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Mukhya Sevika practice questions

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Question 1Child Development and Early Childhood Care

A Mukhya Sevika is reviewing growth charts for children in an anganwadi. According to WHO growth standards, which weight-for-age pattern most strongly indicates severe acute malnutrition requiring urgent referral?

  1. Weight-for-age exactly at the median for age
  2. Weight-for-age between minus 1 and minus 2 standard deviations
  3. Weight-for-age below minus 3 standard deviations of the median Correct answer.
  4. Weight-for-age above plus 2 standard deviations

Explanation

WHO weight-for-age below minus 3 SD of the median signals severe underweight and is a red flag for severe acute malnutrition needing urgent assessment and referral. Values between minus 1 and minus 2 SD are mild deviations, not severe acute malnutrition. Median or above reflects adequate or excess weight, not wasting.

Question 2Child Development and Early Childhood Care

During a home visit, a Sevika observes a 10-month-old who sits without support, transfers objects hand to hand, and responds to her own name. Which developmental interpretation is most accurate?

  1. Delayed, because name response normally appears after 15 months
  2. These milestones are broadly age-appropriate and need routine monitoring Correct answer.
  3. Advanced, because hand transfer normally appears after 12 months
  4. Delayed, because supported standing is expected by 10 months

Explanation

Independent sitting, object transfer and response to name are all expected around 6 to 10 months, so this profile is age-appropriate. Supported standing typically emerges later, near 9 to 12 months, and does not make this child delayed. Hand transfer and name response appear well before 12 and 15 months respectively.

Question 3Child Development and Early Childhood Care

A Sevika is explaining the first 1,000 days concept to a mothers' group. Which time frame correctly defines this window?

  1. From conception through the first six months after birth
  2. From six months through the third birthday
  3. From birth through the first birthday
  4. From conception through the child's second birthday Correct answer.

Explanation

The first 1,000 days span the period from conception to the child's second birthday, covering roughly 270 days of pregnancy plus 730 days after birth. This window is emphasised because nutrition and stimulation during it strongly shape later growth and cognition. The other options truncate or shift the window incorrectly.

Question 4Child Development and Early Childhood Care

A 4-year-old in an anganwadi repeatedly snatches toys and hits peers when a favourite item is taken. Which response best reflects sound early childhood guidance?

  1. Punish the child by removing all play materials for the rest of the day
  2. Ignore the behaviour entirely so the child outgrows it
  3. Teach and model turn-taking and label feelings, while setting a calm limit on hitting Correct answer.
  4. Label the child as aggressive in front of the group

Explanation

Aggressive behaviour at this age is best addressed by teaching replacement skills such as turn-taking and naming emotions, combined with a calm, consistent limit. This builds self-regulation rather than shame. Group punishment, total ignoring and public labelling either escalate distress or fail to teach the missing skill.

Question 5Child Development and Early Childhood Care

A Sevika is counselling a family on complementary feeding. Which statement about initiation is correct?

  1. Complementary foods should replace breast milk completely by nine months
  2. Complementary foods should start at three months to fill nutritional gaps
  3. Complementary foods should be delayed until twelve months to prevent allergies
  4. Complementary foods should start at six completed months while breastfeeding continues Correct answer.

Explanation

WHO and national guidance recommend exclusive breastfeeding for six months, then complementary feeding from six completed months while breastfeeding continues up to two years or beyond. Starting at three months raises infection and allergy risk and displaces breast milk. Replacing breast milk by nine months or delaying solids to twelve months deprives the child of needed energy and nutrients.

Question 6Child Development and Early Childhood Care

A Sevika notes that a 3-year-old uses only single words, does not follow simple two-step instructions, and rarely makes eye contact. What is the most appropriate next step?

  1. Reassure the family that speech delay always resolves by age five
  2. Begin teaching the alphabet to accelerate speech
  3. Advise stopping all screen time and review only after one year
  4. Refer for developmental and hearing assessment while continuing supportive stimulation Correct answer.

Explanation

Combined language delay and limited eye contact warrant prompt developmental and hearing evaluation so that intervention can begin early. Early identification improves outcomes and is a core anganwadi responsibility. Passive reassurance, a long review interval, or pushing academic skills does not address the underlying concern.

