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NCLEX safety and infection control questions

20 free NCLEX-style questions on isolation precautions, PPE, falls, restraints, medication safety and emergency response, with the answer and a full 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 nurse is preparing to enter the private room of a 71-year-old client admitted with COVID-19 pneumonia who is receiving oxygen at 4 L/min by nasal cannula. Which set of protective equipment should the nurse put on?

  1. A surgical mask and gloves, switching to an N95 for suctioning
  2. A surgical mask, eye protection, a gown and gloves
  3. A fit-tested N95 respirator and gloves, adding a gown for bathing
  4. A fit-tested N95 respirator, eye protection, a gown and gloves
Show the answer and rationale

Answer: D

CDC recommends that staff caring for a client with suspected or confirmed COVID-19 wear an N95 or higher-level respirator, eye protection (goggles or a face shield), a gown and gloves, with the gloves put on last over the gown cuffs. A surgical mask with eye protection, a gown and gloves is the runner-up because it is the droplet-plus-contact set, but a facemask does not protect the wearer from inhaling small particles, so CDC calls for a respirator. Leaving out the gown or eye protection, or saving the N95 for suctioning, leaves the nurse unprotected during routine close care.

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

Question 2 of 20

A nurse is reviewing hand hygiene with a newly hired assistive personnel (AP). Which statement by the AP indicates a need for further teaching?

  1. 'I wash with soap and water instead of using hand rub when blood gets on my hands.'
  2. 'I clean my hands when I leave a room even if I touched only the bed rail and the IV pump.'
  3. 'Alcohol hand rub is fine after I care for my client who has MRSA in a wound.'
  4. 'If my gloves didn't tear, I don't need to clean my hands after I take them off.'
Show the answer and rationale

Answer: D

Gloves can have tiny defects, and the hands pick up organisms as gloves come off, so CDC calls for hand hygiene right after every glove removal, torn or not; gloves never replace hand hygiene. Cleaning the hands after touching only the bed rail and pump is easy to dismiss as unnecessary, but the client's surroundings carry the client's organisms, and touching them is one of the moments for hand hygiene. Alcohol rub works against MRSA, and hands visibly soiled with blood call for soap and water.

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

Question 3 of 20

An infant is wearing soft elbow immobilizers after a cleft lip repair. Which action by the parent requires follow-up by the nurse?

  1. Removes one immobilizer at a time to move the arm and check the skin
  2. Takes both immobilizers off while the infant naps alone in the crib
  3. Stays at the bedside the entire time that an immobilizer is off
  4. Leaves the immobilizers on while cuddling the infant in a rocking chair
Show the answer and rationale

Answer: B

Elbow immobilizers keep the infant's hands away from the suture line, so they are removed one at a time, only while an adult is watching, to exercise the arm and inspect the skin, and they are checked for proper fit. Removing both during an unsupervised nap lets the infant rub or scratch the repair and disrupt the incision, the injury the devices are meant to prevent. Keeping them on while cuddling may seem overly restrictive, but a held infant can still reach the lip, so it is safe, as is staying at the bedside while one is off.

๐Ÿ“š Learn it: Restraints: Last Resort, Timed Orders, Quick-Release Knots

Question 4 of 20

An 80-year-old client with heart failure who takes furosemide each morning was found on the floor at 1100 after getting up from her recliner to go to the bathroom. She was not injured. She is oriented, says she "couldn't wait" for help and has been incontinent of urine twice since admission. Which addition to her plan of care best addresses the cause of this fall?

  1. Use a chair alarm whenever she sits in the recliner
  2. Ask the provider to move the furosemide dose to bedtime
  3. Offer toileting on a schedule, especially after her diuretic dose
  4. Ask the provider about an indwelling urinary catheter
Show the answer and rationale

Answer: C

She fell because urgency after a morning diuretic sent her hurrying to the bathroom, so scheduled toileting timed to the hours after the dose gets her there before the urge becomes overwhelming. A chair alarm is the runner-up, but it sounds only once she is already standing and does nothing about the urgency. A bedtime dose would shift the diuresis to the night, when falls are more dangerous, and an indwelling catheter is not used to manage incontinence because it raises the risk of urinary tract infection.

