CHN QUESTIONS:lMCl

SITUATIONS:Sinie the 1970s,the estimatedannual number of deaths among children less than 5 years old
has decreasedby almost a third. Providingquality care to sick children in these conditions is a
serious challenge.ln responseto this challenge,WHO and UNICEFdevelopeda strategy known
as IntegratedManagementof Childhood lllness (lMCl).

1. The core of the llt4Clstrategyis integratedcase managementof the mostcommonchildhoodproblems,with

a focuson the most importantcausesof death.Whichone is not a maincomponentin lfvlolstrategy?
A. lmprovementsin the case-management skillsof healthstaffthroughthb provisionof locallyadapted
guidelineson lMCl and throughactivitiesto promotetheir use
B. lmprovement of the public'sacceptanceol lMCl.
C. lmprovements in the healthsystemrequiradfor effectivemanagementof childhoodlllness
D. lmprovements in familyand communitypractices

2. The clinicalguidelines;whichare basedon expertclinicalopinionand researchresults,are desiqnedfor the

managementof :
A. Sickchildrenaged 1 week up to 5 years
B. Sickchildrenaged 1 monthup to 5 years
C. Sickchildrenaged 1 year up to 5 years
D. Sickchildrenaged 1 day up to 5 years

3. Whichof the followingis wrongaboutiMCt?

A. lntegratedcase managementrelieson casedetection
B . T h e t r e a t m e n t sa r e d e v e l o p e da c c o r d i n gt o a c t i o n o r i e n t e dc l a s s i f i c a t i o nrsa t h e rt h a n e x a c t
diagnosis.
C. The guidelinesgive instructions for how to routinelyassessa childfor generaldangersigns
D. The treatmentsare developedaccordingto diagnosisratherthan actionorieniedclassifications

4. ln the lMCl clinicalguidelines,

this measuresthe proportionor percentageof thosewiththe diseasewho are
correctlyidentifiedby the sign.
A. Specificity C. True positives
B. Sensitivily D. Falsepositives

5 This measuresthe proportionof those withoutthe diseasewho are correctlycalledfree of the diseaseby
usingthe llvlcl sign guidelines.
A. Specificity C. True positives
B. Sensitivity D. Falsepositives

SITUATION: Whenassessinga sick child,a combinationof individualsigns leadsto one or moreclassifications,

rather than to a diagnosis. lMCl classilicationsare action orientedand allow nurses and other
health care providers to determine if a child should be urgently referred to another health
tacility.

6. lMCl is a case managementprocessfor a first-level

facilitysuchas the following,except:
A. A hsalthcenter C. Hospitalpediatricward
B. An outpatientdepartmentof a hospital D. A clinic

7. The completelMCl case managementprocessinvolvesthe followingelements:

l. Assessa childby checkingfirstfor dangersigns
ll. Classifya child'sillnessesusinga colour-coded
triagesyslem.
lll. ldentifyspecifictreatmentsfor the child.
lV. Providepracticaltreatmentinstructions

A. t, , lll c. r, , lv
B . i r , l ,t v D . l , , r ,r v
8. FORALLSICKCHILDFIEN
age I weekupto 5 yearswhoarebrought
to theclinic,whatisthefirstinformation
that you needto ask?
A. Ask why the childwas broughtto the clinic C. Ask the child'sage
B. Ask for specificsignsand symptoms D. Ask for dangersigns

9 The case managementprocessfor sick childrenage 2 monthsup to 5 years is presentedon threecharts.

Whichcharttitleis not included?
A. Assess,classityand treatthe sjckyounginfant C. Counselthe mother
S. Assessand classifythe sickchild D. Treatthe child
 10. The lMcl case managementchartsand recordingformsguideyou throughthe
toflowingsteps:
A. Assessthe sick child or sick younginfant; Ctassidthe iilnebs;tOlntifytrealmen't;
Treatthe chitdor
younginfant; Counselthe mother; Givefollow_up care
B Assessthe sick child or sick young infant; classifythe illness; ldentifytreatment;'freat
the child or
younginfant;Give follow-upcare Counselthe mother;
c Assessthe sick childor sickyounginfant;Classifythe illness;Treatthe childor young
Inlant; tdentify
treatment;Give follow-upcare ; Counselthe mother.
D. Assessthe sickchildor sickyounginfant;Treatthe childor younginfant
; Classifythe iltness;ldentify
treatment;Counselthe mother; Givefollow-uocare

