COMPREHENSIVE REVIEW NCLEX-RN
EXAMINATION FUNDAMENTALS
REVIEW QUESTIONS AND ANSWERS
The nurse is preparing to initiate an intravenous line containing a high dose of
potassium chloride and plans to use an intravenous infusion pump. The nurse brings
the pump to the beside, prepares to plug the pump cord into the wall, and notes that no
receptacle is available in the wall socket. The nurse should take which action?
A.) Initiate the intravenous line without the use of a pump.
B.) Contact the electrical maintenance department for assistance.
C.) Plug in the pump cord in the available plug above the room sink.
D.) Use an extension cord from the nurses' lounge for the pump plug. - Answer-
ANSWER: B.) Contact the electrical maintenance department for assistance.
*Rationale: Electrical equipment must be maintained in good working order and should
be grounded; otherwise it presents a physical hazard.
The nurse obtains a prescription from a health care provider to restrain a client and
instructs an unlicensed assistive personnel (UAP) to apply the safety device to the
client. Which observation by the nurse indicates unsafe application of the safety device
by the UAP?
A.) Placing a safety knot in the safety device straps.
B.) Safely securing the safety device straps to the side rails.
C.) Applying safety device straps that do not tighten when force is applied against them.
D.) Securing so that two fingers can slide easily between the safety device and the
client's skin. - Answer-ANSWER: B.) Safely securing the safety device straps to the side
rails.
* Rationale: The safety device straps are secured to the bed frame and never to the
side rail to avoid accidental injury in the event that the side rail is released.
The community health nurse is providing a teaching session about terrorism to
members of the community and is discussing information regarding anthrax. The nurse
tells those attending that anthrax can be transmitted by which route(s)? * Select all that
apply.*
, A.) Bites from ticks or deer flies.
B.) Inhalation of bacterial spores.
C.) Through a cut or abrasion in the skin.
D.) Direct contact with an infected individual.
E.) Sexual contact with an infected individual.
F.) Ingestion of contaminated under-cooked meat. - Answer-ANSWER:
B.) Inhalation of bacterial spores.
C.) Through a cut or abrasion in the skin.
F.) Ingestion of contaminated under-cooked meat.
* Rationale: Anthrax is caused by Bacillus anthracis and can be contracted through the
digestive system or abrasions in the skin, or inhaled through the lungs. It cannot be
spread from person to person or from animal to person.
The nurse is giving a report to an unlicensed assistive personnel (UAP) who will be
caring for a client who has hand restraints ( safety devices). The nurse instructs the
UAP to check the skin integrity of the restrained hands how frequently?
A.) Every 2 hours.
B.) Every 3 hours.
C.) Every 4 hours.
D.) Every 30 minutes. - Answer-ANSWER: D.) Every 30 minutes.
* Rationale: The neurovascular and circulatory status of the extremity should also be
checked every 30 minutes. In addition , the safety device should be removed at least
every 2 hours to permit muscle exercise and to promote circulation.
The nurse is reviewing a plan of care for a client with an internal radiation implant.
Which intervention if noted in the plan indicates the need for revision of the plan?
A.) Wearing gloves when emptying the client's bedpan.
B.) Keeping all lines in the room until the implant is removed.
C.) Wearing a lead apron when providing direct care to the client.
D.) Placing the client in a semiprivate room at the end of the hallway. - Answer-
ANSWER: D.) Placing the client in a semiprivate room at the end of the hallway.
* Rationale: A private room with a private bath is essential if a client has an internal
radiation implant. This is necessary to prevent accidental exposure of other clients to
radiation. The remaining options identify accurate interventions for a client with an
internal radiation implant and protect the nurse from exposure.
EXAMINATION FUNDAMENTALS
REVIEW QUESTIONS AND ANSWERS
The nurse is preparing to initiate an intravenous line containing a high dose of
potassium chloride and plans to use an intravenous infusion pump. The nurse brings
the pump to the beside, prepares to plug the pump cord into the wall, and notes that no
receptacle is available in the wall socket. The nurse should take which action?
A.) Initiate the intravenous line without the use of a pump.
B.) Contact the electrical maintenance department for assistance.
C.) Plug in the pump cord in the available plug above the room sink.
D.) Use an extension cord from the nurses' lounge for the pump plug. - Answer-
ANSWER: B.) Contact the electrical maintenance department for assistance.
*Rationale: Electrical equipment must be maintained in good working order and should
be grounded; otherwise it presents a physical hazard.
The nurse obtains a prescription from a health care provider to restrain a client and
instructs an unlicensed assistive personnel (UAP) to apply the safety device to the
client. Which observation by the nurse indicates unsafe application of the safety device
by the UAP?
A.) Placing a safety knot in the safety device straps.
B.) Safely securing the safety device straps to the side rails.
C.) Applying safety device straps that do not tighten when force is applied against them.
D.) Securing so that two fingers can slide easily between the safety device and the
client's skin. - Answer-ANSWER: B.) Safely securing the safety device straps to the side
rails.
* Rationale: The safety device straps are secured to the bed frame and never to the
side rail to avoid accidental injury in the event that the side rail is released.
The community health nurse is providing a teaching session about terrorism to
members of the community and is discussing information regarding anthrax. The nurse
tells those attending that anthrax can be transmitted by which route(s)? * Select all that
apply.*
, A.) Bites from ticks or deer flies.
B.) Inhalation of bacterial spores.
C.) Through a cut or abrasion in the skin.
D.) Direct contact with an infected individual.
E.) Sexual contact with an infected individual.
F.) Ingestion of contaminated under-cooked meat. - Answer-ANSWER:
B.) Inhalation of bacterial spores.
C.) Through a cut or abrasion in the skin.
F.) Ingestion of contaminated under-cooked meat.
* Rationale: Anthrax is caused by Bacillus anthracis and can be contracted through the
digestive system or abrasions in the skin, or inhaled through the lungs. It cannot be
spread from person to person or from animal to person.
The nurse is giving a report to an unlicensed assistive personnel (UAP) who will be
caring for a client who has hand restraints ( safety devices). The nurse instructs the
UAP to check the skin integrity of the restrained hands how frequently?
A.) Every 2 hours.
B.) Every 3 hours.
C.) Every 4 hours.
D.) Every 30 minutes. - Answer-ANSWER: D.) Every 30 minutes.
* Rationale: The neurovascular and circulatory status of the extremity should also be
checked every 30 minutes. In addition , the safety device should be removed at least
every 2 hours to permit muscle exercise and to promote circulation.
The nurse is reviewing a plan of care for a client with an internal radiation implant.
Which intervention if noted in the plan indicates the need for revision of the plan?
A.) Wearing gloves when emptying the client's bedpan.
B.) Keeping all lines in the room until the implant is removed.
C.) Wearing a lead apron when providing direct care to the client.
D.) Placing the client in a semiprivate room at the end of the hallway. - Answer-
ANSWER: D.) Placing the client in a semiprivate room at the end of the hallway.
* Rationale: A private room with a private bath is essential if a client has an internal
radiation implant. This is necessary to prevent accidental exposure of other clients to
radiation. The remaining options identify accurate interventions for a client with an
internal radiation implant and protect the nurse from exposure.
