NCLEX-PN Prep: High-Yield Topics on Patient Safety and Basic Care for the Practical Nursing Exam

Patient safety and basic care make up a large share of NCLEX-PN questions. The exam wants to see if you prevent harm, deliver routine care correctly, and know what to do first when risks appear. This guide highlights high-yield topics, explains the “why” behind safe choices, and gives practical examples you can use on test day and at the bedside.

How the NCLEX-PN tests safety and basic care

Questions often present a brief scenario with normal tasks like feeding, bathing, positioning, or giving meds. The challenge is not complex disease knowledge. It is picking the safest, most effective action. The exam prizes actions that prevent harm, use resources wisely, and follow policy. Think of safety as your first priority, not a later step.

Core priority frameworks that guide safe choices

ABCs (Airway, Breathing, Circulation): Threats to airway or breathing come first. A new wheeze beats a mild fever. The reason: hypoxia kills fastest.
Maslow: Physiologic needs (oxygen, fluids, warmth, pain control) beat psychosocial needs. Safety protects physiologic function.
Nursing process: Assess before act. If you lack data, collect it. Acting without assessment risks harm.
Least restrictive/least invasive: Try safer, simpler measures first. They carry fewer complications and protect patient rights.
Stable vs. unstable: Prioritize unstable, new, or changing conditions over predictable chronic problems. Unstable patients deteriorate faster.
Right task, right person, right situation: Delegate only tasks that match role and competence. Mismatched tasks create safety errors.

Infection control essentials

Hand hygiene: Use alcohol rub for routine care. Use soap and water for visible soil, C. difficile, and norovirus. Alcohol does not kill spores.
Standard precautions: Gloves with any body fluid risk. This prevents cross-contamination.
Transmission-based:
- Contact: Gown and gloves (e.g., MRSA, VRE, C. difficile).
- Droplet: Surgical mask within 3–6 feet (e.g., influenza, meningitis).
- Airborne: N95 and negative-pressure room (e.g., TB, measles, varicella).
PPE order: Don: gown, mask/respirator, goggles/face shield, gloves. Doff: gloves, goggles/face shield, gown, mask. This limits self-contamination.
Sterile field: Keep it dry, above waist, and in view. One-inch edges are unsterile. Do not reach over the field. Moisture wicks microbes.
Sharps safety: Do not recap. Activate safety device. Dispose in puncture-proof container. Needlesticks transmit bloodborne disease.
Specimens: Early morning sputum is best. Get blood cultures before antibiotics. Clean-catch urine requires perineal cleaning. Right timing and technique improve accuracy.

Medication safety you must master

Five rights + two: Right patient, drug, dose, route, time + right documentation and right reason. Using two identifiers prevents mix-ups.
Allergies and interactions: Always verify allergies and compare to MAR. Many reactions are avoidable.
Hold parameters: Withhold if outside safe range (e.g., hold beta-blocker if HR below ordered limit). This prevents adverse effects.
High-alert meds: Insulin, anticoagulants, opioids. Double-check doses. Small errors can be fatal.
Do not crush: Enteric-coated and extended-release pills. Crushing alters absorption and can cause toxicity.
Insulin basics: Know onset/peak of rapid, short, and long-acting insulin. Hypoglycemia peaks at insulin peak times.
IV safety (general PN level): Verify correct fluid, rate, and site. Report infiltration, phlebitis, or reaction. Follow facility policy on IV meds within PN scope.
After giving meds: Reassess effect at the right time (e.g., oral pain meds in 30–60 minutes). You must evaluate safety and response.

Falls and environmental safety

Risk factors: Age, confusion, sedatives, hypotension, incontinence, poor vision, previous falls. These raise risk of injury.
Prevention bundle: Low bed, locked wheels, call light in reach, non-skid socks, clutter-free floor, nightlight, hourly rounding, offer toileting. These remove common hazards.
Bed/chair alarms: Use for high-risk patients. Alerts allow rapid help.
Restraints: Last resort after de-escalation, reorientation, sitter, diversions, and medication review. Need a time-limited provider order, frequent checks, circulation checks, quick-release knot to bed FRAME, two-finger space, remove periodically for ROM and toileting. Restraints can injure and cause delirium.
Oxygen safety: No smoking, no petroleum near oxygen, secure tanks, avoid open flames. Oxygen fuels fire.
Fire response: RACE (Rescue, Alarm, Contain, Extinguish), PASS for extinguishers (Pull, Aim, Squeeze, Sweep). Structured actions save time.

