Handling hazardous materials NCLEX-RN Practice Questions

Handling Hazardous Materials NCLEX-RN Practice Questions

When caring for patients, nurses frequently encounter hazardous materials such as cytotoxic drugs, contaminated bodily fluids, biohazardous waste, and occasionally radiologic sources. Safe handling protects patients, staff, and the environment. This topic-wise practice set focuses on essential NCLEX-RN competencies within Safety & Infection Control, including PPE selection and sequence, spill response, waste segregation, use of closed-system transfer devices, SDS interpretation, labeling, transport, and radiation precautions. You will also review vesicant extravasation steps, chemo waste disposal, and patient teaching for home safety after treatment. These questions are written at real NCLEX-RN exam level and are particularly valuable for advanced learners and M. Pharma students who need deeper operational understanding of hazardous materials in clinical settings.

Q1. Upon discovering a fresh chemotherapy spill on the unit floor, what is the nurse’s first action?

• Immediately call the pharmacy to neutralize the drug
• Clear and restrict the area to prevent exposure, then don appropriate PPE
• Wipe the spill with paper towels to prevent spreading
• Place a caution sign and continue routine care

Correct Answer: Clear and restrict the area to prevent exposure, then don appropriate PPE

Q2. Which PPE combination is most appropriate when connecting an IV bag of doxorubicin using a closed-system transfer device (CSTD)?

• Single pair of vinyl exam gloves only
• Double chemotherapy-tested gloves and a disposable, impermeable chemotherapy gown
• Cotton gown and a surgical mask
• Sterile gloves only

Correct Answer: Double chemotherapy-tested gloves and a disposable, impermeable chemotherapy gown

Q3. How should an empty IV bag and tubing that contained a trace amount of chemotherapy be disposed of?

• Red biohazard sharps container
• Black RCRA bulk hazardous waste container
• Designated chemotherapy trace waste container per facility policy
• Regular trash after rinsing the tubing

Correct Answer: Designated chemotherapy trace waste container per facility policy

Q4. Before administering a chemotherapy infusion, how should the nurse ensure the IV tubing is primed?

• Prime the tubing with the chemotherapy agent to reduce air
• Prime the tubing with a compatible, non-drug IV solution before connecting the chemo
• Prime after connecting to the patient to minimize delays
• Ask the patient to cough during priming to reduce exposure

Correct Answer: Prime the tubing with a compatible, non-drug IV solution before connecting the chemo

Q5. A nurse is splashed in the eye with cyclophosphamide during disconnection. What is the priority action?

• Notify the provider, then flush the eye
• Flush the affected eye at an eyewash station for at least 15 minutes, then report the exposure
• Apply antibiotic drops and return to work
• Cover the eye with a sterile pad and go to the ED

Correct Answer: Flush the affected eye at an eyewash station for at least 15 minutes, then report the exposure

Q6. Which document provides standardized information about hazards, safe handling, storage, first aid, and PPE for a chemical used on the unit?

• Medication Administration Record (MAR)
• Safety Data Sheet (SDS)
• Provider order set
• Pharmacokinetics monograph

Correct Answer: Safety Data Sheet (SDS)

Q7. A secondary container is prepared from a bulk chemical. Which labeling action meets OSHA/GHS requirements?

• Leave it unlabeled if only used the same shift
• Label with the patient’s name and room number
• Apply a workplace label with product identifier and hazard warnings
• Use color tape to indicate risk level

Correct Answer: Apply a workplace label with product identifier and hazard warnings

Q8. While caring for a patient receiving temporary brachytherapy, the nurse finds a dislodged radioactive source in the bed. What should the nurse do first?

• Pick it up with gloved hands and place it in biohazard trash
• Use long-handled forceps to place it into a lead-lined container and notify radiation safety
• Wrap it in gauze and keep it at the bedside
• Call housekeeping to remove it

Correct Answer: Use long-handled forceps to place it into a lead-lined container and notify radiation safety

Q9. Which statement should the nurse include when teaching a patient and family about handling excreta after chemotherapy at home?

