Nclexpn Quiz: Standard And Transmission Based Precautions

What this quiz covers

This quiz focuses on Standard And Transmission Based Precautions, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexpn.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

Question 1

1. Place the client in an airborne infection isolation room and wear an N95 respirator
2. Implement contact precautions and wear gown and gloves for room entry (correct answer)
3. Use droplet precautions and wear a surgical mask when within 3 feet (1 meter)
4. Use sterile gloves only when changing the dressing; no gown is needed

Explanation: This question tests the application of infection control precautions. The key factor in determining the appropriate precaution is the contact transmission mode of MRSA through direct contact with the draining wound. Implementing contact precautions with gown and gloves for room entry is the priority because it prevents the spread of resistant bacteria via hands or clothing. Airborne precautions are for airborne pathogens like TB, droplet precautions address respiratory droplets, and sterile gloves without a gown do not fully protect against contact transmission, making them incorrect. Infection control principles emphasize using barrier precautions to interrupt contact transmission of multidrug-resistant organisms. Guidelines from the CDC recommend dedicating equipment and thorough cleaning to prevent cross-contamination. A transferable strategy is to don PPE before entering rooms of clients with known resistant infections and perform hand hygiene after removal to protect other clients and staff.

Question 2

1. Don a standard surgical mask before entering the client's room.
2. Wear a fit-tested N95 respirator for the duration of the room entry. (correct answer)
3. Ask the client to wear a surgical mask while the nurse is in the room.
4. Keep the door to the room open to ensure adequate ventilation.

Explanation: Pulmonary tuberculosis requires Airborne Precautions. Health care personnel entering the room must wear a fit-tested N95 respirator or higher-level respirator to protect against inhaling the small airborne droplet nuclei that carry Mycobacterium tuberculosis. A standard surgical mask (A) filters large particles and droplets but does not provide adequate protection against the small aerosol particles of TB — this is the critical distinction between Droplet and Airborne Precautions. Asking the client to wear a surgical mask (C) may help limit the client's output of infectious particles but does not replace the nurse's respiratory protection. Keeping the door open (D) is directly contraindicated — the door must remain closed to maintain negative pressure and prevent airborne organisms from escaping into the hallway.

Question 3

1. Airborne Precautions.
2. Contact Precautions.
3. Droplet Precautions. (correct answer)
4. Protective Environment.

Explanation: Bacterial meningitis, most commonly caused by Neisseria meningitidis or Streptococcus pneumoniae, is transmitted via large respiratory droplets generated by coughing, sneezing, or close contact. Droplet Precautions are required — along with a private room and surgical mask for health care personnel within 3 feet of the client — until the client has received at least 24 hours of effective antibiotic therapy. Airborne Precautions (A) are used for pathogens transmitted via small-particle aerosols that can remain suspended in air, such as tuberculosis, measles, and varicella — not bacterial meningitis. Contact Precautions (B) are not the standard for meningitis unless a concurrent contact-transmitted organism is identified. Protective Environment (D) is reserved for profoundly immunocompromised clients such as those receiving stem cell transplants.

Question 4

1. Wash hands thoroughly with soap and water. (correct answer)
2. Use an alcohol-based hand rub for at least 20 seconds.
3. Apply a fresh pair of gloves before touching the door handle.
4. Clean the client's bedside table with a standard alcohol wipe.

Explanation: Hand hygiene with soap and water is mandatory — not optional — when caring for clients with C. diff. The physical friction of washing combined with water rinses the spores off the hands mechanically. Alcohol-based hand rubs (A) are ineffective against C. diff spores because the spores' protective coat is highly resistant to alcohol; using ABHR after C. diff care provides a false sense of security and is a significant infection control error. The 20-second duration listed in Choice B further signals confusion — 20 seconds applies to soap-and-water technique, not ABHR. Applying fresh gloves before touching the door handle (C) is incorrect technique; gloves should be removed inside the room, not replaced for exiting. Cleaning environmental surfaces with standard alcohol wipes (D) is also ineffective against C. diff spores; an EPA-registered sporicidal agent is required for environmental disinfection in C. diff rooms.

