1

CHN 1 - PNLE
1. Which is the primary goal of community health nursing?
A. To support and supplement the efforts of the medical profession in the promotion of health and
prevention of illness
B. To enhance the capacity of individuals, families and communities to cope with their health needs
C. To increase the productivity of the people by providing them with services that will increase their
level of health
D. To contribute to national development through promotion of family welfare, focusing particularly
on mothers and children.
2. CHN is a community-based practice. Which best explains this statement?
A. The service is provided in the natural environment of people.
B. The nurse has to conduct community diagnosis to determine nursing needs and problems.
C. The services are based on the available resources within the community.
D. Priority setting is based on the magnitude of the health problems identified.
3. Population-focused nursing practice requires which of the following processes?
A. Community organizing
B. Nursing process
C. Community diagnosis
D. Epidemiologic process
4. R.A. 1054 is also known as the Occupational Health Act. Aside from number of employees, what other
factor must be considered in determining the occupational health privileges to which the workers will be
entitled?
A. Type of occupation: agricultural, commercial, industrial
B. Location of the workplace in relation to health facilities
C. Classification of the business enterprise based on net profit
D. Sex and age composition of employees

5. A business firm must employ an occupational health nurse when it has at least how many employees?
A. 21
B. 101
C. 201
D. 301
6. When the occupational health nurse employs ergonomic principles, she is performing which of her
roles?
A. Health care provider
B. Health educator
C. Health care coordinator
D. Environmental manager
7. A garment factory does not have an occupational nurse. Who shall provide the occupational health
needs of the factory workers?
A. Occupational health nurse at the Provincial Health Office
B. Physician employed by the factory
C. Public health nurse of the RHU of their municipality
D. Rural sanitary inspector of the RHU of their municipality
8. Public health services are given free of charge. Is this statement true or false?
A. The statement is true; it is the responsibility of government to provide basic services.
B. The statement is false; people pay indirectly for public health services.
C. The statement may be true or false, depending on the specific service required.
D. The statement may be true or false, depending on policies of the government concerned.
9. According to C.E.Winslow, which of the following is the goal of Public Health?
A. For people to attain their birthrights of health and longevity
B. For promotion of health and prevention of disease

C. For people to have access to basic health services

D. For people to be organized in their health efforts
10. We say that a Filipino has attained longevity when he is able to reach the average lifespan of Filipinos.
What other statistic may be used to determine attainment of longevity?
A. Age-specific mortality rate
B. Proportionate mortality rate
C. Swaroops index
D. Case fatality rate
11. Which of the following is the most prominent feature of public health nursing?
A. It involves providing home care to sick people who are not confined in the hospital.
B. Services are provided free of charge to people within the catchment area.
C. The public health nurse functions as part of a team providing a public health nursing services.
D. Public health nursing focuses on preventive, not curative, services.
12. According to Margaret Shetland, the philosophy of public health nursing is based on which of the
following?
A. Health and longevity as birthrights
B. The mandate of the state to protect the birthrights of its citizens
C. Public health nursing as a specialized field of nursing
D. The worth and dignity of man
13. Which of the following is the mission of the Department of Health?
A. Health for all Filipinos
B. Ensure the accessibility and quality of health care
C. Improve the general health status of the population
D. Health in the hands of the Filipino people by the year 2020
14. Region IV Hospital is classified as what level of facility?

A. Primary
B. Secondary
C. Intermediate
D. Tertiary
15. Which is true of primary facilities?
A. They are usually government-run.
B. Their services are provided on an out-patient basis.
C. They are training facilities for health professionals.
D. A community hospital is an example of this level of health facilities.
16. Which is an example of the school nurses health care provider functions?
A. Requesting for BCG from the RHU for school entrant immunization
B. Conducting random classroom inspection during a measles epidemic
C. Taking remedial action on an accident hazard in the school playground
D. Observing places in the school where pupils spend their free time
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. You are a new B.S.N. graduate. You want to become a Public Health Nurse. Where will you apply?
A. Department of Health
B. Provincial Health Office
C. Regional Health Office
D. Rural Health Unit

19. R.A. 7160 mandates devolution of basic services from the national government to local government
units. Which of the following is the major goal of devolution?
A. To strengthen local government units
B. To allow greater autonomy to local government units
C. To empower the people and promote their self-reliance
D. To make basic services more accessible to the people
20. Who is the Chairman of the Municipal Health Board?
A. Mayor
B. Municipal Health Officer
C. Public Health Nurse
D. Any qualified physician
21. Which level of health facility is the usual point of entry of a client into the health care delivery
system?
A. Primary
B. Secondary
C. Intermediate
D. Tertiary
22. The public health nurse is the supervisor of rural health midwives. Which of the following is a
supervisory function of the public health nurse?
A. Referring cases or patients to the midwife
B. Providing technical guidance to the midwife
C. Providing nursing care to cases referred by the midwife
D. Formulating and implementing training programs for midwives
23. One of the participants in a hilot training class asked you to whom she should refer a patient in labor
who develops a complication. You will answer, to the
A. Public Health Nurse

B. Rural Health Midwife

C. Municipal Health Officer
D. Any of these health professionals
24. You are the public health nurse in a municipality with a total population of about 20,000. There are 3
rural health midwives among the RHU personnel. How many more midwife items will the RHU need?
A. 1
B. 2
C. 3
D. The RHU does not need any more midwife item.
25. If the RHU needs additional midwife items, you will submit the request for additional midwife items
for approval to the
A. Rural Health Unit
B. District Health Office
C. Provincial Health Office
D. Municipal Health Board
26. As an epidemiologist, the nurse is responsible for reporting cases of notifiable diseases. What law
mandates reporting of cases of notifiable diseases?
A. Act 3573
B. R.A. 3753
C. R.A. 1054
D. R.A. 1082
27. According to Freeman and Heinrich, community health nursing is a developmental service. Which of
the following best illustrates this statement?
A. The community health nurse continuously develops himself personally and professionally.
B. Health education and community organizing are necessary in providing community health
services.

C. Community health nursing is intended primarily for health promotion and prevention and
treatment of disease.
D. The goal of community health nursing is to provide nursing services to people in their own places
of residence.
28. Which disease was declared through Presidential Proclamation No. 4 as a target for eradication in the
Philippines?
A. Poliomyelitis
B. Measles
C. Rabies
D. Neonatal tetanus
29. The public health nurse is responsible for presenting the municipal health statistics using graphs and
tables. To compare the frequency of the leading causes of mortality in the municipality, which graph will
you prepare?
A. Line
B. Bar
C. Pie
D. Scatter diagram
30. Which step in community organizing involves training of potential leaders in the community?
A. Integration
B. Community organization
C. Community study
D. Core group formation

CHN 1 PNLE Answers and Rationales

1. Answer: (B) To enhance the capacity of individuals, families and communities to cope with
their health needs
2. Answer: (B) The nurse has to conduct community diagnosis to determine nursing needs and
problems.
3. Answer: (C) Community diagnosis. Population-focused nursing care means providing care
based on the greater need of the majority of the population. The greater need is identified through
community diagnosis.
4. Answer: (B) Location of the workplace in relation to health facilities. Based on R.A. 1054, an
occupational nurse must be employed when there are 30 to 100 employees and the workplace is
more than 1 km. away from the nearest health center.
5. Answer: (B) 101. Again, this is based on R.A. 1054.
6. Answer: (D) Environmental manager. Ergonomics is improving efficiency of workers by
improving the workers environment through appropriately designed furniture, for example.
7. Answer: (C) Public health nurse of the RHU of their municipality. Youre right! This question
is based on R.A.1054.
8. Answer: (B) The statement is false; people pay indirectly for public health
services. Community health services, including public health services, are pre-paid services,
though taxation, for example.
9. Answer: (A) For people to attain their birthrights of health and longevity. According to
Winslow, all public health efforts are for people to realize their birthrights of health and longevity.
10. Answer: (C) Swaroops index. Swaroops index is the percentage of the deaths aged 50 years or
older. Its inverse represents the percentage of untimely deaths (those who died younger than 50
years).
11. Answer: (D) Public health nursing focuses on preventive, not curative, services.The
catchment area in PHN consists of a residential community, many of whom are well individuals
who have greater need for preventive rather than curative services.
12. Answer: (D) The worth and dignity of man. This is a direct quote from Dr. Margaret Shetlands
statements on Public Health Nursing.
13. Answer: (B) Ensure the accessibility and quality of health care
14. Answer: (D) Tertiary. Regional hospitals are tertiary facilities because they serve as training
hospitals for the region.
15. Answer: (B) Their services are provided on an out-patient basis. Primary facilities government
and non-government facilities that provide basic out-patient services.

16. Answer: (B) Conducting random classroom inspection during a measles epidemic. Random
classroom inspection is assessment of pupils/students and teachers for signs of a health problem
prevalent in the community.
17. Answer: (B) Efficiency. Efficiency is determining whether the goals were attained at the least
possible cost.
18. Answer: (D) Rural Health Unit. R.A. 7160 devolved basic health services to local government
units (LGUs ). The public health nurse is an employee of the LGU.
19. Answer: (C) To empower the people and promote their self-reliance. People empowerment is
the basic motivation behind devolution of basic services to LGUs.
20. Answer: (A) Mayor. The local executive serves as the chairman of the Municipal Health Board.
21. Answer: (A) Primary. The entry of a person into the health care delivery system is usually
through a consultation in out-patient services.
22. Answer: (B) Providing technical guidance to the midwife. The nurse provides technical
guidance to the midwife in the care of clients, particularly in the implementation of management
guidelines, as in Integrated Management of Childhood Illness.
23. Answer: (C) Municipal Health Officer. A public health nurse and rural health midwife can
provide care during normal childbirth. A physician should attend to a woman with a complication
during labor.
24. Answer: (A) 1. Each rural health midwife is given a population assignment of about 5,000.
25. Answer: (D) Municipal Health Board. As mandated by R.A. 7160, basic health services have
been devolved from the national government to local government units.
26. Answer: (A) Act 3573. Act 3573, the Law on Reporting of Communicable Diseases, enacted in
1929, mandated the reporting of diseases listed in the law to the nearest health station.
27. Answer: (B) Health education and community organizing are necessary in providing
community health services. The community health nurse develops the health capability of people
through health education and community organizing activities.
28. Answer: (B) Measles. Presidential Proclamation No. 4 is on the Ligtas Tigdas Program.
29. Answer: (B) Bar. A bar graph is used to present comparison of values, a line graph for trends over
time or age, a pie graph for population composition or distribution, and a scatter diagram for
correlation of two variables.
30. Answer: (D) Core group formation. In core group formation, the nurse is able to transfer the
technology of community organizing to the potential or informal community leaders through a
training program.

10

CHN 2 - PNLE
1. In which step are plans formulated for solving community problems?
A. Mobilization
B. Community organization
C. Follow-up/extension
D. Core group formation
2. The public health nurse takes an active role in community participation. What is the primary goal of
community organizing?
A. To educate the people regarding community health problems
B. To mobilize the people to resolve community health problems
C. To maximize the communitys resources in dealing with health problems
D. To maximize the communitys resources in dealing with health problems

11

3. An indicator of success in community organizing is when people are able to

A. Participate in community activities for the solution of a community problem
B. Implement activities for the solution of the community problem
C. Plan activities for the solution of the community problem
D. Identify the health problem as a common concern
4. Tertiary prevention is needed in which stage of the natural history of disease?
A. Pre-pathogenesis
B. Pathogenesis
C. Prodromal
D. Terminal
5. Isolation of a child with measles belongs to what level of prevention?
A. Primary
B. Secondary
C. Intermediate
D. Tertiary
6. On the other hand, Operation Timbang is _____ prevention.
A. Primary
B. Secondary
C. Intermediate
D. Tertiary
7. Which type of family-nurse contact will provide you with the best opportunity to observe family
dynamics?
A. Clinic consultation
B. Group conference
C. Home visit

12

D. Written communication
8. The typology of family nursing problems is used in the statement of nursing diagnosis in the care of
families. The youngest child of the de los Reyes family has been diagnosed as mentally retarded. This is
classified as a:
A. Health threat
B. Health deficit
C. Foreseeable crisis
D. Stress point
9. The de los Reyes couple have a 6-year old child entering school for the first time. The de los Reyes
family has a:
A. Health threat
B. Health deficit
C. Foreseeable crisis
D. Stress point
10. Which of the following is an advantage of a home visit?
A. It allows the nurse to provide nursing care to a greater number of people.
B. It provides an opportunity to do first hand appraisal of the home situation.
C. It allows sharing of experiences among people with similar health problems.
D. It develops the familys initiative in providing for health needs of its members.
11. Which is CONTRARY to the principles in planning a home visit?
A. A home visit should have a purpose or objective.
B. The plan should revolve around family health needs.
C. A home visit should be conducted in the manner prescribed by the RHU.
D. Planning of continuing care should involve a responsible family member.
12. The PHN bag is an important tool in providing nursing care during a home visit. The most important
principle of bag technique states that it

13

A. Should save time and effort.

B. Should minimize if not totally prevent the spread of infection.
C. Should not overshadow concern for the patient and his family.
D. May be done in a variety of ways depending on the home situation, etc.
13. To maintain the cleanliness of the bag and its contents, which of the following must the nurse do?
A. Wash his/her hands before and after providing nursing care to the family members.
B. In the care of family members, as much as possible, use only articles taken from the bag.
C. Put on an apron to protect her uniform and fold it with the right side out before putting it back into
the bag.
D. At the end of the visit, fold the lining on which the bag was placed, ensuring that the contaminated
side is on the outside.
14. The public health nurse conducts a study on the factors contributing to the high mortality rate due to
heart disease in the municipality where she works. Which branch of epidemiology does the nurse practice
in this situation?
A. Descriptive
B. Analytical
C. Therapeutic
D. Evaluation
15. Which of the following is a function of epidemiology?
A. Identifying the disease condition based on manifestations presented by a client
B. Determining factors that contributed to the occurrence of pneumonia in a 3 year old
C. Determining the efficacy of the antibiotic used in the treatment of the 3 year old client with
pneumonia
D. Evaluating the effectiveness of the implementation of the Integrated Management of Childhood
Illness
16. Which of the following is an epidemiologic function of the nurse during an epidemic?
A. Conducting assessment of suspected cases to detect the communicable disease

