ANSWER KEY EXAM DRILL 2 – Community Health Nursing NURSING PRACTICE II - CHN and CARE of the MOTHER and

CHILD General Instructions 1. This test booklet contains 100 test questions. 2. Read INSTRUCTIONS TO EXAMINEES printed on your answer sheet. 3. Shade only one (1) box for each question on your answer sheets. Two or more boxes shaded will invalidate your answer. 4. AVOID ERASURES

INSTRUCTIONS: 1. Detach one (1) answer sheet from the bottom of your Examinee ID/ Answer Sheet Set. 2. Write the subject title “Nursing Practice I” on the box provided. 3. Shade Set Box “A” on your answer sheet if your test booklet is Set A; Set box “B” if your test booklet is Set B. Multiple Choice Situational Situation 1: Patrice has to deal with the indigenous people in the area. 1. The family’s response to health and illness is reflected in A. B. C. D. its utilization of existing health services the type of illness and causes of death in the family the number of vulnerable members of the family the degree of assistance given to family

2. To effectively give nursing care to an indigenous family, the nurse should first
A. B. C. D.

understand their culture assess health beliefs and practices work with their traditional healers share experiences in community health work

3. To modify harmful practices among indigenous families, the most important factor is to:
A. B. C. D.

ensure that change blends to their culture increase health knowledge of the family involve the families in bringing out change persuade the families to change practices

4. An indicator that behavior change is maintained and sustained is when:
A. B. C. D.

change is incorporated to everyday life barriers to change has been removed there is awareness for the need to change the family verbalizes the awareness on the need for change

1

Situation 2: The public health nurse performs various roles and responsibilities in CHN practice. 5. The nurse actively participates in the development of the community health plan. She ensures that the nursing component of the plan is incorporated in her role as: A. Supervisor C. Collaborator B. Coordinator D. Independent 6. When the nurse conducts scientific investigation of a phenomenon towards improving health care, she performs her role as A. Health monitor C. Community Organizer B. Program manager D. Researcher 7. Utilization of screening methods to determine deviations from health will entail the exercise of this role. A. Health monitor C. Provider of care B. Advocate of change D. Supervisor 8. This major role transcends in the performance of the other CH Nurse’s roles: A. Client advocate C. health educator B. manager D. Provider of care 9. When the nurse initiates people’s participation, she is performing her role as A. Manager B. Community Organizer C. Supervisor D. Health educator Situation 3: The following questions refer to the public health nurses’ roles and functions. 10. As a service provider, the PHN can provide family planning services by C. giving accurate information about necessary service alternative choices for family planning B. supporting changes in choice with D. performing all of these activities necessary service
A. supporting beneficiary choice with

11. For a group of children, where interactions with causative agents of diseases have taken place, the nurse’s concern is to provide: A. diagnostic and curative care C. rehabilitation B. promotive and preventive care D. all of these 12. As a supervisor, the PHN does the following EXCEPT: A. providing nursing care to families with complicated nursing problems B. assessing the effects of her nursing care provided to the family C. assisting the doctor in treatment of cases D. reviewing the management of patients done by the midwife
A. Nurse supervisor B. Municipal mayor

13. In the health project implementation, the public health nurse is being supervised by the C. Physician D. Manager

14. In the provision of CHN services, PH Nurse practice will provide care to: 1 – a pregnant women in the family

2

2 – dysfunctional family in a community 3 – young adults in the community 4 – an ethnic community A. All these C. 1 & 2 B. 1, 2, & 3 D. 1 only 15. In the care of population groups, the nurse must focus on A. displaced families C. sick segments of the community B. vulnerable groups D. healthy individuals 16. The context of care of the community is/are the A. emphasis of the local government B. current health and socioeconomic conditions of the people C. problems and needs D. perceived needs and priority of the people Situation 4. The individual is taken as the clientele in CHN. 17. An individual will take preventive health actions if he/she believes that: C. he/she may have a replace of the expenses disease B. he/she is susceptible to the disease D. there is no cure for the disease
A. his/her disease/illness entails a lot of

18. Patrice did a home visit to a postpartum client, Elida, G4P4. She hasn’t taken a bath for three weeks now. How can the nurse encourage her to take a bath? A. Make an aromatic bath consisting of B. Discuss with her the importance of personal hygiene. the boiled mixture of plants with C. Respect her decision. volatile oils. D. Give a sponge bath 19. Ben wishes to undergo HIV antibody test. The nurse can assist Ben through the following EXCEPT A. conducting the test in the center C. explaining the window period of the ensuring anonymity and confidentiality infection B. making an initial risk assessment on D. referring Ben to the appropriate possible exposure and infection health facility 20. Lucy is five months pregnant. In assessing her nutritional–metabolic pattern in the nursing history, the following should be asked EXCEPT: A. Eating patterns and food preferences B. Fluid intake C. Wound healing patterns D. Disturbances in bowel elimination Situation 5 – Patrice applies the concepts of Family Health Nursing in the care of the Mendoza family. Ruel and Aida Mendoza have three children: Roy, 6 years old, Steve, 4 years and Necie, 2 year old. They live in the house of Julia, Aida’s mother.
A. nuclear and patriarchal B. matriarchal and nuclear

21. This is an example of a family that is

C. patriarchal and extended D. matriarchal and extended

22. Which of the following, if present, will be the top priority problem of the Mendoza family?

3

A. Unemployment of Ruel B. Family size beyond what family

resources can provide

C. Congestion D. Ascariasis of Roy

23. ‘Nanay Julia had a stroke and died. The death of a family member is a A. Health threat C. Stress point B. Health deficit D. B and C 24. Aida remarked about Roy’s ascariasis as “natural lang sa bata (common among children)”. The salience of the problem is A. Serious but not requiring immediate C. Low salience action D. Data not sufficient B. Moderate salience 25. The youngest child has marasmus. The success of the intervention is measured in terms of weight gain. If the weight gain of 2 pounds is reflected in the objective, such is referred to as a/an: A. Criterion B. Standard C. Anthropometric data D. Vital sign of malnutrition Situation 6: Sarah, 26 years old, is a postpartum case who was referred to the public health nurse for family nursing care. Her one-month-old son was premature at birth. Her other children are aged 4, 3 and 2 years. 26. Patrice must be aware that the objective of family nursing care is to: coordinate with the other agency representatives for the care of the family evaluate effects of nursing interventions done analyze family dynamics and learn new things help the family achieve optimum wellness