Question 7Child Development and Early Childhood Care

Which nutrient deficiency is most specifically associated with night blindness in young children?

  1. Vitamin A deficiency Correct answer.
  2. Iodine deficiency
  3. Vitamin D deficiency
  4. Iron deficiency

Explanation

Vitamin A is essential for rhodopsin formation in the retina, and deficiency classically causes night blindness and, if untreated, xerophthalmia. Iron deficiency causes anaemia and fatigue, vitamin D deficiency affects bone mineralisation, and iodine deficiency affects thyroid function and cognition.

Question 8Child Development and Early Childhood Care

A Sevika is organising a preschool session for 3 to 6 year olds. Which activity best supports early literacy foundations?

  1. Memorising the alphabet in reverse order
  2. Copying letters repeatedly on worksheets
  3. Silent independent writing practice
  4. Shared picture-book reading with open questions and rhyme play Correct answer.

Explanation

Shared reading with open questions and rhyme play builds vocabulary, phonological awareness and comprehension, which are the foundations of literacy. Rote copying, reverse memorisation and silent writing without guidance do not develop meaning-based pre-literacy skills and are not developmentally appropriate for this age.

Question 9Child Development and Early Childhood Care

A 2-year-old has a mid-upper arm circumference of 11.5 cm and bilateral pitting oedema of the feet. What does this combination most likely indicate?

  1. Severe acute malnutrition with a medical complication requiring facility-based care Correct answer.
  2. Normal nutritional status for age
  3. Isolated iron deficiency anaemia
  4. Mild stunting without acute wasting

Explanation

A MUAC below 11.5 cm and bilateral pitting oedema are both criteria for severe acute malnutrition, and the presence of oedema indicates a medically complicated case needing facility-based management. Normal status, mild stunting and isolated anaemia do not produce this combination.

Question 10Child Development and Early Childhood Care

A Sevika is assessing a 6-month-old with a haemoglobin of 8.5 g/dL. Which factor is most important to explore first in the history?

  1. Maternal anaemia and timing of umbilical cord clamping Correct answer.
  2. Number of siblings in the household
  3. Type of cooking fuel used at home
  4. Whether the child has started crawling

Explanation

In infancy, iron stores depend heavily on maternal iron status and on delayed cord clamping, so maternal anaemia and clamping timing are the most relevant historical factors. Sibling count, cooking fuel and crawling are unrelated to the aetiology of early anaemia.

Question 11Child Development and Early Childhood Care

A 3-year-old is brought with a history of several episodes of loss of consciousness after being scolded. Which initial approach is most appropriate for the Sevika?

  1. Refer for medical evaluation while advising the family to avoid harsh discipline Correct answer.
  2. Diagnose the child as having epilepsy and start medication
  3. Advise the family to ignore the episodes completely
  4. Attribute the episodes to malnutrition and increase food intake

Explanation

Episodes triggered by scolding may represent breath-holding spells or another paroxysmal event, so medical evaluation is needed to distinguish causes. Reducing harsh discipline also prevents recurrence and supports the child's emotional safety. The Sevika should not diagnose epilepsy, start medication, or dismiss the episodes.

Question 12Child Development and Early Childhood Care

A Sevika is planning stimulation activities for a 4-month-old. Which activity is most developmentally appropriate?

  1. Encouraging the infant to write with a crayon
  2. Holding colourful rattles within reach for batting and tracking Correct answer.
  3. Playing simple board games with rules
  4. Teaching the infant to stack blocks into a tower

Explanation

At four months, infants are developing visual tracking and reaching, so rattles placed within reach support these emerging skills. Block stacking, rule-based games and crayon writing require much later motor and cognitive abilities and are not appropriate for this age.

Question 13Child Development and Early Childhood Care

A Sevika is counselling parents about toilet training. Which advice is most consistent with developmental readiness?

  1. Use punishment for each accident to speed learning
  2. Begin rigidly at 12 months regardless of the child's cues
  3. Begin when the child shows signs such as staying dry for longer periods and signalling discomfort Correct answer.
  4. Start night-time training before daytime dryness is achieved

Explanation

Toilet training works best when the child shows readiness signs such as longer dry intervals, awareness of wetness, and interest in the toilet. A fixed early schedule, punishment, or starting night training before daytime control increases resistance and accidents.

