# A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in the intensive care unit. Which infection control measure should the nurse implement first when entering the patient's room?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=319493  
> language: ko  
> subject: Next Gen NCLEX

## 문제

A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in the intensive care unit. Which infection control measure should the nurse implement first when entering the patient's room?

## 보기

1. Put on gloves and gown before entering the room **✔ 정답**
2. Place a surgical mask on the patient
3. Ensure the patient's room door remains open for monitoring
4. Administer prescribed antibiotics immediately upon entry

**정답: 1**

## 해설

For MRSA pneumonia on contact precautions, donning gloves and gown before entering the room is the first priority to prevent transmission via direct or indirect contact. Other options are either patient-specific interventions or compromise infection control.

## 심화 해설

Core Nursing Explanation
**Key Concept Analysis**: This question tests the application of Transmission-Based Precautions in a high-risk clinical setting. The patient has Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. MRSA is a multi-drug resistant organism (MDRO) primarily spread through Contact Transmission (direct contact with the patient or indirect contact with contaminated surfaces/equipment). The "first" action upon entering the room refers to the immediate, priority step in the sequence of donning personal protective equipment (PPE) to protect the healthcare worker and prevent environmental contamination.

**Answer Rationale**: Key Point! For patients on Contact Precautions, the correct sequence is to perform Hand Hygiene, then don Gown and Gloves **before** entering the patient's environment. This is the first and most critical infection control measure. The gown protects clothing/uniform from contamination, and gloves protect the hands. Since MRSA pneumonia involves the respiratory tract, some facilities may also require a mask for the nurse if there is a risk of splash from respiratory secretions, but the foundational, non-negotiable first step for MRSA is contact precautions (gown and gloves).

**Distractor Analysis**:

Watch out for confusion! Option ②, placing a surgical mask on the patient, is a component of Droplet Precautions (for pathogens like influenza). For MRSA pneumonia, the primary route is contact, not droplet. A mask on the patient is not the standard first action for MRSA.

Option ③, keeping the door open, directly violates the principles of Airborne Infection Isolation (which requires a negative pressure room with a closed door) and general infection control by potentially allowing pathogens to spread into the corridor. It is incorrect and unsafe.

Option ④, administering antibiotics immediately, is a therapeutic intervention, not an infection control measure. While important, it does not protect the nurse or others from transmission and should only be done after appropriate PPE is donned.

**Related Concepts**: Understanding the hierarchy of infection control: Standard Precautions apply to all patients. Transmission-Based Precautions (Contact, Droplet, Airborne) are added based on the specific pathogen's mode of spread. The sequence of PPE donning and doffing is a critical nursing skill to prevent self-contamination.

Concept Summary

| Concept | Key Points |
| --- | --- |
| Contact Precautions | Used for pathogens spread by direct/indirect contact (e.g., MRSA, VRE, C. diff). Requires gown and gloves upon room entry. |
| Droplet Precautions | Used for pathogens spread by large droplets from cough/sneeze (e.g., influenza, pertussis). Requires surgical mask upon room entry. |
| Airborne Precautions | Used for pathogens spread by small airborne nuclei (e.g., TB, measles). Requires N95 respirator and a negative pressure room. |
| PPE Donning Sequence | 1. Perform hand hygiene. 2. Gown. 3. Mask/respirator. 4. Eye protection. 5. Gloves. |
| PPE Doffing Sequence | 1. Gloves. 2. Gown. 3. Perform hand hygiene. 4. Eye protection. 5. Mask/respirator. 6. Perform hand hygiene. |

Side-by-Side Comparison!

| Precaution Type | Pathogen Examples | Required PPE (for HCW) | Room Type |
| --- | --- | --- | --- |
| Contact | MRSA, VRE, C. diff, RSV | Gown & Gloves | Private or cohort |
| Droplet | Influenza, Pertussis, Meningitis | Surgical Mask | Private or cohort (door may be open) |
| Airborne | TB, Measles, Chickenpox | N95 Respirator (or higher) | Negative Pressure (AIIR), door closed |

Anatomy, Physiology & Pharmacology Points
• **Pathophysiology**: MRSA is a strain of *Staphylococcus aureus* resistant to beta-lactam antibiotics (methicillin, oxacillin). It produces enzymes (e.g., penicillinase) and alters penicillin-binding proteins (PBPs). Pneumonia caused by MRSA presents similarly to other bacterial pneumonias (fever, cough, purulent sputum) but is more challenging to treat.
• **Pharmacology**: First-line treatment for MRSA pneumonia often includes intravenous antibiotics like Vancomycin or Linezolid. Nursing considerations include monitoring trough levels for vancomycin and assessing for side effects like "Red Man Syndrome" or nephrotoxicity.

Memory Tips
• **Acronym**: For PPE donning sequence: **G**et **M**y **G**ear **G**loves (Gown, Mask, Goggles, Gloves). Remember, hand hygiene is first and between steps!
• **Association**: Think "**C**ontact" = "**C**over your Clothes" (Gown) and "**C**over your Hands" (Gloves).

