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ANSWER KEY D. Sodium Anxiety & Anxiety Disorders Answer: A 1. A client asks how his prescribed alprazolam (Xanax) helps his anx...

ANSWER KEY D. Sodium Anxiety & Anxiety Disorders Answer: A 1. A client asks how his prescribed alprazolam (Xanax) helps his anxiety Rationale: The effects of caffeine are similar to some anxiety disorder. The nurse explains that antianxiety medications such as symptoms, and, therefore, caffeine ingestion will worsen alprazolam affect the function of which neurotransmitter that is believed anxiety. The other types of foods are also potentially harmful to be dysfunctional in anxiety disorders? to physical as well as psychological health, but the worst A. Serotonin offender is caffeine. B. Norepinephrine C. GABA 7. A client experiences panic attacks when confronted with D. Dopamine riding in elevators. The therapist is teaching the client ways to relax while incrementally exposing the client to getting on an Answer: C elevator. This technique is called Rationale: Gamma-aminobutyric acid (GABA) is the amino acid A. systematic desensitization. neurotransmitter believed to be dysfunctional in anxiety disorders. B. flooding. GABA reduces anxiety, and norepinephrine increases it; researchers C. cognitive restructuring. believe that a problem with the regulation of these neurotransmitters D. exposure therapy. occurs in anxiety disorders. Serotonin is usually implicated in psychosis and mood disorders. Dopamine is indicated in psychosis. Answer: A Rationale: One behavioral therapy often used to treat phobias 2. The nurse knows that which one of the following statements is true is systematic (serial) desensitization, in which the therapist about stress and anxiety? progressively exposes the client to the threatening object in a A. All people handle stress in the same way. safe setting until the client's anxiety decreases. Flooding is a B. Stress is a person's reaction to anxiety. form of rapid desensitization in which a behavioral therapist C. Anxiety occurs when a person has trouble dealing with life confronts the client with the phobic object (either a picture or situations, problems, and goals. the actual object) until it no longer produces anxiety. D. Stress is the wear and tear that life causes on the Cognitive restructuring involves challenging the client's body. irrational beliefs. Exposure therapy is similar to flooding. Answer: D 8. The nurse enters the client's room and finds the client Rationale: Stress is the wear and tear that life causes on the body. It anxiously pacing the floor. The client begins shouting at the occurs when a person has difficulty dealing with life situations, nurse, “Get out of my room!” The best intervention by the problems, and goals. Each person handles stress differently. Anxiety is a nurse would be to vague feeling of dread or apprehension; it is a response to external or A. approach the client and ask, “What's wrong?” internal stimuli that can have behavioral, emotional, cognitive, and B. call for help and say, “Calm down.” physical symptoms. Anxiety is a response to stress. C. turn and walk away from the room without saying anything. 3. A client says to the nurse, “I just can't talk in front of the group. I D. stand at the doorway and say, “You seem feel like I'm going to pass out.” The nurse assesses the client's anxiety upset.” to be at which level? A. Mild Answer: D B. Moderate Rationale: Staying with the client while allowing personal C. Severe space is an important and safe intervention; this therapeutic D. Panic communication technique is designed to get the client to communicate feelings. It may not be safe for the nurse to Answer: C approach the client. Help is not needed at this time, and Rationale: Physiologic responses to severe anxiety include headache, saying, “Calm down,” is not effective. Turning and walking nausea, vomiting, diarrhea, trembling, rigid stance, vertigo, pale, away from the client may seem like rejection and may worsen tachycardia, and chest pain. the client's anxiety as well as damage the nurse-client relationship. 4. A client who suffers from frequent panic attacks describes the attack as feeling disconnected from himself. The nurse notes in the client's SITUATION. Nursing students from Rembrandt School of chart that the client reports experiencing Nursing are assigned to the Psychiatric Ward. Paolo, one of A. hallucinations. the students, seems confused and needs to review regarding B. depersonalization. anxiety and its disorders before he starts to handle patients. C. derealization. D. denial. 9. Paolo is correct when identifying which one of the following statements is true? Answer: B A. Anxiety and fear are the same. Rationale: During a panic attack, the client may describe feelings of B. Anxiety is unavoidable. being disconnected from himself or herself (depersonalization) or C. Anxiety is always harmful. sensing that things are not real (derealization). Denial is not admitting D. Fear is feeling threatened by an unknown entity. reality. Hallucinations involve sensing something that is not there. Answer: B 5. An anxiolytic agent, lorazepam (Ativan), has been prescribed for the Rationale: Anxiety is distinguished from fear, which is feeling client. Which of the following statements by the client would indicate to afraid or threatened by a clearly identifiable external stimulus the nurse that client education about this medication has been that represents danger to the person. Anxiety is unavoidable effective? in life and can serve many positive functions such as A. “My anxiety will be eliminated if I take this medication as motivating the person to take action to solve a problem or to prescribed.” resolve a crisis. B. “This medication presents no risk of addiction or dependence.” 10. Paolo understands correctly when identifying which C. “I will probably always need to take this medication for my objective is appropriate for all clients with anxiety disorders? anxiety.” A. The client will experience reduced anxiety and D. “This medication will relax me, so I can focus on accept the fact that underlying conflicts cannot be problem solving.” treated. B. The client will experience reduced anxiety Answer: D and develop alternative responses to Rationale: Anxiolytics are designed for short-term use to relieve anxiety. anxiety-provoking situations. These drugs are designed to relieve anxiety so that the person can deal C. The client will experience reduced anxiety and learn more effectively with whatever crisis or situation is causing stress. to control primitive impulses. Benzodiazepines have a tendency to cause dependence. Clients need to D. The client will experience reduced anxiety and know that anti-anxiety agents are aimed at relieving symptoms such as strive for insight through psychoanalysis. anxiety but do not treat the underlying problems that cause the anxiety. Answer: B 6. When teaching a client with generalized anxiety disorder, which is Rationale: A primary client outcome is improved adaptive the highest priority for the nurse to teach the client to avoid? coping skills. A. Caffeine B. High-fat foods 11. Paolo is sent to the Psychiatric ward and assigned to a C. Refined sugars client who is currently experiencing a panic attack. Which of the following is the most appropriate response by the student nurse? Assertiveness training would help the person to take more A. “Just try to relax.” control over life situations. Decatastrophizing helps the client B. “There is nothing here to harm you.” to realistically appraise the situation. These are both used for C. “You are safe. Take a deep breath.” general anxiety. When a person is exposed to a phobic D. “What are you feeling right now?” object, the person is not likely in control. Reminding a person to calm down is not at all an effective way to manage Answer: C anxiety. Rationale: Nursing interventions for panic disorder include providing a safe environment and ensuring the client's privacy during a panic attack, remaining with the client during a panic attack, helping the client to focus on deep breathing, talking to the client in a calm, reassuring voice, teaching the client to use relaxation techniques, helping the client to use cognitive restructuring techniques, and the engaging client to explore how to decrease stressors and anxiety- provoking situations. 12. Paolo is assisting a patient who is working on the technique of systematic desensitization. When the patient feels anxious, the student nurse can best use the principles of this technique by stating, A. “Use the deep breathing techniques we practiced yesterday.” B. “What is the worst that will happen if you confront this fear?” C. “Tell me how you are feeling right now.” D. “I can see you are anxious. Let's stop for a minute.” Answer: A Rationale: Systematic desensitization can be used to help clients overcome irrational fears and anxiety associated with phobias. The client learns and practices relaxation techniques to decrease and manage anxiety. He or she is then exposed to the least anxiety- provoking situation and uses relaxation techniques to manage the resulting anxiety. Confronting irrational thoughts is part of rational emotive therapy. Encouraging expression of feelings is associated with gestalt therapy. SELECT ALL THAT APPLY 13. When a client is experiencing a panic attack while in the recreation room, what interventions are the nurse's first priorities? Select all that apply. A. Provide a safe environment. B. Request a prescription for an antianxiety agent. C. Offer the client therapy to calm down D. Ensure the client's privacy. E. Engage the client in recreational activities. Answer: A, D Rationale: During a panic attack, the nurse's first concern is to provide a safe environment and to ensure the client's privacy. If the environment is overstimulating, the client should move to a less stimulating place. Decreasing external stimuli will help lower the client's anxiety level. The client's safety is priority. Anxious behavior can be escalated by external stimuli. In a large area, the client can feel lost and panicked, but a smaller room can enhance a sense of security. An antianxiety agent may be helpful, but it is not the priority. It would likely be stimulating to engage the client in recreational activities. 