Free NCLEX-RN Safety and Infection Control questions
22 original Safety and Infection Control questions on accident, error and injury prevention, emergency response / disaster, hazardous and infectious materials, incident / error reporting, standard/transmission-based precautions, asepsis, restraints and safety devices, in Next Generation NCLEX formats.
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NCLEX-RN Safety and Infection Control questions
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A client with a productive cough is admitted, and the provider documents suspected pulmonary tuberculosis. Which room placement and staff protection should the nurse arrange?
Correct answer: C
Suspected or confirmed pulmonary tuberculosis requires airborne precautions plus standard precautions. The client goes into an airborne infection isolation room with the door closed, and staff wear a fit-tested N95 or higher respirator. Precautions start on suspicion; the nurse does not wait for sputum results.
- A A surgical mask is droplet-level protection and does not protect staff from airborne tuberculosis particles; the door should also stay closed.
- B Gown and gloves are contact precautions, and a curtain does not stop airborne particles from reaching a roommate.
- C Correct: tuberculosis spreads by small airborne particles, so the client needs an airborne infection isolation room and staff need a fit-tested N95 respirator.
- D A face shield with gown and gloves does not filter airborne particles; a fit-tested respirator is required.
Learn this topic: Which isolation precautions does each infection need? 5-minute lesson
Source: CDC Isolation Precautions Guideline, Appendix A: Type and Duration of Precautions · CDC: Transmission-Based Precautions ·
The nurse is reviewing new admissions on a medical unit. For each client's condition, select the transmission-based precaution the nurse should implement in addition to standard precautions.
Contact Droplet Airborne Clostridioides difficile diarrhea Pertussis Measles (rubeola) Meningococcal meningitis Scabies Suspected pulmonary tuberculosis Select one option in each row.
Correct answer: Clostridioides difficile diarrhea: Contact; Pertussis: Droplet; Measles (rubeola): Airborne; Meningococcal meningitis: Droplet; Scabies: Contact; Suspected pulmonary tuberculosis: Airborne
Match the precaution to how the organism travels. Organisms spread by touch or contaminated surfaces (C. difficile, scabies) need contact precautions; organisms spread in large respiratory droplets (pertussis, meningococcal disease) need droplet precautions; organisms carried on tiny airborne particles (measles, tuberculosis) need airborne precautions with an airborne infection isolation room and an N95 respirator.
- Clostridioides difficile diarrhea Contact: C. difficile spreads through stool on hands and surfaces, so gloves and a gown are worn for contact with the client and the room.
- Pertussis Droplet: pertussis spreads in respiratory droplets; precautions continue until 5 days after effective antibiotics start.
- Measles (rubeola) Airborne: measles particles stay suspended in air, so the client needs an airborne infection isolation room.
- Meningococcal meningitis Droplet: meningococcal meningitis needs droplet precautions until 24 hours after effective therapy starts.
- Scabies Contact: scabies spreads by skin contact; precautions continue until 24 hours after effective treatment starts.
- Suspected pulmonary tuberculosis Airborne: suspected pulmonary tuberculosis needs airborne precautions from the moment it is suspected.
Learn this topic: Which isolation precautions does each infection need? 5-minute lesson
Source: CDC Isolation Precautions Guideline, Appendix A: Type and Duration of Precautions · Open RN Nursing Fundamentals 2e, 9.6 Preventing Infection · CDC: Clinical Safety: Hand Hygiene for Healthcare Workers ·
A nursing home resident is colonized with methicillin-resistant Staphylococcus aureus (MRSA) and has an indwelling urinary catheter. The resident has no diarrhea and no draining wounds, and is on enhanced barrier precautions. When should staff wear a gown and gloves? Select all that apply.
Select all that apply.
Correct answer: A, C, E
Enhanced barrier precautions target gown and glove use to high-contact care: dressing, bathing, transferring, hygiene, changing linens or briefs, toileting help, device care and wound care. Low-contact tasks need only standard precautions. Residents on enhanced barrier precautions are not confined to their rooms and may join group activities.
- A Correct: changing linens is listed as a high-contact care activity.
- B Delivering a tray is not high-contact care, so standard precautions are enough.
- C Correct: care of an indwelling device such as a urinary catheter is high-contact care.
- D Talking with the resident involves no high-contact care and needs no gown or gloves.
- E Correct: bathing or showering is a high-contact care activity.
- F Residents on enhanced barrier precautions may attend group activities, and walking alongside is not high-contact care.
Learn this topic: Which isolation precautions does each infection need? 5-minute lesson
Source: CDC: Implementing Enhanced Barrier Precautions in Nursing Homes ·
An 80-year-old client admitted with pneumonia becomes confused during the night and twice tries to climb out of bed alone. There is no restraint order. Which action should the nurse take first?
Correct answer: B
Restraints are a last resort and may be used only after less restrictive measures fail. The nurse starts with fall precautions and alternatives to restraint, such as a low, locked bed and a bed exit alarm, plus closer supervision and an assessment for delirium. Side rails used to keep a client from leaving the bed count as a restraint.
- A Side rails raised to stop a client from leaving the bed meet the definition of a restraint, and a confused client may climb over them.
- B Correct: a low, locked bed and a bed exit alarm are less restrictive measures that should be tried before any restraint.
- C Restraint orders may never be written as PRN (as-needed) orders.
- D A vest restraint skips the required trial of less restrictive alternatives and can cause entanglement or strangulation.
