1.

Answer: (D) Retinol capsule regardless of when the last dose was given
An infant 6 to 12 months classified as a case of measles is given Retinol 100,000 IU;
a child is given 200,000 IU regardless of when the last dose was given.

2. Answer: (B) Ask where the family resides.

Because malaria is endemic, the first question to determine malaria risk is where
the client’s family resides. If the area of residence is not a known endemic area, ask
if the child had traveled within the past 6 months, where he/she was brought and
whether he/she stayed overnight in that area.

3. Answer: (B) Destroying breeding places of mosquitoes

Aedes aegypti, the vector of Dengue fever, breeds in stagnant, clear water. Its
feeding time is usually during the daytime. It has a cyclical pattern of occurrence,
unlike malaria which is endemic in certain parts of the country.

4. Answer: (C) Determining whether a place is endemic or not

This is diagnostic and therefore secondary level prevention. The other choices are
for primary prevention.

5. Answer: (B) Pinworm

Pinworm ova are deposited around the anal orifice.

6. Answer: (C) Cough for 3 weeks

A client is considered a PTB suspect when he has cough for 2 weeks or more, plus
one or more of the following signs: fever for 1 month or more; chest pain lasting for
2 weeks or more not attributed to other conditions; progressive, unexplained
weight loss; night sweats; and hemoptysis.

7. Answer: (D) Clients diagnosed for the first time through a positive sputum exam
Category I is for new clients diagnosed by sputum examination and clients
diagnosed to have a serious form of extrapulmonary tuberculosis, such as TB
osteomyelitis.

8. Answer: (B) Having the health worker or a responsible family member monitor
drug intake
Directly Observed Treatment Short Course is so-called because a treatment
partner, preferably a health worker accessible to the client, monitors the client’s
compliance to the treatment.

9. Answer: (C) Thickened painful nerves

The lesion of leprosy is not macular. It is characterized by a change in skin color
(either reddish or whitish) and loss of sensation, sweating and hair growth over the
lesion. Inability to close the eyelids (lagophthalmos) and sinking of the nosebridge
are late symptoms.
10. Answer: (D) 5 skin lesions, positive slit skin smear
A multibacillary leprosy case is one who has a positive slit skin smear and at least 5
skin lesions.

11. Answer: (B) Liver cirrhosis

The etiologic agent of schistosomiasis in the Philippines is Schistosoma japonicum,
which affects the small intestine and the liver. Liver damage is a consequence of
fibrotic reactions to schistosoma eggs in the liver.

12. Answer: (C) Proper use of sanitary toilets

The ova of the parasite get out of the human body together with feces. Cutting the
cycle at this stage is the most effective way of preventing the spread of the disease
to susceptible hosts.

13. Answer: (B) II

A communal faucet or water standpost is classified as Level II.

14. Answer: (A) Use of sterile syringes and needles

Hepatitis A is transmitted through the fecal oral route. Hepatitis B is transmitted
through infected body secretions like blood and semen.

15. Answer: (A) DPT

DPT is sensitive to freezing. The appropriate storage temperature of DPT is 2 to 8° C
only. OPV and measles vaccine are highly sensitive to heat and require freezing.
MMR is not an immunization in the Expanded Program on Immunization.

16. Answer: (D) Any of these health professionals

R.A. 3753 states that any birth attendant may sign the certificate of live birth.

17. Answer: (C) Magnitude of the health problem

Magnitude of the problem refers to the percentage of the population affected by a
health problem. The other choices are criteria considered in both family and
community health care.

18. Answer: (D) Its main strategy is certification of health centers able to comply
with standards.
Sentrong Sigla Movement is a joint project of the DOH and local government units.
Its main strategy is certification of health centers that are able to comply with
standards set by the DOH.

19. Answer: (D) Those who just had a delivery within the past 15 months
The ideal birth spacing is at least two years. 15 months plus 9 months of pregnancy
= 2 years.

20. Answer: (C) Adequate information for couples regarding the different methods
To enable the couple to choose freely among different methods of family planning,
they must be given full information regarding the different methods that are
available to them, considering the availability of quality services that can support
their choice.

21. Answer: (B) Retinol 200,000 IU

Retinol 200,000 IU is a form of megadose Vitamin A. This may have a teratogenic
effect.

22. Answer: (A) Her OB score is G5P3.

Only women with less than 5 pregnancies are qualified for a home delivery. It is
also advisable for a primigravida to have delivery at a childbirth facility.

