UWorldvnNCLEX-RNvnTESTvn2
Avnnursevncoworkervnisvncalledvnintovnworkvnfromvnhomevntovnhelpvncarevnforvna
nvninfluxvnofvnclientsvnbeingvnadmittedvnaftervnavnbusvnaccident.vnWhilevnassisti
ngvnthevncoworkervnpreparevnforvnincomingvnclients,vnthevnnursevnbecomesvnco
ncernedvnthatvnthevncoworkervnmayvnbevnundervnthevninfluencevnofvnanvnimpairi
ngvnsubstance.vnWhichvnactionvnbyvnthevnnursevnisvnbest?
1.
Askvnanothervncoworkervntovnobservevnthevnindividualvntovnconfirmvnthevnsuspi
cion
2.
Confrontvnthevncoworkervnaboutvnthevnconcernvnandvnoffervnemotionalvnsuppo
rt
3.
Speakvnwithvnthevnnursingvnsupervisorvnaboutvnthevnconcern
4.
Telephonevnthevnappropriatevnregulatoryvnagencyvnandvnmakevnavnreportvn-
vncorrectvnanswer✔ ✔ 3.
Avnnursevnisvnadministeringvnavnrituximabvninfusionvntovnavnclientvnwithvnlymp
homavninvnanvnoncologyvnclinic.vnWhichvnclientvnsymptomvnwouldvnbevnavnprio
rityvntovnreportvntovnthevnhealthvncarevnprovider?
1.
Dizzinessvnandvnsuddenvndiarrhea
,2.
Nauseavnandvnonsetvnofvnvomiting
3.
New-onsetvntachypneavnandvndyspnea
4.
Temperaturevnofvn101vnFvn(38.3vnC)vn-vncorrectvnanswer✔ ✔ 3.
ThevnstudentvnnursevnplansvnpostmortemvncarevnforvnanvnOrthodoxvnJewishvncli
entvnhospitalizedvnforvnthevnlastvnweekvnwithvnheartvnfailurevnwhovndidvnnotvnsig
nvnconsentsvnforvnanyvnpostmortemvnactions.vnWhichvnstatementvnbyvnthevnstud
entvnwouldvnrequirevnfurthervneducationvnbyvnthevnsupervisingvnnurse?
1.
"Ivnwillvnallowvnthevnfamilyvntovnremainvnwithvnthevnclientvnatvnallvntimes."
2.
"Ivnwillvncallvnthevnnextvnofvnkinvnbeforevnprovidingvnanyvnpostmortemvncare."
3.
"Ivnwillvnpreparevnthevnclientvnforvntransfervntovnthevnmorguevnforvnautopsy."
4.
"Ivnwillvnprovidevnavnsheetvntovnbevnplacedvnovervnthevnclient'svnface."vn-
vncorrectvnanswer✔ ✔ 3.
,Thevnnursevnisvncaringvnforvnavnclientvnwithvnchronicvnpancreatitis.vnWhichvnme
alvnshouldvnthevnnursevnrecommendvnwhenvnassistingvnthevnclientvninvnselectin
gvnfoodvnitemsvnfromvnavnmenu?
1.
Bakedvntilapiavnwithvnlemonvnwedge,vnsweetvnpotatoes,vnandvngreenvnpeas
2.
Creamvnofvnpotatovnsoupvnandvnroastvnbeefvnsandwichvnonvnavncroissant
3.
Sautéedvnsalmon,vnmacaronivnandvncheese,vnstringvnbeans,vnandvnavnbiscuit
4.
Shrimpvnenchiladasvnwithvntomatovnsalsa,vnrice,vncornbread,vnandvnrefriedvnbe
ansvn-vncorrectvnanswer✔ ✔ 1.
Thevnnursevnisvnpreparingvntovnchangevnthevndressingvnofvnavnclient'svnsubclavia
nvncentralvnvenousvncathetervnusingvnavnchlorhexidinevngluconatevn(CHG)-
impregnatedvnpatchvnandvntransparentvnadhesivevndressing.vnPlacevnthevnproce
duralvnstepsvninvnthevncorrectvnorder.vnAllvnoptionsvnmustvnbevnused.
ApplyvnCHGvnpatchvnovervncathetervninsertionvnsitevnandvncovervnwithvnavnsteri
levntransparentvndressing
CleansevnthevnsitevnwithvnCHGvnforvnatvnleastvn30vnsecondsvnusingvnfriction;vnall
owvntovnairvndryvncompletely
, Discardvnthevncleanvngloves,vnperformvnhandvnhygiene,vnandvnapplyvnsterilevngl
oves
Performvnhandvnhygiene,vndonvnfacevnmask,vnplacevnavnmaskvnonvnthevnclient,vna
ndvnapplyvncleanvngloves
RemovevnoldvndressingvnandvnCHG-
impregnatedvnpatch;vnassessvninsertionvnsitevn-vncorrectvnanswer✔ ✔
Performvnhandvnhygiene,vndonvnfacevnmask,vnplacevnavnmaskvnonvnthevnclient,
vnandvnapplyvncleanvngloves
RemovevnoldvndressingvnandvnCHG-
impregnatedvnpatch;vnassessvninsertionvnsite
Discardvnthevncleanvngloves,vnperformvnhandvnhygiene,vnandvnapplyvnsterilevngl
oves
CleansevnthevnsitevnwithvnCHGvnforvnatvnleastvn30vnsecondsvnusingvnfriction;vnall
owvntovnairvndryvncompletely
ApplyvnCHGvnpatchvnovervncathetervninsertionvnsitevnandvncovervnwithvnavnsteri
levntransparentvndressing
Avnnursevncoworkervnisvncalledvnintovnworkvnfromvnhomevntovnhelpvncarevnforvna
nvninfluxvnofvnclientsvnbeingvnadmittedvnaftervnavnbusvnaccident.vnWhilevnassisti
ngvnthevncoworkervnpreparevnforvnincomingvnclients,vnthevnnursevnbecomesvnco
ncernedvnthatvnthevncoworkervnmayvnbevnundervnthevninfluencevnofvnanvnimpairi
ngvnsubstance.vnWhichvnactionvnbyvnthevnnursevnisvnbest?
