REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
REVIEW UNIVERSITY FOR NURSES, INC.
Successfully Training Filipino Nurses and Midwives for Global Setting
P.U.P. Hasmin Hos...
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Checked cic & icf mid set b preboard one of the public health ak apr 20&21, 2013 by auntie digs for xrox

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Checked cic & icf mid set b preboard one of the public health ak apr 20&21, 2013 by auntie digs for xrox

  1. 1. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 PRE-MIDWIFERY LICENSURE EXAMINATION CARE OF INFANT AND CHILDREN APRIL 20 & 21, 2013 SET - B GENERAL INSTRUCTIONS: This test questionnaire contains 100 test items. Shade only one (1) box for each question on your answer sheets. Two or more boxes shaded will invalidate your answer. AVOID ERASURES. 1. One of the public health concerns in our country is malnutrition. All but one is common nutritional deficiencies which could lead to serious physical, mental & problems. a. Vit. A b. Folic acid c. Iron d. Iodine Ans:BFolic acid 2. Included in the Philippine Nutrition Program’s Life –Cycle are as follows, EXCEPT: a. 0-3 year old children b. Adolescent females c. Pregnant & lactating mothers Ans: D– CHN pp. 158 – Nutrition Program ---- Strategies #2 d. School age children 3. Vit. A capsule is distributed & given 2 times a year, through the ―ArawngSangkapPinoy‖ ASAP‖ which is also known as: a. Infant & Young Child Feeding Program (IYCF) c. Integrated Management of Childhood Illness (IMCI) b. GarantisadongPambata (GP) d. MicronutrientSupplémentation Program Ans: B– 2 x a year distribution of Vit. A capsules through the ASAP known as GarantisadongPinoy (GP) 4. In doing the admission assessment, the midwife should expect to find which signs of dehydration in an infant? a. Fever and bradycardia c. Hypotension and anuria b. Irritability and sunken eyeballs d. Dry mucous membranes and bulging anterior fontanel ANS: B-signs of dehydration in infants would include irritability and sunken, dry eyeballs due to fluid loss. Fever may be present, and tachycardia, not bradycardia (A) is common. Low BP often results, followed by oliguria; anuria (C) is rare and would be an ominous sign of renal failure. Finally, the oral buccal mucosa may be quite dry, and the anterior fontanel may be sunken, not bulging. 5. The surgeon orders a preoperative series of cleansing enemas for an infant with Hirschprung’s disease. The midwife should expect the solution ordered for these enemas to be: a. Soapsuds enema (SSE) b. Normal saline c. Pediatric Fleets d. Tap water ANS: B-the only solution that should be used in doing cleansing enemas for a child with Hirschprung’s disease is normal saline, because the child will retain some of the fluid which will be absorbed through the bowel wall. As an isotonic solution, normal saline will not alter the fluid balance like a non-isotonic solution almost certainly would (A, C, D). 6. A child has been admitted for surgery to correct a congenital megacolon. Enemas are ordered preoperatively to cleanse the bowel. The midwife should use: a. Tap water b. Soap suds c. Isotonic saline d. Hypertonic phosphate ANS: C-isotonic saline is compatible with body fluids. It is neither hypertonic nor hypotonic, so it does not cause a change in osmotic pressure and upset the balance of intracellular and extracellular fluid and electrolytes. (A)- This hypotonic solution might cause fluid and electrolyte imbalance. (B)- soap- suds enemas consist of water with added soap products and are therefore hypotonic; this can cause fluid shifts and electrolyte imbalances. (D)- This solution would cause excess fluid loss and therefore be dangerous. 7. In reviewing what he would do if he experienced a hypoglycaemic episode, a teenager correctly states that he would eat piece of candy or drink a glass of orange juice. The midwife should then instruct him to follow this concentrated sweet with: a. A dextrostix test A urine dipstick for glucose A glass of milk 5 U of regular insulin ANS: C-because concentrated sweets will cause a rise in blood sugar, followed by a precipitous drop, the nurse should teach this patient that he should follow up this concentrated sweet with a complex carbohydrate such as a glass of milk. The complex carbohydrate will help maintain a consistent level of blood sugar, thus avoiding the precipitous drop. Any other action would be inappropriate at this time. 8. Following surgery to close the myelomenginocele sac, the midwife should place the infant on her: a. Abdomen, with head 10 degrees lower than hips c. Abdomen, with hips 10 degrees lower than head b. Abdomen, with head of bed elevated 30 degrees d. Abdomen, flat in bed ANS: A-the infant is placed on her abdomen, postoperatively; to prevent trauma or pressure to the sutured area on her back. In addition, the infant’s head should be positioned 10 degrees lower than her hips to prevent the pressure of circulating CSF from affecting the suture line on the lower back. An obvious contraindication to this position is if increased The House of Quality Review, The Home of Topnotchers! 1|Page
  2. 2. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 intracranial pressure is present, in which case the infant would be positioned flat in bed (D). In general, the head is never higher than the hips (B or C) during the immediate postoperative period for this type of surgery. 9. The food Fortification Act of 2000, provides for the mandatory fortification of staples such as: 1. Flour with Iron &Vit A 2. Cooking oil 3. Refined sugar with Vit A 4. Rice with Iron 5.Fortification of processed foods 6.Fortification of milk & coffee a. 1, 2, 3, 4 b.. 1, 2, 3, 4, 5, c. 1, 2, 4, 5 d. 1, 2, 3, 5, 6 ANS:1, 2, 3, 4, 5 10. The best method to prevent the spread of infection from an infant with AGE to other staff members or visitors would be: a. Double bagging all linens b. Obtaining stool cultures c. Strict hand washing d. Wearing disposable gloves ANS: C- the best means to prevent any type of infection in any type of setting is good hand washing. Other techniques are secondary. 11. A school-age child experiences the following signs or symptoms of rheumatic fever. The midwife should plan any interventions based on the knowledge that the only one that may result in permanent damage is: a. Sydenham’s chorea b. Migratory polyarthritis c. Carditis d. Erythema marginatum ANS: C-carditis can lead to permanent, irreversible cardiac damage, specifically mitral valvular stenosis. The other manifestations of rheumatic fever (A, B, D) are transient and do not leave any permanent effects. 12. A 9-year-old is admitted to the hospital with a second attack of rheumatic fever. In doing an admission assessment on this child, which group of symptoms would the midwife most likely find? a. Petechiae, malaise, and joint pain c. Tachycardia, erythema marginatum, and fever in late afternoon b. Chorea, anemia, and hypertension d. Subcutaneous nodules, dependent edema, and conjunctivitis ANS: C- the most common symptom in children with rheumatic fever is tachycardia due to cardiac involvement; in addition, these children may develop a rash ―erythema marginatum‖, and a characteristic fever which spikes in the late afternoon. They do not usually present with petechiae (A), hypertension (B) or conjunctivitis (D). 13. A school-age child with rheumatic fever develops heart failure and is placed on digoxin, Lasix and potassium. The chief purpose for giving potassium is to: a. Enhance the cardiogenic effect of digoxin c. Prevent Hypokalemia b. Potentiate the diuretic action of Lasix d. Pharmacologically induce Hyperkalemia ANS: C- clients receiving digoxin in addition to lasix are particularly prone to developing hypokalemia, which can result in digoxin toxicity and potentially fatal cardiac dysrhythmias. Potassium supplements are frequently administered to avoid this problem rather than for any of the other reasons cited here (A, B, D). 