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A nurse cares for every client in the hospital, regardless of diagnosis or known infection status. Which precautions apply to ALL clients at all times?
Answer: Standard precautions.
Applied to blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes for every patient; includes hand hygiene, PPE as needed, safe injection practices, and respiratory hygiene/cough etiquette.
What examples of 'respiratory hygiene/cough etiquette' are included under standard precautions?
Answer: Cover mouth/nose when coughing or sneezing, use tissues and discard immediately, perform hand hygiene afterward, wear a mask if coughing, and maintain distance from others in common areas.
This applies to anyone with respiratory symptoms, not just clients on droplet precautions.
Which three categories make up transmission-based precautions, used IN ADDITION to standard precautions for specific infections?
Answer: Contact, droplet, and airborne precautions.
Based on the organism's route of transmission; precautions can be combined for diseases that spread by more than one route (e.g., varicella requires airborne + contact).
A client is diagnosed with a MRSA wound infection. The nurse enters the room to change the dressing. What PPE must the nurse don?
Answer: Gown and gloves (contact precautions).
Contact precautions prevent spread via direct contact with the client or contaminated surfaces/equipment; a mask is not routinely required unless splash risk exists.
List the diseases/organisms that require contact precautions.
Answer: MRSA, VRE, C. difficile, scabies, lice, RSV, impetigo, draining/uncontained wound infections, viral conjunctivitis, and other multidrug-resistant organisms.
Dedicated equipment (stethoscope, BP cuff) should stay in the room whenever possible.
A client has Clostridioides difficile infection with diarrhea. Which hand hygiene method should the nurse use after removing gloves, and why?
Answer: Wash hands with soap and water, not alcohol-based hand rub.
C. diff and norovirus form spores that alcohol does not kill; mechanical washing physically removes the spores.
A client is admitted with suspected bacterial meningitis. What precautions should the nurse initiate, and what PPE is required?
Answer: Droplet precautions; a surgical mask worn when within about 3 feet of the client.
Droplet precautions prevent spread of large respiratory droplets that do not travel far or remain suspended in air; a private room is preferred and the door may stay open.
List the diseases that require droplet precautions.
Answer: Influenza, pertussis (whooping cough), mumps, rubella, bacterial meningitis, diphtheria, streptococcal pharyngitis/pneumonia, and epiglottitis.
Key feature: large droplets expelled by coughing, sneezing, or talking that travel only short distances.
A nurse must transport a client on droplet precautions to radiology. What should the client wear during transport?
Answer: A surgical mask on the client.
Protects others in hallways and elevators from respiratory droplets expelled by the client.
A client is suspected of having active pulmonary tuberculosis. What precautions and room type are required?
Answer: Airborne precautions; a negative-pressure isolation room with the door kept closed.
Prevents small droplet nuclei (less than 5 microns) from remaining suspended in air and traveling through air-handling systems.
What PPE must a nurse wear when entering an airborne precautions room, and what special requirement applies to it?
Answer: An N95 (or higher-level) respirator that has been fit-tested to the individual nurse.
A standard surgical mask does NOT protect against airborne organisms; the N95 filters very small particles.
List the diseases that require airborne precautions.
Answer: Tuberculosis (TB), measles (rubeola), varicella (chickenpox), and disseminated herpes zoster.
Varicella and disseminated zoster require BOTH airborne AND contact precautions because the lesions are also infectious on contact.
A nonimmune nurse must care for a client with active varicella (chickenpox). What is the priority action?
Answer: Avoid assigning a nonimmune staff member if possible; if unavoidable, use both airborne and contact precautions (fit-tested N95, gown, gloves).
Varicella spreads both by airborne droplet nuclei and by direct contact with vesicular lesions.
A client with active TB also develops a draining MRSA wound. What precautions should the nurse implement?
Answer: Both airborne precautions (N95, negative-pressure room) and contact precautions (gown, gloves) simultaneously.
Transmission-based precautions are combined whenever a client has more than one indication.
A nurse is about to enter an airborne isolation room to perform a sterile dressing change. In what order should PPE be donned?
Answer: Gown → mask/respirator → goggles or face shield → gloves.
Mnemonic: 'Gown, Mask, Goggles, Gloves.' Gloves go on last so they cover the gown's cuffs.
After leaving an isolation room, in what order should the nurse remove (doff) PPE?
Answer: Gloves → goggles/face shield → gown → mask/respirator (mask removed last, after leaving the room).
Remove the most heavily contaminated items first (gloves); the mask/respirator is removed last because it protects the airway until the nurse is clear of the space.
Why does the nurse perform hand hygiene immediately after removing gloves, even before removing the rest of the PPE?
Answer: To reduce contamination transferred from the gloves before touching other PPE or surfaces.
Hand hygiene should be performed between steps of PPE removal and again after all PPE has been removed.
What are the two primary methods of hand hygiene, and which is preferred for routine care when hands are not visibly soiled?
Answer: Alcohol-based hand rub (preferred when hands are not visibly soiled) or soap-and-water handwashing.