Learn this topic: How do nurses prevent falls and use restraints safely? 5-minute lesson
Source: Open RN Nursing Fundamentals 2e, 5.7 Restraints · Open RN Nursing Fundamentals 2e, 5.6 Preventing Falls · 42 CFR 482.13 Condition of participation: Patient's rights (restraint or seclusion) ·
A 42-year-old client in the emergency department was placed in bilateral soft wrist restraints at 0820 after striking a staff member. Click to highlight the findings in the 0915 nursing note that require follow-up by the nurse.
0915: The restraint order reads . The provider . Right hand ; left hand warm with brisk capillary refill. Client . Client was and .
Click each part of the text to highlight it. Click again to remove the highlight.
Correct answer: wrist restraints as needed for agitation; is cool and pale; has been calm and following directions for 40 minutes
Restraint orders can never be PRN, so an as-needed order must be clarified with the provider. A cool, pale hand signals poor circulation in a restrained limb and needs immediate attention. Restraints must be removed at the earliest possible time, so a client who has been calm and following directions should be evaluated for release.
- wrist restraints as needed for agitation Requires follow-up: restraint orders may never be written as PRN or standing orders.
- evaluated the client face to face at 0850 No follow-up needed: for violent behavior the client must be seen face to face within 1 hour, and 0850 is within 1 hour of 0820.
- is cool and pale Requires follow-up: a cool, pale hand suggests impaired circulation in the restrained limb.
- has been calm and following directions for 40 minutes Requires follow-up: restraints must be discontinued at the earliest possible time, so the nurse evaluates the client for release.
- offered fluids at 0900 No follow-up needed: offering fluids meets the restrained client's basic needs.
- repositioned at 0900 No follow-up needed: regular position changes help prevent complications of immobility.
Learn this topic: How do nurses prevent falls and use restraints safely? 5-minute lesson
Source: 42 CFR 482.13 Condition of participation: Patient's rights (restraint or seclusion) · Open RN Nursing Fundamentals 2e, 5.7 Restraints · OpenStax Clinical Nursing Skills, 9.5 Limited Movement Devices ·
Complete the statements about restraint safety. An order to restrain a 30-year-old client for violent behavior is valid for up to before it must be renewed. The client must be seen face to face by a physician, other licensed practitioner or specially trained registered nurse within of starting the restraint. Raising all four side rails so a client who wants to get up cannot leave the bed is considered .
Choose the best option from each list to complete the sentence.
Correct answer: 4 hours; 1 hour; a restraint
For violent or self-destructive behavior, each restraint order lasts up to 4 hours for adults, 2 hours for ages 9 to 17 and 1 hour for children under 9, renewable up to 24 hours in total, and the client must be seen face to face within 1 hour. Whether side rails are a restraint depends on purpose: used to keep a client from leaving the bed, they restrict freedom of movement and are a restraint.
- 4 hours is the adult limit; 2 hours applies to ages 9 to 17, 1 hour to children under 9, and 24 hours is the total renewal cap, not a single order.
- The face-to-face evaluation must happen within 1 hour of starting a restraint for violent or self-destructive behavior.
- Side rails used to prevent a client from voluntarily leaving the bed meet the definition of a restraint; rails raised to help with repositioning do not.
Learn this topic: How do nurses prevent falls and use restraints safely? 5-minute lesson
Source: 42 CFR 482.13 Condition of participation: Patient's rights (restraint or seclusion) · Open RN Nursing Fundamentals 2e, 5.7 Restraints ·
A nurse is helping triage adults at the scene of a bus crash using START triage. Which victim should the nurse tag red (immediate)?
Correct answer: D
START checks walking, breathing, perfusion and mental status in order. A victim who is breathing faster than 30 per minute is tagged red because breathing is compromised, even if the victim is quiet and follows commands. Walking victims are green, stable non-walking victims who pass every check are yellow, and a victim who does not breathe after the airway is opened is black.
- A No breathing after the airway is opened places the victim in the black (expectant) category.
- B A victim who can walk to the designated area is tagged green, no matter how loud the distress.
- C Normal breathing rate, a radial pulse and following commands make this serious injury yellow (delayed).
- D Correct: a respiratory rate over 30 per minute is a breathing compromise and is tagged red.
Learn this topic: How do nurses triage victims in a disaster? 5-minute lesson
Source: HHS REMM: START Adult Triage Algorithm · HHS REMM: START Adult Triage Algorithm, Text Version · Open RN Nursing: Mental Health and Community Concepts 2e, 18.3 Emergency Preparedness, Response, and Recovery ·
After a warehouse explosion, the nurse uses START triage on adult victims. For each victim, select the triage tag the nurse should assign.
Green (minor) Yellow (delayed) Red (immediate) Black (expectant) Walks to the designated area holding a swollen wrist Cannot walk; respirations 22/min, capillary refill 1 second, follows commands, open lower leg fracture Cannot walk; respirations 20/min, capillary refill 4 seconds, follows commands Not breathing; no breathing after the airway is opened Cannot walk; respirations 24/min, radial pulse present, does not follow simple commands Select one option in each row.