14

B. Monitoring the condition of the cases affected by the communicable disease

C. Participating in the investigation to determine the source of the epidemic
D. Teaching the community on preventive measures against the disease
17. The primary purpose of conducting an epidemiologic investigation is to
A. Delineate the etiology of the epidemic
B. Encourage cooperation and support of the community
C. Identify groups who are at risk of contracting the disease
D. Identify geographical location of cases of the disease in the community
18. Which is a characteristic of person-to-person propagated epidemics?
A. There are more cases of the disease than expected.
B. The disease must necessarily be transmitted through a vector.
C. The spread of the disease can be attributed to a common vehicle.
D. There is a gradual build up of cases before the epidemic becomes easily noticeable.
19. In the investigation of an epidemic, you compare the present frequency of the disease with the usual
frequency at this time of the year in this community. This is done during which stage of the investigation?
A. Establishing the epidemic
B. Testing the hypothesis
C. Formulation of the hypothesis
D. Appraisal of facts
20. The number of cases of Dengue fever usually increases towards the end of the rainy season. This
pattern of occurrence of Dengue fever is best described as
A. Epidemic occurrence
B. Cyclical variation
C. Sporadic occurrence
D. Secular variation

15

21. In the year 1980, the World Health Organization declared the Philippines, together with some other
countries in the Western Pacific Region, free of which disease?
A. Pneumonic plague
B. Poliomyelitis
C. Small pox
D. Anthrax
22. In the census of the Philippines in 1995, there were about 35,299,000 males and about 34,968,000
females. What is the sex ratio?
A. 99.06:100
B. 100.94:100
C. 50.23%
D. 49.76%
23. Primary health care is a total approach to community development. Which of the following is an
indicator of success in the use of the primary health care approach?
A. Health services are provided free of charge to individuals and families.
B. Local officials are empowered as the major decision makers in matters of health.
C. Health workers are able to provide care based on identified health needs of the people.
D. Health programs are sustained according to the level of development of the community.
24. Sputum examination is the major screening tool for pulmonary tuberculosis. Clients would sometimes
get false negative results in this exam. This means that the test is not perfect in terms of which
characteristic of a diagnostic examination?
A. Effectiveness
B. Efficacy
C. Specificity
D. Sensitivity
25. Use of appropriate technology requires knowledge of indigenous technology. Which medicinal herb is
given for fever, headache and cough?

16

A. Sambong
B. Tsaang gubat
C. Akapulko
D. Lagundi
26. What law created the Philippine Institute of Traditional and Alternative Health Care?
A. R.A. 8423
B. R.A. 4823
C. R.A. 2483
D. R.A. 3482
27. In traditional Chinese medicine, the yielding, negative and feminine force is termed
A. Yin
B. Yang
C. Qi
D. Chai
28. What is the legal basis for Primary Health Care approach in the Philippines?
A. Alma Ata Declaration on PHC
B. Letter of Instruction No. 949
C. Presidential Decree No. 147
D. Presidential Decree 996
29. Which of the following demonstrates intersectoral linkages?
A. Two-way referral system
B. Team approach
C. Endorsement done by a midwife to another midwife
D. Cooperation between the PHN and public school teacher

17

30. The municipality assigned to you has a population of about 20,000. Estimate the number of 1-4 year
old children who will be given Retinol capsule 200,000 I.U. every 6 months.
A. 1,500
B. 1,800
C. 2,000
D. 2,300

CHN 2 PNLE Answers and Rationales

1. Answer: (B) Community organization. Community organization is the step when community
assemblies take place. During the community assembly, the people may opt to formalize the
community organization and make plans for community action to resolve a community health
problem.
2. Answer: (D) To maximize the communitys resources in dealing with health
problems. Community organizing is a developmental service, with the goal of developing the
peoples self-reliance in dealing with community health problems. A, B and C are objectives of
contributory objectives to this goal.
3. Answer: (A) Participate in community activities for the solution of a community
problem. Participation in community activities in resolving a community problem may be in any
of the processes mentioned in the other choices.
4. Answer: (D) Terminal. Tertiary prevention involves rehabilitation, prevention of permanent
disability and disability limitation appropriate for convalescents, the disabled, complicated cases
and the terminally ill (those in the terminal stage of a disease)
5. Answer: (A) Primary. The purpose of isolating a client with a communicable disease is to protect
those who are not sick (specific disease prevention).
6. Answer: (B) Secondary. Operation Timbang is done to identify members of the susceptible
population who are malnourished. Its purpose is early diagnosis and, subsequently, prompt
treatment.

18

7. Answer: (C) Home visit. Dynamics of family relationships can best be observed in the familys
natural environment, which is the home.
8. Answer: (B) Health deficit. Failure of a family member to develop according to what is expected,
as in mental retardation, is a health deficit.
9. Answer: (C) Foreseeable crisis. Entry of the 6-year old into school is an anticipated period of
unusual demand on the family.
10. Answer: (B) It provides an opportunity to do first hand appraisal of the home
situation.. Choice A is not correct since a home visit requires that the nurse spend so much time
with the family. Choice C is an advantage of a group conference, while choice D is true of a clinic
consultation.
11. Answer: (C) A home visit should be conducted in the manner prescribed by the RHU.The
home visit plan should be flexible and practical, depending on factors, such as the familys needs
and the resources available to the nurse and the family.
12. Answer: (B) Should minimize if not totally prevent the spread of infection. Bag technique is
performed before and after handling a client in the home to prevent transmission of infection to
and from the client.
13. Answer: (A) Wash his/her hands before and after providing nursing care to the family
members. Choice B goes against the idea of utilizing the familys resources, which is encouraged
in CHN. Choices C and D goes against the principle of asepsis of confining the contaminated
surface of objects.
14. Answer: (B) Analytical. Analytical epidemiology is the study of factors or determinants affecting
the patterns of occurrence and distribution of disease in a community.
15. Answer: (D) Evaluating the effectiveness of the implementation of the Integrated
Management of Childhood Illness. Epidemiology is used in the assessment of a community or
evaluation of interventions in community health practice.
16. Answer: (C) Participating in the investigation to determine the source of the
epidemic. Epidemiology is the study of patterns of occurrence and distribution of disease in the
community, as well as the factors that affect disease patterns. The purpose of an epidemiologic
investigation is to identify the source of an epidemic, i.e., what brought about the epidemic.
17. Answer: (A) Delineate the etiology of the epidemic. Delineating the etiology of an epidemic is
identifying its source.
18. Answer: (D) There is a gradual build up of cases before the epidemic becomes easily
noticeable. A gradual or insidious onset of the epidemic is usually observable in person-to-person
propagated epidemics.
19. Answer: (A) Establishing the epidemic. Establishing the epidemic is determining whether there
is an epidemic or not. This is done by comparing the present number of cases with the usual

19

number of cases of the disease at the same time of the year, as well as establishing the relatedness
of the cases of the disease.
20. Answer: (B) Cyclical variation. A cyclical variation is a periodic fluctuation in the number of
cases of a disease in the community.
21. Answer: (C) Small pox. The last documented case of Small pox was in 1977 at Somalia.
22. Answer: (B) 100.94:100. Sex ratio is the number of males for every 100 females in the
population.
23. Answer: (D) Health programs are sustained according to the level of development of the
community. Primary health care is essential health care that can be sustained in all stages of
development of the community.
24. Answer: (D) Sensitivity. Sensitivity is the capacity of a diagnostic examination to detect cases of
the disease. If a test is 100% sensitive, all the cases tested will have a positive result, i.e., there will
be no false negative results.
25. Answer: (D) Lagundi. Sambong is used as a diuretic. Tsaang gubat is used to relieve diarrhea.
Akapulko is used for its antifungal property.
26. Answer: (A) R.A. 8423
27. Answer: (A) Yin. Yang is the male dominating, positive and masculine force.
28. Answer: (B) Letter of Instruction No. 949. Letter of Instruction 949 was issued by then
President Ferdinand Marcos, directing the formerly called Ministry of Health, now the Department
of Health, to utilize Primary Health Care approach in planning and implementing health programs.
29. Answer: (D) Cooperation between the PHN and public school teacher. Intersectoral linkages
refer to working relationships between the health sector and other sectors involved in community
development.
30. Answer: (D) 2,300. Based on the Philippine population composition, to estimate the number of 14 year old children, multiply total population by 11.5%.

20

CHN 3 - PNLE
1. Estimate the number of pregnant women who will be given tetanus toxoid during an immunization
outreach activity in a barangay with a population of about 1,500.
A. 265
B. 300
C. 375
D. 400
2. To describe the sex composition of the population, which demographic tool may be used?
A. Sex ratio
B. Sex proportion
C. Population pyramid
D. Any of these may be used.
3. Which of the following is a natality rate?
A. Crude birth rate
B. Neonatal mortality rate
C. Infant mortality rate
D. General fertility rate
4. You are computing the crude death rate of your municipality, with a total population of about 18,000,
for last year. There were 94 deaths. Among those who died, 20 died because of diseases of the heart and
32 were aged 50 years or older. What is the crude death rate?
A. 4.2/1,000
B. 5.2/1,000
C. 6.3/1,000
D. 7.3/1,000

21

5. Knowing that malnutrition is a frequent community health problem, you decided to conduct nutritional
assessment. What population is particularly susceptible to protein energy malnutrition (PEM)?
A. Pregnant women and the elderly
B. Under-5 year old children
C. 1-4 year old children
D. School age children
6. Which statistic can give the most accurate reflection of the health status of a community?
A. 1-4 year old age-specific mortality rate
B. Infant mortality rate
C. Swaroops index
D. Crude death rate
7. In the past year, Barangay A had an average population of 1655. 46 babies were born in that year, 2 of
whom died less than 4 weeks after they were born. There were 4 recorded stillbirths. What is the neonatal
mortality rate?
A. 27.8/1,000
B. 43.5/1,000
C. 86.9/1,000
D. 130.4/1,000
8. Which statistic best reflects the nutritional status of a population?
A. 1-4 year old age-specific mortality rate
B. Proportionate mortality rate
C. Infant mortality rate
D. Swaroops index
9. What numerator is used in computing general fertility rate?
A. Estimated midyear population
B. Number of registered live births

22

C. Number of pregnancies in the year

D. Number of females of reproductive age
10. You will gather data for nutritional assessment of a purok. You will gather information only from
families with members who belong to the target population for PEM. What method of data gathering is
best for this purpose?
A. Census
B. Survey
C. Record review
D. Review of civil registry
11. In the conduct of a census, the method of population assignment based on the actual physical location
of the people is termed
A. De jure
B. De locus
C. De facto
D. De novo
12. The Field Health Services and Information System (FHSIS) is the recording and reporting system in
public health care in the Philippines. The Monthly Field Health Service Activity Report is a form used in
which of the components of the FHSIS?
A. Tally report
B. Output report
C. Target/client list
D. Individual health record
13. To monitor clients registered in long-term regimens, such as the Multi-Drug Therapy, which
component will be most useful?
A. Tally report
B. Output report
C. Target/client list

23

D. Individual health record

14. Civil registries are important sources of data. Which law requires registration of births within 30 days
from the occurrence of the birth?
A. P.D. 651
B. Act 3573
C. R.A. 3753
D. R.A. 3375
15. Which of the following professionals can sign the birth certificate?
A. Public health nurse
B. Rural health midwife
C. Municipal health officer
D. Any of these health professionals
16. Which criterion in priority setting of health problems is used only in community health care?
A. Modifiability of the problem
B. Nature of the problem presented
C. Magnitude of the health problem
D. Preventive potential of the health problem
17. The Sentrong Sigla Movement has been launched to improve health service delivery. Which of the
following is/are true of this movement?
A. This is a project spearheaded by local government units.
B. It is a basis for increasing funding from local government units.
C. It encourages health centers to focus on disease prevention and control.
D. Its main strategy is certification of health centers able to comply with standards.
18. Which of the following women should be considered as special targets for family planning?
A. Those who have two children or more

24

B. Those with medical conditions such as anemia

C. Those younger than 20 years and older than 35 years
D. Those who just had a delivery within the past 15 months
19. Freedom of choice is one of the policies of the Family Planning Program of the Philippines. Which of
the following illustrates this principle?
A. Information dissemination about the need for family planning
B. Support of research and development in family planning methods
C. Adequate information for couples regarding the different methods
D. Encouragement of couples to take family planning as a joint responsibility
20. A woman, 6 months pregnant, came to the center for consultation. Which of the following substances
is contraindicated?
A. Tetanus toxoid
B. Retinol 200,000 IU
C. Ferrous sulfate 200 mg
D. Potassium iodate 200 mg. capsule
21. During prenatal consultation, a client asked you if she can have her delivery at home. After history
taking and physical examination, you advised her against a home delivery. Which of the following
findings disqualifies her for a home delivery?
A. Her OB score is G5P3.
B. She has some palmar pallor.
C. Her blood pressure is 130/80.
D. Her baby is in cephalic presentation.
22. Inadequate intake by the pregnant woman of which vitamin may cause neural tube defects?
A. Niacin
B. Riboflavin
C. Folic acid

