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Difficulty: HardStandard and Transmission-Based Precautions

A practical nurse (PN) is gathering personal protective equipment (PPE) before entering the isolation room of a newly admitted client. For which client must the PN don an N95 respirator, an isolation gown, and clean gloves prior to entry?

  1. An immunocompromised client diagnosed with disseminated herpes zoster.Answer
  2. B
    A client with active pulmonary tuberculosis who is experiencing frequent night sweats.
  3. C
    A client with severe respiratory syncytial virus (RSV) who requires frequent suctioning.
  4. D
    A client with localized herpes zoster whose uncrusted lesions are fully covered by a dressing.

Answer

The client with disseminated herpes zoster requires both an N95 respirator (airborne precautions) and an isolation gown with gloves (contact precautions).
Disseminated herpes zoster (caused by the varicella-zoster virus) is highly contagious and can be transmitted through both airborne viral particles and direct contact with lesion exudate. Therefore, healthcare workers must implement both airborne precautions (requiring a fit-tested N95 respirator) and contact precautions (requiring an isolation gown and gloves) prior to entering the client's room.

Step-by-Step Solution

1
Analyze the PPE specified in the stem to determine the required transmission-based precautions.
An N95 respirator is used for airborne precautions. An isolation gown and clean gloves are used for contact precautions. The question is asking which client requires BOTH airborne and contact precautions.
Identifying the corresponding isolation categories is the first step in matching the PPE to the correct pathogen.
2
Evaluate the isolation requirements for each client option.
Disseminated herpes zoster requires airborne and contact precautions. Pulmonary tuberculosis requires airborne precautions only. RSV requires contact and droplet precautions. Localized covered herpes zoster requires standard precautions.
Different pathogens and clinical presentations dictate specific combinations of infection control measures.
3
Select the client whose requirements perfectly match the combination of an N95 respirator, gown, and gloves for room entry.
The immunocompromised client with disseminated herpes zoster is the only client requiring this exact PPE combination.
Applying the exact mandated precautions prevents nosocomial transmission of highly contagious viruses.

Key Concept

Disseminated herpes zoster (varicella-zoster virus) requires the concurrent use of both airborne and contact precautions until lesions are dry and crusted.
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Standard and Transmission-Based Precautions

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