Correct answer: Walks to the designated area holding a swollen wrist: Green (minor); Cannot walk; respirations 22/min, capillary refill 1 second, follows commands, open lower leg fracture: Yellow (delayed); Cannot walk; respirations 20/min, capillary refill 4 seconds, follows commands: Red (immediate); Not breathing; no breathing after the airway is opened: Black (expectant); Cannot walk; respirations 24/min, radial pulse present, does not follow simple commands: Red (immediate)
START moves through walking, breathing, perfusion and mental status. Walking victims are green. A victim who fails breathing (rate over 30), perfusion (capillary refill over 2 seconds or no radial pulse) or mental status (cannot follow simple commands) is red. A victim who passes all three is yellow, and a victim who does not breathe after the airway is opened is black.
- Walks to the designated area holding a swollen wrist Green: a victim who can walk to the designated area is in the minor (walking wounded) category.
- Cannot walk; respirations 22/min, capillary refill 1 second, follows commands, open lower leg fracture Yellow: breathing under 30, normal capillary refill and following commands mean the serious fracture can wait for transport.
- Cannot walk; respirations 20/min, capillary refill 4 seconds, follows commands Red: capillary refill longer than 2 seconds shows poor perfusion.
- Not breathing; no breathing after the airway is opened Black: no spontaneous breathing after the airway is opened places the victim in the expectant category.
- Cannot walk; respirations 24/min, radial pulse present, does not follow simple commands Red: inability to follow simple commands fails the mental status check even though breathing and pulse are adequate.
Learn this topic: How do nurses triage victims in a disaster? 5-minute lesson
Source: HHS REMM: START Adult Triage Algorithm · HHS REMM: START Adult Triage Algorithm, Text Version · Open RN Nursing: Mental Health and Community Concepts 2e, 18.3 Emergency Preparedness, Response, and Recovery ·
A nurse enters a client's room and finds a small fire burning in the wastebasket next to the bed. The nurse's first action is to . Next, the nurse . When using the fire extinguisher, the nurse aims the nozzle at .
Choose the best option from each list to complete the sentence.
Correct answer: move the client away from the fire; activates the fire alarm; the base of the fire
Fire response follows RACE: rescue anyone in immediate danger, activate the alarm, confine the fire by closing doors and windows, then extinguish a small fire or evacuate. Extinguishers follow PASS: pull the pin, aim low at the base of the fire, squeeze the handle and sweep side to side, because the base is where the fire is smothered.
- Rescue comes first in RACE: the client next to the fire is in immediate danger; alarm, confine and extinguish follow.
- Activating the alarm is the second RACE step so others can start safety measures; calling family and documenting can wait.
- Aim at the base of the fire; spraying the top of the flames or the smoke does not smother the fire.
Learn this topic: How do nurses triage victims in a disaster? 5-minute lesson
Source: Open RN Nursing Fundamentals 2e, 5.9 Environmental Safety ·
Nurses' Notes
Day 3, 0700: 82-year-old client admitted 2 days ago with community-acquired pneumonia, receiving IV ceftriaxone. Walks with a walker at home; fell at home 2 months ago. Home medications include furosemide daily. Received lorazepam 0.5 mg by mouth at 2200 for sleep. Shares a semiprivate room with another client.
Overnight the client had 5 loose, watery stools since 0100, one of them incontinent in bed, and reports cramping lower abdominal pain. At 0530 the client was found sitting on the edge of the bed, trying to stand without the walker, saying, "I have to get to my bathroom at home." Call light found on the floor. Client is oriented to person only (oriented to person, place and time on admission) and is picking at the IV site on the left forearm. Lungs: crackles in the right lower lobe, fewer than on admission. Drank 240 mL of water at 0600. Stool sample for C. difficile toxin sent to the lab at 0630.
Vital Signs
Time Temp HR RR BP SpO2 Day 1, admission 101.8°F (38.8°C) 96/min 24/min 128/74 mm Hg 92% room air Day 3, 0700, lying 100.6°F (38.1°C) 108/min 20/min 108/62 mm Hg 95% room air Day 3, 0705, standing — 122/min — 86/50 mm Hg — Laboratory Results
Test Day 1 Day 3 Normal range WBC 14,200/microL 16,900/microL 4,500–11,000/microL Potassium 4.1 mEq/L 3.2 mEq/L 3.7–5.2 mEq/L Stool C. difficile toxin — Pending No toxin detected The nurse reviews the client's record at 0700. Click to highlight the findings that require immediate follow-up.
Since 0100 the client . At 0530 the client was . Client is . Call light . Lungs: . Client . SpO2 .
Click each part of the text to highlight it. Click again to remove the highlight.
Correct answer: had 5 loose, watery stools; trying to stand without the walker; oriented to person only; found on the floor
New, frequent watery stools in a hospitalized older adult on antibiotics point to a possible C. difficile infection, and a client with three or more stools in 24 hours is isolated on suspicion, before the test result. New confusion, trying to stand without the walker and a call light out of reach are cues of a high, immediate fall risk. Fewer crackles and a better oxygen saturation show the pneumonia is improving, and drinking water is not a concern.
- had 5 loose, watery stools Requires follow-up: frequent watery stools during antibiotic therapy suggest C. difficile infection, which calls for isolation on suspicion, and they also cause fluid loss.
- trying to stand without the walker Requires follow-up: getting up alone without the assistive device the client needs is a direct fall risk.
- oriented to person only Requires follow-up: the client was fully oriented on admission, so new confusion needs assessment for delirium and raises fall risk.
- found on the floor Requires follow-up: the call light must be within reach so the client can ask for help instead of getting up alone.
- crackles in the right lower lobe, fewer than on admission No immediate follow-up: fewer crackles than on admission show the pneumonia is improving.
