Guide – Practice Questions
with Verified Answers. GRADED
A+. Latest 2026/2027 Update
A client arrives for a vaccination at an influenza prevention clinic. A nursing
assessment identifies a current febrile illness with a cough. The nurse should:
a. Give the vaccine
b. Administer aspirin with the vaccine
c. Hold the vaccine and notify the health care provider
d. Reschedule administration of the vaccine for the next month - Answer✔✔-
D!
The appropriate response is to delay the administration of the vaccine until the
client is healthy. Vaccines should not be administered during a febrile illness.
Administering an aspirin is a dependent function of the nurse and requires a
,health care provider's prescription. Although holding the vaccine and
administering it after the fever and cough are resolved is appropriate, notifying
the health care provider is not necessary.
A daughter of a Chinese speaking client approaches a nurse and asks multiple
questions while maintaining direct eye contact. What culturally related concept
does the daughter's behavior reflect?
a. Prejudice
b. Stereotyping
c. Assimilation
d. Ethnocentrism - Answer✔✔-C!
Assimilation involves incorporating the behaviors of the dominant culture.
Maintaining eye contact is characteristic of the American culture and not Asian
cultures. Prejudice is a negative belief about another person or group and does
not characterize this behavior. Stereotyping is the perception that all members
of a group are alike. Ethnocentrism is the perception that one's beliefs are
better than those of others.
A client has a hiatal hernia. The client is 5 feet 3 inches tall and weighs 160
pounds. When the nurse discusses prevention of esophageal reflux, what
should be included?
a. "Increase your intake of fat with each meal."
,b. "Lie down after eating to help your digestion."
c. "Reduce your caloric intake to foster weight reduction."
d. "Drink several glasses of fluid during each of your meals." - Answer✔✔-C!
Weight reduction decreases intraabdominal pressure, thereby decreasing the
tendency to reflux into the esophagus. Fats decrease emptying of the stomach,
extending the period that reflux can occur; fats should be decreased. Lying
down after eating increases the pressure against the diaphragmatic hernia,
increasing symptoms. Drinking several glasses of fluid during each meal will
increase the pressure; fluid should be discouraged with meals.
During an interview, the nurse discovers that the spouse of a debilitated,
chronically constipated client digitally removes stool from the client's rectum.
What response to disimpaction is the nurse attempting to prevent by
presenting other strategies to regulate the client's bowel movements?
a. Increased pulse rate
b. Slowing of the heart
c. Dilation of the bronchioles
d. Coronary Artery Vasodilation - Answer✔✔-B!
, Disimpaction can cause vagal stimulation, which slows the heart. The vagus is
the principal nerve of the parasympathetic portion of the autonomic nervous
system, and its axon terminals release acetylcholine. The response of the
viscera to acetylcholine varies, but in general the organ is in a relaxed state.
Increased pulse rate is an action of the sympathetic nervous system
(accelerator nerve) caused by the release of norepinephrine. Stimulation of the
sympathetic nervous system dilates bronchioles in the lungs; the vagus nerve
constricts them. There are parasympathetic fibers to the coronary blood
vessels; sympathetic impulses dilate these vessels.
Test-Taking Tip: You have at least a 25% chance of selecting the correct
response in multiple-choice items. If you are uncertain about a question,
eliminate the choices that you believe are wrong and then call on your
knowledge, skills, and abilities to choose from the remaining responses.
A nurse has just administered an immunization injection to a 2-month-old
infant. What instructions should the nurse give the parent if the infant has a
reaction?
a. Give aspirin for pain; if swelling at the injection site develops, call the health
care provider.
b. Apply heat to the injection site for the first day after the injection; apply ice if
the arm is inflamed.
c. Give acetaminophen for fever; call the health care provider if the child
exhibits marked drowsiness or seizures.
d. Apply ice to the injection site if soreness develops; call the health care
provider if the child comes down with a fever - Answer✔✔-C!