Adventist University of the Philippines

COLLEGE OF NURSING
Level III
NCMN 326 Care of clients with problems in oxygenation, fluid
and electrolyte balance, nutrition and metabolism, and endocrine
Topic: COMMUNICABLE DISEASES
2nd Semester C.Y. 2019-2020
Name: Anastasya Rorong

Instruction: Rationalize your answer on each given options and provide references.
Answer “L” if physiological response is LOCAL and “S” if it is SYSTEMATIC.

1. Loss of function
Answer: L: Local response occurs within the area affected by the harmful stimulus. (Brunner’s
& Suddarth’s Medical-Surgical Nursing, pgs. 94-95).

2. Tenderness
Answer: L: Pain and swelling is present during local inflammation (CD Lecture, p. 17)

3. Fever
Answer: S: Fever is a sign of systemic inflammation (CD Lecture, p. 16)
4. Body malaise
Answer: S: Malaise and loss of energy is a sign of systemic inflammation. (CD Lecture, Slide
#95)
Identify the given choices below if it is Passive immunity or Active immunity.
5. Colostrum
Answer: Passive Immunity: Transfer of preformed antibodies from the
mother via the placenta and breast milk to the infant. (CD Lecture, slide #28).

6. Vaccine: Active Immunity. Active immunity refers to immunologic defences developed by the
person’s own body. Use of vaccine or toxoids, is to stimulate formation of antibodies. (CD
Handout p.5/Cheever & Hinkle, 2018 Med-Surgical Book p.1007)

7. Tetanus immunoglobulins: Passive Immunity. Injection/administration of antibodies or

antitoxins as immunoglobulins; may provide immediate protection. (CD Lecture, slide #28).

8. Identify the six links in the chain of infection (according to its proper order):

A. Etiologic agent, reservoir, portal of entry to the susceptible host, method of transmission,
portal of exit, susceptible host. Portal of exit first then mode of transmission followed by
portal of entry (Cheever & Hinkle, 2018 Med-Surgical Book p.2125).
B. Infectious agent, portal of entry, mode of transmission, portal of exit, reservoir, susceptible
host. Reservoir comes after infectious agent, followed by portal of exit, next mode of
transmission, then portal of entry before susceptible host (Cheever & Hinkle, 2018 Med-Surgical
Book p.2125).

C. Causative agent, reservoir, portal of exit, mode of transmission, portal of entry,

susceptible host. Rationale: Causative agent is a type of microorganism that causes infection.
The place where the microorganism resides, nourished and resides is the reservoir. From
reservoir, an organism must have a portal or mode of exit to another environment for
transmission to occur. A mode of transmission is necessary to transfer the infectious
microorganism with its new host. A portal of entry is needed for the organism to gain access to
the new host. Finally, for infection to occur, the new host must be susceptible or not possessing
immunity to a pathogen (Cheever & Hinkle, 2018 Med-Surgical Book p.2125).

D. Susceptible host, reservoir, portal of exit, mode of transmission, portal of entry, infectious
agent. Susceptible host is the last chain for this is where the infection might to transfer to.
Infectious agents come first in the chain of infection for this is the agent that causes infection or
diseases. (Cheever & Hinkle, 2018 Med-Surgical Book p.2125).

9. __________is a person or animal reservoir of a specific infectious agent that usually does not
manifest any clinical signs of the disease is called:

A. Vector

Rationale: A vector is an animal, flying or crawling insect that serves as intermediate means of
transporting the infectious agent. (CD Lecture, slide #64).
B. Vehicle
Rationale: A vehicle is any substance that serves as an intermediate means to transport and
introduce an infectious agent into a susceptible host through a suitable portal of entry. (CD
Lecture, slide #63).

C. Carrier (Rationale: The reservoir is a person who is a carrier of the infectious agent but
who is not himself or herself sick. (Primrose, 2015 pg. 44)

D. Host
Rationale: An organism that provides living conditions to support a microorganism (Cheever &
Hinkle, 2018 Med-Surgical Book p.2124)

10. The term fomite refers to:

A. Insects, capable of transmitting etiologic agent

Rationale: Vector-borne transmission. (CD Lecture slide #64).