- drank 240 mL of water at 0600 No immediate follow-up: oral fluid intake is appropriate for a client losing fluid in stool.
- 95% on room air No immediate follow-up: SpO2 is better than the 92% recorded on admission.
Learn this topic: Which isolation precautions does each infection need? 5-minute lesson
Source: MedlinePlus: C. diff Infections · CDC: Clinical Overview of C. diff Infection · Open RN Nursing Fundamentals 2e, 5.6 Preventing Falls ·
Nurses' Notes
Day 3, 0700: 82-year-old client admitted 2 days ago with community-acquired pneumonia, receiving IV ceftriaxone. Walks with a walker at home; fell at home 2 months ago. Home medications include furosemide daily. Received lorazepam 0.5 mg by mouth at 2200 for sleep. Shares a semiprivate room with another client.
Overnight the client had 5 loose, watery stools since 0100, one of them incontinent in bed, and reports cramping lower abdominal pain. At 0530 the client was found sitting on the edge of the bed, trying to stand without the walker, saying, "I have to get to my bathroom at home." Call light found on the floor. Client is oriented to person only (oriented to person, place and time on admission) and is picking at the IV site on the left forearm. Lungs: crackles in the right lower lobe, fewer than on admission. Drank 240 mL of water at 0600. Stool sample for C. difficile toxin sent to the lab at 0630.
Vital Signs
Time Temp HR RR BP SpO2 Day 1, admission 101.8°F (38.8°C) 96/min 24/min 128/74 mm Hg 92% room air Day 3, 0700, lying 100.6°F (38.1°C) 108/min 20/min 108/62 mm Hg 95% room air Day 3, 0705, standing — 122/min — 86/50 mm Hg — Laboratory Results
Test Day 1 Day 3 Normal range WBC 14,200/microL 16,900/microL 4,500–11,000/microL Potassium 4.1 mEq/L 3.2 mEq/L 3.7–5.2 mEq/L Stool C. difficile toxin — Pending No toxin detected For each client finding, specify whether it increases the client's risk for a fall, the risk of spreading infection to others, or both. Each finding may support more than one risk.
Fall risk Infection spread risk Walks with a walker at home Lorazepam 0.5 mg at 2200 BP 108/62 mm Hg lying, 86/50 mm Hg standing Watery stools with incontinence in bed Shares a semiprivate room Fell at home 2 months ago Select all that apply in each row.
Correct answer: Walks with a walker at home: Fall risk; Lorazepam 0.5 mg at 2200: Fall risk; BP 108/62 mm Hg lying, 86/50 mm Hg standing: Fall risk; Watery stools with incontinence in bed: Fall risk; Watery stools with incontinence in bed: Infection spread risk; Shares a semiprivate room: Infection spread risk; Fell at home 2 months ago: Fall risk
Fall risk factors include gait problems needing an assistive device, benzodiazepines, orthostatic blood pressure drops, frequent or urgent toileting and a recent fall. Diarrhea that may be C. difficile can contaminate hands, linens and surfaces, and a shared room exposes another client. Urgent, incontinent stools fit both problems, which is why this client needs fall and infection measures together.
- Walks with a walker at home Fall: needing an assistive device such as a walker signals gait or balance problems.
- Lorazepam 0.5 mg at 2200 Fall: lorazepam is a benzodiazepine, one of the highest-risk medication classes for falls because of sedation, dizziness and impaired balance.
- BP 108/62 mm Hg lying, 86/50 mm Hg standing Fall: the blood pressure drop on standing (orthostatic hypotension) can cause dizziness and falls.
- Watery stools with incontinence in bed Both: urgent toileting drives the client to get up alone, and infectious stool can spread to hands, linens and surfaces.
- Shares a semiprivate room Infection spread: a roommate can be exposed; clients needing contact precautions should have a single room when possible.
- Fell at home 2 months ago Fall: a fall within the past 3 months marks the client as higher risk for falling again.
Learn this topic: Which isolation precautions does each infection need? 5-minute lesson
Source: Open RN Nursing Fundamentals 2e, 5.6 Preventing Falls · MedlinePlus: Lorazepam · MedlinePlus: Low blood pressure · Open RN Nursing Fundamentals 2e, 9.6 Preventing Infection · CDC Isolation Precautions Guideline, Appendix A: Type and Duration of Precautions ·
Nurses' Notes
Day 3, 0700: 82-year-old client admitted 2 days ago with community-acquired pneumonia, receiving IV ceftriaxone. Walks with a walker at home; fell at home 2 months ago. Home medications include furosemide daily. Received lorazepam 0.5 mg by mouth at 2200 for sleep. Shares a semiprivate room with another client.
Overnight the client had 5 loose, watery stools since 0100, one of them incontinent in bed, and reports cramping lower abdominal pain. At 0530 the client was found sitting on the edge of the bed, trying to stand without the walker, saying, "I have to get to my bathroom at home." Call light found on the floor. Client is oriented to person only (oriented to person, place and time on admission) and is picking at the IV site on the left forearm. Lungs: crackles in the right lower lobe, fewer than on admission. Drank 240 mL of water at 0600. Stool sample for C. difficile toxin sent to the lab at 0630.
