Nursing Practice II edgeworth

NURSING PRACTICE II – Community Health Nursing and Care of the Mother and Child Situation 1 – Nurse Minette is an Independent Nurse Practitioner following-up referred clients in their respective homes. Here she handles a case of POSTPARTIAL MOTHER AND FAMILY focusing on HOME CARE. 1. Nurse Minette needs to schedule a first home visit to OB client Leah. When is a first home-care visit typically made? A. Within 4 days after discharge B. Within 24 hours after discharge C. Within 1 hour after discharge D. Within 1 week of discharge 2. Leah is developing constipation from being on bed rest. What measures would you suggest she take to help prevent this? A. Eat more frequent small meals instead of three large one daily B. Walk for at least half an hour daily to stimulate peristalsis C. Drink more milk, increased calcium intake prevents constipation D. Drink eight full glasses of fluid such as water daily 3. If you were Minette, which of the following actions would alert you that a new mother is entering a postpartal taking-hold phase? A. She urges the baby to stay awake so that she can breast-feed him or her B. She tells you she was in a lot of pain all during labor C. She says that she has not selected a name for the baby as yet D. She sleeps as if exhausted from the effort of labor 4. At 6-week postpartum visit what should this postpartal mother’s fundic height be? A. Inverted and palpable at the cervix B. Six fingerbreadths below umbilicus C. No longer palpable on her abdomen D. One centimeter above the symphysis pubis 5. This postpartal mother wants to loose the weight she gained in pregnancy pregnancy,, so she is reluctant to increase her caloric intake for breast-feeding. By how much should a lactating mother increase her caloric intake during the first 6 months after birth? A. 350 kcal/day B. 500 kcal/day C. 200 kcal/day D. 1000 kcal/day Situation 2 – As the CPE is applicable for all professional nurse, the professional growth and development of Nurses with specialties shall be addressed by a Specialty Certification Council. The following questions apply to these special groups of nurses. 6. Which of the following serves as the legal basis and statute authority for the Board of Nursing to promulgate measures to effect the creation of a Specialty Certification Certification Council and promulgate professional development programs for this group of nurse-professionals? A. R.A. 7610 B. P.D. 223 C. R.A. 9173 D. R.A. 7164 7. By force of law law,, therefore, the PRC-Board of Nursing released Resolution No. 14 Series of 1999 entitled: “Adoption of a Nursing Specialty Certification Program and Creation of Nursing Specialty Certification Council.” This rule-making power is called: A. Quasi-Judicial Power B. Regulatory Power C. Quasi-Legislative Power D. Executive/Promulgating Power 8. Under the PRC-Board of Nursing Resolution promulgating the adoption of a Nursing Specialty Certification Program and Council, which two (2) of the following serves as the strongest for its enforcement? (a) Advances made in Science and Technology Technology have provided the climate for specialization in almost all aspects of human endeavor; and (b) As necessary consequence, there has emerged a new concept known as globalization which seeks to remove barriers in trade, industry and services imposed by the national laws of countries all over the world; and (c) Awareness Awareness of this development should impel the nursing sector to prepare our people in the services sector to meet the above challenge; and (d) Current trends of specialization in nursing practice recognized by the International Council of Nurses (ICN) of which the Philippines is a member for the benefit of the Filipino in terms of deepening and refining nursing practice and enhancing the quality of nursing care. A. b & c are strong justifications B. a & b are strong justifications C. a & c are strong justifications D. a & d are strong justifications

