1.

While working in a pediatric clinic, you receive a telephone call from the parent
of a 10-year-old who is receiving chemotherapy for leukemia. The client’s sibling
has chickenpox. Which of these actions will you anticipate taking next?

A. Teach the parents regarding contact and airborne precaution.

B. Administer varicella-zoster immune globulin to the client.
C. Prepare the client for admission to a private room in the hospital.
D. Educate the parent about the correct use of acyclovir (Zovirax).

2. Which action will you take to most effectively reduce the incidence of hospital-
associated urinary tract infections?

A. Teach assistive personnel how to provide good perineal hygiene.

B. Ensure that clients have enough adequate fluid intake.
C. Limit the use of indwelling foley catheter (IFC).
D. Perform dipstick urinalysis for clients with risk factors for UTI.

3. You are caring for a client who has been admitted to the hospital with a
leg ulcer that is infected with vancomycin-resistant S. aureus (VRSA). Which of
these nursing actions can you delegate to an LPN/LVN?

A. Obtain wound cultures during dressing changes.

B. Plan ways to improve the client’s oral protein intake.
C. Assess risk for further skin breakdown.
D. Educate the client about home care of the leg ulcer.

4. You are the pediatric unit charge nurse today and is working with a new RN.
Which action by the new RN requires the most immediate action on your part?

A. The new RN tells the nursing assistant to use an N95 respirator mask when caring for
a child who has pertussis.
B. The new RN places a child who has chemotherapy-induced neutropenia into a
negative-pressure room.
C. The new RN admits a new client with respiratory syncytial virus (RSV) infection to a
room with another child who has RSV.
D. The new RN wears goggles to change linens of a client who has diarrhea caused by C.
difficile.

5. A client comes to the outpatient clinic where you work complaining of

abdominal pain, diarrhea, shortness of breath and epistaxis. Which of the following
actions would you take first?

A. Ask the client about any recent travel to Asia or the Middle East.
B. Screening clients for upper respiratory tract symptoms.
C. Determine whether the client has had recommended immunizations.
D. Call an ambulance to take the client immediately to the hospital.

6. A client who has recently traveled to China comes to the emergency department
(ED) with increasing shortness of breath and is strongly suspected of having a
severe acute respiratory syndrome (SARS). Which of these prescribed actions will
you take first?

A. Place the client on contact and airborne precautions.

B. Obtain blood, urine, and sputum for cultures.
C. Administer methylprednisolone (Solu-Medrol) 1 gram/IV.
D. Infuse normal saline at 100ml/hr.

7. Four clients with infections arrive at the emergency department with some
existing infection, however, only one private room is available. Which of the
following client is the most appropriate to assign to the private room?

A. A client with toxic shock syndrome and a temperature of 102.4°F (39.1°C).

B. A client with diarrhea caused by C. difficile.
C. A client with a wound infected with VRE.
D. A client with a cough who may have Koch disease.

8. You are caring for four clients who are receiving IV infusions of normal saline.
Which client is at highest risk for bloodstream infections?

A. A client who has a midline IV catheter in the left antecubital fossa.

B. A client with a peripherally inserted central catheter (PICC) line in the right upper
arm.
C. A client with an implanted port in the right subclavian vein.
D. A client who has nontunneled central line in the left internal jugular vein.

9. A client who has frequent watery stools and a possible Clostridium

difficile infection is hospitalized with dehydration. Which nursing action should the
charge nurse delegated to an LPN/LVN?

A. Explaining the purpose of ordered stool cultures to the client and family.
B. Administering the ordered metronidazole (Flagyl) 500 mg PO to the client.
C. Reviewing the client’s medical history for any risk factors for diarrhea.
D. Performing ongoing assessments to determine the client’s hydration.

10. You are a school nurse. Which action will you take to have the most impact on
the incidence of infectious disease in the school?

A. Ensure that students are immunized according to national guidelines.

B. Provide written information about infection control to all patients.
C. Make soap and water readily available in the classrooms.
D. Teach students how to cover their mouths when coughing.

11. You are caring for a newly admitted client with increasing dyspnea
and dehydration who has possible avian influenza (bird flu). Which of these
prescribed actions will you implement first?
A. Administer the first dose of oseltamivir (Tamiflu).
B. Obtain blood and sputum specimens for testing.
C. Provide oxygen using a non-rebreather mask.
D. Infuse 5% dextrose in water at 75ml/hr.

12. A hospitalized 88-year-old client who has been receiving antibiotics for 10 days
tells you that he is having frequent watery stools. Which action will you take first?

A. Place the client on contact precaution.

B. Instruct the client about correct handwashing.
C. Obtain stool specimens for culture.
D. Notify the physician about the loose stools.

13. Which of the following information about a client who has

meningococcal meningitis has the best indicator that you can discontinue droplet
precautions?