14. A child with leukaemia is receiving vincristine. The midwife should observe this child closely for the side effect of: a. Diarrhea b. Diplopia c. Haemorrhagic cystitis d. Peripheral neuropathy ANS: D- Vincristine is an anti-neoplastic Vinca alkaloid, which has the major side effect of peripheral neuropathy; this may be manifested in numbness, tingling, foot drop, paresthesia, etc. In addition, vincristine may also cause constipation, not diarrhea (A). Haemorrhagic cystitis (C) may be caused by cyclophosphamide (Cytoxan), not vincristine. Vincristine does not cause visual changes (B). 15. A 3 year-old is admitted to the hospital with classic haemophilia (factor VIII deficiency). Which admission procedure by the midwife will probably be the most frightening for this child? a. Blood pressure b. Rectal temperature c. Urine specimen d. Weight ANS: B- toddlers typically fear those procedures that are ―intrusive‖ that is, where something goes into their bodies. Therefore, a rectal temperature would be most likely evoke the most anxiety in a 3-year-old. Generally 3-year-old would be relatively cooperative with getting weighted (D) and giving a urine specimen ©, although having BP taken might also be somewhat threatening (A). 16. The parents of a 10-year-old boy with haemophilia are very worried about their other children, two girls and another boy. They want to know what the chances are concerning the other children having the disorder or being carriers. An appropriate answer to this question would be that: a. ―Neither of the girls will be affected, but the other son will be a carriers, but half of the boys will be affected ―. b. ―Both of the girls will be carriers, but half of the boys will be affected.‖ c. ―Each son has a 50% chance of being either affected or a carrier, and the girls will all be carriers‖ d. ―Each son has a 50% chance of being affected, and each daughter a 50% chance of being a carrier.‖ The House of Quality Review, The Home of Topnotchers! 2|Page
  3. 3. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 ANS: D-the mating of a carrier female (XOXH) and an unaffected male (XOYO) results in the following possible offspring; a carrier female (XOXH), an unaffected female (XOXO), an unaffected male (XOYO), or an affected male (XHYO). (A)- For each child there is a 50% chance of not being affected. (B)- For each child there is a 50% chance of being affected. (C)- Males cannot carry the trail; female have a 50% chance of being carriers. 17. Which of the following is not included in the Essential Maternal & Child Health Service Package? a. Micronutrient Supplementation c. Macronutrient Supplementation b. Breast Feeding d. Complementary Feeding Ans: C 18. The doctor attempts to shine a light through a myelomeningocele sac and notes ―no transillumination.‖ The midwife should interpret this finding to mean that the sac: a. Can be easily repaired c. Contains meninges and CSF b. Cannot be evaluated by this technique d. Contain meninges, CSF, and the spinal cord ANS: D-transillumination, or the procedure of shining a light through the sac, is the usual means for evaluating the contents of the sac. When there is ―no transillumination‖ (the light cannot shine through the sac), this indicates the presence of solid material, or the spinal cord, within the sac. Thus (B) and (C) are incorrect. Transillumination has no bearing on determining whether the sac can be easily repaired (A). 19. Between meals, the midwife should place an infant with CHF in which position? a. In a infant seat with head elevated c. Supine with head slightly hyperextended b. Prone with head turned to side d. Side-lying with the head of the bed elevated 30degree ANS: A-as with an adult with CHF, the infant should be positioned in a chair/infant seat, in semi fowler’s position, to provide maximum expansion of the lungs and to assist the heart. Placing him on his stomach (B) might be an acceptable second choice, providing he can tolerate this position. He should never be placed on his back (C), even with his head slightly hyper extended, because of the possibility of aspiration and other respiratory complications. A side lying (D) would not allow for maximum expansion of the lungs; an infant seat is more appropriate. 20. A toddler tries to pull her IV out, and the midwife determines she must be restrained to maintain the IV site. Which restraint would the midwife be most correct in applying? a. Posey jacket b. Elbow c. Mummy d. Clove-hitch ANS: D-to restraint a toddler receiving IV therapy, clove-hitch restraint to two or more limbs is most effective in maintaining the IV site. A Posey jacket (A) would allow the toddler use of her hands with which to pull at her IV. Elbow restraints (B) would still allow the toddler to stand and twist at the IV tubing. A mummy restraint (C) would be unnecessary restrictive for a toddler. 21. In the Universal Supplementation of Vit. A for infants 6-11 months, one capsule or one dose is given anytime during the 6-11 months period, but usually the most favourable time to give this is at: a. 6 months b. 7 months c. 8 months d. 9 months Ans: D– 9 months during measles immunization 22. For a infant with severe chronic CHF, the formula the midwife should plan to offer would be: a. Isomil b. Lofenalac c. Lonalac d. Similac 27 with iron ANS: C-an infant with severe chronic CHF should be on a low sodium formula, Lonalac. Isomil (A) is a lactose-free formula that contains a normal amount of sodium. Lofenalac (B) is the formula used to treat infants with PKU and also contains a normal amount of sodium. Similac 27 with iron (D) is most frequently used for preterm infants and also contains a normal amount of sodium. 23. While admitting an infant, the midwife notes all the following abnormal findings. Which one is considered the classic sign of Hirschprung’s disease? a. Abdominal distention b. Anorexia c. Constipation d. Vomitus flecked with feces ANS: C-the classic sign of Hirschprung’s disease is obstinate constipation that persists despite all efforts at treatment. Other symptoms may also occur but are not generally considered specific to Hirschprung’s disease as much as they indicate intestinal obstruction; abdominal distension (A), anorexia (B), and vomiting (D). The House of Quality Review, The Home of Topnotchers! 3|Page
  4. 4. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 24. The midwife performs a Metro Manila Developmental Screening Test(MMDST) on a 3-year-old. Which behavior should the midwife expect this child to be capable of doing? a. Going up stairs on alternate feet c. Dressing without supervision b. Pedalling a bicycle d. Tying shoelaces ANS: A-three-year-olds should be able to coordinate the brain and gross motor activity necessary to go to stairs using alternate feet. They should also be able to pedal (Big Wheels‖ or a tricycle but not a bicycle (B). Three-year-olds should also be able to get dressed with supervision but not without it(C). They should not be ready to master tying shoelaces (D) for another year or two. 25. A 2-year-old is admitted to the hospital with acute bilateral otitis media. Her temperature is 103degree F, and she has tremors in her arms and legs. In addition to a spinal tap to rule out bacterial meningitis, the doctor orders all the following. Which order should the midwife perform first? a. Respiratory isolation c. Tylenol 120 mg POq4h b. IV 5% dextrose in 0.45 normal saline solution at 35mL/h d. Seizure precautions ANS: A-in caring for a patient with a potentially contagious condition such as meningitis, the first priority is protecting the nurse and other patients by observing appropriate infection control measures, in this case, respiratory isolation. All other nursing care measures would then follow in the appropriate order (B, C, D). 26. In doing an infant’s admission examination, the nurse notes all the following abnormal findings. Which one is the most common sign of heart disease the midwife should assess? a. Circumoral cyanosis b. Hypertension c. Diastolic murmur d. Tachycardia ANS: D- the majority of infants with CHD present with tachycardia, or a heart rate above 160 betas/min; this is often the first sign of CHD that the nurse can assess. Circumoral cyanosis (A), hypertension (B), and diastolic murmur (C) all may or may not be present, depending on the type and severity of the defect. 