ear”
b. “Take the medication until the pain and fever are gone” d.
“Take all of the medication as ordered”
ANSWER: D
To prevent reinfection, the entire prescribed antibiotic needs to be
taken, with a course of treatment lasting 7 to 10
days. Acetaminophen is the drug of choice instead of aspirin; heat
helps to decrease pain.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
46. The nurse is assessing a newborn 5 minutes after birth. He has
full flexion of the extremities, is acrocyanotic, has
a heart rate of 124, a full, lust cry, and resists the suction catheter.
The nurse should record the Apgar score as:
a. 6 b. 7 c. 8 d. 9
ANSWER: D
Nine is the correct answer. The baby gets 2 points for full flexion of
the extremities, 1 point for being acrocyanotic, 2
points for heart rate, 2 points for respirations (full, lust cry), and 2
points for resisting suction catheter.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
47. The mother of a newborn learns that her infant son has lost 8 oz
since birth 2 days ago. The nurse explains that
this weight loss is normal. What explanation will the nurse provide
for the weight loss result?
a. Feeding infants every 4 hours instead of every 3 hours c. Limited
food intake since birth
b. Loss of fluid from the cord stump d. Regurgitation of feedings
ANSWER: C Weight loss occurs through excessive extracellular fluid
loss, meconium loss, and limited food intake. Infants take in
small amounts of feedings and energy expenditure exceeds intake.
48. A 4-week-old premature infant has been receiving epoetin alfa
(Epogen) for the last three weeks. Which
assessment finding indicates to the nurse that the drug is effective?
a. Slowly increasing urinary output over the last week. c.
Changes in apical heart rate from the 180s to the 140s.
b. Respiratory rate changes from the 40s to the 60s. d. Change
in indirect bilirubin from 12 mg/dl to 8 mg/dl.
ANSWER: C
Epogen, given to prevent or treat anemia, stimulates erythropoietin
production, resulting in an increase in RBCs. Since
the body has not had to compensate for anemia with an increased
heart rate, changes in heart rate from high to
normal is one indicator that Epogen is effective. Option A is not
related to Epogen administration. Respiratory rate
should decrease rather than increase (Option B) with Epogen
administration. Option D is usually related to resolution
of hyperbilirubinemia, treated with phototherapy or increased oral
intake in the infant.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
49. Immediately after birth a newborn infant is suctioned, dried, and
placed under a radiant warmer. The infant has
spontaneous respirations and the nurse assesses an apical heart rate
of 80 beats/minute and respirations of 20
breaths/minute. What action should the nurse perform next?
a. Initiate positive pressure ventilation. c. Initiate CPR on the
infant.
b. Intervene after the one minute Apgar is assessed. d. Assess the
infant's blood glucose level.
ANSWER: A
The nurse should immediately begin positive pressure ventilation
because this infant's vital signs are not within the
normal range, and oxygen deprivation leads to cardiac depression in
infants. (The normal newborn pulse is 100 to 160
beats/minute and respirations are 40 to 60 breaths/minute.) Waiting
until the infant is 1 minute old to intervene may
worsen the infant's condition. According to neonatal resuscitation
guidelines, CPR is not begun until the heart rate is
60 or below or between 60 and 80 and not increasing after 20 to 30
seconds of PPV. Option D can be checked after
treating the respiratory rate.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
50. A newborn, whose mother is HIV positive, is scheduled for
follow-up assessments. The nurse knows that the most
likely presenting symptom for a pediatric client with AIDS is:
a. Shortness of breath b. Joint pain c. A persistent cold
d. Organomegaly
ANSWER: C
Respiratory tract infections commonly occur in the pediatric
population. However, the child with AIDS has a decreased
ability to defend the body against these infections and often the
presenting symptom of a child with AIDS is a
persistent cold. Options A, B, and D are symptoms of complications
which may occur later in the disease process.
51. The nurse in a well baby clinic is assessing a 12-month old child.
He is 30 inches tall and weighs 30 lb. His birth
weight is 8 lbs. How does the nurse interpret this data?
a. Normal height, increased weight c. Small for age, normal weight
b. Normal height, decreased weight d. Tall for age, but weight
appropriate for height
ANSWER: A
Normal height is 29-32 inches; weight is tripled by the age of 1 year.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
52. The mother of an infant who has had a cleft lip repair has been
taught the postoperative care needed. What does
the nurse hope to see when evaluating this mother’s understanding
of this care?
a. Positioning the child on his abdomen to facilitate drainage of oral
secretions
b. Comforting the child as soon as he starts to fuss, to prevent his
crying
c. Using a regular bottle nipple to feed the infant in a semi-reclining
position
d. Cleaning the suture line with warm water and washcloth once a
day
ANSWER: B
Crying pulls the edges of suture line and may widen the scar line.
