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NCLEX infection control and isolation practice questions

20 free NCLEX-style infection control questions: contact, droplet and airborne precautions, PPE, sterile versus clean technique and breaking the chain of infection, each with the answer and rationale.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A 3-month-old infant is hospitalized with confirmed pertussis. The infant lives with both parents and a 5-year-old brother who is up to date on his vaccines, and no one else in the home is coughing. Which information about antibiotic prophylaxis should the nurse give the parents?

  1. 'Only family members who are behind on their vaccines need one.'
  2. 'Your son needs a vaccine booster instead of an antibiotic.'
  3. 'Anyone in the home who starts to cough will need an antibiotic.'
  4. 'Everyone in the home should take an antibiotic, even if vaccinated.'
Show the answer and rationale

Answer: D

Pertussis spreads readily within families, so CDC-based guidance recommends antibiotic prophylaxis for all household contacts within 21 days of exposure, regardless of age or vaccination status. Limiting prophylaxis to family members who are behind on vaccines is the runner-up because vaccination seems protective, but vaccinated people can still become infected and pass pertussis to the infant or others. Waiting until someone coughs lets that person spread the infection before treatment starts, and a vaccine dose does not take the place of prophylaxis after an exposure.

๐Ÿ“š Learn it: Contact, Droplet, Airborne: Pick the Right Door

Question 2 of 20

A nurse is observing a new nurse prepare injections for two clients. Which action by the new nurse requires the nurse to intervene?

  1. Entering a multidose vial for each client with a new needle and syringe
  2. Dating a multidose vial to be discarded 28 days after it is opened
  3. Scrubbing the stopper of a brand-new vial with alcohol before use
  4. Using the same single-dose vial for the second client's dose
Show the answer and rationale

Answer: D

A single-dose vial is used for one client and one procedure and then discarded, even if medication remains, because it lacks a preservative and reuse has caused outbreaks of hepatitis and bacterial infection. Using a multidose vial for both clients looks like the same reuse and is the strongest distractor, but it has a preservative, so entering it for each client with a new sterile needle and syringe is acceptable if it stays out of the client care area. Disinfecting the stopper before every entry, even on a new vial, and discarding an opened multidose vial after 28 days unless the manufacturer says otherwise are correct practices.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Question 3 of 20

A nurse is caring for a client who has no known infection. During which task should the nurse wear a mask and eye protection in addition to gloves?

  1. Emptying wound drainage from a closed suction drain into a container
  2. Flushing a peripheral IV line with saline from a prefilled syringe
  3. Irrigating a deep abdominal wound with a syringe
  4. Emptying a urine collection bag into a measuring container at the bedside
Show the answer and rationale

Answer: C

Standard precautions match protective equipment to the expected exposure, and pressurized wound irrigation can splash blood and body fluid toward the nurse's face, so a mask and eye protection or a face shield are added to gloves. Flushing an IV line with a prefilled syringe is the runner-up because it also uses a syringe, but it is a closed connection with no anticipated splash to the face. Emptying a closed suction drain and emptying a urine collection bag involve possible hand contact with body fluid, for which gloves alone are enough.

๐Ÿ“š Learn it: Contact, Droplet, Airborne: Pick the Right Door

Question 4 of 20

A nurse observes a nursing student perform hand hygiene with an alcohol-based hand rub while caring for a client. Which action by the student requires correction?

  1. Uses hand rub, not soap and water, after taking off a pair of gloves
  2. Lets the hand rub stay on the skin without rinsing it off at a sink
  3. Dries the hands with a paper towel right after rubbing them
  4. Applies enough hand rub to cover palms, backs and fingers
Show the answer and rationale

Answer: C

Alcohol-based hand rub kills organisms as it is rubbed in and evaporates, so the hands are rubbed together over all surfaces until completely dry, about 20 seconds; wiping it off with a towel shortens the contact time and leaves organisms behind. Hand rub after removing gloves can look like a shortcut, but it is preferred unless the hands are visibly soiled or the client has a spore-forming infection such as C. difficile. Hand rub is not rinsed off, and using enough product to cover every surface, including the backs of the hands, thumbs and fingertips, is correct.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Question 5 of 20

A 74-year-old client in a private room with its own bathroom is on day 5 of IV piperacillin-tazobactam for pneumonia. Since midnight the client has had four loose, unformed stools and has received no laxatives. The provider orders a stool test for Clostridioides difficile. Which action should the nurse take?

