Fundamentals, Safety & Infection Control
✅ Reviewed by NCLEXDeck Clinical Review Board — Updated June 2026
Comprehensive NCLEX-RN Review — Prioritization, Delegation, Safety, Legal/Ethical, Infection Control, Positioning
1. Prioritization Frameworks
These are the backbone of the NCLEX — apply them to every "which client first" or "what's the priority" question.
ABCs
Airway → Breathing → Circulation. The client with an airway or breathing threat is almost always first.
Maslow's Hierarchy
Physiologic needs before psychosocial. (Airway/safety trumps self-actualization every time.)
Acute vs Chronic / Stable vs Unstable
Unstable, new, or unexpected findings take priority over expected/chronic ones.
Nursing Process (ADPIE)
Assess before intervening — if unsure, assessment is often the first action (unless an ABC emergency requires immediate action).
⭐ NCLEX TIP
"Which client do you see first?" → pick the unstable/at-risk airway/breathing/circulation client, or the one with a new/unexpected change. Chronic, stable, or expected findings can wait.
2. Delegation (RN vs LPN/LVN vs UAP)
The RN cannot delegate the nursing process — assessment, planning, evaluation, teaching, or care of unstable clients.
| Role | Can Do |
|---|
| RN | Assessment, care planning, evaluation, client teaching, unstable clients, IV push meds, blood administration, first assessment/admission |
| LPN/LVN | Stable clients with predictable outcomes, reinforcing teaching, oral/IM/SubQ meds, routine skills (dressings, catheters, tube feeds), monitoring |
| UAP/AP | ADLs, hygiene, feeding (stable), vital signs (stable), ambulation, positioning, I&O, specimen collection, bed making |
Five Rights of Delegation: right task, right circumstance, right person, right direction/communication, right supervision.
⭐ NCLEX TIP
Delegate stable, routine, predictable tasks. If the answer involves assessing, teaching, or an unstable client — that's RN. UAP does not assess, teach, or handle anything requiring clinical judgment.
3. Fall Prevention & Restraints
- Bed low and locked, call light in reach, non-skid footwear, adequate lighting, clear pathways
- Fall-risk assessment on admission and per policy; hourly rounding
- Restraints: last resort, least restrictive, provider order required (time-limited, not PRN), monitor circulation/skin/ROM, offer toileting/food/water, quick-release ties to bed frame (not side rails)
4. Infection Control
- Hand hygiene is the single most effective measure. Soap and water for visibly soiled hands, C. diff, and norovirus; alcohol-based rub otherwise.
- Follow standard + transmission-based precautions (airborne/droplet/contact — see Immune chapter)
- Sterile vs. clean technique: sterile for invasive procedures, catheter insertion, surgical wounds
- Sharps in puncture-resistant containers; never recap needles
5. Client Safety Events & Error Reporting
- Incident/occurrence report: complete for any error or unusual event; factual/objective; do not reference it in the chart or place in the medical record
- Medication error: assess the client first (safety), then notify provider, then document and file report
- Never events and root-cause analysis (systems focus, not blame)
6. Legal & Ethical Essentials
- Informed consent: the provider obtains it; the nurse witnesses the signature and confirms understanding
- Advance directives / DNR: honor client wishes; verify documentation
- Confidentiality/HIPAA: minimum necessary disclosure
- Mandatory reporting: abuse (child/elder/vulnerable), certain communicable diseases
- Torts: negligence, malpractice, assault/battery, false imprisonment (improper restraint)
7. Positioning Quick Reference
| Condition | Position |
|---|
| Increased ICP | HOB elevated 30°, head midline/neutral |
| Postural drainage / shock | Modified Trendelenburg (shock: legs up) |
| After lumbar puncture | Flat/supine |
| Air embolism | Left lateral + Trendelenburg |
| Autonomic dysreflexia | High Fowler's (sit up) — lower BP |
| Post-op tonsillectomy / unconscious | Side-lying (drainage, prevent aspiration) |
| After liver biopsy | Right side-lying (pressure) |
| Left-sided heart failure / dyspnea | High Fowler's |
| Pregnant / vena cava compression | Left lateral |