NCLEX Safety and Infection Control Practice Test
What is in this test
| Topic | Focus | Items |
|---|---|---|
| Transmission-Based Precautions | Airborne, droplet, contact and protective | 5 |
| Error Prevention and Client Identification | Rights of medication, verification and time out | 4 |
| Standard Precautions and Hand Hygiene | The baseline that applies to every client | 4 |
| Restraints, Falls and Environmental Safety | Least restrictive intervention first | 4 |
| Emergency Response and Disaster Planning | Triage, evacuation and mass casualty | 3 |
| Equipment and Hazardous Material Safety | Oxygen, electrical, chemical and radiation | 2 |
Item formats in this test: Multiple choice, Ordered response, Select all that apply, Hot spot, Chart / exhibit. This is test 2 of 9 — there is one for every client-need category.
The 22 questions
A client is admitted with suspected pulmonary tuberculosis. Which room assignment and personal protective equipment should the nurse arrange?
Show answer and rationale
Correct answer: B. Private negative-pressure room with an N95 respirator for staff
Tuberculosis spreads by droplet nuclei that remain suspended in air, so airborne precautions are required: a private negative-pressure room with the door closed and a fit-tested N95 or higher respirator for anyone entering.
Why the other options are wrong
- A. A surgical mask does not filter droplet nuclei, and a shared room exposes another client.
- C. Positive pressure pushes air out of the room, which is the opposite of what is needed. Positive pressure is for protective isolation.
- D. Gown and gloves address contact spread, not airborne spread.
A nurse discovers a small fire in a client’s waste bin. Place the actions in the correct sequence, from first to last.
- AMove the client out of the room
- BActivate the fire alarm
- CClose the door to contain the fire
- DUse the extinguisher on the fire
Show answer and rationale
Correct order: 1) A. Move the client out of the room 2) B. Activate the fire alarm 3) C. Close the door to contain the fire 4) D. Use the extinguisher on the fire
RACE: Rescue anyone in immediate danger, Activate the alarm, Confine the fire by closing doors, then Extinguish if the fire is small and it is safe to do so.
A nurse is preparing to administer a medication. Which combination of identifiers is acceptable?
Show answer and rationale
Correct answer: B. Full name and date of birth
Two client-specific identifiers are required, and full name with date of birth is the standard pairing. Both are verified against the medication record and the client’s identification band.
Why the other options are wrong
- A. Location is never a valid identifier because clients are moved.
- C. Diagnosis is not unique to the client, and room number is not a valid identifier.
- D. A name on a door is a location marker and can be outdated.
At which moments must the nurse perform hand hygiene? Select all that apply.
- ABefore touching a client
- BBefore a clean or aseptic procedure
- CAfter exposure or risk of exposure to body fluids
- DAfter touching the client’s surroundings, even if the client was not touched
- EOnly when gloves were not worn
Show answer and rationale
Correct answers: A. Before touching a client; B. Before a clean or aseptic procedure; C. After exposure or risk of exposure to body fluids; D. After touching the client’s surroundings, even if the client was not touched
Hand hygiene is performed before touching a client, before a clean or aseptic procedure, after body fluid exposure risk, after touching a client and after touching their surroundings.
Why the other options are wrong
- E. Gloves are not a substitute for hand hygiene. Hands are decontaminated before applying and after removing gloves.
A nurse is teaching a client who will use home oxygen. Which statement indicates the teaching was effective?
Show answer and rationale
Correct answer: B. "I will keep my oxygen at least three metres from the gas stove."
Oxygen supports combustion, so it is kept well away from open flames and heat sources. Keeping the concentrator a safe distance from a gas stove shows the client has understood the risk.
Why the other options are wrong
- A. Petroleum-based products are flammable and are avoided around oxygen. Water-soluble lubricant is used instead.
- C. Oxygen saturates clothing, hair and bedding, so smoking anywhere near the equipment remains dangerous.
- D. Wool and synthetic fabrics generate static. Cotton bedding is recommended.
A nurse has finished administering a subcutaneous injection. Which action is correct?
Show answer and rationale
Correct answer: B. Activate the safety device and place the syringe in the sharps container at the point of use
Engaging the safety device immediately and disposing at the point of use minimises the time an exposed needle is handled, which is when most needlestick injuries occur.
Why the other options are wrong
- A. Recapping is a leading cause of needlestick injury and is avoided.
- C. Breaking or bending a needle creates a sharps hazard and aerosolises contents.
- D. Transporting an uncapped needle exposes the nurse and everyone in the corridor.
A client on droplet precautions must be transported to the radiology department. Which action is appropriate?
Show answer and rationale
Correct answer: B. The client wears a surgical mask during transport
During transport of a client on droplet or airborne precautions, the client wears the mask, which contains respiratory secretions at the source and protects everyone along the route.
Why the other options are wrong
- A. An N95 is unnecessary for droplet organisms, and leaving the client unmasked spreads droplets in corridors.
- C. Necessary diagnostic testing is not cancelled; it is performed with appropriate precautions.
- D. Gown and gloves address contact spread and do not contain respiratory droplets.
