NCLEX Safety & Essential Care questions
The PrepScore bank has 36 Safety & Essential Care 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 Generate solutions, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
The cross-cutting NCLEX domains: infection control, fall and risk prevention, basic care, psychosocial response, and health promotion teaching.
Three worked questions
Q1. A 75-year-old male is found on the floor next to the bed by the night nurse. He is moaning and not following commands. The nurse identifies an unwitnessed fall. Which action should the nurse take FIRST?
- A. Check the client's level of consciousness and ABCs (airway, breathing, circulation) — assess for injury and stability
- B. Notify the provider before assessing the client's level of consciousness or ABCs (assess client first per nursing priority)
- C. Help the client back to bed without assessment despite the unwitnessed fall + altered responsiveness + risk of spine/head injury
- D. Document the fall in the chart before assessing the client's level of consciousness or ABCs (assess client first per nursing priority)
Show answer and rationale
Answer: Check the client's level of consciousness and ABCs (airway, breathing, circulation) — assess for injury and stability
Unwitnessed fall priority: assess LOC + ABCs first. Then determine if safe to move (rule out spine/head injury) before assisting to bed. Notifying provider, helping back to bed, or documenting before assessment are wrong.
Q2. A medical-surgical nurse is performing routine care on multiple patients. The nurse implements The Joint Commission National Patient Safety Goals for patient identification. Which actions are PART OF THE NATIONAL PATIENT SAFETY GOALS for patient identification? Select all that apply.
- A. Use at least 2 patient identifiers before any care (medication, blood, procedure, treatment)
- B. Use the room number as one identifier (NOT acceptable — room number changes and is not patient-specific)
- C. Match the identifier to the wristband + chart + medication administration record + order
- D. Confirm allergies before every medication administration
- E. Ask the patient (or caregiver) to state their name + DOB
Show answer and rationale
Answer: Use at least 2 patient identifiers before any care (medication, blood, procedure, treatment)Match the identifier to the wristband + chart + medication administration record + orderConfirm allergies before every medication administrationAsk the patient (or caregiver) to state their name + DOB
NPSG patient identification: 2 identifiers + match wristband/chart/MAR/order + confirm allergies + ask patient to state name/DOB. Room number is NOT acceptable (changes, not patient-specific).
Q3. A 32-year-old G1P0 at 36 weeks gestation with severe preeclampsia is receiving IV magnesium sulfate infusion. The L&D nurse evaluates current findings before continuing. Which finding REQUIRES THE NURSE TO HOLD the medication?
- A. DTRs +2 (normal — within therapeutic range)
- B. Respiratory rate 10 (< 12 — magnesium toxicity threshold; HOLD + notify provider + ensure IV calcium gluconate at bedside)
- C. Urine output 35 mL/hr (≥ 30 mL/hr threshold — normal range for continuing magnesium)
- D. BP 148/92 (still elevated but does not contraindicate magnesium — antihypertensives continue separately)
Show answer and rationale
Answer: Respiratory rate 10 (< 12 — magnesium toxicity threshold; HOLD + notify provider + ensure IV calcium gluconate at bedside)
Magnesium toxicity threshold for RR is < 12. RR 10 = HOLD infusion + notify provider + ensure IV calcium gluconate (antidote) at bedside. DTRs +2, UOP 35 mL/hr, and BP 148/92 are within continuation range.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
Equipment in the room is not equipment in use. The fall plan = bed alarm engaged + call light in reach + scheduled toileting + orthostatic check before standing + non-skid footwear + clear, specific patient teaching + reassessment after diuretic doses. A single intervention (e.g., non-skid socks) does not constitute a plan.
Alcohol-based hand rub does NOT kill C. diff spores — soap and water mechanically remove them. C. diff requires contact precautions, a private room (or cohort with another C. diff client), dedicated equipment, and gown + gloves for every room entry. Implement empirically on suspicion — do not wait for the stool result.
Active or suspected pulmonary TB requires a negative-pressure room (door closed) with empiric isolation on clinical suspicion. Healthcare workers wear a fit-tested N95 (or PAPR). When the patient must leave the room, the PATIENT wears a surgical mask. Do not confuse contact and airborne; do not use a surgical mask as HCW PPE for TB.
Restraints are last-resort, applied only after less restrictive measures fail, with a specific provider order (type, indication, duration, max time), monitored q15 min for behavior, released q2 h per policy for ROM/skin/toileting. Tie to the bed FRAME with a quick-release knot — never to a side rail. Re-evaluate need every shift. Chemical restraint (sedation for behavior) follows the same rules.
Prevention is a bundle: reposition q2 h, FLOAT the heels off the bed (not just cushion), pressure-redistribution surface, moisture control (toileting program + barrier), nutrition support (protein, hydration), and no massage of compromised skin. Stage 1 (non-blanchable redness) is intact skin already injured — act now.
Plan + means + isolation = acute high risk regardless of affect. Do not leave the client alone. Implement precautions per policy (q15 visualization or 1:1). Search belongings and remove contraband. Notify the team — suicide risk disclosure is an exception to confidentiality. Means restriction at home is part of any discharge plan.
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 Safety & Essential Care questions does the bank have?
36 multiple-choice items, plus 10 unfolding cases in the Safety & Essential Care 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 Generate solutions, though every step appears.
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