NRNP 6540 MIDTERM CHAPTER 26
EXAM QUESTIONS AND ANSWERS
GRADED A+ 2025/2026
The nurse in the occupational health clinic prepares to administer the influenza vaccine by nasal
spray to an employee. Which question should the nurse ask before administration of this
vaccine?
A. "Are you allergic to chicken?"
B. "Could you be pregnant now?"
C. "Did you ever have influenza?"
D. "Have you ever had hepatitis B?" - ANS B. "Could you be pregnant now?"
rationale:
The live attenuated influenza vaccine (LAIV) is given by nasal spray and approved for healthy
people age 2 to 49 years. The LAIV is given only to nonpregnant, healthy people. The inactivated
vaccine is given by injection and is approved for use in people 6 months or older. The
inactivated vaccine can be used in pregnancy, in people with chronic conditions, or in people
who are immunosuppressed. Influenza vaccination is contraindicated if the person has a history
of Guillain-Barré syndrome or a hypersensitivity to eggs.
A patient whose tracheostomy was inserted 30 minutes ago is recovering in the postanesthesia
recovery unit when the tracheostomy tube is expelled by coughing. What is the priority action
by the nurse?
A. Suction the tracheostomy opening.
B. Maintain the airway with a sterile hemostat.
C. Use an Ambu bag and mask to ventilate the patient.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,D. Insert the tracheostomy tube obturator into the stoma. - ANS B. Maintain the airway with
a sterile hemostat.
Rationale:
As long as the patient is not in acute respiratory distress after dislodging the tracheostomy tube,
the nurse should use a sterile hemostat to maintain an open airway until a sterile tracheostomy
tube can be reinserted into the tracheal opening. The tracheostomy is an open surgical wound
that has not had time to mature into a stoma. If the patient is in respiratory distress, the nurse
will use an Ambu bag and mask to ventilate the patient temporarily.
The nurse is reviewing the health history of a patient with laryngeal cancer. Which finding would
the nurse expect?
A. Family history of lung cancer
B. Recent inhalation of noxious fumes
C. Frequent straining of the vocal cords
D. Chronic use of alcohol and tobacco products - ANS D. Chronic use of alcohol and tobacco
products
rationale:
Tobacco use causes 85% of head and neck cancers. Excess alcohol use is another major risk
factor. Other risk factors include exposure to the sun, asbestos, industrial carcinogens,
marijuana use, radiation therapy to the head and neck, and poor oral hygiene.
A patient is being discharged from the emergency department after being treated for epistaxis.
In teaching first aid measures in the event the epistaxis would recur, what measures should the
nurse suggest? (Select all that apply.)
A. Tilt patient's head backwards.
B. Apply ice compresses to the nose.
C. Tilt head forward while sitting upright.
D. Pinch the entire soft lower portion of the nose.
E. Lying down until 15 minutes after the bleeding ceases - ANS C. Tilt head forward while
sitting upright.
D. Pinch the entire soft lower portion of the nose.
rationale:
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Use simple first aid measures to control nosebleeds. These include: (1) placing the patient in a
sitting position, leaning slightly forward with head tilted forward and (2) applying direct
pressure by squeezing the entire soft lower portion of the nose (nostrils) together for 5 to 15
minutes. Tilting the head back does not stop the bleeding but allows the blood to enter the
nasopharynx, which could result in aspiration or nausea or vomiting from swallowing blood.
Lying down also will not decrease the bleeding.
The nurse observes clear nasal drainage in a patient newly admitted with facial trauma with a
nasal fracture. What is the nurse's priority action?
A. Test the drainage for the presence of glucose.
B. Suction the nose to maintain airway clearance.
C. Document the findings and continue monitoring.
D. Apply a drip pad and reassure the patient this is normal. - ANS A. Test the drainage for the
presence of glucose.
Clear nasal drainage suggests leakage of cerebrospinal fluid (CSF). The drainage should be
tested for the presence of glucose, which would indicate the presence of CSF. Suctioning should
not be done. Documenting the findings and monitoring are important after notifying the health
care provider. A drip pad may be applied, but the patient should not be reassured that this is
normal.
A patient had an open reduction repair of a bilateral nasal fracture. The nurse plans to
implement an intervention that focuses on both nursing and medical goals for this patient.
Which intervention should the nurse implement?
A. Apply an external splint to the nose.
B. Insert plastic nasal implant surgically.
C. Humidify the air for mouth breathing.
D. Maintain surgical packing in the nose. - ANS D. Maintain surgical packing in the nose.
Rationale:
A goal that is common to nursing and medical management of a patient after rhinoplasty is to
prevent the formation of a septal hematoma and potential infections resulting from a septal
hematoma. Therefore, the nurse helps to keep the nasal packing in the nose. The packing
applies direct pressure to oozing blood vessels to stop postoperative bleeding. A medical goal
includes realigning the fracture with an external or internal splint. The nurse helps maintain the
airway by humidifying inspired air because the nose is unable to do so following surgery
because it is swollen and packed with gauze.