A. Cough is productive of clear, nonpurulent mucus.

B. Pupils are equal and reactive to light.
C. Temperature is lower than 100°F (37.8°C).
D. Appropriate antibiotics have been given for 24 hours.

14. You are the charge nurse on the pediatric unit when a pediatrician calls wanting
to admit a child with rubeola (measles). Which of these factors is of most concern in
determining whether to admit the child to your unit?

A. There are several children receiving chemotherapy on the unit.

B. The infection control nurse liaison is not on the unit today.
C. The unit is not staffed with the usual number of RNs.
D. No negative-airflow rooms are available on the unit.
15. A client who states that he may have been contaminated by anthrax arrives at
the ED. The following actions are part of the ED protocol for possible anthrax
exposure or infection. Which action will you take first?

A. Escort the client to a decontamination room.

B. Assess the client for signs of infection.
C. Notify hospital security personnel about the client.
D. Administer ciprofloxacin (Cipro) 250 mg PO.

16. A client has been diagnosed with disseminated herpes zoster. Which personal
protective equipment (PPE) will you need to put on when preparing to assess the
client? Select all that apply

A. Goggles.
B. Gown.
C. Gloves.
D. Shoe covers.
E. N95 respirator.
F. Surgical face mask.

17. As the infection control nurse in an acute care hospital, which action will you
take to most effectively reduce the incidence of health-care-associated infections?

A. Screen all newly admitted clients for colonization or infection with MRSA.
B. Develop policies that automatically start antibiotic therapy for clients colonized by
multi-drug resistant organisms.
C. Ensure that dispensers for alcohol-based hand rubs are readily available in all client
care areas of the hospital.
D. Require nursing staff to don gowns to change wound dressings for all clients.
18. You are preparing to leave the room after performing oral suctioning on a client
who is on contact and airborne precautions. In which order will you perform the
following actions?

 1. Take off the gown.

 2. Remove N95 respirator.
 3. Perform hand hygiene.
 4. Take off goggles.
 5. Remove gloves.

A. 5, 4, 1, 2, 3
B. 4, 5, 2, 1, 3
C. 1, 2, 4, 5, 3
D. 2, 4, 2, 1, 3

19. You are preparing to change the linens on the bed of a client who has a draining
sacral wound infected by MRSA. Which PPE items will you plan to use. Select all
that apply

A. Gloves.
B. N95 respirator.
C. Surgical Mask.
D. Googles.
E. Gown.

20. You are preparing to care for a 6-year-old who has just undergone allogeneic
stem cell transplantation and will need protective environmental isolation. Which
nursing tasks will you delegate to a nursing assistant? Select all that apply.

A. Posting the precautions for protective isolation o the door of the client’s room.
B. Stocking the client’s room with the needed PPE items.
C. Talking to the family members about the reasons for the isolation.
D. Reminding visitors to wear a respirator mask, gloves, and gown.
E. Teaching the client to perform thorough hand washing after using the bathroom.

21. A 29-year-old client is diagnosed with scarlet fever. Which of the following is the
most appropriate type of isolation for this client?

A. Airborne.
B. Contact.
C. Droplet.
D. Standard.

22. A newly admitted client with streptococcal pharyngitis (tonsillitis) has been
placed on droplet precaution. Which of the following statements indicates the best
understanding for this type of isolation?

A. The client can be placed in a room with another client with measles (rubeola).
B. A special mask (N95) should be worn when working with the client.
C. Must maintain a spatial distance of 3 feet.
D. Gloves should be only worn when giving direct care.

23. Malcolm is a newly assigned as a triage nurse, on his first day of work, the
following clients arrive at the ED. Which among the client require the most rapid
action to protect other clients in the ED from infection?

A. A travel blogger who needs tuberculosis testing after an exposure to a person with TB
during his trip.
B. An elderly woman who has a history of a methicillin-resistant Staphylococcus aureus
(MRSA) leg wound infection.
C. A pregnant woman with a blister-like rash on the face and is possibly having varicella.
D. An infant with a runny nose and whose older brother has pertussis.
24. A client with a vancomycin-resistant enterococcus (VRE) infection is admitted to
the medical unit. Which action can be delegated to a nursing assistant who is
assisting with the client’s care?

A. Implement contact precautions when handling the client.

B. Educate the client and family members on ways to prevent transmission of VRE.
C. Monitor the results of the laboratory culture and sensitivity test.
D. Collaborate with other departments when the client is transported for ordered test.

25. Which of the following infection control activity should be delegated to an

experienced nursing assistant?

A. Asking clients about the duration of antibiotic therapy.

B. Demonstrating correct handwashing techniques to client and family.
C. Disinfecting blood pressure cuffs after clients are discharged.
D. Screening clients for upper respiratory tract symptoms.

Answers and Rationale

Here are the answers and rationale for the NCLEX quiz.

