# The charge nurse on a medical unit reviews isolation precautions at 0700. Room 1: an adult with no immunocompromising condition has herpes zoster in one thoracic dermatome, with the lesions covered by a dressing. Room 2: a client receiving chemotherapy has zoster lesions on the trunk, both arms, and the face. Room 3: a client with meningococcal meningitis has received IV ceftriaxone since 0100 yesterday. Room 4: a client with pulmonary tuberculosis has completed 14 days of four-drug therapy; yesterday's sputum smear was positive for acid-fast bacilli. Room 5: a client admitted at 0200 has had four loose stools; a C. difficile test was sent at 0600. Which decisions by the charge nurse are correct? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=617277&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

The charge nurse on a medical unit reviews isolation precautions at 0700. Room 1: an adult with no immunocompromising condition has herpes zoster in one thoracic dermatome, with the lesions covered by a dressing. Room 2: a client receiving chemotherapy has zoster lesions on the trunk, both arms, and the face. Room 3: a client with meningococcal meningitis has received IV ceftriaxone since 0100 yesterday. Room 4: a client with pulmonary tuberculosis has completed 14 days of four-drug therapy; yesterday's sputum smear was positive for acid-fast bacilli. Room 5: a client admitted at 0200 has had four loose stools; a C. difficile test was sent at 0600. Which decisions by the charge nurse are correct? Select all that apply.

1

Place the client in Room 2 on contact precautions only

2

Maintain standard precautions only for the client in Room 1

3

Discontinue airborne precautions for the client in Room 4

4

Discontinue droplet precautions for the client in Room 3

5

Assign a nurse without varicella immunity to Room 1

6

Start contact precautions now for the client in Room 5

## Explanation

Localized zoster in a client without immunocompromise, with lesions covered, needs only standard precautions, and droplet precautions for meningococcal disease end after 24 hours of effective therapy (this client has had 30 hours). Suspected C. difficile diarrhea should be placed on contact precautions while the test is pending. Disseminated zoster in a client on chemotherapy needs airborne plus contact precautions, TB isolation continues while the sputum smear is still positive regardless of 2 weeks of therapy, and staff without varicella immunity should not care for a client with zoster.

## In-depth explanation

Quick answer
Standard precautions only in Room 1, stop droplet precautions in Room 3, and start contact precautions in Room 5 (options 2, 4, 6).

Why this is correct
Each decision requires reading the room data. Room 1 has localized zoster in one dermatome, the lesions are covered, and the client is not immunocompromised, so standard precautions are enough. Room 3 started ceftriaxone at 0100 yesterday, which is 30 hours before 0700 today, beyond the 24 hours of effective therapy after which droplet precautions can stop. Room 5 has new diarrhea and a pending C. difficile test, so contact precautions begin now instead of after the result.

Easy analogy or mental picture
Isolation is like a traffic light that changes with the data: extent of rash, hours of antibiotics, and smear results turn it green or keep it red, not the diagnosis name alone.

Memory hook
Zoster: one covered dermatome = standard; spread or immunocompromised = airborne plus contact. Meningococcus: 24 hours of therapy. TB: negative smears, not days of therapy.

NCLEX decision rule
Match precautions to the organism's route, the extent of disease, the client's immune status, and objective criteria for ending isolation, and start empiric precautions while tests are pending.

Why the other choices are wrong
Contact precautions only for Room 2 (option 1) is tempting because zoster usually spreads by contact with lesions, but disseminated zoster, or zoster in an immunocompromised client, requires airborne plus contact precautions. Ending airborne precautions in Room 4 (option 3) is tempting because 2 weeks of effective therapy is a commonly taught milestone, but this client's sputum smear is still positive, so isolation continues until clinical improvement and negative smears. Assigning a nurse without varicella immunity to Room 1 (option 5) is tempting because Room 1 needs only standard precautions, but susceptible staff should not provide care to any client with zoster when immune staff are available.

References
1CDC: Guideline for Isolation Precautions (Appendix A, Type and Duration of Precautions)Localized versus disseminated zoster, droplet precautions until 24 hours of effective therapy for meningococcal disease, airborne precautions for TB until smears are negative, and empiric contact precautions for suspected C. difficile
2CDC: Tuberculosis (TB)Criteria for discontinuing airborne isolation in pulmonary tuberculosis

## Clinical scenario

Scenario
A charge nurse reviews five clients whose precaution needs depend on immune status, extent of lesions, hours of effective therapy, sputum results, and pending test results.

## Key concepts

- **Disseminated zoster** — Herpes zoster spread beyond one or two adjacent dermatomes, which can transmit varicella by the airborne route.
- **Droplet precautions** — Precautions using a facemask for organisms spread by large respiratory droplets, such as Neisseria meningitidis.
- **Empiric precautions** — Precautions started based on the client's syndrome, such as acute diarrhea, before a laboratory diagnosis is confirmed.

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