PNLE November 2023 Intensive Review Program

Infant Care and Feeding

Multiple Choice: Select the BEST answer for each of the following questions. Mark only one answer for each item by
shading the box corresponding to the letter of your choice on the answer sheet provided.

1. The pituitary hormone that stimulates the secretion of milk from the mammary glands is
a. prolactin
b. progesterone
c. estrogen
d. Oxytocin

2. What is the Apgar (APGAR) score for a child with a heart rate of 90, irregular and weak cry, cyanotic extremities,
weak and slightly flexed extremities, and grimacing facial expression?
a. 0 b. 3 c. 5 d. 7

3. Which of the following forms of birth trauma involves a diffuse, edematous, and often dark swelling of the soft tissues
of the scalp that extends across the midline and/or suture lines?
a. Erb palsy
b. Caput succedaneum
c. Fractured clavicle
d. Cephalhematoma

4. A newborn presents with an arm that is extended, internally rotated, and flexed at the wrist. Moro reflex of the right
arm is absent but right hand grasp is intact. Which of the following is most likely?
a. Erb palsy
b. Klumpke palsy
c. Fractured clavicle
d. Caput succedaneum

5. Which of the following is NOT common in postmature (>42 weeks) infants?

a. Meconium aspiration
b. Hyperglycemia
c. Hypocalcemia
d. Polycythemia

6. Which of the following are transient dark blue-black pigmented macules over the lower back and buttocks that are
sharply demarked (do not fade into surrounding skin)?
a. Child abuse bruises
b. Erythema toxicum neonatorum
c. Mongolian spots
d. Seborrheic dermatitis

7. The following are nursing measures to stimulate lactation EXCEPT

a. Frequent regular breast feeding
b. Breast pumping
c. Breast massage
d. Application of cold compress on the breasts

8. The normal respiration of a newborn immediately after birth is characterized as:

a. Shallow and irregular with short periods of apnea lasting not longer than 15 seconds, 30-60 breaths per
minute
b. 20-40 breaths per minute, abdominal breathing with active use of intercostals muscles
c. 30-60 breaths per minute with apnea lasting more than 15 seconds, abdominal breathing
d. 30-50 breaths per minute, active use of abdominal and intercostal muscles

9. The anterior fontanel is characterized as:

a. 3-4 cm antero-posterior diameter and 2-3 cm transverse diameter, diamond shape
b. 2-3 cm antero-posterior diameter and 3-4 cm transverse diameter and diamond shape
c. 2-3 cm in both antero-posterior and transverse diameter and diamond shape.
d. None of the above

10. The ideal site for vitamin K injection in the newborn is:
a. Right upper arm
b. Left upper arm
c. Either right or left buttocks
d. Middle third of the thigh

11. The minimum birth weight for full term babies to be considered normal is:
a. 2,000gms
b. 3,000gm
c. 2,500gms
d. 1,500gms
12. The procedure done to prevent ophthalmia neonatorum is:
a. Marmet’s technique
b. Crede’s method
c. Ophthalmic wash
d. Ritgen’s method

13. Which of the following characteristics will distinguish a postmature neonate at birth
a. Plenty of lanugo and vernix caseosa
b. Lanugo mainly on the shoulders and vernix in the skin folds
c. Pinkish skin with good turgor
d. Almost leather-like, dry, cracked skin, negligible vernix caseosa

14. Immunity transferred to the fetus from an immune mother through the placenta is:
a. active natural immunity
b. passive natural immunity
c. active artificial immunity
d. passive artificial immunity

15. Closure of the foramen ovale after birth is caused by

a. a decrease in the aortic blood flow
b. a decrease in pressure in the left atrium
c. An increase in the pulmonary blood flow
d. An increase in the pressure in the right atrium

16. The Moro reflex response is marked by:

a. Abduction and then adduction of the arms
b. extension of the arms
c. Abduction of the arms
d. Extension of the legs and fanning of the toes

17. An infant’s intestines are sterile at birth, therefore lacking the bacteria Necessary for the synthesis of:
a. Bilirubin
b. Prothrombin
c. Bile salts
d. Intrinsic factor

18. The midwife teaches a group of postpartal clients that all their newborns will be screened for PKU to
a. detect possible retardation
b. Test for thyroid insufficiency
c. Measure protein metabolism
d. identify chromosomal damage

