SAS 1

1. Florence Nightingale’s theory focused on environment. Which of

the following did she define and describe in her theory?
a. Food, air, water, elimination, and shelter
b. Ventilation, warmth, light, diet, cleanliness, and
noise c. Physical, emotional, mental and spiritual
d. Physiologic, safety, love & belongingness, self-esteem, and self
actualization

RATIO: Florence Nightingale’s Environmental Theory defined Nursing as

“the act of utilizing the patient’s environment to assist him in his recovery.”
It involves the nurse’s initiative to configure environmental settings
appropriate for the gradual restoration of the patient’s health and that
external factors associated with the patient’s surroundings affect the life or
biologic and physiologic processes and his development. The ten major
concepts of the Environment Theory, also identified as Nightingale’s Canons,
are: Ventilation and warming; Light and noise; Cleanliness of the area;
Health of houses; Bed and bedding; Personal cleanliness; Variety; Offering
hope and advice; Food and Observation.

2. In Jean Watson’s Theory of Human Caring, she has stated that nursing
is concerned with the following EXCEPT
a. Promoting health
b. Preventing illness
c. Caring for the sick
d. Identifying the basic needs

RATIO: Jean Watson’s Theory of Human Caring states that “nursing is

concerned with promoting health, preventing illness, caring for the sick, and
restoring health.”

3. According to Jean Watson, which one is central to nursing practice

and promotes health better than a simple medical cure?
a. Caring
b. Compassion
c. Dedication
d. Empathy

RATIO: According to Watson, caring is central to nursing practice and

promotes health better than a simple medical cure. She believes that a
holistic approach to health care is central to the practice of caring in
nursing.
4. In Jean Watson’s theory she has stated to focus on which of the
following?
a. Treatment of diseases
b. Rehabilitation
c. Health promotion
d. Control of environment

RATIO: Jean Watson’s theory focuses on health promotion, as well as

the treatment of diseases.

5. In Patricia Benner’s nursing theory she has described the advanced

beginner nurse as
a. They are taught general rules to help perform tasks, and their rule
governed behavior is limited and inflexible.
b. Shows acceptable performance, and has gained prior
experience in actual nursing situations.
c. Generally, has two or three years’ experience on the job in the same field.
d. Perceives and understands situations as whole parts.

RATIO: The advanced beginner shows acceptable performance, and has

gained prior experience in actual nursing situations. This helps the nurse
recognize recurring meaningful components so that principles, based on
those experiences, begin to formulate in order to guide actions.

6. How many levels of nursing experience did Patricia Benner

identify? a. 3
b. 4
c. 5
d. 7

RATIO: The theory identifies five levels of nursing experience:

novice, advanced beginner, competent, proficient, and expert.

7. According to Katie Eriksson’s nursing theory, she said to take which of

the following into use when caring for the human being in health and
suffering? a. Charity
b. Chastity
c. Comfort
d. Caritas

RATIO: According to Katie Eriksson’s nursing theory , Caritative caring

means that we take “caritas” into use when caring for the human being
in health and suffering
8. Which of the following is NOT a part of Dorothea Orem’s nursing theory?
a. The theory of self-care
b. The self-care deficit theory
c. The 21 nursing problems
d. The theory of nursing systems

RATIO: Orem’s general theory of nursing in three related parts:Theory

of self care; Theory of self care deficit and Theory of nursing system.

9. This theory from Dorothea Orem focuses on the performance or practice

of activities that individuals initiate and perform on their own behalf to
maintain life, health and well-being.
a. Theory of self-care
b. The self-care deficit theory
c. The theory of nursing systems
d. All of the above

RATIO The theory of self-care, focuses on the performance or practice of

activities that individuals perform on their own behalf. Those might be
actions to maintain one’s life and life functioning, develop oneself or correct
a health deviation or condition.

10. How many methods of helping did Dorothea Orem

identify? a. 3
b. 5
c. 7
d. 9

RATIO: Orem identified 5 methods of helping: Acting for and doing for
others; Guiding others; Supporting another; Providing an environment
promoting personal development about meet future demands; and
Teaching another

11. In Martha E. Roger’s Theory of Human Beings she defined nursing as

a. “The act of assisting others in the provision and management of self-care
to maintain or improve human functioning at home level of effectiveness.”
b. “Unique profession in that is concerned with all of the variables affecting
an individual’s response to stress.”
c. “An art and science that is humanistic and humanitarian.” D.
“Health care profession that focuses on human life processes and patterns
and emphasizes promotion of health for individuals, families, groups, and
society as a whole.”
RATIO: Rogers’ theory defined Nursing as “an art and science that is
humanistic and humanitarian. It is directed toward the unitary human and
is concerned with the nature and direction of human development. The
goal of nurses is to participate in the process of change.”

12. Which of the following sentences is NOT a concept related to Florence

Nightingale’s theory?
a. "Poor or difficult environments led to poor health and disease" b.
"Environment could be altered to improve conditions so that the natural
laws would allow healing to occur"
c. The goal of nursing is “to put the patient in the best condition for
nature to act upon him”
d. "Human beings are open systems in constant interaction with
the environment"

RATIO: Letter D is from Imogene King’s Goal Attainment theory. The rest of
the choices are related concepts to Florence Nightingale’s Theory

13. In Martha E. Roger’s the Science of Unitary Human Beings contains

two dimensions: the science of nursing, which is the knowledge specific to
the field of nursing that comes from scientific research; and
a. Art of nursing
b. Adaptation Model
c. Behavioral Systems Model
d. Carative caring

RATIO: SUHB contains two dimensions: the science of nursing, which is the
knowledge specific to the field of nursing that comes from scientific
research; and the art of nursing, which involves using the science of
nursing creatively to help better the lives of the patient.

14. What are the five variables identified in Betty Neuman’s System
model?
a. Oral, Anal, Phallic, Latent, and Genital
b. Physiologic, safety and security, love and belongingness, self-esteem, and
self actualization
c. Ventilation, warmth, light, diet, cleanliness, and noise
d.Physiological, psychological, sociocultural, developmental, and
spiritual
RATIO: The client system identified by Betty Neuman is a composite of
five variables (physiological, psychological, sociocultural, developmental,
and spiritual
15. In Betty Neuman’s model, the focus is on the client as a system
(which may be an individual, family, group, or community) and on the
client’s responses to
a. Illness
b. Stressors
c. Needs
d. Health promotion

RATIO: Neuman (1982) believes that nursing is concerned with the

whole person. She views nursing as a “unique profession in that it is
concerned with all of the variables affecting an individual’s response to
stress”

16. In Imogene King’s nursing theory, her model focuses on the

attainment on which of the following?
a. Goal
b. Well-being
c. Balanced nutrition
d. Basic needs

RATIO: The model focuses on the attainment of certain life goals. It

explains that the nurse and patient go hand-in-hand in communicating
information, set goals together, and then take actions to achieve those
goals.

17. Which of the following is the theory associated with Sister Callista Roy?
a. Behavioral System Model
b. Theory of Carative Caring
c. Adaptation Model of Nursing
d. Theory of Bureaucratic Nursing

RATIO: The Adaptation Model of Nursing is a prominent nursing theory

aiming to explain or define the provision of nursing science. In her theory,
Sister Callista Roy’s model sees the individual as a set of interrelated
systems that maintain a balance between various stimuli.

18. In Dorothy Johnson’s Behavioral System Model, she defined which of

the following statements?
a. “Nursing is a science and the performing art of nursing is practiced in
relationships with persons (individuals, groups, and communities) in their
processes of becoming.” - Parse
b. “participation in care, core and cure aspects of patient care, where
CARE is the sole function of nurses, whereas the CORE and CURE are
shared with other members of the health team.” Lydia Hall
c. “People may differ in their concept of nursing, but few would disagree
that nursing is nurturing or caring for someone in a motherly fashion.”
Ernestine Wiedenbach
d. “an external regulatory force which acts to preserve the
organization and integration of the patients’ behaviors at an
optimum level under those conditions in which the behavior
constitutes a threat to the physical or social health, or in
which illness is found.”

RATIO: Letter A is from Rosemarie Rizzo Parse’s Theory of Human

Becoming, Letter B is from LydiaHall’s Core, Care and Cure Theory, while
Letter C is from Ernestine Wiedenbach’s The Helping Art of Clinical
Nursing.

19. According to Myra Levine’s theory, she states that nursing is

a. An art
b. Human interaction
c. Concerned with promoting health, preventing illness, caring for the
sick, and restoring health.
d. Science and the performing art of nursing is practiced in relationships
with persons (individuals, groups, and communities) in their processes of
becoming.”

RATIO: Nursing is the human interaction relying on communication, rooted

in the individual human being’s organic dependency in his relationships
with other human beings.

20. In Hildegard Peplau’s Theory of Interpersonal Relations, she

has identified four components which are
a. Digestion, respiration, elimination, and sleep
b. Person, environment, health, and nursing
c. Orientation, identification, exploitation, and
resolution d. Air, food, water, and shelter

RATIO: Peplau theorized that nurse-patient relationships must pass

through three phases in order to be successful: (a) orientation, (b)
working, and (c) termination.

21. Which phase of interpersonal relations in Peplau’s Theory

of Interpersonal Relations should the nurse establish
rapport with the client?
a. Orientation
b. Identification
c. Exploitation
d. Resolution

RATIO: During the brief orientation phase, hospitalized patients realize

they need help and attempt to adjust to their current (and often new)
experiences.

22. The nursing theorist who identified the 5 stages of the nursing process is

a. Lydia Hall
b. Madeleine Leininger
c. Ida Jean Orlando
d. Imogene King

RATIO: The nursing process functions as a systematic guide to client

centered care with 5 sequential steps. These are assessment, diagnosis,
planning, implementation, and evaluation.

23. According to Joyce Travelbee’s theory, nursing is accomplished through

a. Human-to-human relationships
b. Nurse-patient relationship
c. Manipulation of the environment
d. Promoting health

RATIO: Travelbee's grand theory of Human-to-Human Relationships

provides nurses with a foundation necessary to connect therapeutically with
other human beings. The assumptions involve humans, who are nurses,
relating to humans who are suffering, are in distress, or have the potential
to suffer.

24. In Lydia Hall’s Core, Care, Cure model, she has identified the core
as which of the following?
a. Primary role of a professional nurse such as providing bodily care for the
patient
b. The patient receiving nursing care
c. The aspect of nursing which involves the administration of medications
and treatments
d. the purpose of nursing was to help and support an individual, family, or
community
RATIO: The core, according to Hall's theory, is the patient receiving
nursing care. The core has goals set by him or herself rather than by any
other person and behaves according to their feelings and values.

25. Faye Glenn Abdellah’s 21 nursing problems were categorized into which
of the following?

a. Physical, sociological, and emotional needs

b. Prevention, treatment, and rehabilitation
c. Physiological, psychological, and spiritual
d. Food, air, and water

RATIO: The 21 nursing problems fall into three categories: physical,

sociological, and emotional needs of patients; types of interpersonal
relationships between the patient and nurse; and common elements of
patient care.

SAS 2

1. Nurse Edberg is about to perform physical assessment of the

abdomen. Which order of assessment must Nurse
Edberg do?
a. Inspection, palpation, percussion, and auscultation
b. Auscultation, percussion, palpation, and inspection
c. Inspection, auscultation, percussion, and
palpation d. Any order that the nurse desires

ANSWER: C
RATIO: With abdominal assessment, you inspect first, then
auscultate, percuss, and palpate. This order is different from the
rest of the body systems, for which you inspect, then percuss,
palpate, and auscultate.

2. Nurse Ann is going to assess a newly admitted client who is suspected to

have Dengue Hemorrhagic Fever.
Which of the following should she record as subjective
data? a. Body temperature of 38.8 degrees Celsius
b. Complete blood count result
c. Patient’s complaint about abdominal pain
d. Client’s blood pressure of 110/78

ANSWER: C
 RATIO: Subjective data are information from the client's point of view
(“symptoms”), including feelings, perceptions, and concerns
obtained through interviews.

3. Which of the following is the purpose of physical

examination? a. To obtain subjective data from the patient
b. To know about the patient’s chief complaint
c. To determine changes in a patient’s health status and how to
respond to a problem as well as promote healthy lifestyles and
wellbeing
d. To evaluate the outcome of the nursing interventions

ANSWER: C
RATIO: The purpose of physical examination is to determine changes
in a patient’s health status and how to respond to a problem as well
as promote healthy lifestyles and wellbeing.

4. A student nurse is instructed to perform an intramuscular injection by

using the Z-track method. The student nurse
must know that the purpose of doing the Z-track method
is a. To enhance blood flow to the injection site
b. To allow faster absorption of the drug into the muscle
c. To prevent drug leakage into the subcutaneous tissue, helps seal
the drug in the muscle, and minimizes skin irritation. d. To allow
faster drug clearance.

ANSWER: C
RATIO: By leaving a zigzag path that seals the needle track, this
technique prevents drug leakage into the subcutaneous tissue, helps
seal the drug in the muscle, and minimizes skin irritation.

5. Nurse Aladdin Abdulrahman is reviewing the patient’s blood pressure

after administering an oral antihypertensive
30 minutes before. The nurse is employing which stage of the
nursing process?
a. Nursing diagnosis
b. Planning
c. Implementation
d. Evaluation

ANSWER: D
RATIO: The last phase of the process is the evaluation phase. This is
 where the medical professionals assess and evaluate the success of
the planning and implementation processes. This phase ensures that
the individual is making progress towards his/her goals and is
achieving the desired outcome.

6. A patient named Jasmine Allamudin is in the bathroom when Nurse Belle

enters to give a prescribed medication.
What should the nurse in charge do?
a. Wait for the patient to return to her bed then leave the medication at her
bedside.
b. Return shortly to the patient’s room and remain there until
the patient takes her medication.
c. Tell the patient to be sure to take the medication and then leave it at her
bedside.
d. Leave the medication at her patient’s bedside.

ANSWER: B
RATIO: Option B is the proper action that the nurse should
impose upon giving medications.

7. Dr. Rodrigo Robredo orders heparin, 7500 units, to be administered

subcutaneously every 6 hours. The vial reads
10000 units per milliliter. Nurse Leni should anticipate giving how
much heparin for each dose?
a. 0.25 ml
b. 0.5 ml
c. 0.75 ml
d. 1.25 ml

ANSWER: C
RATIO: 0.75 ml is anticipated to be administered to the patient as per
doctor’s order.

8. A patient named Panfilo dela Rosa is suffering from hypoxia. The

physician is most likely to order which of the
following tests?
a. Arterial blood gas analysis
b. Total hemoglobin and hematocrit
c. Chest X-ray
d. Complete blood count

ANSWER: A
 RATIO: One of the principal utilities of arterial blood gas (ABG)
analysis is to help assess blood oxygenation status. The two ABG
parameters used for this assessment are pO2(a) (partial pressure
of oxygen in arterial blood) and sO2(a) (% of total hemoglobin
that is saturated with oxygen).

9. Nurse Ishbelle uses a stethoscope to auscultate a female patient’s chest.

Which statement about the stethoscope
with the bell and the diaphragm is true?
a. The bell detects thrills best
b. The bell detects high-pitched sounds best
c. The diaphragm detects high-pitched sounds best
d. The diaphragm detects low-pitched sounds best

ANSWER: C
RATIO: The stethoscope has two different heads to receive sound,
the bell and the diaphragm. The bell is used to detect low-
frequency sounds; the diaphragm, high frequency sounds.

10. Nurse Vincent is teaching the community about the importance

of exercise to prevent the occurrence of type II
diabetes mellitus.
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Passive prevention

ANSWER: A
RATIO: Primary prevention aims to prevent disease or injury before it
ever occurs. This is done by preventing exposures to hazards that
cause disease or injury, altering unhealthy or unsafe behaviours that
can lead to disease or injury, and increasing resistance to disease or
injury should exposure occur.

11. When observing universal precaution, the nurse must always

practice which of the following to prevent the
transmission of infection?
a. Having a proper diet
b. Maintain adequate exercise
c. Taking supplemental vitamins and minerals
d. Practice hand hygiene at all times
 ANSWER: D
RATIO: Universal precautions are intended to prevent parenteral,
mucous membrane, and nonintact skin exposures of health-care
workers to bloodborne pathogens.

12. Nurse Jason is going to feed the patient via the nasogastric tube.
Which nursing action is essential in performing
enteral feeding?
a. Elevating the head of the bed
b. Positioning the patient to the left side
c. Warming the formula before administering it
d. Hanging a full day’s worth of formula at one time

ANSWER: A
RATIO: Position patient sitting up at 45 to 90 degrees (unless
contraindicated by the patient's condition), with a pillow under the
head and shoulders. This allows the NG tube to pass more easily
through the nasopharynx and into the stomach.

13. Nurse Joy is going to administer a tablet via the sublingual route.
She should instruct her patient to place the
tablet on the:
a. Inside of the cheek
b. Floor of the mouth
c. Roof of the mouth
d. Top of the tongue

ANSWER: B
RATIO: Sublingual administration involves placing a drug under your tongue
to dissolve and absorb into your blood through the tissue there
14. Which of the following best describes Kussmaul respirations? a.
Increased rate and depth of breathing over a prolonged period of
time. In response to metabolic acidosis, the body's attempt to blow
off CO2 to buffer a fixed acid such as ketones.
b. Gradual increase in volume and frequency, followed by a gradual
decrease in volume and frequency, with
apnea periods of 10 - 30 seconds between cycle.
c. Short episodes of rapid, deep inspirations followed by 10 - 30 second
apneic period.
d. Only able to breathe comfortable in upright position (such as sitting in
chair), unable to breath laying
down.
 ANSWER: A
RATIO: Your body maintains a steady pH level of 7.35 to 7.45.
When this pH level becomes higher or lower, your body has to find
ways to try make up for the pH changes. This is where Kussmaul
breathing comes in.

15. Doctor Rodrigo Robredo has ordered dextrose 5% in water, 1000 ml

to be infused over 8 hours. The I.V. tubing is
delivering 15 drops per milliliter. Nurse Bong should run the infusion rate
at: a. 15 drops per minute
b. 21 drops per minute
c. 31 drops per minute
d. 125 drops per minute

ANSWER: C
RATIO: Infusion rate is 31 drops per minute.

16. Which of the following is true about the working phase of the nurse
patient relationship?
a. Obtain subjective data
b. Make the patient comfortable
c. Greet the patient
d. Establish rapport

ANSWER: B
RATIO: Option B is true about the working phase of the nurse-patient
relationship.

17. Which of the following interventions is considered as a primary level

of prevention?
a. Using physical therapy to help the patient cope with above-the-knee
amputation.
b. Obtaining a breast biopsy to detect breast cancer
c. Administering an anti-Hepatitis B immunization to an infant
d. Administering Ceftriaxone (Rocephin) to a patient who has gonorrhea

ANSWER: C
RATIO: Option C is is considered as a primary level of prevention

18. Nurse JM is tasked to do a nursing care plan in the ward.

The identification of actual or potential health problems
is done during which step of the nursing process?
a. Assessment
b. Nursing diagnosis
c. Planning
d. Implementation

ANSWER: A
RATIO: The identification of actual or potential health
problems is done during the Assessment Phase.

19. A female patient named Mikasa Ackerman has been found to

be suffering from deep-vein thrombosis. Which
nursing diagnosis should Nurse Eren prioritize at this time? a. Altered
peripheral tissue perfusion related to venous congestion b. Risk
for injury related to edema
c. Fluid volume excess related to peripheral vascular
disease d. Impaired gas exchange related to decreased
blood flow

ANSWER: A
RATIO: Altered peripheral tissue perfusion related to venous
congestion is the priority of Nurse Eren.

20. Nurse Erina has found out that after giving proper interventions to Soma
who has fever brought about by
meningitis, the patient’s fever has not subsided yet. She is revising
patient Soma’s nursing care plan. During
which step of the nursing process does revision take
place? a. Nursing diagnosis
b. Planning
c. Evaluation
d. Assessment

ANSWER: C
RATIO: During the evaluation step of the nursing process the nurse
determines whether the goals established have been achieved, and
evaluates the success of the plan.
21. A client named Kakashi has been prescribed with diphenhydramine
(Benadryl) for his allergies. He then contacts
the nurse and complains of drowsiness after taking the medication making it
almost impossible for him to do his
work. This is an example of
a. Drug synergism
b. Side effect
c. First-pass effect

ANSWER: B
RATIO: A side effect is an unwanted symptom caused by
medical treatment. All medicines can cause side effects,
including prescription, over-the
counter and complementary medicines.

22. Doctor Eren has ordered Nurse Misaka to administer cefuroxime (Ceftin)
500 mg via IV bolus t.i.d to a patient with
acute glumerulonephritis. The nurse would expect to give the drug to be
given
a. Twice a day
b. Thrice a day
c. Once a day
d. Four times a day

ANSWER: B
RATIO: TID means thrice a day.

23. A physician orders 250 mg of an antibiotic suspension, the label on the

suspension read “500 mg/5 ml” how much
would the nurse administer?
a. 2.5 ml
b. 5 ml
c. 7.5 ml
d. 10 ml

ANSWER: A
RATIO: Option A is valid.

24. A nurse is to administer 500 mg of a drug intramuscularly. The label

on the multidose vial reads 250 mg/ml. how
much of the medication would the nurse prepare on the
syringe? a. 0.5 ml
b. 1 ml
c. 1.5 ml
d. 2 ml
ANSWER: D
RATIO: Option D is correct.

25. When assessing for the liver functioning of a patient who is

receiving hepatotoxic drugs the nurse must check
which of the following?
a. Blood urea nitrogen (BUN)
b. Creatinine clearance (CLcr)
c. Complete blood count
d. Alanine aminotransferase and aspartame aminotransferase

ANSWER: D
RATIO: ALT and AST are liver enzymes.

SAS 3

1. Which of the following statements by Nurse Stella is a great example

of the therapeutic communication technique known as giving
recognition?

a. “I’m glad that you are already taking your medication. They will help
you a lot.”

b. “I can see that you have a new dress today and it seems that
you have washed your hair.”

c. “I will sit beside you until it is time for your group session.”

d. “I’ve noticed that you did not attend the group session today. Are
you willing to talk about that?”

RATIO: Option B is an example of a therapeutic communication technique

of giving recognition.

2. A client named Rodrigo De Lima tells the nurse, “Whenever I am furious,

I always get into a fistfight with my spouse, sometimes I punch my children
as well.” The nurse states, “I have observed you smiling while you talk
about domestic violence.” The therapeutic communication technique
employed by the nurse is

a. Making observations

b. Formulating a plan of action

c. Providing general leads

d. Exploring
RATIO: As the nurse stated that she have observed the patient smiling.

3. A client named Agot tells Nurse Jinky, mo “I feel awful because my mom
does not allow me to go back home after I am discharged from the
hospital.” Which response from Nurse Jinky is therapeutic?

a. “Your mom sounds like she is an empathic person. I’ll help you talk
to her.”
b. “You feel that your mom will not allow you to return to
your home?”

c. “Why will you not speak this out with your mom? You may probably
learn that she really does not feel that way?”

d. “It’s somehow common for patients to have feelings like this after
long periods of being in the hospital.”

RATIO: This is an example of the therapeutic communication technique of

restatement. Restatement is the repeating of the main idea that the client
has verbalized. This lets the client know whether or not an expressed
statement has been understood and gives him or her the chance to
continue, or clarify if necessary.

4. Nurse Ronald is conducting an interview to a depressed patient.

Which statement from Nurse Ronald is a great example of giving
general leads?

a. “I can see that and then?”

b. “Why are you feeling so depressed right now?”

c. “Can you give me the date and time we are currently in

today?” d. “You seem so tense right now.”

RATIO: It is a therapeutic communication which the nurse gives

general leads to the patient by letting it share all of her thoughts

5. Nurse Roque has told to his patient who will undergo an major surgery,
“Don’t worry, we’ve got some great doctors here at the hospital. You’ll be in
good shape once the operation is done.” The type of non-therapeutic
technique applied in the statement is
a. Interrogation

b. Giving advice

c. False reassurance

d. Defending
RATIO: The nurse’s statements in the situation portrays false
reassurance. Giving false reassuranceindicates to the patient that there is
no cause for anxiety therefore devaluing the patient’s feelings.

6. A patient named Panfilo has had a left above-the-knee amputation after

a motor vehicular accident. Upon regaining consciousness, the patient
states, “What happened? I can’t recall anything.” What is the nurse’s initial
response?

a. “I think you will recall more about the incident as you get

better.” b. “It was necessary to amputate your leg after the

accident.” c. “You were in a motor-vehicular accident last

night.” d. “Tell me what you think happened?”

RATIO: This is truthful and gives the patient information that may
initiate recollection about the accident.

7. After giving anxiolytics, the patient says to Nurse Tina, “It seems that
you are too busy to stay with me.” How should nurse Tina respond?

a. “You’ll feel better after I’ve given you the medication.”

b. “You will be able to sleep after the drug starts to take effect.”

c. “I have to attend to other patients, however, I will be back

after 10 minutes.”

d. “I apologize but I need to attend to other patients in the ward.”

RATIO: The nurse should tell the patient that she has other thing to do
and assure that will still take care of her.

8. A patient named Historia seems tense and anxious during a nurse-

client interaction, which nursing statement belittles the patient’s feelings
and concerns?

a. “You seem to be assuming a lot of things.”

b. “I have observed that you are biting your nails again.”

c. “You seem anxious today.”

d. “Come on, I know you can do better than that.”

RATIO: This nursing statement is an example of a non-therapeutic

communication known as belittling feelings. This occurs if the nurse
misjudges the degree of the client’s discomfort showing a lack of
empathy.

9. Which of the following statements from Nurse Katrina shows a

good example of focusing?

a. “You mentioned about growing up with your mother. Let’s

discuss that further.”

b. “Your time with me today is for an hour. I’ll stay with you until

then.” c. “I’m finding it hard to understand what you mean.”

d. “Tell me one of the wonderful things that has occurred to you this week.”

RATIO: Focusing is a therapeutic communication that takes notice of a

single though or word and works with the client who is experiencing flight
of ideas or looseness of association.

10. A patient named Mocha tells the nurse, “You will not believe what my
father said to me during visiting hours. How dare he talk to me that way. I
don’t deserve any of that.” Which would be the best response by the
nurse?

a. “Describe to me what has occurred during your time with

your father.”

b. “Why do you think your father has behaved that way?”

c. “What do you think is your role in this relationship with your

father?” d. “Does your father often treat you in that manner?”

RATIO: The nurse should make sure what was the situation and why
does the father talks to the patient in that way

11. A patient named Bong is experiencing hallucinations and tells the

nurse, “I can hear voices telling me to eat a lot of soap.” Which of the
following therapeutic communication skills must the nurse employ?

a. Focusing

b. Seeking clarification
c. Present reality

d. Provide general leads

RATIO: The nurse must employ the therapeutic communication

technique known as present reality whenever a patient is experiencing
either a hallucination, illusion, or delusion.

12. When Nurse Martha visits a patient at home the patient tells her,
“I haven’t slept during the last couple of nights.”

Which of the following statements from the nurse is therapeutic for

the patient?

a. “I too have trouble sleeping sometimes.”

b. “I see that you have difficulty of sleeping.”

c. “Is that so?”

d. “I see.”

RATIO: : The nurse is employing restatement as a therapeutic

communication skill in this situation. This type of skill assists the nurse
in obtaining a more specific perception of the problem of the patients.

