Practice Test on Community Health Nursing

1. During a home visit, the nurse observes a client who is recovering from a left total hip replacement and is walking with a cane. Which observation indicates the client understands how to walk with a cane?
a. He walks alternating the cane in his left hand, moving the cane forward with the unaffected leg.
b. He walks alternating the cane from his right hand to his left in time with his steps.
c. The cane is held in the left hand and is moved forward when he moves his right foot forward.
d. He holds the cane in his right hand and moves it forward when he moves his left foot forward.
2. This is defined as the state of complete physical, mental, and social well-being and not merely the absence of disease relating to reproductive health and to its function and processes
a. Health c. reproductive health
b. Maternal health & child health nursing d. procreation
3. Goals of reproductive health include the following except:
a. every pregnancy should be intended
b. every sex act should be free of coercion and infection
c. every birth should be healthy
d. achieved a less than desired family size
4. The center of maternal deaths are mainly due to:
a. woman b. child c. woman & child d. the family
5. The major causes of death in infants & child are:
a. Chicken pox c. diarrhea and respiratory infections
b. Tuberculosis d. congenital heart diseases
6. The supplementation is ideally given to pregnant women from the 5th month of pregnancy up to 2 months post partum
a. Iron b. Penicillin c. Vitamin C d. Aspirin
7. The following are qualified for home deliveries except
a. Full term c. Less than 5 pregnancies
b. History of diabetes and hypertension d. cephalic presentation
8. All but one is qualified for home deliveries:
a. Adequate pelvis c. no history of complications during previous deliveries
b. No previous CS d. preterm pregnancies
9. The nurse is assessing an 18 month old child with iron deficiency anemia to determine whether the child is taking the prescribed iron preparation. Which of the following assessments is the best indicator of adequate dosage and intake of the prescribed iron preparation?
a. Characteristics of stool c. color of oral mucous membranes
b. Height and weight pattern d. age-appropriate vital signs.
10. The nurse is conducting a class aimed at helping persons prevent cancer. Which statement made by a participant indicates to the nurse a need for more instruction?
a. “I will try to eat at least five servings of fruits and vegetables a day”
b. “I won’t smoke in the house anymore”
c. “it is important that I have regular PAP smear”
d. “I will wear sun block when I go to the beach.”
11. After delivery, the nurse should check that the mother have
a. Contracted uterus b. normal VS c. placenta must be expelled D.AOTA
12. It is recommended that infants be exclusively breastfed for the first
a. 2 weeks b. month c. 6 months d. 2 years
13. A surgical procedure which provides permanent contraception for women who chooses to have no more children.
a. Vasectomy b. billings method c. cervical mucus method D. bilateral tubal ligation
14. A family planning method that reduces the risk of ovarian and endometrial cancer among women
a. Condoms b. lactating amenorrhea method c. pills d. tubal ligation
15. A disadvantage of this family planning method is that it may cause allergy for people who are sensitive to latex or lubricants
a. Condoms b. lactating amenorrhea c. pills d. Tubal ligation
16. Which among the family planning methods has the lowest percentage of effectiveness?
a. Vasectomy b. Tubal ligation c. pills d. basal body temperature
17. A pregnant woman who had 4 doses of tetanus is said to be __% protected from tetanus
a. 80 b. 90 c. 99 d. 100
18. A nurse gives a lecture regarding hypertension to a small group. The group understood the teachings if they identify this as a modifiable risk factor for hypertension
a. Race b. family history c. advancing age d. high salt intake
19. A key factor in preventing hypertension is diet. The diet mainly prescribed for hypertensive patients is
a. High salt, low potassium
b. low salt, high fat
c. high fiber, high salt
d. Low fat, low salt
20. Exposure to dyes and solvents and chronic bladder inflammation are risk factors for development of
a. breast cancer b. lung cancer c. bladder cancer d. prostate cancer
21. Risk factors for breast cancer include
a. early menarche, late menopause b. low fat diet c. physical activity
d. no history of breast cancer in the family
22. The primary cause of COPD is
a. obesity b. barrel chest c. drug overdose d. smoking
23. The diagnosis of COPD is confirmed by
a. ECG b. Spinal tap c. spirometer d. creatinine kinase level
24. A mother asks what causes asthma. The nurse should tell the mother that in asthma
a. old age is a main risk factor c. it is transmitted by mosquito bites
b. it can be triggered by gas, smoke and dust mites d. decreased insulin in blood
25. Which of the following is not a warning sign for cancer?
a. change in bowel or bladder habits
b. unexplained anemia
c. obvious change in wart or mole
d. sudden weight loss due to crash dieting.
26. The cheapest and most affordable screening procedure for breast cancer is
a. mammogram b. simple mastectomy c. breast self-examination (BSE) d.biopsy
27. A female client has a history of breast cancer in her family. The nurse should advise her to have a mammogram starting at age
a. 30 b. 35 c. 40 d. 45
