What's tested on the NCLEX: Safe and Effective Care Environment

The NCLEX-RN exam is designed to challenge your ability critically think through information provided to make safe and sound judgements about patient care. If you are a student that focuses primarily on memorizing every drug, every nursing intervention, and every disease process, then you may miss the mark. However, if you are a student that can identify potential and actual risks for patient harm, can analyze trends in lab values and vital signs, and can plan to intervene when you recognize something as abnormal, then you are likely to pass the exam on your first attempt.
The NCLEX-RN® exam is not divided into separate content areas. It tests integrated nursing content. Many nursing programs are based on the medical model. Students take separate medical, surgical, pediatric, psychiatric, and obstetric classes. On the NCLEX-RN® exam, all content is integrated. Let’s take a look at one important competency, a client need as described on the NCLEX-RN®: Safe and Effective Care Environment.

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4 Tips for Acing the Safe and Effective Care Secton

  • Advocate for the patient

    First, and foremost, it’s important to be an advocate for the patient. The RN is the health care professional spending a majority of time with the patient. Thus, it’s also the person who knows the patient best among the healthcare team.
    In advocating for the patient and managing their care effectively, it is the RN’s responsibility to make sure informed consent is obtained before procedures. That does not just mean signing the paper the doctor hands you after explaining a procedure to a patient. Rather, it is the RN’s responsibility, as well as her/his right, to confirm and ask the patient if they understand what is going to happen to them. Thus, look to see if the patient looks confused, or ask if they have any questions before signing consent as a witness.

  • Keep information confidential

    Confidentiality is an important part of a safe and effective care environment. This includes asking a patient if he/she is comfortable answering questions and talking about their health care with family members in the room. Note, just because a patient’s spouse is in the room doesn’t give the spouse the right to be a part of the patient’s health care decisions.
    Alternatively, also consider that a patient may want someone they trust in the room to have a second pair of ears when they are receiving information. Given how overwhelming the health care setting can be, perhaps the patient would even like to delegate a health care proxy and or living will to aide in decision making. As RNs, we can provide the information to the patient on these advanced directives.
    Reporting information over the phone is another component of confidentiality. All too often, we receive calls from family members wanting updates on patients. However, because we are never able to 100% confirm the caller’s true identity, limited information should be given over the phone.

  • Make a discharge plan

    In nursing school, we are taught that from the moment a patient is admitted to the hospital, a discharging planning should begin. With this planning comes anticipating the needs of the patient at home. Will this patient need oxygen? Will they require visiting nurse services? While these are tasks for case management to coordinate, it is the primary RN’s role to ensure that work behind the scenes is happening so that the patient can discharge home safely.
    Delegation of tasks and prioritization of care are key components for the RN that will make the tasks, such as the one previously mentioned, more doable. Look at the tasks ahead of you and decide what you can ask your nursing assistant for assistance with. Be sure the tasks you are delegating are within the professional’s scope of practice though. In other words, a patient care technician should not be passing out medications. Also, assess who is most critical and should be seen first. For example, the patient with the trach collar should be seen before the patient with cellulitis.

  • Maintain high quality care

    Safety is our second subcategory and of huge concern in the hospital setting. Proper medication administration includes giving the right patient, the right dose, the right drug, through the right route, at the right time. Two patient identifiers, name and date of birth, will aid in confirming the right patient. Checking medications at the bedside and signing them off in the electronic medication record will also prevent errors.
    Another way to provide patient safety is through hand hygiene, especially when working with a patient’s IV line. Be sure to wash your hands, wear gloves, and scrub the hub for 15 seconds prior to connecting tubing to prevent central line associated bloodstream infection.
    Hospital falls are another safety concern. All patients should be assessed once a shift for any cognitive changes or changes in medications that may increase their risk of falls. Patient falls can be detrimental to the patient, and while sometimes unavoidable, there are many interventions that can be implemented to prevent them: yellow socks, hourly rounding, frequent toileting, a reachable call bell, and a side table with the patient’s personal belongings. Always make sure you are reassessing your patients’ fall risks.
    Further, to protect yourself, your patient and other patients, always maintain the appropriate standard precautions. Does your patient have the flu? Droplet precautions should be maintained, meaning you are wearing a gown, gloves, and mask upon entering a room. Is your patient neutropenic? Have they been educated on hand washing, avoiding fresh fruits and flowers, as well as other individuals who are sick?

Subcategory 1: Management of Care

The first subcategory of the Safe and Effective Care Environment client need is Management of Care, which accounts for about 20 percent of the questions on the exam. Nursing actions that are covered in this subcategory include:

  • Advance directives/self-determination/life planning
  • Advocacy
  • Assignment, delegation, and supervision
  • Case management
  • Client rights
  • Collaboration with interdisciplinary team
  • Concepts of management
  • Confidentiality/information security
  • Consultation
  • Continuity of care
  • Establishing priorities
  • Ethical practice
  • Information technology
  • Informed consent
  • Legal rights and responsibilities
  • Organ donation
  • Performance improvement (quality improvement)
  • Referrals
  • Supervision

NCLEX-RN® Sample Question: Management of Care

Here is an example of a Management of Care question:

After receiving a report from the night nurse, which of the following clients should the nurse see FIRST?
1. A 31-year-old woman refusing sucralfate before breakfast
2. A 40-year-old man with left-sided weakness asking for assistance to the commode
3. A 52-year-old woman complaining of chills who is scheduled for a cholecystectomy
4. A 65-year-old man with a nasogastric tube who had a bowel resection yesterday

The correct answer is (3). This is the least stable client.

Subcategory 2: Safety and Infection Control

The second subcategory for this client need is Safety and Infection Control, which accounts for 12 percent of the questions on the exam. Nursing actions that are covered in this subcategory include:

  • Accident/injury prevention
  • Emergency response plan
  • Ergonomic principles
  • Error prevention
  • Handling hazardous and infectious materials
  • Home safety
  • Reporting of incident/event/irregular occurrence/variance
  • Safe use of equipment
  • Security plan
  • Standard precautions/transmission-based precautions/surgical asepsis
  • Use of restraints/safety devices


NCLEX-RN® Sample Question: Safety and Infection Control

Here is an example of a Safety and Infection Control question:

The physician orders tobramycin sulfate 3 mg/kg IV every 8 hours for a 3-year-old boy. The nurse enters the client’s room to administer the medication and discovers that the boy does not have an identification bracelet.
Which of the following should the nurse do?
1. Ask the parents at the child’s bedside to state their child’s name.
2. Ask the child to say his first and last name.
3. Have a coworker identify the child before giving the medication.
4. Hold the medication until an identification bracelet can be obtained.

The correct answer is (1). This action will allow the nurse to correctly identify the child and enable the nurse to give the medication on time.


How to succeed on the NCLEX: A Kaplan expert tip


If I told you that I remembered every medication, every disease process, and every nursing diagnosis when I sat for my NCLEX-RN licensure exam, I would be telling a very big lie. The truth is that you do not need to rely on recall to correctly answer the NCLEX-RN questions. However, you must be comfortable in your knowledge of the basic components of nursing, especially when it’s concerning the focus areas of: prioritization, delegation, effective communication, medication administration, nursing scope of practice, and the nursing process.

Next: What’s tested on the NCLEX: Health Promotion and Maintenance >

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