A. B. C. D.

27. In working with Sarah’s family, the nurse must remember that her patient is/patients are: A. Sarah, the postpartum mother C. The premature infant B. Sarah and her 1 month-old child D. The family as a unit 28. In your fist home visit, you conducted a family assessment. The most important part of your assessment is to: A. ask the family what their needs are B. assess the interrelations of the family members C. assess the family’s environmental condition D. explore the families past generations 29. Advising Sarah to always wash her hands before caring for her premature infant is in keeping with this principle of premature infant care: A. Prevention of infection C. Proper feeding B. Minimal handling D. Effects the interventions will have on the family 30. The nursing interventions done to Sarah and the members of her family must be evaluated in terms of: A. the interventions’ impact on Saran and the premature infant B. the difference in the family interrelationships

4

C. the difference in the individuals’ lifestyle D. the effects the interventions will have on the family

Situation 7: Being the public health nurse, Patrice provides nursing care to the family. 31. The nurse performs this to determine the family’s nursing problems/ needs: C. assessment D. evaluation 32. An appropriate source of information about the family is/are: A. interview results with the members of C. analysis of the family’s situation the family D. actual observation of family’s B. family service and progress records situation
A. family health care plan information B. goal setting

33. The family presents several problems. Which of the following criteria is considered in determining the priority health problems? A. involvement of the members of the C. preventive potential of the problem D. expected consequence of the problem family in the problem B. cooperation and support of the family 34. This is an important factor that serves as basis in preparing the family health care plan: A. data gathered from the health center D. needs as expressed by the midwife B. needs and problems as seen and assigned in the area where the family accepted by the family resides C. needs and problems gathered and recognized by the nurse herself 35. The family health care plan includes the following components listed in sequence: A. objectives, statement of problems, intervention B. evaluation, statement of problems objectives, interventions, evaluation C. statement of problems, objectives, interventions, evaluation D. objectives, interventions, evaluation, statement of problem Situation 8: Patrice met Marian, the school nurse. 36. Patrice establishes a working relationship with Marian. This is emphasizing the component of the school health nursing called: A. School health services C. School health instruction B. Healthful school living D. School-community linkage 37. On July 23, there will be a fire drill in the school. This is an activity of this component of school health nursing: A. School health services C. School health instruction B. Healthful school living D. School-community linkage 38. Isolation of communicable diseases, referral, and follow-through are being performed by the school health nurse in relation to A. School health services C. School health instruction B. Healthful school living D. School-community linkage 39. Which of the following is not an activity of the school nurse in implementing the component of healthful school living A. Drug-watch committee C. Rehabilitation of substance abusers B. Environmental sanitation D. Food sanitation

5

A. B. C. D.

40. What is the role of the nurse in the component of healthful school living Health educator-counselor Provider of care Health monitor Community health organizer

Situation 9 – Patrice also visited Steph, the factory nurse, and talked about occupational health nursing.
A. Health of all workers B. Industrial peace C. Dignity of labor

41. The most basic concern of Steph is

D. Harmony between management and

workers

42. A major physical health problem in the spinning section of this textile factory is A. occupational asthma or bysinossis C. security of tenure B. tuberculosis D. urinary tract infection 43. Women workers are often complaining about UTI and varicosities. Steph must recommend to the management this intervention/these interventions: A. Breaks every two hours C. Additional fixture like chairs in the B. Faucet for drinking water work area D. All of these 44. Steph noted that there were two cases of malignant lymphomas in the dye section of the factory. She is conducting a series case study. This is an activity under what level of disease-prevention? A. Primary C. Tertiary B. Secondary D. Intermediate 45. In applying concept of primary health care, Steph will: establish a referral network with the company hospital strengthen clinic services train workers on first aid spend a segment of duty hours on the hospital to ensure care of confined workers

A. B. C. D.

Situation 10 – Community Diagnosis is an assessment tool for determining community health status. Patrice coordinates with the members of the health team to determine the health situation of Pasong Tala.
A. Census B. Sample survey

46. The most practical type of community survey accounting for the bulk of data is: C. Questionnaire D. Interview 47. The best instrument for the community survey is the: C. Group interview guide D. Personal interview schedule

A. Telephone interview questionnaire B. Self -accomplished questionnaire

48. In dealing with the health data, particularly births and deaths, Patrice needs to check civil registries. Based on the Civil Registry Law, records and reports in a municipality are accepted and kept by the: A. Municipal Health Officer Mayor B. Municipal Treasurer

6

C. Mayor

D. Municipal Secretary

49. Keno Kopya is a construction worker in Pasay City. Scaffolding collapsed and he was hit badly. He was rushed to the UP – PGH in Manila where he expired. His remains were taken to Pasong Tala in Dasmariñas where he lives and was, then, buried in Carmona cemetery. His death will be reported and registered in : A. Pasay City B. Dasmariñas C. Manila D. Carmona 50. Primary Health care endorses the concept of team work. Which of the following factors would make health services effective and efficient? A. Team Planning C. Workshops B. Group work D. Team Building Answer: A Rationale: More than ever, primary health care puts the concept of teamwork to the force. Team Planning by health personnel in the same level and the various health levels will be essential for the effectiveness and efficiency of health services. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p 69-70. 51. Nurse Nelia is scheduled will conduct a home visit to the Hernandez family. The first step during a home visit is one of the following: A. count the available appliances C. greet client and introduce self B. explain purpose of the visit D. wash hands and perform procedure Answer: C Rationale: A home visit is a professional face to face contact made by a nurse to the patient or the family to provide necessary health care activities and to further attain an objective of the agency. It is made to the client or to a responsible member of the family. The first step in home visit is to greet client or household member and introduce your self. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p52-53. 52. Which among the following is the most important principle during a home visit? A. inquiry about health and welfare B. performance of health assessment C. use of available information about the client D. evaluation of past service Answer: C Rationale: Planning for a home visit is an essential tool in achieving best results. When we plan to go on a home visit, it is necessary to assemble the records of the patients and list the names to be visited, study the case and have a written nursing care plan. There are 5 principles involved during home visits: (1) A home visit must have a purpose or objective; (2) Planning for a home visit should make use of all available information about the patient and his family through family records; (3) In planning a visit, we should consider and give priority to the essential needs of the individual and his family; (4) Panning and delivery of care should involve the individual and family; (5) The plan should be flexible. Source: Public Health Nursing in the Philippines 10th edition by DOH, p51. 53. The frequency of home visit is determined by which of the following?