27. A toddler is to be placed in a croupette. The midwife should plan to perform which nursing action? a. Remove all toys from the crib b. Withhold all liquids and solids temporarily c. Monitor oxygen concentration daily and record in notes d. Evaluate the toddler’s reaction to oxygen therapy in terms of vital signs and color ANS: D- if the toddler responds well to oxygen therapy, she should show clinical improvement in terms of pink lips and nail beds and normal vital signs, especially pulse. ―All‖ toys do not have to be removed from her crib (A) nor will she have to be NPO (B), although she will probably be somewhat anorexic and prefer clear, cool liquids initially. Oxygen concentrations should be monitored and recorded at least every 2 hours (C). 28. When preparing an infant who is immunosuppresed after chemotherapy for discharge, the midwife explains to the parents that the measles, mumps, and rubella(MMR) immunization must: a. Be discussed with the pediatrician on the next visit b. Not the given until the infant is at least 2 years of age c. Not the given as long as the infant is receiving chemotherapy d. Be given to protect the infant from getting any of these diseases ANS: C-MMR vaccine is composed of live viruses and its administration could be life threatening for an immunosuppressed child. (A)- At the discharge the parents need information about immunizations, because MMR vaccine is generally given at 12 to 15 months of age. (B)- This child will receive the MMR vaccine when blood values return to normal regardless of age, but not before 12 months of age. (D)- Because the MMR vaccine is composed of live viruses, giving it can be as life-threatening as actually having the disease. 29. Children ages 21 – 71 months, under the Universal Supplementation of Vit. A, one capsule is given every 6 months and the dosage is: a. 50,000 ―IU‖ b. 100,000 ―IU‖ c. 150,000 ―IU‖ d. 200,000 ―IU‖ ANS: D– 200,000 ―IU‖ 30. For High Risk children, like a 6-11 months child with measles or a Preschool child with measles , Vit A supplementation should be: a. 6-11 months 150,000 ―IU‖; Preschool 200,000 ―IU‖ c.6-11 months 100,000 ―IU‖; Preschool 200,000 ―IU‖ b. 6-11 months 100,000 ―IU‖; Preschool child 150,000 ―IU‖ d.6-11 months 150,000 ―IU‖; Preschool ―250,000 ―IU‖ ANS: C The House of Quality Review, The Home of Topnotchers! 4|Page
  5. 5. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 31. For Malnourished children ages 6 – 12 years old, Vit A supplementation, the correct dosage is given at: a. 100,000 ―IU‖ b. 150,000 ―IU‖ c. 200,000 ―IU‖ d. 250,000 ―IU‖ ANS: C 32. For children with Xerophthalmia, age 6-11months, Vit A is given immediately upon diagnosis, & the correct dose is: a. 50,000 ―IU‖ b. 100,000‖IU‖ c. 150,000 ―IU‖ d. 200,000 ―IU‖ ANS: B– pp. 161 33. For 12 – 50 months, children with xerophthalmia, is treated with correct dosage of VIt. A; a. 100,000 ―IU‖ b. 150,000 ―IU‖ c. 200,000 ―IU‖ ANS: C d. 250,000 ―IU‖ 34. The midwife teaching a nursing education class emphasizes that the common nursing care to help prevent both sickle cell crisis and celiac crisis is : a. Limitation of activity c. High-iron, low-fat, high-protein diet b. Protection from infection d. Careful observation of all vital signs ANS: C-warmth causes vasodilatation, which will help lessen the pain of a vaso-occlusive crisis. (A)- IV fluids if ordered, should be increased to dilute the blood and prevent further sickling. (B)- cold will cause more vasoconstriction and increase pain. (D)- This is an inadequate dose for an adolescent. 35. The midwife’s background knowledge of the basic nutrients that act as partners in building red blood cells will be used to develop a teaching plan for a child with nutritional anemia. These nutrient partners of iron are: a. Calcium and vitamins b. Vitamin D and riboflavin c. Proteins and ascorbic acid d. Carbohydrates and thiamine ANS: C- proteins are essential for the synthesis of the blood proteins, albumin, fibrinogen, and haemoglobin. Ascorbic acid influences the removal of iron from ferritin (making more iron available for production of heme) and influences the conversion of folic acid to folinic acid. (A)- These are not involved in building red blood cells. (B) and (D)- Same as answer A. 36. Iron supplementation to infant ages 6 – 11 months, should be given the correct dose as; a. 10 mg.of elemental iron c. 20 mg.of elemental iron b. 15 mg.of elemental iron d. 25 mg.of elemental iron ANS: B 37. Iron supplementation for Low Birth Weight children should be at a correct dose of: a. 15 mg. elemental iron b. 20 mg elemental iron c. 25 mg elemental iron ANS: A d. 10 mg elemental iron 38. When evaluating the laboratory reports for a 1-year-old child, the midwife recalls that the normal hematocrit range for a child of this age is: a. 19% to 32% b. 29% to 41% c. 37% to 47% d. 42% to 69% ANS: B-this is the expected hematocrit range for a 1 year old. (A)- This would be too low; it would only occur with a problem such as prolonged blood loss. (C)- This is too high; this would be expected for an adult female. (D)- This is too high; this would be expected for a newborn. 39. Iron supplementation to Pre - school children should be at a correct dose of: a. 15 mg elemental iron b. 20 mg elemental iron c. 25 mg elemental iron ANS: D d. 30 mg elemental iron 40. A child undergoes heart surgery to repair the defects associated with tetralogy of Fallot. Post-operatively, it is essential that the midwife prevent: a. Crying b. Coughing c. Hard stools d. Unnecessary movement ANS: C-forceful evacuation results in the child’s taking a deep breath, holding it, and straining (Valsalva maneuver). This increased intrathoracic pressure puts excessive strain on the heart sutures. (A)- Crying is not a problem after cardiac surgery; it may, in fact, help prevent respiratory complications. (B)- Coughing and deep breathing are essential for the prevention of postoperative respiratory complications. (D)- Activity is gradually increased postoperatively. 41. The laboratory analysis for a 5-year-old admitted for repair of tetralogy of Fallot indicates a high red blood cell count. The nurse recognizes that this polycythemia can best be understood as a compensatory mechanism for: a. Low BP b. Cardiomegaly c. Low iron level d. Tissue oxygen need The House of Quality Review, The Home of Topnotchers! 5|Page
  6. 6. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 ANS: D-decreased tissue oxygenation stimulates erythropoiesis, resulting in excessive production of red blood cells. (A)- This would not be a direct cause of polycythemia. (B)- Same as answer A. (C) - This may or may not affect the production of red blood cells. 42. A 3-year-old is scheduled for an arterial cardiac catheterization, Nursing care after this procedure should include: a. Encouraging early ambulation c. Restricting fluids until blood pressure is stabilized b. Monitoring the site for bleeding d. Comparing blood pressure in the affected and unaffected extremities ANS: B-haemorrhage is a major life-threatening complication, because arterial blood is under pressure and an artery has been entered (punctured) by a catheter. (A)- The child is kept in bed for 6 to 78 hours after the procedure. (C)Fluids may be given as soon as tolerated. (D)- Pulses, not BP must be checked for quality and symmetry. 43. A young child has coarctation of the aorta. When taking the child’s vital signs, the midwife can expect to observe: a. Notching of the clavicle c. Weak, thread radial pulses b. Bounding femoral pulses d. Higher BP in the upper extremities ANS: D-coarctation of the aorta is a narrowing of the aorta, usually in the thoracic segment, causing decreased blood flow below the constriction and increased blood volume above it. (A)- This is not related to coarctation of the aorta. (B)In coarctation of the aorta, femoral pulses would be weak or absent, and BP in the lower extremities would be decreased. (C)- In coarctation of the aorta, radial pulses would be full and bouning. 44. A 2-year-old child has a congenital right-to-left shunt defect of the heart. The midwife would expect to observe: a. Orthopnea b. An elevated hematocrit c. Absence of pedal pulses d. Edema in the extremities ANS: B-polycythema reflected in an elevated hematocrit level is a direct attempt of the body to compensate for the decrease in oxygenation to all body cells caused by the mixture of oxygenated and unoxygenataed circulating blood. (A)This is not characteristic of right-to-left shunt heart disease in children. (C)- This is characteristic of coarctation of the aorta. (D)- edema is not a common finding in right-to-left shunt heart disease. 