COMMUNICABLE DISEASE NURSING

Situation 1. Specific defenses of the body involve the immune system. Nurses should be knowledgeable on the
importance of immunity in the prevention of communicable diseases.
1. The nurse knows which of the following is true about immunity?
a. Antibody-mediated defense occurs through the T-cell system
b. Cellular immunity is mediated by antibodies produced by B-cells
c. Antibodies are produced by the B-cells
d. Humoral or circulating immunity is lost with AIDS

Answer: C
Rationale: Antibodies are produced by the B-cells and are part of the body's plasma proteins. (Kozier & Erb's
Fundamentals of Nursing, 8th Edition)

2. The nurse explains to a mother whose child just received a tetanus toxoid injection that the toxoid confers
which of the following immunity?
a. Lifelong passive immunity
b. Long-lasting active immunity
c. Lifelong active natural immunity
d. Lifelong active artificial immunity

Answer: B
Rationale: Toxoids and vaccines are considered artificial active immunity. The administration of antigens (toxoids
and vaccines) stimulates antibody production. The duration of its effect lasts for many years, however, it is not
lifelong (option C and D) because the immunity must be reinforced by booster. It is not a passive (option A) and
natural (option C) immunity. (Kozier & Erb's Fundamentals of Nursing, 8th Edition)

3. A mother asked a nurse on the duration of the effectiveness of a natural passive immunity. The nurse is correct
when she tell the mother that the effect lasts for: a. 2 to 3 weeks c. 6 months to 1 year
b. Permanent d. 2 to 5 years

Answer: C
Rationale: The effectiveness of a natural passive immunity lasts for 6 months to 1 year. (Kozier & Erb's
Fundamentals of Nursing, 8th Edition)

4. When it is impossible to determine whether a patient has been immunized against tetanus, the preparation of
choice used to produced passive immunity for several weeks with minimal danger of allergic reactions is: a. DTP
vaccine c. Tetanus antitoxin
b. Tetanus toxoid d. Tetanus immune globulin

Answer: D
Rationale: Tetanus immune globulin (TIG) provides antibodies against tetanus; it is used if the patient has never
received tetanus toxoid or has not received it for over 10 years. It confers passive immunity.

5. A patient who was exposed to hepatitis A is given gamma globulin to provide passive immunity, which: a.
Increases production of short-lived antibodies
b. Provides antibodies that neutralize the antigen
c. Accelerates antigen-antibody union at the hepatic sites
d. Stimulates the lymphatic system to produce large numbers of antibodies

Answer: B
 Rationale: Gamma globulin, an immune globulin, contains most of the antibodies circulating in the blood. When
injected into an individual, it prevents a specific antigen from entering a host cell. (Mosby's, 18 th Edition)

Situation 2. Immunization is the process by which resistance to infectious disease is induced or augmented.
6. A nursing student is assigned to administer immunizations to children in a clinic. The nursing instructor asks the
student about the contraindications in receiving an immunization. The student responds correctly by telling the
instructor that a contraindication to receiving an immunization is if a child has: a. A cold c. Mild diarrhea
b. Otitis media d. A severe febrile illness

Answer: D
Rationale: A severe febrile illness is a reason to delay immunization but only until child has recovered from the
acute stage of the illness.

7. A clinic nurse prepares to administer a measles, mumps, rubella (MMR) vaccine to a 5-year-old child. The nurse
administers this vaccine:
a. Intramuscularly in the anterolateral aspect of the thigh
b. Intramuscularly in the deltoid muscle
c. Subcutaneously in the outer aspect of the upper arm
d. Subcutaneously in the gluteal muscle

Answer: C
Rationale: The MMR vaccine is administered subcutaneously in the outer aspect of the upper arm.

8. A mother brings her 6-month-old daughter to a well baby clinic for her regular checkup. When discussing
childhood immunizations, the nurse explains that routine childhood immunizations protect against:
a. Calmette-Guerin bacillus, poliomyelitis, hepatitis A, measles
b. Measles, mumps, rubella, pertussis, herpes simplex
c. Diphtheria, measles, tetanus, mononucleosis
d. Poliomyelitis, pertussis, mumps, tetanus

Answer: D
Rationale: Routine childhood immunizations protect against Calmette-Guerin bacillus, poliomyelitis, measles,
mumps, rubella, diphtheria, pertussis, tetanus, and hepatitis B.

9. A rubella vaccine is prescribed to be administered to a 2 day postpartum patient. The nurse preparing to
administer the vaccine develops a list of the potential risks associated with this vaccine. The nurse reviews the
list with the patient and cautions the patient to avoid: a. Sunlight for 3 days
b. Scratching the injection site
c. Pregnancy for 2 to 3 months after the vaccination
d. Sexual intercourse for 2 to 3 months after the vaccination

Answer: C
Rationale: Rubella vaccine is a live attenuated virus that evokes an antibody response that provides immunity for
15 years. Because rubella is a live vaccine, it will act as the virus and is potentially teratogenic in the
organogenesis phase of fetal development. The client needs to be informed about the potential effects that this
vaccine may have and the need to avoid becoming pregnant for a period of 2 to 3 months after receiving the
vaccine.

10. The mother of a child in well baby clinic asks the nurse which immunization contains live virus?
a. MMR and OPV c. DPT and OPV
b. Hib and MMR d. DPT and Hib
 Answer: A
Rationale: MMR and OPV contain live attenuated virus.

Situation 3. Whenever possible, the nurse implements strategies to prevent infection. Integration of Infection
Control measures with the Nursing Process is imperative in the prevention of the further spread of infection.
11. The most effective nursing action for controlling the spread of infection includes which of the following? a.
Thorough hand cleansing
b. Wearing gloves and masks when providing direct client care
c. Implementing appropriate isolation precautions
d. Administering broad-spectrum prophylactic antibiotics

Answer: A
Rationale: Since the hands are frequently in contact with clients and equipment, they are the most obvious
source of transmission. Regular and routine hand cleansing is the most effective way to prevent movement of
potentially infective materials. (Kozier & Erb's Fundamentals in Nursing, 8th Edition)

12. Ms. Vibac is a chronic carrier of infection. To prevent the spread of the infection to other patients or health care
providers, the nurse emphasizes interventions that do which of the following? a. Eliminate the reservoir
b. Block the portal of exit from the reservoir
c. Block the portal of entry into the host
d. Decrease the susceptibility of the host

Answer: B
Rationale: Blocking the movement of the organism from the reservoir will succeed in preventing the infection of
any other persons. (Kozier & Erb's Fundamentals in Nursing, 8th Edition)

13. When caring for a single patient during one shift, it is appropriate for the nurse to reuse which of the following
personal protective equipment?
a. Goggles c. Surgical mask
b. Gown d. Clean gloves

Answer: A
Rationale: Unless overly contaminated by material that has splashed in the nurse's face and cannot be effectively
rinsed off, goggles may be worn repeatedly. (Kozier & Erb's Fundamentals in Nursing, 8 th Edition)

14. In caring for Mr. Bacte who is on contact precautions for a draining infected foot ulcer, the nurse should
perform which of the following?
a. Wear a mask during dressing changes
b. Provide disposable meal trays and silverware
c. Follow standard precautions in all interactions with the patient
d. Use surgical aseptic technique for all direct contact with the patient

Answer: C
Rationale: Standard Precautions include all aspects of contact precautions with the exception of placing the
client in a private room. (Kozier & Erb's Fundamentals in Nursing, 8th Edition)

15. Regardless of the type of isolation precautions that a patient has been assigned, which of the following actions
by the nurse should be given the highest priority in terms of infection control? a. Using strict aseptic technique
b. Washing of hand before and after giving client care
c. Checking sterile supplies for expiration date
d. Changing intravenous tubing according to hospital policy
 Answer: B
Rationale: Regardless of isolation precautions, the basic action by the nurse to prevent infection is hand washing.
All of the other options should also be followed but handwashing establishes the first line of defense and is
therefore the highest importance.