B. Objects upon which the pathogen may be found (Rationale: Indirect contact. Fomites are
inanimate objects that can become contaminated with infectious agents and serve as a
mechanism for transfer between hosts (CD Handout, slide #63)).

C. Fresh bodily secretions of a contagious patient

Rationale: Body fluids, such as sweat, tears, vomit or urine may contain and pass on these viruses
when blood is present in the fluid, but the risk is low (Cheever & Hinkle, 2018 Med- Surgical
Book p.2125).

D. Germs causing contagious diseases in humans

Rationale: Pathogen are microorganisms that cause diseases (Cheever & Hinkle, 2018 Med-
Surgical Book p.2125).

11. The transfer of microorganisms from one person to another through any medium is
commonly known as:

A. Direct contact transmission

Rationale: Entails a person to person transfer of microorganisms (CD lecture, slide no.58

B. Indirect contact transmissio (Rationale: The transfer of microorganisms involves a medium

(CD lecture, slide no.62)

C. Droplet nuclei transmission

Rationale: The source and host have to be within three feet (CD lecture, slide no.59)

D. Airborne transmission

Rationale: Microorganisms are transmitted through air to a new host vi a port of entry

e.g. respiratory tract (CD lecture, slide no.65)

12. As microorganism leaves its source, it requires a means of transmission to reach another
person through a receptive portal of entry. Identify example of indirect transmission.

A. Having sexual intercourse with an infected person.

Rationale: Direct transmission through contact of body fluids and can also be through contact
with infected skin or mucus membrane. The exposure may be through vaginal/oral or anal sex
(young women’s health 2016)
B. Use of eating and cooking utensils.
Rationale: Direct transmission when the bacteria remains on used utensils and spreading to other
utensils thus infecting others under the same dwelling (Science Daily, 2015)

C. Sneezing during conversation (Rationale: Indirect transmission occurs when a person is

within a three feet radius from the person sneezing (CD lecture, slide no.58)

D. Touching another person.

Rationale: Direct transmission that involves immediate and direct transfer of microorganisms
from person to person. (CD lecture, slide no.58)

13. Which of the following situations is an example of microorganism transmission via droplet
contact?

A. A virus is transmitted through sexual intercourse.

Rationale: This is a form of direct transmission when a disease-causing microorganism passes
from one sick person to another healthy individual during sexual contact (Kane Health, 2015)
B. Infected wound drainage contacts the nurse’s hands.
Rationale: This is a form of direct transmission of microorganisms (Samuel, 2016)
C. A contaminated stethoscope touches the skin of a client.

Rationale: This is a type of indirect contact where the stethoscope becomes an intermediary
carrier of the microorganisms (CD lecture, slide no.62)

D. Microorganisms contact a person’s nasal mucus when someone coughs nearby

(Rationale: A form of droplet transfer of microorganisms whenever a healthy individual is
within a radius of three feet from the person coughing. (CD lecture, slide no.59)

14. Procedure observed to protect patient from environmental microorganisms is called:

A. Surgical aseptic technique
Rationale: Using practices and procedures to prevent contamination from pathogens. It involves
applying the strictest rules to minimize the risk of infection. Healthcare workers use aseptic
technique in surgery rooms, clinics, outpatient care centers, and other health care settings
(NCLEX-RN, 2019)

B. Reverse isolation (Rationale: used to protect you from germs when your immune system is
not working properly. Germs can be carried on droplets in the air, medical equipment, or
another person's body or clothing (CD lecture, slide no.12)
C. Segregation

Rationale: Also known as strict isolation is a system that keeps different groups separate from
each other, either through physical dividers or using social pressures and laws. (Terhi & Ainna,
2015)
D. Quarantine

Rationale: Used to protect the public by preventing exposure to people who have or may have a
contagious disease. (William, Sheil, 2020)

