1.The most prevalent form of meningitis among children
aged 2 months to 3 years is caused by which microorganism?
|
A
|
Haemophilus influenzae
|
|
B
|
Morbillivirus
|
|
C
|
Streptococcus pneumoniae
|
|
D
|
Neisseria meningitidis
|
2.The student nurse is aware that the pathognomonic
sign of measles is Koplik’s spot and you may see Koplik’s spot by inspecting
the:
|
A
|
Nasal mucosa
|
|
B
|
Buccal mucosa
|
|
C
|
Skin on the abdomen
|
|
D
|
Skin on neck
|
3.Angel was diagnosed as having Dengue fever. You will
say that there is slow capillary refill when the color of the nail bed that you
pressed does not return within how many seconds?
|
A
|
3 seconds
|
|
B
|
6 seconds
|
|
C
|
9 seconds
|
|
D
|
10 seconds
|
4.In Integrated Management of Childhood Illness, the
nurse is aware that the severe conditions generally require urgent referral to
a hospital. Which of the following severe conditions DOES NOT always require
urgent referral to a hospital?
|
A
|
Mastoiditis
|
|
B
|
Severe dehydration
|
|
C
|
Severe pneumonia
|
|
D
|
Severe febrile disease
|
5.Myrna a public health nurse will conduct outreach
immunization in a barangay Masay with a population of about 1500. The estimated
number of infants in the barangay would be:
|
A
|
45 infants
|
|
B
|
50 infants
|
|
C
|
55 infants
|
|
D
|
65 infants
|
6.The community nurse is aware that the biological used
in Expanded Program on Immunization (EPI) should NOT be stored in the freezer?
|
A
|
DPT
|
|
B
|
Oral polio vaccine
|
|
C
|
Measles vaccine
|
|
D
|
MMR
|
7.It is the most effective way of controlling
schistosomiasis in an endemic area?
|
A
|
Use of molluscicides
|
|
B
|
Building of foot bridges
|
|
C
|
Proper use of sanitary toilets
|
|
D
|
Use of protective footwear, such as rubber boots
|
8.Several clients is newly admitted and diagnosed with
leprosy. Which of the following clients should be classified as a case of
multibacillary leprosy?
|
A
|
3 skin lesions, negative slit skin smear
|
|
B
|
3 skin lesions, positive slit skin smear
|
|
C
|
5 skin lesions, negative slit skin smear
|
|
D
|
5 skin lesions, positive slit skin smear
|
9.Nurses are aware that diagnosis of leprosy is highly
dependent on recognition of symptoms. Which of the following is an early sign
of leprosy?
|
A
|
Macular lesions
|
|
B
|
Inability to close eyelids
|
|
C
|
Thickened painful nerves
|
|
D
|
Sinking of the nose bridge
|
10.Marie brought her 10 month old infant for
consultation because of fever, started 4 days prior to consultation. In
determining malaria risk, what will you do?
|
A
|
Perform a tourniquet test.
|
|
B
|
Ask where the family resides.
|
|
C
|
Get a specimen for blood smear.
|
|
D
|
Ask if the fever is present everyday.
|
11.Susie brought her 4 years old daughter to the RHU
because of cough and colds. Following the IMCI assessment guide, which of the
following is a danger sign that indicates the need for urgent referral to a
hospital?
|
A
|
Inability to drink
|
|
B
|
High grade fever
|
|
C
|
Signs of severe dehydration
|
|
D
|
Cough for more than 30 days
|
12.Jimmy a 2-year old child revealed “baggy pants”. As
a nurse, using the IMCI guidelines, how will you manage Jimmy?
|
A
|
Refer the child urgently to a hospital for confinement.
|
|
B
|
Coordinate with the social worker to enroll the child in a feeding
program.
|
|
C
|
Make a teaching plan for the mother, focusing on menu planning for her
child.
|
|
D
|
Assess and treat the child for health problems like infections and
intestinal parasitism.
|
13.Gina is using Oresol in the management of diarrhea
of her 3-year old child. She asked you what to do if her child vomits. As a
nurse you will tell her to:
|
A
|
Bring the child to the nearest hospital for further assessment.
|
|
B
|
Bring the child to the health center for intravenous fluid therapy.
|
|
C
|
Bring the child to the health center for assessment by the physician.
|
|
D
|
Let the child rest for 10 minutes then continue giving Oresol more
slowly.
