NURSING PRACTICE TestCOMMUNITY HEALTH NURSING AND CARE OF THE MOTHER AND CHILD

1. In a Barangay in Iloilo where there were high incidences malaria, a child was brought by her mother with on and off feeling of dryness and warm skin, temperature reached 37.5 C and above , the child has no genera; danger signs, with stiff neck, no runny nose, no measles and no other obvious cause of fever. The Child may be classified as having: A. MalariaC. Fever: Malaria unlikelyB. Fever: No MalariaD. Severe febrile disease/Malaria

2. It is understood that if a child were living in a no malaria risk area but who has presenting signs of stiff neck. The child may be classified as having:A. Severe febrile diseaseB. Fever no malariaC. MalariaD. Severe Malaria

3. You attended to a 3 year old child with measles and with eye complications. This should be treated with the following EXCEPT:A. Apply gentian violetC. Give Vitamin AB. Apply tetracycline ointmentD. Follow-up 2 days

4. In classifying dengue cases, which of the following is NOT possible classification of dengue hemorrhagic fever?A. None of theseC. Dengue Hemorrhagic Fever: unlikelyB. Sever Dengue Hemorrhagic FeverD. Dengue Hemorrhagic Fever

5. You are attending to 5 cases of dengue in 2 clusters of Barangays assigned to you. Which of the following treatment modalities SHOULD NOT be considered if the children you are attending to has severe dengue hemorrhagic fever?A. Give aspirinB. Give ORS if there is skin petechiaeC. Apply alternative plan if there is bleeding from the nose or gumsD. Prevent low blood sugar

Situation 2- Documentation is an important aspect of every nurses activity. This is a major area of responsibility which helps facilitate continuity of work within a 24 hour cycle.

6. A 26 year old mother was admitted for hyperemesis gravidarum. While taking the history of this client it would be MOST important to report which of the following?A. The client has cool lower extremity bilaterally.B. The client has diminished palpable peripheral pulses.C. The client is anxious about the effect of her condition to the baby.D. The client has allergy of shellfish

7. You are on duty and you received report from the previous shift. Which of the following clients should you attend to FIRST?A. A client who is receiving ciprofloxacin and complains of a fine macular rashB. A client who is receiving a blood transfusion and complains of a dry mouthC. A client who is scheduled to receive heparin and the PTT is 70 seconds D. A client who is receiving IV potassium and complains of burning at the IV site

8. You are reviewing the nurses notes in your clients chart. You would be MOST concerned by which of the following entries?A. Foley catheter draining clear urine and the pH is 6.5B. The client drinks 3 glasses of orange juice every dayC. The clients skin is blanched over the scapular areasD. Vital signs are within normal limits

9. You are attending to clients in your clinic. As you return to your desk you find 4 phone messages. Which of the following messages should you return FIRST?A. A client is nauseated and has vomited 6 times in the previous 24 hours.B. A client with stage II decubitus ulcer at home reports that the dressing has come off.C. A client is complaining of leg pain after walking half a mile.D. A client with cold symptoms has an oral temperature of 39.4C

10. At approximately 6PM, a nurse deployed for duty in one of the affiliate hospitals, begin to open the nurse notes for the evening shift. The last entry is noted for 1pm, and there is no signature. The MOST appropriate nursing response is to:

A. Begin charting on the next line below the last entry, inform the day nurse, to make a last entry to complete the chartB. Do not enter anything until the day nurse has been notified of the problem and returns to the unit to complete her charting.C. Review with the client the activities after 1PM, and enter what are determined to be the activities after 1PM.D. Leave approximately 3 or 4 lines for the day nurse to enter some of her missed entries and sign the chart.

Situation 3- The nurse is involved in community organizing activities of Barangay Tapat. The following questions pertain to this situation.

11. The nurse makes an ocular survey of Barangay Tapat. Upon reaching the barangay it is appropriate for her to:A. Pay a visit to the barangay captain C. Introduce self to the communityB. Encourage community involvementD. Assemble community members for a meeting

12. Carrying out the planned activities involving maximum community participation is referred to as:A. MobilizationB. IntegrationC. Community Organization D. Community assembly

13. To ensure collective participation of the people, community organization should be formed through a community assembly. The purpose of having community assemblies are the following, EXCEPT:A. Gain cooperation, pledge support and work together on their ownB. Help people i9dentify their own problemC. Plan for the solution of identified problem/sD. Undertake measures to solve existing problems of the community

14. Which of the following approaches is the BEST in applying community organization in Community Health?A. Primary Health CareC. Community-Oriented OrganizationB. Universal Health CareD. Community Development

15. Community organizing ends when the community is already self-reliant. This signals that the community organizers are now ready to pull out of the community because:A. Organizers can expand to other poor communities C. It indicates that community organization is finishedB. It can evaluate the outcomes of the programsD. It will prevent dependency of the community

Situation 4- A nurse is assigned to a community health center where the variety of experiences and the culture of the community influences the care she gives to the clients.

