1. A 28-month-old child with severe diarrhea is 7.

While on your night rounds, you have

admitted. Upon assessment, the child is noticed two nursing aides placing bed sheets
feverish, has dry lips, and irritable. What is that they have taken from the floor. What is
your first nursing priority upon admission? * the proper nursing action? *

Asses the hydration status Remind them the principle of medical

asepsis
2. You were assigned to a patient. Upon 8. In a burn patient, in order to promote
assessment, the patient elicited Homan’s sign. adequate fluid within 24 hours, what
What is the nursing priority using this intravenous fluid is appropriate? *
assessment? *
Lactated Ringer’s Solution
Encourage good venous circulation
9. Being assigned in a pediatric ward, what is
the characteristic sign of a normal
3. You were assigned to a patient with a
psychosocial development of a toddler? *
nasogastric tube attached for almost three
days. It is time to irrigate it, what is the Negative behavior
protocol that you will follow? *
10. Defining stress, all of the following
Gently instill 20 mL normal saline and then
withdraw solution. describes its characteristics except: *

4. A nurse therapeutically responds to a Stress always results in a feeling of

patient with AIDS when he expressed feelings distress
of depression and facing death with the
following phrase: “Are you afraid of dying?” 11. A one-year-old child is admitted. Looking
What type of therapeutic technique is she into the physical development of the child,
using? * what will be affected or may have a delay? *

Using open-ended question Walking

5. What role does a nurse exhibits if she 12. A mother is concerned about the diet of
stands to protect the needs and wishes of the her child that has noncomplicated acute
patient? * glomerulonephritis. What is the appropriate
diet regimen you must teach as a nurse? *
Client advocate
Regular diet, no added salt.
6. A post appendectomy patient is assigned to
you. You have assessed him that he needs
more knowledge about proper wound care.
What role should you apply in this situation? *

Teacher
13. A patient is on Respiratory Isolation for 19. In teaching HIV in high school students,
Tuberculosis (TB). Which of the following what is the appropriate health practice that the
would be an indicator for the removal of nurse should emphasize? *
Isolation Precautions? *
Use a latex condom and water soluble
Sputum Culture is negative for AFB,
following a course of INH and PAS during intercourse

14. A client is diagnosed to have Congestive 20. Which of the following is appropriate in a
Heart Failure. Upon auscultating the client’s depressed patient? *
lungs, the nurse hears crackling sounds
Using open-ended questions
bilaterally at the bases. What term should you
use in documenting this finding? * 21. In a geriatric unit, you have noticed that
one patient seemed to change his behavior.
Rales Which of the following symptoms DOES NOT
indicate that the patient is going into
depression? *
15. Which of the following response of a 10-
year-old patient with acute appendicitis is an Being talkative
alarming sign? *
22. In admitting an elderly patient, it is a
“My pain has gone away.”
nurse’s goal to orient the patient. What is the
effective nursing action in order to prevent
16. A nurse assigned to a child with Acute
disorientation? *
Glomerulonephritis is picking up doctor’s
orders to put in the Kardex. Which of the Orient the patient every night before he or
orders should the nurse question? * she sleeps

Daily blood pressure 23. What is the proper order in the physical
assessment when it comes to the examination
17. Which of the following is an INCORRECT of the abdomen? *
statement regarding diet therapy for a patient
in renal failure? * Inspection, Auscultation, Percussion,
Palpation
Provide a diet high in Potassium rich food
24. In assessing the cranial nerve function, a
18. You are assigned to speak to a group of nurse finds out that a patient has a difficulty in
High School students about HIV and AIDS. In determining the different scents when the
discussing transmission, the nurse knows that eyes is closed. Which of the following cranial
the highest concentration of the HIV virus in nerve had a problem? *
infected patients is in the: *
CN I
Blood
25. In examining a patient with asthma in 29. Mrs. Jimenez went to the health center for
exacerbation, what lung sound is pre-natal check-up. the student nurse took her
predominant? * weight and revealed 142 lbs. She asked the
student nurse how much should she gain
Wheezes
weight in her pregnancy. *
26. Mrs. Jimenez went to the health center for
pre-natal check-up. the student nurse took her 25-35 lbs
weight and revealed 142 lbs. She asked the
30. Which of the following urinary symptoms
student nurse how much should she gain
does the pregnant woman most frequently
weight in her pregnancy. *
experience during the first trimester: *
25-35 lbs
frequency
27. Mrs. Precilla Abuel, a 32-year-old
31. Nurse Luis is assessing the newborn’s
multiripara is admitted to labor and delivery.
heart rate. Which of the following would be
Her last 3 pregnancies in short stage one of
considered normal if the newborn is
labor. The nurses decide to observe her
sleeping? *
closely. The physician determines that Mrs.
Abuel’s cervix is dilated to 6 cm. Mrs. Abuel 100 beats per minute
states that she is extremely uncomfortable. To
32. Betina 30 weeks AOG discharged with a
lessen Mrs. Abuel’s discomfort, the nurse can
diagnosis of placenta previa. The nurse knows
advise her to: *
that the client understands her care at home
Assume Sim’s position when she says: *