๐Ÿ“š Learn it: Falls: Bed Low, Wheels Locked, Call Light in Reach

Question 5 of 20

At 0300, a provider calls the unit with a new prescription for oral potassium chloride for a client whose potassium level is 3.1 mEq/L (3.1 mmol/L). Which action by the nurse best prevents an error in this telephone order?

  1. Ask the pharmacist to call the provider within the hour to confirm the dose and route
  2. Write down the complete order, then read it back to the provider
  3. Accept the order as heard and ask the provider to review and sign it within 24 hours
  4. Repeat each part of the order aloud while the provider is still talking
Show the answer and rationale

Answer: B

For a verbal or telephone order, the nurse writes down or enters the complete order and then reads it back to the prescriber, who confirms it is correct, a Joint Commission requirement that catches misheard drug names, doses and units before they reach the client. Repeating fragments while the provider is still speaking is the runner-up because it sounds like verification, but it is not a read-back of the recorded order. A later confirmation call from the pharmacist adds delay and another handoff, and the prescriber reviewing and signing the order later authenticates it but cannot correct a misunderstanding in time.

๐Ÿ“š Learn it: The Rights of Medication Administration and the Errors That Beat Them

Question 6 of 20 ยท Select all that apply

A nurse is supervising an assistive personnel (AP) who is caring for a client on contact precautions for an MRSA infection of a sacral pressure injury in an acute care hospital. Which actions by the AP are appropriate? Select all that apply.

  1. Hangs the gown on the back of the door to reuse at the next visit
  2. Puts on a gown and gloves before changing the client's bed linens
  3. Skips the gown and gloves when setting the lunch tray on the overbed table
  4. Disinfects the shared vital signs monitor before using it for the next client
  5. Puts on a surgical mask before entering to take the client's vital signs
  6. Takes off the gown and gloves before stepping out of the room
Show the answer and rationale

Answer: B, D, F

Contact precautions call for a gown and gloves for any interaction that may involve contact with the client or the client's environment, removal and disposal of the PPE before leaving the room, and dedicated equipment or cleaning and disinfecting shared equipment before it is used for another client. Skipping PPE to set down a tray is the most tempting error, but the overbed table is part of the client's environment and can carry MRSA to the AP's hands and uniform. A mask is not part of contact precautions for a wound infection, and a used gown is contaminated and is never hung up for reuse.

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

Question 7 of 20

A nurse has removed a client from a room with a small wastebasket fire and activated the alarm, and now returns with a fire extinguisher and pulls the pin. Which action shows correct use of the extinguisher?

  1. Aim the nozzle at the base of the fire and sweep side to side
  2. Move in close so the spray covers the flames from directly above
  3. Sweep the spray side to side across the tops of the flames
  4. Stand several feet back and aim at the middle of the flames
Show the answer and rationale

Answer: A

After the pin is pulled, PASS continues with aiming at the base of the fire, squeezing the handle and sweeping from side to side, because the base is where the fuel is burning. Standing several feet back is correct, which makes aiming at the middle of the flames tempting, but the spray then passes through the flames without reaching the fuel. Sweeping the tops of the flames also misses the fuel, and the nurse sprays from several feet away rather than moving in close, backing out and closing the door if the fire is not quickly controlled.

๐Ÿ“š Learn it: RACE, PASS and the Hazards Hiding in Plain Sight

Question 8 of 20

A 7-year-old is diagnosed with scabies at a clinic, and a scabicide cream is prescribed for the child and the rest of the household. Which statement by the parent indicates the teaching was effective?

  1. 'I'll wash his sheets and towels in cold water so they won't shrink.'
  2. 'I'll spray his mattress and the couch with an insect spray tonight.'
  3. 'I'll seal his stuffed animals in a plastic bag for at least 3 days.'
  4. 'If he still itches next week, I'll put on another treatment.'
Show the answer and rationale

Answer: C

Scabies mites generally do not survive more than 2 to 3 days away from human skin, so items that cannot be washed are sealed in a plastic bag for at least 72 hours, while bedding, clothing and towels are washed in hot water and dried in a hot dryer. Retreating next week is the runner-up because ongoing itching looks like treatment failure, but itching can last several weeks after the mites are dead, and CDC considers retreatment when itching lasts more than 2 to 4 weeks or new burrows or rash appear. CDC advises against insecticide sprays and fumigants, and cold water does not kill the mites and eggs.