The baby should be prevented from crying as much
as possible by keeping the infant’s needs met and providing
postoperative analgesia. Prone position is avoided as the
infant can move back and forth on the bed, putting tension on the
sutures and Logan bar. Drainage secretions are
suctioned by a bulb syringe or placing the infant on his side. Special
nipples are available to allow closure of the jaw
without damaging the lip repair. Cleaning is performed as a sterile
procedure with the use of cotton applications
dipped in saline (as ordered).
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition
SITUATION: Because pregnancy is a physiologic process, the health
sector aims to make pregnancy for the women
and gestation for the fetus as safe and medically uneventful as far as
possible.
53. The 2000 Philippine Health Statistics revealed that the main
cause of reported maternal deaths is due to:
a. Postpartum hemorrhage b. Pregnancy with abortive outcomes
c. Hypertension d. None of the above
ANSWER: C
The 2000 Philippine Health Statistics revealed that the main cause of
reported maternal deaths is due to hypertension
accounting for 25%. This is closely followed by postpartum
hemorrhage with 20.3% and pregnancy with abortive
outcomes which are neither preventable nor non predictable with a
percentage of 9%.
Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health
Nursing In The Philippines.10th ed.
54. Every woman has the right to visit the nearest health care facility
for antenatal registration and to avail prenatal
care services. How often should the expectant mother visit the
health center when she is on her 8th month of
pregnancy?
a. Every other day after the 8th month of pregnancy till delivery
b. Every week after the 8th month of pregnancy till delivery
c. Every 2 weeks after the 8th month of pregnancy till delivery
d. None of the above ANSWER: C
The expectant mother should visit the barangay health center every
2 weeks after the 8th month of pregnancy until
delivery. The first visit should be done early in the pregnancy as
possible before four months or during the first
trimester. The 2nd visit should be during the 2nd trimester and the
third visit on the 3rd trimester.
Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health
Nursing In The Philippines.10th ed.
55. Tetanus toxoid vaccination is important for pregnant women and
child bearing women to prevent them and their
baby from acquiring tetanus. How many doses of Tetanus Toxoid
vaccine should be given to the mother in order to
protect the baby from acquiring neonatal tetanus?
a. One dose b. Two doses c. Three doses d. Four doses
ANSWER: B
When two doses of Tetanus Toxoid injection are given at one month
interval between each dose during pregnancy or
even before pregnancy period, the baby is protected against
neonatal tetanus.
Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health
Nursing In The Philippines.10th ed.
56. How many doses of Tetanus Toxoid vaccine are needed to
protect a mother and her baby against the disease,
during her pregnancy and for lifetime immunity?
a. Three doses b. Four doses c. Five doses d. Six doses
ANSWER: C
When five doses of Tetanus Toxoid injection are given, the mother
and her baby is protected against the disease,
during her pregnancy and for lifetime immunity.
Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health
Nursing In The Philippines.10th ed.
57. Micronutrient supplementation is vital for pregnant women. To
prevent Vitamin A deficiency, pregnant women
should receive vitamin A 10,000 IU starting:
a. First trimester c. 2 weeks before delivery
b. Second trimester onwards d. 1 month after delievry
ANSWER: B
Vitamin A supplementation is only given during the 4th month of
pregnancy onwards. It is not given before the 4th
month of pregnancy because it might cause congenital problems in
the baby.
Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health
Nursing In The Philippines.10th ed.
58. A pregnant woman with hypertension is suffering from
postpartum hemorrhage. The following are the first aid
measures to be done by the community health nurse, except:
a. Massage uterus and expel clots
b. Give Ergometrine 0.2 mg IM and another dose after 15 minutes
c. Place cupped palmed hands on the uterine fundus and feel for the
state of contraction
d. Apply bimanual uterine compression if postpartum bleeding still
persists
ANSWER: B
Ergometrine 0.2 mg IM is only given when the pregnant woman is
not suffering from pre-eclampsia, eclampsia or
hypertension. Options A, C and D are all first aid measures treatment
for postpartum bleeding that the community
heath nurse should perform.
Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health
Nursing In The Philippines.10th ed.
59. The community health nurse should give supportive care to the
pregnant mother during labor. The nurse should
do the following, except:
a. Encourage the mother to take a bath during the onset of labor
b. Encourage the mother to drink and eat when she feels hungry
c. Remind the mother to empty the bladder every 2 hours
d. Encourage the mother to do breathing exercises for her to have
energy in pushing the baby out of her birth canal.
ANSWER: B
Options A, C and D are all supportive care the nurse can give to the
mother. This will help her deliver clean, safe and
free from fatigue. Option B is the answer because the nurse should
encourage the mother to drink but not to eat as
this may interfere with surgery in case needed.
Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health
Nursing In The Philippines.10th ed.
60. The nurse should assess the progress of labor. She knows that
the pregnant woman is in false labor if:
a. The cervix is dilated 4 cm c. The membranes are not ruptured
b. There is an increase in contractions d. All of the above
ANSWER: C
The nurse knows it is false labor when there is no cervical dilatation,
there is no increase in uterine contractions after
8 hours and the membranes have not ruptured.
Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health
Nursing In The Philippines.10th ed.
61. The community health nurse should counsel the mother on the
recommended schedule of her first postpartum
visit, which is:
a. 3-5 days after delivery b. 6 weeks after delivery c. A day after
delivery d. 3 weeks after delivery
ANSWER: A
The recommended schedule for the first visit should be the 1st week
post partum preferably 3-5 days after delivery.
The second visit should be done six (6) weeks postpartum.
Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public Health
Nursing In The Philippines.10th ed.
62. During family planning counseling sessions, the nurse should
include which topic in the discussion?
a. Birth control methods b. Birth spacing c. Ideal number of
children d. All of the above
ANSWER: D
The nurse should discuss the following about Family Planning (FP): 1)
family planning methods, 2) proper spacing of
births – it has been said that the birth spacing of 3 to 5 years interval
will help the mother completely recover from
previous pregnancy and childbirth and 3) the right number of
children Reference: Cuevas, F. P. et. al. (2007) DOH Book: Public
Health Nursing In The Philippines.10th ed.
63. It is the nurse’s responsibility to give the couple enough
information about the different methods of contraception.
What are the factors that should be considered in method selection?
a. The age of the woman c. The effectiveness of a method
b. The woman's reproductive stage d. All of the above
ANSWER: D
All of the following factors should be considered when helping the
couples choose the best method of contraception. a)
The age of the woman- there are methods that are appropriate to
use according to a woman’s age, b) The woman's
reproductive stage- there are methods that are appropriate to use
according to a woman’s reproductive stage c) The
effectiveness of a method, and d) The woman’s health status.
Reference: Department of Health. URL: http://www.doh.gov.ph
64. A population pyramid is a graphical illustration that shows the
distribution of various age groups in a human
population which normally forms the shape of a pyramid. A
population pyramid with a broad base indicates:
a. Higher proportion of children and a low proportion of older
people
b. Higher proportion of older people and a low proportion of
children
c. Higher female populations
d. Higher male populations
ANSWER: A
A population pyramid showing a broad base, indicating a high
proportion of children, a rapid rate of population
growth, and a low proportion of older people. This wide base
indicates a large number of children. A steady upwards
narrowing shows that more people die at each higher age band. This
type of pyramid indicates a population in which
there is a high birth rate, a high death rate and a short life
expectancy. This is the typical pattern for less
economically developed countries, due to little access to and
incentive to use birth control, negative environmental
factors (for example, lack of clean water) and poor access to health
care.
Reference: http://en.wikipedia.org/wiki/Population_pyramid
65. A mother who wishes to use Lactation Amenorrhea method as a
form of family planning method should be
instructed:
a. To use other forms of FP methods after 3 months
b. About the potential side effects
c. To wait for at least 1 month to be more effective as a FP method
d. Alternate breastfeeding with formula feeding to be more effective
ANSWER: C
Lactating Amenorrhea Method or LAM is a temporary postpartum
method of postponing pregnancy based on
physiological infertility experienced by breast feeding women. As a
rule, after 3 months of breastfeeding, the woman
should be advised to choose another method of contraception.
Reference: Pillitteri, A..Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family. 6th Edition,
Vol. 1 Page 123
66. In providing guidance for a couple wishing to avoid pregnancy,
the nurse reviews the record of a client who has a
normal 29-day cycle. On which of the following days would the
nurse expect the client to ovulate?
a. Day 5 or 6 b. Day 13 or 14 c. Day 15 or 16 d. Day 28 or
29
ANSWER: C
Ovulation occurs most commonly 14 days before the next menstrual
period. In a 29-day cycle, this would be day 15
or 16.
Option A and B – are incorrect because it describes a time prior to
normal ovulation.
Option D – is incorrect because ovulation occurs before the last
week of the menstrual cycle.
Reference: Pillitteri, A.. (2007). Maternal & Child Health Nursing:
Care of the Childbearing & Childrearing Family. 5th
Edition, Vol. 1 Page 110
67. A client who is taking oral contraceptives should immediately
report which symptom associated with the adverse
effect of OC’s?
a. Blurred vision b. Nausea c. Breakthrough bleeding d. Breast
tenderness
ANSWER: A
Options B, C and D are the common side-effects of OCs. They usually
subside after a few months of use or may be
managed by a different routine or brand of contraceptive. Option A
is an adverse effect of OCs. It might indicate a
cerebrovascular accident occurring and thus must be reported
immediately to their health care provider.
Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family. 6th Edition,
Vol. 1 Page 125
68. A mother asks Nurse Basyang about subcutaneous implants and
how long will the implants be effective. Her best
response is:
a. “It is effective for one month” c. “It is effective for up to 5
years”
b. “It is effective for twelve months” d. “It is effective for ten
years”
ANSWER: C
Subcutaneous implants or Norplant consists of six nonbiodegradable
Silastic implants that are filled with synthetic
progesterone and embedded just under the skin on the inside of the
upper arm. Once embedded, the implants appear
only as irregular lines, simulating small veins. Over the next three (3)
to five (5) years, the implants slowly release
the hormone, suppressing ovulation, stimulating thick cervical
mucus and changing the endometrium so that the
ovulation is difficult.
Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family. 6th Edition,
Vol. 1 Page 129
69. A client who gave birth to a healthy 8 pound infant 3 hours ago is
admitted to the postpartum unit. Which nursing
plan is best in assisting this mother to bond with her newborn
infant?
a. Encourage the mother to provide total care for her infant. b.
Provide privacy so the mother can develop a relationship with the
infant.
c. Encourage the father to provide most of the infant's care during
hospitalization.
d. Meet the mother's physical needs and demonstrate warmth
toward the infant.
ANSWER: D
It is most important to meet the mother's requirement for attention
to her needs so that she can begin infant care-
taking (option D). Nurse theorist Reva Rubin describes the initial
postpartal period as the "taking-in phase," which is
characterized by maternal reliance on others to satisfy the needs for
comfort, rest, nourishment, and closeness to
families and the newborn. Option A could impede development of
maternal bonding. Option B is important but not the
priority. Option C might encourage paternal bonding, but does not
specifically encourage maternal bonding.
Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family. 6th Edition
70. Which maternal behavior is the nurse most likely to see when a
new mother receives her infant for the first time?
a. She eagerly reaches for the infant, undresses the infant, and
examines the infant completely.
b. Her arms and hands receive the infant and she then traces the
infant's profile with her fingertips.
c. Her arms and hands receive the infant and she then cuddles the
infant to her own body.
d. She eagerly reaches for the infant and then holds the infant close
to her own body.
ANSWER: B
Attachment/bonding theory indicates that most mothers will
demonstrate behaviors described in option B during the
first visit with the newborn, which may be at delivery or later. After
the first visit, the mother may exhibit greater
affection such as eagerly reaching, hugging, etc.
71. A client who is attending antepartum classes asks the nurse why
her healthcare provider has prescribed iron
tablets. The nurse's response is based on what knowledge?
a. Supplementary iron is more efficiently utilized during pregnancy.
b. It is difficult to consume 18 mg of additional iron by diet alone.
c. Iron absorption is decreased in the GI tract during pregnancy.
d. Iron is needed to prevent megaloblastic anemia in the last
trimester.
ANSWER: B
Consuming enough iron-containing foods to facilitate adequate fetal
storage of iron and to meet the demands of
pregnancy is difficult so iron supplements are often recommended.
Dietary iron is just as "good" as iron in tablet
form. Iron absorption occurs readily during pregnancy, and is not
decreased within the GI tract. Megaloblastic anemia
is caused by folic acid deficiency.
Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family. 6th Edition
72. When educating a pregnant client about home safety, which of
the following information is least appropriate for
the nurse to include in the teaching plan?
a. When taking a shower, place a non-skid mat on the floor of the
tub or shower.
b. Avoid climbing stairs
c. Avoid wearing high heels.
d. Use non-slip rugs on the floors.
ANSWER: B
A woman's center of gravity changes during pregnancy, increasing
her risk of falls. She should use a non-skid mat in
the tub or shower. Wearing high heels will increase unbalance and
can contribute to falls. Non-slip rugs will prevent
tripping and falling. There is no reason that a pregnant woman in
good health should avoid climbing stairs; in fact,
stair climbing is good exercise.
Reference: Pilliteri, A. (2007). Maternal & Child Health Nursing: Care
of the Childbearing & Childbearing Family. 5th
Edition, Vol. 1. Page 364.
73. A woman comes to the health clinic because she thinks she is
pregnant. Tests are performed and the pregnancy is confirmed. The
client’s last menstrual period began on September 8 and lasted for 6
days. The nurse calculates that
her expected date of confinement (EDC) is:
a. May 15 b. June 15 c. June 21 d. July 8
ANSWER: B
EDC is calculated according to Nagele’s rule (first day of the last
normal menstrual period -3 months and +7 days and
1 year). Assumes that every woman has a 28 day cycle and
pregnancy occurred on fourteenth day. Most women
deliver within period extending from 7 days before to 7 days after
the EDC.
