Ten free infection control and precautions NCLEX practice questions with full rationales — standard, contact, droplet, and airborne precautions, C. difficile, PPE donning and doffing, and protective isolation. Answer each one, then reveal the correct answer and see why every option is right or wrong. No sign-up needed to practice here.
High-Yield Infection Control Review
Infection control on the NCLEX rests on two layers. The first is Standard Precautions, applied to EVERY client regardless of diagnosis: hand hygiene before and after contact, and personal protective equipment (PPE) selected by the anticipated exposure to blood, body fluids, secretions, and mucous membranes. Standard precautions treat all body substances as potentially infectious. The second layer is Transmission-Based Precautions, added on top of standard precautions for specific pathogens. Contact precautions (gown, gloves, dedicated equipment, private room or cohort) apply to MRSA, VRE, C. difficile, RSV, scabies, and draining wounds. Droplet precautions (surgical mask within about 3-6 feet, private room or cohort) apply to Neisseria meningitidis, influenza, pertussis, mumps, and rubella. Airborne precautions (fit-tested N95 respirator plus a negative-pressure/airborne infection isolation room) apply to tuberculosis, measles (rubeola), and varicella/disseminated herpes zoster; TB and measles are airborne-only, while varicella and disseminated herpes zoster require airborne PLUS contact precautions until all lesions crust over. A helpful memory aid for airborne is "My Chicken Hez TB" (Measles, Chickenpox/varicella, Herpes zoster disseminated, TB).
Two landmines dominate NCLEX infection items. First, Clostridioides difficile (C. diff): use CONTACT precautions AND wash with SOAP AND WATER, because alcohol-based hand sanitizer does NOT kill C. diff spores. The environment must be cleaned with a bleach/sporicidal agent. Second, the PPE sequence. DON in the order gown, mask/respirator, goggles or face shield, then gloves. DOFF in the order gloves, goggles/face shield, gown, then mask/respirator LAST, removing the most contaminated item first and taking the respirator off outside the room.
Finally, protective (reverse/neutropenic) isolation protects the client FROM the environment rather than protecting others. It is used for the severely immunocompromised: a private room with positive-pressure/HEPA filtration where available, no fresh flowers or standing water, restriction of ill visitors, and meticulous hand hygiene (some institutions also use a low-microbial diet). Knowing which direction the airflow and the protection point is often the difference between a right and wrong answer.
Infection Control & Precautions NCLEX Practice Questions
Question 1 · Standard Precautions
A nurse is caring for several clients on a medical unit. Which statement best describes when standard precautions should be used?
- A Only when visible blood is present on the client
- B Only when the client is on transmission-based precautions
- C Only when a client has a confirmed infectious disease
- D For the care of all clients regardless of diagnosis
Show answer & rationale
Correct answer: D
Standard precautions are applied to the care of ALL clients at all times, regardless of diagnosis or presumed infection status, because any client may be colonized or infected with an organism that has not yet been identified. Standard precautions include hand hygiene and the use of PPE (gloves, gown, mask, eye protection) based on the anticipated exposure to blood, body fluids, secretions, excretions, and mucous membranes. Restricting precautions to clients with a confirmed infectious disease is unsafe because many infections are undiagnosed at the point of care, and standard precautions exist precisely to protect against unrecognized pathogens. Limiting them to clients on transmission-based precautions is incorrect because transmission-based precautions are an ADDITIONAL tier layered on top of standard precautions for specific organisms, not a replacement. Waiting for visible blood is also wrong: standard precautions treat all body substances as potentially infectious, and many pathogens are present in fluids that show no visible blood. Clinical pearl: think of standard precautions as the constant baseline for every client, every time, with transmission-based precautions added when a specific route of spread is known or suspected. This reflects current CDC guidance that standard precautions are the foundation for preventing transmission in all healthcare settings.
Question 2 · Contact Precautions
A client is admitted with a wound infected with methicillin-resistant Staphylococcus aureus (MRSA) that has copious drainage. Which PPE should the nurse plan to wear when providing direct wound care?
- A Gown and gloves
- B Gloves only
- C Fit-tested N95 respirator only
- D Surgical mask and gloves only
Show answer & rationale
Correct answer: A
MRSA transmitted through a draining wound requires CONTACT precautions, so the nurse dons a gown and gloves for direct care, uses dedicated or disposable equipment, and places the client in a private room or cohorts with another MRSA client. A gown protects clothing and skin from contact with the drainage, and gloves protect the hands, which are the primary vehicle for spreading resistant organisms. A fit-tested N95 respirator is used for AIRBORNE pathogens such as tuberculosis, measles, and varicella, not for a wound infection, so it does not match the transmission route. A surgical mask with gloves reflects DROPLET precautions and omits the gown, leaving the nurse exposed to contamination from copious drainage. Gloves alone are insufficient because splashing or contact with drainage can contaminate the nurse's clothing and skin. Because wound care with heavy drainage may generate splashing, the nurse should also add a mask and eye protection under standard precautions if splashing is anticipated. Clinical pearl: for contact precautions remember gown plus gloves, and think MRSA, VRE, C. diff, RSV, and scabies. CDC guidance emphasizes dedicated patient-care equipment and meticulous hand hygiene to limit transmission of multidrug-resistant organisms.