16. While in the community health center, you note various practices among the families you serve. Which of the following situations will be OF CONCERN to you as the nurse?A. Aling Pat applies Vicks VapoRub to the chest and back of her grandson with colds B. Mang Berting wears a copper bracelet for his rheumatoid arthritisC. Aling Lita uses Atis seeds on the hair of her granddaughter to treat lice.D. Mang Pedro gives his son various herbs everyday

17. Mr. Estrella diagnosed with Alzheimers disease, is brought to the center by his daughter to seek help regarding home care. In planning the care of Mr. Estrella priority should focus onA. Providing food rich in fiber to prevent constipation.B. Protecting the client from possible injury in his environmentC. Assisting the client to perform activities of daily living.D. Assisting all family members deal the challenges of long term care of this client.

18. You are following up a client who has cataract. The most important nursing action/instruction to implement would be toA. Advise the client to wear, dark glasses indoors and outdoors to guard v.s. sun glareB. Provide adequate lighting at home at all times. C. Instruct family not to change furniture arrangement at homeD. Advise the client to have the cataracts removed.

19. While on duty at the community health center, some clients are brought for consultation. Based on your assessment, the FIRST client to attend would be:A. Aling Tekya, with Dementia, who wanders in the streets every morning.B. Mang Miyo, 65 year old with congestive heart failure and 3+ pitting edema.C. Aling Lena, 56 year old, terminal client with weight loss (15 lbs) last month.D. Mang Ramon, 70 year old, with Parkinsons Disease and started hallucinating.

20. You are visiting a newly discharged cerebrovascular accident (CVA) client currently confined to a wheelchair for long periods of time. Your most appropriate PRIORITY intervention would be to:A. Ask the client to move his buttocks every two hours to increase blood circulation to the area.B. Prevent skin breakdown by putting a pressure relieving cushion in the seat of the wheelchair.C. Refer to physical therapist to teach client to transfer from bed to wheelchair.D. Instruct family to feed client high protein diet for better skin integrity.

Situation 5- Nurse Jen Delos Santos, initiated the organizing of the Caring Frontiers Nursing Service Company in Leyte. This was envisioned to deliver health care and various nursing services through home health care services well within the scope of nursing practice.

21. Nurse Dana is one of their Registry Officials and acts as a liaison between families and communities served by the company to actively engage on policy and social change that will support and promote family health in their province. Nurse Dana is performing what role?A. Care ProviderB. CounselorC. Client AdvocateD. Facilitator

22. Formulating and implementing a supervisory plan, monitoring and evaluating beginning nurse practitioners performance in the implementation of public health programs are what functions of a public health nurse?A. TrainerB. CoordinatorC. SupervisorD. Manager

23. As an advocate, Registry Nurse Dana places her clients rights as priority. She is aware that advocacy work involves which of the following?A. Influencing public opinionC. Coordination with the health teamB. Obtaining a general information about the communityD. Prioritizing health conditions and problems

24. According to the World Health Organization (WHO), one of the leading causes of mortality in the Philippines is which of the following?A. LeukemiaC. Malignant NeoplasmB. Heart DiseaseD. Lower respiratory tract infections

25. Registry Nurse Dana is conducting a community diagnosis composed of Demographic variables, socio-economic variables, health and illness patterns, health resources and political/leadership patterns. What type of community diagnosis is Nurse Dana conducting?A. Individualized Nursing DiagnosisC. Comprehensive Community DiagnosisB. Population Focused DiagnosisD. Problem Oriented Community Diagnosis

Situation 6- Myths and fallacies as pertain care of the birthing mothers and their newborn have been debunked resulting in the development of what is now known as Essential Intrapartum Newborn Care or EINC. The following applies.

26. On December 7, 2009, the Department of Health issued an Administrative Order implementing the ENC protocol with the goal of rapidly reducing the number of newborn deaths in the Philippines. With international standards integrated in Intrapartal care the program has now evolved into the EINC program under the guidance of the W.H.O. Now considered as myths and fallacies include:1. Use of enema to reduce the risk of infections and shorten the duration of labor.2. Shaving the pubic hair of women in labor as hygienic practice to minimize infection.3. Restricted intake of food and fluid during active labor for possible risk of aspirating gastric contents due to anesthesia4. Application of IV therapy to hydrate women dut to food and drink restrictions.5. Use of fundal pressure to help the mother in the expulsion of her fetus.6. Early amniotomy and oxytocin augmentation in order to prevent operative deliveryA. 4, 5, and 6B. none of theseC. 1, 2 and 3D. all of these