13. Nurse Mona is assigned 4 patients in the infectious disease ward.

Which of the following patients must Nurse Mona attend to first?

a. A 54-year old male patient who is recently diagnosed to have

pulmonary tuberculosis

b. A 66-year old female patient who has community acquired pneumonia

c. A 37-year old male patient who is diagnosed to have
Acquired Immunodeficiency Syndrome (AIDS)

d. A 24-year old female patient who is suspected to have a

streptococcus infection

RATIO: Aids is an infectious disease

14. A 7-year old child recently had German measles or rubella.

Being immune to rubella after having the disease would be
a. Natural active acquired immunity

b. Artificial active acquired immunity

c. Natural passive acquired immunity

d. Artificial passive acquired immunity

RATIO: Natural active acquired immunity is immunity that is acquired

gained through illness and recovery.

15. Nurse Susan is currently assigned to the medical ward. She is tasked
to properly practice the proper isolation techniques. Which of the following
patients should Nurse Susan place in reverse isolation?

a. A 45-year old patient who is suffering from pneumonia

b. A 28-year old patient who is diagnosed with acute

myelogenous leukemia

c. A 33-year old patient who has a diabetic foot

d. A 55-year old patient who is suffering from pulmonary tuberculosis

RATIO: patients who have leukemia are immunocompromised. The nurse

must practice reverse isolation techniquesbin order to prevent the
patient from having infection.

16. A patient named Bato who has an infected would of the head is
positive for methicillin-resistant staphylococcus aureus. Nurse Chel must
practice which of the following?

a. Standard precautions
b. Respiratory isolation

c. Reverse isolation

d. Contact Isolation

RATIO: Contact or Body Substance Isolation (BSI) involves the use of

barrier protection (e.g. gloves,mask, gown, or protective eyewear as
appropriate) whenever direct contact with any bodily fluid is expected.
When determining the type of isolation to use, one must consider the mode
of transmission.
The hands of personnel continues to be the principal mode of transmission
for methicillin resistant staphylococcus aureus (MRSA).

17. Nurse Joyce is teaching the community the best way to prevent
the transmission of infection. This is best done by teaching which of
the following to the community?

a. Proper wearing and using face masks

b. Hand hygiene

c. Cleaning the surroundings

d. Eating nutritious food

RATIO: The best way to avoid the transmission of infection is to do

hand hygiene.

18. Nurse Jessie is currently adhering to the principles of medical asepsis

when performing patient care in the hospital setting. Which nursing
action performed by the nurse follows these recommended guidelines?

a. The nurse carries the patient’s soiled bed linens close to the body
to prevent spreading microorganisms into the air.

b. The nurse places soiled bed linens and hospital gowns on the
floor when making the bed.

c. The nurse moves the patient table away from the nurse’s body
when wiping it off after a meal.

d. The nurse cleans the most soiled items in the patient’s bathroom first
and follows with the cleaner items.

RATIO: This prevents the transmission of infection if objects are held

away from the nurse’s body.

19. A 44-year old female is recently diagnosed to have pulmonary

tuberculosis. She is currently undergoing treatment at the DOTS center.
The nurse assigned to her must know that the tubercle bacilli is
transmitted in which of the following?

a. Airborne
b. Contact

c. Droplet

d. All of the above

RATIO: Infectious droplet nuclei are generated when persons who have
pulmonary or laryngeal TB disease cough, sneeze, shout, or sing. TB is
spread from person to person through the air. The dots in the air
represent droplet nuclei containing tubercle bacilli.

20. Nurse Naya is teaching the community about the importance of hand
hygiene. Which component of hand washing should the nurse include that
is most important for removing microorganisms?

a. Friction

b. Water

c. Time

d. Soap

RATIO: Lathering and scrubbing hands creates friction, which helps lift
dirt, grease, and microbes from skin.

SAS 4

SITUATION: Aling Nena, a 32year old fish vendor from Barangay Carael
came to see you at the prenatal clinic. She brought with her all her three
children. Feliza, 1 year 6 months; Loreta, 3 and Voltaire, 7 years old. She
mentioned that she stopped taking oral contraceptives several months
ago and now suspects she is pregnant. She cannot remember her LMP.

1. Which hormone is necessary for a positive pregnancy

test? a. Progesterone

b. Human chorionic gonadotropin

c. Estrogen

d. Lactogen

RATIO: A pregnancy test can tell whether you are pregnant by checking
for a particular hormone in your urine or blood. The hormone is called
human chorionic gonadotropin (HCG). HCG is made in a woman's placenta
after a fertilized egg implants in the uterus.

2. With this pregnancy, Aling Nena is a

a. P3 G3

b. Primigravida

c. P3 G4

d. P0 G3

RATIO: Gravidity is defined as the number of times that a woman has been
pregnant. Parity is defined as the number of times that she has given birth
to a fetus with a gestational age of 24 weeks or more, regardless of
whether the child was born alive or was stillborn.

3. In explaining the development of her baby, you identified in

chronological order of growth of the fetus as it occurs in pregnancy as

a. Ovum, embryo, zygote, fetus, infant

b. Zygote, ovum, embryo, fetus, infant

c. Ovum, zygote, embryo, fetus, infant

d. Zygote, ovum, fetus, embryo, infant

RATIO: The process of prenatal development occurs in three main stages.
The first two weeks after conception are known as the germinal stage, the
third through the eighth week is known as the embryonic period, and the
time from the ninth week until birth is known as the fetal period.
4. When teaching Aling Nena about her pregnancy, you should include
personal common discomforts. Which of the following is an indication
for prompt professional supervision?

a. Constipation and hemorrhoids

b. Backache

c. Facial edema

d. Frequency of urination

RATIO: Some swelling during pregnancy is normal. Sudden swelling in your

face and hands or around the eyes could be a red flag for a serious
condition called preeclampsia. Preeclampsia is excessive swelling and
accompanied by other symptoms such as high blood pressure and high
levels of protein in your urine.

5. Which of the following statements would be appropriate for you to

include in Aling Nena’s prenatal teaching plan?

a. Exercise is very stressful, it is not recommended

b. Limit your food intake to vegetables only

c. Alcohol has no harmful effects on the fetus

d. Avoid unnecessary fatigue, rest periods should be included in

your schedule

RATIO: Is it normal to feel tired in pregnancy? It's common to feel tired,

or even exhausted, during pregnancy, especially in the first 12 weeks.
Hormonal changes at this time can make you feel tired, nauseous and
emotional. The only answer is to rest as much as possible.

SITUATION: Nurse Dina is assigned at the City Health Office to teach

contraception to Mang Jess and Aling Sion who are respectively 35 and 34
years old. The couple has had 4 children and has decided to use
contraceptives. The couple seems interested in both the artificial methods
and surgical methods of contraception.

6. Aling Sion asks Nurse Dina about the details of bilateral tube ligation.
Which of the following information is NOT true with regard to bilateral
tube ligation?

a. It is a surgical procedure that can be done through laparoscopy.

b. It is a surgical procedure that creates a temporary

contraception or sterilization that can be easily reversed in the
future.

c. There is a risk of ectopic pregnancy albeit a rare occurrence

d. No other contraceptive methods will be used once the female

undergoes the minor surgery.

RATIO: Risks associated with tubal ligation include: Damage to the

bowel, bladder or major blood vessels. Reaction to anesthesia. Improper
wound healing or infection.
7. Mang Jess on the other hand wants information about vasectomy.
Which of the following is NOT true regarding vasectomy?

a. A vasectomy can be done in an ambulatory setting, such as in a

primary health care clinic.

b. The man may experience a small amount of local pain afterward,

which can be managed by taking a mild analgesic and applying ice to the
site.

c. The male can have unprotected sex with his spouse immediately after
the surgery has been done.

d. The surgical procedure is about 99.5% effective.

RATIO: Vasectomy offers many advantages as a method of birth control.

The main benefit is effectiveness. A vasectomy is over 99.99% effective in
preventing pregnancies. Like female tubal ligation, vasectomy is a one-time
procedure that provides permanent contraception.

8. During the discussion about oral contraceptive pills Aling Sion asked
Nurse Dina, “What do I do if I forget to take an oral contraceptive
pill?” Nurse Dina must reply which of the following?

a. “If the pill omitted was one of the placebo ones, ignore it and just
take the next pill on time the next day.”

b. “If you forgot to take one of the active pills, take it as soon as you
remember. Continue the following day with your usual pill schedule.
Missing one pill this way should not initiate ovulation.”

c. “If you miss two consecutive active pills, take two pills as soon as you
remember. Then, continue the following day with your usual schedule.
You may experience some vaginal spotting with two forgotten pills.”

d. All of the above

RATIO: If you just missed one, take it as soon as you remember. If you
don't remember until the next day, go ahead and take 2 pills that day. If you
forget to take your pills for 2 days, take 2 pills the day you remember and 2
pills the next day.

9. The couple has finally chosen the intrauterine device as a method of

contraception. Nurse Dina must inform Aling Sion of which of the
following?

a. Breast tenderness after insertion of the IUD

b. Vaginal discoloration 1 week after insertion of the IUD

c. Amenorrhea for 6 months after the insertion of the IUD

d. Vaginal spotting and uterine cramping during the first 2 or

3 weeks after IUD insertion.

RATIO: However, it's perfectly normal to have discomfort and spotting that
lasts for several hours afterward. These cramps may gradually decrease in
severity but continue on and off for the first few weeks after insertion.
They should subside entirely within the first three to six months.
10. Aling Sion asks Nurse Dina, “How long should I be having the
intrauterine device?” Nurse Dina must tell Aling Sion that the
effectiveness of the Copper T380 IUD is at around

a. 10 years

b. 5 years

c. 3 years

d. 6 months
RATIO: Copper T 380 A, the intrauterine device (IUD), has now been
clinically approved by the US Food and Drug Administration (FDA) to have
a longer lifespan. According to a population council news release, the
device, which originally had a 4-year term duration, has been found out to
be effective for 6 years.

SITUATION: Rodrigo a 35-year-old male and Leni a 33-year-old female is

visiting a fertility clinic. The couple has mentioned that they have been
married for 7 years and have been trying since then to conceive a child.
They have always been unsuccessful. It was found out that the female has
obstructed fallopian tubes. The physician has recommended the couple to
undergo in vitro fertilization (IVF).

11. The nurse must know that the process of in vitro fertilization
involves which of the following procedures?

a. Oophorectomy

b. Laparoscopy

c. Salpingectomy

d. Drug therapy

RATIO: Typically, transvaginal ultrasound aspiration is used to retrieve

eggs. During this procedure, an ultrasound probe is inserted into your
vagina to identify follicles, and a needle is guided through the vagina and
into the follicles.

12. How many hours after fertilization will the laboratory-grown zygotes
be inserted into the woman’s uterus?

a. 12 hours

b. 24 hours

c. 48 hours

d. 40 hours

RATIO: For patients with at least one normal fallopian tube, GIFT may be an
option. Zygote intrafallopian transfer (ZIFT), another variation of IVF,
involves transferring pre-embryos into the fallopian tubes just 24 hours
after in vitro fertilization. At this stage, the fertilized eggs are called
zygotes.

13. Based from the information above, how many fertilized eggs will
be inserted in the woman’s uterus?
a. 1 only

b. 1-2 fertilized ova

c. 3-4 fertilized ova

d. Up to 5 fertilized ova may be transferred

RATIO: During IVF, mature eggs are collected (retrieved) from ovaries
and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs
(embryos) are transferred to a uterus. One full cycle of IVF takes about
three weeks. Sometimes these steps are split into different parts and the
process can take longer.

14. Why is progesterone or luteinizing hormone prescribed a woman

after undergoing IVF?

a. Due to the blockage of the fallopian tubes

b. Hormonal imbalances brought about by the procedure c.

The corpus luteum can be injured by the aspiration of the follicle

d. Due to cysts growing on the mother’s ovaries

RATIO: Progesterone production is the domain of the ovary until the

placenta takes over progesterone production at around 8-10 weeks
gestational age. Because of the estimated timing and the desire to
be conservative, most IVF clinics in the US recommend
progesterone supplementation for 8-10 weeks after egg
retrieval/FET.

15. Prior to aspiration of ova from the female which of the following
hormones will be given to the woman 1 month prior to the
procedure?

a. Follicle-stimulating hormone
b. Luteinizing hormone

c. Estrogen

d. Human chorionic gonadotropin hormone

RATIO: Before beginning IVF, women will first undergo ovarian reserve
testing. This involves taking a blood sample and testing it for the level of
follicle stimulating hormone (FSH). The results of this test will give your
doctor information about the size and quality of your eggs. Your doctor
will also examine your uterus.

SITUATION: Aling Leni, a 33-year-old mother came to the health center

for her prenatal check-up. She is currently in her second trimester of her
pregnancy, at about 22 age of gestation with a score of P2G4.

16. Upon interview, Aling Leni told Nurse Kristine that she can feel fetal
movements. Nurse Kristine that the fetal movements can be felt by the
mother as early as

a. 12-15 weeks AOG

b. 16-20 weeks AOG

c. 21-25 weeks AOG

d. 8-11 weeks AOG

RATIO: When will I feel my baby moving? You might start to feel your
baby moving, often called 'quickening', around 18 weeks into your
pregnancy. If this is your first pregnancy, it might not happen until about
20 weeks. However, by the second pregnancy, you might notice the tell-
tale signs as early as 16 weeks.

17. Nurse Kristine began assessing Aling Leni’s pregnancy. Which of

the following findings would indicate for a positive pregnancy?

a. Linea nigra that has formed on the mother’s abdomen

b. Goodell’s sign

c. Fetal movements felt by the mother

d. Fetal heart tone heard by the nurse through the stethoscope

RATIO: Positive signs of pregnancy are those signs that are definitely
confirmed as a pregnancy. They include fetal heart sounds,
ultrasound scanning of the fetus, palpation of the entire fetus,
palpation of fetal movements, x-ray, and actual delivery of an infant.

18. Nurse Kristine has told Aling Leni about the importance of taking
folic acid supplements. Aling Leni asks the significance of taking these
supplements. Nurse Kristine must state that

a. Folic acid prevents the occurrence of mental retardation in

the fetus

b. Folic acid prevents iron deficiency anemia in the pregnant mother

c. Folic acid prevents neural tube defects from developing in the

fetus d. Folic acid prevents gestational diabetes in the mother

RATIO: When the baby is developing early during pregnancy, folic acid
helps form the neural tube. Folic acid is very important because it can help
prevent some major birth defects of the baby's brain (anencephaly) and
spine (spina bifida).

19. Aling Leni has observed that there was a change in the color of her
vagina which went from pink to violet. Which of the following statements by
Nurse Kristine is correct with this finding?

a. “It is a normal occurrence during pregnancy known as

Chadwick’s sign.”

b. “It is a normal occurrence during pregnancy known as Goodell’s

sign.” c. “It is a normal occurrence during pregnancy known as Hegar’s

sign.”

d. “It is a normal occurrence during pregnancy known as Braxton-

Hicks’ sign.”
RATIO: Chadwick sign is a bluish discoloration of the cervix, vagina, and
labia resulting from increased blood flow. It can be observed as early as 6
to 8 weeks after conception, and its presence is an early sign of pregnancy.
20. Which of the following is TRUE with regard to Aling Nena’s
psychological change during her second trimester of her pregnancy?

a. The woman and her partner both spend time recovering from the surprise
of learning that they are pregnant and concentrate on what it feels like to be
pregnant.

b. The woman and her partner move through emotions such as

narcissism and introversion as they concentrate on what it feels like to
be a parent.

c. The woman and her partner prepare clothing and sleeping

arrangements for the baby but also grow impatient as they ready
themselves for birth.

d. The woman has a common reaction of ambivalence, or

feeling both pleased and not pleased about the pregnancy.

RATIO: Fatigue, morning sickness, and moodiness usually improve or go

away. You may feel more forgetful and disorganized than before. You may
feel lots of emotions about things like the way you look or feeling the
baby move.

SAS 5

SITUATION: Baby James, an 8-hour old newborn is admitted to the NICU

because of low APGAR Score. His mother had a prolonged second stage of
labor.

1. Which of the following is the most important concept associated with

all high-risk newborn?

A. Support the high-risk newborn's cardiopulmonary adaptation by

maintaining adequate airway

B. Identify complications with early intervention in the high

risk newborn to reduce morbidity and mortality

C. Assess the high risk newborn for any physical complications that
will assist the parent with bonding

D. Support mother and significant others in their request toward

adaptation to the high risk newborn

RATIO: A high-risk infant is an infant that appears well but has a much
greater chance than most infants of developing a clinical problem, such as
hypothermia, hypoglycaemia, apnoea, infection, etc. in the newborn period.
High-risk infants appear clinically well on examination.

2. Which of the following would the nurse expect to find in a newborn

with birth asphyxia?

A. Hyperoxemia

B. Acidosis

C. Hypocapnia

D. Ketosis

RATIO: Hypocapnia (from the Greek words υπό meaning below normal and
καπνός kapnós meaning smoke), also known as hypocarbia, sometimes
incorrectly called acapnia, is a state of reduced carbon dioxide in the
blood. Hypocapnia usually results from deep or rapid breathing, known as
hyperventilation.

3. When planning and implementing care for the newborn that has
been successfully resuscitated, which of the following would be
important to assess?

A. Muscle flaccidity

B. Hypoglycemia

C. Decreased intracranial pressure

D. Spontaneous respiration
RATIO: Assessment of Oxygen Need and Administration of Oxygen - Optimal
management of oxygen during neonatal resuscitation becomes particularly
important because of the evidence that either insufficient or excessive
oxygenation can be harmful to the newborn infant.

4. When assessing the head of the newborn’s head, the nurse has observed
for swelling and the appearance of the head is as though it appears like a
cone. Which of the following terms must the nurse note on her chart?

a. Caput succedaneum

b. Molding

c. Cephalhematoma

d. Craniosynostosis

RATIO: “Caput succedaneum” refers to swelling, or edema, of an infant's

scalp that appears as a lump or bump on their head shortly after delivery.
This condition is harmless and is due to pressure put on the infant's head
during delivery. It doesn't indicate damage to the brain or the bones of the
cranium.

5. For this newborn who is experiencing birth asphyxia, which of

the following would be the most appropriate nursing diagnosis?

a. Imbalanced nutrition: less than body requirements

b. Risk for hypothermia

c. Ineffective breathing pattern

d. Impaired gas exchange

RATIO: An ineffective breathing pattern is a condition of inadequate

ventilation due to an impairment in the mechanism of inspiration and
expiration. Prolonged inadequate ventilation may lead to compromised
respiratory function performance, such as providing oxygen for the tissues,
and removing waste products.

SITUATION: Rhea, a 32-year-old primigravida at 39-40 weeks AOG was

admitted to the labor room due to hypogastric and lumbo-sacral pains.
Internal examination revealed a fully dilated, fully effaced cervix. Station
0.

6. She is immediately transferred to the DR table. Which of the

following conditions signify that delivery is near?

a. A desire to defecate

b. Begins to bear down with uterine contraction

c. Perineum bulges

d. All of the above

RATIO: When delivery is near, baby drops, cervix dilates, cramps

and increased back pain and Loose-feeling joints.
7. Artificial rupture of the membrane is done. Which of the following
nursing diagnoses is the priority?

a. High risk for infection related to membrane rupture

b. Risk for injury related to prolapsed cord

c. Alteration in comfort related to increasing strength of

uterine contraction

d. Anxiety related to unfamiliar procedure

RATIO: Amniotomy does not hurt or cause pain to the mother or the baby.
The mother may experience a little discomfort when the amniotic hook (the
instrument to perform amniotomy) is passed through the birth canal.
Amniotomy is typically followed by increased contractions to facilitate
labor.

8. Rhea complains of severe abdominal pain and back pain during

contraction. Which two of the following measures will be MOST effective in
reducing pain?

a. Rubbing the back with a tennis ball and effleurage

b. Guided imagery

c. Proper breathing techniques

d. Offer warm compresses

RATIO: The conscious relaxation and controlled breathing of the

Lamaze method can be a useful and effective comfort strategy during
childbirth.

9. Lumbar epidural anesthesia is administered. Which of the following

nursing responsibilities should be done immediately following
procedure?
a. Reposition from side to side

b. Administer oxygen

c. Increase IV fluids as indicated

d. Assess for maternal hypotension

RATIO: Clinical observations are to continue until the epidural has ceased
including hourly sedation, heart rate, respiratory rate, pain score (while
awake). Blood pressure and temperature are to be assessed 4 hourly until
the epidural has ceased.

10. Which is NOT the drug of choice for epidural

anesthesia? a. Sensorcaine

b. Xylocaine

c. Ephedrine

d. Marcaine

RATIO: Xylocaine (lidocaine HCl) Injections are sterile, nonpyrogenic,

aqueous solutions that contain a local anesthetic agent with or without
epinephrine and are administered parenterally by injection. See
INDICATIONS for specific uses.

SITUATION: Mocha, a 27-year-old mother is at G4P3 at full term gestation is

brought to the ER after a gush of fluid passes through her vagina while
shopping at the supermarket.

11. Mocha is brought to the emergency room. The fetal heart tone (FHT) is
noted to be 116 beats per minute. Which of the following actions should
the nurse do first?

a. Monitor FHT every 15 minutes

b. Administer oxygen inhalation

c. Ask the charge nurse to notify the obstetrician

d. Place her on the left lateral position

RATIO: A normal fetal heart rate (FHR) usually ranges from 120 to 160
beats per minute (bpm) in the in utero period. It is measurable
sonographically from around 6 weeks and the normal range varies during
gestation, increasing to around 170 bpm at 10 weeks and decreasing from
then to around 130 bpm at term.

12. Nurse Jhunela checks the perineum of Mocha. Which of the

following characteristic of the amniotic fluid would cause an alarm to
the nurse?

a. Greenish

b. Scanty

c. Colorless

d. Blood tinged

RATIO: All the other choices are normal signs of the amniotic fluid, or as
to what it should look like. Fluid that looks green or brown usually means
that the baby has passed the first bowel movement (meconium) while in
the womb. (Usually, the baby has the first bowel movement after birth.) If
the baby passes meconium in the womb, it can get into the lungs through
the amniotic fluid.

13. Mocha asks nurse Jhunela, "Why do I have to be on complete bed rest?
I am not comfortable in this position." Which of the following response of
the nurse is most appropriate?

a. Keeping you on bed rest will prevent the possibility of cord

prolapse b. Completed bed rest will prevent more amniotic fluid to

escape

c. You need to conserve your energy so you will be strong enough to

push later during the delivery

d. Let us ask your obstetrician when she returns to check on you

RATIO: In most cases, bed rest is used to give the body it's best chance to
normalize. Bed rest will be used with women who have conditions related
to high blood pressure in order to decrease stress and lower blood
pressure.
14. Mocha wants to know how many fetal movements per hour is
normal, the correct response of nurse Jhunela would be

a. Twice

b. Thrice

c. Four times

d. 10-12 times

RATIO: A common way to do a kick count is to see how much time it takes
to feel 10 movements. Ten movements (such as kicks, flutters, or rolls) in 1
hour or less are considered normal. But do not panic if you do not feel 10
movements. Less activity may simply mean the baby is sleeping.

15. Upon examination by the obstetrician, he charted that Mocha is in

the early stage of labor. Which of the following is true in this state?

a. Self-focused

b. Effacement is 100%

c. Lasts for 2 hours

d. Cervical dilatation of 1-3 cm

RATIO: Your cervix starts out three to four centimeters long. When it is
50 percent effaced, it is about two centimeters long. When it is 100
percent effaced, it is "paper-thin." Effacement can happen over days
before labor starts.

SITUATION: Baby boy Berlin was delivered spontaneously following a term

pregnancy. Apgar scores are 8 and 9 respectively. Routine procedures are
carried out.

16. When is the APGAR Score taken?

a. Immediately after birth and at 30 minutes after birth

b. At 5 minutes after birth and at 30 minutes after birth

c. At 1 minute after birth and at 5 minutes after

birth d. Immediately after birth and at 5 minutes after

birth

RATIO: The Apgar score describes the condition of the newborn infant
immediately after birth and, when properly applied, is a tool for standardized
assessment 18. It also provides a mechanism to record fetal-to-neonatal
transition. Apgar scores do not predict individual mortality or adverse
neurologic outcome.

17. The best way to position a newborn during the first week of life is to
lay him

a. Prone with head slightly elevated

b. On his back, flat

c. On his side with his head flat on bed

d. On his back with head slightly elevated

RATIO: In addition to avoiding inclined surfaces, the commission is

reminding parents that babies can suffocate if they sleep with blankets,
pillows, or other items. The safest way for a baby to sleep is flat on
their back, in a bare crib, and on a flat, firm surface.

18. Baby boy Berlin has large sebaceous glands on his nose, chin,
and forehead. These are known as

a. Milia

b. Lanugo

c. Hemangiomas

d. Mongolian spots

RATIO: A sebaceous gland is a microscopic exocrine gland in the skin

that opens into a hair follicle to secrete an oily or waxy matter, called
sebum, which lubricates the hair and skin of mammals.

19. Baby boy Berlin must be carefully observed for the first 24 hours

for? a. Respiratory distress

b. Duration of cry
c. Frequency of voiding

d. Range in body temperature

RATIO: Preterm birth, intrapartum-related complications (birth asphyxia or

lack of breathing at birth), infections and birth defects cause most neonatal
deaths.

20. According to the WHO, when should the mother starts breastfeeding the
infant?

a. Within 30 minutes after birth

b. Withing 12 hours after birth

c. Within a day after birth

d. After infant’s condition establishes

RATIO: WHO and UNICEF recommend that children initiate breastfeeding

within the first hour of birth and be exclusively breastfed for the first 6
months of life – meaning no other foods or liquids are provided, including
water. Infants should be breastfed on demand – that is as often as the child
wants, day and night.

SAS 6

1.A client, 12 weeks’ gestation, comes to the prenatal clinic complaining of

severe nausea and frequent vomiting. The nurse suspects that this client
has hyperemesis gravidarum and knows that this is frequently associated
with a. Excessive amniotic fluid
b. A GI history of cholecystitis
c. High levels of chorionic
gonadotropin hormone
d. Slowed secretion of free
hydrochloric acid

RATIONALE: The usual findings for a woman suffering from hyperemesis

gravidarum is having high levelsof serum HCG. Normal level at around 12
weeks gestation should be at 25,700– 288,000 mIU/mL.

2.A client in the thirty-third week of pregnancy begins to experience

contractions. She is to be treated at home with bed rest. The teaching
plan for this client should include the information that the client a. Needs
to have the foot of the bed raised on blocks
b. Needs to sit in bed with several large pillows
supporting her back
c. Should be placed on her side with her head
raised on a small pillow
d. Should assume the knee-chest position every 2 hours for 10
minutes while awake

RATIONALE: The best lying or sleeping position might vary. No matter in

what position you lie, place a pillow under your head, but not your
shoulders. The pillow should be a thickness that allows your head to be in
a normal position to avoid training your back. You might also want to put
a pillow between your legs for support.

3.In the fifth month of pregnancy, ultrasonography is performed on a client.

The results indicate that the fetus is small for gestational age and there is
evidence of a low-lying placenta. The nurse would use this information in the
last trimester of pregnancy by assessing the client for signs of possible a.
Placenta
previa
b. Premature
labor
c. Abruptio
placenta
d. Precipitate
delivery

RATIONALE: Neonates from pregnancies with placenta previa have a

mild increase in the risk of intra-uterine growth restriction (IUGR)/small
for gestational age (SGA).

4.A client experiences an episode of painless vaginal bleeding during the last
trimester. The nurse realizes that this may be caused by
a. Placenta
previa
b. Abruptio
placenta
c. Frequent intercourse
d. Excessive alcohol ingestion

RATIONALE: Symptomatic placenta previa usually manifests as vaginal

bleeding in the late second or third trimester, often after sexual intercourse.
The bleeding typically is painless unless labor or placental abruption occurs.

5.The care of a client with placenta

previa includes a. Vital signs at least
once per shift
b. A tap-water enema before delivery
c. Observation and recording of
the bleeding
d. Limited ambulation until
bleeding stops

RATIONALE: Continued bleeding can put the fetus in jeopardy. The

client should be restricted to complete bed rest until bleeding stops. Vital
signs should be recorded every 4 hours until bleeding stops.