14. Which of the following are cognitive-behavioral therapy techniques that may be used effectively with anxious clients? Select all that apply. A. Positive reframing B. Decatastrophizing C. Assertiveness training D. Humor E. Unlearning Answer: A, B, C, E Rationale: Positive reframing means turning negative messages into positive messages. Decatastrophizing involves the therapist's use of questions to more realistically appraise the situation. Assertiveness training helps the person take more control over life situations. Positive reframing, decatastrophizing, and assertiveness training are cognitive & behavioral therapy techniques. Humor is not a cognitive & behavioral therapy technique. Unlearning is the theory underlying behavioral therapy. 15. Which techniques would be most effective for a client who has situational phobias? Select all that apply. A. Flooding B. Reminding the person to calm down C. Systematic desensitization D. Assertiveness training E. Decatastrophizing Answer: A, C Rationale: Systematic desensitization is when the therapist progressively exposes the client to a threatening object in a safe setting until the client's anxiety decreases. Flooding is a form of rapid desensitization in which the behavior therapist confronts the client with the phobic object until it no longer produces anxiety. Systematic desensitization and flooding are behavioral therapies used in the treatment of phobias.  ANSWER KEY Answer: D Personality Disorders Rationale: Managing emotions, especially anger and frustration, can be a major problem. Taking a time-out or 1. Which disorder is characterized by pervasive mistrust and leaving the area and going to a neutral place to regain suspiciousness of others? internal control are often helpful strategies. Time-outs help A. Paranoid personality disorder clients to avoid impulsive reactions and angry outbursts in B. Schizoid personality disorder emotionally charged situations, regain control of emotions, C. Histrionic personality disorder and engage in constructive problem solving. D. Dependent personality disorder 6. What would the nurse expect to assess in a client with Answer: A narcissistic personality disorder? Rationale: Paranoid personality disorder is characterized by pervasive A. Genuine concern for others mistrust and suspiciousness of others. Schizoid personality disorder is B. Mistrust of others characterized by a pervasive pattern of detachment from social C. Grandiose and superior self-concept relationships and a restricted range of emotional expression in D. Dependence on others for decision making interpersonal settings. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Answer: C Dependent personality disorder is characterized by a pervasive and Rationale: Clients with narcissistic personality disorder believe excessive need to be taken care of, which leads to submissive and themselves superior to others and expect to be treated as clinging behavior and fears of separation. such. 2. Which thought process would cause a client with antisocial 7. A client with antisocial personality disorder is begging to personality disorder to want to do everything for himself? use the phone to call his wife, even though it is against the A. Belief in his own self-worth unit rules. The client begs, “It is just this once, and she will B. Inability to delay gratification be so hurt if I don't call her.” Which would be the most C. Rewards for competitive behavior appropriate response by the nurse? D. Sense of mistrust of others A. “Only to help your wife, you can call this time.” B. “I will get in trouble with my supervisor if I let you Answer: D call.” Rationale: Clients believe others are just like them, that is, ready to C. “You may not use the phone to call your exploit and use others for their own gain. These clients are devoid of wife.” personal emotions, and actually the self is quite shallow and empty. D. “You cannot call because you need to focus on your These clients view relationships as serving their needs and pursue recovery while you are here, not your wife.” others only for personal gain. There is no competition because these clients believe they are only taking care of themselves because no one Answer: C else will. Rationale: The client may attempt to bend the rules “just this once” with numerous excuses and justifications. The nurse's 3. A nursing student appears to cooperate with the group but does not refusal to be manipulated or charmed will help decrease complete agreed upon tasks at the appropriate time repeatedly and manipulative behavior. Avoid any discussion about why then display negativity. The nursing student may be showing signs of requirements exist. State the requirement in a matter-of-fact which personality disorder or behavior? manner. Avoid arguing with the client. A. Paranoid B. Borderline SITUATION. Bernard was recently diagnosed with borderline C. Narcissistic personality disorder after he observed that he has difficulty D. Passive-aggressive behavior maintaining relationships with others. He is currently seeking help because he recently feels empty all the time. Answer: D Rationale: Passive-aggressive behavior is characterized by a negative 8. Upon admission, a client with a personality disorder attitude and a pervasive pattern of passive resistance to demands for identified the following as areas of concern for which the adequate social and occupational performance. These clients may client would like help. According to studies, which will most appear cooperative, even ingratiating, or sullen and withdrawn, likely be addressed by the health-care team? depending on the circumstances. Paranoid personality disorder is A. Psychological distress characterized by pervasive mistrust and suspiciousness of others. B. Self-care Borderline personality disorder is characterized by a pervasive pattern C. Sexual expression of unstable interpersonal relationships, self-image, and affect as well as D. Budgeting marked impulsivity. Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and lack of Answer: A empathy. Rationale: The treatment of individuals with a personality disorder often focuses on mood stabilization, decreasing 4. Which of the following is a psychosocial explanation for the impulsivity, and developing social and relationship skills. In development of personality disorders? addition, clients perceive unmet needs in a variety of areas, A. Highly self-directed people reflect uncooperativeness and such as self-care (keeping clean and tidy); sexual expression intolerance. (dissatisfaction with sex life); budgeting (managing daily B. Cooperative people become increasingly helpless over time. finances); psychotic symptoms; and psychological distress. C. Failure to complete a developmental task jeopardizes Typically psychotic symptoms and psychological distress are future personality development. often the only areas addressed by health-care providers. D. Self-transcendence contributes to self-consciousness and materialism. 9. After the initial interview and small talk with the nurse, Bernard tells the nurse, “I feel so comfortable talking with Answer: C you. You seem to have a special way about you that really Rationale: Failure to complete a developmental task jeopardizes the helps me.” Which would be the most appropriate response by person's ability to achieve future developmental tasks. Self-directed the nurse? people are realistic and effective and can adapt their behavior to A. “I'm glad you feel comfortable with me.” achieve goals. Highly cooperative people are described as empathic, B. “I'm here to help you just as all the staffs tolerant, compassionate, supportive, and principled. People low in self- are.” directedness are helpless and unreliable. Self-transcendence describes C. “You feel others don't understand you?” the extent to which a person considers himself or herself to be an D. “I cannot be your friend. We need to be clear on integral part of the universe. that.” 5. The nurse teaches an antisocial client to take a time-out in his room Answer: B when challenged by another person instigating an argument. What is Rationale: For the borderline personality disorder client, the main reason for the time-out? personal boundaries are unclear, and clients often have A. It allows time for the instigator to leave the area. unrealistic expectations. Clients easily can misinterpret the B. It allows adequate space between the client and the nurse's genuine interest and caring as a personal friendship, instigating individual. and the nurse may feel flattered by a client's compliments. C. It prevents the client from experiencing negative The nurse must be quite clear about establishing the consequences of behavior. boundaries of the therapeutic relationship to ensure that D. It allows an opportunity for the client to regain neither the client's nor the nurse's boundaries are violated. control of emotions. 