1. Infants, age one month to one year, grow in a rapid pace both quantitatively and qualitatively. Mrs.

Bridgete
gave birth to a 9 lbs baby boy a month ago. She asks you, When will my babys weight double or triple?. You
answer her correctly if you said, Most infants
. double their birth weight by 4-6 months
and triple by 1 year.
Most infants double their birth weight by 4-6 months and triple by 1
year. During the first 6 months of life, the infant gains approximately
2lbs per month. And during the next 6 months, the infant gains
approximately 1lb per month. (Pilliteri pp. 827)

2. Which developmental milestone may a 4 month old child be able to perform?
a. when placed in a sitting position, there is the
absence of head lag
Head lag disappears when a child reaches 4 months. Infants
can sit steadily only at 9 months of age. Cruising begins at 11
months when child already can stand up and walk by holding
onto objects to maintain balance. 7 months old infants enjoy
transferring a toy from one hand to another. (Pilliteri pp. 830-
832

3. The Naegeles Rule is a useful tool in determining the Expected Date of Birth (EDB) of a pregnant woman.
Mrs. Susan is a very excited mom-to-be who consulted the clinic for the first time. If the first day of her last
menstrual period is July 8, 2011, when is she due for delivery?
d. April 15, 2012
To calculate for the date of delivery, subtract 3 from the
months, add 7 to the days and add 1 to the year if the
month is from April to December. (Pilliteri Vol. 1, pp. 197

4. Developmental tasks are tasks designated for each age bracket which serve as the foundation for tasks to
be accomplished in the future. A mother of an 8 year old girl asks you how to foster an environment which
helps in the development of her child. Since the child is in Industry versus inferiority stage of psychosocial
development, you did not correctly answer her if you said?
c. allow a child to stay home the whole day and
prevent socialization with children of the same
age
Eight year old children actively seek the company of other
children, so they must be allowed to go out the house and
explore. Children feel a sense of accomplishment when they
finish a task, so tasks given to them must be easy and simple.
A reward or praise would be a helpful participation from the
parents. (Pilliteri pp. 917-919)




5. Pediatric clients fear most of the procedures which must be performed to them. Nurses follow special
considerations in obtaining the vital signs of young clients. Nurse Princess is about to get the temperature of a
2 year old boy using a thermometer through the tympanic route. To facilitate an accurate measurement, she
should straighten the ear canal by:
c. pulling the pinna downward and backward
Straighten the ear canal by pulling the pinna
downward and backward in a child younger than
age 3 which directs the sensor beam towards
the center of the tympanic membrane and not to
the sides of the canal. (Pilliteri pp. 1119)

6. A nurse prepares to prevent heat loss in the newborn resulting from evaporation by?
b. drying the infant with a warm blanket
Gently dry infants so little body heat is lost by
evaporation. (Pillitteri, 2007, p. 657

7. Epidural Anesthesia is the use of an anesthetic agent introduced into the epidural space between L2-L3, L3-
L4, or L4-L5. Mariz is to undergo EA induction as pain relief for her labor and delivery. The most concern for
patients undergoing this procedure is hypotension. To help manage this, the following nursing interventions
should be done, except:
d. Fluids must be withheld and oxygen should
not be administered.
If hypotension already occurs, raise the leg, oxygen must
be administered and intravenous fluids must be initiated to
stabilize cardiopulmonary status. Support must be
continuously given to the woman because the injection is
frightening to most patients. The woman should not lie
supine but must remain on her side to prevent Supine
Hypotension Syndrome. (Pilliteri Vol. 1, pp. 551-552

8. PROM, placenta previa, hydramnios and fetal malpresentation are among the causes of umbilical cord
prolapse. The best position for a woman experiencing prolapsed cord during labor would be:
d.Trendelenburg
Cord prolapsed leads to cord compression
because the fetal presenting part presses against
the cord at the pelvic brim which may result to fetal
anoxia. Management is aimed at relieving the
compression. This may be done by placing the
woman in a knee-chest position or Trendelenburg
position or by placing gloved hand in the vagina
and manually elevating fetal head off the cord.
(Pillitteri, 2007



9. Nurse Mary is on evening shift at the nursery room and taking care of 8 newborn babies. Which of the
following findings will she consider normal in assessing the anterior fontanel of a neonate?
d. pulsates
Fontanelles are soft spots. Sunken means dehydration
and bulging means increased ICP. Pulses may be noted
especially during crying (Pillitteri, 2007, p. 643)

