COMMUNITY HEALTH NURSING By: Darius Candelario . INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS
A. SICK YOUNG INFANT AGED 1 WEEK TO 2 MONTHS (all the sick young infant referred below are aged 1 week to 2 months) 1) What is the minimum axillary temperature (in °C) for fever in sick young infants? a. 38.5 b. 37.5 c. 38 d. 37 2) In a sick young infant, which respiratory rate is considered as “fast breathing?” a. 40 or more breaths per minute b. 50 or more breaths per minute c. 60 or more breaths per minute d. 70 or more breaths per minute 3) The sick young infant is said to have low body temperature. The public health nurse knows that the axillary temperature of the infant would be less than: a. 36.5 °C b. 36 °C c. 35.5 °C d. 35 °C 4) If assessment of a sick young infant reveals convulsions, or fast breathing, or severe chest indrawing, or nasal flaring, or grunting, or bulging fontanelle, which treatment would be considered inappropriate? a. Treat the infant to prevent the lowering of his or her blood sugar level. b. Give the infant the first dose of intramuscular antibiotics. c. Treat the local infection in the health center, and teach the mother to treat local infections at home. d. Advise the mother regarding how to keep the infant warm on the way to the hospital 5) A young infant infant has a pus draining draining from the ear, or umbilical redness extending to the skin, fever, or low body temperature, many/severe skin pustules, or abnormal movement, or is
abnormally sleepy or difficult to awaken. What treatment would be appropriate? a. Give an appropriate oral antibiotic. b. Refer the infant urgently to a hospital. c. Advise the mother regarding how to give home care to the infant. d. Follow up in 2 days. 6) The young infant who has diarrhea has two or more of the following signs: abnormally sleepy or difficult to awaken, sunken eyes, pinched skin goes back to its original state very slowly (longer than 2 seconds). How will you classify the diarrhea for dehydration? a. No dehydration b. Severe dehydration c. Some dehydration d. Severe, persistent diarrhea 7) If the infant with Severe Dehydration also has Possible Serious Bacterial Infection or Dysentery, which of the following treatment would be considered inappropriate? a. Give the infant fluid for severe dehydration (Plan C: Treat Severe Dehydration Quickly) b. Refer the infant urgently to a hospital, with the mother giving frequent sips of ORS on the way. c. Advise the mother to continue breastfeeding the infant. d. Advise the mother how to keep the infant warm on the way to the hospital. 8) If the infant who has diarrhea, has two of the following sinsrestless, irritable; sunken eyes; pinched skin goes back to its original state very slowlywhat slowlywhat will be the appropriate treatment to give? a. Refer the infant to a hospital. b. Give the infant fluid to treat the diarrhea at home (Plan A). c. Give the infant fluid and food for some dehydration (Plan B). d. Refer the infant urgently to a hospital, with the mother giving the infant frequent sips of ORS on the way. 9) The community health nurse is caring for the young infant with diarrhea lasting for 14 days or more.