10. When establishing a relationship with Bernard who has borderline personality disorder, which is most important for the nurse to D. Narcissistic personality disorder do? E. Obsessive-compulsive personality disorder A. Aggressively confront the client about boundary violations. B. Limit interactions to 10 minutes at a time. Answer: A, C, D C. Respect the client's boundaries at all times. Rationale: Schizotypal personality disorder is characterized by D. Tell the client the relationship will last as long as the client a pervasive pattern of social and interpersonal deficits marked wishes. by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions Answer: C and behavioral eccentricities. Borderline personality disorder Rationale: Clients with borderline personality disorder have issues with is characterized by a pervasive pattern of unstable boundaries; by respecting the client's boundaries, the nurse can assist interpersonal relationships, self-image, and affect as well as the client to develop better boundary control. marked impulsivity. Antisocial personality disorder is characterized by a pervasive pattern of disregard for and 11. Which of the following is a realistic outcome for the care of a person violation of the rights of others, and with the central with a personality disorder? characteristics of deceit and manipulation. Narcissistic A. Outcomes that focus on satisfaction with daily life personality disorder is characterized by a pervasive pattern of B. Outcomes that focus on the client's perception of others grandiosity, need for admiration, and lack of empathy. C. Outcomes that focus on increased client insight Obsessive-compulsive personality disorder is characterized by D. Outcomes that focus on change in behavior a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the Answer: D expense of flexibility, openness, and efficiency. Rationale: The treatment focus often is behavioral change. Although treatment is unlikely to affect the client's insight or view of the world and others, it is possible to make changes in behavior. SELECT ALL THAT APPLY 12. Which challenges are posed when working with clients with personality disorders? Select all that apply. A. Clients with personality disorders are obviously unable to function more effectively. B. It can take a long time to change their behaviors, attitudes, or coping skills. C. The nurse can easily but mistakenly believe the client simply lacks motivation or the willingness to make changes. D. Clients with personality disorders challenge the ability of therapeutic staff to work as a team. E. Team members may have differing opinions about individual clients. Answer: B, C, D, E Rationale: It can take clients with a personality disorder a long time to change their behaviors, attitudes, or coping skills; and nurses working with them easily can become frustrated or angry. The nurse can easily but mistakenly believe the client simply lacks motivation or the willingness to make changes because clients with personality disorders look as though they are capable of functioning more effectively. Clients with personality disorders challenge the ability of therapeutic staff to work as a team. Team members may have differing opinions about individual clients. 13. The nurse is planning the type of approach that will be most effective in developing a therapeutic relationship with the client. The nurse should use a matter-of-fact approach with clients with which types of personality disorders? Select all that apply. A. Paranoid B. Antisocial C. Schizotypal D. Narcissistic E. Avoidant Answer: A, B, D Rationale: Paranoid, antisocial, and narcissistic personalities need a serious, straightforward approach that includes limit setting and a matter-of-fact approach. Schizotypal personalities need to improve community functioning through social skills training. Avoidant personalities require support and reassurance to promote self-esteem. 14. Which are important in the limit-setting technique to deal with manipulative behavior? Select all that apply. A. Stating the behavioral limit B. Identifying the consequences if the limit is exceeded C. Identifying the expected or desired behavior D. Providing choices E. Allowing flexibility Answer: A, B, C Rationale: Limit setting is an effective technique that involves three steps: 1. Stating the behavioral limit (describing the unacceptable behavior) 2. Identifying the consequences if the limit is exceeded 3. Identifying the expected or desired behavior. Providing choices and allowing flexibility would be counterproductive as the expectations must be consistent. 15. Of the following personality disorders, which are most likely related to lack of caring about others? Select all that apply. A. Schizotypal personality disorder B. Borderline personality disorder C. Antisocial personality disorder  ANSWER KEY C. Tell the child he should wait and ask the doctor his Developmental Milestones questions. D. Tell the child that she will answer his questions at a 1. The nurse determines that a 7-month-old infant is developmentally later time. delayed when the infant A. Is unable to sit unsupported for brief periods. Answer: A B. Is unable to crawl to get a toy. Rationale: The child is taking the initiative to ask questions, C. Frequently rolls from back to stomach. as all preschoolers do, and the nurse should always answer D. Grasps the bottle and brings it to his mouth. those questions as appropriately and accurately as possible. A book illustrating what will happen to the child may help him, Answer: A but it will not encourage his intellectual initiative (Choice B). Rationale: At 7 months, an infant should be sitting with minimal By not answering the child’s questions, the nurse may be support. The ability to sit is one of the most important milestones in stifling his sense of initiative (Choice C and D). development. The other options are either already mastered at an earlier age or are expected at an older age: Crawling is not expected 7. The mother of an adolescent complains that he has had until 8–9 months; rolling in both directions should have been mastered some recent behavioral changes. He comes home from school between 4 and 6 months; grasping a bottle to feed is evident by 6 every day, closes his door, and refrains from interaction with months. his family. The nurse’s best response to the mother is: A. “You should speak with your son and ask him 2. Considering the toddler’s developmental stage, the most effective directly what is wrong with him.” method to encourage adequate nutritional intake following an acute B. “You should set limits with your son and tell him illness is to offer a variety of that this is unacceptable behavior.” A. Semisoft foods at designated meal times. C. “Your son’s behavior is abnormal, and he is going B. Finger foods at frequent intervals. to need a psychiatric referral.” C. Pureed foods made in the blender. D. “Your son’s behavior is normal. You should D. The child’s favorite foods four times a day. listen to him without being judgmental.” Answer: B Answer: D Rationale: The developmental stage for toddlers is the autonomy stage. Rationale: The child’s behavior is typical of a teen’s response The child wants to do things for himself and will respond well to finger to developmental and psychosocial changes of adolescence. foods offered frequently, not just at designated mealtimes (Choice A). If The child does not need a psychological referral at this time the child will eat a variety of nutritious finger foods, the nutritional (Choice C). Setting limits may also help in children, however, status will be reestablished more effectively. Blenderized (Choice C) it does not address the reason for his behavioral changes foods may or may not be accepted. Offering any foods that the child (Choice B). Confrontation does not help in this case because desires at meals may not meet the nutritional requirements (Choice D). he may feel as though the parents are being judgmental, and Also, frequent feeding of nutritional foods throughout the day works he will likely not want to communicate with them (Choice A). best for toddlers’ erratic eating habits. 8. A 9-year-old girl builds a clubhouse in her backyard. She 3. The nurse teaches the mother that the best method to prevent hangs a sign outside her clubhouse that has “No boys childhood poisoning is to allowed” printed on it. The child’s parents are concerned that A. Keep her purse out of the child’s reach. she is excluding their neighbor’s son, and they are upset. B. Never refer to medicines as candy. What should the school nurse tell the child’s parents? C. Keep all cabinets locked at all times. A. Her behavior is cause for concern and should be D. Store medicine only in high cupboards. addressed. B. Her behavior is common among school-age Answer: C children. Rationale: The other answers are also necessary information but C. Her feelings about boys will subside within the next keeping all cabinets locked is critical. It is not enough to keep medicine year. only in high cupboards (Choice D) because other products, such as D. They should have their daughter speak with the cleaning materials, can be poison. school counselor. 