PNLE II for Community Health Nursing and Care of the Mother and Child

20.Myra is the public health nurse in a municipality with a total population of about 20,000. There are 3 rural health midwives among the RHU personnel. How many more midwife items will the RHU need? 1 2 3 The RHU does not need any more midwife item.

Answer: (A) 1. Each rural health midwife is given a population assignment of about 5,000.

8. A pregnant client is receiving oxytocin (Pitocin) for induction of labor. A condition that warrant the nurse in-charge to discontinue I.V. infusion of Pitocin is: Contractions every 1 ½ minutes lasting 70-80 seconds. Maternal temperature 101.2 Early decelerations in the fetal heart rate. Fetal heart rate baseline 140-160 bpm.

Answer: (A) Contractions every 1 ½ minutes lasting 70-80 seconds. Contractions every 1 ½ minutes lasting 70-80 seconds, is indicative of hyperstimulation of the uterus, which could result in injury to the mother and the fetus if Pitocin is not discontinued.

5. Nurse Michelle is assessing a 24 year old client with a diagnosis of hydatidiform mole. She is aware that one of the following is unassociated with this condition? Excessive fetal activity. Larger than normal uterus for gestational age. Vaginal bleeding Elevated levels of human chorionic gonadotropin.

Answer: (A) Excessive fetal activity. The most common signs and symptoms of hydatidiform mole includes elevated levels of human chorionic gonadotropin, vaginal bleeding, larger than normal uterus for gestational age, failure to detect fetal heart activity even with sensitive instruments, excessive nausea and vomiting, and early development of pregnancy-induced hypertension. Fetal activity would not be noted.

1. May arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. She also tells the nurse that a home pregnancy test was positive but she began to have mild cramps and is now having moderate vaginal bleeding. During the physical examination of the client, the nurse notes that May has a dilated cervix. The nurse determines that May is experiencing which type of abortion? Inevitable Incomplete Threatened Septic

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

19.Tony is aware the Chairman of the Municipal Health Board is: Mayor Municipal Health Officer Public Health Nurse Any qualified physician

Answer: (A) Mayor. The local executive serves as the chairman of the Municipal Health Board.

11.Nurse Ryan is aware that the best initial approach when trying to take a crying toddler's temperature is: Talk to the mother first and then to the toddler. Bring extra help so it can be done quickly. Encourage the mother to hold the child. Ignore the crying and screaming

Answer: (A) Talk to the mother first and then to the toddler. When dealing with a crying toddler, the best approach is to talk to the mother and ignore the toddler first. This approach helps the toddler get used to the nurse before she attempts any procedures. It also gives the toddler an opportunity to see that the mother trusts the nurse

6. A pregnant client is receiving magnesium sulfate for severe pregnancy induced hypertension (PIH). The clinical findings that would warrant use of the antidote , calcium gluconate is: Urinary output 90 cc in 2 hours. Absent patellar reflexes. Rapid respiratory rate above 40/min. Rapid rise in blood pressure.

Answer: (B) Absent patellar reflexes. Absence of patellar reflexes is an indicator of hypermagnesemia, which requires administration of calcium gluconate

13. Which action should nurse Marian include in the care plan for a 2 month old with heart failure? Feed the infant when he cries. Allow the infant to rest before feeding. Bathe the infant and administer medications before feeding. Weigh and bathe the infant before feeding.

Answer: (B) Allow the infant to rest before feeding. Because feeding requires so much energy, an infant with heart failure should rest before feeding.

17.When the nurse determines whether resources were maximized in implementing Ligtas Tigdas, she is evaluating Effectiveness Efficiency Adequacy Appropriateness

Answer: (B) Efficiency. Efficiency is determining whether the goals were attained at the least possible cost.

21.According to Freeman and Heinrich, community health nursing is a developmental service. Which of the following best illustrates this statement? The community health nurse continuously develops himself personally and professionally. Health education and community organizing are necessary in providing community health services. Community health nursing is intended primarily for health promotion and prevention and treatment of disease. The goal of community health nursing is to provide nursing services to people in their own places of residence.

Answer: (B) Health education and community organizing are necessary in providing community health services. The community health nurse develops the health capability of people through health education and community organizing activities.

2. Nurse Reese is reviewing the record of a pregnant client for her first prenatal visit. Which of the following data, if noted on the client's record, would alert the nurse that the client is at risk for a spontaneous abortion? Age 36 years History of syphilis History of genital herpes History of diabetes mellitus

Answer: (B) History of syphilis. Maternal infections such as syphilis, toxoplasmosis, and rubella are causes of spontaneous abortion.

4. Nurse Oliver is teaching a diabetic pregnant client about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that the second half of pregnancy require: Decreased caloric intake Increased caloric intake Decreased Insulin Increase Insulin

Answer: (B) Increased caloric intake. Glucose crosses the placenta, but insulin does not. High fetal demands for glucose, combined with the insulin resistance caused by hormonal changes in the last half of pregnancy can result in elevation of maternal blood glucose levels. This increases the mother's demand for insulin and is referred to as the diabetogenic effect of pregnancy.

22.Nurse Tina is aware that the disease declared through Presidential Proclamation No. 4 as a target for eradication in the Philippines is? Poliomyelitis Measles Rabies Neonatal tetanus

Answer: (B) Measles. Presidential Proclamation No. 4 is on the Ligtas Tigdas Program.