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

Question 9 of 20

A nurse is observing a newly hired nurse pour sterile normal saline into a basin on a sterile field before a wound dressing change. Which action by the new nurse requires the nurse to intervene?

  1. Sets the bottle cap on the table with its inner surface facing up
  2. Holds the bottle with the label against the palm of the hand
  3. Rests the lip of the bottle on the rim of the basin while pouring
  4. Pours in a slow, steady stream to keep the saline from splashing
Show the answer and rationale

Answer: C

The outside of the bottle is not sterile, so it is held above the basin and never touches the basin or the field; resting the lip on the rim contaminates the basin and the saline in it. Setting the cap down with its inside facing up looks careless and is the tempting choice, but it keeps the sterile inner surface from touching the table. Holding the label against the palm keeps drips from blurring it, and pouring slowly prevents splashes that would wet the drape and let organisms wick through it.

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

Question 10 of 20

A 34-year-old client on an inpatient psychiatric unit has been in 4-point restraints for violent behavior since 0900 yesterday, and each 4-hour order has been renewed. At 0900 today, the client is still trying to bite and kick staff. What must happen before a new restraint order can be written?

  1. The provider renews the order by telephone after an RN update
  2. The client's family gives consent for continued restraint
  3. A trained RN completes a new 1-hour face-to-face evaluation
  4. A physician or other licensed practitioner sees the client in person
Show the answer and rationale

Answer: D

Orders for violent or self-destructive behavior last up to 4 hours for an adult and may be renewed for a total of 24 hours; after that, a physician or other licensed practitioner responsible for the client must see and assess the client in person before writing a new order. A trained RN may perform the face-to-face evaluation required within 1 hour of starting restraint, which makes that choice tempting, but it does not replace the practitioner's 24-hour assessment. A telephone renewal does not meet this requirement, and family consent is not what authorizes restraint.

๐Ÿ“š Learn it: Restraints: Last Resort, Timed Orders, Quick-Release Knots

Practice 10 more Safety & 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 nurse observes two assistive personnel (AP) using a floor-based full-body sling lift to move a client from the bed to a wheelchair. Which action by the AP requires the nurse to intervene?

  1. Rolling the lift to the wheelchair with the client raised just clear of the bed
  2. Locking the wheelchair brakes before lowering the client
  3. Using a sling with a frayed strap because it is the right size
  4. Opening the legs of the lift's base as wide as they will go
Show the answer and rationale

Answer: C

A frayed or torn sling can give way under the client's weight and drop the client from the lift, so it is taken out of service and replaced with an intact sling of the right size and type, inspected before every use. Rolling the lift with the client suspended is the runner-up because a client hanging in a sling looks unsafe, but moving the lift to the chair with the client held low, just clear of the bed, is how a floor lift is designed to work and keeps the center of gravity low. Opening the base legs wide adds stability, and a locked wheelchair cannot roll away as the client is lowered.

๐Ÿ“š Learn it: Falls: Bed Low, Wheels Locked, Call Light in Reach

Question 12 of 20

A client with rheumatoid arthritis takes methotrexate 15 mg by mouth once a week. On admission, the medication reconciliation lists 'methotrexate 15 mg PO daily.' What should the nurse do first?

  1. Ask the pharmacist to change the order to once weekly
  2. Review the CBC and liver tests before the scheduled dose
  3. Verify the schedule with the client and the prescriber before any dose
  4. Give the first dose now and call the prescriber to clarify
Show the answer and rationale

Answer: C

Methotrexate for rheumatoid arthritis is taken once a week, and taking the weekly dose every day has caused fatal bone marrow suppression, mouth ulcers and organ failure, which is why it is a high-alert medication and the schedule is verified before any dose. Asking the pharmacist to change the order sounds efficient, but it assumes the schedule instead of confirming it with the client and the prescriber who wrote the order. Giving a dose before the order is clarified repeats the possible error, and reviewing the blood counts and liver tests is routine monitoring that does not fix the wrong frequency.