|
14.Nikki a 5-month old infant was brought by his
mother to the health center because of diarrhea for 4 to 5 times a day. Her
skin goes back slowly after a skin pinch and her eyes are sunken. Using the
IMCI guidelines, you will classify this infant in which category?
|
A
|
No signs of dehydration
|
|
B
|
Some dehydration
|
|
C
|
Severe dehydration
|
|
D
|
The data is insufficient.
|
15.Chris a 4-month old infant was brought by her
mother to the health center because of cough. His respiratory rate is
42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines
of assessment, his breathing is considered as:
|
A
|
Fast
|
|
B
|
Slow
|
|
C
|
Normal
|
|
D
|
Insignificant
|
16.Maylene had just received her 4th dose of tetanus
toxoid. She is aware that her baby will have protection against tetanus for
|
A
|
10 years
|
|
B
|
5 years
|
|
C
|
3 years
|
|
D
|
Lifetime
|
17.Nurse Ron is aware that unused BCG should be
discarded after how many hours of reconstitution?
|
A
|
2 hours
|
|
B
|
4 hours
|
|
C
|
8 hours
|
|
D
|
At the end of the day
|
18.The nurse explains to a breastfeeding mother that
breast milk is sufficient for all of the baby’s nutrient needs only up to:
|
A
|
5 months
|
|
B
|
6 months
|
|
C
|
1 year
|
|
D
|
2 years
|
19.Nurse Ron is aware that the gestational age of a
conceptus that is considered viable (able to live outside the womb) is:
|
A
|
8 weeks
|
|
B
|
12 weeks
|
|
C
|
24 weeks
|
|
D
|
32 weeks
|
20.When teaching parents of a neonate the proper
position for the neonate’s sleep, the nurse Patricia stresses the importance of
placing the neonate on his back to reduce the risk of which of the following?
|
A
|
Aspiration
|
|
B
|
Sudden infant death syndrome (SIDS)
|
|
C
|
Suffocation
|
|
D
|
Gastroesophageal reflux (GER)
|
21.Which finding might be seen in baby James a neonate
suspected of having an infection?
|
A
|
Flushed cheeks
|
|
B
|
Increased temperature
|
|
C
|
Decreased temperature
|
|
D
|
Increased activity level
|
22.Baby Jenny who is small-for-gestation is at increased
risk during the transitional period for which complication?
|
A
|
Anemia probably due to chronic fetal hypoxia
|
|
B
|
Hyperthermia due to decreased glycogen stores
|
|
C
|
Hyperglycemia due to decreased glycogen stores
|
|
D
|
Polycythemia probably due to chronic fetal hypoxia
|
23.Marjorie has just given birth at 42 weeks’
gestation. When the nurse assessing the neonate, which physical finding is
expected?
|
A
|
A sleepy, lethargic baby
|
|
B
|
Lanugo covering the body
|
|
C
|
Desquamation of the epidermis
|
|
D
|
Vernix caseosa covering the body
|
24.After reviewing the Myrna’s maternal history of
magnesium sulfate during labor, which condition would nurse Richard anticipate
as a potential problem in the neonate?
|
A
|
Hypoglycemia
|
|
B
|
Jitteriness
|
|
C
|
Respiratory depression
|
|
D
|
Tachycardia
|
25.Which symptom would indicate the Baby Alexandra was
adapting appropriately to extra-uterine life without difficulty?
|
A
|
Nasal flaring
|
|
B
|
Light audible grunting
|
|
C
|
Respiratory rate 40 to 60 breaths/minute
|
|
D
|
Respiratory rate 60 to 80 breaths/minute
|
26.When teaching umbilical cord care for Jennifer a
new mother, the nurse Jenny would include which information?
|
A
|
Apply peroxide to the cord with each diaper change
|
|
B
|
Cover the cord with petroleum jelly after bathing
|
|
C
|
Keep the cord dry and open to air
|
|
D
|
Wash the cord with soap and water each day during a tub bath.
|
27.Nurse John is performing an assessment on a
neonate. Which of the following findings is considered common in the healthy
neonate?
|
A
|
Simian crease
|
|
B
|
Conjunctival hemorrhage
|
|
C
|
Cystic hygroma
|
|
D
|
Bulging fontanelle
|
28.Dr. Esteves decides to artificially rupture the
membranes of a mother who is on labor. Following this procedure, the nurse
Hazel checks the fetal heart tones for which the following reasons?