Situation 4. Malaria continues to be a major health problem in the Philippines. It requires sustained and
systematic efforts toward prevention of transmission through vector control, and early detection and treatment of
malarial cases.
16. The nurse is reviewing the physical examination and laboratory tests of a client with malaria. The nurse
understands that an important finding on malaria is: a. Polyuria c. Splenomegaly
b. Leukocytosis d.. Erythrocytosis

Answer: C
Rationale: Malarial parasites invade the erythrocytes, subsequently dividing and causing the cell to burst. The
spleen enlarges from the sloughing of red blood cells.

17. When caring for a patient with malaria, the nurse should know that:
a. Seizure precautions must be followed
b. Blood transfusions usually are indicated
c. Isolation is necessary to prevent cross-infection
d. Nutrition should be provided between intestinal paroxysms

Answer: D
Rationale: Maintaining adequate nutritional and fluid balance is essential to life and must be accomplished
during periods when intestinal motility is not too excessive so that absorption can occur.

18. When teaching a patient about drug therapy against Plasmodium falciparum, the nurse should include the fact
that:
a. The infection is controlled
b. Immunity will prevent reinfestation
c. The infection can generally be eliminated
d. Transmission by the Anopheles mosquito can occur

Answer: C
Rationale: Quinine sulfate is used in malaria when the plasmodia are resistant to the less toxic chloroquine.
However, a new strain of Plasmodium, resistant to quinine, must me be treated with combination of quinine
(quickacting), pyrimethamine, and sulfonamide (slow-acting).

19. Blackwater fever occurs in some patients with malaria. Therefore, the nurse should observe a patient with
malaria for:
a. Diarrhea c. Low-grade fever
b. Dark red urine d. Coffee-ground emesis

Answer: B
Rationale: Plasmodium falciparum in persons with malaria can cause hemoglobinuria, intravascular hemolysis,
and renal failure as a result of destruction of RBCs.

20. The nurse explains to the patient that the best way to prevent malaria is to avoid:
a. Mosquito bites
b. Untreated water
c. Undercooked food
d. Overpopulated areas
 Answer: A
Rationale: Malaria is caused by the protozoan Plasmodium falciparum, which is carried by mosquitoes.

Situation 5. Dengue is a major health concern in the community. There had been a sudden increase in the
incidence of dengue as a result of poor environmental sanitation and increase breeding places for mosquitoes.
21. In what stage of the acute febrile infection wherein tourniquet test, which may be positive on the 3 rd day, may
become negative due to low or vasomotor collapse? a. Febrile stage c. Invasive Stage
b. Hemorrhagic stage d. Convalescent stage

Answer: B
Rationale: The toxic or hemorrhagic stage occurs on the 4 th to 7th days of infection. During this stage there would
be lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from gastrointestinal tract
in the form of hematemesis or melena. Unstable blood pressure, narrow pulse pressure and shock can also
occur. Death can occur in many cases. The tourniquet test, which may be positive on the 3 rd day of infection, may
become negative due to low or vasomotor collapse. (Public Health Nursing in the Philippines)

22. During the first 3 days of infection, the following signs and symptoms are common, except: a. Abdominal pain
and headache
b. Flushing which may be accompanied by vomiting
c. Lowering of temperature
d. Epistaxis and conjunctival infection

Answer: C
Rationale: The febrile or invasive stage occurs on the first 4 days of the infection. This stage starts abruptly as
high fever (up to 105 F), abdominal pain and headache (option A), which can also be accompanied by other
symptoms such as chilliness, rash, backache, and severe muscle ache; later flushing which may be accompanied
by nausea and vomiting (option B), conjunctival infection and epistaxis (option D).
In option C, lowering of temperature occurs during the toxic or hemorrhagic stage, which occurs on the 4 th to 7th
days of infection. (Public Health Nursing in the Philippines)

23. The nurse should frequently monitor a patient with dengue for developing signs and symptoms of Dengue
Shock Syndrome, which include all of the following, except: a. Restlessness and cold clammy skin
b. Rapid weak pulse and narrowing of pulse pressure
c. Severe abdominal pain
d. Hypertension and massive hemorrhage

Answer: D
Rationale: Dengue shock syndrome (DSS), the most severe form of dengue fever, includes all Dengue
Hemorrhagic Fever (DHF) symptoms, as well as its own symptoms. Initial signs of DSS include restlessness, cold
clammy skin.
(Public Health Nursing in the Philippines)

24. Rumpel-Leede Capillary-Fragility test is a clinical diagnostic method performed to determine possible dengue
infection. Which of the following steps, done by the nurse, would be considered incorrect? a. A test is positive
when 25 petechiae per 1 inch square are observed
b. Count the number of petechiae inside the box
c. Release the cuff and make an imaginary 2.5 cm square or 1 inch square just below the cuff, at the antecubital
fossa
d. Inflate the blood pressure cuff on the lower arm to a point midway between the systolic and diastolic
pressure for 5 minutes
 Answer: D
Rationale: A tourniquet test (also known as a Rumpel-Leede Capillary-Fragility test or simply a capillary fragility
test) determines capillary fragility. It is a clinical diagnostic method to determine a patient’s hemorrhagic
tendency. It assesses fragility of capillary walls and is used to identify thrombocytopenia (a reduced platelet
count). It is performed to determine possible dengue infection. The steps are as follows:
1. Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic
pressure for 5 minutes.
2. Release the cuff and make an imaginary 2.5 cm square or 1 inch square just below the cuff, at the
antecubital fossa.
3. Count the number of petechiae inside the box.
4. A test is positive when 20 or more petechiae per 1 inch square are observed. (Public Health Nursing in the
Philippines)

25. Supportive and symptomatic treatment should be provided to patients with dengue. This includes which of the
following, except:
a. For fever and muscles pains give paracetamol
b. For headache give analgesics such as aspirin
c. Give ORS to replace fluid as in moderate dehydration at 75 ml/kg in 4-6 hours or up to 2-3 liters in adults d.
Includes intensive monitoring and follow-up

Answer: B
Rationale: Supportive and symptomatic treatment should be provided to patients with dengue which includes:
1. For fever and muscle pains give paracetamol (option D). For headaches, give analgesics. DON’T give ASPIRIN.
2. Rapid replacement of body fluids is the most important treatment.
3. Includes intensive monitoring and follow-up (option B).
4. Give ORS to replace fluid as in moderate dehydration at 75 ml/kg in 4-6 hours or up to 2-3 liters in adults
(option C). (Public Health Nursing in the Philippines)

