NCLEX RN Safety and Infection Control Questions

NCLEX RN Safety and Infection Control Questions Related

Review NCLEX RN Safety and Infection Control Questions related questions and content

An emergency department nurse is a member of an all-hazards disaster preparedness planning group. The group is developing a specific emergency response plan in the event that a client with smallpox arrives in the emergency department. Which interventions should initially be included in the plan? Select all that apply.

  • A. Isolate the client.
  • B. Don protective equipment immediately.
  • C. Notify infectious disease specialists, public health officials, and the police.
  • D. Lock down the emergency department and the entire hospital immediately.
  • E. Identify all client contacts, including transport services to the emergency department and clients in the waiting room.
  • F. Administer smallpox vaccines to all hospital staff, client contacts, and clients sitting in the emergency department waiting room immediately.
Correct Answer: A,B,C,E

Rationale: An all-hazards disaster preparedness group is a multifaceted internal and external disaster preparedness group that establishes action plans for every type of disaster or combination of disaster events. In the event of emergency department exposure to a communicable disease such as smallpox, the client would be isolated immediately and the staff would immediately don protective equipment. The emergency department would be locked down immediately. Locking down the entire hospital may not be necessary and infectious disease specialists and public health officials will determine whether it is necessary to take this action. Infectious disease specialists, public health officials, and the police are notified. All client contacts (name, addresses, telephone numbers), including transport services to the emergency department and clients in the waiting room, would be identified so that the public health department can follow through on notifying and treating these individuals appropriately. Although getting the vaccine within 3 days after exposure will help prevent the disease or make it less severe, it is unreasonable and unnecessary to administer smallpox vaccines to all hospital staff, client contacts, and clients sitting in the emergency department waiting room.

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A primary health care provider has written a prescription to administer methylergonovine maleate to a postpartum client. The nurse should contact the primary health care provider to verify the prescription if which condition is present in the mother?

  • A. Hypertension
  • B. Excessive lochia
  • C. Difficulty locating the uterine fundus
  • D. Excessive bleeding and saturation of more than one peripad per hour
Correct Answer: A

Rationale: Methylergonovine maleate is an ergot alkaloid used to treat uterine atony. It is contraindicated for the hypertensive woman, individuals with severe hepatic or renal disease, and during the third stage of labor. Excessive lochia, a uterine fundus that is difficult to locate, and excessive bleeding are clinical manifestations of uterine atony indicating the need for methylergonovine.

The nurse is planning to instruct a client with a diagnosis of chronic vertigo about safety measures to prevent exacerbation of symptoms or injury. Which instruction is most important for the nurse to incorporate in a teaching plan?

  • A. Turn the head slowly when spoken to.
  • B. Remove throw rugs and clutter in the home.
  • C. Drive at times when the client does not feel dizzy.
  • D. Walk to the bedroom and lie down when vertigo is experienced.
Correct Answer: B

Rationale: The client should maintain the home in a clutter-free state and have thrown rugs removed because the effort of trying to regain balance after slipping could trigger the onset of vertigo. To further prevent vertigo attacks, the client should change position slowly and should turn the entire body, not just the head, when spoken to. The client with chronic vertigo should avoid driving and using public transportation. The sudden movements involved in each could precipitate an attack. If vertigo does occur, the client should immediately sit down or lie down (rather than walking to the bedroom) or grasp the nearest piece of furniture.

The nurse places a hospitalized client with a diagnosis of active tuberculosis in a private, well-ventilated isolation room. In addition, which action should the nurse take before entering the client's room?

  • A. Wash the hands.
  • B. Wash the hands and wear a gown and gloves.
  • C. Wash the hands and place a high-efficiency particulate air (HEPA) respirator over the nose and mouth.
  • D. The nurse needs no special precautions, but the client is instructed to cover his or her mouth and nose when coughing or sneezing.
Correct Answer: C

Rationale: Tuberculosis is a highly communicable disease caused by Mycobacterium tuberculosis. The nurse wears a HEPA respirator when caring for a client with active tuberculosis. Hands are always thoroughly washed before and after caring for the client. Option 1 is an incomplete action. Option 2 is also inaccurate and incomplete. Gowning is only indicated when there is a possibility of contaminating clothing. Option 4 is an incorrect statement because special precautions are needed.

The nurse is preparing to administer a first dose of prescribed pentamidine isethionate intravenously to a client. Before administering the dose, which safety measure should the nurse consider for this client?

  • A. Assign to a private room.
  • B. Establish a supine position.
  • C. Place on respiratory precautions.
  • D. Assist to a semi-Fowler's position.
Correct Answer: B

Rationale: Pentamidine isethionate is an antiinfective medication and can cause severe and sudden hypotension, even with administration of a single dose. The client should be lying down during administration of this medication. The blood pressure is monitored frequently during administration. Assigning to a private room, instituting respiratory precautions, or assisting to a semi-Fowler position are all unnecessary interventions.

The nurse is assigned to care for a client who is in traction. Which intervention by the nurse should ensure a safe environment for the client?

  • A. Making sure that the knots are at the pulleys sites
  • B. Checking the weights to be sure that they are off the floor
  • C. Making sure that the head of the bed is kept at a 90-degree angle
  • D. Monitoring the weights to be sure that they are resting on a firm surface
Correct Answer: B

Rationale: To achieve proper traction, weights need to be free-hanging, with knots kept away from the pulleys. The head of the bed is usually kept low to provide countertraction. Weights are not to be kept resting on a firm surface.

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