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PNLE: Community Health Nursing Exam 4 (PM)
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Question 1
A 4-week old baby was brought to the health center for his first immunization. Which can be given to him?
A
Infant BCG
B
DPT1
C
OPV1
D
Hepatitis B vaccine 1
Question 1 Explanation:
Infant BCG may be given at birth. All the other immunizations mentioned can be given at 6 weeks of age.
Question 2
Which of the following signs indicates the need for sputum examination for AFB?
A
Fever for 1 week
B
Cough for 3 weeks
C
Chest pain for 1 week
D
Hematemesis
Question 2 Explanation:
A client is considered a PTB suspect when he has cough for 2 weeks or more, plus one or more of the following signs: fever for 1 month or more; chest pain lasting for 2 weeks or more not attributed to other conditions; progressive, unexplained weight loss; night sweats; and hemoptysis.
Question 3
A mother brought her daughter, 4 years old, to the RHU because of cough and colds. Following the IMCI assessment guide, which of the following is a danger sign that indicates the need for urgent referral to a hospital?
A
High grade fever
B
Cough for more than 30 days
C
Signs of severe dehydration
D
Inability to drink
Question 3 Explanation:
A sick child aged 2 months to 5 years must be referred urgently to a hospital if he/she has one or more of the following signs: not able to feed or drink, vomits everything, convulsions, abnormally sleepy or difficult to awaken.
Question 4
You will not give DPT 2 if the mother says that the infant had
A
Fever for 3 days after DPT 1.
B
Abscess formation after DPT 1.
C
Local tenderness for 3 days after DPT 1.
D
Seizures a day after DPT 1.
Question 4 Explanation:
Seizures within 3 days after administration of DPT is an indication of hypersensitivity to pertussis vaccine, a component of DPT. This is considered a specific contraindication to subsequent doses of DPT.
Question 5
Which of the following clients should be classified as a case of multibacillary leprosy?
A
3 skin lesions, negative slit skin smear
B
5 skin lesions, positive slit skin smear
C
5 skin lesions, negative slit skin smear
D
3 skin lesions, positive slit skin smear
Question 5 Explanation:
A multibacillary leprosy case is one who has a positive slit skin smear and at least 5 skin lesions.
Question 6
Which clients are considered targets for DOTS Category I?
A
Relapses and failures of previous PTB treatment regimens
B
Clients diagnosed for the first time through a positive sputum exam
C
Sputum negative cavitary cases
D
Clients returning after a default
Question 6 Explanation:
Category I is for new clients diagnosed by sputum examination and clients diagnosed to have a serious form of extrapulmonary tuberculosis, such as TB osteomyelitis.
Question 7
A 1 ½ year old child was classified as having 3rd degree protein energy malnutrition, kwashiorkor. Which of the following signs will be most apparent in this child?
A
Voracious appetite
B
Edema
C
Wasting
D
Apathy
Question 7 Explanation:
Edema, a major sign of kwashiorkor, is caused by decreased colloidal osmotic pressure of the blood brought about by hypoalbuminemia. Decreased blood albumin level is due a protein-deficient diet.
Question 8
A 2-month old infant was brought to the health center for immunization. During assessment, the infant’s temperature registered at 38.1°C. Which is the best course of action that you will take?
A
Go on with the infant’s immunizations.
B
Refer the infant to the physician for further assessment.
C
Give Paracetamol and wait for his fever to subside.
D
Advise the infant’s mother to bring him back for immunization when he is well.
Question 8 Explanation:
In the EPI, fever up to 38.5°C is not a contraindication to immunization. Mild acute respiratory tract infection, simple diarrhea and malnutrition are not contraindications either.
Question 9
During the physical examination of a young child, what is the earliest sign of xerophthalmia that you may observe?
A
Conjunctival xerosis
B
Corneal opacity
C
Keratomalacia
D
Night blindness
Question 9 Explanation:
The earliest sign of Vitamin A deficiency (xerophthalmia) is night blindness. However, this is a functional change, which is not observable during physical examination.The earliest visible lesion is conjunctival xerosis or dullness of the conjunctiva due to inadequate tear production.
Question 10
Scotch tape swab is done to check for which intestinal parasite?
A
Ascaris
B
Schistosoma
C
Pinworm
D
Hookworm
Question 10 Explanation:
Pinworm ova are deposited around the anal orifice.
Question 11
Based on assessment, you classified a 3-month old infant with the chief complaint of diarrhea in the category of SOME DEHYDRATION. Based on IMCI management guidelines, which of the following will you do?
A
Give the infant’s mother instructions on home management.
B
Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours.
C
Bring the infant to the nearest facility where IV fluids can be given.
D
Keep the infant in your health center for close observation.
Question 11 Explanation:
In the IMCI management guidelines, SOME DEHYDRATION is treated with the administration of Oresol within a period of 4 hours. The amount of Oresol is best computed on the basis of the child’s weight (75 ml/kg body weight). If the weight is unknown, the amount of Oresol is based on the child’s age.