  1. Start contact precautions now, before the result is back
  2. Start contact precautions if the diarrhea lasts 24 more hours
  3. Start contact precautions if the stool test result is positive
  4. Use standard precautions, since the client has a private bathroom
Show the answer and rationale

Answer: A

CDC advises isolating clients with unexplained diarrhea while the cause is being evaluated, so the nurse starts contact precautions now in the private room with its own toilet rather than after the result returns; for confirmed C. difficile infection they continue at least 48 hours after the diarrhea resolves. Waiting for a positive result is the runner-up because it seems to avoid needless isolation, but spores shed in the meantime contaminate hands, equipment and surfaces. A private bathroom helps but does not replace gowns and gloves, and another day of diarrhea only adds to the contamination.

๐Ÿ“š Learn it: Contact, Droplet, Airborne: Pick the Right Door

Question 6 of 20

A nurse is gathering supplies from the clean storage room for a sterile procedure at the bedside. Which package may the nurse open onto the sterile field?

  1. A commercial kit with no expiration date whose seal is dry and intact
  2. A wrapped tray whose chemical indicator tape has not changed color
  3. A peel pouch with a pinhole near one of its sealed corners
  4. A wrapped tray with a dried water spot on its outer wrapper
Show the answer and rationale

Answer: A

Sterility is event-related: a sterile package stays sterile until something compromises it, such as moisture, a tear or a hole, so a dry, intact commercial kit without an expiration date can be used. The dried water spot is the tempting choice because the wrapper now looks dry, but moisture wicks organisms through the wrapping, and the tray stays contaminated after it dries. Indicator tape that has not changed color means the tray may never have been sterilized, and any hole in a peel pouch breaks its barrier.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Question 7 of 20

A nurse is putting on protective equipment before entering the room of a client on contact and droplet precautions. Which action by the nurse requires correction?

  1. Pulling the glove cuffs up over the gown sleeves
  2. Putting on the gloves first and then the gown
  3. Using a surgical mask, not an N95 respirator
  4. Putting on the mask after the gown, then the goggles
Show the answer and rationale

Answer: B

CDC's donning sequence is gown, then mask or respirator, then goggles or face shield, and gloves last, so the gloves can be pulled up over the gown's cuffs. A surgical mask may look like too little protection, but droplet precautions call for a mask, and an N95 respirator is for airborne precautions. Putting the mask on after the gown and before the goggles, and covering the gown cuffs with the gloves, are correct steps.

๐Ÿ“š Learn it: Contact, Droplet, Airborne: Pick the Right Door

Question 8 of 20

During a sterile dressing change, a nurse wearing sterile gloves is working from a sterile field set up on the overbed table. Which action requires the nurse to change gloves?

  1. Clasping the gloved hands in front of the chest while the client turns
  2. Smoothing the fingers of one glove with the other gloved hand
  3. Picking up a gauze pad that lies partly in the outer inch of the drape
  4. Taking a gauze pad that a coworker dropped onto the field from above
Show the answer and rationale

Answer: C

The outer 1 inch (2.5 cm) of a sterile drape is considered contaminated, so a gauze pad lying in that border is no longer sterile, and picking it up contaminates the glove; the nurse changes gloves and discards the pad. Adjusting one glove with the other gloved hand is the tempting choice because it looks like touching, but both surfaces are sterile. A coworker may drop items onto the field from above it without reaching over it, and keeping the gloved hands together in front of the chest, above the waist and in sight, protects them while the client moves.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Question 9 of 20

A 68-year-old client admitted with pyelonephritis is on contact precautions in a private room because a stool culture grew vancomycin-resistant enterococcus (VRE). He is continent, walks independently and asks whether he can eat lunch with his wife in the hospital cafeteria. Which response by the nurse is appropriate?

