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. Which level of care serves as a referral center for primary health facilities?

• A. Secondary level health care
• B. Primary health care
• C. Tertiary level care
• D. Intermediate level care

Correct answer: A

Rationale: Secondary level health care is the correct answer as it serves as a referral center for primary health facilities. Primary health care refers to basic health services provided in the community setting. Tertiary level care involves specialized services like hospitals with advanced medical equipment and expertise. Intermediate level care is not a standard term in the hierarchy of health care services.

3. An example of individual influences on health status would be:

• A. Cigarette smoking
• B. A parent with adult-onset diabetes
• C. Exposure to toxic substances in the workplace
• D. All of the above

Correct answer: D

Rationale: The correct answer is 'D' because all the listed factors - cigarette smoking, a parent with adult-onset diabetes, and exposure to toxic substances in the workplace - can individually influence a person's health status. Cigarette smoking directly impacts health by increasing the risk of various diseases. Having a parent with adult-onset diabetes can also influence one's health due to genetic predisposition and lifestyle factors. Exposure to toxic substances in the workplace can lead to health issues. Choices A, B, and C are not mutually exclusive but rather represent different aspects of individual influences on health status, making 'D' the most comprehensive and accurate answer.

4. The nurse is assessing a client with portal hypertension. Which of the following findings would the nurse expect?

• A. Expiratory wheezes
• B. Blurred vision
• C. Ascites
• D. Dilated pupils

Correct answer: C

Rationale: Ascites is a common finding in clients with portal hypertension. Portal hypertension results in increased pressure in the portal vein, leading to the development of ascites, which is the accumulation of fluid in the abdominal cavity. Expiratory wheezes (Choice A) are associated with respiratory conditions. Blurred vision (Choice B) is more commonly linked to eye disorders or neurological issues. Dilated pupils (Choice D) can be related to neurological conditions or drug effects, but not specifically to portal hypertension.

5. In the provision of preventive care to workers, the nurse must be aware of biological hazards that are harmful to workers and their families, such as:

• A. bacteria, fungi, and insects
• B. noise
• C. toxic metals, poisonous gas fumes, and dust
• D. stress

Correct answer: A

Rationale: The correct answer is A: bacteria, fungi, and insects. Biological hazards in the workplace can include microorganisms like bacteria and fungi that can cause infections, as well as insects that may carry diseases. Noise (choice B) is considered a physical hazard, not a biological one. Toxic metals, poisonous gas fumes, and dust (choice C) are examples of chemical hazards, not biological hazards. While stress (choice D) can be a health concern in the workplace, it is not classified as a biological hazard.

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