6.A client is admitted with the diagnosis of possible placenta previa.

Following the physician’s orders, the nurse starts IV fluids, administers
oxygen, and draws blood for laboratory tests. The client’s apprehension is
increasing and she asks the nurse what is happening. The nurse tells her not
to worry, that she is going to be all right, and everything is under control.
The nurse’s statements are
a. Adequate, since all preparations are routine and need no explanation
b. Proper, since the client’s anxieties would be increased if
she knows the dangers c. Correct, since only the physician
should explain why treatments are being done
d. Questionable, since the client has the right to know
what treatment is being given and why

RATIONALE: The client’s rights have been violated. All clients have
the right to a complete and accurate explanation of treatment based
on cognitive ability

7.A client comes to the clinic for a sonography at 36 weeks’ gestation.

Before the test begins, the client complains of severe abdominal pain. Heavy
vaginal bleeding is noted and the client’s BP drops while her pulse rate
increases. The nurse should suspect that the client has
a. Hydatidiform
mole b.
Endometriosis
c. Marginal placenta previa
d. Complete abruptio placenta

RATIONALE: The signs and symptoms are associated with abruptio

placenta. Signs and symptoms of placenta previa include, bright red
painless bleeding, and placenta is situated at the lower aspect of the
uterus. A hydatidiform mole is growth of an abnormal fertilized egg or an
overgrowth of tissue from the placenta. Women appear to be pregnant, but
the uterus enlarges much more rapidly than ina normal pregnancy.

8.Which of the following would be the initial action of a nurse to a mother

who is suffering from abruptio placenta?
a. Monitor for contractions
b. Obtain baseline vital signs and measure
the abdominal girth
c. Monitor fetal heart tone
d. Measure the urine output of the mother

RATIONALE: The initial nursing action should always be assessment

which should be Letter B. obtaining baseline information and measuring
the abdominal girth is important in order to compare later results and
changes. The nurse should always follow the steps in the nursing process.

9.Abruptio placenta is most likely to occur in a

woman with a. Cardiac disease
b. Hyperthyroidism
c. Cephalopelvic disproportion
d. Pregnancy-induced hypertension

RATIONALE: High blood pressure during pregnancy can affect the

development of the placenta, causing the nutrient and oxygen supply to
the baby to be limited. This can lead to an early delivery, low birth weight,
placental separation (abruption) and other complications for the baby.

10. The nurse must anticipate for which of the following complications of
the blood that may occur after abruptio placenta?
a. Thrombosis
b. Disseminated intravascular
coagulation
c. Cerebrovascular accident
d. Deep vein thrombosis

RATIONALE: Disseminated intravascular coagulation due to placental

abruption with intrauterine fetal death is not uncommon. It can result in
increased maternal mortality rates and the need for hysterectomy or
greater transfusion volumes if the delivery is not completed within six to
eight hours.
11. The first assessable objective sign of a seizure in a client with
eclampsia is frequently a. Epigastric pain, nausea, and vomiting b.
Persistent headache and
blurred vision c. Spots or flashes
of light before the eyes
d. Rolling of the eyes to one side with a fixed stare

RATIONALE: Rolling of the eyes to one side with a fixed stare is a sign
of central nervous system involvement that the nurse can see without
obtaining subjective data from the client. It is a sign of an impending
seizure.

12. Which of the following would be the definitive treatment for

pregnancy-induced hypertension? a. Oral antihypertensives b.
Magnesium
sulfate c.
Diuretics
d. Delivery

RATIONALE: The definitive treatment of preeclampsia is delivery

13. When giving magnesium sulfate to a severely preeclamptic mother

who is at 25 weeks AOG, the nurse must prepare which of the following
medications at the bedside in case magnesium toxicity occurs?
a. Potassium
chloride b.
Aluminum
hydroxide
c. Calcium gluconate
d. Spironolactone

RATIONALE: Calcium gluconate is the antidote for magnesium sulfate

toxicity. Calcium Gluconate is the gluconate salt of calcium. An element or
mineral necessary for normal nerve, muscle, and cardiac function,
calcium as the gluconate salt helps to maintain calcium balance and
prevent bone loss when taken orally.

14. Which of the following assessment findings from the patient would the
nurse suspect for her to have pregnancy-induced hypertension? a. Nausea
and vomiting usually felt by the mother in the morning b. The mother
tells you that she no longer can
wear her wedding ring
c. Complains that she has difficulty defecating
d. Reports of frequency of urination especially in the afternoon
RATIONALE: One of the signs of having preeclampsia is edema of the
hands and face. If the mother can no longer wear her wedding ring this
may indicate that her fingers are edematous due to PIH.

15. The nurse understands that the diabetic mother’s metabolism is

significantly altered during pregnancy as a result of
a. The lower renal threshold for glucose
b. The increased effect of insulin during pregnancy
c. An increase in the glucose tolerance level of the blood
d. The effect of hormones produced in pregnancy on
carbohydrate and lipid metabolism

RATIONALE: In pregnancy, the hormones that are secreted by the

placenta make the mother’s body less responsive to insulin. This is known
as insulin resistance. It should be noted that all pregnancies have a degree
of insulin resistance in order to make nutrients in the maternal bloodstream
available for the growing fetus.

16. Which of the following conditions may happen to the fetus in a mother
who is diagnosed to have gestational diabetes?
a. Small-for
gestational age b.
Hydrocephaly
c. Large-for
gestational age
d. Low birth weight

RATIONALE: The increased risk of macrosomia in GDM is mainly due to

the increased insulin resistance of the mother. In GDM, a higher amount of
blood glucose passes through the placenta into the fetal circulation. As a
result, extra glucose in the fetus is stored as body fat causing macrosomia,
which isalso called ‘large for gestational age'.

17. A mother was assessed for the type of abortion that she may have,
the cervix is still closed, there is slight bleeding and mild uterine
contractions, the fetus is still in the womb of the mother. Which among the
following is happening?
a. Threatened
abortion
b. Missed abortion
c. Complete abortion
d. Incomplete abortion
RATIONALE: A threatened abortion is defined as vaginal bleeding before
20 weeks gestational age in the setting of a positive urine and/or blood
pregnancy test with a closed cervical os, without passage of products of
conception and without evidence of a fetal or embryonic demise.

18. Which of the following is NOT a characteristic of

ectopic pregnancy a. Any gestation outside the uterine
cavity
b. Most frequent in the fallopian tubes, where the tissue is incapable of
the growth needed to accommodate pregnancy, so rupture of the site
usually occurs before 12 weeks.
c. Any condition that diminishes the tubal lumen may predispose a woman
to ectopic pregnancy.
d. There is also a low lying placenta present during
the ultrasonography

RATIONALE: Choices A, B, and C is true for ectopic pregnancy while

letter D is not true and is indicative of a condition known as placenta
previa

19. Which of the following laboratory findings would be significant in the

mother who has ectopic pregnancy
a. Increased hematocrit and
hemoglobin levels b. Decreased
hematocrit and hemoglobin levels
c. Elevated red blood cell count
d. Decreased white blood cell count

RATIONALE: Low hemoglobin and hematocrit values, together with

higher gravidity at the time of admission, may indicate an increased risk
of tubal rupture.

20. The characteristic pain of a mother who has

ectopic pregnancy is a. Pain felt just above the
symphysis pubis of the mother
b. Pain felt during contractions of
the uterus c. Pain felt at one
side of the abdomen
d. Pain felt at the right lower quadrant of the abdomen

RATIONALE: The pain felt by the mother with ectopic pregnancy is usually
one-sided in the lower abdomen. Since only one fallopian tube is affected in
this type of pregnancy
SAS 7

1. A 22-year old woman named Riza has been brought into the delivery
room and was diagnosed to have tachysystole labor. What would be
the characteristic of tachysystole labor?

a. Infrequent and brief contractions

b. More than 5 contractions per 10 minute intervals in 2

consecutive intervals

c. Prolonged active phase

d. Uterus can be easily indented by the fingertip

RATIO: Uterine tachysystole (more than 5 contractions per 10 minutes in

2 consecutive intervals) is common during labour, particularly with use of
labour‐ stimulating agents. Tachysystole may reduce fetal oxygenation by
interrupting maternal blood flow to the placenta during contractions.
Reducing uterine contractions may improve placental blood flow,
improving fetal oxygenation.

2. Which of the following would contribute to the pain felt by the

mother during tachysystole labor?

a. Cephalopelvic disproportion

b. Malpresentation

c. Anoxia

d. Malposition

RATIO: Malpositions are abnormal positions of the vertex of the fetal

head (with the occiput as the reference point) relative to the maternal
pelvis. Malpresentations are all presentations of the fetus other than
vertex.

3. A 25-year old woman named Josefina is in the delivery room has been
diagnosed to have hypotonic labor. The nurse would confirm the
diagnosis with the presence of which of the following characteristics?
a. Contractions has more than 90 seconds duration

b. Frequency of contractions are less than 2 minutes

c. The number of contractions is usually infrequent which is

not more than 2 or 3 occurring in a 10-mute period

d. Strong and frequent contractions

RATIO: Hypotonic labor is an abnormal labor pattern, notable especially

during the active phase of labor, characterized by poor and inadequate
uterine contractions that are ineffective to cause cervical dilation,
effacement, and fetal descent, leading to a prolonged or protracted
delivery.

4. Which of the following cases would strongly contribute to the

hypotonic labor of the mother?

a. Nulliparity

b. Polyhydramnios

c. Small for gestational age fetus

d. Grand multiparity

RATIO: Hypotonic contractions occur as a result of fetopelvic

disproportion, fetal malposition, overstretching of the uterus caused by a
large newborn, multifetal gestation, or excessive maternal anxiety. The
woman with hypotonic contractions can become exhausted and
dehydrated.

5. In order for the nurse to prevent the occurrence of hypotonic labor,

the nurse should avoid excessive use of which of the following
medications?

a. Oxytocin

b. Methergine

c. Sedatives

d. Analgesic
RATIO: Sedatives can cause uterine muscle relaxation which can worsen
the labor of a mother who is suffering from a hypotonic labor. In order to
increase the force of contractions of mothers with this condition, oxytocin
is further increased.

6. During hypotonic labor the fetus may be in distress. When the

obstetrician has performed amniotomy, which of the following is the nurse
going to do?

a. Observe for the odor of the amniotic fluid

b. Determine the amount of amniotic fluid present

c. Observe for the color of the amniotic fluid

d. Check for the presence of blood in the amniotic fluid

RATIO: Amniotic fluid usually is clear and odorless. However, in certain

circumstances, the fluid may either contain meconium or may be blood
tinged. It is important to note the color of the fluid at the time of rupture.

7. When assessing the mother who is undergoing hypotonic labor the nurse
must assess signs of infection if the labor is already prolonged. Which of
the following would indicate that the mother has an infection?

a. Fetal bradycardia

b. Presence of meconium in the amniotic fluid

c. Fever and chills

d. Distended bladder

RATIO: Fever and chills are indication that mother has an infection.

8. If induction of labor is unsuccessful and full dilatation has not occurred

when the mother has hypotonic labor the next step that the nurse is
going to expect for the obstetrician to do is

a. Prep the mother for caesarean section

b. Use assistive tools such as forceps

c. Help the mother in the labor through vacuum
extraction d. Perform an episiotomy

RATIO: If all measures by the obstetrician has been made and are
unsuccessful the next thing that the nurse is going to anticipate is for
the physician to perform CS. Letters B, C, and D are no longer helpful
since these choices need the full dilatation of the cervix.

9. During an ultrasonography the physician has noticed that the baby’s

hips and knees are flexed so that the baby is sitting cross-legged, with
feet beside the bottom. What is being presented in this situation?

a. Frank breech

b. Incomplete breech

c. Complete breech

d. Footling breech

RATIO: Complete breech is when both of the baby's knees are bent and
his feet and bottom are closest to the birth canal. Incomplete breech is
when one of the baby's knees is bent and his foot and bottom are closest
to the birth canal. Frank breech is when the baby's legs are folded flat up
against his head and his bottom is closest to the birth canal. There is also
footling breech where one or both feet are presenting.

10. Which of the following conditions must the nurse alert to the
obstetrician when performing a delivery?

a. Cord prolapse

b. Rupture of membranes

c. Crowning of head

d. External rotation of the head

RATIO: Umbilical cord prolapse is an uncommon but potentially fatal

obstetric emergency. When this occurs during labor or delivery the
prolapsed cord is compressed between the fetal presenting part and the
cervix. This can result in a loss of oxygen to the fetus, and may even result
in a stillbirth.

11. When the fetus is in a breech presentation, the nurse must

perform which of the following procedures early in labor?
a. Ritgen’s maneuver

b. Episiotomy

c. External cephalic version

d. Fundal push

RATIO: ECV is one way to turn a baby from breech position to head down
position while it’s still in the uterus. It involves the doctor applying
pressure to your stomach to turn the baby from the outside. Sometimes,
they use ultrasound as well.

12. Vaginal breech delivery is done by a skilled health care provider and
is safe and feasible under the following conditions EXCEPT

a. Adequate clinical pelvimetry

b. Complete or frank breech

c. Had a previous caesarean section for cephalopelvic

disproportion 2 years ago

d. Fetus has a flexed head

RATIO: Cephalopelvic disproportion (CPD) is a pregnancy complication in

which there is a size mismatch between the mother’s pelvis and the fetus’
head or in this case the baby’s feet and bottom. The baby’s head/ bottom is
proportionally too large or the mother’s pelvis is too small to easily allow
the baby to fit through the pelvic opening. This can make vaginal delivery
dangerous or impossible.

13. During ultrasonography the obstetrician has found out that the fetus is
in a complete breech presentation on the 28th week age of gestation. The
doctor will attempt to perform external version at what week?

a. 37 weeks

b. 32 weeks
c. 38 weeks

d. 30 weeks
RATIO: If your baby is still in a breech position at 36 weeks, your doctor
or midwife might suggest you consider an external cephalic version, or
ECV. The aim is to turn your baby so that it is head-down when labour
starts.

An ECV is performed after 37 weeks of pregnancy.

14. Caesarean section will be performed if the type of breech presented

is

a. Complete breech

b. Frank breech

c. Double footling breech

d. None of the above

RATIO: A frank breech presentation is preferred when vaginal delivery is

attempted. Complete breeches and footling breeches are still candidates,
as long as the presenting part is well applied to the cervix. For transverse
babies, It is almost impossible to deliver a transverse baby vaginally. So if
a baby is still lying sideways at term or when labor begins, a C-section
(caesarean) may be the safest option for delivering the baby.

15. In a transverse type of position, the presenting part is

usually a. One of the shoulders

b. An iliac crest

c. A hand

d. Any of the above

RATIO: In the transverse lie, the presentation is usually the back

or shoulder; in the oblique lie, it is usually the shoulder or the
arm.
16. This type of presentation is caused by hyper-extension of the fetal
head so that neither the occiput nor the sinciput is palpable on vaginal
examination

a. Sinciput

b. Occiput
c. Transverse

d. Face

RATIO: Face presentation is caused by hyper-extension of the fetal head

so that neither the occiput nor the sinciput are palpable on vaginal
examination. On abdominal examination, a groove may be felt between the
occiput and the back. On vaginal examination, the face is palpated, the
examiner’s finger enters the mouth easily and the bony jaws are felt.

17. Which of the following is true with regards to face chin-anterior

position type of malpresention?

a. Descent and delivery of the head may occur

b. The fully extended head is blocked by the sacrum which

prevents descent and labor is arrested

c. Labor progress is slowed with slowed descent of the fetal head

d. Fetus lies horizontally in the pelvis so that the longest fetal axis
is perpendicular to that of the mother

RATIO: The chin serves as the reference point in describing the position of
the head. It is necessary to distinguish only chin-anterior positions in
which the chin is anterior in relation to the maternal pelvis. In the chin-
posterior position, however, the fully extended head is blocked by the
sacrum. This prevents descent and labour is arrested.

18. Which of the following medical procedures is avoided during a

face presentation?

a. Augmentation of labor with oxytocin

b. Caesarean section

c. Delivery by forceps
d. Vacuum extraction

RATIO: There is an increased risk of trauma to the baby when the face
presents first, and the physician should not internally manipulate (try to
rotate) the baby. In addition, the physician must not use vacuum
extractors
or manual extraction (grasping the baby with hands) to pull the baby
from the uterine cavity.

19. When assessing for the well-being of the fetus the nurse must
monitor which of the following if the fetus is malpresented?

a. Vital signs of the mother

b. Fetal heart beat

c. Maternal contractions

d. Maternal respirations

RATIO: If there are fetal heart rate abnormalities (less than 100 or
more than 180 beats per minute), suspect fetal distress.

20. Kiara the mother who is already prolonged in labor says to the
nurse, “This is hopeless; I really can’t do it anymore. I’m so much
frustrated.” Which of the following nursing responses is most
therapeutic

a. “The doctor is doing everything she can in order to help you get past
this labor.”

b. “Would you opt to be placed in a caesarean section instead?”

c. “It must be hard for you to be experiencing this. But let’s

think positive and be patient, you can still do this.”

d. “We’ll see other options that we can do in order to augment this labor
that you are experiencing.”

RATIO: Comfort measures that provide natural pain relief can be very
effective during labor and childbirth. Birthing techniques such as
hydrotherapy, hypnobirthing, patterned breathing, relaxation, and
visualization can increase the production of endogenous endorphins
that bind to receptors in the brain for pain relief.

SAS 8

1. Nurse Nami is currently visiting the Dimatulac family 2 weeks after being
discharged from the hospital. Upon observation, the nurse notes that the
umbilical cord has dried and fallen off. The area appears to have healed
with no discharges or erythema present. The mother can be taught to a.
Cover the umbilicus with a band-aid
b. Continue to clean the stump with 70% alcohol for a
week c. Apply an antibiotic ointment on the stump
d. Give the infant a tub bath now
RATIONALE: When your baby is born the umbilical cord is cut and there is
a stump left. The stump should dry and fall off by the time your baby is 5
to 15 days old. ... Sponge bathe the rest of your baby, as well. DO NOT
put your baby in a tub of water until the stump has fallen off.

2. Aling Jona a mother of a term newborn has curiously asked about

the thick, white, cheesy coating on her son’s skin. The nurse must
correctly describe this as
a. lanugo
b. milia
c. café-au-lait spots
d. vernix caseosa
RATIONALE: Vernix caseosa, also known as vernix or birthing custard, is
the waxy white substance found coating the skin of newborn human
babies. It is produced by dedicated cells and is thought to have some
protective roles during fetal development and for a few hours after birth.

3. When Nurse Kiara is assessing the newborn, she has noted that the
newborn has caput succedaneum. Which of the following statements
about this condition is correct?
a. It usually resolves within 3 to 6 weeks
b. It involves swelling of tissue over the presenting part of
the presenting head
c. It doesn’t cross the cranial suture lines
d. It’s a collection of blood between the skull and the periosteum
RATIONALE: Caput succedaneum involves diffuse swelling of the scalp, with
subcutaneous fluid collection unrelated to the periosteum with poorly
defined margins.
4. Nurse Diwata is attending a newborn. To help her limit the development
of hyperbilirubinemia in the newborn, her plan of care for her patient
should include
a. Monitoring for the passage of meconium each
shift b. Instituting phototherapy for 30 minutes every 6
hours
c. Substituting breastfeeding for formula during the 2nd day after birth d.
Supplementing breastfeeding with glucose water during the first 24 hours
RATIONALE: Bilirubin is excreted via GI tract; if meconium is retained, the
bilirubin is reabsorbed.

5. Nurse Gian is preparing to administer a vitamin K shot to a newborn.

Aling Julia is asking the nurse why her newborn infant needs the injection.
The best nursing response would be
a. “Your infant needs vitamin K to develop immunity passive
artificial immunity.”
b. “Vitamin K will protect your infant from having jaundice.”
c. “Newborn infants are deficient in vitamin K, and this shot will prevent
your infant from any abnormal bleeding.”
d. “Newborns have sterile bowels, and vitamin K will help promote the
growth of good bacteria in the digestive tract.”
RATIONALE: Vitamin K helps the blood to clot and prevents serious
bleeding. In newborns, vitamin K injections can prevent a now rare, but
potentially fatal, bleeding disorder called 'vitamin K deficiency bleeding'
(VKDB), also known as 'haemorrhagic disease of the newborn' (HDN).

6. A preterm neonate is to be fed with breast milk through the

nasogastric tube. The nurse recognizes that breast milk is preferred over
formula milk because it
a. Has fewer fatty acids
b. Provide antibodies
c. Is higher in carbohydrates
d. Contains more lactose
RATIONALE: Breast milk is ideal for the preterm baby who needs
additional protection against infection through maternal antibodies.

7. Nurse Santibanez is admitting a preterm newborn to the nursery.

The nurse should assess which of the following from this newborn? a.
Clavicle fracture
b. Palsies
c. Respiratory distress
d. Shoulder dystocia
RATIONALE: Respiratory distress syndrome (RDS) is a common problem
in premature babies. It can cause babies to need extra oxygen and help
with breathing. RDS occurs most often in babies born before the 28th
week of pregnancy and can be a problem for babies born before 37
weeks of pregnancy.

8. Nurse Mikasa is caring for a newborn who has just been diagnosed
with hypospadias. After discussing the defect with the parents, the nurse
must teach that
a. Surgery will be performed in stages
b. Initial repair is delayed until the age of 6 to 8
c. post-operative appearance will be normal
d. Circumcision can be performed at any time
RATIONALE: Hypospadias repair is done most often when boys are
between 6 months and 2 years old. The surgery is done as an outpatient.
The child rarely has to spend a night in the hospital.

9. A full-term newborn was just born. Nurse Sasha must know that the
most important nursing intervention to perform first would be
a. Assessing the APGAR score
b. Remove the wet blankets
c. Apply eye prophylaxis
d. Elicit the Moro reflex

RATIONALE: When newborns are wet they can become hypothermic

from heat loss resulting from evaporation. They may then develop cold
stress syndrome.

10. Which of the following newborns is at highest risk for cold

stress syndrome?
a. Neonate who has Trisomy 21
b. Infant who has a diabetic mother
c. Infant with erythroblastosis fetalis
d. post-term infants
RATIONALE: Cold stress syndrome (CSS) in the Florida manatee
Trichechus manatus latirostris has been defined as morbidity and mortality
resulting from prolonged exposure to water temperatures <20°C.

11. A newborn is born with erythroblastosis fetalis. Which of the

following signs and symptoms would the nurse expect to observe?
a. Ruddy complexion
b. Erythema toxicum
c. Anasarca
d. Alopecia
RATIONALE: Babies born with erythroblastosis fetalis often are in
severe congestive heart failure and, therefore, exhibit anasarca.

12. Four newborns with the following conditions are in the well-baby
nursery. The baby with which of the following conditions is at high risk
for physiological jaundice?
a. Mongolian spots
b. Harlequin coloring
c. Cephalhematoma
d. Caput succedaneum

RATIONALE: Newborns with a cephalhematoma have a collection of

blood that will need to be reabsorbed and will be at greater risk for
developing physiological jaundice.

13. Nurse Angel notes that a 6-hour-old newborn has cyanotic hands
and feet. Which of the following nursing interventions would be
appropriate? a. Assess oxygen saturation with the pulse oximeter
b. Swaddle the newborn in a blanket
c. Place the child under the UV light
d. Administer oxygen

RATIONALE: The baby's extremities are cyanotic as a result of the baby's

immature circulatory system. Swaddling helps to warm the baby's hands
and feet. Acrocyanosis, or bluish discoloration of the hands and feet in the
neonate (also called peripheral cyanosis), is a normal finding and shouldn't
last more than 24 hours after birth.

14. The nursing history for a newborn suspected of having pyloric

stenosis would most likely reveal which of the following?
a. Frequent vomiting of bile-stained fluid
b. Cyanosis and vomiting immediately after feedings
c. Mild emesis progressing to projectile vomiting
d. Absence of gastrointestinal peristalsis
RATIONALE: Pyloric stenosis is a problem that affects babies between
birth and 6 months of age and causes forceful vomiting that can lead to
dehydration. It is the second most common problem requiring surgery in
newborns. The lower portion of the stomach that connects to the small
intestine is known as the pylorus.

15. Nurse Alyana is assessing the reflexes of a newborn. The nurse

assesses which of the following reflexes by placing a finger in the
newborn’s mouth? a. Sucking reflex
b. Landau reflex
c. Babinski reflex
d. Moro reflex
RATIONALE: The sucking reflex is tested by placing something, such as a
finger, in the infant’s mouth and seeing if the infant begins to suck on
the
object. The Moro reflex is tested by suddenly lowering the newborn’s body.
The infant should demonstrate a bilateral arm extension and leg flexion. The
rooting reflex is tested by stroking the cheek. The infant may openthe
mouth. The Babinski reflex is tested by firmly stroking the plantar surface.
The anticipated response is the incurving of the toes as in plantar the grasp,
with uncurling and fanning out

16. Nurse Kim is assessing a newborn on admission to the NICU. Which

of the following findings should the nurse report to the attending
physician? a. Intercostal retractions
b. Caput succedaneum
c. Epstein’s pearls
d. Harlequin sign
RATIONALE: Intercostal retractions occur when the muscles between the
ribs pull inward. The movement is most often a sign that the person has a
breathing problem. Intercostal retractions are a medical emergency.

17. An indirect bilirubin level at birth is 1 to 4 mg/100 ml. any increase

over this amount reflects the release of bilirubin as excessive red blood
cells begin their breakdown. To treat the occurrence of jaundice brought by
these events it is important for the newborn to undergo?
a. Vaccination
b. Phototherapy
c. Cord dressing
d. APGAR scoring
RATIONALE: Phototherapy is a type of medical treatment that involves
exposure to fluorescent light bulbs or other sources of light like halogen
lights, sunlight, and light emitting diodes (LEDs) to treat certain medical
conditions.

18. If the newborn’s APGAR score is zero. Which of the following would
be the best nursing intervention?
a. Resuscitate the patient
b. Place the patient in close monitoring
c. Do nothing since the patient is a well-baby
d. Inject IV epinephrine
RATIONALE: An Apgar score that remains 0 beyond 10 minutes of age
may, however, be useful in determining whether continued resuscitative
efforts are indicated because very few infants with an Apgar score of 0 at
10 minutes have been reported to survive with a normal neurologic
outcome 3 4 5.
19. Assess the Apgar score of the female infant with the following
assessments: the infant appears blue overall, she grimaces when slapped on
the foot and when a catheter is placed in her nostril, the heart has 72 beats
per minute, there is some flexion of the extremities and there is a slow
weak cry. What is the APGAR score?
a. 2
b. 3
c. 4
d. 5
RATIONALE: Appears blue overall – 0; grimaces when slapped on the foot
– 1; heart rate of 72 bpm – 1; some flexion of extremities – 1; slow weak
cry – 1; (0+1+1+1+1=4)

20. Upon assessing the newborn child on his fifth minute you have
observed for the following: the child’s heart rate is 123 beats per minute,
there is a slow, irregular weak cry, he sneezes when a catheter is placed in
his nostril, he grimaces when the foot is slapped and there is acrocyanosis.
What is the APGAR score?
a. 6
b. 7
c. 8
d. 9
RATIONALE: The Apgar score describes the condition of the newborn infant
immediately after birth and, when properly applied, is a tool for
standardized assessment 18. It also provides a mechanism to record fetal-
to-neonatal transition. Apgar scores do not predict individual mortality or
adverse neurologic outcome.

SAS 9

1. The relationship that is of extreme importance in the formation of the

personality is the
a. Peer
b. Sibling
c. Parent-child
d. Heterosexual
RATIO: The Parent-Child Relationship is one that nurtures the physical,
emotional and social development of the child. It is a unique bond that
every child and parent will can enjoy and nurture. This relationship lays
the foundation for the child's personality, life choices and overall
behaviour.