4. During the hospitalization of a 14-month-old toddler, the parents Answer: B have spent time at the bedside. When the parents returned home, the Rationale: It is common and normal among school-age toddler begins screaming and throwing things out of the crib. In this children to prefer to have friends of the same gender. situation, the most effective nursing action is to A. Turn on a child’s program on the TV as a distractor. SITUATION. Remelie, a mother of two toddlers, is B. Ignore the crying and wait until the child wears himself out. concerned on how to properly take care of them. She C. Stay in the room, talking and trying to comfort the toddler. approaches her friend, Nurse Lindsay, to seek advices D. Call the parents and ask them to return to the regarding the care of toddlers. hospital. 9. At mealtime, Remelie’s children are known to: Answer: D A. generally try a variety of different foods willingly. Rationale: The most effective action is to call the parents to return, if B. only eat commercially prepared, pureed baby food. possible. Currently, parents are encouraged to stay with the child C. sit in his high chair for long periods of time. around the clock. No one can take the place of the parents with acute D. be served approximately 1 ton of food per separation anxiety of this child (most acute between 9 and 18 months year of life. of age). The second choice is for the nurse to try to comfort the child. While the nurse cannot take the place of his parents, the nurse can be Answer: D comforting. The more time the nurse is with the child, the more trust Rationale: Serving size should be approximately 1 ton of solid develops. food per year of age (or one-fourth to one-third the adult portion size) so the child isn’t overwhelmed with larger 5. The nurse expects that the 1-month-old infant will be able to portions. A. Actively follow movements of familiar persons with the eyes. 10. To help prevent aspiration of foods, Remelie should avoid B. Respond to “No, No.” cooking and feeding: C. Turn the head toward a familiar noise. A. Small pieces of cooked, lean meat D. Discriminate between family and strangers. B. Round chunks of meat such as hot dogs C. Cooked vegetables, such as lima beans and corn Answer: A D. Frozen desserts such as ice cream Rationale: Actively following movements with the eyes occurs at 1 month. Responding to “No” (Choice B) and turning the head in Answer: B response to a noise (Choice C) begins at 4 months, and discrimination Rationale: To help prevent aspiration, avoiding large, round between family and strangers (Choice D) appears at 5–6 months of age chunks of meat such as hot dogs is advisable. (Slicing them into short, lengthwise pieces is a safer option.) 6. What can a nurse do to reinforce a 5-year-old’s intellectual initiative when he asks about his upcoming surgery? 11. When one of Remelie’s kids are playing, they’ll most A. Answer the child’s questions about his upcoming likely: surgery in simple terms. A. play with similar objects near, rather than B. Provide the child with a book that has vivid illustrations about with, another child. his surgery. B. become more interactive with children around him.  C. willingly share his toys with other children. D. play with one toy for a while because of his long attention span. Answer: A Rationale: During the toddler stage, children typically play with others without actually interacting. In this type of parallel play, children play side-by-side, usually with similar objects. SELECT ALL THAT APPLY 12. Which stressor is common in hospitalized toddlers? Select all that apply. A. Social isolation. B. Interrupted routine. C. Sleep disturbances. D. Self-concept disturbances. E. Fear of being hurt. Answer: B, C, E Rationale: Common stressors of a hospitalized toddler include interrupted routine, sleep pattern disturbances, and fear of being hurt. Social isolation (Choice A) and self-concept disturbances (Choice D) are stressors of a hospitalized teen. 13. The nurse realizes that a 3½-year-old’s mother needs further education about the Metro Manila Developmental Screening Test when she states: (Select all that apply) A. “It screens for gross motor skills.” B. “It screens for fine motor skills.” C. “It screens for intelligence level.” D. “It screens for language development.” E. “It screens for school readiness.” Answer: C, E Rationale: The Metro Manila Developmental Screening Test or MMDST evaluates children from 1 month to 6 ½ years of age and is used to screen gross and fine motor skills, language development, and social development. It does not screen for intelligence level (Choice C) and school readiness (Choice E). 14. Which statements would indicate to the nurse that a school-age child is not developmentally on track for age? Select all that apply. A. The child is able to follow a four- to five-step command. B. The child started wetting the bed on admission to the hospital. C. The child has an imaginary friend named Kelly. D. The child enjoys playing board games with her sister. E. The child is not able to follow rules. Answer: C, E Rationale: Most school-age children do not have imaginary friends (Choice C) and understand the rules and its consequences if not being obeyed (Choice E). 15. Which statements by an infant’s mother lead the nurse to believe that she needs further education about the nutritional needs of a 6- month-old? Select all that apply. A. “I will continue to breastfeed my son and will give him oatmeal cereal two times a day.” B. “I will start my son on fruits and gradually introduce vegetables.” C. “I will start my son on carrots and will introduce one new vegetable every few days.” D. “I will not give my son any more than 4 to 6 ounces of baby juice per day.” E. “I will make sure my son gets cereal three times a day.” Answer: B, D, E Rationale: It is essential to introduce new foods one at a time to determine whether a child has any allergies. Infants must be started on vegetables prior to giving fruits as the fruits’ sweetness may inhibit infants from taking vegetables (Choice B). Infants may also be given fruit juice, but it is recommended not to exceed 6 ounces per day (Choice D). They may also be introduced to cereal as another source of iron, however, they must take it twice a day (Choice E).  ANSWER KEY Developmental Theories SITUATION. Nurse Ronald is taking care of children 1. According to developmental theories, which important event is admitted in the Pediatric Ward at Cebu City Medical Center. essential to the development of the toddler? He intends to use what he learned at nursing school and A. The child learns to feed self. apply it to the care of hospitalized pediatric clients. B. The child develops friendships. C. The child learns to walk. 7. Which activity can Nurse Ronald provide for a 9-year-old to D. The child participates in being potty-trained. encourage a sense of industry? A. Allow the child to choose what time to take his Answer: D medication. Rationale: Developmental theorists such as Erickson and Freud believe B. Provide the child with the homework his that toilet training is the essential event that must be mastered by the teacher has sent. toddler C. Allow the child to assist with his bath. D. Allow the child to help with his dressing change. 2. A 3-year-old child in a daycare program is seen playing with his toys in the playroom. Which actions, according to the cognitive theory, is Answer: B aligned with his cognitive level at this age? Rationale: The school-age child is focused on academic A. He is able to classify and collect different kinds of blocks performance; therefore, the child can achieve a sense of B. He recognizes his external environment as different from industry by completing his homework and staying on track himself with his classmates. C. He does not allow his playmates to borrow his dinosaur toy 8. A 16-year-old is having a discussion with Nurse Ronald D. He starts to use his body reflexes about the teen’s recent diagnosis of lupus. In explaining the child’s prognosis, the nurse uses the knowledge that Answer: C adolescents are: Rationale: A 3-year-old child is expected to have a concept of A. Preoccupied with thoughts of the here and now. ownership but is not willing to share their items, which is a common B. Able to understand and imagine possibilities manifestation in the Preoperational level. for the future. C. Capable of thinking only in concrete terms. 3. A 16-year-old male is hospitalized for cystic fibrosis. He will be D. Overly concerned with past events and admitted for 2 weeks while he receives IV antibiotics. Which action relationships. taken by the nurse will most enhance his psychosocial development? A. Fax the teen’s teacher and have her send in his homework. Answer: B B. Encourage the teen’s friends to visit him in the Rationale: Adolescents are becoming abstract thinkers and hospital. are able to imagine possibilities for the future. They are not C. Encourage the teen’s grandparents to visit frequently. preoccupied with past events and also do not think in D. Tell the teen he is free to use his phone to call or text friends. concrete terms. Answer: B 9. How can Nurse Ronald best facilitate the trust relationship Rationale: Teens are most concerned about being like their peers. between infant and parents while the infant is hospitalized? Having the teen’s friends visit will help him feel he is still part of the The nurse should: school and social environment A. Encourage the parents to remain at their child’s bedside as much as possible. 