7

A. Administration of medication B. Need for health teaching C. Result of the health studies D. Acceptance of the family Answer: D Rationale: There is no definite rule as to the frequency of a home visit. Since the population in a given community is much more than what the nurse can handle, prioritization of needs for a home visit is necessary. The frequency of home visit should take into consideration the following factors: (1) The physical, psychological, and educational needs of the individual and family; (2) The acceptance of the family for the services offered, the willingness and interest to cooperate; (3) The policy of a given agency and the emphasis placed on a given health program; (4) A careful evaluation of past services given to a family and how this family made use of such nursing services; (5) The ability of the patient and his/her family to recognize their own needs, their knowledge of available resources and their abilities to use these resources on their own accord. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p53. 54. Which among the following principles is the most important when doing proper bag technique? A. replace supplies fully every visit B. avoid transfer of infection C. clean supplies ready for use D. PHN bag is indispensable equipment Answer: B Rationale: 'The bag technique is a tool by which the nurse, during her visit will enable her to perform a nursing procedure with ease and deftness, to save time and effort, with the end view of rendering effective nursing care to clients. There are 4 principles of bag technique. (1) Performing the bag technique will minimize, if not prevent the spread of any infection. (2) It saves time and effort in performing nursing procedures. (3) The bag technique should show the effectiveness of the total care given to an individual or family. (4) The bag technique can be performed in a variety of ways depending on the agency's policy, the home situation or as long as principles of avoiding transfer of infection is always observed. Source: Public Health Nursing in the Philippines 10th edition by DOH, p52. 55. Which of the following herbal plants is used for respiratory problems and fever? a. Lagundi b. Sambong c. Niyog-niyogan d. Yerba Buena Answer: A Rationale: Lagundi (Vitex negundo) is a shrub growing wild in vacant lots and waste land. Matured branches are planted. The flowers are blue and bell-shaped. The small fruits turn black when ripe. It is better to collect the leaves when are in bloom. This herbal medicine can be used in asthma, cough, fever, dysentery, colds, pain, skin diseases (dermatitis, scabies, ulcer, eczema), headache, rheumatism, sprain, contusions, insect bites and aromatic bath for sick. B is incorrect. Sambong is a plant that reaches 1 to 3 meters in height with rough hairy leaves. Young plants around mother plant may be separated when they have three or more leaves. It is used as anti edema, diuretic, and anti urolithiasis.

8

C is incorrect. Niyog-Niyogan is a vine which bears tiny fruits and grows wild in the backyards. The seeds must come from mature, dried but newly opened fruits. It is used as an anti helminthic – used to expel round worm ascariasis. Source: Public Health Nursing in the Philippines 10th edition by DOH , p.324 56. Older persons use which of the following aromatic herbs for body pain, rheumatism and arthritis? A. sambong B. Yerba Buena C. tsaang gubat D. Ulasimang Bato Answer: B Rationale: Yerba Buena (Mentha cordifella) is a small multi-branching aromatic herb. The leaves are small, elliptical and with toothed margin. The stem creeps to the ground, and develops roots. It may also be propagated through cuttings. It can be used for headache, stomachache, rheumatism, arthritis, cough and cold, swollen gums, toothache, menstrual and gas pain, nausea and fainting, insect bites and pruritis. Source: Public Health Nursing in the Philippines 10th edition by DOH, p325. 57. Which of the following herbal plants is used for a lifestyle-related DM? A. Ulasimang Bato B. Bawang C. Carmona Retusa D. Ampalaya Answer: D Rationale: Ampalaya (Memordica charantia) can be used in lowering blood sugar level and Diabetes Mellitus ( mild non insulin dependent) A is incorrect. Ulasimang bato (Peperonia pellucida) is a weed, with heart-shaped leaves that grow in shady parts of the garden and yard, used in lowering uric acid (rheumatism and gout). B is incorrect. Bawang is used for hypertension, toothache and lowering the cholesterol level in the blood. C is incorrect. Carmona Retusa or Tsaang Gubat is a shrub with small, shiny nice looking leaves that grows in wild cultivated areas and forests. Mature stem are used for planting. It can be use in treatment of stomachache. Source: Public Health Nursing in the Philippines 10th edition by DOH, p326-328 58. Which of the following FP method is recommended to exclusively breastfeeding mothers? A. symptom thermal B. cervical mucous C. BBT D. LAM Answer: D Rationale: LAM or Lactating Amenorrhea Method is a temporary introductory postpartum method of [postponing pregnancy based on physiological infertility experienced by Breastfeeding Women. Its advantages are: It is universally available to all post partum women. Using LAM, protection from an unplanned pregnancy begins immediately postpartum. There are no other commodities required and it contributes to improve maternal and child health and nutrition. However, it is considered as an introductory, short

9

term family planning method which is effective only for a maximum of 6 month postpartum. Also, the effectiveness of LAM may decrease if a mother and child are separated for extended period of time and full or nearly full BF may be difficult to maintain for up to 6 months due to a variety of social circumstances. Source: Public Health Nursing in the Philippines 10th edition by DOH, p130. 59. Which among the following records is used when rendering prenatal care in the RHU? A. prenatal record B. home based mothers’ record C. target client list D. mother’s book Answer: B Rationale: The Home Based Mother's Record (HMBR) shall be used when rendering prenatal care as a guide in the identification of risk factors, danger signs, and to be able to do appropriate measure. Health promotion messages and information on danger signs must be given emphasis. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH 60. Which of the following is given to all pregnant mothers? A. chloroquine C. iodized salt B. iron D. all Answer: D Rationale: All pregnant women shall be given Tetanus Toxoid Immunization according to the WHO recommended schedule. Iron supplementation shall be given from the 5th month of pregnancy up to 2 months post partum. (100-200 mg orally per daily per orem for 210 days). In goiter endemic areas, all pregnant women shall be given one iodized oil capsule every year. In malaria infested areas, all pregnant women shall be given prophylaxis in the form of Chloroquine (150 mg base/ tablet) 2 tablets per week for the whole duration of pregnancy. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p96. 61. Which of tetanus? a. b. c. d. the following should you explain to the mother regarding the characteristics of prevented by BCG immunization usually introduced though a skin injury caused by non-spore forming organism person-to-person transmission