Question 3 · Droplet Precautions
The nurse admits a client with suspected bacterial meningitis caused by Neisseria meningitidis. Which action is the priority for infection control?
- A Wear a gown and gloves only when entering the room
- B Place the client in a negative-pressure room and wear an N95 respirator
- C Place the client in a private room and wear a surgical mask
- D Reserve a mask for use only during suctioning
Show answer & rationale
Correct answer: C
Neisseria meningitidis (bacterial meningitis) spreads by respiratory droplets, so DROPLET precautions are indicated: a private room (or cohort) and a surgical mask worn when working within about 3 to 6 feet of the client. Large respiratory droplets travel only a short distance and do not remain suspended in air, so a surgical mask is adequate. A negative-pressure room and N95 respirator describe AIRBORNE precautions used for tuberculosis, measles, and varicella; meningococcal disease does not require airborne isolation, and this level of isolation is not the correct match. Gown and gloves alone reflect CONTACT precautions and fail to protect the nurse's respiratory mucosa from droplets, which is the actual route of spread. Reserving a mask only for suctioning is unsafe because droplets are generated by talking, coughing, and sneezing, not just suctioning, so the mask must be worn whenever close to the client. Clinical pearl: suspected meningococcal meningitis needs droplet precautions maintained until at least 24 hours of effective antibiotic therapy, and close contacts may need prophylaxis. Remember droplet organisms with the phrase think of the germs that make you cough and sneeze: influenza, pertussis, meningococcus, mumps, and rubella.
Question 4 · Airborne Precautions
A client with active pulmonary tuberculosis is admitted to the unit. Which combination of precautions is required?
- A Gown, gloves, and a private room with the door closed
- B Fit-tested N95 respirator and negative-pressure room
- C Surgical mask for staff and a standard private room
- D Standard precautions only with the door kept open
Show answer & rationale
Correct answer: B
Active pulmonary tuberculosis is transmitted by tiny airborne droplet nuclei that remain suspended in the air for long periods, so AIRBORNE precautions are required: a fit-tested N95 respirator (or higher-level respirator) plus placement in a negative-pressure airborne infection isolation room with the door kept closed. The negative-pressure room prevents contaminated air from flowing out into the corridor, and the N95 filters the fine particles a surgical mask cannot. A surgical mask with a private room is inadequate because a surgical mask does not seal against the face or filter droplet nuclei, and a standard private room lacks the required air handling. Gown and gloves with a private room describe contact precautions and do nothing to protect the airway, which is the route of TB spread. Standard precautions with the door open is dangerous because it allows infectious droplet nuclei to escape and provides no respiratory protection. Clinical pearl: use the mnemonic My Chicken Hez TB for airborne conditions: Measles, Chickenpox (varicella), disseminated Herpes zoster, and TB. CDC guidance also directs staff to keep the door closed, limit client transport, and place a surgical mask on the client (not an N95) if transport outside the room is unavoidable.
Question 5 · C. difficile
A nurse finishes caring for a client with Clostridioides difficile (C. diff) infection. Which hand hygiene action is correct?
- A Rinse hands with water alone since gloves were worn
- B Apply hand sanitizer twice for extra spore coverage
- C Use an alcohol-based hand sanitizer because it is faster and more effective
- D Wash hands with soap and water
Show answer & rationale
Correct answer: D
For C. diff the nurse must wash the hands with SOAP AND WATER, because C. diff produces spores that are NOT killed by alcohol-based hand sanitizer. The mechanical action of soap-and-water washing physically removes spores from the skin, which sanitizer cannot do. Choosing an alcohol-based sanitizer is the classic NCLEX landmine; although sanitizer is preferred for many organisms, it is ineffective against C. diff spores, so relying on it would leave the hands contaminated. Applying sanitizer twice does not solve the problem because the issue is not the amount of product but that alcohol does not kill spores at all. Rinsing with water alone, even after wearing gloves, is inadequate because gloves can have micro-perforations or become contaminated during removal, and water without soap does not effectively remove spores. C. diff also requires CONTACT precautions (gown and gloves) and environmental cleaning with a bleach or sporicidal agent, since routine disinfectants do not kill spores. Clinical pearl: whenever you see C. diff, norovirus, or Bacillus anthracis, think soap and water, not sanitizer. This aligns with CDC recommendations for interrupting fecal-oral transmission of spore-forming organisms.