27. In the immediate care of the newborn there are also practices which were debunked as practices based on false beliefs. Which are they?1. Routine suctioning believed to be necessary to clear the babys airway and stimulate him to breathe.2. Foot printing as a means of Identification for the newborn.3. Early bathing and washing as a form of hygienic practice.4. Routine Separation (baby in the nursery while mother is in her room)5. Continuance to providing artificial feeding (starts with pre-lacteals then artificial milks substitutes)A. 2 and 5B. 1, 3 and 4C. only 2D. All of the above

28. On INTRAPARTAL CARE, one among 5 recommended practices include MATERNAL POSITIONING especially during the 1st stage of labor. The recommended practice now isA. Allow women to assume an upright position v.s. the former recumbent (supine/semi-recumbent and lateral)B. Strictly follow the traditional medical model of labor and deliveryC. Encourage women to take up the position they find most comfortable to themD. Allow women to assume any other upright position (walking, standing, sitting, kneeling) v.s. recumbent

29. On ESSENTIAL CARE OF THE NEWBORN, the three (3) new major RECOMMENDED PRACTICES are1. Practice Rooming-in2. Skin to skin contact3. Strict Handwashing of Carers handling the newborn child4. Use of partograph5. Properly timed cord clamping6. Initiation of BreastfeedingA. 1, 3 and 4B. 4, 6 and 2C. 2, 5, and 6D. 4, 5 and 1:

30. Essential Intrapartum and Newborn Care (EINC) is our countrys instrument in health addressing the challenge of the United Nations 2 out of 8 Millennium Development Goals (MDGs) targeted to be achieved by 2015. Which are these 2 MGDs?A. MDGs 3 and 6B. MDGs 4 and 5C. MDGs 1 and 2D. MDGs 7 and 8

Answers with Rationale:

