Editing Infection Control and Safety – RN Practice Questions

These 15 items are written at NCLEX-RN complexity for the subject [[Infection Control and Safety]]. They emphasize prioritization across multiple patients, outbreak and root-cause reasoning, delegation, and evaluation of an infection prevention plan. Options are numbered as they render on the page. Items marked '''Select all that apply''' have more than one correct option.

==Question 1==
A client is admitted to the emergency department with a six-week history of productive cough, hemoptysis, night sweats, and a 15-pound unintentional weight loss. Which action should the nurse take '''first'''?
# Obtain three sputum specimens for acid-fast bacilli.
# Place the client in an airborne infection isolation room and apply a fit-tested N95 respirator before entering.
# Notify the local health department of a suspected reportable disease.
# Administer the first dose of the ordered four-drug antituberculosis regimen.

'''Answer:''' 2. Place the client in an airborne infection isolation room and apply a fit-tested N95 respirator before entering.

''Rationale:'' Transmission-based precautions are initiated on clinical suspicion, before diagnostic confirmation, so containment comes first. Options 1, 3, and 4 are all appropriate later actions, but collecting sputum, reporting, and treating all occur after the client and staff are protected. Reporting requires a confirmed or presumed diagnosis and follows containment, and antituberculosis therapy is not started before specimens are collected.

==Question 2==
The charge nurse on a medical unit is notified of four new cases of ''Clostridioides difficile'' infection in eight days on a unit that averages one case per month. Which action by the charge nurse demonstrates the '''best''' root-cause thinking?
# Instruct all staff to use alcohol-based hand rub more frequently between clients.
# Request an order for oral vancomycin prophylaxis for the remaining clients on the unit.
# Review antibiotic use on the unit and audit hand hygiene and environmental cleaning practices with infection prevention.
# Move all four clients to a single room together and post contact precaution signage.

'''Answer:''' 3. Review antibiotic use on the unit and audit hand hygiene and environmental cleaning practices with infection prevention.

''Rationale:'' A cluster requires identifying the common exposure. Broad-spectrum antibiotic exposure is the dominant risk factor for ''C. difficile'', and inadequate hand hygiene and failure to use a sporicidal disinfectant are the usual transmission drivers. Option 1 is actively wrong because alcohol does not kill spores; soap and water is required. Option 2 is not an accepted practice and worsens antibiotic pressure. Option 4 is partially reasonable, since cohorting confirmed cases with the same organism is acceptable, but signage and cohorting alone do not address why the cluster occurred.

==Question 3==
A nurse is caring for four clients. Which client should the nurse assess '''first'''?
# A client with methicillin-resistant ''Staphylococcus aureus'' pneumonia on contact precautions who reports new dyspnea with an oxygen saturation of 87 percent on 2 liters by nasal cannula.
# A client with ''C. difficile'' who has had six loose stools in the past four hours.
# A client on airborne precautions for suspected tuberculosis whose sputum results are pending.
# A client who is two days postoperative with a temperature of 101.2 degrees Fahrenheit and a clean, dry incision.

'''Answer:''' 1. The client with new dyspnea and an oxygen saturation of 87 percent.

''Rationale:'' Prioritize by airway, breathing, and circulation, not by the drama of the isolation label. New hypoxia is an actual physiologic emergency. Option 2 is expected for the diagnosis and requires assessment of fluid and electrolyte status but is not immediately life-threatening. Option 3 is stable and already contained. Option 4 is a common expected postoperative finding, frequently atelectasis, and is assessed after the hypoxic client.

==Question 4==
'''Select all that apply.''' Which actions are components of standard precautions and are therefore performed for '''every''' client regardless of diagnosis?
# Performing hand hygiene before and after client contact.
# Wearing gloves when contact with blood, body fluids, mucous membranes, or non-intact skin is anticipated.
# Wearing a fit-tested N95 respirator on entry to every client room.
# Using a mask and eye protection when a splash or spray is likely.
# Disposing of sharps at the point of use without recapping.
# Placing every client in a private room.

'''Answer:''' 1, 2, 4, and 5.

''Rationale:'' Standard precautions apply to all clients and include hand hygiene, PPE selected by anticipated exposure, respiratory hygiene, safe injection practices, safe handling of equipment and linens, and sharps safety. Option 3 is an airborne precaution used only for specific pathogens. Option 6 is a transmission-based patient placement measure, not a universal requirement.

==Question 5==
A client with acute leukemia and an absolute neutrophil count of 300 cells per microliter is placed in a protective environment. Which finding requires '''immediate''' nursing intervention?
# The client's temperature is 100.6 degrees Fahrenheit.
# The client's family brought a bouquet of fresh flowers to the room.
# The client reports fatigue after walking in the hallway.
# The room door was left open by housekeeping.