1. Answer: B. Administer varicella-zoster immune globulin to the client.

Varicella-zoster immune globulin administration can prevent the development of

chickenpox in high-risk clients and will typically be prescribed.

 Option A: Contact and airborne precautions will be implemented to prevent the

spread of infection to other children if the child develops varicella.
 Options C and D: Hospitalization and acyclovir therapy may be required if the
child develops a varicella-zoster virus infection.

2. Answer: C. Limit the use of IFC’s.

The most effective way to reduce the incidence of UTIs in the hospital setting is to avoid
using retention catheters.

 Options A, B, and D: These actions also reduce the risk for and/or detect UTI,
but avoidance of indwelling catheter will be more effective.

3. Answer: A. Obtain wound cultures during dressing changes.

LPN/LVN education and scope of practice include performing dressing changes and
obtaining specimens for wound culture.

 Options B, C, and D: Teaching, assessment, and planning of care are complex

actions that should be carried out by a licensed nurse.

4. Answer: B. The new RN places a child who has chemotherapy-induced

neutropenia into a negative-pressure room.

Clients who are neutropenic should be placed in positive-airflow rooms; placement of the
child in a negative airflow room will increase the likelihood of infection for this client.

 Options A and D: The use of an N95 respirator is not necessary for pertussis,
and goggles are not needed for changing the linens of clients infected with C.
difficile; however, these protections do not increase the risk to the clients.
 Option C: Although private rooms are preferred for clients who need droplet
precautions, such as client with RSV infection, they can be placed in rooms
with other clients who are infected with the same microorganism.

5. Answer: A. Ask the client about any recent travel to Asia or the Middle East.

The client’s clinical manifestation suggest possible avian influenza (bird flu). If the
client has traveled recently in Asia or the Middle East, where outbreaks of bird flu have
occurred, you will need to institute airborne and contact precautions immediately.
  Options B, C, and D: The other actions may also be appropriate but are not the
initial action to take for this client, who may transmit the infection to other
clients or staff members.

6. Answer: A. Place the client on contact and airborne precautions.

Since SARS is a severe disease with a high mortality rate, the initial action should be to
protect other clients and health care workers by placing the client in isolation. If an
airborne-agent isolation (negative pressure) room is not available in the ED, droplet
precautions should be initiated until the client can be moved to a negative-pressure room.

 Options B, C, and D: The other options should also be taken rapidly but are not
as important as preventing transmission of the disease.

7. Answer: D. A client with a cough who may have Koch disease.

Clients with infections that require airborne precautions (such as TB) need to be in
private rooms.

 Option A: Standard precautions are required for the client with toxic shock
syndrome.
 Options B and C: Clients with infections that require contact precautions (such
as C.difficile and VRE infections) should ideally be placed in private rooms;
however, they can be placed in rooms with other clients with the same
diagnosis.

8. Answer: D. A client who has nontunneled central line in the left internal jugular
vein.

Several factors increase the risk for infection for this client: central lines are associated
with a higher infection risk, the skin of the neck and chest having a high number of
microorganisms, and the line is tunneled.
  Options A and B: Peripherally inserted IV lines such as midline catheters and
PICC line are associated with a lower incidence of infection.
 Option C: Implanted ports are placed under the skin and so are less likely to be
associated with catheter infection than a nontunneled central IV line.

9. Answer: B. Administering the ordered metronidazole (Flagyl) 500 mg PO to the

client.

LPN/LVN education and scope of practice and education include the administration of
medications.

 Options A, C, and D: Assessment of hydration status, client and family

education, and assessment of risk factors for diarrhea should be done by a
licensed nurse.

10. Answer: A. Ensure that students are immunized according to national

guidelines.

The incidence of once common infectious diseases such as measles, chickenpox, and
mumps has been most effectively reduced by immunization of all school-aged children.

 Options B, C, and D: The other options are also helpful but will not have as
great as an impact as immunization.

11. Answer: C. Provide oxygen using a non-rebreather mask.

Because the respiratory manifestations associated with avian influenza are potentially
life-threatening, the nurse’s initial action should be to start oxygen therapy.

 Options A, B, and D: The other interventions should be implemented after

addressing the client’s respiratory problem.

12. Answer: A. Place the client on contact precaution.

The client’s age, history of antibiotic therapy, and watery stools suggest that he may have
Clostridium difficile infection. The initial action should be able to place him on contact
precautions to prevent the spread of C. difficile to other clients.

 Options B, C, and D: The other actions are also needed and should be taken
after placing the client on contact precautions.

13. Answer: D. Appropriate antibiotics have been given for 24 hours.

Current CDC evidenced-based guidelines indicate that droplet precautions for clients
with meningococcal meningitis can be discontinued when the client has received
antibiotic therapy for 24 hours.

