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Safety and Infection Prevention and Control

NCLEX Infection Control Practice Questions

Quick answer

Infection control covers the everyday steps that stop germs moving from one client to the next: hand hygiene, PPE, sterile technique, line and catheter care, and sharps handling. It sits inside Safety and Infection Prevention and Control, which makes up 10 to 16 percent of the NCLEX-RN, and these questions show up in nearly every exam.

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Most students know the big rules here. What trips them up is the small detail inside the rule. You know to wash your hands, but do you know the one time an alcohol rub is not good enough? You know to keep a sterile field sterile, but can you say exactly which part of the drape is no longer sterile and what happens when you turn around? The exam writers love these edges because they separate the nurse who memorized a list from the nurse who understands why the list exists. A common trap is picking the answer that sounds most thorough, when the question is really asking what you do in the first ten seconds. Read for the action verb, then pick the step that stops transmission right now.

Practice questions

1

A nurse has just removed a bedpan from a client with confirmed Clostridioides difficile diarrhea. The nurse's hands are not visibly soiled. Which hand hygiene method should the nurse use?

  1. AAlcohol-based hand rub for at least 20 seconds
  2. BSoap and water for at least 20 seconds
  3. CAlcohol-based hand rub, then don a fresh pair of gloves
  4. DAntiseptic wipe followed by alcohol-based hand rub
Show answer

Answer: B

C. diff forms spores, and alcohol does not kill spores. Washing with soap and running water physically removes the spores from the skin, which is why it is required after every contact with a C. diff client or their environment, even when the hands look clean.

Why the others are wrong

Alcohol rub (A and C) feels faster but leaves spores on the hands, and adding gloves does not fix that. An antiseptic wipe (D) does not provide the friction and rinsing that soap and water do, and alcohol afterward adds nothing against spores.

2

A nurse is about to enter the room of a client on contact and droplet precautions. In which order should the nurse put on personal protective equipment?

  1. AGloves, gown, mask, eye protection
  2. BMask, eye protection, gown, gloves
  3. CGown, mask, eye protection, gloves
  4. DGown, gloves, mask, eye protection
Show answer

Answer: C

Donning goes gown first, then mask or respirator, then goggles or face shield, then gloves last so the glove cuffs can be pulled over the gown sleeves. Gloves go on last because they are the item most likely to be contaminated if touched during the rest of the process.

Why the others are wrong

Starting with gloves (A) means contaminating them while tying the gown and placing the mask. Putting the mask on before the gown (B) risks the gown ties disturbing the mask seal and is not the standard sequence. Gloves before mask (D) means touching the face with gloved hands that have already handled the gown.

3

A nurse is leaving the room of a client on contact precautions. Which item should the nurse remove first?

  1. AGown
  2. BMask
  3. CGloves
  4. DEye protection
Show answer

Answer: C

Gloves are the dirtiest item and come off first, inside the doorway, before anything else is touched. The usual sequence is gloves, then eye protection, then gown, then mask after leaving the room, with hand hygiene at the end and any time hands become contaminated in between.

Why the others are wrong

Removing the gown first (A) would be done with contaminated gloves that spread organisms to the gown ties and the nurse's wrists. The mask (B) comes off last and outside the room because it protects the airway until the end. Eye protection (D) is removed after gloves, not before, so the gloves do not touch the face.

4

A nurse is setting up a sterile field for a dressing change. Which action by the nurse breaks sterile technique?

  1. AOpening the first flap of the sterile package away from the body
  2. BPlacing a sterile forceps on the drape 2 inches from the edge
  3. CHolding the sterile drape at waist level while unfolding it
  4. DTurning to the counter behind to reach for the saline bottle
Show answer

Answer: D

Once the nurse turns away, the field is out of sight and anything could contaminate it. Never turn your back on a sterile field, and never reach across it. Gather everything you need before opening the field so this does not happen.

Why the others are wrong

Opening the far flap first (A) is correct so the nurse does not reach over the field later. A 1 inch border around the edge of the drape is considered unsterile, so an item 2 inches in (B) is fine. Keeping sterile items at or above waist level (C) is correct; anything that drops below the waist is considered contaminated.

5

A client has had an indwelling urinary catheter in place for 48 hours after a hip replacement. Which action by the nurse best reduces the risk of a catheter-associated urinary tract infection?

  1. AIrrigate the catheter with sterile saline every shift
  2. BAsk the surgeon whether the catheter can be removed today
  3. CChange the drainage bag every 24 hours
  4. DApply antibiotic ointment at the urethral meatus twice daily
Show answer

Answer: B

Every day a catheter stays in raises infection risk, so the single most effective step is getting it out as soon as it is no longer needed. Post-op catheters should generally come out within 24 to 48 hours, and nurses are expected to prompt that review rather than wait for an order.

Why the others are wrong

Routine irrigation (A) opens the closed system and introduces bacteria. Changing the bag daily (C) also breaks the closed system and is not recommended; the system is changed only when needed. Antibiotic ointment at the meatus (D) does not reduce CAUTI and can promote resistance; routine cleaning with soap and water is what the bundle calls for.

6

A nurse is caring for a client with a central venous catheter. Which observation requires the nurse to intervene?

  1. AThe transparent dressing is dated 5 days ago and is intact
  2. BA nursing assistant scrubs the injection cap for 15 seconds before flushing
  3. CThe IV tubing for the continuous fluids was changed 72 hours ago
  4. DA new graduate accesses the line without scrubbing the hub
Show answer

Answer: D

Scrubbing the hub with an alcohol or chlorhexidine wipe for at least 15 seconds and letting it dry before every access is a core part of the central line bundle. Skipping it pushes skin and environmental organisms straight into the bloodstream.