SITUATION: Slgns, classifications,treatmentsand counseling difter between

sick young infants and sick . ri:,..-,
children. lt is essentialto start the case managementprocess by selecting ",_."r
tie appropriateset
of lMCl charts

1l The ASSESSAND CLASSIFYchartdescribeshowto assessthe child,classifythe

child'sillnessesandidentify
treatments.This columncolumnon the Ieftside of the chartdescribeshow totake
a historyano do a physical
examination.
A. Assessand classifycolumn C. Assesscolumn
B. Classifycolumn D. ldentifycolumn
12. This columnmeansto make a decisionaboutthe severityof the illness.
A. Treatmentcolumn C. Assesscolumn
B. Classifycolumn D. ldentjfycolLrmn
l3 This partbf the assessand classilychart helpsyou to quicklyidentifytreatmentfor
the classificationswritten
on your case recordingform.Appropriate treatmentsare recommended for eachclassificatron.
A. Treatmentcolumn C. tOentity freatmeni cotumn:
B. Classifycolumn . D. ldentifycolumn
14' TREAT meansgivingtreatmentin clinic,preseribing drugsor othertreatmentsto be gjvenat home,and also
teachingthe caretakerhow to carryout the treatments.
What ttr,,tct
chartshowstrowtJ oo ttretreatmentsteps
identifiedon the firstchart?
A Treatthe childchart C. Treatmentchart
B: Assessand classifychart D. Intervention chart
l5 Recommendations on feeding,fluidsand when to returnare grvenon the charttifled:
A. Assessand classifychart C. Counselthe motherchart
B. Treatthe childchart D. Follow_up carechart
slTUATloN: The nurse needs to understandthe basic charts, tables and recording
lorms for the sick child
in tMCt.

16. ln l.MClprotocol,you can best see if the childis improvingon the drugor othertreatment
thatwas prescribed
throughthis activity:
A. Homevisit C. Clinicvisit
B. Follow-upvisit D. RHUvisit
17' What sectionof the chartin lMcl describesthe stepsfor conductingeachtypeof visitto follow-up
the child,s
condition?
A. Give follow-upcare section C. Assessandclassifysection
B. l\4other's counselingsection D. Treatthechildsection
.lS
Accordingto thischart,you shouldask the motheraboutthe child'sproblemand check
the chjldfor general
d a n g e rs i g n s .
A. Assessand classifythe sick childchart
B. Case recordingform
C. Assessmentchart
D. Classifyand treatthe childchart

19' Checkthe childfor generaloangersigns,commonsymptomsof the sick childand the mainproblem.

Which
of the followingis a not includedin the lMCl four mainsymptomsof a sick child?
A. coughor difficultbreathing C. fever
B. diarrhea D. easybruising
20 whichof thelofiowing
is notroutinely
checkedin a sickchildusingthe lMCrcharts?
A. malnutrition C. lmmunization status
B, anemia
 slTUATloN: A child who has one or mote of the maln symptoms could have a serious
illness, The serious
diseasescan cause death or disabillty in young children il they are not treated.

21. In assessingthe child,the nurseobserves.

good communication skills.One of thesesiatementsviotatedthe
guidelinesin the use of therapeutic
communication:
A. Listencarefullyto whatthe mothertellsyou
B. Use wordsthe motherunderstands
C. Give the mothertime to answerthe questions
D. Do not ask additionalqusstionswhenthe motheris not sure abouther answer
,,. -..,
.'.
22. A motherbringsher childto the clinic.The nursedeterminesif this is an initialvisit .I
or a follow-upvisit. lf it is
an initialvisitfor an identifledproblem:
4 Give follow-upcare C. Assessand classifythe chilo
B. Assessand treatthe child D. Assessand give healthteachrngs

23. lf thls is a follow-upvisitfor the problem:

A. Give follow-upcare C. Assessand classifythe chjld
B. Assessand treatthe child D. Assessand give healthteachings
?4. This columnon the left side of the chartdescribeshow to take a historyand do a physical
examination.
The
instructions
in thiscolumnbeginwith ask the motherwhatthe chird,spiobremsare
A. Assesscolumn C. Mother,sinterviewcolumn
B. Classifycolumn D. Ask column
25. When you see the mother,or the child,scaretaker,withthe sick child,you first:
A. Ask the motheraboutthe child
. B. Greetthe motherappropriately
C. Checkif the child'sweightand temperaturewere recorded
D. Assessthe child

SITUATIoN: when patientsarriveat most cllnics,ctinic staff identitythe reasonfor the

child's visit. Individual
record is made for each patient.