Classify in which condition can a nurse wear A= Sterile gloves; B= Clean gloves; or C=
Clean bare hands
15. Urinary Catheterization

Answer: A

Rationale: The potential for contact with a patient's blood/body fluids while starting a catheter
is present and increases with the inexperience of the operator. Sterile gloves must be worn while
starting the foley, not only to protect the user, but also to prevent infection in the patient. It is a
sterile procedure that nurses are obligated to wear sterile gloves. (William C. & Sheil Jr., 2016)

16. Emptying urine bag

Answer: B
Rationale: When emptying urine bags the nurse should use clean gloves because it limits the
spread of potential diseases from the patient to the nurse (CD Elysian lecture 2020)

17. Performing skin test

Answer: C
Rationale: Skin tests can be done using clean bare hands as it is not necessary to use any gloves
for this procedure (CD Elysian lecture 2020)

18. The time interval between the first exposure to the appearance of the first signs and
symptoms is called:

A. Prodromal period (Rationale: Occurs after the incubation period and is when the pathogen
continues to multiply in the hosts body and will experience the general signs and symptoms that
the illness will bring such as a fever. (Lumen Microbiology website)
B. Incubation period
Rationale: Time in which the pathogen will multiply in the host and can vary from 1-2 days to
months and years (Lumen Microbiology website)
C. Stage of illness
Rationale: Time in which the signs and symptoms of the disease are most severe. (Lumen
Microbiology website)

D. Convalescence
Rationale: Final stage in which the patient returns to normal, yet some diseases can inflect
damage that the body cannot fully recover from (Lumen Microbiology website)

19. In caring for a client on contact precautions for a draining infected foot ulcer, the nurse
should perform which of the following?

A. Wear a mask during dressing changes

Rationale: Precaution used to prevent droplet or airborne diseases from infecting the nurse (CD
lecture Elysian 2020)
B. Provide disposable eating utensils and tray
Rationale: This is not a part of contact precautions at all (CD lecture Elysian 2020)

C. Follow standard precautions in all interactions with the client

(Rationale: Gloves are a part of the personal protective equipment used when dealing with
patients in order to limit the spread of disease (CD lecture Elysian 2020)
D. Use surgical aseptic technique for all direct contact with the client.
Rationale: This is done during a surgery in order to not spread the disease to the health care
workers (CD lecture Elysian 2020)

20. A nurse is preparing a poster for a community health education and is listing the risk factors
of having an infectious disease. SELECT ALL risk factors that the nurse would place on the
list.

1. A person with a successful organ transplant.

Rationale: Organ transplants are susceptible to communicable diseases being spread from the
donor to the recipient (Med Surgical Book)
2. A neonate.
Rationale: The neonate can be at risk of infectious disease due to the weak immune system (Med
Surg)
3. An adult with chronic illness.
Rationale: Patients with a chronic illness are very susceptible to other infectious diseases as
their immune system is already weakened. (Med Surg)
4. A woman with cancer.
Rationale: Cancer weakens the immune system of the patient which can cause infectious
diseases to attack the host easier. (Med Surg)
5. An elderly with dementia.
Rationale: The older people get the more susceptible they are to infections (Alzheimer.org)

A. 2,3,4,5
B. 1,2,4,5
C. 1,2,3,4
D. 1-5 (answers)

21. Before administering a vaccine, what food allergy should be asked to the client?

A. Nuts

Rationale: Most vaccines in the market doesn’t contain peanut products. (Immunize, 2020)

B. Eggs

(Rationale: This precaution was put in place because the vaccines are produced from viruses
grown in eggs. There is a theoretical possibility that trace amounts of egg proteins can be
transferred during vaccination. Burchum, J. & Rosenthal, L. (2018).
C. Beef

Rationale: For options C and D. Being allergic to meat rarely reacts to vaccines, since most
components of vaccines contains gelatin which is mostly found in egg protein and not in meat
(Chung, 2014)
D. white meat

