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Difficulty: MediumStandard and Transmission-Based Precautions

A client diagnosed with active pulmonary tuberculosis and a draining methicillin-resistant *Staphylococcus aureus* (MRSA) leg wound is isolated in a negative-pressure room. After completing a dressing change, the practical nurse must remove an N95 respirator, a face shield, a disposable gown, and gloves. Which action demonstrates the correct procedure to prevent environmental cross-contamination?

  1. Remove the gloves, face shield, and gown inside the isolation room, and remove the N95 respirator after exiting.Answer
  2. B
    Remove the gloves, face shield, gown, and N95 respirator inside the isolation room before opening the door.
  3. C
    Remove the gloves and gown inside the isolation room, and remove the face shield and N95 respirator after exiting.
  4. D
    Exit the isolation room first, then remove the gloves, face shield, gown, and N95 respirator in the hallway.

Answer

Remove the gloves, face shield, and gown inside the isolation room, and remove the N95 respirator after exiting.
To prevent the spread of MRSA, the nurse must remove contact precaution PPE (gloves and gown) and standard precaution PPE (face shield) inside the client's room. To prevent exposure to airborne tuberculosis pathogens, the N95 respirator must remain securely in place until the nurse has completely exited the negative-pressure room and closed the door.

Step-by-Step Solution

1
Identify the transmission-based precautions required for the client's diagnoses.
Airborne precautions (N95) are required for tuberculosis, and contact precautions (gown, gloves) are required for MRSA.
Determining the required precautions dictates the correct doffing procedure and appropriate locations for removal.
2
Determine where to safely remove the contact and standard precaution PPE (gloves, face shield, gown).
These items must be removed inside the client's room before opening the door.
Removing contaminated garments inside the room prevents spreading MRSA and other pathogens into the clean hallway environment.
3
Determine where to safely remove the airborne precaution PPE (N95 respirator).
The respirator must be removed only after exiting the room and closing the door.
The N95 respirator protects against suspended infectious airborne particles, which remain circulating in the negative-pressure room's air.

Key Concept

Doffing protocols for combined airborne and contact precautions
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Topics

Standard and Transmission-Based Precautions

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