Soap and water is required when hands are visibly soiled, or for spore-forming organisms such as C. difficile, Bacillus anthracis, and norovirus, since alcohol does not kill spores.
According to the WHO '5 Moments for Hand Hygiene,' name the 5 key times to perform hand hygiene.
Answer: 1) Before touching a patient, 2) before a clean/aseptic procedure, 3) after a body fluid exposure risk, 4) after touching a patient, 5) after touching the patient's surroundings.
Hand hygiene is considered the single most effective measure to prevent healthcare-associated infections.
A nurse finishes giving an injection. What is the correct disposal technique for the needle?
Answer: Immediately dispose of the uncapped needle and syringe as a single unit into a puncture-resistant sharps container; never recap the needle.
Recapping needles (especially two-handed) is a leading cause of needlestick injuries and is prohibited.
A nurse sustains a needlestick injury from a used needle. What is the priority first action?
Answer: Wash the area immediately with soap and water (do not squeeze or milk the wound), then report the exposure per facility protocol.
Follow with an incident report, occupational/employee health evaluation, and possible source and recipient testing with post-exposure prophylaxis if indicated.
A client becomes combative and the nurse is considering restraints. What must be tried first?
Answer: Least restrictive alternatives (de-escalation, reorientation, a sitter, decreasing stimulation) before applying restraints.
Restraints are a last resort, used only when the client is a danger to self or others, and require a healthcare provider's order.
A client is placed in restraints for violent behavior. How often must the nurse assess circulation, skin integrity, and the continued need for restraint, and how often is the client released for range of motion?
Answer: Assess at least every 15 minutes; release and perform range of motion at least every 2 hours.
The provider's restraint order must also be renewed periodically (e.g., every 4 hours for adults) and can never be written as PRN or standing.
Can a nurse apply restraints without a provider's order in an emergency?
Answer: Yes — in an emergency the nurse may apply restraints first to ensure safety, but must obtain a time-limited provider's order within a specified short time frame.
The order can never be PRN and must specify the type and duration of restraint.
A 78-year-old client on diuretics and sedatives is admitted and scored as high fall risk on a standardized tool. What should the nurse implement?
Answer: Bed in lowest position, call light within reach, nonskid footwear, bed/chair alarm, frequent rounding, a clutter-free environment, and a fall-risk identifier (e.g., colored armband).
Tools like the Morse Fall Scale assess risk based on history of falling, secondary diagnosis, ambulatory aid, IV therapy, gait, and mental status.
A fire breaks out in a client's room. Using the RACE mnemonic, what is the FIRST action the nurse should take?
Answer: Rescue — remove any clients in immediate danger.
RACE = Rescue, Alarm (activate the alarm and notify staff), Confine (close doors to contain fire/smoke), Extinguish (use an extinguisher if safe) or Evacuate.
What does the PASS mnemonic describe, and what does each letter stand for?
Answer: How to use a fire extinguisher: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side.
Used once the fire is confined and small enough to extinguish safely.
During a hospital fire, should the nurse use the elevator to evacuate clients?
Answer: No — never use elevators during a fire; use the stairs and evacuate horizontally through fire doors into an adjacent smoke compartment before attempting vertical evacuation.
Elevators can fail or open onto the fire floor; horizontal evacuation is generally safer and faster than full evacuation.
Name the 'rights' of medication administration the nurse must verify before giving any drug.
Answer: Right patient, right drug, right dose, right route, right time, right documentation, right reason, right response, and the client's right to refuse.
Some lists cite 6 core rights (patient, drug, dose, route, time, documentation); expanded lists add reason, response, and refusal.
What two identifiers must a nurse use to verify the right patient before giving medication?
Answer: Two patient identifiers, such as full name and date of birth.
Room number is never an acceptable identifier because clients may be moved or share a room.
A nurse accidentally gives a medication to the wrong client. What is the priority action?
Answer: Assess the client immediately for adverse effects, notify the provider, and then complete an incident/occurrence report.
Client safety assessment and treatment always come before paperwork.
Should the nurse document in the client's chart that an incident report was filed?
Answer: No — the incident report is separate from the medical record and must not be referenced in the chart.
The incident report is a quality-improvement/risk-management tool; the chart should contain only objective facts about the event and the client's condition/response.
On the NCLEX-RN test plan, under which major Client Needs category does 'Safety and Infection Control' fall?
Answer: Safe and Effective Care Environment.
This major category has two subcategories: Management of Care and Safety and Infection Control.
Name all four major Client Needs categories on the NCLEX-RN test plan.
Answer: 1) Safe and Effective Care Environment, 2) Health Promotion and Maintenance, 3) Psychosocial Integrity, 4) Physiological Integrity.
Safe and Effective Care Environment splits into Management of Care and Safety/Infection Control; Physiological Integrity splits into four further subcategories (Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential, Physiological Adaptation).
What percentage of NCLEX-RN exam questions typically fall under 'Safety and Infection Control'?
Answer: Approximately 9–15% of exam questions.
Percentages are set by the NCSBN test plan and updated periodically; Management of Care is typically weighted higher, around 15–21%.
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