NCLEX-RN® Safety and Infection Prevention and Control: Standard, Contact, Droplet, and Airborne Precautions

A clean reference for infection-control questions: which precautions for which disease, PPE order, room type, and the most-tested mistakes.

Overview

Safety and Infection Prevention and Control is 10–16% of the NCLEX-RN®. It is also the easiest sub-category to gain points in quickly because the rules are simple and predictable. Master the four precaution levels and the common diseases that go with each, and you have most of these points secured.

This guide covers the four levels — Standard, Contact, Droplet, Airborne — and adds the most-tested patient-safety rules.

The four precaution levels

Four precaution levels Standard, contact, droplet, airborne with PPE summary for each. Four precaution levels Standard Hand hygiene + gloves PRN All clients Contact Gown + gloves Private room or cohort Droplet Surgical mask Private room or cohort Airborne N95 + neg- pressure room Door closed
Figure 1. The four levels stack — every level above standard adds to it.

Standard precautions

Used for every patient, every time. Hand hygiene before and after every contact. Gloves any time you might touch blood, body fluids, mucous membranes, or non-intact skin. Mask, gown, eye protection if splash is possible.

Contact precautions

For organisms spread by direct or indirect contact: MRSA, VRE, C. difficile, scabies, lice, RSV, draining wounds, major skin infections.

PPE: gown and gloves to enter the room. Private room or cohort with same organism. Dedicated equipment (stethoscope, BP cuff) where possible. Hand hygiene with soap and water for C. diff — alcohol gel does not kill spores.

Droplet precautions

For organisms spread by large droplets (within ~3 feet): influenza, pertussis, mumps, rubella, meningococcal meningitis, group A strep, H. influenzae, RSV in some settings, COVID-19 in many institutions.

PPE: surgical mask within 3 feet of the patient. Private room or cohort. Patient wears a surgical mask if they leave the room.

Airborne precautions

For organisms spread by small droplet nuclei that hang in the air: tuberculosis (TB), measles, varicella (chickenpox), disseminated zoster (shingles).

PPE: N95 respirator (fit-tested) for the nurse. Negative-pressure room with door closed. Patient wears a surgical mask if transport is required.

Memory aid: Mr SAM

A common mnemonic for airborne organisms: MTV — Measles, TB, Varicella. For droplet: SPIDER M — Strep, Pertussis, Influenza, Diphtheria, Epi-glottitis, Rubella, Meningitis (meningococcal/H. flu).

Many test items hide a contact organism (MRSA, C. diff) inside an unrelated stem and ask which precaution. Pattern-match the bug, then pick the level.

PPE order — donning and doffing

This is one of the most-asked NCLEX® safety questions. Memorise it cold.

PPE order Donning order: gown, mask or respirator, goggles, gloves. Doffing order: gloves, goggles, gown, mask. PPE order Don (put on) 1. Gown 2. Mask / N95 3. Goggles / face shield 4. Gloves Gloves last so cuffs are covered Doff (take off) 1. Gloves 2. Goggles / face shield 3. Gown 4. Mask / N95 (last, outside) Mask last to protect airway
Figure 2. Don in one order; doff in the reverse — except mask comes off last to protect the nurse's airway.

High-yield safety rules

Beyond infection control, the safety sub-category tests a handful of universal rules:

  • Two patient identifiers — name + date of birth — before every medication or procedure.
  • Time-out before invasive procedures to confirm patient, procedure, site.
  • Restraint use is a last resort: order required, least-restrictive, time-limited (4 hr adults, 2 hr ages 9–17, 1 hr under 9), continuous monitoring, neurovascular checks, release every 2 hours.
  • Fall precautions: bed low, brakes locked, call light in reach, non-slip footwear, scheduled toileting.
  • Fire safety: RACE (Rescue, Alarm, Contain, Extinguish) and PASS (Pull, Aim, Squeeze, Sweep).
  • Chemical exposure: SDS sheet for the substance, copious irrigation if eye splash, isolate the contaminated area.

Vaccines — live vs inactivated

A common test trap. Live vaccines must not be given to immunocompromised patients or in pregnancy. Live: MMR, varicella, intranasal flu, oral polio, BCG, yellow fever, rotavirus. Everything else is generally fine.

A worked example

Question. A nurse is admitting a client with suspected pulmonary TB. Which actions should the nurse take? Select all that apply. A. Place the client in a private room with negative airflow. B. Wear a surgical mask when entering the room. C. Apply a fit-tested N95 respirator before entry. D. Place a surgical mask on the client during transport. E. Limit visitors to those wearing N95 masks.

Apply the rules:

  • A — true. Airborne → negative-pressure room.
  • B — false. Surgical mask is droplet, not airborne. Leave.
  • C — true. N95 fit-tested for airborne. Select.
  • D — true. Patient wears surgical mask in transport. Select.
  • E — true. Visitors require N95 protection.

Answer: A, C, D, E.

FAQ

Which precaution is used for tuberculosis?

Airborne precautions. TB requires an N95 respirator for the nurse and a negative-pressure room with the door closed. The patient wears a surgical mask during any transport.

Is alcohol-based hand sanitizer enough for C. difficile?

No. C. difficile spores are not killed by alcohol gel. Use soap and water for hand hygiene, plus contact precautions with gown and gloves.

What PPE is used for COVID-19?

Most institutions use droplet precautions with a surgical mask for routine care, plus eye protection. N95 + airborne precautions are required during aerosol-generating procedures (intubation, suctioning, nebulizer treatments).

How do I remember which order to don and doff PPE?

Donning: gown → mask → goggles → gloves. Doffing: gloves → goggles → gown → mask. The mask comes off last to protect the nurse's airway from contaminated outer surfaces.

Can I give the MMR vaccine to a pregnant client?

No. MMR is a live vaccine and is contraindicated in pregnancy and immunocompromised states. The exam expects you to know which vaccines are live: MMR, varicella, intranasal influenza, oral polio, BCG, yellow fever, and rotavirus.

See also:

Practice on RN Clarity: Question Bank · Flashcards · Mock Tests