10. Amnioinfusion refers to the addition of sterile fluid to the amniotic fluid. Mrs. Lauren is scheduled for
amnioinfusion after evaluation through external fetal monitor. Her baby is having variable deceleration of FHR
which shows cord compression. As the nurse assigned to her, Nurse Redge correctly assisted the physician
with the procedure when she does the following except:
d. monitors the fetal heart rate and uterine
contraction just once
The nurse should help maintain strict aseptic technique
during insertion and while caring for the catheter. The
fetal heart rate and uterine contraction should be
continuously monitored. Monitor the temperature hourly
to help ascertain if there already is an infection. (Pilliteri
Vol. 1, pp. 526-527

11. Conclusive diagnostic procedure for Hirschsprungs disease is:
d. Barium Enema
A barium enema is generally ordered to substantiate the
diagnosis. The barium will outline on x-ray film the
narrow, nerveless portion and the proximal distended
portion of the bowel. The definitive diagnosis is by a
biopsy of the affected segment to show the lack of
innervation or by anorectal manometry, a technique to
test the strength or innervations of the internal rectal
sphincter by inserting a balloon catheter into the rectum
and measuring the pressure exerted against it. (Pillitteri,
2007, p.1442

12. The first teeth erupt at approximately 4 to 6 months of life. JB is a 4 year old boy who has extreme fear of
visiting the dentist. He is scheduled for a dental checkup today. His mother, Rachel, asks you for some tips or
guidelines in taking good care of JBs teeth. Which will you not include?
b. Parents should allow kids to floss their own
teeth.
Parents should be the ones to check that all tooth surfaces
are cleaned. They should floss the teeth of their children
because this is a skill beyond a preschoolers motor ability.
(Pilliteri pp. 894)

13. Fontanels are unossified membranous tissue formed by the junction of the sutures of the skull. Nurse Mel
is assessing a five month old baby girl. The following does not hold true about the posterior fontanel except:
i. The posterior fontanel is triangular in shape.
ii. The posterior fontanel is diamond in shape.
iii. It is bulging when the baby is quiet and flat when the baby is crying.
iv. It is fused.
v. It is soft and firm.
vi. Posterior fontanel is larger in size than the anterior.
vii. It closes at approximately 12-18 months.
viii. It closes at approximately 2-3 months
c.i, v, viii
Only three statements from the list above are true. The posterior fontanel is triangular in
shape, soft and firm and closes at approximately 2 to 3 months of life. It is the anterior
fontanel which is diamond in shape, also soft and firm, larger than the posterior and
closes at 12 to 18 months. Fontanels are not fused. And they may be bulging when
baby is crying, but not when baby is quiet and lying still. This may be a sign of
increasing intracranial pressure, reflecting a condition from within. (Pillitteri 2007 pp.
694, Wong pp. 269 and 274

14. Preeclampsia is a hypertensive disorder of pregnancy developing after 20 weeks gestation and is
characterized by triad signs of hypertension, proteinuria and edema. A 24 year old gravida 1 para 0 was seen
in the emergency room. During an assessment at 37 weeks gestation, which of the following data would not
indicate mild preeclampsia?
b. Urine output 200 ml
In severe preeclampsia the blood pressure is 150-160/100-110, +4
proteinuria, more marked edema and weight gain and oliguria less
than 400 ml. (Pillitteri, 2007

15. Female pelvis must be adequate to allow the passage of the fetal head. The biggest antero-posterior
diameter of the pelvic cavity is:
d. Transverse diameter
Transverse diameter 12.4-13.5 cm, AP
diameter 9.5 11 cm (Pillitteri, 2007)

16. During toddlerhood, growth and development are slow and steady. A mother of a 3-year old girl comes to
you and looks overly concerned. She confided, My daughter doesnt want to share toys with her cousins. I am
terrified. Maybe somethings wrong with her. Your best response will be:
b. I understand what you feel right now. This action of your
daughter is normal in her age. At this time, children play side by
side and not with each other.
During toddler years, parallel play is evident
wherein the child plays beside another child
next to him or her, but not with them. They do
not share toys with each other. Parents must
just make sure that each child has the same
set of toys. (Pilliteri pp.865-867)

17. Restraints provide safety and security during a certain procedure. It should only be used as necessary
because it may harbor fear and anxiety for the child. A 5 month old child needs to be restrained. The procedure
requires her to be in supine position. What type of restraint will most probably be used?
b. Jacket restraint
Jacket restraint is used for children not older than 6
months who needs to be positioned supine in a
procedure. Elbow restraints prevent children from
touching head or face. Clove hitch restraint secure
only one hand or one leg for a procedure (Pilliteri pp.
1110-1112)