September 8 - 3 months = June 8 + 7 days = June 15 of next year.
Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family. 6th Edition
74. A woman comes to the clinic for routine prenatal check-up at 34
weeks’ gestation. Abdominal palpation reveals
the fetal position as right occipital anterior (ROA). At which of the
following sites would the nurse expect to find the
fetal heart tone?
a. Below the umbilicus, on the mother’s left side c. Above the
umbilicus, on the mother’s left side
b. Below the umbilicus, on the mother’s right side d. Above the
umbilicus, on the mother’s right side
ANSWER: B
Describing fetal position is the practice of defining position of baby
relative to mother’s pelvis. The point of maximum
intensity (PMI) of the fetus is a point on mother’s abdomen where
FHT is the loudest, usually over the fetal back.
Divide mother’s pelvis into 4 parts or quadrants: right and left
anterior (front), and right and left posterior (back).
Abbreviated as R and L for right and left, and A and P for anterior
and posterior. The head, particularly the occiput, is
the most common presenting part, and is abbreviated O. LOA is
most common fetal presentation and FHT heard on
left side. In a vertex presentation, FHT is heard below the umbilicus.
In a breech presentation, FHT is heard above
umbilicus. Occiput and back are pressing against right side of
mother’s abdomen; FHT would be heard below umbilicus
on right side.
Reference: Pilliteri, A. (2007). Maternal & Child Health Nursing: Care
of the Childbearing & Childbearing Family. 5th
Edition, Vol. 2. Page 475-476.
75. Mrs. Dimaano complains about her morning sickness. The nurse
provides health teachings to the client. Which of
the following statements made by the client indicates a need for
further instruction by the nurse? a. “ I will avoid spicy or fatty foods”
c. “I will eat small frequent meals”
b. “ I will postpone eating until supper” d. “I will eat crackers and
dry toast before arising”
ANSWER: B
Standard measures for control of morning sickness include eating
crackers or toast before arising from bed in the
morning, eating small frequent meals, avoiding fatty and spicy foods,
and arising slowly to avoid orthostatic
hypotension. Delaying eating until suppertime does not promote
proper nutrition for the pregnant woman and fetus.
Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of
the Childbearing and Childrearing Family. 5th ed.
76. Nurse Mian is preparing to assist in performing Leopold’s
maneuver to a pregnant client. Which of the following
should the nurse include in preparing the client for this procedure?
a. Tell the client to drink a glass of water before the procedure
b. Locate the fetal heart tones
c. Tell the client to void before beginning the examination
d. Advise the client not to eat anything 4 hours before the exam
ANSWER: C
An empty bladder contributes to a woman’s comfort during the
examination. Drinking water to fill the bladder may be
performed before a sonogram but are not applicable to performing
Leopold maneuvers. Often the Leopold maneuvers
are performed to aid the examiner in locating the fetal heart tones.
Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of
the Childbearing and Childrearing Family. 5th ed.
77. Mrs. Makiss is scheduled for a nonstress test. After the test, the
result documented on the chart is no
accelerations during the 40 minute observation. The nurse
interprets these findings as:
a. A reactive stress test c. An unsatisfactory stress test
b. A nonreactive stress test d. The results are inconclusive
ANSWER: B
A reactive nonstress test (normal/negative) indicates a healthy fetus.
It is described as two or more fetal heart rate
(FHR) accelerations of at least 15 beats or more lasting at least 15
seconds from the beginning of the acceleration to
the end in association with fetal movement, during a 20 minute
period. A nonreactive nonstress test (abnormal) is
described as no accelerations or accelerations of less than 6 beats
per minute or lasting less than 15 seconds in
duration for a chosen time period. An unsatisfactory test cannot be
interpreted because of the poor quality of the
FHR. The results are conclusive as nonreactive.
Reference: Pilliterri, A Maternal and Child Health Nursing: Care of
the Childbearing and Childrearing Family. 5th ed.
78. Another client had a nonstress tests for the past few weeks and
the results were reactive. A few minutes ago, the
results were nonreactive. The nurse anticipates that the client will
be prepared for:
a. A return appointment in 2 to 7 days to repeat the nonstress test
b. A contraction stress test
c. Hospital admission with continuous fetal monitoring
d. Immediate induction of labor
ANSWER: B
A nonreactive nonstress test needs further assessment. There is not
enough data in the question to indicate that the
procedures in options c and d are necessary at this time. To send the
client home for 2 to 7 days may place the fetus
in jeopardy as in option a. A contraction stress test is the next test
needed to further assess the fetal status.