Communication, delegation, and documentation

SBAR: Situation, Background, Assessment, Recommendation. This prevents communication errors.
Therapeutic communication: Open-ended questions, reflection, and empathy. Avoid “why” questions, false reassurance, or advice. This builds trust and accurate data.
HIPAA: Share minimum necessary, only with those involved in care. Privacy protects patient rights and is required by law.
Informed consent: Provider explains risks/benefits. The nurse verifies understanding, answers nursing questions, and witnesses the signature. Do not obtain consent for the provider.
Incident reports: For falls, med errors, device failures. Do not chart the report itself in the medical record. Document facts and patient status. Reports improve systems safety.
Delegation (typical PN exam rules):
- Pns can collect data, perform wound care, administer many meds per policy, reinforce teaching, and care for stable patients with predictable outcomes.
- Do not assign initial teaching, initial assessment, or unstable patients to UAP or delegate these tasks yourself.
- UAP can do ADLs, routine vital signs on stable patients, ambulation, intake/output, hygiene, and simple non-sterile tasks.
- Always give clear instructions and follow up. Safety depends on supervision.

Basic comfort and hygiene

Bathing and perineal care: Front-to-back for females. This prevents UTIs. Warm water and privacy maintain dignity and comfort.
Oral care: For unconscious patients, use a side-lying position and suction equipment. Prevent aspiration and pneumonia.
Indwelling catheter care: Keep a closed system, bag below bladder, no kinks, daily peri-care, secure catheter. This reduces CAUTI.
Sleep promotion: Cluster care, reduce noise, manage pain, avoid caffeine late. Sleep restores healing and cognition.

Nutrition and feeding safety

Dysphagia precautions: Sit upright at 90 degrees, chin tuck, small bites, slow pace, thickened liquids if ordered, keep upright 30–60 minutes after meals. These steps prevent aspiration.
Feeding techniques: Check pocketing, alternate solids and liquids, do not use straws if ordered against. Observe for cough, wet voice, or drooling.
Enteral feeding basics: Confirm placement by x-ray initially. Before each use, verify placement per policy, check residuals if required, HOB 30–45 degrees during and after feeding, flush before/after meds. Position and patency prevent aspiration and tube blockage.
Malnutrition risk: Older adults, chronic illness, depression, alcohol use, difficulty chewing. Early nutrition consult reduces complications.

Mobility, positioning, and skin integrity

Positioning:
- High Fowler’s for respiratory distress or NG tube insertion.
- Left lateral Sims for enemas and rectal meds.
- Post-liver biopsy: right side-lying to tamponade bleeding.
- Post-lumbar puncture: flat as ordered to reduce headache.
- Logroll with spinal precautions to protect alignment.
Pressure injury prevention: Reposition at least every 2 hours, float heels, use pressure-redistribution surfaces, keep skin clean and dry, manage moisture and nutrition, inspect bony prominences daily. Pressure and moisture break skin.
Early skin cues: Non-blanchable redness is stage 1. Remove pressure and protect skin immediately to stop progression.
DVT prevention: Ambulate early, apply SCDs/TEDs, leg exercises, adequate hydration. Stasis causes clots.
Heat and cold therapy: Heat increases blood flow; cold reduces swelling and pain. Avoid on areas with poor circulation or neuropathy. Check skin frequently to prevent burns or frostbite.

Elimination and specimen stewardship

Urinary retention: Assess bladder distension, timed voiding, bladder scan per policy. Catheterize only if necessary. Catheters raise infection risk.
Constipation prevention: Fluids, fiber, activity, respond to urge. Opioids slow gut; consider stool softeners as ordered.
Ostomy care: Empty pouch when one-third full, cut wafer to stoma size, protect peristomal skin, observe stoma color (should be pink to red, moist). Skin integrity supports adherence and comfort.
Specimens: For stool occult blood, avoid red meat and vitamin C if instructed prior, as they alter results. Label at bedside to avoid mix-ups.

Fluid balance and electrolytes: practical cues

Intake and output: Typical urine output goal is around 30 mL/hour. Falling below suggests hypovolemia or renal issues. Report trends early.
Dehydration signs: Dry mucosa, poor skin turgor, tachycardia, hypotension, concentrated urine. Replace fluids as ordered to protect perfusion.
Hyponatremia: Confusion, headache, seizures in severe cases. Brain cells swell in low sodium.
Hypernatremia: Thirst, dry tongue, agitation. Cells shrink in high sodium.
Hypokalemia: Muscle weakness, arrhythmias, U waves. Often from diuretics. Replace carefully.
Hyperkalemia: Peaked T waves, weakness, risk of dysrhythmias. Verify hemolysis before acting and notify provider for critical values.

