NCLEX-RNSafety and Infection Prevention and ControlHard
A nurse is caring for a client who is diagnosed with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and is exhibiting severe respiratory distress. The client is placed on an oxygen mask at 10 L/min. Which action should the nurse take to ensure proper infection control while providing care?
- AWear a surgical mask and gloves during all interactions.
- BMaintain a distance of at least 3 feet from the client at all times.
- CUse an N95 respirator, gown, gloves, and eye protection.
- DPlace the client in a room with positive air pressure.
Show answer & explanationAnswer & explanation
Correct answer: C. Use an N95 respirator, gown, gloves, and eye protection.
Clients with SARS-CoV-2 (COVID-19) infection, especially those with severe respiratory distress requiring high-flow oxygen, can generate aerosols, increasing the risk of airborne transmission. Therefore, the nurse must use an N95 respirator (or equivalent), gown, gloves, and eye protection (face shield or goggles) to protect against both droplet and potential airborne spread, as well as contact with contaminated surfaces.
Why the other options are wrong
- A. A surgical mask and gloves are insufficient for a client with severe respiratory distress and suspected aerosol generation from high-flow oxygen.
- B. While maintaining distance is helpful, close contact is often required for direct client care, making PPE essential.
- D. Clients with airborne diseases like severe COVID-19 should be in a negative air pressure room to prevent the spread of airborne particles, not positive air pressure.
COVID-19 PPE for Aerosol-Generating Procedures
Specific personal protective equipment required when caring for clients with SARS-CoV-2 infection, particularly during procedures that may generate aerosols.
- Aerosol-generating procedures (e.g., high-flow oxygen, nebulizer treatments, intubation) increase the risk of airborne transmission.
- Requires N95 respirator, eye protection, gown, and gloves.
- Clients should ideally be in an Airborne Infection Isolation Room (AIIR) if available.
Memory trick: N95, GOWN, GLOVES, EYES – Protect YOURSELF from the COUGH!