NCLEX-PN Safety and Infection Control Practice Questions

Preventing injury and the spread of infection — asepsis, precautions, restraints, falls, and emergency response. It sits under Safe and Effective Care Environment on the NCLEX-PN test plan and carries an approximate weight of 13% of the exam.

Below are 11 practice questions for this domain — 7 multiple-choice and 4 select-all-that-apply. Every item gives a rationale for each option, not just the correct one: on the NCLEX-PN the distractors are usually plausible actions that are simply lower priority, so knowing why an answer is wrong is worth as much as knowing why one is right.

How to use this page. Read the vignette, commit to an answer, and only then open “Show the answer and rationales”. Reading the worked answer first feels productive and teaches almost nothing — the recall attempt is what makes it stick.

Select-all-that-apply items are graded all-or-nothing: partial credit does not exist, so a single missed option loses the whole question.

Easy Multiple choice

1. C. difficile — choosing hand hygiene

A licensed practical nurse finishes changing the linens for a client who has active Clostridioides difficile (C. difficile) diarrhea and is on contact precautions. The nurse has removed the gown and gloves and is preparing to perform hand hygiene before leaving the room.

Which method of hand hygiene is most appropriate at this time?

  1. Wash the hands with soap and water at the sink.
  2. Apply alcohol-based hand sanitizer for at least 20 seconds.
  3. Rinse the hands with plain water and air dry.
  4. Skip hand hygiene because gloves were worn during the task.
Show the answer and rationales

Correct answer: A

  • A. Correct . C. difficile forms spores that alcohol-based gel does not kill. Soap and water physically removes the spores from the hands, so it is the correct choice after caring for a client with C. difficile.
  • B. Incorrect . Alcohol-based sanitizer does not kill spore-forming organisms such as C. difficile, so it cannot be relied on to remove the spores here.
  • C. Incorrect . Plain water alone does not adequately remove spores or other pathogens. Friction with soap is needed to lift the spores from the skin.
  • D. Incorrect . Gloves are never a substitute for hand hygiene, and hands must be cleaned after gloves are removed because they can become contaminated.

Reference: CDC clean hands and C. difficile infection-control guidance

Easy Multiple choice

2. Removing PPE — correct sequence

A licensed practical nurse has finished caring for a client on contact precautions and is leaving the room wearing a gown, surgical mask, goggles, and gloves. The nurse prepares to remove the personal protective equipment.

Which item of personal protective equipment should the nurse remove first?

  1. Gloves
  2. Goggles
  3. Gown
  4. Surgical mask
Show the answer and rationales

Correct answer: A

  • A. Correct . Gloves are the most heavily contaminated item, so they are removed first to avoid spreading pathogens to the face and clothing. The recommended order is gloves, then goggles, then gown, then mask.
  • B. Incorrect . Goggles are removed after the gloves. Taking the goggles off first would require touching the face area with contaminated gloves.
  • C. Incorrect . The gown is removed after the gloves and goggles. Removing it first would mean handling soiled ties while still wearing contaminated gloves.
  • D. Incorrect . The mask is removed last, after the nurse has left the room, because the front is considered contaminated and the face must be protected until everything else is off.

Reference: CDC sequence for putting on and removing personal protective equipment

Medium Select all that apply

3. Caring for a client in wrist restraints

A client is confused and has repeatedly pulled at an essential intravenous line despite alternatives being tried. The provider has ordered bilateral soft wrist restraints, and the nurse is now responsible for the client's ongoing care.

Which actions are appropriate when caring for this client? Select all that apply.

