Medical/surgical asepsis NCLEX-RN Practice Questions

Medical/surgical asepsis NCLEX-RN Practice Questions prepare you to apply infection prevention principles precisely in clinical settings. This topic-wise set targets core Safety & Infection Control competencies: maintaining sterile fields, correct PPE sequencing, sterile gloving, wound care, catheterization, central line dressing, and procedural asepsis. You will practice prioritizing actions when sterility is threatened, distinguishing medical from surgical asepsis, and integrating evidence-based techniques (e.g., chlorhexidine use, “clean-to-dirty” wound cleaning, solution handling). Scenarios mirror real NCLEX complexity—requiring rapid judgment, rationale-driven choices, and attention to detail—ideal for M. Pharma students strengthening clinical reasoning alongside nursing standards. Use these questions to refine precision, identify pitfalls that contaminate fields, and internalize safe, reliable aseptic workflows that protect patients and staff.

Q1. A nurse suspects Clostridioides difficile infection after changing a patient’s incontinent stool. Which hand hygiene action is most appropriate immediately after glove removal?

• Perform hand hygiene with an alcohol-based hand rub for 20 seconds
• Wash hands with soap and water for at least 20 seconds
• Use antiseptic wipes to clean fingertips only
• Don new gloves to continue care without hand hygiene

Correct Answer: Wash hands with soap and water for at least 20 seconds

Q2. The nurse is preparing to enter a room requiring contact and droplet precautions to perform a sterile dressing change. Which sequence for donning PPE is correct?

• Hand hygiene, gown, mask, goggles/face shield, gloves
• Gown, hand hygiene, mask, gloves
• Mask, goggles, gown, gloves
• Hand hygiene, mask, gloves, gown

Correct Answer: Hand hygiene, gown, mask, goggles/face shield, gloves

Q3. After completing a sterile wound dressing in droplet/contact isolation, which item should the nurse remove first to minimize self-contamination?

• Mask
• Gown
• Gloves
• Goggles/face shield

Correct Answer: Gloves

Q4. While assisting with a sterile urinary catheter insertion, which action by the nurse contaminates the sterile field?

• Keeping sterile items above waist level
• Turning to adjust the overhead light by reaching across the sterile field
• Opening the outermost flap of a sterile pack away from the body
• Maintaining a 1-inch border around the sterile field as nonsterile

Correct Answer: Turning to adjust the overhead light by reaching across the sterile field

Q5. The nurse prepares to add sterile normal saline to a sterile basin on the field. Which technique maintains sterility?

• Hold the bottle with the label facing away from the palm and pour directly into the basin from 4–6 inches
• Place the bottle cap with the inner surface up on the bedside table and pour from 6–8 inches
• Hold the bottle with the label in the palm, “lip” the solution, and pour 1–2 inches above the basin
• Touch the edge of the sterile basin gently with the bottle to guide the pour

Correct Answer: Hold the bottle with the label in the palm, “lip” the solution, and pour 1–2 inches above the basin

Q6. During sterile female urinary catheter insertion, which action correctly maintains surgical asepsis?

• Use the nondominant hand to insert the catheter while the dominant hand retracts the labia
• Consider the nondominant hand contaminated after touching the labia and use the sterile dominant hand to insert the catheter
• Lubricate the catheter using the nondominant sterile hand right before insertion
• Place the sterile kit on the patient’s lap below waist level to maintain proximity

Correct Answer: Consider the nondominant hand contaminated after touching the labia and use the sterile dominant hand to insert the catheter

Q7. Which step best demonstrates correct sterile gloving technique?

• Grasp the outside of the first glove cuff with the ungloved hand and pull it on
• Insert ungloved fingers under the outer cuff of the second glove to pull it over the first glove
• Touch the palm of the first glove with the bare dominant hand to adjust the fit
• Hold both gloves at waist level while donning to prevent contamination

Correct Answer: Grasp the outside of the first glove cuff with the ungloved hand and pull it on

Q8. While changing a central venous catheter dressing using sterile technique, which intervention best reduces catheter-associated infection risk?

• Apply sterile gloves only; patient masking is unnecessary
• Use sterile gauze and change the dressing every 72 hours regardless of condition
• Have both nurse and patient wear masks during the dressing change
• Cleanse the site with povidone-iodine using a circular motion for 10 seconds

Correct Answer: Have both nurse and patient wear masks during the dressing change

Q9. For surgical hand antisepsis before entering the OR, which principle is correct?