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Which of the following treatments is appropriate? a. Give Vitamin A b. If the young infant has dehydration and has a Possible Serious Bacterial Infection, treat the dehydration before referral to a hospital. c. Refer the infant to a hospital d. None of the above 10) Where will the community health nurse pinch the skin, to look and feel for dehydration? a. Sternal area b. Arm c. Elbow d. Abdomen 11) What signs should necessarily be present to classify the infant’s feeding problem as “Possible Serious Bacterial Infection?” a. Ulcers or white patches in the mouth b. No attachment at all c. Not suckling effectively d. Breastfeeds less than 8 times in 24 hours 12) What treatment consists an inappropriate nursing action for a young infant who has Possible Serious Bacterial Infection? a. Give the infant the first dose of intravascular antibiotics. b. Treat the infant to prevent the lowering of his or her blood sugar level. c. Advise the mother regarding how to keep the infant warm on the way to the hospital. d. Refer the infant urgently to a hospital. 13), 14), 15) Complete the Immunization Schedule AGE VACCINE Birth 13) _BCG_ 6 weeks DPT-1,14) _OPV 1_, 15) _ Hep-B Hep-B 1__ 16) What is the first-line antibiotic for local bacterial infection in the young infant? a. Amoxicillin b. Cotrimoxazole c. Gentamicin d. Benzylpenicillin Benzylpenicillin
17) What is the second-line antibiotic for local bacterial infection in the young infant? a. Amoxicillin b. Cotrimoxazole c. Gentamicin d. Benzylpenicillin Benzylpenicillin 18) Which appropriate oral antibiotic for local infection should not be given to infants < than 1 month of age who are premature or jaundiced? a. Amoxicillin b. Cotrimoxazole c. Gentamicin d. Benzylpenicillin Benzylpenicillin 19) Which appropriate oral antibiotic for local infection is given only twice daily for 5 days? a. Amoxicillin b. Cotrimoxazole c. Gentamicin d. Benzylpenicillin Benzylpenicillin 20) Which appropriate oral antibiotic for local infection is given three times daily for 5 days? a. Amoxicillin b. Cotrimoxazole c. Gentamicin d. Benzylpenicillin Benzylpenicillin 21) Referral is the best option for a young infant classified as having a POSSIBLE SERIOUS BACTERIAL INFECTION. If referral is not possible, though, we give intramuscular antibiotics for at least 5 days. How often do we give benzylpenicillin? a. q 4 hours b. q 5 hours c. q 6 hours d. q 8 hours 22) Referral is the best option for a young infant classified as having a POSSIBLE SERIOUS BACTERIAL INFECTION. If referral is not possible, though, we give intramuscular antibiotics for at least 5 days. What is the correct frequency in giving gentamicin? a. QID b. OD c. TID d. BID 23) & 24) Identify the right dose of Gentamicin Gentamicin corresponding to the weight of the young infant
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WT
GENTAMICIN Dose: 5 mg/kg
1 kg
0.5 ml
2 kg 1.0 ml 3 kg 1.5 ml 4 kg 23) _2 ml_ ml_ 5 kg 24) _2.5 ml_ ml_ 25) & 26) Identify the right dose of Benzylpenicillin Benzylpenicillin corresponding to the weight of the young infant WT BENZ BENZYL YLPE PENI NICI CILL LLIN IN
1 kg
25) _0.2 mL_ mL_
2 kg 26) _0.4 ml_ ml_ 3 kg 0.6 ml 4 kg 0.8 ml 5 kg 1.0 ml 27) In teaching the mother of a young infant to treat skin pustules at home, which of the following actions reflect an incorrect teaching of the community health nurse? a. Gently wash of the pus and crusts with 70% ethyl alcohol b. Dry the infected area c. Paint the infected area with Gentian Violet. d. Wash her hands again. 28) In teaching the mother of a young infant to treat umbilical infection, which of the following actions reflect an erroneous teaching of the community health nurse? a. Clean the infected area with soap and water. water. b. Wash her hands. c. Paint the infected area with Gentian Violet. d. Wash her hands again. 29) In teaching the mother of a young infant to treat oral thrush, which of the following actions reflect an inappropriate teaching of the community health nurse? a. Wash her hands. b. Wipe the infant’s mouth with a clean, soft cloth wrapped around
her (the mother’s) finger and dipped in tap water. c. Paint the infant’s mouth with half-strength Gentian Violet. d. Wash her hands again. To answer # 30) – 38), write a. for 2 days; b. 14 days; c. 5 days; and d. 30 days; e. return immediately If the the chil child d has: has: Retu Re turn rn for for foll follow ow-up in: LOCAL BACTERIAL 30) _ a_ INFECTION
LOW WEIGHT FOR AGE ANY FEEDING PROBLEM
31) _ b_
THRUSH Drin Drinki king ng poorl oorly y Has developed a fever Has Has fast fast breat breathin hing g Has difficulty in breathing Has blood in the stool
33) _a _ 34) 34) _ e__ 35) _ e_
32) _ a_
36) _ e_ 37) _ e_ 38) _ e_
