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Difficulty: Very hardStandard and Transmission-Based Precautions

While conducting an infection control audit across a multispecialty acute care facility, the nursing supervisor observes several staff members interacting with clients on transmission-based precautions. Which of the following observed actions require the nursing supervisor to intervene? (Select all that apply)

  1. An unlicensed assistive personnel (UAP) uses an alcohol-based hand rub upon exiting the room of a client with confirmed norovirus gastroenteritis.Answer
  2. B
    A registered nurse removes their fit-tested N95 respirator in the hallway after closing the door to the negative-pressure room of a client with active pulmonary tuberculosis.
  3. C
    A pediatric nurse dons a protective gown, a surgical mask, a face shield, and gloves, in that specific sequence, prior to entering the room of an infant with respiratory syncytial virus (RSV).
  4. A transport technician places an N95 respirator on a client with disseminated herpes zoster before transporting the client to the radiology department.Answer
  5. A unit coordinator cohorts a client with a methicillin-resistant Staphylococcus aureus (MRSA) wound infection in the same room as a client with a vancomycin-resistant Enterococcus (VRE) urinary tract infection.Answer
  6. F
    A nurse assigns a client with Neisseria meningitidis to a private room but leaves the room door open to maintain continuous visual monitoring.

Answer

The nursing supervisor must intervene when the UAP uses alcohol hand rub for norovirus, when the technician places an N95 respirator on the client during transport, and when the unit coordinator cohorts clients with two different multidrug-resistant organisms.
The actions requiring intervention are those that violate standard infection control protocols. Using an alcohol-based sanitizer is ineffective against norovirus, which requires mechanical friction with soap and water. Placing an N95 respirator on a client during transport is contraindicated; a standard surgical mask should be used to contain exhaled droplets without unnecessarily increasing the client's work of breathing. Finally, cohorting clients with different multidrug-resistant organisms (MRSA and VRE) creates a severe risk for cross-contamination and is strictly prohibited.

Step-by-Step Solution

1
Analyze the question stem to identify the nurse's objective.
The stem asks which actions 'require the nursing supervisor to intervene,' meaning the correct answers are the unsafe, incorrect, or contraindicated actions.
Correctly identifying a negatively phrased question is critical to selecting the right options on the NCLEX.
2
Evaluate the hand hygiene method for norovirus.
Norovirus is an enteric pathogen that requires strict handwashing with soap and water; alcohol-based sanitizers are insufficient. This action is unsafe and requires intervention.
Non-enveloped viruses resist alcohol-based sanitizers.
3
Evaluate the PPE donning and doffing techniques.
Removing an N95 outside a negative-pressure room is correct. Donning PPE in the order of gown, mask, shield, and gloves is also correct. These actions are safe and do not require intervention.
Following strict CDC sequencing prevents self-contamination and inhalation of airborne pathogens.
4
Evaluate the transport protocol for Airborne precautions.
Placing an N95 respirator on a client is incorrect; clients should wear standard surgical masks to contain source secretions. This action is unsafe and requires intervention.
An N95 protects the wearer from inhalation, whereas a surgical mask contains the wearer's exhalation. N95s on clients can compromise their respiratory effort.
5
Evaluate the cohorting and room assignment rules.
Cohorting MRSA and VRE together is dangerous and incorrect. Leaving the door open for Droplet precautions (Neisseria meningitidis) is safe and acceptable.
Clients must have the exact same organism to be cohorted. Droplet precautions do not require negative pressure or a closed door.

Key Concept

Transmission-Based Precautions (Airborne, Droplet, Contact, and Enteric) require specific interventions regarding hand hygiene, personal protective equipment (PPE) sequencing, client transport, and room assignments.
Estimated Time:2m 0s
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Topics

Standard and Transmission-Based Precautions

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