18. Which of the following nurses did not follow with the provisions of Republic Act 7600?
i. Nurse A roomed-in and encouraged breastfeeding to an infant born at 39 weeks age of gestation 1 hour after
delivery
ii. Nurse B roomed-in and encouraged breastfeeding to an infant born via the Caesarian delivery 3 hours after
birth.
iii. Nurse C roomed-in and encouraged breastfeeding to a premature infant 30 minutes after delivery.
iv. Nurse D roomed-in and encouraged breastfeeding to an infant with low birth weight and cannot suck
immediately 30 minutes after delivery.
a.iv and i
Section 5 provides that newborn infants shall be put to the breast of the mother
immediately after birth and forthwith roomed-in within thirty minutes like well
infants regardless of age gestation and infants with low birth weights but who
can suck. Section 6 provides that infants delivered by caesarian section shall be
roomed-in and breastfed within three to four hours after birth. (Republic Act
7600)

19. This inborn disorder is characterized by vomiting, abdominal distention, and obstinate constipation:
b.Intussusceptions
Pyloric stenosis the pyloric sphincter is the
opening between the lower portion of the stomach
and the beginning portion of the intestine, the
duodenum. If hypertrophy or hyperplasia of the
muscle surrounding the sphincter occurs, it is
difficult for the stomach to empty, a condition
called pyloric stenosis. ..Children begin to vomit
almost immediately after each feeding. The
vomiting grows increasingly forceful until it is
projectile, possibly projecting as much as 3 to 4
feet. Many infants have signs of dehydration from
the vomiting when they are first seen. Lack of
tears, dry mucous membranes of the mouth,
sunken fontanelles, fever, decreased urine
output, poor skin turgor, wt loss are common
signs of dehydration. Alkalosis also may be
present because of the excessive loss of Cl- ions
from the stomach fluid, along with accompanying
hypochloremia, hypokalemia, and starvation.
Hypopnea (slowed respirations) occurs as the
body attempts to compensate for the alkalosis.
(Pillitteri, 2007, p. 1424)
Intussusception is the invagination of one portion
of the intestine into another. The disorder
generally occurs during the second half of the first
year of life. This condition is a surgical
emergency. Children with this disorder suddenly
draw up their legs and cry as if they were in
severe pain; they may vomit. After the peristaltic
wave that caused the discomfort passes, they are
symptom free and play happily. In approx 15
minutes, the same phenomenon of intense
abdominal pain strikes again. Vomitus will begin
to contain bile because the obstruction is
invariably below the ampulla of Vater, to the point
in the intestine where bile empties into the
duodenum. After approx 12 hrs, blood appears in
the stool, described as currant jelly appearance.
The abdomen becomes distended as the bowel
above the intussusception distends. (Pillitteri,
2007, p. 1433)
Hirschsprungs disease (anganglionic
megacolon), is absence of ganglionic innervations
to the muscle of a section if the bowelin most
instances, the lower portion of the sigmoid colon
just above the anus. This results in chronic
constipation or ribbonlike stools (stools passing
through such a small, narrow segment look like
ribbons). The portion of the bowel proximal to the
obstruction dilates, distending the abdomen.
Generally has history of constipation or
intermittent constipation and diarrhea. (Pillitteri, p.
1442)

Choanal Atresia is congenital obstruction of the
posterior nares by an obstructing membrane or
bony growth, preventing a newborn from drawing
air through the nose and down the nasopharynx.
(Pillitteri, 2007

20. Growth and Development of a person follows a continuous process starting from the time he or she is
conceived to the time he dies. Childrens imagination and magical thinking is very active during the preschool
years. Mrs Jessica tells you, My son, Niko, frequently wakes up in the middle of the night screaming. He
always has a bad dream. What can I do? Your best response will be:
c. If your son wakes up from a nightmare, you
must reassure him that everythings okay and
that he is safe. You may stay with him until he
falls back to sleep again.
The childs vivid imagination contributes to his fears.
Parents play a major role in reducing these fears and
helping the children cope with them. A very bright light may
cater the fear. A dim night light can help solve the problem.
Children who wake up terrified and screaming need the
reassurance that they are safe. Giving sleep medications to
counteract the sleep disturbance does not solve the basic
problem, so it is rarely recommended. (Pilliteri pp. 895-896)

