1. May arrives at the health care clinic and tells the nurse that her last 9.

9. Calcium gluconate is being administered to a client with

menstrual period was 9 weeks ago. She also tells the nurse that a pregnancy induced hypertension (PIH). A nursing action that must be
home pregnancy test was positive but she began to have mild cramps initiated as the plan of care throughout injection of the drug is:
and is now having moderate vaginal bleeding. During the physical a) Ventilator assistance
examination of the client, the nurse notes that May has a dilated b) CVP readings
cervix. The nurse determines that May is experiencing which type of c) EKG tracings
abortion? d) Continuous CPR
a) Inevitable
b) Incomplete 10. A trial for vaginal delivery after an earlier caesareans, would
c) Threatened likely to be given to a gravida, who had:
d) Septic a) First low transverse cesarean was for active herpes type 2
infections; vaginal culture at 39 weeks pregnancy was positive.
2. Nurse Reese is reviewing the record of a pregnant client for her b) First and second caesareans were for cephalopelvic
first prenatal visit. Which of the following data, if noted on the disproportion.
client’s record, would alert the nurse that the client is at risk for a c) First caesarean through a classic incision as a result of severe
spontaneous abortion? fetal distress.
a) Age 36 years d) First low transverse caesarean was for breech position. Fetus in
b) History of syphilis this pregnancy is in a vertex presentation.
c) History of genital herpes
d) History of diabetes mellitus 11.Nurse Ryan is aware that the best initial approach when trying to
take a crying toddler’s temperature is:
3. Nurse Hazel is preparing to care for a client who is newly admitted a) Talk to the mother first and then to the toddler.
to the hospital with a possible diagnosis of ectopic pregnancy. Nurse b) Bring extra help so it can be done quickly.
Hazel develops a plan of care for the client and determines that c) Encourage the mother to hold the child.
which of the following nursing actions is the priority? d) Ignore the crying and screaming.
a) Monitoring weight
b) Assessing for edema 12.Baby Tina a 3 month old infant just had a cleft lip and palate
c) Monitoring apical pulse repair. What should the nurse do to prevent trauma to operative site?
d) Monitoring temperature a) Avoid touching the suture line, even when cleaning.
b) Place the baby in prone position.
4. Nurse Oliver is teaching a diabetic pregnant client about nutrition c) Give the baby a pacifier.
and insulin needs during pregnancy. The nurse determines that the d) Place the infant’s arms in soft elbow restraints.
client understands dietary and insulin needs if the client states that
the second half of pregnancy require: 13. Which action should nurse Marian include in the care plan for a 2
a) Decreased caloric intake month old with heart failure?
b) Increased caloric intake a) Feed the infant when he cries.
c) Decreased Insulin b) Allow the infant to rest before feeding.
d) Increase Insulin c) Bathe the infant and administer medications before feeding.
d) Weigh and bathe the infant before feeding.
5. Nurse Michelle is assessing a 24 year old client with a diagnosis of
hydatidiform mole. She is aware that one of the following is 14.Nurse Hazel is teaching a mother who plans to discontinue breast
unassociated with this condition? feeding after 5 months. The nurse should advise her to include which
a) Excessive fetal activity. foods in her infant’s diet?
b) Larger than normal uterus for gestational age. a) Skim milk and baby food.
c) Vaginal bleeding b) Whole milk and baby food.
d) Elevated levels of human chorionic gonadotropin. c) Iron-rich formula only.
d) Iron-rich formula and baby food.
6. A pregnant client is receiving magnesium sulfate for severe
pregnancy induced hypertension (PIH). The clinical findings that 15.Mommy Linda is playing with her infant, who is sitting securely
would warrant use of the antidote , calcium gluconate is: alone on the floor of the clinic. The mother hides a toy behind her
a) Urinary output 90 cc in 2 hours. back and the infant looks for it. The nurse is aware that estimated age
b) Absent patellar reflexes. of the infant would be:
c) Rapid respiratory rate above 40/min. a) 6 months
d) Rapid rise in blood pressure. b) 4 months
c) 8 months
7. During vaginal examination of Janah who is in labor, the d) 10 months
presenting part is at station plus two. Nurse, correctly interprets it as:
a) Presenting part is 2 cm above the plane of the ischial spines. 16.Which of the following is the most prominent feature of public
b) Biparietal diameter is at the level of the ischial spines. health nursing?
c) Presenting part in 2 cm below the plane of the ischial spines. a) It involves providing home care to sick people who are not
d) Biparietal diameter is 2 cm above the ischial spines. confined in the hospital.
b) Services are provided free of charge to people within the
8. A pregnant client is receiving oxytocin (Pitocin) for induction of catchments area.
labor. A condition that warrant the nurse in-charge to discontinue c) The public health nurse functions as part of a team providing a
I.V. infusion of Pitocin is: public health nursing services.
a) Contractions every 1 ½ minutes lasting 70-80 seconds. d) Public health nursing focuses on preventive, not curative,
b) Maternal temperature 101.2 services.
c) Early decelerations in the fetal heart rate.
d) Fetal heart rate baseline 140-160 bpm. 17.When the nurse determines whether resources were maximized in
implementing Ligtas Tigdas, she is evaluating
a) Effectiveness
b) Efficiency
c) Adequacy
d) Appropriateness
18.Vangie is a new B.S.N. graduate. She wants to become a Public 27.A fullterm client is in labor. Nurse Betty is aware that the fetal
Health Nurse. Where should she apply? heart rate would be:
a) Department of Health a) 80 to 100 beats/minute
b) Provincial Health Office b) 100 to 120 beats/minute
c) Regional Health Office c) 120 to 160 beats/minute
d) Rural Health Unit d) 160 to 180 beats/minute

19.Tony is aware the Chairman of the Municipal Health Board is: 28.The skin in the diaper area of a 7 month old infant is excoriated
a) Mayor and red. Nurse Hazel should instruct the mother to:
b) Municipal Health Officer a) Change the diaper more often.
c) Public Health Nurse b) Apply talc powder with diaper changes.
d) Any qualified physician c) Wash the area vigorously with each diaper change.
d) Decrease the infant’s fluid intake to decrease saturating
20.Myra is the public health nurse in a municipality with a total diapers.
population of about 20,000. There are 3 rural health midwives among
the RHU personnel. How many more midwife items will the RHU 29.Nurse Carla knows that the common cardiac anomalies in children
need? with Down Syndrome (tri-somy 21) is:
a) 1 a) Atrial septal defect
b) 2 b) Pulmonic stenosis
c) 3 c) Ventricular septal defect
d) The RHU does not need any more midwife item. d) Endocardial cushion defect