45. A common finding in most children with cardiac anomalies is: a. Mental retardation b. Delayed physical growth c. Clubbing of the fingertips d. A family history of cardiac anomalies ANS: B- children with cardiac anomalies often use increased energy in activities of daily living: decreased oxygen and increased energy output in the developing child results in a slow growth rate. (A)- Mental retardation is not a common finding in children with congenital heart disease. (C)- Clubbing is not characteristics of most children with cardiac anomalies, only of those with more sever hypoxia. (D)- Cardiac anomalies are more often a result of prenatal, rather than genetic factors. 46. A 5-month-old infant is brought to the pediatric clinic for monthly checkup. The midwife is aware that the assessment finding that would need the most immediate follow-up would be: a. Strabismus b. Tachycardia c. Mild hypotonia d. Inability to sit with support ANS: B- tachycardia in infants is often a sign of a heart defect. This infant should be examined fro the presence of a heart defect. (A)- This is frequently seen in young children; it is related to immature muscle control and does not require intervention unless it persists into toddlerhood. (C)- This does not warrant immediate attention, but the infant should be reevaluated at the next visit. (D)- This finding at this age does not require immediate attention; however, the infant should be monitored for the attainment of this and other developmental milestones at future visits. 47. A 3-year-old preschooler has been hospitalized with nephritic syndrome. The best way to detect fluid retention would be to: a. Have the child urinate in a bedpan c. Weigh the child at the same time every day b. Measure the child’s abdominal girth daily d. Test the child’s urine for Hematuria and proteinuria ANS: C-daily weights are an important direct way to assess fluid retention or loss. (A)- This may not always happen and would not be accurate. (B)- This is a measure for the degree of ascites; it would only measure fluid retention indirectly. (D)- Assessment of urine for blood and protein gives information about the disease process but not about the amount of fluid retention. 48. During clinic visit, a child with nephritic syndrome has a muddy, pale appearance and complains of not wanting to eat and feeling tired. The midwife suspects that the child is: a. In impending renal failure c. Developing a viral infection b. Being too active in school d. Not taking the ordered medication The House of Quality Review, The Home of Topnotchers! 6|Page
  7. 7. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 ANS: A- poor appetite and decreased energy are associated with the accumulation of toxic waste; anemia accounts for the pallor. (B)- Once remission has occurred, usual activities can be resumed with discretion. (C)- An elevated temperature probably would be present but an infection would not cause a muddy pallor. (D)- Discontinuing the corticosteroids and diuretics that are usually prescribed would probably result in recurrence of edema in steroiddependent children. 49. The parents of a child with acute glomerulonephritis are very concerned about activity restrictions after discharge. The midwife bases the answer to them on the fact that after the urinary findings are nearly normal: a. Activity must be limited for 1 month c. The child must remain in bed for 2 weeks b. The child must not play active games d. Activity does not affect the course of the disease ANS: D- when urinary findings are normal, such as an evidence of hematuria or proteinuria, the child may resume preillness activities. (A)- This restriction is unnecessary. (B)- Same as answer A. (C) - Bed rest u=is unnecessary at this stage. 50. A child is admitted with the diagnosis of acute glomerulonephritis (AGN). When performing a physical assessment, the midwife should expect to find: a. anorexia, Hematuria, proteinuria (1+),and decreased blood pressure b. normal blood pressure, anorexia, proteinuria (1+),and glycosuria(3+) c. lowered blood pressure, preorbital edema, proteinuria(1+),and decreased specific gravity(1.00) d. moderately elevated blood pressure, preorbital edema, proteinuria(4+), and increased specific gravity(1.030) ANS: D- the glomerular filtration rate is reduced, resulting in sodium retention, protein loss, and fluid accumulation producing these signs. (A)- Not all of these support the diagnosis of glomerulonephritis (AGN). (B) and (C)- Same as answer A. 51. The maintenance of fluid and electrolyte balance is more critical in children than in adults because: a. Cellular metabolism is less stable than in adults b. The proportion of water in the body is less than in adults c. Renal function is immature in children below 4 years of age d. The extracellular fluid requirement per unit of body weight is greater than in adults ANS: D-the extracellular body fluid represents 45% at birth, 25% at age 2, and 20% at maturity. Another measurement is percentage of total body weight, which is 80% at birth, 63% at 3, and approximately 60% at 12 years. (A)- Cellular metabolism in children is not less stable than in adults. (B)- The proportion of total body water in children (up to 2 years) is greater than it is in adults. (C)- Renal function is immature during infancy only. 52. The behavior of an infant with colic is usually suggestive of: a. An allergic response to certain proteins in milk c. Paroxysmal pain and grunting respirations b. Inadequate peristalsis resulting in constipation d. Constant severe pain and absence of stools ANS: C-the traditional efforts to explain and treat colic center on control of gas in the intestinal tract that is causing the paroxysmal pain. (A)- Excessive intake of carbohydrates may cause flatus, but diet changes rarely prevent colic attacks. (B)- Colic is thought to be caused by excessive fermentation and gas production. (D)- The exact cause of colic is not known. 53. The midwife plans to discuss childhood nutrition with parents of children with Down syndrome in an attempt to minimize a common nutritional problem encountered in children with Down syndrome namely: a. Rickets b. Anaemia c. Obesity d. Rumination ANS: C-obesity is a common nutritional problem in children with Down syndrome. It is thought to be related to excessive caloric intake and impaired growth. (A)- This is a nutritional disorder related to vitamin D deficiency; it is not especially encountered is these children. (B)- This is the most common nutritional problem in children (iron deficiency); it is not specially encountered in these children. (D)- This us a psychiatric eating disorder of infancy characterized by repeated regurgitation without gastrointestinal illness; it is not usually encountered in these children. 54. Mebendazole (Vermox) is ordered for a child with pinworms. It is advisable that this drug also be administered to: a. The child’s younger brother who is 1 year old b. All members of the child’s family who test positive c. All people using the same toilet facilities as the child d. The child’s mother, father, and siblings even if they are symptom-free ANS: D-all household members should be treated at the same time unless they are younger than 2 years or pregnant. (A)- This drug is not recommended for children under the age of 2. (B)- Positive testing is not a criterion for The House of Quality Review, The Home of Topnotchers! 7|Page