25

D. Thiamine
23. You are in a clients home to attend to a delivery. Which of the following will you do first?
A. Set up the sterile area.
B. Put on a clean gown or apron.
C. Cleanse the clients vulva with soap and water.
D. Note the interval, duration and intensity of labor contractions.
24. In preparing a primigravida for breastfeeding, which of the following will you do?
A. Tell her that lactation begins within a day after delivery.
B. Teach her nipple stretching exercises if her nipples are everted.
C. Instruct her to wash her nipples before and after each breastfeeding.
D. Explain to her that putting the baby to breast will lessen blood loss after delivery.
25. A primigravida is instructed to offer her breast to the baby for the first time within 30 minutes after
delivery. What is the purpose of offering the breast this early?
A. To initiate the occurrence of milk letdown
B. To stimulate milk production by the mammary acini
C. To make sure that the baby is able to get the colostrum
D. To allow the woman to practice breastfeeding in the presence of the health worker
26. In a mothers class, you discuss proper breastfeeding technique. Which is of these is a sign that the
baby has latched on to the breast properly?
A. The baby takes shallow, rapid sucks.
B. The mother does not feel nipple pain.
C. The babys mouth is only partly open.
D. Only the mothers nipple is inside the babys mouth.
27. You explain to a breastfeeding mother that breast milk is sufficient for all of the babys nutrient needs
only up to ____.
A. 3 months

26

B. 6 months
C. 1 year
D. 2 years
28. What is given to a woman within a month after the delivery of a baby?
A. Malunggay capsule
B. Ferrous sulfate 100 mg. OD
C. Retinol 200,000 I.U., 1 capsule
D. Potassium iodate 200 mg, 1 capsule
29. Which biological used in Expanded Program on Immunization (EPI) is stored in the freezer?
A. DPT
B. Tetanus toxoid
C. Measles vaccine
D. Hepatitis B vaccine
30. Unused BCG should be discarded how many hours after reconstitution?
A. 2
B. 4
C. 6
D. At the end of the day

CHN 3 PNLE Answers and Rationales

27

1. Answer: (A) 265. To estimate the number of pregnant women, multiply the total population by
3.5%.
2. Answer: (D) Any of these may be used. Sex ratio and sex proportion are used to determine the
sex composition of a population. A population pyramid is used to present the composition of a
population by age and sex.
3. Answer: (A) Crude birth rate. Natality means birth. A natality rate is a birth rate.
4. Answer: (B) 5.2/1,000. To compute crude death rate divide total number of deaths (94) by total
population (18,000) and multiply by 1,000.
5. Answer: (C) 1-4 year old children. Preschoolers are the most susceptible to PEM because they
have generally been weaned. Also, this is the population who, unable to feed themselves, are often
the victims of poor intrafamilial food distribution.
6. Answer: (C) Swaroops index. Swaroops index is the proportion of deaths aged 50 years and
above. The higher the Swaroops index of a population, the greater the proportion of the deaths
who were able to reach the age of at least 50 years, i.e., more people grew old before they died.
7. Answer: (B) 43.5/1,000. To compute for neonatal mortality rate, divide the number of babies who
died before reaching the age of 28 days by the total number of live births, then multiply by 1,000.
8. Answer: (A) 1-4 year old age-specific mortality rate. Since preschoolers are the most
susceptible to the effects of malnutrition, a population with poor nutritional status will most likely
have a high 1-4 year old age-specific mortality rate, also known as child mortality rate.
9. Answer: (B) Number of registered live births. To compute for general or total fertility rate,
divide the number of registered live births by the number of females of reproductive age (15-45
years), then multiply by 1,000.
10. Answer: (B) Survey. A survey, also called sample survey, is data gathering about a sample of the
population.
11. Answer: (C) De facto. The other method of population assignment, de jure, is based on the usual
place of residence of the people.
12. Answer: (A) Tally report. A tally report is prepared monthly or quarterly by the RHU personnel
and transmitted to the Provincial Health Office.
13. Answer: (C) Target/client list. The MDT Client List is a record of clients enrolled in MDT and
other relevant data, such as dates when clients collected their monthly supply of drugs.
14. Answer: (A) P.D. 651. P.D. 651 amended R.A. 3753, requiring the registry of births within 30
days from their occurrence.
15. Answer: (D) Any of these health professionals. D. R.A. 3753 states that any birth attendant may
sign the certificate of live birth.

28

16. Answer: (C) Magnitude of the health problem. Magnitude of the problem refers to the
percentage of the population affected by a health problem. The other choices are criteria
considered in both family and community health care.
17. Answer: (D) Its main strategy is certification of health centers able to comply with
standards. Sentrong Sigla Movement is a joint project of the DOH and local government units. Its
main strategy is certification of health centers that are able to comply with standards set by the
DOH.
18. Answer: (D) Those who just had a delivery within the past 15 months. The ideal birth spacing
is at least two years. 15 months plus 9 months of pregnancy = 2 years.
19. Answer: (C) Adequate information for couples regarding the different methods. To enable the
couple to choose freely among different methods of family planning, they must be given full
information regarding the different methods that are available to them, considering the availability
of quality services that can support their choice.
20. Answer: (B) Retinol 200,000 IU. Retinol 200,000 IU is a form of megadose Vitamin A. This may
have a teratogenic effect.
21. Answer: (A) Her OB score is G5P3. Only women with less than 5 pregnancies are qualified for a
home delivery. It is also advisable for a primigravida to have delivery at a childbirth facility.
22. Answer: (C) Folic acid. It is estimated that the incidence of neural tube defects can be reduced
drastically if pregnant women have an adequate intake of folic acid.
23. Answer: (D) Note the interval, duration and intensity of labor contractions.. Assessment of
the woman should be done first to determine whether she is having true labor and, if so, what stage
of labor she is in.
24. Answer: (D) Explain to her that putting the baby to breast will lessen blood loss after
delivery. Suckling of the nipple stimulates the release of oxytocin by the posterior pituitary gland,
which causes uterine contraction. Lactation begins 1 to 3 days after delivery. Nipple stretching
exercises are done when the nipples are flat or inverted. Frequent washing dries up the nipples,
making them prone to the formation of fissures.
25. Answer: (B) To stimulate milk production by the mammary acini. Suckling of the nipple
stimulates prolactin reflex (the release of prolactin by the anterior pituitary gland), which initiates
lactation.
26. Answer: (B) The mother does not feel nipple pain.. When the baby has properly latched on to
the breast, he takes deep, slow sucks; his mouth is wide open; and much of the areola is inside his
mouth. And, youre right! The mother does not feel nipple pain.
27. Answer: (B) 6 months. After 6 months, the babys nutrient needs, especially the babys iron
requirement, can no longer be provided by mothers milk alone.

29

28. Answer: (C) Retinol 200,000 I.U., 1 capsule. A capsule of Retinol 200,000 IU is given within 1
month after delivery. Potassium iodate is given during pregnancy; malunggay capsule is not
routinely administered after delivery; and ferrous sulfate is taken for two months after delivery.
29. Answer: (C) Measles vaccine. Among the biologicals used in the Expanded Program on
Immunization, measles vaccine and OPV are highly sensitive to heat, requiring storage in the
freezer.
30. Answer: (B) 4. While the unused portion of other biologicals in EPI may be given until the end of
the day, only BCG is discarded 4 hours after reconstitution. This is why BCG immunization is
scheduled only in the morning.

CHN 4 - PNLE
1. In immunizing school entrants with BCG, you are not obliged to secure parental consent. This is
because of which legal document?
A. P.D. 996
B. R.A. 7846
C. Presidential Proclamation No. 6
D. Presidential Proclamation No. 46
2. Which immunization produces a permanent scar?
A. DPT
B. BCG
C. Measles vaccination

30

D. Hepatitis B vaccination
3. A 4-week old baby was brought to the health center for his first immunization. Which can be given to
him?
A. DPT1
B. OPV1
C. Infant BCG
D. Hepatitis B vaccine 1
4. You will not give DPT 2 if the mother says that the infant had
A. Seizures a day after DPT 1.
B. Fever for 3 days after DPT 1.
C. Abscess formation after DPT 1.
D. Local tenderness for 3 days after DPT 1.
5. A 2-month old infant was brought to the health center for immunization. During assessment, the
infants temperature registered at 38.1C. Which is the best course of action that you will take?
A. Go on with the infants immunizations.
B. Give Paracetamol and wait for his fever to subside.
C. Refer the infant to the physician for further assessment.
D. Advise the infants mother to bring him back for immunization when he is well.
6. A pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will have
protection against tetanus for how long?
A. 1 year
B. 3 years
C. 10 years
D. Lifetime
7. A 4-month old infant was brought to the health center because of cough. Her respiratory rate is
42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines of assessment, her
breathing is considered

31

A. Fast
B. Slow
C. Normal
D. Insignificant
8. Which of the following signs will indicate that a young child is suffering from severe pneumonia?
A. Dyspnea
B. Wheezing
C. Fast breathing
D. Chest indrawing
9. Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management
for the child?
A. Prescribe an antibiotic.
B. Refer him urgently to the hospital.
C. Instruct the mother to increase fluid intake.
D. Instruct the mother to continue breastfeeding.
10. A 5-month old infant was brought by his mother to the health center because of diarrhea occurring 4 to
5 times a day. His skin goes back slowly after a skin pinch and his eyes are sunken. Using the IMCI
guidelines, you will classify this infant in which category?
A. No signs of dehydration
B. Some dehydration
C. Severe dehydration
D. The data is insufficient.
11. Based on assessment, you classified a 3-month old infant with the chief complaint of diarrhea in the
category of SOME DEHYDRATION. Based on IMCI management guidelines, which of the following
will you do?
A. Bring the infant to the nearest facility where IV fluids can be given.
B. Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours.

32

C. Give the infants mother instructions on home management.

D. Keep the infant in your health center for close observation.
12. A mother is using Oresol in the management of diarrhea of her 3-year old child. She asked you what to
do if her child vomits. You will tell her to
A. Bring the child to the nearest hospital for further assessment.
B. Bring the child to the health center for intravenous fluid therapy.
C. Bring the child to the health center for assessment by the physician.
D. Let the child rest for 10 minutes then continue giving Oresol more slowly.
13. A 1 year old child was classified as having 3rd degree protein energy malnutrition, kwashiorkor.
Which of the following signs will be most apparent in this child?
A. Voracious appetite
B. Wasting
C. Apathy
D. Edema
14. Assessment of a 2-year old child revealed baggy pants. Using the IMCI guidelines, how will you
manage this child?
A. Refer the child urgently to a hospital for confinement.
B. Coordinate with the social worker to enroll the child in a feeding program.
C. Make a teaching plan for the mother, focusing on menu planning for her child.
D. Assess and treat the child for health problems like infections and intestinal parasitism.
15. During the physical examination of a young child, what is the earliest sign of xerophthalmia that you
may observe?
A. Keratomalacia
B. Corneal opacity
C. Night blindness
D. Conjunctival xerosis

33

16. To prevent xerophthalmia, young children are given Retinol capsule every 6 months. What is the dose
given to preschoolers?
A. 10,000 IU
B. 20,000 IU
C. 100,000 IU
D. 200,000 IU
17. The major sign of iron deficiency anemia is pallor. What part is best examined for pallor?
A. Palms
B. Nailbeds
C. Around the lips
D. Lower conjunctival sac
18. Food fortification is one of the strategies to prevent micronutrient deficiency conditions. R.A. 8976
mandates fortification of certain food items. Which of the following is among these food items?
A. Sugar
B. Bread
C. Margarine
D. Filled milk
19. What is the best course of action when there is a measles epidemic in a nearby municipality?
A. Give measles vaccine to babies aged 6 to 8 months.
B. Give babies aged 6 to 11 months one dose of 100,000 I.U. of Retinol
C. Instruct mothers to keep their babies at home to prevent disease transmission.
D. Instruct mothers to feed their babies adequately to enhance their babies resistance.
20. A mother brought her daughter, 4 years old, to the RHU because of cough and colds. Following the
IMCI assessment guide, which of the following is a danger sign that indicates the need for urgent referral
to a hospital?
A. Inability to drink

34

B. High grade fever

C. Signs of severe dehydration
D. Cough for more than 30 days
21. Management of a child with measles includes the administration of which of the following?
A. Gentian violet on mouth lesions
B. Antibiotics to prevent pneumonia
C. Tetracycline eye ointment for corneal opacity
D. Retinol capsule regardless of when the last dose was given
22. A mother brought her 10 month old infant for consultation because of fever, which started 4 days prior
to consultation. To determine malaria risk, what will you do?
A. Do a tourniquet test.
B. Ask where the family resides.
C. Get a specimen for blood smear.
D. Ask if the fever is present everyday.
23. The following are strategies implemented by the Department of Health to prevent mosquito-borne
diseases. Which of these is most effective in the control of Dengue fever?
A. Stream seeding with larva-eating fish
B. Destroying breeding places of mosquitoes
C. Chemoprophylaxis of non-immune persons going to endemic areas
D. Teaching people in endemic areas to use chemically treated mosquito nets
24. Secondary prevention for malaria includes
A. Planting of neem or eucalyptus trees
B. Residual spraying of insecticides at night
C. Determining whether a place is endemic or not
D. Growing larva-eating fish in mosquito breeding places

35

25. Scotch tape swab is done to check for which intestinal parasite?
A. Ascaris
B. Pinworm
C. Hookworm
D. Schistosoma
26. Which of the following signs indicates the need for sputum examination for AFB?
A. Hematemesis
B. Fever for 1 week
C. Cough for 3 weeks
D. Chest pain for 1 week
27. Which clients are considered targets for DOTS Category I?
A. Sputum negative cavitary cases
B. Clients returning after a default
C. Relapses and failures of previous PTB treatment regimens
D. Clients diagnosed for the first time through a positive sputum exam
28. To improve compliance to treatment, what innovation is being implemented in DOTS?
A. Having the health worker follow up the client at home
B. Having the health worker or a responsible family member monitor drug intake
C. Having the patient come to the health center every month to get his medications
D. Having a target list to check on whether the patient has collected his monthly supply of drugs
29. Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an
early sign of leprosy?
A. Macular lesions
B. Inability to close eyelids
C. Thickened painful nerves

36

D. Sinking of the nosebridge

30. Which of the following clients should be classified as a case of multibacillary leprosy?
A. 3 skin lesions, negative slit skin smear
B. 3 skin lesions, positive slit skin smear
C. 5 skin lesions, negative slit skin smear
D. 5 skin lesions, positive slit skin smear

CHN 4 PNLE Answers and Rationales

1. Answer: (A) P.D. 996. Presidential Decree 996, enacted in 1976, made immunization in the EPI
compulsory for children under 8 years of age. Hepatitis B vaccination was made compulsory for
the same age group by R.A. 7846.
2. Answer: (B) BCG. BCG causes the formation of a superficial abscess, which begins 2 weeks after
immunization. The abscess heals without treatment, with the formation of a permanent scar.
3. Answer: (C) Infant BCG. Infant BCG may be given at birth. All the other immunizations
mentioned can be given at 6 weeks of age.
4. Answer: (A) Seizures a day after DPT 1. Seizures within 3 days after administration of DPT is
an indication of hypersensitivity to pertussis vaccine, a component of DPT. This is considered a
specific contraindication to subsequent doses of DPT.
5. Answer: (A) Go on with the infants immunizations. In the EPI, fever up to 38.5C is not a
contraindication to immunization. Mild acute respiratory tract infection, simple diarrhea and
malnutrition are not contraindications either.
6. Answer: (A) 1 year. The baby will have passive natural immunity by placental transfer of
antibodies. The mother will have active artificial immunity lasting for about 10 years. 5 doses will
give the mother lifetime protection.