• Scrub hands and forearms for at least 30 seconds with plain soap
• Perform a timed scrub (per policy, e.g., 2–6 minutes) keeping hands above elbows, or use an approved alcohol-based surgical hand rub per manufacturer’s instructions
• Use warm water and lotion to prevent skin breakdown, then don sterile gloves
• Scrub until visible lather disappears to avoid residue

Correct Answer: Perform a timed scrub (per policy, e.g., 2–6 minutes) keeping hands above elbows, or use an approved alcohol-based surgical hand rub per manufacturer’s instructions

Q10. Which situation represents contamination of a sterile field requiring it to be re-established?

• Turning your back on the sterile field momentarily to reach supplies
• Keeping the field at waist level and in view
• Moisture from sterile saline wicking through the sterile drape
• Placing sterile instruments 2 inches from the field’s edge

Correct Answer: Moisture from sterile saline wicking through the sterile drape

Q11. When cleansing a postoperative midline incision with sutures during a sterile dressing change, which technique is correct?

• Clean from the outer skin toward the incision using the same swab for each pass
• Clean from the incision center outward with a new sterile swab for each stroke
• Clean from bottom to top to facilitate drainage
• Clean in a back-and-forth motion over the incision to maximize friction

Correct Answer: Clean from the incision center outward with a new sterile swab for each stroke

Q12. A patient with severe neutropenia is admitted. Which instruction reflects appropriate protective (reverse) isolation?

• Fresh flowers are permitted if kept at least 3 feet from the patient
• Encourage raw fruits and vegetables to increase vitamin intake
• Limit visitors with recent illness and avoid fresh flowers or plants in the room
• Shared equipment is acceptable if wiped after use

Correct Answer: Limit visitors with recent illness and avoid fresh flowers or plants in the room

Q13. The nurse sustains a needlestick after medication administration. What is the priority first action?

• Report the incident to the nurse manager
• Wash the puncture site with soap and water
• Obtain the patient’s HIV and hepatitis status
• Begin post-exposure prophylaxis immediately

Correct Answer: Wash the puncture site with soap and water

Q14. During a sterile catheterization, the nurse’s gloved dominant hand accidentally touches the patient’s thigh. What is the best immediate action?

• Proceed with insertion to avoid delaying the procedure
• Continue using the same gloves but add extra lubricant
• Step back, remove the contaminated glove, and re-glove with a new sterile glove without contaminating the field
• Discard the entire catheter kit and start over from the beginning

Correct Answer: Step back, remove the contaminated glove, and re-glove with a new sterile glove without contaminating the field

Q15. Which respiratory protection is required when entering the room of a patient with suspected pulmonary tuberculosis?

• Surgical mask
• N95 respirator or higher-level particulate respirator
• Face shield alone
• Powered air-purifying respirator (PAPR) for all staff regardless of fit testing

Correct Answer: N95 respirator or higher-level particulate respirator

Q16. Which indicator most reliably confirms a sterile package is safe to use?

• Package is dry and free of visible soil; expiration date passed by 1 day
• Package is intact, dry, within expiration date; chemical indicator has changed to the designated color
• Autoclave tape is present, regardless of color change
• Package was stored near a sink but remains sealed

Correct Answer: Package is intact, dry, within expiration date; chemical indicator has changed to the designated color

Q17. The nurse adds a sterile gauze pack to an established sterile field. Which action maintains sterility?

• Drop the item from approximately 6 inches above the field without reaching over it
• Place the item at the edge of the 1-inch border to ensure easy access
• Lean over the field to gently set the package in the center
• Brush aside instruments to make room before dropping the item

Correct Answer: Drop the item from approximately 6 inches above the field without reaching over it

Q18. Preparing the skin for a central line dressing, which technique is best practice?

• Wipe with alcohol in circular motion for 10 seconds and cover immediately
• Scrub with chlorhexidine using back-and-forth friction for at least 30 seconds and allow to dry completely
• Apply povidone-iodine and blot dry to speed dressing placement
• Alternate alcohol and saline to maximize cleaning

Correct Answer: Scrub with chlorhexidine using back-and-forth friction for at least 30 seconds and allow to dry completely

Q19. After a sterile procedure, how should the nurse remove a surgical mask?

• Untie the top tie first, then the bottom tie, touching the front to fold it
• Remove by grasping ties or ear loops only, starting with the bottom tie, without touching the mask front
• Pull the mask down by the chin area and discard
• Lift the front of the mask away and then untie

Correct Answer: Remove by grasping ties or ear loops only, starting with the bottom tie, without touching the mask front

Q20. Which action is essential to maintain the integrity of a sterile field during a bedside procedure?