Situation 6. Nurse Granyels is taking care of patients diagnosed with chickenpox and shingles.
26. Nurse Granyels reviews the health care record of Dyomanji, age 10, diagnosed with varicella zoster. The
following are findings the nurse expect to note as characteristic of this disorder, except: a. Slight fever
b. Centripetal rashes
c. Vesicular for 3-4 days and leaves granular scabs
d. Painful vesicular eruptions along the route of inflamed nerves

Answer: D
Rationale: Chickenpox (varicella zoster) is an acute infectious disease of sudden onset with slight fever
. (Public Health nursing in the Philippines)

27. Dyomanji’s mother calls the nurse station to find out when her son can return to school. What is the best
response for Nurse Granyels to make?
a. All the lesions must be completely gone before contact with others is resumed
b. Within two to three weeks, the itching should be under control and good hand washing established so that
contact with others can be started
c. Dyomanji can return six days after the first lesions appear, because the crusts will be formed
d. Dyomanji must first learn to cough with his mouth covered, put tissues in the trash, and wash his hands after
touching his nose and mouth

Answer: C
Rationale: Varicella zoster, the chickenpox virus, is found in the respiratory secretions of infected persons and
also in the skin lesions that are not scabbed over. Scabs are not infectious. By six days after the rash first appears,
all the lesions will be scabbed over. (NSNA, NCLEX-RN Review, 4th Edition)
28. Mr. Clottey, age 50, is seen by the physician and suspects herpes zoster. Nurse Granyels prepares the items
needed to perform the diagnostic test to confirm this diagnosis. Which item will the nurse obtain? a. A Wood’s
light c. A patch test kit
b. A culture swab and tube d. A biopsy kit

Answer: B
Rationale: Herpes zoster (shingles) is caused by a reactivation of the varicella zoster virus, the cause of the virus
for chicken pox. With classic presentation of herpes zoster, the clinical examination is diagnostic. A viral culture
of the lesion provides the definitive diagnosis.

29. What should Nurse Granyels expect to find during the initial assessment of Mr. Clottey?
a. Rhinorrhea, small red lesions including some with vesicles that are widespread over the face and body
b. A painful vesicular eruption following a nerve pathway
c. Blisters on the lips and in the corners of the mouth
d. Painful fluid-filled vesicles in the genital area

Answer: B
Rationale: Herpes zoster (shingles) produces painful vesicular eruptions along a nerve pathway. (NSNA, NCLEX-
RN Review, 4th Edition)

30. Which pharmacological therapy would Nurse Granyels expect to be prescribed to treat Mr. Clottey’s disorder?
a. Tetracycline hydrochloride (Achromycin)
b. Erythromycin base (E-mycin)
c. Acyclovir (Zovirax)
d. Indomethacin (Indocin)

Answer: C
Rationale: The goals of treatment for herpes zoster are to relieve pain, to prevent infection and scarring, and to
reduce the possibility of post-herpetic neuralgia. Oral analgesics are prescribed to reduce the incidence of
persistent pain. The lesions may also be injected with corticosteroids. Acyclovir, if started early, may reduce the
severity of herpes zoster.

Situation 7. Nurse Damaso is taking care of Basilio, 17 months old, who is admitted to the hospital with Rubeola.
He has rashes, coryza, cough, conjunctivitis, temperature of 38ºC and white spots in his mouth.
31. Sources of infection in rubeola are secretions of the nose and throat of the infectious person. Filterable virus of
measles is transmitted through:
a. Water supply c. Food ingestion
b. Droplet d. Sexual contact

Answer: B
Rationale: Measles is spread through direct and indirect contact with droplets. (Pillitteri, Maternal and Child
Health Nursing, 5th Edition)

32. The characteristic signs of rubeola are which of the following group?
a. Rashes which spread from the face to the trunk and limbs, conjunctivitis, high fever and tiny white spots in
the mucosa inside the cheek
b. Skin eruptions which are abundant on covered areas of the body than on the exposed areas
c. Vomiting, headache, fine petechial and morbilliform rashes and epistaxis
d. Severe backache and rashes which are more abundant on extremities than on the trunk

Answer: A
 Rationale: The characteristic signs of measles are which of the following: Rashes which spread from the face to
the trunk and limbs ending in branny desquamation, conjunctivitis (Stimson's sign), high fever and tiny white
spots in the mucosa inside the cheek (Koplik spots). (Public Health Nursing in the Philippines, 2007)

33. Nurse Damaso knows that the incubation period of rubeola is:
a. Varies from 3 days to 1 month or more, falling between 7-14days in high proportion of cases b. 12 to 26
days, usually 18 days
c. 2-3 weeks, commonly 13 to 17 days
d. 10 days from exposure to appearance of fever and about 14 days until rash appears

Answer: D
Rationale: The incubation period of Rubeola is 10 days from exposure to appearance of fever and about 14 days
until rash appears. (Public Health Nursing in the Philippines, 2007)

34. Basilio's immunity from his mother lasted only 6 months. He was brought by his mother because of spots in his
buccal mucosa. What do you call these spots?
a. Rose spots c. Forscheimer's spots
b. Pseudomembrane d. Koplik spots

Answer: D
Rationale: Koplik spots are tiny grayish to whitish spots found in the buccal mucosa of a client with Rubeola.
(Public
Health Nursing in the Philippines, 2007)

35. A nursing intervention that is important in caring for Basilio would include the following, except:
a. Wearing face mask when administering nursing care to the child
b. Increase fluid intake of the child by drinking water frequently
c. Administer as prescribed antipyretics to reduce fever
d. Ensuring that the room is well lighted

Answer: D
Rationale: Clients with Rubeola has conjunctivitis (Stimson's sign), as a result an important nursing intervention
is to protect the eyes of the client from glare of strong light as they are apt to be inflamed. Place the client in a
dimlighted room, not well lighted. (Public Health Nursing in the Philippines, 2007)

Situation 8. A 45-year-old male, diabetic with chronic Hepatitis B, is admitted because of pneumonia. Regular
CBG monitoring was performed every 6 hours. While giving the insulin subcutaneously, the nurse accidentally
pricked her finger. The nurse previously received only one dose of hepatitis B vaccine.
36. Which of the following should be done initially?
a. Check for her Hepatitis B status with HBsAg and Anti-HBs
b. Administer HBIg immediately
c. Administer both HBIg and the first dose of Hepatitis B vaccine
d. Administer both HBIg and the first dose of Hepatitis B vaccine, after collecting blood samples to HBsAg
reactivity

Answer: A
Rationale: The patient's blood must initially be screened for presence of HBsAg and Anti-HBs. A positive HBsAg
confirms active replication of and infection with hepatitis B virus. If this happens, active immunization (HBV
vaccine) will no longer be given since it does not provide protection to those already exposed to HBV. The
presence of Anti-HBs usually indicates development of immunity. Most people (more than 90%) who contract
HBV infection develop antibodies and recover spontaneously in 6 months. If this happens, administering HBIg is
no longer necessary.
 Note: HBV vaccine is given IM in 3 doses: the first dose is given at birth, the second and third doses are given 1
and 6 months after the first dose (Smeltzer, 2008). From another source, the second and third doses are given 6
and 14 weeks after the first dose (PHN book). Antibody response may be measured by an Anti-HBs level 1 to 3
months after completion of the basic course of vaccine.