Question 14Child Development and Early Childhood Care

A Sevika is assessing a 5-year-old's language. Which finding most clearly warrants referral for speech and language evaluation?

  1. Asking many 'why' questions
  2. Speech that is unintelligible to unfamiliar adults at age five Correct answer.
  3. Occasional mispronunciation of the sound 'r'
  4. Use of short sentences of four to five words

Explanation

By age five, most speech should be intelligible to unfamiliar listeners, so persistent unintelligibility is a red flag for speech sound disorder or hearing loss. Minor residual errors on 'r' are common, and four-to-five-word sentences and frequent 'why' questions are normal at this age.

Question 15Child Development and Early Childhood Care

A Sevika is explaining the purpose of growth monitoring to a new anganwadi worker. Which statement best captures its main aim?

  1. To replace clinical examination by a doctor
  2. To decide which children should be excluded from supplementary nutrition
  3. To rank children in the centre by size
  4. To detect early deviations in growth so that timely action can be taken Correct answer.

Explanation

Growth monitoring is a screening and follow-up tool whose main purpose is early detection of growth faltering so that counselling and intervention can start promptly. It is not a ranking exercise, not a basis for exclusion, and not a substitute for clinical assessment.

Question 16Child Development and Early Childhood Care

A Sevika observes that a 7-year-old in her area works after school and appears tired and withdrawn. Which action best fits her role?

  1. Advise the child to work fewer hours but continue
  2. Confront the employer directly without informing anyone
  3. Ignore the situation as it is outside the anganwadi's mandate
  4. Report concerns through the child protection mechanism and link the family to support services Correct answer.

Explanation

Suspected child labour is a protection concern that should be reported through established child protection channels while linking the family to welfare support. Direct confrontation without reporting is unsafe, ignoring it neglects the mandate, and advising reduced hours still permits harmful labour.

Question 17Child Development and Early Childhood Care

A Sevika notes that a 2-year-old has not received any immunisation since birth. Which principle should guide her counselling?

  1. Restart the entire schedule from birth
  2. Give only the vaccines due at the current age and skip earlier ones
  3. Follow the national immunisation schedule and catch up missed doses without restarting the series Correct answer.
  4. Wait until the child turns five to begin

Explanation

National immunisation guidance supports catch-up vaccination following the schedule, without restarting a series from the beginning. Restarting wastes doses and delays protection, waiting until five leaves the child vulnerable, and skipping earlier doses leaves gaps in immunity.

Question 18Child Development and Early Childhood Care

A Sevika is designing a play corner for 3 to 6 year olds. Which arrangement best supports both active play and safety?

  1. Low open shelves with labelled toy bins and a soft mat away from sharp edges Correct answer.
  2. Small beads and marbles as the main play material
  3. High locked cupboards with toys kept out of children's reach
  4. A space next to a staircase with no barrier

Explanation

Low open shelving with labelled bins promotes independent choice and tidy habits, and a soft mat away from sharp edges reduces injury risk. High locked storage prevents access, an unguarded staircase is a fall hazard, and small beads and marbles are choking hazards for young children.

Question 19Child Development and Early Childhood Care

A Sevika observes a 9-month-old who cannot sit without support, has poor head control, and does not babble. Which conclusion is most defensible?

  1. The child is advanced because head control is present
  2. Only language is delayed, so a review in six months is sufficient
  3. The findings are normal because all children sit by 12 months
  4. Multiple domains show significant delay, so urgent developmental referral is indicated Correct answer.

Explanation

Independent sitting and babbling are expected well before nine months, and poor head control at this age is a significant motor sign. Delay across motor and language domains warrants urgent developmental assessment rather than watchful waiting.

Question 20Child Development and Early Childhood Care

A Sevika is counselling a mother on responsive feeding for a 12-month-old. Which practice best reflects responsive feeding?

  1. Feeding strictly by the clock regardless of cues
  2. Feeding only while the child is distracted by a screen
  3. Forcing the child to finish a fixed quantity at each meal
  4. Recognising hunger and fullness cues and allowing the child to self-feed with support Correct answer.