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9. Which of the following IS NOT a correct statement as regards Specialty Certification? A. The Board of Nursing intended to create the Nursing Specialty Certification Program as a means of perpetuating the creation of an elite force of Filipino Nurse Professionals. B. The Board of Nursing shall oversee the administration of the NSCP through the various Nursing Specialty Boards which will eventually be created C. The Board of Nursing at the time exercised their powers under R.A. 7164 in order to adopt the creation of the Nursing Specialty Certification Council and Program D. The Board of Nursing consulted nursing leaders of national nursing associations and other concerned nursing groups which later decided to ask a special group of nurses of the program for nursing specialty Certification. 10. The NSCC was created for the purpose of implementing the Nursing Specialty policy under the direct supervision and stewardship of the Board of Nursing. Who shall comprise the NSCC? A. A Chairperson who is the current President of the APO; a member from the Academe; and the last member coming from the Regulatory Board B. The chairperson and members of the Regulatory Board ipso facto acts as the CPE Council C. A Chairperson, chosen from among the Regulatory Board members; a Vice Chairperson appointed by the BON atlarge; two other members also chosen at-large; and one representing the consumer group; D. A Chairperson who is the President of the Association Association from the Academe; a member from the Regulatory Board; and the last member coming from the APO Situation 3 –Nurse Anna Anna is a new BSN graduate and has just passed her Licensure Examination for Nurses in the Philippines. She has likewise been hired as a new Community Health Nurse in one of the Rural Health Units in their City, which of the following conditions may be acceptable TRUTHS applied to Community Health Nursing Practice. 11. Which of the following is the primary focus of community health nursing practice? 11. A. Cure of illnesses B. Prevention of illnesses C. Rehabilitation back to health D. Promotion of health 12. In community health nursing, which of the following is our unit of service as nurses? A. The community B. The extended members of every family C. The individual members of the Barangay D. The Family 13. A very important part of the Community Health Nursing Assessment Process includes: A. the application of professional judgment in estimating importance of facts to family and community B. evaluation structures and qualifications of health center team C. coordination with other sectors in relation to health concerns D. carrying out nursing procedures as per plan of action 14. In community health nursing it is important to take into account the family health data coupled with an equally important need to perform ocular inspection of the area as activities which are powerful elements of: A. evaluation B. assessment C. implementation D. planning 15. The initial step in PLANNING PLANNING process in order to engage in any nursing project or activities at the community level involves A. goal-setting B. monitoring C. evaluation of data D. provision of data Situation 4 – Please continue responding as a professional nurse in these other health situations through the following questions. 16. Transmission Transmission of HIV from an infected individual to another person occurs: A. Most frequently in nurses with needlesticks B. Only if there is a large viral load in the blood C. Most commonly as a result of sexual contact





18. The nurse would anticipate a cesarean birth for a client who has which infection present at the onset of labor? A. Herpes-simplex virus B. Human papilloma virus C. Hepatitis D. Toxoplasmosis 19. After a vaginal examination, the nurse determines that the client’s fetus is in an occiput posterior position. The nurse would anticipate that the client will have: A. A precipitous birth B. Intense back pain C. Frequent leg cramps D. Nausea and vomiting 20. The rationales for using a prostaglandin gel for a client prior to the induction of labor is to: A. Soften and efface the cervix B. Numb cervical pain receptors C. Prevent cervical lacerations D. Stimulate uterine contractions Situation 5 – Nurse Lorena is a Family Planning and Infertility Nurse Specialist and currently attends to FAMILY FAMILY PLANNING CLIENTS CLIENTS AND INFERTILE INFERTILE COUPLES. The following conditions pertain to meeting the nursing needs of this particular population group. 21. Dina, 17 years old, asks you how a tubal ligation prevents pregnancy. pregnancy. Which would be the best answer? A. Prostaglandins released from the cut fallopian tubes can kill sperm B. Sperm can not enter the uterus because the cervical entrance is blocked. C. Sperm can no longer reach the ova, because the fallopian tubes are blocked D. The ovary no longer releases ova as there is no where for them to go. 22. The Dators are a couple undergoing testing for infertility. Infertility Infertility is said to exist when: A. a woman has no uterus B. a woman has no children C. a couple has been trying to conceive for 1 year D. a couple has wanted a child for 6 months 23. Another client named Lilia is diagnosed as having endometriosis. This condition interferes with fertility because: A. endometrial implants can block the f allopian tubes B. the uterine cervix becomes inflamed and swollen C. the ovaries stop producing adequate estrogen D. pressure on the pituitary leads to decreased FSH levels 24. Lilia is scheduled to have a hysterosalphingogram. Which of the following instructions would you give her regarding this procedure? A. She will not be able to conceive for 3 months after the procedure B. The sonogram of the uterus will reveal any tumors present C. Many women experience mild bleeding as an after effect D. She may feel some cramping when the dye is inserted 25. Lilia’s cousin on the other hand, knowing nurse Lorena’s specialization asks what artificial insemination by donor entails. Which would be your best answer if you were Nurse Lorena? A. Donor sperm are introduced vaginally into the uterus or cervix B. Donor sperm are injected intra-abdominally into each ovary C. Artificial Artificial sperm are injected vaginally to test tubal patency D. The husband’s sperm is administered intravenously weekly Situation 6 – There are other important basic knowledge in the performance of our task as Community Health Nurse in relation to IMMUNIZATION, these include: 26. The correct temperature to store vaccines in a refrigerator is: A. between -4 deg C and +8 deg C B. between 2 deg C and +8 deg C C. between -8 deg C and 0 deg C D. between -8 deg C and +4 deg C