Answer: B Rationale: Tetanus or lockjaw is an acute exotoxin mediated infection caused by the anaerobic, spore-forming, gram positive bacillus Clostridium tetani. Normally, transmission is through a puncture wound that is contaminated by soil, dust, or animal excreta containing C. tetani, or by way of burns or minor wounds. After the bacillus enters the body, it causes local infection and tissue necrosis. It also produces toxins that then enter the bloodstream and lymphatics and eventually spread to the nervous system tissue. Tetanus occurs worldwide, but it's more prevalent in agricultural regions and developing countries that lack mass immunization programs. It is one of the most common causes of neonatal deaths in developing countries , where infants of unimmunized mothers are delivered under unsterile conditions. In such infants, the unhealed umbilical cord is the portal of entry. The

10

incubation period varies from 3 days to 1 month or more, falling between 7 and 14 days in high proportion of cases. This communicable disease is not transmitted from man to man. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p252. Source: Handbook of infectious disease by Longworth, p.304. 62. Which of the following of sign (s) is an indication of tetanus? a. muscular contraction of the neck muscles b. abdominal rigidity c. risus sardonicus d. all of these Answer: D Rationale: If tetanus remains localized, signs of onset are spasm and increases muscle tone near the wound. If the tetanus is generalized (systemic), indications include marked muscle hypertonicity, hyperactive deep tendon reflexes, profuse sweating, low grade fever, and painful, involuntary muscle contractions: (1) neck and facial muscles, especially cheek muscles – lockjaw (trismus),and grotesque, grinning expression called risus sardonicus. (2) Somatic muscles – arched- back rigidity (opisthotonos), board-like abdominal rigidity. (3) Intermittent tonic convulsions lasting several minutes, which may result in cyanosis and sudden death by asphyxiation. Source: Handbook of infectious disease by Longworth, p.304 63. To prevent tetanus infection, you informed the mothers that they should be given tetanus toxoid starting: A. strictly in the third trimester C. strictly in the first trimester B. strictly in the second trimester D. anytime during pregnancy Answer: D Rationale: Neonatal Tetanus is one of the public health concerns hat we need to address among newborns. To protect them from deadly disease tetanus toxoid immunization is important for pregnant women and child bearing age women. Both mother and child are protected against tetanus and neonatal tetanus. A series of 2 doses of tetanus toxoid vaccination must be received by a woman 1 month before delivery to protect baby from neonatal tetanus. And the 3 booster dose shots to complete the five doses following the recommended schedule provide full protection for both the mother and the child. When 2 doses of TT injection is given at 1 month interval between each dose during pregnancy or even before pregnancy period the baby is protected against neonatal tetanus. Completing the 5 doses following the schedule provide lifetime immunity. The 1st dose of tetanus Toxoid(TT1) is given as early as possible during pregnancy; TT2 should be given with at least a month interval after the 1st dose, this will give 80% protection for infants from neonatal tetanus and gives 3 years protection for the mother. The 3rd dose, TT3, is given with at least 6 months interval from TT2. It will give 95% protection to infants and give 5 years protection for the mother. TT4 is give at least one year after the 3rd dose. This will give 99% protection to the mother for 10 years and infants born to the mother will be protected from the said disease. The last dose, TT5 , should be administered after a year following the TT4 , it will yield 99% protection to all infants born to that mother and give a lifetime protection for the mother. Source: Public Health Nursing in the Philippines 10th edition by DOH, p 150. 64. All of the following may have a home delivery EXCEPT a. more than 5 deliveries c. full term b. imminent delivery d. no PROM

11

Answer: A Rationale: At risk pregnancies and mothers who develop obstetrical complications during labor should be immediately referred to the nearest facility or institution with capability to manage obstetric emergencies but obstetric first aid should be administered first before transport. Actively practicing but untrained birth attendants (hilots) should be identified, trained and supervised by a personnel of the nearest BHS/RHU trained on maternal care. The following are qualifications for home delivery: (1) full term; (2) less than 5 pregnancies ; (3) cephalic presentation; (4) without existing diseases such as diabetes, bronchial asthma, heart disease, hypertension, goiter, tuberculosis, severe anemia. (5) No history of complications like hemorrhage during previous deliveries. (6) No history of difficulty delivery and prolonged labor (more than 24 hours for primi and more than 12 hours for multigravida). (7) No previous caesarian section; (8) imminent deliveries- those who are about to deliver and can no longer reach the nearest health facility in time for delivery. In case of imminent deliveries by risk mothers they should still be referred to appropriate level of health facility if the risk remains after delivery but if the risk condition has disappeared then no referral is needed. (8) No PROM or premature rupture of membranes; (9) Adequate pelvis; (10) Abdominal enlargement is appropriate for age of gestation. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p96-97. 65. Unlicensed personnel or TBAs may attend to home deliveries only: a. when properly endorsed to the midwife b. when mother is her neighbor c. when there is no licensed personnel during delivery d. when the RHU is closed Answer: C Rationale: Home deliveries for normal pregnancies attended by licensed health personnel shall be encouraged. Trained hilots (TBAs) may be allowes to attend home deliveries only in the following circumstances: (1) In areas where there are no licensed health personnel on maternal care. (2) When, at the time of delivery, such personnel are not available. Source: Public Health Nursing in the Philippines 10th edition by DOH, p96. 66. The first post partum check-up visit should be done: a. within 48 hours c. ASAP b. within 12 hours d. within 24 hours Answer: D Rationale: For home deliveries, the first postpartum visit shall be done within 24 hours after the delivery, the next visit shall be at least one week after the delivery, and third visit two to four weeks thereafter. The visit to the health facility shall be within four to six weeks after delivery. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p104. 67. During your post partum check-up of the mother, you must include the following activities EXCEPT: A. check for bleeding C. take vital signs B. hygiene D. jaundice Answer: D