Question 6 · PPE Donning Sequence
Before entering the room of a client on contact and droplet precautions, in which order should the nurse don personal protective equipment?
- A Gown, mask, goggles, gloves
- B Goggles, gloves, gown, mask
- C Gloves, gown, mask, goggles
- D Mask, gown, gloves, goggles
Show answer & rationale
Correct answer: A
The correct donning sequence is gown first, then mask or respirator, then goggles or face shield, and gloves last. Putting the gown on first covers the torso and provides a base layer; the mask and eye protection secure the face; and gloves go on last so they can be pulled over the cuffs of the gown, creating a continuous barrier at the wrists. Beginning with gloves is wrong because gloves donned first would be contaminated while adjusting the gown and mask and would not seal over the gown cuffs. Starting with the mask before the gown disrupts the recommended order and can leave the gown cuffs exposed. Beginning with goggles and placing the gown after gloves reverses the sequence entirely, leaving no clean barrier at the wrists. Clinical pearl for donning: think Gown, Mask, Goggles, Gloves, moving from the body outward and ending with the hands so they stay clean until the last step. Remember that doffing is nearly the reverse and prioritizes removing the most contaminated items first: gloves, goggles/face shield, gown, and the mask or respirator LAST, taken off outside the room. CDC PPE sequences are designed to minimize self-contamination during both application and removal.
Question 7 · Protective Isolation
A client receiving chemotherapy has severe neutropenia and is placed on protective (neutropenic) isolation. Which action by a nursing assistant requires the nurse to intervene?
- A Restricting a visitor who has an upper respiratory infection
- B Placing the client in a private room
- C Bringing the client a fresh bouquet of flowers from the gift shop
- D Performing hand hygiene before entering the room
Show answer & rationale
Correct answer: C
Protective (reverse/neutropenic) isolation is used for severely immunocompromised clients to protect the client FROM environmental organisms. Fresh flowers and standing water harbor Pseudomonas, Aspergillus, and other organisms that can cause life-threatening infection in a neutropenic client, so bringing a bouquet is unsafe and the nurse must intervene. Performing hand hygiene before entering is correct and essential, since meticulous hand hygiene is the cornerstone of protecting the client. A private room, ideally with positive-pressure/HEPA air filtration where available, is appropriate because it reduces exposure to airborne environmental organisms and other clients' flora. Restricting a visitor with a respiratory infection is also correct, because ill visitors are a direct threat to an immunocompromised client. Additional measures include removing standing water and, per some institution policies, a low-microbial diet (evidence for restricting raw produce is limited). Clinical pearl: the direction of protection is the key distinction. Protective isolation protects the client from the world (positive pressure, air flows OUT), whereas airborne precautions protect the world from the client (negative pressure, air flows IN). Anything introducing microbes to the neutropenic client, such as flowers, raw produce, or sick visitors, is a red flag on the NCLEX.
Question 8 · Disease-to-Precaution Mapping
The nurse is identifying clients who require AIRBORNE precautions. Which conditions require airborne precautions? Select all that apply.
- A Influenza
- B Pulmonary tuberculosis
- C Measles (rubeola)
- D Clostridioides difficile infection
- E Varicella (chickenpox)
- F Disseminated herpes zoster
Show answer & rationale
Correct answer: B, C, E, F
Airborne precautions are required for pulmonary tuberculosis, measles (rubeola), varicella (chickenpox), and disseminated herpes zoster, all of which are captured by the mnemonic My Chicken Hez TB (Measles, Chickenpox/varicella, disseminated Herpes zoster, TB). These pathogens travel in tiny droplet nuclei that stay suspended in air, so they require a fit-tested N95 respirator and a negative-pressure isolation room. Influenza does NOT require airborne precautions; it spreads by respiratory droplets and calls for DROPLET precautions with a surgical mask. Clostridioides difficile does NOT require airborne precautions; it spreads by the fecal-oral route and requires CONTACT precautions plus soap-and-water hand hygiene, because spores survive alcohol sanitizer. Varicella and disseminated herpes zoster are notable because they require BOTH airborne AND contact precautions, since the vesicular fluid is infectious on contact and the virus is also airborne. Clinical pearl: localized herpes zoster (shingles) in an immunocompetent client needs only standard precautions with lesions covered, but disseminated zoster or zoster in an immunocompromised client is treated like varicella with airborne plus contact precautions. Matching each disease to its transmission route is one of the highest-yield infection-control skills on the NCLEX.