Question 12
To prevent xerophthalmia, young children are given Retinol capsule every 6 months. What is the dose given to preschoolers?
A
20,000 IU
B
200,000 IU
C
10,000 IU
D
100,000 IU
Question 12 Explanation:
Preschoolers are given Retinol 200,000 IU every 6 months. 100,000 IU is given once to infants aged 6 to 12 months. The dose for pregnant women is 10,000 IU.
Question 13
Which of the following signs will indicate that a young child is suffering from severe pneumonia?
A
Dyspnea
B
Fast breathing
C
Chest indrawing
D
Wheezing
Question 13 Explanation:
In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating severe pneumonia.
Question 14
A mother brought her 10 month old infant for consultation because of fever, which started 4 days prior to consultation. To determine malaria risk, what will you do?
A
Ask where the family resides.
B
Do a tourniquet test.
C
Get a specimen for blood smear.
D
Ask if the fever is present everyday.
Question 14 Explanation:
Because malaria is endemic, the first question to determine malaria risk is where the client’s family resides. If the area of residence is not a known endemic area, ask if the child had traveled within the past 6 months, where he/she was brought and whether he/she stayed overnight in that area.
Question 15
In immunizing school entrants with BCG, you are not obliged to secure parental consent. This is because of which legal document?
A
Presidential Proclamation No. 46
B
Presidential Proclamation No. 6
C
P.D. 996
D
R.A. 7846
Question 15 Explanation:
Presidential Decree 996, enacted in 1976, made immunization in the EPI compulsory for children under 8 years of age. Hepatitis B vaccination was made compulsory for the same age group by R.A. 7846.
Question 16
A mother is using Oresol in the management of diarrhea of her 3-year old child. She asked you what to do if her child vomits. You will tell her to
A
Bring the child to the health center for assessment by the physician.
B
Bring the child to the health center for intravenous fluid therapy.
C
Let the child rest for 10 minutes then continue giving Oresol more slowly.
D
Bring the child to the nearest hospital for further assessment.
Question 16 Explanation:
If the child vomits persistently, that is, he vomits everything that he takes in, he has to be referred urgently to a hospital. Otherwise, vomiting is managed by letting the child rest for 10 minutes and then continuing with Oresol administration. Teach the mother to give Oresol more slowly.
Question 17
Management of a child with measles includes the administration of which of the following?
A
Antibiotics to prevent pneumonia
B
Tetracycline eye ointment for corneal opacity
C
Retinol capsule regardless of when the last dose was given
D
Gentian violet on mouth lesions
Question 17 Explanation:
An infant 6 to 12 months classified as a case of measles is given Retinol 100,000 IU; a child is given 200,000 IU regardless of when the last dose was given.
Question 18
Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of leprosy?
A
Sinking of the nosebridge
B
Macular lesions
C
Thickened painful nerves
D
Inability to close eyelids
Question 18 Explanation:
The lesion of leprosy is not macular. It is characterized by a change in skin color (either reddish or whitish) and loss of sensation, sweating and hair growth over the lesion. Inability to close the eyelids (lagophthalmos) and sinking of the nosebridge are late symptoms.
Question 19
Food fortification is one of the strategies to prevent micronutrient deficiency conditions. R.A. 8976 mandates fortification of certain food items. Which of the following is among these food items?
A
Bread
B
Filled milk
C
Margarine
D
Sugar
Question 19 Explanation:
R.A. 8976 mandates fortification of rice, wheat flour, sugar and cooking oil with Vitamin A, iron and/or iodine.
Question 20
The following are strategies implemented by the Department of Health to prevent mosquito-borne diseases. Which of these is most effective in the control of Dengue fever?
A
Destroying breeding places of mosquitoes
B
Teaching people in endemic areas to use chemically treated mosquito nets
C
Chemoprophylaxis of non-immune persons going to endemic areas
D
Stream seeding with larva-eating fish
Question 20 Explanation:
Aedes aegypti, the vector of Dengue fever, breeds in stagnant, clear water. Its feeding time is usually during the daytime. It has a cyclical pattern of occurrence, unlike malaria which is endemic in certain parts of the country.
Question 21
A pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will have protection against tetanus for how long?
A
1 year
B
Lifetime
C
3 years
D
10 years
Question 21 Explanation:
The baby will have passive natural immunity by placental transfer of antibodies. The mother will have active artificial immunity lasting for about 10 years. 5 doses will give the mother lifetime protection.
Question 22
Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management for the child?
A
Instruct the mother to continue breastfeeding.
B
Instruct the mother to increase fluid intake.
C
Prescribe an antibiotic.
D
Refer him urgently to the hospital.
Question 22 Explanation:
Severe pneumonia requires urgent referral to a hospital.Other answers choices are done for a client classified as having pneumonia.
