Examkin

Question

Difficulty: Very hardStandard and Transmission-Based Precautions

A nurse is planning care for a client who is admitted with active pulmonary tuberculosis and a concurrent *Clostridioides difficile* infection. Which of the following actions by the nurse indicate appropriate application of standard and transmission-based precautions? (Select all that apply)

  1. Assigning the client to a private, airborne infection isolation room (AIIR) with negative air pressure.Answer
  2. Disinfecting the dedicated reusable stethoscope in the room using an EPA-registered sporicidal wipe.Answer
  3. Removing the isolation gown and gloves and performing hand hygiene inside the client's room, while retaining the N95 respirator until after exiting and closing the door.Answer
  4. D
    Instructing the client to wear a fitted N95 respirator when transport to the radiology department is essential.
  5. E
    Performing hand hygiene exclusively with an alcohol-based hand rub upon exiting the room, provided the nurse's hands are not visibly soiled.
  6. F
    Delegating to the unlicensed assistive personnel (UAP) the task of evaluating visitor compliance with the prescribed isolation precautions.

Answer

The correct actions include assigning the client to a negative-pressure airborne infection isolation room, disinfecting dedicated reusable equipment with a sporicidal wipe, and removing the gown and gloves while performing hand hygiene inside the room before removing the N95 respirator outside the room.
This scenario requires a complex synthesis of Airborne Precautions (for active pulmonary tuberculosis) and Contact/Enteric Precautions (for Clostridioides difficile). Airborne precautions require a private, negative-pressure airborne infection isolation room (AIIR). Contact/Enteric precautions mandate the use of dedicated, single-use, or correctly disinfected reusable equipment (using sporicidal agents like bleach) to kill robust C. difficile spores. Proper personal protective equipment (PPE) doffing requires removing the most contaminated items (gown and gloves) and performing hand hygiene inside the room. The N95 respirator must remain in place to protect the nurse from airborne droplet nuclei until after the nurse has safely exited the room and the door is closed.

Step-by-Step Solution

1
Identify the specific transmission pathways for the client's concurrent infections.
Tuberculosis requires Airborne Precautions, and C. difficile requires Contact/Enteric Precautions.
Understanding the modes of transmission is the essential first step in selecting the correct combination of protective measures.
2
Determine the appropriate room assignment and environmental controls.
The client must be placed in a private, negative-pressure AIIR.
Airborne droplet nuclei can remain suspended in the air; negative pressure ensures contaminated air is exhausted safely outside rather than into hospital corridors.
3
Establish the correct equipment disinfection protocol.
Reusable equipment must be dedicated to the client and cleaned with a sporicidal agent.
C. difficile forms spores that are resistant to standard alcohol-based disinfectants and require bleach or other sporicidal wipes to be destroyed.
4
Determine the proper sequence for doffing personal protective equipment (PPE).
Gown and gloves are removed inside the room followed by hand hygiene; the N95 respirator is removed after exiting and closing the door.
Removing contact PPE inside prevents environmental spread of spores, while retaining the N95 protects the nurse from airborne particles until safely out of the isolation zone.

Key Concept

Management of Concurrent Airborne and Enteric Contact Precautions
Rate this question

Topics

Standard and Transmission-Based Precautions

More questions from this topic