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Difficulty: HardStandard and Transmission-Based Precautions

During the morning handoff, a practical nurse (PN) receives an assignment for a resident recently transferred from a skilled nursing facility. The resident has a confirmed diagnosis of active pulmonary tuberculosis and is also experiencing severe diarrhea associated with a Clostridioides difficile infection. Which of the following infection control interventions must the PN implement? (Select all that apply)

  1. Don a fit-tested N95 respirator, disposable gown, and gloves before entering the client's room.Answer
  2. Perform hand hygiene strictly using soap and water rather than an alcohol-based hand rub.Answer
  3. Maintain dedicated, noncritical medical equipment such as a stethoscope and blood pressure cuff inside the client's room.Answer
  4. D
    Remove the N95 respirator inside the isolation room immediately after doffing the gown and gloves.
  5. E
    Delegate the initial assessment of the client's respiratory status and lung sounds to the unlicensed assistive personnel (UAP).

Answer

The PN must don an N95 respirator, gown, and gloves prior to entry; use soap and water for hand hygiene; and leave dedicated noncritical equipment inside the client's room.
The client requires a combination of Airborne Precautions for tuberculosis and enteric Contact Precautions for C. diff. This necessitates wearing a gown, gloves, and a fit-tested N95 respirator upon entry. Because C. diff spores are resistant to alcohol-based hand sanitizers, the nurse must meticulously wash hands with soap and water. Furthermore, to prevent cross-contamination, dedicated noncritical equipment must remain strictly in the client's room.

Step-by-Step Solution

1
Analyze the client's infectious pathogens.
The client has active pulmonary tuberculosis (TB) and Clostridioides difficile (C. diff).
Identifying the pathogens determines which transmission-based precautions are legally and clinically mandated.
2
Determine the required isolation categories.
TB requires Airborne Precautions (negative-pressure room, N95 respirator). C. diff requires Contact Precautions (gown, gloves, dedicated equipment) and enteric hygiene protocols.
The nurse must synthesize multiple protocols when a client has co-infections.
3
Evaluate the appropriate hand hygiene method.
Soap and water must be used instead of alcohol-based sanitizers.
C. diff forms spores that are entirely unaffected by alcohol; only the mechanical friction of washing removes them.
4
Apply the correct doffing sequence principles.
Gowns and gloves are removed inside the room, but the N95 must be kept on until the nurse has exited the room and shut the door.
Removing the respirator inside the room exposes the nurse's respiratory tract to airborne infectious nuclei.
5
Apply the legal scope of practice regarding delegation.
The nurse must perform the respiratory assessment rather than assigning it to the UAP.
Assessment and clinical evaluation are out of the scope of practice for unlicensed personnel.

Key Concept

Synthesis of Multiple Transmission-Based Precautions and Scope of Practice
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Topics

Standard and Transmission-Based Precautions

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