Auxiliary Nurse Midwife (ANM) Licensing Exam preparation SET 2

Q1

Which of the following is NOT one of the five essential components of PHC?

A

Health education

B

Safe water and sanitation

C

Specialized tertiary care

D

Essential medicines

Q2

A community health worker provides health education about the importance of exclusive breastfeeding to a group of pregnant women. This activity falls under which level of prevention?

A

Primordial prevention

B

Primary prevention

C

Secondary prevention

D

Tertiary prevention

Q3

If the crude birth rate in a rural municipality is 24 per 1,000 population per year, how many births would be expected in a population of 8,000?

A

192 births

B

96 births

C

240 births

D

1920 births

Q4

A health worker plans to use a local festival to promote family planning. Which health education strategy aligns best with this plan?

A

Distribute brochures during the festival

B

Organize a drama skit about spacing births on the main stage

C

Set up a TV screening tent

D

Send SMS alerts about family planning

Q5

Which health education media is most appropriate for delivering a message about safe disposal of used syringes in a community with limited electricity?

A

Television commercial

B

Printed poster with pictograms placed near the health post

C

Online video tutorial

D

Mobile app with interactive games

Q6

The community health volunteer wants to educate mothers about preventing iron-deficiency anaemia. Which food combination enhances non-heme iron absorption?

A

Rice with lentils and lemon juice

B

Millet porridge with butter

C

Plain boiled potatoes

D

Tea with boiled eggs

Q7

Which environmental factor is most commonly a reservoir for the malaria parasite in endemic areas of Nepal?

A

Anopheles mosquito breeding sites

B

Contaminated drinking water

C

Domestic livestock

D

Soil contaminated with helminth eggs

Q8

What is the recommended interval between the two doses of HPV vaccine for girls aged 9-13 years in Nepal?

A

0 and 1 month

B

0 and 2 months

C

0 and 6 months

D

0 and 12 months

Q9

Which of these is an example of 'Rat-proofing' a house?

A

Spraying insecticide on the walls

B

Closing holes and cracks in walls and floors

C

Using rodenticides in the kitchen

D

Cleaning the house every day

Q10

When conducting NCD risk assessment in rural communities, which screening tool is most appropriate for the ANM to utilize?

A

Advanced lipid profiling equipment

B

Simple questionnaire assessing major risk factors

C

Electrocardiogram machine

D

Dual-energy X-ray absorptiometry scanner

Q11

The National Oral Health Programme promotes fluoride varnish application for which age group?

A

Children 6-59 months

B

Adults 20-40 years

C

Elderly >60 years

D

Pregnant women

Q12

A 20-week pregnant woman presents with vaginal bleeding and a closed cervical os. Ultrasound shows a viable intra-uterine fetus with a subchorionic hematoma. What is the most appropriate ANC follow-up?

A

Immediate referral for termination

B

Advise bed rest, avoid intercourse, repeat ultrasound in 2 weeks

C

Start oral progesterone and continue routine ANC schedule

D

Admit for IV tocolytics

Q13

Which renal adaptation leads to increased urinary frequency in early pregnancy?

A

Decreased GFR

B

Increased bladder capacity

C

Uterine pressure on bladder

D

Reduced ADH secretion

Q14

Which of the following is the most common danger sign of pregnancy recognized by the ANM during antenatal care?

A

Severe headache

B

Vaginal bleeding

C

High fever

D

Hypertension

Q15

A 24-year-old primigravida at 28 weeks gestation has received one dose of TT in childhood. How many additional TT doses should she receive during this pregnancy?

A

One dose only

B

Two doses 4 weeks apart

C

Three doses at 0, 4, and 8 weeks

D

No further doses required

Q16

During antenatal counselling, the ANM should advise a pregnant woman to avoid which of the following exercises after 28 weeks of gestation?

A

Walking at a moderate pace

B

Supine leg raises

C

Pelvic tilt exercises

D

Side-lying breathing exercises

Q17

At what cervical dilation is the first stage of labour considered to be complete?

A

5 cm

B

7 cm

C

10 cm

D

8 cm

Q18

Which of the following parameters is NOT routinely plotted on a standard partograph during labour?

A

Maternal pulse

B

Fetal heart rate

C

Cervical dilatation

D

Bishop score

Q19

Active management of the third stage of labour (AMTSL) includes all of the following EXCEPT:

A

Administration of a uterotonic within 1 minute of birth

B

Controlled cord traction after signs of placental separation

C

Uterine massage before placental delivery

D

Immediate clamping and cutting of the cord

Q20

What is the purpose of Controlled Cord Traction (CCT) during the third stage of labour?

A

To stimulate the baby's breathing

B

To prevent uterine inversion

C

To facilitate the delivery of the placenta

D

To stop the bleeding from the umbilical cord

Q21

In the context of postpartum haemorrhage prevention, what is the recommended dosage of tranexamic acid if massive bleeding occurs?