2. An infant child named Giselle would learn to explore the environment

through which of the following?
a. mouth
b. hands
c. feet
d. eyes

RATIO: Infants explore the world by mouthing objects or

fingering them. This also helps them separate self from
environment.

3. A mother of a child tells the nurse, “I constantly see my five-year-old

son fondling with his genitals.” She appears tensed because according to
him this may seem deviant for a preschooler. The nurse should tell the
father that
a. “This behavior is abnormal. You should scold your child when
you see him next time.”
b. “Just ignore the behavior of the child.”
c. “This act is to deviant. He probably will develop sexual disorders
later on.”
d. “Tell the child to do it privately in his room. And make no
issue out of it.”

RATIO: Proper sex education must be done by parents that they should
explain that certain things are done in some places but not in others.
Children can relate to this kind of direction without feeling inhibited, just as
they can accept the fact that they use bathroom in private or eat only at
the table.
4. A mother tells the nurse, “My 4-year-old daughter tells me that she
hates me. What should I do?” As a nurse you are going to tell her a. “You
may be mistreating your daughter. That’s why she hates you.”
b. “You should take your daughter out for a play sometimes for her
to like you.”
c. “You should tell your daughter that you love her very much.”
d. “You should be patient about your daughter. She is
undergoing a stage which is normal for her. Just be
supportive.”
RATIO: Electra complex is the strong emotional attachment of a
preschool girl toward her father is normal phenomenon

5. A 2-year-old child named James is very curious about his

environment. Which of the following statements would be true about a
toddler?
a. Allowing the toddler to explore his environment for him to
learn while providing him with safety.
b. Inhibit all of the child’s desires.
c. Give in always to the child’s temper tantrums to stop the child
from crying.
d. Be strict in the child’s toilet training.

RATIO: Babies are born learners, with a natural curiosity to figure out
how the world works. Curiosity is the desire to learn. It is an
eagerness to explore, discover and figure things out. Parents and
caregivers don't have to “make” their children curious or “push” their
children to learn.

6. Which of the following would indicate that the adolescent has already
developed a sense of identity?
a. A teenager is performing poorly in his course because his
parents chose the course for him.
b. A teenager who is not satisfied with his course because her
friends goaded her to join them.
c. A teenager who secretly hides his sexuality to everyone, but in
his thoughts, he is a homosexual.
d. A teenager who excels very well in a course, and loves
what he is studying.

RATIO: Those who are able to develop a strong sense of identity are
better able to have self-confidence, or a sense of trust in their abilities,
qualities, and judgements.
7. The infant named Juliana at this stage can say mam-ma and dad-da,
plus 2 words such as milk and water. She can also take her first few steps
at this stage. Her birth weight has already tripled. What month is she in?
a. 12 months
b. 11 months
c. 9 months
d. 10 months

RATIO: At 12 months, the weight of an infant triples and they can generally
say two words besides “ma-ma” and “da-da”; they use those two words
with meaning.
8. Which of the following behaviors would a newly born infant who is
named Kyla going to demonstrate?
a. Playing with mobile toys
b. Patty Cake
c. Peek-a-Boo
d. Enjoys face of caregiver

RATIO: Newborn enjoys watching a simple mobile.

9. A mother named Susan asks Nurse Joyce about the type of toys that
are appropriate for her child who is 10 months old. Which of the following
must Nurse Joyce advise to the mother?
a. Mobile toys
b. Push or pull toys
c. Jack-in-the-box
d. Walker

RATIO: 10 months old may enjoy playing with egg cartons, blocks,
balls, stacking toys, and push-pull toys.

10. Lavender Brown is crawling or creeping on the floor with her

abdomen of it. She already can exhibit the pincer grasp by using
her thumb and forefinger. What month can she be in?
a. 6 months
b. 10 months
c. 11 months
d. 9 months

RATIO: A major milestone of 10 months is the ability to bring the thumb

and the first finger together in a pincer grasp and the baby at 10 months
could pulls self to standing from creeping or crawling.
11. During the assessment of the newborn Nurse Stella is stroking the
side of the sole of the foot in an inverted “J” curve from the heel
upward, the newborn fans the toes. This is known as
a. Moro reflex
b. Extrusion reflex
c. Babinski reflex
d. Rooting reflex

RATIO: Babinski reflex is one of the normal reflexes in infants. Reflexes are
responses that occur when the body receives a certain stimulus. The
Babinski reflex occurs after the sole of the foot has been firmly stroked.
The big toe then moves upward or toward the top surface of the foot.
12. A mother named Janella is asking Nurse Jade when her son will be
able to do toilet training. Nurse Jade must know that physical readiness
for toilet training occurs at age
a. 18-24 months
b. 36-42 months
c. 12-17 months
d. 43-50 months

RATIO: Many children show signs of being ready for potty training between
ages 18 and 24 months. However, others might not be ready until they're 3
years old. There's no rush. If you start too early, it might take longer to
train your child.

A her toddler son Charlie. When leaving the department toys he has seen.

13. When dealing with temper tantrums the parents must take into
consideration the following interventions EXCEPT
a. Give the toddler frequent opportunities to make developmentally
appropriate choices.
b. Give in always to the child’s wants in order to prevent the child
from having temper tantrums.
c. Give the child advance warning of a request to help prevent
temper tantrums.
d. Ignore tantrums when the toddler is seeking attention or
trying to get what he wants.

RATIO: The best approach for parents is to tell their child simply that
they disapprove of the tantrum and then ignore it. They might say,
“I’ll be in the bedroom. When you’re done kicking, you come into the
bedroom, too.” Children who are left alone in a room this way will
usually not continue a tantrum but will stop after 1 or 2 minutes and
rejoin their parents. Parents should then accept the child warmly
and proceed as if tantrum had not occurred.

14. A mother named Janine is observing her 6-year old daughter play with
her friends at the playground. She has seen them playing tag. This would be
an example of which of the following types of play?
a. Parallel play
b. Solitary play
c. Cooperative play
d. Competitive play

RATIO: Tag (also called tig, it, tiggy, tips, tick, tip) is a playground
game involving two or more players chasing other players in an attempt
to "tag" and mark them out of play, usually by touching with a hand.

15. Maria has belonged to a series of clubs for 9-year-old girls. A usual
characteristic of clubs for this age is
a. The club has formal rules and regulations
b. It is designed to help shy children socialize
c. It is designed for same-sex to spite or exclude another
child
d. Clubs include both boys and girls

RATIO: Nine-year-olds take the values of their peer group very seriously.
They are much more interested in how other children dress than in what
their parents want them to wear. This is typically the gang age because
children form clubs, usually “spite clubs.” This means if there are four girls
on the block, three form a club and exclude the fourth. The reason for
exclusion is often unclear; it might be that the fourth child has a chronic
disease, that she has more or less money than the others, that she was at
the dentist’s the day the club was formed, or simply that the club cannot
exist unless there is someone to exclude. Such clubs typically have a secret
password and secret meeting place. Membership is generally all girls or all
boys.

16. A mother named Alison has consulted her nurse friend with regard to
the types of play that her school-aged child can do. Suggested play for the
9-12 years old include the following EXCEPT
a. Sculpturing materials such as pottery clay
b. Model kits, collections and hobbies
c. Video game of a more mature content
d. Handicrafts of all kind
RATIO: Pottery is a fun and educational activity ideal for kids older than 4
years old.

17. This is one of the strongest motivating forces of behavior of the

adolescents

a. Peers
b. Celebrities
c. Parents
d. Siblings

RATIO: Adolescence develop values through talking to peers and they

have a need to interact with peers to learn more about themselves
and others.

18. Sharon a 15-year-old female has recently consulted the school

nurse about certain fears. What would be the major fear of the
adolescent?
a. Fear of the dark
b. Fear of separation
c. Fear of body image disturbance
d. Fear of intrusive procedures

RATIO: During adolescence, physical changes are occurring that

sometimes bother them.

19. A 4-yeard old child named Levi is talking to his toy cars and action
figures. The mother of this child seems bothered because she thinks
that her child may be developing developmental disorders. What would
be the best response by the nurse?
a. “Your son may really have a developmental disorder like autism.
You need to see a psychiatrist at once.”
b. “Your son’s behavior is normal for a preschooler. Just
don’t make any issue out of it.”
c. “Your son’s behavior is deviant. You should further observe your
son for other signs.”
d. “You should apprehend your child immediately if you see this
type of behavior again.”

RATIO: Preschoolers do not need many toys. Their imaginations are

keener than they will be at any other time in their lives, so they enjoy
games that use imitation such as pretending to be teachers, cowboys,
firefighters, and store clerks. They imitate exactly what they see parents
doing: eating
meals, mowing the lawn, cleaning the house, arguing, and so forth, so
parents’ actions directly influence their behavior. Many preschoolers have
imaginary friends as a normal part of having an active imagination.

20. Which is NOT true regarding the toddler’s toilet training? a.

Physical maturation must be reached before training is
possible.
b. Helping the toddler understand the physiologic signals by
pointing out behaviors they display when they need to void or
defecate.
c. Helping the toddler make the connection between dry pants and
 the toilet or potty chair.
d. Bladder training comes first before bowel training.

RATIO: Toilet training need not start this early, however, because
cognitively and socially, many children do not understand what is being
asked of them until they are 2 or even 3 years old. The markers of
readiness are subtle, but as a rule children are ready for toilet training when
they begin to be uncomfortable in wet diapers

SAS 10

Situation 1: An infant named Russell was diagnosed to have Down

syndrome. This syndrome has a trisomy in the 21st chromosome
causing certain abnormalities in the child.

1. The doctor explained to Russell’s parents that the type of Down

syndrome that he has is Mosaicism. Which of the following
statements would best explain this type?
a. This kind of Down syndrome is frequently associated to women
with advanced age.
b. There is mixture of normal cells and cells that are trisomic
for 21.
c. Chromosome is transmitted by the mother who is a carrier but
age is not a factor.
d. This type is inherited when the father is carrier of the genes
that are trisomic for 21 and a mother who is normal.

RATIO: Mosaic Down syndrome, or mosaicism, is a rare form of Down

syndrome. Down syndrome is a genetic disorder that results in an extra
copy of chromosome 21. People with mosaic Down syndrome have a
mixture of cells. Some have two copies of chromosome 21, and some have
three.

2. Nurse Gina, who is taking care of baby Russell noticed that there is
speckling of the iris of the child. This speckling is commonly known as a.
Mongolian spots
b. Kayser-Fleischer Ring
c. Brushfield’s Spots
d. Roth’s Spot

RATIO: Spots, Brushfield's: Speckled iris. Little white spots

that(are)slightly elevated on the surface of the iris and are arranged in
a ring concentric with the pupil. These spots occur in normal children
but are far more frequent in Down's syndrome (trisomy 21).

3. Russell is further assessed for other signs of Down syndrome. The nurse
would indicate that positive signs of Down syndrome are the following
EXCEPT
a. Delayed or incomplete sexual development (men with Down
syndrome usually are infertile)
b. Inner epicanthic folds and oblique palpebral fissures
c. Hypotonic musculature (protruding abdomen, umbilical
hernia)
d. Small head with a sloping forehead

RATIO: Option A, B, and D are positive signs of Down syndrome.

4. The nurse is about to take the history of the parents of Russell.

Which of the following findings would show that the mother of Russell
would indicate a high-risk factor to have a child with Down syndrome?
a. The mother is suffering from adult-onset diabetes mellitus. b. The
mother during pregnancy took in liberal amounts of ferrous sulfate.
c. The mother is age 45 during her pregnancy.
d. The mother did not properly medicate herself with insulin during
pregnancy

RATIO: One factor that increases the risk for having a baby with Down
syndrome is the mother's age. Women who are 35 years or older when they
become pregnant are more likely to have a pregnancy affected by Down
syndrome than women who become pregnant at a younger age.

5. After teaching the parents about their child’s condition, which of

the following statements would need further teaching?
a. “Our son will need supervision when he will grow up because he
may be cognitively challenged.”
b. “Russell must avoid crowded places as to prevent him from
having an infection.”
c. “We will try to take him to a regular school and help him
mingle with children the same age as his.”
d. “We may need to bring Russell to a speech therapist to help him
talk.”

RATIO: A person with Down's syndrome will have some degree of

learning disability, but the level of ability will be different for each
individual. A child with Down's syndrome might take longer than
other children their age to reach certain milestones and to develop
certain skills.

Situation 2: A child named Christian is seen to have both unilateral cleft

lip and palate. He was born to have deformity.
He is now 9 months of age and the parents brought their child to
the hospital to have a repair.

6. The child will have to undergo Cheiloplasty as the surgeon has

advised the parents. The following is NOT true regarding this kind of
operation.
a. Age for repair is usually after the child has grown but before
speech is well developed.
b. Helps parents with the visible aspects of the defect
c. Aids infant’s ability to suck
d. Performed soon after birth – further modification may be
necessary

RATIO: Surgery of the lip will be performed at approximately 4-6 months

of age. The child must be healthy and gaining weight. The guideline
followed is that children must weigh ten pounds before the surgery will
be done.

7. After the operation the nurse should expect which of the following
equipment at the bedside of the child?
a. Tracheostomy set
b. Defibrillator
c. Ambu bag
d. Endotracheal tube and suction

RATIO: Removal of secretions may improved breathing.

8. It is imperative to teach the parents to turn their child from

side to side to prevent which of the following complications of
prolonged immobility on the bed?
a. Orthostatic hypotension
b. Hypostatic pneumonia
c. Aspiration pneumonia
d. Anemia
RATIO: Hypostatic pneumonia usually results from the collection of
fluid in the dorsal region of the lungs and occurs especially in those (as
the bedridden) confined to a supine position for extended periods.

9. The child is sent home after everything has already been stabilized but
the doctor again advised the parents to return with their child for the next
operation which is palatoplasty? When would be the best time to do this?
a. 1 1⁄2 years old
b. 5 years old
c. 7 years old
d. 3 years old

RATIO: Surgery of the palate generally occurs between 9-15 months of

age. It is done at this time in an effort to provide the child with the best
physiological mechanisms for language and speech development.

10. After the child has had palatoplasty, which of the following position
should the child be placed unto to prevent aspiration pneumonia and
drainage of secretions?
a. High-Fowlers
b. Supine
c. Reverse-Tredenlenburg
d. Prone

RATIO: A child with only a cleft palate repair may sleep on their
stomach. It is important to keep the stitches clean and without crusting.
Prone position is a good way to prevent aspiration pneumonia.

Situation 3: Mark was observed to have spina bifida upon birth. This
condition is a malformation of the spine that is caused by certain factors.
Immediate interventions should be done in order for the child to develop
properly. The mother of mark is also suffering from seizure disorders
and is known to take anticonvulsant medications during her pregnancy.

11. The doctor upon observing Mark’s spina bifida has seen protrusion of
both meninges and spinal cord. This kind of spina bifida is known as a.
Spina bifida occulta
b. Meningocele
c. Myelomeningocele
d. Anencephaly

RATIO: Myelomeningocele is the most severe form of spina bifida. It

happens when both the meninges and the bottom end of the spinal cord
push through the hole in the spine, forming a large fluid-filled sac that
bulges out of a baby's back.

12. The father of Mark asks the nurse what is the common cause of this
kind of condition. The nurse is utterly correct when she says a. “Spina
bifida is primarily caused by intake of a teratogen known as thalomid.”
b. “This condition is caused by a deficiency in folate during
the pregnancy of your wife.”
c. “Spina bifida is passed on genetically and your wife is a probable
carrier of this ailment.”
d. “The condition of your child can be caused in the deficiency of
thiamine and riboflavin during pregnancy.”

RATIO: Not having enough folic acid during pregnancy is one of the most
important factors that can increase your chances of having a child with
spina bifida. Folic acid (also known as vitamin B9) occurs naturally in
some foods, such as broccoli, peas and brown rice.

13. This is the defect of the occipitocervical region with swelling and
displacement of the medulla and spinal cord
a. Hydrocephalus
b. Chiari malformation
c. Galeazzi’s sign
d. Kernig’s sign

RATIO: This malformation occurs during fetal development and is

characterized by downward displacement by more than four millimeters, of
the cerebellar tonsils beneath the foramen magnum into the cervical spinal
canal. This displacement may block the normal pulsations of CSF between
the spinal canal and the intracranial space. This form of Chiari
malformation may be associated with syringomyelia/hydromyelia.

14. When taking care of the sac of the child with spina bifida it is essential
for the nurse to do which of the following
EXCEPT?
a. Avoid pressure on the sac
b. The area must be kept clean, especially from urine and feces c.
Sterile gauze with antibiotic solution may be placed over the sac d.
Administer oral paracetamol to reduce fever

RATIO: Only option A, B, C are appropriate and applicable to patients

with spina bifida.

15. Which of the following drugs for seizure would most likely cause the
child to have neural tube defects?
a. Valproic acid (Depakene)
b. Carbamazepine (Tegretol)
c. Lamotrigine (Oxtellar)
d. Topiramate (Topimax)

RATIO: Valproate and carbamazepine have been associated

specifically with the development of neural tube defects (NTDs),
especially spina bifida.

Situation 4: A newborn named Julie is seen to have hydrocephalus.

Her head circumference was larger than what is normal. She also has
protruding eyeballs. There are prominent scalp veins.

16. Julie’s intracranial pressure is expected to above the normal

range. What would be the normal intracranial pressure in infants?
a. 10 to 15 mm Hg
b. Less than 3 to 7 mm Hg
c. Less than 1.5 to 6 mm Hg
d. 20 to 25 mm Hg

RATIO: Normal ICP values are less than 10 – 15 mmHg for older children,
less than 3 – 7 mmHg for younger children and less than 1.5 – 6 mmHg in
term infants. ICP values greater than 20 – 25 mmHg are considered to be
increased and require treatment in most instances.

17. Which of the following signs and symptoms would indicate that
Julie is suffering from increased intracranial pressure?
a. Projectile vomiting not associated with feeding,
irritability, anorexia, high shrill cry, seizures
b. Dizziness, there is low-pitched cry, increased feeding, fever and
weight loss
c. Child appears calm, lethargy, leakage of cerebrospinal fluid from
the ears and nose
d. There are rashes on the scalp, bloodshot eyes, epistaxis, and
gum bleeding

RATIO: Option A are accurate signs and symptoms of infants having

an increased intracranial pressure.
18. The doctor of Julie advised the parents to undergo treatment to
relieve the hydrocephalus of the child. What would be the best
intervention for the child’s condition?
a. Ventriculo-peritoneal shunting
b. Ventriculostomy
c. Burr-hole drainage
d. Craniotomy

RATIO: A ventriculoperitoneal (VP) shunt is a medical device

that relieves pressure on the brain caused by fluid
accumulation. VP shunting is a surgical procedure that primarily
treats a condition called hydrocephalus.

19. If hydrocephalus is left untreated the child may grow up to be

a. Cognitively challenged
b. Autistic
c. Attention-deficit hyperactive disorder
d. Conduct disorder

RATIO: If left untreated, hydrocephalus can cause developmental

delays, personality changes and memory loss. In severe cases,
untreated hydrocephalus may result in nerve damage, vision loss and
even death.

20. When monitoring for the child’s intracranial pressure it is important

that the nurse must avoid giving the child which of the following
medications?
a. Diuretics
b. Sedative
c. Analgesics
d. Antipyretics

RATIO: Diuretics draw water out of the neurons. This helps to reduce the
fluid within the intracranial space.Analgesia and sedation (particularly in the
pre-hospital, ER, and intensive care setting) are used to reduce agitation and
metabolic needs of the brain, but watch for side effects, since these
medications may cause low blood pressure. Antipyretic is not indicated as a
medication for increase ICP.

SAS 11
1. Which of the following statement best describe pyloric stenosis? a. Failure
of the membrane separating the rectum from the anus to absorb during
eighth week of fetal life
b. Absence of parasympathetic ganglion cells in a portion of the bowel,
which causes enlargement of the bowel proximal to the defect
c. Telescoping of one portion of the intestine into another; occurs more
frequently at the ileocecal valve
d. Congenital hypertrophy of muscular tissue of the pyloric
sphincter, usually asymptomatic until 2 to 4 weeks after birth

RATIONALE: Pyloric stenosis is a condition that affects an infant's pylorus, a

muscle at the end of the stomach. When the pylorus thickens, food can’t pass
through. Pyloric stenosis symptoms include forceful vomiting, which may
cause dehydration.

2.What site is commonly affected to a child who is suffering

from aganglionic megacolon?
a. Ascending colon
b. Descending
colon
c. Transverse
colon
d. Rectosigmoid
colon

RATIONALE: Hirschsprung’s disease (congenital megacolon) is caused by the

failed migration of colonic ganglion cells during gestation. Varying lengths of
the distal colon are unable to relax, causing functional colonic obstruction.
Hirschsprung’s disease most commonly involves the rectosigmoid region of
the colon but can affect the entire colon and, rarely, the small intestine.

3. Which of the following is the characteristic of stools in an infant who

has aganglionic megacolon?
a. Passage of ribbonlike or
pellet-like stools
b. Currant-jelly stools
c. Rice-watery
stools d. Black
tarry stools
RATIONALE: Constipation results from absence of ganglion cells in the rectum
and colon, and is present since the neonatal period with passage of frequent
foul-smelling, ribbon-like, or pellet-like stools.
4. If an olive-mass is palpated on the abdomen of the child, the child is
positive for pyloric stenosis. Where is this usually palpated? a. Right lower
quadrant
b. Left upper
quadrant
c. Right upper
quadrant
d. Left lower
quadrant

RATIONALE: An enlarged pylorus, classically described as an "olive," can be

palpated in the right upper quadrant or epigastrium of the abdomen in 60-
80% of infants with pyloric stenosis. Palpation of an olive is pathognomonic
for pyloric stenosis.

5. What is the description of the vomitus of the patient who is suffering

from pyloric stenosis?
a. Projectile, non-bile stained
b.Non projectile, red stained
c.Projectile, brown stained
d.Non projectile, yellow stained

RATIONALE: Babies with pyloric stenosis usually have progressively

worsening vomiting during their first weeks or months of life. The vomiting is
often described as non bilious and projectile vomiting, because it is more
forceful than the usual spit ups commonly seen at this age.

6.After feeding the infant who has undergone an abdominal surgery

because of pyloric stenosis. The child must be placed on which of the
following position afterwards?
a. Supine
b. Left side
lying
c. Prone
d. Right side lying

RATIONALE: Prone with the head of the bed elevated

7.When positioning the infant who has diaphragmatic hernia it is best
to place the infant on
a. The affected side
b. The stomach
c. The unaffected
side d. The back
RATIONALE: To allow greater respiration in the unaffected side.

8.Which of the following types of enema would help relieve

the intussusception of the child?
a. Barium enema
b. Fleet enema
c. Carminative
enema d.
Cleansing enema

RATIONALE: In a barium enema, a liquid mixture called barium is

used instead of air to fix the blockage in the same way.

9.A child named Paul Macchiato is diagnosed to have β-Thalassemia, his

parents are of Italian descent. He tells you that he is constantly tired even by
doing a small amount of activity. Which of the following is the best nursing
diagnosis for him?
a. Body image
disturbance
b. Activity
intolerance
c. Altered family
processes
d. Impaired gas
exchange

RATIONALE: Activity intolerance related to imbalance of oxygen supply

and consumption needs.

10. β – Thalassemia is an autosomal disorder with varied expressivity. The

basic defect of this disease is found to be associated with which of the
following deficiencies?
a. α-chain polypeptide deficiency
b. Iron deficiency
c. β – chain polypeptide deficiency
d. Vitamin B12 deficiency
RATIONALE: Beta thalassemia is a blood disorder that reduces the production
of hemoglobin . Hemoglobin is the iron-containing protein in red blood cells
that carries oxygen to cells throughout the body. In people with beta
thalassemia, low levels of hemoglobin lead to a lack of oxygen in many parts
of the body.

11. This is known as the excessive storage of iron in various tissues of the
body, especially the spleen, heart, and pancreas.
a. Hemosiderosis
b.
Hemochromat
osis
c. Ferrosis
d. Hematoma

RATIONALE: Hemochromatosis, or iron overload, is a condition in which your

body stores too much iron. It's often genetic. It can cause serious damage to
your body, including to your heart, liver and pancreas.

12. A child who has Wilm’s tumor (nephroblastoma) also has

cryptorchidism which is
a. Undescended testes
b. Abnormal enlargement of
the testes
c. Absence of the testes
d. Swelling of the testes

RATIONALE: An undescended testicle (cryptorchidism) is a testicle that hasn't

moved into its proper position in the bag of skin hanging below the penis
(scrotum) before birth. Usually just one testicle is affected, but about 10
percent of the time both testicles are undescended.

13. A child named Robert is being diagnosed for the presence of tumor in
the kidneys. It was found that he has nephroblastoma. The tumor is only
encapsulated within the kidney. What stage of cancer is the child on? a.
Stage
I
b. Stage
II c.
Stage III
d. Stage
IV
RATIONALE: Stage I: Cancer is found in one kidney only and can be
completely removed by surgery. About 41% of all Wilms tumors are stage
I.

14. If the child has the presence of an encapsulated tumor in the kidney,
the most appropriate nursing diagnosis for him is
a. Fear
b. Altered family
processes
c. Risk for injury
d.Altered nutrition

RATIONALE: Wilms tumor (also called Wilms' tumor or nephroblastoma) is a

type of childhood cancer that starts in the kidneys. It is the most common
type of kidney cancer in children. About 9 of 10 kidney cancers in children are
Wilms tumors

15. When caring for the child with nephroblastoma the priority nursing
intervention for the child is
to
a. Palpate the abdomen for tender swelling and a nontender mass which
is usually confined to one side of the abdomen
b. Observe for the presence of blood in the urine which is
indicative of stage III cancer
c. Look for signs of metastasis such as cough,
dyspnea, shortness of breath.
d. Place a sign over the bed saying, “Do not palpate the abdomen.”

RATIONALE: Other findings associated with compression of

neighboring organs or metastasis
(e.g., lungs: cough, dyspnea, shortness of breath)

Situation: A 5-year old female named Erina Nakiri was brought to the hospital.
According to her mother she has been experiencing fever for more than 5
days. Upon assessment Nurse Alice has observed polymorphous rash on the
trunk. Aside from those she has observed peeling of the palms and soles. The
child also has a strawberry-tongue.

16. The possible diagnosis of the

child would be a. Measles
b. Scarlet fever
c. Kawasaki
disease
d. Rubella
RATIONALE: Kawasaki disease (KD), or mucocutaneous lymph node
syndrome, is an illness that causes inflammation in arteries, veins, and
capillaries. It also affects your lymph nodes and causes symptoms in your
nose, mouth, and throat. It's the most common cause of heart disease in
children.

17. The cause of Erina’s disease

would be a. Viral
b. Allergic
reaction
c. Unknown
d. Bacterial

RATIONALE: Scientists haven't found an exact cause for Kawasaki disease. It

might be linked to genes, viruses, bacteria, and other things in the world
around a child, such as chemicals and irritants. The disease probably isn't
contagious, but it sometimes happens in clusters in a community.

18. One of the possible complications from this

disease would be
a. Aneurysms
b.
Hypertensio
n
c. Seizures
d. Asthma
RATIONALE: Without prompt treatment, Kawasaki disease can damage the
coronary arteries and the heart muscle itself in as many as 1 in 4 children.
Over the first few weeks, a weakening of a coronary artery can result in
enlargement of the vessel wall (an aneurysm).