28. The best time to perform BSE is
a. 1 week before menstrual period b. 1 week after the menstrual period
c. during menstrual period d. once every 2 weeks
29. The primary screening tool for cervical cancer among over the age of 18 is
a. digital rectal exam b. Leopold’s maneuver c. Pap’s smear d. RBC count
30. which of the following laboratory test is used for early detection of prostate cancer?
a. testicular self examination b. PSA determination C. chest x-ray d. sputum cytology
31. This is defined by the WHO as the state of well being where a person can realize his or her own abilities to cope stresses in life and work productively
a. mental disorder b. mental health c. mental vitality d. mental illness
32. Currently the leading cause of end stage renal disease in the Philippines is
a. complications in the kidney due to diabetes
b. complications in the kidney from hypertension
c. chronic glumerulonephritis
d. nephrosis
33. if the patient is deemed “incompetent” this means that:
a. he/she can’t afford the hospital bill
b. he/she won’t follow medical directions
c. a court proceeding has declared him/her unable to make his/her own decisions
d. as a nurse you have assessed that he/she is not making good choices or decisions.
34. the principles that govern right and proper conduct of a person regarding life, biology and health professions is referred as:
a. morality b. religion c. bioethics d. values
35. the purpose of having a nurse’s code of ethics is:
a. to determine the roles and functions of the health care giver, nurses, clients
b. to help the public understand professional conduct expected of nurses
c. identify nusing action recommend for specific health care situations
d. delineate the scope and areas of nursing
36. the most important nursing responsibility where ethical situations emerge in patient care is to:
a. be accountable for each actions
b. not take sides, always remain neutral and fair
c. assume that ethical questions are the responsibility of the health team
d. act only when advised that the action is ethically sound
37. you inform the patient about his rights which includes the following, except
a. right to expect that the records about his care will be treated as confidential
b. right to obtain information about another patient.
c. right to consent to or decline to participate in research studies or experiments.
d. right to expect reasonable continuity of care
38. an example of management function of a nurse is:
a. directing and evaluating the staff nurses
b. performing nursing procedures for the clients
c. teaching patient do breathing and coughing exercises
d. preparing for a surprise party of a client
39. when the head nurse in your ward plots and approves your work schedules and direct your work, she is demonstrating
a. delegation b. authority c. accountability d. responsibility
40. the following tasks can be safely delegated by a nurse to a non-nurse health worker except:
a. irrigation of Nasogastric tube c. change IV infusion
b. take VS d. transfer a client from bed to chair
41. you made a mistake in giving the medicine to the wrong client. You notify the client’s doctor and write an incidental report. You are demonstrating:
a. authority b. accountability c. autocracy d. responsibility
42. which of this clients has a problem with the transport of oxygen from the lungs to the tissues?
a. diarrhea c. fracture on the femur
b. brain tumor d. anemia
43. lab exam shows reduced oxygen level on the blood, this condition is called:
a. hypoxia c. cyanosis
b. anemia d. hypoxemia
44. the client is having breathing difficulties when lying on his back and must sit upright in bed to breathe effectively and comfortably. The nurse documents this situation as:
a. orthopnea c. apnea
b. tachypnea d. dyspnea
45. the priority action on patients from a vehicular accident is to
a. assess the extent of injuries incurred by the victim
b. assist the police investigation
c. report the incident to the nearest police station
d. assess damage to property
46. priority attention must be given to which of these clients?
a. john with chest injury, pale and has difficulty in breathing
b. mike who has a lacerations on the arms with mild bleeding
c. gil with severe anxiety due to trauma on a accident
d. cha with swelling ankle with some abrasions
47. you are attending a certification program on CPR offered and required by the hospital employing you. This is called
a. professional course towards credits c. inservice education
b. continuing education d. advance training
48. when taking the BP of a client who recently smoke or drinks coffee , how long should the nurse wait before taking the BP for accuracy?
a. 1 hour b. 30 min c. 15 min d. 5 min
49. cancer cure is dependent on
a. proficiency in doing BSE c. watching out for warning signs of cancer
b. early detection and prompt treatment d. use of alternative means of treatment
50. when taking the BP, reading the cuff should be
a. deflate fully then immediately start second reading for same client
b. deflate quickly after inflating up to 180 mmHg
c. inflated to 30 mmHg above the estimated systolic BP based on the palpitation of radial or bronchial artery.
d. large enough to wrap around upper arm of the adult client 1cm above the brachial artery.
51. Lifestyle related diseases in general shares areas common risk factors. These are the following except.
a. genetics b. nutrition c. physical activity d. smoking