12

Rationale: Post partum check up for mothers should include: check for bleeding and infection; Check for VS, breastfeeding practices and Postpartum counseling to include birth spacing, cord care, hygiene, breastfeeding and nutrition. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH. P105 68. PHC is a strategy that focuses on which of the following groups? A. maternal & child B. communicable disease patients C. post hospitalized cases D. individual, families and communities Answer: D Rationale: WHO defines PHC as essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and the country can afford at every stages of development. The concept of PHC is characterized by partnership and empowerment of the people that shall permeate as a core strategy in the effective provision of essential health services that are community based, accessible, acceptable and sustainable at a cost which the community and the government can afford. It is a strategy, which focuses responsibility for health on the individual, his family and the community. It includes the full participation and active involvement of the community towards the development of self reliant people, capable of achieving an acceptable level of health and well being. Source: Public Health Nursing in the Philippines 10th edition by DOH, p30. 69. As a nurse in the RHU you are planning for the family health care of the Reyes family. Aside from the midwife, who among the following is also involved with your plan? A. municipal health officer B. nutritionist C. doctor on duty D. community health worker Answer: D Rationale: Team planning by he same personnel in the same level and the various health levels will be essential for the effectiveness and efficiency of health services. As a nurse, you will be planning family health care with the midwife and the community health worker. Team work in primary health care entails joint planning, implementation, and evaluation of community activities by the team members with the community health needs/problems as based on action. Joint efforts in the implementation of health programs are demonstrated by the health team where the nurse is the team leader with midwife and other community health workers. Source: Public Health Nursing in the Philippines 10th edition by DOH, p33. Situation 11: The following are the data you gathered from Barangay Talahib 1. total population: 120 2. total families included in the survey: 25 3. there were 85 cases of old and new cases of respiratory diseases 4. there were 29 new cases of respiratory diseases 5. there were 7 deaths reported for the past year 6. 3 of these deaths were due to respiratory diseases 70. Based on the above data: What variables would you need to compute for the prevalence rate of respiratory diseases?

13

Answer: B Rationale: Prevalence Rate measures the proportion of the population which exhibits a particular disease at a particular time. This can only be determined following a survey of the population concerned. It deals with total (old &new) number cases. PR= No. of new and old cases of a certain disease registered at a given time X 100 Total No. of persons examined at same given time Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p332. 71. What variables would you need to compute for the incidence rate of the respiratory diseases? A. 1 & 2 C. 2 & 3 B. 1 & 3 D. 1 & 4 Answer: D Rationale: Incidence Rate measures the frequency of occurrence of the phenomenon during a given period of time. It deals only with new cases. IR = No. of new cases of disease registered during a specified period of time X 100,000 Estimated population as of July of same year Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p332. 72. In computing for specific mortality rate for respiratory diseases, what numerator would you use? A. 3 C. 5 B. 4 D. 6 Answer: D Rationale: Specific Mortality Rate or Specific Death Rate describes more accurately the risk of exposure of certain classes or groups to a particular disease. To understand the forces of mortality, the rates should be made specific provided the data are available for both the population and the event in their specifications. Specific rates render more comparable and thus, reveal the problems of public health. SMR = Deaths in specific class or group registered in a given calendar year x 100,000 Estimated population as of July 1 in the same specified class or group of said year Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p331. 73. An analysis of the data given above would lead us to the identification of A. community diagnosis C. community health problems B. problem tree D. health status problems Answer: C Rationale: Specific Death Rates renders more comparable, thus revealing the problems of public health. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p331 74. Assuming that you have computed 300 infants eligible for Hepa B immunization, how many doses of Hepa B would you need? a. 300 c. 900 b. 600 d. 1,200 Answer: C

A. 1 & 2 B. 1 & 3

C. 2 & 3 D. 1 & 4

14

Rationale: Three doses of Hepa B Vaccine is given in every infant. It is given with a minimum interval of 4 weeks. Assuming that 300 infants are eligible for DPT immunization and there are 3 doses required per infant, 900 doses of DPT will be needed. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p110. 75. While the total number of measles doses need would be? a. 300 b. 600 c. 900 d. 1,200 Answer: A Rationale: Measles vaccine is given at the minimum age of 9 months, single dose. At least 80% of measles can be prevented by immunization at this age. Assuming that there are also 300 infants eligible for Measles vaccine and there should be 1 dose in each infant, therefore 300 doses are needed. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p111. 76. Which of these vaccines are the most sensitive to sunlight and are therefore kept frozen at the RHU? a. BCG & DPT c. OPV and measles b. BCG & OPV d. all of these Answer: C Rationale: Vaccines are substances very sensitive at various temperatures. To avoid spoilage and maintain its potency, vaccines need to be stored at correct temperature. OPV and measles are the types of vaccine that is most sensitive to heat. Both of it should be stored in a storage temprerature of -15°C to -25°Cor at the freezer. The vaccines that are least sensitive to heat are: DPT, Hep B, BCG, and Tetanus toxoid. These vaccines could be stored at temperature of +2°C to +8 °C or in the refrigerator. Source: Public Health Nursing in the Philippines 10th edition by DOH, p151. 77. Which of the following is a contraindication for immunization? a. lethargy c. Temperature of 38.2 0C b. malnutrition d. all Answer: A Rationale: Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindications to vaccination. Generally, one should immunize unless the child is so sick that he needs hospitalization. The absolute contraindications to immunization are: (1) DPT2 or DPT3 to a child who has had convulsion or shock within 3 days the previous dose. Vaccines containing the whole cell pertussis component should not be given to children with an evolving neurological disease(uncontrolled epilepsy of progressive encephalopathy). (2) Liver vaccines like BCG vaccines must not be given to individuals who are immunosuppressed due to malignant disease, therapy with immunosuppressive agents or irradiation. Source: Public Health Nursing in the Philippines 10th edition by DOH, p143. 78. Which pillar of the Sentrong Sigla Movement requires the assessment of the health organizations’ programs, infrastructure, human resources and community interventions? a. Quality Assurance c. Health Promotion b. Grants and Technical Assistance d. Award Answer: A