Rationale: For options C and D. Being allergic to meat rarely reacts to vaccines, since most
components of vaccines contains gelatin which is mostly found in egg protein and not in meat
(Chung, 2014)

22. Which of the following is the enanthem found in patients with measles (Rubeola)?

A. Forchheirmer spots

Rationale: Pathognomonic sign of German measles (rubella), (CD Summary, German measles).
B. Koplik’s spots
(Rationale: Koplik’s spots distinguish the disease because none of the other exanthems has this
finding. (Pillitteri, 2010).
C. White spots
Rationale: Characteristic of koplik’s spot. (CDC, 2020).

D. Rose spots
Rationale: Pathognomonic sign of patients with typhoid fever. (CD Summary, Typhoid fever).

23. Which of the following is the best environment to put a patient infected with tetanus?

A. A well-lit, ventilated room

Rationale: Avoid sudden stimuli and light. (CD summary, Tetanus).

B. A well-lit, quiet private room
Rationale: Even though the room is quiet, a semi dark room is still the best for patient’s tetanus
to avoid muscle spasms. (CD summary, Tetanus).

C. Semi-dark, quiet private room

(Rationale: Provide a quiet environment with reduced external stimuli to decrease the incidence
of spasms. (Ricci & Kyle, 2009)
D. In a ward with 2 other roommates
Rationale: The attendants should be explained very well that no visitor or person except the
caretaker should be allowed near the patient. Occurrence of convulsions can result to any sound;
physical disturbance howsoever mild or even small light should be avoided. (Pande, 2010).

24. Breaking the links of the chain of infection is very important to preserve health. Which
among the following nursing actions is to be performed to prevent nurses from acquiring
infection?
A. Minimize patient contact until the patient is well
Rationale: PPE should be worn when coming into contact with specific body fluids. Hand
washing is another potent weapon in the nurse's arsenal against infection, and is the single most
important nursing intervention to prevent infection. (AMN Healthcare, 2015).

B. Wear masks and goggles in cleaning an oozing wound.

Rationale: It is used when client is known to have suspected illnesses easily transmitted by direct
client contact or by contact with client’s items (Berman et.al 2016).
C. Choose patients who have no active infection during assignment.
Rationale: Proper use of PPE is always recommended to prevent acquiring infection and without
compromising the nurse and patient’s interaction.
D. Wearing appropriate personal protective equipment each patient contact (Rationale:
Personal protective equipment (PPE) is defined as ‘all equipment that is intended to be worn or
held by a person at work and which protects them against one or more risks to health and
safety’. Its use is an integral component of infection prevention and control. (Weston, Burgess &
Roberts, 2016).

25. Inflammation is tissue’s defensive response after an injurious event or an infectious agent.
Identify ALL the manifestations and findings that is associated with inflammation.
1. Pain
2. Redness
3. Jaundice
4. Swelling
5. Warmth
6. Coldness

A. 1,2,3,4
B. 1,2,3,5
Rationale: For options A and B, although some of the classic signs of inflammation is included
jaundice is also included. Jaundice forms when there is too much bilirubin in your system.
Bilirubin is a yellow pigment that is created by the breakdown of dead red blood cells in the
liver. It is not a manifestation of an inflammation related after an injurious event. (Moore, 2016).
C. 2,3,4,6
Rationale: Coldness is not related in the classic signs of inflammation (CD Lecture, p.17)
D. 1,2,4,5
(Rationale: A normally functioning immune system is required to trigger an inflammatory
response and production of the signs of inflammation or infection: fever, redness, pain, swelling,
and warmth. Source: Williams, L. & Hopper, P. (2015).

