MATERNAL

1. When the shiny portion of the placenta comes out first. this is called the ___ mechanism.

Answer: Schultze mechanism

2. A postpartum patient was in labor for 30 hours and had ruptured membranes for 24 hours. For which of the
following would the nurse be alert?

a. Endometritis

b. Endometriosis

c. Salpingitis

d. pelvic thrombophlebitis

Rationale: Endometritis is an infection of the uterine lining and can occur after prolonged rupture of membranes.
Endometriosis does not occur after a strong labor and prolonged rupture of membranes. Salpingitis is a tubal infection
and could occur if endometritis is not treated. Pelvic thrombophlebitis involves a clot formation but it is not a
complication of prolonged rupture of membranes.

vhttps://www.proprofs.com/quiz-school/quizshow.php?title=121nclex-questions-maternal-child-nursing-1-
wwwrnpediacom&q=2

3. A nurse is conducting an examination of a 6 month old baby. During the examination, the nurse should be able to
elicit which reflex?

a. Babinski's

b. startle

c. Moros

4. Dance

Rationale: The nurse should be able to elicit the Babinski's reflex because it may be present the entire first year of
life.The startle reflex actually disappears around 4 months of age; the Moro's reflex, by 3 or 4 months of age; and the
dance reflex, after the third or fourth week.

5. An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipate
including interventions that address which metabolic disorder?

a. Hypoglycemia

b. metabolic alkalosis

c. metabolic acidosis

d. hyperkalemia

RATIONALE: In a client with bulimia nervosa, metabolic alkalosis may occur secondary to hydrogen loss caused by
frequent, self-induced vomiting. Typically, the blood glucose level is within normal limits, making hypoglycemia unlikely.
In bulimia nervosa, hypokalemia is more common than hyperkalemia and typically results from potassium loss related to
frequent vomiting.

6. According to Erikson's psychosocial theory of development, an 8 year old child would be in which stage?

a. Trust versus mistrust

b. Initiative versus guilt

c. Industry versus inferiority

d. identity versus role confusion

RATIONALE: In middle childhood, the 6- to 12-year-old child is mastering the task of industry versus inferiority. The trust
versus mistrust task is in infancy (birth to 1 year). In early childhood, the 1- to 3-year-old child is in the stage of initiative
versus guilt. Identity versus role confusion occurs during adolescence.

7. An infant is diagnosed with congenital hip dislocation. On assessment, the nurse expects to note:

a. symmetrical thigh and gluteal folds

b. Ortolani's sign

c. increased hip abduction

d. femoral lengthening

RATIONALE: In a child with a congenital hip dislocation, assessment typically reveals Ortolani's sign, asymmetrical thigh
and gluteal folds, limited hip abduction, femoral shortening, and Trendelenburg's sign.
https://www.rn101.net/pediatrics-quiz

8. A patient tells you her last menstrual period was September 10th, 2014. According to the Nagele's rule when is her
expected due date?

A. June 17, 2015

B. June 10, 2015

C. May 17, 2015

D. June 10, 2014

Ratinale: Using the Nagele's rule to calculate an expected due date you would add 7 days to the first day of the last
menstrual period which would be September 17, 2014. Then subtract 3 months which would be June 17, 2014 and then
add 1 year and this would make the expected due date June 17, 2015.

9. During a vaginal assessment on a patient who is 8 weeks pregnant, you note a bluish coloration of the mucous
membrane of the cervix, vagina, and vulva. You would document this finding as what?

a. CHadwick's sign

b. Goodell's sign
c. Hegar's sign

d. Ballottement

Rationale: This description is known as Chadwick's sign and can happen as early as 6 weeks gestation.

10. You are measuring the fundal height on a patient who is 20 weeks pregnant. Where do you expect to locate the
fundus of the uterus?

a. Umbilicus

b. Symphysis pubis

c. Xiphoid process

d. None of the above because the fundus can not be located until 30 weeks gestation

Ratonale: At 20 to 22 weeks gestation the fundus should be located at the umbilicus. At 16 weeks the fundus can be
found between the symphysis pubis and umbilicus, and at 36 weeks gestation is the fundus is found at the xiphoid
process.

11. A pregnant woman arrives at the emergency department (ED) with abruptio placentae at 34 weeks’ gestation.
She’s at risk for which of the following blood dyscrasias?

A. Thrombocytopenia.

B. Idiopathic thrombocytopenic purpura (ITP).

c.. Disseminated intravascular coagulation (DIC).

