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. In which of the following settings would a community health nurse be less likely to be involved?

• A. neighborhood clinic, community clinic, or senior center
• B. physician's office with a focus on individual client care
• C. home-based care
• D. neighborhood planning board

Correct answer: B

Rationale: Community health nurses are less likely to be involved in a physician's office with a focus on individual client care because their role primarily revolves around promoting and maintaining the health of populations and communities rather than providing direct care to individual clients. Options A, C, and D are more aligned with the community health nurse's role as they involve working in community-based settings, providing home-based care, and participating in community planning and advocacy.

3. During the care of a client with Legionnaire's disease, which finding would require the nurse's immediate attention?

• A. Pleuritic pain on inspiration
• B. Dry mucus membranes in the mouth
• C. A decrease in respiratory rate from 34 to 24
• D. Decrease in chest wall expansion

Correct answer: D

Rationale: A decrease in chest wall expansion suggests that the client may be experiencing a serious complication, such as worsening pneumonia or respiratory failure, requiring immediate medical attention. This finding indicates a potential decrease in lung function, which could lead to respiratory distress. Pleuritic pain on inspiration may be related to the disease process but does not indicate an immediate need for intervention. Dry mucus membranes in the mouth may require attention but are not as critical as a decrease in chest wall expansion. A decrease in respiratory rate could be concerning but is not as urgent as a decrease in chest wall expansion, which directly impacts respiratory function.

4. James is an 18-month-old child who has had a cough for 7 days with no general danger signs, a temperature of 37.5°C, and a respiratory rate of 41 breaths per minute. How will you classify James' breathing?

• A. Slow breathing
• B. Fast breathing
• C. Normal breathing
• D. Very fast breathing

Correct answer: C

Rationale: The correct answer is 'Normal breathing.' A respiratory rate of 41 breaths per minute is considered normal for an 18-month-old child. Choices A, B, and D are incorrect because a respiratory rate of 41 breaths per minute falls within the normal range for a child of James' age and does not indicate slow, fast, or very fast breathing.

5. The nurse is caring for a child with cystic fibrosis. The nurse would anticipate that the child would be deficient in which vitamins?

• A. B, D, and K
• B. A, D, and K
• C. A, C, and D
• D. A, B, and C

Correct answer: B

Rationale: Children with cystic fibrosis often have difficulty absorbing fat-soluble vitamins (A, D, and K) due to pancreatic insufficiency, making supplementation necessary. Choice A (B, D, and K) is incorrect because vitamin A deficiency is not commonly associated with cystic fibrosis. Choice C (A, C, and D) is incorrect as vitamin C deficiency is not typically related to cystic fibrosis. Choice D (A, B, and C) is incorrect as vitamin B deficiencies are not commonly seen in cystic fibrosis but rather fat-soluble vitamin deficiencies.

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