Place the patient in a negative pressure room when smallpox is suspected in the ED.

If a client in the ED presents with symptoms consistent with smallpox, what should the nurse do first?

• A. Send the client to the waiting room.
• B. Place the client in a negative pressure room.
• C. Put a surgical mask on the client.
• D. Initiate contact precautions.

Answer: (B)

The best course of action when a client presents with symptoms consistent with smallpox is to place the client in a negative pressure room. This is crucial for controlling airborne pathogens, as smallpox is highly infectious and can be transmitted through the air. Negative pressure rooms help prevent the spread of the virus to other areas in the healthcare facility by ensuring that air flows into the room and not out, minimizing the risk of airborne transmission. By isolating the patient in a negative pressure room, healthcare providers can also implement additional precautions safely and effectively. This method is critical in managing outbreak situations and protecting both the care environment and other patients from exposure. Initiating contact precautions, placing a surgical mask on the client, or sending them to the waiting room would not provide the necessary level of containment for a highly infectious condition like smallpox. These actions do not appropriately address the airborne nature of the virus and may ultimately increase the risk of spreading the infection to others in the healthcare setting.

When a patient in the emergency department walks in with fever, a rash, and symptoms that could hint at smallpox, the pace of the room changes. The goal isn’t just to treat a person—it’s to protect everyone else in the building. In this kind of moment, the first move matters more than most other steps that come later. So, what should a nurse do first?

Place the patient in a negative pressure room.

Yes, that’s the key action. Why? Because smallpox is highly contagious and capable of spreading through the air. The air you breathe in a shared space can carry particles far enough to reach someone else, even if they’re not standing close. A negative pressure room creates a room inside the building where air flows into the room from the outside, but doesn’t flow out into corridors, hallways, or other patient rooms. In practical terms, this helps keep the virus contained, giving the care team a safer environment to assess, diagnose, and treat.

Let me explain what negative pressure does in a way that sticks. Picture a small room with a slightly stronger breeze pulling air inward rather than pushing it outward. That inward pull means any airborne particles stay contained in that space and are filtered or exhausted through special ventilation systems. The door stays closed, the corridor stays safer, and you buy time to put more protections in place without letting the contagion run free.

What makes this the best first move, exactly? Because smallpox, and many other airborne pathogens, isn’t just about direct contact or sneaking through a sneeze. It travels through tiny particles that can linger in the air. If you hard-stop the chance of those particles escaping, you dramatically lower the risk of spreading to other patients, visitors, and staff. It’s not that the other precautions are unimportant; it’s that, in this moment, containment is your best friend.

What about the other options you might see on a test or hear someone mention in a busy shift? Let’s break them down quickly, so you know why they aren’t the first move here.

• Send the client to the waiting room. A tempting impulse in a crowded ED is to move a patient somewhere away from the main flow. But with a disease that travels through the air, the risk isn’t just about being near the waiting room. It’s about the potential to seed airborne particles into hallways, other rooms, or shared spaces. The waiting room becomes a risk hub rather than a shield. That’s not containment; that’s letting the danger drift.

• Put a surgical mask on the client. A mask is useful for droplet control—think coughing or sneezing in close proximity. It does little to stop airborne particles that may linger in the room. In a high-stakes scenario with a confirmed or strongly suspected airborne pathogen, a mask alone isn’t enough protection for others in the facility.

• Initiate contact precautions. That step matters, and it’s part of the larger workflow, but it doesn’t address the airborne spread as effectively as a negative pressure environment. It’s a piece of the puzzle, not the whole picture. In other words, don’t skip the containment piece while you throw on gloves and a gown.

So, you’ve placed the patient in a negative pressure room. What comes next? The chain of actions that follow is where a lot of the real work happens, and where the team’s coordination shines.