D. Heparin-associated thrombosis and thrombocytopenia (HATT)

Rationale: Explanation:

Abruptio placentae is a cause of DIC because it activates the clotting cascade after hemorrhage.

Option A: Thrombocytopenia results from decreased production of platelets.

Option B: ITP doesn’t have a definitive cause.

Option D: A patient with abruptio placentae wouldn’t get heparin and, as a result, wouldn’t be at risk for HATT.

12. It described as premature separation of a normally implanted placenta during the second half of pregnancy,
usually with severe hemorrhage?

a. Placenta previa

b. Ectopic pregnancy

c. Incompetent cervix

d. Abruptio placentae
Rationale: Abruptio placentae is described as premature separation of a normally implanted placenta during the second
half of pregnancy, usually with severe hemorrhage. Placenta previa refers to implantation of the placenta in the lower
uterine segment, causing painless bleeding in the third trimester of pregnancy. Ectopic pregnancy refers to the
implantation of the products of conception in a site other than the endometrium. Incompetent cervix is a conduction
characterized by painful dilation of the cervical os without uterine contractions.

COMMUNITY NURSING
1. What is the priority nursing assessment to monitor when administering vaccinations?

A. Myalgias

B. Anaphylaxis

C. Symptoms of infection

D. Pain at the injection site

Rationale: B. Anaphylaxis

Anaphylaxis is a potential life-threatening adverse reaction to vaccines. Pain and myalgias can occur but are not life
threatening.

2. These vaccines are given 3 doses at one month intervals:

A. DPT (Diphtheria, Pertussis, Tetanus), BCG (Bacillus Calmette-Guérin), TT (Tetanus Toxoid)

B. DPT (Diphtheria, Pertussis, Tetanus), TT (Tetanus Toxoid), OPV (oral polio vaccine)

C. OPV (oral polio vaccine), Hep. B, DPT (Diphtheria, Pertussis, Tetanus)

D. Measles, OPV (oral polio vaccine), DPT (Diphtheria, Pertussis, Tetanus)

Answer. C

3. Family Code of the Philippines

Rationale: EO 209

4. The Health Insurance Portability and Accountability Act (HIPAA) privacy regulations are enforced by:

A. state statutes.

B. federal statutes.

C. nurse practice acts.

D. individual health care agencies.

Rationale: B. Federal Statutes

HIPAA is enforced by federal statutes. Nurse practice acts are an example of state statutes. Nurse practice acts do not
enforce HIPAA privacy regulations; instead they define nursing practice. Federal statutes enforce HIPPA, although it is
the responsibility of individual health care agencies to comply with the regulations that are defined by HIPAA.

DIF: Cognitive level: Knowledge

REF: p. 138

5. Grayish white in the buccal mucuosa of the baby: indicates measles

ANswer: Koplik spots

PSYCHIATRIC NURSING
1.A 21-year-old patient has a diagnosis of schizophrenia and is stuporous, yet exhibits sudden, excessive motor
activity with repetitive sit-ups. What is this behavior called?

A. Delusional.

B. Hallucinogenic.

C. Paranoid.

D. Catatonic

Rationale:: Catatonic schizophrenia occurs suddenly and includes motor immobility or excessive motor activity.

2. Your patient is preoccupied with perfection and control, has difficulty relaxing, exhibits rule-conscious behavior,
and cannot discard anything. What type of personality disorder does this behavior reflect?

A. Antisocial personality.

B. Obsessive-compulsive personality.

C. Manic behavior.

D. Anxiety disorder.

B. Obsessive-compulsive personality.

Rationale: Obsessive-compulsive disorder is a personality disorder that includes perfection, control, procrastination,
excessive devotion to work, difficulty relaxing, rule-conscious behavior, and inability to discard anything.
3. Your patient has been hospitalized for acute alcohol withdrawal. It is the fifth day, and he is having visual
hallucinations followed by a seizure. What is the most likely source of the patient's problem?

A. Autonomic dysreflexia (AD).

B. A brain tumor.

C. Sleep deprivation.

D. Delirium tremens (DTs).

Rationale: Delirium tremens occurs as acute alcohol withdrawal progresses. It includes symptoms such as clouding of
sensorium, hallucinations, seizures, and autonomic hyperactivity.

4. Which of the following medical conditions has similar signs and symptoms as those seen in a major depressive
episode?

A. Pancreatitis.

B. Cholecystitis.

C. Tuberculosis.

D. Hypothyroidism.

Rationale: Signs and symptoms of hypothyroidism include changes in weight, sleep disturbances, decreased energy, and
difficulty in thinking—just like in depression

A nurse prepares to give a MMR to a 5 yr old. What route should this be given?