|
A
|
To determine fetal well-being.
|
|
B
|
To assess for prolapsed cord
|
|
C
|
To assess fetal position
|
|
D
|
To prepare for an imminent delivery.
|
29.Which of the following would be least likely to
indicate anticipated bonding behaviors by new parents?
|
A
|
The parents’ willingness to touch and hold the newborn.
|
|
B
|
The parent’s expression of interest about the size of the newborn.
|
|
C
|
The parents’ indication that they want to see the newborn.
|
|
D
|
The parents’ interactions with each other.
|
30.Following a precipitous delivery, examination of the
client’s vagina reveals a fourth-degree laceration. Which of the following
would be contraindicated when caring for this client?
|
A
|
Applying cold to limit edema during the first 12 to 24 hours.
|
|
B
|
Instructing the client to use two or more peri pads to cushion the
area.
|
|
C
|
Instructing the client on the use of sitz baths if ordered.
|
|
D
|
Instructing the client about the importance of perineal (kegel)
exercises.
|
31.A pregnant woman accompanied by her husband, seeks
admission to the labor and delivery area. She states that she’s in labor and
says she attended the facility clinic for prenatal care. Which question should
the nurse Oliver ask her first?
|
A
|
“Do you have any chronic illnesses?”
|
|
B
|
“Do you have any allergies?”
|
|
C
|
“What is your expected due date?”
|
|
D
|
“Who will be with you during labor?”
|
32.A neonate begins to gag and turns a dusky color.
What should the nurse do first?
|
A
|
Calm the neonate.
|
|
B
|
Notify the physician.
|
|
C
|
Provide oxygen via face mask as ordered
|
|
D
|
Aspirate the neonate’s nose and mouth with a bulb syringe.
|
33.When a client states that her “water broke,” which
of the following actions would be inappropriate for the nurse to do?
|
A
|
Observing the pooling of straw-colored fluid.
|
|
B
|
Checking vaginal discharge with nitrazine paper.
|
|
C
|
Conducting a bedside ultrasound for an amniotic fluid index.
|
|
D
|
Observing for flakes of vernix in the vaginal discharge.
|
34.A baby girl is born 8 weeks premature. At birth,
she has no spontaneous respirations but is successfully resuscitated. Within
several hours she develops respiratory grunting, cyanosis, tachypnea, nasal
flaring, and retractions. She’s diagnosed with respiratory distress syndrome,
intubated, and placed on a ventilator. Which nursing action should be included
in the baby’s plan of care to prevent retinopathy of prematurity?
|
A
|
Cover his eyes while receiving oxygen.
|
|
B
|
Keep her body temperature low.
|
|
C
|
Monitor partial pressure of oxygen (Pao2) levels.
|
|
D
|
Humidify the oxygen.
|
35.Which of the following is normal newborn calorie
intake?
|
A
|
110 to 130 calories per kg.
|
|
B
|
30 to 40 calories per lb of body weight.
|
|
C
|
At least 2 ml per feeding
|
|
D
|
90 to 100 calories per kg
|
36.Nurse John is knowledgeable that usually individual
twins will grow appropriately and at the same rate as singletons until how many
weeks?
|
A
|
16 to 18 weeks
|
|
B
|
18 to 22 weeks
|
|
C
|
30 to 32 weeks
|
|
D
|
38 to 40 weeks
|
37.Which of the following classifications applies to
monozygotic twins for whom the cleavage of the fertilized ovum occurs more than
13 days after fertilization?
|
A
|
conjoined twins
|
|
B
|
diamniotic dichorionic twins
|
|
C
|
diamniotic monochorionic twin
|
|
D
|
monoamniotic monochorionic twins
|
38.Tyra experienced painless vaginal bleeding has just
been diagnosed as having a placenta previa. Which of the following procedures is
usually performed to diagnose placenta previa?
|
A
|
Amniocentesis
|
|
B
|
Digital or speculum examination
|
|
C
|
External fetal monitoring
|
|
D
|
Ultrasound
|
39.Nurse Arnold knows that the following changes in
respiratory functioning during pregnancy is considered normal:
|
A
|
Increased tidal volume
|
|
B
|
Increased expiratory volume
|
|
C
|
Decreased inspiratory capacity
|
|
D
|
Decreased oxygen consumption
|
40.Emily has gestational diabetes and it is usually
managed by which of the following therapy?