A client has developed watery diarrhoea and a stool sample is positive for Clostridioides difficile. Which nursing action is essential?
Show answer and rationale
Correct answer: B. Wash hands with soap and water after removing gloves
C. difficile forms spores that alcohol does not kill. Mechanical removal by washing with soap and running water is required, along with contact precautions and bleach-based environmental cleaning.
Why the other options are wrong
- A. Alcohol-based rub is ineffective against C. difficile spores.
- C. C. difficile is spread by contact with spores, not by respiratory droplets.
- D. An N95 respirator is for airborne organisms and is unnecessary here.
A nurse is preparing to enter the room of a client on contact and droplet precautions. Place the personal protective equipment in the order it should be applied, from first to last.
- AGown
- BMask
- CGoggles or face shield
- DGloves
Show answer and rationale
Correct order: 1) A. Gown 2) B. Mask 3) C. Goggles or face shield 4) D. Gloves
Gown, mask, goggles, gloves. Gloves are applied last so that they cover the cuffs of the gown, and because they are the item most likely to become contaminated first during care.
A confused client keeps pulling at their intravenous line. Which action should the nurse take first?
Show answer and rationale
Correct answer: C. Cover the site with a loose gauze wrap and move the client closer to the nurses’ station
The least restrictive effective intervention comes first. Concealing the site and increasing observation may resolve the behaviour entirely without restricting movement or adding a medication.
Why the other options are wrong
- A. Restraints are a last resort after alternatives have been tried and documented.
- B. Chemical restraint carries the same last-resort standard and increases delirium and fall risk.
- D. Four raised side rails are legally considered a restraint and also increase injury risk if the client climbs over.
A client is in bilateral soft wrist restraints. Which nursing actions are required? Select all that apply.
- ATie the restraint with a quick-release knot to the movable bed frame
- BCheck circulation, sensation and movement distal to the restraint at regular intervals
- CSecure the restraint to the side rail so it moves with the rail
- DRelease the restraints periodically to offer fluids, toileting and range of motion
- EObtain a PRN order so restraints can be reapplied whenever the client becomes agitated
Show answer and rationale
Correct answers: A. Tie the restraint with a quick-release knot to the movable bed frame; B. Check circulation, sensation and movement distal to the restraint at regular intervals; D. Release the restraints periodically to offer fluids, toileting and range of motion
Restraints are tied with a quick-release knot to the movable bed frame, circulation is checked regularly, and the client is released on a schedule for hydration, elimination and range of motion.
Why the other options are wrong
- C. Tying to a side rail means the restraint tightens or injures the client when the rail is lowered.
- E. PRN restraint orders are prohibited. Each episode requires a fresh, time-limited order.
A client has a sealed internal radiation implant in place. The nurse finds the implant lying on the bed linen. Which action should the nurse take?
Show answer and rationale
Correct answer: B. Pick it up with long-handled forceps and place it in the lead container in the room
A dislodged implant is handled only with long-handled forceps and placed in the lead-lined container kept in the room. This minimises exposure through distance and shielding while securing the source.
Why the other options are wrong
- A. Gloves provide no protection from gamma radiation, and repositioning the implant is not a nursing function.
- C. Sending contaminated linen away spreads the source outside the controlled area.
- D. Leaving an unshielded source exposed continues to irradiate the client and anyone entering.
Which interventions reduce fall risk for a hospitalised older adult? Select all that apply.
- AKeep the bed in the lowest position with the wheels locked
- BEnsure the call light is within reach before leaving the room
- CProvide non-slip footwear for ambulation
- DAdminister a sedative at bedtime so the client does not get up
- EOffer scheduled toileting rather than waiting for the client to call
Show answer and rationale
Correct answers: A. Keep the bed in the lowest position with the wheels locked; B. Ensure the call light is within reach before leaving the room; C. Provide non-slip footwear for ambulation; E. Offer scheduled toileting rather than waiting for the client to call
A low locked bed, an accessible call light, non-slip footwear and proactive toileting all reduce the circumstances in which falls occur. Urgency to reach the toilet is one of the most common precipitants.
Why the other options are wrong
- D. Sedatives increase fall risk in older adults through confusion, unsteadiness and delayed reaction time.
A client receiving chemotherapy has an absolute neutrophil count of 380 per cubic millimetre. Which instruction should the nurse give the family?
Show answer and rationale
Correct answer: C. "Anyone with a cold or sore throat should not visit."
An absolute neutrophil count under 500 means severe neutropenia, and the client cannot mount a normal response to infection. Excluding visitors with any infectious symptoms is a core protective measure.
Why the other options are wrong
- A. Fresh flowers and standing water harbour fungi and bacteria and are prohibited.
- B. Raw fruit and vegetables carry surface organisms and are avoided during severe neutropenia.
- D. Standing water in a humidifier is a reservoir for organisms.
A nurse is preparing an intravenous heparin infusion. Which action is required before starting the infusion?
Show answer and rationale
Correct answer: A. Have a second licensed nurse independently verify the concentration, dose and pump settings
Heparin is a high-alert medication where an error can be fatal. An independent double check by a second licensed nurse of the drug, concentration, dose and pump programming is standard practice.