37

7. Answer: (C) Normal. In IMCI, a respiratory rate of 50/minute or more is fast breathing for an
infant aged 2 to 12 months.
8. Answer: (D) Chest indrawing. In IMCI, chest indrawing is used as the positive sign of dyspnea,
indicating severe pneumonia.
9. Answer: (B) Refer him urgently to the hospital. Severe pneumonia requires urgent referral to a
hospital. Answers A, C and D are done for a client classified as having pneumonia.
10. Answer: (B) Some dehydration. Using the assessment guidelines of IMCI, a child (2 months to 5
years old) with diarrhea is classified as having SOME DEHYDRATION if he shows 2 or more of
the following signs: restless or irritable, sunken eyes, the skin goes back slow after a skin pinch.
11. Answer: (B) Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours. In the IMCI
management guidelines, SOME DEHYDRATION is treated with the administration of Oresol
within a period of 4 hours. The amount of Oresol is best computed on the basis of the childs
weight (75 ml/kg body weight). If the weight is unknown, the amount of Oresol is based on the
childs age.
12. Answer: (D) Let the child rest for 10 minutes then continue giving Oresol more slowly. If the
child vomits persistently, that is, he vomits everything that he takes in, he has to be referred
urgently to a hospital. Otherwise, vomiting is managed by letting the child rest for 10 minutes and
then continuing with Oresol administration. Teach the mother to give Oresol more slowly.
13. Answer: (D) Edema. Edema, a major sign of kwashiorkor, is caused by decreased colloidal
osmotic pressure of the blood brought about by hypoalbuminemia. Decreased blood albumin level
is due a protein-deficient diet.
14. Answer: (A) Refer the child urgently to a hospital for confinement. Baggy pants is a sign of
severe marasmus. The best management is urgent referral to a hospital.
15. Answer: (D) Conjunctival xerosis. The earliest sign of Vitamin A deficiency (xerophthalmia) is
night blindness. However, this is a functional change, which is not observable during physical
examination.The earliest visible lesion is conjunctival xerosis or dullness of the conjunctiva due to
inadequate tear production.
16. Answer: (D) 200,000 IU. Preschoolers are given Retinol 200,000 IU every 6 months. 100,000 IU
is given once to infants aged 6 to 12 months. The dose for pregnant women is 10,000 IU.
17. Answer: (A) Palms. The anatomic characteristics of the palms allow a reliable and convenient
basis for examination for pallor.
18. Answer: (A) Sugar. R.A. 8976 mandates fortification of rice, wheat flour, sugar and cooking oil
with Vitamin A, iron and/or iodine.
19. Answer: (A) Give measles vaccine to babies aged 6 to 8 months. Ordinarily, measles vaccine is
given at 9 months of age. During an impending epidemic, however, one dose may be given to
babies aged 6 to 8 months. The mother is instructed that the baby needs another dose when the
baby is 9 months old.

38

20. 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 or more of the following signs: not able to feed or drink, vomits
everything, convulsions, abnormally sleepy or difficult to awaken.
21. Answer: (D) Retinol capsule regardless of when the last dose was given. An infant 6 to 12
months classified as a case of measles is given Retinol 100,000 IU; a child is given 200,000 IU
regardless of when the last dose was given.
22. Answer: (B) Ask where the family resides. Because malaria is endemic, the first question to
determine malaria risk is where the clients family resides. If the area of residence is not a known
endemic area, ask if the child had traveled within the past 6 months, where he/she was brought and
whether he/she stayed overnight in that area.
23. Answer: (B) Destroying breeding places of mosquitoes. Aedes aegypti, the vector of Dengue
fever, breeds in stagnant, clear water. Its feeding time is usually during the daytime. It has a
cyclical pattern of occurrence, unlike malaria which is endemic in certain parts of the country.
24. Answer: (C) Determining whether a place is endemic or not. This is diagnostic and therefore
secondary level prevention. The other choices are for primary prevention.
25. Answer: (B) Pinworm. Pinworm ova are deposited around the anal orifice.
26. Answer: (C) Cough for 3 weeks. A client is considered a PTB suspect when he has cough for 2
weeks or more, plus one or more of the following signs: fever for 1 month or more; chest pain
lasting for 2 weeks or more not attributed to other conditions; progressive, unexplained weight
loss; night sweats; and hemoptysis.
27. Answer: (D) Clients diagnosed for the first time through a positive sputum exam. Category I
is for new clients diagnosed by sputum examination and clients diagnosed to have a serious form
of extrapulmonary tuberculosis, such as TB osteomyelitis.
28. Answer: (B) Having the health worker or a responsible family member monitor drug
intake. Directly Observed Treatment Short Course is so-called because a treatment partner,
preferably a health worker accessible to the client, monitors the clients compliance to the
treatment.
29. Answer: (C) Thickened painful nerves. The lesion of leprosy is not macular. It is characterized
by a change in skin color (either reddish or whitish) and loss of sensation, sweating and hair
growth over the lesion. Inability to close the eyelids (lagophthalmos) and sinking of the
nosebridge are late symptoms.
30. Answer: (D) 5 skin lesions, positive slit skin smear. A multibacillary leprosy case is one who has
a positive slit skin smear and at least 5 skin lesions.

39

CHN 5 - PNLE
1. In the Philippines, which condition is the most frequent cause of death associated with schistosomiasis?
A. Liver cancer
B. Liver cirrhosis
C. Bladder cancer
D. Intestinal perforation
2. What is the most effective way of controlling schistosomiasis in an endemic area?
A. Use of molluscicides
B. Building of foot bridges
C. Proper use of sanitary toilets
D. Use of protective footwear, such as rubber boots
3. When residents obtain water from an artesian well in the neighborhood, the level of this approved type
of water facility is
A. I
B. II
C. III
D. IV
4. For prevention of hepatitis A, you decided to conduct health education activities. Which of the
following is IRRELEVANT?
A. Use of sterile syringes and needles
B. Safe food preparation and food handling by vendors
C. Proper disposal of human excreta and personal hygiene
D. Immediate reporting of water pipe leaks and illegal water connections

40

5. Which biological used in Expanded Program on Immunization (EPI) should NOT be stored in the
freezer?
A. DPT
B. Oral polio vaccine
C. Measles vaccine
D. MMR
6. You will conduct outreach immunization in a barangay with a population of about 1500. Estimate the
number of infants in the barangay.
A. 45
B. 50
C. 55
D. 60
7. In Integrated Management of Childhood Illness, severe conditions generally require urgent referral to a
hospital. Which of the following severe conditions DOES NOT always require urgent referral to a
hospital?
A. Mastoiditis
B. Severe dehydration
C. Severe pneumonia
D. Severe febrile disease
8. A client was diagnosed as having Dengue fever. You will say that there is slow capillary refill when the
color of the nailbed that you pressed does not return within how many seconds?
A. 3
B. 5
C. 8
D. 10
9. A 3-year old child was brought by his mother to the health center because of fever of 4-day duration.
The child had a positive tourniquet test result. In the absence of other signs, which is the most appropriate
measure that the PHN may carry out to prevent Dengue shock syndrome?

41

A. Insert an NGT and give fluids per NGT.

B. Instruct the mother to give the child Oresol.
C. Start the patient on intravenous fluids STAT.
D. Refer the client to the physician for appropriate management.
10. The pathognomonic sign of measles is Kopliks spot. You may see Kopliks spot by inspecting the
_____.
A. Nasal mucosa
B. Buccal mucosa
C. Skin on the abdomen
D. Skin on the antecubital surface
11. Among the following diseases, which is airborne?
A. Viral conjunctivitis
B. Acute poliomyelitis
C. Diphtheria
D. Measles
12. Among children aged 2 months to 3 years, the most prevalent form of meningitis is caused by which
microorganism?
A. Hemophilus influenzae
B. Morbillivirus
C. Steptococcus pneumoniae
D. Neisseria meningitidis
13. Human beings are the major reservoir of malaria. Which of the following strategies in malaria control
is based on this fact?
A. Stream seeding
B. Stream clearing
C. Destruction of breeding places

42

D. Zooprophylaxis
14. The use of larvivorous fish in malaria control is the basis for which strategy of malaria control?
A. Stream seeding
B. Stream clearing
C. Destruction of breeding places
D. Zooprophylaxis
15. Mosquito-borne diseases are prevented mostly with the use of mosquito control measures. Which of
the following is NOT appropriate for malaria control?
A. Use of chemically treated mosquito nets
B. Seeding of breeding places with larva-eating fish
C. Destruction of breeding places of the mosquito vector
D. Use of mosquito-repelling soaps, such as those with basil or citronella
16. A 4-year old client was brought to the health center with the chief complaint of severe diarrhea and the
passage of rice water stools. The client is most probably suffering from which condition?
A. Giardiasis
B. Cholera
C. Amebiasis
D. Dysentery
17. In the Philippines, which specie of schistosoma is endemic in certain regions?
A. S. mansoni
B. S. japonicum
C. S. malayensis
D. S. haematobium
18. A 32-year old client came for consultation at the health center with the chief complaint of fever for a
week. Accompanying symptoms were muscle pains and body malaise. A week after the start of fever, the
client noted yellowish discoloration of his sclera. History showed that he waded in flood waters about 2
weeks before the onset of symptoms. Based on his history, which disease condition will you suspect?

43

A. Hepatitis A
B. Hepatitis B
C. Tetanus
D. Leptospirosis
19. MWSS provides water to Manila and other cities in Metro Manila. This is an example of which level
of water facility?
A. I
B. II
C. III
D. IV
20. You are the PHN in the city health center. A client underwent screening for AIDS using ELISA. His
result was positive. What is the best course of action that you may take?
A. Get a thorough history of the client, focusing on the practice of high risk behaviors.
B. Ask the client to be accompanied by a significant person before revealing the result.
C. Refer the client to the physician since he is the best person to reveal the result to the client.
D. Refer the client for a supplementary test, such as Western blot, since the ELISA result may be
false.
21. Which is the BEST control measure for AIDS?
A. Being faithful to a single sexual partner
B. Using a condom during each sexual contact
C. Avoiding sexual contact with commercial sex workers
D. Making sure that ones sexual partner does not have signs of AIDS
22. The most frequent causes of death among clients with AIDS are opportunistic diseases. Which of the
following opportunistic infections is characterized by tonsillopharyngitis?
A. Respiratory candidiasis
B. Infectious mononucleosis

44

C. Cytomegalovirus disease
D. Pneumocystis carinii pneumonia
23. To determine possible sources of sexually transmitted infections, which is the BEST method that may
be undertaken by the public health nurse?
A. Contact tracing
B. Community survey
C. Mass screening tests
D. Interview of suspects
24. Antiretroviral agents, such as AZT, are used in the management of AIDS. Which of the following is
NOT an action expected of these drugs.
A. They prolong the life of the client with AIDS.
B. They reduce the risk of opportunistic infections
C. They shorten the period of communicability of the disease.
D. They are able to bring about a cure of the disease condition.
25. A barangay had an outbreak of German measles. To prevent congenital rubella, what is the BEST
advice that you can give to women in the first trimester of pregnancy in the barangay?
A. Advice them on the signs of German measles.
B. Avoid crowded places, such as markets and moviehouses.
C. Consult at the health center where rubella vaccine may be given.
D. Consult a physician who may give them rubella immunoglobulin.
26. You were invited to be the resource person in a training class for food handlers. Which of the
following would you emphasize regarding prevention of staphylococcal food poisoning?
A. All cooking and eating utensils must be thoroughly washed.
B. Food must be cooked properly to destroy staphylococcal microorganisms.
C. Food handlers and food servers must have a negative stool examination result.
D. Proper handwashing during food preparation is the best way of preventing the condition.