19.With Erina’s disease, Nurse Alice must know that it is common

from which geographic location?
a.
Mediterranea
n b. Pacific
c. Middle
East d.
Caribbean

RATIONALE: Children of Asian or Pacific Island descent, such as Japanese

or Korean, have higher rates of Kawasaki disease.
20. The doctor has started acetylsalicylic acid (Aspirin) therapy for Erina.
The nurse must know that the purpose of the drug therapy is a. Prevent
thrombus formation
b. Control the child’s
hypertension c. Increase
the blood volume
d. Improve cardiac contractility
RATIONALE: They'll probably be given high-dose aspirin until their fever
subsides. They may then be prescribed low-dose aspirin until 6 to 8 weeks
after the start of their symptoms. This is to reduce blood clots if there are
problems developing in the blood vessels that supply blood to the heart.

SAS 12

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.

RATIO: 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.

RATIO: Community-based practice means providing care to people in their

own natural environments: the home, school and workplace, for example.
3. Population-focused nursing practice requires which of the following
processes?

A. Community organizing
B. Nursing process

C. Community diagnosis

D. Epidemiologic process

RATIO: 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. 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

RATIO: 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. 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

RATIO: 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.

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

RATIO: Ergonomics is improving efficiency of workers by improving the

worker's environment through appropriately designed furniture, for
example.

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

RATIO: Since there is no occupational nurse in the factory, the nearest

health center with a public health nurse will be the one to cater their
occupational health needs and not the regional.

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.

RATIO: Community health services, including public health services, are

prepaid paid services, through taxation, for example.
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

RATIO: According to Winslow, all public health efforts are for people to
realize their birthrights of health and longevity.

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. Swaroop’s index

D. Case fatality rate

RATIO: Swaroop’s 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. 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.
RATIO: 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. 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

RATIO: This is a direct quote from Dr. Margaret Shetland’s statements on

Public Health Nursing.

13. Region IV Hospital is classified as what level of

facility? A. Primary

B. Secondary

C. Intermediate

D. Tertiary

RATIO: Regional hospitals are tertiary facilities because they serve as

training hospitals for the region.

14. 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.

RATIO: Primary facilities government and non-government facilities that

provide basic out-patient services.
15. Which is an example of the school nurse’s 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

RATIO: Random classroom inspection is assessment of pupils/students and

teachers for signs of a health problem prevalent in the community.

16. When the nurse determines whether resources were maximized in

implementing Ligtas Tigdas, she is evaluating

A. Effectiveness

B. Efficiency

C. Adequacy

D. Appropriateness

RATIO: Efficiency is determining whether the goals were attained at the

least possible cost.

17. 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

RATIO: R.A. 7160 devolved basic health services to local government units
(LGU’s). The public health nurse is an employee of the LGU.

18. 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

RATIO: People empowerment is the basic motivation behind devolution of

basic services to LGU’s.

19. Who is the Chairman of the Municipal Health Board?

A. Mayor

B. Municipal Health Officer

C. Public Health Nurse

D. Any qualified physician

RATIO: The local executive serves as the chairman of the Municipal Health
Board.

20. 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

RATIO: The entry of a person into the health care delivery system is usually
through a consultation in out-patient services.

SAS 13

1. 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.
RATIO: The community health nurse develops the health capability of
people through health education and community organizing activities.

2.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
RATIO:Presidential Proclamation No. 4 is on the Ligtas Tigdas Program.

3.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
RATIO: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.
4.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

RATIO: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.

5.In which step are plans formulated for solving

community problems?
A. Mobilization
B. Community
organization
C. Follow
up/extension
D. Core group
formation
RATIO: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.

6.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 community’s resources in dealing with
health problems
D. To maximize the community’s resources in dealing
with health problems
RATIO: To maximize the community’s resources in dealing with health
problems Community organizing is a developmental service, with the
goal of developing the people’s self-reliance in dealing with community
health problems. A, B and C are objectives of contributory objectives to
this goal.

7. 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
RATIO:Participation in community activities in resolving a community
problem may be in any of the processes mentioned in the other
choices.

8.Tertiary prevention is needed in which stage of the natural history of

disease?
A.Pre-pathogenesis
B.Pathogenesis
C.Prodromal
D.Termi
nal
RATIO: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)
9.Isolation of a child with measles belongs to what level
of prevention?
A. Primary
B.Secondar
y C.
Intermediat
e D.
Tertiary
RATIO:The purpose of isolating a client with a communicable disease is to
protect those who are not sick (specific disease prevention).

10.On the other hand, Operation Timbang is _____

prevention. A.Primary
B. Secondary
C.Intermediate
D.Tertiary
RATIO:Operation Timbang is done to identify members of the susceptible
population who are malnourished. Its purpose is early diagnosis and,
subsequently, prompt treatment.

11. 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
D. Written
communication
RATIO:Dynamics of family relationships can best be observed in the
family's natural environment, which is the home.

12. 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
RATIO:Failure of a family member to develop according to what is
expected, as in mental retardation, is a health deficit.
13. 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
RATIO:Entry of the 6-year old into school is an anticipated period of
unusual demand on the family.

14. 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 family’s initiative in providing for health
needs of its members.

RATIO: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.

15.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
RATIO:The home visit plan should be flexible and practical, depending on
factors, such as the family's needs and the resources available to the
nurse and the family.

16. 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
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.
RATIO: 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.

17.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.
RATIO: Wash his/her hands before and after providing nursing care to
the family members.Choice B goes against the idea of utilizing the
family’s resources, which is encouraged in CHN. Choices C and D goes
against the principle of asepsis of confining the contaminated surface of
objects.

18.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
RATIO:Analytical epidemiology is the study of factors or determinants
affecting the patterns of occurrence and distribution of disease in a
community.

19. 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
RATIO:Epidemiology is used in the assessment of a community or
evaluation of interventions in community health practice.

20. Which of the following is an epidemiologic function of the nurse

during an epidemic?
21. A. Conducting assessment of suspected cases to detect the
communicable disease
22. 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
RATIO: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.
SAS 14

1. 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%

RATIO: When number of males and females are given, the formula for sex
ratio would be r=(m/f)×100. Where, r = Gender (sex) Ratio; m = Number
of Males; and f = Number of Females.
Solution:
r=(m/f)x100
r= (35,299,000/34,968,000) x 100
r= 100.94

2. 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.

RATIO: Primary health care is essential health care that can be sustained
in all stages of development of the community.

3. 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
RATIO: 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.
4. Use of appropriate technology requires knowledge of indigenous
technology. Which medicinal herb is given for fever, headache and
cough?

A. Sambong
B. Tsaang gubat
C. Akapulko
D. Lagundi

RATIO: Among the medicinal uses of Lagundi are to stop coughing, relieve
asthma, facilitate the discharge of phlegm and to lower fever due to
colds or flu. It is also a pain reliever for headache and toothache.

5. 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

RATIO: Letter of Instruction No. 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.

6. 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

RATIO: Intersectoral linkages refer to working relationships between

the health sector and other sectors involved in community
development.

7. 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
 RATIO: Based on the Philippine population composition, to estimate the
number of 1-4 year old children, multiply total population by 11.5%.

8. 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

RATIO: To estimate the number of pregnant women, multiply the

total population by 3.5%.

9. 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.

RATIO: 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.

10. Which of the following is a natality rate?

A. Crude birth rate
B. Neonatal mortality rate
C. Infant mortality rate
D. General fertility rate

RATIO: Natality means birth. A natality rate is a birth rate.

11. 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
RATIO: To compute crude death rate divide total number of deaths (94)
by total population (18,000) and multiply by 1,000.

12. 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

RATIO: Preschoolers are the most susceptible to PEM because they

have generally been weaned. Also, this is the population who, unable
the feed themselves, are often the victims of poor intrafamilial food
distribution.

13. 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

RATIO: 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.

14. 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. Swaroop’s index

RATIO: 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.

15. What numerator is used in computing general fertility

rate? A. Estimated midyear population
B. Number of registered live births
C. Number of pregnancies in the year
D. Number of females of reproductive age

RATIO: 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.

16. 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

RATIO: A survey, also called sample survey, is data gathering about

a sample of the population.

17. 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

RATIO: The other method of population assignment, de jure, is based on

the usual place of residence of the people.

18. 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

RATIO: A tally report is prepared monthly or quarterly by the RHU

personnel and transmitted to the Provincial Health Office.

19. 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
D. Individual health record

RATIO: 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.

20. 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

RATIO: P.D. 651 amended R.A. 3753, requiring the registry of births
within 30 days from their occurrence.

SAS 15

1. Integrated Management of Childhood Illness (IMCI) is promulgated by the

UNICEF together with DOH in order to properly treat common childhood
diseases usually in the
a. Hospital
b. Community
c. Clinic
d. School

RATIO: Effective and affordable interventions to address common conditions

exist but they do not yet reach the populations most in need, the young and
impoverish communities. IMCI is a major strategy for child survival, healthy
growth and development and is based on the combined delivery of essential
interventions at community, health facility and health systems levels.

2. A 2-year old boy was brought by his mother to the health center for a
regular yearly check-up. As a nurse in the
health center you are going to observe first for the general danger signs. All
but one is the danger sign.
a. Lethargic or unconscious
b. The child has had convulsions
c. There is bulging fontanel
d. The child vomits everything he eats

RATIO: The general danger signs that are being recognized include being
unable to drink or breastfeed, vomiting everything child eats, convulsions
and being lethargic or unconscious. Bulging fontanel is not included.

3. If the child presents with no symptoms of the general danger signs the
next thing to do is assess for
a. fever.
b. cough or difficulty of breathing.
c. anemia or malnutrition.
d. ear infection.

RATIO: Even if present, next thing to assess are the mainsymptoms which
includes coughing or difficult breathing , fever, malnutrition or anaemia,
checking of immunizations, diarrhea, ear problems and even HIV status.

4. When observing the 2-year old child for signs of pneumonia you
documented that the child is having 45 breaths/min, there is chest indrawing
and stridor. You are going to classify this as
a. cough or colds.
b. pneumonia.
c. no pneumonia.
d. severe pneumonia or very severe disease.

RATIO: Cough or difficult breathing with or without fast breathing, chest

indrawing or danger signs such as lethargy or unconsciousness, convulsions,
or inability to eat or drink, and stridor in calm child are the signs of severe
pneumonia.

5. When assessing for the child’s breath sounds you heard a specific
adventitious breath sound which is stridor. This
is best described as
a. harsh sound upon inhalation.
b. harsh sound upon exhalation.
c. clicking and rattling noises upon auscultation.
d. course crackling sound.

RATIO: Stridor is a high-pitched turbulent sound and is most commonly

inspiratory.

6. In order to relieve the cough of the child you are going to recommend the
mother the following treatment EXCEPT.
a. Breastfeed the child.
b. Offer the child calamansi juice.
c. Give the child codeine cough syrup.
d. Offer the child with ginger ale.

RATIO: The FDA doesn't recommend over-the-counter (OTC) medicines for

cough and cold symptoms in children younger than 2 years old. Prescription
cough medicines containing codeine or hydrocodone are not indicated for
use in children younger than 18 years old.

7. When assessing the child who is having diarrhea you observed that the
child is restless, has sunken eyes, and is
thirsty and drinking eagerly while the skin pinch goes back slowly. You are
going to classify this as
a. Some dehydration
b. Severe dehydration
c. Moderate dehydration
d. No dehydration

RATIO: Some dehydration will be classified if the child is restless or irritable,

has sunken eyes, drinks eagerly, thirsty, and when skin pinched goes back
slowly.

8. If you are going to check for the skin pinch of the child or the skin turgor,
where is the best area to check for this?
a. Forearm
b. Thigh
c. Cheek
d. Abdomen

RATIO: Assessment of skin turgor is performed by pinching skin on the

lateral abdominal wall at the level of the umbilicus.

9. When asking the mother for the history of the child’s diarrhea the mother
tells you that her child defecates with blood in the stool. You will suspect for
what type of infection?
a. Typhoid fever
b. Dysentery
c. Cholera
d. Acute gastroenteritis

RATIO: Dysentery is diarrhoea with blood in the stool, with or without

mucus. The most common cause of dysentery is Shigella bacteria.

10. A mother brought her child to the health center and you observed that
the child has stiff neck and is having convulsions. They are living in a
malaria endemic area. You are going to classify this as?
a. Malaria
b. Very severe febrile disease
c. No malaria
d. Measles

RATIO: Severe febrile disease symptoms include fever; general danger sign,
such a lethargy or unconsciousness, convulsions or inability to drink; and
stiff neck (a sign of meningitis).

11. If the child is under the pink category of malaria which antimalarial
would be best for the child for initial treatment?
a. Quinine
b. Sulfadoxine
c. Primaquine
d. Artemeter-Lumefantrine
RATIO: Pink category of malaria is the very severe febrile disease. Give first
dose of artesunate or quinine should be given.

12. When assessing the child for measles you have observed that the child
has pus draining from the eye and there
are mouth ulcers. How will you classify this type of measles?
a. Measles
b. Measles with eye or mouth complications
c. No measles
d. Severe complicated measles

RATIO: If the child has pus draining from the eye, or mouth ulcers that are
not deep or extensive, classify the child as having MEASLES WITH EYE OR
MOUTH COMPLICATIONS.

13. This is the drug of choice for a child with clouding and pus draining from
the eyes with severe measles.
a. Tetracycline
b. Amoxicillin
c. Gentian violet
d. Cotrimoxazole

RATIO: Eye infections will be treated with tetracycline eye ointment.

14. This is the medication used to paint the mouth for a child who is
experiencing mouth ulcer which is a complication
of measles infection.
a. Gentian violet
b. Tetracycline
c. ORS
d. Amoxicillin

RATIO: Treating mouth ulcers controls infection and helps the child to eat.
With treating mouth ulcers, half-strength gentian violet (.25%) should be
used, which should be used in the mouth, not full-strength (0.5%).
15. This is one way of diagnosing dengue hemorrhagic fever wherein you are
going to use a sphygmomanometer on
the arm of the patient and count the number of rashes upon its inflation.
This is known as
a. Rumpel Leede’s test
b. ELISA test
c. Blood smear
d. BP test

RATIO: Capillary fragility test (also known as a Rumpel–Leede capillary

fragility test or tourniquet test) determines capillary fragility and is a clinical
diagnostic method to determine hemorrhagic tendency of a patient. A blood
pressure cuff is applied and inflated to a point between the systolic and
diastolic blood pressures for 5 min. The test is positive if there are 10 or
more petechiae per square inch.

16. When assessing the child with ear infection you’ve seen that there is pus
draining from the ears. The mother tells
you that the pus has been present for more than two weeks. What is the
classification of this ear infection?
a. No ear infection
b. Mastoiditis
c. Chronic ear infection
d. Acute ear infection

RATIO: Ear discharge reported for 2 weeks or more (with pus seen draining
from the ear) is treated as a chronic ear infection.

17. Upon observing the child’s palms that the child has some palmar pallor.
You are going to suspect the child to have?
a. No anemia
b. Severe anemia
c. Some anemia
d. Anemia
RATIO: A child with some palmar pallor should be classified as having
ANAEMIA.

18. When the child is anemic you are going to give the child, aside from iron,
mebendazole. The mother asks you what
the drug is for. You are going to say that
a. “This drug is an antibiotic to help eradicate the bacterial infection causing
your child’s anemia.”
b. “Mebendazole helps in purging helminthes or worms inside the
gastrointestinal tract of your child that are
responsible for your child’s anemia.”
c. “This drug helps in the absorption of iron in the gastrointestinal tract to
improve the child’s oxygenation.”
d. “Mebendazole is a potent antiviral that kills the virus that damages the
red blood cells of your child causing
severe anemia.”

RATIO: Hookworm and whipworm infections contribute to anaemia because

the loss of blood from the gut results in iron deficiency. Give the child
mebendazole only if there is hookworm or whipworm in the area.

19. In checking the child immunization status of a 3-month old infant. The
infant should already have which of the
following vaccines?
a. BCG, a dose of DPT, OPV and HEP-B
b. BCG, 2 doses of DPT, OPV and 3rd dose of HEP-B
c. BCG, 3 doses of DPT, OPV, HEP-B and a dose of Measles
d. BCG and HEPA-B

RATIO: BCG and Hepa B are given at birth. Another dose of Hep B is givan
at 1 to 2 months after birth. Both DPT and OPV should be given at 6th and
10th week, before the baby turns 3 months old. MMR vaccine which includes
measles is at 9 months old.

20. When checking a 14-month old child’s Vitamin A status. The child should
already have how many doses of the
vitamin?
a. 1
b. 2
c. 3
d. 4

RATIO: Give 3 doses of vitamin A. Give the first dose on the first day and
the second dose on day 2. Give the third dose after two weeks if possible.

SAS 16

1. In the diagnosis of HIV, which of the following tests would confirm

that Freddie is positive for the virus?
a. Enzyme-linked immunosorbent assay (ELISA)
test b. Western-blot test
c. Viral load test
d. Home access express test

RATIO: ELISA Test ELISA, which stands for enzyme-linked

immunosorbent assay, is used to detect HIV infection. If an ELISA test is
positive, the Western blot test is usually administered to confirm the
diagnosis.

2. Freddie is asking Nurse Freda on how the virus is transmitted. The

nurse must know that Freddie must have gotten
the virus through unprotected sexual intercourse. Which of the following
sexual acts would least likely transmit HIV?
a. Anal sex
b. Vaginal sex
c. Oral sex
d. None of the above

RATIO: There is little to no risk of getting or transmitting HIV from oral

sex. Sexual activities that don't involve contact with body fluids (semen,
vaginal fluid, or blood) carry no risk of HIV transmission

3. Nurse Freda is planning for the confinement of Freddie at the infectious

disease ward. Which of the following types of isolation precautions will
Nurse Freda implement with regard to Freddie’s diagnosis?
a. Contact precautions
b. Airborne precautions
c. Reverse isolation precautions
d. Droplet precautions
RATIO: Infectious diseases commonly spread through the direct transfer
of bacteria, viruses or other germs from one person to another. This can
happen when an individual with the bacterium or virus touches, kisses, or
coughs or sneezes on someone who isn't infected

4. Freddie has stated to the nurse, “I think my friends have abandoned

me when they learned about my condition. I
feel so hopeless.” The nurse’s most appropriate nursing intervention for his
statement would be
a. Powerlessness
b. Deficient knowledge
c. Social isolation
d. Disturbed thought processes

RATIO: The patient experiences or perceives a need or desire for

increased involvement with others but is unable to make that contact.

5. When doing the discharge planning for Freddie, the nurse must advise the
patient to avoid which of the following
types of food?
a. Lean meats such as beef sirloin and chicken breast
b. Raw fresh food such as sushi
c. Soft fruits such as bananas or pears
d. Peanut butter on toast and crackers

RATIO: Patient with HIV should avoid eating raw eggs, meats, or
seafood (including sushi and oysters/shellfish).

SITUATION: A 10-year old child named Rolando was brought to the

hospital with signs and symptoms of fever with a
temperature of 38.9 degrees Celsius; complaints of headache; and nausea.
Serum laboratory tests show that Roland has
lower than the usual platelet count. His doctor diagnosed him to
have dengue fever.

6. Nurse Kim is currently attending to the needs of Rolando. Nurse Kim

must know that the prevalence of dengue
fever in the Philippines is
a. Epidemic
b. Pandemic
c. Endemic
d. Sporadic
RATIO: The Philippines declared the country's outbreak of dengue to be
a national epidemic. Dengue is a mosquito-borne viral infection causing
a severe flu-like illness and, sometimes causing a potentially lethal
complication called severe dengue.

7. Based from the laboratory results of Rolando, Nurse Kim must formulate
which of the following appropriate nursing
diagnosis for this patient?
a. Risk for bleeding
b. Deficient fluid volume
c. Ineffective tissue perfusion
d. Risk for shock

RATIO: Patient with dengue fever is at risk for bleeding

8. Since Rolando has a low platelet count, the attending physician

has ordered to infuse platelet concentrate to the
patient. After blood typing and cross-matching, Nurse Kim together with her
colleague Nurse Joyce has started the
transfusion of the blood product. How many minutes will the nurse stay with
the patient after starting the transfusion?
a. 30 minutes
b. 5 minutes
c. 15 minutes
d. 45 minutes

RATIO: Baseline vital signs should be taken just prior to initiating the
transfusion, and the nurse must stay with the patient during the first 15
minutes of transfusion, to monitor for any immediate reaction.

9. Nurse Kim plans to give antipyretics to Rolando to help control the

fever. Which of the following antipyretics would
Nurse Kim question from the doctor’s order?
a. Paracetamol
b. Acetaminophen
c. Ibuprofen
d. Aspirin

RATIO: Patients should be advised to stay well hydrated and to avoid

aspirin (acetylsalicylic acid), aspirin-containing drugs, and other
nonsteroidal anti inflammatory drugs (such as ibuprofen) because of their
anticoagulant properties
10. Signs of plasma leakage in dengue fever appears after how many
days after the fever breaks out?
a. 1 day
b. 2 days
c. 3 days
d. 7 days

SITUATION: A 45-year-old male banker named Arturito presents to

the health department with complaints of a sore on his
penis. The patient says that it is painless and started out as a “small
red bump” and “turned into this”. You note the area is
ulcerated, red, has sharp borders and is approximately 2.5 cm. The
patient reports to having multiple sexual partners the
past 3 months. A blood sample was collected from and results show that
he is positive for syphilis.

11. Nurse Monica, who is currently assigned to Arturito, must know

that syphilis is caused by which of the of following
microorganisms?
a. Clostridium perfringens
b. Treponema pallidum
c. Chlamydia trachomatis
d. Serratia marcescens

RATIO: The cause of syphilis is a bacterium called Treponema pallidum.

The most common route of transmission is through contact with an
infected person's sore during sexual activity. The bacteria enter your body
through minor cuts or abrasions in your skin or mucous membranes.

12. Rapid point-of-care test has determined his diagnosis of syphilis.

Along with syphilis, this method of testing also
detects the presence of
a. Hepatitis A
b. Neisseria gonorheae
c. Human immunodeficiency virus (HIV)
d. Human papilloma virus (HPV)

13. Arturito asks Nurse Monica about the complications of syphilis if it is

left untreated. Nurse Monica must state that
its complication is
a. Epididymitis
b. Epididymo-orchitis
c. Meningitis
d. Immunosuppression

RATIO: In the late stages of syphilis, the disease may have damaged vital
organs of the body such as the heart, blood vessels, brain, nerves, eyes,
liver, bones and joints. Complications such as meningitis, stroke,
dementia and heart disease may occur, with serious consequences, even
death.

14. Nurse Monica must expect the physician to prescribe which of

the following drugs for the treatment of syphilis?
a. Penicillin-G
b. Cotrimoxazole
c. Ceftriaxone
d. Amikacin

RATIO: The preferred treatment at all stages is penicillin, an

antibiotic medication that can kill the organism that causes syphilis.

15. Nurse Monica is doing patient education prior to patient discharge.

Which of the following statements from Arturito
would require further education?
a. “I must abstain from sexual contact with anyone until the skin lesion is
healed.”
b. “I will be immune from the disease once I am cured from it.”
c. “When I resume sexual activities, I must wear condoms at all
times.” d. “It is better if I limit my sexual partners to one.”

RATIO:

SITUATION: A 3-year-old boy named Denver was sent to the hospital for
the presence of fever (38.5 degrees Celsius),
rashes all over the body, and presence of the white spots on the
patient’s oral mucosa. Upon assessment, Denver is
diagnosed to have measles.

16. Nurse Raquel is assessing the patient’s oral mucosa and saw spots
that look like tiny grains of white sand
surrounded by a red ring. The nurse must note this on her chart
as a. Rose spots
b. Cullen sign
c. Koplik spots
d. Forscheimer’s spots
RATIO: Measles, a viral disease, can cause spots to form inside the
cheeks. These spots, called Koplik spots, resemble tiny grains of grayish
white sand surrounded by a red ring

17. Nurse Raquel must know that measles is transmitted through which
of the following methods?
a. Airborne respiratory droplets
b. Mosquito bite
c. Direct skin-to-skin contact
d. Fecal-oral
RATIO: Measles is a highly contagious virus that lives in the nose and
throat mucus of an infected person. It can spread to others through
coughing and
sneezing. If other people breathe the contaminated air or touch the
infected surface, then touch their eyes, noses, or mouths, they can
become infected.

18. The average incubation period of measles is around

a. 7-21 days
b. 10-14 days
c. 17-23 days
d. 12-25 days

RATIO: The incubation period of measles, from exposure to

prodrome, averages 10–12 days. From exposure to rash onset
averages 14 days (range, 7–21 days).

19. The causative agent for measles is

a. Rubella virus
b. Paramyxovirus
c. Varicella zoster virus
d. Rubeola virus

RATIO: Measles is an acute infection caused by the rubeola virus. It is

highly contagious and usually seen in children.

20. The mother of Denver is asking Nurse Raquel if there is a cure

for measles. Which of the following statements by
Nurse Raquel would be correct?
A. “Yes, there is a cure. The doctor can provide an antiviral for this
disease.” B. “Yes, we can give your son a vaccine in order for him to be free
from this disease.”
C. “There is no cure. However, your son’s immune system will
be fighting off this disease with proper treatment of his signs
and symptoms.”
D. “Sadly, there is no cure for this disease. Doctors are still trying to find
the cure for measles.”

RATIO: There's no specific treatment for measles, but the condition usually
improves within 7 to 10 days. A GP will probably suggest taking things
easy at home until you're feeling better. Stay away from work or school
for at least 4 days from when the measles rash first appears to reduce the
risk of spreading the infection.

SAS 17

SITUATION: Harriet Roque a 47-year-old female patient came to the rural

health unit complaining the appearance of lesions on her skin which are
multiple, symmetrical and erythematous. Some of the lesions are already
raised, large erythematous plaques which appear rough. A skin smear was
obtained and came back to be positive for mycobacterium leprae. She has
multibacillary leprosy.

1. Patient Harriet asked the nurse on duty, Nurse Justine, on how she has
contracted the disease. Nurse Justine must state which of the following?

a. “Leprosy is transmitted via direct skin-to-skin contact.”

b. “Leprosy is acquired by eating foods contaminated with the bacteria.”

c. “Leprosy is a bacterial infection that is cause by tick bites.”

d. “Leprosy spreads from person-to-person by nasal secretions or

droplets from the upper respiratory tract.”

RATIO: The infection spreads from person to person by nasal secretions or

droplets. Scientists currently think it may happen when a person with
Hansen's disease coughs or sneezes, and a healthy person breathes in the
droplets containing the bacteria. Prolonged, close contact with someone with
untreated leprosy over many months is needed to catch the disease.

2. What is the description of the mycobacterium leprae bacteria?

a. Acid-fast; gram positive bacterium

b. Non-acid fast; gram positive bacterium

c. Acid-fast; gram negative bacterium

d. Non-acid fast; gram negative bacterium

RATIO: Mycobacterium leprae is an obligate intracellular pathogen, first

identified in the nodules of lepromatous leprosy patients by Armauer Hansen
in 1873. It is a rod-shaped, Gram-positive organism that is acid-fast when
stained by the Ziehl–Nielsen or the better Fite methods.

3. Nurse Justine is teaching Harriet about the home management of leprosy.

Which of the following statements by the patient would require further
teaching?

a. “I should keep my skin moist to prevent dryness and fissuring and avoid
ulceration or infection of skin.”

b. “I should protect my hands and feet to avoid inadvertent injury and

prevent chronic disability.”

c. “I should wear plastic footwear and gloves when going out or

using my hands for work.”

d. “Ensure adequate intake of fluid to maintain optimal skin hydration.”

RATIO: Educate the patient to avoid plastic footwear or gloves which trap
moisture and cause ulceration. Instead encourage patient in wearing cloth
gloves or socks as protective equipment for work or when going out.

