Question Set B: Next-Generation Items, With Rationales
A bowtie frame of five ruled cells sized for handwriting: two feeder cells at left, one center cell, and two action cells plus one monitoring cell at right, joined by arrows reading left to right.
9. MATRIX Assign each patient to every precaution category that applies. Two patients require two categories.
| Patient | Standard only | Contact | Droplet | Airborne |
|---|---|---|---|---|
| A. Unimmunized 5-year-old, febrile, crops of vesicles at different stages across the trunk and face | ||||
| B. 30-year-old kidney transplant recipient with vesicles crossing four dermatomes and the opposite flank | ||||
| C. Nursing home resident with intense nocturnal itching and burrows in the finger webs | ||||
| D. Adult with a gray adherent pharyngeal membrane and confirmed diphtheria | ||||
| E. Adult with uncomplicated leg cellulitis, skin intact, no drainage |
Rationale. A and B are airborne plus contact: varicella and disseminated zoster both stay suspended and live on the lesions. C is contact, D is droplet, E is standard only.
10. ORD A nurse finds a small fire burning in a patient bathroom trash container. The patient is in bed in the same room. Place the eight actions in order.
- Aim the extinguisher nozzle at the base of the fire
- Close the door to the room
- Move the patient out of the room
- Sweep the nozzle from side to side
- Pull the extinguisher pin
- Activate the fire alarm
- Squeeze the extinguisher handle
- Retrieve the extinguisher from the corridor cabinet
Rationale. Answer: 3, 6, 2, 8, 5, 1, 7, 4. RACE runs first and PASS runs inside its final step; the patient leaves before the alarm is pulled.
11. DDT A patient develops profuse watery stool on day 5 of intravenous antibiotic therapy. Complete the sentence.
The nurse places the patient on [drop-down 1] precautions, applies [drop-down 2] before entering the room, and performs hand hygiene with [drop-down 3] after removing the equipment.
- Drop-down 1: contact · droplet · airborne · protective environment
- Drop-down 2: gown and gloves · a surgical mask · a fit-tested respirator · gloves alone
- Drop-down 3: an alcohol-based rub · soap and water · a chlorhexidine rub · no agent, because gloves were worn
Rationale. Answer: contact, gown and gloves, soap and water. The discriminating reason is that the suspected organism forms spores, which alcohol does not kill.
12. BOW A 46-year-old recent arrival from a high-incidence country is admitted from a homeless shelter with 8 weeks of cough, a 22-pound unintentional weight loss, and night sweats. Complete the bowtie.
- Center, condition most likely: tuberculosis · community-acquired pneumonia · heart failure · influenza
- Left wing, two supporting cues: cough lasting 8 weeks · unintentional weight loss with night sweats · blood pressure 130/78 · reports one alcoholic drink weekly
- Right wing, two actions: place in an airborne infection isolation room with the door closed · collect sputum for acid-fast testing · place a surgical mask on staff entering · begin droplet precautions
- Right wing, one parameter to monitor: respiratory status and oxygen saturation · urine output · pupil response · bowel sounds
Rationale. Answer: tuberculosis; the 8-week cough and the weight loss with night sweats; airborne isolation room and sputum collection; respiratory status and oxygen saturation. Empiric airborne precautions go on before confirmation.
Margin noteNo category is ever named in the prompt.
TakeawayNext-generation items withhold the label, so each one is really a cue-recognition item in a new shape.
The bowtie mechanic itself belongs to → BOOK 02 · P4.
Verify at reprint: every matrix cell against the current CDC/HICPAC isolation precautions guideline and its infection-specific appendix, the two dual-category patients individually. Verify item 10 against current NFPA fire response guidance for health care occupancies.