1. Sub Q in the gluteal muscle

2. IM in the deltoid

3. subq in the outer aspect of the upper arm

4. IM in the anterolateral aspect of the thigh

MMR is given subq in the outer aspect of the upper arm

2. A child has third-degree burns of the hands, face, and chest. Which nursing diagnosis takes priority?

A. Disturbed body image related to physical appearance

B. Risk for infection related to epidermal disruption

C. Ineffective airway clearance related to edema

D. Impaired urinary elimination related to fluid loss

Rationale: Initially, when a preschool client is admitted to the hospital for burns, the primary focus is on assessing and
managing an effective airway. Body image disturbance, impaired urinary elimination, and infection are all integral parts
of burn management but aren’t the first priority.

3. Nurse marianne is caring for an infant with spina bifida. Which technique is most important in recognizing possible
hydrocephalus?

A. Magnetic resonance imaging (MRI)

B . Performing a lumbar puncture

C. Obtaining skull X-ray

D. Measuring head circumference

Rationale: Measuring head circumference is the most important assessment technique for recognizing possible
hydrocephalus, and is a key part of routine infant screening. Skull X-rays and MRI may be used to confirm the diagnosis.
A lumbar puncture isn’t appropriate.

4. A 4-month-old with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing
intervention has the highest priority?

A . Obtaining history information from the parents

B. Administering acetaminophen (Tylenol)

C. Instituting droplet precautions

D. Orienting the parents to the pediatric unit

Rationale: Instituting droplet precautions is a priority for a newly admitted infant with meningococcal meningitis.
Acetaminophen may be prescribed but administering it doesn’t take priority over instituting droplet precautions.
Obtaining history information and orienting the parents to the unit don’t take priority
 THEORETICAL FOUNDATION OF NURSING
1. A patient with diabetes is controlling the disease with insulin and diet. The nursing health care provider is focusing
efforts to teach the patient self-management. Which of the following nursing theories is useful in promoting self
management?

1. Neuman

2. Orem

3. Roy

4. Peplau

ANSWER: OREM

Orem's theory of self-care provides a solid theoretical background for self-management for a variety of diseases. This
theory shows the nurse how to direct the patient toward self-management to promote health and/or sustain wellness.

5. She Conceptualized the patient as a compilation of 14 basic human needs (to breathe, eat and drink, eliminate
waste products, move and maintain posture, rest, sleep, dress and undress, maintain body temperature, be clean,
avoid danger, communicate, worship, work, play, learn)

ANSWRR: VIRGINIA HENDERSON (needs theory)

6. Considered the mother of psychiatric nursing; focus of her middle-range theory includes interpersonal relations
among a nurse, a patient, nd a patient's family and developing the nurse patient relationship

ANSWER: Hildegard Peplau

 Medical Surgical

 Which of the following is recognized as reliable and critical markers of myocardial infarction?
Answer: Troponin I and T

 Type of Angina that has predictable and consistent pain that occurs on exertion and is relieved by rest
and/or nitroglycerin
Answer: Stable Angina

 An abnormal accumulation of of lipid, or fatty substances, and fibrous tissue in the lining of arterial
blood vessel walls
Answer: Atherosclerosis

 Pink, frothy sputum are pathognomonic signs of lung disease?

Answer: Pulmonary Edema

 The neural and hormonal activities that respond to stress and maintain homeostasis are located in the:
a. Cerebral cortex
b. Hypothalamus
c. Medulla oblongata
d. pons.

 It is a type of cellular adaptation to stressors wherein one type of mature cell transforms into another
type of cell.
a. Hyperplasia
b. Dysplasia
c. Atrophy
d. Metaplasia

 The following are local inflammatory responses to stressors except:

a. Erythema
b. Warmth
c. Pain
d. Fever

 During sympathetic response to stress a person may experience:

a. Decrease of mental acuity
b. Constriction of pupils
c. Increase blood glucose level
d. Bronchoconstriction
 Which of the following is the major electrolyte found in intracellular fluid
a. Potassium
b. Sodium
c. Chloride
d. Magnesium

 What is the normal range for sodium concentration in blood?

a. 135 to 145 mEq/L
b. 160 to 175 mEq/L
c. 90 to 110 mEq/L
d. 3.5 to 5.0 mEq/L

 What is the normal range for potassium concentration in blood?

a. 6.5 to 7.5 mEq/L
b. 3.5 to 5.0 mEq/L
c. 135 to 145 mEq/L
d. 90 to 110 mEq/L

 Widening of QRS complex and absence of P wave occurs when a patient is experiencing which of the
following?

a. Hyperkalemia
b. Hypokalemia
c. Hypernatremia
d. Hypocalcemia

 The difference between the systolic and the diastolic pressure is called the:
a. pulse pressure
b. auscultatory gap
c. pulse deficit
d. Korotkoff sound.