  1. Secure the restraint ties to the movable bed frame using a quick-release knot.
  2. Check circulation, skin, and range of motion at regular intervals.
  3. Confirm the restraint allows two fingers to slide between it and the wrist.
  4. Tie the restraints to the side rails so they move with the rails.
  5. Keep the restraints in place continuously until discharge.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Restraints are tied to the movable part of the bed frame that moves with the bed, never to the side rails, using a quick-release knot so they do not tighten when the bed is repositioned and can be released instantly in an emergency.
  • B. Correct . Frequent checks of circulation, skin integrity, and range of motion catch complications such as impaired blood flow or skin breakdown before they cause harm.
  • C. Correct . A restraint that admits two fingers is snug enough to be effective but loose enough to avoid cutting off circulation, which is the correct fit.
  • D. Incorrect . Restraints are never tied to the side rails. If a rail is lowered, the restraint could pull tight or injure the client, so the bed frame is used instead.
  • E. Incorrect . Restraint orders are time-limited and must be renewed per policy, and the restraints are released regularly to assess the client and meet basic needs. Continuous use without reassessment is not acceptable.

Reference: The Joint Commission and standard nursing restraint-safety guidance

Medium Multiple choice

4. Fall risk — which client to see first

A licensed practical nurse begins a shift on a medical unit and receives report on four clients. The nurse must decide which client is at greatest risk for a fall and should be seen first.

Which client should the nurse see first?

  1. An 82-year-old who is confused and received a sedative an hour ago.
  2. A 45-year-old who is alert and walking independently in the hallway.
  3. A 60-year-old waiting for a scheduled discharge later today.
  4. A 30-year-old requesting a refill of the water pitcher.
Show the answer and rationales

Correct answer: A

  • A. Correct . Advanced age, confusion, and recent sedation are major fall-risk factors. This client is the most likely to fall and should be checked first so safety measures can be reinforced.
  • B. Incorrect . An alert, independently mobile client has a low fall risk and does not need to be seen before the confused, sedated older adult.
  • C. Incorrect . A stable client awaiting discharge is not the immediate fall-risk priority compared with a confused, recently sedated older adult.
  • D. Incorrect . A routine comfort request can be addressed shortly. It does not outrank the safety risk posed by the confused, sedated older client.

Reference: Standard fall-risk assessment and nursing safety guidance

Medium Multiple choice

5. Fire in a client room — first action

A nurse walking past a client's room sees flames coming from a wastebasket near the bed. The client is receiving oxygen by nasal cannula and is able to walk with assistance.

Which action should the nurse take first?

  1. Remove the client from the room.
  2. Pull the fire alarm at the nearest pull station.
  3. Close the door to contain the fire and smoke.
  4. Use the extinguisher to put out the flames.
Show the answer and rationales

Correct answer: A

  • A. Correct . The RACE sequence puts people first — Rescue, then Alarm, Contain, and Extinguish or Evacuate. Moving the client away from the fire and the oxygen source is the priority action.
  • B. Incorrect . Activating the alarm is the second step in RACE. The client in immediate danger must be removed from the room before the alarm is pulled.
  • C. Incorrect . Containing the fire comes after rescuing the client and sounding the alarm. Closing the door first would leave the client trapped with the fire.
  • D. Incorrect . Extinguishing is the last step and is only attempted after people are safe, especially with oxygen in use, which intensifies a fire. The client must be removed first.

Reference: National Fire Protection Association RACE and oxygen-safety guidance

Medium Select all that apply

6. Home oxygen safety — reinforcing teaching

A client is being discharged home with continuous oxygen by nasal cannula. The registered nurse has begun discharge teaching, and the licensed practical nurse is reinforcing the safety instructions with the client and family.

Which instructions should the nurse reinforce about home oxygen use? Select all that apply.

