NCLEX Safety and Infection Control
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Where this fits in the test plan
Safety and Infection Control is about 12% of the items you will see. That percentage is worth taking literally when you plan revision time: a category at 12% deserves roughly 12% of your question practice, not equal time with everything else.
| Topic | Focus | Study time |
|---|---|---|
| Standard Precautions and Hand Hygiene high yield | The baseline that applies to every client | 10 min |
| Transmission-Based Precautions high yield | Airborne, droplet, contact and protective | 13 min |
| Error Prevention and Client Identification | Rights of medication, verification and time out | 12 min |
| Restraints, Falls and Environmental Safety | Least restrictive intervention first | 12 min |
| Emergency Response and Disaster Planning | Triage, evacuation and mass casualty | 11 min |
| Equipment and Hazardous Material Safety | Oxygen, electrical, chemical and radiation | 9 min |
Standard Precautions and Hand Hygiene
The baseline that applies to every client
Standard precautions apply to every client regardless of diagnosis, on the assumption that all blood and body fluids may be infectious. Hand hygiene is the single most effective infection control measure, and remains the correct first answer in most infection control items.
Subtopics: Hand hygiene · PPE selection · Sharps safety · Chain of infection
Hand hygiene beats everything
Alcohol-based rub is preferred for routine decontamination. Soap and water is required when hands are visibly soiled and after caring for a client with C. difficile or other spore-forming organisms.
PPE sequence
On: gown, mask, goggles, gloves. Off: gloves, goggles, gown, mask. Gloves are dirtiest so they come off first; the mask comes off last.
Chain of infection
Agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host. Breaking any link stops the spread, and hand hygiene breaks the transmission link.
Sharps
Never recap a used needle. Dispose at the point of use in a puncture-resistant container that is replaced when three-quarters full.
High-yield points
- Perform hand hygiene before touching a client, before a clean procedure, after body fluid exposure risk, after touching a client, and after touching their surroundings.
- Gloves are not a substitute for hand hygiene; hands are washed before and after glove use.
- Standard precautions include respiratory hygiene and cough etiquette for anyone entering the facility.
- Alcohol rub does not kill C. difficile spores or norovirus.
- Wear a gown and eye protection whenever splashing is likely, not only when the diagnosis is known.
Transmission-Based Precautions
Airborne, droplet, contact and protective
Transmission-based precautions are added on top of standard precautions when the organism spreads in a specific way. Exam items usually give a diagnosis and ask for the room, the personal protective equipment, or what to do during transport.
Subtopics: Airborne · Droplet · Contact · Protective isolation · Transport of the isolated client
Airborne
Particles stay suspended, so the room must be negative pressure with the door closed and staff must wear an N95 or higher. Measles, varicella, disseminated herpes zoster and tuberculosis.
Droplet
Larger particles fall within about two metres. A private room is preferred and a surgical mask is worn on entry. Influenza, pertussis, meningococcal disease, mumps, rubella and many bacterial pneumonias.
Contact
Gown and gloves on entry, dedicated equipment. Multidrug-resistant organisms, C. difficile, respiratory syncytial virus, scabies, impetigo and draining wounds.
Protective
Positive-pressure room with HEPA filtration for severely immunocompromised clients. The precautions protect the client from the environment.
High-yield points
- Varicella and disseminated zoster need both airborne and contact precautions.
- For transport, the client wears the mask, not extra staff protection.
- C. difficile requires soap and water hand hygiene and bleach-based surface cleaning.
- A client with tuberculosis on effective therapy still needs airborne precautions until three consecutive negative sputum smears.
- Neutropenic clients get no fresh flowers, no standing water, no raw fruit or vegetables and no live vaccines.
- Cohorting clients with the same organism is acceptable when a private room is unavailable.
Error Prevention and Client Identification
Rights of medication, verification and time out
Most preventable harm in hospitals traces back to identification, communication or a high-alert medication. The exam rewards the answer that verifies before it acts.
Subtopics: Rights of medication administration · Two identifiers · High-alert medications · Surgical time out
The rights of medication administration
Right client, drug, dose, route, time, documentation, reason, response and the client’s right to refuse. Verify three times: when taking the medication out, when preparing it and at the bedside.
Two identifiers
Full name and date of birth, or name and medical record number. The room number is never an identifier.
High-alert medications
Insulin, heparin, opioids, concentrated electrolytes and chemotherapy require an independent double check by a second licensed nurse.
