Nursing Elites

1. A hepatitis B screen is performed on a pregnant client, and the results indicate the presence of antigens in the client's blood. On the basis of this finding, the nurse makes which determination?

• A. Hepatitis immune globulin and vaccine will be administered to the newborn infant soon after birth
• B. The results are negative.
• C. The results indicate that the mother does not have hepatitis B
• D. The client needs to receive the hepatitis B series of vaccines.

Correct answer: A

Rationale: A hepatitis B screen is performed to identify antigens in maternal blood. If antigens are present, it indicates that the mother is a carrier, and the newborn will need to receive hepatitis immune globulin and vaccine soon after birth to prevent transmission. Therefore, choice A is correct. Choices B and C are incorrect because the presence of antigens indicates a positive result, not a negative one or the absence of hepatitis B in the mother. Choice D is incorrect as it suggests the client needs to receive the hepatitis B series of vaccines, which is not the immediate action required when antigens are found in the maternal blood.

2. When working with multicultural populations, the nurse should consider all of the following when planning care for a client with an altered sexuality pattern except:

• A. some Hispanic and Native-American cultures are very open when discussing sexuality.
• B. some cultures view the postpartum period as a state of impurity.
• C. some women in the African-American culture view childbearing as a validation of their femaleness.
• D. some Native-American women believe monthly menstruation maintains physical well-being and harmony.

Correct answer: A

Rationale: When working with multicultural populations, it is essential to understand cultural variations in beliefs and practices related to sexuality. While it is true that some cultures view the postpartum period as a state of impurity and that some women in the African-American culture view childbearing as a validation of their femaleness, the statement 'some Hispanic and Native-American cultures are very open when discussing sexuality' is incorrect. In reality, many cultures, including Hispanic and Native-American cultures, are sometimes hesitant to discuss sexuality. For example, some Navajos, Hispanics, and Orthodox Jews may consider the postpartum period as impure, leading to seclusion of women until the end of bleeding, marked by a ritual bath. Additionally, many Native-American women believe in the importance of monthly menstruation for physical well-being and harmony. Therefore, the statement about Hispanic and Native-American cultures being very open about discussing sexuality is not accurate in the context of working with multicultural populations.

3. All of the following factors, when identified in the history of a family, are correlated with poverty except:

• A. high infant mortality rate
• B. frequent use of Emergency Departments
• C. consultation with folk healers
• D. low incidence of dental problems

Correct answer: D

Rationale: The correct answer is 'low incidence of dental problems.' Dental problems are prevalent in families living in poverty due to the lack of preventive care and access to dental services. High infant mortality rate is closely correlated with poverty as it reflects various social determinants of health. Families in poverty may resort to frequent use of Emergency Departments due to limited access to primary care. Consulting with folk healers is also common among families in poverty as they might seek alternative and more accessible healthcare options. However, a low incidence of dental problems is less likely in families experiencing poverty.

4. The nurse is teaching parents of a newborn about feeding their infant. Which of the following instructions should the nurse include?

• A. Use the defrost setting on microwave ovens to warm bottles.
• B. When refrigerating formula, discard partially used bottles after 24 hours.
• C. When using formula concentrate, mix one part concentrate and two parts water.
• D. If a portion of one bottle is left for the next feeding, discard it.

Correct answer: B

Rationale: The correct answer is to use the defrost setting on microwave ovens to warm bottles. It is crucial to be cautious when heating bottles in a microwave to prevent milk from becoming superheated. The defrost setting is recommended, and the formula's temperature should always be checked before feeding the baby. Choice B, which advises to discard partially used bottles of refrigerated formula after 24 hours, is also correct. This is important to prevent the introduction of pathogens by the baby into the formula. Choice C, recommending mixing one part formula concentrate with two parts water, is essential for ensuring the correct dilution. Choice D, suggesting to discard any remaining portion of a bottle for the next feeding, is incorrect. It is not necessary to discard the remaining portion if it has been refrigerated promptly and used within a safe time frame. Adding fresh formula to a partially used bottle is not recommended, as it can lead to the growth of pathogens that may be transferred to the new formula.

5. An LPN is reviewing medication lists for several clients recently admitted to the hospital. Which of the following scenarios would be least concerning?

• A. A client taking allopurinol for gout states they have been taking black cohosh to help with post-menopausal symptoms.
• B. A client has an order for warfarin and states they have been taking Ginkgo biloba to improve their memory.
• C. A client taking Lipitor states they have been taking ginseng for an energy boost.
• D. A client has a prescription for an SSRI and states they have been taking St. John's wort to also help with their depression.

Correct answer: C

Rationale: The least concerning scenario is when a client taking Lipitor states they have been taking ginseng for an energy boost. While ginseng may cause an increased risk of bleeding, it should not interact with Lipitor. On the other hand, St. John's wort should not be taken with an SSRI as it may cause serotonin syndrome, posing a more serious concern. Black cohosh should not be taken with allopurinol as they can both cause hepatotoxicity, especially in combination. Ginkgo biloba should not be taken with warfarin as it causes an increased risk of bleeding, making it a more concerning scenario compared to the client taking Lipitor and ginseng.

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