  1. 'Yes, if you put on a clean gown and clean your hands before you go.'
  2. 'Yes, as long as you wear a surgical mask while you are out of the room.'
  3. 'Let's have your meal brought here; trips out are only for tests and treatments.'
  4. 'Yes, if a staff member wearing a gown and gloves goes along with you.'
Show the answer and rationale

Answer: C

Contact precautions limit a client's movement outside the room to medically necessary purposes, so the nurse offers to bring the meal to the room rather than send a client who carries VRE through a public dining area. A clean gown and hand hygiene are the right preparation when the client must leave for a test, which makes that the runner-up, but they do not make a cafeteria visit necessary. VRE spreads by contact with the client, his stool and contaminated surfaces rather than through the air, so a mask adds nothing, and staff remove their gowns and gloves before leaving a room instead of wearing them through the hospital.

๐Ÿ“š Learn it: Contact, Droplet, Airborne: Pick the Right Door

Question 10 of 20

A nurse has just given an intramuscular injection using a syringe with a needle safety shield. What should the nurse do with the syringe?

  1. Activate the shield and drop the syringe into the sharps container in the room
  2. Activate the shield and carry the covered syringe to the sharps container in the soiled utility room
  3. Recap the needle using the one-handed scoop technique before leaving the bedside
  4. Activate the shield, set the syringe on the bedside tray, and discard it after finishing care
Show the answer and rationale

Answer: A

OSHA requires contaminated sharps to be discarded as soon as possible in a sharps container located as close as feasible to where they are used, and a safety device is activated right after use, so the shield goes on at the bedside and the syringe goes into the room's container. Carrying the shielded syringe to the soiled utility room is the runner-up because the needle is covered, but transport to a distant container adds handling and delay when a container is in the room. Setting the shielded syringe on the tray to discard later leaves a used sharp unsecured at the bedside, and the one-handed scoop, though it is the safe way to recap, is allowed only when no alternative exists; the safety shield is that alternative.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Practice 10 more Infection control questions free โ†’

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

Question 11 of 20

A client with type 2 diabetes who lives with two young grandchildren is starting insulin injections with a pen at home. Which statement about the used pen needles indicates understanding?

  1. 'I'll use an empty plastic soda bottle with the cap screwed on tight.'
  2. 'I'll keep the needle container on the bathroom counter next to my insulin.'
  3. 'I'll put the capped container in the recycling bin once it's full.'
  4. 'I'll drop them in an empty detergent bottle with a screw cap, up high.'
Show the answer and rationale

Answer: D

Used needles go straight into an FDA-cleared sharps container or, if one is not available, a heavy-duty plastic household container such as a laundry detergent bottle with a tight screw-on lid, labeled, kept upright and stored out of children's reach, then disposed of according to local rules. A soda bottle has a screw cap, but its thin plastic can be pierced by a needle. A container on the bathroom counter is within the grandchildren's reach, and needle containers do not go in the recycling, where they stick sorting and sanitation workers.

๐Ÿ“š Learn it: Contact, Droplet, Airborne: Pick the Right Door

Question 12 of 20

A nurse is assisting a provider who is inserting a central venous catheter at the bedside, using the unit's insertion checklist. The provider's sterile glove brushes the client's bed rail. What should the nurse do?

  1. Tell the provider about the break once the catheter is secured
  2. Hand the provider a sterile glove to pull on over the touched one
  3. Speak up and pause the procedure until the glove is changed
  4. Ask the provider to stop and restart with a new insertion kit
Show the answer and rationale

Answer: C

Central line insertion bundles empower the nurse to stop the procedure whenever sterile technique is broken, so the nurse speaks up at once and waits while the provider changes the contaminated glove before continuing. Waiting until the catheter is secured seems less disruptive, but by then the glove has handled the catheter and site, accepting a preventable bloodstream infection. A glove pulled over the touched one is contaminated as it goes on, and a new kit is not needed when only the glove was touched.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Question 13 of 20

A client with a methicillin-resistant Staphylococcus aureus (MRSA) infection of a draining hip wound is on contact precautions and needs a CT scan in the radiology department. Which action should the nurse take to prepare the client for transport?

