Medication and practice errors, hazards and security

51 NCLEX-RN practice questions on Medication and practice errors, hazards and security, part of Safety and Infection Prevention and Control. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Hard · Matrix

   A nurse is returning infants to their mothers after hearing screens. The mother's band reads 'Baby girl Okafor, 48213'. For each finding, indicate whether the nurse may give the infant to her or must hold the infant.

   For each row, choose: Give the infant / Hold the infant

   1. Infant band: 'Baby girl Okoro, 48213'
   2. Infant band missing; bassinet card reads 'Okafor, 48213'
   3. Infant band: 'Baby girl Okafor, 48213'
   4. Infant band: 'Baby girl Okafor, 48218'

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   Answer:

   • Infant band: 'Baby girl Okoro, 48213': Hold the infant
   • Infant band missing; bassinet card reads 'Okafor, 48213': Hold the infant
   • Infant band: 'Baby girl Okafor, 48213': Give the infant
   • Infant band: 'Baby girl Okafor, 48218': Hold the infant

   Evaluate outcomes: an infant goes to a parent only when both name and number on the infant's band match the parent's band exactly. Any mismatch or missing band means holding the infant and following the identification policy.

   • Infant band: 'Baby girl Okoro, 48213': The name does not match even though the number does.
   • Infant band missing; bassinet card reads 'Okafor, 48213': A bassinet card is not an identifier; the infant must be re-identified per policy.
   • Infant band: 'Baby girl Okafor, 48213': Name and number match on both bands.
   • Infant band: 'Baby girl Okafor, 48218': One digit differs, so the bands do not match.

2. Question 2 · Medium · Select all that apply

   The nurse manager reviews the newborn security plan on a maternity unit. Which elements belong in the plan?

   1. APosting the infant's full name on the door for visitors
   2. BA unit-specific photo badge worn by all maternity staff
   3. CAn electronic security tag on each infant
   4. DMatching ID bands on infant and mother checked at every reunion
   5. EMoving infants in hallways only in their bassinets

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   Answer: B, C, D, E

   Generate solutions: newborn security combines matching bands, electronic tags, distinctive staff badges, bassinet transport and parent teaching. Displaying infants' names publicly helps abductors and is avoided.

   • A: Public names help an abductor pose as family or staff.

3. Question 3 · Hard · Matrix

   The nurse teaches a client and caregiver about oral capecitabine at home. For each instruction, indicate whether it is indicated or contraindicated.

   For each row, choose: Indicated / Contraindicated

   1. Store the tablets in a shared weekly pill organizer
   2. Close the toilet lid before flushing
   3. The caregiver wears gloves to handle the tablets
   4. Wash clothing soiled by body fluids separately
   5. Crush the tablets in food if they are hard to swallow

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   Answer:

   • Store the tablets in a shared weekly pill organizer: Contraindicated
   • Close the toilet lid before flushing: Indicated
   • The caregiver wears gloves to handle the tablets: Indicated
   • Wash clothing soiled by body fluids separately: Indicated
   • Crush the tablets in food if they are hard to swallow: Contraindicated

   Generate solutions: home hazardous drug safety means gloves for caregivers, intact tablets kept in their own container, separate laundering of soiled linen and lid-down flushing. Crushing and mixing with other medicines expose the household.

   • Store the tablets in a shared weekly pill organizer: Hazardous drugs are kept apart from other medicines in their own labeled container.
   • Close the toilet lid before flushing: This limits splashing of drug-containing excreta.
   • The caregiver wears gloves to handle the tablets: Gloves prevent skin contact with a hazardous drug.
   • Wash clothing soiled by body fluids separately: Body fluids carry drug residue for about 48 hours.
   • Crush the tablets in food if they are hard to swallow: Crushing releases hazardous dust; ask the pharmacist about options.

4. Question 4 · Medium · Matrix

   For each event, indicate whether it is a near miss or an error that reached the client.

   For each row, choose: Near miss / Error that reached the client

   1. The scanner warns 'wrong patient' and the nurse stops before giving the dose
   2. A nurse draws up the wrong insulin and a second nurse spots it before injection
   3. Pharmacy sends a double-strength tablet; the nurse catches it before giving it
   4. A scheduled antibiotic is given 3 hours late
   5. A client receives an extra dose of a statin and shows no ill effects

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   Answer:

   • The scanner warns 'wrong patient' and the nurse stops before giving the dose: Near miss
   • A nurse draws up the wrong insulin and a second nurse spots it before injection: Near miss
   • Pharmacy sends a double-strength tablet; the nurse catches it before giving it: Near miss
   • A scheduled antibiotic is given 3 hours late: Error that reached the client
   • A client receives an extra dose of a statin and shows no ill effects: Error that reached the client

   Analyze cues: a near miss is caught before it reaches the client; an error that reaches the client is still an error even with no harm. Both are reported, because near misses show where the system needs another barrier.