21.According to Freeman and Heinrich, community health nursing is 30.Malou was diagnosed with severe preeclampsia is now receiving
a developmental service. Which of the following best illustrates this I.V. magnesium sulfate. The adverse effects associated with
statement? magnesium sulfate is:
a) The community health nurse continuously develops himself a) Anemia
personally and professionally. b) Decreased urine output
b) Health education and community organizing are necessary in c) Hyperreflexia
providing community health services. d) Increased respiratory rate
c) Community health nursing is intended primarily for health
promotion and prevention and treatment of disease. 31.A 23 year old client is having her menstrual period every 2 weeks
d) The goal of community health nursing is to provide nursing that last for 1 week. This type of menstrual pattern is bets defined by:
services to people in their own places of residence. a) Menorrhagia
b) Metrorrhagia
22.Nurse Tina is aware that the disease declared through Presidential c) Dyspareunia
Proclamation No. 4 as a target for eradication in the Philippines is? d) Amenorrhea
a) Poliomyelitis
b) Measles 32. Jannah is admitted to the labor and delivery unit. The critical
c) Rabies laboratory result for this client would be:
d) Neonatal tetanus a) Oxygen saturation
b) Iron binding capacity
23.May knows that the step in community organizing that involves c) Blood typing
training of potential leaders in the community is: d) Serum Calcium
a) Integration
b) Community organization 33.Nurse Gina is aware that the most common condition found
c) Community study during the second-trimester of pregnancy is:
d) Core group formation a) Metabolic alkalosis
b) Respiratory acidosis
24.Beth a public health nurse takes an active role in community c) Mastitis
participation. What is the primary goal of community organizing? d) Physiologic anemia
a) To educate the people regarding community health problems
b) To mobilize the people to resolve community health problems 34.Nurse Lynette is working in the triage area of an emergency
c) To maximize the community’s resources in dealing with health department. She sees that several pediatric clients arrive
problems. simultaneously. The client who needs to be treated first is:
d) To maximize the community’s resources in dealing with health a) A crying 5 year old child with a laceration on his scalp.
problems. b) A 4 year old child with a barking coughs and flushed
appearance.
25.Tertiary prevention is needed in which stage of the natural history c) A 3 year old child with Down syndrome who is pale and asleep
of disease? in his mother’s arms.
a) Pre-pathogenesis d) A 2 year old infant with stridorous breath sounds, sitting up in
b) Pathogenesis his mother’s arms and drooling.
c) Prodromal
d) Terminal 35.Maureen in her third trimester arrives at the emergency room with
painless vaginal bleeding. Which of the following conditions is
26.The nurse is caring for a primigravid client in the labor and suspected?
delivery area. Which condition would place the client at risk for a) Placenta previa
disseminated intravascular coagulation (DIC)? b) Abruptio placentae
a) Intrauterine fetal death. c) Premature labor
b) Placenta accreta. d) Sexually transmitted disease
c) Dysfunctional labor.
d) Premature rupture of the membranes.
 d) Powder with cornstarch
36.A young child named Richard is suspected of having pinworms. 45.During tube feeding, how far above an infant’s stomach should
The community nurse collects a stool specimen to confirm the the nurse hold the syringe with formula?
diagnosis. The nurse should schedule the collection of this specimen a) 6 inches
for: b) 12 inches
a) Just before bedtime c) 18 inches
b) After the child has been bathe d) 24 inches
c) Any time during the day
d) Early in the morning 46. In a mothers’ class, Nurse Lhynnete discussed childhood diseases
such as chicken pox. Which of the following statements about
37.In doing a child’s admission assessment, Nurse Betty should be chicken pox is correct?
alert to note which signs or symptoms of chronic lead poisoning? a) The older one gets, the more susceptible he becomes to the
a) Irritability and seizures complications of chicken pox.
b) Dehydration and diarrhea b) A single attack of chicken pox will prevent future episodes,
c) Bradycardia and hypotension including conditions such as shingles.
d) Petechiae and hematuria c) To prevent an outbreak in the community, quarantine may be
imposed by health authorities.
38.To evaluate a woman’s understanding about the use of diaphragm d) Chicken pox vaccine is best given when there is an impending
for family planning, Nurse Trish asks her to explain how she will use outbreak in the community.
the appliance. Which response indicates a need for further health
teaching? 47.Barangay Pinoy had an outbreak of German measles. To prevent
a) “I should check the diaphragm carefully for holes every time I congenital rubella, what is the BEST advice that you can give to
use it” women in the first trimester of pregnancy in the barangay Pinoy?
b) “I may need a different size of diaphragm if I gain or lose a) Advice them on the signs of German measles.
weight more than 20 pounds” b) Avoid crowded places, such as markets and movie houses.
c) “The diaphragm must be left in place for atleast 6 hours after c) Consult at the health center where rubella vaccine may be
intercourse” given.
d) “I really need to use the diaphragm and jelly most during the d) Consult a physician who may give them rubella
middle of my menstrual cycle”. immunoglobulin.

39.Hypoxia is a common complication of laryngotracheobronchitis. 48.Myrna a public health nurse knows that to determine possible
Nurse Oliver should frequently assess a child with sources of sexually transmitted infections, the BEST method that
laryngotracheobronchitis for: may be undertaken is:
a) Drooling a) Contact tracing
b) Muffled voice b) Community survey
c) Restlessness c) Mass screening tests
d) Low-grade fever d) Interview of suspects

