# A 6-year-old child is admitted to the pediatric unit with suspected diphtheria. Which isolation precaution should the nurse implement immediately upon admission?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542269  
> language: ko  
> subject: Child Health

## 문제

A 6-year-old child is admitted to the pediatric unit with suspected diphtheria. Which isolation precaution should the nurse implement immediately upon admission?

## 보기

1. Contact precautions with gown and gloves
2. Droplet precautions with surgical mask **✔ 정답**
3. Airborne precautions with N95 respirator
4. Standard precautions only

**정답: 2**

## 해설

Diphtheria is transmitted via respiratory droplets, requiring droplet precautions to prevent spread. Other options are less appropriate for this mode of transmission.

## 심화 해설

Understanding the Pathogen and Transmission

Diphtheria is an acute, toxin-mediated infection caused by Corynebacterium diphtheriae. The bacterium primarily infects the mucous membranes of the respiratory tract, including the tonsils, pharynx, and nose. The classic hallmark is the formation of a thick, gray, adherent pseudomembrane that can cause airway obstruction [3,4].

The mode of transmission is the critical factor determining the correct isolation precaution. C. diphtheriae is transmitted via respiratory droplets when an infected person coughs, sneezes, or even talks. Close contact with oral or respiratory secretions is the primary route of spread [1,2]. This mechanism directly dictates the use of droplet precautions, as the infectious particles are large droplets that travel short distances (typically up to 3 feet) and do not remain suspended in the air for long periods.

Rationale for Droplet Precautions

The nurse must initiate Droplet Precautions immediately upon admission to prevent transmission to healthcare workers, other patients, and visitors. This involves placing the child in a private room (or cohorting with a patient infected with the same organism) and wearing a surgical mask when working within 3 feet of the patient . The pathogen is contained within large respiratory droplets, making a surgical mask an effective barrier. Airborne precautions with an N95 respirator are reserved for pathogens with very small particles (≤5 microns) that can remain infectious over time and distance, such as tuberculosis, measles, or varicella. Contact precautions are essential for organisms spread by direct or indirect contact with skin or contaminated surfaces, but they are insufficient as the sole precaution for a disease transmitted by the respiratory droplet route. Standard precautions, which include hand hygiene and gloves for potential contact with body fluids, are used for all patients but are not adequate alone to interrupt droplet transmission.

Clinical Implications and Nursing Priority

The urgency of implementing droplet precautions is underscored by the severe, toxin-mediated complications of diphtheria. The diphtheria toxin can cause life-threatening myocarditis, leading to dilated cardiomyopathy and heart failure, as well as peripheral neuropathy manifesting as palatal paralysis or polyneuritis [3,4]. A child with suspected diphtheria requires strict isolation to protect others while the healthcare team focuses on neutralizing the toxin with antitoxin, eradicating the organism with antibiotics, and managing the airway. The isolation strategy is a non-negotiable first step in the care plan, directly linked to the pathogen's portal of exit from the infected host.

## 임상 시나리오

Diphtheria Isolation PrecautionsImmediate nursing action upon admission
Initiate Droplet Precautions immediately for suspected diphtheria. Place the patient in a private room and wear a surgical mask when within 3 feet of the patient.

The pathogen Corynebacterium diphtheriae spreads via large respiratory droplets from coughing or sneezing. An N95 respirator is not required as the particles are not airborne.

CautionDo not rely on Standard Precautions alone. The hallmark pseudomembrane poses a risk of airway obstruction, requiring continuous monitoring in addition to isolation.

## 핵심 개념

- **Diphtheria** — Acute, toxin-mediated infection caused by Corynebacterium diphtheriae, characterized by a pseudomembrane in the throat.
- **Droplet Precautions** — Measures to prevent transmission of pathogens spread through large respiratory droplets, including a private room and surgical mask within 3 feet.
- **Corynebacterium diphtheriae** — Gram-positive bacterium that causes diphtheria, transmitted via respiratory droplets.
- **Pseudomembrane** — A thick, gray, adherent membrane formed in the pharynx, a hallmark of diphtheria that can cause airway obstruction.

## 같은 주제 문제

- [A 6-year-old child is brought to the emergency department with a 3-day history of sore thr…](https://mymerci.kr/pages/nclex_q.php?qn_id=542264)
- [A 6-year-old child is brought to the emergency department with a 3-day history of sore thr…](https://mymerci.kr/pages/nclex_q.php?qn_id=542265)
- [A 4-year-old child is admitted to the pediatric unit with suspected diphtheria. The child …](https://mymerci.kr/pages/nclex_q.php?qn_id=542266)
- [A 6-year-old child is admitted to the pediatric unit with suspected diphtheria. The child …](https://mymerci.kr/pages/nclex_q.php?qn_id=542267)
- [A 7-year-old child is admitted to the pediatric unit with suspected diphtheria. Which nurs…](https://mymerci.kr/pages/nclex_q.php?qn_id=542268)
- [A 4-year-old child is admitted to the pediatric unit with suspected diphtheria. Which nurs…](https://mymerci.kr/pages/nclex_q.php?qn_id=542270)

---

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

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