๐Ÿ“š Learn it: The Rights of Medication Administration and the Errors That Beat Them

Question 13 of 20

A perioperative nurse is completing fire risk assessments for four procedures scheduled today. Which client is at greatest risk for a surgical fire?

  1. A client having a facial mole removed with electrocautery and oxygen by mask
  2. A client having a thyroidectomy with electrocautery and a cuffed breathing tube
  3. A client having a cesarean birth with an alcohol-based prep and electrocautery
  4. A client having carpal tunnel release with electrocautery and nasal oxygen
Show the answer and rationale

Answer: A

A surgical fire needs an ignition source, a fuel and an oxidizer, and most occur during procedures above the xiphoid, such as on the face, head or neck, when electrocautery is used near oxygen given by an open mask or cannula, which pools under the drapes; this client has all three close together. The team lowers the oxygen concentration as far as is safe, lets alcohol-based preps dry completely before draping and keeps saline on hand. The thyroidectomy is above the xiphoid, but its oxygen is sealed inside a cuffed breathing tube, which carries much less risk. Nasal oxygen during hand surgery is far from the cautery, and a cesarean is below the chest, where a dried prep in room air poses less risk.

๐Ÿ“š Learn it: RACE, PASS and the Hazards Hiding in Plain Sight

Question 14 of 20 ยท Select all that apply

At 2140, soft wrist restraints are applied under a provider's order to a client with delirium who has twice tried to pull out a chest tube despite a sitter at the bedside and redirection. Which information should the nurse document about this restraint episode? Select all that apply.

  1. The staffing level on the unit when the restraint was applied
  2. The client's response, including the reason for continued use
  3. The client's specific behavior that led to the restraint
  4. The less restrictive measures tried before the restraint
  5. The family's verbal consent to the restraint
  6. That an incident report was filed about the restraint
Show the answer and rationale

Answer: B, C, D

The record of a restraint episode describes the client's behavior and the intervention used, the less restrictive measures tried, the condition that warranted restraint, and the client's response, including the rationale for continuing it. An incident report is a separate quality document that is never mentioned in the medical record, family consent is not what authorizes restraint, and staffing levels are never a justification, because restraint may not be used for staff convenience.

๐Ÿ“š Learn it: Restraints: Last Resort, Timed Orders, Quick-Release Knots

Question 15 of 20

A 17-year-old with a spreading petechial rash is diagnosed with meningococcal meningitis in the emergency department, and droplet precautions are started 2 hours after arrival. Which staff member should the nurse refer to employee health for antibiotic prophylaxis?

  1. The housekeeper who cleaned the room after the client was moved to the ICU
  2. The nurse who suctioned the client's mouth and throat before anyone wore a mask
  3. The nurse who started the client's IV line while wearing a surgical mask
  4. The assistive personnel who brought a meal tray and spoke with the client from the doorway
Show the answer and rationale

Answer: B

CDC recommends prophylaxis, regardless of vaccination status, for staff who had unprotected, close face-to-face contact with the client's respiratory secretions, such as mouth-to-mouth resuscitation, intubation or open airway suctioning, started as soon as possible and ideally within 24 hours of identifying the case. The nurse who started the IV line was also in close contact with the client, which makes that the runner-up, but her surgical mask protected her. Brief contact from the doorway while delivering a tray and cleaning the room afterward are not considered exposures.

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

Question 16 of 20

A nurse manager in a neonatal intensive care unit is observing staff during a hand hygiene audit. Which observation requires follow-up?

  1. A nurse wearing acrylic nail tips is feeding a preterm newborn
  2. A nurse with chapped hands uses the unit-supplied hand lotion on breaks
  3. A parent removes rings and a watch before scrubbing at the sink
  4. A nurse uses alcohol rub, not soap, before touching a newborn
Show the answer and rationale

Answer: A

Artificial nails and extenders harbor more bacteria and yeast than natural nails even after hand hygiene and have been linked to outbreaks in neonatal units, so CDC advises that staff caring for high-risk clients, such as those in intensive care, not wear them and that natural nails be kept short. Hand rub instead of soap can look like a shortcut, but CDC prefers it whenever the hands are not visibly soiled because it kills more organisms in less time. Facility-supplied lotion prevents the dermatitis that lets more organisms colonize the hands, and removing jewelry before scrubbing supports good hand hygiene.