4. Which comment should the parent of a 2½-year-old expect from the B. Keep parents informed about all aspects of their toddler about a new baby brother? child’s condition. A. “When the baby takes a nap, will you play with me?” C. Encourage the parents to hold their child as B. “Can I play with the baby?” much as possible. C. “The baby is so cute. I love him.” D. Advise the parents to participate actively in their D. “It is time to put him away so we can play.” child’s care. Answer: D Answer: C Rationale: This is a typical statement that would be made by a toddler. Rationale: Having parents hold their child while in the hospital Toddlers are very egocentric and do not consider the needs of the other is an excellent means of building the trust relationship. child, as per psychosocial development. Infants are most secure when they are being held, patted, and spoken to. 5. Freud identified stages of psychosexual development. Which of the following stages would a 5-year-old child most likely be experiencing, 10. The best method to explain a procedure to a hospitalized according to Freud’s theory? preschool-age child is to: A. Oral A. Show the child a pamphlet with pictures showing B. Anal the procedure. C. Phallic B. Have the 5-year-old next door tell the 4-year-old D. Latency about the experience. C. Demonstrate the procedure on a doll. Answer: C D. Show the child a video of the procedure. Rationale: In Freud’s psychosexual development theory, children aged 3 to 6 years are in the Phallic stage, where they become more aware of Answer: C their bodies, as well as gender differences. This stage is also associated Rationale: A 4-year-old child understands in very concrete with the Oedipus and Electra complexes. The Oral stage (0-1 year) and and simple terms. Therefore, medical play is an excellent Anal stage (1-3 years) precede the Phallic stage. The Latency period method for helping to understand the procedure. occurs after the Phallic stage (6-12 years), and the Genital stage begins in adolescence. 11. Which nursing action would help foster a hospitalized 3- year-old’s sense of autonomy? 6. Which statement accurately describes how the school nurse should A. Let the child choose what time to take the oral approach an 11-year-old to do a physical assessment? antibiotics. A. Ask the child’s parents to remain in the room during the B. Allow the child to have a doll for medical play. physical exam. C. Allow the child to administer her own dose of B. Auscultate the heart, lungs, and abdomen first. co-amoxiclav via oral syringe. C. Explain that the physical exam will not hurt. D. Let the child watch age-appropriate videos. D. Explain what the nurse will be doing in basic understandable terms. Answer: C Rationale: Allowing preschoolers to participate in actions of Answer: D which they are capable is an excellent way to enhance their Rationale: School-age children are capable of understanding basic autonomy. Medication administration, especially done orally, functions of the body and can understand what the nurse will be doing can be done by a preschooler to promote autonomy, if explained in basic terms. The child should be given the choice of however, a preschooler should not be allowed to choose having his parents present for the exam since school-age children value administration times. Other choices are a good way to occupy privacy (Choice A). The physical exam can be done via head-to-toe the child during hospitalization, but they do not enhance sequence (Choice B) and may hurt the child, thus it is not advised not autonomy. to promise that the exam will not hurt (Choice C). SELECT ALL THAT APPLY 12. Which of the following stages in Erikson’s psychosocial development theory are related to the early childhood years (ages 1 to 6)? Select all that apply. A. Trust vs. Mistrust B. Autonomy vs. Shame and Doubt C. Initiative vs. Guilt D. Industry vs. Inferiority E. Identity vs. Role Confusion Answer: B, C Rationale: According to Erik Erikson, the early childhood years encompass the stages of Autonomy vs. Shame and Doubt (ages 1-3), where children begin asserting independence, and Initiative vs. Guilt (ages 3-6), where children initiate activities and develop a sense of leadership and decision-making. Trust vs. Mistrust is the stage for infancy (0-1 year), Industry vs. Inferiority is for middle childhood (6-12 years), and Identity vs. Role Confusion occurs in adolescence (12-18 years). 13. According to Piaget’s theory of cognitive development, which abilities are characteristic of the Preoperational stage (ages 2-7)? (Select all that apply) A. Use of symbolic thinking B. Egocentrism C. Logical operational thought D. Conservation of mass E. Development of imagination Answer: A, B, E Rationale: In Piaget’s Preoperational stage, children engage in symbolic thinking, using language and imagination to represent objects. Egocentrism, where children view the world from their own perspective, is prominent. However, they lack logical operational thought and do not yet understand conservation (mass, volume, number). These logical skills develop in the Concrete Operational stage (ages 7-11). 14. Both Erikson and Freud proposed developmental theories with distinct stages. Which of the following correctly pairs Erikson’s psychosocial stages with Freud’s psychosexual stages during early childhood? Select all that apply. A. Trust vs. Mistrust – Oral B. Autonomy vs. Shame and Doubt – Anal C. Initiative vs. Guilt – Phallic D. Industry vs. Inferiority – Latency E. Identity vs. Role Confusion – Genital Answer: A, B, C, D Rationale: Erikson’s stages align with Freud’s in terms of age groupings and developmental tasks. Trust vs. Mistrust (0-1 year) aligns with the Oral stage, where infants depend on caregivers for feeding. Autonomy vs. Shame and Doubt (1-3 years) corresponds with the Anal stage, emphasizing self-control. Initiative vs. Guilt (3-6 years) aligns with Freud’s Phallic stage, where children explore initiative and personal identity. Industry vs. Inferiority (6-12 years) matches the Latency stage, where social and cognitive skills are developed. Identity vs. Role Confusion pertains to adolescence and is linked to Freud's Genital stage. 15. A 10-year-old child is in the Conventional level of Kohlberg’s stages of moral development. Which of the following moral behaviors are consistent with this stage? (Select all that apply.) A. Obeys rules to avoid punishment B. Seeks approval from peers by conforming to social norms C. Makes decisions based on societal rules and laws D. Considers universal ethical principles E. Understands the concept of a social contract Answer: B, C Rationale: Children in the Conventional level (typically ages 9-12) follow rules because they seek the approval of others and have internalized societal norms. They make moral decisions based on adherence to laws and social expectations. Avoiding punishment is more characteristic of the Preconventional level, while understanding universal ethical principles and social contracts occurs in the Postconventional level.  ANSWER KEY placing the bag on the patient’s bed is not hygienic. Home Visit & Bag Technique 7. During a home visit, the nurse performs a dressing change. 1. What is the primary purpose of the CHN bag technique in community Which item should be used to handle sterile dressing health nursing? materials from the public health bag? A. To reduce the amount of equipment nurses needed to carry A. Nothing, just the bare hands B. To prevent spread of infection B. Kidney basin C. To organize equipment for easier access C. Alcohol lamp D. To ensure the safety of the nurse during visits D. Sterile forceps Answer: B Answer: D Rationale: The primary purpose of the bag technique is to prevent or Rationale: Sterile forceps are used to handle dressing minimize the spread of infection. By ensuring the nurse's equipment materials to maintain sterility and prevent contamination. does not come into contact with potentially contaminated items in the Bare hands, even when washed, are not considered sterile, patient’s home, the technique helps control infection risks. Organizing and using forceps ensures a safer method of handling sterile equipment and ensuring the safety of the nurse are secondary benefits supplies during procedures. but are not the main focus of the technique (Choice C and D). 