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: C

Rationale: The correct answer is C: Consideration of prophylactic therapy. A 12-mm induration in a healthcare worker is considered positive for PPD. In the absence of active TB on chest radiograph, the next step is to consider prophylactic therapy to prevent the development of active TB. This is based on the guidelines for the management of latent TB infection. Choice A is incorrect as a positive PPD warrants further evaluation regardless of the chest radiograph result. Choice B, the Quantiferon assay, is not the next step after a positive PPD and negative chest radiograph. Choice D, beginning therapy for pulmonary TB pending sputum cultures, is not indicated in this scenario as there is no evidence of active TB.

Correct Answer: C

Rationale: The correct answer is C: Majority are classified as secondary face presentation. In face presentation, the fetal head is hyperextended, presenting the face to the birth canal. Primary face presentation is rare. The bi-parietal diameter is not the presenting diameter in face presentation, as it is in vertex presentation. Locating the anterior fontanelle is not diagnostic of face presentation, as the fontanelles can be difficult to palpate during labor. Therefore, the correct statement is that the majority of face presentations are classified as secondary face presentation.

Correct Answer: C

Rationale: Correct Answer: C - Fine needle aspiration does not allow grading of tumors. Rationale: 1. Fine needle aspiration (FNA) collects cells for cytology evaluation, not tissue for grading. 2. Grading requires evaluation of tissue architecture, which is not possible with FNA. 3. FNA is useful for diagnosis but not for determining tumor grade. Summary: A: Incorrect - Excisional biopsy is preferred over incisional biopsy to obtain the entire tumor for diagnosis and grading. B: Incorrect - Core needle biopsy has a lower false positive rate compared to fine needle aspiration. D: Incorrect - Core needle and incisional biopsies differ in the amount of tissue sampled and potential for false results.

Correct Answer: D

Rationale: Step-by-step rationale for why D is correct: 1. Hyperemesis gravidarum is severe nausea and vomiting during pregnancy. 2. Prolonged vomiting can lead to electrolyte imbalances and nutritional deficiencies. 3. Vitamin B deficiency, specifically thiamine, can result in Wernicke’s encephalopathy. 4. Mallory-Weiss syndrome can occur due to repeated retching and vomiting. 5. Therefore, hyperemesis gravidarum can lead to both Wernicke’s encephalopathy and Mallory-Weiss syndrome. Summary: A: Placenta praevia is related to abnormal placental placement, not vomiting. B: Hypertensive disorders are associated with high blood pressure, not vomiting-related complications. C: Vitamin B deficiency can lead to Wernicke’s encephalopathy but is not directly caused by hyperemesis gravidarum.

Correct Answer: D

Rationale: Step 1: Campylobacter jejuni is a bacteria commonly associated with foodborne illness, often found in undercooked poultry and unpasteurized milk. Step 2: The patient's symptoms and microbiological findings are consistent with Campylobacter infection. Step 3: Advising the patient that there is no readily identified food source of this bacteria is important for preventing future exposure and potential reinfection. Step 4: Choices A, B, and C are incorrect as they do not address the specific educational need related to food safety and prevention of Campylobacter infection.

Correct Answer: D

Rationale: 1. Emotional counseling helps women cope with grief. 2. Explaining causes provides closure and understanding. 3. Supporting future pregnancies ensures better outcomes. 4. All options address different aspects of support needed after stillbirth. 5. Therefore, providing emotional counseling, explaining causes, and supporting future pregnancies collectively offer comprehensive care.

Correct Answer: D

Rationale: The correct answer is D (All of the above) because during pregnancy, UTI symptoms include painful urination, increased frequency of urination, and lower abdominal pain. Painful urination is a common symptom due to inflammation of the urinary tract. Increased frequency of urination is caused by the pressure of the growing uterus on the bladder. Lower abdominal pain can also occur due to the infection. Therefore, all these symptoms are indicative of a UTI during pregnancy. Other choices are incorrect as they do not encompass the comprehensive range of symptoms typically seen in a UTI during pregnancy.

Correct Answer: B

Rationale: Correct Answer: B (Managing as an outpatient case) Rationale: 1. Moderate pre-eclampsia indicates stable condition. 2. Outpatient management allows close monitoring without hospitalization. 3. Early intervention can prevent progression to severe pre-eclampsia. 4. Hospital admission is reserved for severe cases or complications (not moderate). 5. Encouraging fluids is important, but not the specific management for pre-eclampsia.

Correct Answer: C

Rationale: The presenting diameter in brow presentation is the suboccipitofrontal diameter. This is because in brow presentation, the fetal head is in a deflexed position, with the largest diameter being from the subocciput (back of the head) to the frontal bone (forehead). This allows the head to enter the pelvis in the transverse diameter. A: Mentovertical - This refers to the chin to the top of the head, not the correct diameter for brow presentation. B: Submentobregmatic - This refers to the chin to the bregma, not the correct diameter for brow presentation. D: Occipitalfrontal - This refers to the back of the head to the forehead, not the correct diameter for brow presentation.