Nursing Elites

1. While assessing an Rh-positive newborn whose mother is Rh-negative, the nurse recognizes the risk for hyperbilirubinemia. Which of the following should be reported immediately?

• A. Jaundice evident at 26 hours
• B. Hematocrit of 55%
• C. Serum bilirubin of 12 mg/dL
• D. Positive Coombs test

Correct answer: C

Rationale: A serum bilirubin level of 12 mg/dL in a newborn is concerning and can indicate a significant risk of hyperbilirubinemia, which requires immediate medical intervention to prevent complications like kernicterus. Jaundice at 26 hours (Choice A) is a symptom, not a laboratory result, and needs monitoring but not an immediate report. Hematocrit of 55% (Choice B) may be elevated but is not indicative of hyperbilirubinemia. A positive Coombs test (Choice D) indicates the presence of antibodies on the newborn's red blood cells but does not directly correlate with the risk of hyperbilirubinemia.

2. What is the measure of the number of existing cases of a disease in a specific population at a given time?

• A. Incidence
• B. Prevalence
• C. Mortality rate
• D. Morbidity rate

Correct answer: B

Rationale: Prevalence is the correct answer as it refers to the number of existing cases of a disease in a specific population at a given time. Incidence, on the other hand, refers to the number of new cases of a disease in a defined population over a specific period. Mortality rate is the measure of the number of deaths in a particular population due to a specific cause, while morbidity rate is the frequency of a disease in a specific population.

3. A client has been admitted for meningitis. In reviewing the laboratory analysis of cerebrospinal fluid (CSF), the nurse would expect to note

• A. High protein
• B. Clear color
• C. Elevated sed rate
• D. Increased glucose

Correct answer: A

Rationale: High protein levels in the cerebrospinal fluid are indicative of bacterial meningitis, as the presence of bacteria in the CSF leads to increased protein production. Elevated protein levels can be seen in inflammatory conditions like meningitis. Choice B, clear color, is not expected in meningitis as it is typically associated with cloudy or turbid CSF. Elevated sed rate (choice C) and increased glucose (choice D) are not typically associated with the laboratory findings seen in meningitis.

4. A client is admitted with a diagnosis of myocardial infarction (MI). The client is complaining of chest pain. The nurse knows that pain related to an MI is due to

• A. Insufficient oxygenation of the cardiac muscle
• B. Potential circulatory overload
• C. Left ventricular overload
• D. Electrolyte imbalance

Correct answer: A

Rationale: The correct answer is A: Insufficient oxygenation of the cardiac muscle. Myocardial infarction pain is primarily caused by inadequate oxygen reaching the heart muscle, leading to ischemia and tissue damage. Choices B, C, and D are incorrect because circulatory overload, left ventricular overload, and electrolyte imbalance are not the primary causes of chest pain in myocardial infarction. Circulatory overload may lead to other symptoms like edema, left ventricular overload can result in heart failure symptoms, and electrolyte imbalance may present with various manifestations, but none of these directly cause the characteristic chest pain associated with an MI.

5. A home health nurse is at the home of a client with diabetes and arthritis. The client has difficulty drawing up insulin. It would be most appropriate for the nurse to refer the client to:

• A. A social worker from the local hospital
• B. An occupational therapist from the community center
• C. A physical therapist from the rehabilitation agency
• D. Another client with diabetes mellitus who takes insulin

Correct answer: B

Rationale: An occupational therapist is the most appropriate professional to refer the client to in this situation. Occupational therapists can provide assistance with techniques and tools to help the client manage insulin administration despite arthritis. Referring the client to a social worker (Choice A) may not directly address the client's difficulty with insulin. While physical therapists (Choice C) focus on mobility and strength, they may not specialize in techniques for insulin administration. Referring the client to another client with diabetes (Choice D) is not a professional or appropriate solution to address the client's difficulty.

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