40.How should Nurse Michelle guide a child who is blind to walk to 49.A 33-year old female client came for consultation at the health
the playroom? center with the chief complaint of fever for a week. Accompanying
a) Without touching the child, talk continuously as the child symptoms were muscle pains and body malaise. A week after the
walks down the hall. start of fever, the client noted yellowish discoloration of his sclera.
b) Walk one step ahead, with the child’s hand on the nurse’s History showed that he waded in flood waters about 2 weeks before
elbow. the onset of symptoms. Based on her history, which disease condition
c) Walk slightly behind, gently guiding the child forward. will you suspect?
d) Walk next to the child, holding the child’s hand. a) Hepatitis A
b) Hepatitis B
41.When assessing a newborn diagnosed with ductus arteriosus, c) Tetanus
Nurse Olivia should expect that the child most likely would have an: d) Leptospirosis
a) Loud, machinery-like murmur.
b) Bluish color to the lips. 50.Mickey a 3-year old client was brought to the health center with
c) Decreased BP reading in the upper extremities the chief complaint of severe diarrhea and the passage of “rice water”
d) Increased BP reading in the upper extremities. stools. The client is most probably suffering from which condition?
a) Giardiasis
42.The reason nurse May keeps the neonate in a neutral thermal b) Cholera
environment is that when a newborn becomes too cool, the neonate c) Amebiasis
requires: d) Dysentery
a) Less oxygen, and the newborn’s metabolic rate increases.
b) More oxygen, and the newborn’s metabolic rate decreases. 51.The most prevalent form of meningitis among children aged 2
c) More oxygen, and the newborn’s metabolic rate increases. months to 3 years is caused by which microorganism?
d) Less oxygen, and the newborn’s metabolic rate decreases. a) Hemophilus influenzae
b) Morbillivirus
43.Before adding potassium to an infant’s I.V. line, Nurse Ron must c) Steptococcus pneumoniae
be sure to assess whether this infant has: d) Neisseria meningitidis
a) Stable blood pressure
b) Patant fontanelles 52.The student nurse is aware that the pathognomonic sign of
c) Moro’s reflex measles is Koplik’s spot and you may see Koplik’s spot by
d) Voided inspecting the:
a) Nasal mucosa
44.Nurse Carla should know that the most common causative factor b) Buccal mucosa
of dermatitis in infants and younger children is: c) Skin on the abdomen
a) Baby oil d) Skin on neck
b) Baby lotion
c) Laundry detergent
 62.Jimmy a 2-year old child revealed “baggy pants”. As a nurse,
53.Angel was diagnosed as having Dengue fever. You will say that using the IMCI guidelines, how will you manage Jimmy?
there is slow capillary refill when the color of the nailbed that you a) Refer the child urgently to a hospital for confinement.
pressed does not return within how many seconds? b) Coordinate with the social worker to enroll the child in a
a) 3 seconds feeding program.
b) 6 seconds c) Make a teaching plan for the mother, focusing on menu
c) 9 seconds planning for her child.
d) 10 seconds d) Assess and treat the child for health problems like infections
and intestinal parasitism.
54.In Integrated Management of Childhood Illness, the nurse is
aware that the severe conditions generally require urgent referral to a 63.Gina is using Oresol in the management of diarrhea of her 3-year
hospital. Which of the following severe conditions DOES NOT old child. She asked you what to do if her child vomits. As a nurse
always require urgent referral to a hospital? you will tell her to:
a) Mastoiditis a) Bring the child to the nearest hospital for further assessment.
b) Severe dehydration b) Bring the child to the health center for intravenous fluid
c) Severe pneumonia therapy.
d) Severe febrile disease c) Bring the child to the health center for assessment by the
physician.
55.Myrna a public health nurse will conduct outreach immunization d) Let the child rest for 10 minutes then continue giving Oresol
in a barangay Masay with a population of about 1500. The estimated more slowly.
number of infants in the barangay would be:
a) 45 infants 64.Nikki a 5-month old infant was brought by his mother to the
b) 50 infants health center because of diarrhea for 4 to 5 times a day. Her skin
c) 55 infants goes back slowly after a skin pinch and her eyes are sunken. Using
d) 65 infants the IMCI guidelines, you will classify this infant in which category?
a) No signs of dehydration
56.The community nurse is aware that the biological used in b) Some dehydration
Expanded Program on Immunization (EPI) should NOT be stored in c) Severe dehydration
the freezer? d) The data is insufficient.
a) DPT
b) Oral polio vaccine 65.Chris a 4-month old infant was brought by her mother to the
c) Measles vaccine health center because of cough. His respiratory rate is 42/minute.
d) MMR Using the Integrated Management of Child Illness (IMCI) guidelines
of assessment, his breathing is considered as:
57.It is the most effective way of controlling schistosomiasis in an a) Fast
endemic area? b) Slow
a) Use of molluscicides c) Normal
b) Building of foot bridges d) Insignificant
c) Proper use of sanitary toilets
d) Use of protective footwear, such as rubber boots 66.Maylene had just received her 4th dose of tetanus toxoid. She is
aware that her baby will have protection against tetanus for
58.Several clients is newly admitted and diagnosed with leprosy. a) 1 year
Which of the following clients should be classified as a case of b) 3 years
multibacillary leprosy? c) 5 years
a) 3 skin lesions, negative slit skin smear d) Lifetime
b) 3 skin lesions, positive slit skin smear
c) 5 skin lesions, negative slit skin smear 67.Nurse Ron is aware that unused BCG should be discarded after
d) 5 skin lesions, positive slit skin smear how many hours of reconstitution?
a) 2 hours
59.Nurses are aware that diagnosis of leprosy is highly dependent on b) 4 hours
recognition of symptoms. Which of the following is an early sign c) 8 hours
of leprosy? d) At the end of the day
a) Macular lesions
b) Inability to close eyelids 68.The nurse explains to a breastfeeding mother that breast milk is
c) Thickened painful nerves sufficient for all of the baby’s nutrient needs only up to:
d) Sinking of the nosebridge a) 5 months
b) 6 months
60.Marie brought her 10 month old infant for consultation because of c) 1 year
fever, started 4 days prior to consultation. In determining malaria d) 2 years
risk, what will you do?
a) Perform a tourniquet test. 69.Nurse Ron is aware that the gestational age of a conceptus that is
b) Ask where the family resides. considered viable (able to live outside the womb) is:
c) Get a specimen for blood smear. a) 8 weeks
d) Ask if the fever is present everyday. b) 12 weeks
c) 24 weeks
61.Susie brought her 4 years old daughter to the RHU because of d) 32 weeks
cough and colds. Following the IMCI assessment guide, which of the
following is a danger sign that indicates the need for urgent referral 70.When teaching parents of a neonate the proper position for the
to a hospital? neonate’s sleep, the nurse Patricia stresses the importance of placing
a) Inability to drink the neonate on his back to reduce the risk of which of the following?
b) High grade fever a) Aspiration
c) Signs of severe dehydration b) Sudden infant death syndrome (SIDS)
d) Cough for more than 30 days c) Suffocation
d) Gastroesophageal reflux (GER)
71.Which finding might be seen in baby James a neonate suspected d) Instructing the client about the importance of perineal (kegel)
of having an infection? exercises.
a) Flushed cheeks
b) Increased temperature 81. A pregnant woman accompanied by her husband, seeks
c) Decreased temperature admission to the labor and delivery area. She states that she’s in labor
d) Increased activity level and says she attended the facility clinic for prenatal care. Which
question should the nurse Oliver ask her first?
72.Baby Jenny who is small-for-gestation is at increased risk during a) “Do you have any chronic illnesses?”
the transitional period for which complication? b) “Do you have any allergies?”
a) Anemia probably due to chronic fetal hyposia c) “What is your expected due date?”
b) Hyperthermia due to decreased glycogen stores d) “Who will be with you during labor?”
c) Hyperglycemia due to decreased glycogen stores
d) Polycythemia probably due to chronic fetal hypoxia 82.A neonate begins to gag and turns a dusky color. What should the
nurse do first?
73.Marjorie has just given birth at 42 weeks’ gestation. When the a) Calm the neonate.
nurse assessing the neonate, which physical finding is expected? b) Notify the physician.
a) A sleepy, lethargic baby c) Provide oxygen via face mask as ordered
b) Lanugo covering the body d) Aspirate the neonate’s nose and mouth with a bulb syringe.
c) Desquamation of the epidermis
d) Vernix caseosa covering the body 83. When a client states that her “water broke,” which of the
following actions would be inappropriate for the nurse to do?
74.After reviewing the Myrna’s maternal history of magnesium a) Observing the pooling of straw-colored fluid.
sulfate during labor, which condition would nurse Richard anticipate b) Checking vaginal discharge with nitrazine paper.
as a potential problem in the neonate? c) Conducting a bedside ultrasound for an amniotic fluid index.
a) Hypoglycemia d) Observing for flakes of vernix in the vaginal discharge.
b) Jitteriness
c) Respiratory depression 84. A baby girl is born 8 weeks premature. At birth, she has no
d) Tachycardia spontaneous respirations but is successfully resuscitated. Within
several hours she develops respiratory grunting, cyanosis, tachypnea,
75.Which symptom would indicate the Baby Alexandra was adapting nasal flaring, and retractions. She’s diagnosed with respiratory
appropriately to extra-uterine life without difficulty? distress syndrome, intubated, and placed on a ventilator. Which
a) Nasal flaring nursing action should be included in the baby’s plan of care
b) Light audible grunting to prevent retinopathy of prematurity?
c) Respiratory rate 40 to 60 breaths/minute a) Cover his eyes while receiving oxygen.
d) Respiratory rate 60 to 80 breaths/minute b) Keep her body temperature low.
c) Monitor partial pressure of oxygen (Pao2) levels.
76. When teaching umbilical cord care for Jennifer a new mother, the d) Humidify the oxygen.
nurse Jenny would include which information?
a) Apply peroxide to the cord with each diaper change 85. Which of the following is normal newborn calorie intake?
b) Cover the cord with petroleum jelly after bathing a) 110 to 130 calories per kg.
c) Keep the cord dry and open to air b) 30 to 40 calories per lb of body weight.
d) Wash the cord with soap and water each day during a tub bath. c) At least 2 ml per feeding
d) 90 to 100 calories per kg
77.Nurse John is performing an assessment on a neonate. Which of
the following findings is considered common in the healthy neonate? 86. Nurse John is knowledgeable that usually individual twins will
a) Simian crease grow appropriately and at the same rate as singletons until how many
b) Conjunctival hemorrhage weeks?
c) Cystic hygroma a) 16 to 18 weeks
d) Bulging fontanelle b) 18 to 22 weeks
c) 30 to 32 weeks
78.Dr. Esteves decides to artificially rupture the membranes of a d) 38 to 40 weeks
mother who is on labor. Following this procedure, the nurse Hazel
checks the fetal heart tones for which the following reasons? 87. Which of the following classifications applies to monozygotic
a) To determine fetal well-being. twins for whom the cleavage of the fertilized ovum occurs more than
b) To assess for prolapsed cord 13 days after fertilization?
c) To assess fetal position a) conjoined twins
d) To prepare for an imminent delivery. b) diamniotic dichorionic twins
c) diamniotic monochorionic twin
79.Which of the following would be least likely to indicate d) monoamniotic monochorionic twins
anticipated bonding behaviors by new parents?
a) The parents’ willingness to touch and hold the new born. 88. Tyra experienced painless vaginal bleeding has just been
b) The parent’s expression of interest about the size of the new diagnosed as having a placenta previa. Which of the following
born. procedures is usually performed to diagnose placenta previa?
c) The parents’ indication that they want to see the newborn. a) Amniocentesis
d) The parents’ interactions with each other. b) Digital or speculum examination
c) External fetal monitoring
80.Following a precipitous delivery, examination of the client’s d) Ultrasound
vagina reveals a fourth-degree laceration. Which of the following
would be contraindicated when caring for this client? 89. Nurse Arnold knows that the following changes in respiratory
a) Applying cold to limit edema during the first 12 to 24 hours. functioning during pregnancy is considered normal:
b) Instructing the client to use two or more peripads to cushion the a) Increased tidal volume
area. b) Increased expiratory volume
c) Instructing the client on the use of sitz baths if ordered. c) Decreased inspiratory capacity
d) Decreased oxygen consumption
90. Emily has gestational diabetes and it is usually managed by 98. Celeste who used heroin during her pregnancy delivers a neonate.
which of the following therapy? When assessing the neonate, the nurse Lhynnette expects to find:
a) Diet a) Lethargy 2 days after birth.
b) Long-acting insulin b) Irritability and poor sucking.
c) Oral hypoglycemic c) A flattened nose, small eyes, and thin lips.
d) Oral hypoglycemic drug and insulin d) Congenital defects such as limb anomalies.