26' Mrs Tamia broughther two-year-oldson to the clinic.You noticedthat the child'sweightand ternperature
have not been measuredand r'corded.what wourdbe the nextbestacflonto take?
A. Weighthe childand take the temoerature
B. Ask the BHW to take the child'swejghtand temperature
C. Assessand classifythe child'smainsymptoms.
D. Ask the mother'sparticjpationin weighingthe child

27' You ask Mrs.Tamiawhatthe child'sproblemsare. The mainreasonfor askinga motherthe chitd,sproblem
at the start of the visit is:
A. To open good communication withthe mother.
B. To come up withstandardbaselinedata
C. To havean overviewof the child'sstatus
D. To be able to classifythe child'scondition

slTUATloN: Fatimais 18 months_old.Shewejghs 11,5kg, Hertemperatureis 37.5"C.The

healthworker asked,
"What are the child's problems?" The mother said';Fatima has been coughing for
6 days, and
. 6he is having trouble breathing."This is ttle initial vislt for thls illness.

28. t\4oving
downthe leftsideof the ASSESSAND CLASSIFychart,you finda boxti ed CHECKFORGENERAL
DANGERSIGNS.Ask the questionsand look for the clinicalsigns describedjn thjs box, which
one is not
includsd?
A. ts the childabteto drinkor breastfeed?
B. Doesthe chlldvomiteverything?
C. Has the childhad convulsions?
D. ls the childableto breathwithease?

29. Mrs' Tamiatellsyou that the childfallsasleepoften latelyand seldomdrinksfrom a cup when offeredwith
fluids.The nextnursingactionis to:
A. Ask moreaboutdiarrhea,leverand possible.ear problems
B. Completethe assessmentand any pre-referral keatmentimmediately
C. Checkfor malnutrition and anemia
D. Give the childfluidsand antibiotics
t 30. A childwho is breastfedmay havedilficultysuckingwhen his noseis blocked.lf the childcan breastfeedafter
the nos€ is cleared:
A. The child does not have the danger sjgn C. Fleassessthe child's sucking on the next feeding
B. The child still has a danger sign D. Offer fluids f rom a cup

Nilrs.Tamiaclaimsthat her childvomitedseveraltimesbut can holddownsome fluids.This is consioereot

A . A d a n g e rs i g n
B. Not a dangersign
i'"---
C. Moredata needed )r
D. A possibledangersign so try offeringsome food to furtherassessthe child.

32. The motheralsomentionedthat the lasttimethe childsulferedfromsejzurewas one and halfyearsago This
informationcan be classifiedas:
A. A dangersjgn C. A majorsymptom
8.. Not a dangersign withthe currentproblem D. A minorsymptom

33. l t t h e c h i l di s s l e e p i n g
a n d h a s c o u g ho r d i f l i c u lbt r e a t h i n g
A. countthe numberof breathsfirstbeforeyou try to wakethe chjld
B. countthe numberof breathsafterwakingthe child
C. Referthe childimmsdiatelyto the districthospital
D. lmmediately wake or shakethe child

SITUATION: NurseAnita,a public healthnurse,ia asse6sing 18-month-oldBonny with troubledbreathing.The

mothersaidthal Boonyis ableto drink.He has not beenvomiting.He has not hadconvulsionsduring
this illness' Nurse Anita asked,"Does he seem unusuallysleepy?"The mothersaid, ,,yes.',

34. NurseAnitaclappedhis hands.She askedthe motherto shakethe child.Bonnyopenedhis eyes,but did not
lookaround She talkedto Bonny,but he did notwatchher face.He staredblanklyand appearednotto notice
what was goingon aroundhim. NurseAnitais awarethat:
A. Bonnyneedsjmmediatereferral
' 8. Bonnyneedsmore rest
C, Bonnyis demonstraling a normalbehaviorof his age
D. Bonnycan be treatedwithinthe healthcenter

SITUATION: Gori, 3 years old is brought to the clinic due to fever, cough and difficulty of breathing. you
sugpect that this is a case pneumonia

3 5 . Your basic assessmentof Gorishouldinclude:

A. Lookingfor signsof ear infection
B. Lookingsignsof dehydratjon
C. All of these
D. Lookingfor intercostals
and subcostalretractions