21. Josie, a pregnant woman, is scheduled for ultrasound tomorrow. Preparation before the procedure is crucial
to help decrease the anxiety of the patient. How will Nurse Mela prepare and explain the procedure to Josie?
By saying,
i. This procedure involves x-rays, which may be harmful for the baby.
ii. Your husband may stay inside the room with you throughout the procedure.
iii. You need to drink a lot of fluids before the procedure. This will aid in the visualization of the baby.
iv. I guarantee that you will not feel any discomfort during the procedure.
a. ii and iii are correct
Ultrasound measures the response of sound waves against solid
objects. A woman who is about to undergo ultrasound needs a
good explanation of the procedure. It must be said the ultrasound
does not include x-rays, so it is safe for the husband to stay with
his wife during the procedure. Full bladder must also be instituted.
And the discomfort brought about by the gel must be said, as well
as the slight distress caused by the full bladder. (Pilliteri Vol. 1, pp.
204-205)

22. The formation of dental caries is a common problem during the school age period. Mrs. Ella asks you what
she can do in order to help prevent the development of this problem to her child. What will you not advise her to
do?
i. assist her child to brush his teeth regularly
ii. Have her child visit the dentist at least once or twice a year
iii. Prohibit her child from eating snacks low in protein foods like cheese and chicken
iv. Allow her child to eat chocolate bars instead of eating hard candies
b. iv only
Snacks are best limited to high protein foods like cheese and chicken.
This must not be prohibited. i, ii and iv are all correct and must be
advocated. (Pilliteri 923-927)

23. A patient with severe preeclampsia is receiving magnesium sulfate therapy to prevent convulsion. When
monitoring the clients response to therapy, the priority assessment would include deep tendon reflexes, urinary
output and respiratory rate. The nurse would consider the following characteristic of magnesium sulfate used in
the treatment of toxemia, EXCEPT:
d. Antidote to toxicity is Vit. K
The antidote to magnesium sulfate toxicity is 1 gram of
10% calcium gluconate. (Pillitteri, 2007)

24. Nurse Mela is now caring for a 38 weeks gestation mother with Diabetes Mellitus who is scheduled for
vaginal delivery but is at a high risk for developing complications. Which of the following is not true about the
expected delivery of this woman?
b. Intravenous glucose solution must be used as a plasma
volume expander when a woman is given an epidural
anesthesia.
In our time today, vaginal delivery is preferred
over a caesarian delivery because of the
increased risk of developing complications from
a CS section. If a woman will be given an
epidural anesthetic, the use of an intravenous
glucose solution as a plasma volume expander
is avoided. Labor is induced by rupture of
membranes or an oxytocin infusion after
measures to induce cervical ripening. Both
labor contractions and fetal heart sounds are
monitored continuously. An internal FH monitor
may be used. A womans glucose level is
regulated during labor by an intravenous
infusion of regular insulin. (Pillitteri Vol. 1, pp.
378-383)

25. A newborn weighing 8 pounds is delivered via cesarean delivery. For the first 20 minutes of life, the
newborn is expected to be:
d. Crying and alert
Transition period is the first 6-8 hours of life. There are
three phases, 1st period of reactivity, resting period and
2nd period of reactivity. The first phase is the first 30
minutes; the child is awake and crying. (Lowdermilk, page
532)

26.The 6 Ps that affect the outcome and duration of labor are the Passage, Passenger, Person/Psyche,
Positioning, Placenta, and Power. Power includes the uterine contractions and maternal bearing down. The
best time to teach the client how to bear down is during the Latent phase, when the client is still comfortable.
The nurse would teach the woman to bear down.
c. Only after full cervical dilatation
Pushing during the cervical stage of labor before full cervical
dilatation can cause maternal fatigue, which can lead to
exhaustion during the Expulsive stage of labor when the mother
already needs to push to expel the fetus. Exhaustion can lead
to forceps delivery, difficult labor, and fetal compromise. B.)
The voluntary power (maternal bearing down) and involuntary
power (uterine contractions) should act together in order to be
more effective. C.) Clients with heart conditions (whether male
or female) are not encouraged to perform valsalva maneuver
(ex., pushing, straining, etc.) because it can cause vagal
stimulation, which could cause bradycardia. Women with heart
conditions deliver via forceps delivery to prevent pushing in
normal spontaneous delivery and to prevent blood loss in
caesarian delivery. (Pillitteri, 2007)