NURSING HEALTH HISTORY

 NURSING HEALTH HISTORY

Purpose
• To elicit information about all variables that may affect the client’s health status
• To obtain data that help the nurse understand and appreciate the client’s life experiences
• To initiate a non-judgmental, trusting interpersonal relationship with the client

 BIOGRAOHIC DATA
• Name
• Address
• Age
• Sex
• Race
• Marital status
• Occupation
• Religion
• Health care financing
• User source of medicare

 CHIEF COMPLAINT
• Reason for visit
• “What is troubling you?”
• Recorded in client’s words

 HISTORY OF PRESENT ILLNESS
• Usual health status
• Chronologic story
• Relevant family history
• Disability assessment

 PAST HISTORY
• Childhood illnesses
• Childhood immunizations
• Allergies
• Accident and injuries
• Hospitalization
• Medications

 FAMILY Hx OF ILLNESS
• Ages of siblings, parents, etc.
• Current state of health
• If deceased, cause of death

 REVIEW OF SYSTEMS
• Subjective data
• Checklist

 LIFE-STYLE
• Personal habits
• Diet
• Sleep/rest patterns
• Activities of daily living
• Instrumental activities of daily living
• Recreation/hobbies

 SOCIAL DATA
• Family relationships/friendships
• Ethnic affiliations
• Educational history
• Occupational history
• Economic status
• Home and neighborhood conditions

 PSYCHOLOGIC DATA
• Major stressors
• Usual coping pattern
• Communication style
• Self-concept
• Mood

 PATTERN OF HEALTH CARE
• Note all health care resources

 ABBREVIATIONS

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Chapter 16 ASSESSING
Page 256 Fundamentals of Nursing – Kozier 7th Edition


 Nursing Process
- Is a systematic, rational method of planning and providing individualized nursing care for individuals, families, groups and communities.
- Originated by Hall(1995), Johnson(1959), Orlando (1961), Wiedenbach (1963)

 Phases of Nursing Process

 Assessing
- Collecting, organizing, validating and documenting client data – client’s personal perceptions
- Involves active participation by the client and nurse in obtaining subjective and objective data about the client’s health status
Subjective data, symptoms, covert data – client’s personal perception
Objective data – detectable by an observer
- Sources of data: primary and secondary
Primary – client
Secondary – family members or other support persons, client records (medical and laboratory), health care professionals, literature
- Data collection methods
Observing
Interviewing
Directive interview – structured
Nondirective interview – rapport building interview
o Types of Interview Questions
- Open-ended questions, neutral question
- Closed questions, leading questions
Examining
 Diagnosing
- analyzing and synthesizing data
 Planning
- determining how to prevent, reduce or resolve the identified client problems; how to support client strengths, and how to implement nursing interventions in an organized, individualized and goal directed manner
 Implementing
- carrying out the planned interventions
 Evaluating
- measuring the degree to which goals/outcomes have been achieved and identifying factors that positively or negatively influence goal achievement

 Characteristics of Nursing Process
- Cyclic, dynamic
- Client Centered
- Interpersonal and collaborative
- Universally applicable
- Focus on problem solving and decision making

Leopold's Maneuvers

Leopold's maneuvers

In obstetrics, Leopold's Maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus.

