National Council Licensure Examination for Registered Nurses (NCLEX-RN) Safe and Effective Care Environment: Safety and Infection Control Syllabus

What does MDRO stand for and give three examples.

Multidrug-Resistant Organism. Examples: MRSA (methicillin-resistant Staph aureus), VRE (vancomycin-resistant Enterococcus), and CRE (carbapenem-resistant Enterobacteriaceae); also ESBL-producing gram-negatives.

What is the primary antibiotic used to treat MRSA, and what for VRE?

MRSA is treated with vancomycin (or linezolid/daptomycin); VRE, being resistant to vancomycin, is treated with linezolid or daptomycin.

What is antimicrobial stewardship and why does it matter for MDROs?

The coordinated effort to optimize antibiotic use — right drug, dose, duration, and de-escalation — to slow development of resistance, a key strategy in preventing MDRO emergence.

Define an 'outbreak' (epidemic) in infection control.

The occurrence of disease cases in excess of what is normally expected in a defined community, population, or time period.

What are the first steps in outbreak management on a unit?

Identify and confirm cases, implement appropriate isolation/precautions, reinforce hand hygiene, notify infection control/public health, cohort patients and staff, and investigate the source/transmission route.

What infection-control precaution is critical for C. difficile and why?

Contact precautions with soap-and-water handwashing (alcohol rubs don't kill spores) and cleaning with a sporicidal agent such as diluted bleach; place in a private room.

What is the strongest single risk factor for a client falling in the hospital?

A history of a previous fall; other major factors include age >65, altered mental status, impaired mobility/gait, polypharmacy, and toileting needs.

Name five key fall-prevention interventions for a high-risk hospitalized client.

Bed in low/locked position, two side rails up (not all four), call light within reach, nonslip footwear, adequate lighting, clear pathways, frequent rounding/toileting, and bed/chair alarms.

Why is raising all four side rails generally considered a restraint?

Four raised side rails restrict the client's freedom to exit the bed voluntarily, meeting the definition of a physical restraint and increasing entrapment/injury risk.

What body mechanics principles reduce nurse injury during client handling?

Bend at the knees/hips (not the back), keep the load close to the body, maintain a wide base of support, use large leg muscles, avoid twisting, and use assistive/mechanical lift devices for heavy loads.

Define a physical restraint and a chemical restraint.

A physical restraint is any manual method or device that restricts free movement or normal access to one's body; a chemical restraint is a medication used to control behavior or restrict movement that is not standard treatment for the client's condition.

What must be true before restraints are applied (legal/clinical requirements)?

Restraints are a last resort after less restrictive alternatives fail; they require a provider's order that is time-limited, specifies type and reason, and cannot be a PRN/standing order; emergency application allows a face-to-face evaluation within a set time.

How often must a restrained client be monitored and reassessed?

Typically every 15–30 minutes for circulation, skin, positioning, and needs; release and reposition at least every 2 hours; behavioral restraints require frequent face-to-face reevaluation.

What are the maximum time limits for behavioral (violent) restraint orders by age?

Adults (≥18): up to 4 hours; ages 9–17: up to 2 hours; children under 9: up to 1 hour — renewable per provider evaluation.

What type of knot must be used to secure a restraint and to what is it tied?

A quick-release (slip) knot tied to the movable part of the bed frame, never to side rails — so it can be released rapidly in an emergency.

What is the difference between a sentinel event and a near miss?

A sentinel event is an unexpected occurrence causing death or serious physical/psychological injury (or risk thereof); a near miss (close call) is an error that was caught before reaching the client and causing harm.

What are the recommended elements of the 'rights' of medication administration?

Right client, right drug, right dose, right route, right time, right documentation, right reason, right response — verified using two client identifiers.

What are the two acceptable client identifiers used before any procedure or medication?

Any two of: full name, date of birth, and medical record number — never the room number; confirm using the ID band and by asking the client to state them.

What is RACE in fire safety?

Rescue (clients in danger), Alarm (activate alarm/call), Confine (close doors/windows), Extinguish or Evacuate.

What is PASS for using a fire extinguisher?

Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side.

Which type of fire extinguisher is used for electrical fires?

Class C (or multipurpose ABC) — uses CO2 or dry chemical; never use water (Class A) on electrical or grease fires.

What are key elements of a home safety assessment for a fall-risk older adult?

Remove throw rugs and clutter, install grab bars/handrails, ensure adequate lighting and nightlights, nonslip mats in tub, accessible items, secure cords, and proper footwear.

What is the priority safety teaching for poison prevention in a home with young children?

Store all medications and chemicals locked and out of reach in original containers, use cabinet locks, and keep the Poison Control number (1-800-222-1222) accessible.

What is the safe water heater temperature setting to prevent scald burns, especially with children/older adults?

120°F (49°C) or lower.

How should used needles and sharps be disposed of?

Immediately into a puncture-resistant, leak-proof, labeled sharps container — never recap (or use one-handed scoop), bend, or break needles.

What is the immediate action after a needlestick injury?

Wash the site with soap and water (flush mucous membranes/eyes with water/saline), report immediately, and seek post-exposure evaluation/prophylaxis; document the source if known.

What document provides information on the hazards of a chemical and is required to be accessible to workers?

The Safety Data Sheet (SDS, formerly MSDS), required under OSHA's Hazard Communication Standard.

In disaster/mass-casualty START triage, what do the color tags red, yellow, green, and black mean?

Red = immediate (life-threatening but survivable, treat first); Yellow = delayed (serious but can wait); Green = minimal ('walking wounded'); Black = expectant/deceased (unsalvageable).

How does triage priority during a mass-casualty incident differ from everyday emergency triage?

In mass-casualty/disaster triage the goal shifts to the greatest good for the greatest number — those with severe, non-survivable injuries are deprioritized (black/expectant), whereas in daily triage the most critical client is treated first.

What are the first physiologic parameters assessed in START triage to assign a red tag?

Respirations (>30/min or absent until airway repositioned), Perfusion (radial pulse absent or cap refill >2 sec), and Mental status (cannot follow simple commands) — the RPM method.

What should a nurse do first when witnessing an unsafe or impaired practice by a colleague?

Ensure immediate client safety, then report the unsafe practice through the proper chain of command/supervisor and per facility policy and the nurse practice act — patient safety and the duty to report override loyalty to a coworker.