Vital Signs
Time Temp HR RR BP SpO2 Day 1, admission 101.8°F (38.8°C) 96/min 24/min 128/74 mm Hg 92% room air Day 3, 0700, lying 100.6°F (38.1°C) 108/min 20/min 108/62 mm Hg 95% room air Day 3, 0705, standing — 122/min — 86/50 mm Hg — Laboratory Results
Test Day 1 Day 3 Normal range WBC 14,200/microL 16,900/microL 4,500–11,000/microL Potassium 4.1 mEq/L 3.2 mEq/L 3.7–5.2 mEq/L Stool C. difficile toxin — Pending No toxin detected The client's new diarrhea is most likely caused by . At this moment, the client is at highest risk for as evidenced by .
Choose the best option from each list to complete the sentence.
Correct answer: Clostridioides difficile infection; a fall with injury; new confusion, urgent stools and an orthostatic BP drop
C. difficile infection usually follows antibiotic use and is more likely in adults 65 and older and in hospitalized clients; it causes watery diarrhea, fever and abdominal pain. Right now the most pressing threat is a fall with injury: the client is newly confused, has urgent stools, received a benzodiazepine (lorazepam) and drops blood pressure on standing, and has already tried to get up alone.
- C. difficile fits watery diarrhea, cramping, fever and a rising WBC count during antibiotic therapy in an older hospitalized adult; potassium is low, not high, and the pneumonia findings are improving.
- Multiple fall risk factors are present and the client has already tried to stand alone; nothing in the record shows swallowing problems, skin breakdown or worsening breathing.
- Confusion, urgent toileting and orthostatic hypotension are fall risk factors; the crackles, SpO2 and WBC count describe the infections, not the fall risk.
Learn this topic: How do nurses prevent medication errors? 5-minute lesson
Source: MedlinePlus: C. diff Infections · CDC: Clinical Overview of C. diff Infection · MedlinePlus: Lorazepam · Open RN Nursing Fundamentals 2e, 5.6 Preventing Falls · MedlinePlus: Low blood pressure · MedlinePlus: Potassium blood test · MedlinePlus: WBC count ·
Nurses' Notes
Day 3, 0700: 82-year-old client admitted 2 days ago with community-acquired pneumonia, receiving IV ceftriaxone. Walks with a walker at home; fell at home 2 months ago. Home medications include furosemide daily. Received lorazepam 0.5 mg by mouth at 2200 for sleep. Shares a semiprivate room with another client.
Overnight the client had 5 loose, watery stools since 0100, one of them incontinent in bed, and reports cramping lower abdominal pain. At 0530 the client was found sitting on the edge of the bed, trying to stand without the walker, saying, "I have to get to my bathroom at home." Call light found on the floor. Client is oriented to person only (oriented to person, place and time on admission) and is picking at the IV site on the left forearm. Lungs: crackles in the right lower lobe, fewer than on admission. Drank 240 mL of water at 0600. Stool sample for C. difficile toxin sent to the lab at 0630.
Vital Signs
Time Temp HR RR BP SpO2 Day 1, admission 101.8°F (38.8°C) 96/min 24/min 128/74 mm Hg 92% room air Day 3, 0700, lying 100.6°F (38.1°C) 108/min 20/min 108/62 mm Hg 95% room air Day 3, 0705, standing — 122/min — 86/50 mm Hg — Laboratory Results
Test Day 1 Day 3 Normal range WBC 14,200/microL 16,900/microL 4,500–11,000/microL Potassium 4.1 mEq/L 3.2 mEq/L 3.7–5.2 mEq/L Stool C. difficile toxin — Pending No toxin detected At 0900 the stool test is positive for C. difficile toxin. The provider prescribes contact precautions and fall precautions. For each nursing action, indicate whether it is indicated or not indicated for the plan of care.
Indicated Not indicated Move the client to a private room Put on a gown and gloves on every entry into the room Skip hand hygiene after care because gloves were worn Apply bilateral soft wrist restraints to keep the client in bed Offer toileting on a set schedule during hourly rounds Wear a fit-tested N95 respirator for all care Select one option in each row.
Correct answer: Move the client to a private room: Indicated; Put on a gown and gloves on every entry into the room: Indicated; Skip hand hygiene after care because gloves were worn: Not indicated; Apply bilateral soft wrist restraints to keep the client in bed: Not indicated; Offer toileting on a set schedule during hourly rounds: Indicated; Wear a fit-tested N95 respirator for all care: Not indicated
C. difficile needs contact precautions: a single room when possible, and a gown and gloves put on at room entry. Gloves are the priority because no hand-hygiene method removes every spore, but they never replace hand hygiene after removal. Falls are prevented with universal precautions plus scheduled toileting, not restraints, which are a last resort after alternatives fail. An N95 respirator is for airborne infections.
- Move the client to a private room Indicated: clients on contact precautions should be placed in a single room when possible, protecting the roommate.
- Put on a gown and gloves on every entry into the room Indicated: contact precautions call for a gown and gloves, put on at room entry.
- Skip hand hygiene after care because gloves were worn Not indicated: gloves are not a substitute for hand hygiene, which is done every time gloves come off.
- Apply bilateral soft wrist restraints to keep the client in bed Not indicated: restraints are used only after less restrictive measures fail, and they can cause falls and injury.
- Offer toileting on a set schedule during hourly rounds Indicated: scheduled toileting addresses the urgent stools that drive the client to get up alone.
- Wear a fit-tested N95 respirator for all care Not indicated: C. difficile is not airborne; an N95 respirator is for airborne precautions.