|
A
|
Diet
|
|
B
|
Long-acting insulin
|
|
C
|
Oral hypoglycemic
|
|
D
|
Oral hypoglycemic drug and insulin
|
41.Magnesium sulfate is given to Jemma with
preeclampsia to prevent which of the following condition?
|
A
|
Hemorrhage
|
|
B
|
Hypertension
|
|
C
|
Hypomagnesemia
|
|
D
|
Seizure
|
42.Cammile with sickle cell anemia has an increased
risk for having a sickle cell crisis during pregnancy. Aggressive management of
a sickle cell crisis includes which of the following measures?
|
A
|
Antihypertensive agents
|
|
B
|
Diuretic agents
|
|
C
|
I.V. fluids
|
|
D
|
Acetaminophen (Tylenol) for pain
|
43.Which of the following drugs is the antidote for
magnesium toxicity?
|
A
|
Calcium gluconate (Kalcinate)
|
|
B
|
Hydralazine (Apresoline)
|
|
C
|
Naloxone (Narcan)
|
|
D
|
Rho (D) immune globulin (RhoGAM)
|
44.Marlyn is screened for tuberculosis during her first
prenatal visit. An intradermal injection of purified protein derivative (PPD)
of the tuberculin bacilli is given. She is considered to have a positive test
for which of the following results?
|
A
|
An indurated wheal under 10 mm in diameter appears in 6 to 12 hours.
|
|
B
|
An indurated wheal over 10 mm in diameter appears in 48 to 72 hours.
|
|
C
|
A flat circumcised area under 10 mm in diameter appears in 6 to 12
hours.
|
|
D
|
A flat circumcised area over 10 mm in diameter appears in 48 to 72
hours.
|
45.Dianne, 24 year-old is 27 weeks’ pregnant arrives
at her physician’s office with complaints of fever, nausea, vomiting, malaise,
unilateral flank pain, and costovertebral angle tenderness. Which of the
following diagnoses is most likely?
|
A
|
Asymptomatic bacteriuria
|
|
B
|
Bacterial vaginosis
|
|
C
|
Pyelonephritis
|
|
D
|
Urinary tract infection (UTI)
|
46.Rh isoimmunization in a pregnant client develops
during which of the following conditions?
|
A
|
Rh-positive maternal blood crosses into fetal blood, stimulating fetal
antibodies.
|
|
B
|
Rh-positive fetal blood crosses into maternal blood, stimulating
maternal antibodies.
|
|
C
|
Rh-negative fetal blood crosses into maternal blood, stimulating
maternal antibodies.
|
|
D
|
Rh-negative maternal blood crosses into fetal blood, stimulating fetal
antibodies.
|
47.To promote comfort during labor, the nurse John
advises a client to assume certain positions and avoid others. Which position
may cause maternal hypotension and fetal hypoxia?
|
A
|
Lateral position
|
|
B
|
Squatting position
|
|
C
|
Supine position
|
|
D
|
Standing position
|
48.Celeste who used heroin during her pregnancy
delivers a neonate. When assessing the neonate, the nurse Lynnette expects to
find:
|
A
|
Lethargy 2 days after birth.
|
|
B
|
Irritability and poor sucking.
|
|
C
|
A flattened nose, small eyes, and thin lips.
|
|
D
|
Congenital defects such as limb anomalies.
|
|
.
|
49.The
uterus returns to the pelvic cavity in which of the following time frames?
|
A
|
7th to 9th day postpartum.
|
|
B
|
2 weeks postpartum.
|
|
C
|
End of 6th week postpartum.
|
|
D
|
When the lochia changes to alba.
|
50.Maureen, a primigravida client, age 20, has just
completed a difficult, forceps-assisted delivery of twins. Her labor was
unusually long and required oxytocin (Pitocin) augmentation. The nurse who’s
caring for her should stay alert for:
|
A
|
Uterine inversion
|
|
B
|
Uterine atony
|
|
C
|
Uterine involution
|
|
D
|
Uterine discomfort
|
ANSWERS & EXPLAINATIONS
Question 1 Explanation: ANS-A
Hemophilus meningitis is unusual over the age
of 5 years. In developing countries, the peak incidence is in children less than
6 months of age. Morbillivirus is the etiology of measles. Streptococcus
pneumoniae and Neisseria meningitidis may cause meningitis, but age
distribution is not specific in young children.
