Standard, transmission-based and enhanced barrier precautions

60 NCLEX-RN practice questions on Standard, transmission-based and enhanced barrier precautions, part of Safety and Infection Prevention and Control. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Hard · Matrix

   The nurse in a nursing home reviews the residents. For each resident, indicate the precautions that apply.

   For each row, choose: Contact precautions / Enhanced barrier precautions / Standard precautions only

   1. Long-term indwelling urinary catheter, no known resistant organism
   2. Type 2 diabetes with intact skin, no devices and no resistant organism
   3. Percutaneous gastrostomy feeding tube, no known resistant organism
   4. Carbapenem-resistant Enterobacterales in a rectal swab; continent, no wounds or devices
   5. Acute diarrhea from Clostridioides difficile
   6. MRSA wound infection with drainage that soaks through the dressing

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   Answer:

   • Long-term indwelling urinary catheter, no known resistant organism: Enhanced barrier precautions
   • Type 2 diabetes with intact skin, no devices and no resistant organism: Standard precautions only
   • Percutaneous gastrostomy feeding tube, no known resistant organism: Enhanced barrier precautions
   • Carbapenem-resistant Enterobacterales in a rectal swab; continent, no wounds or devices: Enhanced barrier precautions
   • Acute diarrhea from Clostridioides difficile: Contact precautions
   • MRSA wound infection with drainage that soaks through the dressing: Contact precautions

   CJMM: analyse cues. Contact precautions are for acute diarrhea, uncontained drainage or specific outbreaks; enhanced barrier precautions cover residents with targeted MDROs, chronic wounds or indwelling devices; others need standard precautions only.

   • Long-term indwelling urinary catheter, no known resistant organism: Indwelling devices qualify for enhanced barrier precautions.
   • Type 2 diabetes with intact skin, no devices and no resistant organism: No indication beyond standard precautions.
   • Percutaneous gastrostomy feeding tube, no known resistant organism: A feeding tube is an indwelling device.
   • Carbapenem-resistant Enterobacterales in a rectal swab; continent, no wounds or devices: Colonisation with a targeted MDRO calls for enhanced barrier precautions when contact precautions do not otherwise apply.
   • Acute diarrhea from Clostridioides difficile: Acute C. difficile diarrhea requires contact precautions.
   • MRSA wound infection with drainage that soaks through the dressing: Drainage that cannot be contained requires contact precautions.

2. Question 2 · Easy · Select all that apply

   The nurse is caring for a client on a medical unit. In which situations should the nurse perform hand hygiene?

   1. AAfter removing gloves at the end of care
   2. BBefore instilling the client's prescribed eye drops
   3. CBetween typing at the station computer and answering the station phone
   4. DBefore touching the client to take a radial pulse
   5. EAfter touching the bed rails and the over-bed table

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   Answer: A, B, D, E

   CJMM: take action. The moments for hand hygiene are before touching a client, before a clean or aseptic task, after body-fluid exposure risk (including glove removal), after touching a client and after touching the client's surroundings.

   • C: Both are shared surfaces outside the client zone; no hand hygiene moment falls between them.

3. Question 3 · Hard · Select all that apply

   A client transferred from a long-term acute care hospital has Candida auris on a screening skin swab. Which actions should the nurse take?

   1. AUse alcohol-based hand rub for routine hand hygiene
   2. BClean surfaces with a disinfectant registered as effective against C. auris
   3. CStop precautions after a single negative follow-up swab
   4. DNotify infection prevention according to policy
   5. EClean the room with a quaternary ammonium product
   6. FPlace the client in a private room on contact precautions

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   Answer: A, B, D, F

   CJMM: take action. Candida auris is a multidrug-resistant yeast that persists on skin and surfaces: use a private room, contact precautions, a disinfectant proven against it, hand hygiene and prompt notification of infection prevention.

   • C: Colonisation persists for long periods; one negative swab does not clear the client.
   • E: Many quaternary ammonium products do not kill C. auris.