23. Answer: (C) Folic acid

It is estimated that the incidence of neural tube defects can be reduced drastically if
pregnant women have an adequate intake of folic acid.

24. Answer: (D) Note the interval, duration and intensity of labor contractions.
Assessment of the woman should be done first to determine whether she is having
true labor and, if so, what stage of labor she is in.

25. Answer: (D) Explain to her that putting the baby to breast will lessen blood loss
after delivery.
Suckling of the nipple stimulates the release of oxytocin by the posterior pituitary
gland, which causes uterine contraction. Lactation begins 1 to 3 days after delivery.
Nipple stretching exercises are done when the nipples are flat or inverted. Frequent
washing dries up the nipples, making them prone to the formation of fissures.

26. Answer: (B) To stimulate milk production by the mammary acini

Suckling of the nipple stimulates prolactin reflex (the release of prolactin by the
anterior pituitary gland), which initiates lactation.

27. Answer: (B) The mother does not feel nipple pain.
When the baby has properly latched on to the breast, he takes deep, slow sucks; his
mouth is wide open; and much of the areola is inside his mouth. And, you’re right!
The mother does not feel nipple pain.

28. Answer: (B) 6 months

After 6 months, the baby’s nutrient needs, especially the baby’s iron requirement,
can no longer be provided by mother’s milk alone.

29. Answer: (C) Retinol 200,000 I.U., 1 capsule

A capsule of Retinol 200,000 IU is given within 1 month after delivery. Potassium
iodate is given during pregnancy; malunggay capsule is not routinely administered
after delivery; and ferrous sulfate is taken for two months after delivery.
30. Answer: (C) Measles vaccine
Among the biologicals used in the Expanded Program on Immunization, measles
vaccine and OPV are highly sensitive to heat, requiring storage in the freezer.

31. Answer: (B) 4

While the unused portion of other biologicals in EPI may be given until the end of
the day, only BCG is discarded 4 hours after reconstitution. This is why BCG
immunization is scheduled only in the morning.

32. Answer: (A) P.D. 996

Presidential Decree 996, enacted in 1976, made immunization in the EPI
compulsory for children under 8 years of age. Hepatitis B vaccination was made
compulsory for the same age group by R.A. 7846.

33. Answer: (B) BCG

BCG causes the formation of a superficial abscess, which begins 2 weeks after
immunization. The abscess heals without treatment, with the formation of a
permanent scar.

34. Answer: (C) Infant BCG

Infant BCG may be given at birth. All the other immunizations mentioned can be
given at 6 weeks of age.

35. Answer: (A) Seizures a day after DPT 1.

Seizures within 3 days after administration of DPT is an indication of
hypersensitivity to pertussis vaccine, a component of DPT. This is considered a
specific contraindication to subsequent doses of DPT.

36. Answer: (A) Go on with the infant’s immunizations.

In the EPI, fever up to 38.5°C is not a contraindication to immunization. Mild acute
respiratory tract infection, simple diarrhea and malnutrition are not
contraindications either.

37. Answer: (A) 1 year

The baby will have passive natural immunity by placental transfer of antibodies.
The mother will have active artificial immunity lasting for about 10 years. 5 doses
will give the mother lifetime protection.

38. Answer: (C) Normal

In IMCI, a respiratory rate of 50/minute or more is fast breathing for an infant aged
2 to 12 months.

39. Answer: (D) Chest indrawing

In IMCI, chest indrawing is used as the positive sign of dyspnea, indicating severe
pneumonia.
40. Answer: (B) Refer him urgently to the hospital.
Severe pneumonia requires urgent referral to a hospital. Answers A, C and D are
done for a client classified as having pneumonia.

41. Answer: (B) Some dehydration

Using the assessment guidelines of IMCI, a child (2 months to 5 years old) with
diarrhea is classified as having SOME DEHYDRATION if he shows 2 or more of the
following signs: restless or irritable, sunken eyes, the skin goes back slow after a
skin pinch.

42. Answer: (D) Refer the client for a supplementary test, such as Western blot,
since the ELISA result may be false.
A client having a reactive ELISA result must undergo a more specific test, such as
Western blot. A negative supplementary test result means that the ELISA result was
false and that, most probably, the client is not infected.

43. Answer: (A) Being faithful to a single sexual partner

Sexual fidelity rules out the possibility of getting the disease by sexual contact with
another infected person. Transmission occurs mostly through sexual intercourse
and exposure to blood or tissues.

