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NCLEX-RN category

NCLEX Safety and Infection Control Practice Questions

Quick answer

Safety and Infection Prevention and Control is weighted at 10 to 16 percent of the NCLEX-RN. It covers protecting clients and staff from injury, error and infection, and on a 150-question exam that works out to roughly 15 to 24 questions.

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Students tend to treat this category as the easy one and then lose points on it, because the questions are rarely about knowing a fact. They are about what you do in the room at that moment. A stem will describe a smoke smell, a confused client climbing over the rail, or a toddler who swallowed something, and all four options will sound like things a nurse might do. The trap is choosing the option that fixes the whole problem instead of the one that removes the immediate danger. Keep asking who or what is at risk right now, and pick the action that deals with that before anything else. The questions below span the wider category, from falls and restraints to fire, equipment and security. The sub-topic pages linked at the bottom cover infection control and isolation precautions in more depth.

Practice questions

1

An 82-year-old client was admitted last night after a hip fracture repair and is receiving oxycodone for pain. The client has urinary urgency and wears bifocals. Which action by the nurse does the most to reduce the risk of a fall?

  1. ARaise all four side rails and keep the bed at hip height for easier transfers
  2. BPlace the call light and urinal within reach, keep the bed low and locked, and round every hour
  3. CAsk the family to stay at the bedside around the clock
  4. DHold the oxycodone until the client is able to walk independently
Show answer

Answer: B

Nearly every fall risk in this stem (age, surgery, opioid, urgency, poor vision) is managed by making the environment safe and checking on the client before the client tries to get up alone.

Why the others are wrong

Four raised rails count as a restraint and lead to higher falls when clients climb over them, and a high bed makes the fall worse. Family presence helps but cannot be the plan. Holding pain medication leaves the client unable to mobilize safely and is not the nurse's call.

2

A client with dementia keeps pulling at the IV line and trying to get out of bed. The nurse is considering options before calling the provider. Which intervention should the nurse try first?

  1. AApply soft wrist restraints and reassess in two hours
  2. BRequest an order for lorazepam
  3. CCover the IV site with a sleeve, move the client to a room near the nurses' station and offer a familiar activity
  4. DTell the client firmly that pulling at the line will hurt
Show answer

Answer: C

The standard is least restrictive first. Hiding the line, increasing observation and giving the client something to do addresses the behavior without taking away freedom or adding a sedative.

Why the others are wrong

Restraints require a provider order and are only used after alternatives fail. Chemical restraint with a benzodiazepine raises fall and delirium risk in dementia. A confused client cannot hold on to a verbal warning.

3

The nurse smells smoke and finds a small fire in a wastebasket in a two-bed room with both clients in bed. What should the nurse do first?

  1. APull the nearest fire alarm
  2. BMove both clients out of the room and close the door
  3. CUse the fire extinguisher on the wastebasket
  4. DTurn off the oxygen supply at the wall
Show answer

Answer: B

RACE starts with Rescue. Anyone in immediate danger is moved first, then the alarm is pulled, then the fire is contained by closing the door, and only then is extinguishing attempted.

Why the others are wrong

The alarm comes right after the clients are out, not before. Extinguishing a fire with clients still in the room puts them at risk if it spreads. Shutting off oxygen is part of containment and comes after rescue and alarm.

4

A "code pink" infant abduction alert is announced on the postpartum unit. A nurse at the far end of the hall sees a visitor walking quickly toward the stairwell carrying a large duffel bag. Which action should the nurse take?

  1. AReturn to the nurses' station and wait for security to arrive
  2. BStay at the stairwell door, observe the visitor, and report the description and location to security without physically stopping the person
  3. CGrab the duffel bag and open it to check for an infant
  4. DAsk the visitor to show identification and then let them continue if they refuse
Show answer

Answer: B

During an infant abduction response every staff member covers an exit, watches for anyone carrying a bag or bundle large enough to hold a baby, and reports what they see so security can respond. Staff observe and report; they do not put themselves in a physical struggle.

Why the others are wrong

Leaving the exit uncovered defeats the purpose of the plan. Grabbing a bag from a stranger is unsafe for the nurse and for an infant who could be inside. Letting a person leave after refusing identification during an active alert ignores the response plan.

5

While preparing to use an IV infusion pump, the nurse notices the plug has a cracked casing and a frayed section of cord. The pump still powers on. Which action should the nurse take?

  1. AWrap the frayed area with tape and use the pump since it works
  2. BUse the pump but plug it into a grounded outlet
  3. CRemove the pump from service, tag it as unsafe, and get a replacement from biomedical engineering
  4. DUse the pump only for this shift and report it at handoff
Show answer

Answer: C

Damaged cords are a shock and fire hazard no matter whether the device turns on. The nurse takes it out of use, labels it so no one else grabs it, and reports it so it can be repaired.

Why the others are wrong

Tape does not restore insulation. A grounded outlet does not make a damaged cord safe. Waiting until handoff leaves the hazard in a client care area for hours.