8. What is the reason for including paper lining inside the 2. How should the CHN bag be handled during a home visit? public health or CHN bag? A. Placed on the floor A. To protect the equipment from dust B. Kept closed and on a clean surface B. To make waste disposal easier after procedures C. Carried without regard to cleanliness C. To provide a clean surface on which to place D. Opened and scattered on one surface sterile items D. To save space inside the bag for other equipment Answer: B Answer: C Rationale: This is the correct handling method to prevent contamination Rationale: Paper lining is used to create a clean and sterile and maintain the sterility of the bag and its contents. Keeping it closed surface for placing items such as instruments and dressings until needed helps minimize exposure to potential contaminants. during the procedure. This helps maintain asepsis and 3. Which of the following items should NOT be stored inside the public prevents contamination of sterile supplies. The paper lining health or CHN bag during a home visit? serves to protect the items and ensure cleanliness during use. A. Sphygmomanometer SITUATION. Nurse Sabrina is assigned to conduct a home B. Sterile dressing visit to a family in a rural area of Cantipla, Cebu. Olivia, who C. Hand towel recently gave birth, requires follow-up care. Olivia and her D. Thermometers husband, Louis have their own unique approach to Answer: A postpartum care, often relying on traditional beliefs and Rationale: The sphygmomanometer and stethoscope are carried practices. separately and should not be placed inside the bag to avoid 9. In planning her home visit, what is the most important contamination. Other items like sterile dressings, hand towels, and factor Nurse Sabrina should consider? thermometers are typically stored in the CHN bag for use during the A. The family’s previous health issues visit. B. The patient’s individual needs and 4. Why is it important for the public health bag and its contents to be preferences well protected from contact with any article in the patient’s home? C. The distance from the clinic to the family’s home A. To prevent contamination of nursing equipment D. The availability of transportation for future visits B. To maintain the cleanliness of the patient’s home Answer: B C. To avoid disturbing the family during the visit Rationale: The most important factor is the patient’s D. To minimize the weight of the bag individual needs and preferences (B). This ensures that the Answer: A care provided is relevant and tailored to the specific Rationale: The primary reason for protecting the bag and its contents is circumstances of the family. While other factors are to prevent contamination. Nursing equipment needs to remain sterile or important, focusing on the patient's needs is fundamental to clean to ensure that it does not contribute to the spread of infection effective nursing care. within the home or to future patients. 10. What should Nurse Sabrina do first upon arriving at Olivia 5. What is the most appropriate action a nurse should take if the public and Louis’ home? health bag accidentally comes into contact with a contaminated surface A. Introduce herself and state the purpose of during a home visit? her visit A. Immediately disinfect the bag and continue the B. Begin assessing Mrs. Santos immediately procedure C. Inspect the living conditions of the home B. Discontinue the visit and return to the clinic D. Set up her equipment for the visit C. Notify the patient and proceed with caution Answer: A D. Leave the bag in the contaminated area and retrieve supplies Rationale: The first action should be to introduce herself and as needed state the purpose of her visit. Establishing rapport and Answer: A clarifying the purpose helps create a trusting environment Rationale: If the public health bag comes into contact with a before any assessments or care are provided. contaminated surface, the nurse should disinfect the bag immediately to 11. Olivia shares her concerns about their postpartum prevent the potential spread of infection. There is no need to practices and is eager for Nurse Sabrina to provide guidance discontinue the visit unless the contamination cannot be managed, but on the appropriate care for herself and her infant. She is proper disinfection is crucial to maintaining sterile conditions (Choice B). particularly interested in learning about proper breastfeeding 6. Which of the following is a fundamental principle of the bag techniques and infant hygiene. What steps should Nurse technique that guides the nurse’s actions during a home visit? Sabrina take to ensure effective health teaching during her A. The bag should always remain open to allow easy access to visit? supplies A. Use medical jargon to explain postpartum care B. The nurse should always wash their hands before and B. Demonstrate breastfeeding techniques and after handling items from the bag infant hygiene practices using a doll C. Equipment should be replaced with new supplies after each C. Provide written materials in English only visit, regardless of usage D. Conduct the teaching session without involving D. The bag should be placed directly on the patient’s bed for family members easy access during care Answer: B Answer: B Rationale: Demonstrating breastfeeding techniques and infant Rationale: Hand hygiene is a fundamental principle in the bag technique care using a doll allows for practical, hands-on learning that to prevent cross-contamination. The nurse should always wash their can be easily understood. Medical jargons or terminology hands before and after handling any items from the bag. Keeping the should be avoided since clients may not be familiar with it, bag open is not advisable as it increases contamination risks, and making it harder for them to understand information (Choice A). Providing materials in English language may be ineffective. It would be better to provide education in a language where they can fully understand (Choice C). Involving the family in the teaching process and using culturally relevant materials is key to effective health education (Choice D). SELECT ALL THAT APPLY 12. Which items should Nurse John include in his CHN bag for a home visit? A. Personal snacks B. Disposable syringes and needles C. Hand soap in a dish D. Handkerchief E. Sterile dressings Answer: B, C, E Rationale: Disposable syringes are used for vaccinations and any injections. Hand soap is necessary for maintaining hygiene during the visit. Sterile dressings are important for wound care. Personal snacks and handkerchief are not relevant to patient care, therefore should not be included in the CHN bag (Choice A and D). 13. Which of the following statements about the organization of the bag's contents are true? A. Arrange items by type for easy access. B. Place frequently used items at the bottom. C. Use labeled compartments if available. D. Keep similar items together for clarity. E. Mix items randomly to save space. Answer: A, C, D Rationale: Arranging by type helps in quick retrieval during emergencies and saves time. Labeling enhances efficiency and organization. Keeping similar things together speeds up access to needed resources. Frequently used items should be accessible (Choice B). Mixing things randomly is counterproductive and may delay provision of care (Choice E). 14. Which of the following are essential components of a successful home visit? A. Greeting the patient and introducing oneself. B. Stating the purpose of the visit clearly. C. Ignoring the patient's family dynamics. D. Performing assessments based on the patient's needs. E. Documenting observations and care provided. Answer: A, B, D, E Rationale: Introducing oneself establish rapport and builds trust. Stating the purpose of the visit clarifies the objectives of the home visit. Performing assessments based on needs ensures that the care being provided is aligned with their needs. Documenting observations provides records for reference. Ignoring family dynamics would not be helpful and can significantly affect patient care (Choice C). 15. Which factors should a nurse consider when determining the frequency of home visits? A. The patient’s physical and psychological needs. B. The family’s willingness to cooperate. C. The nurse’s personal schedule and convenience. D. Whenever the patient and the nurse like E. The family’s ability to recognize their own needs. Answer: A, B, E Rationale: Understanding patients’ needs ensure comprehensive care and determines the needed frequency of visits. The family’s readiness to engage with services can influence the effectiveness of care and the need for regular visits. Ability to recognize their own needs can affect how often they require visits and how much support they may need to utilize community resources. While scheduling is important, the focus should primarily be on the needs of the patient and family, not on the nurse's convenience and preference (Choice C and D).  