Question 23
Secondary prevention for malaria includes
A
Determining whether a place is endemic or not
B
Residual spraying of insecticides at night
C
Planting of neem or eucalyptus trees
D
Growing larva-eating fish in mosquito breeding places
Question 23 Explanation:
This is diagnostic and therefore secondary level prevention. The other choices are for primary prevention.
Question 24
Which immunization produces a permanent scar?
A
DPT
B
Hepatitis B vaccination
C
BCG
D
Measles vaccination
Question 24 Explanation:
BCG causes the formation of a superficial abscess, which begins 2 weeks after immunization. The abscess heals without treatment, with the formation of a permanent scar.
Question 25
To improve compliance to treatment, what innovation is being implemented in DOTS?
A
Having a target list to check on whether the patient has collected his monthly supply of drugs
B
Having the health worker or a responsible family member monitor drug intake
C
Having the health worker follow up the client at home
D
Having the patient come to the health center every month to get his medications
Question 25 Explanation:
Directly Observed Treatment Short Course is so-called because a treatment partner, preferably a health worker accessible to the client, monitors the client’s compliance to the treatment.
Question 26
Assessment of a 2-year old child revealed “baggy pants”. Using the IMCI guidelines, how will you manage this child?
A
Make a teaching plan for the mother, focusing on menu planning for her child.
B
Refer the child urgently to a hospital for confinement.
C
Coordinate with the social worker to enroll the child in a feeding program.
D
Assess and treat the child for health problems like infections and intestinal parasitism.
Question 26 Explanation:
“Baggy pants” is a sign of severe marasmus. The best management is urgent referral to a hospital.
Question 27
A 4-month old infant was brought to the health center because of cough. Her respiratory rate is 42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines of assessment, her breathing is considered
A
Slow
B
Insignificant
C
Normal
D
Fast
Question 27 Explanation:
In IMCI, a respiratory rate of 50/minute or more is fast breathing for an infant aged 2 to 12 months.
Question 28
A 5-month old infant was brought by his mother to the health center because of diarrhea occurring 4 to 5 times a day. His skin goes back slowly after a skin pinch and his eyes are sunken. Using the IMCI guidelines, you will classify this infant in which category?
A
Some dehydration
B
No signs of dehydration
C
Severe dehydration
D
The data is insufficient.
Question 28 Explanation:
Using the assessment guidelines of IMCI, a child (2 months to 5 years old) with diarrhea is classified as having SOME DEHYDRATION if he shows 2 or more of the following signs: restless or irritable, sunken eyes, the skin goes back slow after a skin pinch.
Question 29
What is the best course of action when there is a measles epidemic in a nearby municipality?
A
Give measles vaccine to babies aged 6 to 8 months.
B
Instruct mothers to keep their babies at home to prevent disease transmission.
C
Instruct mothers to feed their babies adequately to enhance their babies’ resistance.
D
Give babies aged 6 to 11 months one dose of 100,000 I.U. of Retinol
Question 29 Explanation:
Ordinarily, measles vaccine is given at 9 months of age. During an impending epidemic, however, one dose may be given to babies aged 6 to 8 months. The mother is instructed that the baby needs another dose when the baby is 9 months old.
Question 30
The major sign of iron deficiency anemia is pallor. What part is best examined for pallor?
A
Around the lips
B
Nailbeds
C
Palms
D
Lower conjunctival sac
Question 30 Explanation:
The anatomic characteristics of the palms allow a reliable and convenient basis for examination for pallor.
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PNLE: Community Health Nursing Exam 4 (EM)
Choose the letter of the correct answer. You got 30 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed PNLE: Community Health Nursing Exam 4 (EM).
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
The following are strategies implemented by the Department of Health to prevent mosquito-borne diseases. Which of these is most effective in the control of Dengue fever?
A
Destroying breeding places of mosquitoes
B
Teaching people in endemic areas to use chemically treated mosquito nets
C
Chemoprophylaxis of non-immune persons going to endemic areas
D
Stream seeding with larva-eating fish
Question 1 Explanation:
Aedes aegypti, the vector of Dengue fever, breeds in stagnant, clear water. Its feeding time is usually during the daytime. It has a cyclical pattern of occurrence, unlike malaria which is endemic in certain parts of the country.
Question 2
In immunizing school entrants with BCG, you are not obliged to secure parental consent. This is because of which legal document?
A
R.A. 7846
B
Presidential Proclamation No. 6
C
Presidential Proclamation No. 46
D
P.D. 996
Question 2 Explanation:
Presidential Decree 996, enacted in 1976, made immunization in the EPI compulsory for children under 8 years of age. Hepatitis B vaccination was made compulsory for the same age group by R.A. 7846.
Question 3
To prevent xerophthalmia, young children are given Retinol capsule every 6 months. What is the dose given to preschoolers?
A
10,000 IU
B
20,000 IU
C
100,000 IU
D
200,000 IU
Question 3 Explanation:
Preschoolers are given Retinol 200,000 IU every 6 months. 100,000 IU is given once to infants aged 6 to 12 months. The dose for pregnant women is 10,000 IU.