19. Twenty hours after birth and with patent anus, the infant has not passed meconium. The midwife suspects which of
the following conditions?
a. Imperforate anus
b. Celiac Disease
c. Hirschprung’s Disease
d. Intussuception

20. As a midwife is caring for baby with hypospadias. You will anticipate that one of these procedures needs to be
delayed
a. Circumcision
b. Meatoplasty
c. Catheterization
d. None of the above

21. Bowel control is achieved on what month

a. 15 months
b. 18 months
c. 24 months
d. 36 months

22. Gender Identity is developed at what age?

a. 24 months
b. 3 months
c. 3 years old
d. 5 years old

23. 2 hours after birth, a neonate is transferred to the nursery for further assessment. The midwife is planning to prevent
hypothermia. What is the common source of convective heat loss?
a. Low room humidity
b. Cool weight scale
c. Cool incubator walls
d. Cool aircon

24. The hormone responsible for the let-down reflex is?

a. Prolactin
b. Estrogen
c. oxytocin
d. Progesterone
25. A significant sign that is baby is being fed effectively is
a. The neonate voids once or twice every 24 hours
b. The neonate breastfeeds four times in 24 hours
c. The neonate losses 20% of birth weight in few days after birth
d. The other nipple is also flowing with milk

26. Cutting of the cord completes the circulation causing an increased pressure at the left side of the heart which leads to
closure of what shunt?
a. Foramen ovale
b. Ductus venosus
c. Ductus arteriosus
d. Umbilical vein

27. When midwife Grace touches Bb Gomez’s shoulders, the skin feels warm. Ms. Grace knows that Bb Gomez is
producing heat by burning the best insulator of the body which is
a. Glucose
b. White fat
c. Brown fat
d. Adipose tissue

28. When suctioning a newborn it should be fast and gentle since prolong ed and deep suctioning can cause the
following, EXCEPT:
a. Spasms of the larynx
b. Decreased oxygenation
c. Proper mucus drainage
d. Decreased heart rate

29. A great factor in the initiation of breastmilk production is

a. Decreased estrogen and increased progesterone
b. Decreased estrogen and progesterone
c. Increased estrogen and progesterone
d. Absence of estrogen and progesterone

30. Neonatal eye deviation is common due to

a. Inability to focus to light
b. Poor occulomotor development
c. Congenital anomaly of the eye
d. Lazy eye

31. The routine Crede’s prophylaxis with Erythromycin ophthalmic ointment is done to prevent what type of infection?
a. Fungal
b. Staphylococcal
c. Streptococcal
d. Gonorrhea

32. During physical exam, a principle to follow in assessing an infant is to follow

a. cephalocaudally
b. from the least intrusive to the most intrusive area
c. from the most intrusive to the least intrusive area
d. Proximodistally

33. Bb Troy is undergoing phototherapy. As a midwife in charge of Bb Troy, you should be aware of that phototherapy is
effective when Bb Troy
a. develops priapism
b. Passes bright green stools
c. unconjugated bilirubin increases
d. consume more milk and fluids

34. Normally, the anterior fontanel closes at what age?

a. 2-3 months
b. 9 -10 months
c. 6 -8 months
d. 12 – 18 months

35. The MOST highly developed sense of the newborn

a. Sense of touch
b. Sense of Sight
c. Sense of taste
d. Sense of hearing

36. Solid food is usually given to the child at what age?

a. 4 months
b. 5 months
c. 6 months
d. 7 months

37. In assessing Bb Suhol, the midwife will observe which of the following sign of diaphragmatic hernia
a. APGAR score of 8
b. Scaphoid abdomen
c. Excessive drooling
d. General accrocyanosis
38. Rooting reflex is elicited by stroking the baby’s
a. soles
b. lips
c. mouth
d. cheek

39. The type of immunity a neonate acquire when he is breastfed is called

a. Artificial passive immunity
b. Natural Active immunity
c. Natural passive immunity
d. Artificial active immunity

40. A baby is breastfed. Midwife Lorna expects the baby’s stool to have the following characteristics, EXCEPT
a. Pasty with light yellow color
b. Golden yellow and mushy
c. Frequent and soft
d. Golden yellow with sweet smelling odor

41. The substance responsible for the odor of the stool if the baby is breastfed is
a. Linoleic acid
b. Lactic acid
c. Acetic acid
d. Hydrochloric acid

