Nursing Elites

1. The nurse is preparing to administer a vaccine to a newborn. Before administering the vaccine, the nurse should

• A. warm the vaccine to room temperature.
• B. gently cleanse the chosen injection site.
• C. check the infant's temperature.
• D. administer the full dose at a single injection site.

Correct answer: C

Rationale: Before administering a vaccine to a newborn, it is essential for the nurse to check the infant's temperature. This is important to ensure that the newborn does not have a fever, which could indicate an underlying infection or illness. Warming the vaccine to room temperature is not necessary and could be harmful. Vigorously massaging the injection site is not recommended as it can cause discomfort and tissue damage. Dividing the dose for administration to three injection sites is not standard practice for vaccine administration to a newborn.

2. During a late-night study session, a pathophysiology student reaches out to turn the page of her textbook. Which component of her nervous system contains the highest level of control of her arm and hand action?

• A. Cerebral cortex
• B. Basal ganglia
• C. Brainstem
• D. Cerebellum

Correct answer: A

Rationale: The correct answer is A: Cerebral cortex. The cerebral cortex, particularly the motor cortex, is responsible for the voluntary control of precise movements such as turning a page. The cerebral cortex plays a crucial role in the highest level of control of motor functions, including those of the arm and hand. Choice B, Basal ganglia, is more involved in motor planning and coordination, while choice C, Brainstem, is responsible for basic life functions and reflexes. Choice D, Cerebellum, is primarily involved in coordination, precision, and accurate timing of movements, rather than the highest level of control for specific actions like page-turning.

3. What clinical manifestations would the nurse expect to find in a client who is experiencing anaphylaxis?

• A. Dilated bronchioles, constriction of peripheral blood vessels, decreased capillary permeability
• B. Asthma, deep vein thrombosis, hepatic encephalopathy
• C. Narrowing of the bronchioles, dilation of the peripheral blood vessels, increased capillary permeability
• D. Left-sided heart failure, pulmonary embolism, urinary tract infection

Correct answer: C

Rationale: In anaphylaxis, the client would present with narrowing of the bronchioles, dilation of the peripheral blood vessels, and increased capillary permeability. These manifestations lead to symptoms such as difficulty breathing, low blood pressure, and swelling. Choices A, B, and D are incorrect because they do not describe the typical clinical manifestations of anaphylaxis.

4. Following the administration of her annual influenza vaccination, a health care worker remains at the clinic for observation due to pain at the injection site. What should the nurse recommend?

• A. ASA
• B. Acetaminophen
• C. Meperidine (Demerol)
• D. Heat application

Correct answer: B

Rationale: The correct recommendation for pain at the injection site after an influenza vaccination is Acetaminophen. Acetaminophen is a suitable choice for managing mild to moderate pain and fever commonly associated with vaccinations. Choice A, ASA (aspirin), is not recommended due to the risk of Reye's syndrome in children and teenagers following viral illnesses. Choice C, Meperidine (Demerol), is a potent opioid analgesic and is not typically indicated for mild pain relief. Choice D, heat application, is not the standard recommendation for pain at an injection site and may not provide adequate relief.

5. How should rifampin most likely be administered to a patient diagnosed with tuberculosis?

• A. Orally, with food
• B. Orally, on an empty stomach
• C. Intramuscularly
• D. Intravenously, as a bolus

Correct answer: A

Rationale: Rifampin is typically administered orally, and it is recommended to be taken with food to enhance its absorption and reduce gastrointestinal side effects. Administering rifampin intramuscularly or intravenously is not the standard route of administration for this medication used in tuberculosis treatment.

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