 Options A, B, and C: The other information may indicate that the client’s
condition is improving but does not indicate that droplet precaution should be
discontinued.

14. Answer: D. No negative-airflow rooms are available on the unit.

Because clients with rubeola require implementation of airborne precautions, which

include placement in a negative airflow room, this child cannot be admitted to the
pediatric unit.

 Options A, B, and C: The other circumstances may require actions such as staff
reassignments but would not prevent the admission of a client with rubeola.

15. Answer: A. Escort the client to a decontamination room.

To prevent contamination of staff or other clients by anthrax, decontamination of the

client by removal and disposal of clothing and showering is the initial action in possible
anthrax exposure.
  Option B: Assessment of the client for signs of infection should be before
decontamination.
 Option C: Notification of security personnel is necessary in the case of possible
bioterrorism, but this should occur before decontaminating and caring for the
client.
 Option D: According to the CDC guidelines, antibiotics should be administered
only if there are signs of infection or the contaminating substance tests positive
for anthrax.

16. Answer: B. Gown. C. Gloves. E. N95 respirator.

Because herpes zoster is spread through airborne means and by direct contact with the
lesions, you should wear an N95 respirator or high-efficiency particulate air filter
respirator, a gown, and gloves.

 Options A and D: Goggles and shoe covers are not needed for airborne or
contact precautions.
 Option F: Surgical face mask filters only large particles and will not provide
protection from herpes zoster.

17. Answer: C. Ensure that dispensers for alcohol-based hand rubs are readily
available in all client care areas of the hospital.

Because the hands of health care workers are the most common means of transmission of
infection from one client to another, the most effective method of preventing the spread
of infection is to make supplies for hand hygiene readily available for staff to use.

 Option A: Although some hospitals have started screening newly admitted

clients for MRSA, there is no evidence that this decreases the spread of
infection.
 Option B: Because administration of antibiotics to individuals who are
colonized by bacteria may promote the development of antibiotic resistance,
 antibiotic use should be restricted to clients who have clinical manifestations of
infection.
 Option D: Wearing a gown to care for clients who are not on contact
precautions is not necessary.

18. Answer: A. 5, 4, 1, 2, 3

The sequence will prevent contact of the contaminated gloves and gowns with areas
(such as your hair) that cannot be easily cleaned after client contact and stop transmission
of microorganisms to you and your other clients.

19. Answer: A. Gloves. E. Gown.

A gown and gloves should be used when coming in contact with linens that may be
decontaminated by the client’s wound secretions.

 Options B, C, and D: The other items are not necessary because transmission
by splashes, droplets, or airborne means will not occur when the bed is
changed.

20. Answer: A. Posting the precautions for protective isolation o the door of the
client’s room;
B. Stocking the client’s room with the needed PPE items; D. Reminding visitors to
wear a respirator mask, gloves, and gown.

Because all staff who care for clients should be familiar with the various type of isolation,
the nursing assistant will be able to stock the room and post the precautions on the
client’s door. Reminding visitors about previously taught information is a task that can be
done by the nursing assistant, although the RN is responsible for the initial teaching.

 Options C and E: Client teaching and discussion of the reason for protective
isolation fall within the RN-level scope of practice.
21. Answer: C. Droplet.

Tonsillitis is contagious and is spread by droplet transmission.

22. Answer: C. Must maintain a spatial distance of 3 feet.

The most common forms of transmission of an organism in a client with tonsillitis are
through coughing, sneezing, and talking. Droplets can travel no more than 3ft so
precautions should be maintained when there is a possibility of entering this distance.

 Option A: Client requires a private room.

 Option B: An N95 mask is not required for this client. A face mask instead can
be used when dealing with the client.
 Option D: Gloves, gowns, face mask and eye protection should be worn in
giving direct care.

23. Answer: C. A pregnant woman with a blister-like rash on the face and is
possibly having varicella.

Chickenpox (Varicella) is transmitted by airborne and that can be easily transferred to the
other clients in the emergency unit. The pregnant woman with the rash should be isolated
right away from other clients through placement in a negative-pressure room.

 Option A: The client who has been exposed to TB does not place the other
clients at risk for infection because there are no symptoms of active TB.
 Options B and D: Droplet and contact precautions should be instituted for the
clients with pertussis and MRSA infection, but this can be done after isolating
the client with possible varicella.

24. Answer: A. Implement contact precautions when handling the client.

All hospital personnel who care for the client are responsible for correct implementation
of contact precautions.

 Options B, C, and D: The other options should be carried out by a licensed

nurse.

25. Answer: C. Disinfecting blood pressure cuffs after clients are discharged.

Nursing assistants can follow agency protocol to disinfect items that come in contact wth
intact skin by cleaning with chemicals such as alcohol.

 Options A, B, and D: The other options should be carried out by a licensed

nurse.