A

1 g intravenously over 10 minutes, may repeat once

B

500 mg orally once

C

1 g intramuscularly once

D

2 g intravenously as a single dose

Q22

Which of the following is a contraindication or a reason to avoid a routine episiotomy?

A

The mother's desire for a fast delivery

B

Evidence of a flexible, stretching perineum

C

Fetal distress

D

Primigravida status

Q23

Which of the following is the recommended position for the newborn during the first 2 hours after birth to promote thermal stability?

A

Placing the baby in a crib under a radiant warmer

B

Skin-to-skin contact on the mother's chest

C

Wrapping the baby tightly in a blanket and placing on a table

D

Holding the baby upright in the mother's lap

Q24

A mother on postpartum day 10 reports a painful, hard lump in the breast with overlying skin redness and fever 39°C. Ultrasound shows a fluid-filled collection. What is the diagnosis?

A

Breast abscess

B

Mastitis

C

Galactocele

D

Fibroadenoma

Q25

Which of the following is a normal physiological change in the postpartum cardiovascular system?

A

Stroke volume returns to pre-pregnancy levels by 2 weeks

B

Heart rate remains elevated at >100 bpm for 6 weeks

C

Blood pressure progressively rises after delivery

D

Peripheral resistance decreases permanently

Q26

A postnatal client is breastfeeding and desires a non-hormonal, long-acting reversible contraceptive method. Which is the best choice?

A

Copper-T IUCD

B

Hormonal IUS

C

Subdermal implant

D

Injectable DMPA

Q27

If a mother reports excessive perineal pain on day 7, what is the appropriate action by the ANM during the scheduled visit?

A

Prescribe oral antibiotics immediately

B

Refer her to the nearest health facility

C

Advise home remedies and reassess in 24 hours

D

Schedule an additional visit on day 10

Q28

Which method of heat loss occurs when a newborn is placed on a cold weighing scale?

A

Evaporation

B

Radiation

C

Conduction

D

Convection

Q29

What is the 'Football Hold' (Clutch Hold) primarily recommended for?

A

Healthy term newborns

B

Mothers who had a Cesarean section or twins

C

Babies who are sleeping

D

Mothers who are breastfeeding while walking

Q30

Which maternal condition would most likely necessitate temporary cessation of KMC?

A

Controlled diabetes mellitus

B

Active tuberculosis with cough

C

Breast engorgement

D

Mild anemia

Q31

A low birth weight baby is found to have a temperature of 35.5°C axillary. The first action should be:

A

Administer antipyretic

B

Place the baby under a radiant warmer

C

Initiate kangaroo mother care

D

Give a warm bath

Q32

An ANM observes that a newborn's skin is mottled and the capillary refill time is delayed. This finding most likely indicates:

A

Normal peripheral circulation

B

Hypoglycemia

C

Poor perfusion/sign of shock

D

Vitamin K deficiency

Q33

In the context of newborn immunization, what does 'OPV-0' signify?

A

The first dose of the primary series

B

The booster dose

C

The birth dose

D

The oral dose for adults

Q34

In the WHO growth standards, what does a weight-for-age percentile below the 3rd indicate?

A

Severe underweight

B

Mild underweight

C

Normal weight

D

Overweight

Q35

According to IMCI, when should a child with diarrhea be given zinc supplementation?

A

Only if severe dehydration

B

For all cases of diarrhea

C

Only if bloody diarrhea

D

Never

Q36

Which of the following is NOT a sign of 'Some Dehydration' in a child?

A

Restless or irritable

B

Sunken eyes

C

Skin pinch goes back very slowly (> 2 seconds)

D

Drinks eagerly

Q37

What is the respiratory rate threshold for fast breathing in a 2-month-old infant?

A

40 breaths/min

B

50 breaths/min

C

60 breaths/min

D

30 breaths/min

Q38

Which of the following is a sign of Kwashiorkor but NOT Marasmus?

A

Weight loss

B

Severe wasting

C

Bilateral pitting edema

D

Irritability

Q39

Which of the following is the most effective barrier method for preventing both pregnancy and sexually transmitted infections (STIs)?

A

Diaphragm

B

Male condom

C

Female condom

D

Spermicide

Q40

Which of the following is a benefit of vasectomy compared to tubal ligation?

A

Lower cost

B

No need for anesthesia

C

Immediate effectiveness

D

No postoperative pain

Q41

Which of the following statements is CORRECT regarding the use of Levonorgestrel (LNG) emergency pills?

A

They are used to treat infertility

B

They should be taken as soon as possible

C

They are only effective if taken after 72 hours

D

They provide protection for the next 30 days

Q42

A postpartum woman is complaining of heavy vaginal bleeding soaking more than one pad per hour, with a soft, displaced uterus. What is the most likely diagnosis?