   • The scanner warns 'wrong patient' and the nurse stops before giving the dose: The system caught the error before administration.
   • A nurse draws up the wrong insulin and a second nurse spots it before injection: The error was intercepted at the double check.
   • Pharmacy sends a double-strength tablet; the nurse catches it before giving it: The error was stopped before reaching the client.
   • A scheduled antibiotic is given 3 hours late: A late dose is an omission or timing error that reached the client.
   • A client receives an extra dose of a statin and shows no ill effects: The dose was given; no harm does not make it a near miss.

5. Question 5 · Easy · Matrix

   The nurse reviews written medication orders. For each notation, indicate whether it is acceptable or on the Do Not Use list.

   For each row, choose: Acceptable / Do not use

   1. 'MSO4' for morphine sulfate
   2. '0.5 mg' with a leading zero
   3. 'U' for units
   4. 'QD' for daily
   5. '1.0 mg' with a trailing zero

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   Answer:

   • 'MSO4' for morphine sulfate: Do not use
   • '0.5 mg' with a leading zero: Acceptable
   • 'U' for units: Do not use
   • 'QD' for daily: Do not use
   • '1.0 mg' with a trailing zero: Do not use

   Recognize cues: Do Not Use notations (U, IU, QD, QOD, trailing zeros, missing leading zeros, MS, MSO4, MgSO4) cause ten-fold and wrong-drug errors. The nurse clarifies such orders before acting.

   • 'MSO4' for morphine sulfate: MSO4 is confused with magnesium sulfate.
   • '0.5 mg' with a leading zero: A leading zero is required so the decimal is not missed.
   • 'U' for units: U can be misread as 0 or 4; write 'units'.
   • 'QD' for daily: QD is confused with QID; write 'daily'.
   • '1.0 mg' with a trailing zero: A trailing zero may be misread as 10 mg.

6. Question 6 · Medium · Matrix

   For each item, indicate the correct waste container.

   For each row, choose: Sharps container / Hazardous drug waste / Regular trash

   1. Broken glass ampule after drawing up a dose
   2. Paper wrapper from a sterile dressing
   3. Empty IV bag and tubing used for a chemotherapy drug
   4. Insulin pen needle after an injection
   5. Gown and gloves worn to give IV chemotherapy

   Answer and explanation in LearnFree account

7. Question 7 · Hard · Select all that apply

   A client was given an extra, unordered dose of IV vancomycin by mistake. After the provider is informed, which entries should the nurse make in the client's record?

   1. AThe drug, dose, route and time actually given
   2. BThe nurse's assessment findings after the dose
   3. CA note that a safety event report was completed
   4. DThe provider notified, the time and any new orders
   5. EA statement that pharmacy labeling caused the error
   6. FThe client's response to the follow-up care

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8. Question 8 · Medium · Select all that apply

   The nurse is assigned a client with a sealed radioactive implant for cervical cancer. Which actions are appropriate?

   1. AGive a full bed bath each morning
   2. BWear the nurse's own radiation dosimeter badge
   3. CKeep long-handled forceps and a lead container in the room
   4. DPost a radiation warning sign on the door
   5. EPlan care so time in the room is as short as possible
   6. FLend the dosimeter badge to a coworker on the next shift

   Answer and explanation in LearnFree account

9. Question 9 · Medium · Select all that apply

   A client at home uses oxygen by nasal cannula. Which instructions reduce the risk of fire?

   1. AStore the spare cylinder beside the gas stove
   2. BDo not smoke or allow smoking in the home
   3. CUse a water-based lubricant for dry lips and nose
   4. DChoose cotton bedding and clothing over wool
   5. ERun the concentrator on an extension cord to reach the bed
   6. FApply petroleum jelly to the nostrils for dryness

   Answer and explanation in LearnFree account

10. Question 10 · Medium · Select all that apply

    The nurse is to give an IV antineoplastic drug. Which actions reduce the nurse's exposure to the hazardous drug?

    1. AWear a disposable, low-permeability gown closed in the back
    2. BUse a closed-system transfer device for connections
    3. CDiscard used gloves and tubing in the hazardous drug waste bin
    4. DWear a surgical mask to block drug aerosols
    5. EWear two pairs of chemotherapy-tested gloves
    6. FPrime the tubing with the drug at the bedside

    Answer and explanation in LearnFree account

11. Question 11 · Medium · Select all that apply

    The nurse reviews new admission orders. Which orders must the nurse clarify before carrying them out?

    1. APotassium chloride 20 mEq IV push now
    2. BMetoprolol 25 mg
    3. CHeparin 5,000 units subcut every 12 hours
    4. DAcetaminophen 650 mg PO every 6 hours PRN for temperature over 101 °F
    5. EInsulin glargine 10 U at bedtime
    6. FFurosemide 40 mg PO daily

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12. Question 12 · Hard · Select all that apply

    The nurse reviews new orders for an adult client who has never taken opioids. Which orders should the nurse question before giving them?

    1. ADigoxin 0.125 mg PO daily
    2. BHeparin 50,000 units subcut every 8 hours
    3. CAcetaminophen 1,000 mg PO every 8 hours
    4. DMethotrexate 7.5 mg PO daily for rheumatoid arthritis
    5. EHydromorphone 10 mg IV every 2 hours PRN pain
    6. FEnoxaparin 40 mg subcut daily for DVT prophylaxis

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13. Question 13 · Hard · Select all that apply

    About 250 mL of an IV chemotherapy drug has spilled on the floor of a client room. Which actions are part of correct spill management?