Question 2 Explanation: ANS-B
Koplik’s spot may be seen on the mucosa of
the mouth or the throat.
Question 3 Explanation: ANS-A
Adequate blood supply to the area allows the
return of the color of the nailbed within 3 seconds.
Question 4 Explanation: ANS-B
The order of priority in the management of
severe dehydration is as follows: intravenous fluid therapy, referral to a
facility where IV fluids can be initiated within 30 minutes, Oresol or
nasogastric tube. When the foregoing measures are not possible or effective,
than urgent referral to the hospital is done.
Question 5 Explanation: ANS-A
To estimate the number of infants, multiply
total population by 3%.
Question 6 Explanation: ANS-A
DPT is sensitive to freezing. The appropriate
storage temperature of DPT is 2 to 8° C only. OPV and measles vaccine are
highly sensitive to heat and require freezing. MMR is not an immunization in
the Expanded Program on Immunization
Question 7 Explanation: ANS-C
The ova of the parasite get out of the human
body together with feces. Cutting the cycle at this stage is the most effective
way of preventing the spread of the disease to susceptible hosts
Question 8 Explanation: ANS-D
A multibacillary leprosy case is one who has
a positive slit skin smear and at least 5 skin lesions.
Question 9 Explanation: ANS-C
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 nose bridge are late symptoms.
Question 10 Explanation: ANS-B
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 she was brought and whether she stayed
overnight in that area
Question 11 Explanation: ANS-A
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 12 Explanation: ANS-A
“Baggy pants” is a sign of severe marasmus.
The best management is urgent referral to a hospital.
Question 13 Explanation: ANS-D
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 14 Explanation: ANS-B
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 15 Explanation: ANS-C
In IMCI, a respiratory rate of 50/minute or
more is fast breathing for an infant aged 2 to 12 months.
Question 16 Explanation: ANS-A
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 17 Explanation: ANS-B
While the unused portion of other biologicals
in EPI may be given until the end of the day, only BCG is discarded 4 hours
after reconstitution. This is why BCG immunization is scheduled only in the
morning
Question 18 Explanation: ANS-B
After 6 months, the baby’s nutrient needs,
especially the baby’s iron requirement, can no longer be provided by mother’s
milk alone.
Question 19 Explanation: ANS-C
At approximately 23 to 24 weeks’ gestation,
the lungs are developed enough to sometimes maintain extrauterine life. The
lungs are the most immature system during the gestation period. Medical care
for premature labor begins much earlier (aggressively at 21 weeks’ gestation)
Question 20 Explanation: ANS-B
Supine positioning is recommended to reduce
the risk of SIDS in infancy. The risk of aspiration is slightly increased with
the supine position. Suffocation would be less likely with an infant supine
than prone and the position for GER requires the head of the bed to be
elevated.
Question 21 Explanation: ANS-C
Temperature instability, especially when it
results in a low temperature in the neonate, may be a sign of infection. The
neonate’s color often changes with an infection process but generally becomes
ashen or mottled. The neonate with an infection will usually show a decrease in
activity level or lethargy
Question 22 Explanation: ANS-D
The small-for-gestation neonate is at risk
for developing polycythemia during the transitional period in an attempt to
decrease hypoxia. The neonates are also at increased risk for developing
hypoglycemia and hypothermia due to decreased glycogen stores.
Question 23 Explanation: ANS-C
Postdate fetuses lose the vernix caseosa, and
the epidermis may become desquamated. These neonates are usually very alert.
Lanugo is missing in the postdate neonate
Question 24 Explanation: ANS-C
Magnesium sulfate crosses the placenta and
adverse neonatal effects are respiratory depression, hypotonia, and
bradycardia. The serum blood sugar isn’t affected by magnesium sulfate. The
neonate would be floppy, not jittery.
Question 25 Explanation: ANS-C
A respiratory rate 40 to 60 breaths/minute is
normal for a neonate during the transitional period. Nasal flaring, respiratory
rate more than 60 breaths/minute, and audible grunting are signs of respiratory
distress.
Question 26 Explanation: ANS-C
Keeping the cord dry and open to air helps
reduce infection and hastens drying. Infants aren’t given tub bath but are
sponged off until the cord falls off. Petroleum jelly prevents the cord from
drying and encourages infection. Peroxide could be painful and isn’t
recommended
Question 27 Explanation: ANS-
Conjunctival hemorrhages are commonly seen in
neonates secondary to the cranial pressure applied during the birth process.