1. Correct Answer: D. Signs of Very Severe Febrile Disease/Malaria includes any general danger signs and stiff neck Reference: IMCI Manual (2009 edition) p. 42. Correct Answer: A Reference: IMCI Manual (2009 edition) p. 43. Correct Answer: A. Measles with Eye Complications includes the said treatment. Application of gentian violet is for mouth ulcer Reference: IMCI Manual (2009 edition) p. 4 4. Correct Answer; D. This is not included In the classification of dengue hemorrhagic fever Reference: IMCI Manual (2009 edition) p. 45. Correct Answer: A. Aspirin has anti coagulant property that puts the patient for bleeding. 6. Correct Answer: B. Hyperemesis Gravidarum sometimes pernicious or persistent vomiting is nausea and vomiting of pregnancy ot is severe that dehydration, ketonuria and significant weight loss occur within the first week of first 12 weeks of pregnancy. The pregnant mother may is now developing shock which is characterized by thready pulse. Reference: Medical surgical Nursing by J. Black page 2456 Maternal and child health nursing page 7. Correct Answer: D Never give Potassium via Intravenous push or IM. It is given via Infusion only. Reference: Nursing Drug Handbook 2013 p. 1103 8. Correct Answer: C Detectingchanges in skin coloris challenging because there is such a wide range of skin coloration in all individuals. Subtle changes like skin blanching may occur gradually over time, or there may be a sudden onset. Blanching of skin is usually a localized reaction and may be a sign that the skin tissue is not receiving its usual blood supply due to swelling,cold, or other problems, such as insufficient blood flow through thevessels.Incorrect- Urine pH is 6.0 but a range of 4.6 to 8.0 is considered normal. 9. Correct Answer: A Patient is at risk for dehydration and fluid and electrolyte imbalance. 10. Correct Answer- B. DO NOT CHART FOR SOMEONE ELSE. Documenting for someone else should not be done; each nurse should document own abbreviations and care and be legally accountable for own entries. Reference: Nursing Fundamentals by M. Hogan p/ 73 Fundamentals of Nursing by Kozier et. Al. p.26211. Option D CORRECT. Before going to the community the nurse should conduct consultations with local government and non-government agencies/organization. Make courtesy calls to barangay officials. REFERENCE: COPAR Jimenez p.67Test Taking Strategy: Similar word and Similar Distractors (COMMUNITY)12. Option A CORRECT. MOBILIZATION is the process of generating and sustaining the active and coordinated participation of all sectors at various levels to facilitate and accelerate improvement of the situation of the community specially the vulnerable groups. It involves actual organization of people, identification of a system for doing assigned tasks.Option C INCORRECT. Community organization involves putting together a group of people to pursue a common agenda and achieve common goals.Option D INCORRECT. Integration means establishing rapport with the people in a continuing effort to imbibe community life.REFERENCE: COPAR by Jimenez13. Answer A CORRECT. Community assembly is done in order to present data gathered and in order to have an opportunity to ask the members if the problems presented and discussed were real ones. The assembly also asks which problem is resolved FIRST and what suggestions are appropriate for its solution. This particular option is part of mobilization is part MOBILIZATION.Option B, C, and D INCORRECT. These options are all planning activities in Community Assemblies.REFERENCE: Jimenez, p.11614. Option C CORRECT. Community development draws an existing human and material resources in the community to enhance self-help and social support and develop flexible system for strengthening public participation and direction of health matters. Option B INCORRECT. Primary Health Care is a practical approach to the effective provision of health services that are community-based, accessible and acceptable and sustainable at a cost which the communirtyREFERENCE- PHN White p.6015. Option C CORRECT. The main objective of phasing-out in the community after Community Organizing is for the community people to practice self-reliance, thus preventing dependency.16. Correct Answer: D. Giving various herbs put his son at risk for danger. There are suggested herbs that can utilize but it should be based on the department of health and food and drugs administration. 17. Correct Answer- B The priority with the nursing intervention to patient with Alzheimers disease is promiting safety and protecting the client from injury. Safety considerations involve protecting against injury, meeting physiologic needs and managing risk posed by the environment, including stimuli such as delusions and hallucinations. Reference: Psychiatric Nursing by S. Videbeck p. 478 18. Correct Answer: A. The nurse instructs the patient and family in applying and caring for the eye shield. Sun glasses should be worn while outdoors during the day because the eye is sensitive to light. Reference: Medical Surgical Nursing by Smeltzer et al. p. 1775 19. Correct Answer: B. Congestive Heart Failure causes either pulmonary congestion or a disturbance in the respiratory control mechanism. These problems in turn precipitate respiratory distress. Reference: Medical Surgical Nursing by J. Black page 1653 20. Correct Answer: B In using wheelchair, the primary care provider should placed a pressure relieving cushion in the seat to prevent skin breakdown. Patient experienced paralysis so Option A is not effective. Option A and D is also important but not a priority21. Correct Answer: C Liaison means Communication between two or more groups. This is a form of client advocate because it directly intervenes on the clients behalf, often influencing others. Reference: Fundamentals of Nursing page 93 22. Correct Answer: C. -As a supervisor she formulates a supervisory plan and conducts supervisory visit to implement the plan. She conducts supervisory visits using a supervisory checklist. Incorrect- A. Trainer- the PHN initiates the formulation of staff development and training programs for midwives and other auxillary workers. She does training needs assessment for theses health workers, designs the training program and conducts the collaboration with other resource person. Incorrect- B- Coordinator-bring activities or group of activities systematically into proper relation or harmony with each other. They are actively involved socially and politically to empower individuals, families and communities as an entity to initiate and maintain health promoting environments. Incorrect- D- Manager- She organizes the nursing nursing service of the local health agency. Reference: Public Health Nursing in the Philippines by NLGPN p. 37-4123. Correct Answer: D Values basic to Client advocacy: Clients have the right to expect a nurse-client relationship based on shared respect, trust, collaboration in solving problems related to health and health care needs and consideration of their thoughts and feelings. Reference: Fundamentals of nursing by Kozier et. Al p. 93 Box 5-8 24. Correct Answer: B- Heart Disease accounts for 30%, Leukemia (CANCER) accounts for 10% Reference: www. who.int25. Correct Answer: C- A comprehensive community diagnosis aims to obtain general information about the community with the intent of determining not only prevalent conditions and risk factors (epidemiologic approach) but also the socio-economic (socio-economic approachand lifestyle behaviors and attitudes that have effect on health (behavioral approach) Incorrect- D- This type responds to a particular need of a target group. Ex. A nurse is confronted with health and medical problems resulting from mining company. Since a community diagnosis investigates the community, meaning, the people and its environment the nurse precedes with the identification of the population who were affected by the hazards posed by mine tailings. Reference: Nursing Practice in the Community by A. Maglaya (5th edition) p. 152-155 26. Correct Answer- D. All of these are included Reference: Evidence Based Practices for Safe and Quality of Care for Birthing Mothers and Newborns 27. Correct Answer. D. All of these are false belief Reference: Evidence Based Practices for Safe and Quality of Care for Birthing Mothers and Newborns28. Correct Answer: C In essential newborn care, comfortable position is best for maternal positioning during the first labor. Reference: Evidence Based Practices for Safe and Quality of Care for Birthing Mothers and Newborns 29. Correct Answer: C Reference: Newborn care until the first week of life (WHO-DOH manual) 30. Correct Answer: B. Millennium Developmental Goals:1. Eradicatingextreme poverty and hunger,2. Achievinguniversal primary education,3. Promotinggender equalityandempoweringwomen,4. Reducingchild mortalityrates,5. Improvingmaternal health,6. CombatingHIV/AIDS,malaria, and other diseases,7. Ensuring environmentalsustainability, and8. Developing a global partnership for developmentReference: www. who.int

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