B. THE SICK YOUNG CHILD AGED 2 MONTHS TO 5 YEARS (all the child or sick young child referred below are aged 2 months to 5 years) 39) If the child is 2 – 12 months, fast breathing is: a. 40 or more breaths per minute b. 50 or more breaths per minute c. 60 or more breaths per minute d. 80 or more breaths per minute 40) If the child is 12 months old, fast breathing is: a. 30 or more breaths per minute b. 40 or more breaths per minute c. 50 or more breaths per minute d. 60 or more breaths per minute 41) After counting counting the child’s breaths in one minute, the nurse confirms the presence of fast breathing. Which of the following treatments is considered to be inappropriate? a. Give Vitamin A
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b. Give the child an appropriate antibiotic for 5 days. c. Soothe the throat and relieve the cough with a safe remedy. d. Advise the mother regarding when to return immediately to the health center. 42) The sick young child’s ear problem is assessed to possess the following signs: pus is seen draining from the ear, and there has been discharge for 14 days or more. Which of the following treatments represent an incorrect nursing action? a. Dry the ear by wicking b. Do not give an antibiotic for 5 days c. Do not give paracetamol for pain d. Follow up in 7 days. 43), 44), 45) Complete the Child’s Immunization Schedule AGE VACCINE Birth BCG 6 wks. wks. DPT-1, DPT-1, OPV-1, OPV-1, 43) _ Hepa-B Hepa-B 1_ 44) DPT-2, OPV-2, 45) _ Hepa-B Hepa-B 2 _ 10 10 _ wks_ wks_ 46) The community health nurse knows that the first dose of Vitamin A supplementation supplementation is scheduled at: a. 4 months or above b. 5 months or above c. 6 months or above d. 8 months or above 47) The community health nurse knows that the subsequent doses of Vitamin A supplementation is scheduled to be given every: a. 6 months b. 4 months c. 5 months d. 9 months 48) A sick young child is seen in the clinic with chest indrawing. What will be the correct classification of his condition? a. No pneumonia b. Cough or cold c. Very Severe Disease d. Pneumonia 49) A child has no signs of pneumonia or a very severe disease, thus, classified under “No pneumonia: cough or cold.” For how long should the
coughing be present to entail that the child be referred to a hospital for assessment? a. more than 20 days b. more than 30 days c. more than 40 days d. more than 45 days 50) A child who has diarrhea also is abnormally sleepy, has sunken eyes, and is drinking poorly. If the child has no other severe classification, classification, the community health nurse will give food and fluid according to: a. Plan A b. Plan B c. Plan C d. Plan D 51) A child who has diarrhea also is restless, irritable, and has sunken eyes. If the child has no other severe classification, classification, the community health nurse will give food and fluid according to: a. Plan A b. Plan B c. Plan C d. Plan D 52) A child who has diarrhea is classified to have Severe Dehydration. The community nurse is aware that there is cholera in the child’s area. What is the minimum age of the child that will qualify him for an antibiotic for cholera? a. 2 years b. 1 year c. 1 ½ years d. 3 years 53) A child who has diarrhea for 14 days or more has dehydration. Which of the following treatments consists of an appropriate nursing action? a. Advise the mother regarding the feeding of a child who has Persistent Diarrhea b. Do not give Vitamin A c. Follow up in 5 days d. Treat the dehydration before referral to a hospital unless the child has another severe classification. 54) - 56) AGE VACCINE 14 wks 54) 54) _ DPT-3_, DPT-3_, 55) _ OPV-3_, OPV-3_, Hep B-3
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56) _ 9 Measles mos_ mos_ 57) A child who has fever who has malaria risk is seen with stiff neck. What will be the appropriate classification classification for this child? a. Malaria b. Very Severe Febrile Disease c. Very Severe Febrile Disease/Malaria d. Fever: Malaria Unlikely 58) If a blood smear test was not done in a child with fever who has malaria risk. He has no runny nose, no measles, and no other causes of fever. What appropriate treatment will the nurse give to the child? a. Refer the child urgently to a hospital. b. Give the first dose of an appropriate antibiotic. c. Treat the child with an oral antimalarial d. Give one dose of paracetamol in the health center for high fever (37.5°C axillary temperature) 59) A child who has fever, no malaria risk and no signs of a very severe febrile disease would be referred to a hospital for assessment only if: a. Fever has been present every day for more than 7 days. b. Fever has been in on-and-off for more than 7 days. c. Fever has been present every day for 7 days. d. Fever has been present every day for 10 days. 60) A child who has fever and no malaria risk, is seen with a general danger sign and stiff neck. Which of the following treatments would be appropriately carried out by the community nurse? a. Advise the mother regarding when to return immediately to the health center. b. Follow up in two days if fever persists. c. Give 2 doses of paracetamol in the health center for high fever (38.5 °C axillary temp.)