Reference: Pilliterri, A Maternal and Child Health Nursing: Care of
the Childbearing and Childrearing Family. 5th ed.
79. A pregnant woman is having a contraction stress test (CST)
preformed. Which of the following shows a negative
test result?
a. 50% or more contractions cause a late deceleration
b. No FHR decelerations occur with contractions
c. Decrease in FHR that occurs toward the end of a contraction and
continues after the contraction
d. All of the options indicate a negative result
ANSWER: B
The CST is negative or normal if no fetal heart rate decelerations
occur with contractions. Options a and c indicates
that the CST is positive or abnormal.
Reference: Pilliterri, A. Maternal and Child Health Nursing: Care of
the Childbearing and Childrearing Family. 5th ed
page 204
80. During her first trimester, a woman experiences many
physiologic changes that lead her to think she is pregnant.
Which of the following changes will the nurse likely tell her are
normal changes for an 8 week pregnancy?
a. Dysuria b. Colostrum secretion c. Nosebleeds d.
Dependent edema
ANSWER: C
Epistaxis occurs in the 1st trimester. It is related to capillary dilation.
Dysuria is an abnormal condition with urinary
tract infection; colostrums occurs at 16 weeks gestation; and
dependent edema may occur in the third trimester
81. Following her baby’s birth, the woman’s uterine fundus is soft,
midline, 2 cm above the umbilicus, and she has
saturated two pads within 30 minutes. Which immediate need by
the client should be addressed?
a. Be cleaned and have another pad change c. Have an increase
in her IV fluids of Ringer’s Lactate
b. Empty her bladder d. Have her fundus massaged
ANSWER: D
Massaging the fundus is most important because her uterus is soft
and higher than normal. Fundal massage causes
uterine contraction leading to vasoconstriction, which will lead to
decreased bleeding. Cleaning and pad change along
with replacing IV fluid are important, but not before an action to
decrease bleeding. Information given does not
indicate the bladder is full.
82. Nurse Junifer is caring for a woman who is having labor induced
with an oxytocin (Pitocin) drip. Which assessment
of the client indicates there is a problem?
a. The fetal heart rate is 160 beats per minute c. Contraction
duration is 60 seconds
b. The woman has three contractions in 5 minutes d. Early fetal
rate decelerations are occurring ANSWER: B
If the woman has more than three contractions in 5 minutes, the
oxytocin should be discontinued. Normal fetal heart
rate is 120-160 bpm; normal contraction is 40-90 seconds; early
decelerations indicate fetal head compression but
not distress.
83. Mrs. Fortalejo is in labor and taking three cleansing breaths
followed by four, slow, deep breaths with each
contraction. She is experiencing much discomfort with her
contractions. What action is most appropriate for the nurse
to take?
a. Demonstrate to Mrs. Fortalejo a different breathing pattern
during contractions
b. Ask the physician for an order of pain medication
c. Have the man take a break and instruct Mrs. Fortalejo in another
breathing pattern
d. Leave the couple alone as they have their routine established
ANSWER: A
Appropriate demonstration does not belittle the man or diminish his
wife’s confidence in him. This allows the man to
maintain continued control in the situation.
84. Nurse Kristine is teaching childbirth education classes. What
topic should be included during the second trimester?
a. Overview of the conception c. Infant care
b. Medication and breastfeeding d. Strategies to relieve the
discomforts of pregnancy
ANSWER: D
Many discomforts arise during the second trimester and information
regarding relief will make pregnancy much more
comfortable. The other topics would be discussed at other periods
of pregnancy.
85. Nurse Esther is caring for a woman in labor who suddenly
complains of dizziness, becomes pale, and has a 30-
point drop in her BP with an increase in pulse rate. What is the most
appropriate initial nursing action?
a. Turn her to her left side c. Notify her physician
b. Have her breathe into a paper bag d. Increase her IV fluids
ANSWER: A
The signs and symptoms described are those of vena caval
syndrome. It is most important to remove the gravid
uterus from the inferior vena cava and aorta. Turning the woman to
the left side will accomplish this.
86. A woman is 25% over her ideal weight of 140 pounds. She would
like to lose weight before becoming pregnant.
The woman is 2 months into her weight loss program. Which
indicates she is following proper weight management
principles?
a. Carefully selects only carbohydrate and fat choices for meals
b. Has lost a total of 4 pounds
c. Is now 5% over her ideal weight
d. Goes to beginning aerobics for three times a week
ANSWER: D
Traditional weight loss programs combine dieting, exercise,
psychosocial support, and behavior modification. Protein
should be included in the diet; a 4 lb weight is inadequate for 2
months; or has occurred too quickly, respectively.