Overview and rationale

The maneuvers consist of four distinct actions, each helping to determine the position of the fetus. The maneuvers are important because they help determine the position and presentation of the fetus, which in conjunction with correct assessment of the shape of the maternal pelvis can indicate whether the delivery is going to be complicated, or whether a Cesarean section is necessary.

The examiner's skill and practice in performing the maneuvers are the primary factor in whether the fetal lie is correctly ascertained, and so the maneuvers are not truly diagnostic. Actual position can only be determined by ultrasound performed by a competent technician or professional.

Performing the maneuvers

Leopold's Maneuvers are difficult to perform on obese women and women who have hydramnios. The palpation can sometimes be uncomfortable for the woman if care is not taken to ensure she is relaxed and adequately positioned. To aid in this, the health care provider (or other professional) should first ensure that the woman has recently emptied her bladder. If she has not, she may need to have a straight urinary catheter inserted to empty it if she is unable to micturate herself. The woman should lay on her back with her shoulders raised slightly on a pillow and her knees drawn up a little. Her abdomen should be uncovered, and most women appreciate it if the individual performing the maneuver warms their hands prior to palpation.

First maneuver

While facing the woman, palpate the woman's upper abdomen with both hands. A professional can often determine the size, consistency, shape, and mobility of the form that is felt. The fetal head is hard, firm, round, and moves independently of the trunk while the buttocks feels softer, is symmetric, and has small bony processes; unlike the head, it moves with the trunk.

Second maneuver

After the upper abdomen has been palpated and the form that is found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but also deep pressure using the palms of his or her hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus. This is then repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities (arms, legs, etc.) should feel like small irregularities and protrusions. The fetal back, once determined, should connect with the form found in the upper abdomen and also a mass in the maternal inlet, lower abdomen.

Third maneuver - Pawlick's Grip

In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen. The individual performing the maneuver first grasps the lower portion of the abdomen just above the symphysis pubis with the thumb and fingers of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneauver. If the woman enters labor, this is the part which will most likely come first in a vaginal birth. If it is the head and is not actively engaged in the birthing process, it may be gently pushed back and forth.

Fourth maneuver

The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved gently down the sides of the uterus toward the pubis. The side where there is the resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back .

Cautions

Leopold's maneuvers are intended to be performed by health care professionals, as they have received training and instruction in how to perform them. That said, as long as care is taken not to roughly or excessively disturb the fetus, there is no real reason it cannot be performed at home as an informational exercise. It is important to note that all findings are not truly diagnostic, and as such ultrasound is required to conclusively determine fetal lie.

The Menstrual Cycle

The Menstrual Cycle

The "typical" menstrual cycle occurs regularly over 28 days. Most women have cycles with an interval that lasts from 21 to 35 days. Frequently cycles are unusually short or long during adolescence.

THE FIRST HALF OF THE MENSTRUAL CYCLE (Day 1 to About Day 14 in a 28-Day Cycle)

The Menstrual Phase

The first day of your menstrual period is considered Day 1 of your cycle. The menstrual phase includes your period. During this time, the endometrium (the built-up lining of the uterus) is shed, along with a little blood. Many of the problems that women experience with their menstrual cycle occur during this phase. For example, some women experience menstrual disorders such as dysmenorrhea (painful periods) or menorrhagia (unusually heavy periods).

The Follicular/Proliferate Phase

During the proliferate phase, the body produces a hormone called follicle-stimulating hormone (FSH). Follicle-stimulating hormone promotes the growth of a follicle (egg sac) within the ovary. An ovum (egg) matures in the follicle during the proliferative phase. FSH also stimulates the ovary to produce increasing amounts of estrogen. In turn, the estrogen causes endometrial tissue to build up (or proliferate), lining the interior of the uterus.

THE MIDPOINT OF THE MENSTRUAL CYCLE (About Day 14 in a 28-Day Cycle)

The mature ovum bursts from the follicle about midway (approximately 2 weeks before onset of next menstrual period) through the menstrual cycle. This process is known as ovulation. The ovum then travels from the ovary down the fallopian tube, and into the uterus.