• Keep the field at or above waist level and in direct view at all times
• Turn away briefly to gather additional sterile supplies
• Allow the patient to rest an arm across the drape to stabilize it
• Cover the field with a clean towel if the provider is delayed

Correct Answer: Keep the field at or above waist level and in direct view at all times

Q21. Which visitor education best supports respiratory hygiene/cough etiquette to reduce transmission?

• Cover coughs with hands and continue visiting
• Use tissues or elbow to cover sneeze, perform hand hygiene, wear a mask if symptomatic, and maintain a 3-foot distance
• Wear a face shield only when coughing
• Discard tissues in regular trash at the nurses’ station

Correct Answer: Use tissues or elbow to cover sneeze, perform hand hygiene, wear a mask if symptomatic, and maintain a 3-foot distance

Q22. How should soiled linens from a patient on contact precautions be handled?

• Carry linens against the uniform to prevent dropping
• Place in a leak-resistant bag inside the room; if double-bagging is used, a second person holds a clean bag outside the room
• Transport in an open bin for air drying
• Shake linens to remove debris before bagging

Correct Answer: Place in a leak-resistant bag inside the room; if double-bagging is used, a second person holds a clean bag outside the room

Q23. To prevent contamination when withdrawing medication from a multi-dose vial, which action is best?

• Use the same needle to withdraw doses for the same patient within 24 hours
• Scrub the rubber septum with alcohol for 15–30 seconds and use a new sterile needle and syringe
• Remove the metal cap and keep the vial uncapped for easy access
• Store the vial without dating if used infrequently

Correct Answer: Scrub the rubber septum with alcohol for 15–30 seconds and use a new sterile needle and syringe

Q24. When donning a sterile gown for an OR procedure, which step maintains sterility?

• Grasp the outside of the gown at the chest to pull it on
• Touch only the inside of the gown and keep hands at shoulder level until gloved
• Allow the gown to brush the floor briefly if sleeves are long
• Don gloves first, then the gown using closed-gloving technique

Correct Answer: Touch only the inside of the gown and keep hands at shoulder level until gloved

Q25. When opening a sterile drape package on a bedside table, which flap should be opened first?

• Closest flap toward the body
• Right side flap first, then left
• Farthest flap away from the body
• Any flap order is acceptable if done quickly

Correct Answer: Farthest flap away from the body

Q26. Which procedure requires sterile technique rather than clean technique?

• Administering an enema
• Oral suctioning with a Yankauer
• Tracheostomy suctioning
• Removing peripheral IV tubing

Correct Answer: Tracheostomy suctioning

Q27. A room requires terminal cleaning after a patient with confirmed C. difficile is discharged. Which environmental cleaning agent is indicated?

• Quaternary ammonium disinfectant
• Phenolic disinfectant
• Sodium hypochlorite (bleach)-based sporicidal disinfectant
• Hydrogen peroxide wipes only

Correct Answer: Sodium hypochlorite (bleach)-based sporicidal disinfectant

Q28. After opening a 500 mL bottle of sterile normal saline for wound irrigation at the bedside, what should the nurse do with the remaining solution?

• Recap and store indefinitely if the cap is tightly closed
• Label with date and time of opening and discard per policy, typically within 24 hours
• Pour remaining solution back into the sterile field basin for later use
• Share the bottle between patients if no visible contamination is observed

Correct Answer: Label with date and time of opening and discard per policy, typically within 24 hours

Q29. When initiating a peripheral IV, which skin antisepsis step is essential to maintain asepsis?

• Wipe the site with chlorhexidine and insert the catheter while the site is still wet
• Scrub the site with chlorhexidine using friction and allow it to air-dry completely before insertion
• Clean with sterile saline to avoid chemical irritation
• Use povidone-iodine, then immediately blot dry to prevent runoff

Correct Answer: Scrub the site with chlorhexidine using friction and allow it to air-dry completely before insertion

Q30. During a sterile dressing change, the patient coughs directly toward the field. What is the nurse’s best action?

• Continue the procedure to minimize exposure time
• Cover the field with a clean towel and proceed
• Discard contaminated supplies, perform hand hygiene, and set up a new sterile field
• Ask the patient to turn away and resume using the same field

Correct Answer: Discard contaminated supplies, perform hand hygiene, and set up a new sterile field

Download