Learn this topic: Which isolation precautions does each infection need? 5-minute lesson
Source: CDC: Clinical Overview of C. diff Infection · CDC Isolation Precautions Guideline, Appendix A: Type and Duration of Precautions · CDC: Transmission-Based Precautions · Open RN Nursing Fundamentals 2e, 9.6 Preventing Infection · Open RN Nursing Fundamentals 2e, 5.6 Preventing Falls · Open RN Nursing Fundamentals 2e, 5.7 Restraints · CDC: Clinical Safety: Hand Hygiene for Healthcare Workers ·
Nurses' Notes
Day 3, 0700: 82-year-old client admitted 2 days ago with community-acquired pneumonia, receiving IV ceftriaxone. Walks with a walker at home; fell at home 2 months ago. Home medications include furosemide daily. Received lorazepam 0.5 mg by mouth at 2200 for sleep. Shares a semiprivate room with another client.
Overnight the client had 5 loose, watery stools since 0100, one of them incontinent in bed, and reports cramping lower abdominal pain. At 0530 the client was found sitting on the edge of the bed, trying to stand without the walker, saying, "I have to get to my bathroom at home." Call light found on the floor. Client is oriented to person only (oriented to person, place and time on admission) and is picking at the IV site on the left forearm. Lungs: crackles in the right lower lobe, fewer than on admission. Drank 240 mL of water at 0600. Stool sample for C. difficile toxin sent to the lab at 0630.
Vital Signs
Time Temp HR RR BP SpO2 Day 1, admission 101.8°F (38.8°C) 96/min 24/min 128/74 mm Hg 92% room air Day 3, 0700, lying 100.6°F (38.1°C) 108/min 20/min 108/62 mm Hg 95% room air Day 3, 0705, standing — 122/min — 86/50 mm Hg — Laboratory Results
Test Day 1 Day 3 Normal range WBC 14,200/microL 16,900/microL 4,500–11,000/microL Potassium 4.1 mEq/L 3.2 mEq/L 3.7–5.2 mEq/L Stool C. difficile toxin — Pending No toxin detected The client has been moved to a private room on contact precautions. The nurse is about to give care and then leave the room. Which actions should the nurse take? Select all that apply.
Select all that apply.
Correct answer: A, C, D
Contact precautions use dedicated equipment that stays in the room, and PPE comes off gloves first, then gown, followed by hand hygiene. For C. difficile, gloves and a gown are the main barrier because no hand-hygiene method removes every spore. Fall prevention uses alternatives such as a bed exit alarm and a call light in reach; side rails used to keep a client in bed are a restraint.
- A Correct: dedicated equipment such as a stethoscope and blood pressure cuff stays in the room of a client on transmission-based precautions.
- B The PPE removal sequence takes off the gloves first, then the gown, followed by hand hygiene.
- C Correct: hand hygiene follows PPE removal every time; CDC prefers alcohol-based hand rub unless hands are visibly soiled, even for C. difficile, and calls for soap and water during outbreaks.
- D Correct: a bed exit alarm is an alternative to restraints, and a reachable call light is a universal fall precaution.
- E Side rails raised to stop a client from leaving the bed are a restraint, and a confused client may climb over them.
- F A mask on the client is a droplet or airborne source-control measure; C. difficile spreads by contact.
Learn this topic: Which isolation precautions does each infection need? 5-minute lesson
Source: Open RN Nursing Fundamentals 2e, 9.6 Preventing Infection · Open RN Nursing Skills 2e, 4.7 Checklist for Personal Protective Equipment (PPE) · CDC Isolation Precautions Guideline, Appendix A: Type and Duration of Precautions · Open RN Nursing Fundamentals 2e, 5.6 Preventing Falls · Open RN Nursing Fundamentals 2e, 5.7 Restraints · CDC: Clinical Safety: Hand Hygiene for Healthcare Workers ·
Nurses' Notes
Day 3, 0700: 82-year-old client admitted 2 days ago with community-acquired pneumonia, receiving IV ceftriaxone. Walks with a walker at home; fell at home 2 months ago. Home medications include furosemide daily. Received lorazepam 0.5 mg by mouth at 2200 for sleep. Shares a semiprivate room with another client.
Overnight the client had 5 loose, watery stools since 0100, one of them incontinent in bed, and reports cramping lower abdominal pain. At 0530 the client was found sitting on the edge of the bed, trying to stand without the walker, saying, "I have to get to my bathroom at home." Call light found on the floor. Client is oriented to person only (oriented to person, place and time on admission) and is picking at the IV site on the left forearm. Lungs: crackles in the right lower lobe, fewer than on admission. Drank 240 mL of water at 0600. Stool sample for C. difficile toxin sent to the lab at 0630.
Vital Signs
Time Temp HR RR BP SpO2 Day 1, admission 101.8°F (38.8°C) 96/min 24/min 128/74 mm Hg 92% room air Day 3, 0700, lying 100.6°F (38.1°C) 108/min 20/min 108/62 mm Hg 95% room air Day 3, 0705, standing — 122/min — 86/50 mm Hg — Laboratory Results
Test Day 1 Day 3 Normal range WBC 14,200/microL 16,900/microL 4,500–11,000/microL Potassium 4.1 mEq/L 3.2 mEq/L 3.7–5.2 mEq/L Stool C. difficile toxin — Pending No toxin detected On day 4, the nurse evaluates the client's care. For each finding, indicate whether the plan has been effective or not effective.