37. Choose the correct statement about hepatitis B vaccine:

a. All persons at risk should receive active immunization
b. Evidence suggests that HIV may be harbored in the vaccine
c. Booster doses are recommended every 5 years
d. One dose in the dorsogluteal muscle is recommended

Answer: A
Rationale: All persons at risk should receive active immunization

38. The nurse taking care of the patient is correct in identifying which of the following statements as true regarding
Hepatitis B virus transmission?
a. Blood, saliva, semen, and vaginal secretions contain low Hepatitis B virus
b. Urine, feces, and sweat contain high Hepatitis B virus titers
c. After needle stick injury, the risk of the health care worker acquiring the hepatitis B virus is greater from
HBsAg patient, compared to the pricks of acquiring HIV from an HIV+ patient
d. The risk of transmission after needle stick injury is increased of the source is HBeAg+

Answer: D
Rationale: The presence of Hepatitis B early antigen (HBeAg) signifies that the client is highly infectious.

39. A patient positive for HBeAg signifies that the patient:

a. Is highly infectious
b. Is not infectious
c. Has chronic hepatitis B virus infection
d. Has evidence of immunity to hepatitis B virus

Answer: A
Rationale: The presence of Hepatitis B early antigen (HBeAg) signifies that the client is highly infectious. HBeAg is
detected in the blood about 1 week after the appearance of HBsAg.

40. The type of viral hepatitis that is linked to chronic hepatitis B is:
a. A b. C c. D d. E

Answer: C
Rationale: The type D virus depends on the double-shelled type B virus to replicate. For this reason, type D
infection can't outlast a type B infection.

Situation 9. Salmon, 18 years old, is spending his Summer Vacation in Siquijor. A week before the vacation ends,
he developed fever, diarrhea and rose spots on his abdomen.
41. Based on Salmon's clinical findings, the nurse will suspect the patient to have contacted which infection?
a. Amoebiasis c. Cholera
b. Dysentery d. Typhoid fever

Answer: D
Rationale: Typhoid fever is characterized by continued fever, anorexia (loss of appetite), slow pulse, involvement
of lymphoid tissues, especially ulceration of Peyer's patches, enlargement of spleen, rose spots on trunk and
abdomen and diarrhea. (Public Health Nursing in the Philippines, 2007)
42. Salmon's condition is caused by a:
a. Bacteria c. Protozoa
b. Virus d. Fungi

Answer: A
Rationale: Typhoid fever is caused by Salmonella typhosa or typhoid bacillus, which is a bacterium. (Public Health
Nursing in the Philippines, 2007)

43. The characteristic signs and symptoms of the said condition in #41 are the following, except:
1. Rose spots on trunk and abdomen
2. Continued fever
3. Bloody stool
4. Diarrhea
5. Intermittent fever
6. Slow pulse
7. Rice watery stool
8. Loss of appetite

a. 2, 4 and 8 c. 3, 5 and 7
b. 2, 7 and 8 d. 4, 6 and 7

Answer: C
Rationale: Typhoid fever is characterized by continued fever, anorexia (loss of appetite), slow pulse, involvement
of lymphoid tissues, especially ulceration of Peyer's patches, enlargement of spleen, rose spots on trunk and
abdomen and diarrhea.
(Public Health Nursing in the Philippines, 2007)
44. The nurse provided the family with health education to prevent transmission of infection as the disease can be
transmitted to family members through the following, except:
a. Flies
b. Direct contact
c. Contaminated food and water
d. Airborne transmission

Answer: D
Rationale: Typhoid fever can be transmitted through the following mode of transmission: direct or indirect
contact with patient or carrier; contaminated food and water with flies as vectors; and improper food handling.
(Public Health Nursing in the Philippines, 2007)

45. As a preventive control measure for the said condition in #41, which of the following must be discussed in the
health education program for the public?
1. Sanitary disposal of human feces and maintenance of fly proof latrine
2. Use of repellants and insecticides
3. Removal of stagnant water in empty water drums and flower pots
4. Proper food handling and preparation

a. 1 and 4 c. 3 and 4
b. 2 and 3 d. 1 and 2

Answer: A
Rationale: Preventive control measures include sanitary disposal of human feces and maintenance of fly proof
latrine and proper food handling and preparation. (Public Health Nursing in the Philippines, 2007)
Situation 10. Katayama fever is a significant tropical disease in our country, since it is not only a public concern
but a socio-economic problem. As the nurse working in a far-flung health center, you must know how to address
this health problem.
46. In order to confirm the diagnosis of Katayama fever, you advise a patient to have which of these examinations?
a. X-ray of the abdomen c. CBC
b. Urinalysis d. Stool examination

Answer: D
Rationale: The male and female parasites live in blood vessels of intestines and liver, but the eggs are laid in the
terminal capillary vessels in the submucosa of the intestines, and through the ulcerations reach the lumen of the
intestines and pass out with the feces. The presence of parasitic eggs in the stool confirms the diagnosis of
Schistosomiasis, otherwise known as Katayama fever.

47. You know that the mode of transmission of Katayama fever is:
a. Contact with affected stray animals
b. Use of sanitary toilets
c. Infected flies and rodent
d. Contact with water infected with cercariae

Answer: D
Rationale: Schistosoma cercariae (free swimming larval forms) can penetrate the skin of persons who are
wading, swimming, bathing or washing in contaminated water.
48. Which of the following is the drug of choice for Katayama fever?
a. Biltricide c. Chloramphenicol
b. Hetrazan d. Tetracycline

Answer: A
Rationale: Praziquantel (Biltricide) is the drug of choice for Schistosomiasis.

49. The following are preventive measures for Katayama fever, except:
a. Use of safe water
b. Avoid bathing and washing in infested waters
c. Use of sanitary toilets
d. Elimination of breeding sites of mosquitoes

Answer: D
Rationale: This is a preventive measure for vector-borne diseases, such as Dengue fever, Malaria, and Filariasis.
Schistosomiasis is a water-borne disease.

50. Which of the following is not a complication of Katayama fever?

a. Liver cirrhosis and portal hypertension
b. Cor pulmonale, pulmonary hypertension
c. Meningitis and hepatomegaly
d. Ascitis and renal failure

Answer: C
Rationale: Meningitis is not a complication of Schistosomiasis.

Situation 11. Filariasis is endemic in some parts of the Philippines. The disease often progresses to become
chronic, debilitating and often unfamiliar to health workers.
51. Ej, a 36-year-old man, is brought by his wife to a doctor’s clinic to be tested for filariasis. The most likely
diagnostic test that he will undergo is:
a. Immunochromatographic test (ICT)
b. Nocturnal Blood Examination
c. Stool examination
d. Urinalysis

Answer: A
Rationale: The clinic provides services from 8am to 5pm. The ICT is an antigen test that can be done in daytime.