28. This vaccine content is derived f rom RNA recombinants. recombinants. A. Measles B. Tetanus toxoids C. Hepatitis B vaccines D. DPT 29. This is the vaccine needed before a child reaches one (1) year in order for him/her to qualify as a :fully immunized child”. A. DPT B. Measles C. Hepatitis B D. BCG 30. Which of the following dose of tetanus toxoid is given to the mother to protect her infant from neonatal tetanus and likewise provide 10 years protection for the mother? A. Tetanus toxoid 3 B. Tetanus toxoid 2 C. Tetanus toxoid 1 D. Tetanus toxoid 4 Situation 7 – Records contain those comprehensive descriptions of patient’s health conditions and needs and at the same serve as evidences of every nurse’s accountability in the care giving process. Nursing records normally differ from institution to institution nonetheless they follow similar patterns of meeting needs f or specific types of information. The following pertains to documentation/records management. 31. This special form is used when the patient is admitted to the unit. The nurse completes the information in this record particularly his/her basic personal data, current illness, previous health history history,, health history of the family family,, emotional profile, environmental history as well as physical assessment together with nursing diagnosis on admission. What do you call this record? A. Nursing Kardex B. Nursing Health History and Assessment Worksheet C. Medicine and Treatment Record D. Discharge Summary 32. These are sheets/forms which provide an efficient and time saving way to record information that must be obtained repeatedly at regular and/or short intervals of time. This does not replace the progress notes; instead this record of information on vital signs, intake and output, treatment, postoperative care, post partum care, and diabetic regimen, etc. This is used whenever specific measurements or observations are needed to be documented repeatedly. What is this? A. Nursing Kardex B. Graphic Flow Sheets C. Discharge Summary D. Medicine and Treatment Record 33. These records show all medications and treatment provided on a repeated basis. What do you call this record? A. Nursing Health History and Assessment Worksheet B. Discharge Summary C. Nursing Kardex D. Medicine and Treatment Record 34. This flip-over card is usually kept in a portable file at the Nurse’s Station. It has 2-parts: the activity and treatment section and a nursing care plan section. This carries information about basic demographic data, primary medical diagnosis, current orders of the physician to be carried out by the nurse, written nursing care plan, nursing orders, scheduled tests and procedures, safety precautions in patient care and factors related to daily living activities. This record is used in the charge-of-shift reports or during the bedside rounds or walking rounds. What record is this? A. Discharge Summary B. Medicine and Treatment Record C. Nursing Health History and Assessment Worksheet D. Nursing Kardex 35. Most nurses regard this conventional recording of the date, time, and mode by which the patient leaves a healthcare unit but this record includes importantly, directs of planning for discharge that starts soon after the person is admitted to a healthcare institution. It is accepted that collaboration or multidisciplinary involvement (of all members of the health team) in discharge results in comprehensive care. What do you call this?