Bulging fontanelles are a sign of intracranial pressure. Simian creases are
present in 40% of the neonates with trisomy 21. Cystic hygroma is a neck mass
that can affect the airway.
Question 28 Explanation: ANS-B
After a client has an amniotomy, the nurse
should assure that the cord isn’t prolapsed and that the baby tolerated the
procedure well. The most effective way to do this is to check the fetal heart
rate. Fetal well-being is assessed via a nonstress test. Fetal position is
determined by vaginal examination. Artificial rupture of membranes doesn’t
indicate an imminent delivery.
Question 29 Explanation: ANS-D
Parental interaction will provide the nurse
with a good assessment of the stability of the family’s home life but it has no
indication for parental bonding. Willingness to touch and hold the newborn,
expressing interest about the newborn’s size, and indicating a desire to see
the newborn are behaviors indicating parental bonding
Question 30 Explanation: ANS-B
Using two or more peripads would do little to
reduce the pain or promote perineal healing. Cold applications, sitz baths, and
Kegel exercises are important measures when the client has a fourth-degree
laceration
Question 31 Explanation: ANS-D
When obtaining the history of a client who
may be in labor, the nurse’s highest priority is to determine her current
status, particularly her due date, gravidity, and parity. Gravidity and parity
affect the duration of labor and the potential for labor complications. Later,
the nurse should ask about chronic illnesses, allergies, and support persons
Question 32 Explanation: ANS-C
The nurse’s first action should be to clear
the neonate’s airway with a bulb syringe. After the airway is clear and the
neonate’s color improves, the nurse should comfort and calm the neonate. If the
problem recurs or the neonate’s color doesn’t improve readily, the nurse should
notify the physician. Administering oxygen when the airway isn’t clear would be
ineffective.
Question 33 Explanation: ANS-C
It isn’t within a nurse’s scope of practice
to perform and interpret a bedside ultrasound under these conditions and
without specialized training. Observing for pooling of straw-colored fluid,
checking vaginal discharge with nitrazine paper, and observing for flakes of
vernix are appropriate assessments for determining whether a client has
ruptured membranes
Question 34 Explanation: ANS-C
Monitoring PaO2 levels and reducing the
oxygen concentration to keep PaO2 within normal limits reduces the risk of
retinopathy of prematurity in a premature infant receiving oxygen. Covering the
infant’s eyes and humidifying the oxygen don’t reduce the risk of retinopathy
of prematurity. Because cooling increases the risk of acidosis, the infant
should be kept warm so that his respiratory distress isn’t aggravated.
Question 35 Explanation: ANS-A
Calories per kg is the accepted way of
determined appropriate nutritional intake for a newborn. The recommended
calorie requirement is 110 to 130 calories per kg of newborn body weight. This
level will maintain a consistent blood glucose level and provide enough
calories for continued growth and development
Question 36 Explanation: ANS-C
Individual twins usually grow at the same
rate as singletons until 30 to 32 weeks’ gestation, then twins don’t’ gain
weight as rapidly as singletons of the same gestational age. The placenta can
no longer keep pace with the nutritional requirements of both fetuses after 32
weeks, so there’s some growth retardation in twins if they remain in utero at
38 to 40 weeks
Question 37 Explanation: ANS-A
The type of placenta that develops in
monozygotic twins depends on the time at which cleavage of the ovum occurs.
Cleavage in conjoined twins occurs more than 13 days after fertilization.
Cleavage that occurs less than 3 day after fertilization results in diamniotic
dichorionic twins. Cleavage that occurs between days 3 and 8 results in diamniotic
monochorionic twins. Cleavage that occurs between days 8 to 13 result in
monoamniotic monochorionic twins.
Question 38 Explanation: ANS-D
Once the mother and the fetus are stabilized,
ultrasound evaluation of the placenta should be done to determine the cause of
the bleeding. Amniocentesis is contraindicated in placenta previa. A digital or
speculum examination shouldn’t be done as this may lead to severe bleeding or
hemorrhage. External fetal monitoring won’t detect a placenta previa, although
it will detect fetal distress, which may result from blood loss or placenta
separation.