Question 4
You will not give DPT 2 if the mother says that the infant had
A
Fever for 3 days after DPT 1.
B
Local tenderness for 3 days after DPT 1.
C
Abscess formation after DPT 1.
D
Seizures a day after DPT 1.
Question 4 Explanation:
Seizures within 3 days after administration of DPT is an indication of hypersensitivity to pertussis vaccine, a component of DPT. This is considered a specific contraindication to subsequent doses of DPT.
Question 5
Which of the following clients should be classified as a case of multibacillary leprosy?
A
3 skin lesions, negative slit skin smear
B
5 skin lesions, negative slit skin smear
C
5 skin lesions, positive slit skin smear
D
3 skin lesions, positive slit skin smear
Question 5 Explanation:
A multibacillary leprosy case is one who has a positive slit skin smear and at least 5 skin lesions.
Question 6
A pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will have protection against tetanus for how long?
A
10 years
B
Lifetime
C
3 years
D
1 year
Question 6 Explanation:
The baby will have passive natural immunity by placental transfer of antibodies. The mother will have active artificial immunity lasting for about 10 years. 5 doses will give the mother lifetime protection.
Question 7
Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management for the child?
A
Refer him urgently to the hospital.
B
Instruct the mother to continue breastfeeding.
C
Prescribe an antibiotic.
D
Instruct the mother to increase fluid intake.
Question 7 Explanation:
Severe pneumonia requires urgent referral to a hospital.Other answers choices are done for a client classified as having pneumonia.
Question 8
Which immunization produces a permanent scar?
A
Measles vaccination
B
DPT
C
BCG
D
Hepatitis B vaccination
Question 8 Explanation:
BCG causes the formation of a superficial abscess, which begins 2 weeks after immunization. The abscess heals without treatment, with the formation of a permanent scar.
Question 9
Secondary prevention for malaria includes
A
Determining whether a place is endemic or not
B
Residual spraying of insecticides at night
C
Growing larva-eating fish in mosquito breeding places
D
Planting of neem or eucalyptus trees
Question 9 Explanation:
This is diagnostic and therefore secondary level prevention. The other choices are for primary prevention.
Question 10
A 4-month old infant was brought to the health center because of cough. Her respiratory rate is 42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines of assessment, her breathing is considered
A
Normal
B
Insignificant
C
Fast
D
Slow
Question 10 Explanation:
In IMCI, a respiratory rate of 50/minute or more is fast breathing for an infant aged 2 to 12 months.
Question 11
A 2-month old infant was brought to the health center for immunization. During assessment, the infant’s temperature registered at 38.1°C. Which is the best course of action that you will take?
A
Refer the infant to the physician for further assessment.
B
Advise the infant’s mother to bring him back for immunization when he is well.
C
Give Paracetamol and wait for his fever to subside.
D
Go on with the infant’s immunizations.
Question 11 Explanation:
In the EPI, fever up to 38.5°C is not a contraindication to immunization. Mild acute respiratory tract infection, simple diarrhea and malnutrition are not contraindications either.
Question 12
Which of the following signs will indicate that a young child is suffering from severe pneumonia?
A
Fast breathing
B
Chest indrawing
C
Dyspnea
D
Wheezing
Question 12 Explanation:
In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating severe pneumonia.
Question 13
During the physical examination of a young child, what is the earliest sign of xerophthalmia that you may observe?
A
Conjunctival xerosis
B
Corneal opacity
C
Night blindness
D
Keratomalacia
Question 13 Explanation:
The earliest sign of Vitamin A deficiency (xerophthalmia) is night blindness. However, this is a functional change, which is not observable during physical examination.The earliest visible lesion is conjunctival xerosis or dullness of the conjunctiva due to inadequate tear production.
Question 14
A 1 ½ year old child was classified as having 3rd degree protein energy malnutrition, kwashiorkor. Which of the following signs will be most apparent in this child?
A
Wasting
B
Apathy
C
Edema
D
Voracious appetite
Question 14 Explanation:
Edema, a major sign of kwashiorkor, is caused by decreased colloidal osmotic pressure of the blood brought about by hypoalbuminemia. Decreased blood albumin level is due a protein-deficient diet.
Question 15
Which of the following signs indicates the need for sputum examination for AFB?
A
Fever for 1 week
B
Cough for 3 weeks
C
Hematemesis
D
Chest pain for 1 week
Question 15 Explanation:
A client is considered a PTB suspect when he has cough for 2 weeks or more, plus one or more of the following signs: fever for 1 month or more; chest pain lasting for 2 weeks or more not attributed to other conditions; progressive, unexplained weight loss; night sweats; and hemoptysis.
Question 16
A mother brought her 10 month old infant for consultation because of fever, which started 4 days prior to consultation. To determine malaria risk, what will you do?
A
Do a tourniquet test.
B
Get a specimen for blood smear.
C
Ask if the fever is present everyday.
D
Ask where the family resides.