  8. 8. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 administration to family members. (C)- This is not a significant criterion for administration of medication because eggs are airborne. 55. Pinworms cause a number of symptoms besides anal itching,. A complication of pinworm infestation, although rare, that the midwife should observe for is: a. Hepatitis b. Stomatitis c. Appendicitis d. Pneumonitis ANS: C-the worm attaches itself to the bowel wall in the cecum and appendix and can damage the mucosa, causing appendicitis. (A)- The pinworm does not migrate to the liver. (B)- Although pinworms (and their ova) are ingested by mouth, they do not attach there; inflammation of the mouth is not a complication of pinworm infestation. (D)- the pinworm does not migrate to the respiratory system. 56. A 9-year-old child has just been diagnosed with recurrent abdominal pain (RAP). What should the midwife plan to include in the home –care instructions when the child is discharged? Select all that apply. a. _______ bowel training c. _______ clear liquids when pain recurs b. _______ high-fiber diet d. _______ ice packs to the abdomen when pain occurs ANS: A AND B.(A)- This helps the child to re-establish bowel habits. (B)- this, is addition to a bulk laxative, is beneficial for a child with recurrent abdominal pain. (C)- Fiber, not clear liquids, is recommended. (D)- Warm applications, such as heating pads are recommended. 57. Corrective surgery for hypertrophic pyloric stenosis is completed, and the infant is returned in stable condition to the pediatric unit with an intravenous infusion and a nasogastric tube in place. The priority nursing action should be to: a. Apply adequate restraints c. Assess the IV site for infiltration b. Administer a mild sedative d. Attach the Nasogastric tube to wall suction ANS: A- protecting the iv and nasogastric tube form becoming dislodged is a priority. (b)- this is not the priority action.(C) and (D)- Same as answer B. 58. Surgery to correct hypertrophic pyloric stenosis is performed on a 2 week-old infant who has been formula –fed. The midwife caring for the infant notices that the postoperative orders are similar to those for other infants having undergone such surgery and include: a. Thickened formula 24 hours after surgery c. Regular formula feeding 24 hours after surgery b. Withholding all feedings for the first 24 hours d. Additional glucose feedings as desired after the first 24 hours ANS: C-initial feedings of glucose and electrolytes in water or breast milk are given 4 to 6 hours after surgery. When clear fluids are retained, usually within 24 hours, formula feedings are begun. (A)- Regular formula should be started 24 hours after surgery in an attempt to gradually return the infant to a full feeding schedule. (B)- This is not necessary. (D)Same as answer B. 59. The mother of a toddler who has swallowed liquid drain cleaner containing lye calls the poison control center. She is advised to administer: a. Syrup of ipecac b. Two ounces of milk c. Dilute vinegar solution d. Sodium bicarbonate solution ANS: C- lye, a basic, is neutralized by administration of a weak acid such as vinegar. (A)- This induces vomiting and would cause further burning of tissue when the lye was vomited back through the esophagus. (B)- Milk is useful to soothe irritated mucous membranes but will not inactivate the poison. (D)- Bicarbonate is used to neutralize acids. 60. An 8-month-old infant has a gastrostomy tube and is given 240 mL of tube feeding q4h. One of the primary nursing responsibilities is to: a. Open the tube 1 hour before feeding c. Give 10 mL of normal saline before and after feeding b. Position on the right side after feeding d. Elevate the tube 30cm (12inches) above the mattress ANS: B- positioning on the right side after feeding facilitates digestion because the pyloric sphincter is on the side and gravity aids in emptying the stomach. (A) –Feeding may proceed immediately after opening the tube. (C)- Placement of the tube and residual should be ascertained before administering any fluid. (D)- The usual height for elevation of the gastrostomy tube when feeding an infant is 6 to 8 inches above the child’s stomach. 61. A mother brings her week-old infant to the clinic because the infant continually regurgitates. Chalasia is suspected. The midwife instructs the mother to: a. Keep the infant prone following feedings c.Administer a minimum of 8 oz of formula at each feeding b. Prevent the infant from crying for prolonged periods d.Keep the infant in a semi sitting position, particularly after feedings ANS: D-chalasia is an incompetent cardiac sphincter which allows a reflux of gastric contents into the esophagus and eventual regurgitation. Placing the infant in an upright position keeps the gastric contents in the stomach by gravity and The House of Quality Review, The Home of Topnotchers! 8|Page
  9. 9. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 limits the pressure against the cardiac sphincter. (A)- This will promote regurgitation; it is an unsafe position because of the danger of SIDS. (B)- This ill probably have little effect chalasia. (C)- This will promote vomiting because it is too much formula for a week-old infant. 62. Chickenpox can sometimes be fatal to children who are receiving: a. Insulin b. Steroids c. Antibiotics d. Anticonvulsants ANS: B-steroids have an anti-inflammatory effect. It is believed that resistance to certain viral diseases, including chickenpox, is greatly decreased when a child takes steroids regularly. (A)- There is no known correlation between chickenpox and insulin. (C)- Because chickenpox is viral, antibiotics would have no effect. (D)- There is no known correlation between chickenpox and anti-convulsants. 63. A 10-year old is diagnosed with lymphocytic thyroiditis. The midwife should explain to the parents and child that this condition is: a. Chronic b. Inherited c. Difficult to treat d. Probably temporary ANS: D-the goiter associated with this disease associated with this disease (Hashimoto’s disease) is usually transient and regresses spontaneously in 1 or 2 years. The child usually is euthyroid but may be slightly hypo-or-hyperthyroid. (A)This not a chronic disease. (B)- There seems to be a strong genetic predisposition, but no mode of inheritance has been identified. (C)- This is not an untreatable or fatal disorder; it can be controlled with a medical regimen. 64. One nutritional principle to the followed in children with type1 diabetes is to provide for compensatory changes. The midwife should review with the child how compensation for increased physical activity can be achieved and instruct the child to: a. Take the oral hypoglycaemic medication on days of heavy exercise b. Increase dietary intake when there is a plan to exercise more than usual c. Lower the insulin dose in the morning when extra exercise in the morning when extra exercise is anticipated d. Eat simple sugars that are more rapidly absorbed to compensate for extra exercise ANS: B- by increasing the diet- that is, increasing the child’s carbohydrate intake- a hypoglycaemic reaction caused by exercise is less likely to occur. (A)- An oral hypoglycaemic is an inappropriate treatment for individuals with type I diabetes. (C)- This is not an appropriate reason for altering the insulin dosage. (D)_ This type of intake is less effective than other nutrients absorbed more slowly, which provide a more consistent blood glucose level. 65. At At a. b. c. d. 7am, the midwife receives the information that a diabetic adolescent’s 6am fasting blood glucose was 180mg/dL. the time, the midwife should: Encourage the adolescent to get up and the exercise Ask the adolescent to obtain an immediate glucometer reading Give the adolescent a complex carbohydrate such as milk or cheese Have the adolescent administer the prescribed does of regular insulin ANS: D- blood glucose of 180 mg/dL is above the average range, and regular insulin, which is fast-acting, is needed. (A)- Exercise will not correct the problem; regular insulin is needed. (B)- This action will not correct the problem; the blood glucose is already known. (C)- Food intake would increase the blood glucose at this time. 66. A 16-year-old recently diagnosed with type 1 diabetes, will receive Novolin N insulin subcutaneously. When providing counselling about the insulin and the potential for hypoglycaemia, the midwife should include information that NPH (Novolin N) insulin given subcutaneously will peak in: a. 1-2 hours b. 2-4 hours c. 4-12 hours d. 5-7 hours ANS: C- NPH (Novolin N) insulin peaks in 4 to 12 hours; it has an onset of 1 to 2 hours and duration of 18 to 24 hours. (A)- This is the onset of action of NPH (Novolin N) insulin. (B)- This is the peak action of regular (Novolin R) insulin. (D)This is the duration of action of regular (Novolin R) insulin. 67. An a. b. c. d. evening snack is planned for a child receiving Humulin N insulin. The midwife understands that this will provide: Added calories to help the child gain weight Encouragement for the child to stay on a diet High-carbohydrate nourishment for immediate utilization Nourishment with a latent effect to counteract late insulin activity ANS: D- a bedtime snack for the evening. Humulin N insulin lasts for 24 to 48 hours. Protein and carbohydrate ingestion before sleep prevents hypoglycaemia during the night, when action of Humulin N insulin will be high. (A)- There are no data to indicate such a need; a bedtime snack is routinely provided to help cover intermediate-acting insulin during sleep. (B)- The snack is important for diet/insulin balance the night, not encouragement. (C)- The snack must contain mainly protein-rich foods to help cover the intermediate-acting insulin during sleep. The House of Quality Review, The Home of Topnotchers! 9|Page
