Free NCLEX-RN Safety & Infection Control Questions
Free NCLEX-RN safety and infection control practice questions with rationales — precautions, error prevention, and safe equipment use.
A nurse is preparing to give oral chemotherapy and handle the client's body fluids afterward. Which action reflects safe practice?
Correct answer: C
Chemotherapy agents are hazardous, so the nurse wears chemotherapy-rated (tested) gloves and other PPE per policy and disposes of drug and contaminated waste in a labeled cytotoxic container. Standard exam gloves, even doubled, are not tested against chemotherapy permeation. A gown is worn per policy whenever hazardous drugs are handled, not only after a spill, and emptying urine requires PPE, so a single flush alone does not make the task safe.
Why the other options are wrong
- A. Standard nitrile or latex exam gloves have not undergone testing against chemotherapy penetration and can allow hazardous chemicals to leach through to the skin. Key distinction: Only gloves certified under ASTM standards specifically for chemotherapy handling provide an adequate barrier.
- B. Hazardous drug particles and aerosols are invisible, meaning exposure can occur during routine administration or fluid handling without a visible spill. Key distinction: A protective gown is worn proactively to prevent exposure, not reactively after contact has already occurred.
- D. A single flush can leave cytotoxic drug metabolites behind in the toilet bowl, exposing subsequent users or staff to contact. Key distinction: Double-flushing is required to dilute and clear the drug, and the lid must be closed first to contain hazardous aerosols.
Key takeaway: Handle chemotherapy and the client's fluids with PPE, and discard waste in a labeled cytotoxic container.
A preschooler is admitted with chickenpox (varicella) showing itchy vesicles in several stages across the trunk. Which transmission-based precautions should the nurse implement?
Correct answer: B
Varicella spreads through the air and by direct contact with the vesicle fluid, so the child needs both airborne precautions (a negative-pressure room and an N95 respirator) and contact precautions. Many people assume chickenpox is only a droplet illness, but the virus travels farther than large droplets and requires airborne isolation, not droplet isolation.
Why the other options are wrong
- A. Droplet precautions are inadequate because the varicella-zoster virus is carried on tiny aerosolized particles that drift through the air and can bypass standard surgical masks.
- C. Contact precautions alone do not protect against the airborne route of transmission, placing anyone entering the room without an N95 respirator at risk of inhalation exposure.
- D. Combining droplet and contact precautions still fails to address the airborne transmission of varicella, which requires negative-pressure ventilation and N95 respiratory protection.
Key takeaway: Varicella needs airborne plus contact precautions, not droplet precautions, because it spreads through the air.
A school-age child is admitted with suspected bacterial meningitis. Which transmission-based precaution should the nurse initiate on admission?
Correct answer: D
Bacterial meningitis spreads through respiratory droplets, so the nurse starts droplet precautions on admission and keeps them until the child has received about 24 hours of effective antibiotics, after which the child is no longer considered infectious. Airborne precautions are for smaller particles such as tuberculosis, contact precautions with stool cultures fit an enteric illness, and continuing droplet precautions until discharge extends isolation past the point it is needed.
Why the other options are wrong
- A. Airborne precautions are for small-particle pathogens like measles, varicella, and tuberculosis that float in the air. Bacterial meningitis pathogens are larger droplets and do not require a negative-pressure room.
- B. Contact precautions for stool are used for enteric pathogens (such as rotavirus or C. difficile), which is not the route of transmission for bacterial meningitis.
- C. Droplet precautions are only required until the child is no longer infectious. Maintaining them until discharge unnecessarily isolates the child and extends precaution measures longer than needed.
Key takeaway: Suspected bacterial meningitis calls for droplet precautions until 24 hours of effective antibiotics.
A nurse counsels parents of young children about preventing childhood lead poisoning. Which source should the nurse identify as the leading cause of childhood lead poisoning in the United States?
Correct answer: C
Paint made before 1978 often contained lead, and as it deteriorates it produces chips and fine dust that young children swallow through normal hand-to-mouth behavior, making it the leading source of childhood lead poisoning. Take-home lead on work clothing, lead-glazed imported dishware, and lead solder in old pipes are all genuine exposure routes, but each accounts for far fewer cases than deteriorating leaded paint and dust.
Why the other options are wrong
- A. Occupational take-home lead occurs when parents bring industrial lead dust home on work clothes, but it represents a small fraction of pediatric cases compared to housing hazards. Key distinction: Take-home lead is an occupational hazard, whereas pre-1978 housing paint dust is the primary nationwide source.
- B. Lead-glazed imported dishware can leach lead into acidic foods, but this causes sporadic localized toxicity rather than widespread epidemiological lead poisoning. Key distinction: Glazed ceramics represent episodic dietary exposure, whereas lead dust in older homes provides continuous daily exposure.
- D. Lead solder in older copper pipes can contaminate drinking water, especially when water sits stagnant. Key distinction: Water contamination is a recognized secondary risk factor, but ingested paint dust and chips remain the single largest driver of elevated pediatric blood lead levels.
Key takeaway: Deteriorating pre-1978 paint and its dust are the leading source of childhood lead poisoning.
A client is admitted with Clostridioides difficile infection and profuse diarrhea. Which measures should the nurse implement? Select all that apply.
Correct answers: o1, o2, o3, o4
C. difficile spreads by spores that survive on surfaces and hands, so it needs contact precautions with a gown and gloves, dedicated equipment, and a private room or cohorting with another C. difficile client. Hand hygiene must be soap and water, because alcohol-based sanitizer does not kill the spores. Standard quaternary-ammonium cleaners do not kill spores either; a sporicidal agent such as a bleach solution is required. An N95 is for airborne organisms and is not needed for a contact organism.