A

Uterine atony

B

Retained placental fragments

C

Laceration of the birth canal

D

Coagulopathy

Q43

For an infant (<1 year) the recommended technique for chest compressions by a single rescuer is:

A

Two-finger technique at the center of the chest just below the nipple line

B

Two-thumb encircling hands technique

C

Heel of one hand on the lower half of the sternum

D

Heel of both hands stacked on the lower half of the sternum

Q44

During first aid for a suspected organophosphate poisoning, which clinical sign indicates the need for immediate atropine therapy?

A

Miosis and excessive salivation

B

Dry mouth and dilated pupils

C

Bradycardia with hypotension

D

Severe abdominal pain

Q45

A nurse records "pale conjunctiva, fatigue, and hemoglobin 8 g/dL" in the assessment. Which nursing diagnosis is most appropriate?

A

Risk for infection

B

Impaired gas exchange

C

Fatigue

D

Anemia

Q46

A needle stick injury occurs. The immediate action the ANM should take is:

A

Squeeze the wound to bleed

B

Wash the wound with soap and water

C

Apply antiseptic and bandage

D

Report to supervisor after finishing shift

Q47

What is the most appropriate action when a nurse cannot read a doctor's handwritten order?

A

Guess the medication based on the diagnosis

B

Ask another nurse to guess the meaning

C

Clarify the order with the prescribing physician

D

Ignore the order until the doctor returns

Q48

A woman using depot medroxyprogesterone acetate (DMPA) reports new-onset low back pain and bone aches after two years of use. What is the likely underlying issue?

A

Calcium deficiency due to reduced bone mineral density

B

Vitamin D toxicity

C

Hyperparathyroidism

D

Osteoarthritis unrelated to DMPA

Q49

A 3-year-old child with severe pneumonia is allergic to penicillins. Which alternative injectable antibiotic is most appropriate?

A

Ceftriaxone

B

Ampicillin

C

Azithromycin

D

Erythromycin

Q50

Informed choice counseling must include all of the following EXCEPT:

A

Only the method's effectiveness

B

Only potential side effects

C

Benefits, risks, alternatives, and the client's values

D

Only the cost of the method

Q51

Which topical agent is most appropriate for dressing a superficial partial-thickness burn at a peripheral health post before referral?

A

Silver sulfadiazine cream

B

Bacitracin ointment

C

Normal saline-soaked gauze

D

Vaseline-impregnated gauze

Q52

Which of the following is the most appropriate way to document a patient's vital signs in a graphic sheet?

A

Writing a paragraph describing the trends

B

Plotting the values using dots and connecting them with lines

C

Listing the values in a table at the end of the week

D

Writing only the abnormal values

Q53

When using a sling for an upper extremity fracture, the hand should be positioned how relative to the elbow?

A

Lower than the elbow

B

Level with the elbow

C

Slightly higher than the elbow

D

Extended straight out

Q54

In a resource-limited setting, what is the most appropriate method to immobilize a patient with suspected cervical spine injury for transport?

A

Apply a rigid cervical collar

B

Place a rolled towel behind the neck and a head block to limit movement

C

Tie a splint around the neck

D

Secure the patient with a shoulder harness

Q55

Which is the most common reason for early discontinuation of the progestogen-only pill (POP)?

A

Weight gain

B

Mood swings

C

Irregular bleeding

D

Increased libido

Q56

In an Integrated Vector Management (IVM) approach, which of the following actions represents the 'community participation' component?

A

Purchasing insecticide sprays for the health post

B

Training local volunteers to monitor and eliminate breeding sites

C

Hiring external pest control contractors for indoor residual spraying

D

Developing national vector control policies

Q57

Which factor most increases the risk of developing a third-degree perineal tear when an episiotomy is performed?

A

Performing the episiotomy with a scalpel instead of scissors

B

Using a mediolateral rather than a midline incision

C

Making the incision too short (<2 cm)

D

Applying excessive traction on the fetal head during delivery

Q58

क्या पोखरमा रहेको स्वास्थ्य चौकीमा एकलव्यक्तिको चट्टानी बालीको घरमा सुरक्षित फाँकट पानीको व्यवस्थापनका लागि अम्ल आधारित विधि प्रयोग गर्नुपर्छ भन्ने कुरामा सान्‍योजना कति महत्वपूर्ण छ?

A

विपरीत दिशाले पानी सञ्चय गर्ने विधि

B

पानीलाई ढल फुटाएर बेकार पार्ने विधि

C

पानीको स्वादलाई सुधार्ने विधि

D

पानीलाई उबालेर गर्म राख्ने विधि

Q59

During immediate newborn care, the ANM notes that the vernix caseosa is still present on the infant's skin. What is the recommended approach regarding vernix?

