NCLEX-PN
Reduction of Risk Potential NCLEX PN Questions
Question 1 of 5
In a disaster, triage situation, the nurse should be least concerned with which of the following regarding a client in crisis?
Correct Answer: C
Rationale: The least important factor (of those listed) during an emergency situation is the number of accompanying family members.
Question 2 of 5
The nurse sustains a needle puncture that requires HIV prophylaxis. Which of the following medication regimens should be used?
Correct Answer: B
Rationale: Unless there is drug resistance, the initial prophylaxis based on CDC recommendations is 2 NNRTIs.
Question 3 of 5
A client has been placed in isolation because he is diagnosed with a contagious illness. The nurse should be aware that:
Correct Answer: A
Rationale: Linens should be double-bagged. Isolation refers to techniques used to prevent or to limit the spread of infection. Some form of isolation has been used for centuries, whether to protect a high-risk person from exposure to pathogens or to prevent the transmission of pathogens from an infected person to others. Special handling of articles and linen soiled by any body fluid is indicated. These articles should be placed in impervious bags before they are removed from the client's bedside. Bagging in watertight containers is indicated to prevent exposure of personnel and contamination of the environment. The outside of the bag should not be contaminated when placing articles inside it. Each hospital and community agency has procedures for labeling and decontaminating exposed articles. Items that are visibly soiled with body substances should be rinsed and placed in plastic bags or clearly marked containers, often labeled 'Contaminated.' If the outside of the bag becomes contaminated, placing that bag in another bag (double-bagging) is required.
Question 4 of 5
When a drug is listed as Category X and prescribed to women of child-bearing age/capacity, the nurse and the interdisciplinary team should counsel the client that:
Correct Answer: B
Rationale: Category X drugs have many practice limitations when prescribed and dispensed to women. For example, the prescription is valid for only seven days, and if not filled, it expires. The FDA provides a pregnancy-prevention program for clients taking Isotretinoin (Accutane). Prior to prescribing a Category X drug, a pregnancy test should be performed.
Question 5 of 5
The nurse should perform which intervention when a client is restrained?
Correct Answer: C
Rationale: The minimum standard is to visually assess the restraint every 30 minutes. Documentation is typically performed per a checklist or flow sheet. The ends of the restraint are tied to a part of the bed that allows for position changes without unfastening them.