6

A nurse realizes that a client received 40 mg of furosemide at 0900 when the order was for 20 mg. The client's blood pressure and heart rate are stable. What should the nurse do first?

  1. AComplete an incident report and place it in the client's chart
  2. BNotify the provider and continue to monitor the client
  3. CDocument in the nurses' notes that an incident report was filed
  4. DWait to see whether the client has any symptoms before telling anyone
Show answer

Answer: B

The client comes first. The provider is told right away so any needed monitoring or treatment can be ordered, and the client is told about the error as well. The incident report is completed after the client is safe.

Why the others are wrong

An incident report goes to risk management, never into the chart, and the chart should not mention that one was filed. Waiting for symptoms delays care and hides the error.

7

The nurse is about to hang a unit of packed red blood cells. Which action correctly confirms the client's identity?

  1. AAsk the client to say their name and compare it with the name on the door
  2. BCheck the client's room number and bed number against the blood bank form
  3. CWith a second licensed nurse at the bedside, compare the client's name and date of birth on the wristband with the blood product and the order
  4. DScan the wristband barcode alone, since the scanner replaces a second checker
Show answer

Answer: C

Two identifiers from the wristband (name and date of birth or medical record number) are checked at the bedside, and blood products require two qualified staff to verify the client, the unit and the order before it starts.

Why the others are wrong

Room number and bed number are never acceptable identifiers because clients move. A door label and a spoken name alone do not meet the two-identifier standard. Barcode scanning supports the check but does not remove the two-person verification for blood.

8

A home health nurse visits a 79-year-old client who lives alone. Which finding in the home needs to be addressed first?

  1. AThe bathroom has a grab bar next to the toilet
  2. BSeveral throw rugs are spread across the hallway between the bedroom and bathroom
  3. CThe water heater is set to 120 F
  4. DThe client keeps a nightlight on in the bedroom
Show answer

Answer: B

Loose rugs on the path an older adult walks at night are one of the most common causes of falls at home, and that is the hazard in this list.

Why the others are wrong

A grab bar, a nightlight, and a water heater set at 120 F are all correct safety measures and need no change.

9

A mother calls the clinic and says her 3-year-old has just swallowed an unknown number of her iron tablets about 10 minutes ago. The child is alert. What should the nurse instruct the mother to do first?

  1. AGive the child syrup of ipecac to make him vomit
  2. BGive the child a large glass of milk to coat the stomach
  3. CCall Poison Control right away and follow their directions
  4. DWatch the child at home and call back if he vomits or becomes drowsy
Show answer

Answer: C

Poison Control gives the right instruction for the specific substance, and iron is one of the most dangerous pediatric ingestions. They decide whether the child goes to the emergency department.

Why the others are wrong

Induced vomiting is no longer recommended and can cause aspiration. Milk is not a treatment and can delay care. Iron toxicity can look mild at first and then become severe, so watching at home is unsafe.

10

A client with a known seizure disorder is being admitted to the medical unit. Which item should the nurse have at the bedside?

  1. AA padded tongue blade to place between the teeth during a seizure
  2. BSuction equipment and oxygen, with the bed in a low position and side rails padded
  3. CSoft wrist restraints to prevent injury during a seizure
  4. DA dose of oral phenytoin to give at the first sign of an aura
Show answer

Answer: B

Seizure precautions are about protecting the airway and preventing injury. Suction and oxygen are ready, the bed is low, and the rails are padded so the client cannot strike hard surfaces.

Why the others are wrong

Nothing goes in the mouth during a seizure. Restraints can cause fractures when the client convulses against them. Oral medication is not given during or just before a seizure because the client cannot swallow safely.

Quick tips

  • When the stem describes a fire, run RACE in order in your head before you look at the options. Rescue beats alarm, alarm beats contain, contain beats extinguish.
  • Any option that uses restraints, four side rails, or a sedative to control behavior is almost never the first choice. Look for the least restrictive answer.
  • Room number and bed number are never client identifiers. Name plus date of birth or medical record number, checked on the wristband, is the standard before medications and blood.
  • After a medication error, the sequence is assess the client, notify the provider, then fill out the incident report. The report never goes in the chart.
  • For any poisoning, the first phone call is Poison Control, not the emergency room, and nobody induces vomiting.

Related topics

FAQ

How many safety and infection control questions are on the NCLEX?

The category is 10 to 16 percent of the exam. If your test stops at 85 questions that is about 9 to 14 questions, and on a full 150-question exam it can be up to 24. Many of them are priority or "first action" items.

What is the difference between RACE and PASS?

RACE is what you do when you find a fire: Rescue, Alarm, Contain, Extinguish. PASS is how you work the extinguisher: Pull, Aim, Squeeze, Sweep. The exam often tests RACE by asking what to do first.

Do I need to memorize the restraint rules for the NCLEX?

Know the main points. Restraints need a provider order, never a PRN order, and the client is checked and the restraint released at set intervals. Most NCLEX questions, though, test whether you try alternatives before reaching for a restraint at all.

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