The Luteal/Secretory Phase

Once the ovum has been released, the follicle becomes a sac known as the corpus luteum ("yellow body," because it contains yellowish, fatty matter). A hormone called luteinizing hormone (LH) causes the corpus luteum to grow and to secrete progesterone, another female hormone.

During the secretory phase, progesterone makes the endometrial lining stronger and spongy in texture. Progesterone also stimulates glands in the endometrium. These glands produce uterine fluid, and their purpose is to support embryonic development if fertilization has occurred at or around the time of ovulation. It is in this phase of the menstrual cycle that women who suffer from premenstrual syndrome (PMS) may begin to experience their symptoms. Generally symptoms are worse during the last seven to ten days of the cycle, ending at or soon after the start of the menstrual period. In a woman who hasn't become pregnant, the level of progesterone peaks about a week after ovulation and then begins to drop along with the estrogen level. The flow of blood to the endometrium decreases, and its upper portion is broken down and shed during menstruation. At the same time, the corpus luteum withers.

The dip in estrogen and progesterone at the end of the cycle help let the body know that it's time to start the cycle all over again. The menstrual cycle doesn't have to be a drag, it actually shows how complex your body is and a sign that it is functioning properly! Congratulations, you are a woman and being a woman is terrific!

What You Need To Know About Menstruation

What You Need To Know About Menstruation

If you're a teenage girl you probably have started having a period. If you have not, you might be anxious about the subject or a bit concerned. This whole menstruation thing might seem a bit mysterious, it is to many young women. It's actually very complex, but interesting too.

Menstruation is the outward proof that a girl is becoming a woman. Having a period is your body's way of saying it’s functioning properly.

During puberty, hormones are released from the brain that stimulate the ovaries. The ovaries then produce estrogen and progesterone -- hormones that cause the eggs in the ovaries to mature so the woman can become pregnant when she chooses to. Here's how the process goes:

Every month, one egg leaves one of the ovaries on its way to the uterus via the fallopian tubes. Meanwhile, in preparation for the egg, the uterus starts to develop a thicker lining and it’s walls become cushiony (the endometrial lining). If the egg reaches the uterus and is fertilized by a sperm cell, it attaches to this cushiony wall.

Most of the time the egg just passes right through without fertilization. Since the uterus no longer needs the extra blood and tissue which made up the walls thick, it sheds them by way of the vagina. This cycle will happen nearly every month until the ovaries stop releasing eggs, usually several decades later. (Menopause).

Periods are different for every woman. Some girls start menstruation when they're 9 or 10; some in their late teens. The length of the cycle also varies. Some periods last longer than 28 days, some shorter. If you have just begun your menstruation, your body will need time to regulate itself to these changes. Your periods might be a bit erratic at first. You may have two cycles in one month and miss having one the next month. How long your period lasts also varies . Some girls have their periods for only 3 or 4 days, others as long as a week. The menstrual flow of blood can vary from woman to woman also.

Some girls may have body and or mood changes around the time of their period. Menstrual cramps are pretty common during the first few days of your period. These are most likely caused by prostagladins. Prostaglandins causes the muscles of the uterus to contract. These cramps tend to become less uncomfortable and sometimes even disappear completely as a girl gets older. Over-the-counter pain medication like ibuprofen or acetaminophen can often give relief; if not, a health care provider can help. If your cramps are very severe, see a gynecologist.

As your period approaches, you may experience premenstrual syndrome (PMS). You may find your emotions amplified during this time. Many women get depressed, irritated, angry, and others cry more than usual or get cravings for certain foods. PMS may be related to changes in hormones. Hormone levels rise and fall during a menstrual cycle, affecting the way a female feels both mentally and physically.

Emotions can become more intense than usual, and many women may feel bloated because of water retention. When your period begins, PMS usually goes away. You may also have acne flare-ups.

Periods are a complex part of puberty, but also your body's way of telling you it is functioning properly and you have taken good care of it. You can still exercise, swim and do everything you enjoy. If you have any questions about periods, ask a parent, health teacher, health care provider, or nurse. You can also ask friends or sisters who have already had their periods. In time you will see that periods are a normal and routine part of your life.