36. Which of the following is TRUE about the Code of Ethics of Filipino Nurses? A. The Philippine Nurses Association Association for being the accredited professional organization was given the privilege to formulate a Code of Ethics for Nurses which the Board of Nursing promulgated B. Code for Nurses was first formulated in 1982 published in the Proceedings of the Third Annual Convention of the PNA House of Delegates C. The present code utilized the Code of Good Governance for the Professions in the Philippines D. Certificates of Registration Registration of RNs may be revoked or suspended for violations of any provisions of the Code of Ethics. 37. Based on the Code of Ethics for Filipino Nurses, what is regarded as the hallmark of nursing responsibility and accountability? A. Human rights of clients, regardless of creed and gender B. The privilege of being a registered professional nurses C. Health, being a fundamental right of every individual D. Accurate Accurate documentation of actions and outcomes 38. Which of the following nurses behavior is regarded as a violation of the Code of Ethics of Filipino Nurses? A. A nurse withholding harmful information to the family members of a patient B. A nurse declining commission sent by a doctor for her referral C. A nurse endorsing a person running for congress. D. Nurse Reviewers and/or nurse review center managers who pays a considerable amount of cash for reviewees who would memorize items from the licensure exams and submit these to them after the examination. 39. A nurse nurse should be cognizant that professional programs for specialty certification by the Board of Nursing accredited through the: A. Professional Regulation Commission B. Nursing Specialty Certification Council C. Association Association of Deans of Philippine Colleges of Nursing D. Philippine Nurse Association 40. Mr. Santos, Santos, R.N. works in a nursing home, and he knows that o ne of his duties is to be an advocate for his patients. Mr.. Santos knows a primary duty of an advocate is to; Mr A. act as the patient’s legal representative B. complete all nursing responsibilities on time C. safeguard the well being of every patient D. maintain the patient’s right to privacy Situation 9 – Nurse Joanna works as an OB-Gyne Nurse and attends to several HIGH-RISK PREGNANCIES PREGNANCIES:: Particular women with preexisting or Newly Acquired illness. The following conditions apply 41. Bernadette is a 22-year old woman. Which condition would make her more prone than others to developing a Candida infection during pregnancy? A. Her husband plays golf 6 days a week B. She was over 35 when she became pregnant C. She usually drinks tomato juice f or breakfast D. She has developed gestational diabetes 42. Bernadette develops a deep vein thrombosis following an auto accident and is prescribed heparin sub-Q. What should Joanna educate her about in regard to this? A. Some infants will be born with allergic symptoms to heparin B. Her infant will be born with scattered petechiae on his trunk C. Heparin can cause darkened skin in newborns D. Heparin does not cross placenta and so does not affect a fetus 43. The cousin of Bernadette with sickle-cell anemia alerted Joanna that she may need further instruction on prenatal care. What statement signifies this fact? A. I’ve stopped jogging so I don’t risk becoming dehydrated. B. I take an iron pill every day to help gro w new red blood cells C. I am careful to drink at least eight glasses of fluid every day D. I understand why folic acid is important for red cell formation 44. Bernadette routinely takes acetylsalicylic acid (aspirin) for arthritis. Why should she limit or discontinue this toward the end of pregnancy? A. Aspirin Aspirin can lead to deep vein thrombosis following birth B. Newborns develop a red rash from salicylate toxicity C. Newbors develop withdrawal headaches from salicylates





Situation 10 – Still in your self-managed Child Health Nursing Clinic, you encounter these cases pertaining to the CARE OF CHILDREN WITH PULMONARY AFFECTIONS. 46. Josie brought her 3 months old child to your clinic because of cough and colds. Which of the following is your primary action? A. Give cotrimoxazole tablet or syrup B. Assess the patient using the chart on management of children with cough C. Refer to the doctor D. Teach Teach the mother how to count her child’s breathing 47. In responding to the care concerns of children with sever disease, referral to the hospital is of the essence especially if the child manifests which of the following? A. Wheezing B. Stop feeding well C. Fast breathing D. Difficulty to awaken 48. Which of the following is the most important responsibility of a nurse in the prevention of unnecessary deaths from pneumonia and other severe diseases? A. Giving antibiotics B. Taking of the temperature of the sick child C. Provision of Careful Assessment D. Weighing of the sick child 49. You You were able to identify factors that lead to respiratory problems in the community where your health facility serve. Your primary role therefore in order to reduce morbidity due to pneumonia is to: A. Teach Teach mothers how to recognize early signs and symptoms of pneumonia B. Make home visits to sick children C. Refer cases to hospitals D. Seek assistance and mobilize the BHWs to have a meeting with mothers 50. Which of the following is the principal focus of the CARI program of the Department of Health? A. Enhancement of health team capabilities B. Teach Teach mothers how to detect signs and where to refer C. Mortality reduction through early detection D. Teach Teach other community health workers how to assess patients.