Question 5

1. The client's age and history of recent antibiotic use.
2. The reports of 10 to 12 episodes of watery, foul-smelling diarrhea. (correct answer)
3. The presence of dry mucous membranes and poor skin turgor.
4. The client's lethargy during the admission assessment.

Explanation: Frequent, unexplained watery diarrhea — particularly following recent antibiotic use, which disrupts normal gut flora and allows C. diff to proliferate — is the primary clinical cue that necessitates immediate Contact Precautions. The pattern of 10 to 12 daily episodes is both specific enough to raise strong suspicion for C. diff and directly indicates the fecal-oral transmission risk that isolation is designed to interrupt. Advanced age and antibiotic history (A) are significant risk factors that provide context, but they are predisposing factors rather than the active clinical finding that triggers isolation. Dry mucous membranes and poor skin turgor (C) and lethargy (D) are signs of dehydration and systemic illness — important for clinical management but not the cues that specifically indicate the need for transmission-based precautions.

Question 6

1. Hospital-acquired pneumonia.
2. Surgical site infection.
3. Development of a pressure injury.
4. Severe dehydration and electrolyte imbalance. (correct answer)

Explanation: Ten to twelve episodes of watery diarrhea per day cause rapid loss of free water and electrolytes — particularly sodium, potassium, and bicarbonate — placing this elderly client at immediate risk for severe dehydration and potentially dangerous electrolyte disturbances. The admission findings of dry mucous membranes, poor skin turgor, and lethargy already indicate active fluid volume deficit. In older adults, electrolyte imbalances such as hyponatremia and hypokalemia can have serious cardiac and neurological consequences. Hospital-acquired pneumonia (A) is not related to the current presentation. Development of a pressure injury (C) is a secondary concern related to immobility and skin exposure to stool, but is not the immediate primary complication. Surgical site infection (B) is not applicable as the client has not had surgery.

Question 7

1. Ensure a dedicated stethoscope and blood pressure cuff are in the room. (correct answer)
2. Place a "Droplet Precautions" sign on the client's door.
3. Arrange for a roommate who also has a history of diarrhea.
4. Stock the room with alcohol-based hand sanitizer for staff use.

Explanation: Contact Precautions require that dedicated or single-use client care equipment — such as a stethoscope and blood pressure cuff — remain in the client's room to prevent cross-contamination between clients. Reusable equipment that leaves the room must be thoroughly disinfected before use on another client. Choice B is incorrect; the appropriate sign is Contact Precautions, not Droplet Precautions — applying the wrong sign risks staff using inadequate PPE. Choice C is incorrect; cohorting clients requires a confirmed matching diagnosis, not just a symptom — C. diff should be isolated in a private room with its own bathroom if possible, and a history of diarrhea alone is not grounds for cohorting. Choice D is particularly dangerous in this context: stocking only ABHR implies it is sufficient for C. diff care, but ABHR is ineffective against C. diff spores; soap and water must be the primary hand hygiene method and must be available.

Question 8

1. You must wear an N95 respirator at all times while in the room.
2. Please do not bring any fresh flowers or potted plants into the room. (correct answer)
3. You will need to wear a sterile gown and gloves before touching the client.
4. The client must stay in the room with the door open for air circulation.

Explanation: Protective Environments are designed to shield profoundly immunocompromised clients from environmental organisms to which a healthy immune system would normally respond. Fresh flowers and potted plants are prohibited because the soil and stagnant water in which they grow harbor mold and fungi — particularly Aspergillus species — which can cause life-threatening invasive infections in neutropenic clients. Choice A is incorrect; visitors wear a surgical mask (not an N95) to protect the immunocompromised client from the visitor's respiratory organisms — N95 respirators are for airborne precautions protecting health care workers, not visitors in a protective environment. Choice C is incorrect; visitors wear clean (not sterile) gowns and gloves — sterile technique is reserved for invasive procedures. Choice D is directly contraindicated; the door must remain closed to maintain the positive pressure environment that keeps unfiltered hallway air from entering the room.