44. Answer: (B) Infectious mononucleosis

Cytomegalovirus disease is an acute viral disease characterized by fever, sore
throat and lymphadenopathy.

45. Answer: (A) Contact tracing

Contact tracing is the most practical and reliable method of finding possible
sources of person-to-person transmitted infections, such as sexually transmitted
diseases.

46. Answer: (D) They are able to bring about a cure of the disease condition.
There is no known treatment for AIDS. Antiretroviral agents reduce the risk of
opportunistic infections and prolong life, but does not cure the underlying
immunodeficiency.

47. Answer: (D) Consult a physician who may give them rubella immunoglobulin.
Rubella vaccine is made up of attenuated German measles viruses. This is
contraindicated in pregnancy. Immune globulin, a specific prophylactic against
German measles, may be given to pregnant women.

48. Answer: (B) To enhance the capacity of individuals, families and communities to
cope with their health needs.
To contribute to national development through promotion of family welfare,
focusing particularly on mothers and children.
49. Answer: (B) The nurse has to conduct community diagnosis to determine
nursing needs and problems.
Community-based practice means providing care to people in their own natural
environments: the home, school and workplace, for example.

50. Answer: (D) Public health nursing focuses on preventive, not curative, services.
The catchment area in PHN consists of a residential community, many of whom are
well individuals who have greater need for preventive rather than curative services.

II.

1. Answer: B. Right lower quadrant

Right lower quadrant. The landmark to look for when looking for PMI is the location
of the fetal back in relation to the right or left side of the mother and the
presentation, whether cephalic or breech. The best site is the fetal back nearest the
head.

2. Answer: D. The mass palpated is the buttocks.

The palpated mass is the fetal buttocks since it is broad and soft and moves with
the rest of the mass.

3. Answer: B. The mass palpated is the head.

When the mass palpated is hard round and movable, it is the fetal head.

4. Answer: C. Human Chorionic Gonadotropin

Human chorionic gonadotropin (HCG) is the hormone secreted by the chorionic villi
which is the precursor of the placenta. In the early stage of pregnancy, while the
placenta is not yet fully developed, the major hormone that sustains the pregnancy
is HCG.

5. Answer: A. Follicle stimulating hormone

The hormone that stimulates the maturation if the of the graafian follicle is the
Follicle Stimulating Hormone which is released by the anterior pituitary gland.

6. Answer: B. Vertical position

Vertical position means the fetal spine is parallel to the maternal spine thus making
it easy for the fetus to go out the birth canal.

 Options A and C: If transverse or oblique, the fetus can’t be delivered

normally per vagina.
7. Answer: B. The fundus of the uterus is high pushing the diaphragm upwards
From the 32nd week of the pregnancy, the fundus of the enlarged uterus is pushing
the respiratory diaphragm upwards. Thus, the lungs have reduced space for
expansion consequently reducing the oxygen supply.
8. Answer: B. Fullness of the breast and urinary frequency
The fullness of the breast is due to the increased amount of progesterone in
pregnancy. The urinary frequency is caused by the compression of the
urinary bladder by the gravid uterus which is still within the pelvic cavity during the
first trimester.

9. Answer: D. (+) ultrasound

A positive ultrasound will confirm that a woman is pregnant since the fetus in utero
is directly visualized.

10. Answer: D. Quickening

Quickening is the first fetal movement felt by the mother makes the woman realize
that she is truly pregnant. In early pregnancy, the fetus is moving but too weak to
be felt by the mother. In the 18th-20th week of gestation, the fetal movements
become stronger thus the mother already feels the movements.

11. Answer: A. Backache

Backache usually occurs in the lumbar area and becomes more problematic as the
uterus enlarges. The pregnant woman in her third trimester usually assumes a
lordotic posture to maintain balance causing an exaggeration of the lumbar
curvature. Low broad heels provide the pregnant woman with a good support.

12. Answer: C. Let the woman lie down and dorsiflex the foot towards the
knees
Leg cramps is caused by the contraction of the gastrocnimeus (leg muscle). Thus,
the intervention is to stretch the muscle by dosiflexing the foot of the affected leg
towards the knee.

13. Answer: A. week

In the 9th month of pregnancy the mother needs to have a weekly visit to the
prenatal clinic to monitor fetal condition and to ensure that she is adequately
prepared for the impending labor and delivery.

14. Answer: A. 1 pound a week

During the 3rd trimester the fetus is gaining more subcutaneous fat and is growing
fast in preparation for extra uterine life. Thus, one pound a week is expected.