Explanation

Responsive feeding means noticing and responding to hunger and satiety cues, encouraging self-feeding, and avoiding pressure. Forcing fixed quantities, screen-distracted feeding and rigid clock-based feeding override cues and are linked to poorer intake regulation.

Question 21Child Development and Early Childhood Care

A Sevika is analysing why some children in her area show growth faltering despite adequate food availability. Which factor is most likely to be a hidden contributor?

  1. Attending preschool regularly
  2. Frequent untreated diarrhoea and poor water and sanitation Correct answer.
  3. Living in a joint family
  4. Having a television at home

Explanation

Repeated diarrhoea and poor water and sanitation cause nutrient loss and malabsorption, contributing to growth faltering even when food is available. Television ownership, preschool attendance and joint family structure are not direct causes of growth faltering.

Question 22Child Development and Early Childhood Care

A Sevika needs to adapt activities for a 4-year-old with a mild physical disability in a group setting. Which approach best reflects inclusive practice?

  1. Lower expectations and skip cognitive activities
  2. Modify materials and positioning so the child participates in the same group activities Correct answer.
  3. Exclude the child from physical play for safety
  4. Create a separate activity schedule away from peers

Explanation

Inclusive practice adapts materials, positioning and support so that a child with a disability takes part in the same activities as peers, which supports learning and social belonging. Segregation, exclusion from play and lowering cognitive expectations reduce participation and development.

Question 23Child Development and Early Childhood Care

A Sevika reviews two growth records: Child A has low weight-for-age but normal height-for-age; Child B has low height-for-age but normal weight-for-age. Which interpretation is most accurate?

  1. Child A shows stunting while Child B shows wasting
  2. Both children show normal growth
  3. Both children show acute undernutrition
  4. Child A shows acute undernutrition (wasting) while Child B shows chronic undernutrition (stunting) Correct answer.

Explanation

Low weight-for-age with preserved height suggests recent or acute undernutrition, reflected as wasting. Low height-for-age with preserved weight suggests long-standing or chronic undernutrition, reflected as stunting. The two patterns describe different histories and require different responses.

Question 24Child Development and Early Childhood Care

A Sevika is designing a programme to improve cognitive outcomes in children under three. Which combination is most strongly supported by evidence?

  1. Screen-based learning apps as the main stimulation
  2. Adequate nutrition plus responsive caregiving and opportunities for play and exploration Correct answer.
  3. Structured academic drilling from six months
  4. Isolation from caregivers to build independence

Explanation

Evidence supports nurturing care: adequate nutrition, responsive caregiving, and opportunities for play and exploration jointly promote cognitive development in the early years. Academic drilling, screen-based apps as the main input, and separation from caregivers are not supported and may be harmful.

Question 25Child Development and Early Childhood Care

A Sevika must act on a report that a 4-year-old is frequently left alone at home while the mother works. Which principle should guide her response?

  1. The matter should be ignored because the mother is earning a livelihood
  2. The child should be removed from the home immediately without assessment
  3. The family should be publicly named to deter others
  4. The child's best interests should guide action, using referral and family support rather than blame Correct answer.

Explanation

Child protection decisions are guided by the best interests of the child, combining assessment, referral to protection services and support to the family. Ignoring the risk leaves the child unsafe, immediate removal without assessment is disproportionate, and public naming causes harm without protection.

Question 26Child Development and Early Childhood Care

A Sevika is explaining the concept of developmental milestones to a group of new anganwadi workers. Which statement best describes what a developmental milestone represents?

  1. A medical diagnosis given only when a child's growth is below the norm
  2. A skill or behaviour that most children in a defined age range can typically perform Correct answer.
  3. A fixed target that every child must reach on exactly the same date
  4. A test score used to rank children against each other in the centre

Explanation

Developmental milestones describe skills or behaviours that most children in a given age band can typically demonstrate, such as sitting, babbling, or using two-word phrases. They are reference points for monitoring progress, not rigid deadlines or ranking tools. A child who lags in one area is observed and supported rather than immediately labelled.