ANSWER KEY D. Alcohol Traditional & Alternative Medicine Answer: D 1. Which is the primary goal of Traditional Medicine Act or RA 8423? Rationale: Tinctures are typically made using alcohol as the A. To integrate the use traditional and alternative solvent, as it effectively extracts a wide range of active medicines into the national healthcare system constituents from the plant material. B. To limit the practice of traditional healers in rural areas C. To decrease the sales of synthetic medicines SITUATION. A community health nurse is conducting a D. Focus solely on herbal medicines health education session in a rural village. The focus is on the Answer: A use of traditional medicinal plants for common ailments. Rationale: The Traditional and Alternative Medicine Act (RA 8423) aims 9. Anna, a resident in the village asks the nurse which to promote and ensure safe and effective use of traditional and preparation method is most suitable for extracting the alternative medicines, alongside modern healthcare approaches, to medicinal properties of Sambong leaves? provide holistic and accessible care to Filipinos. It does not focus solely A. Infusion on herbal medicines (Choice D) or restrict the practice of traditional B. Poultice healers (Choice B) but rather encourages the regulation of both modern C. Tincture and traditional medicine (Choice C). D. Decoction 2. Which plant is known for its antifungal properties and is often used Answer: D for skin infections? Rationale: Sambong leaves are typically decocted due to their E. Akapulko tough structure and the presence of essential oils and other F. Yerba Buena active compounds that are more effectively extracted through G. Ampalaya boiling. H. Lagundi Answer: A 10. Jolina, a community resident, shares her worries about Rationale: Akapulko or “Ringworm bush” is traditionally used for its her child's diarrhea and asks the nurse for recommendations antifungal effects, making it effective against skin infections like on medicinal plants that could help. What medicinal plant can ringworm. you recommend to her? A. Akapulko 3. What health benefit is Ampalaya (bitter gourd) primarily associated B. Ulasimang bato with? C. Tsaang gubat A. Improving digestion D. Yerba Buena B. Lowering blood sugar levels Answer: C C. Treating respiratory issues Rationale: Tsaang Gubat is effective in treating diarrhea due D. Reducing inflammation to its astringent and anti-inflammatory properties. The leaves Answer: B contain compounds that help tighten the intestinal walls, Rationale: Ampalaya or “bitter gourd” is widely recognized for its ability reducing the frequency and volume of bowel movements. to lower blood sugar levels, making it beneficial for managing diabetes. Additionally, Tsaang Gubat has antimicrobial properties that can help combat infections in the gastrointestinal tract, which 4. Which of the following plants is commonly used to relieve cough and are often a cause of diarrhea. asthma symptoms? 11. The community leader, Draco, expresses his worries A. Lagundi about the growing number of children in their community B. Bawang with intestinal worms and asks which medicinal plant could be C. Bayabas used. As the nurse, what would you recommend for him to D. Ulasimang bato give? Answer: A A. Bawang Rationale: Lagundi is recognized for its ability to relieve cough and B. Ampalaya respiratory conditions, making it a go-to remedy for asthma symptoms. C. Niyog-niyogan D. Bayabas 5. Bayabas leaves are often used for which of the following? Answer: C A. Skin whitening B. Wound healing Rationale: Niyog-niyogan helps improve digestive health and C. Hair loss prevention may reduce inflammation in the gut, creating an environment D. Anxiety relief that is less hospitable to parasites. Answer: B 12. The nurse informs the community about the benefits of Rationale: Bayabas or guava leaves are traditionally utilized for their garlic, or bawang, highlighting its ability to lower blood antimicrobial properties, making them effective for wound healing and pressure and relieve toothaches. A resident asks about the toothache. best way to prepare it. How should the nurse respond? A. Infusion 6. What part of the Akapulko plant is primarily used for medicinal B. Decoction purposes? C. Tincture A. Roots D. Poultice B. Flowers C. Bark Answer: D D. Leaves Rationale: When garlic is crushed and applied as a poultice, it Answer: D releases its potent antibacterial, anti-inflammatory, and Rationale: The leaves of the Akapulko plant are used for their antifungal analgesic properties, which can help relieve localized pain, properties, essential in treating skin conditions. reduce swelling, and fight infections. 7. What is the primary method for preparing a decoction? SELECT ALL THAT APPLY A. Steeping plant material in cold water B. Boiling plant material in water 13. All of the following herbal medicinal plants can be C. Soaking plant material in alcohol prepared through decoction except: Select all that apply. D. Blending plant material into a fine granule A. Sambong B. Akapulko Answer: B C. Niyog-niyogan Rationale: Decoction involves boiling plant materials, such as leaves, D. Bawang roots and bark, in water to extract their medicinal properties. E. Yerba Buena F. None of the above 8. What is the primary solvent used in tincture preparation? A. Water Answer: D B. Glycerin Rationale: All of the mentioned herbal medicinal plants can be C. Vinegar prepared through decoction except bawang. Boiling garlic would significantly reduce its therapeutic effects, especially its antimicrobial and anti-inflammatory properties. Instead, garlic is often used fresh in methods like crushing, making a poultice, or in tincture form (Choice D). 14. Yerba Buena (Mentha cordifolia) can be used to treat which of the following conditions? Select all that apply. A. Dysmenorrhea B. Fever C. Constipation D. Colds E. Skin rashes Answer: A, B, D Rationale: Yerba Buena contains analgesic and antispasmodic compounds that help relieve pain and reduce muscle spasms, making it effective for menstrual cramps. It has antipyretic properties, which help reduce body temperature. It works by promoting sweating, which aids in lowering a fever. Also, it has mild expectorant properties which help clear the respiratory tract by loosening mucus, making it easier to expel. 15. Which plants are commonly applied as a poultice for their medicinal properties? Select all that apply. A. Lagundi B. Bawang C. Akapulko D. Ampalaya E. Sambong Answer: B, C Rationale: Poultice is the pounding and grinding to extract juice from the plant, which is applied directly to the skin. Bawang and Akapulko are prepared as poultices because this method allows their active compounds to be directly applied to the affected area, providing localized treatment  ANSWER KEY D. New York, USA Primary Health Care Answer: B, Rationale: The Astana Declaration on Primary Health Care 1. How does Primary Health Care (PHC) differ from Primary care (PC)? was adopted in Astana, Kazakhstan on October 25-26, 2018. A. Primary Health Care addresses personal health services while Primary care addresses population-based public health 7. Which Letter of Instruction (LOI) marked a step in the systems. adoption of primary health care in the Philippines? B. The focus for the both of them is the family. A. LOI No. 121 C. Primary health care is community-based and requires B. LOI No. 949 active involvement by community in making health- C. LOI No. 494 related decisions while in Primary care, community D. LOI No. 994 participation is provider-directed. D. Neither of the two acknowledges the prevention and Answer: B promotion components of health Rationale: LOI No. 949, issued in 1981, was an important document in promoting primary health care in the Philippines. Answer: C This instruction emphasized the importance of integrating Rationale: PHC is community-based and driven and requires active primary health care into the country’s health system, focusing community participation in making decisions to improve health. PC, on on improving accessibility, equity, and community the other hand, is expert-driven and involves HCPs who advise participation in health services. individuals and communities about what is best for their health. Primary care addresses personal health services and not population-based public 8. The four (4) Pillars of Primary Health Care include all of the health services (Choice A). The focus of PHC is the community or following except: aggregates, while PC’s focus is more of the individual or the family A. Active community participation (Choice B). PHC and PC also have similarities. Both acknowledge the B. Inter-sectoral linkages only prevention and promotion components of health and well-being (Choice C. Use of appropriate technology D). D. Support mechanisms made available 2. What was the primary goal of the First International Conference on Answer: B Primary Health Care? Rationale: The four (4) pillars or cornerstones of PHC include A. To establish health insurance programs active community participation, multi-sectoral linkages, use of B. Promote medical advancements appropriate technology and support mechanisms made C. Focus on secondary and tertiary health care services available. Active community participation is the main CHN D. A key to achieve “Health for All” element. Multi-sectoral linkages include intra-sectoral (within DOH) and intersectoral (outside DOH) involvement. Use of Answer: D appropriate technology involves using traditional medicines Rationale: The primary objective of the First International Conference that is safe for the clients. on Primary Health Care (Option C) held in Alma-Ata in 1978 was to endorse primary health care as a key to achieving "Health for All." The conference aimed to emphasize the importance of primary health care SITUATION. Nurse Ellen The Generous, is a community in improving health outcomes and achieving global health equity. health nurse working in the rural area of Cebu. The local health center where she is working, is implementing a new 3. Which declaration emerged from the First International Conference of PHC initiative aimed at improving maternal and child health. PHC and became a cornerstone