15. Answer: C. 7th month

In Bartholomew’s Rule of 4, the landmarks used are the symphysis pubis, umbilicus
and xyphoid process. At the level of the umbilicus, the AOG is approximately 5
months and at the level of the xyphoid process 9 months. Thus, midway between
these two landmarks would be considered as 7 months AOG.

16. Answer: A. Naegele’s rule

Naegele’s Rule is determined based on the last menstrual period of the woman.
17. Answer: C. Nov. 7
Based on the last menstrual period, the expected date of delivery is Nov. 7. The
formula for the Naegele’s Rule is subtract 3 from the month and add 7 to the day.

18. Answer:  A. Strengthen perineal muscles

Kegel’s exercise is done by contracting and relaxing the muscles surrounding the
vagina and anus in order to strengthen the perineal muscles

19.Answer: D. Backache
Backache is caused by the stretching of the muscles of the lower back because of
the pregnancy. Pelvic rocking is good to relieve backache.

20. Answer: A. The mother may have physiologic anemia due to the increased
need for red blood cell mass, as well as the fetal, requires about 350-400 mg of
iron to grow
About 400 mgs of Iron is needed by the mother in order to produce more RBC
mass to be able to provide the needed increase in blood supply for the fetus. Also,
about 350-400 mgs of iron is need for the normal growth of the fetus. Thus, about
750-800 mgs iron supplementation is needed by the mother to meet this additional
requirement.

21. Answer: A. Protein, minerals and vitamins

In normal pregnancy there is a higher demand for protein (body building foods),
vitamins (esp. vitamin A, B, C, folic acid) and minerals (esp. iron, calcium,
phosphorous, zinc, iodine, magnesium) because of the need of the growing fetus.

22. Answer: B. No fetal movement is felt on the 6th month

Fetal movement is usually felt by the mother during 4.5 – 5 months. If the
pregnancy is already in its 6th month and no fetal movement is felt, the pregnancy
is not normal either the fetus is already dead intra-uterine or it is an H-mole.

23. Answer: A. Asking her to void

A pelvic examination includes abdominal palpation. If the pregnant woman has a
full bladder, the manipulation may cause discomfort and accidental urination
because of the pressure applied during the abdominal palpation. Also, a full
bladder can impede the accuracy of the examination because the bladder (which is
located in front of the uterus) can block the uterus.

24. Answer: C. Drink at least 2 liters of fluid 2 hours before the procedure and
not void until the procedure is done
Drinking at least 2 liters of water 2 hours before the procedure will result to a
distended bladder. A full bladder is needed when doing an abdominal ultrasound
to serve as a “window” for the ultrasonic sound waves to pass through and allow
visualization of the uterus (located behind the urinary bladder).
25. Answer: A. Dry carbohydrate food like crackers
Morning sickness maybe caused by hypoglycemia early in the morning thus giving
carbohydrate food will help.

26. Answer: D. 12 months

A child’s birth weight usually triples by 12 months and doubles by 4 months. No specific birth weight
parameters are established for 7 or 9 months.

27. Answer: C. Sitting near each other while playing with separate dolls

Toddlers engaging in parallel play will play near each other, but not with each other. Thus, when two
toddlers sit near each other but play with separate dolls, they are exhibiting parallel play.

 Options A, B, and D: Sharing crayons, playing a board game with a nurse, or sharing dolls with
two different nurses are all examples of cooperative play.

28. Answer: A. Instituting infection control precautions

Acute lymphocytic leukemia (ALL) causes leukopenia, resulting in immunosuppression and increasing the

risk of infection, a leading cause of death in children with ALL. Therefore, the initial priority nursing
intervention would be to institute infection control precautions to decrease the risk of infection.

 Option B:  Iron-rich foods help with anemia, but dietary iron is not an initial intervention.

 Option C: The prognosis of ALL usually is good. However, later on, the nurse may need to assist
the child and family with coping since death and dying may still be an issue in need of
discussion.

 Option D: Injections should be discouraged, owing to increased risk of bleeding due to

thrombocytopenia.

29. Answer: A. Measures to reduce fever

The pertussis component may result in fever and the tetanus component may result in injection
soreness. Therefore, the mother’s verbalization of information about measures to reduce fever indicates
understanding.

 Option B: No dietary restrictions are necessary after this injection is given.