Question 9

1. Document the incident as a breach in standard precautions.
2. Advise the staff member that paper towels are only used after soap and water.
3. Instruct the staff member to wash their hands with soap and water instead.
4. Reinforce that the hands must be rubbed together until the alcohol is dry. (correct answer)

Explanation: Alcohol-based hand rub is effective only when applied correctly. The product must be rubbed vigorously over all surfaces of the hands — including the fingernails, between the fingers, and the backs of the hands — and allowed to air-dry completely through evaporation. Drying with a paper towel immediately after application physically removes the product before it can exert its antimicrobial effect, rendering the hand hygiene step ineffective. The correct response is immediate re-education on technique. Formal documentation (A) is not warranted for a technique error identified and corrected in real time; the appropriate action is bedside coaching. Instructing the staff member to use soap and water instead (C) is incorrect; ABHR is appropriate for routine hand hygiene and does not need to be replaced — it needs to be used correctly. Choice B confuses the two hand hygiene methods; paper towels are indeed used after soap-and-water washing to dry the hands mechanically, but this does not apply to ABHR.

Question 10

1. A client with a localized Herpes Zoster (shingles) infection.
2. A client who is receiving treatment for a Methicillin-resistant Staphylococcus aureus (MRSA) infection.
3. A client with a suspected case of Bordetella pertussis (whooping cough).
4. A client who is three days postoperative and has an incision line. (correct answer)

Explanation: To minimize the risk of cross-contamination, the nurse should assess clients in order from most susceptible to least susceptible — seeing non-infectious, vulnerable clients before clients with known or suspected infections. The post-operative client on Day 3 has an open incision line that serves as a direct portal of entry for pathogens; this wound vulnerability makes them the most at risk of acquiring an infection from organisms the nurse might inadvertently carry from other clients' rooms. Importantly, this client is not themselves a source of a transmissible infection. The clients with shingles (A), suspected pertussis (C), and MRSA (B) all have active infections that pose transmission risks — they should be assessed after the clean post-operative client, with appropriate PPE donned for each. Pertussis (C) warrants Droplet Precautions and is particularly contagious, reinforcing that it should not be the first room entered.

Question 11

1. Keeping the sterile field within the nurse's line of vision at all times.
2. Reaching across the sterile field to pick up a piece of sterile gauze. (correct answer)
3. Opening the sterile glove package on a separate, clean bedside table.
4. Dropping a sterile transparent dressing onto the center of the field.

Explanation: Reaching across a sterile field is a direct violation of surgical aseptic technique. When the nurse's arm, sleeve, or unsterile portion of their body passes over the field, microorganisms and particles can fall from above onto the sterile surface — contaminating it even if no direct contact is made. Items on a sterile field should always be retrieved by approaching from the side, never by reaching across or over the field. Keeping the sterile field in the line of vision (A) is a correct principle of sterile technique — a sterile field that is out of sight is considered contaminated. Opening the glove package on a separate clean surface (C) is correct technique; it avoids potentially contaminating the sterile field during the glove application process. Dropping sterile items onto the center of the field (D) is acceptable technique for introducing supplies without contaminating the field, as long as the item lands within the sterile boundary and is not touched by an unsterile surface during the drop.

Question 12

1. The air in the room is recirculated through the hospital's central AC.
2. The room has a minimum of 6 to 12 air changes per hour. (correct answer)
3. The door to the room stays open to allow for easy staff access.
4. The air from the room is exhausted directly into the hallway.

Explanation: Airborne Infection Isolation Rooms (AIIRs) are negative-pressure rooms with specific engineering requirements to safely contain airborne pathogens. A minimum of 6 to 12 air changes per hour is required — this range represents the acceptable standard for existing facilities, while current guidelines specify a minimum of 12 ACH for new construction. Frequent air exchange dilutes and removes airborne infectious particles from the room environment. Recirculating room air through the central HVAC system (A) is prohibited because it would spread infectious particles throughout the entire building. Recirculated air must pass through HEPA filtration if it re-enters any occupied space. The door must remain closed at all times (C) — this is essential to maintaining the negative pressure differential that prevents room air from flowing outward. Exhausting air directly into the hallway (D) is explicitly prohibited; exhaust must be directed outside the building or through a HEPA filter before any recirculation.