ANSWER KEY NURSING PRACTICE II – Community Health Nursing and Care of the Mother and Child Situation 1 – Nurse Minette is an Independent Nurse Practitioner following-up referred clients in their respective homes. Here she handles a case of POSTPARTIAL MOTHER AND FAMILY focusing on HOME CARE. 1. Nurse Minette needs to schedule a first home visit to OB client Leah. When is a first home-care visit typically made? Within 24 hours after discharge 2. Leah is developing constipation from being on bed rest. What measures would you suggest she take to help prevent this? Drink eight full glasses of fluid such as water daily 3. If you were Minette, which of the following actions would alert you that a new mother is entering a postpartal taking-hold phase? She urges the baby to stay awake so that she can breast-feed him or her 4. At 6-week postpartum visit what should this postpartal mother’s fundic height be? No longer palpable on her abdomen 5. This postpartal mother wants to loose the weight she gained in pregnancy pregnancy,, so she is reluctant to increase her caloric intake for breast-feeding. By how much should a lactating mother increase her caloric intake during the first 6 months after birth? 500 kcal/day







7. By force of law law,, therefore, the PRC-Board of Nursing released Resolution No. 14 Series of 1999 entitled: “Adoption of a Nursing Specialty Certification Program and Creation of Nursing Specialty Certification Council.” This rule-making power is called: Quasi-Legislative Power 8. Under the PRC-Board of Nursing Resolution promulgating the adoption of a Nursing Specialty Certification Program and Council, which two (2) of the following serves as the strongest for its enforcement? (a) Advances made in Science and Technology Technology have provided the climate for specialization in almost all aspects of human endeavor; and (b) As necessary consequence, there has emerged a new concept known as globalization which seeks to remove barriers in trade, industry and services imposed by the national laws of countries all over the world; and (c) Awareness Awareness of this development should impel the nursing sector to prepare our people in the services sector to meet the above challenge; and (d) Current trends of specialization in nursing practice recognized by the International Council of Nurses (ICN) of which the Philippines is a member for the benefit of the Filipino in terms of deepening and refining nursing practice and enhancing the quality of nursing care. a & b are strong justifications 9. Which of the following IS NOT a correct statement as regards Specialty Certification? The Board of Nursing intended to create the Nursing Specialty Certification Program as a means of perpetuating the creation of an elite force of Filipino Nurse Professionals. 10. The NSCC was created for the purpose of implementing the Nursing Specialty policy under the direct supervision and stewardship of the Board of Nursing. Who shall comprise the NSCC? A. A Chairperson who is the current President of the APO; a member from the Academe; and the last member coming from the Regulatory Board B. The chairperson and members of the Regulatory Board ipso facto acts as the CPE Council C. A Chairperson, chosen from among the Regulatory Board members; a Vice Chairperson appointed by the BON atlarge; two other members also chosen at-large; and one representing the consumer group; D. A Chairperson who is the President of the Association Association from the Academe; a member from the Regulatory Board; and the last member coming from the APO No answer..maybe a bonus question… Situation 3 –Nurse Anna Anna is a new BSN graduate and has just passed her Licensure Examination for Nurses in the Philippines. She has likewise been hired as a new Community Health Nurse in one of the Rural Health Units in their City, which of the following conditions may be acceptable TRUTHS applied to Community Health Nursing Practice. 11.. Which of the following is the primary focus of community health nursing practice? 11 Promotion of health 12. In community health nursing, which of the following is our unit of service as nurses? The Family 13. A very important part of the Community Health Nursing Assessment Process includes: the application of professional judgment in estimating importance of facts to family and community 14. In community health nursing it is important to take into account the family health data coupled with an equally important need to perform ocular inspection of the area as activities which are powerful elements of: assessment 15. The initial step in PLANNING PLANNING process in order to engage in any nursing project or activities at the community level involves goal-setting





