# A nurse is caring for a hospitalized patient with confirmed influenza A. Which nursing intervention should be implemented first to prevent transmission to other patients and healthcare workers?

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## 문제

A nurse is caring for a hospitalized patient with confirmed influenza A. Which nursing intervention should be implemented first to prevent transmission to other patients and healthcare workers?

## 보기

1. Place the patient in droplet precautions with a private room **✔ 정답**
2. Administer oseltamivir (Tamiflu) as prescribed
3. Encourage increased fluid intake to prevent dehydration
4. Monitor vital signs every 4 hours for fever patterns

**정답: 1**

## 해설

Droplet precautions are the priority to prevent nosocomial transmission via respiratory droplets. Other interventions like antiviral administration, hydration, and monitoring are important but secondary to infection control.

## 심화 해설

Understanding the Priority: Infection Prevention and Control

The core of this question lies in the NCLEX-RN principle of prioritization, specifically within the Safety and Infection Control category. When a patient is diagnosed with a communicable respiratory illness like influenza A, the nurse's immediate responsibility is to protect other vulnerable patients and the healthcare team from acquiring the infection. This aligns with the foundational "chain of infection" model; breaking the chain at the mode of transmission is the most effective first step.

Why Droplet Precautions Are the First and Most Critical Action

Influenza A is primarily transmitted via large respiratory droplets generated when an infected person coughs, sneezes, or talks. These droplets can travel approximately 3 to 6 feet before settling on surfaces. Placing the patient in droplet precautions with a private room directly interrupts this transmission route, creating a physical barrier between the infectious source and susceptible hosts. The urgency of this intervention is strongly supported by evidence on healthcare-associated respiratory virus infections (HARVIs). A study on pediatric inpatients found that respiratory viruses, including influenza, can spread within healthcare facilities "despite stringent infection prevention measures," highlighting the constant risk of nosocomial transmission [4]. Therefore, immediate isolation is not just a guideline but a critical, non-negotiable safety action.

Furthermore, the modern context of respiratory illness management reinforces this priority. A comprehensive nursing prevention and control system for fever clinics, designed for an era of co-existing multiple pathogens, was shown to be effective in "preventing nosocomial cross-infection" through structured protocols [2]. The very first element of such a system is the rapid identification and physical separation of potentially infectious patients. A narrative review on hospital influenza outbreak management in the post-COVID era also emphasizes that practices like improved ventilation and routine testing have reshaped control norms, but the cornerstone remains the prompt application of appropriate transmission-based precautions to prevent hospital-acquired influenza, which "amplifies morbidity, mortality, length of stay, and operational strain" [1].

Analyzing the Other Options in the Context of Prioritization

While the other interventions are important components of care, they are secondary to the safety imperative of isolation. Administering oseltamivir (Tamiflu) is a pharmacologic intervention to reduce viral shedding and symptom duration in the infected patient, but it does not provide an immediate physical barrier to protect others upon the patient's admission or diagnosis. Encouraging fluid intake addresses the patient's comfort and hydration status, a basic physiological need, but it does not mitigate the immediate public health risk within the hospital. Monitoring vital signs is an assessment task essential for tracking the patient's clinical course, yet it is a lower priority than an intervention that prevents harm to multiple individuals. Using Maslow's hierarchy of needs or the ABC (Airway, Breathing, Circulation) framework, a safety risk that threatens an entire patient care unit takes precedence over a single patient's medication, comfort, or ongoing monitoring. The nurse's first action must always be to contain the biological hazard, a principle validated by the development of scales measuring nurses' compliance with standard precautions, which are the bedrock of preventing cross-infection .References (research sources)

- [1]Hospital Influenza Outbreak Management in the Post-COVID Era: A Narrative Review of Evolving Practices and Feasibility Considerations.Research articleHuang WH, Ho YF, Yeh JY, Liu PY, Huang PH. (2025) · DOI: 10.3390/healthcare14010050

- [2]Effectiveness of a comprehensive nursing prevention and control system for respiratory infections in fever clinics in the era of co-existence of multiple pathogens.Research articleWang H, Yan M, Zhang P, Ma J, Zhao S, Li X, Dai H, Zhou Y, Cui R. (2026) · DOI: 10.3389/fpubh.2026.1740733

- [4]Impact of healthcare-associated respiratory virus infections in children.Research articleMiyashita A, Shibata M, Funakoshi H, Nakamura K, Miyokawa S, Horikoshi Y. (2026) · DOI: 10.1016/j.infpip.2026.100517

## 임상 시나리오

Clinical Practice Guide: Immediate Isolation for Suspected Influenza A

1. Immediate Isolation and Signage

Upon clinical suspicion or confirmed diagnosis of influenza A, immediately place the patient in a single-occupancy private room with a closed door. Post droplet precaution signage prominently at the room entrance to alert all staff and visitors before entry.

2. Personal Protective Equipment (PPE) Donning

Healthcare workers and visitors must don a standard surgical mask upon entering the patient's room. Perform hand hygiene before and after patient contact. If there is a risk of splash or spray (e.g., suctioning, nebulizer therapy), add eye protection (goggles or face shield). Gowns and gloves are required per standard precautions when anticipating contact with respiratory secretions or contaminated surfaces.

3. Patient Placement and Cohorting

Keep the patient in the private room throughout the infectious period (typically 5-7 days from symptom onset, longer in immunocompromised or pediatric patients). If a private room is unavailable, cohort the patient with another patient confirmed to have the same influenza strain. Maintain a spatial separation of at least 3 feet between beds, ideally with a physical barrier.

4. Patient Transport and Movement

Limit patient movement outside the room to medically essential purposes only. When transport is unavoidable (e.g., to radiology), the patient must wear a surgical mask to contain respiratory droplets. Notify the receiving department in advance of the patient's isolation status.

5. Environmental Cleaning and Duration

Perform routine cleaning and disinfection of frequently touched surfaces in the patient's environment at least daily. Discontinue droplet precautions only according to facility policy, typically based on symptom resolution and a defined time period, not solely on negative rapid antigen tests which may have low sensitivity.

## 핵심 개념

- **Droplet Precautions** — Infection prevention measures for pathogens transmitted by large respiratory droplets (>5 microns) traveling 3-6 feet, requiring a private room and mask.
- **Influenza A** — A highly contagious acute viral respiratory infection transmitted primarily via large droplets from coughing or sneezing.
- **Chain of Infection** — A model illustrating the six elements required for infection transmission: infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host.
- **Nosocomial Transmission** — An infection acquired within a healthcare facility, also known as a healthcare-associated infection (HAI).
- **Oseltamivir (Tamiflu)** — An antiviral neuraminidase inhibitor used to treat and prevent influenza A and B by reducing viral replication.

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