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

Question 17 of 20

A nurse is reviewing medication use on a medical unit. Which situation is an example of a chemical restraint?

  1. Haloperidol given to treat hallucinations in a client with acute psychosis
  2. A sedative given so a restless client with dementia stays in bed all night
  3. Lorazepam given to control tremors in a client in alcohol withdrawal
  4. Morphine given for incisional pain that leaves the client too drowsy to get up
Show the answer and rationale

Answer: B

A medication is a chemical restraint when it is used to manage behavior or restrict movement and is not a standard treatment or dose for the client's condition, which describes sedating a restless client with dementia to keep the client in bed; the nurse looks instead for causes of the restlessness such as pain, a full bladder or delirium. Antipsychotics such as haloperidol are often misused as restraints, which makes that choice tempting, but given for hallucinations in acute psychosis it is a standard treatment. Lorazepam for alcohol withdrawal and morphine for pain are standard treatments even when the drowsiness they cause keeps the client in bed.

๐Ÿ“š Learn it: Restraints: Last Resort, Timed Orders, Quick-Release Knots

Question 18 of 20

An RN is caring for a client who was admitted 1 hour ago after a fall at home. Which task can the RN delegate to an assistive personnel (AP)?

  1. Decide whether the client needs a bed exit alarm at night
  2. Walk the client to the bathroom at the times listed in the care plan
  3. Check the client's legs for injury after the client reports new hip pain
  4. Complete the fall risk screening for the admission record
Show the answer and rationale

Answer: B

Helping a client to the toilet on a schedule the RN has set is a routine, predictable task within the AP's role. Fall risk screening on admission looks like a checklist an AP could fill in, but it is part of the RN's initial assessment, which cannot be delegated. Deciding whether to use a bed alarm is planning, and checking for injury after new hip pain is assessment of a client whose condition may be changing, both RN responsibilities.

๐Ÿ“š Learn it: Falls: Bed Low, Wheels Locked, Call Light in Reach

Question 19 of 20

A client returning from interventional radiology has a peripheral IV line, an epidural catheter for pain control and a nasogastric feeding tube, all disconnected for the transfer. Which action best prevents a tubing misconnection when the nurse reconnects them?

  1. Use an adapter for any connector that does not quite fit the port
  2. Read the label taped near each connector before connecting the line
  3. Have a second nurse double-check the connections after they are made
  4. Trace each line from the client to its source before connecting it
Show the answer and rationale

Answer: D

Joint Commission alerts on tubing misconnections direct nurses to trace every line from the client to its point of origin before connecting or reconnecting it, especially after transfers and at handoffs, and to label lines near the connection when several are present. A label is a useful backup, but it can be missing or wrong after a transfer, so it does not replace tracing the line. A second nurse's check after connecting comes too late, because a misconnected line infuses at once. An adapter that forces a fit is the kind of shortcut behind deadly errors such as enteral feeding or epidural medication infused into a vein.

๐Ÿ“š Learn it: The Rights of Medication Administration and the Errors That Beat Them

Question 20 of 20

A client with moderate dementia and a history of wandering is not in his room, and a quick check of the unit's bathrooms and lounge does not find him. What should the nurse do next?

  1. Ask another nurse to watch the unit desk while you search the parking lot alone
  2. Search all rooms, stairwells, and exits on the unit before notifying anyone else
  3. Notify security and start the facility's missing-client procedure
  4. Call the client's daughter to ask if she took him out or knows where he went
Show the answer and rationale

Answer: C

A confused client who is missing is in immediate danger from traffic, weather and falls, so the nurse notifies security and activates the facility missing-client response at once, giving a description and the time the client was last seen. Searching the parking lot alone is the runner-up because it extends the search, but it leaves the unit, splits staff and delays the organized response that covers exits and grounds. A wider unit search before alerting anyone and calling the daughter first both lose critical minutes; family notification happens as part of the response, not instead of it.

๐Ÿ“š Learn it: RACE, PASS and the Hazards Hiding in Plain Sight

Practice 10 more Safety & 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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