Pain and comfort measures

Assessment: Use a consistent pain scale. Ask location, quality, intensity, timing, and impact. Specifics guide safe relief.
Non-drug measures: Repositioning, heat/cold if appropriate, relaxation, distraction. These reduce dose needs and side effects.
Opioid safety: Monitor respiratory rate, sedation, and oxygen saturation. Hold and notify if RR drops or sedation deepens. Opioids depress breathing.
Reassess: Check pain relief and function after interventions. This closes the loop of safe care.

Emergency cues and first actions

Seizure precautions: Pad side rails, suction and oxygen ready, remove hazards. During seizure, turn to side, note time, protect head, do not restrain or put objects in mouth. Aspiration and injury are main risks.
Anaphylaxis: Stop the trigger (e.g., infusion), maintain airway, give epinephrine and oxygen per orders, elevate head if breathing allows. Rapid airway compromise is the danger.
Hypoglycemia: If awake, give fast carbs; if altered, follow facility protocol (e.g., glucagon). Brain depends on glucose.
Blood transfusion reaction: Stop transfusion, keep IV open with normal saline, assess vitals, notify provider and blood bank, recheck identifiers, send blood and tubing to lab. Early steps reduce severity.
Choking (conscious adult): Ask, “Are you choking?” If unable to speak or cough, start abdominal thrusts. Airway obstruction kills quickly.

Lifespan and cultural safety points

Older adults: High fall risk, polypharmacy, delirium risk with infection or new meds. Start low with meds, go slow, and reorient often.
Pediatrics: Weight-based dosing, aspiration risk with small objects, keep meds and hazards locked. Family-centered care improves adherence.
Cultural competence: Use trained interpreters, not family, for teaching and consent. This protects accuracy and privacy.
Beliefs and preferences: Ask about diet, modesty, blood products, and end-of-life preferences. Respect increases safety and trust.

Quick practice scenarios with rationales

1) You enter a room where a patient on oxygen has petroleum jelly on cracked lips and a candle burning.
- Best first action: Extinguish the candle and remove ignition sources. Then replace petroleum with water-based lubricant and reinforce teaching.
- Why: Fire risk is the immediate threat (ABCs and safety first).
2) A confused patient keeps pulling at the IV. The provider suggests restraints.
- Best first action: Try least restrictive alternatives: move patient closer to nurses’ station, provide a sitter, cover IV with a protective sleeve, reorient.
- Why: Use least restrictive measures before restraints to reduce harm and uphold rights.
3) The UAP reports a new red area on a patient’s sacrum.
- Best action: Go assess the skin, relieve pressure, and implement prevention (reposition, barrier cream). Document and notify as needed.
- Why: New findings require nurse assessment before further delegation or planning.
4) A post-op patient has RR 8/min after IV opioid.
- Best action: Assess responsiveness and airway, support ventilation, prepare to give naloxone per protocol, and notify provider.
- Why: Opioids depress respiration; airway and breathing come first.
5) Droplet isolation patient needs transport to x-ray.
- Best action: Put a surgical mask on the patient. Staff wear masks as needed. Notify receiving department.
- Why: Masking the source reduces spread during transport.

Test-day habits that improve your score

Identify the threat: Ask, “What could harm this patient in the next minutes or hours?” Choose the option that removes that threat first.
Apply a framework: ABCs, least restrictive/invasive, nursing process, and stable vs. unstable will narrow choices fast.
Scope check: If an option sounds like initial teaching, initial assessment, or triage/diagnosis, it is likely not a PN task on the exam.
Look for specifics: Vague options are often weaker. Options with clear actions, assessments, or safety steps are usually better.
Eliminate unsafe shortcuts: Skipping hand hygiene, ignoring alarms, or restraining without alternatives are red flags.

Final takeaways

Prevent harm first: Safety beats speed. Remove hazards and protect the airway, breathing, and circulation.
Assess, then act: Data drives safe decisions and correct delegation.
Use the frameworks: They turn complex scenarios into clear choices.
Master routines: Hand hygiene, PPE, positioning, feeding, skin care, and med checks appear often on NCLEX-PN because they prevent daily harm.
Communicate clearly: SBAR, therapeutic communication, and solid documentation reduce errors.

Practice these habits until they are automatic. On the NCLEX-PN and in real care, small safe steps—done consistently—protect patients and prove your readiness as a practical nurse.

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com