A

Remove all vernix with warm water and soap immediately

B

Leave vernix intact as it provides natural thermal and antimicrobial protection

C

Apply talcum powder over the vernix to dry the skin

D

Scrape vernix off gently with a sterile blade

Q60

In community health posts, which method is recommended for confirming the presence of stridor in a child with cough?

A

Observe child while breathing quietly

B

Listen with stethoscope over trachea

C

Ask mother if child makes a high-pitched sound when crying

D

Perform chest percussion

Q61

Which feature of a pit latrine is most effective in preventing flies from entering the pit and transmitting disease?

A

Concrete slab over the pit

B

Vent pipe with a fly screen

C

Sand layer at the bottom of the pit

D

Metal door on the superstructure

Q62

According to Nepal's national NCD action plan, which community-level intervention is considered most effective for reducing population salt intake?

A

Mandatory front-of-pack labeling of sodium content

B

Health education on using low-salt spices at home

C

Regulating the amount of salt added to processed foods

D

Encouraging consumption of fresh fruits and vegetables

Q63

When storing amoxicillin suspension at a health post, which practice is essential to maintain its potency?

A

Keep in the refrigerator at 4 °C

B

Store at room temperature away from direct sunlight

C

Freeze the suspension between uses

D

Keep it in a sealed container under direct sunlight

Q64

When a client asks whether a contraceptive method will affect future fertility, the most accurate response is:

A

All hormonal methods cause permanent infertility.

B

Fertility returns quickly after stopping most reversible methods, except IUD which may cause delays.

C

Fertility returns to normal after stopping the method, though timing varies by method.

D

Only sterilization affects fertility.

Q65

An order states "Apply ear drops to left ear only". The nurse mistakenly administers the drops to the right ear. Which right has been compromised?

A

Right patient

B

Right route

C

Right dose

D

Right time

Q66

A breastfeeding mother, three weeks postpartum, requests emergency contraception. Which method is the safest choice according to Nepal guidelines?

A

Ulipristal acetate tablet.

B

Levonorgestrel emergency pill.

C

Copper T IUD insertion.

D

Yuzpe method using combined oral contraceptives.

Q67

In nursing terminology, a "standing order" refers to:

A

An order that remains in effect until it is cancelled or revised

B

A one-time physician order

C

A verbal instruction given only during emergencies

D

A medication dosage chart

Q68

What is the typical change in systolic blood pressure during the second trimester of a normal pregnancy?

A

It remains unchanged

B

It decreases by 10-15 mmHg

C

It increases by 10-15 mmHg

D

It fluctuates widely without a pattern

Q69

A child presents with a supracondylar fracture of the humerus. Which forearm position should be maintained during splinting to reduce the risk of neurovascular compromise?

A

Elbow flexed 90° with the forearm pronated

B

Elbow fully extended with the forearm supinated

C

Elbow flexed 120° with the forearm supinated

D

Elbow flexed 90° with the forearm supinated

Q70

A patient with a suspected pelvic fracture requires urgent referral. Which positioning is recommended during ambulance transport to minimise further injury?

A

Place the patient in a supine position with a pelvic binder applied

B

Elevate the hips 30 degrees using pillows

C

Position the patient prone with legs extended

D

Place the patient in a seated position with legs dangling

Q71

Which of the following is NOT a criterion for referral of a low-birth-weight infant?

A

Weight less than 1800 g

B

Weight of 2100 g

C

Birth weight less than 1500 g

D

Weight less than 2000 g with difficulty breathing

Q72

While taking vital signs, the nurse wants to assess for peripheral edema. The most appropriate technique is:

A

Press thumb over shin for 5 seconds

B

Inspect ankles only

C

Palpate sacrum

D

Measure blood pressure first

Q73

A pregnant woman is seated with her legs crossed while her blood pressure is taken. How can this posture affect the reading?

A

Systolic pressure may be increased by about 5 mmHg

B

Diastolic pressure may be decreased by about 5 mmHg

C

There is no effect on the measurement

D

Both systolic and diastolic pressures are decreased

Q74

A midwife is monitoring a woman in active labour using a partograph. The cervical dilatation line has reached the alert line. What is the most appropriate next step in management?

A

Increase oxytocin infusion immediately

B

Reassess maternal and fetal condition and prepare for possible referral

C

Apply fundal pressure to assist delivery

D

Discontinue routine monitoring and observe

Q75

A woman presents with amenorrhea for 8 weeks. Which of the following is the most appropriate initial clinical method to confirm pregnancy in a resource-limited setting?

A

Transvaginal ultrasound

B

Urine pregnancy test

C

Serum beta-hCG assay

D

Abdominal palpation for uterine enlargement

Q76

When using the WHO growth chart for a 3-year-old child, which measurement should be used to assess for wasting?

A

Weight-for-age

B

Height-for-age

C

Weight-for-height

D

BMI-for-age

Q77

In the chain of survival, what is the first action a bystander should perform?