45

27. In a mothers class, you discussed childhood diseases such as chicken pox. Which of the following
statements about chicken pox is correct?
A. The older one gets, the more susceptible he becomes to the complications of chicken pox.
B. A single attack of chicken pox will prevent future episodes, including conditions such as shingles.
C. To prevent an outbreak in the community, quarantine may be imposed by health authorities.
D. Chicken pox vaccine is best given when there is an impending outbreak in the community.
28. Complications to infectious parotitis (mumps) may be serious in which type of clients?
A. Pregnant women
B. Elderly clients
C. Young adult males
D. Young infants

CHN 5 PNLE Answers and Rationales

1. Answer: (B) Liver cirrhosis. The etiologic agent of schistosomiasis in the Philippines is
Schistosoma japonicum, which affects the small intestine and the liver. Liver damage is a
consequence of fibrotic reactions to schistosoma eggs in the liver.
2. Answer: (C) Proper use of sanitary toilets. The ova of the parasite get out of the human body
together with feces. Cutting the cycle at this stage is the most effective way of preventing the
spread of the disease to susceptible hosts.

46

3.

Answer: (B) II. A communal faucet or water standpost is classified as Level II.

4. Answer: (A) Use of sterile syringes and needles. Hepatitis A is transmitted through the fecal oral
route. Hepatitis B is transmitted through infected body secretions like blood and semen.
5.

Answer: (A) DPT. DPT is sensitive to freezing. The appropriate storage temperature of DPT is 2
to 8 C only. OPV and measles vaccine are highly sensitive to heat and require freezing. MMR is
not an immunization in the Expanded Program on Immunization.

6. Answer: (A) 45. To estimate the number of infants, multiply total population by 3%.
7. Answer: (B) Severe dehydration. The order of priority in the management of severe dehydration
is as follows: intravenous fluid therapy, referral to a facility where IV fluids can be initiated within
30 minutes, Oresol/nasogastric tube, Oresol/orem. When the foregoing measures are not possible
or effective, tehn urgent referral to the hospital is done.
8. Answer: (A) 3. Adequate blood supply to the area allows the return of the color of the nailbed
within 3 seconds.
9. Answer: (B) Instruct the mother to give the child Oresol. Since the child does not manifest any
other danger sign, maintenance of fluid balance and replacement of fluid loss may be done by
giving the client Oresol.
10. Answer: (B) Buccal mucosa. Kopliks spot may be seen on the mucosa of the mouth or the
throat.
11. Answer: (D) Measles. Viral conjunctivitis is transmitted by direct or indirect contact with
discharges from infected eyes. Acute poliomyelitis is spread through the fecal-oral route and
contact with throat secretions, whereas diphtheria is through direct and indirect contact with
respiratory secretions.
12. Answer: (A) Hemophilus influenzae. Hemophilus meningitis is unusual over the age of 5 years.
In developing countries, the peak incidence is in children less than 6 months of age. Morbillivirus
is the etiology of measles. Streptococcus pneumoniae and Neisseria meningitidis may cause
meningitis, but age distribution is not specific in young children.
13. Answer: (D) Zooprophylaxis. Zooprophylaxis is done by putting animals like cattle or dogs close
to windows or doorways just before nightfall. The Anopheles mosquito takes his blood meal from
the animal and goes back to its breeding place, thereby preventing infection of humans.
14. Answer: (A) Stream seeding. Stream seeding is done by putting tilapia fry in streams or other
bodies of water identified as breeding places of the Anopheles mosquito
15. Answer: (C) Destruction of breeding places of the mosquito vector. Anopheles mosquitoes
breed in slow-moving, clear water, such as mountain streams.
16. Answer: (B) Cholera. Passage of profuse watery stools is the major symptom of cholera. Both
amebic and bacillary dysentery are characterized by the presence of blood and/or mucus in the
stools. Giardiasis is characterized by fat malabsorption and, therefore, steatorrhea.

47

17. Answer: (B) S. japonicum. S. mansoni is found mostly in Africa and South America; S.
haematobium in Africa and the Middle East; and S. malayensis only in peninsular Malaysia.
18. Answer: (D) Leptospirosis. Leptospirosis is transmitted through contact with the skin or mucous
membrane with water or moist soil contaminated with urine of infected animals, like rats.
19. Answer: (C) III. Waterworks systems, such as MWSS, are classified as level III.
20. Answer: (D) Refer the client for a supplementary test, such as Western blot, since the ELISA
result may be false. A client having a reactive ELISA result must undergo a more specific test,
such as Western blot. A negative supplementary test result means that the ELISA result was false
and that, most probably, the client is not infected.
21. Answer: (A) Being faithful to a single sexual partner. Sexual fidelity rules out the possibility of
getting the disease by sexual contact with another infected person. Transmission occurs mostly
through sexual intercourse and exposure to blood or tissues.
22. Answer: (B) Infectious mononucleosis. Cytomegalovirus disease is an acute viral disease
characterized by fever, sore throat and lymphadenopathy.
23. Answer: (A) Contact tracing. Contact tracing is the most practical and reliable method of finding
possible sources of person-to-person transmitted infections, such as sexually transmitted diseases.
24. Answer: (D) They are able to bring about a cure of the disease condition. There is no known
treatment for AIDS. Antiretroviral agents reduce the risk of opportunistic infections and prolong
life, but does not cure the underlying immunodeficiency.
25. Answer: (D) Consult a physician who may give them rubella immunoglobulin. Rubella
vaccine is made up of attenuated German measles viruses. This is contraindicated in pregnancy.
Immune globulin, a specific prophylactic against German measles, may be given to pregnant
women.
26. Answer: (D) Proper handwashing during food preparation is the best way of preventing the
condition. Symptoms of this food poisoning are due to staphylococcal enterotoxin, not the
microorganisms themselves. Contamination is by food handling by persons with staphylococcal
skin or eye infections.
27. Answer: (A) The older one gets, the more susceptible he becomes to the complications of
chicken pox. Chicken pox is usually more severe in adults than in children. Complications, such
as pneumonia, are higher in incidence in adults.
28. Answer: (C) Young adult males. Epididymitis and orchitis are possible complications of mumps.
In post-adolescent males, bilateral inflammation of the testes and epididymis may cause sterility.

48

PNLE CHN / MCHN (1)

1. May arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago.
She also tells the nurse that a home pregnancy test was positive but she began to have mild cramps and is
now having moderate vaginal bleeding. During the physical examination of the client, the nurse notes that
May has a dilated cervix. The nurse determines that May is experiencing which type of abortion?
A. Inevitable
B. Incomplete
C. Threatened
D. Septic
2. Nurse Reese is reviewing the record of a pregnant client for her first prenatal visit. Which of the
following data, if noted on the clients record, would alert the nurse that the client is at risk for a
spontaneous abortion?
A. Age 36 years
B. History of syphilis
C. History of genital herpes
D. History of diabetes mellitus
3. Nurse Hazel is preparing to care for a client who is newly admitted to the hospital with a possible
diagnosis of ectopic pregnancy. Nurse Hazel develops a plan of care for the client and determines that
which of the following nursing actions is the priority?
A. Monitoring weight
B. Assessing for edema

49

C. Monitoring apical pulse

D. Monitoring temperature
4. Nurse Oliver is teaching a diabetic pregnant client about nutrition and insulin needs during pregnancy.
The nurse determines that the client understands dietary and insulin needs if the client states that the
second half of pregnancy require:
A. Decreased caloric intake
B. Increased caloric intake
C. Decreased Insulin
D. Increase Insulin
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 unassociated with this condition?
A. Excessive fetal activity.
B. Larger than normal uterus for gestational age.
C. Vaginal bleeding
D. Elevated levels of human chorionic gonadotropin.
6. A pregnant client is receiving magnesium sulfate for severe pregnancy induced hypertension (PIH). The
clinical findings that would warrant use of the antidote , calcium gluconate is:
A. Urinary output 90 cc in 2 hours.
B. Absent patellar reflexes.
C. Rapid respiratory rate above 40/min.
D. Rapid rise in blood pressure.
7. During vaginal examination of Janah who is in labor, the 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.
B. Biparietal diameter is at the level of the ischial spines.
C. Presenting part in 2 cm below the plane of the ischial spines.
D. Biparietal diameter is 2 cm above the ischial spines.

50

8. A pregnant client is receiving oxytocin (Pitocin) for induction of labor. A condition that warrant the
nurse in-charge to discontinue I.V. infusion of Pitocin is:
A. Contractions every 1 minutes lasting 70-80 seconds.
B. Maternal temperature 101.2
C. Early decelerations in the fetal heart rate.
D. Fetal heart rate baseline 140-160 bpm.
9. Calcium gluconate is being administered to a client with pregnancy induced hypertension (PIH). A
nursing action that must be initiated as the plan of care throughout injection of the drug is:
A. Ventilator assistance
B. CVP readings
C. EKG tracings
D. Continuous CPR
10. A trial for vaginal delivery after an earlier caesareans, would likely to be given to a gravida, who had:
A. First low transverse cesarean was for active herpes type 2 infections; vaginal culture at 39 weeks
pregnancy was positive.
B. First and second caesareans were for cephalopelvic disproportion.
C. First caesarean through a classic incision as a result of severe fetal distress.
D. First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex
presentation.
11.Nurse Ryan is aware that the best initial approach when trying to take a crying toddlers temperature is:
A. Talk to the mother first and then to the toddler.
B. Bring extra help so it can be done quickly.
C. Encourage the mother to hold the child.
D. Ignore the crying and screaming.
12.Baby Tina a 3 month old infant just had a cleft lip and palate repair. What should the nurse do to
prevent trauma to operative site?
A. Avoid touching the suture line, even when cleaning.

51

B. Place the baby in prone position.

C. Give the baby a pacifier.
D. Place the infants arms in soft elbow restraints.
13. Which action should nurse Marian include in the care plan for a 2 month old with heart failure?
A. Feed the infant when he cries.
B. Allow the infant to rest before feeding.
C. Bathe the infant and administer medications before feeding.
D. Weigh and bathe the infant before feeding.
14.Nurse Hazel is teaching a mother who plans to discontinue breast feeding after 5 months. The nurse
should advise her to include which foods in her infants diet?
A. Skim milk and baby food.
B. Whole milk and baby food.
C. Iron-rich formula only.
D. Iron-rich formula and baby food.
15.Mommy Linda is playing with her infant, who is sitting securely alone on the floor of the clinic. The
mother hides a toy behind her back and the infant looks for it. The nurse is aware that estimated age of the
infant would be:
A. 6 months
B. 4 months
C. 8 months
D. 10 months
16.Which of the following is the most prominent feature of public health nursing?
A. It involves providing home care to sick people who are not confined in the hospital.
B. Services are provided free of charge to people within the catchments area.
C. The public health nurse functions as part of a team providing a public health nursing services.
D. Public health nursing focuses on preventive, not curative, services.

52

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 Health Nurse. Where should she
apply?
A. Department of Health
B. Provincial Health Office
C. Regional Health Office
D. Rural Health Unit
19.Tony is aware the Chairman of the Municipal Health Board is:
A. Mayor
B. Municipal Health Officer
C. Public Health Nurse
D. Any qualified physician
20.Myra is the public health nurse in a municipality with a total population of about 20,000. There are 3
rural health midwives among the RHU personnel. How many more midwife items will the RHU need?
A. 1
B. 2
C. 3
D. The RHU does not need any more midwife item.
21.According to Freeman and Heinrich, community health nursing is a developmental service. Which of
the following best illustrates this statement?
A. The community health nurse continuously develops himself personally and professionally.

53

B. Health education and community organizing are necessary in providing community health
services.
C. Community health nursing is intended primarily for health promotion and prevention and
treatment of disease.
D. The goal of community health nursing is to provide nursing services to people in their own places
of residence.
22.Nurse Tina is aware that the disease declared through Presidential Proclamation No. 4 as a target for
eradication in the Philippines is?
A. Poliomyelitis
B. Measles
C. Rabies
D. Neonatal tetanus
23.May knows that the step in community organizing that involves training of potential leaders in the
community is:
A. Integration
B. Community organization
C. Community study
D. Core group formation
24.Beth a public health nurse takes an active role in community participation. What is the primary goal of
community organizing?
A. To educate the people regarding community health problems
B. To mobilize the people to resolve community health problems
C. To maximize the communitys resources in dealing with health problems.
D. To maximize the communitys resources in dealing with health problems.
25.Tertiary prevention is needed in which stage of the natural history of disease?
A. Pre-pathogenesis
B. Pathogenesis

54

C. Prodromal
D. Terminal
26.The nurse is caring for a primigravid client in the labor and delivery area. Which condition would
place the client at risk for disseminated intravascular coagulation (DIC)?
A. Intrauterine fetal death.
B. Placenta accreta.
C. Dysfunctional labor.
D. Premature rupture of the membranes.
27.A fullterm client is in labor. Nurse Betty is aware that the fetal heart rate would be:
A. 80 to 100 beats/minute
B. 100 to 120 beats/minute
C. 120 to 160 beats/minute
D. 160 to 180 beats/minute
28.The skin in the diaper area of a 7 month old infant is excoriated and red. Nurse Hazel should instruct
the mother to:
A. Change the diaper more often.
B. Apply talc powder with diaper changes.
C. Wash the area vigorously with each diaper change.
D. Decrease the infants fluid intake to decrease saturating diapers.
29.Nurse Carla knows that the common cardiac anomalies in children with Down Syndrome (tri-somy 21)
is:
A. Atrial septal defect
B. Pulmonic stenosis
C. Ventricular septal defect
D. Endocardial cushion defect

55

30.Malou was diagnosed with severe preeclampsia is now receiving I.V. magnesium sulfate. The adverse
effects associated with magnesium sulfate is:
A. Anemia
B. Decreased urine output
C. Hyperreflexia
D. Increased respiratory rate
31.A 23 year old client is having her menstrual period every 2 weeks that last for 1 week. This type of
menstrual pattern is bets defined by:
A. Menorrhagia
B. Metrorrhagia
C. Dyspareunia
D. Amenorrhea
32. Jannah is admitted to the labor and delivery unit. The critical laboratory result for this client would be:
A. Oxygen saturation
B. Iron binding capacity
C. Blood typing
D. Serum Calcium
33.Nurse Gina is aware that the most common condition found during the second-trimester of pregnancy
is:
A. Metabolic alkalosis
B. Respiratory acidosis
C. Mastitis
D. Physiologic anemia
34.Nurse Lynette is working in the triage area of an emergency department. She sees that several pediatric
clients arrive simultaneously. The client who needs to be treated first is:
A. A crying 5 year old child with a laceration on his scalp.