 Option C: Subsequent rash is more likely to be seen 5 to 10 days after receiving the MMR
vaccine, not diphtheria, pertussis, and tetanus vaccine.

 Option D: A Diarrhea is not associated with this vaccine.

30. Answer: A. Report the child’s condition to Protective Services immediately.

Multiple bruises and burns on a toddler are signs child abuse. Therefore, the nurse is responsible for
reporting the case to Protective Services immediately to protect the child from further harm.

 Option B: Scheduling a follow-up visit is inappropriate because additional harm may come to the
child if the nurse waits for further assessment data.

 Option C: Although the nurse should notify the physician, the goal is to initiate measures to
protect the child’s safety. Notifying the physician immediately does not initiate the removal of
the child from harm nor does it absolve the nurse from responsibility.
  Option D: Multiple bruises and burns are not normal toddler injuries.

31. Answer: B. Projection

The mother is using projection, the defense mechanism used when a person attributes his or her own
undesirable traits to another.

 Option A: Displacement is the transfer of emotion onto an unrelated object, such as when the
mother would kick a chair or bang the door shut.

 Option C: Repression is the submerging of painful ideas into the unconscious.

 Option D: Psychosis is a state of being out of touch with reality.

32. Answer: A. Susceptibility to respiratory infection

Children with congenital heart disease are more prone to respiratory infections.

 Options B, C, and D: Bleeding tendencies, frequent vomiting, and diarrhea and seizure

disorders are not associated with congenital heart disease.

33. Answer: D. Notify the physician immediately and prepare for intubation.

The child is exhibiting classic signs of epiglottitis, always a pediatric emergency. The physician must be
notified immediately and the nurse must be prepared for an emergency intubation or tracheostomy.

 Option A: Further assessment with auscultating lungs and placing the child in a mist tent wastes
valuable time. The situation is a possible life-threatening emergency.

 Option B: Having the child lie down would cause additional distress and may result in respiratory
arrest.

 Option C: Throat examination may result in laryngospasm that could be fatal.

34. Answer: A. A shorter urethra in females

In females, the urethra is shorter than in males. This decreases the distance for organisms to travel,
thereby increasing the chance of the child developing a urinary tract infection.

 Option B: Frequent emptying of the bladder would help to decrease urinary tract infections by
avoiding sphincter stress.

 Option C: Increased fluid intake enables the bladder to be cleared more frequently, thus helping
to prevent urinary tract infections.

 Option D: The intake of acidic juices helps to keep the urine pH acidic and thus decrease the
chance of flora development.

35. Answer: B. Notify the physician immediately

Compartment syndrome is an emergent situation and the physician needs to be notified immediately so
that interventions can be initiated to relieve the increasing pressure and restore circulation.

 Option A: Acetaminophen (Tylenol) will be ineffective since the pain is related to the increasing
pressure and tissue ischemia.

 Option C: The cast, not traction, is being used in this situation for immobilization, so releasing
the traction would be inappropriate.
  Option D:  In this situation, specific action not continued monitoring is indicated.

36. Answer: D. 12 months

The varicella zoster vaccine (VZV) is a live vaccine given after age 12 months. The first dose of hepatitis
B vaccine is given at birth to 2 months, then at 1 to 4 months, and then again at 6 to 18 months. DTaP is
routinely given at 2, 4, 6, and 15 to 18 months and a booster at 4 to 6 years.

37. Answer: C. Large blocks

Because the 8-month-old is refining his gross motor skills, being able to sit unsupported and also
improving his fine motor skills, probably capable of making hand-to-hand transfers, large blocks would
be the most appropriate toy selection.

 Option A: Push-pull toys would be more appropriate for the 10 to 12-month-old as he or she
begins to cruise the environment.

 Options B and D: Rattles and mobiles are more appropriate for infants in the 1 to 3 month age
range. Mobiles pose a danger to older infants because of possible strangulation.

38. Answer: B. Fear of body mutilation is a common preschool fear

During the preschool period, the child has mastered a sense of autonomy and goes on to master a sense
of initiative. During this period, the child commonly experiences more fears than at any other time. One
common fear is fear of the body mutilation, especially associated with painful experiences.

 Options A, C, and D: The preschool child uses simple, not complex, reasoning, engages in
associative, not competitive, play (interactive and cooperative play with sharing), and is able to
tolerate longer periods of delayed gratification.

39. Answer: A. Slow to feed self

Mild mental retardation refers to development disability involving an IQ 50 to 70. Typically, the child is
not noted as being retarded, but exhibits slowness in performing tasks, such as self-feeding, walking,
and taking.