26. An active natural immunity is a result of:

A. Formation of antibodies from the administration of vaccines or toxoids

Answer: Active Artificially acquired
Rationale: Use of vaccines or toxoids to stimulate formation of antibodies (CD Lecture, slide
#28)
 B. Formation of antibodies from the presence of active infection in the body. Answer:
Active Naturally Acquired
Rationale: Antibodies are formed during the course of the disease; may provide life-long
immunity (CD Lecture, slide #28)
C. Formation of antibodies from an immune mother and will be passed on to the baby Answer:
Passive Naturally Acquired
Rationale: Transfer of preformed antibodies from the mother via the placenta and breast milk to
the infant. (CD Lecture, slide #28)

D. Formation of antibodies from injection of immune serum from an animal or another human.
Answer: Passive Artificially Acquired
Rationale: Injection/administration of antibodies or antitoxins as immunoglobulins; may provide
immediate protection. (CD Lecture, slide #28)

27. A passive natural immunity is a result of:

A. Formation of antibodies from the administration of vaccines or toxoids

Answer: Active Artificially acquired
Rationale: Use of vaccines or toxoids to stimulate formation of antibodies (CD Lecture, slide
#28)
B. Formation of antibodies from the presence of active infection in the body.
Answer: Active Naturally Acquired
Rationale: Antibodies are formed during the course of the disease; may provide life-long
immunity (CD Lecture, slide #28)
C. Formation of antibodies from an immune mother and will be passed on to the baby.
Answer: Passive Naturally Acquired
Rationale: Transfer of preformed antibodies from the mother via the placenta and breast milk to
the infant. (CD Lecture, slide #28)
D. Formation of antibodies from injection of immune serum from an animal or another human.
Answer: Passive Artificially Acquired
Rationale: Injection/administration of antibodies or antitoxins as immunoglobulins; may provide
immediate protection. (CD Lecture, slide #28)

28. The nurse instructor asks a nursing student to describe standard precautions. The student
correctly tells the instructor that it is the:

A. Precautions used for all patients to obstruct the spread of bloodborne pathogens only. Answer:
Universal Precaution
Rationale: Blood and Body Fluid Precaution (CD Lecture, slide #116)
B. Precautions used for specific diseases in which some practices are not applicable to others.

Answer: Transmission-based Precaution

Rationale: Regardless if applicable or not, we need to protect ourselves and others around us
from diseases and pathogens. (CD Lecture).
C. Precautions which inhibit the growth of microorganisms by the use of antiseptics and
disinfectants.

Answer: Aseptic technique

Rationale: Using practices and procedures to prevent contamination from the pathogens. It
involves applying the strictest rules to minimize the risk of infection. (Healthline, 2017)

D. Precautions used in caring for all hospitalized patients regardless of their diagnosis and
possible infection status
Rationale: Healthcare workers can prevent themselves from acquiring unknown pathogens; it
also protects the client and their families from infection as well. (CD Lecture).

29. In doing a health teaching regarding how food and waterborne diseases are being transmitted
to other persons, the nurse mentioned about the 5 Fs which are:

A. Fomites, flies, feces, food, and fingers

(Rationale: This is the best answer; these are the basic everyday objects that touch one thing to
another).

B. Flies, feces, food, fumigation, and filth

Rationale: Before the procedure starts, fumigation requires all materials to be removed from the
area, as long as filth does not touch any of your food, water, or yourself, then it is still
uncontaminated. (Brunner’s & Suddarth’s, Medical-Surgical Nursing).

C. Fingers, filth, frozen, food, and fomites also known as vehicle borne Rationale: Frozen and
vehicle born are N/A.

D. Fast food, street food, contaminated food, spoiled and half-cooked food
Rationale: Spoiled and half-cooked food is not correct because it is considered contaminated.
(Brunner’s & Suddarth’s, Medical-Surgical Nursing).
30. Which among the following patient isolation precaution must be employed to a client with
food-waterborne diseases?