Question 13

1. Instruct the UAP to wear a gown and gloves only if the client is actively having a bowel movement.
2. Verify that the UAP washes their hands with soap and water after leaving the room. (correct answer)
3. Tell the UAP that a surgical mask is necessary because the diarrhea is foul-smelling.
4. Allow the UAP to use the client's dedicated stethoscope on other clients in the hall.

Explanation: The nurse's supervisory responsibility is to ensure all staff providing care to this client adhere to the specific infection control requirements of C. diff — most critically, that hand hygiene is performed with soap and water (not ABHR) after every room exit. This is the non-negotiable action that prevents spore transmission. Choice A is incorrect; gown and gloves are required for all interactions involving contact with the client or contaminated surfaces, regardless of whether a bowel movement is occurring at that moment. Choice C is incorrect; a surgical mask is not indicated for C. diff, which is transmitted via the fecal-oral route, not respiratory droplets — the odor does not change the transmission category. Choice D is a serious infection control violation; the dedicated stethoscope must remain in the room and never be used on other clients without thorough disinfection.

Question 14

1. Standard Precautions only.
2. Contact and Droplet Precautions.
3. Airborne and Contact Precautions. (correct answer)
4. Droplet and Protective Environment.

Explanation: Disseminated Herpes Zoster — defined as lesions spanning multiple dermatomes or present in an immunocompromised client — requires both Airborne and Contact Precautions. Airborne Precautions are necessary because the varicella-zoster virus can be aerosolized from the lesions and transmitted via small airborne particles, in addition to direct contact with vesicular fluid. This is in contrast to localized shingles in an immunocompetent client, which requires only Contact Precautions. Standard Precautions alone (A) are insufficient for disseminated disease. Contact and Droplet (B) is incorrect because droplets are large-particle and short-range; varicella-zoster in disseminated form requires the higher level of respiratory protection provided by Airborne Precautions with a fit-tested N95. Protective Environment (D) is for immunocompromised clients who need protection from the environment, not for infectious clients who require isolation.

Question 15

1. Risk for impaired skin integrity related to frequent stools.
2. Risk for infection transmission to other clients and staff. (correct answer)
3. Deficient knowledge related to the cause of diarrhea.
4. Disturbed sleep pattern related to abdominal cramping.

Explanation: Within the Safe and Effective Care Environment domain, the priority nursing hypothesis is preventing the transmission of a highly contagious and environmentally hardy pathogen to other vulnerable clients and staff. C. diff spores can survive on environmental surfaces for months, and a single lapse in Contact Precautions can initiate an outbreak with serious consequences for immunocompromised patients on the unit. Risk for impaired skin integrity (A) is a real and important concern — prolonged fecal contact causes skin breakdown — but it is a clinical management priority rather than an environmental safety priority. Deficient knowledge (C) and disturbed sleep (D) are relevant but represent lower-acuity concerns that do not carry the same immediate safety implications for the broader care environment.

Question 16

1. A gown and clean gloves. (correct answer)
2. A surgical mask and clean gloves.
3. An N95 respirator and a gown.
4. Goggles and a surgical mask.

Explanation: Contact Precautions require a gown and clean gloves for all interactions that may involve contact with the client or potentially contaminated surfaces in the client's environment. A mask is not required by Contact Precautions alone. However, if splashing or spraying of blood or body fluids is anticipated — which is a real consideration during wound care and linen change — a mask and goggles or face shield would additionally be indicated under Standard Precautions. A surgical mask without a gown (B) is inadequate for skin and surface contact protection. An N95 respirator (C) is required for Airborne Precautions, not Contact Precautions. Goggles and a surgical mask alone (D) provide respiratory and splash protection but no barrier against skin or clothing contact with contaminated surfaces.