Effective Not effective Client is oriented to person, place and time Client used the call light and waited for help to walk to the bathroom BP 84/50 mm Hg on standing, and the client reports dizziness A nursing assistant emptied the client's bedpan without wearing gloves No falls during the past 24 hours Two loose stools in 12 hours, down from 5 overnight Select one option in each row.
Correct answer: Client is oriented to person, place and time: Effective; Client used the call light and waited for help to walk to the bathroom: Effective; BP 84/50 mm Hg on standing, and the client reports dizziness: Not effective; A nursing assistant emptied the client's bedpan without wearing gloves: Not effective; No falls during the past 24 hours: Effective; Two loose stools in 12 hours, down from 5 overnight: Effective
Restored orientation, calling for help before getting up, no falls and fewer stools show progress. A continued blood pressure drop with dizziness on standing means fall risk from orthostatic hypotension persists and needs follow-up. Handling C. difficile stool without gloves is an infection-control failure, because gloves are the key barrier against spores on the hands.
- Client is oriented to person, place and time Effective: the client has returned to the orientation recorded on admission.
- Client used the call light and waited for help to walk to the bathroom Effective: calling for help before getting up shows the fall plan is working.
- BP 84/50 mm Hg on standing, and the client reports dizziness Not effective: an ongoing blood pressure drop with dizziness on standing keeps the client at high fall risk.
- A nursing assistant emptied the client's bedpan without wearing gloves Not effective: contact precautions require gloves for contact with C. difficile stool, and gloves are the priority because hand hygiene cannot remove every spore.
- No falls during the past 24 hours Effective: no falls shows the fall prevention measures are working so far.
- Two loose stools in 12 hours, down from 5 overnight Effective: fewer stools show the diarrhea is improving.
Learn this topic: How do nurses prevent medication errors? 5-minute lesson
Source: CDC: Clinical Overview of C. diff Infection · CDC Isolation Precautions Guideline, Appendix A: Type and Duration of Precautions · Open RN Nursing Fundamentals 2e, 9.6 Preventing Infection · Open RN Nursing Fundamentals 2e, 5.6 Preventing Falls · MedlinePlus: Low blood pressure · CDC: Clinical Safety: Hand Hygiene for Healthcare Workers ·
At 1400, a nurse discovers that a client's 1000 dose of an IV antibiotic was not given. The nurse notifies the provider and gives the dose as prescribed. Complete the statements. The incident report is completed by . The incident report . In the client's medical record, the nurse documents .
Choose the best option from each list to complete the sentence.
Correct answer: the staff member involved in the event; is not part of the medical record; the event, provider notification and care given
An incident (variance) report is completed by the staff member involved whenever an error, injury, fall or near miss occurs. It is a quality and safety tool for finding system problems, not a disciplinary record, and it is not part of the medical record. The chart describes the event itself, provider notification and the care given, but it does not mention the incident report.
- The staff member involved in the occurrence completes the report, because that person knows what happened and what was done in response.
- Incident reports are kept out of the medical record and are used to improve systems, not to punish staff.
- The medical record documents the event, provider notification and interventions, but never refers to the incident report itself.
Source: Open RN Nursing Fundamentals 2e, 2.5 Documentation · Open RN Nursing Fundamentals 2e, 5.2 Basic Safety Concepts ·
Fifteen minutes after a medication pass, a nurse realizes that a client received amlodipine 10 mg by mouth instead of the prescribed 5 mg. Which action should the nurse take first?
Correct answer: D
Client safety comes first: when a medication error occurs, the nurse's first response is to assess and monitor the client for effects of the medication. Next, the nurse notifies the nurse manager and the provider, who may order treatment or extra monitoring. The incident report comes after that, and it is never mentioned in the medical record.
- A The incident report is completed, but only after the client is assessed and the right people are notified.
- B The nurse manager and provider are notified, but assessing the client comes first.
- C Incident reports are not part of the medical record and are not mentioned in it.
- D Correct: the first response to a medication error is to monitor the client's condition.
Learn this topic: How do nurses prevent medication errors? 5-minute lesson
Source: Open RN Nursing Skills 2e, 15.2 Basic Concepts of Administering Medications · Open RN Nursing Fundamentals 2e, 2.5 Documentation ·
A nurse educator observes nurses during a medication pass. Which actions help prevent medication errors? Select all that apply.
Select all that apply.
Correct answer: A, C, E
Safe medication practice combines two identifiers, the rights checked three times, immediate documentation and clarification of unclear orders. The room number is never an identifier because clients change rooms. Nurses give only medications they checked themselves, and a barcode alert is a signal to stop and investigate, not to work around it.
- A Correct: at least two identifiers are confirmed against the wristband and the MAR before giving a medication.
- B Incorrect: a room number is never used as an identifier, because clients change rooms.
- C Correct: documenting immediately after giving a dose prevents another nurse from repeating it.
- D Incorrect: a nurse never gives a medication that the nurse did not personally check.
- E Correct: an order with an error-prone abbreviation is clarified with the provider and rewritten.
- F Incorrect: overriding an alert is a workaround; the nurse stops and investigates.
Learn this topic: How do nurses prevent medication errors? 5-minute lesson
Source: Open RN Nursing Skills 2e, 15.2 Basic Concepts of Administering Medications · Open RN Nursing Pharmacology 2e, 2.5 Preventing Medication Errors · Open RN Nursing Management and Professional Concepts 2e, 5.5 Protecting Your Nursing License ·
Complete the statements about checking the rights of medication administration. The nurse performs the first check . The third check is done . The documentation right is completed .