4. One of the patient teachings that Nurse Justine is going to include when
teaching the patient about the side effects of Rifampicin would be

a. Tinnitus

b. Elevated liver enzymes

c. Nephrotoxicity

d. Yellow-orange tinged urine and secretions

RATIO: Rifampin may cause temporary discoloration of your teeth, sweat,
urine, saliva, and tears (a yellow, orange, red, or brown color). This side
effect is usually not harmful.

5. How many months should Harriet be taking the multiple drug treatment
for her type of leprosy?

a. 6 months

b. 2 months

c. 9 months

d. 12 months

RATIO: In 1981, WHO recommended MDT. The currently recommended MDT

regimen consists of three medicines: dapsone, rifampicin and clofazimine.
This treatment lasts six months for pauci-bacillary and 12 months for
multi-bacillary cases. MDT kills the pathogen and cures the patient.

SITUATION: A 7-year-old child named Berto is brought to the hospital with

clinical manifestations of fever 38.5 degrees Celsius, neck and facial rigidity,
board-like abdomen, and a grinning expression. The parents of Berto has
stated that their son has an infected foot injury. The patient was diagnosed
to have tetanus.

6. Nurse Carol has noticed that Berto is constantly arching his back. Nurse
Carol knows that this in one of the characteristic signs of tetanus. She must
place this on the chart as

a. Nuchal rigidity

b. Opisthotonos

c. Trismus

d. Risus sardonicus
RATIO: Opisthotonos is a spasm of the muscles causing backward arching of
the head, neck, and spine, as in severe tetanus, some kinds of meningitis,
and strychnine poisoning.

7. Which of the following tetanus toxins is responsible for muscle spasms?

a. Tetanolysin

b. Tetanospasmin

c. Neurotoxin

d. Hematoxin

RATIO: Tetanospasmin is a neurotoxin that inhibits the release of

γ-aminobutyric acid (GABA) and results in a variety of clinical signs
commonly associated with tetanus including muscle spasms and rigidity,
trismus (lockjaw), dysphagia, tendon rupture, opisthotonus, respiratory
difficulty, and death.

8. One of the equipment that Nurse Carol has to prepare at the patient’s
bedside with regard to tetanus is.

a. Oxygen tank and mask

b. Tracheostomy set

c. Endotracheal tube and laryngoscope

d. Blood urea-nitrogen and

RATIO: The use of tracheostomy in the management of patients with severe

tetanus will undoubtedly prevent death due to asphyxia from laryngeal
muscle spasm (and acute airway obstruction), respiratory muscle spasm and
aspiration.

9. Which of the following status should Nurse Carol ask from the parents of
Carlo?

a. Nutritional status
b. Vitamin A status

c. Deworming status

d. Immunization status

RATIO: The tetanus vaccine is part of the recommended series of childhood

and adult immunizations. It protects against the bacterial infection tetanus,
also known as lockjaw. Tetanus causes painful muscle spasms and can lead
to death. The tetanus vaccine has made tetanus a preventable disease.

10. The parents told Nurse Carol that they are not aware of immunizations
of any kind that is why they have not availed it for their children since they
were still infants. Which of the following nursing diagnosis would be most
applicable for them?

a. Anticipatory grieving

b. Knowledge deficit

c. High risk for infection

d. Social isolation

RATIO: A lack of cognitive information or psychomotor ability needed for

health restoration, preservation, or health promotion is identified as a
knowledge deficit. Knowledge plays an influential and significant part of a
patient's life and recovery.

SITUATION: A 25-year-old female patient named Karen came to the

emergency room with complaints of acute, profuse, watery diarrhea. She is
also experiencing nausea and vomiting. Nurse Joy also has checked that the
patient has poor skin turgor brought about by dehydration from diarrhea.
Rectal swab from the patient has revealed that she has cholera.

11. Nurse Joy should know that the characteristic appearance of the stools
of a patient with cholera should be

a. Black-tarry stools
b. Stools that are blood streaked

c. Loose and watery

d. Rice-watery stools

RATIO: the characteristic symptom of severe cholera ("cholera gravis") is

the passage of profuse "rice-water" stool, a watery stool with flecks of
mucus . It typically has a fishy odor.

12. Which of the following questions is important for Nurse Joy to ask from
Karen?

a. “When did you last eat your meals?”

b. “What were the foods or drinks that you may have taken prior to
having the signs and symptoms of cholera?”

c. “How many times have you eaten within the last 24 hours?”

d. “Have you been washing your hands regularly prior to eating?”

RATIO: A person can get cholera by drinking water or eating food

contaminated with cholera bacteria. In an epidemic, the source of the
contamination is usually the feces of an infected person that contaminates
water or food. The disease can spread rapidly in areas with inadequate
treatment of sewage and drinking water.

13. Karen told Nurse Joy that she has experienced 13 bowel movements
within the last 24 hours. Which of the following pH imbalances would Karen
be at risk with?

a. Metabolic alkalosis

b. Respiratory acidosis

c. Metabolic acidosis

d. Respiratory alkalosis
RATIO: Diarrhea is the most common cause of external loss of alkali
resulting in metabolic acidosis.

14. Which of the following nursing diagnosis would be most appropriate for
Karen based on the situation above?

a. Altered tissue perfusion

b. Fluid volume deficit

c. Activity intolerance

d. Altered nutrition: less than body requirements

RATIO: Severe diarrhea can lead to dehydration or severe nutritional

problems. Problems associated with diarrhea include fluid and electrolyte
imbalances, impaired nutrition, and altered skin integrity.

15. Enteric precaution is practiced around the patient with cholera. Which of
the following is NOT true with regard to enteric precautions?

a. Clean hands frequently with soap and water

b. Wear a gown and gloves when entering the patient’s room

c. Always wear a mask when entering the room

d. Place and “enteric precaution” sign outside the patient’s door

RATIO: Enteric precautions are taken to prevent infections that are

transmitted primarily by direct or indirect contact with fecal material. They're
indicated for patients with known or suspected infectious diarrhea or
gastroenteritis. Clostridium difficile is the most common cause of
hospital-acquired infectious diarrhea.

SITUATION: A 35-year-old male patient named Juan went to the hospital

with a chief complaint of cough that has lasted for 4 weeks. He explained
that he already is coughing out blood, is also experiencing night sweats, and
is often tired. He is suspected to have pulmonary tuberculosis.
16. Which of the following diagnostic procedures would be the most
definitive for pulmonary tuberculosis?

a. Mantoux test

b. Tuberculin test

c. Sputum culture

d. Chest x-ray

RATIO: To diagnose pulmonary TB specifically, a doctor will ask a person to

perform a strong cough and produce sputum up to three separate times. The
doctor will send the samples to a laboratory. At the lab, a technician will
examine the sputum under a microscope to identify TB bacteria.

17. Since Juan is exhibiting the signs and symptoms of pulmonary

tuberculosis. The nurse must expect which of the following actions to be
done by the attending physician?

a. Give prescription for isoniazid, 300 mg OD for 2 weeks, and send him
home

b. Give a tuberculin test and ask him to come back after 2 days to have it
read

c. Admit him to the hospital and place him in the isolation room

d. Prescribe isoniazid and tell him to go home and rest

RATIO: Persons who have or are suspected of having infectious TB disease

should be placed in an area away from other patients, preferably in an
airborne infection isolation (AII) room. He will be admitted to the hospital,
placed in respiratory isolation, and three sputum cultures should be obtained
to confirm the diagnosis. He would most likely be given isoniazid and two or
three other antitubercular antibiotics until the diagnosis is confirmed, then
isolation and treatment would continue if the cultures were positive for TB.
After 7 to 10 days, three more consecutive sputum cultures will be obtained.
If they're negative, he would be considered non-contagious and may be sent
home, although he'll continue to take the antitubercular drugs for 9 to 12
months.
18. Isoniazid (INH) and rifampicin (Rifadin) have been prescribed for a client
with TB. Nurse Lisa is reviewing the medical record of Juan. Which of the
following would require physician notification?

a. Rheumatic fever

b. Hepatitis B

c. Allergy to penicillin

d. Heart disease

RATIO: The combination of these two drugs was associated with higher rate
of hepatotoxicity when compared to each drug on its own. Isoniazid and
rifampin are contraindicated in clients with acute liver disease or a history of
hepatic injury.

19. Nurse Lisa is teaching Juan about dietary elements that should be
increased in the diet. The nurse suggests that the Juan should increase
which of the following in his diet?

a. Meats and citrus fruits

b. Grains and broccoli

c. Eggs and spinach

d. Potatoes and fish

RATIO: The nurse teaches the client with TB to increase intake of protein,
iron, and vitamin C.

20. Which of the following among Juan’s family members exposed to him
would be at highest risk for contracting the disease?

A. 57-year-old mother

B. 10-year-old daughter

C. 7-year-old son
D. 76-year-old grandmother

RATIO: Elderly persons are believed to be at higher risk for contracting TB

because of decreased immunocompetence. Other high-risk populations in
the US include the urban poor, AIDS, and minority groups.

SAS 18

1. A child is admitted to the pediatric unit with a diagnosis of

suspected meningococcal meningitis. Which of the following nursing
measures should the nurse do FIRST?
a. Institute seizure precautions
b. Assess neurologic status
c. Place in respiratory isolation
d. Assess vital signs

RATIO: The initial therapeutic management of acute bacterial meningitis

includes isolation precautions, initiation of antimicrobial therapy and
maintenance of optimum hydration. Nurses should take necessary
precautions to protect themselves and others from possible infection.

2. A client is diagnosed with methicillin resistant staphylococcus aureus

pneumonia. What type of isolation is MOST appropriate for this client?
a. Reverse isolation
b. Respiratory isolation
c. Standard precautions
d. Contact isolation

RATIO: Contact or Body Substance Isolation (BSI) involves the use of

barrier protection (e.g. gloves, mask, gown, or protective eyewear as
appropriate) whenever direct contact with any body fluid is expected.
When determining the type of isolation to use, one must consider the
mode of transmission. The hands of personnel continues to be the principal
mode of transmission for methicillin resistant staphylococcus aureus
(MRSA). Because the organism is limited to the sputum in this example,
precautions are taken if contact with the patient"s sputum is expected. A
private room and BSI, along with good hand washing techniques, are the
best defense against the spread of MRSA pneumonia

3. Several clients are admitted to an adult medical unit. The nurse would
ensure airborne precautions for a client with which of the following medical
conditions?
a. A diagnosis of AIDS and cytomegalovirus
b. A positive PPD with an abnormal chest x-ray
c. A tentative diagnosis of viral pneumonia
d. Advanced carcinoma of the lung

RATIO: The client who must be placed in airborne precautions is the

client with a positive PPD (purified protein derivative) who has a
positive x-ray for a suspicious tuberculin lesion.

4. Which of the following is the FIRST priority in preventing

infections when providing care for a client?
a. Handwashing
b. Wearing gloves
c. Using a barrier between client’s furniture and nurse’s bag
d. Wearing gowns and goggles

RATIO: Handwashing remains the most effective way to avoid spreading

infection. However, too often nurses do not practice good handwashing
techniques and do not teach families to do so. Nurses need to wash their
hands before and after touching the client and before entering the nursing
bag.

5. An adult woman is admitted to an isolation unit in the hospital

after tuberculosis was detected during a pre-employment physical.
Although frightened about her diagnosis, she is anxious to cooperate
with the therapeutic regimen. The teaching plan includes information
regarding the most common means of transmitting the tubercle bacillus
from one individual to another. Which contamination is usually
responsible?
a. Hands.
b. Droplet nuclei.
 c. Milk products.
d. Eating utensils.

RATIO: Hands are the primary method of transmission of the common cold.
The most frequent means of transmission of the tubercle bacillus is by
droplet nuclei. The bacillus is present in the air as a result of coughing,
sneezing, and expectoration of sputum by an infected person. The tubercle
bacillus is not transmitted by means of contaminated food. Contact with
contaminated food or water could cause outbreaks of salmonella, infectious
hepatitis, typhoid, or cholera. The tubercle bacillus is not transmitted by
eating utensils. Some exogenous microbes can be transmitted via reservoirs
such as linens or eating utensils.

6. A 2-year-old is to be admitted in the pediatric unit. He is

diagnosed with febrile seizures. In preparing for his admission, which
of the following is the most important nursing action?
a. Order a stat admission CBC.
b. Place a urine collection bag and specimen cup at the
bedside.
c. Place a cooling mattress on his bed.
d. Pad the side rails of his bed.

RATIO: Preparing for routine laboratory studies is not as high a priority as

preventing injury and promoting safety. Preparing for routine laboratory
studies is not as high a priority as preventing injury and promoting safety. A
cooling blanket must be ordered by the physician and is usually not used
unless other methods for the reduction of fever have not been successful.
The child has a diagnosis of febrile seizures. Precautions to prevent injury
and promote safety should take precedence.

7. A young adult is being treated for second and third degree burns over
25% of his body and is now ready for discharge. The nurse evaluates his
understanding of discharge instructions relating to wound care and is
satisfied that he is prepared for home care when he makes which
statement?
a. “I will need to take sponge baths at home to avoid exposing the
wounds to unsterile bath water.”
b. “If any healed areas break open I should first cover
them with a sterile dressing and then report it.”
 c. “I must wear my Jobst elastic garment all day and can only
remove it when I’m going to bed.”
d. “I can expect occasional periods of low-grade fever and
can take Tylenol every 4 hours.”

RATIO: Bathing or showering in the usual manner is permitted, using a mild

detergent soap such as Ivory Snow. This cleanses the wounds, especially
those that are still open, and removes dead tissue. The client is taught to
report changes in wound healing such as blister formation, signs of infection,
and opening of a previously healed area. Sterile dressings are applied until
the wound is assessed and a plan of care developed.

8. An eighty-five-year-old man was admitted for surgery for benign

prostatic hypertrophy. Preoperatively he was alert, oriented, cooperative,
and knowledgeable about his surgery. Several hours after surgery, the
evening nurse found him acutely confused, agitated, and trying to climb
over the protective side rails on his bed. The most appropriate nursing
intervention that will calm an agitated client is
a. limit visits by staff.
b. encourage family phone calls.
c. position in a bright, busy area.
d. speak soothingly and provide quiet music.

RATIO: The client needs frequent visits by the staff to orient him and to
assess his safety. Phone calls from his family will not help a client who is
trying to climb over the side rails and may even add to his danger. Putting
the client in a bright, busy area would probably add to his confusion. The
environment is an important factor in the prevention of injuries. Talking
softly and providing quiet music have a calming effect on the agitated
client.

9. Ms. Smith is admitted for internal radiation for cancer of the cervix.
The nurse knows the client understands the procedure when she makes
which of the following remarks the night before the procedure?
a. She says to her husband, “Please bring me a hamburger and
French fries tomorrow when you come. I hate hospital food.”
b. “I told my daughter who is pregnant to either come
to see me tonight or wait until I go home from the
hospital.”
c. “I understand it will be several weeks before all the
radiation leaves my body.”
 d. “I brought several craft projects to do while the radium is
inserted.”

RATIO: The client will be on a clear liquid or very low residue diet.
Hamburgers and french fries are not allowed. People who are pregnant
should not come in close contact with someone who has internal radiation
therapy. The radioactivity could possibly damage the fetus. This statement is
not true. As soon as the radiation source is removed (probably 36 to 72
hours after insertion), the client is no longer contaminated with radioactivity.
Craft projects usually require the client to sit. The client must remain flat
with very little head elevation during the time the rods are in place.

10. The nurse in charge is evaluating the infection control procedures on

the unit. Which finding indicates a break in technique and the need for
education of staff?
a. The nurse aide is not wearing gloves when feeding an elderly
client.
b. A client with active tuberculosis is asked to wear a mask
when he leaves his room to go to another department for
testing.
c. A nurse with open, weeping lesions of the hands
puts on gloves before giving direct client care.
d. The nurse puts on a mask, a gown, and gloves before
entering the room of a client on strict isolation.

RATIO: There is no need to wear gloves when feeding a client. However,

universal precautions (treating all blood and body fluids as if they are
infectious) should be observed in all situations. A client with active
tuberculosis should be on respiratory precautions. Having the client wear
a mask when leaving his private room is appropriate. Persons with
exudative lesions or weeping dermatitis should not give direct client care
or handle client-care equipment until the condition resolves. Strict
isolation requires the use of mask, gown, and gloves.

11. The charge nurse observes a new staff nurse who is changing a
dressing on a surgical wound. After carefully washing her hands the nurse
dons sterile gloves to remove the old dressing. After removing the dirty
dressing, the nurse removes the gloves and dons a new pair of sterile
gloves in preparation for cleaning and redressing the wound. The most
appropriate action for the charge nurse is to:
 a. interrupt the procedure to inform the staff nurse that
sterile gloves are not needed to remove the old dressing.
b. congratulate the nurse on the use of good technique.
c. discuss dressing change technique with the nurse at a later
date.
d. interrupt the procedure to inform the nurse of the need to
wash her hands after removal of the dirty dressing and gloves.

RATIO: Nonsterile gloves are adequate to remove the old dressing.

However, the use of sterile gloves does not put the client in danger so
discussion of this can wait until later. The staff nurse is doing two things
incorrectly. Nonsterile gloves are adequate to remove the old dressing. The
nurse should wash her hands after removing the soiled dressing and before
donning sterile gloves to clean and dress the wound. The nurse should wash
her hands after removing the soiled dressing and before donning the sterile
gloves to clean and dress the wound. Not doing this compromises client
safety and should be brought to the immediate attention of the nurse. The
staff nurse is doing two things incorrectly. Nonsterile gloves are adequate to
remove the old dressing. However, the use of sterile gloves does not put the
client in danger so discussion of this can wait until later. However, the nurse
should wash her hands after removing the soiled dressing and before
donning sterile gloves to clean and dress the wound. Not doing this
compromises client safety and should be brought to the immediate attention
of the nurse.

12. Nurse Jane is visiting a client at home and is assessing him for risk of
a fall. The most important factor to consider in this assessment is:
a. Correct illumination of the environment.
b. amount of regular exercise.
c. the resting pulse rate.
d. status of salt intake.

RATIO: To prevent falls, the environment should be well lighted. Night lights
should be used if necessary. Other factors to assess include removing loose
scatter rugs, removing spills, and installing handrails and grab bars as
appropriate. The amount of regular exercise is not the most important factor
to assess. It is only indirectly related. The resting pulse rate is not related to
preventing falls. The salt intake is not directly related to preventing falls.
13. Mrs. Jones will have to change the dressing on her injured right leg
twice a day. The dressing will be a sterile dressing, using 4 X 4s, normal
saline irrigant, and abdominal pads. Which statement best indicates that
Mrs. Jones understands the importance of maintaining asepsis?
a. “If I drop the 4 X 4s on the floor, I can use them as long as they
are not soiled.”
b. “If I drop the 4 X 4s on the floor, I can use them if I rinse
them with sterile normal saline.”
c. “If I question the sterility of any dressing material, I
should not use it.”
d. “I should put on my sterile gloves, then open the bottle of
saline to soak the 4 X 4s.”

RATIO: Anything dropped on the floor is no longer sterile and should not be
used. The statement indicates lack of understanding. Anything dropped on
the floor is no longer sterile and should not be used. The statement
indicates lack of understanding. If there is ever any doubt about the sterility
of an instrument or dressing, it should not be used. The 4 X 4s should be
soaked prior to donning the sterile gloves. Once the sterile gloves touch the
bottle of normal saline they are no longer sterile. This statement indicates a
need for further instruction.

14. A client has been placed in blood and body fluid isolation. The nurse is
instructing auxiliary personnel in the correct procedures. Which statement by
the nursing assistant indicates the best understanding of the correct protocol
for blood and body fluid isolation?
a. Masks should be worn with all client contact.
b. Gloves should be worn for contact with nonintact
skin, mucous membranes, or soiled items.
c. Isolation gowns are not needed.
d. A private room is always indicated.

RATIO: Masks should only be worn during procedures that are likely to
cause splashes of blood or body fluid. Gloves should be worn for all contact
with blood and body fluids, nonintact skin and mucous membranes; for
handling soiled items; and for performing venipuncture. Gowns should be
worn during procedures that are likely to cause splashes of blood or body
fluids. A private room is only indicated if the client's hygiene is poor.
15. A client has been placed in blood and body fluid isolation. The nurse is
instructing auxiliary personnel in the correct procedures. Which statement by
the nursing assistant indicates the best understanding of the correct protocol
for blood and body fluid isolation?
a. Masks should be worn with all client contact.
b. Gloves should be worn for contact with nonintact
skin, mucous membranes, or soiled items.
c. Isolation gowns are not needed.
d. A private room is always indicated.

RATIO: Masks should only be worn during procedures that are likely to
cause splashes of blood or body fluid. Gloves should be worn for all contact
with blood and body fluids, nonintact skin and mucous membranes; for
handling soiled items; and for performing venipuncture. Gowns should be
worn during procedures that are likely to cause splashes of blood or body
fluids. A private room is only indicated if the client's hygiene is poor.

16. The nurse is evaluating whether nonprofessional staff understand

how to prevent transmission of HIV. Which of the following behaviors
indicates correct application of universal precautions?
a. A lab technician rests his hand on the desk to steady it while
recapping the needle after drawing blood.
b. An aide wears gloves to feed a helpless client.
c. An assistant puts on a mask and protective eye wear
before assisting the nurse to suction a tracheostomy.
d. A pregnant worker refuses to care for a client known to
have AIDS.

RATIO: Needles that have been used to draw blood should not be recapped.
If it is necessary to recap them, an instrument such as a hemostat should
be used to recap. The hand should never be used. Gloves are not necessary
when feeding, since there is no contact with mucus membranes. Although
saliva may have small amounts of HIV in it, the virus does not invade
through unbroken skin. There is no evidence in the question to indicate
broken skin. Masks and protective eye wear are indicated anytime there is
great potential for splashing of body fluids that may be contaminated with
blood. Suctioning of a tracheostomy almost always stimulates coughing,
which is likely to generate droplets that may splash the health care worker.
Clients who are suctioned frequently or have had an invasive procedure like
a tracheostomy are likely to have blood in the sputum. There is no reason
to restrict pregnant workers from caring for persons with AIDS as long as
they utilize universal precautions.

17. Jermaine, 1-year old child has a staph skin infection. His brother
has also developed the same infection. Which behavior by the children is
most likely to have caused the transmission of the organism?
a. Bathing together.
b. Coughing on each other.
c. Sharing pacifiers.
d. Eating off the same plate.

RATIO: Direct contact is the mode of transmission for staphylococcus.

Staph is not spread by coughing. Staph is not spread through oral
secretions. Direct contact is required. Staph is not spread through oral
secretions.

18. Jessie, a young man with newly diagnosed acquired immune

deficiency syndrome (AIDS) is being discharged from the hospital. The
nurse knows that teaching regarding prevention of AIDS transmission has
been effective when the client:
a. verbalizes the role of sexual activity in spread of the
disorder.
b. states he will make arrangements to drop his college
classes.
c. acknowledges the need to avoid all contact sports.
d. says he will avoid close contact with his three-year-old
niece.

RATIO: The AIDS virus is spread through direct contact with body fluids such
as blood and through sexual intercourse. Casual contact with other people
does not pose a risk of transmission of AIDS. Unless the client is feeling very
ill, there is no need for him to drop his college classes. Contact sports are
not contraindicated unless there is a significant chance of bleeding and direct
contact with others. Casual contact with other people does not pose a risk of
transmission of AIDS. There is no need to limit casual contact with children.
 19. Which question is least useful in the assessment of a client with
AIDS?
a. Are you a drug user?
b. Do you have many sex partners?
c. What is your method of birth control?
d. How old were you when you became sexually active?

RATIO: Drug use is a risk factor for AIDS. Multiple sex partners is a risk
factor for AIDS. Birth control methods are important to prevent a baby
from being born with the AIDS virus. The age at which sexual activity
began it not relevant as it does not usually provide information that
identifies the presence of risk factors for AIDS.

20. Mrs. Parker, a 70-year-old woman with severe macular degeneration,

is admitted to the hospital the day before scheduled surgery. The nurse’s
preoperative goals for Mrs. M. would include:
a. independently ambulating around the unit.
b. reading the routine preoperative education materials.
c. maneuvering safely after orientation to the room.
d. using a bedpan for elimination needs.

RATIO: Independently ambulating around the unit is not appropriate

because the unit environment can change and injury could result. Assistance
is necessary because of the client's visual deficit. It is unlikely the client can
see well enough to read the materials. Maneuvering safely after orientation
to the room is a realistic goal for a person with impaired vision. Orienting the
client to the room should help the client to move safely. Using the bedpan is
an unnecessary restriction on the client as she can be oriented to the
bathroom or to call for assistance.

SAS 19

Situation: A 65-year old male named Tony Stark was recently admitted to
the hospital with the presence of cough together with back and joint pains.
He was diagnosed to have infective endocarditis.

1. Which of the following would be a risk factor in the development of Tony’s

disease?
a. Old age
b. Having arthritis
 c. Living in the city
d. His job as a farmer
RATIO: Endocarditis occurs most often in older adults over age 60.

2. Upon assessment the nurse noticed small erythematous nodular

lesions on the palms of the patient. Tony has stated that these lesions
are not painful. The nurse must document this as
a. Osler’s nodes
b. Splinter hemorrhages
c. Janeway lesions
d. Roth’s spots

RATIO: Janeway lesions are irregular, nontender hemorrhagic macules

located on the palms, soles, thenar and hypothenar eminences of the hands,
and plantar surfaces of the toes. They typically last for days to weeks. They
are usually seen with the acute form of bacterial endocarditis.

3. The nurse must know that the infection of Tony is found on

the a. Valves and endothelium
b. Myocardium
c. Pericardium
d. Epicardium

RATIO: Endocarditis is a life-threatening inflammation of the inner lining of

your heart's chambers and valves (endocardium).

4. Parenteral antibiotic therapy is done for Tony, the nurse must assess
which of the following first prior to administration of the drug?
a. Patient’s vital signs
b. Allergies to the antibiotic prescribed
c. Body temperature
d. Level of pain

RATIO: Around 1 in 15 people have an allergic reaction to antibiotics,

especially penicillin and cephalosporins.

5. Antibiotic therapy for patients with infective endocarditis usually takes

how many weeks? a. 2 weeks
b. 1 week
c. 4-6 weeks
d. 8-10 weeks

RATIO: The antibiotics are adjusted to the sensitivity of the organism that
 grows from the blood culture as soon as that is available. IV antibiotics is
usually given for as long as 6 weeks to cure of the infection. Symptoms are
monitored throughout therapy and blood cultures are repeated to determine
the effectiveness of treatment.

Situation: A 33-year old patient named Steve Rogers was admitted to the
emergency room experiencing chest pain and a temperature of 38.1o
Celsius. The nurse has assessed that the patient has increased respiratory
rate and heart rate. The patient was diagnosed to have acute pericarditis.

6. During assessment nurse Natasha has noticed hypotension, elevated

jugular pressure, and muffled heart sounds. These signs are known as a.
Pulsus paradoxus
b. Cardiac tamponade
c. Pericardial friction rub
d. Beck triad

RATIO: Beck triad is a collection of three clinical signs associated with

pericardial tamponade which is due to an excessive accumulation of fluid
within the pericardial sac. The three signs are: low blood pressure (weak
pulse or narrow pulse pressure) muffled heart sounds. raised jugular venous
pressure.

7. During the patient’s CT scan the physician has observed an accumulation

of excessive fluid in the pericardial space. The nurse must observe for signs
of
a. Cardiac tamponade
b. Pericardial friction rub
c. Beck triad
d. Pleuritic pain

RATIO: Cardiac tamponade results from fluid buildup in the sac around the
heart. this fluid buildup is called a pericardial effusion. Often the pericardial
sac also becomes inflamed.