42. The stage of growth and development characterized with the child learning to do basic things
a. Newborn
b. Toddler
c. Pre-school
d. School age

43. The activity of the child during this stage is toilet-training.

a. Newborn
b. Toddler
c. Pre-school
d. School age

44. During what month does eruption of the first temporary teeth appear?
a. 6 months
b. 7 months
c. 8 months
d. 9 months

45. An 8 month old infant is brought in the clinic for a well-baby visit. If the baby’s birth weight is 6 lbs, which present
weight is within the normal range for this infant?
a. 12 lbs
b. 13 lbs
c. 14 lbs
d. 15 lbs

46. Mrs Santos brought her 10 months old infant to the clinic stating her infant is drooling and fussy. She thought these
signs are related to teething. As a midwife in the clinic you expect the infant to have how many set of decidous teeth?
a. 8 – 10
b. 6 – 8
c. 4 - 6
d. 2- 4

47. DPT is given to an infant

a. Orally, 3 x with an interval of 4 weeks
b. Intramuscularly, 3 x with an interval of 4 weeks
c. Subcutaneously, 3 x with an interval of 4 weeks
d. Intramuscularly, 3 x with an interval of 6 weeks

48. Which of the following is NOT true of milia?

a. It is an abnormality
b. It is a plugged the sebaceous glands
c. It disappear in 3-4 weeks without treatment
d. It is commonly found on the cheeks, nose and chin

49. The parents of a 4 month-old-infant who has not been circumcised express concern that the infant’s penile foreskin
does not retract. The midwife advises the parents that:
a. circumcision is needed
b. b. the foreskin is frequently not retractable until the age of three
c. c. The condition is unhealthy
d. This condition will interfere with urination

50. A mother who is breastfeeding her healthy four-month-old infant is concerned about the infant's need for iron
supplementation. The midwife understands:
a. that no extra iron is required.
b. that the infant will receive adequate amounts of iron when cereal is added to the diet
c. the need for an iron-fortified formula.
 d. the need to start the infant on a daily iron supplement.

51. A child who has received an immunization for diphtheria, tetanus, and pertussis develops swelling at the injection site,
tenderness, low-grade fever, and malaise. The midwife informs the child's parents that
a. they should delay future immunizations until seen by an allergist.
b. this is a mild reaction and teaches them how to manage it.
c. c. This is a severe reaction and that they should bring the child to the emergency room.
d. This is an appropriate reaction and they need not do anything.

52. While evaluating a three-day-old infant, a midwife practitioner turns the infant on the side to examine the back and
notes a sharp line of demarcation dividing the upper and lower parts of the body. The dependent half is bright red and
the superior half is pale. The etiology of this phenomenon is:
a. an elevated central hematocrit level, typically greater than 65%.
b. an immature autonomic regulatory system, generally referred to as the "harlequin sign."
c. Decreased blood flow to the superior half, usually caused by coarctation of the aorta.
d. vasodilation of peripheral blood vessels, usually caused by sepsis.

53. When is the first hepatitis B immunization administered to an infant who is born to a mother whose hepatitis B status
is unknown?
a. Within 12 hours of birth
b. At two weeks of age
c. At one month of age
d. At two months of age

54. Appropriate anticipatory guidance for parents who bring a four-month-old infant for a well child visit includes informing
the parents to:
a. be aware that stranger anxiety is common in children this age.
b. maintain a record of their child's food preferences.
c. prevent falls from rolling off furniture, beds, and changing tables.
d. use behavior modification to decrease crying spells.

55. Which is an accurate statement about colic in infants?

a. Colic can be alleviated by adding cereal to the formula.
b. Colic can be avoided by withholding solids until the infant is at least 4 months old.
c. Colic is determined by the mother's diet.
d. Colic will diminish with time.

56. A 21-year-old primigravida gives birth at 29 weeks gestation. At one minute after birth, the baby appears blue in color,
has a heart rate of 40/minute, exhibits no respirations, is flaccid with no movement, and does not respond to
stimulation. Which of the following is the baby's Apgar score most likely to be at 1 minute?
a. 0
b. 1
c. 2
d. 3

57. A 16-year-old primigravida gives birth to a 38 week gestational age male. At the time of delivery, it is noted that the
umbilical cord has a single artery and vein. Which of the following is the most significant result of this finding in the
cord?
a. There is a greater likelihood for congenital anomalies.
b. Maternal diabetes is probably present
c. There is increased risk for infection
d. This appearance is typical for the umbilical cord.