52. The vector for Filariasis is:

a. Wuchereria bancrofti c. Anopheles
b. Aedes poecilus d. Aedes aegypti

Answer: B
Rationale: The vector for Filariasis is the mosquito Aedes poecilus.

53. A long incubation period characterizes Filariasis that typically ranges from:
a. 2-4 weeks c. 2-3 years
b. 4-6 weeks d. 8-16 months

Answer: D
Rationale: Incubation period ranges from 8-16 months.

54. Ej is in the acute stage of the disease. He will manifest which of the following clinical findings?
a. Lymphangitis, lymphadenitis, epidydimitis
b. Hydrocele, lymphedema, elephantiasis
c. Orchitis, hydrocele, elephantiasis
d. Lymphadenitis, lymphedema and orchitis

Answer: A
Rationale: Lymphangitis, lymphadenitis, epidydimitis, funiculitis and orchitis are acute clinical manifestations of
Filariasis.

55. Effective methods that the government would likely to pursue to eliminate filariasis in the country are all of the
following, except:
a. Pursue annual mass drug administration using two drugs in all endemic areas for at least five consecutive
years
b. Vaccination of all susceptible persons in high risk areas and high risk populations
c. Intensify health information and advocacy campaigns in its prevention, control and elimination
d. Halt progression of disease through disability prevention

Answer: B
Rationale: There is no known vaccination for Filariasis. Diethylcarbamazine Citrate (DEC) is given to patients with
clinical manifestations and/or microfilariae.

Situation 12. Mrs. Churia brings her 4-year-old daughter, Trish, to the pediatrician because she lost weight, is
quite irritable, and has intense perianal pruritus that causes continuous scratching. The mother suspects that her
daughter has “worms”.
56. Basing on the chief complaints, the nurse is correct in identifying that more likely, the child has: a.
Ascariasis c. Trichuriasis
 b. Enterobiasis d. Hookworm infection

Answer: B
Rationale: Intense perianal itching is a characteristic of enterobiasis. Enterobius vermicularis, or pinworms, live in
the cecum. At night, female pinworms migrate down the intestinal tract and out the anus to deposit eggs in the
anal and perianal region. The movement of the worms causes the anal area to itch, and the child awakens at
night crying and scratching.

57. Nurse Ria can assist in confirming Trish’s suspected diagnosis by:
a. Asking the mother to collect stools for 3 consecutive days for culture
b. Instructing the mother how and when to do an anal transparent-tape test
c. Having the mother bring in the child’s stools for visual examination for 3 days
d. Assisting the mother to schedule a hypersensitivity test of the child’s blood serum

Answer: B
Rationale: Pinworms emerge nocturnally to lay eggs in the perianal area; eggs are caught on transparent tape in
the morning before toileting. (NSNA, NCLEX-RN Review, 4th Edition)

58. The most effective time to perform the diagnostic test is:
a. Just following a bowel movement
b. Immediately after meals
c. At bedtime before bathing
d. Early morning before rising

Answer: D
Rationale: The adult pinworm lives in the rectum or colon and emerges onto the perirectal skin during the hours
of sleep, depositing its eggs during this time. (NSNA, NCLEX-RN Review, 4th Edition)

59. Antihelminthic drugs used include:

a. Albendazole and Pyrantel
b. Metronidazole and Albendazole
c. Cotrimoxazole and Metronidazole
d. All of the above

Answer: A
Rationale: Antihelminthic drugs used in treating parasitic infections include: Albendazole and Mebendazole
(Vermox) that inhibits glucose and other nutrient uptake of helminth; Pyrantel embonate (Antiminth) that
paralyzes intestinal tract of worm; and Thiabendazole (Mintezol) that interferes with parasitic metabolism.
(NSNA NCLEX-RN Review, 4th Edition)

60. Mebendazole (Vermox) is ordered for Trish. It is advisable that this drug also be administered to:
a. The child’s younger brother who is 1 year old
b. All members of the child’s family who test positive
c. All people using the same toilet facilities as the child
d. The child’s mother, father and siblings even if they are symptom-free

Answer: D
Rationale: All household members should be treated at the same time unless they are younger than 2 years or
pregnant. (NSNA, NCLEX-RN Review, 4th Edition)

Situation 13. During the rainy season, several areas in Metro Manila become flooded with water. Leptospirosis is
one infection that is common during this time of year.
61. Leptospirosis is also known by which of the following names?
a. Drip and Weeping Itch
b. Shigellosis and Lyssa
c. Catarrhal jaundice and Ragpicker disease
d. Spiroketal jaundice and Japanese Seven Days Fever

Answer: D
Rationale: Leptospirosis is also known with the following names: Weil's disease, Mud fever, Trench fever, Flood
fever, Spiroketal jaundice and Japanese Seven Days Fever (option D). (Public Health Nursing in the Philippines,
2007)

62. How many days after infection with leptospires do the urine cultures become positive?
a. Fourth week of illness
b. Third week of illness
c. Second week of illness
d. First week of illness

Answer: C
Rationale: Leptospirosis can be diagnosed by its clinical manifestations, culture of the organism, and
examination of blood and CSF during the first week of illness and urine after the 10 th day (second week of illness).
(Public Health Nursing in the Philippines, 2007)

63. Leptospirosis in human rarely occurs through:

a. Contact with contaminated human urine
b. Indirect contact with contaminated animal urine
c. Direct contact with contaminated animal urine
d. Contact with contaminated soil

Answer: A
Rationale: Leptospirosis can be transmitted through contact (direct or indirect) of the skin, especially open
wounds with water, moist soil or vegetation contaminated with urine of infected host. Rat is the main host to
Leptospirosis although pigs, cattles, rabbits, hare, skunk, and other wild animals can also serve as reservoir.
(Public Health Nursing in the Philippines, 2007)

64. Incubation period of leptospirosis ranges form:

a. Fifteen to fifty days, depending on dose
b. A few hours to 7 days most cases occur within 48 hours of exposure
c. Usually 2-10 days, possibly 3 days or more
d. 7-19 days, with average of 10 days

Answer: D
Rationale: The incubation period of leptospirosis ranges from 7-19 days, with average of 10 days. (Public Health
Nursing in the Philippines, 2007)

65. A patient asked if it is possible to be infected while swimming in flood waters. The nurse replied that:
a. “You can protect yourself by applying 70% alcohol before swimming.”
b. “There is no danger during day time because leptospires die when exposed to sunlight.”
c. “This is not possible as long as you have no open wounds while swimming.”
d. “Infection with leptospirosis is possible with swimming in flood water contaminated with urine of animals
having the infection.”

