1. A client asks the nurse what a third degree laceration is. She was informed that she 7.

7. Bettine Gonzales is hospitalized for the treatment of severe preecplampsia. Which

had one. The nurse explains that this is: of the following represents an unusual finding for this condition?

A. that extended their anal sphincter A. generalized edema

B. through the skin and into the muscles B. proteinuria 4+
C. that involves anterior rectal wall C. blood pressure of 160/110
D. that extends through the perineal muscle. D. convulsions
2. Betina 30 weeks AOG discharged with a diagnosis of placenta previa. The nurse 8. Nurse Geli explains to the client who is 33 weeks pregnant and is experiencing
knows that the client understands her care at home when she says: vaginal bleeding that coitus:

A. I am happy to note that we can have sex occasionally when I have no bleeding. A. Need to be modified in any way by either partner
B. I am afraid I might have an operation when my due comes B. Is permitted if penile penetration is not deep.
C. I will have to remain in bed until my due date comes C. Should be restricted because it may stimulate uterine activity.
D. I may go back to work since I stay only at the office. D. Is safe as long as she is in side-lying position.
3. The uterus has already risen out of the pelvis and is experiencing farther into the 9. Mrs. Precilla Abuel, a 32 year old mulripara is admitted to labor and delivery. Her
abdominal area at about the: last 3 pregnancies in short stage one of labor. The nurses decide to observe her
closely. The physician determines that Mrs. Abuel’s cervix is dilated to 6 cm. Mrs.
A. 8th week of pregnancy Abuel states that she is extremely uncomfortable. To lessen Mrs. Abuel’s discomfort,
B. 10th week of pregnancy the nurse can advise her to:
C. 12th week of pregnancy
D. 18th week of pregnancy A. lie face down
4. Which of the following urinary symptoms does the pregnant woman most B. not drink fluids
frequently experience during the first trimester: C. practice holding breaths between contractions
D. assume Sim’s position
A. frequency 10. Which is true regarding the fontanels of the newborn?
B. dysuria
C. incontinence A. The anterior is large in shape when compared to the posterior fontanel.
D. burning B. The anterior is triangular shaped; the posterior is diamond shaped.
5. Mrs. Jimenez went to the health center for pre-natal check-up. the student nurse C. The anterior is bulging; the posterior appears sunken.
took her weight and revealed 142 lbs. She asked the student nurse how much should D. The posterior closes at 18 months; the anterior closes at 8 to 12 months.
she gain weight in her pregnancy. 11. Mrs. Quijones gave birth by spontaneous delivery to a full term baby boy. After a
minute after birth, he is crying and moving actively. His birth weight is 6.8 lbs. What
A. 20-30 lbs do you expect baby Quijones to weigh at 6 months?
B. 25-35 lbs
C. 30- 40 lbs A. 13 -14 lbs
D. 10-15 lbs B. 16 -17 lbs
6. The nurse is preparing Mrs. Jordan for cesarean delivery. Which of the following C. 22 -23 lbs
key concept should the nurse consider when implementing nursing care? D. 27 -28 lbs
12. During the first hours following delivery, the post partum client is given IVF with
A. Explain the surgery, expected outcome and kind of anesthetics. oxytocin added to them. The nurse understands the primary reason for this is:
B. Modify preoperative teaching to meet the needs of either a planned or emergency
cesarean birth. A. To facilitate elimination
C. Arrange for a staff member of the anesthesia department to explain what to expect B. To promote uterine contraction
post-operatively. C. To promote analgesia
D. Instruct the mother’s support person to remain in the family lounge until after the D. To prevent infection
delivery.
 13. Nurse Luis is assessing the newborn’s heart rate. Which of the following would be 19. Baby boy Villanueva, 4 months old, was seen at the pediatric clinic for his
considered normal if the newborn is sleeping? scheduled check-up. By this period, baby Villanueva has already increased his height
by how many inches?
A. 80 beats per minute
B. 100 beats per minute A. 3 inches
C. 120 beats per minute B. 4 inches
D. 140 beats per minute C. 5 inches
14. The infant with Down Syndrome should go through which of the Erikson’s D. 6 inches
developmental stages first? 20. Alice, 10 years old was brought to the ER because of Asthma. She was
immediately put under aerosol administration of Terbutaline. After sometime, you
A. Initiative vs. Self doubt observe that the child does not show any relief from the treatment given. Upon
B. Industry vs. Inferiority assessment, you noticed that both the heart and respiratory rate are still elevated and
C. Autonomy vs. Shame and doubt the child shows difficulty of exhaling. You suspect:
D. Trust vs. Mistrust
15. The child with phenylketonuria (PKU) must maintain a low phenylalanine diet to A. Bronchiectasis
prevent which of the following complications? B. Atelectasis
C. Epiglotitis
A. Irreversible brain damage D. Status Asthmaticus
B. Kidney failure 21. Nurse Jonas assesses a 2 year old boy with a tentative diagnosis of
C. Blindness nephroblastoma. Symptoms the nurse observes that suggest this problem include:
D. Neutropenia
16. Which age group is with imaginative minds and creates imaginary friends? A. Lymphedema and nerve palsy
B. Hearing loss and ataxia
A. Toddler C. Headaches and vomiting
B. Preschool D. Abdominal mass and weakness
C. School 22. Which of the following danger sings should be reported immediately during the
D. Adolescence antepartum period?
17. Which of the following situations would alert you to a potentially developmental
problem with a child? A. blurred vision
B. nasal stuffiness
A. Pointing to body parts at 15 months of age. C. breast tenderness
B. Using gesture to communicate at 18 months. D. constipation
C. Cooing at 3 months. 23. Nurse Jacob is assessing a 15 month old child with acute otitis media. Which of
D. Saying “mama” or “dada” for the first time at 18 months of age. the following symptoms would the nurse anticipate finding?
18. Isabelle, a 2 year old girl loves to move around and oftentimes manifests
negativism and temper tantrums. What is the best way to deal with her behavior? A. periorbital edema, absent light reflex and translucent tympanic membrane
B. irritability, purulent drainage in middle ear, nasal congestion and cough
A. Tell her that she would not be loved by others is she behaves that way.. C. diarrhea, retracted tympanic membrane and enlarged parotid gland
B. Withholding giving her toys until she behaves properly. D. Vomiting, pulling at ears and pearly white tympanic membrane
C. Ignore her behavior as long as she does not hurt herself and others. 24. Which of the following is the most appropriate intervention to reduce stress in a
D. Ask her what she wants and give it to pacify her. preterm infant at 33 weeks gestation?