A

Call EMS

B

Start compressions

C

Provide rescue breaths

D

Perform defibrillation

Q78

In the active management of the third stage of labour (AMTSL), when exactly should prophylactic oxytocin be administered?

A

After delivery of the placenta

B

Within one minute of delivery of the baby

C

At the onset of labour

D

Immediately after cord clamping but before placental delivery

Q79

Which of the following is a contraindication to Kangaroo Mother Care in a low birth weight baby?

A

Stable vital signs

B

Weight less than 2500 g

C

Baby requiring phototherapy for jaundice

D

Mother is willing and trained

Q80

Which rodent control practice is considered environmentally safe and does not involve chemical poisons?

A

Using anticoagulant bait stations

B

Setting live-capture traps and releasing rodents far away

C

Applying rodenticides on floors

D

Broadcasting rodenticide dust

Q81

Which of the following is an example of data collected during the assessment phase of the nursing process?

A

Observing a patient's breathing pattern

B

Measuring temperature with a thermometer

C

Obtaining patient history through open-ended questions

D

Documenting vital signs

Q82

When administering Zinc tablets to a child, what is the most appropriate instruction regarding the timing of the dose?

A

Give it only when the child has a loose stool

B

Give it once every 48 hours

C

Give it once daily at the same time each day

D

Give it only after the diarrhea has completely stopped

Q83

During a community health visit, an infant aged 9 months presents with cough and a respiratory rate of 51/min. There is no chest wall indrawing, but the infant has a crying which is difficult to soothe. What is the correct classification?

A

No pneumonia

B

Pneumonia

C

Severe pneumonia

D

Very severe disease

Q84

What is the minimum age at which BCG vaccine can be safely given to a newborn in Nepal?

A

At birth or as soon as possible after birth

B

1 week of age

C

2 weeks of age

D

6 weeks of age

Q85

Which practice most effectively prevents re-contamination of treated drinking water at the household level?

A

Storing water in uncovered buckets

B

Using a ladle that touches the water surface

C

Keeping the storage container sealed with a narrow mouth

D

Adding sugar to the water

Q86

During suctioning of a newborn, what is the maximum duration of each suction attempt to prevent hypoxia and bradycardia?

A

2 seconds

B

5 seconds

C

10 seconds

D

15 seconds

Q87

Which sequence of movements describes the mechanism of fetal head delivery during the second stage of labour?

A

Extension, flexion, internal rotation, restitution, external rotation

B

Flexion, internal rotation, extension, restitution, external rotation

C

Flexion, extension, internal rotation, restitution, external rotation

D

Internal rotation, flexion, extension, restitution, external rotation

Q88

During which postnatal visit should the ANM discuss the return of menstruation and fertility awareness with the mother?

A

6-week (day 42) visit

B

Day 1 visit

C

Day 7 visit

D

Day 14 visit

Q89

A doctor orders 'Digoxin 0.25 mg PO daily'. The nurse checks the medication drawer and finds 'Digoxin 0.125 mg tablets'. To provide the correct dose, the nurse should prepare how many tablets?

A

1 tablet

B

2 tablets

C

3 tablets

D

0.5 tablet

Q90

Which laboratory investigation is performed routinely at the first antenatal visit in Nepal?

A

Urine protein estimation

B

Hemoglobin estimation

C

Blood glucose test

D

Syphilis test

Q91

A 26-year-old woman using combined oral contraceptive pills presents with jaundice, dark urine, and right upper quadrant discomfort after 2 months of use. What is the most appropriate next step?

A

Continue the pills and prescribe liver tonics

B

Stop the pills immediately and refer for evaluation of hepatic disorder

C

Reduce the dose of estrogen by half

D

Switch to a progestin-only pill without further evaluation

Q92

During a referral from a primary health center to a district hospital, which document must accompany the patient to ensure continuity of care?

A

Patient's personal identification card

B

Referral slip containing diagnosis, treatment given, and urgent care needs

C

A copy of the patient's birth certificate

D

Family's income statement

Q93

The general fertility rate (GFR) is calculated using which denominator?

A

Total population

B

Women of reproductive age (15 - 49 years)

C

Married women only

D

Live births

Q94

What is the recommended interval between the two doses of the human papillomavirus (HPV) vaccine for girls aged 9-13 years in Nepal?

A

0 and 2 months

B

0 and 6 months

C

1 and 3 months

D

0 and 12 months

Q95

A patient with a 50% TBSA burn is being prepared for transfer. The ANM notes the patient is shivering despite warm ambient temperature. What is the most appropriate intervention?

A

Apply ice packs to reduce body temperature

B

Cover the patient with a clean dry sheet and a warm blanket; minimize exposure

C

Give cold oral fluids

D

Remove all clothing immediately

Q96

Basal metabolic rate (BMR) in pregnancy rises by approximately what percentage compared with the non-pregnant state?