87. A 38-week primigravida who works as a secretary and sits at a
computer 8 hours each day tells the nurse that her
feet have begun to swell. Which instruction would be most effective
in preventing pooling of blood in the lower
extremities?
a. Wear support stockings c. Move about every hour
b. Reduce salt in her diet d. Avoid constrictive clothing
ANSWER: C
Pooling of blood in the lower extremities results from the enlarged
uterus exerting pressure on the pelvic veins.
Moving about every hour (C) will straighten out the pelvic veins and
increase venous return. (A) increase venous
return from varicose veins in the lower extremities, but are little
help with swelling. (B) might be helpful with
generalized edema (which could be an indication of PIH) but is not
specific for edematous lower extremities. (D) does
not specifically address venous return in this particular case.
Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family. 6th Edition
88. A client receiving epidural anesthesia begins to experience
nausea and becomes pale and clammy. What
intervention should the nurse implement first?
a. Raise the foot of the bed c. Evaluate the fetal heart rate
b. Assess for vaginal bleeding d. Take the client's blood pressure
ANSWER: A
These symptoms are suggestive of hypotension which is a side effect
of epidural anesthesia. Raising the foot of the
bed will increase venous return and provide blood to the vital areas.
Increasing the IV fluid rate using a balanced non-
dextrose solution and ensuring that the client is in a lateral position
are also appropriate interventions. Options B and
C will not raise the maternal blood pressure. Since the symptoms are
common side effects of epidural anesthesia and
suggest hypotension, option D can wait until option A is
implemented.
Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family. 6th Edition

89. A 37-week gestation neonate has just been born to a woman
with insulin-dependent diabetes mellitus and is
admitted to the nursery. Which of the following is most essential
when planning immediate care for the infant?
a. Glucose monitoring b. Daily weights c. Supplemental formula
feedings d. An apnea monitor
ANSWER: A
Because the infant is no longer exposed to the mother’s high
circulating glucose levels and its own pancreas is still
secreting insulin on response to the glucose, the infant is subject to
hypoglycemia.
Reference: Pillitteri, A. Maternal & Child Health Nursing: Care of the
Childbearing & Childrearing Family. 6th Edition
90. A 34 week pregnant client calls the clinic complaining of severe
headache, blurred vision, and swollen feet. The
nurse expects the physician to tell the client to:
a. Have it checked in the hospital b. Come to the clinic tomorrow
morning
c. Decrease salt intake and increase fluids
d. Rest for 4 hours a day for 3 days and come to the clinic if
symptoms persist
ANSWER: A
Swelling feet, blurred vision and severe headache are danger signs
of pregnancy. Delaying or dismissing these
symptoms would endanger both the mother and the fetus.
Reference: Adele Pillitteri. Maternal and Child Health Nursing 5th
edition Page 287
91. Nurse Grasya went to give her morning care to a postpartum
mother, she observed the mother talking to the
baby, checking diaper, and asking infant care questions. Nurse
Grasya determines that the client is in which
postpartal phase of psychological adaptation?
a. Taking in b. Taking on c. Taking hold
d. Letting go
ANSWER: C
After a time of passive dependence, the woman begins to initiate
action which signals that the client is in the taking
hold phase with a demonstrated focus on the neonate and learning
about and fulfilling infant care and needs. As a
rule, therefore it is always best to give a woman brief
demonstrations of baby care and then allow her to care for her
child herself – with watchful guidance
Taking In phase – is the first period after delivery where there is
emphasis on reviewing and reliving the labor and
delivery process, concern with self and needing to be mothered.
Eating and sleeping are high priorities during this
phase.
Taking on- is not a phase of postpartum psychological adaptation
Letting go – is the process beginning about 6 weeks postpartum
when the mother may be preparing to go back to
work and defines her new role
Reference: A. Pillitteri. Maternal and Child Nursing. 5th
Edition. Page 624.
92. During an initial prenatal visit a pregnant client states she has
had 2 miscarriages at 12 weeks and 13 weeks, one
child delivered at 38 weeks, and another child delivered at 40 weeks.
The nurse documents this as:
a. G4P2/T2A2 b. G3P3/T2A1 c. G3P2/T2A2 d. G4P3/T3A0
ANSWER: A
G4P2/T2A2 is accurate due to the current pregnancy, 2 term births,
and 2 abortion.
Reference: Adele Pillitteri. Maternal and Child Health Nursing 5th
edition Page 253
93. A woman who is 24-hours postpartum and who has an
episiotomy would be instructed to report which of the
following findings immediately?
a. Decrease in urine output c. Presence of lochia rubra
b. Absence of a daily bowel movement d. Increase in perineal pain
sensation
ANSWER: D
Signs of an infected episiotomy include pain, redness, warmth,
swelling and discharge. Option A: Hormonal changes
cause an increase in renal function during pregnancy. Decreased
steroid levels may partially explain the reduction of
renal function in the postpartum period. Option B: Spontaneous
bowel evacuation may be delayed up to two to three
days after childbirth. Option C: Lochia rubra begins to turn brown
three to four days after childbirth.