56

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

C. A 3 year old child with Down syndrome who is pale and asleep in his mothers arms.
D. A 2 year old infant with stridorous breath sounds, sitting up in his mothers arms and drooling.
35.Maureen in her third trimester arrives at the emergency room with painless vaginal bleeding. Which of
the following conditions is suspected?
A. Placenta previa
B. Abruptio placentae
C. Premature labor
D. Sexually transmitted disease
36.A young child named Richard is suspected of having pinworms. The community nurse collects a stool
specimen to confirm the diagnosis. The nurse should schedule the collection of this specimen for:
A. Just before bedtime
B. After the child has been bathe
C. Any time during the day
D. Early in the morning
37.In doing a childs admission assessment, Nurse Betty should be alert to note which signs or symptoms
of chronic lead poisoning?
A. Irritability and seizures
B. Dehydration and diarrhea
C. Bradycardia and hypotension
D. Petechiae and hematuria
38.To evaluate a womans understanding about the use of diaphragm for family planning, Nurse Trish
asks her to explain how she will use the appliance. Which response indicates a need for further health
teaching?
A. I should check the diaphragm carefully for holes every time I use it
B. I may need a different size of diaphragm if I gain or lose weight more than 20 pounds
C. The diaphragm must be left in place for atleast 6 hours after intercourse

57

D. I really need to use the diaphragm and jelly most during the middle of my menstrual cycle.
39.Hypoxia is a common complication of laryngotracheobronchitis. Nurse Oliver should frequently assess
a child with laryngotracheobronchitis for:
A. Drooling
B. Muffled voice
C. Restlessness
D. Low-grade fever
40.How should Nurse Michelle guide a child who is blind to walk to the playroom?
A. Without touching the child, talk continuously as the child walks down the hall.
B. Walk one step ahead, with the childs hand on the nurses elbow.
C. Walk slightly behind, gently guiding the child forward.
D. Walk next to the child, holding the childs hand.
41.When assessing a newborn diagnosed with ductus arteriosus, Nurse Olivia should expect that the child
most likely would have an:
A. Loud, machinery-like murmur.
B. Bluish color to the lips.
C. Decreased BP reading in the upper extremities
D. Increased BP reading in the upper extremities.
42.The reason nurse May keeps the neonate in a neutral thermal environment is that when a newborn
becomes too cool, the neonate requires:
A. Less oxygen, and the newborns metabolic rate increases.
B. More oxygen, and the newborns metabolic rate decreases.
C. More oxygen, and the newborns metabolic rate increases.
D. Less oxygen, and the newborns metabolic rate decreases.
43.Before adding potassium to an infants I.V. line, Nurse Ron must be sure to assess whether this infant
has:

58

A. Stable blood pressure

B. Patant fontanelles
C. Moros reflex
D. Voided
44.Nurse Carla should know that the most common causative factor of dermatitis in infants and younger
children is:
A. Baby oil
B. Baby lotion
C. Laundry detergent
D. Powder with cornstarch
45.During tube feeding, how far above an infants stomach should the nurse hold the syringe with
formula?
A. 6 inches
B. 12 inches
C. 18 inches
D. 24 inches
46. In a mothers class, Nurse Lhynnete discussed childhood diseases such as chicken pox. Which of the
following statements about chicken pox is correct?
A. The older one gets, the more susceptible he becomes to the complications of chicken pox.
B. A single attack of chicken pox will prevent future episodes, including conditions such as shingles.
C. To prevent an outbreak in the community, quarantine may be imposed by health authorities.
D. Chicken pox vaccine is best given when there is an impending outbreak in the community.
47.Barangay Pinoy had an outbreak of German measles. To prevent congenital rubella, what is the BEST
advice that you can give to women in the first trimester of pregnancy in the barangay Pinoy?
A. Advice them on the signs of German measles.
B. Avoid crowded places, such as markets and movie houses.

59

C. Consult at the health center where rubella vaccine may be given.

D. Consult a physician who may give them rubella immunoglobulin.
48.Myrna a public health nurse knows that to determine possible sources of sexually transmitted
infections, the BEST method that may be undertaken is:
A. Contact tracing
B. Community survey
C. Mass screening tests
D. Interview of suspects
49.A 33-year old female client came for consultation at the health center with the chief complaint of fever
for a week. Accompanying symptoms were muscle pains and body malaise. A week after the start of
fever, the client noted yellowish discoloration of his sclera. History showed that he waded in flood waters
about 2 weeks before the onset of symptoms. Based on her history, which disease condition will you
suspect?
A. Hepatitis A
B. Hepatitis B
C. Tetanus
D. Leptospirosis
50.Mickey a 3-year old client was brought to the health center with the chief complaint of severe diarrhea
and the passage of rice water stools. The client is most probably suffering from which condition?
A. Giardiasis
B. Cholera
C. Amebiasis
D. Dysentery
51.The most prevalent form of meningitis among children aged 2 months to 3 years is caused by which
microorganism?
A. Hemophilus influenzae
B. Morbillivirus
C. Steptococcus pneumoniae

60

D. Neisseria meningitidis
52.The student nurse is aware that the pathognomonic sign of measles is Kopliks spot and you may see
Kopliks spot by inspecting the:
A. Nasal mucosa
B. Buccal mucosa
C. Skin on the abdomen
D. Skin on neck
53.Angel was diagnosed as having Dengue fever. You will say that there is slow capillary refill when the
color of the nailbed that you pressed does not return within how many seconds?
A. 3 seconds
B. 6 seconds
C. 9 seconds
D. 10 seconds
54.In Integrated Management of Childhood Illness, the nurse is aware that the severe conditions generally
require urgent referral to a hospital. Which of the following severe conditions DOES NOT always require
urgent referral to a hospital?
A. Mastoiditis
B. Severe dehydration
C. Severe pneumonia
D. Severe febrile disease
55.Myrna a public health nurse will conduct outreach immunization in a barangay Masay with a
population of about 1500. The estimated number of infants in the barangay would be:
A. 45 infants
B. 50 infants
C. 55 infants
D. 65 infants

61

56.The community nurse is aware that the biological used in Expanded Program on Immunization (EPI)
should NOT be stored in the freezer?
A. DPT
B. Oral polio vaccine
C. Measles vaccine
D. MMR
57.It is the most effective way of controlling schistosomiasis in an endemic area?
A. Use of molluscicides
B. Building of foot bridges
C. Proper use of sanitary toilets
D. Use of protective footwear, such as rubber boots
58.Several clients is newly admitted and diagnosed with leprosy. Which of the following clients should be
classified as a case of multibacillary leprosy?
A. 3 skin lesions, negative slit skin smear
B. 3 skin lesions, positive slit skin smear
C. 5 skin lesions, negative slit skin smear
D. 5 skin lesions, positive slit skin smear
59.Nurses are aware that diagnosis of leprosy is highly dependent on recognition of symptoms. Which of
the following is an early sign of leprosy?
A. Macular lesions
B. Inability to close eyelids
C. Thickened painful nerves
D. Sinking of the nosebridge
60.Marie brought her 10 month old infant for consultation because of fever, started 4 days prior to
consultation. In determining malaria risk, what will you do?
A. Perform a tourniquet test.

62

B. Ask where the family resides.

C. Get a specimen for blood smear.
D. Ask if the fever is present everyday.
61.Susie brought her 4 years old daughter to the RHU because of cough and colds. Following the IMCI
assessment guide, which of the following is a danger sign that indicates the need for urgent referral to a
hospital?
A. Inability to drink
B. High grade fever
C. Signs of severe dehydration
D. Cough for more than 30 days
62.Jimmy a 2-year old child revealed baggy pants. As a nurse, using the IMCI guidelines, how will you
manage Jimmy?
A. Refer the child urgently to a hospital for confinement.
B. Coordinate with the social worker to enroll the child in a feeding program.
C. Make a teaching plan for the mother, focusing on menu planning for her child.
D. Assess and treat the child for health problems like infections and intestinal parasitism.
63.Gina is using Oresol in the management of diarrhea of her 3-year old child. She asked you what to do
if her child vomits. As a nurse you will tell her to:
A. Bring the child to the nearest hospital for further assessment.
B. Bring the child to the health center for intravenous fluid therapy.
C. Bring the child to the health center for assessment by the physician.
D. Let the child rest for 10 minutes then continue giving Oresol more slowly.
64.Nikki a 5-month old infant was brought by his mother to the health center because of diarrhea for 4 to
5 times a day. Her skin goes back slowly after a skin pinch and her eyes are sunken. Using the IMCI
guidelines, you will classify this infant in which category?
A. No signs of dehydration
B. Some dehydration

63

C. Severe dehydration
D. The data is insufficient.
65.Chris a 4-month old infant was brought by her mother to the health center because of cough. His
respiratory rate is 42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines of
assessment, his breathing is considered as:
A. Fast
B. Slow
C. Normal
D. Insignificant
66.Maylene had just received her 4th dose of tetanus toxoid. She is aware that her baby will have
protection against tetanus for
A. 1 year
B. 3 years
C. 5 years
D. Lifetime
67.Nurse Ron is aware that unused BCG should be discarded after how many hours of reconstitution?
A. 2 hours
B. 4 hours
C. 8 hours
D. At the end of the day
68.The nurse explains to a breastfeeding mother that breast milk is sufficient for all of the babys nutrient
needs only up to:
A. 5 months
B. 6 months
C. 1 year
D. 2 years

64

69.Nurse Ron is aware that the gestational age of a conceptus that is considered viable (able to live
outside the womb) is:
A. 8 weeks
B. 12 weeks
C. 24 weeks
D. 32 weeks
70.When teaching parents of a neonate the proper position for the neonates sleep, the nurse Patricia
stresses the importance of placing the neonate on his back to reduce the risk of which of the following?
A. Aspiration
B. Sudden infant death syndrome (SIDS)
C. Suffocation
D. Gastroesophageal reflux (GER)
71.Which finding might be seen in baby James a neonate suspected of having an infection?
A. Flushed cheeks
B. Increased temperature
C. Decreased temperature
D. Increased activity level
72.Baby Jenny who is small-for-gestation is at increased risk during the transitional period for which
complication?
A. Anemia probably due to chronic fetal hyposia
B. Hyperthermia due to decreased glycogen stores
C. Hyperglycemia due to decreased glycogen stores
D. Polycythemia probably due to chronic fetal hypoxia
73.Marjorie has just given birth at 42 weeks gestation. When the nurse assessing the neonate, which
physical finding is expected?
A. A sleepy, lethargic baby

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B. Lanugo covering the body

C. Desquamation of the epidermis
D. Vernix caseosa covering the body
74.After reviewing the Myrnas maternal history of magnesium sulfate during labor, which condition
would nurse Richard anticipate as a potential problem in the neonate?
A. Hypoglycemia
B. Jitteriness
C. Respiratory depression
D. Tachycardia
75.Which symptom would indicate the Baby Alexandra was adapting appropriately to extra-uterine life
without difficulty?
A. Nasal flaring
B. Light audible grunting
C. Respiratory rate 40 to 60 breaths/minute
D. Respiratory rate 60 to 80 breaths/minute
76. When teaching umbilical cord care for Jennifer a new mother, the nurse Jenny would include which
information?
A. Apply peroxide to the cord with each diaper change
B. Cover the cord with petroleum jelly after bathing
C. Keep the cord dry and open to air
D. Wash the cord with soap and water each day during a tub bath.
77.Nurse John is performing an assessment on a neonate. Which of the following findings is considered
common in the healthy neonate?
A. Simian crease
B. Conjunctival hemorrhage
C. Cystic hygroma

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D. Bulging fontanelle
78.Dr. Esteves decides to artificially rupture the membranes of a mother who is on labor. Following this
procedure, the nurse Hazel checks the fetal heart tones for which the following reasons?
A. To determine fetal well-being.
B. To assess for prolapsed cord
C. To assess fetal position
D. To prepare for an imminent delivery.
79.Which of the following would be least likely to indicate anticipated bonding behaviors by new
parents?
A. The parents willingness to touch and hold the new born.
B. The parents expression of interest about the size of the new born.
C. The parents indication that they want to see the newborn.
D. The parents interactions with each other.
80.Following a precipitous delivery, examination of the clients vagina reveals
a fourth-degree laceration. Which of the following would be contraindicated when caring for this client?
A. Applying cold to limit edema during the first 12 to 24 hours.
B. Instructing the client to use two or more peripads to cushion the area.
C. Instructing the client on the use of sitz baths if ordered.
D. Instructing the client about the importance of perineal (kegel) exercises.
81. A pregnant woman accompanied by her husband, seeks admission to the labor and delivery area. She
states that shes in labor and says she attended the facility clinic for prenatal care. Which question should
the nurse Oliver ask her first?
A. Do you have any chronic illnesses?
B. Do you have any allergies?
C. What is your expected due date?
D. Who will be with you during labor?
82.A neonate begins to gag and turns a dusky color. What should the nurse do first?

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A. Calm the neonate.