27. Assessment is an important aspect of the Nursing process which serves as the basis for the plan,
implementation, and evaluation. Nurse Mel is caring for a 10 year old boy scheduled for a thorough physical
examination today. Nurse Mel must keep in mind some nursing considerations in preparation for the procedure.
Which statement, if made by the nurse, needs to be corrected?
a. Let me see your feet. It will be much
easier and faster if I start assessing from
your feet all the way to your head.
Assessment must proceed from the head to toe or the
cephalocaudal procedure and not the other way around. Most
school age children prefer sitting, but are still cooperative in
most positions. They want privacy so given them some.
Procedure must first be explained, especially its relevance to
the well-being of the child. (Wong pp. 21, 165)

28. Gia developed pulmonary embolism evidenced by sudden sharp chest pain, elevated RR and PR with
cyanosis. The immediate nursing action would be to:
.Administer O2 @ 10L/min by face mask
Amniotic fluid embolism occurs when amniotic fluid is forced
into an open maternal uterine blood sinus due to some
defect in the membranes or premature separation of the
placenta. It occurs in 1 in 20,000 births and is not
preventable. Woman sits up suddenly and grasps chest
because of sharp pain and inability to breathe as she
experiences pulmonary constriction. Becomes pale then
turns bluish gray. Immediate intervention is administration
via fm or cannula. Prepare for CPR. Poor prognosis, death
may occur in minutes. (Pillitteri 2010, p. 637)

29. Morning sickness is one of the presumptive signs of pregnancy which occurs more commonly early in the
morning upon awakening. It is attributed to the increased level of Human Chorionic Gonadotrophin and
Progesterone hormones or decreased glucose levels. One of your clients confided about this condition and
asked you what she should do to lessen the discomfort. Your best response is:
c. You may ready dry crackers or hard candies at
bedside, and may eat them before arising.
Increasing the carbohydrate intake seems to relieve
nausea far better than any other nutrition and diet
remedy. Dry crackers may be eaten before arising, same
as with sour ball candies. The pregnant woman may delay
her meal to 10-11 am but can be given soups and regular
drinks to compensate for her early morning calorie needs.
Over the counter medications are discouraged. (Pilliteri
Vol. 1, pp. 233)

30. Mrs. Althea is a 40 year old pregnant woman diagnosed as having Pregnancy-Induced Hypertension. Upon
assessment, her blood pressure was 150/90, and she had 1+edema on both of her feet. Laboratory results also
show that she has 1+ protein in her urine. The following interventions must be done except:
c. Exercise must be encouraged. Walking is the best form
of exercise for all pregnant women.
Bed rest, and not exercise, is the best method to
increase elimination of sodium and promoting
urination. The usual diet of the patient must be
continued with no sodium restriction. Sodium
restriction may worsen the condition. Lastly, the
weight and the vital signs should be routinely
monitored, as well as the edema of the patient.
(Pilliteri Vol. 1, pp. 222)

31. The apical pulse is used as the location for auscultating the heart rate of a child aged 3 years and below, as
well as in persons 3 years old and above with certain heart conditions. You are caring for a 7 year old child who
has Rheumatic Heart Fever. How will you locate for the Point of Maximal Impulse (PMI) of the apical pulse in a
7 year old child?
c. Palpate the PMI at the 4th to 5th ICS to the left of
the sternum at the Midclavicular Line
In locating the apical pulse in a seven year old child,
the nurse must palpate for the angle of Louis and then
slide the fingers towards the left side. The intercostal
space directly to the left of the angle of Louis is the
second space. The Point of maximal impulse is in the
4th to 5th ICS of the Left Midclavicular Line. PMI can
be located at left of mid-clavicular line until age 4, at
mid-clavicular line between ages 4-6, and moves to
the right of mid-clavicular line at age 7(Kozier pp. 538)

32. As the nurse assigned to the Maternal Ward of St. Joseph Medical Center, Nurse Angelou should be aware
about which mothers must not be allowed to breastfeed their infants. He correctly identifies mothers who must
not breastfeed their children except for:
d. Alyanna, who is a multiparous
mother with mild headache and
whose baby has low birth weight.
The following are not candidates for breastfeeding: mothers who are
seriously ill, taking medications contraindicated to breastfeeding and the
violent psychotics. These women, as determined by the physician shall
be exempted from the provisions of Section 5, 6 and 7 provided that the
infants shall be given expressed milk or formula. Additional
contraindications include: Maternal HI, Maternal Human T-lymphotropic
virus, Maternal metabolic disease: Wilsons disease, Infant
Galactosemia, Maternal Drugs, Drugs of abuse, Chemotherapy/radiation
(WHO) (Republic Act 7600)