Question 9 · PPE Doffing Sequence
A nurse is teaching a new graduate about removing (doffing) PPE at the end of care in a client’s room. Which statements indicate correct understanding? Select all that apply.
- A Reuse gloves for the next client if they are not visibly soiled
- B Remove gloves first because they are the most contaminated item
- C Remove the mask or respirator first, before the gloves
- D Perform hand hygiene after removing all PPE
- E Remove the N95 respirator last, outside the room
- F Remove the gown after the gloves and goggles
Show answer & rationale
Correct answer: B, D, E, F
Correct doffing follows the principle of removing the most contaminated items first while protecting the face until the end. The proper order is gloves, then goggles or face shield, then gown, and finally the mask or respirator, with the respirator removed OUTSIDE the room. Removing gloves first is correct because the hands touch the most contaminated surfaces. Removing the gown after the gloves and goggles is correct and keeps the sequence moving from most to least contaminated. Removing the N95 respirator last and outside the room is correct because it protects the airway until the nurse has left the contaminated environment. Performing hand hygiene after all PPE is removed, and also between steps if the hands become contaminated, is correct and essential. Removing the mask or respirator first is wrong; the face covering is removed last so the nurse is not exposed while handling contaminated body and hand PPE. Reusing gloves for another client is never acceptable, because gloves are single-use and reusing them transfers organisms between clients. Clinical pearl: donning moves from the body outward ending with gloves, while doffing starts with the dirtiest item (gloves) and ends with the respirator; hand hygiene bookends the entire process. This mirrors CDC PPE removal guidance to prevent self-contamination.
Question 10 · Contact Precautions / MDROs
The nurse is planning care for a client on CONTACT precautions for vancomycin-resistant enterococcus (VRE). Which interventions are appropriate? Select all that apply.
- A Wear a gown and gloves for direct client contact
- B Require all staff to wear an N95 respirator in the room
- C Place the client in a private room or cohort with another VRE-positive client
- D Perform hand hygiene before and after client contact
- E Leave shared equipment uncleaned between clients to save time
- F Use dedicated or disposable equipment such as a stethoscope and blood pressure cuff
Show answer & rationale
Correct answer: A, C, D, F
VRE is a multidrug-resistant organism spread by direct and indirect contact, so contact precautions apply. Wearing a gown and gloves for direct contact is correct and forms the core barrier for contact precautions. Using dedicated or disposable equipment, such as a stethoscope and blood pressure cuff kept in the room, is correct because shared equipment is a common vehicle for transmitting resistant organisms. Placing the client in a private room or cohorting with another VRE-positive client is correct and prevents spread to uninfected clients. Hand hygiene before and after every contact is correct and remains the single most important measure for preventing MDRO transmission; for VRE, alcohol-based sanitizer is acceptable unless the hands are visibly soiled. Requiring an N95 respirator is unnecessary because VRE is not airborne; an N95 is reserved for tuberculosis, measles, and varicella. Leaving shared equipment uncleaned is unsafe and directly promotes transmission; any equipment that must be shared has to be cleaned and disinfected between clients. Clinical pearl: contact precaution organisms include MRSA, VRE, C. diff, RSV, and scabies. Grouping resistant organisms under gown-plus-gloves with dedicated equipment is a reliable framework for the NCLEX and reflects current CDC MDRO prevention practice.
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Infection Control NCLEX FAQ
What is the difference between standard precautions and transmission-based precautions?
Standard precautions are used for every client at all times and include hand hygiene plus PPE chosen for the anticipated exposure to blood and body fluids. Transmission-based precautions (contact, droplet, airborne) are added on top of standard precautions for specific known or suspected pathogens based on how they spread.
Why do you use soap and water instead of hand sanitizer for C. diff?
Clostridioides difficile forms spores that alcohol-based hand sanitizer does not kill. Washing with soap and water mechanically removes the spores from the skin. C. diff also requires contact precautions and environmental cleaning with a bleach or sporicidal agent, since routine disinfectants do not destroy spores.
Which diseases require airborne precautions?
Tuberculosis, measles (rubeola), varicella (chickenpox), and disseminated herpes zoster require airborne precautions with a fit-tested N95 respirator and a negative-pressure room. Use the mnemonic My Chicken Hez TB: Measles, Chickenpox, disseminated Herpes zoster, and TB. Varicella and disseminated zoster also need contact precautions.
What is the correct order for putting on and taking off PPE?
Don PPE in the order gown, mask or respirator, goggles or face shield, then gloves. Doff in the order gloves, goggles or face shield, gown, then mask or respirator last, removing the respirator outside the room. Perform hand hygiene before donning, after doffing, and any time hands become contaminated.