Next steps after isolation: building a safer process

Once the patient is isolated, the care team can layer in the rest of the protections and procedures without scrambling. Here are the core components that typically follow:

• Airborne precautions for staff. This usually means trained personnel use an N95 respirator or a powered air-purifying respirator (PAPR) when entering the patient’s room. The goal is to stop inhalation of any infectious particles. Fit testing and user training are critical here, because a poorly worn respirator won’t do the job.

• Restrict access to essential personnel. The fewer people in the room, the smaller the chance of exposure. This is about smart staffing and clear communication. If you don’t need to be inside, you don’t go in. When you do enter, you’re part of a well-orchestrated protocol.

• Proper PPE and equipment management. Don’t mix reusable equipment with contaminated areas. Doffing and donning procedures matter—just as much as the PPE itself. This is where a lot of the “human factors” come into play: fatigue, distractions, and the natural urge to hurry can trip you up if you’re not careful.

• Clear signs and containment measures. Doors should stay closed, airflow indicators should be monitored, and the room should be clearly labeled so everyone understands the stakes. It’s not dramatic theater; it’s practical risk management.

• Notify infection control and public health if needed. Depending on the setting, you’ll pull in the right experts to confirm diagnosis, coordinate testing, and document the response. Early coordination helps protect others and keeps the department running.

• Environmental controls and monitoring. The room’s ventilation rate, pressure differentials, and filtration systems need to be checked and maintained. If the room isn’t meeting the required standards, the team adjusts or relocates care while the patient remains isolated.

A few practical notes to help the picture stay clear

• Masking the patient is a useful supplementary step, but it isn’t a stand-alone fix for airborne spread. The room’s ventilation and air handling do much of the heavy lifting when it comes to containment.

• Air changes per hour (ACH) matter, but you don’t need to memorize exact numbers for every situation. The principle to carry is simple: ensure the room’s design minimizes the chance that air, and anything in it, leaves the space.

• Housekeeping and waste handling are part of the safety net. Contaminated linens, linens disposal, and cleaning agents should follow the facility’s infection control guidelines. Consistency here reduces the risk of cross-contamination.

• Documentation and teamwork are the quiet heroes. Quick, precise notes about the patient’s status, room changes, and PPE use help everyone stay aligned. In a high-stakes scene, good communication is as important as good ventilation.

A quick reality check—why this matters beyond one shift

You might wonder, “Is this really common sense in a hospital?” The short answer is yes, and that makes it comforting. When a patient’s symptoms point toward a highly infectious airborne disease, containment isn’t a niche concern. It’s the foundation of safe care for every patient who walks through the doors.

Consider the broader picture: hospitals run on systems. A negative pressure room isn’t just a fancy gadget; it’s a system component that buys time and protects the next patient who arrives for a routine checkup, a scheduled surgery, or a sudden illness. The same logic applies to other infectious threats as well. The principle holds: lead with containment, layer in protections, and maintain clear lines of responsibility and communication.

A final thought that ties it all together

If you’re standing at the bedside, and the question comes up in the moment, remember this sequence: isolate first, then protect, then test and manage. It’s not a flashy sequence, but it’s a reliable one. The negative pressure room is the anchor because it addresses the core risk head-on. Everything else—PPE, proper isolation, careful documentation—builds on that foundation.

If you’re curious about the practical side of hospital operations, you’ll notice the rhythm: the team moves quickly, but not haphazardly. There’s a method to every move, a reason behind each rule, and a shared understanding of what it means to keep a hospital safe for everyone who walks through its doors. That blend of urgency and precision is what nurses bring to the table every day, and it’s what protects the people you care for most.

In the end, it all circles back to the same idea: containment saves lives. When a patient with highly contagious symptoms comes in, the first action—placing the patient in a negative pressure room—sets the course for careful, coordinated care. It’s a practical choice that reflects both science and human responsibility, stitched together in the fast-paced, demanding world of emergency medicine.

If you’ve ever stood at a doorway listening to the hum of the ventilation system, you know what the room is doing for you. It’s giving you time. Time to think clearly, time to gear up safely, and time to get the rest of the care team on the same page. And that, in a heartbeat, can make all the difference.