91. Magnesium sulfate is given to Jemma with preeclampsia to 99. The uterus returns to the pelvic cavity in which of the following
prevent which of the following condition? time frames?
a) Hemorrhage a) 7th to 9th day postpartum.
b) Hypertension b) 2 weeks postpartum.
c) Hypomagnesemia c) End of 6th week postpartum.
d) Seizure d) When the lochia changes to alba.

92. Cammile with sickle cell anemia has an increased risk for having 100. Maureen, a primigravida client, age 20, has just completed a
a sickle cell crisis during pregnancy. Aggressive management of a difficult, forceps-assisted delivery of twins. Her labor was unusually
sickle cell crisis includes which of the following measures? long and required oxytocin (Pitocin) augmentation. The nurse who’s
a) Antihypertensive agents caring for her should stay alert for:
b) Diuretic agents a) Uterine inversion
c) I.V. fluids b) Uterine atony
d) Acetaminophen (Tylenol) for pain c) Uterine involution
d) Uterine discomfort
93. Which of the following drugs is the antidote for magnesium
toxicity?
a) Calcium gluconate (Kalcinate)
b) Hydralazine (Apresoline)
c) Naloxone (Narcan)
d) Rho (D) immune globulin (RhoGAM)

94. Marlyn is screened for tuberculosis during her first prenatal visit.
An intradermal injection of purified protein derivative (PPD) of the
tuberculin bacilli is given. She is considered to have a positive test
for which of the following results?
a) An indurated wheal under 10 mm in diameter appears in 6 to
12 hours.
b) An indurated wheal over 10 mm in diameter appears in 48 to
72 hours.
c) A flat circumcised area under 10 mm in diameter appears in 6
to 12 hours.
d) A flat circumcised area over 10 mm in diameter appears in 48
to 72 hours.