'''Answer:''' 1. The client's temperature is 100.6 degrees Fahrenheit.

''Rationale:'' In severe neutropenia, a single temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher is neutropenic fever, an oncologic emergency. Blood cultures are obtained and broad-spectrum antibiotics are given without delay, typically within one hour. Options 2 and 4 are genuine breaches of the protective environment and must be corrected, but they are potential exposures rather than an existing emergency. Option 3 is expected with anemia and deconditioning.

==Question 6==
The nurse observes a new graduate nurse preparing to care for a client on contact precautions for vancomycin-resistant enterococci. Which action by the new graduate '''requires intervention'''?
# The graduate performs hand hygiene, then dons a gown, then dons gloves before entering the room.
# The graduate carries the unit's shared pulse oximeter into the room to obtain a reading.
# The graduate removes gloves and gown at the doorway and performs hand hygiene before exiting.
# The graduate keeps the client's stethoscope and blood pressure cuff in the room.

'''Answer:''' 2. Carrying the unit's shared pulse oximeter into the room.

''Rationale:'' Contact precautions require dedicated or single-use equipment. Shared equipment brought into the room becomes a vehicle for transmission and, if it must be used, requires disinfection before leaving the room. Options 1, 3, and 4 all describe correct practice.

==Question 7==
'''Select all that apply.''' A client with disseminated herpes zoster is admitted. Which nursing actions are appropriate?
# Place the client in a negative-pressure airborne infection isolation room with the door closed.
# Wear a fit-tested N95 respirator when entering the room.
# Wear a gown and gloves for client contact.
# Assign only staff who have documented immunity to varicella whenever possible.
# Apply a surgical mask to the client and cover the lesions during transport to radiology.
# Use a surgical mask rather than a respirator, because zoster is transmitted only by droplet.

'''Answer:''' 1, 2, 3, 4, and 5.

''Rationale:'' Disseminated zoster requires airborne '''and''' contact precautions, so both an AIIR with a respirator and gown and gloves are needed. Assigning immune staff reduces risk. During transport the client wears a surgical mask and lesions are covered. Option 6 is incorrect; only localized zoster in an immunocompetent client with lesions that can be covered is managed with standard precautions.

==Question 8==
A client with a nonviolent behavior indication has soft wrist restraints applied to protect an endotracheal tube. Which nursing action is '''correct'''?
# Secure the restraint ties to the side rails so the restraints move with the rails.
# Obtain a PRN order so the restraints can be reapplied overnight as needed.
# Tie the restraints to the movable bed frame using a quick-release knot and check circulation, sensation, and motion every two hours.
# Leave the restraints in place continuously until the endotracheal tube is removed.

'''Answer:''' 3. Tie the restraints to the movable bed frame using a quick-release knot and check circulation, sensation, and motion every two hours.

''Rationale:'' Restraints are secured to the movable portion of the bed frame so raising or lowering the bed does not tighten them, and a quick-release knot allows rapid removal in an emergency. Option 1 risks injury when the rail moves. Option 2 is prohibited; PRN and standing restraint orders are not permitted. Option 4 violates the requirement to release the restraint at least every two hours for range of motion, repositioning, toileting, hydration, and skin care, and to discontinue at the earliest possible time.

==Question 9==
A confused older adult client repeatedly attempts to climb out of bed. Which action should the nurse take '''first'''?
# Apply a vest restraint and notify the provider for an order.
# Raise all four side rails to keep the client in bed.
# Assess for pain, hypoxia, a full bladder, and recent medications, and move the client closer to the nurses' station.
# Administer the ordered as-needed lorazepam for agitation.

'''Answer:''' 3. Assess for pain, hypoxia, a full bladder, and recent medications, and move the client closer to the nurses' station.

''Rationale:'' Restraints are a last resort. The nurse first identifies and treats the cause of the behavior and applies the least restrictive intervention. Option 2 is a restraint and adds entrapment and fall-from-height risk. Options 1 and 4 are chemical and physical restraint, appropriate only after alternatives fail and only with a valid order; benzodiazepines also commonly worsen delirium in older adults.

==Question 10==
An unlicensed nursing assistant reports that a client on droplet precautions for influenza needs to go to radiology. Which instruction from the nurse is '''correct'''?
# "Put an N95 respirator on the client before you leave the room."
# "Place a surgical mask on the client, and you do not need to wear a mask in the hallway."
# "The client does not need a mask because the hallway is well ventilated."
# "Wear a gown and gloves, and have the client wear goggles during transport."

'''Answer:''' 2. Place a surgical mask on the client, and the transporter does not need a mask in the hallway.