 The major causative factor in the etiology of cirrhosis is: 

a. acute viral hepatitis
b. chronic alcoholism
c. acute pancreatitis
d. acute bacterial infection 

 A nonmodifiable risk factor for atherosclerosis is:

a. Stress
b. Obesity
c. Positive Family History
d. Hyperlipidemia
 This is the process in which a physical pressure forces fluid through a selectively permeable
membrane.
a. Filtration
b. Osmosis
c. Facilitated Diffusion
d. Primary active transport

 During aerobic cellular respiration, glucose reacts with oxygen, forming ATP. What byproduct
is produced during the same process?
a. Carbon dioxide and bicarbonate
b. Phosphate and bicarbonate
c. Carbon dioxide and water
d. Water and bicarbonate

 Sternum (breastbone) and scapula (shoulder blade) are an example of which type of bone?
a. Long bone
b. Short bone
c. Flat bone
d. Irregular bone

 Elbow, knee and interphalangeal (finger and toe) joints are examples of which classes of
synovial joints?
a. Ball-and-socket joints
b. Pivot joints
c. Gliding joints
d. Hinge joints
 ANAPHY

 This heart valve ensures one-way flow of blood from left atrium to left ventricle:

a. Bicuspid Valve
b. Pulmonic Valve
c. Aortic Valve
d. Tricuspid Valve

 The pacemaker for the entire myocardium is the: 

a. atrioventricular junction
b. bundle of His
c. Purkinje fibers
d. Sinoatrial node

  Choose the alveolar cells that secrete surfactant.

a. Type I cells 
b. Type II cells
c. Type III cells
d. Types I and II cells

 To compute the blood pressure, which formula should be used?

a. BP= Cardiac Output x Systemic Vascular Resistance
b. BP= Cardiac Output + Systemic Vascular Resistance
c. BP= Heart Rate x Stroke Volume
d. BP= Heart Rate + Stroke Volume

  The purpose of the cilia in bronchi is:

a. produce mucus
b. phagocytize bacteria
c. contract smooth muscle
d. move the mucus back to the larynx

 The majority of blood supply to the liver, which is rich in nutrients from the gastrointestinal tract, comes
from the:
a. Hepatic artery
b. Common Bile Duct
c. Portal Artery
d. Hepatic Portal Vein
 What is the net movement of particles from a place of high concentration to a place of lower
concentration?

a. Simple Diffusion
b. Filtration
c. Primary Active Transport
d. Secondary Active Transport

 The word Leukocytosis means

a. High platelet count
b. High red blood cell count
c. High white blood cell count
d. Low red blood cell count
 PHARMACOLOGY

 Also known as proprietary or trade names, are the names under which a drug is marketed. 
a. Chemical Name
b. Brand Name
c. Generic Name
d. Organic Name

 The study of the biochemical and physiologic effects of drugs on the body and the molecular
mechanisms by which those effects are produced.

a. Pharmacokinetics
b. Pharmacodynamics
c. Drug Interactions
d. Therapeutic Use

 Which of the following is an example of Angiotensin-Converting Enzyme (ACE) Inhibitors:

a. Captopril
b. Losartan
c. Aliskiren
d. Eplerenone

 Which of the following is an example of Angiotensin II Receptor Blocker

a. Losartan
b. Captopril
c. Atorvastatin
d. Amlodipine
 FUNDAMENTALS OF NURSING

 It is a systematic, rational method of planning and providing individualized nursing care. Its purpose is
to identify a client's health status and actual or potential health care problems or needs, to establish
plans to meet the identified needs, and to deliver specific nursing interventions to meet those needs.

a. Assessment
b. Diagnosis
c. Evaluation
d. Nursing Process
e. Implementation

 A type of heat loss where heat is disperse by air currents:

a. Radiation
b. Conduction
c. Convection
d. Evaporation

 A patient with a body temperature of  41°C is considered:

a. Pyrexic
b. Hyperpyrexic
c. Afebrile
d. Hypothermic

 In Maslow’s hierarchy of needs, which of the following is the top priority in providing care for the
patient?
a. Self-actualization
b. Safety and Security
c. Physiological
d. Love and Belonging