Choose the best option from each list to complete the sentence.
Correct answer: when taking the package from the dispensing machine or cart; at the bedside, right before giving the medication; immediately after the medication is given
The rights are checked three times: when the medication is removed from the dispensing machine or cart, again after it is removed and before it is poured, and a third time at the bedside right before it is given. Documentation, the sixth right, is completed immediately after the dose is given so that no one gives it a second time.
- The first check happens as the package is removed from the dispensing machine or cart, when the expiration date is also checked.
- The third check is done at the bedside immediately before the medication is given.
- Documenting right after the dose prevents a repeat dose; charting before giving it or hours later invites errors.
Learn this topic: How do nurses prevent medication errors? 5-minute lesson
Source: Open RN Nursing Skills 2e, 15.2 Basic Concepts of Administering Medications ·
A nurse is stuck with a used needle after giving an injection. The nurse has just washed the puncture with soap and water. What should the nurse do next?
Correct answer: A
After cleaning the site, the nurse reports the exposure to the supervisor immediately and seeks medical care right away to judge the risk and the need for preventive treatment. OSHA requires the employer to make a confidential evaluation and follow-up available immediately after an exposure is reported.
- A Correct: report the incident at once and seek medical care right away to determine the risk.
- B Reporting is immediate, not delayed until the end of the shift.
- C The evaluation, including testing of the source client, starts after the report; it is not a reason to delay reporting.
- D Medical evaluation is sought immediately, not left for later.
Learn this topic: How do nurses handle sharps, hazardous drugs, radiation and chemicals safely? 5-minute lesson
Source: CDC NIOSH: Bloodborne Infectious Disease Risk Factors · OSHA 29 CFR 1910.1030, Bloodborne Pathogens ·
A nurse needs information from the safety data sheet (SDS) for a disinfectant used on the unit. For each question, select the SDS section that answers it.
Section 2, Hazard(s) identification Section 4, First-aid measures Section 6, Accidental release measures Section 8, Exposure controls/personal protection Which gloves and eye protection to wear when pouring it What to do if it splashes onto the skin How to clean up a spilled container Whether it is flammable and what warnings apply Select one option in each row.
Correct answer: Which gloves and eye protection to wear when pouring it: Section 8, Exposure controls/personal protection; What to do if it splashes onto the skin: Section 4, First-aid measures; How to clean up a spilled container: Section 6, Accidental release measures; Whether it is flammable and what warnings apply: Section 2, Hazard(s) identification
OSHA requires every SDS to use the same 16 numbered sections in the same order, so information is always in the same place. Section 2 identifies hazards and warnings, section 4 gives first aid after exposure, section 6 covers spills and leaks, and section 8 lists exposure controls and personal protective equipment.
- Which gloves and eye protection to wear when pouring it Protective equipment such as gloves and eye protection is listed in section 8.
- What to do if it splashes onto the skin Initial care after skin, eye or other exposure is in section 4.
- How to clean up a spilled container Response to spills and leaks, including cleanup, is in section 6.
- Whether it is flammable and what warnings apply The chemical's hazards, classification and warnings are in section 2.
Learn this topic: How do nurses handle sharps, hazardous drugs, radiation and chemicals safely? 5-minute lesson
Source: OSHA 29 CFR 1910.1200, Hazard Communication · Open RN Nursing Fundamentals 2e, 5.9 Environmental Safety ·
After reporting a needlestick, a nurse asks about the follow-up the employer must provide under the OSHA Bloodborne Pathogens Standard. Which statements are accurate? Select all that apply.
Select all that apply.
Correct answer: A, D, E
OSHA requires employers to make a confidential post-exposure evaluation and follow-up available immediately, at no cost to the employee. It documents the route and circumstances of the exposure and tests the source individual's blood for HBV and HIV as soon as feasible after consent. The hepatitis B vaccine is offered within 10 working days of starting a job with exposure risk, not only after an exposure.
- A Correct: all evaluations and follow-up, including prophylaxis, are at no cost to the employee.
- B Incorrect: the employer provides the evaluation at no cost, with no condition about missed work.
- C Incorrect: findings stay confidential; they are not shared with coworkers.
- D Correct: the post-exposure medical evaluation is confidential.
- E Correct: the source individual's blood is tested as soon as feasible after consent is obtained.
- F Incorrect: the vaccine is offered within 10 working days of initial assignment to jobs with exposure risk.
Learn this topic: How do nurses handle sharps, hazardous drugs, radiation and chemicals safely? 5-minute lesson
Source: OSHA 29 CFR 1910.1030, Bloodborne Pathogens · CDC NIOSH: Bloodborne Infectious Disease Risk Factors ·
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NCLEX-RN format
| Client needs category | Share of the exam |
|---|---|
| Management of Care | 15–21% |
| Safety and Infection Prevention and Control | 10–16% |
| Health Promotion and Maintenance | 6–12% |
| Psychosocial Integrity | 6–12% |
| Basic Care and Comfort | 6–12% |
| Pharmacological and Parenteral Therapies | 13–19% |
| Reduction of Risk Potential | 9–15% |
| Physiological Adaptation | 11–17% |
The exam has 85 to 150 questions in up to 5 hours, including 15 unscored pretest questions and three unfolding case studies. An on-screen calculator is provided.
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