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PATIENT SAFETY AND QUALITY NCLEX
PRACTICE EXAM – NURSING EDUCATION |
SUMMER 2026 NGN-ALIGNED.
DOMAIN 1: SAFETY & INFECTION PREVENTION AND CONTROL (Questions 1-25)
Q1. A nurse is caring for a client diagnosed with active pulmonary tuberculosis. Which transmission-
based precaution is required for this client?
A. Contact Precautions
B. Droplet Precautions
C. Airborne Infection Isolation Precautions (AIIP) [CORRECT]
D. Protective Environment
Correct Answer: C
Rationale: Tuberculosis is an airborne pathogen that requires Airborne Infection Isolation Precautions
(formerly Airborne Precautions). This involves placement in a negative-pressure airflow room (AIIR)
and use of N95 respirator or higher by personnel entering the room.
Q2. A client is admitted with scabies. Which personal protective equipment (PPE) should the nurse
don before performing a physical assessment?
A. N95 respirator and gown
B. Gloves and gown [CORRECT]
C. Face shield and gloves
D. Gloves only
Correct Answer: B
Rationale: Scabies is an infestation of the skin that spreads via direct skin-to-skin contact or contact
with contaminated linens. It requires Contact Precautions, necessitating the use of a gown and gloves
to prevent transmission.
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Q3. A nurse is caring for a client on Contact and Droplet Precautions due to influenza. In which order
should the nurse remove PPE upon exiting the room?
A. Gown, gloves, face shield, mask
B. Gloves, gown, face shield, mask
C. Gloves, face shield, gown, mask [CORRECT]
D. Mask, face shield, gown, gloves
Correct Answer: C
Rationale: The correct sequence for removing PPE to minimize contamination is: 1) Gloves (remove
first as they are most contaminated), 2) Face shield or goggles, 3) Gown (unfasten ties and pull away
from body), and 4) Mask (remove last by ties, do not touch front). Hand hygiene follows immediately.
Q4. Which client requires implementation of a "Protective Environment" precaution?
A. A client with varicella zoster
B. A client receiving chemotherapy with severe neutropenia [CORRECT]
C. A client with Clostridioides difficile
D. A client with measles
Correct Answer: B
Rationale: A Protective Environment is designed for severely immunocompromised clients, such as
those receiving induction chemotherapy for leukemia or stem cell transplants. It requires positive
pressure airflow and HEPA filtration to protect the client from environmental pathogens.
Sub-Topic: Hand hygiene and PPE protocols (3 questions)
Q5. A nurse applies hand sanitizer upon entering a client's room. After 10 seconds, the nurse's hands
appear dry. Which action should the nurse take?
, 3
A. Proceed to touch the client
B. Apply another pump of sanitizer and continue rubbing
C. Continue rubbing hands together until they are completely dry [CORRECT]
D. Rinse hands with water
Correct Answer: C
Rationale: Hand hygiene with alcohol-based hand rub (ABHR) requires the product to remain in
contact with the skin for the manufacturer-recommended time (typically 15-30 seconds) to kill
microorganisms. Allowing the hands to dry naturally ensures adequate contact time.
Q6. Which situation requires the nurse to perform hand hygiene with soap and water rather than
alcohol-based hand sanitizer? (Select all that apply).
A. Before inserting a peripheral IV
B. After caring for a client with Clostridioides difficile [CORRECT]
C. After removing visibly soiled gloves [CORRECT]
D. After documenting on the computer outside the room
E. Before donning sterile gloves for a central line dressing change
Correct Answers: B, C
Rationale: Soap and water are required when hands are visibly soiled and after caring for clients with
spore-forming bacteria (e.g., C. diff) or viruses (e.g., norovirus), as alcohol-based sanitizers are not
effective against spores.
Q7. A nurse is donning PPE for a sterile procedure. Which action indicates a break in sterile technique?
A. Holding sterile items above waist level
B. Opening the sterile package away from the body
C. Pouring saline onto a sterile field with the bottle held 4 inches above the basin
D. Allowing the sterile drape to unfold with the "1" flap facing the nurse [CORRECT]
, 4
Correct Answer: D
Rationale: When opening a sterile package, the "1" flap should be opened away from the body (distal
flap first), followed by the side flaps, and finally the near flap ("4" flap) toward the body. Opening the
"1" flap toward the nurse risks reaching over the sterile field and contaminating it.
Sub-Topic: Isolation types and application (3 questions)
Q8. A client is admitted with suspected meningococcal meningitis. Which room assignment is
appropriate?
A. A private room with negative pressure
B. A private room with the door closed [CORRECT]
C. A semi-private room with a client on antibiotics
D. A private room with positive pressure
Correct Answer: B
Rationale: Meningococcal meningitis is transmitted via large droplets (>5 microns). Droplet
Precautions require a private room (or cohorting with same organism); negative pressure (Airborne) is
not required. The door may remain closed as an added precaution, but the primary barrier is the mask
worn within 3-6 feet of the client.
Q9. A nurse is caring for a client on Airborne Precautions. Which nursing action is appropriate?
A. Keeping the door slightly ajar to allow airflow
B. Wearing a surgical mask when in the room
C. Placing a surgical mask on the client during transport [CORRECT]
D. Allowing visitors without masks if they stay in the doorway
Correct Answer: C
PATIENT SAFETY AND QUALITY NCLEX
PRACTICE EXAM – NURSING EDUCATION |
SUMMER 2026 NGN-ALIGNED.