A

5-10%

B

15-20%

C

20-25%

D

30-35%

Q97

An ANM is referring a patient with suspected acute myocardial infarction. Which medication should be administered before transport if no contraindication exists?

A

Aspirin 300 mg chewed

B

IV streptokinase

C

IV furosemide

D

Hydrochlorothiazide orally

Q98

Which health facility in Nepal's PHC network is responsible for providing basic curative services to a cluster of villages with a population of about 5,000 - 10,000?

A

District Hospital

B

Primary Health Care Complex

C

Health Post

D

Sub-Area Health Office

Q99

According to WHO growth standards, a child with a weight-for-age z-score between - 2 and - 3 is classified as what type of malnutrition?

A

Normal weight

B

Mild acute malnutrition

C

Moderate acute malnutrition

D

Severe acute malnutrition

Q100

A 28-year-old woman with a family history of thromboembolic disorders requests a temporary, reversible contraceptive method. Which of the following is the most appropriate recommendation?

A

Combined oral contraceptive pills

B

Progestogen-only injectable (DMPA)

C

Copper T 380A intrauterine device

D

Femidon vaginal tablet

Q101

A pregnant woman at 32 weeks gestation who received her first dose of SP for IPTp 5 weeks ago is now due for the next dose. She reports a history of severe sulfonamide allergy. What should the ANM do?

A

Withhold SP and document the allergy; no alternative IPTp is provided

B

Give the next SP dose under close observation

C

Replace SP with a single dose of quinine for malaria prophylaxis

D

Administer a lower dose of SP to reduce risk

Q102

When using a digital oral thermometer, the nurse should wait how long after the patient has ingested a hot beverage before taking the temperature?

A

5 minutes

B

10 minutes

C

15 minutes

D

20 minutes

Q103

Which eye finding in a newborn requires urgent referral?

A

Bilateral mild conjunctival redness

B

Small watery discharge from both eyes

C

Purulent discharge with swelling of the eyelids

D

Mild transient white reflex (leukocoria) that resolves after 2 days

Q104

In a home setting, which of the following practices supports effective kangaroo mother care?

A

Use a warm room and dress the baby lightly

B

Keep the baby covered with a thick blanket

C

Use a heating pad under the baby

D

Restrict KMC to daytime only

Q105

Which of the following is a recognized hunger cue in a newborn during the first month of life?

A

Sudden increase in heart rate

B

Crying with a high-pitched sound

C

Rooting and sucking on hands

D

Pulling at the ear

Q106

A newborn's weight is 2.9 kg at birth. According to WHO growth standards, what is the appropriate weight gain expected by the end of the first week if exclusive breastfeeding is practiced?

A

No change; weight loss up to 10 % is normal then regain

B

Gain of 5–7 % of birth weight

C

Gain of 15–20 % of birth weight

D

Gain of 30 % of birth weight

Q107

Which of the following is the correct technique for performing the 'skin pinch' test to assess dehydration?

A

Pinch the skin on the forearm

B

Pinch the skin on the abdomen

C

Pinch the skin of the lower chest or abdomen

D

Pinch the skin on the thigh

Q108

Which rodent trap operates on a trigger mechanism that releases a spring-loaded bar to kill the rodent instantly?

A

Snap trap

B

Live-catch cage trap

C

Glue board

D

Electronic shock trap

Q109

A grand multiparous woman (G5) is in labour. Which specific preparation should the ANM make in anticipation of postpartum haemorrhage?

A

Keep methylergometrine ready and avoid oxytocin

B

Pre-arrange blood grouping and cross-matching and keep IV line ready

C

Restrict oral intake completely from the second stage

D

Plan for immediate forceps delivery

Q110

Which of the following is the most accurate way to determine if a child has 'fast breathing'?

A

Count breaths for 15 seconds and multiply by 4

B

Observe the chest for 30 seconds and double the count

C

Count breaths for one full minute while the child is calm

D

Estimate the rate based on the child's appearance

Q111

Which micronutrient is universally supplemented to all children aged 9–12 months under Nepal's National Child Health Programme?

A

Vitamin A

B

Vitamin D

C

Iron

D

Zinc

Q112

An ANM is providing postpartum family planning counselling to a woman who had a caesarean section due to obstructed labor. She desires spacing for at least 3 years. Which method is most appropriate?

A

Combined oral contraceptive pill

B

Copper-T IUCD

C

Lactational amenorrhea method only

D

Emergency contraception

Q113

Which of the following maternal medications is considered compatible with breastfeeding and does not require interruption?

A

Amiodarone

B

Lithium

C

Ibuprofen

D

Methotrexate

Q114

When testing household water for fecal contamination using the membrane filtration method, the indicator organism recommended by WHO and adopted in Nepal is:

A

Escherichia coli

B

Total coliforms

C

Salmonella spp.