Question 17

1. The UAP uses the client's phone to call the kitchen for a missing item. (correct answer)
2. The UAP places the meal tray on the client's bedside table.
3. The UAP removes their gloves and gown inside the room before exiting.
4. The UAP uses an alcohol-based hand rub after leaving the client's room.

Explanation: The UAP is wearing contaminated gloves — having entered a Contact Precautions room and potentially touched contaminated surfaces — and is using the client's room phone, which is itself a contaminated surface. Using a contaminated phone brings it into contact with the face, potentially transferring organisms to mucous membranes. The correct action would be to exit the room, remove PPE, perform hand hygiene, and then make the call from outside the room using a clean phone or the nurse call system. Choice B (placing the meal tray on the table) is appropriate and expected. Choice C (removing gloves and gown inside the room before exiting) is acceptable technique per infection control guidelines and does not require intervention — it prevents dragging contaminated PPE out into the hallway. Choice D (ABHR after leaving) is correct hand hygiene practice for general Contact Precautions; this client is not specified as C. diff, so ABHR is appropriate.

Question 18

1. Notify the radiology department and have the client wear a surgical mask. (correct answer)
2. Ensure the transport personnel are wearing N95 respirators.
3. Place a gown and goggles on the client during the transition.
4. Cancel the procedure until the client is no longer on isolation.

Explanation: When a client on Droplet Precautions must leave their room, a surgical mask is placed on the client — not the transport personnel — to contain respiratory secretions at the source and prevent dispersal of droplets throughout the hallways and the receiving department. The receiving department must also be notified in advance so they can prepare the space and minimize contact with other patients. This is the standard approach for maintaining precautions during unavoidable transport. Requiring transport personnel to wear N95 respirators (B) is incorrect; N95s are for Airborne Precautions, and Droplet Precautions personnel wear surgical masks — the key distinction is that it is the client, not the staff, who wears the mask during transport. Placing a gown and goggles on the client (C) is not standard or necessary. Canceling medically necessary procedures (D) is inappropriate when safe transport with appropriate precautions is achievable.

Question 19

1. I should remove my mask first, followed by my gown and gloves.
2. I will take off my goggles after I have exited the room and closed the door.
3. The gown should be removed after I have taken off my mask.
4. I will remove my gloves first, as they are the most contaminated. (correct answer)

Explanation: The standard doffing sequence — gloves first, then goggles or face shield, then gown, and finally the mask or respirator last — is designed to progress from the most contaminated items to the least contaminated. Gloves are considered the most heavily contaminated because they have had direct contact with the client and environmental surfaces throughout the interaction. Removing them first protects the hands from contaminating subsequently handled items. Choice A is incorrect because the mask is the last item removed, not the first; removing it first risks face contamination from the gown or gloves during subsequent removal. Choice C states the gown should come after the mask, which reverses the correct order — the gown should be removed before the mask. Choice B is incorrect because all PPE items except the mask/respirator should be removed before exiting the room; goggles should come off inside or at the doorway, not after leaving.

Question 20

1. Place the needle and syringe in a puncture-resistant container immediately. (correct answer)
2. Recap the needle using the two-handed technique before disposal.
3. Break the needle off the syringe to ensure it cannot be reused.
4. Dispose of the needle in the regular trash can if there was no blood visible.

Explanation: Standard Precautions require that all used sharps be immediately placed into a puncture-resistant, leak-proof sharps container without manipulation. This is the most effective way to prevent needle-stick injuries to the nurse and other personnel. Recapping using the two-handed technique (B) is explicitly prohibited by Standard Precautions; needle-stick injuries occur most commonly during recapping. The one-handed scoop technique is acceptable only as an absolute last resort when no sharps container is available. Breaking the needle (C) is dangerous and prohibited — it creates sharps fragments and aerosols that increase injury and exposure risk. Disposing in regular trash (D) is never acceptable for sharps regardless of whether blood is visible; all used sharps are considered contaminated.