A. reverse isolation
Rationale: Protection from environmental microorganisms (CD Lecture, slide #112)

B. droplet precaution

Rationale: Used for clients known or suspected to have serious illnesses transmitted by particle
droplets larger than 5 microns (CD Lecture, slide #120)
C. quarantine isolation
Rationale: May (or may not) become ill involving dangerous and highly contagious (CD Lecture,
slide #112)

D. Contact precaution

Rationale: Are used for clients known or suspected to have serious illnesses easily transmitted
by direct client contact or contact with items in the client’s environment. (CD Lecture, slide
#121)

31. Preventive measures for diseases brought by mosquitoes least likely include:
A. Planting of Neem trees/ eucalyptus (Rationale: this is one of the most effective plant-
based natural mosquito repellents and will instantly kill all mosquitoes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059459/ )
B. Hanging wet clothes in the houses (Rationale: mosquitoes gravitate toward dark,
warm and moist places where they have access to water and this may include the rooms
with wet clothes hanging inside and they may lay eggs in wet clothes
https://www.precisionvaccinations.com/ )
C. Clean breeding sites like used tires (Rationale: old or unclean tires attract mosquitos
and it makes the mosquitos comfortable and come around https://www.mrmr.biz/ )
D. Using mosquito repellants (Rationale: most of the mosquito repellents evaporate on
the skin and work by blocking a mosquito’s sense of smell, preventing it from finding its
target.

32. A papule is described as:

A. a flat spot on the skin whose color may be lighter or darker than the surrounding skin.
(Rationale: this is the categories of Macule)
B. a small, elevated skin lesion filled with white blood cells. (Rationale: this is the
categories of
Pustular)
 C. a small bump or pimple that rises above the surface of the skin (Rationale: Ma’am
Hernandez CD lecture)
D. a small blister-like elevation on the skin containing serous fluid. (Rationale: this is the
categories of Vesicle)

Classify the following situation as A- Endemic; B- Epidemic; C- Pandemic; D- Sporadic

33. There are only 2 irregular cases of pertussis in the Manila one is in Pasay and the other is in
Quezon city. (Rationale: D-Sporadic, CD lecture ma’am Hernandez)
34. 82% if malaria cases are found in Region IVB (Rationale: A-Endemic, CD lecture ma’am
Hernandez)
35. In the Philippines, there is a total of 12,736 measles cases through Feb. 24. In addition, the
number of deaths in the current outbreak has risen to 203. (Rationale: B-Epidemic, CD lecture
ma’am Hernandez)
36. HIV/AIDS resulted to an estimated 65 million infections and 25 million deaths worldwide.
(Rationale: C-Pandemic, CD lecture ma’am Hernandez)

37. A 30-year-old male client came to the clinic after having diagnosed of gonorrhoea 11 days
ago. As a nurse you will know that the patient is infected by assessing which of the following
symptom?

A. Burning sensation on the penis and swollen lymph nodes in the groin
Rationale: Burning or pain during urination can be a symptom of several STDs. (Healthline,
2016).

B. Hesitancy in urination with purulent discharge from the urethra (Rationale: A disease or
condition found among a certain region or group. (Wesbster, 2019)

C. There is a non-healing painless erosion on the genitalia

Rationale: A person with primary syphilis generally has a sore or sores at the original site of
infection. (CDC, 2015).
D. Headache, rash, stiff neck, irritability and joint pains
Rationale: Syphilis begins with a painless sore at the infection site and, in the second stage,
causes a rash, fever, fatigue, headache, and loss of appetite. (MSD Manual, 2018)

38. Which of the following actions of the nurse would be least likely to result in a client comfort
when attending and going to STD clinics?
A. Addressing the client by name
Rationale: For A and B. Nurses should greet the patient by name, make eye contact, and display
confidence and professionalism. (Registered Nursing, 2020).
B. Making eye contact appropriately.
Rationale: For A and B. Nurses should greet the patient by name, make eye contact, and display
confidence and professionalism. (Registered Nursing, 2020).
C. Asking the nature of the problem in an area that maintains privacy
Rationale: Ensuring privacy can promote more effective communication between physician and
patient, which is essential for quality of care, enhanced autonomy, and preventing economic
harm, embarrassment, and discrimination. (Nurseslab 2019)
D. Standing with your arms crossed as you talk to the client (Rationale: Ineffective
behaviours and responses: having a closed posture-crossing arms on chest. (Nursing Crib,
2020).

