Examkin

Question

Difficulty: MediumStandard and Transmission-Based Precautions

During a shift on an infectious disease unit, a client with disseminated varicella-zoster virus requires routine morning care. The client is appropriately housed in an airborne infection isolation room. Which action should the practical nurse take to maintain safety and standard protocols?

  1. Take off the contaminated gloves and gown inside the isolation room before crossing the threshold into the hallway.Answer
  2. B
    Remove the N95 respirator while still inside the isolation room immediately following the removal of the gown.
  3. C
    Administer the initial dose of intravenous push (IVP) acyclovir to ensure the client receives prompt pharmacological intervention.
  4. D
    Walk into the hallway wearing all protective gear to dispose of the gown and gloves in a designated exterior biohazard container.

Answer

Take off the contaminated gloves and gown inside the isolation room before crossing the threshold into the hallway.
Disseminated varicella-zoster virus requires both airborne and contact precautions. According to standard infection control protocols, the nurse must remove the most contaminated equipment (gloves and gown) inside the client's room prior to exiting. This contains the pathogen within the isolated environment. The N95 respirator is then removed only after leaving the room and closing the door.

Step-by-Step Solution

1
Identify the transmission-based precautions required for disseminated varicella-zoster virus.
The client requires both airborne and contact precautions.
Disseminated varicella spreads through direct contact with fluid from lesions as well as via airborne respiratory droplets.
2
Determine the correct doffing sequence and location for the required personal protective equipment (PPE).
Gloves and gown must be removed inside the isolation room, while the N95 respirator must be removed outside the room.
Removing contact PPE inside prevents spreading pathogens to the hallway, while keeping the respirator on until outside protects the nurse from airborne particles.
3
Evaluate the remaining options against the LPN/LVN scope of practice.
Administering intravenous push (IVP) medications is identified as an out-of-scope action.
IVP medications require rapid clinical judgment and advanced RN-level assessment during administration.

Key Concept

Transmission-Based Precautions and Practical Nurse Scope of Practice
Rate this question

Topics

Standard and Transmission-Based Precautions

More questions from this topic