• It is safe to share a bathroom immediately after treatment
• Wear gloves when handling urine or stool, and double-flush the toilet for at least 48 hours after treatment
• Wash linens with the rest of the household laundry
• Chemo drugs are inactive once they leave the IV

Correct Answer: Wear gloves when handling urine or stool, and double-flush the toilet for at least 48 hours after treatment

Q10. After withdrawing vinblastine into a syringe, how should the nurse dispose of the needle and syringe?

• Recap the needle and place it in a red sharps container
• Remove the needle and discard it separately
• Place the intact needle and syringe immediately into a chemotherapy-labeled puncture-resistant sharps container
• Place it into regular trash after activating a safety device

Correct Answer: Place the intact needle and syringe immediately into a chemotherapy-labeled puncture-resistant sharps container

Q11. The nurse encounters a moderate blood spill in a busy hallway. What is the best initial action?

• Cover the spill with towels and continue patient care
• Restrict traffic around the area and don appropriate PPE before cleanup
• Call environmental services and leave the area open
• Spray air freshener to mask odor

Correct Answer: Restrict traffic around the area and don appropriate PPE before cleanup

Q12. Which disinfectant approach is appropriate for decontaminating a blood spill on a nonporous surface?

• Plain water
• Alcohol wipes only
• EPA-registered disinfectant effective against bloodborne pathogens or a 1:10 bleach solution after initial cleaning
• Soap and water only

Correct Answer: EPA-registered disinfectant effective against bloodborne pathogens or a 1:10 bleach solution after initial cleaning

Q13. The primary purpose of a closed-system transfer device (CSTD) in chemotherapy administration is to:

• Speed up infusion rates
• Prevent aerosolization and leakage during preparation and administration of hazardous drugs
• Replace the need for PPE
• Allow bedside compounding of sterile products

Correct Answer: Prevent aerosolization and leakage during preparation and administration of hazardous drugs

Q14. Which glove type is most appropriate for handling hazardous antineoplastic drugs?

• Chemo-tested nitrile gloves that meet ASTM D6978 standards
• Vinyl exam gloves
• Cloth gloves
• Powdered latex gloves

Correct Answer: Chemo-tested nitrile gloves that meet ASTM D6978 standards

Q15. When should chemotherapy gloves be changed during administration tasks?

• Only if visibly soiled
• Every 30 minutes or immediately if torn, punctured, or contaminated
• At the end of the shift
• After the patient leaves the unit

Correct Answer: Every 30 minutes or immediately if torn, punctured, or contaminated

Q16. After completing a chemotherapy infusion, which PPE removal sequence best minimizes contamination?

• Remove mask first, then gloves, then gown
• Remove outer glove and gown together, then remove inner glove, then perform hand hygiene
• Remove gown, then touch face shield, then gloves
• Keep gloves on while documenting

Correct Answer: Remove outer glove and gown together, then remove inner glove, then perform hand hygiene

Q17. Where should unit stock of hazardous drugs be stored?

• In an open rack at the nurses’ station for quick access
• In the patient’s bedside cabinet
• In a designated, secure, negative-pressure area with appropriate signage
• In the same automated dispensing cabinet as vaccines and eye drops

Correct Answer: In a designated, secure, negative-pressure area with appropriate signage

Q18. A mercury thermometer breaks in an older clinic room. What should the nurse do?

• Vacuum the mercury immediately
• Evacuate the area, don appropriate PPE, use the mercury spill kit, and notify environmental services
• Sweep into a dustpan and discard in regular trash
• Wipe with alcohol pads and reopen the room

Correct Answer: Evacuate the area, don appropriate PPE, use the mercury spill kit, and notify environmental services

Q19. Which action is appropriate for compressed gas cylinder safety on the unit?

• Lay cylinders on their side to prevent tipping
• Secure cylinders upright with a chain or strap to a wall or approved cart
• Store with flammable liquids to save space
• Move by rolling across the floor

Correct Answer: Secure cylinders upright with a chain or strap to a wall or approved cart

Q20. During a small radioactive spill in the imaging suite, the nurse should first:

• Wipe up the spill wearing standard gloves
• Notify the Radiation Safety Officer and restrict access as per facility protocol
• Call pharmacy
• Open windows to ventilate

Correct Answer: Notify the Radiation Safety Officer and restrict access as per facility protocol

Q21. What is the correct method to transport a blood specimen to the lab?