  1. Place a surgical mask on the client and cover the wound with a clean sheet for transport
  2. Tell radiology about the wound drainage after the scan is finished so the room can be cleaned
  3. Keep the gown and gloves on during transport and change them on arrival in radiology
  4. Cover the drainage with a clean dressing, then remove the PPE and clean the hands
Show the answer and rationale

Answer: D

CDC directs staff to cover or contain the infected area, then remove and discard contaminated PPE and perform hand hygiene before transporting a client on contact precautions, and to put on clean PPE to handle the client at the destination. Keeping the gown and gloves on during transport is the runner-up because it seems protective, but PPE worn in the room is contaminated and would carry MRSA to elevator buttons, rails and other people. A mask on the client plus a sheet over the wound borrows from respiratory transport practice but does not contain drainage as a clean dressing does or address contaminated PPE, and radiology needs to know before the client arrives, not after the scan, so staff can be ready in clean PPE.

๐Ÿ“š Learn it: Contact, Droplet, Airborne: Pick the Right Door

Question 14 of 20

A nurse is discarding supplies after changing a client's surgical dressing and drawing a blood sample. Which item should the nurse place in the red biohazard bag?

  1. The needle and tube holder used for the blood draw, still attached
  2. Gloves worn to empty the client's urinal of clear yellow urine
  3. An adhesive bandage with a small dry spot of blood from a venipuncture site
  4. The old gauze dressing, so soaked that blood drips from it when lifted
Show the answer and rationale

Answer: D

Under OSHA's definition, regulated medical waste includes items that would release liquid or semi-liquid blood if compressed and items caked with dried blood that could flake off during handling, so a dripping, soaked dressing goes in the red biohazard bag. The bandage with a small dry spot is the tempting choice, but it cannot release blood and goes in the regular trash unless state rules say otherwise. The needle and holder go into the sharps container as one unit, never into a bag, and gloves used with urine that has no visible blood are ordinary waste.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Question 15 of 20

A glass specimen tube of blood slips from a nurse's gloved hand and breaks on the floor of a client's room, leaving glass fragments in a small puddle of blood. Which action should the nurse take?

  1. Collect the glass with tongs or a brush and dustpan, then mop the floor with soap and water
  2. Pick up large fragments with tongs, then wipe up small fragments and blood with disinfectant towels
  3. Collect the glass with tongs or a brush and dustpan, then clean and disinfect the floor
  4. Collect the glass with a brush and dustpan into a regular trash bag, then clean and disinfect the floor
Show the answer and rationale

Answer: C

OSHA forbids picking up possibly contaminated broken glass directly with the hands, because a fragment can cut through a glove, so the nurse collects all of it by mechanical means such as tongs or a brush and dustpan, places it in a sharps container, and then cleans and decontaminates the area with an approved disinfectant. Using tongs and then soap and water is the runner-up: the glass is handled safely, but soap and water cleans without disinfecting, so bloodborne pathogens can remain. Wiping up small fragments with towels still presses glass against the hand despite the tongs used for large pieces, and a regular trash bag is the wrong container for contaminated sharps, which belong in a sharps container even when the floor is then disinfected.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Question 16 of 20

A nurse observes an assistive personnel (AP) providing morning care to a client. Which action by the AP requires the nurse to intervene?

  1. Gives a back rub on intact skin without putting on gloves
  2. Wipes each eye with a different corner of the same washcloth
  3. Keeps the same gloves on after perineal care to do mouth care
  4. Uses alcohol hand rub, not soap, after removing the gloves
Show the answer and rationale

Answer: C

Gloves are changed, with hand hygiene, when care moves from a contaminated body site to a clean one, so doing mouth care in the gloves used for perineal care carries bowel organisms to the client's mouth. Using one washcloth for the two eyes looks like cross-contamination and is the strongest distractor, but a clean corner for each eye, wiped from the inner to the outer corner, is the standard technique. A bare-handed back rub looks careless, but standard precautions call for gloves for blood, body fluids, mucous membranes, nonintact skin or soiled skin, not clean intact skin, and an alcohol rub after glove removal is correct when the hands are not visibly soiled.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Question 17 of 20

At the start of a shift, a charge nurse on a medical unit reviews four staff members' health concerns. Which staff member should the charge nurse reassign to duties without direct client contact?