95. Dianne, 24 year-old is 27 weeks’ pregnant arrives at her

physician’s office with complaints of fever, nausea, vomiting,
malaise, unilateral flank pain, and costovertebral angle tenderness.
Which of the following diagnoses is most likely?
a) Asymptomatic bacteriuria
b) Bacterial vaginosis
c) Pyelonephritis
d) Urinary tract infection (UTI)

96. Rh isoimmunization in a pregnant client develops during which

of the following conditions?
a) Rh-positive maternal blood crosses into fetal blood, stimulating
fetal antibodies.
b) Rh-positive fetal blood crosses into maternal blood,
stimulating maternal antibodies.
c) Rh-negative fetal blood crosses into maternal blood,
stimulating maternal antibodies.
d) Rh-negative maternal blood crosses into fetal blood,
stimulating fetal antibodies.

97. To promote comfort during labor, the nurse John advises a client
to assume certain positions and avoid others. Which position may
cause maternal hypotension and fetal hypoxia?
a) Lateral position
b) Squatting position
c) Supine position
d) Standing position
Answers and Rationales be cleaned gently to prevent infection, which could interfere
with healing and damage the cosmetic appearance of the repair.
1. Answer: (A) Inevitable. An inevitable abortion is termination
of pregnancy that cannot be prevented. Moderate to severe 13. Answer: (B) Allow the infant to rest before feeding. Because
bleeding with mild cramping and cervical dilation would be feeding requires so much energy, an infant with heart failure
noted in this type of abortion. should rest before feeding.

2. Answer: (B) History of syphilis. Maternal infections such as 14. Answer: (C) Iron-rich formula only. The infants at age 5
syphilis, toxoplasmosis, and rubella are causes of spontaneous months should receive iron-rich formula and that they
abortion. shouldn’t receive solid food, even baby food until age 6
months.
3. Answer: (C) Monitoring apical pulse. Nursing care for the
client with a possible ectopic pregnancy is focused on 15. Answer: (D) 10 months. A 10 month old infant can sit alone
preventing or identifying hypovolemic shock and and understands object permanence, so he would look for the
controlling pain. An elevated pulse rate is an indicator of hidden toy. At age 4 to 6 months, infants can’t sit securely
shock. alone. At age 8 months, infants can sit securely alone but
cannot understand the permanence of objects.
4. Answer: (B) Increased caloric intake. Glucose crosses the
placenta, but insulin does not. High fetal demands for glucose, 16. Answer: (D) Public health nursing focuses on preventive, not
combined with the insulin resistance caused by hormonal curative, services. The catchments area in PHN consists of a
changes in the last half of pregnancy can result in elevation residential community, many of whom are well individuals
of maternal blood glucose levels. This increases the mother’s who have greater need for preventive rather than curative
demand for insulin and is referred to as the diabetogenic effect services.
of pregnancy.
17. Answer: (B) Efficiency. Efficiency is determining whether the
5. Answer: (A) Excessive fetal activity. The most common signs goals were attained at the least possible cost.
and symptoms of hydatidiform mole includes elevated levels of
human chorionic gonadotropin, vaginal bleeding, larger than 18. Answer: (D) Rural Health Unit. R.A. 7160 devolved basic
normal uterus for gestational age, failure to detect fetal heart health services to local government units (LGU’s ). The public
activity even with sensitive instruments, excessive nausea health nurse is an employee of the LGU.
and vomiting, and early development of pregnancy-induced
hypertension. Fetal activity would not be noted. 19. Answer: (A) Mayor. The local executive serves as the
chairman of the Municipal Health Board.
6. Answer: (B) Absent patellar reflexes. Absence of patellar
reflexes is an indicator of hypermagnesemia, which requires 20. Answer: (A) 1. Each rural health midwife is given a population
administration of calcium gluconate. assignment of about 5,000.

7. Answer: (C) Presenting part in 2 cm below the plane of the 21. Answer: (B) Health education and community organizing are
ischial spines. Fetus at station plus two indicates that the necessary in providing community health services. The
presenting part is 2 cm below the plane of the ischial spines. community health nurse develops the health capability of
people through health education and community organizing
8. Answer: (A) Contractions every 1 ½ minutes lasting 70-80 activities.
seconds. Contractions every 1 ½ minutes lasting 70-80
seconds, is indicative of hyperstimulation of the uterus, which 22. Answer: (B) Measles. Presidential Proclamation No. 4 is on the
could result in injury to the mother and the fetus if Pitocin is Ligtas Tigdas Program.
not discontinued.
23. Answer: (D) Core group formation. In core group formation,
9. Answer: (C) EKG tracings. A potential side effect of calcium the nurse is able to transfer the technology of community
gluconate administration is cardiac arrest. Continuous organizing to the potential or informal community leaders
monitoring of cardiac activity (EKG) throught administration through a training program.
of calcium gluconate is an essential part of care.
24. Answer: (D) To maximize the community’s resources in
10. Answer: (D) First low transverse caesarean was for breech dealing with health problems. Community organizing is a
position. Fetus in this pregnancy is in a vertex developmental service, with the goal of developing the
presentation. This type of client has no obstetrical indication people’s self-reliance in dealing with community health
for a caesarean section as she did with her first caesarean problems. A, B and C are objectives of contributory objectives
delivery. to this goal.