A. Sensory stimulation including several senses at a time

B. tactile stimulation until signs of over stimulation develop
C. An attitude of extension when prone or side lying
D. Kangaroo care
 25. The parent of a client with albinism would need to be taught which preventive
healthcare measure by the nurse:

A. Ulcerative colitis diet

B. Use of a high-SPF sunblock
C. Hair loss monitoring
D. Monitor for growth retardation
 1. Nurse Bella explains to a 28 year old pregnant woman undergoing a non-stress test 7. The client asks the nurse, “When will this soft spot at the top of the head of my
that the test is a way of evaluating the condition of the fetus by comparing the fetal baby will close?” The nurse should instruct the mother that the neonate’s anterior
heart rate with: fontanel will normally close by age:

A. Fetal lie A. 2-3 months

B. Fetal movement B. 6-8 months
C. Maternal blood pressure C. 10-12 months
D. Maternal uterine contractions D. 12-18 months
2. During a 2 hour childbirth focusing on labor and delivery process for primigravida. 8. When a mother bleeds and the uterus is relaxed, soft and non-tender, you can
The nurse describes the second maneuver that the fetus goes through during labor account the cause to:
progress when the head is the presenting part as which of the following:
A. Atony of the uterus
A. Flexion B. Presence of uterine scar
B. Internal rotation C. Laceration of the birth canal
C. Descent D. Presence of retained placenta fragments
D. External rotation 9. Mrs. Pichie Gonzales’s LMP began April 4, 2010. Her EDD should be which of the
3. Mrs. Jovel Diaz went to the hospital to have her serum blood test for alpha- following:
fetoprotein. The nurse informed her about the result of the elevation of serum AFP.
The patient asked her what was the test for: A. February 11, 2011
B. January 11, 20111
A. Congenital Adrenal Hyperplasia C. December 12, 2010
B. PKU D. Nowember 14, 2010
C. Down Syndrome 10. Which of the following prenatal laboratory test values would the nurse consider as
D. Neural tube defects significant?
4. Fetal heart rate can be auscultated with a fetoscope as early as:
A. Hematocrit 33.5%
A. 5 weeks of gestation B. WBC 8,000/mm3
B. 10 weeks of gestation C. Rubella titer less than 1:8
C. 15 weeks of gestation D. One hour glucose challenge test 110 g/dL
D. 20 weeks of gestation 11. Aling Patricia is a patient with preeclampsia. You advise her about her condition,
5. Mrs. Bendivin states that she is experiencing aching swollen, leg veins. The nurse which would tell you that she has not really understood your instructions?
would explain that this is most probably the result of which of the following:
A. “I will restrict my fat in my diet.”
A. Thrombophlebitis B. “I will limit my activities and rest more frequently throughout the day.”
B. PIH C. “I will avoid salty foods in my diet.”
C. Pressure on blood vessels from the enlarging uterus D. “I will come more regularly for check-up.”
D. The force of gravity pulling down on the uterus 12. Mrs. Grace Evangelista is admitted with severe preeclampsia. What type of room
6. Mrs. Ella Santoros is a 25 year old primigravida who has Rheumatic heart disease should the nurse select this patient?
lesion. Her pregnancy has just been diagnosed. Her heart disease has not caused her
to limit physical activity in the past. Her cardiac disease and functional capacity A. A room next to the elevator.
classification is: B. The room farthest from the nursing station.
C. The quietest room on the floor.
A. Class I D. The labor suite.
B. Class II
C. Class III
D. class IV
 13. During a prenatal check-up, the nurse explains to a client who is Rh negative that 19. Celine, a mother of a 2 year old tells the nurse that her child “cries and has a fit