9. Calcium gluconate is being administered to a client with pregnancy induced hypertension (PIH). A nursing action that must be initiated as the plan of care throughout injection of the drug is: Ventilator assistance CVP readings EKG tracings Continuous CPR

Answer: (C) EKG tracings. A potential side effect of calcium gluconate administration is cardiac arrest. Continuous monitoring of cardiac activity (EKG) throught administration of calcium gluconate is an essential part of care.

14.Nurse Hazel is teaching a mother who plans to discontinue breast feeding after 5 months. The nurse should advise her to include which foods in her infant's diet? Skim milk and baby food. Whole milk and baby food. Iron-rich formula only. Iron-rich formula and baby food.

Answer: (C) Iron-rich formula only. The infants at age 5 months should receive iron-rich formula and that they shouldn't receive solid food, even baby food until age 6 months.

3. Nurse Hazel is preparing to care for a client who is newly admitted to the hospital with a possible diagnosis of ectopic pregnancy. Nurse Hazel develops a plan of care for the client and determines that which of the following nursing actions is the priority? Monitoring weight Assessing for edema Monitoring apical pulse Monitoring temperature

Answer: (C) Monitoring apical pulse. Nursing care for the client with a possible ectopic pregnancy is focused on preventing or identifying hypovolemic shock and controlling pain. An elevated pulse rate is an indicator of shock.

7. During vaginal examination of Janah who is in labor, the presenting part is at station plus two. Nurse, correctly interprets it as: Presenting part is 2 cm above the plane of the ischial spines. Biparietal diameter is at the level of the ischial spines. Presenting part in 2 cm below the plane of the ischial spines. Biparietal diameter is 2 cm above the ischial spines.

Answer: (C) Presenting part in 2 cm below the plane of the ischial spines. Fetus at station plus two indicates that the presenting part is 2 cm below the plane of the ischial spines.

15.Mommy Linda is playing with her infant, who is sitting securely alone on the floor of the clinic. The mother hides a toy behind her back and the infant looks for it. The nurse is aware that estimated age of the infant would be: 6 months 4 months 8 months 10 months

Answer: (D) 10 months. A 10 month old infant can sit alone and understands object permanence, so he would look for the hidden toy. At age 4 to 6 months, infants can't sit securely alone. At age 8 months, infants can sit securely alone but cannot understand the permanence of objects.

23.May knows that the step in community organizing that involves training of potential leaders in the community is: Integration Community organization Community study Core group formation

Answer: (D) Core group formation. In core group formation, the nurse is able to transfer the technology of community organizing to the potential or informal community leaders through a training program.

10. A trial for vaginal delivery after an earlier caesareans, would likely to be given to a gravida, who had: First low transverse cesarean was for active herpes type 2 infections; vaginal culture at 39 weeks pregnancy was positive. First and second caesareans were for cephalopelvic disproportion. First caesarean through a classic incision as a result of severe fetal distress. First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex presentation.

Answer: (D) First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex presentation. This type of client has no obstetrical indication for a caesarean section as she did with her first caesarean delivery.

12.Baby Tina a 3 month old infant just had a cleft lip and palate repair. What should the nurse do to prevent trauma to operative site? Avoid touching the suture line, even when cleaning. Place the baby in prone position. Give the baby a pacifier. Place the infant's arms in soft elbow restraints.

Answer: (D) Place the infant's arms in soft elbow restraints. Soft restraints from the upper arm to the wrist prevent the infant from touching her lip but allow him to hold a favorite item such as a blanket. Because they could damage the operative site, such as objects as pacifiers, suction catheters, and small spoons shouldn't be placed in a baby's mouth after cleft repair. A baby in a prone position may rub her face on the sheets and traumatize the operative site. The suture line should be cleaned gently to prevent infection, which could interfere with healing and damage the cosmetic appearance of the repair.

16.Which of the following is the most prominent feature of public health nursing? It involves providing home care to sick people who are not confined in the hospital. Services are provided free of charge to people within the catchments area. The public health nurse functions as part of a team providing a public health nursing services. Public health nursing focuses on preventive, not curative, services.

Answer: (D) Public health nursing focuses on preventive, not curative, services. The catchments area in PHN consists of a residential community, many of whom are well individuals who have greater need for preventive rather than curative services.

18.Vangie is a new B.S.N. graduate. She wants to become a Public Health Nurse. Where should she apply? Department of Health Provincial Health Office Regional Health Office Rural Health Unit

Answer: (D) Rural Health Unit. R.A. 7160 devolved basic health services to local government units (LGU's ). The public health nurse is an employee of the LGU.

25.Tertiary prevention is needed in which stage of the natural history of disease? Pre-pathogenesis Pathogenesis Prodromal Terminal

Answer: (D) Terminal. Tertiary prevention involves rehabilitation, prevention of permanent disability and disability limitation appropriate for convalescents, the disabled, complicated cases and the terminally ill (those in the terminal stage of a disease).

24.Beth a public health nurse takes an active role in community participation. What is the primary goal of community organizing? To educate the people regarding community health problems To mobilize the people to resolve community health problems To maximize the community's resources in dealing with health problems. To maximize the community's resources in dealing with health problems.

Answer: (D) 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.