4. Question 4 · Hard · Select all that apply

   Several clients on a medical unit develop sudden vomiting and watery diarrhea, and norovirus is suspected. Which actions should the nurse take?

   1. AWash the hands with soap and water after care
   2. BClean surfaces with a product approved for norovirus, such as bleach
   3. CPlace the ill clients on contact precautions
   4. DWear a mask and eye protection when cleaning up vomit
   5. EMove well clients into the ill clients' rooms to free beds
   6. FLet staff with symptoms keep working if they wear a mask

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   Answer: A, B, C, D

   CJMM: take action. A norovirus outbreak needs contact precautions, soap-and-water hand washing, a norovirus-effective disinfectant, face protection for vomit cleanup and exclusion of ill staff for 48 hours after symptoms end.

   • E: This exposes well clients; ill clients may be cohorted together instead.
   • F: Ill staff should stay off work until at least 48 hours after symptoms resolve.

5. Question 5 · Medium · Matrix

   For each client, indicate whether the nurse needs a surgical mask or an N95 respirator to give routine care.

   For each row, choose: Surgical mask / N95 respirator

   1. Child with pertussis
   2. Client with meningococcal meningitis, treated for 6 hours
   3. Client with suspected pulmonary tuberculosis
   4. Client with influenza A
   5. Client with confirmed COVID-19

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   Answer:

   • Child with pertussis: Surgical mask
   • Client with meningococcal meningitis, treated for 6 hours: Surgical mask
   • Client with suspected pulmonary tuberculosis: N95 respirator
   • Client with influenza A: Surgical mask
   • Client with confirmed COVID-19: N95 respirator

   CJMM: take action. Droplet diseases need a surgical mask; tuberculosis and COVID-19 call for a fit-tested N95 respirator.

   • Child with pertussis: Pertussis needs droplet precautions.
   • Client with meningococcal meningitis, treated for 6 hours: Droplet precautions continue until 24 hours of effective therapy.
   • Client with suspected pulmonary tuberculosis: Airborne precautions require a fit-tested respirator.
   • Client with influenza A: Routine influenza care uses droplet precautions.
   • Client with confirmed COVID-19: CDC advises a respirator for care of clients with COVID-19.

6. Question 6 · Medium · Select all that apply

   Which measures are part of standard precautions for every client, regardless of diagnosis?

   1. AGloves when contact with blood or body fluids is expected
   2. BA gown for every entry into the client's room
   3. CAn N95 respirator for every client with a fever
   4. DA mask and eye protection when splashes are likely
   5. EA private room for every client

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7. Question 7 · Medium · Select all that apply

   The nurse is preparing injections for several clients. Which practices follow safe injection guidelines?

   1. AGive the same drug to two clients from one syringe after changing the needle
   2. BScrub the vial's rubber septum with alcohol before each entry
   3. CUse a single-dose vial for one client and discard the remainder
   4. DUse a new needle and a new syringe for each entry into a vial
   5. EDraw flushes for several clients from one bag of IV saline

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8. Question 8 · Medium · Select all that apply

   The nurse is caring for a client admitted with confirmed influenza A. Which actions follow droplet precautions?

   1. AKeep the door closed and the room under negative pressure
   2. BWear an N95 respirator for all routine care
   3. CWear a gown and gloves for every room entry
   4. DWear a surgical mask on entering the room
   5. EPlace a surgical mask on the client for transport out of the room

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9. Question 9 · Medium · Matrix

   The charge nurse observes staff on a unit with several isolation rooms. For each observation, indicate whether it is correct practice or needs correction.

   For each row, choose: Correct practice / Needs correction

   1. A nurse removes the N95 after leaving the airborne isolation room and closing the door
   2. A nurse wears a gown from a contact-precautions room to the supply room
   3. A nurse wears an N95 respirator hanging around the neck at the nurses' station
   4. A nurse wipes a shared bladder scanner with a disinfectant wipe after use
   5. A nurse removes the gown and gloves at the doorway inside a contact-precautions room

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10. Question 10 · Medium · Matrix

    For each procedure, indicate whether the nurse should use sterile technique or clean technique in the hospital.

