NCLEX Infection Control & Procedural Safety questions
The PrepScore bank has 53 Infection Control & Procedural Safety questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Take action and Analyze cues, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Surgical timeout, exposure protocols, hazmat / chemo spills, fire safety (RACE/PASS), MDRO precautions, VAP and SSI bundles, hand hygiene, isolation transitions.
Three worked questions
Q1. A 70-year-old male on the medical unit develops C. difficile diarrhea after recent antibiotic therapy. The unit nurse activates infection control. Which infection control measure is APPROPRIATE?
- A. Alcohol-based hand rub only (alcohol does NOT kill C. diff spores — must use soap and water)
- B. Soap and water hand washing (mechanically removes spores) + contact precautions (gown and gloves) + private room + dedicated equipment + bleach-based environmental cleaning + signage
- C. N95 respirator (not appropriate — C. diff is contact-transmitted, not airborne)
- D. Negative-pressure airborne isolation room (not appropriate — C. diff is contact-transmitted, not airborne)
Show answer and rationale
Answer: Soap and water hand washing (mechanically removes spores) + contact precautions (gown and gloves) + private room + dedicated equipment + bleach-based environmental cleaning + signage
C. diff infection control: SOAP AND WATER hand washing (alcohol does NOT kill spores) + contact precautions + private room + dedicated equipment + bleach environmental cleaning + signage. N95/negative pressure are for airborne pathogens.
Q2. The infection control nurse is assigning patient rooms on the unit. The nurse evaluates which patient requires airborne precautions based on disease etiology. Which client requires AIRBORNE PRECAUTIONS?
- A. A client with MRSA wound infection (CONTACT precautions — not airborne)
- B. A client with active pulmonary tuberculosis (AIRBORNE precautions — droplet nuclei < 5 microns travel long distances)
- C. A client with influenza (DROPLET precautions — large droplets > 5 microns travel < 3 ft)
- D. A client with C. difficile colitis (CONTACT precautions — not airborne)
Show answer and rationale
Answer: A client with active pulmonary tuberculosis (AIRBORNE precautions — droplet nuclei < 5 microns travel long distances)
AIRBORNE precautions: TB, measles, varicella, disseminated zoster, COVID with aerosol procedure. N95 + negative pressure room + closed door + minimize transport. MRSA + C. diff = contact; influenza = droplet.
Q3. The infection control nurse evaluates 5 patients for appropriate precautions. The nurse identifies which clients require contact precautions. Which clients REQUIRE CONTACT PRECAUTIONS? Select all that apply.
- A. Active pulmonary TB (AIRBORNE precautions — not contact)
- B. MRSA wound infection (CONTACT — drainage contact)
- C. VRE colonization (CONTACT — colonization persistent)
- D. Norovirus gastroenteritis (CONTACT + soap and water — highly contagious through feces/vomit)
- E. Pertussis (DROPLET precautions — not contact)
Show answer and rationale
Answer: MRSA wound infection (CONTACT — drainage contact)VRE colonization (CONTACT — colonization persistent)Norovirus gastroenteritis (CONTACT + soap and water — highly contagious through feces/vomit)
CONTACT precautions: MRSA + VRE + C. diff (soap and water) + norovirus (soap and water) + RSV + scabies + lice. TB = airborne; pertussis = droplet.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
Surgical timeout = correct patient (2 identifiers) + correct site (marked + visible) + correct procedure + position + allergies + antibiotic timing + equipment + imaging + fire risk. Time pressure NEVER overrides verification. Any identifier mismatch = stop until resolved. Any team member, including the nurse, has the authority + the duty to stop.
Wash with soap + warm water — do NOT squeeze (mechanical pressure drives blood deeper). Report to Employee Health within minutes, not at the end of shift. Source patient testing for HIV/HCV/HBV (with consent). PEP for HIV ideally within 1-2 hours, max 72. Baseline labs + scheduled follow-up (6 wk, 3 mo, 6 mo). Never 'finish shift, do paperwork later.'
RACE: Rescue people in danger zone, Alarm (pull + call code), Contain (close doors + shut off oxygen), Extinguish if small + contained + you have clear exit OR Evacuate. PASS the extinguisher: Pull pin, Aim at base, Squeeze handle, Sweep side to side. Evacuate horizontally first (next compartment), then vertically via stairs/evac chairs — NEVER elevators.
Cytotoxic spills require chemo spill kit, double-glove + gown + N95 + goggles + shoe covers. Isolate area + move bystanders. Skin contact = wash with soap + water for at least 15 minutes; eye contact = 15-min saline irrigation. Bag contaminated materials in cytotoxic waste container. Incident report + occupational health follow-up — never general housekeeping for cytotoxic.
MRSA, VRE, CRE all require contact precautions (gown + gloves all entry). Use dedicated equipment (stethoscope, BP cuff, thermometer) that stays in the room. Alcohol rub effective for MRSA/VRE/CRE; reserve soap-and-water for C. diff + visibly soiled. Do NOT cohort different MDROs (e.g., MRSA + VRE) in the same room — they can acquire each other. Same organism can be cohorted with infection control approval.
VAP prevention is a bundle: HOB elevated 30-45° unless contraindicated, chlorhexidine oral care q2-4h, daily sedation interruption + spontaneous breathing trial, sub-glottic suctioning, DVT prophylaxis + PUD prophylaxis. Antibiotic prophylaxis is NOT part of VAP prevention.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Infection Control & Procedural Safety questions does the bank have?
53 multiple-choice items, plus 10 unfolding cases in the Infection Control & Procedural Safety pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Take action and Analyze cues, though every step appears.
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