  1. Keep the oxygen and tubing several feet away from stoves, candles, and other heat sources.
  2. Post no-smoking signs and do not allow smoking in the home.
  3. Use water-based lubricant on the lips instead of petroleum-based products.
  4. Apply petroleum jelly to the nares to relieve dryness from the cannula.
  5. Use an electric razor near the cannula to avoid nicks while shaving.
Show the answer and rationales

Correct answers: A, B, C

  • A. Correct . Oxygen vigorously supports combustion, so it must be kept well away from open flames and heat sources to prevent a fire.
  • B. Correct . No smoking is permitted near oxygen because a lit cigarette can ignite an oxygen-enriched environment. Posted signs warn visitors as well.
  • C. Correct . Petroleum-based products are flammable near oxygen, so water-based products are used for the lips and skin instead.
  • D. Incorrect . Petroleum jelly is flammable and should not be used near oxygen. A water-based lubricant is the safe alternative for dry nares.
  • E. Incorrect . Electric razors can produce sparks and are a fire hazard near oxygen. They should not be used in the area where oxygen is in use.

Reference: American Lung Association and MedlinePlus home oxygen safety instructions

Medium Multiple choice

7. Influenza — selecting precautions

A client is admitted with confirmed seasonal influenza and a fever of 101.8 degrees Fahrenheit (38.8 degrees Celsius). The charge nurse asks the licensed practical nurse to help set up the appropriate transmission-based precautions.

Which action correctly applies the precautions needed for this client?

  1. Place the client in a private room and wear a surgical mask when within 3 to 6 feet.
  2. Place the client in a negative-pressure room and wear an N95 respirator.
  3. Apply only standard precautions because the client has a known diagnosis.
  4. Wear a gown and gloves on entry and dedicate equipment to the room.
Show the answer and rationales

Correct answer: A

  • A. Correct . Influenza spreads by large respiratory droplets that travel only a short distance, so droplet precautions call for a private room (or cohorting) and a surgical mask within close range of the client.
  • B. Incorrect . A negative-pressure room and N95 are for airborne organisms such as tuberculosis. Influenza spreads by droplets and does not require this level of containment.
  • C. Incorrect . Standard precautions apply to all clients but are not enough alone for influenza. Droplet precautions must be added on top of standard precautions.
  • D. Incorrect . Gown and gloves on entry describe contact precautions, which are used for organisms spread by touch such as MRSA. Influenza requires droplet precautions instead.

Reference: CDC seasonal influenza infection prevention and droplet precautions guidance

Medium Multiple choice

8. Needlestick injury — first action

While discarding a used insulin syringe, a licensed practical nurse sustains a needlestick to the finger from the contaminated needle. The nurse is alone in the medication room.

Which action should the nurse take first?

  1. Wash the puncture site with soap and water.
  2. Recap the needle carefully and place it in the sharps container.
  3. Squeeze the puncture site firmly to force out any blood.
  4. Complete the incident report before doing anything else.
Show the answer and rationales

Correct answer: A

  • A. Correct . The first step after a needlestick is to wash the site immediately with soap and water to reduce the pathogen load. Reporting and medical evaluation for post-exposure prophylaxis follow right after.
  • B. Incorrect . Used needles are never recapped because recapping is a leading cause of needlestick injuries. The injury has already occurred, and recapping does nothing to protect the nurse.
  • C. Incorrect . Squeezing or milking the wound is not recommended and can damage tissue without lowering infection risk. Gentle washing with soap and water is the correct first action.
  • D. Incorrect . Reporting is required, but it is not the first action. Washing the site promptly comes first, then the injury is reported and medical evaluation sought.

Reference: CDC and OSHA occupational blood and body fluid exposure guidance

Medium Multiple choice

9. Suspected active TB — room placement

A client is admitted with a three-week history of productive cough, night sweats, and a 10-pound weight loss. The provider suspects active pulmonary tuberculosis and has ordered sputum collection for acid-fast bacilli.

Which action should the nurse take first?