Question 27Child Development and Early Childhood Care

During a home visit, a Sevika observes a 10-month-old repeatedly dropping a spoon from the high chair and watching where it falls. The mother says the child is being naughty. What is the most appropriate guidance?

  1. Remove all objects so the child stops the behaviour
  2. Refer the child urgently because repetitive dropping suggests a developmental disorder
  3. Recognise this as normal learning about cause and effect and provide safe objects to drop Correct answer.
  4. Scold the child briefly so the habit does not continue

Explanation

Deliberate dropping and watching the fall is a normal sensorimotor behaviour through which infants learn cause and effect and object permanence. The appropriate response is to accept the behaviour and offer safe, suitable objects for practice. Scolding or removing all objects misses the developmental purpose of the activity.

Question 28Child Development and Early Childhood Care

A Sevika is reviewing the diet of a 2-year-old who eats mainly rice with a little dal and rarely eats vegetables, fruits, or milk. Which nutritional concern should she prioritise in counselling the family?

  1. Excess dietary fibre causing poor absorption of fat
  2. Inadequate iron and vitamin A intake from a monotonous cereal-based diet Correct answer.
  3. Overhydration from excessive water intake
  4. Excess protein intake leading to obesity

Explanation

A diet dominated by rice with little variety is typically low in iron-rich foods and vitamin A-rich fruits and vegetables, raising the risk of anaemia and vitamin A deficiency. Counselling should focus on adding green leafy vegetables, fruits, eggs, milk, and other iron-rich items. The pattern described does not suggest excess protein, excess fibre, or overhydration.

Question 29Child Development and Early Childhood Care

A Sevika is planning a daily routine for a group of 3-year-olds in an anganwadi centre. Which schedule best reflects developmentally appropriate practice for this age group?

  1. Long periods of seated worksheet practice with short breaks for play
  2. Unstructured free play all day with no adult interaction or routine
  3. Alternating short structured activities with free play, rest, and snacks across the day Correct answer.
  4. One continuous teacher-led lesson of two hours with no rest period

Explanation

Three-year-olds have short attention spans and learn best through play, so a routine that alternates brief structured activities with free play, rest, and snacks suits their developmental needs. Long seated lessons or worksheet drills exceed their attention capacity. Completely unstructured time without adult interaction also misses chances for guided learning.

Question 30Child Development and Early Childhood Care

A Sevika compares two 4-year-olds. Child A speaks in short sentences, follows two-step instructions, and plays cooperatively, but cannot yet hop on one foot. Child B speaks only in single words, does not respond to name, and avoids eye contact, but runs and climbs well. Which interpretation best guides her next steps?

  1. Child A needs referral for motor delay; Child B needs only more play opportunities
  2. Child A's profile is within normal variation; Child B shows language and social concerns warranting further assessment Correct answer.
  3. Both children are developing normally because each has at least one strong area
  4. Both children need referral because each has a delay in at least one domain

Explanation

By age four, sentence speech, following two-step instructions, and cooperative play are expected, while the ability to hop on one foot may still be emerging, so Child A's profile is within normal variation. Child B's single-word speech, poor response to name, and avoidance of eye contact together raise concern about language and social development. Isolated strength in gross motor skills does not offset these concerns, so further assessment and referral are indicated.

Question 31Nutrition, Health and Hygiene

A Mukhya Sevika is reviewing the supplementary nutrition register of an anganwadi and wants a quick, low-cost field check for visible iodine deficiency in school-age children. Which sign should she specifically look for during the health screening?

  1. Spongy, bleeding gums
  2. Bowing of the legs with widened wrists
  3. Visible enlargement of the thyroid gland in the neck Correct answer.
  4. Bitot's spots on the conjunctiva

Explanation

Iodine deficiency impairs thyroid hormone synthesis, and the body compensates by enlarging the thyroid gland, producing a visible goitre in the neck. Goitre is therefore the classic field sign used in iodine deficiency disorder surveys. The other listed signs belong to vitamin D, vitamin A and vitamin C deficiencies respectively.

Question 32Nutrition, Health and Hygiene

Under the Integrated Child Development Services supplementary nutrition component, a severely underweight child enrolled at the anganwadi centre is entitled to which take-home ration norm?