Why the others are wrong

An intact transparent dressing is changed every 7 days (A), so day 5 is within range. Scrubbing for 15 seconds (B) is correct practice, whoever does it. Continuous tubing is changed no more often than every 72 to 96 hours (C), so 72 hours is acceptable.

7

A client is scheduled for abdominal surgery in the morning. Which nursing action lowers the risk of a surgical site infection?

  1. AShave the abdomen with a razor the night before surgery
  2. BHave the client shower with chlorhexidine soap the evening before and the morning of surgery
  3. CHold the prophylactic antibiotic until the client is in the recovery room
  4. DKeep the client lightly covered in the preoperative area to prevent overheating
Show answer

Answer: B

Chlorhexidine showers before surgery cut the bacterial load on the skin, which is where most surgical site infections start. The surgical site infection bundle also includes antibiotic timing, hair clipping only if needed, and keeping the client warm.

Why the others are wrong

Razors (A) cause micro-cuts that let bacteria in; if hair must be removed, clippers are used right before surgery. Prophylactic antibiotics (C) must be given within 60 minutes before the incision, not afterward. Hypothermia (D) impairs wound healing and immune response, so the client should be kept warm, not cooled.

8

A client is receiving mechanical ventilation. Which action by the nurse is part of preventing ventilator-associated pneumonia?

  1. AKeep the head of the bed flat to reduce pressure on the endotracheal tube
  2. BPerform oral care with chlorhexidine on the scheduled rounds
  3. CSuction the airway every 2 hours whether or not secretions are present
  4. DChange the ventilator circuit every 24 hours
Show answer

Answer: B

Bacteria pool in the mouth and slide down past the tube into the lungs, so regular oral care with chlorhexidine is a core part of the ventilator bundle, along with head of bed elevation of 30 to 45 degrees, daily sedation holidays, and readiness-to-wean checks.

Why the others are wrong

A flat bed (A) lets gastric contents reflux into the airway; the head of the bed should be elevated 30 to 45 degrees unless contraindicated. Suctioning on a schedule (C) rather than as needed irritates the airway and adds no benefit. Ventilator circuits (D) are changed only when visibly soiled or malfunctioning, not on a fixed daily schedule.

9

While recapping a used needle, a nurse feels a sharp stick through the glove. Which action should the nurse take first?

  1. AReport the injury to the charge nurse and complete an incident report
  2. BWash the puncture site thoroughly with soap and running water
  3. CCheck the client's chart for hepatitis and HIV status
  4. DGo to employee health for baseline blood work
Show answer

Answer: B

The first step after any needlestick is to wash the site right away with soap and water. Flushing reduces the amount of blood and organisms left at the wound. Everything else, including reporting and testing, comes after the wound is cleaned. Also note the question hides a second lesson: needles should never be recapped.

Why the others are wrong

Reporting (A), reviewing the source client's status (C), and getting baseline labs (D) all need to happen within the hour because post-exposure prophylaxis works best when started early, but none of them comes before washing the wound.

10

A client receiving chemotherapy has an absolute neutrophil count of 400 cells/mm3. The nurse is reviewing precautions with the client's family. Which statement shows the family understands the teaching?

  1. A"We'll bring fresh flowers from the garden to brighten up the room."
  2. B"We'll make a fresh fruit salad so he gets vitamins without any cooking."
  3. C"We'll wash our hands before we come in and stay home if we have a cold."
  4. D"We'll take his temperature rectally every four hours so nothing is missed."
Show answer

Answer: C

Hand washing and keeping sick visitors away are the two most useful things a family can do for a neutropenic client. Even a mild cold can become a serious infection when the neutrophil count is this low.

Why the others are wrong

Fresh flowers and plants (A) carry soil organisms and standing water that grow bacteria. Raw fruit and uncooked foods (B) can carry bacteria the client cannot fight, so produce should be well washed and peeled or cooked. Rectal temperatures (D) can tear the rectal mucosa and seed bacteria into the bloodstream, so they are avoided; temperatures are taken orally or by another route.

Quick tips

  • Alcohol rub is fine almost everywhere, but after C. diff, after norovirus, and whenever hands are visibly dirty, you need soap and water. If the question mentions diarrhea and spores, think wash.
  • Learn PPE order as a story: gown, mask, goggles, gloves to go in; gloves, goggles, gown, mask to come out. Gloves on last and off first.
  • Sterile field rules in one breath: 1 inch edge is dirty, below the waist is dirty, out of sight is dirty, wet is dirty.
  • For any tube or line question (urinary catheter, central line, ventilator), the best answer is usually the one that gets the device out sooner or keeps the system closed.
  • When a sharps question asks what to do first, the answer is almost always wash the site, then report. And sharps go in the red puncture-proof box, never in the regular trash or a bag that could be squeezed.

Related topics

FAQ

When do you have to use soap and water instead of hand sanitizer?

Use soap and water when hands are visibly soiled, after caring for a client with C. diff or norovirus, after using the restroom, and before eating. Alcohol rub does not kill C. diff spores, so this is the one that shows up on the exam most.

What is the correct order to put on and take off PPE?

Put on gown, then mask, then eye protection, then gloves. Take off gloves, then eye protection, then gown, then mask, and do hand hygiene at the end. The mask or respirator comes off last, after leaving the room.

How do I remember sterile field rules for NCLEX?

Four things make a sterile item unsterile: it is within 1 inch of the drape edge, it drops below your waist, it leaves your line of sight (like when you turn around), or it gets wet. If any of those happen in a question, the field is contaminated and you start over.

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