11. Answer: (A) Talk to the mother first and then to the 25. Answer: (D) Terminal. Tertiary prevention involves
toddler. When dealing with a crying toddler, the best approach rehabilitation, prevention of permanent disability and disability
is to talk to the mother and ignore the toddler first. This limitation appropriate for convalescents, the disabled,
approach helps the toddler get used to the nurse before she complicated cases and the terminally ill (those in the terminal
attempts any procedures. It also gives the toddler an stage of a disease).
opportunity to see that the mother trusts the nurse.
26. Answer: (A) Intrauterine fetal death. Intrauterine fetal death,
12. Answer: (D) Place the infant’s arms in soft elbow abruptio placentae, septic shock, and amniotic fluid embolism
restraints. Soft restraints from the upper arm to the wrist may trigger normal clotting mechanisms; if clotting factors are
prevent the infant from touching her lip but allow him to hold a depleted, DIC may occur. Placenta accreta, dysfunctional labor,
favorite item such as a blanket. Because they could damage the and premature rupture of the membranes aren’t associated with
operative site, such as objects as pacifiers, suction catheters, DIC.
and small spoons shouldn’t be placed in a baby’s mouth after
cleft repair. A baby in a prone position may rub her face on the 27. Answer: (C) 120 to 160 beats/minute. A rate of 120 to 160
sheets and traumatize the operative site. The suture line should beats/minute in the fetal heart appropriate for filling the heart
with blood and pumping it out to the system.
 metabolic rate and rate of oxygen consumption, therefore, the
28. Answer: (A) Change the diaper more often. Decreasing the newborn increase heat production.
amount of time the skin comes contact with wet soiled diapers
will help heal the irritation. 43. Answer: (D) Voided. Before administering potassium I.V. to
any client, the nurse must first check that the client’s kidneys
29. Answer: (D) Endocardial cushion defect. Endocardial cushion are functioning and that the client is voiding. If the client is not
defects are seen most in children with Down syndrome, voiding, the nurse should withhold the potassium and notify
asplenia, or polysplenia. the physician.
30. Answer: (B) Decreased urine output. Decreased urine output
may occur in clients receiving I.V. magnesium and should be 44. Answer: (C) Laundry detergent. Eczema or dermatitis is an
monitored closely to keep urine output at greater than 30 allergic skin reaction caused by an offending allergen. The
ml/hour, because magnesium is excreted through the kidneys topical allergen that is the most common causative factor is
and can easily accumulate to toxic levels. laundry detergent.
45. Answer: (A) 6 inches. This distance allows for easy flow of the
31. Answer: (A) Menorrhagia. Menorrhagia is an excessive formula by gravity, but the flow will be slow enough not to
menstrual period. overload the stomach too rapidly.

32. Answer: (C) Blood typing. Blood type would be a critical value 46. Answer: (A) The older one gets, the more susceptible he
to have because the risk of blood loss is always a potential becomes to the complications of chicken pox. Chicken pox is
complication during the labor and delivery process. usually more severe in adults than in children. Complications,
Approximately 40% of a woman’s cardiac output is delivered such as pneumonia, are higher in incidence in adults.
to the uterus, therefore, blood loss can occur quite rapidly in
the event of uncontrolled bleeding. 47. Answer: (D) Consult a physician who may give them rubella
immunoglobulin. Rubella vaccine is made up of attenuated
33. Answer: (D) Physiologic anemia. Hemoglobin values and German measles viruses. This is contraindicated in pregnancy.
hematocrit decrease during pregnancy as the increase in plasma Immune globulin, a specific prophylactic against German
volume exceeds the increase in red blood cell production. measles, may be given to pregnant women.

34. Answer: (D) A 2 year old infant with stridorous breath sounds, 48. Answer: (A) Contact tracing. Contact tracing is the most
sitting up in his mother’s arms and drooling. The infant with practical and reliable method of finding possible sources of
the airway emergency should be treated first, because of the person-to-person transmitted infections, such as sexually
risk of epiglottitis. transmitted diseases.

35. Answer: (A) Placenta previa. Placenta previa with painless 49. Answer: (D) Leptospirosis. Leptospirosis is transmitted
vaginal bleeding. through contact with the skin or mucous membrane with water
or moist soil contaminated with urine of infected animals, like
36. Answer: (D) Early in the morning. Based on the nurse’s rats.
knowledge of microbiology, the specimen should be collected
early in the morning. The rationale for this timing is that, 50. Answer: (B) Cholera. Passage of profuse watery stools is the
because the female worm lays eggs at night around the perineal major symptom of cholera. Both amebic and bacillary
area, the first bowel movement of the day will yield the dysentery are characterized by the presence of blood and/or
best results. The specific type of stool specimen used in the mucus in the stools. Giardiasis is characterized by fat
diagnosis of pinworms is called the tape test. malabsorption and, therefore, steatorrhea.

37. Answer: (A) Irritability and seizures. Lead poisoning primarily 51. Answer: (A) Hemophilus influenzae. Hemophilus meningitis is
affects the CNS, causing increased intracranial pressure. This unusual over the age of 5 years. In developing countries, the
condition results in irritability and changes in level of peak incidence is in children less than 6 months of age.
consciousness, as well as seizure disorders, hyperactivity, and Morbillivirus is the etiology of measles. Streptococcus
learning disabilities. pneumoniae and Neisseria meningitidis may cause meningitis,
but age distribution is not specific in young children.
38. Answer: (D) “I really need to use the diaphragm and jelly most
during the middle of my menstrual cycle”. The woman must 52. Answer: (B) Buccal mucosa. Koplik’s spot may be seen on the
understand that, although the “fertile” period is approximately mucosa of the mouth or the throat.
mid-cycle, hormonal variations do occur and can result in early
or late ovulation. To be effective, the diaphragm should be 53. Answer: (A) 3 seconds. Adequate blood supply to the area
inserted before every intercourse. allows the return of the color of the nailbed within 3 seconds.

