A 22-year-old female client presents to the emergency department with a 4-week history of chronic cough, drenching night sweats, and a 5 kg weight loss. Chest x-ray reveals a right upper lobe infiltrate, and pulmonary tuberculosis (TB) is suspected; admission is pending. Which type of isolation room should the nurse arrange for this client?

Tuberculosis is transmitted via airborne droplet nuclei (<5 micrometers) of Mycobacterium tuberculosis that remain suspended in the air for prolonged periods, so an airborne infection isolation room (AIIR) with negative pressure plus an N95 (or higher) respirator is required. Option 1 is incorrect because standard precautions alone cannot block airborne transmission. Option 3 is incorrect because a surgical mask cannot filter droplet nuclei. Option 4 is contact precautions, used for organisms such as MRSA or C. difficile, and is inappropriate for TB.

In-depth explanation

<span class="merci-scenario-label">Clinical Judgment</span><br>Apply NCJMM: Recognize cues (<span class="merci-kw">chronic cough, night sweats, weight loss, right upper lobe infiltrate</span> = classic TB) → Analyze cues (transmission = airborne route) → Generate solutions (AIIR + N95) → Take action (immediate transfer to negative-pressure room + don N95) → Evaluate outcomes (no further exposure to other clients or staff).<br><br><span class="merci-scenario-label">Memory Tip</span><br><span class="merci-kw-mark">My Chicken Hez TB</span> — Measles, Chickenpox (Varicella), Herpes zoster (disseminated), Tuberculosis. These four require airborne isolation. <span class="merci-kw">Patient wears a surgical mask, staff wears an N95</span> — never confuse the two.<br><br><span class="merci-scenario-label">KR vs US</span><br>Korea has one of the highest TB incidence rates in the OECD, and TB is frequently encountered in everyday practice — sometimes managed in standard isolation rooms with surgical masks. NCLEX (US) explicitly enforces <span class="merci-kw">AIIR (negative pressure) + N95</span>; any choice that puts a surgical mask on the nurse for TB care is wrong.

Clinical scenario

<span class="merci-scenario-label">Clinical Practice Guide</span><br><span class="merci-kw">CDC 2005 TB guidelines</span>: an AIIR maintains <span class="merci-kw">≥6 air changes per hour (existing facilities) or ≥12 ACH (new construction)</span>, with air exhausted directly outdoors or through HEPA filtration. Healthcare workers wear an N95 respirator (fit-tested) or a PAPR. The patient wears a surgical mask whenever leaving the room.<br><br><span class="merci-scenario-label">Caution</span><br>NCLEX frequently uses surgical-mask-vs-N95 confusion as a trap. Remember: <span class="merci-kw">patient wears a surgical mask; staff wears an N95</span>. Any option that has the nurse using a surgical mask for direct TB care is wrong.

Key concepts

• Airborne Infection Isolation Room (AIIR) — A negative-pressure single-occupancy room with ≥6 air changes per hour (existing facilities) or ≥12 ACH (new construction). Air is exhausted directly outdoors or through HEPA filtration. Required for confirmed or suspected TB, measles, chickenpox, and disseminated herpes zoster.
• N95 respirator — A particulate-filtering facepiece respirator that filters at least 95% of airborne particles ≥0.3 micrometers. Requires fit-testing before use. When fit-testing is not possible (e.g., facial hair), a PAPR (powered air-purifying respirator) is used as an equivalent or higher level of protection.
• Mycobacterium tuberculosis — An acid-fast bacillus that causes pulmonary or extrapulmonary tuberculosis. Transmitted as droplet nuclei (<5 micrometers) via the airborne route. Diagnosis: AFB sputum smear (×3), nucleic acid amplification test (NAAT) for rapid detection, and culture as the gold standard.