Why the other options are wrong
- o5. Alcohol-based sanitizer does not kill C. difficile spores; hand hygiene must be soap and water.
- o6. An N95 respirator is for airborne precautions; C. difficile spreads by contact, not the airborne route.
- o7. A standard quaternary-ammonium disinfectant does not kill spores; a sporicidal agent (such as bleach) is required.
Key takeaway: C. difficile means contact precautions, soap-and-water hand hygiene, dedicated equipment, and sporicidal cleaning. Alcohol sanitizer and standard disinfectants do not kill the spores.
A client requires airborne precautions. Which measures should the nurse implement? Select all that apply.
Correct answers: o1, o2, o3, o4
Airborne precautions require a negative-pressure room with the door kept closed, a fit-tested N95 (or PAPR) for anyone entering, and a surgical mask on the client during any necessary transport. The N95 is worn for every entry, not only during aerosol-generating procedures; airborne isolation needs a private negative-pressure room rather than symptom-based cohorting; and a fit-tested N95 is sufficient, so a PAPR is an alternative rather than a requirement for all staff.
Why the other options are wrong
- o5. In airborne precautions a fit-tested N95 is worn for every entry to the room, not only during aerosol-generating procedures.
- o6. Airborne isolation calls for a private negative-pressure room; cohorting by similar symptoms can mix clients with different organisms and does not provide airborne containment.
- o7. A fit-tested N95 is adequate for airborne precautions. A PAPR is an acceptable alternative, such as for a staff member who cannot be fit-tested, not a requirement for everyone.
Key takeaway: Airborne precautions: negative-pressure room, door closed, fit-tested N95 for every entry, surgical mask on the client for transport. Not an N95 reserved for aerosol-generating procedures, not symptom-based cohorting, and not a mandatory PAPR for all staff.
A client is taking immunosuppressant medication after an organ transplant and asks about getting vaccines this season. Which vaccine is contraindicated for this client?
Correct answer: D
Live attenuated vaccines, such as the nasal spray influenza vaccine, can cause infection in a significantly immunosuppressed client and are contraindicated. Inactivated and non-live vaccines, including the injectable flu shot, Tdap, and pneumococcal vaccines, do not contain live organisms and are generally acceptable.
Why the other options are wrong
- A. The intramuscular influenza vaccine is inactivated and contains no live virus; it cannot cause infection. Key distinction: The injectable flu shot is safe and recommended, whereas the intranasal flu vaccine is live and contraindicated.
- B. Tdap is a toxoid and subunit vaccine that contains no live bacteria; it is safe for immunosuppressed clients. Key distinction: Tdap is recommended to prevent pertussis and tetanus, which can be severe in immunocompromised individuals.
- C. The pneumococcal vaccine is a conjugate or polysaccharide vaccine containing no live pathogens; it does not pose an infectious risk. Key distinction: Immunosuppressed clients are encouraged to receive this vaccine to prevent pneumococcal pneumonia.
Key takeaway: Live vaccines are contraindicated in significant immunosuppression; inactivated vaccines are generally acceptable.
A client has an indwelling urinary catheter. Which actions reduce the risk of a catheter-associated urinary tract infection while keeping the closed drainage system intact? Select all that apply.
Correct answers: o3, o2, o4, o1
CAUTI prevention protects the closed system and keeps urine flowing away from the bladder. Keeping the bag below the bladder prevents backflow, securing the tubing prevents traction and urethral trauma, hand hygiene prevents transfer of organisms, and emptying into a clean dedicated container without contaminating the spout keeps the system closed. The incorrect actions each break the closed system or over-treat the skin in the mistaken belief that more sterile technique is safer.
Why the other options are wrong
- o5. Routine irrigation opens the closed system and introduces organisms. It is only done for a specific order such as clot management, not routinely.
- o6. Disconnecting to collect a specimen breaks the closed system. Specimens are drawn from the sampling port with aseptic technique.
- o7. Antiseptic scrubbing several times a shift irritates the urethral meatus. Routine care is gentle cleansing with soap and water.
Key takeaway: Keep the system closed and flowing downhill. Irrigating, disconnecting, or over-cleaning feels more sterile but each raises CAUTI risk.
A client has a sealed radioactive implant (brachytherapy) in place for cervical cancer. Which actions should the nurse take? Select all that apply.
Correct answers: o1, o2, o3, o4
Radiation exposure is controlled by time, distance, and shielding: the nurse limits time at the bedside, keeps the maximum practical distance, and wears a dosimeter to track exposure. A lead container and long forceps stay in the room so a dislodged source can be secured without handling it directly. Because the implant is a sealed source, the client's body fluids and linens are not radioactive, so they are not treated as radioactive waste. Pregnant staff and children are restricted from the room, and 'no restrictions' ignores the time-distance-shielding rules.
Why the other options are wrong
- o5. Pregnant staff and visitors and young children are restricted from a client with a radioactive implant.
- o6. A sealed implant does not make body fluids or linens radioactive; only a dislodged source is handled as radioactive.
- o7. Time, distance, and shielding precautions still apply even though the sealed source is internal.
Key takeaway: Sealed radioactive implant: limit time, maximize distance, wear a dosimeter, and keep a lead container and forceps for a dislodged source. Body fluids are not radioactive; restrict pregnant persons and children.