DOMAIN 1: SAFETY & INFECTION PREVENTION AND CONTROL (Questions 1-25)
Q1. A nurse is caring for a client diagnosed with active pulmonary tuberculosis. Which transmission-
based precaution is required for this client?
A. Contact Precautions
B. Droplet Precautions
C. Airborne Infection Isolation Precautions (AIIP) [CORRECT]
D. Protective Environment
Correct Answer: C
Rationale: Tuberculosis is an airborne pathogen that requires Airborne Infection Isolation Precautions
(formerly Airborne Precautions). This involves placement in a negative-pressure airflow room (AIIR)
and use of N95 respirator or higher by personnel entering the room.
Q2. A client is admitted with scabies. Which personal protective equipment (PPE) should the nurse
don before performing a physical assessment?
A. N95 respirator and gown
B. Gloves and gown [CORRECT]
C. Face shield and gloves
D. Gloves only
Correct Answer: B
Rationale: Scabies is an infestation of the skin that spreads via direct skin-to-skin contact or contact
with contaminated linens. It requires Contact Precautions, necessitating the use of a gown and gloves
to prevent transmission.
, 2
Q3. A nurse is caring for a client on Contact and Droplet Precautions due to influenza. In which order
should the nurse remove PPE upon exiting the room?
A. Gown, gloves, face shield, mask
B. Gloves, gown, face shield, mask
C. Gloves, face shield, gown, mask [CORRECT]
D. Mask, face shield, gown, gloves
Correct Answer: C
Rationale: The correct sequence for removing PPE to minimize contamination is: 1) Gloves (remove
first as they are most contaminated), 2) Face shield or goggles, 3) Gown (unfasten ties and pull away
from body), and 4) Mask (remove last by ties, do not touch front). Hand hygiene follows immediately.
Q4. Which client requires implementation of a "Protective Environment" precaution?
A. A client with varicella zoster
B. A client receiving chemotherapy with severe neutropenia [CORRECT]
C. A client with Clostridioides difficile
D. A client with measles
Correct Answer: B
Rationale: A Protective Environment is designed for severely immunocompromised clients, such as
those receiving induction chemotherapy for leukemia or stem cell transplants. It requires positive
pressure airflow and HEPA filtration to protect the client from environmental pathogens.
Sub-Topic: Hand hygiene and PPE protocols (3 questions)
Q5. A nurse applies hand sanitizer upon entering a client's room. After 10 seconds, the nurse's hands
appear dry. Which action should the nurse take?
, 3
A. Proceed to touch the client
B. Apply another pump of sanitizer and continue rubbing
C. Continue rubbing hands together until they are completely dry [CORRECT]
D. Rinse hands with water
Correct Answer: C
Rationale: Hand hygiene with alcohol-based hand rub (ABHR) requires the product to remain in
contact with the skin for the manufacturer-recommended time (typically 15-30 seconds) to kill
microorganisms. Allowing the hands to dry naturally ensures adequate contact time.
Q6. Which situation requires the nurse to perform hand hygiene with soap and water rather than
alcohol-based hand sanitizer? (Select all that apply).
A. Before inserting a peripheral IV
B. After caring for a client with Clostridioides difficile [CORRECT]
C. After removing visibly soiled gloves [CORRECT]
D. After documenting on the computer outside the room
E. Before donning sterile gloves for a central line dressing change
Correct Answers: B, C
Rationale: Soap and water are required when hands are visibly soiled and after caring for clients with
spore-forming bacteria (e.g., C. diff) or viruses (e.g., norovirus), as alcohol-based sanitizers are not
effective against spores.
Q7. A nurse is donning PPE for a sterile procedure. Which action indicates a break in sterile technique?
A. Holding sterile items above waist level
B. Opening the sterile package away from the body
C. Pouring saline onto a sterile field with the bottle held 4 inches above the basin
D. Allowing the sterile drape to unfold with the "1" flap facing the nurse [CORRECT]
, 4
Correct Answer: D
Rationale: When opening a sterile package, the "1" flap should be opened away from the body (distal
flap first), followed by the side flaps, and finally the near flap ("4" flap) toward the body. Opening the
"1" flap toward the nurse risks reaching over the sterile field and contaminating it.
Sub-Topic: Isolation types and application (3 questions)
Q8. A client is admitted with suspected meningococcal meningitis. Which room assignment is
appropriate?
A. A private room with negative pressure
B. A private room with the door closed [CORRECT]
C. A semi-private room with a client on antibiotics
D. A private room with positive pressure
Correct Answer: B
Rationale: Meningococcal meningitis is transmitted via large droplets (>5 microns). Droplet
Precautions require a private room (or cohorting with same organism); negative pressure (Airborne) is
not required. The door may remain closed as an added precaution, but the primary barrier is the mask
worn within 3-6 feet of the client.
Q9. A nurse is caring for a client on Airborne Precautions. Which nursing action is appropriate?
A. Keeping the door slightly ajar to allow airflow
B. Wearing a surgical mask when in the room
C. Placing a surgical mask on the client during transport [CORRECT]
D. Allowing visitors without masks if they stay in the doorway
Correct Answer: C