Question 16 Explanation:
Because malaria is endemic, the first question to determine malaria risk is where the client’s family resides. If the area of residence is not a known endemic area, ask if the child had traveled within the past 6 months, where he/she was brought and whether he/she stayed overnight in that area.
Question 17
Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of leprosy?
A
Sinking of the nosebridge
B
Macular lesions
C
Thickened painful nerves
D
Inability to close eyelids
Question 17 Explanation:
The lesion of leprosy is not macular. It is characterized by a change in skin color (either reddish or whitish) and loss of sensation, sweating and hair growth over the lesion. Inability to close the eyelids (lagophthalmos) and sinking of the nosebridge are late symptoms.
Question 18
A 4-week old baby was brought to the health center for his first immunization. Which can be given to him?
A
OPV1
B
DPT1
C
Infant BCG
D
Hepatitis B vaccine 1
Question 18 Explanation:
Infant BCG may be given at birth. All the other immunizations mentioned can be given at 6 weeks of age.
Question 19
What is the best course of action when there is a measles epidemic in a nearby municipality?
A
Give babies aged 6 to 11 months one dose of 100,000 I.U. of Retinol
B
Instruct mothers to keep their babies at home to prevent disease transmission.
C
Give measles vaccine to babies aged 6 to 8 months.
D
Instruct mothers to feed their babies adequately to enhance their babies’ resistance.
Question 19 Explanation:
Ordinarily, measles vaccine is given at 9 months of age. During an impending epidemic, however, one dose may be given to babies aged 6 to 8 months. The mother is instructed that the baby needs another dose when the baby is 9 months old.
Question 20
Based on assessment, you classified a 3-month old infant with the chief complaint of diarrhea in the category of SOME DEHYDRATION. Based on IMCI management guidelines, which of the following will you do?
A
Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours.
B
Keep the infant in your health center for close observation.
C
Give the infant’s mother instructions on home management.
D
Bring the infant to the nearest facility where IV fluids can be given.
Question 20 Explanation:
In the IMCI management guidelines, SOME DEHYDRATION is treated with the administration of Oresol within a period of 4 hours. The amount of Oresol is best computed on the basis of the child’s weight (75 ml/kg body weight). If the weight is unknown, the amount of Oresol is based on the child’s age.
Question 21
Scotch tape swab is done to check for which intestinal parasite?
A
Ascaris
B
Hookworm
C
Pinworm
D
Schistosoma
Question 21 Explanation:
Pinworm ova are deposited around the anal orifice.
Question 22
Which clients are considered targets for DOTS Category I?
A
Sputum negative cavitary cases
B
Clients returning after a default
C
Clients diagnosed for the first time through a positive sputum exam
D
Relapses and failures of previous PTB treatment regimens
Question 22 Explanation:
Category I is for new clients diagnosed by sputum examination and clients diagnosed to have a serious form of extrapulmonary tuberculosis, such as TB osteomyelitis.
Question 23
A mother brought her daughter, 4 years old, to the RHU because of cough and colds. Following the IMCI assessment guide, which of the following is a danger sign that indicates the need for urgent referral to a hospital?
A
Signs of severe dehydration
B
Cough for more than 30 days
C
Inability to drink
D
High grade fever
Question 23 Explanation:
A sick child aged 2 months to 5 years must be referred urgently to a hospital if he/she has one or more of the following signs: not able to feed or drink, vomits everything, convulsions, abnormally sleepy or difficult to awaken.
Question 24
The major sign of iron deficiency anemia is pallor. What part is best examined for pallor?
A
Palms
B
Nailbeds
C
Around the lips
D
Lower conjunctival sac
Question 24 Explanation:
The anatomic characteristics of the palms allow a reliable and convenient basis for examination for pallor.
Question 25
Food fortification is one of the strategies to prevent micronutrient deficiency conditions. R.A. 8976 mandates fortification of certain food items. Which of the following is among these food items?
A
Sugar
B
Margarine
C
Bread
D
Filled milk
Question 25 Explanation:
R.A. 8976 mandates fortification of rice, wheat flour, sugar and cooking oil with Vitamin A, iron and/or iodine.
Question 26
Assessment of a 2-year old child revealed “baggy pants”. Using the IMCI guidelines, how will you manage this child?
A
Coordinate with the social worker to enroll the child in a feeding program.
B
Refer the child urgently to a hospital for confinement.
C
Make a teaching plan for the mother, focusing on menu planning for her child.
D
Assess and treat the child for health problems like infections and intestinal parasitism.
Question 26 Explanation:
“Baggy pants” is a sign of severe marasmus. The best management is urgent referral to a hospital.
Question 27
A 5-month old infant was brought by his mother to the health center because of diarrhea occurring 4 to 5 times a day. His skin goes back slowly after a skin pinch and his eyes are sunken. Using the IMCI guidelines, you will classify this infant in which category?
A
Severe dehydration
B
The data is insufficient.