• Carry the uncapped tube in the hand for speed
• Place in a sealed biohazard bag with a leak-proof primary container and visible biohazard symbol
• Place in the nurse’s pocket to avoid dropping
• Send uncovered in the pneumatic tube

Correct Answer: Place in a sealed biohazard bag with a leak-proof primary container and visible biohazard symbol

Q22. The NIOSH hazardous drug list is primarily used to:

• Determine insurance approval for chemotherapy
• Identify drugs that require special handling, PPE, and engineering controls
• Set patient dosing schedules
• Replace SDS requirements

Correct Answer: Identify drugs that require special handling, PPE, and engineering controls

Q23. Which action minimizes aerosol generation when disconnecting IV tubing after a hazardous drug infusion?

• Clamp and quickly pull apart the connection
• Use the CSTD per manufacturer instructions to equalize pressure before disconnection
• Remove connectors with bare hands to feel for pressure
• Aspirate air into the line prior to disconnection

Correct Answer: Use the CSTD per manufacturer instructions to equalize pressure before disconnection

Q24. A patient receiving a vesicant chemotherapy develops signs of extravasation. What is the priority action?

• Remove the IV catheter immediately
• Stop the infusion, aspirate any residual drug through the catheter, leave the catheter in place, and notify the provider
• Apply a cold pack and continue the infusion slowly
• Elevate the limb and reassess in 30 minutes

Correct Answer: Stop the infusion, aspirate any residual drug through the catheter, leave the catheter in place, and notify the provider

Q25. How should linens contaminated with chemotherapy excreta be handled in the hospital?

• Shake out the linens to remove debris, then bag
• Wear gloves and gown, place directly into a leak-proof, labeled bag, and send per facility protocol
• Mix with regular linens to avoid stigma
• Rinse in the patient’s sink before bagging

Correct Answer: Wear gloves and gown, place directly into a leak-proof, labeled bag, and send per facility protocol

Q26. Which statement is correct regarding food and drink in areas where hazardous drugs are handled?

• Permitted if kept on a separate counter
• Permitted for staff hydration during long shifts
• Prohibited in all drug preparation, storage, and handling areas
• Allowed if drinks have lids

Correct Answer: Prohibited in all drug preparation, storage, and handling areas

Q27. A cytotoxic spill exceeds the capacity of the unit spill kit. What should the nurse do?

• Begin cleanup with available towels
• Evacuate and isolate the area, close doors, and activate the facility hazardous materials response
• Cover with absorbent pads and continue patient care
• Ask a nursing assistant to assist with manual cleanup

Correct Answer: Evacuate and isolate the area, close doors, and activate the facility hazardous materials response

Q28. When is a respirator (e.g., fit-tested N95 or PAPR) indicated during hazardous drug spill response?

• Never; surgical masks are sufficient
• Only when odors are present
• When the SDS or spill kit instructions indicate potential aerosolization or inhalation risk
• Only in sterile compounding rooms

Correct Answer: When the SDS or spill kit instructions indicate potential aerosolization or inhalation risk

Q29. A hazardous drug label includes the GHS “health hazard” pictogram (silhouette with starburst on chest). This indicates the substance may cause:

• Acute skin burns only
• Carcinogenicity, reproductive toxicity, or specific target organ toxicity
• Explosions if heated
• Environmental aquatic toxicity

Correct Answer: Carcinogenicity, reproductive toxicity, or specific target organ toxicity

Q30. A capecitabine capsule breaks while the nurse is preparing medications. What is the correct response?

• Scoop the powder with bare hands and discard in regular trash
• Crush remaining pieces and administer with applesauce
• Don chemotherapy-tested gloves, use the hazardous drug spill materials to collect the powder, dispose in chemotherapy waste, and report the incident
• Rinse the capsule under water and re-encapsulate

Correct Answer: Don chemotherapy-tested gloves, use the hazardous drug spill materials to collect the powder, dispose in chemotherapy waste, and report the incident

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