NCLEX PN Reduction of Risk Potential Questions

Extract:

Question 1 of 5

The mother calls the nurse to ask when her newborn will be brought back to her room to finish feeding. The mother states that a doctor came about 30 minutes ago to take the baby for an examination and has not returned with her baby. Which action should be taken by the nurse first?

Correct Answer: B

Rationale: The suspicious circumstance of a doctor taking the baby for 30 minutes warrants immediate initiation of abduction procedures to ensure the newborn's safety.

Question 2 of 5

The nurse is caring for the client who received afterload internal radiotherapy (brachytherapy) for treatment of uterine cancer. The nurse manager evaluates that the nurse uses correct hazardous material precautions when noting that the nurse takes which action?

A. Double-bags linens before removing them from the client's room B. Minimizes the amount of time spent in contact with the client C. Maintains a distance of 1 foot away from the client D. Wears lead gloves and apron and a dosimetry badge with client contact

Correct Answer: B

Rationale: Minimizing time spent with the client reduces radiation exposure, a key precaution in brachytherapy.

Question 3 of 5

The orientation nurse educator reviewing the biohazard legend with a class of new employees states that the emblem is affixed to containers whenever:

A. there is presence of blood and body fluids. B. there is the need for droplet precaution. C. there is contact isolation. D. there is the potential for airborne transmission.

Correct Answer: A

Rationale: When body substances are handled, the potential for transmission is increased; therefore, federal regulations require warning labels to communicate with other employees and/or waste collectors. The biohazard alert is a three-ring symbol overlaying a central concentric ring. Blood, drainage from wounds, feces, and urine are all body fluids that can transfer infection and disease to others.

Question 4 of 5

The experienced nurse is observing the new nurse providing care to the hospitalized cheat. Which action requires the experienced nurse to intervene to ensure client safety?

A. Turns on the client's bathroom light and turns out the room lights after settling the client for sleep B. Checks the client's room number and name on the name band to verify client identity prior to giving a medication C. Stirs thickening powder into the glass of juice and cup of milk before giving these to the client who has dysphagia D. Delays the HCP from performing a thoracentesis by calling "a timeout" to verify the client's identity, consent, procedure, and site

Correct Answer: B

Rationale: Room number is not a unique client identifier. The nurse should use two unique identifiers, such as the client's name and medical record number, to verify identity before medication administration.

Question 5 of 5

After securing the client's safety from a faulty electric bed, the nurse should take which action?

A. Discuss the matter with the client's significant others. B. Document the incident in the client's record in detail. C. Notify the physician. D. Prepare an incident report.

Correct Answer: D

Rationale: After the situation is safe for the client, the nurse should record the occurrence on an incident form according to the agency protocol.

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