C
No signs of dehydration
D
Some dehydration
Question 27 Explanation:
Using the assessment guidelines of IMCI, a child (2 months to 5 years old) with diarrhea is classified as having SOME DEHYDRATION if he shows 2 or more of the following signs: restless or irritable, sunken eyes, the skin goes back slow after a skin pinch.
Question 28
A mother is using Oresol in the management of diarrhea of her 3-year old child. She asked you what to do if her child vomits. You will tell her to
A
Bring the child to the health center for assessment by the physician.
B
Bring the child to the nearest hospital for further assessment.
C
Let the child rest for 10 minutes then continue giving Oresol more slowly.
D
Bring the child to the health center for intravenous fluid therapy.
Question 28 Explanation:
If the child vomits persistently, that is, he vomits everything that he takes in, he has to be referred urgently to a hospital. Otherwise, vomiting is managed by letting the child rest for 10 minutes and then continuing with Oresol administration. Teach the mother to give Oresol more slowly.
Question 29
To improve compliance to treatment, what innovation is being implemented in DOTS?
A
Having the patient come to the health center every month to get his medications
B
Having the health worker follow up the client at home
C
Having the health worker or a responsible family member monitor drug intake
D
Having a target list to check on whether the patient has collected his monthly supply of drugs
Question 29 Explanation:
Directly Observed Treatment Short Course is so-called because a treatment partner, preferably a health worker accessible to the client, monitors the client’s compliance to the treatment.
Question 30
Management of a child with measles includes the administration of which of the following?
A
Gentian violet on mouth lesions
B
Tetracycline eye ointment for corneal opacity
C
Antibiotics to prevent pneumonia
D
Retinol capsule regardless of when the last dose was given
Question 30 Explanation:
An infant 6 to 12 months classified as a case of measles is given Retinol 100,000 IU; a child is given 200,000 IU regardless of when the last dose was given.
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1. In immunizing school entrants with BCG, you are not obliged to secure parental consent. This is because of which legal document?
P.D. 996
R.A. 7846
Presidential Proclamation No. 6
Presidential Proclamation No. 46
2. Which immunization produces a permanent scar?
DPT
BCG
Measles vaccination
Hepatitis B vaccination
3. A 4-week old baby was brought to the health center for his first immunization. Which can be given to him?
DPT1
OPV1
Infant BCG
Hepatitis B vaccine 1
4. You will not give DPT 2 if the mother says that the infant had
Seizures a day after DPT 1.
Fever for 3 days after DPT 1.
Abscess formation after DPT 1.
Local tenderness for 3 days after DPT 1.
5. A 2-month old infant was brought to the health center for immunization. During assessment, the infant’s temperature registered at 38.1°C. Which is the best course of action that you will take?
Go on with the infant’s immunizations.
Give Paracetamol and wait for his fever to subside.
Refer the infant to the physician for further assessment.
Advise the infant’s mother to bring him back for immunization when he is well.
6. A pregnant woman had just received her 4th dose of tetanus toxoid. Subsequently, her baby will have protection against tetanus for how long?
1 year
3 years
10 years
Lifetime
7. A 4-month old infant was brought to the health center because of cough. Her respiratory rate is 42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines of assessment, her breathing is considered
Fast
Slow
Normal
Insignificant
8. Which of the following signs will indicate that a young child is suffering from severe pneumonia?
Dyspnea
Wheezing
Fast breathing
Chest indrawing
9. Using IMCI guidelines, you classify a child as having severe pneumonia. What is the best management for the child?
Prescribe an antibiotic.
Refer him urgently to the hospital.
Instruct the mother to increase fluid intake.
Instruct the mother to continue breastfeeding.
10. A 5-month old infant was brought by his mother to the health center because of diarrhea occurring 4 to 5 times a day. His skin goes back slowly after a skin pinch and his eyes are sunken. Using the IMCI guidelines, you will classify this infant in which category?
No signs of dehydration
Some dehydration
Severe dehydration
The data is insufficient.
11. Based on assessment, you classified a 3-month old infant with the chief complaint of diarrhea in the category of SOME DEHYDRATION. Based on IMCI management guidelines, which of the following will you do?
Bring the infant to the nearest facility where IV fluids can be given.
Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours.
Give the infant’s mother instructions on home management.
Keep the infant in your health center for close observation.
12. A mother is using Oresol in the management of diarrhea of her 3-year old child. She asked you what to do if her child vomits. You will tell her to
Bring the child to the nearest hospital for further assessment.
Bring the child to the health center for intravenous fluid therapy.
Bring the child to the health center for assessment by the physician.
Let the child rest for 10 minutes then continue giving Oresol more slowly.
13. A 1 ½ year old child was classified as having 3rd degree protein energy malnutrition, kwashiorkor. Which of the following signs will be most apparent in this child?
Voracious appetite
Wasting
Apathy
Edema
14. Assessment of a 2-year old child revealed “baggy pants”. Using the IMCI guidelines, how will you manage this child?
Refer the child urgently to a hospital for confinement.
Coordinate with the social worker to enroll the child in a feeding program.
