NCLEX isolation precautions: airborne, droplet, contact
Written and reviewed by Dana Whitfield, RN, MSN · 7 min read · Updated August 2026
Short answer
Three transmission-based precautions sit on top of standard precautions. Airborne needs a negative-pressure room and an N95 — measles, TB, varicella. Droplet needs a private room and a surgical mask within three to six feet — influenza, pertussis, meningitis. Contact needs gown and gloves — C. difficile, MRSA, scabies. Items usually test the room and the mask, not the disease.
Airborne: the small-particle three
Measles, tuberculosis, varicella — remember them as My Chicken Hez TB if you need a hook, but three items is a short list to hold directly. These organisms travel on droplet nuclei small enough to stay suspended, so the control is the room, not the distance.
A negative-pressure room with the door closed, and an N95 respirator that has been fit-tested. A surgical mask is the wrong answer for airborne every time, and 'the nurse applies a surgical mask before entering the room of a client with active TB' is a stem written to be caught.
Droplet: bigger particles, shorter range
Influenza, pertussis, mumps, rubella, meningococcal meningitis, group A strep, adenovirus. Droplets fall within about three to six feet, so a private room and a surgical mask on entry are enough — no negative pressure, no N95.
The client wears a surgical mask when transported. That transport detail is a common item on its own, and it applies to airborne too: the client masks, the corridor does not become an isolation zone.
Contact, and the C. diff exception
Gown and gloves for entry, dedicated equipment, private room where possible: MRSA, VRE, RSV, scabies, impetigo, draining wounds, C. difficile.
C. difficile carries two exceptions the exam loves. Soap and water, not alcohol-based rub, because alcohol does not kill spores — and bleach-based cleaning for the room. Any item pairing C. diff with hand sanitizer is testing precisely this.
Protective isolation, which runs the other way
Neutropenic or protective isolation protects the client from the environment rather than the environment from the client: positive-pressure room, no fresh flowers, no raw fruit or vegetables, no visitors with any infection, and a mask on anyone entering.
Positive versus negative pressure is the single distinction to get right. Negative pressure keeps air in for an infectious client; positive pressure keeps air out for a vulnerable one, and reversing them is the most consequential error in this content area.
PPE order, both ways
On: gown, mask, goggles, gloves. Off: gloves, goggles, gown, mask. The logic is that gloves are dirtiest so they come off first, and the mask stays on longest because you are still in the room's air until you leave.
Doffing order appears more often than donning order, because it is where contamination actually happens. If an item offers a sequence, check the first item removed before you read anything else.
Whatever you take from this, the next step is the same: answer questions and read the rationales. Our safe and effective care practice questions are the closest set to what this guide covers, there are ten more on the practice questions hub, and the pricing page spells out what the free tier includes.
One question from the safe and effective care set
A nurse on a medical unit receives report on four clients. Which client should the nurse assess first?
Rationale
Prioritization items are airway, breathing, circulation, in that order — the ranking survives every rewording. Audible gurgling around a fresh tracheostomy is a partially obstructed airway and it is the only option that can kill the client in the next few minutes. Fever, post-op pain, and a glucose of 232 are all real problems that need the nurse, just not first.
Answer: C
Common questions
What are the three types of transmission-based precautions?
Airborne (negative-pressure room, N95), droplet (private room, surgical mask within three to six feet), and contact (gown and gloves). All three sit on top of standard precautions, which apply to every client.
Why can't you use hand sanitizer for C. difficile?
Alcohol-based rubs do not kill C. difficile spores. Hand hygiene must be soap and water with mechanical friction, and the room requires a bleach-based cleaning agent.
What is the correct order for removing PPE?
Gloves, goggles, gown, then mask. Gloves are the most contaminated so they come off first, and the mask comes off last, after leaving the room.