33. Newborns circulation is still immature. If the newborn was placed on one side more than 2 hours, the
newborn manifest this skin color:
d.Harlequin
Harlequins sign -- Occasionally, because of immature
circulation, a newborn who has been lying on his or her
side appears red on the dependent side of the body, and
pale on the upper side, as if a line has been drawn down
the center of the body. This is a transient phenomenon;
although startling, it is of no clinical significance. The odd
coloring fades immediately if the infants position is
changed, or the baby kicks or cries vigorously. Jaundice
yellowing of the skin, normally occurs on the second or
third day of life (physiologic jaundice). A gray color in
newborns generally indicates infection. (Pillitteri, 2007)

34. Diabetes mellitus is a chronic hereditary disease characterized by marked hyperglycemia due to
abnormalities in CHO, fats and protein metabolism. The classic triad signs of diabetes mellitus are excessive
appetite, excessive urination and excessive thirst. A pregnant patient at age 25, 26 weeks gestation, diabetic
Class B on Whites classification, has come for her prenatal visit. On assessment, which sign should the nurse
likely to identify?
c. Fetal heart tones of 142/min
At 26 weeks, the FHT can already be auscultated revealing
normal values. AT 26 weeks AOG the fundus would be
palpated above the umbilicus or midway between the xiphoid
process and the umbilicus or slightly higher because fetuses of
diabetics tend to be bigger. Triads of diabetes are polyuria,
polyphagia and polydipsia. Increasing estriol levels signify fetal
health. (Pillitteri, 2007)



35. An appropriate nursing measure for infants or young children with hemophilia is to:
d. Use a small-gauge needle and apply firm pressure In hemophilia, injections or other invasive procedures
after administering immunization
must be avoided in order to prevent hemorrhage. But if
the patient is for immunization, you can give the
vaccine but using small-gauge needle and then apply
firm pressure afterwards less than 10 minutes to
prevent bleeding on the site. Why less than 10
minutes? Prolonged pressing the site can lead to tissue
ischemia because of impediment in circulation.
(Pillitteri, 2007)

36. A Caesarian birth entails the incision through the abdominal wall. Mrs. Joan had Caesarian delivery to an 8
lb baby boy. She is now for discharge today. As her nurse, you need to provide health teachings to ensure the
well-being of both the mother and her child at home. Part of this teaching is the following except:
c. she can walk 3 flights of stairs 3 days after the
surgery
Health education before the discharge of a pregnant woman
is very crucial for the health and well-being of both the
mother and her baby. The following should be taught to the
mother: how to recognize signs of possible complications
directly related to the surgery such as the redness and pain
of the incision site, heavy lochia and temperature above
38C; not to lift any object heavier than 10lbs for the first
week after the operation; to limit walking upstairs to only
once a day; to maintain the level of pain relief so she can
ambulate and care for her child. (Pilliteri Vol. 1, pp. 582-
584)

37. Republic Act 7600 or the Rooming In and Breastfeeding Act of 1992 states that all babies born both from
private and public hospitals in the Philippines must be allowed to stay in the room of the mother so that
breastfeeding may be initiated and continued through the post-partum period. What are the provisions of this
act?
i. This act prevents the practice of breastfeeding and utilizes the use of powdered milk substitutes as the
source of nourishment for the baby
ii. This act advocates the practice of breastfeeding especially in institutions, both public and private, which are
active supporters of the advocacy to protect the said practice.
iii. This act helps fulfill the needs of both the mother and the baby. It wholly develops and provides for an
environment which fosters an atmosphere where the basic needs physical, emotional, and cognitive needs
are given.
iv. The basic goal of this act is to help the State, as well as the local government to save much more resources.
In this way, many people will benefit and receive more
b. ii and iii
The State adopts rooming-in as a national policy to encourage, protect and support
the practice of breastfeeding. It shall create an environment where the basic
physical, emotional, and psychological needs of mothers and infants are fulfilled
through the practice of rooming-in and breastfeeding. This act does not encourage
the use of supplemental feedings aside from breast milk. Further, helping the state
save resources is not the basic goal of this act, but to encourage the provision of the
best food for babies, which is the breast milk. (Republic Act 7600)