Make a teaching plan for the mother, focusing on menu planning for her child.
Assess and treat the child for health problems like infections and intestinal parasitism.
15. During the physical examination of a young child, what is the earliest sign of xerophthalmia that you may observe?
Keratomalacia
Corneal opacity
Night blindness
Conjunctival xerosis
16. To prevent xerophthalmia, young children are given Retinol capsule every 6 months. What is the dose given to preschoolers?
10,000 IU
20,000 IU
100,000 IU
200,000 IU
17. The major sign of iron deficiency anemia is pallor. What part is best examined for pallor?
Palms
Nailbeds
Around the lips
Lower conjunctival sac
18. Food fortification is one of the strategies to prevent micronutrient deficiency conditions. R.A. 8976 mandates fortification of certain food items. Which of the following is among these food items?
Sugar
Bread
Margarine
Filled milk
19. What is the best course of action when there is a measles epidemic in a nearby municipality?
Give measles vaccine to babies aged 6 to 8 months.
Give babies aged 6 to 11 months one dose of 100,000 I.U. of Retinol
Instruct mothers to keep their babies at home to prevent disease transmission.
Instruct mothers to feed their babies adequately to enhance their babies’ resistance.
20. A mother brought her daughter, 4 years old, to the RHU because of cough and colds. Following the IMCI assessment guide, which of the following is a danger sign that indicates the need for urgent referral to a hospital?
Inability to drink
High grade fever
Signs of severe dehydration
Cough for more than 30 days
21. Management of a child with measles includes the administration of which of the following?
Gentian violet on mouth lesions
Antibiotics to prevent pneumonia
Tetracycline eye ointment for corneal opacity
Retinol capsule regardless of when the last dose was given
22. A mother brought her 10 month old infant for consultation because of fever, which started 4 days prior to consultation. To determine malaria risk, what will you do?
Do a tourniquet test.
Ask where the family resides.
Get a specimen for blood smear.
Ask if the fever is present everyday.
23. The following are strategies implemented by the Department of Health to prevent mosquito-borne diseases. Which of these is most effective in the control of Dengue fever?
Stream seeding with larva-eating fish
Destroying breeding places of mosquitoes
Chemoprophylaxis of non-immune persons going to endemic areas
Teaching people in endemic areas to use chemically treated mosquito nets
24. Secondary prevention for malaria includes
Planting of neem or eucalyptus trees
Residual spraying of insecticides at night
Determining whether a place is endemic or not
Growing larva-eating fish in mosquito breeding places
25. Scotch tape swab is done to check for which intestinal parasite?
Ascaris
Pinworm
Hookworm
Schistosoma
26. Which of the following signs indicates the need for sputum examination for AFB?
Hematemesis
Fever for 1 week
Cough for 3 weeks
Chest pain for 1 week
27. Which clients are considered targets for DOTS Category I?
Sputum negative cavitary cases
Clients returning after a default
Relapses and failures of previous PTB treatment regimens
Clients diagnosed for the first time through a positive sputum exam
28. To improve compliance to treatment, what innovation is being implemented in DOTS?
Having the health worker follow up the client at home
Having the health worker or a responsible family member monitor drug intake
Having the patient come to the health center every month to get his medications
Having a target list to check on whether the patient has collected his monthly supply of drugs
29. Diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of leprosy?
Macular lesions
Inability to close eyelids
Thickened painful nerves
Sinking of the nosebridge
30. Which of the following clients should be classified as a case of multibacillary leprosy?
3 skin lesions, negative slit skin smear
3 skin lesions, positive slit skin smear
5 skin lesions, negative slit skin smear
5 skin lesions, positive slit skin smear
Answers and Rationales
Answer: (A) P.D. 996. Presidential Decree 996, enacted in 1976, made immunization in the EPI compulsory for children under 8 years of age. Hepatitis B vaccination was made compulsory for the same age group by R.A. 7846.
Answer: (B)BCG. BCG causes the formation of a superficial abscess, which begins 2 weeks after immunization. The abscess heals without treatment, with the formation of a permanent scar.
Answer: (C) Infant BCG. Infant BCG may be given at birth. All the other immunizations mentioned can be given at 6 weeks of age.
Answer: (A) Seizures a day after DPT 1. Seizures within 3 days after administration of DPT is an indication of hypersensitivity to pertussis vaccine, a component of DPT. This is considered a specific contraindication to subsequent doses of DPT.
Answer: (A) Go on with the infant’s immunizations. In the EPI, fever up to 38.5°C is not a contraindication to immunization. Mild acute respiratory tract infection, simple diarrhea and malnutrition are not contraindications either.
Answer: (A)1 year. The baby will have passive natural immunity by placental transfer of antibodies. The mother will have active artificial immunity lasting for about 10 years. 5 doses will give the mother lifetime protection.
Answer: (C)Normal. In IMCI, a respiratory rate of 50/minute or more is fast breathing for an infant aged 2 to 12 months.
