Nokea
The PRIORITY action to take when nursing a neonate on phototherapy is to
- A. Turn the neonate every six hours routinely
- B. Encourage mother to discontinue breastfeeding
- C. Notify physician if the skin turns bronze-colored
- D. Check the neonate’s vital signs every 2-4 hourly
Correct Answer: D
Rationale: The correct answer is D: Check the neonate’s vital signs every 2-4 hourly. This is the priority action because neonates undergoing phototherapy are at risk for dehydration and temperature instability. Monitoring vital signs regularly helps to detect any signs of dehydration, such as decreased urine output or increased heart rate, and ensures timely intervention.
Explanation for other choices:
A: Turning the neonate every six hours routinely is important for preventing pressure ulcers but is not the priority when compared to monitoring vital signs for potential complications.
B: Encouraging the mother to discontinue breastfeeding is incorrect as breastmilk provides essential nutrients and hydration, which are important for neonates, even during phototherapy.
C: Notifying the physician if the skin turns bronze-colored is important to address a potential adverse reaction to phototherapy but does not take precedence over monitoring vital signs for immediate concerns.
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Trial of scar is likely to have an auspicious outcome if the
- A. Estimated fetal weight is below 3500 grams
- B. Maternal body mass index is estimated at 27.5
- C. Gestational age is approximately 42 weeks
- D. Maternal age is approximately 42 years
Correct Answer: A
Rationale: The correct answer is A because an estimated fetal weight below 3500 grams indicates a lower risk of complications during childbirth. Higher fetal weight increases the likelihood of shoulder dystocia and birth injuries. Maternal body mass index, gestational age, and maternal age do not directly impact the likelihood of a favorable outcome during a trial of scar.
Aims of exchange transfusion procedure includes:
- A. Cure of haemolysis and restoration of hemoglobin level
- B. Cure of hypoxia and removal of all toxic materials
- C. Stabilization of baby’s immune system and liver functions
- D. Control of haemolysis and restoration of hemoglobin level
Correct Answer: D
Rationale: The correct answer is D because exchange transfusion aims to control hemolysis by removing the damaged red blood cells and replacing them with healthy ones, thus restoring hemoglobin levels. This procedure does not cure haemolysis or hypoxia entirely, nor does it stabilize the immune system or liver functions. It specifically targets controlling hemolysis and restoring hemoglobin levels to improve the patient's condition.
Jennifer is an RN applicant for a staff nurse position in the surgical ICU. She has had a screening PPD and comes back in 48 hours to have it read. There is a 12-mm induration at the site of injection. A chest radiograph is negative. The AGACNP knows that the next step in Jennifers evaluation and management should include
- A. No further care, because the chest radiograph is negative
- B. Quantiferon serum assay for exposure
- C. Consideration of prophylactic therapy
- D. Beginning therapy for pulmonary TB pending sputum cultures
Correct Answer: C
Rationale: The correct answer is C: Consideration of prophylactic therapy. A 12-mm induration in a healthcare worker is considered positive for PPD. In the absence of active TB on chest radiograph, the next step is to consider prophylactic therapy to prevent the development of active TB. This is based on the guidelines for the management of latent TB infection. Choice A is incorrect as a positive PPD warrants further evaluation regardless of the chest radiograph result. Choice B, the Quantiferon assay, is not the next step after a positive PPD and negative chest radiograph. Choice D, beginning therapy for pulmonary TB pending sputum cultures, is not indicated in this scenario as there is no evidence of active TB.
A 42-year-old woman presents to the emergency department after being raped. The AGACNP examines her and realizes that the patients husband is the rapist. The patient does not want to press charges and wants to return home with her husband. The AGACNPs initial action should be to
- A. Report the physical assault to law enforcement
- B. Have the patient sign a release to go home with her husband
- C. Consult psychiatry for a psych hold
- D. Provide counseling to the patient regarding her options M. R. is a 52-year-old female who presents complaining of significant abdominal pain, which she rates as 8 to 9 on a 1 to 10 scale. The pain has been going on for a matter of hours, and she is afraid it won’t go away on its own. She denies any nausea or vomiting, and she cannot remember precisely when her last bowel movement occurred; probably it was a few days ago. She reports that she is ―always‖ constipated. On physical examination, she is tachycardic but otherwise has normal vital signs; her abdomen is tensely rigid, but no point tenderness to palpation is appreciated. The entire abdomen percusses as tympanic—there is no distinct dullness over the upper quadrants. Bowel sounds are present but hypoactive and intermittent. There is rebound tenderness to palpation. The AGACNP suspects:
Correct Answer: D
Rationale: The correct answer is D: Provide counseling to the patient regarding her options. The AGACNP's initial action should prioritize the patient's well-being and autonomy. Counseling allows the patient to understand her options, including legal, medical, and emotional support. Reporting to law enforcement (A) without the patient's consent violates her autonomy. Having the patient sign a release to go home with her husband (B) disregards the potential danger and trauma she may face. Consulting psychiatry for a psych hold (C) may not address the immediate emotional and physical needs of the patient.
Specific management of moderate pre-eclampsia involves
- A. Admission at first contact
- B. Managing as an outpatient case
- C. Admission in the intensive care unit
- D. Encouraging plenty of oral fluids
Correct Answer: B
Rationale: Correct Answer: B (Managing as an outpatient case)
Rationale:
1. Moderate pre-eclampsia indicates stable condition.
2. Outpatient management allows close monitoring without hospitalization.
3. Early intervention can prevent progression to severe pre-eclampsia.
4. Hospital admission is reserved for severe cases or complications (not moderate).
5. Encouraging fluids is important, but not the specific management for pre-eclampsia.