A 4-month-old infant was brought by her mother to the health center because of a cough. His respiratory rate is 42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines for assessment

Rosanna Gacasan a 4-month-old infant was brought by her mother to the health center because of a cough. His respiratory rate is 42/minute. Using the Integrated Management of Child Illness (IMCI) guidelines of assessment, his breathing is considered as:

a. Fast
b. Slow
c. Normal
d. Insignificant

Answer Key
In IMCI, a respiratory rate of 50/minute or more is fast breathing for an infant aged 2 to 12 months.



#1. Marilza Christina de Sousa had just received her 4th dose of tetanus toxoid. She is aware that her baby will have protection against tetanus for

The baby will have passive natural immunity by placental transfer of antibodies. The mother will have active artificial immunity lasting for about 10 years. 5 doses will give the mother lifetime protection.


#2. Nurse Dondee Agudong is aware that unused BCG should be discarded after how many hours of reconstitution?

While the unused portion of other biologicals in EPI may be given until the end of the day, only BCG is discarded 4 hours after reconstitution. This is why BCG immunization is scheduled only in the morning.


#3. The nurse explains to a breastfeeding mother that breast milk is sufficient for all of the baby’s nutrient needs only up to

After 6 months, the baby’s nutrient
needs, especially the baby’s iron requirement,
can no longer be provided by mother’s milk


#4. Nurse Lady Laine Aguinod is aware that the gestational age of a conceptus that is considered viable (able to live outside the womb) is

At approximately 23 to 24 weeks’ gestation, the lungs are developed enough to sometimes maintain extrauterine life. The lungs are the most immature system during the gestation period. Medical care for premature labor begins much earlier (aggressively at 21 weeks’ gestation).


#5. When teaching parents of a neonate the proper position for the neonate’s sleep, the nurse Jaina Nangit stresses the importance of placing the neonate on his back to reduce the risk of which of the following?

Supine positioning is recommended to reduce the risk of SIDS in infancy. The risk of aspiration is slightly increased with the supine position. Suffocation would be less likely with an infant supine than prone and the position for GER requires the head of the bed to be elevated.


#6. Which finding might be seen in baby James a neonate suspected of having an infection?

Temperature instability, especially when it results in a low temperature in the neonate, may be a sign of infection. The neonate’s color often changes with an infection process but generally becomes ashen or mottled. The neonate with an infection will usually show a decrease in activity level or lethargy.


#7. Baby Jonnalyn Obara who is small-for-gestation is at increased risk during the transitional period for which complication?

The small-for-gestation neonate is at risk for developing polycythemia during the transitional period in an attempt to decrease hypoxia. The neonates are also at increased risk for developing hypoglycemia and hypothermia due to decreased glycogen stores.


#8. Myla Ramirez has just given birth at 42 weeks’ gestation. When the nurse assessing the neonate, which physical finding is expected?

Postdate fetuses lose the vernix caseosa, and the epidermis may become desquamated. These neonates are usually very alert. Lanugo is missing in the postdate neonate.


#9. After reviewing the Imelda Repolio maternal history of magnesium sulfate during labor, which condition would nurse Mariam Ramli anticipate as a potential problem in the neonate?

Magnesium sulfate crosses the placenta and adverse neonatal effects are respiratory depression, hypotonia, and bradycardia. The serum blood sugar isn’t affected by magnesium sulfate. The neonate would be floppy, not jittery.


#10. Which symptom would indicate the Baby Lizel Reyes was adapting appropriately to extra uterine life without difficulty?

A respiratory rate 40 to 60 breaths/minute is normal for a neonate during the transitional period. Nasal flaring, respiratory rate more than 60 breaths/minute, and audible grunting are signs of respiratory distress.