d. Treat the child to prevent the lowering of his or her blood sugar level. 61) A child who has fever and had measles within the last 3 months, is seen with clouding of the cornea. How will the community nurse classify the child’s case? a. Measles b. Measles with Eye or Mouth Complications c. Severe Complicated Measles d. Very Severe Febrile Disease 62) If a child who has fever and measles at the present has clouding of the cornea or pus draining from the eye, what eye ointment will the community health nurse apply to the child’s eye? a. Tetracycline b. Gentian Violet c. Cotrimoxazole d. Sulfadoxine 63) The community health nurse examines a child who has fever and a dengue risk. If none of the ASK, LOOK and FEEL signs is present, you will conduct a tourniquet test if fever has been present for more than: a. 3 days b. 2 days c. 1 day d. 4 days 64) What positive signs of Severe Dengue Hemorrhagic Fever will require fluid replacement by giving ORS only? a. Bleeding from nose or gums b. Bleeding in the stool or vomitus c. Black stool or vomitus d. Abdominal pain and skin petechiae 65) A child has been brought to the health center with tender swelling behind the ear. What action of the nurse is appropriate? a. Give the first dose of paracetamol for pain. b. Dry the ear by wicking. c. Follow up in 5 days d. Give an antibiotic for 5 days 66) Which treatment for an ear problem should not be done to a child with chronic ear infection?
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a. Dry the ear by wicking b. Follow up in 5 days c. Give an antibiotic for 5 days. d. Do not give paracetamol for pain 67) Upon assessment of a child, the community health nurse found these signs in the child: pus is seen draining from the ear, and there has been discharge for less than 14 days; ear pain. What will be an appropriate treatment for the child? a. Give the first dose of an appropriate antibiotic. b. Do not give paracetamol. paracetamol. c. Refer the child urgently to a hospital. d. Dry the ear by wicking. 68) What shall the community health nurse look and feel in a child to check for malnutrition and anemia? a. Look for edema on both feet b. Feel for cold and clammy extremities c. Look for restlessness restlessness and irritability d. Look for palmar erythema 69) A child who has malnutrition is seen with edema on both feet and severe palmar pallor. What will be the nurse’s appropriate action? a. Give Vitamin A. b. If the weight for age is very low, give Vit A. c. Give albendazole. d. Assess the child’s feeding and counsel the mother regarding the child’s feeding. 70) What is the first-line oral antibiotic for Pneumonia, Acute Ear Infection, Very Severe Disease and Mastoiditis to be given at home? a. Cotrimoxazole b.Amoxycilin c. Nalidixic Acid d. Tetracycline 71) What is the first-line oral antibiotic for Cholera to be given at home? a. Cotrimoxazole b.Amoxycilin c. Nalidixic Acid d. Tetracycline 72) What is the first-line oral antibiotic for Shigella to be given at home? a. Cotrimoxazole b.Amoxycilin
c. Nalidixic Acid d. Tetracycline 73) What is the second-line oral antibiotic for Pneumonia, Acute Ear Infection, Very Severe Disease and Mastoiditis to be given at home? a. Cotrimoxazole b.Amoxycilin c. Nalidixic Acid d. Tetracycline 74) What is the second-line oral antibiotic for Cholera to be given at home? a. Cotrimoxazole b.Amoxycilin c. Nalidixic Acid d. Tetracycline 75) What is the second-line oral antibiotic for Dysentery to be given at home? a. Cotrimoxazole b.Amoxycilin c. Nalidixic Acid d. Tetracycline 76) What is the first-line oral antimalarial antimalarial to be given at home? a. Chloroquine and Primaquine b. Chloroquine and Pyrimethamine Pyrimethamine