# A nurse is entering the room of a patient on contact and droplet precautions for an undiagnosed respiratory illness. Place the steps for donning personal protective equipment in the correct CDC sequence.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372737&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: SIPC

## Question

A nurse is entering the room of a patient on contact and droplet precautions for an undiagnosed respiratory illness. Place the steps for donning personal protective equipment in the correct CDC sequence.

Put on the gown, fastening at the neck and waist.

Perform hand hygiene with soap and water or alcohol-based hand rub.

Put on gloves, extending them over the cuffs of the gown.

Put on the surgical mask or N95 respirator and perform a fit check.

Put on goggles or face shield, adjusting to fit comfortably.

## Explanation

CDC sequence for donning PPE: (1) Perform hand hygiene first; (2) Gown — fastens at neck and waist, fully covers torso and wraps around to back; (3) Mask or N95 respirator — surgical mask for droplet precautions, N95 for airborne; perform a fit check on N95 by exhaling and inhaling sharply; (4) Goggles or face shield — adjusts to fit and covers eyes (and the gap above a regular surgical mask); (5) Gloves — last, with cuffs extended OVER the gown cuff to seal the wrist. Doffing is the reverse order with key differences (gloves first, hand hygiene between every step) and is the higher-risk part of PPE because contamination is highest when removing.

## In-depth explanation

Memorize PPE donning as gown → mask → eye protection → gloves, with hand hygiene first. Two anchors that prevent error: (a) Gown FIRST after hand hygiene because it has the largest surface and must be put on while hands are still clean; (b) Gloves LAST because they go OVER the gown cuff to maintain a continuous barrier from sleeve to fingertip. The fit check on an N95 (positive- and negative-pressure) is essential — without it, the seal is unreliable and droplets bypass the respirator. Doffing reverses the sequence with hand hygiene between every step and removal of contaminated items first; doffing is where most exposures occur, which is why CDC requires a buddy or mirror for high-risk situations.

## Clinical scenario

A nurse is entering the room of a patient on **contact and droplet precautions** for an **undiagnosed respiratory illness**. The nurse must don personal protective equipment in the correct CDC sequence.

## Key concepts

- **CDC PPE Donning Sequence** — Hand hygiene → gown → mask or N95 (with fit check) → goggles or face shield → gloves over gown cuff. Logic: gown first while hands are clean and surface is large; gloves last to seal the gown cuff.
- **N95 Fit Check** — Performed every time an N95 is worn. Exhale sharply — should feel positive pressure and no leakage at the seal. Inhale sharply — should feel slight collapse. If air leaks, readjust and recheck. Fit testing (different from fit check) is a separate annual procedure.
- **PPE Doffing — Higher Risk** — Reverse order with hand hygiene between every step: gloves → goggles/face shield → gown → mask/N95 → final hand hygiene. Most contamination occurs during doffing; CDC recommends a trained observer or mirror for high-risk pathogens (Ebola, COVID variants).

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