Time out
Before an invasive procedure the whole team pauses to confirm the client, the procedure and the site, which the surgeon has marked.
High-yield points
- Never administer a medication another nurse prepared.
- If a client says the pill looks different, stop and verify before giving it.
- Do not use trailing zeros (write 1 mg, not 1.0 mg) and always use a leading zero (0.5 mg, not .5 mg).
- Verbal orders are read back and verified, and used only in an emergency.
- After a medication error: assess the client first, then notify the provider, then complete the incident report.
- Look-alike, sound-alike medications are stored separately and labelled with tall man lettering.
Restraints, Falls and Environmental Safety
Least restrictive intervention first
Restraint and fall items almost always have a correct answer that is less restrictive than the others. Look for the option that keeps the client safe while preserving the most autonomy.
Subtopics: Restraint orders and monitoring · Fall prevention · Seizure precautions · Home safety
Restraint requirements
A provider order that is time-limited and specific, never PRN. Reassessment on a set schedule with circulation checks, hydration, toileting and range of motion at least every two hours.
Fall risk factors
Age over 65, previous fall, altered mental status, sedatives, diuretics, antihypertensives, poor vision, urgency and unfamiliar surroundings.
Seizure precautions
Padded rails up, bed low, suction and oxygen at the bedside. During a seizure, protect the head, turn the client to the side and time the event. Never insert anything into the mouth or restrain the limbs.
Side rails
Four raised side rails count as a restraint. Two raised rails are usually a safety measure.
High-yield points
- Tie restraints with a quick-release knot to the movable bed frame, never to a side rail.
- Try alternatives first: bed alarm, closer observation, family presence, reorientation, activity.
- The first action after a fall is to assess the client before moving them.
- Keep the bed in the lowest position with the call light within reach and non-slip footwear on.
- In the home, remove loose rugs, add grab bars and improve lighting on stairs.
- Never leave a restrained client unattended with the restraint applied incorrectly, and never restrain a client for staff convenience.
Emergency Response and Disaster Planning
Triage, evacuation and mass casualty
Disaster triage inverts everyday nursing priorities. The goal shifts from doing the most for each client to doing the most good for the greatest number, which means the most severely injured may be tagged expectant.
Subtopics: Triage tags · Fire response · Evacuation order · Bioterrorism
Colour triage
Red is immediate and survivable. Yellow is delayed. Green is minor, the walking wounded. Black is expectant or deceased.
Fire response
Rescue, Alarm, Confine, Extinguish or Evacuate. Use the extinguisher with Pull, Aim, Squeeze, Sweep.
Evacuation order
Ambulatory clients first, then those needing a wheelchair, then bedbound clients who require the most staff.
Bioterrorism agents
Anthrax is not spread person to person and is treated with ciprofloxacin or doxycycline. Smallpox requires airborne and contact precautions.
High-yield points
- In a mass casualty event, a client with an airway obstruction that can be relieved is red; a client with massive head injury and no spontaneous respirations is black.
- During a fire, rescue clients in immediate danger before activating the alarm only if they can be moved instantly; otherwise pull the alarm first.
- Discharge stable clients to free beds during a disaster.
- Charge nurses, not staff nurses, generally direct the redistribution of staff.
- Report a suspected bioterrorism exposure to the health department through the facility chain.
Equipment and Hazardous Material Safety
Oxygen, electrical, chemical and radiation
These items are pure recall and are worth banking. The answer is nearly always the one that reduces exposure through time, distance and shielding, or that removes an ignition source.
Subtopics: Oxygen safety · Electrical safety · Chemotherapy handling · Radiation precautions
Oxygen
Oxygen supports combustion. No smoking, no open flames, no petroleum-based products on the face, cotton rather than wool or synthetic bedding.
Radiation
Limit time, maximise distance, use shielding. Pregnant staff and pregnant visitors do not care for or visit clients with an internal radiation implant.
Chemotherapy
Double gloves and a gown, prepare in a biological safety cabinet, dispose in designated containers. Body fluids remain hazardous for about 48 hours.
Electrical
Report frayed cords, do not use extension cords for medical equipment, and ground all devices.
High-yield points
- If a radiation implant dislodges, pick it up with long-handled forceps and place it in the lead container in the room. Never touch it with your hands.
- Keep visits to a client with an implant brief and at a distance, and post the appropriate signage.
- Store oxygen cylinders upright and secured.
- A chemotherapy spill is managed with the spill kit, not with routine cleaning supplies.
- Report any equipment involved in an injury to biomedical engineering and remove it from service.
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