B. Notify the physician.
C. Provide oxygen via face mask as ordered
D. Aspirate the neonates nose and mouth with a bulb syringe.
83. When a client states that her water broke, which of the following actions would be inappropriate for
the nurse to do?
A. Observing the pooling of straw-colored fluid.
B. Checking vaginal discharge with nitrazine paper.
C. Conducting a bedside ultrasound for an amniotic fluid index.
D. Observing for flakes of vernix in the vaginal discharge.
84. A baby girl is born 8 weeks premature. At birth, she has no spontaneous respirations but is
successfully resuscitated. Within several hours she develops respiratory grunting, cyanosis, tachypnea,
nasal flaring, and retractions. Shes diagnosed with respiratory distress syndrome, intubated, and placed
on a ventilator. Which nursing action should be included in the babys plan of care to prevent retinopathy
of prematurity?
A. Cover his eyes while receiving oxygen.
B. Keep her body temperature low.
C. Monitor partial pressure of oxygen (Pao2) levels.
D. Humidify the oxygen.
85. Which of the following is normal newborn calorie intake?
A. 110 to 130 calories per kg.
B. 30 to 40 calories per lb of body weight.
C. At least 2 ml per feeding
D. 90 to 100 calories per kg
86. Nurse John is knowledgeable that usually individual twins will grow appropriately and at the same
rate as singletons until how many weeks?
A. 16 to 18 weeks

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B. 18 to 22 weeks
C. 30 to 32 weeks
D. 38 to 40 weeks
87. Which of the following classifications applies to monozygotic twins for whom the cleavage of the
fertilized ovum occurs more than 13 days after fertilization?
A. conjoined twins
B. diamniotic dichorionic twins
C. diamniotic monochorionic twin
D. monoamniotic monochorionic twins
88. Tyra experienced painless vaginal bleeding has just been diagnosed as having a placenta previa.
Which of the following procedures is usually performed to diagnose placenta previa?
A. Amniocentesis
B. Digital or speculum examination
C. External fetal monitoring
D. Ultrasound
89. Nurse Arnold knows that the following changes in respiratory functioning during pregnancy is
considered normal:
A. Increased tidal volume
B. Increased expiratory volume
C. Decreased inspiratory capacity
D. Decreased oxygen consumption
90. Emily has gestational diabetes and it is usually managed by which of the following therapy?
A. Diet
B. Long-acting insulin
C. Oral hypoglycemic
D. Oral hypoglycemic drug and insulin

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91. Magnesium sulfate is given to Jemma with preeclampsia to prevent which of the following condition?
A. Hemorrhage
B. Hypertension
C. Hypomagnesemia
D. Seizure
92. Cammile with sickle cell anemia has an increased risk for having a sickle cell crisis during pregnancy.
Aggressive management of a sickle cell crisis includes which of the following measures?
A. Antihypertensive agents
B. Diuretic agents
C. I.V. fluids
D. Acetaminophen (Tylenol) for pain
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 physicians 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

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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
98. Celeste who used heroin during her pregnancy delivers a neonate. When assessing the neonate, the
nurse Lhynnette expects to find:
A. Lethargy 2 days after birth.
B. Irritability and poor sucking.
C. A flattened nose, small eyes, and thin lips.
D. Congenital defects such as limb anomalies.
99. The uterus returns to the pelvic cavity in which of the following time frames?
A. 7th to 9th day postpartum.
B. 2 weeks postpartum.
C. End of 6th week postpartum.
D. When the lochia changes to alba.

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100. Maureen, a primigravida client, age 20, has just completed a difficult, forceps-assisted delivery of
twins. Her labor was unusually long and required oxytocin (Pitocin) augmentation. The nurse whos
caring for her should stay alert for:
A. Uterine inversion
B. Uterine atony
C. Uterine involution
D. Uterine discomfort

PNLE CHN / MCHN (1) Answers and Rationales

1. Answer: (A) Inevitable. An inevitable abortion is termination of pregnancy that cannot be
prevented. Moderate to severe bleeding with mild cramping and cervical dilation would be noted
in this type of abortion.

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2. Answer: (B) History of syphilis. Maternal infections such as syphilis, toxoplasmosis, and rubella
are causes of spontaneous abortion.
3. Answer: (C) Monitoring apical pulse. Nursing care for the client with a possible ectopic
pregnancy is focused on preventing or identifying hypovolemic shock and controlling pain. An
elevated pulse rate is an indicator of shock.
4. Answer: (B) Increased caloric intake. Glucose crosses the placenta, but insulin does not. High
fetal demands for glucose, combined with the insulin resistance caused by hormonal changes in
the last half of pregnancy can result in elevation of maternal blood glucose levels. This increases
the mothers demand for insulin and is referred to as the diabetogenic effect of pregnancy.
5. Answer: (A) Excessive fetal activity. The most common signs and symptoms of hydatidiform
mole includes elevated levels of human chorionic gonadotropin, vaginal bleeding, larger than
normal uterus for gestational age, failure to detect fetal heart activity even with sensitive
instruments, excessive nausea and vomiting, and early development of pregnancy-induced
hypertension. Fetal activity would not be noted.
6. Answer: (B) Absent patellar reflexes. Absence of patellar reflexes is an indicator
of hypermagnesemia, which requires administration of calcium gluconate.
7. Answer: (C) Presenting part in 2 cm below the plane of the ischial spines. Fetus at station plus
two indicates that the presenting part is 2 cm below the plane of the ischial spines.
8. Answer: (A) Contractions every 1 minutes lasting 70-80 seconds. Contractions every 1
minutes lasting 70-80 seconds, is indicative of hyperstimulation of the uterus, which could result
in injury to the mother and the fetus if Pitocin is not discontinued.
9. Answer: (C) EKG tracings. A potential side effect of calcium gluconate administration is cardiac
arrest. Continuous monitoring of cardiac activity (EKG) throught administration of calcium
gluconate is an essential part of care.
10. Answer: (D) First low transverse caesarean was for breech position. Fetus in this pregnancy
is in a vertex presentation. This type of client has no obstetrical indication for a caesarean
section as she did with her first caesarean delivery.
11. Answer: (A) Talk to the mother first and then to the toddler. When dealing with a crying
toddler, the best approach is to talk to the mother and ignore the toddler first. This approach helps
the toddler get used to the nurse before she attempts any procedures. It also gives the toddler an
opportunity to see that the mother trusts the nurse.
12. Answer: (D) Place the infants arms in soft elbow restraints. Soft restraints from the upper arm
to the wrist prevent the infant from touching her lip but allow him to hold a favorite item such as a
blanket. Because they could damage the operative site, such as objects as pacifiers, suction
catheters, and small spoons shouldnt be placed in a babys mouth after cleft repair. A baby in a
prone position may rub her face on the sheets and traumatize the operative site. The suture line
should be cleaned gently to prevent infection, which could interfere with healing and damage the
cosmetic appearance of the repair.

73

13. Answer: (B) Allow the infant to rest before feeding. Because feeding requires so much energy,
an infant with heart failure should rest before feeding.
14. Answer: (C) Iron-rich formula only. The infants at age 5 months should receive iron-rich
formula and that they shouldnt receive solid food, even baby food until age 6 months.
15. Answer: (D) 10 months. A 10 month old infant can sit alone and understands object permanence,
so he would look for the hidden toy. At age 4 to 6 months, infants cant sit securely alone. At age 8
months, infants can sit securely alone but cannot understand the permanence of objects.
16. Answer: (D) Public health nursing focuses on preventive, not curative, services. The
catchments area in PHN consists of a residential community, many of whom are well individuals
who have greater need for preventive rather than curative services.
17. Answer: (B) Efficiency. Efficiency is determining whether the goals were attained at the least
possible cost.
18. Answer: (D) Rural Health Unit. R.A. 7160 devolved basic health services to local government
units (LGUs ). The public health nurse is an employee of the LGU.
19. Answer: (A) Mayor. The local executive serves as the chairman of the Municipal Health Board.
20. Answer: (A) 1. Each rural health midwife is given a population assignment of about 5,000.
21. Answer: (B) Health education and community organizing are necessary in providing
community health services. The community health nurse develops the health capability of people
through health education and community organizing activities.
22. Answer: (B) Measles. Presidential Proclamation No. 4 is on the Ligtas Tigdas Program.
23. Answer: (D) Core group formation. In core group formation, the nurse is able to transfer the
technology of community organizing to the potential or informal community leaders through a
training program.
24. Answer: (D) To maximize the communitys resources in dealing with health
problems. Community organizing is a developmental service, with the goal of developing the
peoples self-reliance in dealing with community health problems. A, B and C are objectives of
contributory objectives to this goal.
25. Answer: (D) Terminal. Tertiary prevention involves rehabilitation, prevention of permanent
disability and disability limitation appropriate for convalescents, the disabled, complicated cases
and the terminally ill (those in the terminal stage of a disease).
26. Answer: (A) Intrauterine fetal death. Intrauterine fetal death, abruptio placentae, septic shock,
and amniotic fluid embolism may trigger normal clotting mechanisms; if clotting factors are
depleted, DIC may occur. Placenta accreta, dysfunctional labor, and premature rupture of the
membranes arent associated with DIC.

74

27. Answer: (C) 120 to 160 beats/minute. A rate of 120 to 160 beats/minute in the fetal heart
appropriate for filling the heart with blood and pumping it out to the system.
28. Answer: (A) Change the diaper more often. Decreasing the amount of time the skin comes
contact with wet soiled diapers will help heal the irritation.
29. Answer: (D) Endocardial cushion defect. Endocardial cushion defects are seen most in children
with Down syndrome, asplenia, or polysplenia.
30. Answer: (B) Decreased urine output. Decreased urine output may occur in clients receiving I.V.
magnesium and should be monitored closely to keep urine output at greater than 30 ml/hour,
because magnesium is excreted through the kidneys and can easily accumulate to toxic levels.
31. Answer: (A) Menorrhagia. Menorrhagia is an excessive menstrual period.
32. Answer: (C) Blood typing. Blood type would be a critical value to have because the risk of blood
loss is always a potential complication during the labor and delivery process. Approximately 40%
of a womans cardiac output is delivered to the uterus, therefore, blood loss can occur quite rapidly
in the event of uncontrolled bleeding.
33. Answer: (D) Physiologic anemia. Hemoglobin values and hematocrit decrease during pregnancy
as the increase in plasma volume exceeds the increase in red blood cell production.
34. Answer: (D) A 2 year old infant with stridorous breath sounds, sitting up in his mothers
arms and drooling. The infant with the airway emergency should be treated first, because of the
risk of epiglottitis.
35. Answer: (A) Placenta previa. Placenta previa with painless vaginal bleeding.
36. Answer: (D) Early in the morning. Based on the nurses knowledge of microbiology, the
specimen should be collected early in the morning. The rationale for this timing is that, because
the female worm lays eggs at night around the perineal area, the first bowel movement of the day
will yield the best results. The specific type of stool specimen used in the diagnosis of pinworms is
called the tape test.
37. Answer: (A) Irritability and seizures. Lead poisoning primarily affects the CNS, causing
increased intracranial pressure. This condition results in irritability and changes in level of
consciousness, as well as seizure disorders, hyperactivity, and learning disabilities.
38. Answer: (D) I really need to use the diaphragm and jelly most during the middle of my
menstrual cycle. The woman must understand that, although the fertile period is
approximately mid-cycle, hormonal variations do occur and can result in early or late ovulation.
To be effective, the diaphragm should be inserted before every intercourse.
39. Answer: (C) Restlessness. In a child, restlessness is the earliest sign of hypoxia. Late signs of
hypoxia in a child are associated with a change in color, such as pallor or cyanosis.
40. Answer: (B) Walk one step ahead, with the childs hand on the nurses elbow. This procedure
is generally recommended to follow in guiding a person who is blind.

75

41. Answer: (A) Loud, machinery-like murmur. A loud, machinery-like murmur is a characteristic
finding associated with patent ductus arteriosus.
42. Answer: (C) More oxygen, and the newborns metabolic rate increases. When cold, the infant
requires more oxygen and there is an increase in metabolic rate. Non-shievering thermogenesis is
a complex process that increases the metabolic rate and rate of oxygen consumption, therefore, the
newborn increase heat production.
43. Answer: (D) Voided. Before administering potassium I.V. to any client, the nurse must first check
that the clients kidneys are functioning and that the client is voiding. If the client is not voiding,
the nurse should withhold the potassium and notify the physician.
44. Answer: (C) Laundry detergent. Eczema or dermatitis is an allergic skin reaction caused by an
offending allergen. The topical allergen that is the most common causative factor is laundry
detergent.
45. Answer: (A) 6 inches. This distance allows for easy flow of the formula by gravity, but the flow
will be slow enough not to overload the stomach too rapidly.
46. Answer: (A) The older one gets, the more susceptible he becomes to the complications of
chicken pox. Chicken pox is usually more severe in adults than in children. Complications, such
as pneumonia, are higher in incidence in adults.
47. Answer: (D) Consult a physician who may give them rubella immunoglobulin. Rubella
vaccine is made up of attenuated German measles viruses. This is contraindicated in pregnancy.
Immune globulin, a specific prophylactic against German measles, may be given to pregnant
women.
48. Answer: (A) Contact tracing. Contact tracing is the most practical and reliable method of finding
possible sources of person-to-person transmitted infections, such as sexually transmitted diseases.
49. Answer: (D) Leptospirosis. Leptospirosis is transmitted through contact with the skin or mucous
membrane with water or moist soil contaminated with urine of infected animals, like rats.
50. Answer: (B) Cholera. Passage of profuse watery stools is the major symptom of cholera. Both
amebic and bacillary dysentery are characterized by the presence of blood and/or mucus in the
stools. Giardiasis is characterized by fat malabsorption and, therefore, steatorrhea.
51. Answer: (A) Hemophilus influenzae. Hemophilus meningitis is unusual over the age of 5 years.
In developing countries, the peak incidence is in children less than 6 months of age. Morbillivirus
is the etiology of measles. Streptococcus pneumoniae and Neisseria meningitidis may cause
meningitis, but age distribution is not specific in young children.
52. Answer: (B) Buccal mucosa. Kopliks spot may be seen on the mucosa of the mouth or the
throat.
53. Answer: (A) 3 seconds. Adequate blood supply to the area allows the return of the color of the
nailbed within 3 seconds.