Question 39 Explanation: ANS-A
A pregnant client breathes deeper, which
increases the tidal volume of gas moved in and out of the respiratory tract
with each breath. The expiratory volume and residual volume decrease as the
pregnancy progresses. The inspiratory capacity increases during pregnancy. The
increased oxygen consumption in the pregnant client is 15% to 20% greater than
in the nonpregnant state.
Question 40 Explanation: ANS-A
Clients with gestational diabetes are usually
managed by diet alone to control their glucose intolerance. Oral hypoglycemic
drugs are contraindicated in pregnancy. Long-acting insulin usually isn’t
needed for blood glucose control in the client with gestational diabetes.
Question 41 Explanation: ANS-D
The anticonvulsant mechanism of magnesium is
believes to depress seizure foci in the brain and peripheral neuromuscular
blockade. Hypomagnesemia isn’t a complication of preeclampsia. Antihypertensive
drug other than magnesium are preferred for sustained hypertension. Magnesium
doesn’t help prevent hemorrhage in preeclamptic clients.
Question 42 Explanation: ANS-C
A sickle cell crisis during pregnancy is
usually managed by exchange transfusion oxygen, and L.V. Fluids. The client
usually needs a stronger analgesic than acetaminophen to control the pain of a
crisis. Antihypertensive drugs usually aren’t necessary. Diuretic wouldn’t be
used unless fluid overload resulted.
Question 43 Explanation: ANS-A
Calcium gluconate is the antidote for
magnesium toxicity. Ten milliliters of 10% calcium gluconate is given L.V. push
over 3 to 5 minutes. Hydralazine is given for sustained elevated blood pressure
in preeclamptic clients. Rho (D) immune globulin is given to women with
Rh-negative blood to prevent antibody formation from RH-positive conceptions.
Naloxone is used to correct narcotic toxicity.
Question 44 Explanation: ANS-B
A positive PPD result would be an indurated
wheal over 10 mm in diameter that appears in 48 to 72 hours. The area must be a
raised wheal, not a flat circumcised area to be considered positive
Question 45 Explanation: ANS-C
The symptoms indicate acute pyelonephritis, a
serious condition in a pregnant client. UTI symptoms include dysuria, urgency,
frequency, and suprapubic tenderness. Asymptomatic bacteriuria doesn’t cause
symptoms. Bacterial vaginosis causes milky white vaginal discharge but no
systemic symptoms
Question 46 Explanation: ANS-B
Rh isoimmunization occurs when Rh-positive fetal
blood cells cross into the maternal circulation and stimulate maternal antibody
production. In subsequent pregnancies with Rh-positive fetuses, maternal
antibodies may cross back into the fetal circulation and destroy the fetal
blood cells
Question 47 Explanation: ANS-C
The supine position causes compression of the
client’s aorta and inferior vena cava by the fetus. This, in turn, inhibits
maternal circulation, leading to maternal hypotension and, ultimately, fetal
hypoxia. The other positions promote comfort and aid labor progress. For
instance, the lateral, or side-lying, position improves maternal and fetal
circulation, enhances comfort, increases maternal relaxation, reduces muscle
tension, and eliminates pressure points. The squatting position promotes
comfort by taking advantage of gravity. The standing position also takes
advantage of gravity and aligns the fetus with the pelvic angle.
Question 48 Explanation: ANS-B
Neonates of heroin-addicted mothers are
physically dependent on the drug and experience withdrawal when the drug is no
longer supplied. Signs of heroin withdrawal include irritability, poor sucking,
and restlessness. Lethargy isn’t associated with neonatal heroin addiction. A
flattened nose, small eyes, and thin lips are seen in infants with fetal
alcohol syndrome. Heroin use during pregnancy hasn’t been linked to specific
congenital anomalies
Question 49 Explanation: ANS-A
The normal involutional process returns the
uterus to the pelvic cavity in 7 to 9 days. A significant involutional
complication is the failure of the uterus to return to the pelvic cavity within
the prescribed time period. This is known as subinvolution
Question 50 Explanation: ANS-B
Multiple fetuses, extended labor stimulation
with oxytocin, and traumatic delivery commonly are associated with uterine
atony, which may lead to postpartum hemorrhage. Uterine inversion may precede
or follow delivery and commonly results from apparent excessive traction on the
umbilical cord and attempts to deliver the placenta manually. Uterine
involution and some uterine discomfort are normal after delivery