  10. 10. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 68. After orthopedic surgery, a 15 year-old complains of pain and is given 15 mg of codeine sulphate as ordered every 3 hours PRN. Two hours after having been given this medication, the adolescent complains of severe pain. The midwife should: a. Report that the adolescent has an apparent idiosyncrasy to codeine b. Tell the adolescent that additional medication cannot be given for 1 more hour c. Request that the physician evaluate the adolescent’s need for additional medication d. Administer another dose of codeine within 30 minutes, because it is a relatively safe drug ANS: C-the nurse made the assessment that the medication was ineffective in relieving the child’s pain for the duration ordered. This information should be communicated to the physician for evaluation. (A)- There are no data to support this. The amount of medication was probably inadequate for the client’s pain tolerance level. (B)- The nurse should not ignore the child’s need for pain relief. (D)- The physician’s order is for administration only every 3 hours; legally it an be given only within these guidelines. 69. A 9-year-old child has a fractured tibia, and a full leg cast has been applied. The midwife should immediately notify the physician if assessment demonstrates: a. A pedal pulse of 90 b. An inability to move the toes b. An increased urinary output d. A plaster cast that is still damp after 4 hours ANS: C- a cast is not flexible and can inhibit circulation. Cold toes, loss of sensation in toes, pain, and inability to move toes should be reported to the physician immediately. (A)- The expected pulse for a 9-year-old child ranges from 70 to 110. (B)- This may be related to increased fluid intake. (D)- It takes 24 to 48 hours for a plaster cast to dry. 70. A 7-year-old girl has recently been diagnosed with rheumatoid arthritis. The parents are concerned about the lifelong effects of the disease. Their daughter is already having difficulty going to school in the morning. The parents are investigating other therapies to use with the medications. The midwife should recommend a referral for: a. Physical therapy b. Special education c. Nutritional therapy d. Herbal supplements ANS: A-a physical therapist can prescribe an exercise protocol to keep the joints as mobile as possible; a routine can be developed to help the child alleviate morning stiffness. (B)- Although this might be necessary in the future, there is no evidence that is needed at this time. (C)- Although nutrition is an appropriate part of therapy, it is the physical therapy program than can most directly influence movement. (D)- Over-the-counter medications should not be used without the supervision of the practitioner. 71. When elevating the head of an infant in a spica cast, the midwife should be aware that it is important to: a. Limit this position to 1 hour at a maximum c. Place at least two pillows under the shoulders b. Use folded diapers around the edge of the cast d. Raise the entire mattress or bed at the head of the bed ANS: D- pillows under the head or shoulders of a child in a spica cast will thrust the chest forward against the cast, causing discomfort and respiratory distress. When elevation of the head is desired, the entire mattress or bed should be raised at the head of the bed. (A)- There is no reason to place a time limit on this position. (B)- This will not help in any way. (C)- This will thrust the chest forward against the cast, causing discomfort and respiratory distress. 72. A child with a leg fracture of suspicious origin is brought into the emergency department by his mother and the mother’s boyfriend. It is the child’s first visit to this hospital. After assessing the child, the midwife suggests that the physician order a skeletal survey because it: a. Will pinpoint the exact location and extent of the fracture b. Is more cost effective that ordering three separate x-rays of the leg and hip c. Is the first step toward a complete assessment before a CT scan and an MRI is done d. Will provide a skeletal history of the current fracture and any previous healing or healed fractures ANS: D- abusive parents may ―shop‖ for hospitals that do not have a previous record of their child; the skeletal survey would provide a revealing injury history if there were abuse. (A)- Pinpointing the exact location of a fracture is necessary to plan for appropriate treatment, but it does not provide the information that a skeletal survey would when abuse is suspected. (B)- Cost effectiveness is not the primary concern if abuse is suspected. (C)- A CT scan and MRI would not be required unless internal injuries are suspected. 73. The midwife explains to parents of a toddler with strabismus that if this condition is not corrected in early childhood, it can lead to: a. Glaucoma b. Refractive errors c. Partial loss of sights d. Childhood catheters ANS: C- if the strabismus is not corrected, sight in the affected eye would be lost due to lack of use. (A)- Glaucoma is caused by increased intraocular pressure, not strabismus. (B)- Refractive errors are related to visual acuity rather than strabismus. (D)- Cataracts do not result from strabismus. The House of Quality Review, The Home of Topnotchers! 10 | P a g e
  11. 11. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 74. If monocular strabismus in children is not corrected early enough: a. Dyslexia will develop c. Amblyopia develops in the weak eye b. Peripheral vision will disappear d. Vision in both eyes will be diminished ANS: C-Amblyopia is reduced visual acuity that may occur when an eye weakened by strabismus is not forced to function. (A)- the lack of binocularity could result in impaired depth and spatial perceptions, not dyslexia. (B)- Depth and spatial perceptions are impaired when vision in one eye is severely impaired. (D)- Only vision in the affected eye will be diminished. 75. A 12 year-old child is in the intensive care unit after sustaining a spinal cord injury. Which interventions should the midwife include in this client’s plan of care? Select all that apply. a. _____ Minimizing environmental stimuli c. ______Monitoring and maintaining blood pressure b. ______Monitoring for respiratory complications d. ______Initiating a bowel and bladder training program ANS: B and C.(B)- individuals with spinal cord injury, particularly those higher in the vertebral column, remain unstable for several weeks after the injury. Maintaining a patent airway a priority. (C)- Physiologic instability during the first several weeks after the injury results in fluctuating vital signs including BP readings. (A)- Environmental stimuli do not have to be reduced. (D)- This is too early to institute a bowel and bladder training program. 