Jennifer is an RN applicant for a staff nurse position in the surgical ICU. She has had a screening PPD and comes back in 48 hours to have it read. There is a 12-mm induration at the site of injection. A chest radiograph is negative. The AGACNP knows that the next step in Jennifers evaluation and management should include

Correct Answer: A

Rationale: The correct answer is A: No further care, because the chest radiograph is negative. In this scenario, Jennifer has a positive PPD test with a 12-mm induration but a negative chest radiograph, indicating latent TB infection. The negative chest radiograph rules out active TB disease. As a result, Jennifer does not require further evaluation or treatment for active TB. The positive PPD alone does not warrant further investigations such as Quantiferon assay (B) or prophylactic therapy (C) as these are not indicated for latent TB infection without active disease. Beginning therapy for pulmonary TB (D) is unnecessary and potentially harmful as Jennifer does not have active TB. Thus, the correct course of action is to provide no further care based on the negative chest radiograph.

Correct Answer: D

Rationale: The correct initial action for the AGACNP is to provide counseling to the patient regarding her options (Choice D). This is important to ensure the patient's safety, well-being, and autonomy. Counseling will allow the patient to explore her feelings, understand her options, and make an informed decision about her next steps. Reporting the physical assault to law enforcement (Choice A) should only be done with the patient's consent to respect her wishes. Having the patient sign a release to go home with her husband (Choice B) could potentially put the patient at risk of further harm. Consulting psychiatry for a psych hold (Choice C) may not be appropriate unless the patient is deemed a danger to herself or others.

Correct Answer: C

Rationale: The correct answer is C: Protein intake of 50 g daily. In hepatic encephalopathy, reducing protein intake is crucial to prevent ammonia accumulation. Protein breakdown in the body leads to ammonia production, which worsens encephalopathy symptoms. Limiting protein intake to 50g daily helps decrease ammonia formation. Lactulose (choice A) is used to reduce ammonia absorption in the gut. Spironolactone (choice B) is a diuretic used to treat fluid retention in liver disease. Zolpidem (choice D) is a sedative and not related to managing ammonia accumulation in hepatic encephalopathy. Therefore, choices A, B, and D are incorrect for long-term management of ammonia accumulation in hepatic encephalopathy.

Correct Answer: A

Rationale: The correct answer is A: Ventral displacement. In ventral displacement hypospadias, the urethral opening is located on the underside of the penis, making it necessary to defer circumcision to preserve the prepuce for later surgical repair. Preserving the prepuce in this case is important for reconstructive surgery to correct the hypospadias. Choices B, C, and D do not require deferring circumcision as the location of the urethral opening does not impact the need for prepuce preservation for future surgical repair.

Correct Answer: B

Rationale: The correct answer is B: Infuse albumin and fresh frozen plasma. Given Janet's post-hepatic resection status and abnormal lab values indicating liver dysfunction (elevated bilirubin, low albumin, prolonged prothrombin time, elevated AST and ALT), she is at risk for coagulopathy and hypoalbuminemia. Infusing albumin can help improve her oncotic pressure and fluid balance, while fresh frozen plasma can replenish clotting factors to address the prolonged prothrombin time. This intervention aims to stabilize her condition before transferring to the general medical floor. Canceling the transfer (Choice A) is not necessary if appropriate interventions can be taken. Repeating labs the next day (Choice C) delays potentially needed treatments. Preparing for reoperation (Choice D) is not indicated based on the information provided.