for global health policy? During a home visit in one of the far-flung areas in the A. Geneva Declaration mountains, Nurse Ellen meets Ariana, a pregnant woman in B. Alma-Ata Declaration her second trimester. Ariana is not attending prenatal check- C. Helsinki Declaration ups and lacks knowledge regarding pregnancy and infant D. New York Declaration care. You also noticed that the local health workers are trained in providing antenatal care but are struggling with Answer: B reaching families in the far-flung areas. Rationale: The declaration that emerged from the First International Conference of PHC and became a cornerstone for global health policy is 9. What is the most appropriate immediate action to take the Alma-Ata Declaration. This declaration outlined the principles and during your home visit with Maria? goals of primary health care and set a framework for achieving A. Refer Ariana to a larger hospital in the city universal health coverage. B. Arrange a follow-up appointment with a physician C. Provide Maria with basic information about 4. When did the Philippines formally adopt the principles of primary pregnancy and the importance of regular health care into its national health strategy? prenatal check-ups A. 1978 D. Inform Ariana that she must go to a health center B. 1982 every two weeks and the barangay health worker C. 1986 will educate her D. 1988 Answer: C Answer: A Rationale: The most appropriate immediate action is to Rationale: Philippines is the first Asian country that adopted PHC. The provide Maria with basic information about pregnancy and the Philippines formally adopted the principles of primary health care importance of regular prenatal check-ups. This aligns with the following the Alma-Ata Declaration in 1978. The country began principle of health education and promotion in primary health integrating primary health care principles into its health policies and care, aiming to empower individuals with knowledge to strategies in the years following this declaration. improve their health. 10. What should be the focus when providing services to 5. Which declaration, adopted in 2018, reaffirmed the principles of the Ariana and other community members? Alma-Ata Declaration and emphasized the importance of primary health A. Offering specialized hospital treatments that require care in achieving Universal Health Coverage (UHC)? advanced technology A. Helsinki Declaration B. Providing basic, essential health services B. Astana Declaration such as prenatal care and health education C. Paris Declaration C. Limiting services to only those who can afford them D. New York Declaration D. Focusing solely on improving emergency care services Answer: B Rationale: The Astana Declaration, adopted in 2018, reaffirmed the Answer: B principles of the Alma-Ata Declaration and highlighted the critical role of Rationale: The focus should be on providing basic, essential primary health care in achieving Universal Health Coverage (UHC) and health services such as prenatal care and health education. improving global health outcomes. In the primary health care context, the goal is to offer accessible, affordable, and essential services that address 6. Based on the above scenario (Question No. 5), where was this common health needs and promote overall health, especially declaration adopted? in underserved areas just like in Ariana’s community. A. Helsinki, Finland B. Astana, Kazakhstan 11. As a community health nurse, how can Nurse Ellen C. Paris, France evaluate the effectiveness of the health education provided to Ariana and other community members? Rationale: Health services should be attainable or achievable, A. By evaluating changes in knowledge and health which means individuals should be able to get the care that behaviors through follow-up visits they need. Services must be made easily reachable and B. By making counts of home visits made affordable for everyone. It should also be tailored to the C. By measuring the number of prenatal vitamins distributed cultural practices and beliefs of each community. The health D. By counting the number of brochures (regarding prenatal services provided should be in sufficient quantity and quality, health) given out in order to meet the health needs of individuals in the community. Answer: A Rationale: The effectiveness of the health education can be evaluated by assessing changes in knowledge and health behaviors through follow-up surveys. This method provides insight into whether the education has led to improved understanding and practices related to health. 12. What is a key challenge Nurse Ellen might encounter when coordinating with local health workers to implement this PHC initiative, and how could it be addressed? A. Challenge: Limited communication; Solution: Implement regular meetings and communication channels B. Challenge: High cost of specialized medical equipment; Solution: Invest in advanced medical technology C. Challenge: Excessive administrative paperwork; Solution: Reduce documentation requirements D. Challenge: Overreliance on internal funding; Solution: Seek additional grants Answer: A Rationale: In places like Ariana’s where it is difficult to be reached, having constant communication with their local health workers could be difficult. Indeed, limited communication is a key challenge, and it can be addressed by implementing regular meetings and communication channels. Effective coordination and collaboration are essential for the success of primary health care initiatives, and regular communication helps ensure that all team members are aligned and informed. SELECT ALL THAT APPLY 13. Which of the following are the goals and components of Primary Health Care? Select all that apply. A. Providing comprehensive and accessible health services B. Focusing primarily on secondary care C. Health promotion and preventive measures D. Ensuring community participation in health decision- making E. Decreasing health disparities among populations Answer: A, C, D, E Rationale: Providing essential and affordable health services is a core goal of Primary Health Care, making sure that all necessary services are delivered where the people are. Health promotion and preventive measures are important for empowering communities to manage their own health. Involving the community in making decisions about their health is important for the success of health programs. PHC aims to decrease health disparities or difference so that everyone can access necessary care. PHC is focused on primary and preventive care, not secondary care services (Choice B). 14. Which of the following are elements of Primary Health Care. Select all that apply. A. Essential medications and vaccines B. Expanded Programs of Immunization C. Environmental sanitation D. Advanced medical procedures and equipment E. Focused on secondary and tertiary care F. Health education Answer: A, B, C, F Rationale: The elements of PHC include health education, control of communicable diseases, EPI, locally-endemic disease control and prevention, environmental sanitation, maternal and child health and family planning, treatment of non-communicable disease, supply of medications, nutrition, mental health promotion, and use of hospitals. Advanced surgical procedures are not a primary focus of PHC, which emphasizes basic and essential health services (Choice D). PHC is centered on primary care services, not secondary and tertiary care, which deals with specialized and complex health needs (Choice E). 15. Which of the following are characteristics of Primary Health Care? Select all that apply. A. Attainable B. Affordable C. Available D. Acceptable E. Accessible Answer: A, B, C, D, E  ANSWER KEY D. Pseudomembrane formation in the throat Immunizable Diseases Answer: D Rationale: Pseudomembrane formation (grayish membrane 1. What is the causative agent of leprosy and how it is transmitted? formed in the back of the throat) is a classic sign of A. Mycobacterium leprae; primarily through respiratory droplets and prolonged close contact diphtheria, indicating infection caused by the diphtheria toxin. B. Mycobacterium leprae; primarily through direct skin contact C. Staphylococcus aureus; primarily through contaminated surfaces 7. Nurse Korra notices that a 4-year-old patient in her clinic D. Treponema pallidum; primarily through sexual contact has not yet received the recommended vaccine for diphtheria. What vaccine is used in preventing this disease in children? Answer: A A. MMR (measles, mumps, rubella) vaccine Rationale: Leprosy is caused by the bacterium Mycobacterium leprae, B. DPT (diphtheria, pertussis and tetanus) which is unique to humans and has a slow replication rate. It primarily vaccine spreads through prolonged close contact with an untreated person with C. Varicella (chickenpox) vaccine leprosy and respiratory droplets when an infected person coughs or D. Influenza vaccine sneezes. Understanding the mode of transmission is crucial for implementing effective infection control measures and educating Answer: B patients and communities about prevention strategies. Rationale: The DPT vaccine is specifically designed to protect against diphtheria, along with tetanus and pertussis. 2. Nurse Karen was able to assess a patient with leprosy. Upon assessment, which of the following findings would be considered a pathognomonic sign for th