    For each row, choose: Sterile technique / Clean technique

    1. Changing a colostomy pouch
    2. Oral suctioning with a rigid Yankauer catheter
    3. Inserting an indwelling urinary catheter
    4. Inserting a nasogastric tube
    5. Changing a central venous catheter dressing
    6. Suctioning through an endotracheal tube

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11. Question 11 · Hard · Matrix

    The nurse is placing newly admitted clients. For each client, indicate the most appropriate room.

    For each row, choose: Airborne infection isolation room / Private room with droplet precautions / Shared room acceptable

    1. Client with HIV and no opportunistic infection
    2. Client with a measles rash
    3. Adolescent with suspected meningococcal meningitis, not yet treated
    4. Client with cellulitis of the leg and no drainage
    5. Child with pertussis
    6. Client with suspected laryngeal tuberculosis

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12. Question 12 · Hard · Matrix

    The charge nurse is making assignments. For each nurse-client pairing, indicate whether the assignment is appropriate or inappropriate.

    For each row, choose: Appropriate / Inappropriate

    1. Nurse never fit-tested for an N95, to a client with suspected tuberculosis
    2. Nurse with weeping dermatitis on the hands, to a client with a large draining wound
    3. Pregnant nurse with no rubella immunity, to a client with rubella
    4. Pregnant nurse, to a client on contact precautions for MRSA
    5. Nurse with two documented MMR doses, to a client with measles
    6. Nurse fit-tested for an N95 this year, to a client with pulmonary tuberculosis

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13. Question 13 · Hard · Select all that apply

    After giving an injection, a nurse is stuck by the used needle. Which actions should the nurse take?

    1. AWash the puncture site with soap and water
    2. BWait for the source client's test results before seeking care
    3. CReport the exposure at once to the supervisor and employee health
    4. DSqueeze the wound hard to force out blood
    5. ESoak the site in household bleach
    6. FAsk for an urgent evaluation for postexposure prophylaxis

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14. Question 14 · Hard · Select all that apply

    The charge nurse watches assistive personnel (AP) giving morning care. Which practices require the nurse to intervene?

    1. APuts on gloves after the alcohol hand rub has dried
    2. BShakes the soiled sheet to remove crumbs before bagging it
    3. CGives perineal care, then brushes the client's teeth in the same gloves
    4. DWears gloves in the hallway while walking to the linen cart
    5. EHolds soiled linen away from the uniform
    6. FRemoves gloves and cleans hands before leaving the room

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15. Question 15 · Medium · Select all that apply

    The charge nurse observes a new nurse putting on personal protective equipment before entering the room of a client on contact and airborne precautions. Which actions are correct?

    1. AFastens the gown at the neck and at the waist
    2. BPerforms hand hygiene before putting on the gown
    3. CPuts on gloves first so the gown ties stay clean
    4. DPulls the glove cuffs over the cuffs of the gown
    5. EPuts on the face shield before the N95 respirator
    6. FPerforms a user seal check after placing the N95 respirator

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16. Question 16 · Medium · Matrix

    The nurse reviews enhanced barrier precautions with new staff in a nursing home. For each staff statement, indicate whether it is accurate or inaccurate.

    For each row, choose: Accurate / Inaccurate

    1. A resident on these precautions can still join group meals in the dining room.
    2. A resident on these precautions must be moved to a private room.
    3. We must gown and glove every time we enter, even to drop off a meal tray.
    4. We wear a gown and gloves for high-contact care such as bathing and changing briefs.
    5. They apply to a resident with a chronic wound even with no known resistant organism.

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17. Question 17 · Medium · Select all that apply

    A client with suspected pulmonary tuberculosis will be admitted to the unit. Which features must the client's room have?