15

Rationale: There are 4 pillars of Sentrong Sigla(SS) movement namely – Quality assurance pillar, Health Promotion pillar, Grants and Technical Assistance pillar and Award pillar. The quality assurance pillar sets and updates standards and requirements for quality health services in hospitals and RHUs. It supports continuing efforts for quality assurance, conducts semestral evaluation of the facilities with SS seal and removes from the facility the SS seal if it fails to maintain standards for 2 consecutive evaluation periods. Quality Assurance assesses the : infrastructure/amenities, services, attitudes and behavior of health workers, human resources, equipment, drugs , medicines and supplies, Health information system and community intervention. Health Promotion Pillar creates awareness and demand for improved quality services. It promotes concept of health as personal responsibility, encourages community participation for health action and develops environment for health action. Grants and Technical Assistance pillar, on the other hand, provides financial and logistics assistance to Local Government Units. It also provides access to a pool of technical experts to assist the LGUs in their continuing quality improvement program. The grants may be used by the LGUs to develop capabilities of Health workers and to improve the health facilities in line with SS standards. The awards pillar is responsible in giving recognition of outstanding facilities (national and local). It also organizes events to recognize such facilities. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p126127. 79. In monitoring and evaluating the services rendered by the RHU, this is an indispensable tool that provides the summary of data on service delivery and program accomplishment. a. Target client list c. FHSIS b. Reporting forms d. barangay health plan Answer: A Rationale: Target/Client List constitute the second "building block" of the FHSIS and are intended to serve as: (1) to plan and carry out patient care and service delivery. This list will be considerable value to midwives/nurses in monitoring service delivery to client in general and in particular to groups of patients identified as "targets" or "eligible" for one another program of the department; (2) to facilitate the monitoring and supervision of services; (3) to report services delivered. The objective is to avoid having to go back to individual patient/ family records in order to complete FHSIS Reporting Forms. (4) to provide a clinic-level data base which can be accessed for further studies. B is incorrect. Tally/Reporting Forms constitute the only mechanism through which data are routinely transmitted from or facilities to another in the revised FHSIS. The majority of FHSIS reports are prepared and submitted either monthly or quarterly. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p341 80. From among the vital statistics included in the health profile compiled from the previous year, you would like to determine the number of children (0-5 years old) who died due to diarrhea for that year. The vital statistics that will give you this data would be the a. Prevalence Rate b. Infant mortality Rate c. Proportionate Death rate d. Case Fatality rate Answer: C

16

Rationale: Proportionate mortality Rate shows the numerical relationship between deaths from all causes (or group of causes), age (or group of age) and the total no. of deaths from all causes in all ages taken together. PMR= No. of registered deaths from specific cause or age for a given calendar year x 1000 No. of registration deaths from all causes, all ages in same year A is incorrect. Prevalence Rate measures the proportion of the population which exhibits the particular disease at a particular time. This can only be determined following survey of the population concerned, deals with total (new or old) number of cases. B is incorrect. Infant mortality Rate measures the risk of dying during the 1st year of life. It is a good index of the general health condition of a community since it reflects the changes in the environment and medical condition of the community. IMR= Total number of death under 1 year of age registered in a given calendar year x 1000 Total no. of registered live births of the same calendar year D is incorrect. Case fatality Ratio is the index of a killing power of a disease and is influenced by incomplete reporting and poor morbidity data. CFR = x 1000 No. of registered deaths from a specific disease for a given year No. of registered cases from the same specific disease in the same year Source: Public Health Nursing in the Philippines 10th edition by DOH, p76 -78.

81. Which data is the most sensitive indicator of the total health status on the community? a. Prevalence Rate b. Infant Mortality Rate c. Proportionate Death rate d. Case Fatality rate Answer: B Rationale: infant Mortality rate is a good index of the general health condition if the community since it reflects the changes in the environment and medical condition of a community. Source: Public Health Nursing in the Philippines 10th edition by DOH, p76. 82. What alarmed you the most was that the case fatality rate for diarrhea for that year was 40%. This implies that a. 40% of the population died of diarrhea b. 40% of the population had diarrhea c. 40% of those who had diarrhea died d. 40% of the those who had diarrhea did not receive medical attention Answer: C Rationale: Case Fatality Rate of 40% indicates that 40% of those who had diarrhea died of it. The higher the CFR, the more fatal a disease is. Source: Public Health Nursing in the Philippines 10th edition by DOH, p79. 83. Based on some of your findings during the prenatal check up, the mother was classified having a high risk pregnancy. This would imply the following EXCEPT A. tubal ligation should be done as soon as she delivers B. she is disqualified for home delivery C. she may need to referred to the hospital for her delivery D. she must be closely monitored and evaluated

17

Answer: A Rationale: Patient with serious or potentially serious complications, following the initial evaluation, shall be referred to the most skilled source of medical and hospital care. As a first choice they will be referred if at all possible for continuing care or consultation. As a second choice, they will be followed carefully by the rural health unit, city clinic or puericulture center where they should be seen frequently by the physician. A thorough evaluation of the needs of patients with mild complications will determine the frequency of follow up of these cases. This mothers who are at high risk pregnancy are disqualified for home delivery. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p94-97. 84. The minimum number of prenatal check-up for an expectant mother is A. 3 C. 9 B. 6 D. 12 Answer: A Rationale: There should be at least 3 prenatal visits during pregnancy following the prescribed timing: The 1st prenatal visit should be made as early in pregnancy as possible, during the 1st trimester. The second visit during the 2nd trimester and the third and subsequent visits during the 3rd trimester. More visits should be done for those at risk/ with complications. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p95 85. As part of the routine prenatal check up, all expectant mothers are given 1. Tetanus toxoid 3. Vitamin A capsules 2. Iron supplement 4. Iodized capsule for goiter in endemic areas A. 1, 2 & 3 B. 2, 3 & 4 C. 1, 2, 3 & 4 D. 1 only

Answer: C Rationale: All pregnant women shall be given Tetanus Toxoid Immunization according to the WHO recommended schedule. Iron supplementation shall be given from the 5th month of pregnancy up to 2 months post partum. (100-200 mg orally per daily per orem for 210 days). In goiter endemic areas, all pregnant women shall be given one iodized oil capsule every year. In malaria infested areas, all pregnant women shall be given prophylaxis in the form of Chloroquine (150 mg base/ tablet) 2 tablets per week for the whole duration of pregnancy. Vitamin A 10,000IU, is given twice a week starting the 4th month of pregnancy. Do not give Vitamin A supplementation before the 4th month of pregnancy because it might cause congenital problems in the baby. Source: Public Health Nursing in the Philippines 10th edition by DOH, p120-121 86. To encourage all mothers to breastfeed you enumerate its benefits, which among the following is not true of breastfeeding? A. B. C. D. reduces incidence of infection in infants may help space pregnancy gives passive immunity none of the above