''Rationale:'' For droplet precautions, source control is achieved by masking the client during transport; the masked client contains their own respiratory secretions. An N95 is neither indicated for influenza nor appropriate to place on a client, since it increases work of breathing and is not fit tested for them. Option 3 omits source control. Option 4 misapplies contact precaution PPE and eye protection.

==Question 11==
'''Select all that apply.''' A nurse is establishing a sterile field for a central line dressing change. Which observations indicate that the field has been '''contaminated'''?
# A bottle of sterile saline is set down within the outer 1-inch border of the drape.
# The nurse turns away from the field to answer a colleague's question.
# The nurse holds a sterile gauze package above waist level while opening it.
# A small amount of saline soaks through the drape onto the overbed table.
# The nurse opens the first flap of the sterile package away from the body.

'''Answer:''' 1, 2, and 4.

''Rationale:'' The outer 1-inch border of a sterile field is considered contaminated, so items placed there are not sterile. A sterile field must remain in view at all times; turning the back contaminates it. Moisture soaking through the drape onto an unsterile surface produces strike-through contamination. Options 3 and 5 describe correct technique: sterile items are kept above waist level, and the first flap is opened away from the body.

==Question 12==
Following an unwitnessed fall, a client is found on the floor next to the bed. The client takes apixaban. Which action should the nurse take '''first'''?
# Assist the client back to bed with help from another staff member.
# Complete an incident report and document that it was filed in the medical record.
# Assess the client's level of consciousness, vital signs, and for injury before moving them.
# Notify the provider and request a head computed tomography scan.

'''Answer:''' 3. Assess the client's level of consciousness, vital signs, and for injury before moving them.

''Rationale:'' Moving a client before assessment can convert an occult fracture or spinal injury into a worse injury. Assessment comes first. Provider notification and imaging follow, and are especially important with an anticoagulant and an unwitnessed fall, since intracranial hemorrhage may be delayed and neurologic checks are indicated. An incident report is an internal quality document; it is completed, but the medical record should not state that one was filed.

==Question 13==
A staff nurse performed unprotected suctioning of a client later confirmed to have meningococcal meningitis. Which action by the charge nurse is '''most''' appropriate?
# Reassure the nurse that wearing gloves during suctioning provided adequate protection.
# Refer the nurse to employee health for antimicrobial prophylaxis and report the case to the health department.
# Place the nurse on airborne precautions and exclude them from work for 14 days.
# Obtain a blood culture from the nurse and take no further action unless it is positive.

'''Answer:''' 2. Refer the nurse for antimicrobial prophylaxis and report the case to the health department.

''Rationale:'' ''Neisseria meningitidis'' spreads by respiratory droplets. Healthcare workers with unprotected intense exposure to respiratory secretions, such as suctioning, intubation, or mouth-to-mouth resuscitation, require prophylaxis with rifampin, ciprofloxacin, or ceftriaxone. Meningococcal disease is reportable. Gloves do not protect mucous membranes. The disease is droplet, not airborne, and prophylaxis rather than exclusion or watchful waiting is the standard, since disease onset can be fulminant.

==Question 14==
The nurse manager is evaluating the effectiveness of a unit hand hygiene improvement program. Which measure provides the '''best''' evidence of improved practice?
# The volume of alcohol-based hand rub ordered by the unit each month.
# The number of staff who completed the online hand hygiene module.
# Direct observation audit results showing compliance rates by opportunity, trended alongside device-associated infection rates.
# Staff self-reported hand hygiene compliance on an anonymous survey.

'''Answer:''' 3. Direct observation audit results trended alongside device-associated infection rates.

''Rationale:'' Direct observation of hand hygiene opportunities is the reference standard for compliance measurement, and pairing it with outcome data such as infection rates per 1,000 device days links process to outcome. Product volume is an indirect proxy that cannot identify missed opportunities. Module completion measures knowledge exposure, not behavior. Self-report consistently overestimates compliance.

==Question 15==
A fire is discovered in a soiled utility room on a medical unit. In which order should the nurse act?
# Close doors to client rooms and the utility room, and shut off oxygen to the affected area.
# Remove the client in the room adjacent to the fire.
# Use an ABC extinguisher on the fire if it remains small and an exit is clear.
# Activate the fire alarm and call the emergency number.

'''Answer:''' 2, 4, 1, 3 (RACE: Rescue, Alarm, Confine, Extinguish).

''Rationale:'' RACE sets the sequence. Rescue anyone in immediate danger first, then activate the alarm so the response system and fire department are mobilized, then confine the fire by closing doors and shutting off oxygen and electrical equipment, then extinguish only if the fire is small and contained with a clear escape route. If evacuation becomes necessary, move ambulatory clients first, evacuate horizontally past smoke barrier doors before vertically, and never use an elevator.

[[Category:Infection Control and Safety]]
[[Category:Registered Nurse (NCLEX-RN)]]
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