  1. 200 calories and 5 g protein per day
  2. 300 calories and 8-10 g protein per day
  3. 500 calories and 12-15 g protein per day
  4. 800 calories and 20-25 g protein per day Correct answer.

Explanation

ICDS supplementary nutrition norms provide a double quantity of take-home ration for severely underweight children, delivering about 800 calories and 20-25 g of protein per day. This higher entitlement is meant for nutritional rehabilitation of severe undernutrition. Moderately underweight children receive the standard single ration.

Question 33Nutrition, Health and Hygiene

An anganwadi worker reports that several children in her centre have dry, thickened conjunctiva with a wrinkled appearance, and one child has a softened cornea. Which micronutrient deficiency should the Mukhya Sevika suspect first?

  1. Iron deficiency
  2. Thiamine deficiency
  3. Zinc deficiency
  4. Vitamin A deficiency Correct answer.

Explanation

Conjunctival xerosis with a wrinkled, dry appearance and keratomalacia (corneal softening) are classic ocular manifestations of vitamin A deficiency. These changes progress from night blindness to conjunctival and corneal damage if untreated. Iron, thiamine and zinc deficiencies do not produce this specific eye picture.

Question 34Nutrition, Health and Hygiene

During a growth monitoring session, a Mukhya Sevika plots a child's weight-for-age on the WHO growth chart. The child's weight falls persistently below minus three standard deviations of the median. How should this child be classified?

  1. At risk of overweight
  2. Normal weight for age
  3. Moderately underweight
  4. Severely underweight Correct answer.

Explanation

On weight-for-age charts, a value below minus three standard deviations from the median defines severe underweight. Values between minus two and minus three standard deviations indicate moderate underweight. Classification matters because severely underweight children qualify for intensified nutrition and referral.

Question 35Nutrition, Health and Hygiene

A Mukhya Sevika is asked to explain why colostrum should never be discarded before the first breastfeed. Which statement best captures its nutritional and protective value?

  1. It has the highest fat content of all breast milk and promotes rapid weight gain
  2. It is rich in immunoglobulin A and provides a concentrated first vaccine-like protection Correct answer.
  3. It contains large amounts of lactose that stimulate early gut maturation
  4. It is low in protein and helps the newborn adjust to extrauterine feeding

Explanation

Colostrum is thick, yellowish and rich in secretory immunoglobulin A, which coats the infant's gut and provides the first natural protection against infection. It is also higher in protein and some minerals than mature milk. Discarding it removes this early immunological and nutritional advantage.

Question 36Nutrition, Health and Hygiene

According to infant and young child feeding guidelines followed in anganwadi counselling, at what age should complementary feeding begin while breastfeeding continues?

  1. At four completed months
  2. At twelve completed months
  3. At six completed months Correct answer.
  4. At nine completed months

Explanation

Exclusive breastfeeding is recommended for the first six months, after which complementary foods should be introduced while breastfeeding continues up to two years or beyond. Starting earlier displaces breast milk and raises infection risk, while starting later increases the risk of undernutrition. Six completed months is therefore the standard cut-off.

Question 37Nutrition, Health and Hygiene

A Mukhya Sevika supervises a village where many families store cooked rice overnight at room temperature and reheat it the next morning. Which food safety risk should she emphasise in her hygiene education session?

  1. Growth of Clostridium botulinum in the cooked rice
  2. Development of nitrosamines from reheated rice
  3. Multiplication of Bacillus cereus and production of heat-stable toxins Correct answer.
  4. Formation of aflatoxin in freshly cooked rice

Explanation

Cooked rice left at room temperature is a well-recognised vehicle for Bacillus cereus, whose spores survive cooking and whose emetic toxin is heat-stable. Reheating therefore does not make such rice safe. The practical message is to cool and refrigerate rice promptly and to avoid holding it warm for long periods.

Question 38Nutrition, Health and Hygiene

In a nutrition education session, a Mukhya Sevika wants to explain the concept of a balanced diet using locally available foods. Which description is most appropriate?

  1. A diet that relies mainly on seasonal fruits to meet energy needs
  2. A diet that excludes all fats to prevent obesity
  3. A diet that provides only cereals and pulses in equal quantities
  4. A diet that supplies all nutrients in adequate amounts and correct proportions for the person's age and activity Correct answer.