39. Answer: (C) Restlessness. In a child, restlessness is the earliest 54. Answer: (B) Severe dehydration. The order of priority in the
sign of hypoxia. Late signs of hypoxia in a child are associated management of severe dehydration is as follows: intravenous
with a change in color, such as pallor or cyanosis. fluid therapy, referral to a facility where IV fluids can be
initiated within 30 minutes, Oresol or nasogastric tube. When
40. Answer: (B) Walk one step ahead, with the child’s hand on the the foregoing measures are not possible or effective, then
nurse’s elbow. This procedure is generally recommended to urgent referral to the hospital is done.
follow in guiding a person who is blind.
55. Answer: (A) 45 infants. To estimate the number of infants,
41. Answer: (A) Loud, machinery-like murmur. A loud, multiply total population by 3%.
machinery-like murmur is a characteristic finding associated
with patent ductus arteriosus. 56. Answer: (A) DPT. DPT is sensitive to freezing. The
appropriate storage temperature of DPT is 2 to 8° C only. OPV
42. Answer: (C) More oxygen, and the newborn’s metabolic rate and measles vaccine are highly sensitive to heat and require
increases. When cold, the infant requires more oxygen and freezing. MMR is not an immunization in the Expanded
there is an increase in metabolic rate. Non-shievering Program on Immunization.
thermogenesis is a complex process that increases the
57. Answer: (C) Proper use of sanitary toilets. The ova of the supine position. Suffocation would be less likely with an infant
parasite get out of the human body together with feces. Cutting supine than prone and the position for GER requires the head
the cycle at this stage is the most effective way of preventing of the bed to be elevated.
the spread of the disease to susceptible hosts.
71. Answer: (C) Decreased temperature. Temperature instability,
58. Answer: (D) 5 skin lesions, positive slit skin smear. A especially when it results in a low temperature in the neonate,
multibacillary leprosy case is one who has a positive slit skin may be a sign of infection. The neonate’s color often changes
smear and at least 5 skin lesions. with an infection process but generally becomes ashen or
mottled. The neonate with an infection will usually show
59. Answer: (C) Thickened painful nerves. The lesion of leprosy is a decrease in activity level or lethargy.
not macular. It is characterized by a change in skin color (either
reddish or whitish) and loss of sensation, sweating and hair 72. Answer: (D) Polycythemia probably due to chronic fetal
growth over the lesion. Inability to close the eyelids hypoxia. The small-for-gestation neonate is at risk for
(lagophthalmos) and sinking of the nosebridge are late developing polycythemia during the transitional period in an
symptoms. attempt to decreasehypoxia. The neonates are also at increased
risk for developing hypoglycemia and hypothermia due to
decreased glycogen stores.
60. Answer: (B) Ask where the family resides. Because malaria is
endemic, the first question to determine malaria risk is where
the client’s family resides. If the area of residence is not a
known endemic area, ask if the child had traveled within the 73. Answer: (C) Desquamation of the epidermis. Postdate fetuses
past 6 months, where she was brought and whether she stayed lose the vernix caseosa, and the epidermis may become
overnight in that area. desquamated. These neonates are usually very alert. Lanugo is
missing in the postdate neonate.
61. Answer: (A) Inability to drink. A sick child aged 2 months to 5
years must be referred urgently to a hospital if he/she has one 74. Answer: (C) Respiratory depression. Magnesium sulfate
or more of the following signs: not able to feed or drink, vomits crosses the placenta and adverse neonatal effects are
everything, convulsions, abnormally sleepy or difficult to respiratory depression, hypotonia, and bradycardia. The serum
awaken. blood sugar isn’t affected by magnesium sulfate. The neonate
would be floppy, not jittery.
62. Answer: (A) Refer the child urgently to a hospital for
confinement. “Baggy pants” is a sign of severe marasmus. The 75. Answer: (C) Respiratory rate 40 to 60 breaths/minute. A
best management is urgent referral to a hospital. respiratory rate 40 to 60 breaths/minute is normal for a neonate
during the transitional period. Nasal flaring, respiratory rate
63. Answer: (D) Let the child rest for 10 minutes then continue more than 60 breaths/minute, and audible grunting are signs of
giving Oresol more slowly. If the child vomits persistently, that respiratory distress.
is, he vomits everything that he takes in, he has to be referred
urgently to a hospital. Otherwise, vomiting is managed by 76. Answer: (C) Keep the cord dry and open to air. Keeping the
letting the child rest for 10 minutes and then continuing with cord dry and open to air helps reduce infection and hastens
Oresol administration. Teach the mother to give Oresol more drying. Infants aren’t given tub bath but are sponged off until
slowly. the cord falls off. Petroleum jelly prevents the cord from drying
and encourages infection. Peroxide could be painful and isn’t
64. Answer: (B) Some dehydration. Using the assessment recommended.
guidelines of IMCI, a child (2 months to 5 years old) with
diarrhea is classified as having SOME DEHYDRATION if he 77. Answer: (B) Conjunctival hemorrhage. Conjunctival
shows 2 or more of the following signs: restless or irritable, hemorrhages are commonly seen in neonates secondary to the
sunken eyes, the skin goes back slow after a skin pinch. cranial pressure applied during the birth process. Bulging
fontanelles are a sign of intracranial pressure. Simian creases
65. Answer: (C) Normal. In IMCI, a respiratory rate of 50/minute are present in 40% of the neonates with trisomy 21. Cystic
or more is fast breathing for an infant aged 2 to 12 months. hygroma is a neck mass that can affect the airway.

