QUESTIONS & ANSWERS Plus Rationales
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Questions 1–20: Safety & Infection Control
1. A client is placed on contact precautions. Which personal
protective equipment (PPE) must the nurse wear when
providing direct care?
a) Surgical mask and gloves
b) N95 respirator and gown
c) Gown and gloves
d) Gloves only
Answer: c) Gown and gloves
Rationale: Contact precautions require gown and gloves to
prevent transmission of organisms spread by direct contact. Mask
is not required unless there is risk of splash.
,2. A client with active tuberculosis (TB) is admitted. Which
type of precautions should the nurse implement?
a) Contact precautions
b) Droplet precautions
c) Airborne precautions
d) Standard precautions only
Answer: c) Airborne precautions
Rationale: TB requires airborne precautions (negative pressure
room, N95 respirator, closed door) because the organism is
transmitted via small droplet nuclei that remain airborne.
3. The nurse is preparing to insert an indwelling urinary
catheter for a female client. After positioning the client,
what is the next action the nurse should take?
a) Open the sterile catheter kit
b) Don sterile gloves
c) Clean the meatus with antiseptic solution
d) Assess the client's allergies
Answer: d) Assess the client's allergies
Rationale: Allergy assessment (especially to latex or iodine) must
be completed before any procedure to prevent allergic reaction.
,4. The nurse observes a healthcare provider contaminate a
sterile glove and the sterile field near the end of a sterile
procedure. What is the best action for the nurse to take?
a) Ignore the break since the procedure is nearly complete
b) Identify the break in surgical asepsis and provide another set
of sterile supplies
c) Ask the healthcare provider to leave the room
d) Document the incident after the procedure
Answer: b) Identify the break in surgical asepsis and provide
another set of sterile supplies
Rationale: Any break in sterile technique requires immediate
correction to prevent infection; patient safety is paramount
regardless of how close the procedure is to completion.
5. A client receiving a blood transfusion develops chills,
fever, and back pain. Which action should the nurse take
first?
a) Slow the transfusion rate
b) Stop the transfusion
c) Administer acetaminophen
d) Notify the provider
, Answer: b) Stop the transfusion
Rationale: Suspected hemolytic reaction requires immediate
transfusion cessation; then notify provider and blood bank. Do
not restart transfusion.
6. The nurse is applying a cold compress to a client's
sprained ankle. How long should the compress remain in
place?
a) 5 minutes
b) 20 minutes
c) 45 minutes
d) 1 hour
Answer: b) 20 minutes
Rationale: Cold therapy for 15–20 minutes prevents tissue
damage and reflex vasodilation; longer application can cause
tissue necrosis.
7. A client is placed on fall precautions. Which intervention
is most important?
a) Keep bed in high position
b) Place all four side rails up
c) Ensure call light within reach
d) Apply wrist restraints at night