# A 31-year-old client who has never been vaccinated returned 10 days ago from travel abroad and is seated, unmasked, in a shared urgent-care waiting area. The client reports 4 days of fever, dry cough, runny nose, and red, watery eyes, followed yesterday by a rash. Temperature is 39.4°C (102.9°F), heart rate 112/min, respiratory rate 22/min, and oxygen saturation 95% on room air. The rash is red, blotchy, and maculopapular; it began along the hairline and behind the ears and is now spreading to the trunk. There are no vesicles, and the postauricular lymph nodes are not enlarged. Several tiny blue-white spots on a red base are seen on the buccal mucosa opposite the molars. The client is alert and oriented. Platelet count is 210,000/mm3. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=617368&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

A 31-year-old client who has never been vaccinated returned 10 days ago from travel abroad and is seated, unmasked, in a shared urgent-care waiting area. The client reports 4 days of fever, dry cough, runny nose, and red, watery eyes, followed yesterday by a rash. Temperature is 39.4°C (102.9°F), heart rate 112/min, respiratory rate 22/min, and oxygen saturation 95% on room air. The rash is red, blotchy, and maculopapular; it began along the hairline and behind the ears and is now spreading to the trunk. There are no vesicles, and the postauricular lymph nodes are not enlarged. Several tiny blue-white spots on a red base are seen on the buccal mucosa opposite the molars. The client is alert and oriented. Platelet count is 210,000/mm3. Complete the diagram by selecting the condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Condition

Select 1
Varicella
Dengue fever
Measles
Rubella

Actions to take

Select 2
Place the client in a private room on Droplet Precautions
Mask the client and move to an airborne isolation room
Report to public health once the PCR result is positive
Wear a fit-tested N95 respirator when entering the room
Administer a dose of MMR vaccine to the client now

Parameters to monitor

Select 2
Oxygen saturation and respiratory rate
Size of postauricular and occipital lymph nodes
Appearance of new vesicle crops
Platelet count
Level of consciousness

## Explanation

Cough, coryza, conjunctivitis, buccal Koplik spots, and a rash descending from the hairline after travel indicate measles. Measles spreads by the airborne route, so the client is masked and moved to an airborne infection isolation room, and staff wear fit-tested N95 respirators. Pneumonia and encephalitis are the major complications, so oxygenation and level of consciousness are trended; lymph node size, vesicles, and platelets track rubella, varicella, and dengue.

## In-depth explanation

Quick answer
Measles. Actions: mask the client and move to an airborne isolation room; wear a fit-tested N95 respirator. Monitor: oxygen saturation with respiratory rate, and level of consciousness.

Why this is correct
The 3 Cs prodrome (cough, coryza, conjunctivitis) plus blue-white buccal spots (Koplik spots) and a rash that starts at the hairline and moves downward identify measles. Measles is transmitted by the airborne route, so source control and an airborne infection isolation room (AIIR) are the first priority, and anyone entering needs N95-level protection. Pneumonia is the most common cause of measles death and encephalitis is its most feared neurologic complication.

Easy analogy or mental picture
Picture measles as smoke in a room: it hangs in the air and drifts through the whole waiting area long after the client leaves, so a door and a negative-pressure room are needed, not just distance.

Memory hook
Measles = 'Mist' spread: 3 Cs, Koplik spots, head-to-toe rash, then N95 and AIIR.

NCLEX decision rule
When a rash illness is suspected, choose the precaution that matches the transmission route of the most likely organism, and apply it on suspicion, not after laboratory confirmation.

Why the other choices are wrong
Rubella is a near-neighbour rash, but it has a mild prodrome and prominent postauricular nodes (absent here) and needs only Droplet Precautions, so a private room on Droplet Precautions is inadequate for measles. Varicella causes vesicles in crops (none here). Dengue causes fever and rash after travel but not coryza or Koplik spots, and its platelet trend is the parameter for dengue, not measles. Waiting for PCR before reporting delays contact tracing; suspected measles is reported immediately. MMR vaccine is post-exposure prophylaxis for susceptible contacts, not treatment for the ill client.

References
1CDC — Interim Infection Prevention and Control Recommendations for Measles in Healthcare SettingsSuspected measles requires masking, AIIR placement, Airborne Precautions, N95-level protection, and prompt notification.

## Clinical scenario

Scenario
An unvaccinated traveler with a prodrome of cough, coryza, and conjunctivitis, buccal Koplik spots, and a rash spreading downward from the hairline is waiting unmasked in a shared area.

## Key concepts

- **Koplik spots** — Tiny blue-white spots on a red base on the buccal mucosa that appear before or with the measles rash.
- **Airborne infection isolation room** — A single-patient negative-pressure room with the door kept closed to contain airborne organisms.
- **Source control** — Placing a facemask on a potentially infectious client to limit spread of respiratory particles.

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