66. Answer: (A) 1 year. The baby will have passive natural 78. Answer: (B) To assess for prolapsed cord. After a client has an
immunity by placental transfer of antibodies. The mother will amniotomy, the nurse should assure that the cord isn’t
have active artificial immunity lasting for about 10 years. 5 prolapsed and that the baby tolerated the procedure well. The
doses will give the mother lifetime protection. most effective way to do this is to check the fetal heart rate.
Fetal well-being is assessed via a nonstress test. Fetal position
67. Answer: (B) 4 hours. While the unused portion of other is determined by vaginal examination. Artificial rupture of
biologicals in EPI may be given until the end of the day, only membranes doesn’t indicate an imminent delivery.
BCG is discarded 4 hours after reconstitution. This is why
BCG immunization is scheduled only in the morning. 79. Answer: (D) The parents’ interactions with each other. Parental
interaction will provide the nurse with a good assessment of the
68. Answer: (B) 6 months. After 6 months, the baby’s nutrient stability of the family’s home life but it has no indication for
needs, especially the baby’s iron requirement, can no longer be parental bonding. Willingness to touch and hold the newborn,
provided by mother’s milk alone. expressing interest about the newborn’s size, and indicating a
desire to see the newborn are behaviors indicating parental
69. Answer: (C) 24 weeks. At approximately 23 to 24 weeks’ bonding.
gestation, the lungs are developed enough to sometimes
maintain extrauterine life. The lungs are the most immature 80. Answer: (B) Instructing the client to use two or more peripads
system during the gestation period. Medical care for premature to cushion the area. Using two or more peripads would do little
labor begins much earlier (aggressively at 21 weeks’ gestation) to reduce the pain or promote perineal healing. Cold
applications, sitz baths, and Kegel exercises are important
70. Answer: (B) Sudden infant death syndrome (SIDS). Supine measures when the client has a fourth-degree laceration.
positioning is recommended to reduce the risk of SIDS in
infancy. The risk of aspiration is slightly increased with the
81. Answer: (C) “What is your expected due date?” When progresses. The inspiratory capacity increases during
obtaining the history of a client who may be in labor, the pregnancy. The increased oxygen consumption in the pregnant
nurse’s highest priority is to determine her current status, client is 15% to 20% greater than in the nonpregnant state.
particularly her due date, gravidity, and parity. Gravidity and
parity affect the duration of labor and the potential for labor 90. Answer: (A) Diet. Clients with gestational diabetes are usually
complications. Later, the nurse should ask about chronic managed by diet alone to control their glucose intolerance. Oral
illnesses, allergies, and support persons. hypoglycemic drugs are contraindicated in pregnancy. Long-
acting insulin usually isn’t needed for blood glucose control in
82. Answer: (D) Aspirate the neonate’s nose and mouth with a the client with gestational diabetes.
bulb syringe. The nurse’s first action should be to clear the
neonate’s airway with a bulb syringe. After the airway is clear 91. Answer: (D) Seizure. The anticonvulsant mechanism of
and the neonate’s color improves, the nurse should comfort and magnesium is believes to depress seizure foci in the brain and
calm the neonate. If the problem recurs or the neonate’s color peripheral neuromuscular blockade. Hypomagnesemia isn’t a
doesn’t improve readily, the nurse should notify the physician. complication of preeclampsia. Antihypertensive drug other
Administering oxygen when the airway isn’t clear would be than magnesium are preferred for sustained hypertension.
ineffective. Magnesium doesn’t help prevent hemorrhage in preeclamptic
clients.
83. Answer: (C) Conducting a bedside ultrasound for an amniotic
fluid index. It isn’t within a nurse’s scope of practice to 92. Answer: (C) I.V. fluids. A sickle cell crisis during pregnancy is
perform and interpret a bedside ultrasound under these usually managed by exchange transfusion oxygen, and L.V.
conditions and without specialized training. Observing for Fluids. The client usually needs a stronger analgesic than
pooling of straw-colored fluid, checking vaginal discharge with acetaminophen to control the pain of a crisis. Antihypertensive
nitrazine paper, and observing for flakes of vernix are drugs usually aren’t necessary. Diuretic wouldn’t be used
appropriate assessments for determining whether a client has unless fluid overload resulted.
ruptured membranes.
93. Answer: (A) Calcium gluconate (Kalcinate). Calcium
gluconate is the antidote for magnesium toxicity. Ten milliliters
84. Answer: (C) Monitor partial pressure of oxygen (Pao2) of 10% calcium gluconate is given L.V. push over 3 to 5
levels. Monitoring PaO2 levels and reducing the oxygen minutes. Hydralazine is given for sustained elevated blood
concentration to keep PaO2 within normal limits reduces the pressure in preeclamptic clients. Rho (D) immune globulin is
risk of retinopathy of prematurity in a premature infant given to women with Rh-negative blood to prevent antibody
receiving oxygen. Covering the infant’s eyes and humidifying formation from RH-positive conceptions. Naloxone is used to
the oxygen don’t reduce the risk of retinopathy of prematurity. correct narcotic toxicity.
Because cooling increases the risk of acidosis, the infant should 94. Answer: (B) An indurated wheal over 10 mm in diameter
be kept warm so that his respiratory distress isn’t aggravated. appears in 48 to 72 hours. A positive PPD result would be an
indurated wheal over 10 mm in diameter that appears in 48 to
85. Answer: (A) 110 to 130 calories per kg. Calories per kg is the 72 hours. The area must be a raised wheal, not a flat
accepted way of determined appropriate nutritional intake for a circumcised area to be considered positive.
newborn. The recommended calorie requirement is 110 to 130
calories per kg of newborn body weight. This level will 95. Answer: (C) Pyelonephritis. The symptoms indicate acute
maintain a consistent blood glucose level and provide enough pyelonephritis, a serious condition in a pregnant client. UTI
calories for continued growth and development. symptoms include dysuria, urgency, frequency, and suprapubic
tenderness. Asymptomatic bacteriuria doesn’t cause symptoms.
86. Answer: (C) 30 to 32 weeks. Individual twins usually grow at Bacterial vaginosis causes milky white vaginal discharge but
the same rate as singletons until 30 to 32 weeks’ gestation, then no systemic symptoms.
twins don’t’ gain weight as rapidly as singletons of the same
gestational age. The placenta can no longer keep pace with the 96. Answer: (B) Rh-positive fetal blood crosses into maternal
nutritional requirements of both fetuses after 32 weeks, so blood, stimulating maternal antibodies. Rh isoimmunization
there’s some growth retardation in twins if they remain in utero occurs when Rh-positive fetal blood cells cross into the
at 38 to 40 weeks. maternal circulation and stimulate maternal
antibody production. In subsequent pregnancies with Rh-
87. Answer: (A) conjoined twins. The type of placenta that positive fetuses, maternal antibodies may cross back into the
develops in monozygotic twins depends on the time at which fetal circulation and destroy the fetal blood cells.
cleavage of the ovum occurs. Cleavage in conjoined twins
occurs more than 13 days after fertilization. Cleavage that 97. Answer: (C) Supine position. The supine position causes
occurs less than 3 day after fertilization results in diamniotic compression of the client’s aorta and inferior vena cava by the
dicchorionic twins. Cleavage that occurs between days 3 and 8 fetus. This, in turn, inhibits maternal circulation, leading to
results in diamniotic monochorionic twins. Cleavage that maternal hypotension and, ultimately, fetal hypoxia. The other
occurs between days 8 to 13 result in monoamniotic positions promote comfort and aid labor progress. For instance,
monochorionic twins. the lateral, or side-lying, position improves maternal and fetal
circulation, enhances comfort, increases maternal relaxation,
88. Answer: (D) Ultrasound. Once the mother and the fetus are reduces muscle tension, and eliminates pressure points. The
stabilized, ultrasound evaluation of the placenta should be done squatting position promotes comfort by taking advantage of
to determine the cause of the bleeding. Amniocentesis is gravity. The standing position also takes advantage of gravity
contraindicated in placenta previa. A digital or speculum and aligns the fetus with the pelvic angle.
examination shouldn’t be done as this may lead to severe
bleeding or hemorrhage. External fetal monitoring won’t detect 98. Answer: (B) Irritability and poor sucking. Neonates of heroin-
a placenta previa, although it will detect fetal distress, which addicted mothers are physically dependent on the drug and
may result from blood loss or placenta separation. experience withdrawal when the drug is no longer supplied.
Signs of heroin withdrawal include irritability, poor sucking,
89. Answer: (A) Increased tidal volume. A pregnant client breathes and restlessness. Lethargy isn’t associated with neonatal
deeper, which increases the tidal volume of gas moved in and heroin addiction. A flattened nose, small eyes, and thin lips are
out of the respiratory tract with each breath. The expiratory seen in infants with fetal alcohol syndrome. Heroin use during
volume and residual volume decrease as the pregnancy pregnancy hasn’t been linked to specific congenital anomalies.
99. Answer: (A) 7th to 9th day postpartum. The normal
involutional process returns the uterus to the pelvic cavity in 7
to 9 days. A significant involutional complication is the failure
of the uterus to return to the pelvic cavity within the prescribed
time period. This is known as subinvolution.

100. Answer: (B) Uterine atony. Multiple fetuses, extended labor

stimulation with oxytocin, and traumatic delivery commonly
are associated with uterine atony, which may lead to
postpartum hemorrhage. Uterine inversion may precede or
follow delivery and commonly results from apparent excessive
traction on the umbilical cord and attempts to deliver the
placenta manually. Uterine involution and some uterine
discomfort are normal after delivery.