8. Prior to the patient’s CT scan, one of the responsibilities of nurse Natasha

is to
a. Check for the patient’s anxiety level
b. Obtain any history of allergies in iodine
c. Assess for chest pain in the patient
d. Advise the patient to increase his fluid intake
RATIO: Nurse must assess for any history of allergies to iodinated dye or
shellfish if contrast media is to be used.

9. Steve has complained of chest pain. The most appropriate

nursing diagnosis for this would be a. Risk for
ineffective breathing pattern
b. Activity intolerance
c. Altered tissue perfusion
d. Pain
RATIO: This nursing diagnosis is appropriate for patients who cannot
maintain adequate oxygenation resulting in insufficient tissue perfusion and
carbon dioxide removal. An ineffective breathing pattern is a condition of
inadequate ventilation due to an impairment in the mechanism of
inspiration and expiration. Prolonged inadequate ventilation may lead to
compromised respiratory function performance, such as providing oxygen
for the tissues, and removing waste products.

10. The type of surgery that would treat Steve’s pericarditis would be
a. Pericardiocentesis
b. Cardiac catheterization
c. Balloon angioplasty
d. Fontan procedure

RATIO: Pericardiocentesis is a procedure done to remove fluid that has built

up in the sac around the heart (pericardium). It's done using a needle and
small catheter to drain excess fluid. A fibrous sac known as the pericardium
surrounds the heart.
Situation: A 45-year old male patient named Jim Hopper is admitted to
the hospital with a chief complaint of chest pain together with nausea
and vomiting. He is diagnosed to have atherosclerosis. Nurse Joyce is
assigned to the patient.

11. Nurse Joyce is taking the patient’s health history. Which of the following
statements of the patient may have led to the development of
atherosclerosis?
a. “I rarely cook food. I always order food from fast food
restaurants.”
b. “I have been a smoker for more than 20 years now.”
c. “I have been taking medications for hypertension.”
d. All of the above statements
RATIO: An unhealthy diet can raise your risk for atherosclerosis. Foods that
are high in saturated and trans fats, cholesterol, sodium (salt), and sugar
can worsen other atherosclerosis risk factors. Smoking can damage and
tighten blood vessels, raise cholesterol levels, and raise blood pressure.
Smoking also doesn't allow enough oxygen to reach the body's tissues.
Hypertensive patients are at risk the most for atherosclerosis.

12. Which of the following diagnostic procedures would show the location
and the extent of the narrowing of Jim’s CAD?
a. Coronary angiography
b. ECG
c. Stress test
d. Chest X-ray

RATIO: A coronary angiogram is a procedure that uses X-ray imaging to see

your heart's blood vessels. The test is generally done to see if there's a
restriction in blood flow going to the heart. Coronary angiograms are part of
a general group of procedures known as heart (cardiac) catheterizations.

13. The most important goal in patients who have a coronary artery disease
would be
a. Decreasing the weight of obese patients
b. Increase oxygen supply to the myocardium
c. Taking anticoagulants
d. Offering exercise classes

RATIO: The supply of oxygen to the myocardium is determined by coronary

blood flow and oxygen carrying capacity. Coronary blood flow is a dynamic
process modulated via multiple parameters. Cardiac metabolism is also
affected by several factors. Under certain pathologic states such as coronary
artery disease, the supply of oxygen may be exhausted and an imbalance
between supply and demand occurs which is translated into ischemia.

14. One of the medications prescribed to Jim would be Cholestyramine

(Questran). The nurse must advise the patient to take this medication a.
Before meals
b. After meals
c. At bedtime
d. At noon
RATIO: Cholestyramine works best if you take it with meals. However, your
dosing schedule may depend on when you need to take any other
medications. Cholestyramine should not be taken within 1 hour after or 4
hours before you take other medications.
15. During the diagnosis of the patient’s disease, the doctor has observed
for the development of a fibrous plaque in his coronary artery, this is also
known as
a. Thrombosis
b. Embolus
c. Atheroma
d. Cardiomyopathy
RATIO: An atheroma, or atheromatous plaque ("plaque"), is an abnormal
accumulation of material in the inner layer of the wall of an artery. The
material consists of mostly macrophage cells, or debris, containing lipids,
calcium and a variable amount of fibrous connective tissue.

16. If Jim’s atherosclerosis is left untreated, he may have which of the

following complications?

a. Liver failure
b. Severe hypertension
c. Myocardial infarction
d. Acute renal failure

RATIO: A feared complication of atherosclerosis, which by itself can be seen

as a part of normal aging, is fracture and/or rupture of the fibrous cap,
leading to contact between the blood coagulation components and plaque
material including tissue factor, which triggers thrombosis, leading to
infarction.

17. Jim has been started on anticoagulant therapy. His doctor has
prescribed Warfarin (Coumadin). Which of the following must Nurse
Joyce place at the patient’s bedside?
a. Alteplase
b. Calcium gluconate
c. Protamine sulfate
d. Vitamin K

RATIO: Vitamin K1 is the only effective antidote for long-term management,

but it takes several hours to reverse anticoagulation. Oral vitamin K 1 has
excellent bioavailability, is rapidly absorbed, and is recommended in the
absence of serious or life-threatening hemorrhage.

18. Which of the following will Nurse Joyce immediately report to the doctor
during Jim’s warfarin (Coumadin) therapy?
a. Constipation
b. Bleeding
 c. Increased urine output
d. Nausea
RATIO: The main side effect of warfarin is bleeding more easily than
normal, such as having nosebleeds, bleeding gums, heavier periods and
bruising. This is most likely to happen in the first few weeks of treatment or
if you're unwell.

19. Jim is also prescribed to take propranolol (Inderal). When administering

this the nurse must first check which of the following?
a. Body temperature
b. Urine output
c. Respiratory rate
d. Pulse rate

RATIO: Carefully assess patients’ pulse rate and if with asthma or chronic
lung disease for an exacerbation of their symptoms during beta-blocker
therapy. Propranolol is contraindicated in patients with asthma, chronic
obstructive pulmonary disease (COPD), atrioventricular (AV) block,
intermittent claudication, and psychosis. The most frequent adverse effects
are lightheadedness, fatigue, dyspnea upon exertion, bronchospasm,
insomnia, impotence, and apathy.

20. Nurse Joyce must also teach about dietary changes in Jim’s diet. She
should teach Jim to take how may grams of fiber per day? a. 10 grams
b. 15-18 grams
c. 2-3 grams
d. 20-30 grams
RATIO: Dietary fiber intake during adulthood is inversely associated with
CHD risk. Coronary risk was 10% to 30% lower for each 10-g/d increment
of total, cereal, or fruit fiber.
21. Nurse Joyce must also emphasize about the intake of saturated fats. She
should tell Jim to take how much saturated fats per day?
a. >7% of calories
b. >10% of calories
c. <7% of calories
d. <20% of calories

RATIO: The Dietary Guidelines for Americans recommends limiting

saturated fat to less than 10% of calories a day. The American Heart
Association recommends staying under 7% of daily calories. Because
saturated fat tends to raise low-density lipoprotein (LDL) cholesterol levels
in the blood.
22. Jim is also started on antilipidemics. He has been prescribed to take
Simvastatin (Zocor). The nurse must watch out for
a. Bleeding
b. Hypertension
c. Dizziness
d. Myalgia and arthralgia

RATIO: Myalgia is a potential adverse effect of statin treatment. Myalgia,

with or without muscle weakness, is the most common adverse effect
associated with statin use, and is reported to occur in up to 10% of people
prescribed statins. Since arthralgia and arthopathy are not well-recognized
side-effects of statins, such symptoms may not be attributed to such
medication. Instead, they may be under-reported and attributed to
osteoarthritis, which is common in the predominantly older groups of the
population taking statins.

23. After several months, Jim was sent back to the hospital and has
suffered a myocardial infarction. The physician has referred him to a
cardiac surgeon and he will be undergoing coronary artery bypass
graft. In doing this procedure, a vein graft is used. This is commonly
obtained from the
a. Brachial vein
b. Pedal vein
c. Femoral vein
d. Saphenous vein

RATIO: The most commonly used graft was the saphenous vein (particularly
the great saphenous vein) and is still in use. To reach this vein, a surgical
cut will be made along the inside of your leg, between your ankle and groin.
One end of the graft will be sewn to your coronary artery. The other end will
be sewn to an opening made in your aorta.
24. To change Jim’s lifestyle and prevent his CAD from further complicating,
the nurse must emphasize which of the following?
a. Changes in his diet
b. Avoid eating in fast food restaurants
c. Cessation of smoking
d. All of the above

RATIO: The American Heart Association offers these lifestyle changes to

prevent heart disease including quitting smoking, good nutrition, physically
active, reduce stress, limit alcohol and aim for a healthy weight.
25. Which of the following would help Jim reduce his stress from work?
a. Practicing yoga
b. Taking benzodiazepines
c. Maintaining a balanced diet
d. Resigning from his job and seek better job opportunities

RATIO: Benzodiazepines (sometimes called "benzos") work to calm or

sedate a person, by raising the level of the inhibitory neurotransmitter
GABA in the brain. Researchers have suggested that benzodiazepines
should be the first course of treatment for those with cardiovascular disease
and anxiety. Researchers have found that the treatment of anxiety with
benzodiazepines could improve survival in those with congestive heart
failure.

SAS 20

Situation 5: A 47-year old patient named Scott Lang was brought to the
ER with complaints of chest pain and dyspnea. Upon echocardiography the
doctor has diagnosed myocarditis. Nurse Hope is tasked to obtain the
patient’s health history.
1. Which of the following statements from the patient
would probably have led him to have myocarditis?
a. “I have been taking corticosteroid therapy for
several months now to treat my arthritis.”
b. “I have been experiencing hypertension every now and
then.” c. “I have been stressed a lot lately because of my
work.”
d. “I am fond of eating salty foods.”

RATIO: A viral infection usually causes myocarditis, but it can result from a
reaction to a drug or be part of a more general inflammatory condition.

2. Which of the following drugs prescribed by the doctor is Nurse Hope going
to question?

a. Penicillin-G
b. Ceftriaxone
c. Aspirin
d. Ampicillin

RATIO: Medications or illegal drugs that might cause an allergic or toxic

reaction. Penicillin-induced fatal hypersensitivity myocarditis was recorded
as the cause of death. Few cases of sudden death related to penicillin by a
direct toxic effect on the myocardial tissue were reported. In these cases,
victims were adults.

3. One of the goals in the treatment of myocarditis is to prevent

embolization. The nurse must emphasize which of the
following?

a. Application of elastic pressure stockings

b. ROM exercises
c. Taking anticoagulants
d. All of these
RATIO: Anticoagulants are a group of drugs that reduces the body's
ability to form clots in the blood and thus they play a great role in both
the prevention and treatment of established embolism

4. Scott has suddenly developed shortness of breath, dyspnea, crackles,

and pink-frothy sputum. The nurse must suspect for?

a. Right-sided heart failure

b. Left-sided heart failure
c. Cardiac tamponade
d. Pericardial friction rub

RATIO: Acute pericarditis usually manifests with chest pain,

pericardial friction rub (a scratchy sound heard on auscultation) due
to rubbing of inflamed pericardial layers, electrocardiogram
abnormalities consistent with ischemia, an enlarged cardiac
silhouette, fever, dysphagia,
and coughing Braunwald (1998), Spodick (2001).

5. The goal in the treatment of Scott’s myocarditis would be

a. Eliminating pain
b. Prevention of thrombus formation
c. Treatment of the underlying infection
d. Cardiac monitoring

RATIO: Keep the patient on bed rest to decrease the heart's workload.
Closely monitor him for arrhythmias and treat them as ordered.
Regularly perform physical assessments to identify signs and symptoms
of heart failure.

Situation: A 27-year old patient named Ethan del Rosario has been
diagnosed to have angina pectoris due to having atherosclerosis during
a routine check-up. He has frequently complained of chest pains. He
currently works as a bartender and states about his stress in the nature
of his work. Nurse Joy is assigned to this patient.

6. Upon assessment of nurse Joy, Ethan has stated that he has been
experiencing chest pain whenever he is tired from work. It happens
every time his shift ends. The nurse must note that this type of
angina could be?
a. Silent angina
b. Stable angina
c. Unstable angina
d. Variant angina

RATIO: Angina often occurs when the heart muscle itself needs more blood
than it is getting, for example, during times of physical activity or strong
emotions. Severely narrowed arteries may allow enough blood to reach the
heart when the demand for oxygen is low, such as when you're sitting. But,
with physical exertion—like walking up a hill or climbing stairs—the heart
works harder and needs more oxygen

7. Nurse Joy must also note that the location of Ethan’s chest pain in
angina pectoris would be at the

a. Lateral portion of the chest

b. Slightly to the left of the sternum
c. Center of the chest
d. Slightly to the right of the sternum

RATIO: Angina usually causes uncomfortable pressure, fullness,

squeezing or pain in the center of the chest.

8. The pain felt by Ethan may radiate to the

a. Left shoulder
b. Right shoulder
c. Right arm
d. Abdomen
RATIO: Angina occurs when the heart is not getting enough oxygen. Angina
can cause left arm pain that is often accompanied by shoulder, neck, back,
or jaw discomfort along with a feeling of indigestion. Angina is often a
symptom of coronary artery disease and should be taken seriously. These
pain receptors ultimately are referred to afferent pathways, which are
carried in multiple nerve roots from C7 through T4. The referred/radiating
pain of angina pectoris is believed to occur because these afferent pathways
also carry pain fibers from other regions (eg, the arm, neck, and
shoulders).

9. In angina pectoris, the nurse is going to anticipate for the doctor

to prescribe which of the following to Ethan?

a. NSAIDs
b. Nitroglycerine
c. Reteplase
d. Digoxin

RATIO: Nitrates are often used to treat angina. Nitrates relax and widen
your blood vessels, allowing more blood to flow to your heart muscle. You
might take a nitrate when you have angina-related chest discomfort, before
doing something that normally triggers angina (such as physical exertion) or
on a long-term preventive basis. The most common form of nitrate used to
treat angina is nitroglycerin tablets, which you put under your tongue.

10. In the discharge teaching of Ethan, Nurse Joy must instruct the
patient about the handling of nitroglycerine. She should advise Ethan to

a. Always carry it wherever he goes and place it in a dark glass

bottle b. Place the medication in a well-lit room
c. Store the medication in his medicine cabinet
d. Learn the basics of IM drug administration

RATIO: NTG is unstable and should be stored in light resistant container

in cool environment (not the refrigerator)

11. Nurse Joy must also teach Ethan on how to take nitroglycerine, that
if pain is not relieved, Ethan must take it after how many minutes?

a. 10 minutes
b. 15 minutes
c. 1 minute
d. 5 minutes

RATIO: Nitroglycerin sublingual tablets usually give relief in 1 to 5 minutes.

However, if the pain is not relieved, use a second tablet 5 minutes after
taking the first tablet. If the pain continues for another 5 minutes, a third
tablet may be used. If still have chest pain after a total of 3 tablets, contact
your doctor or go to a hospital emergency room right away. Do not drive
yourself and call 911, if necessary.

12. Nurse Joy will also advise Ethan that when all three doses
of nitroglycerine have been exhausted, Ethan must

a. Take a fourth dose

b. Take morphine sulfate next
c. Call for the hospital immediately
d. Wait for the pain to subside
RATIO: If still have chest pain after a total of 3 tablets, contact your
doctor or go to a hospital emergency room right away. Do not drive
yourself and call 911, if necessary.

13. In nitroglycerine therapy, Nurse Joy must teach Ethan to take

the tablets

a. Orally
b. Sublingually
c. Via the buccal route
d. With food

RATIO: The oral spray, sublingual powder, and sublingual tablets work
quickly to stop an angina attack that has already started or they can be used
to prevent angina if you plan to exercise or expect a stressful event.

14. When giving Atenolol (Tenormin) to Ethan, Nurse Joy has observed
for bradycardia. She should

a. Continue giving the medication

b. Withhold the medication
c. Double the dose of the medication
d. Lower the dosage of the medication

RATIO: Cardiac failure, bradycardia, dizziness, fatigue, and cold extremity

are side effects of Atenolol. Check with your doctor immediately if any of the
following side effects occur while taking atenolol

15. Ethan is also started on acetylsalicylic acid (Aspirin) therapy. Nurse

Joy must instruct the patient to

a. Take it with food

b. Take it on an empty stomach
c. Drink it with coffee
d. Take it before meals

RATIO: Aspirin should not be taken on an empty stomach. It's best to take
it with or just after food. This will make it less likely to upset your stomach.

16. Ethan also is prescribed to take heparin sodium. Nurse Joy must
keep what available?

a. Vitamin K
b. Acetaminophen
c. Furosemide
d. Protamine sulfate

RATIO: Injectable vitamin K is used to reverse the effects of

warfarin. Protamine sulfate is used to reverse the effects of heparin.

17. Which of the following would Nurse Joy advise Ethan to increase in
his diet to help decrease his low-density lipoproteins?

a. Sodium intake
b. Fiber intake
c. Fluid intake
d. All of the above

RATIO: Soluble fiber can reduce the absorption of cholesterol into your
bloodstream. Five to 10 grams or more of soluble fiber a day decreases
your LDL cholesterol.

18. Percutaneous transluminal coronary angioplasty (PTCA) is about to

be done on Ethan to treat his CAD. The nurse must know that this is
done through

a. Open heart surgery

b. A cardiac window
c. Cardiac catheterization
d. Coronary artery stripping

RATIO: Percutaneous transluminal angioplasty (PTA) is a procedure that can

open up a blocked blood vessel using a small, flexible plastic tube, or
catheter, with a "balloon" at the end of it. When the tube is in place, it
inflates to open the blood vessel, or artery, so that normal blood flow is
restored.

19. Ethan asks the nurse why he should take anticoagulants. The
nurse’s reply must be

a. “To prevent the occurrence of blood clots which can lead

to myocardial infarction.”
b. “This is done to decrease your blood pressure.”
c. “It helps your heart properly pump out blood.”
d. “They prevent you from having an infection.”
RATIO: An anticoagulation medication, or “blood thinner,” helps
prevent harmful clots from forming or moving.

20. Which of the following lab values must the nurse monitor if Ethan
is placed on heparin sodium?

a. Prothrombin time
b. Partial thromboplastin time
c. Creatine-kinase
d. Troponin I

RATIO: When caring for a client who is receiving heparin, the nurse should
monitor the aPTT to evaluate medication effectiveness. The aPTT evaluates
the intrinsic and final common pathways of the coagulation cascade that are
affected by heparin.

Situation: A 45-year old patient named Bruce Banner went for a routine
check-up. The nurse on duty has assessed that he has a blood pressure
of 140/90 mmHg. Upon obtaining the patient’s health history and doing
further tests on the patient his doctor has diagnosed him to have
essential hypertension.
21. Which of the following is the cause of having essential hypertension?

a. Chronic renal failure

b. Diabetes mellitus
c. Idiopathic
d. Coronary artery disease

RATIO: One of the factors that can raise the risk of having essential
hypertension include obesity; diabetes; stress; insufficient intake of
potassium, calcium, and magnesium; lack of physical activity; and
chronic alcohol consumption.

22. Which of the following can further worsen the Bruce’s hypertension?

a. The patient’s vegetarian diet

b. His weekly football game with his friends
c. Stress from work
d. His daily intake of rice
RATIO: Your body produces a surge of hormones when you're in a stressful
situation. These hormones temporarily increase your blood pressure by
causing your heart to beat faster and your blood vessels to narrow.

23. Bruce has been prescribed to take metoprolol (Lopressor) for the control
of hypertension. The nurse must know that this drug inhibits the release of

a. Renin
b. Angiotensin I
c. Angiotensin-converting enzyme
d. Aldosterone

RATIO: Beta blockers are known to suppress renin release in hypertension

and in patients taking angiotensin-converting enzyme (ACE) inhibitors.

24. When giving vasodilators such as hydralazine (Apresoline) to Bruce for

the treatment of hypertension, the nurse must advise the patient to watch
for

a. Increased urine output

b. Blurred vision
c. Peripheral edema
d. Rashes

RATIO: Tell your doctor if you experience any chest pain or heart
palpitations while taking hydralazine. Seek urgent medical advice if
you develop a rash, fever, joint or muscle pain, difficulty breathing, or
numbness, or nerve pain in your hands or feet.

25 The nurse is about to give Nifedipine (Adalat) to Bruce. Before giving the
drug, the nurse has assessed for hypotension 88/60 mmHg. The nurse
must do which of the following?

a. Come back after 5 minutes and give the drug

b. Double the dosage of the drug
c. Decrease the drug dosage
d. Withhold the drug

RATIO: If the blood pressure is < 100/60 mmHg and/or the patient has a
sustained pulse > 110 bpm then withhold administration and call the
physician.

SAS 21

1. In Schilling test, this is done by

a. Letting the patient take radioactive iodine
b. Letting the patient take radioactive vitamin B12
c. Letting the patient take radioactive folic acid
d. Letting the patient take radioactive intrinsic factor

RATIO: The Schilling test measures cobalamin absorption by assessing

increased urine radioactivity after an oral dose of radioactive cobalamin. The
test is useful in demonstrating that the anemia is caused by an absence of IF
and is not secondary to other causes of cobalamin deficiency. It is also
useful for identifying patients with classic pernicious anemia, even after
they have been treated with vitamin B12.

2. Under production of the intrinsic factor can cause malabsorption of which

of the following?
a. Vitamin B6
b. Vitamin B1
c. Vitamin B12
d. Vitamin B2

RATIO: Causes of vitamin B12 deficiency include difficulty absorbing vitamin

B12 from food, lack of intrinsic factor (e.g., because of pernicious anemia),
surgery in the gastrointestinal tract, prolonged use of certain medications
(e.g., metformin or proton pump inhibitors, discussed in more detail below in
the section on interactions with medications), and dietary deficiency.

3. The administration of folic acid for megaloblastic anemia would

be a. 1 gram daily
b. 10 mg daily
c. 100 mg daily
d. 1 mg daily

RATIO: The dosage range for folate is 1 to 5 mg daily; 1 mg/d is the usual
dosage for adults with megaloblastic anemia, while a higher dosage is
indicated in hemolysis, malabsorption, alcoholism, and exfoliative dermatitis.

4. For vegetarians suffering from megaloblastic anemia the nurse must

teach the patient to take
a. Vitamin B12 supplements
b. Iron supplements
c. Vitamin C supplements
d. Taking intrinsic factor through IV

RATIO: Vitamin B12 is an essential vitamin for the cells. It’s important for
keeping your nerves, blood cells, and DNA healthy. Animal products
naturally contain this vitamin. Meats, dairy, and eggs are particularly good
sources. Plant-based foods do not naturally contain B12, so people who
follow a vegetarian diet or vegan diet need to make sure they get enough
each day to avoid a deficiency. A lack of vitamin B12 can lead to serious
health consequences, such as pernicious anemia.

5. Patients with megaloblastic anemia may have difficulty maintaining which

of the following
a. Speech
b. Hearing
c. Balance
d. Erection

RATIO: Megaloblastic anemia is a condition in which the bone marrow

produces unusually large, structurally abnormal, immature red blood cells
(megaloblasts). Bone marrow, the soft spongy material found inside certain
bones, produces the main blood cells of the body red cells white cells and
platelets. The symptoms of megaloblastic anemia include aches, pains, and
muscle weakness. Therefore, the patient will have difficulty maintaining his
or her balance.

6. Which of the following races are prone to develop sickle-cell

anemia? a. Europeans
b. Austronesians
c. Africans
d. East Asians
RATIO: Sickle cell disease is more common in certain ethnic groups,
including: People of African descent, including African-Americans (among
whom 1 in 12 carries a sickle cell gene)
Hispanic-Americans from Central and South America
People of Middle Eastern, Asian, Indian, and Mediterranean descent

7. This is known as the prolonged erection of the penis in patients with

sickle cell anemia which is often painful
a. Sickling
b. Priapism
c. Auto-erection
d. Phimosis
RATIO: Priapism is a prolonged erection of the penis. The persistent erection
continues hours beyond or isn't caused by sexual stimulation. Priapism is
usually painful. Although priapism is an uncommon condition overall, it
occurs commonly in certain groups, such as people who have sickle cell
anemia.

8. Which of the following organs is most responsible for sequestration in

sickle cell anemia in children?
a. Liver
b. Pancreas
c. Spleen
d. Stomach

RATIO: When sickled cells are trapped in blood vessels leading out of the
spleen in tea of flowing through it. This is called sequestration. When this
happens, the spleen is very large and it is easy to feel.

9. With current management strategies, the average life expectancy of

patients with sickle-cell anemia is at
a. 28 years
b. 42 years
c. 34 years
d. 12 years

RATIO: With a national median life expectancy of 42–47 years, people with
sickle cell disease (SCD) face many challenges, including severe pain
episodes, stroke, and organ damage. However, a new report published
online today in Blood, the Journal of the American Society of Hematology
(ASH), shows that some people with mildly symptomatic SCD may live long
lives with proper management of the disease, including strong family
support and strict adherence to medication and appointments.
10. This is a blood test used to measure and identify the different type of
hemoglobin in the bloodstream
a. Bone marrow aspiration
b. Hemoglobin electrophoresis
c. Schilling test
d. Complete blood count

RATIO: A hemoglobin electrophoresis test is a blood test used to measure

and identify the different types of hemoglobin in your bloodstream. The
electrophoresis process takes advantage of the fact that hemoglobin types
have different electrical charges. During electrophoresis, an electrical current
is passed through the hemoglobin in a blood sample, which causes the
hemoglobin types to separate at different rates and form bands. By
comparing the pattern formed with that of a normal blood sample, doctors
can see the types and quantities of hemoglobin present in the blood sample.

11. The drug of choice for patients with sickle cell anemia would
be a. Aspirin
b. Iron supplements
c. Folic acid supplements
d. Hydroxyurea (Hydrea)

RATIO: Daily hydroxyurea reduces the frequency of painful crises and might
reduce the need for blood transfusions and hospitalizations. It can also
increase your risk of infections. Don't take the drug if you're pregnant.

12. Prolonged occurrence of priapism in males can lead to

a. Impotence
b. Premature ejaculation
c. Anorgasmia
d. Low sperm cell count

RATIO: Ischemic priapism can cause serious complications. The blood

trapped in the penis is deprived of oxygen. When an erection lasts for too
long, this oxygen-poor blood can begin to damage or destroy tissues in the
penis. As a result, untreated priapism can cause erectile dysfunction.

13. Beta thalassemia are common in

a. Northern Europe
b. Mediterranean population
c. Caribbean people
d. Pacific islanders
RATIO: Beta thalassemia is a fairly common blood disorder worldwide.
Thousands of infants with beta thalassemia are born each year. Beta
thalassemia occurs most frequently in people from Mediterranean countries,
North Africa, the Middle East, India, Central Asia, and Southeast Asia.

14. Regular transfusion of which of the following blood products is beneficial

in patients with beta thalassemia
a. Platelet concentrate
b. Fresh frozen plasma
c. Packed RBCs
d. Fresh whole blood
RATIO: Patients with β-thalassaemia major should receive leucoreduced
packed red blood cells with a minimum haemoglobin content of 40g.
Reduction to 1 × 106 or less leucocytes per unit (mean counts as low as
0.05 × 106 are achievable) (Council of Europe, RE 2006) is considered the
critical threshold for eliminating adverse reactions attributed to
contaminating white cells and for preventing platelet alloimmunisation.

15. Which of the following is NOT a characteristic of

thalassemia? a. Hypochromia
b. Extreme microcytosis
c. Decreased clotting factors
d. Destruction of blood elements

RATIO: Thalassemia is an inherited blood disorder that affects the body's

ability to produce hemoglobin and red blood cells.

16. G6PD is a type of:

a. X-linked disease
b. Autosomal dominant
c. Autosomal recessive
d. Y-linked disease

RATIO: G6PD deficiency is inherited in an X-linked recessive manner.