Explanation

A balanced diet provides energy, protein, fat, vitamins, minerals and fibre in the amounts and proportions needed by an individual. It must be matched to age, physiological state and activity level. No single food group can supply all requirements.

Question 39Nutrition, Health and Hygiene

A Mukhya Sevika notices that a pregnant woman in her area has been advised to take iron and folic acid tablets. What is the standard national recommendation for IFA supplementation during pregnancy?

  1. One tablet daily for the first trimester only
  2. Two tablets daily for the entire nine months
  3. One tablet daily starting after the first trimester for at least 180 days Correct answer.
  4. One tablet weekly throughout pregnancy

Explanation

National guidelines recommend daily iron and folic acid supplementation during pregnancy, beginning after the first trimester, for a minimum of about 180 days. This duration covers the period of greatest iron demand and reduces maternal anaemia. Supplementation is continued in the postpartum period as well.

Question 40Nutrition, Health and Hygiene

A Mukhya Sevika is preparing an information sheet about anaemia among adolescent girls. Which combination of dietary advice is most appropriate for improving iron status?

  1. Consume iron-rich foods with strong tea or coffee at the same meal
  2. Rely on milk as the main source of dietary iron
  3. Avoid green leafy vegetables to reduce oxalate intake
  4. Consume iron-rich foods along with a source of vitamin C such as amla or lemon Correct answer.

Explanation

Vitamin C enhances absorption of non-haem iron from plant foods by keeping iron in the more absorbable ferrous form. Pairing iron-rich foods with amla, lemon or guava is therefore good practice. Inhibitors such as tannins and phytates should be separated from iron-rich meals.

Question 41Nutrition, Health and Hygiene

A Mukhya Sevika is explaining the difference between food security and nutrition security. Which statement best captures nutrition security?

  1. Availability of enough cereals in the household throughout the year
  2. Adequate food intake combined with a healthy environment, health care and care practices Correct answer.
  3. Assured public distribution entitlement at subsidised prices
  4. Freedom from hunger only during the lean season

Explanation

Nutrition security goes beyond mere availability of food to include adequate intake, safe water and sanitation, health care and appropriate care practices. Food security is a necessary but not sufficient condition for nutrition security. This distinction guides multisectoral action in anganwadi work.

Question 42Nutrition, Health and Hygiene

During a home visit, a Mukhya Sevika finds a family using a hand pump located close to a pit latrine. Which contamination risk should she explain most urgently?

  1. Increased salinity due to over-extraction
  2. Chemical contamination of water by excess fluoride
  3. Excessive hardness of groundwater
  4. Bacterial contamination of the water source by leachate from the latrine Correct answer.

Explanation

A pit latrine sited too close to a hand pump allows leachate carrying pathogens to reach the groundwater and contaminate the water source. The risk is greater in shallow aquifers and during the rainy season. The practical advice is to maintain a safe distance and protect the well head.

Question 43Nutrition, Health and Hygiene

A Mukhya Sevika is organising a demonstration of handwashing for children. Which sequence is the correct practice to teach?

  1. Wet hands, apply soap, rub all surfaces for at least 20 seconds, rinse and air dry Correct answer.
  2. Wet hands only and shake them dry before eating
  3. Rinse hands in a common bowl of water and dry on a shared towel
  4. Apply soap first, then wet hands briefly, then wipe on a cloth

Explanation

Effective handwashing requires wetting the hands, applying soap, rubbing all surfaces including between fingers and under nails for about twenty seconds, rinsing with clean running water and air drying. This sequence physically removes and inactivates pathogens. Shared bowls and towels can reintroduce contamination.

Question 44Nutrition, Health and Hygiene

A Mukhya Sevika reviews the immunisation register and finds that a child has not received the birth-dose vaccines. Which vaccines should have been given at birth under the national immunisation schedule?