Answer: D
 Rationale: Infection with leptospirosis is possible with swimming in flood waters contaminated with urine of
animals having the infection.
Option C is incorrect because leptospirosis is possible even without any open wounds while swimming because
the spirochete bacteria (Leptospira interrogans) can enter the mucous membranes of the eyes and mouth.
(Public Health Nursing in the Philippines, 2007)

Situation 14. A mother of a 4-year-old child arrives at a clinic and tells Nurse Tes that the child has been
scratching the skin continuously and has developed a rash.
66. Nurse Tes assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which
finding noted on assessment of the child’s skin? a. Clusters of fluid-filled vesicles
b. Fine threadlike lines
c. Purple-colored lesions
d. Thick, honey-colored crusts

Answer: B
Rationale: Scabies appears as burrows or fine, grayish, thread-like lines. They may be difficult to see if they are
obscured by excoriation and inflammation. (Silvestri, Saunders Comprehensive Review for the NCLEX-RN
Examination, 3rd Edition)

67. Nurse Tes can assist in confirming the child’s diagnosis of scabies by:
a. Gram staining
b. Using a dark field illumination test
c. Scraping from its burrow with a hypodermic needle or curette, and then examined under low power
microscope or by hard lens
d. Microscopic slide of discharge; culture tests; examination

Answer: C
Rationale: To confirm the diagnosis of scabies, a sample is taken by scraping from its burrow with a hypodermic
needle or curette, and then examined under low power microscope or by hard lens. (Public Health nursing in the
Philippines)

68. The incubation period of scabies is which of the following?

a. It occurs within 12 hours from the original contact
b. It occurs within 24 hours from the original contact
c. It occurs within 36 hours from the original contact
d. It occurs within 48 hours from the original contact

Answer: B
Rationale: The incubation period of scabies occurs within 24 hours from the original contact, which is the length
of time required for itch mite to burrow on infected skin and lay ova. (Public Health nursing in the Philippines)

69. Permethrin 5% (Elimite) is prescribed to the child. Nurse Tes instructs the mother regarding the use of this
treatment and tells the mother:
a. That the lotion should be applied to areas of the rash only
b. To apply the lotion and leave it on for 6 hours
c. To apply the lotion to cool, dry skin at least one half hour after bathing
d. To avoid clothing the child while the lotion is in place

Answer: C
Rationale: Permethrin 5% (Elimite) should not be applied until at least one half hour after bathing and should be
applied only to cool, dry skin. (Silvestri, Saunders Comprehensive Review for the NCLEX-RN Examination, 3 rd
Edition)
70. Nurse Tes is reviewing the physician’s orders. Lindane (Kwell, Scabene) has been prescribed for the child. The
nurse questions the order if which of the following is noted in the child’s record?
a. The child is 18 months old
b. The child has a history of frequent respiratory infections
c. A sibling is using Lindane for the treatment of scabies
d. The child is being bottle-fed

Answer: A
Rationale: Lindane is contraindicated for children younger than 2 years of age. These children have more
permeable skin, and high systemic absorption may occur, placing the child at risk of central nervous system
toxicity and seizures. Lindane also is used with caution in children between the ages of 2 and 10. (Silvestri,
Saunders Comprehensive Review for the NCLEX-RN Examination, 3rd Edition)

Situation 15. Mikaela Cotto, a school cafeteria worker, comes to the school clinic complaining of severe scalp
itching. Upon inspection, Nurse Rica finds nail marks on the scalp and small, light-colored, round specks attached
to the hair shafts close to the scalp.
71. These findings suggest that Mrs. Cotto suffers from:
a. Tinea capitis c. Scabies
b. Pediculosis capitis d. Impetigo

Answer: B
Rationale: The light-colored spots attached to the hair shafts are nits, which are the eggs of head lice (pediculosis
capitis). They cannot be brushed off the hair shaft like dandruff. (Gingrich, Medical-Surgical Nursing, 2 nd Edition)

72. To treat the condition of Mrs. Cotto, Nurse Poohkyaw should instruct her to:
a. Saturate her hair with vinegar for 30 minutes, massage vigorously, and then wash with hot water and
shampoo
b. Wash her hair with a pediculicide and then comb thoroughly with a fine-toothed comb
c. Apply an antibacterial cream to scalp lesions
d. Shave her head because that is the only way the problem can be completely eradicated

Answer: B
Rationale: Mrs. Cotto should be instructed to wash her hair with a pediculicide, an agent designed to kill lice.
After shampooing she should comb her hair with a fine-toothed comb to remove the nits or eggs from the hair
shafts. (Gingrich, Medical-Surgical Nursing, 2nd Edition)

73. Nurse Poohkyaw has provided instructions regarding the use of permethrin 1% (Nix) to Mrs. Cotto. Which
statement if made by the client indicates a need for further instructions? a. “The Nix can be obtained over the
counter in a local pharmacy.”
b. “It is applied to the hair after shampooing and left on for 24 hours.”
c. “It is applied to the hair after shampooing, left on for 10 minutes, and then rinsed out.”
d. “The hair should not be shampooed for 24 hours following treatment.”

Answer: B
Rationale: Option B is correct because the client needs further instruction on the application of Nix. (Silvestri,
Saunders Comprehensive Review for the NCLEX-RN Examination, 3rd Edition)

74. Nurse Poohkyaw prepares a list of home care instructions for Mrs. Cotto. Which of the following will the nurse
include in the list?
a. Use anti-lice sprays on all bedding and furniture
b. Bring all bedding and linens to the cleaners to be dry cleaned
 c. Soak combs and brushes in warm water
d. Vacuum floors, play areas, and furniture to remove any hairs that might carry live nits

Answer: D
Rationale: Thorough home cleaning is necessary to remove any remaining lice or nits. (Silvestri, Saunders
Comprehensive Review for the NCLEX-RN Examination, 3rd Edition)

75. Nurse Poohkyaw, the school nurse, initiates a screening program for the condition in #71. When searching for
nits clinging to the hair shafts, the nurse might also observe:
a. Bites, pustules, and excoriated areas on the scalp from scratching
b. Pruritic, scaling, erythematous papules, plaques, and patches with well-defined borders
c. Beefy-red erythematous areas with a few surrounding papules and pustules
d. An inflammation of the hair follicles with pus-filled nodules

Answer: A
Rationale: The scalp itches from the crawling and saliva of the adult louse. The child’s fingernails scratch the skin,
leaving red marks. (NSNA, NCLEX-RN Review, 4th Edition)

Situation 16. Mrs. Baby James, age 57, went to her doctor complaining of difficulty breathing and pain in the left
side of her chest. She states she has had shaking chills and a productive cough. The doctor advises Mrs. James’s
husband to take her to the hospital for admission.
76. The doctor has ordered a sputum specimen for culture and sensitivity. In order to obtain a good specimen,
Nurse Noypi should:
a. Teach the patient deep breathing and coughing techniques
b. Use nasotracheal suction
c. Obtain the specimen after starting antibiotics
d. Withhold food and fluid 30 minutes prior to specimen collection

Answer: A
Rationale: Deep breathing and coughing are essential for obtaining mucus from the bronchi. (NSNA NCLEX-RN
Review, 4th Edition)

77. Mrs. James is admitted to the medical-surgical floor with a diagnosis of bacterial pneumonia in the left lower
lobe. Percussion of the patient’s left lower lobe would most likely produce which of the following findings?
a. Rales c. Hyperresonance
b. Rhonchi d. Dullness

Answer: D
Rationale: When pneumonia is localized in a single lobe, consolidation or infiltration of exudate into the alveoli
can be expected. Dullness is revealed by percussion over the lobe where consolidation has occurred. (NSNA
NCLEXRN Review, 4th Edition)