38. Nurse Mela is conducting health teaching class to a group of mothers diagnosed as having Diabetes
Mellitus during pregnancy. She correctly discusses nutrition and diet requirements if she included:
i. a 2,000-calorie diet divided equally into 3 meals and 3 snacks
ii. a 2,000-calorie diet divided into 3 large meals
iii. Diet low in saturated fats and cholesterol
IV. Diet low in dietary fiber
v. final snack of the day consisting of protein and complex carbohydrates
c.i, iii, v
The diet of a diabetic mother should be from 1,800 to 2,200 calorie diet divided into 3
meals and 3 snacks. The equal distribution keeps the serum level constant. Diet should
have decreased saturated fats and cholesterol and increased dietary fiber. Her final
snack should contain protein and complex carbohydrates to allow slow digestion during
the night to solve the extreme vulnerability to hypoglycemia at night caused by the due
to continuous fetal use of glucose during sleep. (Pilliteri Vol. 1, pp. 380)

39. In preparation for labor and delivery, the pregnant woman must be taught how to determine the events that
signal the beginning of labor. Rupture of membranes is one of these events which predispose a mother and her
child at risk for infection. Which assessment findings signal the rupture of membranes?
i. sudden gush of clear liquid
ii. Nitrazine paper turned into red
iii. Nitrazine paper turned into blue green
iv. ferning is present upon examination under a microscope
v. no ferning is present upon examination under a microscope
d. i, iii, iv
The following are the signals of ROM: sudden gush of fluid from the vagina
with continued minimal leakage which may be mistaken with urine; nitrazine
paper causes an alkaline reaction which turns into blue or green, gray or
deep blue; ferning occurs due to the high estrogen content of the amniotic
fluid. (Pilliteri Vol. 1, pp. 423-514)

40. Physical assessment is one of the methods utilized by a nurse to determine health status and well-being of
a person. You are the head nurse in the pediatric ward. While conducting the exam to a 2 year old boy, you
observe the staff nurse doing the procedure. Which statement if made by the staff nurse will prompt you to
immediately intervene?
a. If you do not cooperate with me, I will not let
you eat your candy. So be good boy.
When doing health assessment, the nurse should never
threaten the child that if she is not good, the nurse will
punish her. The nurse should allow the child to handle the
equipment to help relax her. Parents help may be asked to
remove clothing and the child can bring comfort item from
home. (Pilliteri pp. 989-990)

41. Oedipus complex refers to the strong emotional attachment of the preschool boy with his mother. How will
you know when this phenomenon has been successfully surpassed by a 6 year old boy?
c. when he identifies himself with the roles of his
father
Oedipus complex shows that a boy competes with his
father for the love of the mother, and has been surpassed
by a boy if he already identifies with the father. (Pilliteri
889)

42. Batangas Regional Hospital adopts the policy of Republic Act no. 10028 or the Expanded Breastfeeding
Act of 2009, an act expanding the promotion of breastfeeding. Mrs. Caraan delivered a premature infant
yesterday. Her baby was roomed-in with her this morning. She asks you, I heard formula will provide the best
source of nutrients for my baby. What formula milk do you suggest that I will use? As an advocate of the
policies of the institution, as well as the benefits of both mother and her child, your BEST response will be.
d. This institution is an advocate of the Breastfeeding
act. We encourage and support breast milk as the best
source of nutrients for your baby from birth up to 6
months. Supplementary feedings may just be used from
6 months onwards. I can tell you more of the advantages
of using breast milk for you and your baby.
RA 10028, an act which amends RA 7600, is
otherwise known as an act providing for the
incentives to all government and private health
institutions with rooming-in and breastfeeding
practices and for other purposes. As nurses, we do
not encourage the use of formula milk as a
substitute for breast milk. (Republic Act 10028)

43. Some conditions occurring before or during the course of pregnancy place the woman and her baby at
higher risk for developing complications. Gestational Diabetes happens in women who do not have the disease
before she becomes pregnant but later develops it as pregnancy progresses. Circumstances known to increase
the likelihood of contracting Diabetes Mellitus have been grouped into modifiable and non-modifiable risk
factors. Who among the following women has the highest risk of developing Gestational Diabetes?
d. an obese Thai woman
The factors increasing the risk of developing Diabetes Mellitus
during pregnancy are: obesity, age more than 25 years old, history
of having large babies (more than 10 pounds), history of
unexplained fetal and perineal loss, history of congenital anomalies
in her children, family history of diabetes and Race (Native
American, Hispanic, Asian). (Pillitteri Vol. 1, pp. 378)