39. Which of the following actions would be the least effective STD risk reduction strategy?

A. Abstinence

Rationale: The most reliable way to avoid infection is to not have sex (i.e., anal, vaginal or oral).
(CDC, 2020).

B. Using a male condom after vasectomy

Rationale: A vasectomy won't reduce your risk of getting or spreading sexually transmitted
infections (STIs). The only way to protect you and your partner from STIs is to wear a condom.
(Brito, 2018).
C. Lifelong monogamy of both partners

Rationale: Being in a long-term mutually monogamous relationship with an uninfected partner is

one of the most reliable ways to avoid STDs. But you must both be certain you are not infected
with STDs. (CDC, 2020).

D. Taking oral contraceptives for family planning (Rationale: Although hormonal

contraceptives and IUDs are highly effective at preventing pregnancy, they do not protect
against STDs, including HIV. (CDC, 2020).

40. Which skin condition is the most pruritic in patients with chicken pox?

A. Macule
Rationale: Chickenpox usually begins as itchy red papules progressing to vesicles on the
stomach, back and face, and then spreading to other parts of the body. (Ngan Vanessa, 2018)
B. Papule

Rationale: Like most forms of acne, papules and pustules are the result of an increase in oil and
bacteria trapped inside the pore by dead skin cells. (Proactiv, 2020).
C. Vesicle
(Rationale: Once the chickenpox rash appears, it goes through three phases: Raised pink or red
bumps (papules), which break out over several days. Small fluid-filled blisters (vesicles), which
form in about one day and then break and leak. (Mayo Clinic, 2020)

D. Pustular

Rationale: Pustules may form when your skin becomes inflamed as a result of an allergic
reaction to food, environmental allergens, or poisonous insect bites. However, the most common
cause of pustules is acne. (Cobb, 2017).

41. The child with chickenpox is considered contagious until:

A. The scabs have fallen off

Rationale: Unless the scabs are completely crusted, a person is still contagious (Gompf, 2019)

B. 24 hours after afebrile period

Rationale: Patient is still able to spread the virus from vesicles and through indirect articles
contaminated by patient (Weatherspoon, 2017)
C. The lesions have crusted completely (Rationale: The period of communicability is from 1 to
2 days before appearance of rash until the complete crust of the lesions (CD summary,
Chickenpox

D. Negative results on nose and throat cultures are obtained

Rationale: There are no specific diagnostic exams for chickenpox, unable to use diagnostic
procedures to test for positivity. Although, there are helpful procedures. (Bechtel, 2018).

Situation: Mommy Jiel brought his son Zach who was bitten by a dog to San Lazaro Hospital for
management.
42. During the excitement stage of rabies, the nurse must do the following EXCEPT:
A. Provide a quiet environment, free from stimuli
Rationale: Patients have hallucinations and have delirium so a quiet environment is best. Those
who have rabies are sensitive to light and noise. (Newman, 2017)

B. Provide a room away from the utility room

Rationale: Patient may harm himself or others by abnormal behavior. (Hikufe, 2019)

C. Offer fluid to relieve laryngeal spasm (Rationale: Patients with rabies have muscles spasms
which can affect any attempts to swallow. (CD Summary, Rabies)
D. Place in a quiet isolation room
Rationale: Patients with rabies are sensitive to light and noise. (WHO, 2019).

43. Rabies can be prevented by:

A. Killing all rabid dog.

Rationale: Bats, cats, and livestock can spread rabies too. (Hikufe, 2019). B. Maintaining a good
body resistance.

Rationale: Preventive immunization is helpful along with maintain a good immune system.
(WHO, 2019)

C. Immediate treatment after a dog bite.

Rationale: Wash wound with soap immediately. Antiseptics e.g. povidone iodine or alcohol may
be applied (CD Summary, Rabies)
D. Observation of the dog for 10 days before the start of treatment.
Rationale: Doing so will aid the care providers in knowing if patient was bitten by an animal
with rabies. (CD Summary, Rabies).