RhoGAM will be given: when I have to leave him with a sitter or someone else.” Which of the following
statements would be the nurse’s most accurate analysis of the mother’s comment?
A. Weekly during the 8th month because this is her third pregnancy.
B. During the second trimester, if amniocentesis indicates a problem. A. The child has not experienced limit-setting or structure.
C. To her infant immediately after delivery if the Coomb’s test is positive. B. The child is expressing a physical need, such as hunger.
D. Within 72 hours after delivery if infant is found to be Rh positive. C. The mother has nurtured overdependence in the child.
14. A baby boy was born at 8:50pm. At 8:55pm, the heart rate was 99 bpm. She has D. The mother is describing her child’s separation anxiety.
a weak cry, irregular respiration. She was moving all extremities and only her hands 20. Mylene Lopez, a 16 year old girl with scoliosis has recently received an invitation
and feet were still slightly blue. The nurse should enter the APGAR score as: to a pool party. She asks the nurse how she can disguise her impairment when
dressed in a bathing suit. Which nursing diagnosis can be justified by Mylene’s
A. 5 statement?
B. 6
C. 7 A. Anxiety
D. 8 B. Body image disturbance
15. Billy is a 4 year old boy who has an IQ of 140 which means: C. Ineffective individual coping
D. Social isolation
A. average normal 21. The foul-smelling, frothy characteristic of the stool in cystic fibrosis results from
B. very superior the presence of large amounts of which of the following:
C. above average
D. genius A. sodium and chloride
16. A newborn is brought to the nursery. Upon assessment, the nurse finds that the B. undigested fat
child has short palpebral fissures, thinned upper lip. Based on this data, the nurse C. semi-digested carbohydrates
suspects that the newborn is MOST likely showing the effects of: D. lipase, trypsin and amylase
22. Which of the following would be a disadvantage of breast feeding?
A. Chronic toxoplasmosis
B. Lead poisoning A. involution occurs rapidly
C. Congenital anomalies B. the incidence of allergies increases due to maternal antibodies
D. Fetal alcohol syndrome C. the father may resent the infant’s demands on the mother’s body
17. A priority nursing intervention for the infant with cleft lip is which of the following: D. there is a greater chance of error during preparation
23. A client is noted to have lymphedema, webbed neck and low posterior hairline.
A. Monitoring for adequate nutritional intake Which of the following diagnoses is most appropriate?
B. Teaching high-risk newborn care
C. Assessing for respiratory distress A. Turner’s syndrome
D. Preventing injury B. Down’s syndrome
18. Nurse Jacob is assessing a 12 year old who has hemophilia A. Which of the C. Marfan’s syndrome
following assessment findings would the nurse anticipate? D. Klinefelter’s syndrome
24. A 4 year old boy most likely perceives death in which way:
A. an excess of RBC
B. an excess of WBC A. An insignificant event unless taught otherwise
C. a deficiency of clotting factor VIII B. Punishment for something the individual did
D. a deficiency of clotting factor IX C. Something that just happens to older people
D. Temporary separation from the loved one.
 25. Catherine Diaz is a 14 year old patient on a hematology unit who is being treated
for sickle cell crisis. During a crisis such as that seen in sickle cell anemia, aldosterone
release is stimulated. In what way might this influence Catherine’s fluid and
electrolyte balance?

A. sodium loss, water loss and potassium retention

B. sodium loss, water los and potassium loss
C. sodium retention, water loss and potassium retention
D. sodium retention, water retention and potassium loss