76. A child with diminished sensation in the legs because of cerebral palsy should be taught special safety precautions, including: a. Testing the temperature of water in any water-related activity b. Setting the clock two times during the night to change position c. Tightening straps and buckles more than usual on braces when ambulating d. Looking down at the lower extremities when crutch walking to determine proper positioning of the legs ANS: A-individuals whose thermoreceptives senses are impaired are unable to detect changes or degrees of temperature. They must be taught to first test the temperature in any water-related activity to prevent scalding and burning. (B)- the child with cerebral palsy normally has uncontrolled movement of voluntary muscles and does not need to be awakened at night to prevent skin breakdown. (C)- Over tightening straps and buckles may lead to circulatory impairment and/or skin breakdown. (D)- This is dangerous because this action alters the center of gravity; with practice the child will be bale to place the legs in the appropriate position for walking without looking down. 77. A 4-year-old child has a revision of a ventriculoperitoneal shunt. A sign of an infected shunt that the midwife should assess for would be: a. Lethargy b. Headache c. Stiff neck d. Decreased pulse ANS: C-infectious process could cause meningitis that would result in a stiff neck. (A)- Irritability rather than lethargy would result; lethargy is more often associated with increased intracranial pressure. (B)- Headache is associated with increased intracranial pressure. (D)- The pulse would be increased with an infection; a decreased pulse is associated with increased intracranial pressure. 78. One morning, the nurse notes that a 3-year-old child in a crib has a clamped jaw and is having a tonic-clonic seizure. The priority nursing responsibility at this time is to: a. Start oxygen at 10L c. Restrain the child to prevent injury to soft tissue b. Insert a plastic airway d. Protect the child from harm from the environment ANS: D-because the child is in a crib, the nurse should remain, observes, and protects the child from injury to the head or extremities during the seizure activity. (A)- This is useless until the seizure is over; the child is apneic during a seizure. (B)- Attempts at inserting a plastic airway are futile; this could damage the child’s teeth and jaws. (C)- An individual should never be restrained during a seizure; fractured bones or torn muscles and ligaments can result. 79. A infant is admitted to the neonatal intensive care unit with exstrophy of the bladder. The midwife should cover the exstrophy with a sterile: a. Loose diaper b. Saline gauze pad c. Dry gauze dressing d. Petroleum jelly gauze pad ANS: B- the bladder membrane is exposed; it must remain moist and as far as possible, sterile. (A)- The exposed membrane would dry and there would be an increased risk for infection. (C)- Same as answer A. (D)- The jelly would adhere to the membrane, causing trauma. 80. A 7 year old is admitted for surgery. Preoperatively, it is essential that the midwife: a. Observe the child’s ASO titer c. Check for loose teeth and report the findings to the physician b. Provide the child with a favourite toy d. Encourage a parent to stay until the child goes to the operating room The House of Quality Review, The Home of Topnotchers! 11 | P a g e
  12. 12. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 ANS: C- school age children lose their primary teeth, which could be aspirated during surgery. The anaesthesiologist must take special precautions to maintain safety. (A)- There is no reason to obtain an antistreptolysin (ASO) titer. (B)This is a comforting gesture, but it is not essential. (D)- This is important but not always possible. 81. A toddler is admitted to the hospital because of sudden hoarseness and continuous, somewhat unintelligible speech. When talking with the mother, the midwife will be particularly concerned about: a. Retropharyngeal abscess c. Undetected laryngeal abnormality b. Acute respiratory tract infection d. Respiratory tract obstruction caused by a foreign body ANS: D-respiratory tract obstructions usually occur in the larynx, trachea, or major bronchi (usually right). Hoarseness may indicate vocal cord injury. Unintelligence speech may indicate an interference in the flow of air out of the respiratory tract and/or obstruction or injury to the larynx. (A)- a retropharyngeal abscess would not produce these clinical signs. (B)An acute respiratory infection usually has a gradual onset. (C)- In view of the sudden onset of clinical signs and the age of the child, this is unlikely. 82. While feeding a newborn with the diagnosis of choanal atresia, the midwife notices that the newborn: a. Chokes on the feeding c. Does not appear to be hungry b. Lacks a swallowing reflex d. Takes only about half of the feeding ANS: A-there is little or no opening between the nasal passages and the nasopharynx; therefore, the infant can breathe only through the mouth. When feeding, the infant cannot breathe without aspirating some of the fluid; this causes choking. (B)- The swallowing reflex is present in these infants. (C)- Because it is difficult if not impossible to suck, the infant will be very hungry. (D)- If choanal atresia is unilateral, there may be no symptoms and the infant will be able to feed; if bilateral, sucking will be almost impossible. 83. The average 5 year old is incapable of: a. Tying shoelaces b. Abstract thought c. Making decisions d. Hand-eye coordination ANS: B-Piaget’s stresses that age 7 is the turning point in mental development. New forms of organization appear at this age that marks the beginning of logic, symbolism and abstract thought. (A)- A 5-year-old is capable of tying laces. (C)- a toddler is capable of making simple decisions. (D)- an infant is capable of hand-eye coordination. 84. The midwife understands that a good snack for a 2-year old child with a diagnosis of acute asthma would be: a. Grapes b. Apple slices c. A glass of milk d. a glass of cola ANS: B-of these foods and fluids, an apple provides the best nutrition for a toddler. (A)- This is unsafe; a toddler could choke on the skins of the grapes. (C)- The child may have difficulty swallowing liquids; cold fluid may cause bronchospasm. (D)- Cola is lacking in nutritional value and could be too much of a stimulant. 85. When evaluating a 3 year old ’s developmental progress, the midwife should recognize that development is delayed when the child is unable to: a. Copy a square b. Hop on one foot c. Catch a ball reliably d. Use a spoon effectively ANS: D- this is a task expected of 3 year olds. (A)- This is a task expected of 4 to 5 year olds. (B)- This is a task expected of 4 year olds. (C)- Same as answer B. 86. A 15 month old is playing in the playpen. The midwife evaluates that the child’s ability to perform physical tasks is at the age-related norm when the child is able to: a. Build a tower of six blocks c. Throw all the toys out of the playpen b. Walk across the playpen with ease d. Stand in the playpen holding onto the sides ANS: B-at 15 months, strength and balance have improved, and the toddler can stand and walk alone. (A)- This is usually occurs when the child is 2 years old. (C)- Infants are very capable of throwing toys. (D)- Infants 9 to 12 months of age can stand with support. 87. At a well-child visit, a 1 –year-old boy’s height is assessed by the nurse to be below what is expected. His current height is 28 inches, and his birth length was 20 inches. What should his current height be? a. 27 inches b. 30 inches c. 32 inches d. 35 inches ANS: B-this child is 2 inches shorter than expected. At 1 year of age a child should have increased his or her birth length by 50%; 50% of 20 inches is 10 inches; 10 inches added to the birth length at 20 inches equals 30 inches. (A)This is too short. (C)- This too tall. (D)- Same as answer C. 88. A child with a high blood level of lead is started on a regimen of chelation therapy that consists of calcium disodium edetate (EDTA) and dimecaprol (BAL) q4h for 5 days. The midwife understands that this combination of drugs: a. Removes lead from the bone marrow more efficiently b. Eliminates lead from the body more rapidly through the urine c. Has fewer side effects and removes lead from the brain more effectively The House of Quality Review, The Home of Topnotchers! 12 | P a g e