Answer: D Rationale: Exclusive breastfeeding of infants recommended for the first six months of their lives and breastfeeding with complimentary foods thereafter. Breastfeeding has many

18

physical and psychological benefits for children and mother as well as economic benefits for families and societies. The benefits of breastfeeding to infants are: (1) It provides a nutritional complete food for the young infant. (2) It strengthens the infants immune system, preventing many infections. (3) Safely rehydrates and provides essential nutrients to a sick child, especially those suffering from diarrheal disease. (4) It reduces the infants exposure to infection and increases IQ points. Its benefits for the mothers are: (1) Reduces woman's risk for excessive blood loss after birth. (2) Provides natural methods of delaying pregnancies. (3) Reduces the risk of ovarian and breast cancers and osteoporosis. To household & community: (1) Conserve funds that otherwise would be spent on breast milk substitute, supplies and fuel to prepare them. (2) saves medical cost to families and government by preventing illnesses and by providing immediate postpartum contraception. Source: Public Health Nursing in the Philippines 10th edition by DOH, p136. 87. Aling Ana delivered a healthy, bouncing baby boy at home whom she named Joey. Eager to ensure that Joey is protected against childhood communicable diseases the midwife who attended to Aling Ana’s home delivery gave Joey his first vaccination at the health center. Based on the EPI schedule, which of these would she give Joey? A. BCG C. Hepatitis B Vaccine B. DPT D. OPV Answer: A Rationale: BCG given at earliest possible age protects the possibility of TB meningitis & other TB infectious in which infants are prone. B is incorrect. DPT is given 6 weeks after birth. C should be given within the first 24 hours according to IMCI. But since this is home delivery and the immunization occurred at the health center, the schedule should be at 6 weeks, 10 weeks, 14 weeks. D is incorrect. OPV is given at the same time as DPT. Source: Public Health Nursing in the Philippines 10th edition by DOH, p149. 88. Since Aling Ana was given 2 doses of tetanus toxoid during her pregnancy, you know that Joey was also protected. What type of immunity did Joey receive? A. Natural – Active C. Artificial - Active B. Natural – Passive D. Artificial - Passive Answer: B Rationale: Immunity is the status or quality of being immune or insusceptible in certain diseases. Thera are 2 types of immunity – active & passive. In active immunity, the host produces antibodies in response to natural antigens. It is subdivided further to natural or artificial. In natural active immunity, antibodies are formed in the presence of active infection in the body; whereas in artificial active immunity, the antigens (vaccines or toxoids) are administered to stimulate antibody production. In passive or acquired immunity, the host receives natural or artificial antibodies produce by another source. It can also be either natural or artificial. In natural passive immunity, antibodies are transferred naturally from an immune mother to her baby through the placenta or colostrums, wherein in artificial passive immunity, immune serum (antibody) from an animal or another human is injected. Source: Fundamentals of Nursing 7th edition by Kozier, p635. 89. Which of the following vaccine will you give intradermally to Joey? A. BCG B. DPT C. Measles D. OPV

19

Answer: A Rationale: BCG is the only vaccine routinely administered intradermally. B is incorrect. DPT is given in intramuscular route. C is incorrect. Meascles vaccine is administered subcutaneously. D is incorrect. OPV is given via mouth/ taken orally. Source: Public Health Nursing in the Philippines 10th edition by DOH, p152 90. After 2 days, Aling Ana consulted you in the health center. She wanted you to assess Joey’s immunization site (refer to your answer in 89). You would immediately look at Joey’s A. Left deltoid area B. Left vastus lateralis C. Right deltoid area D. Right vastus lateralis

Answer: C Rationale: BCG vaccine is routinely administered at the right deltoid region of the arm. This is the preferred site. Source: Public Health Nursing in the Philippines 10th edition by DOH, p152. 91. You noticed that there was immediate reaction to the vaccine characterized by inflammation at the injection site. You tell Aling Ana that this is indicative of A. Secondary infection C. a normal reaction B. Wrong technique / administration D. previous exposure to TB Answer: C Rationale: If the vaccine is injected correctly into the skin, a flat wheal with the surface pitted like an orange peel will appear at the injection site, which is a normal reaction. if a guinea pig that has been previously infected with tuberculosis organisms is reinjected intracutaneously, the skin over the injected area undergoes necrosis and a superficial ulcer develops; the ulcer heals quickly and infection of regional lymph nodes is retarded. The phenomenon demonstrates development of ability to localize tubercle bacilli, which is the principle underlying tuberculin tests (q.v.). Called also Koch's reaction. Source: Public Health Nursing in the Philippines 10th edition by DOH, p153. 92. This condition is also known as A. Indolent ulceration B. Lymph glands enlargement C. Koch’s Phenomenon D. none, it is a normal reaction

Answer: C Rationale: if a guinea pig that has been previously infected with tuberculosis organisms is reinjected intracutaneously, the skin over the injected area undergoes necrosis and a superficial ulcer develops; the ulcer heals quickly and infection of regional lymph nodes is retarded. The phenomenon demonstrates development of ability to localize tubercle bacilli, which is the principle underlying tuberculin tests (q.v.). Called also Koch's reaction. Source:http://www.mercksource.com 93. To maintain the “cold chain” the appropriate storage temperature for OPV and measles is A. Frozen at –2 to –8 degrees Celsius B. Frozen at –25 to -15 degrees Celsius C. Refrigerated at 2 to 8 degrees Celsius D. Refrigerated at 15 – 25 degrees Celsius

