★Safe & Effective Care Environment · 10–16% of the exam
Safety and Infection Control
Module 3 of 9 · Free NCLEX Prep Course · The RN Network
Protecting clients, visitors, and staff from harm: precautions, PPE, falls, restraints, fire, and emergencies. These are some of the most predictable points on the entire exam — memorize the precaution categories cold.
Standard and Transmission-Based Precautions
Standard precautions apply to every client, every time: hand hygiene, gloves for body fluid contact, and mask/eye protection when splashes are possible.
Contact precautions (gown + gloves): MRSA, VRE, C. difficile, scabies, RSV, wound infections with uncontained drainage. C. diff requires soap-and-water hand washing — alcohol rub does not kill spores.
Neutropenic/protective precautions reverse the direction: private room, no fresh flowers or standing water, no raw fruits/vegetables per policy, screen visitors for illness, meticulous hand hygiene.
Doffing order: gloves → goggles → gown → mask — remove the dirtiest items first; the mask/respirator comes off last, after leaving the room (airborne) or at the doorway (droplet/contact per policy).
Perform hand hygiene immediately after removing all PPE and any time hands are visibly soiled.
N95 respirators require fit-testing and a seal check with every use.
Double-bagging, dedicated equipment (disposable BP cuffs, stethoscopes) stay in contact-precaution rooms.
Falls, Restraints, and Seizure Safety
Highest fall risk: previous falls, age over 65, sedating medications, orthostatic hypotension, urinary urgency, impaired mobility, and altered cognition. Reassess risk after every status change.
Fall prevention: bed low and locked, call light within reach, non-slip footwear, clutter-free path, hourly rounding, bed alarm for high-risk clients — restraints are never a fall-prevention first resort.
Restraints require: least restrictive device first, a provider order within the required timeframe (never PRN), circulation checks and release for ROM every 2 hours per policy, and a quick-release knot tied to the bed frame — never the side rail.
Seizure precautions: padded side rails, oxygen and suction at bedside, IV access. During a seizure: lower to the floor, turn on side, protect the head, time the seizure — never restrain the client or force anything into the mouth.
Post-fall: assess the client before moving them; assess first, then notify, then document and complete the incident report.
Fire, Electrical, and Environmental Safety
Fire response — RACE: Rescue clients in immediate danger, Alarm, Contain (close doors), Extinguish or Evacuate.
Extinguisher use — PASS: Pull the pin, Aim at the base, Squeeze, Sweep side to side.
Horizontal evacuation first (behind the next fire doors), ambulatory clients first in a full evacuation, then wheelchair, then bedbound.
Oxygen in use: post signage, no open flames or petroleum products, keep tanks secured upright.
Electrical safety: no frayed cords or overloaded outlets; biomedical inspection tags on client equipment; unplug from the plug, not the cord.
Error Prevention and Security Events
Two identifiers (name + DOB or MRN) before every medication, treatment, specimen, and transfer — never the room number.
High-alert medication safeguards: independent double checks (insulin, heparin, chemotherapy), smart pumps, and no borrowing meds from other clients' drawers.
Prevent wrong-site surgery: preoperative verification, site marking with the client involved, and a full team time-out before incision.
Infant/child security: match ID bands every contact, transport one infant at a time, staff wear visible photo ID, respond to abduction alarms per code (often Code Pink).
Report and remove malfunctioning equipment immediately — tag it, do not troubleshoot at the bedside with a client attached.
Practice Questions
Answer each question, then read the rationale — the rationale is where the learning happens.
1.The nurse is assigned four clients. Which client requires an N95 respirator and a negative-pressure room?
Rationale: Tuberculosis requires airborne precautions: N95 respirator and negative-pressure isolation. Influenza and pertussis require droplet precautions (surgical mask); MRSA wound infection requires contact precautions (gown and gloves).
2.After caring for a client with Clostridioides difficile, which action by the nurse is correct?
Rationale: C. difficile forms spores that alcohol-based rubs do not kill — soap and water with friction is required. C. diff is contact precautions (gown and gloves, removed before leaving the room); an N95 is not indicated.
3.A fire starts in a trash can in the room next to the nurses' station. Clients are not in immediate danger. Which action should the nurse take FIRST?
Rationale: RACE: Rescue comes first only when someone is in immediate danger — here no one is. The next step is Alarm, then Contain (close doors), then Extinguish/Evacuate. Activating the alarm mobilizes the entire response system.
4.The nurse applies a wrist restraint to a client per provider order. Which action indicates correct technique?
Rationale: Restraints are secured to the bed frame (which moves with the client) using a quick-release knot. Side rails move independently and can injure the client. Two fingers should fit under the restraint, and it is released for ROM/circulation checks every 2 hours, not once per shift.
5.A client begins having a tonic-clonic seizure while sitting in a chair. What should the nurse do FIRST?
Rationale: Safety first: lower the client to the floor, position side-lying to protect the airway from aspiration, protect the head, and time the seizure. Nothing goes in the mouth, restraint causes injury, and the nurse stays with the client.
6.Which client care assignment is appropriate for a nurse who is pregnant?
Rationale: Contact precautions for MRSA pose no specific fetal risk with proper PPE. Pregnant caregivers should avoid clients with radiation implants and clients with viruses teratogenic or dangerous in pregnancy (rubella; varicella-family viruses like disseminated zoster if non-immune).