78. Which is the most appropriate nursing diagnosis for Mrs. James with bacterial pneumonia? a. Fluid volume
deficit
b. Decreased cardiac output
c. Impaired gas exchange
d. Risk for infection

Answer: C
Rationale: Impaired gas exchange is the most appropriate nursing diagnosis for a patient with bacterial
pneumonia.
(Gingrich, Medical-Surgical nursing, 2nd Edition)
79. Aggressive chest physiotherapy is instituted but isn’t successful in removing Mrs. James’s secretions. Which
type of drug would Nurse Noypi expect the doctor to prescribe following physiotherapy? a. Anticholinergic c.
Antibiotic
b. Mucolytic d. Diuretic

Answer: B
Rationale: The doctor would prescribe a mucolytic to thin the secretions. (Gingrich, Medical-Surgical nursing, 2 nd
Edition)

80. Two days after admission, Mrs. James now has an order to be up in the chair as much as possible. Nurse Noypi
plans to get her up and help her with her morning care. The best plan to accomplish this would be to: a. Get her
up before breakfast, have her eat in the chair, then bathe while still up
b. Allow her to eat breakfast in bed, rest for 30 minutes, get up in the chair, and rest for a few minutes then
allow her to wash her hands and face – nurse to complete bath
c. Allow her to eat in bed, get her up, and provide her with a pan of water for her to bathe
d. Get her up before breakfast, have her bathe before breakfast, eat in the chair, then a rest in the chair

Answer: B
Rationale: This plan allows frequent rest periods for the client. The client should not rush through morning care
activities as rushing will increase hypoxemia, dyspnea, and fatigue. (NSNA NCLEX-RN Review, 4th Edition)

Situation 17. WHO is actively monitoring the progress of the pandemic H1N1 infection through frequent
consultations with the WHO Regional Offices. Here in the Philippines, the Department of Health is strengthening
its efforts in the fight against pandemic (H1N1) 2009.
81. The following are true statements regarding pandemic (H1N1) 2009 infection, except:
a. It is a swine origin Influenza A virus subtype H1N1 virus strain
 b.
Existing vaccines against seasonal flu provide no protection
c. The virus is contagious and is believed to spread from human to human in much the same way as seasonal
flu.
However, pandemic (H1N1) 2009 infection is more contagious than seasonal flu
d. Pandemic (H1N1) 2009 virus can be transmitted from pigs to humans

Answer: D
Rationale:
Option D is not a true statement because the pandemic (H1N1) virus is not zoonotic swine flu, as it is not
transmitted from pigs to humans, but from person to person.

82. Individuals that have been identified as “at greatest risk” or highly susceptible to infection by pandemic (H1N1)
influenza virus include the following, except:
a. Elderly (more than 65 years of age) and obese patients
b. Pregnant women during the third trimester of pregnancy
c. Infants and children less than 2 years of age
d. Patients with chronic health conditions, such as cardiovascular, respiratory or liver disease, or diabetes

Answer: A
Rationale: Individuals that have been identified as “at greatest risk” or highly susceptible to infection by
pandemic (H1N1) influenza virus include the following:
1. Pregnant women during the third trimester of pregnancy (option B);
2. Infants and children less than 2 years of age (option C);
3. Patients with chronic health conditions, such as cardiovascular, respiratory or liver disease, or diabetes
(option D);
4. Immunosuppressed patients related to treatment for transplant surgery, cancer, or due to other
diseases.
5. Neurological disorders can increase the risk of severe disease in children.
83. Antiviral drugs are being used to treat pandemic (H1N1) 2009 infection. Which of the following statements is
true? a. Zanamivir (Relenza) is taken PO as a tablet
b. It is necessary to wait for a laboratory result before starting antiviral drug treatment with either oseltamivir
or zanamivir
c. For oseltamivir (Tamiflu), the standard adult treatment course is one 75 mg capsule twice a day for five days.
d. M2 inhibitors (amantadine and rimantadine) can be effective for treating pandemic (H1N1) 2009 infection

Answer: C
Rationale: There are two approved antiviral drugs for influenza that are available for treatment of pandemic
influenza. These are the neuraminidase inhibitors oseltamivir and zanamivir, more commonly known by their
trade names Tamiflu and Relenza. For oseltamivir (Tamiflu), the standard adult treatment course is one 75 mg
capsule twice a day for five days. For severe or prolonged illness, physicians may decide to use a higher dose or
continue the treatment for longer.

84. Which of these complications is the most common cause of death among patients with pandemic (H1N1)
influenza?
a. Sepsis
b. Respiratory failure
c. Dehydration
d. Electrolyte imbalance

Answer: B
 b.
Rationale: The most common cause of death is respiratory failure. Other causes of death are pneumonia (leading
to sepsis), high fever (leading to neurological problems), dehydration (from vomiting and diarrhea) and
electrolyte imbalance. Fatalities are more likely in young children and the elderly.

85. Nurses should be knowledgeable on the WHO Pandemic Influenza Phases. This six-phased approach allows for
easy incorporation of new recommendations and approaches into existing national preparedness and response
plans. The current WHO phase of pandemic alert is 6, which means:
a. An animal influenza virus circulating among domesticated or wild animals is known to have caused infection
in humans, and is therefore considered a potential pandemic threat
There is verified human-to-human transmission of an animal or human-animal influenza reassortant virus
able to cause “community-level outbreaks”
c. A human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people,
but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks
d. There is human-to-human spread of the virus into at least two countries in one WHO region and community
level outbreaks in at least one other country in a different WHO region

Answer: D
Rationale: The WHO Pandemic Influenza Phases is a six-phased approach that allows for easy incorporation of
new recommendations and approaches into existing national preparedness and response plans. Phases 1-3
correlate with preparedness, including capacity development and response planning activities, while Phases 4-6
clearly signal the need for response and mitigation efforts.

Situation 18. A female patient goes to the clinic with chief complaint of creamy pus-like vaginal discharges. The
female patient tells the nurse in the health clinic that she had sexual intercourse four days ago with her boyfriend
who has gonorrhea. After laboratory work-up, the patient is found to be positive for gonorrhea.
86. The nurse teaches the patient that gonorrhea is highly infectious and: a. Is easily cured
b. Occurs very rarely
c. Can produce sterility
d. Is limited to the external genitalia

Answer: C
Rationale: Inflammation associated with gonorrhea may lead to destruction of the epididymis in males and tubal
mucosal destruction in females

87. The female patient wants to know when she can expect symptoms. The nurse replies that the unusual time
between initial infection with Neisseria gonorrhoeae and the onset of symptoms is: a. Two to five days c. One
to two weeks
b. Five to seven days d. Two to three weeks

Answer: A
Rationale: The usual incubation period between infection with Neisseria gonorrhoeae and the onset of
symptoms is two to five days. (NSNA, NCLEX-RN Review, 4th Edition)

88. For a patient diagnosed with gonorrhea, the nurse should expect the physician to order: a. Acyclovir (Zovirax)
b. Colistin (Cortisporin)
c. Ceftriaxone (Rocephin)
d. Dactinomycin (Actinomycin)

Answer: C
Rationale: Ceftriaxone (Rocephin) inhibits the synthesis of bacterial cell walls. It is effective against Neisseria
gonorrhoeae, gram-negative diplococci.
 b.
89. When teaching the patient about the drug therapy for gonorrhea, the nurse should state that it: a. Cures the
infection
b. Prevents complications
c. Controls its transmission
d. Reverses pathologic changes

Answer: A
Rationale: Ceftriaxone followed by Doxycyline is specific for and eradicates the microorganism. Other treatment
regimens are available for resistant strains.