Answer: (D)Chest indrawing. In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating severe pneumonia.
Answer: (B) Refer him urgently to the hospital. Severe pneumonia requires urgent referral to a hospital. Answers A, C and D are done for a client classified as having pneumonia.
Answer: (B)Some dehydration. Using the assessment guidelines of IMCI, a child (2 months to 5 years old) with diarrhea is classified as having SOME DEHYDRATION if he shows 2 or more of the following signs: restless or irritable, sunken eyes, the skin goes back slow after a skin pinch.
Answer: (B)Supervise the mother in giving 200 to 400 ml. of Oresol in 4 hours. In the IMCI management guidelines, SOME DEHYDRATION is treated with the administration of Oresol within a period of 4 hours. The amount of Oresol is best computed on the basis of the child’s weight (75 ml/kg body weight). If the weight is unknown, the amount of Oresol is based on the child’s age.
Answer: (D) Let the child rest for 10 minutes then continue giving Oresol more slowly. If the child vomits persistently, that is, he vomits everything that he takes in, he has to be referred urgently to a hospital. Otherwise, vomiting is managed by letting the child rest for 10 minutes and then continuing with Oresol administration. Teach the mother to give Oresol more slowly.
Answer: (D)Edema. Edema, a major sign of kwashiorkor, is caused by decreased colloidal osmotic pressure of the blood brought about by hypoalbuminemia. Decreased blood albumin level is due a protein-deficient diet.
Answer: (A) Refer the child urgently to a hospital for confinement. “Baggy pants” is a sign of severe marasmus. The best management is urgent referral to a hospital.
Answer: (D) Conjunctival xerosis. The earliest sign of Vitamin A deficiency (xerophthalmia) is night blindness. However, this is a functional change, which is not observable during physical examination.The earliest visible lesion is conjunctival xerosis or dullness of the conjunctiva due to inadequate tear production.
Answer: (D)200,000 IU. Preschoolers are given Retinol 200,000 IU every 6 months. 100,000 IU is given once to infants aged 6 to 12 months. The dose for pregnant women is 10,000 IU.
Answer: (A) Palms. The anatomic characteristics of the palms allow a reliable and convenient basis for examination for pallor.
Answer: (A)Sugar. R.A. 8976 mandates fortification of rice, wheat flour, sugar and cooking oil with Vitamin A, iron and/or iodine.
Answer: (A)Give measles vaccine to babies aged 6 to 8 months. Ordinarily, measles vaccine is given at 9 months of age. During an impending epidemic, however, one dose may be given to babies aged 6 to 8 months. The mother is instructed that the baby needs another dose when the baby is 9 months old.
Answer: (A) Inability to drink. A sick child aged 2 months to 5 years must be referred urgently to a hospital if he/she has one or more of the following signs: not able to feed or drink, vomits everything, convulsions, abnormally sleepy or difficult to awaken.
Answer: (D)Retinol capsule regardless of when the last dose was given. An infant 6 to 12 months classified as a case of measles is given Retinol 100,000 IU; a child is given 200,000 IU regardless of when the last dose was given.
Answer: (B) Ask where the family resides. Because malaria is endemic, the first question to determine malaria risk is where the client’s family resides. If the area of residence is not a known endemic area, ask if the child had traveled within the past 6 months, where he/she was brought and whether he/she stayed overnight in that area.
Answer: (B) Destroying breeding places of mosquitoes. Aedes aegypti, the vector of Dengue fever, breeds in stagnant, clear water. Its feeding time is usually during the daytime. It has a cyclical pattern of occurrence, unlike malaria which is endemic in certain parts of the country.
Answer: (C) Determining whether a place is endemic or not. This is diagnostic and therefore secondary level prevention. The other choices are for primary prevention.
Answer: (B)Pinworm. Pinworm ova are deposited around the anal orifice.
Answer: (C)Cough for 3 weeks. A client is considered a PTB suspect when he has cough for 2 weeks or more, plus one or more of the following signs: fever for 1 month or more; chest pain lasting for 2 weeks or more not attributed to other conditions; progressive, unexplained weight loss; night sweats; and hemoptysis.
Answer: (D)Clients diagnosed for the first time through a positive sputum exam. Category I is for new clients diagnosed by sputum examination and clients diagnosed to have a serious form of extrapulmonary tuberculosis, such as TB osteomyelitis.
Answer: (B)Having the health worker or a responsible family member monitor drug intake. Directly Observed Treatment Short Course is so-called because a treatment partner, preferably a health worker accessible to the client, monitors the client’s compliance to the treatment.
Answer: (C) Thickened painful nerves. The lesion of leprosy is not macular. It is characterized by a change in skin color (either reddish or whitish) and loss of sensation, sweating and hair growth over the lesion. Inability to close the eyelids (lagophthalmos) and sinking of the nosebridge are late symptoms.
Answer: (D) 5 skin lesions, positive slit skin smear. A multibacillary leprosy case is one who has a positive slit skin smear and at least 5 skin lesions.