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Safety and Infection Prevention and Control

NCLEX Isolation Precautions Practice Questions

Quick answer

Isolation precautions questions ask you to match an infection to the right type of precaution, the right PPE, and the right room, then apply that to messy situations like transport, roommates and visitors. They sit inside Safety and Infection Prevention and Control, which is 10 to 16 percent of the exam, and precaution questions are some of the most predictable points on the test if you have the lists memorized.

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Most students can recite "contact, droplet, airborne" but freeze when the question puts three clients in front of them and asks who gets the one negative pressure room. The exam rarely asks "what precaution does MRSA need." It asks what you do when the MRSA client needs a CT scan, when the pregnant nurse is on the schedule, or when the family wants to visit a child with influenza. The trap that catches people on this topic is mixing up airborne and droplet. Both involve respiratory spread, but the PPE and the room are completely different, and picking an N95 for pertussis or a surgical mask for measles is a wrong answer every time. Know the short list of true airborne diseases cold (measles, varicella, disseminated zoster, tuberculosis) and treat every other respiratory bug as droplet unless the question tells you otherwise.

Practice questions

1

A client is on contact precautions for Clostridioides difficile diarrhea. The nurse observes a nursing student caring for the client. Which action by the student requires the nurse to intervene?

  1. AThe student puts on a gown and gloves before entering the room
  2. BThe student uses an alcohol-based hand rub after removing gloves
  3. CThe student leaves a dedicated stethoscope in the room
  4. DThe student wipes the bedside table with a bleach-based disinfectant
Show answer

Answer: B

Alcohol hand rub does not kill C. difficile spores. After caring for this client, hands must be washed with soap and water, and the mechanical friction and rinsing is what removes the spores. Using only alcohol rub is the single most common break in C. difficile precautions.

Why the others are wrong

Gown and gloves on entry are exactly what contact precautions require. Dedicated equipment that stays in the room prevents spread to other clients. Bleach-based cleaning is needed because standard quaternary disinfectants do not reliably kill spores.

2

The nurse is reviewing new admissions. Which client should the nurse place on contact precautions?

  1. AA child with pertussis
  2. BAn adult with mumps
  3. CAn older adult with scabies
  4. DA child with measles
Show answer

Answer: C

Scabies spreads by direct skin contact and through contaminated linen and clothing, so contact precautions with gown and gloves are required until 24 hours after the first treatment. Contact precautions also cover MRSA, VRE, C. difficile, RSV and other organisms spread by touch.

Why the others are wrong

Pertussis and mumps spread by large respiratory droplets and need droplet precautions with a surgical mask. Measles spreads by tiny particles that stay suspended in the air and needs airborne precautions, not contact.

3

The charge nurse has one semi-private room left on a busy unit. Which two clients can safely be assigned to that room together?

  1. AA client with an MRSA wound infection and a client with a VRE urinary infection
  2. BTwo clients who both have MRSA wound infections
  3. CA client with C. difficile and a client receiving chemotherapy
  4. DAn infant with RSV and an infant admitted with an asthma flare
Show answer

Answer: B

Cohorting means placing clients who have the same organism in the same room. Two clients who both have MRSA cannot give each other anything they do not already have, so they can share a room when private rooms run out.

Why the others are wrong

MRSA and VRE are different organisms, and rooming them together risks cross-contamination and a client ending up with both. A client on chemotherapy is likely immunosuppressed and must never share with a C. difficile client. The infant with asthma does not have RSV, and RSV in a child with reactive airways can be severe.

4

A client is admitted with influenza and placed on droplet precautions. The client's daughter plans to visit every day. Which statement by the daughter shows she understands the teaching?

  1. A"I will wear a surgical mask while I am in the room and throw it away when I leave"
  2. B"I only need the mask if I am going to hug or kiss my mother"
  3. C"I should wear the special fitted respirator the nurses use for tuberculosis"
  4. D"I do not need a mask because I had my flu shot this year"
Show answer

Answer: A

Droplet precautions require a surgical mask on entering the room because influenza spreads by droplets that travel about 3 to 6 feet when the client coughs or talks. The mask is removed and discarded on leaving, followed by hand hygiene.

Why the others are wrong

Droplets reach anyone standing near the bed, not only someone touching the client. An N95 respirator is for airborne diseases and is not needed for influenza. A flu shot lowers the risk of illness but does not replace the mask, and the vaccine does not cover every circulating strain.

5

A client is admitted with varicella (chickenpox). The charge nurse is deciding who will care for the client. Which nurse is the best choice for this assignment?

  1. AA nurse who had chickenpox as a child and has a documented positive varicella titer
  2. BA nurse who is 28 weeks pregnant and has never had chickenpox
  3. CA nurse who has received only one dose of the varicella vaccine and has no titer on file
  4. DA nurse who is currently taking prednisone for a severe asthma flare
Show answer

Answer: A

Varicella needs airborne precautions plus contact precautions, and the safest caregiver is someone with documented immunity. A positive titer means the nurse cannot catch the disease, and that nurse should still wear an N95 respirator and keep the client in a negative pressure room.

Why the others are wrong

A pregnant nurse with no immunity risks severe maternal disease and fetal harm. One vaccine dose with no titer does not prove immunity. A nurse on steroids is immunosuppressed and should not be exposed to an active varicella case.

6

The nurse is admitting three clients at the same time and only one private negative pressure room is available. Which client should be assigned to that room?

  1. AA young adult with meningococcal meningitis who is receiving IV antibiotics
  2. BA child with a fever, cough, red eyes and a spreading rash diagnosed as measles
  3. CAn older adult with a draining MRSA abscess on the leg
  4. DAn adult with mumps and bilateral parotid swelling
Show answer

Answer: B

Measles is one of the few diseases that spreads by airborne particles that stay suspended for hours. It needs a negative pressure room with the door closed and an N95 for everyone who enters. If that room is the only one, the measles client gets it first.