  1. Place the client in a negative-pressure room and apply a fitted N95 respirator before entering.
  2. Place the client in a private room and wear a surgical mask for care.
  3. Begin reinforcing teaching about the prescribed antitubercular medications.
  4. Collect the sputum specimen at the bedside before isolation is arranged.
Show the answer and rationales

Correct answer: A

  • A. Correct . Pulmonary tuberculosis spreads by the airborne route, so the client needs an airborne infection isolation (negative-pressure) room and staff must wear a fitted N95 respirator. Containing transmission comes first.
  • B. Incorrect . A surgical mask does not protect against airborne particles, and an ordinary private room lacks the negative-pressure ventilation that airborne precautions require.
  • C. Incorrect . Teaching is important later, but it does not protect the nurse and others from inhaling infectious particles right now. Isolation must be in place first.
  • D. Incorrect . Collecting sputum without airborne precautions in place exposes staff to infectious aerosols. Proper isolation must be established before the specimen is obtained.

Reference: CDC tuberculosis infection-control and airborne precautions guidance

Hard Select all that apply

10. Sterile field — recognizing contamination

A licensed practical nurse is assisting with a sterile dressing change and is responsible for maintaining the sterile field. The nurse observes several events during the procedure and must decide which ones break sterility.

Which situations indicate the sterile field has become contaminated? Select all that apply.

  1. A sterile item is placed within the outer 1-inch border of the field.
  2. The sterile field is lowered below the nurse's waist level.
  3. The nurse turns away from the field to reach for supplies.
  4. A drop of sterile saline soaks through to the cloth beneath the field.
  5. The nurse holds sterile gloved hands above the waist and in front of the body.
  6. A sterile package is opened with the first flap directed away from the nurse.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . The outer 1-inch border of a sterile field is considered contaminated, so a sterile item resting there is no longer sterile.
  • B. Correct . Anything below waist level or out of direct sight is considered contaminated because it cannot be continuously monitored.
  • C. Correct . A sterile field that is turned away from or left unattended is considered contaminated because it is out of sight.
  • D. Correct . Moisture that wicks through to a non-sterile surface beneath provides a path for microorganisms, so the field is considered contaminated by strike-through.
  • E. Incorrect . Keeping sterile gloved hands above the waist and within sight is correct sterile technique and does not contaminate the field.
  • F. Incorrect . Opening the first flap away from the body is proper technique that keeps the nurse from reaching over the sterile contents, so it does not break sterility.

Reference: Standard surgical asepsis and sterile field principles

Hard Select all that apply

11. Varicella — required precautions

A child is admitted with widespread vesicular lesions and is diagnosed with varicella (chickenpox). The lesions are at varying stages and have not yet crusted over. The licensed practical nurse is assigned to help set up the room.

Which precautions are required for this client until the lesions crust? Select all that apply.

  1. Place the client in a negative-pressure room.
  2. Wear a fitted N95 respirator on entering the room.
  3. Wear a gown and gloves when in contact with the client.
  4. Assign only staff with evidence of immunity to varicella to care for the client.
  5. Use a surgical mask instead of a respirator when entering the room.
  6. Discontinue isolation as soon as the fever resolves.
Show the answer and rationales

Correct answers: A, B, C, D

  • A. Correct . Varicella spreads by the airborne route, so a negative-pressure room is required to keep infectious particles contained.
  • B. Correct . Because varicella is airborne, an N95 respirator is needed to protect the nurse from inhaling infectious particles.
  • C. Correct . Varicella requires contact precautions in addition to airborne precautions, so a gown and gloves are worn to prevent transmission from the vesicular fluid.
  • D. Correct . Only personnel with evidence of immunity should care for a client with varicella, which protects nonimmune staff from infection.
  • E. Incorrect . A surgical mask does not filter airborne particles. Varicella requires an N95 respirator, not a surgical mask.
  • F. Incorrect . Isolation continues until all lesions have crusted over, not when the fever breaks, because the client remains contagious while lesions are present.

Reference: CDC varicella clinical and infection-control guidance

Keep practising

These same questions are mixed into the interactive quizzes for this domain, where they are graded and feed your spaced-repetition schedule. The timed mock exam draws from every domain at its real test-plan weight.

Study sets in this domain

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