Why the other options are wrong
- B. Previous exposure does not verify the current order and is not a safety check.
- C. Flushing with additional heparin adds an uncounted dose.
- D. Heparin therapy is monitored with the activated partial thromboplastin time, not the international normalised ratio.
During a rapid response, a provider gives a verbal medication order. Which nursing action is correct?
Show answer and rationale
Correct answer: B. Write the order down, read it back to the provider and receive confirmation
Verbal orders are accepted only in urgent situations, and they must be written down and read back to the prescriber, who confirms them. This closes the loop and catches mishearing.
Why the other options are wrong
- A. Acting before verification loses the opportunity to catch an error.
- C. A second listener is not the standard; read-back to the prescriber is.
- D. Refusing a verbal order during an emergency delays urgent treatment.
A client begins a generalised tonic-clonic seizure while in bed. Which actions should the nurse take? Select all that apply.
- ATurn the client to a side-lying position
- BInsert a padded tongue blade between the teeth
- CTime the duration of the seizure
- DHold the client’s limbs still to prevent injury
- ELoosen restrictive clothing around the neck
Show answer and rationale
Correct answers: A. Turn the client to a side-lying position; C. Time the duration of the seizure; E. Loosen restrictive clothing around the neck
Side-lying protects the airway from secretions, timing informs treatment decisions, and loosening clothing supports ventilation. Protecting the head and clearing the surroundings complete the response.
Why the other options are wrong
- B. Nothing is inserted into the mouth during a seizure. It risks dental injury, airway obstruction and injury to the nurse.
- D. Restraining limbs during a seizure causes fractures and soft tissue injury.
A nurse is leaving the room of a client on contact precautions. Select the item of personal protective equipment that should be removed first.
Show answer and rationale
Correct answer: C. Gloves
Gloves are removed first because they are the most contaminated item. Removing them first prevents transferring organisms to the face, hair and clothing while taking off the remaining equipment.
A unit must be evacuated because of smoke in an adjacent corridor. Which clients should the nurse move first?
Show answer and rationale
Correct answer: B. Clients who can walk with minimal or no assistance
Ambulatory clients are moved first because they can be evacuated quickly with the least staff, freeing personnel to move clients who need more help.
Why the other options are wrong
- A. Bedbound clients require the most staff and time, so they are moved last.
- C. Having an infusion does not by itself determine evacuation order; mobility does.
- D. Being asleep does not affect the order; the client is woken and their mobility determines the sequence.
During a mass casualty incident, a nurse is triaging arriving casualties. Which client should be tagged red for immediate care?
Show answer and rationale
Correct answer: B. A client with a tension pneumothorax and severe respiratory distress
Red identifies a life-threatening injury that is survivable with immediate intervention. A tension pneumothorax can be relieved quickly with a high probability of survival.
Why the other options are wrong
- A. An open fracture with intact circulation is urgent but can wait, so it is tagged yellow.
- C. Ambulatory clients with minor injuries are tagged green.
- D. A massive head injury with no spontaneous respirations is tagged black or expectant in a mass casualty setting, where resources go where they save the most lives.
Which clients require contact precautions in addition to standard precautions? Select all that apply.
- AA client with a wound colonised with methicillin-resistant Staphylococcus aureus
- BAn infant admitted with respiratory syncytial virus bronchiolitis
- CA client with active pulmonary tuberculosis
- DA client with scabies
- EA client with mumps
Show answer and rationale
Correct answers: A. A client with a wound colonised with methicillin-resistant Staphylococcus aureus; B. An infant admitted with respiratory syncytial virus bronchiolitis; D. A client with scabies
Multidrug-resistant organisms, respiratory syncytial virus and scabies all spread by direct or indirect contact and require gown and gloves on entry with dedicated equipment.
Why the other options are wrong
- C. Tuberculosis requires airborne precautions with a negative-pressure room and an N95 respirator.
- E. Mumps spreads by respiratory droplets and requires droplet precautions.
Client Chart
Review the client information. The nurse is preparing to administer the 0800 medications. Which medication should the nurse hold and clarify with the provider?
Show answer and rationale
Correct answer: A. Metoprolol 25 mg orally
Metoprolol is a beta blocker and is held for a heart rate under 60 or a systolic blood pressure under 100. This client has a heart rate of 52, a systolic pressure of 96, and reports lightheadedness. The dose is held and the provider is contacted.
Why the other options are wrong
- B. Pantoprazole has no heart rate or blood pressure parameter and is safe to give.
- C. A stool softener has no haemodynamic effect.
- D. Acetaminophen is an as-needed analgesic with normal liver-related values and is not the concern here.
What to do with your score
A single 22-item set is too short to predict a pass, so treat the number as a pointer rather than a verdict. What is worth acting on is the pattern: go back through every item you missed, and write down whether you lacked the fact, misread what the item asked for, or knew the fact and still picked second-best. Those three failures need three different fixes — more content review, slower reading, or priority-framework drilling.
Read the rationale on the items you got right too. On a well-written item you can arrive at the correct option for the wrong reason, and that will not survive a harder version of the same question.
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