  13. 13. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 d. Removes lead from the blood more rapidly and increases deposition in the bones ANS: C-fewer side effects are desirable. Rapid elimination of the lead prevents further irreversible damage. (A)- The combination is preferred because it removes lead more effectively from the brain rather then from bone marrow. (B)There is no marked difference in the arte of urinary elimination when these agents are used together. (D)- Each drug is able to accomplish this, but given alone, each can cause more side effects. 89. The midwife administers desmopressin (DDAVP) to a child with enuresis. This medication usually is effective because it acts as: a. A laxative b. A sedative c. An antidiuretic d. An antidepressant ANS: C-DDAVP is an analog of arginine vasopressin, which acts as an anti-diuretic. (A)- DDAVP is used only as antidiuretic. (B) and (D)- same as answer A. 90. After orthopedic surgery, codeine sulphate is given for pain to an adolescent. About 8 hours later, the adolescent complains of itching. A drug that can be ordered to relieve this symptom is: a. Nitrofurazone(Furacin) b. Hyaluronidase(Wydase) c. Acetylsalicylic acid(ecotrin) d. Diphenhydramine(Benadryl) ANS: D-Diphenhydramine(Benadryl) is an antihistamine that prevents histamine from reaching its site of action by competing for the receptors. (A)- Nitrofurazone(Furacin)is a bacterial agent used especially with burns. (B)Hyaluronidase(Wydase)- is a mucolytic enzyme that promotes diffusion and absorption of injected fluids, exudates, transudates. (C)- This is a salicylate. 91. The midwife explains to the parents of a child who is taking methylphenidate(Concerta) for attention deficit hyperactivity disorder(ADHD) that the medication should be given early in the day to limit: a. Nausea b. Anorexia c. Insomnia d. Tachycardia ANS: C-one of the CNS side effects of Concerta is insomnia. Because it is an extended release (ER) medication, it must be given early so that its effect has subsided before bedtime. (A)- Although this is a side effect of Concerta, it is not the reason for administering the medication. (B) and (D)- Same as answer A. 92. A child who is known to have the human immunodeficiency virus(HIV) is admitted with the diagnosis of Pneumocystis carinii pneumonia. The physician orders trimethoxazolesulfamethoxazole (Bactrim) and pentamidine. When administering Bactrim to a child with AIDs, the midwife should monitor for the most common side effect of: a. Jaundice b. Headache c. Toxic nephrosis d. Hypersentivity reactions ANS: D-hypersensitivity reactions such as skin rash, erythema, fever, and pruritus occur with mush greater frequency in clients with AIDS. (A)- Hepatic side effects, such as jaundice, may occur but are not common. (B)- CNS side effects such as headache are rare adverse reactions. (C)- This is a rare side effect. 93. A 6-year-old girl begins thumb-sucking after surgery. This was not the child’s behaviour preoperatively. The midwife should: a. Accept the thumb-sucking c. Report this behaviour to the physician b. Distract her by playing checkers d. Tell her that thumb-sucking causes buckteeth ANS: A-regression is expected in times of stress. It is a transient need that should be accepted, because it helps reduce anxiety. (B)- Distraction works only as long as it is employed. (C)- This behaviour is unrelated to medical progress. (D)Cause (thumb sucking) and future effect (buckteeth) will not be meaningful to a 6 year old; furthermore, thumb sucking may or may not cause malocclusion. 94. Before surgery to relieve an intestinal obstruction, a 3-month-old is kept NPO and has a Nasogastric tube in place. To calm the infant, as well as meet developmental needs, the midwife should: a. Allow the infant to suck on a pacifier c. Hang a brightly colored mobile in the infant’s crib b. Offer the infant a favourite toy to hold d. Place the infant on the abdomen and permit crawling ANS: A- sucking is a primary need of infancy. It decreases anxiety and does not interfere with the gastric decompression. (B)- This would be more helpful if the child were a toddler. (C)- Usually this does not help to calm the infant. (D)- This will probably increase the pain from abdominal distention; 3 month old is not be placed on their abdomens because this practice is associated with SIDS. 95. Before administering a tube feeding to an infant, the midwife should: a. Irrigate the tube with water c. Provide the baby with a pacifier b. Slowly instill 10mL of formula d. Place in the Trendelenburg position ANS: C-a pacifier should be given during the feeding to help the infant associate sucking with feeding and meet oral needs. (A)- This would cause complications if the tube is not in the stomach. (B)- This would be done after placement and a residual are ascertained. (D)- Upright positioning is essential to prevent regurgitation or reflux and subsequent aspiration. The House of Quality Review, The Home of Topnotchers! 13 | P a g e
  14. 14. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 96. The response that would be unusual in infants subjected to prolonged hospitalization would be: a. Lack or slowness of weight pain c. Excessive crying and clinging when approached b. Limited emotional response to stimuli d. Looking at ceiling lights rather than at persons caring for them ANS: C-excessive crying and clinging are the usual responses of an infant who expects to be comforted, not one who has experienced prolonged separation from a parent because of illness. (A)- Prolonged hospitalization an separation from parenting can cause delayed growth or even death in infants. (B)- Withdrawing active attention Is the infant’s way to ―turn off‖ and may learned from multiple failures in interactions with stimuli. (D)- inattentiveness may be learned from failure to gain response form humans in previous experiences. 97. A 4-year-old girl is brought to the emergency department after falling on the handlebars of her tricycle. She is guarding her abdomen, crying, and not allowing anyone to touch her. Which actions would best enable the midwife to initiate the assessment process? a. Medicate the child for pain and then proceed b. Allow the child to guide the examiner’s hand to the area that hurts c. Have the parents restrain the child while the abdomen is auscultated d. Have the physician order a CAT scan since a child this age is unable to cooperate ANS: B-the child will move her hand to the abdomen; the nurse can then engage the child’s cooperation and do a general assessment. (A)- Further assessment is necessary; it should be determined whether the crying is due to pain or fear. (C)- The parents may hold the child, but they should not restrain her because this could increase anxiety. (D)- This is not an initial intervention; the child’s cooperation will be needed for this procedure. 98. Iodine supplementation for school age children, should be given at a dose of one capsule per year, and the correct dose is: a. Iodized oil capsule with 200 mg iodine c. Iodized capsule oil with 100 mg iodine b. Iodized capsule oil with 250 mg iodine d. Iodized capsule oil with 150 mg iodine oil ANS: A 99. The correct definition of exclusive breast feeding is: a. Giving a baby only breast milk for the first 6 months b. Giving a baby only with breast milk & can be given with water c. Giving a baby with only breast milk, no water but can be given with drops or syrups which could be vitamins, minerals or medicines for the first 6 months d. Giving a baby with breast milk, water vitamins & minerals for the first 6 months ANS: C- CHNpp 136 100. After 6 months of age, all babieswould require other foods to complement breast feeding, this is called: a. Exclusive breast feeding c. Breast feeding with complementary feeding b. Exclusive complementary feeding d. Complementary feeding ANS: D– Complementary feeding is giving all babies after 6 months of age with other foods to complement breast milk— this we call as complementary foods. When complementary foods are introduced, breast feeding should still continue up to 2 years f age or beyond. GOOD LUCK AND GOD BLESS!!! SUBMIT YOUR ANSWER SHEET TO YOUR PROCTOR AND WAIT FOR FURTHER INSTRUCTIONS. . Ningloves /Emgy/Lea/Iya/Marky/Jay/Mulo Sir Mark/Sir Oyo/Maam Chit/Maam Digs Toni/Hazel/Rima/Josh The House of Quality Review, The Home of Topnotchers! 14 | P a g e
  15. 15. REVIEW UNIVERSITY FOR NURSES, INC. Successfully Training Filipino Nurses and Midwives for Global Setting P.U.P. Hasmin Hostel, R. Magsaysay Blvd., Sta. Mesa, Manila reviewuniversityfornurses@gmail.com; www.runurses.com Tel. Numbers: (02)-716-4783; (02)-713-8880; (02)708-27-82 The House of Quality Review, The Home of Topnotchers! 15 | P a g e

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