which practice will help to reduce the risk of a needlestick injury

NCLEX-RN

NCLEX RN Actual Exam Test Bank

1. Which practice will help reduce the risk of a needlestick injury?

A. Expose the end of the needle only when ready to enter the room for the procedure
B. Never recap a needle after use
C. Keep a sharps container nearby where it can be easily accessed
D. Exchange needles from a central area rather than passing them between workers

Correct answer: C

Rationale: To reduce the risk of a needlestick injury, it is essential to keep a sharps container nearby where it can be easily accessed. This practice ensures quick and safe disposal of needles after use, minimizing the chances of accidental needlesticks. Recapping needles should be avoided as it increases the risk of injuries. Passing needles between workers should also be avoided to prevent accidental needle pricks during handovers. Therefore, the best practice to prevent needlestick injuries is to maintain a sharps container nearby for safe and immediate disposal of needles.

2. In addition to standard precautions, the nurse caring for a patient with rubella would plan to implement what type of precautions?

A. Droplet precautions
B. Airborne precautions
C. Contact precautions
D. Universal precautions

Correct answer: A

Rationale: Rubella is an illness transmitted by large-particle droplets, so the nurse should implement droplet precautions in addition to standard precautions. Airborne precautions are used for diseases spread through small particles in the air, such as tuberculosis, varicella, and rubeola. Contact precautions are utilized for diseases transmitted by direct contact with the patient or their environment. Universal precautions and body substance isolations are part of the CDC's standard precautions recommendations, but do not specifically address the transmission route of rubella.

3. Nursing care plans contain which of the following?

A. nursing diagnoses
B. medical diagnoses.
C. MD orders.
D. intake and output forms

Correct answer: A

Rationale: Nursing care plans are legal documents that contain nursing diagnoses, such as an "Alteration of respiratory function". They also contain patient goals and nursing interventions.

4. After receiving change-of-shift report, which patient should the nurse assess first?

A. A patient with pneumonia who has crackles in the right lung base
B. A patient with possible lung cancer who has just returned after bronchoscopy
C. A patient with hemoptysis and a 16-mm induration with tuberculin skin testing
D. A patient with chronic obstructive pulmonary disease (COPD) and pulmonary function testing (PFT) that indicates low forced vital capacity

Correct answer: B

Rationale: The correct answer is the patient with possible lung cancer who has just returned after bronchoscopy. After bronchoscopy, the patient may have decreased cough and gag reflexes, necessitating immediate assessment for airway patency to prevent potential complications. The other patients do not exhibit urgent clinical manifestations or have undergone recent procedures that require immediate attention. Therefore, they can be assessed after ensuring the safety and stability of the patient who has just returned after bronchoscopy.

5. A client has died approximately one hour ago. The nurse notes that the client's temperature has decreased in the last hour since their death. Which of the following processes explains this phenomenon?

A. Rigor mortis
B. Postmortem decomposition
C. Algor mortis
D. Livor mortis

Correct answer: C

Rationale: Algor mortis occurs after death when the body's circulation stops, and the client's temperature begins to fall. The client's temperature will drop by approximately 1.8 degrees per hour until it reaches room temperature. During algor mortis, the client's skin gradually loses its elasticity. Rigor mortis refers to the stiffening of the body after death due to chemical changes in the muscles. Postmortem decomposition is the breakdown of tissues after death. Livor mortis is the pooling of blood in the dependent parts of the body, causing a purple-red discoloration.