Reference: A. Pillitteri. Maternal and Child Nursing. 6th Edition. Page
94. A client in active labor is admitted with preeclampsia. Which
assessment finding is most significant in planning this
client's care?
a. Patellar reflex 4+. c. Four-hour urine output 240 ml.
b. Blood pressure 158/80. d. Respiration 12/minute.
ANSWER: A
A 4+ reflex in a client with pregnancy-induced hypertension
indicates hyperreflexia, which is an indication of an
impending seizure. Although option B is significant, some individuals
have preeclampsia superimposed on chronic
hypertension, and an elevated blood pressure alone is not as
significant a finding as option A. Options C and D are
important, but these findings are within normal range.
Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th
edition
95. When explaining "postpartum blues" to a client who is 1 day
postpartum, which symptoms should the nurse
include in the teaching plan?
1. Mood swings 3. Tearfulness 5. Disinterest in the infant
2. Panic attacks 4. Decreased need for sleep
a. 1 and 3 b. 1, 3, 4 c. All except 2 d. All of the above
ANSWER: A
"Postpartum blues" is a common emotional response related to the
rapid decrease in placental hormones after
delivery and include mood swings (1), tearfulness (3), feeling low,
emotional, and fatigued. Numbers 2, 4, and 5 are
more characteristic of postpartum depression that typically occurs 3
to 7 days later than postpartum blues.
Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th
edition
96. A primigravida client with severe preeclampsia is receiving
magnesium sulfate via continuous IV infusion. Which
assessment data indicates to the nurse that the client is
experiencing magnesium sulfate toxicity?
a. Deep tendon reflexes 2+. c. Respiratory rate 18/minute.
b. Blood pressure 140/90. d. Urine output 90 ml/4 hours.
ANSWER: D
Urine outputs of less than 100 ml/4 hours, absent DTRs, and a
respiratory rate of less than 12 breaths/minute are
cardinal signs of magnesium sulfate toxicity. Options A, B, and C do
not indicate a magnesium sulfate toxicity.
Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th
edition
97. A woman with severe PIH was delivered 2 hours ago. Which
nursing action should be included in the plan of care
for her postpartum hospital stay?
a. Continuing to monitor blood pressure, respirations and reflexes
b. Encouraging frequent family visits c. Keeping her NPO
d. Maintain an IV access to the circulatory system
ANSWER: A
Post delivery management of the mother includes close observation
for BP elevation, CNS irritability (visitors are
limited), and respiratory function. The client is at risk for seizure for
24 hours after delivery.
Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th
edition
Painless vaginal bleeding is symptomatic of placenta previa. Vaginal
exams are contraindicated before 36 weeks
unless done in the delivery room set up for emergency cesarian
section if needed. Bed rest is essential and shaving is
not necessary.
Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th
edition
100. Nurse Hannah is caring for a woman with a placenta previa who
has been hospitalized for several weeks. She is
now at 38 weeks’ gestation and her membranes have ruptured. The
amniotic fluid has a greenish color and the
woman has started to bleed again. What would the nurse’s first
action?
a. Administer oxygen c. Call the doctor and prepare for a cesarian
birth
b. Place her in trendelenburg’s position d. Move her to the delivery
room immediately
ANSWER: C
Green amniotic fluid is indicative of fetal distress. This combined
with bleeding from the placenta previa may require a
cesarian section. Oxygen and movement to the delivery room may
be performed, but notifying the doctor would be a
definite plan.
Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th
edition

98. Discharge instructions are given to a woman who had been

admitted with placenta previa. Which statement by the
client to her husband best demonstrates she understands the
teaching?
a. “We can’t have sex”
b. “I have to return in a few days for a vaginal exam”
c. “I will have to have a caesarian delivery for this and other
pregnancies”
d. “I can go back to part-time work beginning tomorrow”
ANSWER: A
Sexual intercourse is avoided as it causes uterine contractions,
contributing to further placental separation or dislodge
the placenta. The client will not have vaginal examination (as it can
cause further separation of the placenta);
cesarian will be evaluated at a later time; bed rest is recommended.
Reference: Adele Pillitteri. Maternal and Child Health Nursing 6th
edition

99. The nurse is caring for a woman who is 35 weeks pregnant. She
comes to the emergency room with painless,
vaginal bleeding. This is her third pregnancy and she states that this
has never happened before. What would be
avoided in caring for this client?
a. Allowing her husband to stay with her c. Shaving the perineum
b. Keeping her at rest d. Performing vaginal examination
ANSWER: D