36. Gori is diagnosedof havingpneumonia.you expecthis respiratory

rateto be:
A. 60 breathsper minute C. .40 breathsper minu,te
B. 50 breathsperminute D. 20 breathsperminute
37. Goriis on antibiotic
therapywhichof the fotlowingstatements
indicalesthattho motherneedsfurtherteaching?
A. "l can slop givingthe antibioticswhen he seemsbetter.,'
B. "He needsto finishthe 5 day treatmenteven if he seemsbetter.,,
C. "l'llcontlnuefeedingmy son as usualor add more if neededduringhrstrealment.,,
D. "l'll bringback my son to the healthcenterin 2 daysor soonerif his conditionworsens.,'

38. In orderto checkwhetherthe motherunderslands

andwillbe ableto carryoutthe instructions
givenher,which
of the followingwill you do:
A. Ask the motherto demonstrate what she has heard
B. Ask the motherto repeatthe jnstructions correctanv misinformatjon
C . A s k t h e m o t h e rw h a tp r o b l e m s h e m i g h th a v ei n g i v i n gt h e a n t i b j o t i c s
D . A n yo i t h e s e

SITUATION: A childwith coughor difficultbreathingmayharvepneumoniaor anothersevererespiratoryinfection.

Pneumoniais the leadingcauseof deathamong Filipinochildrenunder tive yearsold.

39. What are the two mostcommonclinicalsignsin classifyinga childunderpneumoniacategory?

A. Fast breathingand stridor C. Fastbreathingand rustysputum
B. Fast breathing.and chestindrawing D. Chestindrawingand flaringof the nares
 40. Fastbreathingin childrenwrthpneumoniacan be attributedtoj
A. StiffIungsand hypoxia C. Fluidaccumulation
B. Tsnacioussecretions D, Lungcollapse

41. when a two-yearchildwithlast breathingdevelopschestindrawing,he is classified under:

A. Nopneumonia C. Severspneumonia
B. Pneumonla D. Very severepneumonia

42. A childwho has had coughor dillicultbreathingfor more than 30 days has a chroniccough.This could be
indicativeot: '{-'
r
A. Pneumonia C . lnfluenza
B . S e v e r ep n e u m o n i a D. Asthmaor bronchitis
43. ol 37.7oC,resplratory
Mikha,12 monthsold, 12lbs,withTemperature rateof 40 breathsper minute,withcough
is presenting
with
A. Simplecoughand fever C. Feverand normalbreathing
B. Fastbreathing D. Nopneumonia

44. The nurseassessesMikhafor chestindrawing.The childhas chestindrawingii

A. the lowerchestwall goes lN whenthe childbreatheslN
B. the lowerchestwall goes lN whenthe childexhales
C. the lowerchestwall goesOUT whenthe childbreatheslN
D. the wholechestwall (upperand lower)and the abdomenmoveOUT whenthe childbreatheslN.

45. Chestindrawingis also knownas:

A. Subcostalretractions C. Diaphragmretractions
B. Intercostalsretractions D. AorB

46- To accuratelyassesslor stridor,the nursedoesall or any of the following,except:

A. Put your ear nearthe child,smouthbecausestrjdorcan be difficultto hear
B. lookto see whenthe childbreatheslN
C. Be sureto look and listentor stridorwhenthe childis calm.
Dl Ljsten10wheezingnoisewhenthe childbreathesOUT

SITUATION: There are three possible classificationsfor a child with cough or difficutt breathing;
Severepneumoniaor very severedisease,pneumonia,and no pneumonia:coughor cotd

47. Marikar,7 weeksold, was broughtby her motherto the healthcenterbecauseof highfever,cough,frequent
vomitingand one episodeof convulsion.
The nurseputsher chartor case recordunder:
A. Pinkor top row C. Greenor bottomrow
B. Yellowor secondrow D. Moreassessmentdataneeded
48. Consideringlvlarikar's
signsand symptomsand age, she is classjfiedunder:
A. No pneumoniacategory C. Severepneumoniacategory
B. Pneumoniacategory D. Very severedisease

49. Furtherassessmentof Marikarrevealedseverepalmarpallorand noteda 1 5 %w e i g h tl o s s .A s i d et r o mt h e

pneumoniaclassifications,
she is alsoclassifiedunder:
A. Anemiaand low weight C. No anemiaand very low weight
B, Severeanemia D. Severeanemiaand not very low weight

50. BeforereferringMikhato the hospital,the nurseadministers:

A. VltaminA and one doseof lM procainepenicillin200, O0OlU
B. VitaminA and flrstdoseof oralCotrimoxazole
C. VitaminA and one doseof IM procainepenici in 400,000 lU
D . V i t a m i nA a n do n e d o s eo f l M p r o c a i n ep e n i c i l l i n
1 0 0 , 0 0 0l U