NCLEX-PN safety and infection control: precautions, falls, and error prevention

The LPN/LVN implements isolation precautions and maintains infection control measures across all settings. NCLEX-PN tests correct PPE selection, precaution type, and hand hygiene compliance.

Standard Precautions (all patients): Hand hygiene before and after every patient contact, gloves for contact with body fluids, gown for risk of splashing, surgical mask for respiratory secretions. The single most important infection prevention measure is hand hygiene.

Contact Precautions: MRSA, VRE, C. difficile, scabies, large wound drainage. Gown AND gloves for every entry. C. diff: soap and water only (alcohol ineffective against spores). Dedicated patient equipment.

Droplet Precautions: Influenza, pertussis, meningococcal disease, group A Streptococcus pharyngitis, mumps, rubella. Surgical mask when within 3 feet of patient. Private room preferred.

Airborne Precautions: TB, measles, varicella, disseminated zoster. N95 respirator (fit-tested), negative-pressure room, door kept closed. A nurse not immune to varicella should not care for varicella patients.

Fall risk assessment: Morse Fall Scale or STRATIFY commonly used. High-risk factors: age >65, history of previous falls, altered mental status, impaired mobility, orthostatic hypotension, polypharmacy (especially sedatives, diuretics, antihypertensives), urinary urgency/incontinence.

Fall prevention bundle: Bed in lowest position, call light within reach, non-slip footwear, hourly rounding or toileting schedule, bed alarm, clear path to bathroom, adequate lighting, review medications for fall risk contributors. Communicate fall risk to all team members in handoff.

Physical restraints: Last resort after all less restrictive alternatives exhausted. Requires provider order, ongoing monitoring, and regular reassessment for removal. Check circulation, skin integrity, and range of motion every 2 hours. Offer food, fluids, and toileting. Document patient response and continued need. Never tie restraints to bed rails (move with the rail — creates entrapment risk); tie to non-moveable bed frame.

The LPN/LVN has a professional and ethical obligation to report medication errors, near-misses, and adverse events. Transparency is a patient safety principle, not an optional behaviour.

Steps after a medication error: (1) Assess the patient immediately — document assessment findings. (2) Notify the supervising RN and provider. (3) Complete the incident/occurrence report per institutional policy. (4) Document the medication actually given in the medical record — document factually, not defensively. Do NOT write "medication error" in the chart or reference the incident report. (5) Monitor the patient for adverse effects based on what was given and when.

High-risk error scenarios NCLEX-PN tests: Wrong rate IV infusion, wrong insulin type (rapid vs. basal), wrong route (IM ordered but IV given), omitted dose without documentation, duplicate dose because previous administration not documented. In each case: patient safety first, transparency second, documentation third.