  1. A nurse with HIV infection whose viral load is undetectable on treatment
  2. A nurse who is sneezing from seasonal allergies and has no fever
  3. A nurse who formed no antibodies after two hepatitis B vaccine series
  4. A nurse with weeping, cracked dermatitis on the backs of both hands
Show the answer and rationale

Answer: D

CDC advises that health care workers with exudative lesions or weeping dermatitis refrain from direct client care and from handling client-care equipment until the condition resolves, because broken, weeping skin can both acquire and spread pathogens. HIV infection is the tempting choice, but it does not restrict routine nursing care, which poses no meaningful risk to clients. Allergic sneezing is not infectious, and a hepatitis B vaccine nonresponder keeps working but needs prompt evaluation for hepatitis B immune globulin after any exposure.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Question 18 of 20

A nurse sustained a needlestick from a hollow-bore needle just used to draw blood from a client who has HIV infection. The nurse washed the site with soap and water and reported to employee health within 30 minutes. The client's most recent viral load is not in the record. Which statement by the employee health nurse is accurate?

  1. 'You should take the first dose now rather than wait for the client's viral load result.'
  2. 'You'll take the medication for 7 days, until your first follow-up visit.'
  3. 'We'll check the client's viral load first, since an undetectable level means you need no medication.'
  4. 'Medication is started only if your own HIV test turns positive at your 6-week follow-up.'
Show the answer and rationale

Answer: A

HIV post-exposure prophylaxis works best when started as soon as possible, ideally within hours, so the first doses are not delayed for the source's viral load; the course lasts 28 days, with a baseline HIV test of the nurse now and follow-up testing afterward. Waiting for the viral load is tempting because an undetectable level lowers the risk, but it does not remove it, and the delay costs effectiveness. A positive test at 6 weeks would mean the infection prophylaxis is meant to prevent, and 7 days is far too short a course.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Question 19 of 20

During a bed bath, a nurse notes dried crusts along the eyelashes of both eyes of a client who is unconscious. Which action should the nurse take?

  1. Soften crusts with a warm, damp cloth; wipe from inner corner out
  2. Instill the prescribed eye lubricant first, then clean the crusts later
  3. Soften crusts with a warm, damp cloth; wipe from outer corner in
  4. Wipe each eye inner corner out with the same part of a damp cloth
Show the answer and rationale

Answer: A

Crusts are softened with a warm, damp cloth held on the closed lid, then wiped from the inner to the outer canthus with a clean section of the cloth for each eye, so debris moves away from the tear duct and is not carried from one eye to the other. Softening the crusts but wiping from the outer corner inward is the closest choice, yet it pushes debris into the nasolacrimal duct, and reusing one part of the cloth spreads organisms. A client who cannot blink does need the prescribed lubricant to protect the cornea, but the lids are cleaned first.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Question 20 of 20

A nurse is precepting a new perioperative nurse who is performing a surgical hand scrub at the scrub sink. Which action by the new nurse requires correction?

  1. Backs into the operating room with the hands and arms still wet
  2. Scrubs with an antiseptic-soaked sponge instead of a bristle brush
  3. Cleans under each fingernail with a nail cleaner first
  4. Holds the hands lower than the elbows while rinsing
Show the answer and rationale

Answer: D

During a surgical scrub, the hands are held higher than the elbows so that water runs from the cleanest area, the hands, toward the less clean elbows instead of back onto the fingers. Wet hands entering the operating room can look like a break, but the nurse backs in and dries them there with a sterile towel from the fingertips toward the elbow. A brush is not required, and cleaning under the nails at the start is a correct step.

๐Ÿ“š Learn it: Clean Versus Sterile, and the Chain You Are Breaking

Practice 10 more Infection control questions free โ†’

A timed or tutor-mode set in the app, scored by area, with every miss saved for review. Free, no sign-up needed.

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