    1. ANegative air pressure compared with the corridor
    2. BA door left open so staff can watch the client
    3. CA door kept closed except when people enter or leave
    4. DPositive air pressure compared with the corridor
    5. EAir returned to the unit's general ventilation system
    6. FAir exhausted outdoors or passed through a HEPA filter

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18. Question 18 · Hard · Matrix

    For each client, indicate the precautions the nurse should use.

    For each row, choose: Standard precautions only / Contact precautions / Airborne and contact precautions

    1. MRSA wound infection
    2. Localized herpes zoster with lesions covered, in an immunocompetent client
    3. Localized herpes zoster after a stem cell transplant
    4. Chickenpox (varicella)
    5. Chronic hepatitis B
    6. Disseminated herpes zoster

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19. Question 19 · Medium · Select all that apply

    The nurse is changing the transparent dressing over a client's central venous catheter. Which actions maintain asepsis?

    1. AWear a mask and ask the client to turn the head away
    2. BApply antibiotic ointment to the insertion site before covering it
    3. CScrub the site with chlorhexidine-alcohol and let it air-dry
    4. DLabel the new dressing and change it every 7 days or when damp or loose
    5. EPerform hand hygiene before and after the dressing change
    6. FRemove the old dressing with clean gloves, then put on sterile gloves

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20. Question 20 · Easy · Select all that apply

    During influenza season, a client who is coughing is sitting in a crowded clinic waiting area. Which respiratory hygiene measures should the nurse put in place?

    1. ASeat the coughing client at least 3 feet away from others when possible
    2. BGive the coughing client an N95 respirator to wear
    3. CTeach the client to cough into the palm of the hand
    4. DProvide tissues and a no-touch waste bin
    5. EOffer the coughing client a surgical mask
    6. FPlace alcohol-based hand rub within reach of the waiting area

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21. Question 21 · Medium · Select all that apply

    A client has confirmed Clostridioides difficile infection with ongoing diarrhea. Which actions should the nurse include in the plan of care?

    1. AClean the room with a quaternary ammonium product only
    2. BKeep a dedicated stethoscope and thermometer in the room
    3. CWash the hands with soap and water after care
    4. DWear an N95 respirator for routine care
    5. ERely on alcohol-based hand rub alone after leaving the room
    6. FPut on a gown and gloves on entering the room

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22. Question 22 · Hard · Select all that apply

    A client in a semi-private room on a medical unit is diagnosed with measles after admission. Which actions should the nurse take?

    1. AHelp infection prevention list exposed clients, visitors and staff
    2. BAssign only staff with documented measles immunity
    3. CCheck the roommate's measles immunity status
    4. DHave staff wear surgical masks for care in the room
    5. EMove the client to an airborne infection isolation room
    6. FKeep the client in the shared room with the curtain drawn

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23. Question 23 · Medium · Matrix

    A client with active pulmonary tuberculosis will continue treatment at home. For each statement, indicate whether it shows understanding or needs more teaching.

    For each row, choose: Shows understanding / Needs more teaching

    1. I will cover my mouth with a tissue when I cough and throw it away.
    2. I can stop the pills once my cough goes away.
    3. My family members should be tested for tuberculosis.
    4. I will stay home from work until my provider says I'm not contagious.
    5. My family must use separate dishes and wash them apart from mine.

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24. Question 24 · Easy · Matrix

    For each condition, indicate which transmission-based precautions the nurse should use in addition to standard precautions.

    For each row, choose: Contact / Droplet / Airborne

    1. Mycoplasma pneumonia
    2. Norovirus gastroenteritis
    3. Meningococcal meningitis in the first 24 hours of treatment
    4. Measles (rubeola)
    5. Scabies
    6. Active pulmonary tuberculosis

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25. Question 25 · Medium

    The medical unit has no private rooms left. A client with laboratory-confirmed influenza A needs a bed. With whom may this client share a room?

    1. AA client recovering from an appendectomy
    2. BA client with laboratory-confirmed influenza A
    3. CA client receiving chemotherapy with neutropenia
    4. DA client with a cough whose pertussis test is pending

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