diff --git a/tests/settings-dialog-actions.dom.test.tsx b/tests/settings-dialog-actions.dom.test.tsx
new file mode 100644
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--- /dev/null
+++ b/tests/settings-dialog-actions.dom.test.tsx
@@ -0,0 +1,135 @@
+import { fireEvent, render, screen } from "@testing-library/react";
+import { afterEach, describe, expect, it, vi } from "vitest";
+
+// The settings surface owns the destructive privacy actions (clear recent
+// searches, clear saved items), preference reset, and sign-out. These flows had
+// no render coverage. The data/auth/account hooks are mocked (the same harness
+// shape as settings-inert-preferences.dom.test.tsx) so the destructive wiring is
+// asserted without real storage or auth; useTheme/useAppPreferences run
+// unmocked in jsdom.
+
+const { clearRecentQueries, clearFavourites, signInWithEmail, mockRecentCount, mockFavourites } = vi.hoisted(() => {
+  let recentCount = 3;
+  let favouritesData = { medications: [{ id: "m1" }] };
+  return {
+    clearRecentQueries: vi.fn(),
+    clearFavourites: vi.fn(async () => true),
+    signInWithEmail: vi.fn(),
+    mockRecentCount: {
+      get: () => recentCount,
+      set: (count: number) => {
+        recentCount = count;
+      },
+    },
+    mockFavourites: {
+      get: () => favouritesData,
+      set: (data: { medications: Array<{ id: string }> }) => {
+        favouritesData = data;
+      },
+    },
+  };
+});
+
+vi.mock("@/lib/recent-query-storage", () => ({
+  clearRecentQueries: () => clearRecentQueries(),
+  // Non-zero so the "Clear recent searches" action is enabled by default.
+  countRecentQueries: () => mockRecentCount.get(),
+}));
+
+vi.mock("@/components/account-data-provider", () => ({
+  useAccountData: () => ({
+    // One saved item so the "Clear saved items" action is enabled by default.
+    favourites: mockFavourites.get(),
+    clearFavourites,
+    isSaved: () => false,
+    setFavourite: vi.fn(async () => true),
+  }),
+}));
+
+vi.mock("@/lib/supabase/client", () => ({
+  useAuthSession: () => ({
+    status: "signed_out",
+    // Configured so the email sign-in submit is enabled; irrelevant to the
+    // signed-in destructive-action tests (which never render the sign-in form).
+    isConfigured: true,
+    error: null,
+    notice: null,
+    session: null,
+    signInWithEmail,
+    signInWithOAuth: vi.fn(),
+    signOut: vi.fn(),
+  }),
+}));
+
+import { SettingsDialog } from "@/components/clinical-dashboard/settings-dialog";
+
+function renderDialog(identityOverrides: Record<string, unknown> = {}) {
+  const onSignOut = vi.fn();
+  render(
+    <SettingsDialog
+      open
+      onClose={vi.fn()}
+      identity={{
+        displayName: "Local session",
+        initials: "LS",
+        detail: "Browser only",
+        signedIn: true,
+        ...identityOverrides,
+      }}
+      onSignOut={onSignOut}
+      onOpenGuide={vi.fn()}
+    />,
+  );
+  return { onSignOut };
+}
+
+afterEach(() => {
+  vi.clearAllMocks();
+});
+
+describe("SettingsDialog — destructive and account actions", () => {
+  it("clears recent searches through the privacy action", () => {
+    renderDialog();
+    const button = screen.getByRole("button", { name: "Clear recent searches" });
+    expect(button).toBeEnabled();
+    fireEvent.click(button);
+    expect(clearRecentQueries).toHaveBeenCalledTimes(1);
+  });
+
+  it("disables clear recent searches when there are no recent queries", () => {
+    mockRecentCount.set(0);
+    renderDialog();
+    const button = screen.getByRole("button", { name: "Clear recent searches" });
+    expect(button).toBeDisabled();
+    mockRecentCount.set(3); // Reset for other tests
+  });
+
+  it("clears saved items and confirms via a status notice", async () => {
+    renderDialog();
+    fireEvent.click(screen.getByRole("button", { name: "Clear saved items" }));
+    expect(clearFavourites).toHaveBeenCalledTimes(1);
+    expect(await screen.findByText("Saved items cleared.")).toBeVisible();
+  });
+
+  it("signs out through the account action", () => {
+    const { onSignOut } = renderDialog();
+    fireEvent.click(screen.getByRole("button", { name: "Sign out" }));
+    expect(onSignOut).toHaveBeenCalledTimes(1);
+  });
+
+  it("signs in with an entered email address", () => {
+    renderDialog({ signedIn: false });
+    // "Sign in" (rendered in both the desktop and mobile button sets) opens the
+    // email entry form.
+    fireEvent.click(screen.getAllByRole("button", { name: "Sign in" })[0]);
+
+    fireEvent.change(screen.getByLabelText("Email address"), {
+      target: { value: "clinician@clinic.example" },
+    });
+    const submit = screen.getByRole("button", { name: "Continue with email" });
+    expect(submit).toBeEnabled();
+    fireEvent.click(submit);
+
+    expect(signInWithEmail).toHaveBeenCalledWith("clinician@clinic.example");
+  });
+});