Why the others are wrong

Meningococcal meningitis and mumps are droplet infections. A private room and a surgical mask are enough, and no special air handling is required. MRSA is contact only, so a private room or a cohort room with another MRSA client is appropriate.

7

A client on airborne precautions for measles must go to radiology for a chest x-ray that cannot be done at the bedside. Which action should the nurse take first?

  1. APlace a surgical mask on the client before leaving the room
  2. BHave the transporter put on an N95 respirator before entering the hallway
  3. CCancel the x-ray until the client is no longer infectious
  4. DCover the client with a clean sheet to contain the rash
Show answer

Answer: A

When an airborne client leaves the room, the goal is to stop the client from releasing particles into the hallway and elevators. A surgical mask on the client does that, and radiology is notified ahead so the client is not left sitting in a shared waiting area. Transport should be limited to what truly cannot be done in the room.

Why the others are wrong

The staff member pushing the stretcher does not need an N95 in the hallway once the client is masked, though the N95 is still required inside the room. Canceling a needed test is not the answer when the client can be transported safely. Measles is not spread by the rash, and a sheet does nothing for airborne particles.

8

The charge nurse is making assignments. One nurse on the shift is pregnant and has no documented rubella immunity. Which client should the charge nurse avoid assigning to this nurse?

  1. AA client with cytomegalovirus (CMV) infection on standard precautions
  2. BA client with MRSA in a surgical wound on contact precautions
  3. CA toddler with a confirmed rubella rash on droplet precautions
  4. DA client with influenza on droplet precautions
Show answer

Answer: C

Rubella during pregnancy can cause congenital rubella syndrome with deafness, heart defects and cataracts in the fetus. A nurse without documented immunity should not care for a rubella client, and the charge nurse should assign an immune nurse instead.

Why the others are wrong

CMV is spread through body fluids, and standard precautions with consistent hand hygiene and gloves for contact with secretions are considered sufficient for a pregnant nurse, so CMV alone is not a reason to change the assignment. MRSA has no special risk to the fetus. Influenza is a risk to the pregnant nurse, but a mask and vaccination protect her, and it is not on the same level as a known rubella exposure.

9

A client with leukemia has an absolute neutrophil count of 400 cells/mm3 after chemotherapy and is placed in protective isolation. Which finding requires the nurse to intervene?

  1. AThe door to the client's private room is kept closed
  2. BThe unlicensed assistive personnel is wearing a mask while taking vital signs
  3. CA vase of fresh flowers is on the bedside table
  4. DThe client is wearing a surgical mask while being taken for a scan
Show answer

Answer: C

Protective (neutropenic) isolation is the opposite of standard isolation. Instead of keeping the client's organisms in, it keeps everyone else's organisms out. Fresh flowers and standing water carry mold and bacteria that a client with almost no neutrophils cannot fight, so they are removed from the room.

Why the others are wrong

A closed door, a private room and masks on staff all reduce what reaches the client. A mask on the client when leaving the room protects the client from other people, which is exactly the point of protective isolation.

10

The nurse has finished a dressing change on a client who is on contact precautions for VRE and is ready to leave the room. Which step should the nurse take first?

  1. ARemove the gown
  2. BRemove the gloves
  3. CStep into the hallway and then remove the PPE
  4. DPerform hand hygiene
Show answer

Answer: B

Gloves are the most contaminated item and come off first. The nurse then removes the gown by peeling it forward so the dirty outside folds inward, discards both at the doorway inside the room, and performs hand hygiene before touching the door handle.

Why the others are wrong

Taking the gown off while still wearing dirty gloves transfers organisms to the gown ties and the nurse's uniform. PPE is never worn into the hallway, because that spreads the organism beyond the room. Hand hygiene is done after all PPE is off, not before, since the hands are about to touch contaminated gloves and gown.

Quick tips

  • Memorize the airborne list and keep it short: measles, varicella, disseminated zoster and tuberculosis. Everything else that spreads by coughing is droplet. Airborne means N95 and negative pressure. Droplet means a surgical mask and a closed door.
  • Contact precautions have a handful of favorites on the exam: MRSA, VRE, C. difficile, scabies, RSV and most draining wounds. Gown and gloves on entry, dedicated equipment in the room, and soap and water (never alcohol rub alone) for C. difficile.
  • When a question gives you several clients and one special room, find the airborne client. That client wins the negative pressure room. Nobody else needs it.
  • Cohorting only works with the same organism. Two MRSA clients can share. MRSA and VRE cannot. An immunosuppressed client never shares with anyone on isolation.
  • Protective isolation flips the logic. The client wears the mask outside the room, staff and visitors with any illness stay away, and fresh flowers, plants and raw food are kept out.

Related topics

FAQ

What is the difference between droplet and airborne precautions on the NCLEX?

Droplet infections like influenza, pertussis, mumps and meningococcal meningitis travel a few feet and fall. A surgical mask and a private room are enough. Airborne infections like measles and varicella stay suspended in the air, so you need an N95 respirator and a negative pressure room with the door closed.

Can two clients with different infections share a room?

Only if they have the same organism. Cohorting two MRSA clients is fine. Putting an MRSA client with a VRE client, or putting anyone on isolation with an immunosuppressed client, is a wrong answer on the exam.

What is the correct order for taking off PPE when leaving an isolation room?

Gloves first, then gown, then hand hygiene, all done inside the room at the doorway. If a mask or respirator is worn, it comes off last, after you leave the room for airborne precautions, and you wash or sanitize your hands again.

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