44. The evaluation of the motor function is included in the Neurological Assessment o the Physical
examination. Nurse Joseph is performing the Romberg test to Rick, a 15 year old boy. He correctly carries out
the process if he did which of the following?
d. Nurse Joseph instructed Rick to stand with
both feet together and his hands must be on his
sides. Rick first does this with eyes open, and
then with eyes close.
Rick must normally have a negative Romberg test wherein
he may slightly sway but must be able to maintain an upright
position. Asking the patient to close his eyes and identify
which part of his body is being stroked by a wisp of cotton is
a light touch sensation and the patient must be able to
pinpoint the part of the body being stroked. Te use of
percussion hammer involves a test of the patellar reflex.
Lastly, the patient with his eyes closed identifies what the
object is by manipulating it with his hands is the test of
stereognosis or the ability of the person to recognize objects
by touching them. (Kozier pp. 645-651)


45. Vera is diagnosed with Disseminated Intravascular Coagulation (DIC) associated with abruptio placenta.
You know that she is experiencing:
a. Severe bleeding due to lower uterine implantation of DIC occurs when there is such extreme bleeding
the placenta.
that so many platelets and fibrin from the general
circulation rush to the site that not enough are left
from the rest of the body. This results in a paradox:
increased coagulation at one point but bleeding
defect throughout the system. (Pillitteri 2010, p.
567)

46. Executive Order No. 51 adopts a national code of marketing of breastmilk substitutes, breastmilk
supplements and related products. Part of the provisions of this is the inclusion of the guidelines for information
dissemination and education for mothers. In educating breastfeeding mothers, as well as those mothers who
are hesitant to breastfeed their child, what must not be included?
c. Profits from using formula milk as a way of
helping the country and our economy
Section 5 of EO 51 include all of the following points: (1)
the benefits and superiority of breastfeeding; (2) maternal
nutrition, and the preparation for and maintenance of
breastfeeding; (3) the negative effect on breastfeeding of
introducing partial bottlefeeding; (4) the difficulty of
reversing the decision not to breastfeed; and (5) where
needed, the proper use of infant formula, whether
manufactured industrially or homeprepared. (Executive
Order 51)

47. After fertilization, the placenta takes over the function of the corpus luteum by:
d. First trimester
At about the 8th week of pregnancy, the outer layer of cells of the
developing placenta begins to produce progesterone. At this point,
the corpus luteum is no longer needed. This is probable why the
production of hCG, which sustained it, begins to decrease.
(Pillitteri, 2007)

48. Eighteen year old Joey is in one of the most challenging stage of psychosocial development. Which of the
following shows that Joey successfully accomplished his task in this stage?
a. He knows what he wants which is to be a lawyer
soon and he decides on matters relevant to his self
and to his future.
Joey is in the Identity versus Role Confusion stage. In
this stage, the individual must learn how to make a
decision, especially decisions regarding his own
career. They must decide who they want to be and
what kind of person they will be in the future. (Pilliteri
pp. 947)



49. You are the nurse in the Neonatal Intensive Care Unit. A newborn just delivered this morning is in the unit.
Which of the following are normal findings regarding the respiration of a newborn?
i. rapid at a rate of 30-60 breaths per minute
ii. Slow at a rate of 10-20 breaths per minute
iii. Regularly irregular
iv. Irregularly regular
v. short periods of apnea
vi. Abdominal breathing
vii. Chest breathing
viii. Obligate nose breather
ix. Obligate mouth breather
d. i, iii, v, vi, viii
Newborns are obligate nose breathers. Respiration is at a rate of 30-60 breaths
per minute, regularly irregular with short periods of apnea. They are also
obligate nose-breathers. (Pillitteri pp. 683-684)

50. Breast milk is the best for babies from birth up to 6 months of life. Nurses play a vital role in providing the
information about the benefits and advantages of breastfeeding to the mother, her baby and the community.
Nurse Ivy is to conduct health teachings to a group of mothers confined in the Maternal Ward of the hospital
where most of the mothers are hesitant of breastfeeding their babies. Which of the following must be included
in her heath teachings?
i. decreases the chance of acquiring ovarian and breast cancers
ii. provides passive antibodies to help the body fight against infections
iii. provides the baby with the needed nutritional requirements for its young age
iv. provides a more expensive way of giving baby her needed food
v. results to conflict between mother and baby
d. i, ii, iii
Breastfeeding conserve funds that otherwise would have been spent on
buying canned powdered milks. Breastfeeding fosters emotional bonding and
not conflict between the mother and the baby. (Wong 291-393)