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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

An adult client who is ambulating in the corridor with the nurse becomes dizzy and faint. What should the nurse do at this time?

Correct Answer: C

Rationale: Guiding the client to a chair prevents falls and ensures safety during dizziness. Head positioning, seeking help, or faster walking are unsafe or impractical.

Question 3 of 5

The physician has ordered an irrigation of the client's left ear for the removal of cerumen. To prevent vestibular stimulation, the fluid should be degrees Fahrenheit:

Correct Answer: C

Rationale: Cerumen is removed using a mixture of water and hydrogen peroxide at body temperature. Answers A and B are incorrect because they are too cold. Answer D is incorrect because it is too hot.

Question 4 of 5

A client returns from surgery after having a suprapubic prostatectomy. Upon assessing the client, the nurse notes that his urine is bright red with many clots. Which of the following nursing actions is most appropriate?

Correct Answer: B

Rationale: Bright red urine with clots suggests a need to check the continuous bladder irrigation system to ensure it is functioning to prevent clot obstruction.

Question 5 of 5

The home care nurse is observing the client's spouse performing a colostomy irrigation. Which action needs correction?

Correct Answer: D

Rationale: Petroleum jelly is not suitable for lubricating colostomy irrigation catheters, as it may degrade materials or harbor bacteria; water-soluble lubricant is preferred. The height, volume, and position are appropriate.

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