Safety and Infection Control — NCLEX-RN practice questions

The most important infection-prevention practice in all clinical settings is:

1. Wearing a gown and gloves for every client encounter regardless of the anticipated exposure to blood or body fluids
2. Hand hygiene before and after every client contact, using soap-and-water or appropriate alcohol-based rub
3. Giving prophylactic antibiotics to high-risk clients before any invasive bedside procedure on the unit
4. Wearing sterile gloves for all client contact and changing them between each task at the bedside

Answer: B — Hand hygiene before and after every client contact, using soap-and-water or appropriate alcohol-based rub

B) CDC core IPC measure. A/C/D) Each is supplemental or inappropriate.

Which of the following diseases require droplet precautions? SELECT ALL THAT APPLY.

1. Influenza
2. Pertussis (whooping cough)
3. Tuberculosis
4. Bacterial meningitis (until 24 hours of effective antibiotics)
5. Rubella
6. F) Measles

Answer: ABDE

Correct: A, B, D, E. These are transmitted via larger respiratory droplets requiring droplet precautions. C) Wrong — tuberculosis requires airborne precautions, not droplet. F) Wrong — measles requires airborne precautions, not droplet.

Which nursing action is a priority for a client receiving a stem cell/bone marrow transplant during the pre-engraftment period?

1. Standard precautions only, since the transplanted stem cells begin producing neutrophils soon after the infusion is complete
2. Deferring routine monitoring until engraftment is confirmed by rising blood counts, in order to minimize disturbance and conserve the client's limited energy reserves
3. Encouraging normal, unrestricted visitor access in order to support the client's emotional coping during a long hospitalization
4. Strict infection control precautions (protective isolation), monitoring for signs of infection, and neutropenic precautions given profound immunosuppression

Answer: D — Strict infection control precautions (protective isolation), monitoring for signs of infection, and neutropenic precautions given profound immunosuppression

D) Correct — the pre-engraftment period involves profound immunosuppression, requiring strict infection control/protective isolation and close monitoring. A) Standard precautions alone are insufficient. C) Unrestricted visitor access increases infection risk. B) Close monitoring is essential throughout this vulnerable period.

A new graduate asks why the nurse always verifies two patient identifiers before medication administration, even for patients they know well. What is the BEST response?

1. "It's mostly hospital policy; once you know a patient well, the second identifier doesn't add any real safety value here"
2. "Consistently verifying identifiers, regardless of familiarity, prevents errors caused by assumptions or look-alike situations"
3. "You only need to use two identifiers for high-alert medications, such as insulin, opioids, and anticoagulants"
4. "That step can be skipped when you're running behind, as long as you check the name band afterward"

Answer: B — "Consistently verifying identifiers, regardless of familiarity, prevents errors caused by assumptions or look-alike situations"

B) Correct — consistent practice prevents complacency-related errors, which happen even with familiar patients. A) Dismisses an important safety rationale. C) Two-identifier verification applies to all medications. D) Never appropriate to skip a safety check.

A client receiving chemotherapy has an absolute neutrophil count (ANC) of 400/mm³. Which precaution is MOST appropriate?

1. No added precautions are needed at this level, since the total white blood cell count remains adequate for defense
2. Discontinue infection monitoring now that the chemotherapy cycle is complete and the blood counts will recover on their own
3. Encourage large group visits and shared activities to boost the client's morale during the recovery period
4. Implement neutropenic precautions: private room, strict hand hygiene, avoid fresh flowers/raw produce, restrict ill visitors

Answer: D — Implement neutropenic precautions: private room, strict hand hygiene, avoid fresh flowers/raw produce, restrict ill visitors

D) Correct — an ANC below 500/mm³ generally warrants neutropenic precautions to reduce infection risk. A) This ANC level requires specific precautions. C) Group visits increase infection exposure risk. B) Monitoring remains essential during the neutropenic period.

Which action by the nurse caring for a client with Clostridioides difficile (C. diff) requires correction?