c. Sulfadoxine and Pyrimethamine Pyrimethamine d. Sulfadoxine and Primaquine 77) What is the second-line oral antimalarial antimalarial to be given at home? a. Chloroquine and Primaquine b. Chloroquine and Pyrimethamine Pyrimethamine c. Sulfadoxine and Pyrimethamine d. Sulfadoxine and Primaquine 78) – 91) Advise the mother to come to the health center for follow-up at the earliest time indicated for the child’s problems. Answers: a. 2 days, b. 5 days, c. 30 days, d. return immediately Pneumonia 78) _ a__ Dysentery 79) _ a __ Malar Ma laria, ia, if the fever fever persis persists ts 80) _ a _ a __ Fever: Malaria Unlikely, if the 81) _ a _ a fever persists __ Fever: No Malaria, if the 82) _ a _ a fever persists __ Measles with Eye or Mouth 83) _ a _ a Complications __
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Dengue Hemorrhagic Fever Unlikely, if the fever persists Persistent Diarrhea Acute Ear Infection Chronic Ear Infection Feeding Problems Many Other Illnesses, if the child’s condition is not improving Anemia Very Low Low We Weig ight ht for Age
84) _ a _ a _ 85) _ b__ 86) _ b b __ 87) _ b b __ 88) _ b b __ 89) _ b _ b __ 90) _ b __ 91) _ c__ 92) _ d__
Any sick child, who is not able to drink or breastfeed, becomes sicker, and develops a fever A child who has No 93) _ d _ d Pneumonia: Cough or Cold, __ who has fast breathing or difficulty in breathing A child who has Diarrhea: 94) _ d _ d has blood in the stool, and is __ drinking poorly A child who has Fever: 95) _ d _ d Dengue Hemorrhagic Fever __ Unlikely, who has any sign of bleeding, persistent abdominal pain, and persistent vomiting 96) According to “Plan B: Treat Tr eat Some Dehydration with ORS,” how long will the community health nurse give the recommended amount of ORS in the health center? a. over a period of 4 hours b. over a period of 3 hours c. over a period of 6 hours d. over a period of 5 hours 97) In implementing “Plan B” in giving extra fluid for diarrhea and continue feeding, the approximate amount of ORS required (in mL) can also be calculated by multiplying the child’s weight by: a. 50 b. 75 c. 80 d. 90 98) After 2 days, follow-up care is given to a child with pneumonia. If
there is chest indrawing or a general danger sign, what will be the appropriate action of the community health nurse? a. Consume the 5-day dosage of the antibiotic b. Change to second-line antibiotic and advise the mother to return in 2 days c. Give a dose of the secondline antibiotic or intramuscular chloramphenicol d. Change to the second-line antibiotic recommended for shigella in your area. 99) After 2 days, a child less than 12 months old, with dysentery was evaluated with the following findings: number of loose stool evacuations, the amount of blood in the stool, fever, abdominal pain, or eating are the same. What will be the correct action of the nurse? a. Treat the dehydration b. Change to the second-line antibiotic recommended for shigella in your area. Give it for 5 days. c. Refer the child to a hospital d. Continue giving the same antibiotic until the 5-day dosage has been consumed 100) After 5 days, a child with persistent diarrhea is brought to the health center for follow-up care. The diarrhea has not stopped. What will be the correct action of the nurse? a. Change to the second-line antibiotic recommended for shigella in your area. Give it for 5 days. b. Conduct a full assessment of the child. Give him or her any treatment he or she needs. Then, refer the child to a hospital. c. Continue giving the same antibiotic until the 5-day dosage has been consumed d. Give second-line antibiotic or intramuscular intramuscular chloramphenicol
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