D

Vibrio cholerae

Q115

Which of the following is the correct age range for administering the Typhoid conjugate vaccine (TCV) booster dose in Nepal's schedule?

A

9-12 months

B

15-18 months

C

24-59 months

D

5-7 years

Q116

When immobilizing a suspected fracture of the proximal phalanx of a finger, which of the following is the most appropriate method?

A

Apply a buddy splint to the adjacent finger

B

Apply a dorsal splint covering the entire hand

C

Apply a palmar splint with the finger in full extension

D

Apply a cylindrical bandage around the finger alone

Q117

Informed consent for a permanent method (e.g., minilaparotomy under tubectomy) requires all of the following EXCEPT:

A

Explanation of the procedure, benefits, and risks

B

Confirmation that the client understands and consents voluntarily

C

Written or witnessed consent of the client

D

Mandatory participation of the client's husband as a witness

Q118

A 2-year-old child has been completing oral amoxicillin for 3 days and is now afebrile but still coughs. According to IMCI/IMCI guidelines, what is the appropriate action?

A

Discontinue medication and observe

B

Increase antibiotic dose

C

Re-evaluate diagnosis - consider persistence or progression, add shorter course or escalate

D

Send for chest X-ray regardless

Q119

An ANM is preparing the resuscitation corner before a delivery. Which essential equipment must be ready and functional?

A

Oxygen mask for adults only

B

Bulb syringe, clean warm cloths, and a self-inflating bag with newborn-sized mask

C

Refrigerator for breast milk storage

D

Mechanical ventilator for adults

Q120

The minimum personal protective equipment (PPE) an ANM must wear while caring for a patient with suspected airborne tuberculosis is:

A

Gloves and gown only

B

N95 respirator mask

C

Surgical mask

D

Goggles only

Q121

Which of the following investigations is NOT routinely required before voluntary sterilization in a healthy client?

A

Hemoglobin estimation

B

Uric acid test

C

Urine pregnancy test

D

Blood grouping

Q122

A 35-year-old man is bitten by a snake on his foot while walking in a field at night. On examination there are two small puncture marks but no swelling, no pain, and no systemic features after 1 hour. What is the most appropriate next step?

A

Apply a tight pressure bandage immediately

B

Mark the bite site and observe the patient for at least 24 hours for signs of envenomation

C

Incise and suck the wound to remove any venom

D

Inject antivenom prophylactically

Q123

Which health indicator measures the proportion of pregnant women who receive at least four antenatal care visits in a given period?

A

Maternal mortality ratio

B

Low birth weight incidence

C

Antenatal care coverage (4+ visits)

D

Skilled birth attendance rate

Q124

A woman at 29 weeks gestation presents with sudden loss of vision in one eye, severe headache, and epigastric pain with BP of 170/110 mmHg. Which danger sign does the epigastric pain specifically indicate?

A

Gallbladder disease

B

Severe pre-eclampsia with hepatic involvement

C

Gastric ulcer

D

Hepatitis A

Q125

The primary reservoir for tetanus (Clostridium tetani) in a rural community is:

A

Infected domestic animals

B

Contaminated human faeces

C

Soil contaminated with animal excreta

D

Mosquitoes

Q126

During two-rescuer adult CPR, rescuers should switch the compressor role every:

A

2 minutes (5 cycles)

B

1 minute

C

5 minutes

D

30 seconds

Q127

A pregnant woman on prolonged bed rest for preterm labour precautions asks what gentle exercise she can still do safely. The ANM most appropriately recommends:

A

Heavy weight training with ankle weights

B

Active range-of-motion exercises for arms and legs, and ankle pumps

C

High-impact aerobics on the spot

D

Skipping rope

Q128

A postpartum mother on day 6 develops a fever of 38.5°C, tachycardia, lower abdominal pain, and a tender, palpable cord-like mass in the right adnexa. Which complication is most likely?

A

Ovarian cyst rupture

B

Septic pelvic thrombophlebitis

C

Appendicitis

D

Pelvic abscess

Q129

Which of the following is the correct first-aid management for a burn caused by hot tar?

A

Wipe off the tar with a dry cloth

B

Cool with water and leave the tar in place until medically removed

C

Apply butter to dissolve the tar

D

Apply ice directly to harden the tar

Q130

Which of the following is the most appropriate method to assess the nutritional status of a pregnant woman during antenatal visits in the community?

A

Body Mass Index calculation using pre-pregnancy weight

B

Mid-upper arm circumference measurement

C

Skinfold thickness measurement

D

Waist-to-hip ratio

Q131

What is the minimum interval that should elapse between the second and third dose of tetanus toxoid (TT3) in a pregnant woman who received TT1 and TT2 during her current pregnancy?