1. Wearing a gown and gloves when entering the room
2. Using soap and water for hand hygiene after client contact
3. Using alcohol-based hand sanitizer after removing gloves
4. Dedicating equipment such as a stethoscope to the room

Answer: C — Using alcohol-based hand sanitizer after removing gloves

C) Correct (this is the wrong action): alcohol-based sanitizer does NOT kill C. diff spores — soap and water is required. A) Correct contact precaution. B) Correct method for spore removal. D) Correct — dedicated equipment prevents environmental spread.

Which type of personal protective equipment is required when caring for a patient with active tuberculosis?

1. Surgical mask and gloves only, since droplet-sized particles are the main route of spread
2. Gown and gloves only, following standard contact precautions for the client's room
3. N95 respirator, gown, gloves, and eye protection (airborne precautions)
4. No PPE is needed as long as the patient remains in a private room with the door closed

Answer: C — N95 respirator, gown, gloves, and eye protection (airborne precautions)

TB transmits via airborne droplet nuclei. Airborne precautions require an N95 (or PAPR) respirator, negative-pressure room, and standard PPE. A surgical mask is insufficient for airborne pathogens (those <5 μm). Contact precautions (B) apply to MRSA, VRE, C. difficile.

Hand hygiene best practice typically requires:

1. Alcohol-based hand rub alone for every indication, including after caring for a client with C. difficile and after removing gloves soiled with body fluids, since alcohol acts faster at the point of care and covers most of the organisms found on the hands
2. Soap and water at every hand hygiene moment throughout the shift, since washing is always more thorough than a hand rub and avoids the skin breakdown and irritation associated with repeated alcohol use
3. Air-drying the hands after washing rather than using disposable paper towels, with hand hygiene performed at the times when the hands look or feel soiled between client contacts and after glove removal
4. Washing hands with soap and water (for visibly soiled hands or C. difficile / spore exposure) or alcohol-based hand rub otherwise — at key moments including before/after client contact, before aseptic tasks, and after exposure to body fluids

Answer: D — Washing hands with soap and water (for visibly soiled hands or C. difficile / spore exposure) or alcohol-based hand rub otherwise — at key moments including before/after client contact, before aseptic tasks, and after exposure to body fluids

D) Standard practice. A) Alcohol rub does not remove C. difficile spores. B) Soap and water is not required at every moment and reduces adherence. C) Drying method is not the standard, and hygiene is not limited to visibly soiled hands.

A nurse is preparing to start an IV on a client. Which action represents the GREATEST risk of needlestick injury and should be avoided?

1. Recapping the needle using a two-handed technique
2. Activating the safety device on the needle immediately after withdrawal
3. Discarding the needle directly into a labeled sharps container at the bedside
4. Wearing gloves during venipuncture

Answer: A — Recapping the needle using a two-handed technique

A) Correct: two-handed recapping is the classic mechanism for self-inflicted needlesticks — recapping is generally prohibited; if required, use a one-handed scoop. B) Safety devices reduce risk. C) Bedside disposal is standard. D) Gloves reduce blood exposure but do not prevent needlestick — included as a half-true distractor.

A client with bacterial meningitis is admitted. Which precautions does the nurse implement?

1. Standard precautions only, with hand hygiene and gloves, since the organism is not spread between people
2. Airborne precautions with an N95 respirator and a negative-pressure room maintained until cultures are final
3. Droplet precautions (surgical mask within 3 feet, private room or cohort) until 24 hours of effective antibiotic therapy
4. Contact precautions with gown and gloves only, continued until the client has completed the entire prescribed antibiotic course

Answer: C — Droplet precautions (surgical mask within 3 feet, private room or cohort) until 24 hours of effective antibiotic therapy

C) Correct: bacterial meningitis (e.g., N. meningitidis) is spread by respiratory droplets; precautions can be discontinued after 24 h of effective therapy. A) Insufficient for a droplet-transmitted organism. B) Airborne is the wrong tier — overshoots and ties up scarce negative-pressure rooms. D) Contact precautions miss the actual route of transmission.

Hepatitis A vs B vs C transmission?

A: fecal-oral. B: blood, sex, perinatal. C: blood (mostly IV drug use).

Standard precautions?

Used for ALL patients. Hand hygiene, gloves, mask if splash risk, etc.

C. diff handwashing?

Soap and water — alcohol-based sanitizers don't kill spores.

Donning PPE order?

Gown → mask/respirator → goggles/face shield → gloves.