    1. AAbsorb the liquid with pads, working from the outer edge inward
    2. BReport the spill and any staff exposure
    3. CRinse the spilled drug into the nearest floor drain
    4. DRestrict the area and warn others to stay away
    5. EPut on the full PPE from the spill kit, including a respirator
    6. FClean the area with detergent, then rinse with water

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14. Question 14 · Medium · Matrix

    A fire is reported in a client room on the unit. For each action, indicate whether it is appropriate or inappropriate.

    For each row, choose: Appropriate / Inappropriate

    1. Close the doors of all client rooms
    2. Activate the nearest fire alarm pull station
    3. Open the windows to let the smoke out
    4. Move clients horizontally beyond the fire doors first
    5. Use the elevators to move clients off the floor

    Answer and explanation in LearnFree account

15. Question 15 · Hard · Select all that apply

    A nurse sees a colleague scanning barcodes from a sheet of client labels kept at the medication cart instead of the clients' wristbands. Which actions should the nurse take?

    1. AReport the practice to the charge nurse
    2. BStop the colleague before the next dose is given
    3. CFile a safety event report on the workaround
    4. DWait to see whether an error actually happens
    5. EPost a warning about the practice on social media

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16. Question 16 · Medium · Matrix

    For each order situation, indicate whether the nurse may accept the order.

    For each row, choose: May accept / Should not accept

    1. A verbal order from the provider leading a cardiac arrest
    2. A telephone order relayed by the unit clerk from the provider
    3. A telephone order the nurse writes down and reads back in full
    4. A telephone order taken by a nursing student
    5. A verbal order to start a new chemotherapy regimen

    Answer and explanation in LearnFree account

17. Question 17 · Hard · Matrix

    For each client, indicate whether the client's urine needs special handling or standard handling.

    For each row, choose: Special handling / Standard handling

    1. A client with a sealed cervical implant in place
    2. A client 12 hours after oral iodine-131 therapy
    3. A client who received IV cyclophosphamide 6 hours ago
    4. A client receiving external beam radiation daily

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18. Question 18 · Medium · Select all that apply

    A new nurse asks about the facility's safety event reports. Which statements by the nurse educator are accurate?

    1. AWrite only objective facts of what happened.
    2. BReport near misses even when no harm occurred.
    3. CNote in the client's chart that a report was filed.
    4. DThe main purpose is to decide on staff discipline.
    5. EThe nurse involved should complete the report promptly.

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19. Question 19 · Medium · Select all that apply

    A client's blood splashes into the nurse's eyes during a dressing change. Which actions should the nurse take?

    1. AWait until the end of the shift to report
    2. BHave the source client's blood tested per policy, with consent
    3. CReport the exposure to the supervisor and employee health
    4. DFlush the eyes at once with clean water or saline
    5. ERinse the eyes with a dilute bleach solution

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20. Question 20 · Easy · Select all that apply

    Which used items should the nurse discard in a puncture-resistant sharps container?

    1. AAn empty plastic medication cup
    2. BGloves with no visible blood on them
    3. CIV tubing after the needle has been removed
    4. DA needle from a subcutaneous injection
    5. EClean outer packaging from an IV kit
    6. FA broken glass ampule

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21. Question 21 · Hard · Select all that apply

    On a maternity unit, which observations should the nurse report to security at once?

    1. AA father with a matching band walking beside the bassinet
    2. BA person in scrubs with no unit badge offering to take an infant for tests
    3. CThe infant's security tag alarm sounding at the stairwell door
    4. DA grandmother with a visitor badge holding the infant in the mother's room
    5. EA visitor asking detailed questions about exit routes and staff shift changes

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22. Question 22 · Hard

    An insulin infusion rate is to be changed. Which process is an independent double check?

    1. AA second RN watches the first nurse set the rate on the pump
    2. BThe first nurse checks the rate twice at different times alone
    3. CA second RN separately works out the rate from the order and pump
    4. DThe first nurse reads the rate aloud and the second RN agrees

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23. Question 23 · Easy

    Information on safe handling and clean-up of a spilled cleaning chemical is found in the product's:

    1. ADisinfection log
    2. BSafety data sheet
    3. CPurchase order
    4. DIncident report form

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24. Question 24 · Medium

    During care, a nurse finds that a client's sealed radioactive implant has fallen out onto the bed linen. The nurse should:

    1. APick it up with gloved hands and push it back into place
    2. BLeave the room and come back at the end of the shift
    3. CPick it up with long-handled forceps and put it in the lead container
    4. DWrap it in the bed linen and send the linen to laundry

    Answer and explanation in LearnFree account

25. Question 25 · Medium

    A nurse needs to take a newborn from the mother's room to the nursery for a hearing screen. The infant should be moved:

    1. ACarried in the nurse's arms
    2. BIn the mother's arms in a wheelchair
    3. CIn a bassinet pushed by the nurse
    4. DCarried by a parent in the hallway

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