High-Frequency NCLEX Topics
Infection control is a **High Yield** topic. The NCLEX frequently tests:
1. Prioritizing infection control actions (e.g., what to do first).
2. Selecting appropriate PPE for a given disease.
3. The correct sequence for donning and doffing PPE.
4. Patient teaching for home-based infection control (e.g., for family members).

Watch Out for Question Variations!
• Instead of "what should the nurse do first?", the question might ask: "Which action by the nursing assistant requires intervention?" (e.g., entering an MRSA room without a gown).
• The scenario could change the disease: "A patient with pulmonary tuberculosis..." The correct first action would then be to don an N95 respirator.
• It could be a "select all that apply" question listing multiple PPE items for a specific precaution.

## 임상 시나리오

Nursing Clinical Practice Guide
**Clinical Scenario**: You are assigned to Mr. Jones, a 68-year-old in the ICU with ventilator-associated pneumonia (VAP) confirmed as MRSA. The room has a Contact Precautions sign on the door.

**Nursing Intervention Strategy**:
1. **Assessment & Planning**: Before entering, gather all necessary supplies (medications, assessment tools, linens) to minimize exits and entries. Check the PPE supply station outside the room.
2. **Implementation**:
• Perform hand hygiene with alcohol-based rub.
• Don a clean isolation gown, tying securely at neck and waist.
• Don gloves, pulling them over the gown cuffs.
• Enter the room and provide care.
• Before exiting, remove gloves and gown inside the room, discarding in the designated biohazard container.
• Perform hand hygiene immediately after removing PPE and before touching the door handle.
3. **Patient Education & Evaluation**: Educate the patient (if alert) and family on the reason for precautions. Evaluate the effectiveness of isolation by monitoring for any new transmissions of MRSA within the unit.

**Patient Safety and Precautions**:
• **Dedicated Equipment**: Use a dedicated stethoscope, blood pressure cuff, and thermometer that remain in the room.
• **Environmental Cleaning**: High-touch surfaces must be cleaned and disinfected frequently with an EPA-approved disinfectant effective against MRSA.
• **Visitors**: Instruct visitors on proper PPE use and hand hygiene.

Nursing Procedure & Medication Flow
When administering IV vancomycin to this patient:
1. Don appropriate PPE (gown, gloves) before entering.
2. Verify the order and check the patient's allergy status.
3. Assess IV site patency.
4. Administer the infusion over at least 60 minutes (to reduce risk of Red Man Syndrome).
5. Monitor vital signs during infusion.
6. Schedule vancomycin trough levels to be drawn **30 minutes before the fourth dose**.
7. After administration, dispose of supplies in the room's biohazard container, doff PPE, and perform hand hygiene.

A Word from Your Senior Nurse
"In the real world of nursing, infection control isn't just a policy—it's a sacred duty to protect your patients, yourself, and your colleagues. I've seen outbreaks halted by meticulous PPE use and hand hygiene. When you see that isolation sign, don't think of it as a barrier, but as your suit of armor. On the NCLEX, they're testing your foundational knowledge of safety. In practice, this knowledge saves lives. Always ask yourself: 'Am I the vector, or am I the stopgap?' Be the stopgap."

## 핵심 개념

- **Contact Precautions** — Infection control measures used for diseases spread by direct contact with the patient or indirect contact with contaminated items in the patient's environment. Requires use of gown and gloves.
- **Methicillin-resistant Staphylococcus aureus** — A strain of the bacterium *Staphylococcus aureus* that has developed resistance to beta-lactam antibiotics, making infections more difficult to treat. It is a common cause of healthcare-associated infections.
- **Personal Protective Equipment** — Specialized clothing or equipment worn by healthcare workers for protection against infectious materials. Includes gloves, gowns, masks, respirators, and eye protection.
- **Hand Hygiene** — The most important measure to prevent the transmission of infection. Includes washing hands with soap and water or using an alcohol-based hand rub.
- **Transmission-Based Precautions** — The second tier of infection control precautions (beyond Standard Precautions) used for patients with known or suspected infections. Includes Contact, Droplet, and Airborne Precautions.

## 같은 주제 문제

- [A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pn…](https://mymerci.kr/pages/nclex_q.php?qn_id=319484)
- [A nurse is caring for a patient with Clostridium difficile-associated diarrhea (CDAD) in a…](https://mymerci.kr/pages/nclex_q.php?qn_id=319485)
- [A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pn…](https://mymerci.kr/pages/nclex_q.php?qn_id=319486)
- [A nurse is caring for a patient with a central venous catheter (CVC) who develops signs of…](https://mymerci.kr/pages/nclex_q.php?qn_id=319487)
- [A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pn…](https://mymerci.kr/pages/nclex_q.php?qn_id=319488)
- [A nurse is caring for multiple patients in a medical-surgical unit. Which situation requir…](https://mymerci.kr/pages/nclex_q.php?qn_id=319489)
- [A nurse is caring for multiple patients in a medical-surgical unit. Which action by the nu…](https://mymerci.kr/pages/nclex_q.php?qn_id=319490)
- [A nurse is caring for a patient with Clostridioides difficile (C. diff) infection. Which i…](https://mymerci.kr/pages/nclex_q.php?qn_id=319491)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._