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Questions 164

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Question 1 of 5

The nurse in a residence facility for older adults is planning for the year. During which month should the influenza vaccine be offered to the residents?

Correct Answer: C

Rationale: September allows influenza vaccination before the flu season peaks, ensuring immunity. Later or earlier months are less optimal.

Question 2 of 5

The nurse is collecting data on a 2-day-old infant with suspected Hirschsprung disease. Which findings should the nurse anticipate? Select all that apply.

Correct Answer: B,C,D

Rationale: Hirschsprung disease causes intestinal obstruction, leading to a distended abdomen, failure to pass meconium, and nonbilious vomiting. Bright red bleeding suggests other causes (e.g., fissure). Feeding refusal is less specific.

Question 3 of 5

The licensed practical nurse (LPN) assigns the ambulation of a client to unlicensed assistive personnel (UAP). The LPN observes UAP placing the clients Foley bag on the IV pole at the level of the client's chest during client ambulation down the length of the hallway. What action should the LPN take initially?

Correct Answer: A

Rationale: The Foley bag must be kept below bladder level to prevent urine backflow and infection risk. Immediate correction and private education ensure safety and learning without delay.

Question 4 of 5

An adult is taking phenazopyridine hydrochloride (Pyridium) 200 mg PO tid after meals. Which comment by the client indicates a lack of understanding about the medication?

Correct Answer: B

Rationale: Bright orange urine is a normal effect of Pyridium, so concern about it indicates a lack of understanding of the medication's side effects.

Question 5 of 5

The practical nurse is assisting the registered nurse in creating a care plan for a client who is intubated, on mechanical ventilation, and receiving continuous enteral tube feedings via a small-bore nasogastric tube. Which interventions should be included to prevent aspiration in this client? Select all that apply.

Correct Answer: B,C,D,E

Rationale: Elevating the head of the bed (≥30 degrees) reduces reflux, proper cuff pressure seals the airway, monitoring distension detects feed intolerance, and cautious sedation prevents respiratory depression. Residual checks every 4-6 hours are standard, not 12.

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