X-linked recessive conditions are much more common in males, who have
only one X chromosome (and one Y chromosome). Females have two X
chromosomes, so if they have a mutation on one of them, they still have
one X chromosome without the mutation. A G6PD deficiency is an inherited
disorder. It’s most common in men of African, Asian, or Mediterranean
descent. It’s the result of X-linked recessive transmission, which means it’s
much more likely to affect men as opposed to women. The deficiency can
lead to a certain type of anemia known as hemolytic anemia.
17. The diagnosis of G6PD is done through
a. Newborn screening
b. Complete blood count
c. Bone marrow aspiration
d. Hemoglobin electrophoresis

RATIO: Your doctor can diagnose G6PD deficiency by performing a simple

blood test to check G6PD enzyme levels. Other diagnostic tests that may be
done include a complete blood count, serum hemoglobin test, and a
reticulocyte count. All these tests give information about the red blood cells
in the body. They can also help your doctor to diagnose hemolytic anemia.
18. One of the most important patient teaching in patients with G6PD is
to a. Advise patients to avoid foods that are high in iodine
b. Teach the patient about avoiding crowded places
c. Telling the patient to minimize intake of eggs
d. Educating the patient about a list of medications to avoid

RATIO: G6PD helps red blood cells work. It also protects them from
substances in the blood that could harm them. Red blood cells that don't
have enough G6PD are sensitive to some medicines, foods, and infections.
When these things trigger a quick loss of red blood cells over a short time,
it's called a hemolytic crisis. In these cases, the symptoms stopped when
the cause is gone. In rare cases, G6PD deficiency leads to chronic anemia
regardless exposure to triggers.

19. If polycythemia vera is left untreated this might lead to which of the
following diseases?
a. Osteosarcoma
b. Myeloid metaplasia
c. Aplastic anemia
d. Acute lymphocytic leukemia

RATIO: The clinical course of polycythemia vera (PV) is characterized by

significant thrombohemorrhagic complications and variable risk for disease
transformation into myeloid metaplasia with myelofibrosis (MMM) or acute
myeloid leukemia/myelodysplastic syndromes (AML/MDS).

20. The description of erythromelalgia in polycythemia vera is best described

as
a. Numbness of the fingers and toes
b. Chest pain from enlarged spleen
c. Burning sensation in the fingers and toes
d. Clubbing of the fingers and toes
RATIO: Erythromelalgia causes redness and pain in the upper and lower
extremities which is caused by myeloproliferative disease such as
polycythemia vera.

21. This is one of the treatment options in polycythemia vera where the
doctor removes enough blood to deplete the patient’s iron stores
a. Cardiac catheterization
b. Hemoglobin electrophoresis
c. Bone marrow aspiration
d. Phlebotomy
RATIO: Doctors treat PV with a technique called phlebotomy. This procedure
removes blood from your body. Red blood cells contain large amounts of
iron. By removing iron from the body, the production of red blood cells by
the bone marrow slows down.

22. For the prevention of gouty attacks in patients with polycythemia vera
the nurse must anticipate the prescription of which of the following drugs?
a. Dypyridamole (Persantine)
b. Hydroxyurea (Hydrea)
c. Allopurinol (Zyloprim)
d. Acetylsalicylic acid (Aspirin)

RATIO: ZYLOPRIM (allopurinol) reduces serum and urinary uric acid

concentrations. Its use should be individualized for each patient and requires
an understanding of its mode of action and pharmacokinetics ZYLOPRIM
(allopurinol) is indicated in: the management of patients with signs and
symptoms of primary or secondary gout (acute attacks, tophi, joint
destruction, uric acid lithiasis, and/or nephropathy).

23. Which of the following beverages should the nurse teach the patient with
polycythemia vera to avoid?
a. Coffee
b. Alcohol
c. Tea
d. Milk

RATIO: Apparent polycythaemia is often caused by being overweight,

smoking, drinking too much alcohol or taking certain medicines – including
diuretics (tablets for high blood pressure that make you pee more).
Apparent polycythaemia may improve if the underlying cause is identified
and managed.

24. Factor VIII activity of around 1-5% and bleeding with trauma in
hemophilic patients would fall under which severity of bleeding?
a. Mild
b. Moderate
c. Severe
d. Profound

RATIO: Individuals with 1-5% of normal factor VIII activity level have
moderate hemophilia, and are at risk for heavy bleeding after seemingly
minor traumatic injury. Individuals with 5-40% of normal factor VIII activity
level have mild hemophilia, and must prepare carefully for any surgery or
dental procedures.
25. One of the patient teachings that the nurse must NOT advise to patients
with hemophilia would be
a. Advise the patient to use an electric razor
b. Tell the patient to participate in contact sports
c. Teach the patient to cut nails across
d. Advise the patient not to go barefooted

RATIO: Hemophilia is a rare disorder in which your blood doesn't clot

normally because it lacks sufficient blood clotting proteins (clotting factors).
If you have hemophilia, you may bleed for a longer time after an injury
than you would if your blood clotted normally. So it is best to advise the
patient with hemophilia to exercise regularly, always protect his or herself
from injuries that could cause bleeding and the nurse should not teach
patient to cut nails across as it will have a high chance of bleeding.

SAS 22

1. A nursing student is asking her clinical instructor about the lifespan of

red blood cells. The instructor should know that the life of the erythrocytes
is usually at around
a. 60 days
b. 100 days
c. 120 days
d. 180 days

RATIO: The empty hemoglobin molecules then bond with the tissue's carbon
dioxide or other waste gasses to transport them away. Over time, red blood
cells get worn out and eventually die. The average life cycle of a red blood
cell is only 120 days.
 2. When the patient has low hemoglobin and hematocrit, the nurse
must suspect the patient to have
a. Anemia
b. Leukemia
c. Thrombocytopenia
d. Polycythemia

RATIO: Low Hgb is also known as anemia, which means that you don't have
enough red blood cells in your body. With anemia, a blood test will also
show that you have a low red blood cell count and may have low hematocrit,
the volume of red blood cells to other components in your blood.

3. The blood cells that are high in the event that the patient is
suffering from an allergic reaction would be
a. Basophils
b. Eosinophils
c. Neutrophils
d. Both a and b

RATIO: Basophils and eosinophils are important effector cells in human

allergic diseases; they play a significant role in promoting allergic
inflammation through the release of proinflammatory mediators (such as
histamine, leukotriene C4, major basic protein, eosinophil cationic protein,
IL-4, and IL-13, among others).

4. A 7-year-old patient was admitted to the hospital for suspected

dengue fever. The complete blood count shows that the patient has a
platelet count of 20,000 cells per mm3. The nurse interprets this as
a. Neutropenia
b. Thrombocytopenia
c. Leukopenia
d. Anemia

RATIO: Platelets (thrombocytes) are colorless blood cells that help blood
clot. Platelets stop bleeding by clumping and forming plugs in blood vessel
injuries. A normal platelet count ranges from 150,000 to 450,000 platelets
per microliter of blood. Having more than 450,000 platelets is a condition
called thrombocytosis; having less than 150,000 is known as
thrombocytopenia. Thrombocytopenia is a condition in which you have a low
blood platelet count.
 5. The nurse has observed that in the patient’s CBC, the white
blood cells of the patient is at 13000 cells per mm3.
The patient might be having a/an
a. Anemia
b. Infection
c. Dengue hemorrhagic fever
d. Blood dyscrasia

RATIO: The normal number of WBCs in the blood is 4,500 to 11,000 WBCs
per microliter (4.5 to 11.0 × 109/L). A high white blood cell count may
indicate that the immune system is working to destroy an infection. It may
also be a sign of physical or emotional stress. People with particular blood
cancers may also have high white blood cells counts.

6. Which of the following cells are considered to be phagocytes?

a. Monocytes
b. Basophils
c. Neutrophils
d. Both a and c
RATIO: The professional phagocytes are the monocytes, macrophages,
neutrophils, tissue dendritic cells and mast cells. Neutrophils can secrete
products that stimulate monocytes and macrophages. Neutrophil
secretions increase phagocytosis and the formation of reactive oxygen
compounds involved in intracellular killing. Secretions from the primary
granules of neutrophils stimulate the phagocytosis of IgG-antibody-coated
bacteria.

7. Iron-deficiency anemia is common in men and women who have

which of the following co-existing disorders?
a. Ulcers
b. Inflammatory bowel disease
c. GI tumors
d. All of the above

RATIO: Malabsorption of iron is common after some forms of

gastrointestinal surgeries. Most of the iron taken in by foods is absorbed in
the upper small intestine. Any abnormalities in the gastrointestinal (GI)
tract could alter iron absorption and result in iron-deficiency anemia.
8. Which of the following group of drugs can cause chronic blood loss
from the GI tract further contributing to the development of
iron-deficiency anemia?
a. Antibiotics
b. NSAIDs
c. Anti-ulcer drugs
d. Antacids

RATIO: A patient with chronic iron deficiency anaemia on long term

NSAIDs may well have small intestinal damage associated with NSAIDs,
leading to blood loss and chronic iron deficiency anaemia. Overt bleeding,
perforation, or strictures of the small intestine may also occur.

9. Which of the following is NOT a sign or symptom of having

iron-deficiency anemia?
a. Smooth, red tongue
b. Angular cheilosis
c. Stomachache
d. Brittle and rigid nails

RATIO: Anemia caused by chronic lead poisoning may have stomachache.

10. In the event of a dark-skinned patient, the best site to assess the
pallor of the patient with iron-deficiency anemia would be at the
a. Conjunctiva
b. Palms
c. Soles
d. Abdomen

RATIO: Current evidence suggests that conjunctival pallor may be a more

accurate indicator of the presence or absence of anemia than pallor of the
palms or nail beds. In addition, conjunctival pallor has been documented
to appear more frequently in patients with severe anemia, and hence may
be more sensitive than other signs and it is commonly assessed in
dark-skinned individuals.

11. The definitive method of establishing the diagnosis of

iron-deficiency anemia would be
a. Complete blood count
b. Cardiac catheterization
c. Angiography
d. Bone marrow aspiration
RATIO: To screen for iron-deficiency anemia, your doctor may order a
blood test called a complete blood count (CBC) to see if you have lower
than normal red blood cell counts, hemoglobin or hematocrit levels, or
mean corpuscular volume (MCV) that would suggest anemia.

12. The nurse is about to give iron supplements to a patient with

iron-deficiency anemia. Which of the following beverages can be given
together with iron supplementation?
a. Orange juice
b. Milk tea
c. Cappuccino
d. Yogurt drink

RATIO: Orange juice contains ascorbic acid which facilitates iron

absorption by forming a chelate with ferric iron at acid pH that remains
soluble at the alkaline pH of the duodenum.

13. Which of the following routine tests should people above 50 years of
age have to detect ulcerations, polyps or cancer of the GI tract?
a. Colonoscopy
b. Endoscopy
c. Upper GI and Lower GI series
d. All of the above

RATIO: All of the following are diagnostic test used in detecting GI

abnormalities.

14. Which of the following food items would be beneficial for patients
who have iron-deficiency anemia?
a. Chicken breast
b. Chicken liver
c. Red fruits
d. Carrots

RATIO: Eating chicken liver can help you get the iron you need to manage
anemia as it contains 9.2 Iron (mg) per 75g (2 ½ oz serving).
 15. A person taking fluid preparation of ferrous sulfate might have
which of the following is he did not use a straw?
a. Tooth decay
b. Teeth staining
c. Tartar
d. Halitosis

RATIO: Oral iron supplements may cause teeth discoloration due to the
formation of iron salts on teeth surfaces, it plays an inhibitory role in
progression of dental caries.

16. Which of the following vitamins enhances the absorption of iron

in the body?
a. Vitamin A
b. Vitamin K
c. Vitamin C
d. Vitamin D

RATIO: Vitamin C, also known as ascorbic acid, is a water-soluble

vitamin thought to increase the absorption of nonheme iron. Vitamin C
acts as a reducing agent to facilitate iron absorption from the GI tract
and to enable its mobilization from storage.

17. The pathology of aplastic anemia is brought about by

a. Deficiency in vitamin B12
b. Deficiency in folic acid
c. Destruction of red bone marrow stem cells
d. Absence of intrinsic factor from the GI

RATIO: The most common cause of aplastic anemia is from your immune
system attacking the stem cells in your bone
marrow. Other factors that can injure bone marrow and affect blood
cell production include: Radiation and chemotherapy treatments.

18. Which of the following substances is NOT associated with aplastic

anemia?
a. Sulfonamides
b. Phenothiazines
c. Antineoplastic agents
d. Vitamin and mineral supplements
RATIO: Many different medications can cause aplastic anemia, including
chloramphenicol (Chloromycetin), phenylbutazone (Butazolidin),
sulfonamides (Gantanol and others), anticonvulsants, cimetidine
(Tagamet) and Antineoplastic drugs are medications used to treat
cancer. Antineoplastic drugs are also called anticancer, chemotherapy,
chemo, cytotoxic, or hazardous drugs.

19. Management of aplastic anemia is best done through

a. Transfusion of platelet concentrate
b. Transfusion of fresh frozen plasma
c. Bone marrow transplantation
d. Iron supplementation

RATIO: A bone marrow transplant is also called a stem cell transplant or,
more specifically, a hematopoietic stem cell transplant. A stem cell
transplant to rebuild the bone marrow with stem cells from a donor might
be the only successful treatment option for people with severe aplastic
anemia.

20. What is the primary cause of aplastic anemia?

a. Infections
b. Toxic substances
c. Antineoplastic therapy
d. Idiopathic

RATIO: Aplastic anemia is idiopathic but radiation and chemotherapy

treatments could be a factor that can injure bone marrow affecting blood
cell production.

21. In megaloblastic anemia, the patient may have a deficiency in

which of the following?
a. Folic acid
b. Iron
c. Vitamin B12
d. Both a and c

RATIO: Red blood cells carry oxygen throughout the body using a protein
called hemoglobin. If there aren't enough of these cells or this protein,
anemia results. Usually, megaloblastic anemia is due to acquired deficiency
in vitamin B12 or folic acid.
 22. Which of the following best describes the appearance of the
blood cells in megaloblastic anemia?
a. Sickle-shaped
b. Irregularly-shaped
c. Microcytic
d. Large and bizarre

RATIO: Megaloblastic anemia is a form of anemia characterized by very

large red blood cells and a decrease in the number of those cells.

23. This is known as a decrease in all myeloid-derived cells

a. Pancytopenia
b. Thrombocytopenia
c. Anemia
d. Polycythemia

RATIO: Pancytopenia is a condition in which a person’s body has too

few red blood cells, white blood cells, and platelets.

24. The mean corpuscular volume of a patient with megaloblastic

anemia would be
a. 81-96 μm3
b. 75 μm3
c. > 110 μm3
d. < 80 μm3

RATIO: Macrocytic (ie, MCV >100 fL/cell) anemias due to vitamin B12
deficiency or folate deficiency are megaloblastic. An MCV test measures the
size and volume of red blood cells. A normal MCV range is roughly 80–100 fl
. If someone's MCV level is below 80 fl, they will likely develop or have
microcytic anemia. Alternatively, if their MCV levels are greater than 100 fl,
they could experience macrocytic anemia.

25. Folic acid deficiency may be brought about by

a. Decreased consumption of vegetables
b. Increased consumption of meats
c. Increased consumption of vegetables
d. Decreased consumption of seafood
RATIO: A diet low in fresh fruits, vegetables, and fortified cereals is the
main cause of folate deficiency. In addition, overcooking your food can
sometimes destroy the vitamins. Folate levels in your body can become
low in just a few weeks if you don’t eat enough folate-rich foods.

SAS 23

1. In Schilling test, this is done by

a. Letting the patient take radioactive iodine
b. Letting the patient take radioactive vitamin B12
c. Letting the patient take radioactive folic acid
d. Letting the patient take radioactive intrinsic factor

RATIO: The Schilling test measures cobalamin absorption by assessing

increased urine radioactivity after an oral dose of radioactive cobalamin. The
test is useful in demonstrating that the anemia is caused by an absence of IF
and is not secondary to other causes of cobalamin deficiency. It is also
useful for identifying patients with classic pernicious anemia, even after
they have been treated with vitamin B12.

2. Under production of the intrinsic factor can cause malabsorption of which

of the following?
a. Vitamin B6
b. Vitamin B1
c. Vitamin B12
d. Vitamin B2

RATIO: Causes of vitamin B12 deficiency include difficulty absorbing vitamin

B12 from food, lack of intrinsic factor (e.g., because of pernicious anemia),
surgery in the gastrointestinal tract, prolonged use of certain medications
(e.g., metformin or proton pump inhibitors, discussed in more detail below in
the section on interactions with medications), and dietary deficiency.

3. The administration of folic acid for megaloblastic anemia would

be a. 1 gram daily
b. 10 mg daily
c. 100 mg daily
d. 1 mg daily

RATIO: The dosage range for folate is 1 to 5 mg daily; 1 mg/d is the usual
dosage for adults with megaloblastic anemia, while a higher dosage is
indicated in hemolysis, malabsorption, alcoholism, and exfoliative dermatitis.
4. For vegetarians suffering from megaloblastic anemia the nurse must
teach the patient to take
a. Vitamin B12 supplements
b. Iron supplements
c. Vitamin C supplements
d. Taking intrinsic factor through IV

RATIO: Vitamin B12 is an essential vitamin for the cells. It’s important for
keeping your nerves, blood cells, and DNA healthy. Animal products
naturally contain this vitamin. Meats, dairy, and eggs are particularly good
sources. Plant-based foods do not naturally contain B12, so people who
follow a vegetarian diet or vegan diet need to make sure they get enough
each day to avoid a deficiency. A lack of vitamin B12 can lead to serious
health consequences, such as pernicious anemia.

5. Patients with megaloblastic anemia may have difficulty maintaining which

of the following
a. Speech
b. Hearing
c. Balance
d. Erection

RATIO: Megaloblastic anemia is a condition in which the bone marrow

produces unusually large, structurally abnormal, immature red blood cells
(megaloblasts). Bone marrow, the soft spongy material found inside certain
bones, produces the main blood cells of the body red cells white cells and
platelets. The symptoms of megaloblastic anemia include aches, pains, and
muscle weakness. Therefore, the patient will have difficulty maintaining his
or her balance.

6. Which of the following races are prone to develop sickle-cell

anemia? a. Europeans
b. Austronesians
c. Africans
d. East Asians

RATIO: Sickle cell disease is more common in certain ethnic groups,

including: People of African descent, including African-Americans (among
whom 1 in 12 carries a sickle cell gene) Hispanic-Americans from Central
and South America People of Middle Eastern, Asian, Indian, and
Mediterranean descent

7. This is known as the prolonged erection of the penis in patients with

sickle cell anemia which is often painful
a. Sickling
b. Priapism
c. Auto-erection
d. Phimosis
RATIO: Priapism is a prolonged erection of the penis. The persistent erection
continues hours beyond or isn't caused by sexual stimulation. Priapism is
usually painful. Although priapism is an uncommon condition overall, it
occurs commonly in certain groups, such as people who have sickle cell
anemia.

8. Which of the following organs is most responsible for sequestration in

sickle cell anemia in children?
a. Liver
b. Pancreas
c. Spleen
d. Stomach

RATIO: When sickled cells are trapped in blood vessels leading out of the
spleen in tea of flowing through it. This is called sequestration. When this
happens, the spleen is very large and it is easy to feel.

9. With current management strategies, the average life expectancy of

patients with sickle-cell anemia is at
a. 28 years
b. 42 years
c. 34 years
d. 12 years

RATIO: With a national median life expectancy of 42–47 years, people with
sickle cell disease (SCD) face many challenges, including severe pain
episodes, stroke, and organ damage. However, a new report published
online today in Blood, the Journal of the American Society of Hematology
(ASH), shows that some people with mildly symptomatic SCD may live long
lives with proper management of the disease, including strong family
support and strict adherence to medication and appointments.

10. This is a blood test used to measure and identify the different type of
hemoglobin in the bloodstream
a. Bone marrow aspiration
b. Hemoglobin electrophoresis
c. Schilling test
d. Complete blood count
RATIO: A hemoglobin electrophoresis test is a blood test used to measure
and identify the different types of hemoglobin in your bloodstream. The
electrophoresis process takes advantage of the fact that hemoglobin types
have different electrical charges. During electrophoresis, an electrical current
is passed through the hemoglobin in a blood sample, which causes the
hemoglobin types to separate at different rates and form bands. By
comparing
the pattern formed with that of a normal blood sample, doctors can see the
types and quantities of hemoglobin present in the blood sample.

11. The drug of choice for patients with sickle cell anemia would
be a. Aspirin
b. Iron supplements
c. Folic acid supplements
d. Hydroxyurea (Hydrea)

RATIO: Daily hydroxyurea reduces the frequency of painful crises and might
reduce the need for blood transfusions and hospitalizations. It can also
increase your risk of infections. Don't take the drug if you're pregnant.

12. Prolonged occurrence of priapism in males can lead to

a. Impotence
b. Premature ejaculation
c. Anorgasmia
d. Low sperm cell count

RATIO: Ischemic priapism can cause serious complications. The blood

trapped in the penis is deprived of oxygen. When an erection lasts for too
long, this oxygen-poor blood can begin to damage or destroy tissues in the
penis. As a result, untreated priapism can cause erectile dysfunction.

13. Beta thalassemia are common in

a. Northern Europe
b. Mediterranean population
c. Caribbean people
d. Pacific islanders

RATIO: Beta thalassemia is a fairly common blood disorder worldwide.

Thousands of infants with beta thalassemia are born each year. Beta
thalassemia occurs most frequently in people from Mediterranean countries,
North Africa, the Middle East, India, Central Asia, and Southeast Asia.

14. Regular transfusion of which of the following blood products is beneficial

in patients with beta thalassemia
a. Platelet concentrate
b. Fresh frozen plasma
c. Packed RBCs
d. Fresh whole blood

RATIO: Patients with β-thalassaemia major should receive leucoreduced

packed red blood cells with a minimum haemoglobin content of 40g.
Reduction to 1 × 106 or less leucocytes per unit (mean counts as low as
0.05 × 106 are achievable) (Council of Europe, RE 2006) is considered the
critical threshold for eliminating adverse reactions attributed to
contaminating white cells and for preventing platelet alloimmunisation.

15. Which of the following is NOT a characteristic of

thalassemia? a. Hypochromia
b. Extreme microcytosis
c. Decreased clotting factors
d. Destruction of blood elements

RATIO: Thalassemia is an inherited blood disorder that affects the body's

ability to produce hemoglobin and red blood cells.

16. G6PD is a type of:

a. X-linked disease
b. Autosomal dominant
c. Autosomal recessive
d. Y-linked disease

RATIO: G6PD deficiency is inherited in an X-linked recessive manner.

X-linked recessive conditions are much more common in males, who have
only one X chromosome (and one Y chromosome). Females have two X
chromosomes, so if they have a mutation on one of them, they still have
one X chromosome without the mutation. A G6PD deficiency is an inherited
disorder. It’s most common in men of African, Asian, or Mediterranean
descent. It’s the result of X-linked recessive transmission, which means it’s
much more likely to affect men as opposed to women. The deficiency can
lead to a certain type of anemia known as hemolytic anemia.

17. The diagnosis of G6PD is done through

a. Newborn screening
b. Complete blood count
c. Bone marrow aspiration
d. Hemoglobin electrophoresis
RATIO: Your doctor can diagnose G6PD deficiency by performing a simple
blood test to check G6PD enzyme levels. Other diagnostic tests that may be
done include a complete blood count, serum hemoglobin test, and a
reticulocyte count. All these tests give information about the red blood cells
in the body. They can also help your doctor to diagnose hemolytic anemia.

18. One of the most important patient teaching in patients with G6PD is
to a. Advise patients to avoid foods that are high in iodine
b. Teach the patient about avoiding crowded places
c. Telling the patient to minimize intake of eggs
d. Educating the patient about a list of medications to avoid

RATIO: G6PD helps red blood cells work. It also protects them from
substances in the blood that could harm them. Red blood cells that don't
have enough G6PD are sensitive to some medicines, foods, and infections.
When these things trigger a quick loss of red blood cells over a short time,
it's called a hemolytic crisis. In these cases, the symptoms stopped when
the cause is gone. In rare cases, G6PD deficiency leads to chronic anemia
regardless exposure to triggers.

19. If polycythemia vera is left untreated this might lead to which of the
following diseases?
a. Osteosarcoma
b. Myeloid metaplasia
c. Aplastic anemia
d. Acute lymphocytic leukemia

RATIO: The clinical course of polycythemia vera (PV) is characterized by

significant thrombohemorrhagic complications and variable risk for disease
transformation into myeloid metaplasia with myelofibrosis (MMM) or acute
myeloid leukemia/myelodysplastic syndromes (AML/MDS).

20. The description of erythromelalgia in polycythemia vera is best described

as
a. Numbness of the fingers and toes
b. Chest pain from enlarged spleen
c. Burning sensation in the fingers and toes
d. Clubbing of the fingers and toes

RATIO: Erythromelalgia causes redness and pain in the upper and lower
extremities which is caused by myeloproliferative disease such as
polycythemia vera.
21. This is one of the treatment options in polycythemia vera where the
doctor removes enough blood to deplete the patient’s iron stores
a. Cardiac catheterization
b. Hemoglobin electrophoresis
c. Bone marrow aspiration
d. Phlebotomy

RATIO: Doctors treat PV with a technique called phlebotomy. This procedure

removes blood from your body. Red blood cells contain large amounts of
iron.
By removing iron from the body, the production of red blood cells by the
bone marrow slows down.

22. For the prevention of gouty attacks in patients with polycythemia vera
the nurse must anticipate the prescription of which of the following drugs?
a. Dypyridamole (Persantine)
b. Hydroxyurea (Hydrea)
c. Allopurinol (Zyloprim)
d. Acetylsalicylic acid (Aspirin)

RATIO: ZYLOPRIM (allopurinol) reduces serum and urinary uric acid

concentrations. Its use should be individualized for each patient and requires
an understanding of its mode of action and pharmacokinetics ZYLOPRIM
(allopurinol) is indicated in: the management of patients with signs and
symptoms of primary or secondary gout (acute attacks, tophi, joint
destruction, uric acid lithiasis, and/or nephropathy).

23. Which of the following beverages should the nurse teach the patient with
polycythemia vera to avoid?
a. Coffee
b. Alcohol
c. Tea
d. Milk

RATIO: Apparent polycythaemia is often caused by being overweight,

smoking, drinking too much alcohol or taking certain medicines – including
diuretics (tablets for high blood pressure that make you pee more).
Apparent polycythaemia may improve if the underlying cause is identified
and managed.

24. Factor VIII activity of around 1-5% and bleeding with trauma in
hemophilic patients would fall under which severity of bleeding?
a. Mild
b. Moderate
c. Severe
d. Profound

RATIO: Individuals with 1-5% of normal factor VIII activity level have
moderate hemophilia, and are at risk for heavy bleeding after seemingly
minor traumatic injury. Individuals with 5-40% of normal factor VIII activity
level have mild hemophilia, and must prepare carefully for any surgery or
dental procedures.

25. One of the patient teachings that the nurse must NOT advise to patients
with hemophilia would be
a. Advise the patient to use an electric razor
b. Tell the patient to participate in contact sports
c. Teach the patient to cut nails across
d. Advise the patient not to go barefooted

RATIO: Hemophilia is a rare disorder in which your blood doesn't clot

normally because it lacks sufficient blood clotting proteins (clotting factors).
If you have hemophilia, you may bleed for a longer time after an injury
than you would if your blood clotted normally. So it is best to advise the
patient with hemophilia to exercise regularly, always protect his or herself
from injuries that could cause bleeding and the nurse should not teach
patient to cut nails across as it will have a high chance of bleeding.