  1. BCG, oral polio vaccine zero dose and hepatitis B birth dose Correct answer.
  2. Measles, mumps and rubella
  3. DPT, oral polio vaccine and measles
  4. Typhoid conjugate vaccine and rotavirus vaccine

Explanation

The birth dose schedule includes BCG, the zero dose of oral polio vaccine and the hepatitis B birth dose, ideally within twenty-four hours for hepatitis B. These early doses protect against tuberculosis, polio and perinatal hepatitis B transmission. Other vaccines are scheduled at later ages.

Question 45Nutrition, Health and Hygiene

A Mukhya Sevika is asked to identify the most appropriate first-aid measure for a child who has just sustained a small superficial burn while helping in the kitchen. Which action should she advise?

  1. Apply toothpaste to the burn and cover it tightly
  2. Cool the area under clean running water for about twenty minutes Correct answer.
  3. Apply ice directly to the burned area
  4. Burst any blisters that form to release fluid

Explanation

Cooling a superficial burn with clean running water for around twenty minutes limits tissue damage and relieves pain. Ice, toothpaste and similar home remedies can worsen injury or introduce infection. Blisters should be left intact as a natural barrier.

Question 46Nutrition, Health and Hygiene

A Mukhya Sevika is supervising the preparation of oral rehydration solution at an anganwadi centre. Which practice ensures the solution is safe and effective?

  1. Adding extra sugar to make the solution more palatable
  2. Keeping the prepared solution for up to three days at room temperature
  3. Using half a packet in a glass of water to concentrate the salts
  4. Using one full packet in one litre of clean water and discarding after twenty-four hours Correct answer.

Explanation

The standard ORS packet is dissolved in exactly one litre of clean water, and any unused solution should be discarded after twenty-four hours because bacterial growth occurs over time. Correct dilution ensures the sodium-glucose co-transport that drives water absorption. Extra sugar or wrong dilution disturbs this balance.

Question 47Nutrition, Health and Hygiene

A Mukhya Sevika is counselling a mother about the management of a child with diarrhoea at home. Which advice is consistent with standard practice?

  1. Continue breastfeeding and give extra fluids and zinc supplementation Correct answer.
  2. Stop all feeding until diarrhoea stops
  3. Withhold oral rehydration solution unless the child vomits
  4. Give only plain water in large amounts

Explanation

Continued breastfeeding and feeding during diarrhoea maintain nutrition and speed recovery, while extra fluids prevent dehydration. Zinc supplementation for about fourteen days reduces duration and severity. Withholding food or giving only plain water worsens outcomes.

Question 48Nutrition, Health and Hygiene

A Mukhya Sevika is preparing a session on prevention of nutritional anaemia for a women's group. Which laboratory indicator is most commonly used at the community level to screen for anaemia?

  1. Serum retinol level
  2. Haemoglobin concentration in blood Correct answer.
  3. Serum calcium level
  4. Urinary iodine excretion

Explanation

Anaemia is defined by low haemoglobin concentration, and haemoglobin estimation is the standard screening test used in community surveys and anganwadi health check-ups. It is inexpensive and field-friendly. The other tests assess different micronutrients entirely.

Question 49Nutrition, Health and Hygiene

A Mukhya Sevika is assessing a child with visible severe wasting. Which finding best supports this classification?

  1. Mid-upper arm circumference above 13.5 cm
  2. Bilateral pitting oedema of the feet
  3. Visible severe rib prominence and loss of buttock fat with no oedema Correct answer.
  4. Weight-for-height above the median

Explanation

Visible severe wasting is identified by extreme loss of subcutaneous fat and muscle, giving prominent ribs and a loss of buttock fat, without oedema. It is a sign of severe acute malnutrition requiring urgent referral. Oedema indicates a different clinical form of severe acute malnutrition.

Question 50Nutrition, Health and Hygiene

A Mukhya Sevika is asked to explain the purpose of food fortification to a village health committee. Which statement is most accurate?

  1. It increases the shelf life of foods by adding preservatives
  2. It adds essential micronutrients to commonly consumed foods to improve population nutrient intake Correct answer.
  3. It removes naturally occurring toxins from staple foods
  4. It replaces the need for a diversified diet entirely

Explanation

Fortification means adding vitamins or minerals to widely consumed staple foods such as salt, flour or oil to correct or prevent deficiencies at population level. It complements, but does not replace, dietary diversity. Its purpose is nutritional improvement, not preservation.