58. An infant who sits with only minimal support, who attempts to attain a toy beyond reach, and who rolls over from the
supine to the prone position, but does not have pincer grasp, is at which f the following developmental levels.
a. 2 months
b. 6 months
c. 4 months
d. 9 months

59. New parents ask you how to reduce the chance of their baby suffering from SIDS. You tell them to place the child in
which of the following position for sleep?
a. Supine position
b. Seated position
c. Prone position
d. Side-lying

60. A newborn’s mother complain that her son has small , white dots all over his nose. The dots do not wipe off with the
bathing but they are not also erythematous
a. Stork bites
b. Milia
c. Salmon patch
d. Vernix caseosa

61. Which of the following is true about Mongolian spots?

a. Disappear in about a year
b. Are linked to pathologic conditions
c. Are managed by tropical steroids
d. Are indicative of parental abuse

62. Signs of cold stress that the midwife must be alert when caring for a Newborn is :
 a. Hypothermia
b. Shaking
c. Decreased activity level
d. Increased RR

63. Hypothermia is common in NB because of their inability to control heat loss. Which of the following would be
appropriate nursing intervention to prevent heat loss, EXCEPT:
a. Place the crib beside the wall
b. Doing Kangaroo care
c. By using goose neck lamp
d. Drying and wrapping the baby

64. An inborn error of metabolism that causes premature destruction of RBC?

a. G6PD
b. Congenital hypothyroidism
c. PKU
d. Galactosemia

65. After the baby is delivered, the cord was cut between two clamps using a scissors, the baby is placed at the
a. Mother’s breast
b. Mother’s side
c. Take the baby to the nursery
d. Baby’s own bed

66. Which of the following would be inappropriate to assess in a mother who’s breast-feeding?
a. The attachment of the baby to the breast.
b. The mother’s comfort level with positioning the baby.
c. Audible swallowing.
d. The baby’s lips smacking

67. When counseling the client about diet and nutrition during lactation, the midwife stresses that it is especially important
to increase intake of:
a. Fats
b. Calories
c. Protein
d. Vitamin K

68. The midwife explains to the client that the primary action that simulates the neonate to open the mouth and grasp the
nipple is to
a. pull down on his chin
b. touch his cheek gently.
c. place the nipple into this mouth
d. brush his lips lightly with the nipple.

69. During the initial assessment, the midwife notes that the neonate’s Hands and feet are bluish-colored. The midwife
should
a. Wrap the neonate warmly
b. Massage the neonate’s extremities
c. Administer oxygen to the neonate promptly.
d. Report the cyanosis the physician promptly

70. Meconium is expelled

a. Within 24 hours
b. One week after birth
c. 2 days after birth
d. 1 hour after birth

71. Mrs Amor brought her 3 month old infant to the clinic for a well-baby visit. You assess the anterior fontanel for any
abnormality and should position the infant in
a. Supine
b. Side-lying
c. Prone
d. Trendelenburg

72. The following are Immediate Essential Newborn Care, EXCEPT

a. Thermal protection
b. Mother’s milk
c. Normal breathing
d. VIt K injection

73. What are the benefits of immediate skin-to-skin contact?

a. Provides warmth
b. Increases overall duration of exclusive breastfeeding
c. Allows colonization with good bacteria
d. All of the above

74. Under the Essential newborn care, when should the cord be clamped after birth?
a. When the cord pulsation stops
b. Between 1 and 3 minutes
c. between 30 seconds – 1 minute in preterms
d. All of the above are appropriate
75. Giving of initial bath should be delayed until after 6 hours of birth due to following reasons, EXCEPT:
a. Washing exposes to hyperthermia
b. The vernix caseosa acts as a barrier to some bacteria
c. Washing removes the crawling reflex
d. Increases heat loss

76. What vaccines are given in conjunction with Vit K within 90 mins to 6 hours of age?
a. OPV and Hep B
b. BCG and DPT
c. Hep B and BCG
d. OPV and DPT

77. Ear drops, instilled twice a day, are prescribed for a toddler. When Teaching the mother to instill the drops, the
midwife should tell her to Pull the toddler’s ear lobe
a. up and forward
b. down and forward
c. up and backward
d. down and backward