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
EXAM QUESTIONS AND ANSWERS
GRADED A+ 2025/2026
The nurse in the occupational health clinic prepares to administer the influenza vaccine by nasal
spray to an employee. Which question should the nurse ask before administration of this
vaccine?
A. "Are you allergic to chicken?"
B. "Could you be pregnant now?"
C. "Did you ever have influenza?"
D. "Have you ever had hepatitis B?" - ANS B. "Could you be pregnant now?"
rationale:
The live attenuated influenza vaccine (LAIV) is given by nasal spray and approved for healthy
people age 2 to 49 years. The LAIV is given only to nonpregnant, healthy people. The inactivated
vaccine is given by injection and is approved for use in people 6 months or older. The
inactivated vaccine can be used in pregnancy, in people with chronic conditions, or in people
who are immunosuppressed. Influenza vaccination is contraindicated if the person has a history
of Guillain-Barré syndrome or a hypersensitivity to eggs.
A patient whose tracheostomy was inserted 30 minutes ago is recovering in the postanesthesia
recovery unit when the tracheostomy tube is expelled by coughing. What is the priority action
by the nurse?
A. Suction the tracheostomy opening.
B. Maintain the airway with a sterile hemostat.
C. Use an Ambu bag and mask to ventilate the patient.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,D. Insert the tracheostomy tube obturator into the stoma. - ANS B. Maintain the airway with
a sterile hemostat.
Rationale:
As long as the patient is not in acute respiratory distress after dislodging the tracheostomy tube,
the nurse should use a sterile hemostat to maintain an open airway until a sterile tracheostomy
tube can be reinserted into the tracheal opening. The tracheostomy is an open surgical wound
that has not had time to mature into a stoma. If the patient is in respiratory distress, the nurse
will use an Ambu bag and mask to ventilate the patient temporarily.
The nurse is reviewing the health history of a patient with laryngeal cancer. Which finding would
the nurse expect?
A. Family history of lung cancer
B. Recent inhalation of noxious fumes
C. Frequent straining of the vocal cords
D. Chronic use of alcohol and tobacco products - ANS D. Chronic use of alcohol and tobacco
products
rationale:
Tobacco use causes 85% of head and neck cancers. Excess alcohol use is another major risk
factor. Other risk factors include exposure to the sun, asbestos, industrial carcinogens,
marijuana use, radiation therapy to the head and neck, and poor oral hygiene.
A patient is being discharged from the emergency department after being treated for epistaxis.
In teaching first aid measures in the event the epistaxis would recur, what measures should the
nurse suggest? (Select all that apply.)
A. Tilt patient's head backwards.
B. Apply ice compresses to the nose.
C. Tilt head forward while sitting upright.
D. Pinch the entire soft lower portion of the nose.
E. Lying down until 15 minutes after the bleeding ceases - ANS C. Tilt head forward while
sitting upright.
D. Pinch the entire soft lower portion of the nose.
rationale:
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Use simple first aid measures to control nosebleeds. These include: (1) placing the patient in a
sitting position, leaning slightly forward with head tilted forward and (2) applying direct
pressure by squeezing the entire soft lower portion of the nose (nostrils) together for 5 to 15
minutes. Tilting the head back does not stop the bleeding but allows the blood to enter the
nasopharynx, which could result in aspiration or nausea or vomiting from swallowing blood.
Lying down also will not decrease the bleeding.
The nurse observes clear nasal drainage in a patient newly admitted with facial trauma with a
nasal fracture. What is the nurse's priority action?
A. Test the drainage for the presence of glucose.
B. Suction the nose to maintain airway clearance.
C. Document the findings and continue monitoring.
D. Apply a drip pad and reassure the patient this is normal. - ANS A. Test the drainage for the
presence of glucose.
Clear nasal drainage suggests leakage of cerebrospinal fluid (CSF). The drainage should be
tested for the presence of glucose, which would indicate the presence of CSF. Suctioning should
not be done. Documenting the findings and monitoring are important after notifying the health
care provider. A drip pad may be applied, but the patient should not be reassured that this is
normal.
A patient had an open reduction repair of a bilateral nasal fracture. The nurse plans to
implement an intervention that focuses on both nursing and medical goals for this patient.
Which intervention should the nurse implement?
A. Apply an external splint to the nose.
B. Insert plastic nasal implant surgically.
C. Humidify the air for mouth breathing.
D. Maintain surgical packing in the nose. - ANS D. Maintain surgical packing in the nose.
Rationale:
A goal that is common to nursing and medical management of a patient after rhinoplasty is to
prevent the formation of a septal hematoma and potential infections resulting from a septal
hematoma. Therefore, the nurse helps to keep the nasal packing in the nose. The packing
applies direct pressure to oozing blood vessels to stop postoperative bleeding. A medical goal
includes realigning the fracture with an external or internal splint. The nurse helps maintain the
airway by humidifying inspired air because the nose is unable to do so following surgery
because it is swollen and packed with gauze.
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