44. To prevent incidence of rabies which of the following would you teach to the community
people about responsible pet ownership?

A. Allow pets to roam around the streets.

Rationale: Never allow pets to roam the streets (CD Summary, Rabies)
B. Let your pets feed on your garbage.
Rationale: Feeding off of garbage, can cause possible transmission of virus to your pet. (Hikufe,
2019).

C. You are not accountable to your pet’s action.

Rationale: All pet owners are responsible for their pets. (WHO, 2019).
D. Have pet immunized at 3 months of age and every year thereafter.
Rationale: This will prevent the likelihood of pets having rabies (CD Summary, Rabies).

Choose which is the most appropriate precautions (A=Contact Precautions; B=Droplet

precautions C=Airborne precautions) to implement in the following situation:

45. Patient with Typhoid Fever

Answer: A= Fecal-oral Precaution

Rationale: Care providers should demonstrate proper contact precautions when dealing with the
patient and his excretions. (CD summary, Typhoid Fever)

46. Chicken pox

Answer: C= Airborne precaution

Rationale: Chicken pox is cause by human herpes virus type 3 and transmit through airborne,
direct contact from sheds of virus from vesicles and indirect through discharges of infected
person (Hernandez Lecture, 2020).
47. Pneumonia

Answer: B= Droplet precaution

Rationale: Pneumonia is caused by bacteria and transmit via droplet of infected person
(Hernandez Lecture, 2020).
48. Which of the following will be the best and appropriate independent nursing intervention for
patient with DHF (Dengue Haemorrhagic Fever) during the acute phase of the disease?

A. Assist patient to brush teeth using a regular tooth-brush.

Rationale: Bleeding gums is a warning sign of severe dengue (Hernandez Lecture, 2020) B.
Administered anti-pyretic like aspirin for fever.
Rationale: Aspirin is to be avoided when administering anti-pyretic to dengue patient (Hernandez
Lecture, 2020).
C. Advice to exercise to increase immune system.
Rationale: Supportive care includes bed rest is one way to manage dengue fever (Hernandez
Lecture, 2020).
D. Encourage to increase clear fluid intake (Rationale: Oral rehydration therapy is
recommended for patients with moderate dehydration caused by high fever and vomiting
(Nurselabs.com, April 2020)

49. The following are warning signs of DHF EXCEPT:

A. Anorexia (Rationale: Anorexia is an eating disorder or loss of appetite (Brunner &
Suddarth’s, v. 13, p. 800).
B. Abdominal pain
Rationale: Abdominal pain or tenderness, a manifestation of dengue with warning signs
(Hernandez Lecture, 2020).

C. Hepatomegaly
Rationale: Hepatomegaly is a sign and symptom of shock. (Hernandez Lecture, 2020). D.
Increase in Hematocrit

Rationale: Hepatomegaly is a sign and symptom of Malaria disease (Hernandez Lecture,

2020).
50. Which of the following indicate a positive result in Rumpel-Leade’s test?

A. 1-10 rashes per 1-inch square

Rationale: Presumptively positive when 20 or more petechiae per 2.5 cm or 1-inch square are
observed (Hernandez CD Lecture, 2020)
B. 1-10 rashes per 2.5-inch square
Rationale: Presumptively positive when 20 or more petechiae per 2.5 cm or 1-inch square are
observed (Hernandez CD Lecture, 2020)
C. 20 or more rashes per 1-inch square (Rationale: Presumptively positive when 20 or more
petechiae per 2.5 cm or 1-inch square are observed )
D. 20 or more rashes per 2.5-inch square (Rationale: Petechiae of 2.5 cm or 1-inch square
(Hernandez CD Lecture, 2020).

Proverbs 3:5-6 New International Version (NIV)

5 
Trust in the LORD with all your heart
    and lean not on your own understanding;
6 
in all your ways submit to Him,
    and He will make your paths straight.

NSH 2020