78. The first teeth to erupt are usually the

a. second molar
b. first molar
c. lateral incisors
d. central incisors

79. The ability to manipulate small objects with pincer grasps is usually noted at what age?
a. 0 – 2 months
b. 8 – 9 months
c. 3 -5 months
d. 6 – 7 months

80. While performing the PE, the midwife explains to the mother that in a term infant, the sole creases are
a. absent near the heels
b. Spread over the entire foot
c. Evident under the heels only
d. Evident only forward of the transverse arch

81. A mother who is breastfeeding most likely can stimulate milk through
a. frequent sucking
b. complete emptying
c. manual pressure
d. exercise

82. Which of the following is FALSE about maternal –infant bonding

a. Because of maternal instinct, mothers tend to love their infant even if there’s no bonding
b. Critical periods in which bonding takes place in human is within 12 hours.
c. Putting the baby to the breast soon after birth will help in the bonding
d. Infants deprived of bonding is less alert and unresponsive

83. The following are physiological changes occurring in the neonate During the first month of life, but one
a. Skin desquamation
b. Jaundice from the 1st day to 10th day
c. Fever on the 2nd day
d. Spot of blood and mucus in the female genitalia in the 1st few days

84. The following infections may gain entrance into the body Through the umbilicus
1. Omphalitis
2. Tetanus neonatorum
3. Ophthalmia neonatorum
4. Sepsis Neonatorum
a. 1 ,2 and 3
b. 2, 3 and 4
c. 1, 2 and 4
d. 1, 3 and 4

85. A male newborn is found to have a scrotum that is soft and non-Palpable. This condition is called
a. Orchitis
b. Hydrocele
c. Scrotal hernia
d. Cryptorchidism

86. The following characteristics is TRUE of anterior fontanel, EXCEPT

a. Diamond in shape
b. Located at the junction of parietal and frontal bones
c. Smaller than posterior fontanel
d. Normally closes between 12- 18 months of life

87. Infant’s iron reserves are depleted at what age?

a. 3-4 months
b. 5-6 months
 c. 4-5 months
d. 6-9 months

88. Solid food is introduced one at a time to

a. Prevent allergic formation
b. Identify if the baby is allergy to the food
c. Prevent taste confusion
d. teach baby the art of mastication

89. Hypoprothrombinemia prophylaxis is administered by

a. Oral
b. Intramuscular
c. Subcutaneous
d. Intradermal

90. Which of the following is considered a normal find of the cord stump Of a 2 day old infant.
a. Slight swelling at the base of the stump
b. A small amount of serosanguineous drainage from the stump
c. Redness from at the base of the stump
d. Dryness of the stump

91. The finding that would probably necessitate prolonged follow-up Care of a newborn would be:
a. A birth weight of 3500g
b. An initial APGAR score of 5
c. An umbilical cord that contained only two vessels
d. The aspiration of 20 ml of milky-colored fluid from the newborn’s stomach

92. Signs of adequate milk supply, EXCEPT

a. Infant is satisfied after each nursing period
b. Infant sleeps 2-4 hrs
c. Infant gaining weight adequately
d. Infant has 2-3 wet diapers per day

93. Gender identity begins at what age?

a. 20 months
b. 12 months
c. 18 months
d. 8 months

94. The standard by which the infant nutrition is judged

a. Maturation
b. Growth
c. Development
d. Skills

95. The main protein of human milk which is a component of mammary Gland lactose synthesis
a. lactalbumin
b. taurine
c. casein
d. beta-lactoglobulin

96. In immediate essential newborn care, while drying thoroughly the newborn, the midwife should also observe infant’s
a. Breathing
b. congenital anomaly
c. Temperature
d. Heart rate

97. A baby born with hemolysis due to Rh sensitization may have___At birth
a. jaundice
b. edema
c. anemia
d. heart failure

98. The important task of the neonate is:

a. accomplish physiologic stability
b. establish a relationship with the caretaker
c. be free of infection
d. none of the above

99. In the administration of oxygen, care should be exercised in the Premature who have poor vascular supply in the
retina. Oxygen toxicity May cause blindness due to
a. clouding of the cornea
b. shrinking of the eyeball
c. detachment of the retina
d. increase ocular pressure

100. Supplemental Vit A is given initially when the infant is

a. 6 months
b. 5 months
c. 8 months
d. 12 months