20

Answer: B Rationale: Vaccines are substances very sensitive at various temperatures. To avoid spoilage and maintain its potency, vaccines need to be stored at correct temperature. OPV and measles are the types of vaccine that is most sensitive to heat. Both of it should be stored in a storage temperature of -15°C to -25°Cor at the freezer. The vaccines that are least sensitive to heat are: DPT, Hep B, BCG, and Tetanus toxoid. These vaccines could be stored at temperature of +2°C to +8 °C or in the refrigerator. Source: Public Health Nursing in the Philippines 10th edition by DOH, p151. 94. As a CHN, one of your responsibilities is the supervision of the midwife. You know very well that the midwife under your supervision is adept in immunizing infants if she administers DPT by observing the following? A. aspirates first before injecting 0.5 ml, IM at the right vastus lateralis B. aspirates first before injecting 0.05 ml, ID at the right deltoid C. injects 0.5 ml, IM at the right vastus lateralis D. injects 0.05 ml, SQ at the right upper arm Answer: A Rationale: DPT is given deep IM at the upper outer portion of the thigh or vastus lateralis with dose of 0.5ml. Since this is deep IM, aspirating for blood is necessary to avoid a blood vessel. Source: Public Health Nursing in the Philippines 10th edition by DOH, p152. 95. When asked by the midwife under your supervision about the content of the Hepatitis B Vaccine. You immediately replied that it is a A. B. C. D. Live attenuated virus Weakened toxin Plasma derived Killed bacteria

Answer: C Rationale:
EPI VACCINES: CONTENTS, FORMS, Exposure to Certain Conditions
Vaccine Contents Form Conditions when exposed to heat destroyed by heat, sunlight not destroyed by freezing Storage Temperature - 15 to -25 0C

BCG

Live attenuated bacterial vaccine

Freeze dried and to be reconstituted with a special diluent Liquid

DPT

D – Toxoid which is a weakened toxin P – killed bacteria T – toxoid which is a weakened toxin

D – destroyed by freezing/heat P – damaged by heat T – damaged by heat and freezing

- 15 to -25 0C

Polio Vaccine

Live attenuated virus

Liquid

Easily damaged by heat, not destroyed by freezing

2 to 8 0C

21

Measles Vaccine

Live attenuated virus

Freeze dried and to be reconstituted with a special diluent Liquid

Easily damaged by heat, not destroyed by freezing

2 to 8 0C

Hepatitis B Vaccine Tetanus Toxoid

Plasma derived; RNA recombinant Weakened toxin

Damaged by heat or freezing

2 to 8 0C

Liquid

Damaged by heat or freezing

2 to 8 0C

Source: Expanded program on immunization manual. (Revised Edition, 1995). Department of Health, Government of the Philippines p. 35 96. Before giving DPT2, Juan’s mother told you that Juan had seizure after he had DPT1. Your best course of action is A. B. C. D. refer Juan to a neurologist give DPT2 with anti-pyretic and anti-convulsant medication not to give DPT2 teach mother home remedies for convulsion

Answer: C Rationale: DPT2 or DPT3 should not be given to a child who has had convulsions or shock within 3 days the previous dose. So the best course of action is to omit DPT2. Source: Public Health Nursing in the Philippines 10th edition by DOH, p143. 97. It is a policy of the DOH that all children below infants and children will be provided compulsory immunization; this is enshrined as a law based on A. PD 669 C. PD 969 B. PD 696 D PD 996 Answer: D Rationale: Presidential Decree No. 996 (September 16, 1976) requires compulsory immunization for all children below eight years old against communicable diseases. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p109. 98.As a health professional you are aware that AIDS can be acquired through the following modes EXCEPT A. Blood transfusion B. Unsanitary toilets C. Sexual contact D. Sharing of syringe and needles Answer: B Rationale: AIDS/ Acquired Immunodeficiency syndrome is marked by progressive failure of the immune system. Although it is characterized by gradual destruction of cell-mediated (Tcell) immunity, it also affects humoral immunity and even autoimmunity because of the central role of the CD4+ T lymphocyte in immune reactions. The resultant immunodeficiency makes the patient susceptible to opportunistic infections, unusual cancers, and other abnormalities that define AIDS. A retrovirus is the primary etiologic agent. Transmission of HIV occurs by contact with infected blood or body fluids and is associated with identifiable high risked behaviors. As a result, it is most common in homosexual and bisexual men, I.V. drug users, neonates of HIV infected women, recipients of contaminated blood or blood products, and heterosexual partners of persons in the

22

former group. The incubation period varies. Although the time from infection to the development of detectable antibodies is generally 1-3 months, the time from HIV to diagnosis of AIDS has an observe range of less than 1 year to 15 years or longer. Source: Handbook of infectious disease by Longworth, p30. Source: Public Health Nursing in the Philippines 10th edition by DOH, p300. 99. A cornerstone of the AIDS Prevention Program is the early diagnosis of cases to minimize transmission, which of the following is not a sign of HIV? A. persistent diarrhea C. Kaposi’s Sarcoma B. esophageal candidiasis D. loss of sensation in affected area Answer: D Rationale:AIDS is manifested by maculo popular rashes, loss of appetite, weight loss, fever of unknown origin, malaise, persistent diarrhea, tuberculosis, esophageal candidiasis, Kaposi's sarcoma, Pneumocystic carinii pneumonia, gaunt apprehensive looking, forgetfulness, loss of libido, apathy, withdrawal and psychomotor retardation. In later stage:confusion, disorientation, seizures, mutism, loss of memory, and coma. Source: Public Health Nursing in the Philippines 10th edition by DOH, p300. 100. Which on of the following is a principle in nursing care at home? A. It is a policy of the Department of Health B. It is an opportunity for teaching patient and members of the family C. It is cost effective and efficiently done D. The nurse has the responsibility to access the environment Answer: B Rationale: Giving to the individual patient the nursing care required by his/ her specific illness or trauma to help him/ her reach a level of functioning at which he/ she can maintain him/ herself, or die peacefully in dignity. There are 5 principles of Nursing Care at Home. (1) Nursing care utilizes a medical plan of care and treatment. (2) The performance of nursing care utilizes skills that would give maximum comfort and security to the individual. (3) Nursing care given at home should be used as a teaching opportunity to the patient or to any responsible member of the family. (4) the performance of nursing care should recognize dangers in the patient's over-prolonged acceptance of support and comfort. (5) Nursing care is a good opportunity for detecting abnormal signs and symptoms, observing patient's attitude towards care given and the progress exhibited by the patient. Source: Community Health Nursing Services in the Philippines 9th Edition by DOH, p61. ---End of Examination--

23

24