28. When the woman is in Sim’s position, this I will have to remain in bed until my due
puts the weight of the fetus on bed, not on the date comes
woman and allows good circulation in the
lower extremities. Which of the following is the 33. Nurse Geli explains to the client who is 33
most appropriate intervention to reduce stress weeks pregnant and is experiencing vaginal
in a preterm infant at 33 weeks gestation? * bleeding that coitus Need to be modified in
any way by either partner *
Kangaroo care
Should be restricted because it may
Feedback stimulate uterine activity.
Kangaroo care is the use of skin-to-skin
contact to maintain body heat. This method of 34. Isabelle, a 2-year-old girl loves to move
care not only supplies heat but also around and oftentimes manifests negativism
encourages parent-child interaction. and temper tantrums. What is the best way to
deal with her behavior? *

Ignore her behavior as long as she does

not hurt herself and others.
35. During the first hours following delivery, 41. An 8-year-old, African immigrant is
the postpartum client is given IVF with admitted to the pediatric unit with elevated
oxytocin added to them. The nurse viral titers for the poliovirus. For which of the
understands the primary reason for this is: * following signs/symptoms should the nurse
carefully monitor the child? *
To promote uterine contraction
Bradypnea
36. Which of the following danger sings
42. Which of the following is the best method
should be reported immediately during the
to prevent the spread of infection to an
antepartum period? *
immunosuppressed child? *
blurred vision Have people wash their hands prior to
contact with the child.
37. A client asks the nurse what a third degree
43. Which of the following laboratory tests will
laceration is. She was informed that she had
be ordered to determine the presence of the
one. The nurse explains that this is: *
human immunodeficiency virus antigen in an
that extended their anal sphincter infant whose parent is HIV+? *

p24 antigen assay.

38. Bettine Gonzales is hospitalized for the
44. The nurse assesses what clinical
treatment of severe pre eclampsia. Which of
manifestation to be the priority in a child with
the following represents an unusual finding for
Enterobius (pinworm)? *
this condition? *
Nocturnal anal itching
Convulsions
45. An immunized child with a serious
39. A four year-old child is recovering from
puncture wound has been diagnosed with
chicken pox (varicella). The parents would like
tetanus. Which of the following actions is
to have the child return to day care as soon as
critical for the unit charge nurse to perform? *
possible. In order to ensure that the illness is
no longer communicable, the nurse would Reinforce the need to pad the side rails
assess for? * and headboard of the child’s hospital bed.

46. A 5-year-old child who has received no

All lesions crusted
vaccinations is admitted to the pediatric unit
with a diagnosis of diphtheria. Which of the
40. The nurse should implement which
following signs/symptoms would the nurse
precautions for a client who has scabies? *
expect to see? *
Standard precautions and contact
precautions. Markedly edematous neck
 54. The first international conference on
47. The dose of BCG that you will administer Primary Health Care was held in: *
to an infant: *
USSR
0.05 ml
55. The Republic Act that refers to the Magna
48. For home deliveries, the first postpartum Carta of Public Health Workers: *
visit is: *
R.A. 7305
within 24 hours

49. During home delivery, which concepts

must be emphasized? *
1/1
Clean cutting of cord
Clean delivery surface
Clean hands
all of the above

50. The law for hepatitis B is the following: *

0/1
RA 7846

51. Which law provides for mass provision of

micronutrients through fortification of staples
like flour, sugar and oil with Vitamin A and
Iron? *

RA 8976

52. A child who has had diarrhea for 14 days

but has no sign of dehydration is classified
as: *

Persistent diarrhea

53. The source of infection in PTB is through

which of the following? *

Direct contact with infected person