1.
Askvnanothervncoworkervntovnobservevnthevnindividualvntovnconfirmvnthevnsuspi
cion
2.
Confrontvnthevncoworkervnaboutvnthevnconcernvnandvnoffervnemotionalvnsuppo
rt
3.
Speakvnwithvnthevnnursingvnsupervisorvnaboutvnthevnconcern
4.
Telephonevnthevnappropriatevnregulatoryvnagencyvnandvnmakevnavnreportvn-
vncorrectvnanswer✔ ✔ 3.
Avnnursevnisvnadministeringvnavnrituximabvninfusionvntovnavnclientvnwithvnlymp
homavninvnanvnoncologyvnclinic.vnWhichvnclientvnsymptomvnwouldvnbevnavnprio
rityvntovnreportvntovnthevnhealthvncarevnprovider?
1.
Dizzinessvnandvnsuddenvndiarrhea
,2.
Nauseavnandvnonsetvnofvnvomiting
3.
New-onsetvntachypneavnandvndyspnea
4.
Temperaturevnofvn101vnFvn(38.3vnC)vn-vncorrectvnanswer✔ ✔ 3.
ThevnstudentvnnursevnplansvnpostmortemvncarevnforvnanvnOrthodoxvnJewishvncli
entvnhospitalizedvnforvnthevnlastvnweekvnwithvnheartvnfailurevnwhovndidvnnotvnsig
nvnconsentsvnforvnanyvnpostmortemvnactions.vnWhichvnstatementvnbyvnthevnstud
entvnwouldvnrequirevnfurthervneducationvnbyvnthevnsupervisingvnnurse?
1.
"Ivnwillvnallowvnthevnfamilyvntovnremainvnwithvnthevnclientvnatvnallvntimes."
2.
"Ivnwillvncallvnthevnnextvnofvnkinvnbeforevnprovidingvnanyvnpostmortemvncare."
3.
"Ivnwillvnpreparevnthevnclientvnforvntransfervntovnthevnmorguevnforvnautopsy."
4.
"Ivnwillvnprovidevnavnsheetvntovnbevnplacedvnovervnthevnclient'svnface."vn-
vncorrectvnanswer✔ ✔ 3.
,Thevnnursevnisvncaringvnforvnavnclientvnwithvnchronicvnpancreatitis.vnWhichvnme
alvnshouldvnthevnnursevnrecommendvnwhenvnassistingvnthevnclientvninvnselectin
gvnfoodvnitemsvnfromvnavnmenu?
1.
Bakedvntilapiavnwithvnlemonvnwedge,vnsweetvnpotatoes,vnandvngreenvnpeas
2.
Creamvnofvnpotatovnsoupvnandvnroastvnbeefvnsandwichvnonvnavncroissant
3.
Sautéedvnsalmon,vnmacaronivnandvncheese,vnstringvnbeans,vnandvnavnbiscuit
4.
Shrimpvnenchiladasvnwithvntomatovnsalsa,vnrice,vncornbread,vnandvnrefriedvnbe
ansvn-vncorrectvnanswer✔ ✔ 1.
Thevnnursevnisvnpreparingvntovnchangevnthevndressingvnofvnavnclient'svnsubclavia
nvncentralvnvenousvncathetervnusingvnavnchlorhexidinevngluconatevn(CHG)-
impregnatedvnpatchvnandvntransparentvnadhesivevndressing.vnPlacevnthevnproce
duralvnstepsvninvnthevncorrectvnorder.vnAllvnoptionsvnmustvnbevnused.
ApplyvnCHGvnpatchvnovervncathetervninsertionvnsitevnandvncovervnwithvnavnsteri
levntransparentvndressing
CleansevnthevnsitevnwithvnCHGvnforvnatvnleastvn30vnsecondsvnusingvnfriction;vnall
owvntovnairvndryvncompletely
, Discardvnthevncleanvngloves,vnperformvnhandvnhygiene,vnandvnapplyvnsterilevngl
oves
Performvnhandvnhygiene,vndonvnfacevnmask,vnplacevnavnmaskvnonvnthevnclient,vna
ndvnapplyvncleanvngloves
RemovevnoldvndressingvnandvnCHG-
impregnatedvnpatch;vnassessvninsertionvnsitevn-vncorrectvnanswer✔ ✔
Performvnhandvnhygiene,vndonvnfacevnmask,vnplacevnavnmaskvnonvnthevnclient,
vnandvnapplyvncleanvngloves
RemovevnoldvndressingvnandvnCHG-
impregnatedvnpatch;vnassessvninsertionvnsite
Discardvnthevncleanvngloves,vnperformvnhandvnhygiene,vnandvnapplyvnsterilevngl
oves
CleansevnthevnsitevnwithvnCHGvnforvnatvnleastvn30vnsecondsvnusingvnfriction;vnall
owvntovnairvndryvncompletely
ApplyvnCHGvnpatchvnovervncathetervninsertionvnsitevnandvncovervnwithvnavnsteri
levntransparentvndressing
