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: Multiple gestation. Preterm birth is more common in multiple gestation pregnancies due to the increased strain on the mother's uterus and cervix. This can lead to early labor and delivery. Social habits (choice A) and genetic factors (choice B) may play a role in preterm birth but are not highly associated. Chronic conditions (choice D) can also contribute to preterm birth, but multiple gestation is a stronger predictor.

Correct Answer: A

Rationale: The presenting diameter in brow presentation is the submentobregmatic diameter. This is because in brow presentation, the fetal head is partially extended, causing the forehead (bregma) to be the presenting part. The submentobregmatic diameter is the distance between the chin (mentum) and the highest point of the forehead (bregma). This diameter is crucial for successful delivery in brow presentation as it is the smallest diameter that must pass through the maternal pelvis. Summary of other choices: B: Suboccipitofrontal - This diameter is not relevant in brow presentation as it involves the back of the head. C: Occipitalfrontal - This diameter is the distance between the back of the head and the forehead, also not relevant in brow presentation. D: Mentovertical - This diameter is the distance between the chin and the vertex of the head, not the forehead.

Correct Answer: A

Rationale: The correct answer is A: Submentovertival, bitemporal. In a face presentation, the presenting diameters are submentovertival (chin to vertex) and bitemporal (temple to temple). This is because the fetus is in a face-first position with the chin presenting first. Option B is incorrect because submentobregmatic is not a recognized presenting diameter in face presentation. Option C is incorrect as biparietal refers to the widest transverse diameter of the fetal head, not relevant in face presentation. Option D is incorrect as mentovertical is not a valid presenting diameter in face presentation.

Correct Answer: D

Rationale: The correct answer is D: Obturator sign. This finding indicates irritation of the peritoneum and is associated with a ruptured appendix, not acute pancreatitis. A: Severe epigastric pain with radiation to the back is a common presentation of acute pancreatitis, but not necessarily indicative of a seriously ill patient. B: Abdominal guarding and rigidity may suggest peritonitis but are not specific to acute pancreatitis. C: Grey Turner sign, bruising of the flanks, is associated with severe pancreatitis but does not necessarily indicate a seriously ill patient.

Correct Answer: A

Rationale: The presenting diameter in brow presentation is Submentobregmatic (choice A) because it refers to the distance from the submentum (chin) to the bregma (anterior fontanelle). This is the appropriate measurement for the brow presentation as the brow is the prominent part between the forehead and the chin. Choice B (Suboccipitofrontal) is incorrect because it refers to the distance from the subocciput to the frontal bone, which is not relevant to brow presentation. Choice C (Occipitalfrontal) is incorrect because it describes the distance from the occiput to the frontal bone, which again is not specific to brow presentation. Choice D (Mentovertical) is incorrect as it denotes the distance from the chin to the vertex, which is not the relevant measurement for brow presentation.

Correct Answer: B

Rationale: Complete uterine rupture involves a full-thickness disruption of all uterine layers, including the serosa, myometrium, and endometrium. This leads to a complete separation of the uterine wall, potentially resulting in severe bleeding and fetal distress. Choice A is incorrect as it only involves the outermost layer of the uterus. Choice C is incorrect as uterine contractions are usually present during uterine rupture. Choice D is incorrect as the correct definition of complete uterine rupture involves the entire uterine layers being affected.

Correct Answer: A

Rationale: The correct answer is A: A complete blood count and RBC differential. In this case, Mr. Jefferson presents with severe abdominal pain, which could indicate various conditions like pancreatitis, a possible complication of his heavy drinking. A complete blood count (CBC) with RBC differential can help assess for signs of inflammation or infection, which may be elevated in conditions like pancreatitis. The RBC differential can also provide insights into potential causes of abdominal pain, such as anemia or other blood disorders. Summary: - B: Liver function enzymes may be affected in conditions like alcoholic liver disease, but in this case, the focus should be on investigating acute abdominal pain. - C: Serum amylase, lipase, and glucose are typically checked in cases of suspected pancreatitis, but a CBC with RBC differential would provide a more comprehensive initial assessment. - D: A basic metabolic panel may not directly address the underlying cause of the acute abdominal pain and is not the most appropriate test to anticipate

Correct Answer: A

Rationale: The correct answer is A: Six hours postnatally. Cephalohematoma is a collection of blood between a baby's skull and the periosteum. It typically appears several hours after birth due to trauma during delivery, causing bleeding under the periosteum. This allows time for the blood to accumulate and form a distinct swelling, making the onset around six hours postnatally. Choices B, C, and D are incorrect as they do not align with the typical timeline for the development of cephalohematoma.