90. The nurse knows that the major reason treatment of the majority of STDs is delayed is because: a. The client is
embarrassed
Symptoms are thought to be caused by something else
c. Symptoms are ignored
d. The client never has symptoms

Answer: D
Rationale: Chlamydia is the number 1 STD. many women who harbor Chlamydia in the cervix are asymptomatic.
As many as 15%-50% of females and 5%-25% of males with Neisseria gonorrhoeae infection are asymptomatic
carriers. In women, the primary chancre of syphilis may be on the endocervix and thus be undetected. (NSNA,
NCLEX-RN Review, 4th Edition)

Situation 19. Melason, age 26, is 10 weeks pregnant and tested positive for syphilis but has no symptoms.
91. Which of the following is the incubation period of syphilis?
a. 2 to 3 weeks for males; usually no symptoms in females
b. 10 days to 3 months, with average of 21 days
c. 4 to 20 days, with average being 7 days
d. 2 to 8 weeks; it can be as long as a year or several years depending on the severity of the wounds

Answer: B
Rationale: The incubation period of syphilis is 10 days to 3 months, with average of 21 days.

92. Melason asks Nurse Jocath why she needs to be treated since she feels fine. The nurse’s best response to the
patient would include which of the following?
a. “Syphilis can be transmitted to the baby and may cause it to die before birth if you are not treated.”
b. “If you do not receive treatment before the baby is born, your baby could become blind.”
c. “If syphilis is untreated, the baby may be mentally retarded at birth.”
d. “Syphilis may cause your baby to have a heart problem when it is born.”

Answer: A
Rationale: Syphilis is associated with stillbirth, premature birth, and neonatal death.

93. Baby Dengue, 3 months old, was born to Melason who was diagnosed with syphilis. Which information would
be most useful in determining if baby Dengue has congenital syphilis? a. Irritability c. Rhinitis
b. Red rash around anus d. Positive serology

Answer: D
Rationale: Congenital syphilis is difficult to diagnose until the infant develops his own antibodies. A positive
serology confirms the diagnosis of congenital syphilis.

94. Baby Dengue was confirmed positive in congenital syphilis. He is started on penicillin. Which statement is true
about the baby’s ability to transmit the disease now that treatment is started?
 b.
a. He will not be contagious after 48 hours of penicillin therapy
b. After 10 days of antibiotic therapy he will not be contagious
c. He will always be infected and be contagious
d. Congenital syphilis is not contagious

Answer: A
Rationale: After 48 hours of penicillin therapy the infant should not be contagious. Until that time he should be
in isolation.

95. Baby Dengue develops vesicular lesions on the soles of his feet and has a rash on his face. What is the most
appropriate initial intervention for Nurse Jocath? a. Call the physician immediately
b. Apply Neosporin ointment to the rash
c. Cover the infant’s hands with mittens
d. Give diphenhydramine (Benadryl) by mouth
 Answer: C
Rationale: Covering the infant’s hands will minimize trauma to his skin from scratching.
(NSNA, NCLEX-RN Review, 4th Edition)

Situation 20. AIDS cases have been all over the country and yet only few are reported cases due to the stigma
attach to it.
96. The nurse is planning care for an HIV-infected drug abuser. Which goal is unrealistic? a. Quitting the drug
addiction
b. Cooperating with unit goals
c. Learning to clean drug equipment
d. Remaining for the full treatment course

Answer: A
Rationale: Counseling may be insufficient to obtain desired behaviors when the negative consequences seem
distant. Objectives must take into consideration the lifestyle of the individual and where changes can be made
with the client’s cooperation. Therefore, quitting the drug addiction can be unrealistic or inappropriate for
clients seeking only care for their medical problems. (NSNA, NCLEX-RN Review, 4 th Edition)

97. During the past 6 months, a patient diagnosed with acquired immunodeficiency syndrome (AIDS) has had
chronic diarrhea and has lost 18 pounds. Additional assessment findings include tented skin turgor, dry mucous
membranes, and listlessness. Which nursing diagnosis focuses attention on the patient’s most immediate
problem?
a. Deficient fluid volume related to diarrhea and abnormal fluid loss
b. Imbalanced nutrition: less than body requirements related to nausea and vomiting
c. Disturbed thought processes related to central nervous system effects of disease
d. Diarrhea related to the disease process and acute infection

Answer: A
Rationale: Based on the client’s assessment findings, the most immediate problem is dehydration because of the
chronic diarrhea. The nursing diagnosis of deficient fluid volume is the priority, and interventions are geared to
improving the client’s fluid status. (Lippincott’s Review Series: Medical-Surgical Nursing, 4 th Edition)

98. A patient is admitted to the medical unit. She is in the terminal stages of AIDS. During the admission
assessment, the nurse would ask her if she had which of the following? a. A will
b. A do not resuscitate (DNR) order
c. An organ donation card
d. Healthcare proxy

Answer: D
Rationale: A living will, durable power of attorney for healthcare, or a healthcare proxy is an important part of an
admission assessment, especially for a terminally ill client. (NSNA, NCLEX-RN Review, 4th Edition)

99. Which statement, from a participant attending a class on AIDS prevention, indicates an understanding of how to
reduce transmission of HIV?
a. “Mothers who are HIV-positive should still be encouraged to breast feed their babies because breast milk is
superior to cow’s milk.”
b. “I think a needle exchange program, where clean needles are exchanged for dirty needles, should be offered
in every city.”
c. “Orgasms are necessary for the heterosexual transmission of the virus.”
d. “It’s okay to use natural skin condoms since they offer the same protection as the latex condoms.”

Answer: B
 Rationale: Although needle exchange programs are very controversial, it is evident the transmission of HIV can
be significantly reduced when needle exchange programs are introduced.
Option A is incorrect because HIV-positive mothers are encouraged to refrain from breast feeding their infants
because studies have shown that the virus can be passed from the mother to the infant via breast milk.
(NSNA, NCLEX-RN Review, 4th Edition)

100. What should be included in the teaching plan to young adults about the spread of AIDS?
a. Heterosexual transmission of HIV is on the rise
b. The increase of HIV in children is primarily attributed to the rise of sexual abuse
c. The greatest increase of HIV infection is by homosexual transmission
d. Transmission of HIV by IV drug users is prominent even when sterile equipment is used

Answer: A
Rationale: Heterosexual transmission of HIV is a concern, especially in this age group. It is on the rise and this is
often overlooked because the more known transmissions take place among homosexuals and IV drug abusers.
(NSNA, NCLEX-RN Review, 4th Edition)