Situation 5 – Nurse Lorena is a Family Planning and Infertility Nurse Specialist and currently attends to FAMILY FAMILY PLANNING CLIENTS CLIENTS AND INFERTILE INFERTILE COUPLES. The following conditions pertain to meeting the nursing needs of this particular population group. 21. Dina, 17 years old, asks you how a tubal ligation prevents pregnancy. pregnancy. Which would be the best answer? Sperm can no longer reach the ova, because the fallopian tubes are blocked 22. The Dators are a couple undergoing testing for infertility. Infertility Infertility is said to exist when: a couple has been trying to conceive for 1 year 23. Another client named Lilia is diagnosed as having endometriosis. This condition interferes with fertility because: endometrial implants can block the fallopian tubes 24. Lilia is scheduled to have a hysterosalphingogram. Which of the following instructions would you give her regarding this procedure? She may feel some cramping when the dye is inserted 25. Lilia’s cousin on the other hand, knowing nurse Lorena’s specialization asks what artificial insemination by donor entails. Which would be your best answer if you were Nurse Lorena? Donor sperm are introduced vaginally into the uterus or cervix Situation 6 – There are other important basic knowledge in the performance of our task as Community Health Nurse in relation to IMMUNIZATION, these include: 26. The correct temperature to store vaccines in a refrigerator is: between 2 deg C and +8 deg C 27. Which of the following vaccines is not done by intramuscular (IM) injection? Measles vaccine 28. This vaccine content is derived f rom RNA recombinants. recombinants. Hepatitis B vaccines 29. This is the vaccine needed before a child reaches one (1) year in order for him/her to qualify as a :fully immunized child”. Measles 30. Which of the following dose of tetanus toxoid is given to the mother to protect her infant from neonatal tetanus and likewise provide 10 years protection for the mother? Tetanus toxoid 4 Situation 7 – Records contain those comprehensive descriptions of patient’s health conditions and needs and at the same serve as evidences of every nurse’s accountability in the care giving process. Nursing records normally differ from institution to institution nonetheless they follow similar patterns of meeting needs f or specific types of information. The following pertains to documentation/records management. 31. This special form is used when the patient is admitted to the unit. The nurse completes the information in this record particularly his/her basic personal data, current illness, previous health history history,, health history of the family family,, emotional profile, environmental history as well as physical assessment together with nursing diagnosis on admission. What do you call this record? Nursing Health History and Assessment Worksheet 32. These are sheets/forms which provide an efficient and time saving way to record information that must be obtained repeatedly at regular and/or short intervals of time. This does not replace the progress notes; instead this record of information on vital signs, intake and output, treatment, postoperative care, post partum care, and diabetic regimen, etc. This is used whenever specific measurements or observations are needed to be documented repeatedly. What is this? Graphic Flow Sheets





36. Which of the following is TRUE about the Code of Ethics of Filipino Nurses? The present code utilized the Code of Good Governance for the Professions in the Philippines 37. Based on the Code of Ethics for Filipino Nurses, what is regarded as the hallmark of nursing responsibility and accountability? Accurate documentation of actions and outcomes 38. Which of the following nurses behavior is regarded as a violation of the Code of Ethics of Filipino Nurses? Nurse Reviewers and/or nurse review center managers who pays a considerable amount of cash for reviewees who would memorize items from the licensure exams and submit these to them after the examination. 39. A nurse nurse should be cognizant that professional programs for specialty certification by the Board of Nursing accredited through the: Nursing Specialty Certification Council 40. Mr. Santos, Santos, R.N. works in a nursing home, and he knows that o ne of his duties is to be an advocate for his patients. Mr.. Santos knows a primary duty of an advocate is to; Mr maintain the patient’s right to privacy Situation 9 – Nurse Joanna works as an OB-Gyne Nurse and attends to several HIGH-RISK PREGNANCIES PREGNANCIES:: Particular women with preexisting or Newly Acquired illness. The following conditions apply. 41. Bernadette is a 22-year old woman. Which condition would make her more prone than others to developing a Candida infection during pregnancy? She has developed gestational diabetes 42. Bernadette develops a deep vein thrombosis following an auto accident and is prescribed heparin sub-Q. What should Joanna educate her about in regard to this? Heparin does not cross placenta and so does not affect a fetus 43. The cousin of Bernadette with sickle-cell anemia alerted Joanna that she may need further instruction on prenatal care. What statement signifies this fact? I take an iron pill every day to help grow new red blood cells 44. Bernadette routinely takes acetylsalicylic acid (aspirin) for arthritis. Why should she limit or discontinue this toward the end of pregnancy? Salicylates can lead to increased maternal bleeding at childbirth 45. Bernadette received a laceration on her leg from her automobile accident. Why are lacerations of lower extremities potentially more serious in pregnant women than others? Increased bleeding can occur from uterine pressure on leg veins Situation 10 – Still in your self-managed Child Health Nursing Clinic, you encounter these cases pertaining to the CARE OF CHILDREN WITH PULMONARY AFFECTIONS. 46. Josie brought her 3 months old child to your clinic because of cough and colds. Which of the following is your primary action? Assess the patient using the chart on management of children with cough 47. In responding to the care concerns of children with severe disease, referral to the hospital is of the essence especially if the child manifests which of the following? Difficulty to awaken

Nursing Practice II edgeworth

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