A

2 weeks

B

4 weeks

C

6 months

D

1 year

Q132

The angle of incision for a mediolateral episiotomy relative to the midline should be approximately:

A

30 degrees

B

45 degrees

C

60 degrees

D

90 degrees

Q133

During a home visit, the ANM observes that a 10-day-old infant falls asleep at the breast after only 5 minutes of active sucking. What is the most appropriate advice?

A

Switch to formula supplementation immediately

B

Gently wake the baby and encourage continued feeding on the same breast

C

End the feeding and wait three hours before the next feed

D

Apply a nipple shield to increase milk flow

Q134

What is the recommended repeat dose regimen for a client who vomits within 1 hour of taking levonorgestrel emergency contraception?

A

Repeat the same dose with an antiemetic

B

Double the dose of levonorgestrel

C

Skip the dose and rely on barrier method only

D

Use combined oral contraceptives as a substitute

Q135

A mother in the immediate postpartum period reports a sudden onset of severe headache, visual disturbances, and epigastric pain. These symptoms are most suggestive of:

A

Postpartum preeclampsia

B

Postpartum hemorrhage

C

Postpartum infection

D

Postpartum depression

Q136

The correct technique for measuring axillary temperature in an adult includes placing the thermometer:

A

In the center of the armpit with arm pressed against the chest

B

In the anterior axillary line with arm loosely at the side

C

In the posterior axillary fold with arm raised

D

At the apex of the axilla with arm fully abducted

Q137

Which of the following term best describes time interval between primary and secondary cases in a chain of infectious disease transmission?

A

extrinsic incubation period

B

intrinsic incubation period

C

serial interval

D

Window Period

Q138

Pernicious anaemia is caused by the deficiency of which of the following?

A

Vitamin B3

B

Vitamin-B12

C

Vitamin-C

D

Vitamin-A

Q139

At what age is the second dose of the rotavirus vaccine scheduled in Nepal’s routine immunisation programme?

A

8 weeks

B

10 weeks

C

12 weeks

D

14 weeks

Q140

Which of the following is the most appropriate advice for a mother regarding the administration of oral amoxicillin suspension to a child with pneumonia?

A

Mix the medicine with a large bottle of soda

B

Shake the bottle well before each dose

C

Give the medicine only when the child has a fever

D

Store the suspension in direct sunlight

Q141

When using an AED on a patient with a wet chest, what is the most appropriate action?

A

Apply pads directly over the water

B

Wait for the patient to dry naturally

C

Wipe the chest dry before applying pads

D

Place the pads on the back instead

Q142

Which antenatal factor is NOT part of the standard postpartum haemorrhage risk‑assessment checklist used in Nepal?

A

History of previous postpartum haemorrhage

B

Multiple gestation

C

Maternal blood type O negative

D

Pre‑eclampsia

Q143

In the context of waste management, which color-coded bag is typically used for the collection of non-infectious general waste (e.g., paper, plastic wrappers) in a health facility?

A

Yellow

B

Red

C

Black

D

Blue

Q144

What best describes the peer‑educator model in health education?

A

health professionals delivering messages

B

community members of similar age and experience delivering messages

C

use of mass‑media campaigns

D

distribution of pamphlets by volunteers

Q145

A postpartum woman who is 5 weeks postpartum and exclusively breastfeeding wishes to use a barrier method. Which statement about condom use is true?

A

Condoms provide protection against sexually transmitted infections only

B

Condoms must be used with a spermicide for effectiveness

C

Condoms are effective immediately after delivery without any additional counseling

D

Correct and consistent use of condoms provides both pregnancy and STI protection

Q146

When assessing a patient for shock, the ANM finds a heart rate of 120 bpm and a systolic blood pressure of 80 mmHg. This state is most accurately described as:

A

Compensated shock

B

Decompensated shock

C

Normal physiological response

D

Hypertensive crisis

Q147

The third stage of labour is officially defined as the period from:

A

Full dilation to delivery of the fetus

B

Birth of the baby to delivery of the placenta

C

Rupture of membranes to birth of the baby

D

Delivery of the placenta to 2 hours postpartum

Q148

Which of the following is a common postoperative side effect that may occur immediately after a minilaparotomy tubal ligation?

A

Permanent loss of libido

B

Shoulder pain due to gas (if laparoscopy was used)

C

Mild abdominal pain and localized bruising

D

Immediate onset of menopause

Q149

In the Nepal postnatal schedule, the ANM is instructed to review the mother’s birth‑registration documents during which visit?

A

First home visit (day 3)

B

Second home visit (day 7)

C

Third home visit (day 14)

D

Final six‑week visit

Q150

A woman using a copper intrauterine device (Cu‑IUD) presents six months after insertion with heavier menstrual bleeding and dysmenorrhea. Which mechanism best explains the increased bleeding?

A

Increased prostaglandin production

B

Endometrial atrophy

C

Local sterile inflammatory reaction

D

Systemic hormonal suppression