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54. Answer: (B) Severe dehydration. The order of priority in the management of severe dehydration
is as follows: intravenous fluid therapy, referral to a facility where IV fluids can be initiated within
30 minutes, Oresol or nasogastric tube. When the foregoing measures are not possible or effective,
then urgent referral to the hospital is done.
55. Answer: (A) 45 infants. To estimate the number of infants, multiply total population by 3%.
56. Answer: (A) DPT. DPT is sensitive to freezing. The appropriate storage temperature of DPT is 2
to 8 C only. OPV and measles vaccine are highly sensitive to heat and require freezing. MMR is
not an immunization in the Expanded Program on Immunization.
57. Answer: (C) Proper use of sanitary toilets. The ova of the parasite get out of the human body
together with feces. Cutting the cycle at this stage is the most effective way of preventing the
spread of the disease to susceptible hosts.
58. Answer: (D) 5 skin lesions, positive slit skin smear. A multibacillary leprosy case is one who has
a positive slit skin smear and at least 5 skin lesions.
59. Answer: (C) Thickened painful nerves. The lesion of leprosy is not macular. It is characterized
by a change in skin color (either reddish or whitish) and loss of sensation, sweating and hair
growth over the lesion. Inability to close the eyelids (lagophthalmos) and sinking of the
nosebridge are late symptoms.
60. Answer: (B) Ask where the family resides. Because malaria is endemic, the first question to
determine malaria risk is where the clients family resides. If the area of residence is not a known
endemic area, ask if the child had traveled within the past 6 months, where she was brought and
whether she stayed overnight in that area.
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 or more of the following signs: not able to feed or drink, vomits
everything, convulsions, abnormally sleepy or difficult to awaken.
62. Answer: (A) Refer the child urgently to a hospital for confinement. Baggy pants is a sign of
severe marasmus. The best management is urgent referral to a hospital.
63. Answer: (D) Let the child rest for 10 minutes then continue giving Oresol more slowly. If the
child vomits persistently, that is, he vomits everything that he takes in, he has to be referred
urgently to a hospital. Otherwise, vomiting is managed by letting the child rest for 10 minutes and
then continuing with Oresol administration. Teach the mother to give Oresol more slowly.
64. Answer: (B) Some dehydration. Using the assessment guidelines of IMCI, a child (2 months to 5
years old) with diarrhea is classified as having SOME DEHYDRATION if he shows 2 or more of
the following signs: restless or irritable, sunken eyes, the skin goes back slow after a skin pinch.
65. Answer: (C) Normal. In IMCI, a respiratory rate of 50/minute or more is fast breathing for an
infant aged 2 to 12 months.

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66. Answer: (A) 1 year. The baby will have passive natural immunity by placental transfer of
antibodies. The mother will have active artificial immunity lasting for about 10 years. 5 doses will
give the mother lifetime protection.
67. Answer: (B) 4 hours. While the unused portion of other biologicals in EPI may be given until the
end of the day, only BCG is discarded 4 hours after reconstitution. This is why BCG immunization
is scheduled only in the morning.
68. Answer: (B) 6 months. After 6 months, the babys nutrient needs, especially the babys iron
requirement, can no longer be provided by mothers milk alone.
69. Answer: (C) 24 weeks. At approximately 23 to 24 weeks gestation, the lungs are developed
enough to sometimes maintain extrauterine life. The lungs are the most immature system during
the gestation period. Medical care for premature labor begins much earlier (aggressively at 21
weeks gestation)
70. Answer: (B) Sudden infant death syndrome (SIDS). Supine positioning is recommended to
reduce the risk of SIDS in infancy. The risk of aspiration is slightly increased with the supine
position. Suffocation would be less likely with an infant supine than prone and the position for
GER requires the head of the bed to be elevated.
71. Answer: (C) Decreased temperature. Temperature instability, especially when it results in a low
temperature in the neonate, may be a sign of infection. The neonates color often changes with an
infection process but generally becomes ashen or mottled. The neonate with an infection will
usually show a decrease in activity level or lethargy.
72. Answer: (D) Polycythemia probably due to chronic fetal hypoxia. The small-for-gestation
neonate is at risk for developing polycythemia during the transitional period in an attempt to
decreasehypoxia. The neonates are also at increased risk for developing hypoglycemia and
hypothermia due to decreased glycogen stores.
73. Answer: (C) Desquamation of the epidermis. Postdate fetuses lose the vernix caseosa, and the
epidermis may become desquamated. These neonates are usually very alert. Lanugo is missing in
the postdate neonate.
74. Answer: (C) Respiratory depression. Magnesium sulfate crosses the placenta and adverse
neonatal effects are respiratory depression, hypotonia, and bradycardia. The serum blood sugar
isnt affected by magnesium sulfate. The neonate would be floppy, not jittery.
75. Answer: (C) Respiratory rate 40 to 60 breaths/minute. A respiratory rate 40 to 60
breaths/minute is normal for a neonate during the transitional period. Nasal flaring, respiratory rate
more than 60 breaths/minute, and audible grunting are signs of respiratory distress.
76. Answer: (C) Keep the cord dry and open to air. Keeping the cord dry and open to air helps
reduce infection and hastens drying. Infants arent given tub bath but are sponged off until the cord
falls off. Petroleum jelly prevents the cord from drying and encourages infection. Peroxide could
be painful and isnt recommended.

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77. Answer: (B) Conjunctival hemorrhage. Conjunctival hemorrhages are commonly seen in
neonates secondary to the cranial pressure applied during the birth process. Bulging fontanelles are
a sign of intracranial pressure. Simian creases are present in 40% of the neonates with trisomy 21.
Cystic hygroma is a neck mass that can affect the airway.
78. Answer: (B) To assess for prolapsed cord. After a client has an amniotomy, the nurse should
assure that the cord isnt prolapsed and that the baby tolerated the procedure well. The most
effective way to do this is to check the fetal heart rate. Fetal well-being is assessed via a nonstress
test. Fetal position is determined by vaginal examination. Artificial rupture of membranes doesnt
indicate an imminent delivery.
79. Answer: (D) The parents interactions with each other. Parental interaction will provide the
nurse with a good assessment of the stability of the familys home life but it has no indication for
parental bonding. Willingness to touch and hold the newborn, expressing interest about the
newborns size, and indicating a desire to see the newborn are behaviors indicating parental
bonding.
80. Answer: (B) Instructing the client to use two or more peripads to cushion the area. Using two
or more peripads would do little to reduce the pain or promote perineal healing. Cold applications,
sitz baths, and Kegel exercises are important measures when the client has a fourth-degree
laceration.
81. Answer: (C) What is your expected due date? When obtaining the history of a client who
may be in labor, the nurses highest priority is to determine her current status, particularly her due
date, gravidity, and parity. Gravidity and parity affect the duration of labor and the potential for
labor complications. Later, the nurse should ask about chronic illnesses, allergies, and support
persons.
82. Answer: (D) Aspirate the neonates nose and mouth with a bulb syringe. The nurses first
action should be to clear the neonates airway with a bulb syringe. After the airway is clear and the
neonates color improves, the nurse should comfort and calm the neonate. If the problem recurs or
the neonates color doesnt improve readily, the nurse should notify the physician. Administering
oxygen when the airway isnt clear would be ineffective.
83. Answer: (C) Conducting a bedside ultrasound for an amniotic fluid index. It isnt within a
nurses scope of practice to perform and interpret a bedside ultrasound under these conditions and
without specialized training. Observing for pooling of straw-colored fluid, checking vaginal
discharge with nitrazine paper, and observing for flakes of vernix are appropriate assessments for
determining whether a client has ruptured membranes.
84. Answer: (C) Monitor partial pressure of oxygen (Pao2) levels. Monitoring PaO2 levels and
reducing the oxygen concentration to keep PaO2 within normal limits reduces the risk of
retinopathy of prematurity in a premature infant receiving oxygen. Covering the infants eyes and
humidifying the oxygen dont reduce the risk of retinopathy of prematurity. Because cooling
increases the risk of acidosis, the infant should be kept warm so that his respiratory distress isnt
aggravated.
85. Answer: (A) 110 to 130 calories per kg. Calories per kg is the accepted way of determined
appropriate nutritional intake for a newborn. The recommended calorie requirement is 110 to 130

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calories per kg of newborn body weight. This level will maintain a consistent blood glucose level
and provide enough calories for continued growth and development.
86. Answer: (C) 30 to 32 weeks. Individual twins usually grow at the same rate as singletons until 30
to 32 weeks gestation, then twins dont gain weight as rapidly as singletons of the same
gestational age. The placenta can no longer keep pace with the nutritional requirements of both
fetuses after 32 weeks, so theres some growth retardation in twins if they remain in utero at 38 to
40 weeks.
87. Answer: (A) conjoined twins. The type of placenta that develops in monozygotic twins depends
on the time at which cleavage of the ovum occurs. Cleavage in conjoined twins occurs more than
13 days after fertilization. Cleavage that occurs less than 3 day after fertilization results in
diamniotic dicchorionic twins. Cleavage that occurs between days 3 and 8 results in diamniotic
monochorionic twins. Cleavage that occurs between days 8 to 13 result in monoamniotic
monochorionic twins.
88. Answer: (D) Ultrasound. Once the mother and the fetus are stabilized, ultrasound evaluation of
the placenta should be done to determine the cause of the bleeding. Amniocentesis is
contraindicated in placenta previa. A digital or speculum examination shouldnt be done as this
may lead to severe bleeding or hemorrhage. External fetal monitoring wont detect a placenta
previa, although it will detect fetal distress, which may result from blood loss or placenta
separation.
89. Answer: (A) Increased tidal volume. A pregnant client breathes deeper, which increases the tidal
volume of gas moved in and out of the respiratory tract with each breath. The expiratory volume
and residual volume decrease as the pregnancy progresses. The inspiratory capacity increases
during pregnancy. The increased oxygen consumption in the pregnant client is 15% to 20% greater
than in the nonpregnant state.
90. Answer: (A) Diet. Clients with gestational diabetes are usually managed by diet alone to control
their glucose intolerance. Oral hypoglycemic drugs are contraindicated in pregnancy. Long-acting
insulin usually isnt needed for blood glucose control in the client with gestational diabetes.
91. Answer: (D) Seizure. The anticonvulsant mechanism of magnesium is believes to depress seizure
foci in the brain and peripheral neuromuscular blockade. Hypomagnesemia isnt a complication of
preeclampsia. Antihypertensive drug other than magnesium are preferred for sustained
hypertension. Magnesium doesnt help prevent hemorrhage in preeclamptic clients.
92. Answer: (C) I.V. fluids. A sickle cell crisis during pregnancy is usually managed by exchange
transfusion oxygen, and L.V. Fluids. The client usually needs a stronger analgesic than
acetaminophen to control the pain of a crisis. Antihypertensive drugs usually arent necessary.
Diuretic wouldnt be used unless fluid overload resulted.
93. Answer: (A) Calcium gluconate (Kalcinate). Calcium gluconate is the antidote for magnesium
toxicity. Ten milliliters of 10% calcium gluconate is given L.V. push over 3 to 5 minutes.
Hydralazine is given for sustained elevated blood pressure in preeclamptic clients. Rho (D)
immune globulin is given to women with Rh-negative blood to prevent antibody formation from
RH-positive conceptions. Naloxone is used to correct narcotic toxicity.

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94. Answer: (B) An indurated wheal over 10 mm in diameter 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 72
hours. The area must be a raised wheal, not a flat circumcised area to be considered positive.
95. Answer: (C) Pyelonephritis. The symptoms indicate acute pyelonephritis, a serious condition in
a pregnant client. UTI symptoms include dysuria, urgency, frequency, and suprapubic tenderness.
Asymptomatic bacteriuria doesnt cause symptoms. Bacterial vaginosis causes milky white
vaginal discharge but no systemic symptoms.
96. Answer: (B) Rh-positive fetal blood crosses into maternal blood, stimulating maternal
antibodies. Rh isoimmunization occurs when Rh-positive fetal blood cells cross into the maternal
circulation and stimulate maternal antibody production. In subsequent pregnancies with Rhpositive fetuses, maternal antibodies may cross back into the fetal circulation and destroy the fetal
blood cells.
97. Answer: (C) Supine position. The supine position causes compression of the clients aorta and
inferior vena cava by the fetus. This, in turn, inhibits maternal circulation, leading to maternal
hypotension and, ultimately, fetal hypoxia. The other positions promote comfort and aid labor
progress. For instance, the lateral, or side-lying, position improves maternal and fetal circulation,
enhances comfort, increases maternal relaxation, reduces muscle tension, and eliminates pressure
points. The squatting position promotes comfort by taking advantage of gravity. The standing
position also takes advantage of gravity and aligns the fetus with the pelvic angle.
98. Answer: (B) Irritability and poor sucking. Neonates of heroin-addicted mothers are physically
dependent on the drug and experience withdrawal when the drug is no longer supplied. Signs of
heroin withdrawal include irritability, poor sucking, and restlessness. Lethargy isnt associated
with neonatal heroin addiction. A flattened nose, small eyes, and thin lips are seen in infants with
fetal alcohol syndrome. Heroin use during pregnancy hasnt 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.