# A nurse is caring for a client newly admitted with suspected methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Which actions are required by Contact and Droplet Precautions? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=360517&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

A nurse is caring for a client newly admitted with suspected methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Which actions are required by Contact and Droplet Precautions? Select all that apply.

1

Don a surgical mask before entering the room

2

Use a fitted N95 respirator each time entering the room

3

Place the client in a private room or cohort with another client confirmed to have MRSA

4

Transport the client to imaging studies without applying a mask if time is limited

5

Restrict all visitors completely until repeat cultures are negative

6

Wear gloves and a gown for all client contact

## Explanation

MRSA pneumonia requires both Contact Precautions (private/cohort room, gloves and gown for all contact) and Droplet Precautions (surgical mask within 3-6 ft / when entering the room). N95 respirators are required for AIRBORNE precautions (TB, measles, varicella) — MRSA is droplet, not airborne. Visitors are not blanket-restricted; they receive PPE education and follow the same precautions. During transport, the client must wear a surgical mask to contain droplets even if other PPE is removed.

## In-depth explanation

Clinical Judgment
The core of this question is identifying the transmission route → selecting the appropriate isolation level. MRSA pneumonia is transmitted via large droplets (>5μm) from respiratory secretions, so the standard is Droplet + Contact simultaneously. Using the NCJMM: Recognize Cues (MRSA pneumonia) → Analyze (droplet + contact route) → Generate Solutions (PPE, isolation room, mask) → Take Action (select options 1, 2, and 3 simultaneously).

Memory Tip
My Chicken Has TB = 4 Airborne diseases (Measles, Chickenpox, Herpes zoster disseminated, TB). Most other respiratory infections are Droplet (influenza, pertussis, meningococcal, MRSA pneumonia, COVID-19). N95 is for Airborne only!

KR vs US
In Korean clinical practice, the perception that "respiratory infection = N95" is common, but the NCLEX strictly differentiates Droplet and Airborne according to CDC guidelines. MRSA pneumonia is Droplet (surgical mask), while TB and measles are Airborne (N95 + negative pressure room) — this is tested very frequently.

## Clinical scenario

Clinical Practice Guide
CDC 2007 guidelines + 2022 update: Droplet precautions require a surgical mask for activities within 1m (3ft), a private room or cohorting, and a mask on the patient during transport. Contact precautions require gloves and gown for all patient contact, a private room or cohorting, and enhanced cleaning of environmental surfaces.

Caution
In SATA, "select all that apply" but selecting an extra incorrect option results in a penalty (plus-minus scoring). The NCLEX does not tell you the number of correct answers, so judge each option independently as True/False. Options 1, 2, and 3 are the 3 basic elements of Contact + Droplet standard precautions.

## Key concepts

- **MRSA (Methicillin-Resistant Staphylococcus aureus, 메티실린 내성 황색포도알균)** — 베타락탐계 항생제(메티실린 등) 내성을 가진 황색포도알균. 병원 내(HA-MRSA)·지역사회(CA-MRSA) 모두 발생. 폐렴·균혈증·수술부위 감염의 주요 원인이며 vancomycin·linezolid가 1차 치료.
- **Droplet Precautions (비말 예방조치)** — 5μm 초과 큰 비말로 전파되는 감염병(인플루엔자, 백일해, 수막구균, MRSA 폐렴 등) 차단. 외과 마스크, 1인실 또는 코호트, 환자에게도 이송 시 마스크 필수. N95는 불필요.
- **Airborne Precautions (공기매개 예방조치)** — 5μm 이하 미세 비말핵으로 공기 중 장기 부유하는 병원체(결핵, 홍역, 수두, 파종성 대상포진) 차단. 음압 격리실(AIIR) + N95 호흡기. MRSA에는 적용하지 않음.

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