 Options B, C, and D: Little or no speech, marked motor delays, and gait disabilities would be
seen in more severe forms mental retardation.

40. Answer: B. Transverse palmar crease

Down syndrome is characterized by the following a transverse palmar crease (simian crease), separated
sagittal suture, oblique palpebral fissures, small nose, depressed nasal bridge, high arched palate, excess
and lax skin, wide spacing and plantar crease between the second and big toes, hyperextensible and lax
joints, large protruding tongue, and muscle weakness.

41. Answer: A. Sucking ability

Because of the defect, the child will be unable to from the mouth adequately around the nipple, thereby
requiring special devices to allow for feeding and sucking gratification.

 Option B: Respiratory status may be compromised if the child is fed improperly or during
postoperative period

 Option C: Locomotion would be a problem for the older infant because of the use of restraints.

 Option D: GI functioning is not compromised in the child with a cleft lip.
42. Answer: B. Prone

Postoperatively children with cleft palate should be placed on their abdomens to facilitate drainage.

 Option A: If the child is placed in the supine position, he or she may aspirate.

 Option C: Using an infant seat does not facilitate drainage.

 Option D: Side-lying does not facilitate drainage as well as the prone position.

43. Answer: C. Projectile vomiting

Projectile vomiting is a key symptom of pyloric stenosis.

 Option A: Regurgitation is seen more commonly with GERD.

 Option B: Steatorrhea occurs in malabsorption disorders such as celiac disease.

 Option D: “Currant jelly” stools are characteristic of intussusception.

44. Answer: D. Altered oral mucous membranes

GERD is the backflow of gastric contents into the esophagus resulting from relaxation or incompetence
of the lower esophageal (cardiac) sphincter. No alteration in the oral mucous membranes occurs with
this disorder.

 Options A, B, and C: Fluid volume deficit, risk for aspiration, and altered nutrition are
appropriate nursing diagnoses.

45. Answer: A. Vomiting

Thickened feedings are used with GER to stop the vomiting. Therefore, the nurse would monitor the
child’s vomiting to evaluate the effectiveness of using the thickened feedings.

 Options B and C: No relationship exists between feedings and characteristics of stools and
uterine.

 Option D:  If feedings are ineffective, this should be noted before there is any change in the
child’s weight.

46. Answer: C. Wheat

Children with celiac disease cannot tolerate or digest gluten. Therefore, because of its gluten content,
wheat and wheat-containing products must be avoided.

 Options A, B, and D: Rice, milk, and chicken do not contain gluten and need not be avoided.

47. Answer: C. Watery diarrhea

Episodes of celiac crises are precipitated by infections, ingestion of gluten, prolonged fasting, or
exposure to anticholinergic drugs. Celiac crisis is typically characterized by severe watery diarrhea.

 Option A: Respiratory distress is unlikely in a routine upper respiratory infection.

 Option B: Irritability, rather than lethargy, is more likely.

 Option D: Because of the fluid loss associated with the severe watery diarrhea, the child’s
weight is more likely to be decreased.

48. Answer: A. Hirschsprung disease

For the child with Hirschsprung disease, fever and explosive diarrhea indicate enterocolitis, a life-
threatening situation. Therefore, the physician should be notified immediately.

 Option B:  Generally, because of the intestinal obstruction and inadequate propulsive intestinal
movement, antidiarrheals are not used to treat Hirschsprung disease.

 Option C: The child is acutely ill and requires intervention, with monitoring more frequently than
every 30 minutes.

 Option D: Hirschsprung disease typically presents with chronic constipation.

49. Answer: A. Hirschsprung disease

Failure to pass meconium within the first 24 hours after birth may be an indication of Hirschsprung
disease, a congenital anomaly resulting in mechanical obstruction due to inadequate motility in an
intestinal segment.

 Options B, C, and D: Failure to pass meconium is not associated with celiac disease,
intussusception, or abdominal wall defect.

50. Answer: C. Family history

Because intussusception is not believed to have a familial tendency, obtaining a family history would
provide the least amount of information.

 Options A, B, and D: Stool inspection, pain pattern, and abdominal palpation would reveal
possible indicators of intussusception. Current, jelly-like stools containing blood and mucus are
an indication of intussusception. Acute, episodic abdominal pain is characteristics of
intussusception. A sausage-shaped mass may be palpated in the right upper quadrant.