A nurse is caring for a patient with active pulmonary tuberculosis who has been on anti-tuberculosis therapy for 2 weeks. Which nursing action is the MOST important priority to ensure safety in the healthcare environment?
1Monitor the patient's sputum culture results daily to assess treatment effectiveness
2Ensure the patient wears a surgical mask when being transported outside the negative pressure room✓ 정답
3Administer medications at the same time each day to maintain therapeutic levels
4Educate the patient about the importance of completing the full course of treatment
해설
The highest priority is preventing airborne transmission by ensuring the patient wears a surgical mask during transport outside the negative pressure room. Other options are important but do not directly address immediate safety from transmission.
Core Nursing ExplanationKey Concept Analysis: This question tests the application of Transmission-Based Precautions, specifically for Airborne diseases. The core theme is identifying the Key Point! immediate safety priority in infection control. The patient has Active pulmonary tuberculosis (TB), which is transmitted via airborne droplet nuclei. Even after starting therapy, a patient is considered infectious until sputum cultures convert to negative, which typically takes 2-4 weeks. Therefore, the most critical action is to prevent the spread of the pathogen to other patients, visitors, and healthcare workers.
Answer Rationale: The correct answer is ensuring the patient wears a surgical mask during transport. Here’s the clinical and safety rationale:
Key Point! For airborne precautions, the patient must be in a Negative pressure isolation room. When leaving this controlled environment (e.g., for diagnostic tests), the patient becomes a mobile source of infection. A Surgical mask on the patient acts as source control, trapping infectious droplets expelled when the patient coughs, talks, or breathes, thereby protecting others in common areas. This action directly addresses the immediate public health and safety risk of transmission.
Distractor Analysis:
① Monitor sputum culture results daily: While monitoring treatment response is important, sputum cultures are not processed daily; they take weeks to grow. This is not an immediate safety action for the healthcare environment.
③ Administer medications at the same time each day: This is crucial for Medication adherence and maintaining therapeutic levels, which is a long-term treatment priority. However, it does not address the acute infection control risk in the environment.
④ Educate about completing the full course: Patient education on Directly Observed Therapy (DOT) and treatment completion is vital to prevent drug resistance and relapse. This is a key nursing responsibility but is a secondary priority to containing an active, transmissible infection within the facility.
Related Concepts: This integrates knowledge of infection control (Standard and Transmission-Based Precautions), the pathophysiology of TB transmission, and the nursing process where Key Point! safety (preventing harm to others) always takes precedence in priority-setting questions.
Concept Summary
Concept
Key Points
Airborne Precautions
Required for measles, varicella, disseminated zoster, and tuberculosis. Use N95 respirator for healthcare workers, negative pressure room, and surgical mask on patient during transport.
TB Infectious Period
A patient is considered infectious until they have been on effective therapy for 2-3 weeks and have clinical improvement with negative sputum smears.
Source Control
Having the infectious person wear a mask is a primary method to contain respiratory secretions and protect others.
N95 respirator (HCW), Surgical mask (patient for transport)
Negative pressure (AIIR)
Droplet
Influenza, Pertussis, Meningitis
Surgical mask (HCW), Mask on patient if tolerated
Private room or cohort
Contact
MRSA, VRE, C. diff, RSV
Gown & Gloves
Private room or cohort
Anatomy, Physiology & Pharmacology Points
Pathophysiology: Mycobacterium tuberculosis is inhaled into the alveoli. It is carried by droplet nuclei (tiny particles <5µm) that remain suspended in air for long periods, requiring special ventilation controls.
Pharmacology: First-line anti-TB drugs include Isoniazid (INH), Rifampin, Pyrazinamide, and Ethambutol. A multi-drug regimen is essential to prevent resistance.
Memory Tips
Mnemonic for Airborne Diseases: "My Chicken Has Measles, Very Contagious!" (Mycobacterium TB, Chickenpox/Herpes zoster, Measles, Varicella).
Priority Rule: In NCLEX, Safety First. When a question involves a communicable disease, the action that protects others from immediate harm is almost always the top priority.
High-Frequency NCLEX Topics
Infection control, especially Transmission-Based Precautions, is a Key Point! high-yield NCLEX topic. Expect questions on selecting appropriate PPE, room placement, and patient transport procedures. Remember: "Airborne = N95 + Negative Pressure."
Watch Out for Question Variations!
Instead of asking for the priority action, the question might ask: "The nurse is preparing to transport a patient with pulmonary TB for a chest X-ray. Which action by the nurse is essential?" (Answer: Place a surgical mask on the patient.)
The scenario could shift to Watch out for confusion! a patient with suspected vs. confirmed TB, or a patient who has been on treatment for 6 weeks (likely non-infectious) vs. 2 weeks (likely still infectious).
Nursing Clinical Practice GuideClinical Scenario: You are the nurse on a medical unit. Mr. Jones, 58, was admitted 2 weeks ago with a confirmed diagnosis of active pulmonary TB. He is on a four-drug regimen. He needs to be transported to Radiology for a follow-up chest CT scan.
Nursing Intervention Strategy:
Assessment: Verify the physician's order for transport. Assess the patient's understanding of why he needs to wear a mask. Assess for any respiratory distress that might be worsened by the mask.
Planning: Plan the transport route to minimize time in common areas. Notify the receiving department (Radiology) in advance so they can prepare an isolation area or be ready to receive an infectious patient.
Implementation:
Don your own appropriate PPE (at minimum, an N95 respirator) before entering the room.
Provide a surgical mask to the patient and instruct him to wear it securely over his nose and mouth. Educate: "Mr. Jones, this mask helps keep germs from spreading to others as we walk to your test."
Use a dedicated transport wheelchair if possible. Cover any open wounds the patient may have.
Accompany the patient directly to Radiology, avoiding common waiting areas.
Evaluation: Ensure the patient kept the mask on during transport. After returning the patient to his negative pressure room, perform hand hygiene. Document the transport, precautions taken, and patient tolerance.
Patient Safety and Precautions:
Contraindication: If the patient is in severe respiratory distress and wearing a mask worsens hypoxia, alternative arrangements must be made (e.g., portable imaging in the room if absolutely necessary).
Key Monitoring: Monitor the patient for anxiety or discomfort related to the mask and isolation.
Nursing Procedure & Medication FlowMedication Administration for TB:
Drugs like Rifampin turn body fluids (urine, sweat, tears) orange-red. This is a normal side effect. Educate the patient to avoid contact lenses and warn about stained underwear.
Isoniazid (INH) can cause peripheral neuropathy. Pyridoxine (Vitamin B6) is often co-administered as prophylaxis.
Ethambutol can cause optic neuritis (red-green color blindness). Baseline and periodic visual acuity tests are needed.
Key Point! Administer all drugs together, usually once daily, to promote adherence and synergistic bactericidal effect.
A Word from Your Senior Nurse
"In the real world, infection control is everyone's responsibility. It can feel awkward to ask a sick patient to wear a mask, but frame it as an act of protection for their family, other vulnerable patients, and even for us, the healthcare team. Your vigilance in following these precautions literally saves lives by preventing outbreaks. When you study, don't just memorize 'mask for transport'—understand that it's about breaking the chain of infection. That critical thinking will make you a safe and trusted nurse from day one."
Airborne Precautions — Infection control measures for diseases spread via small airborne particles (<5µm) that remain suspended in air, requiring a negative pressure room and N95 respirator.
Negative Pressure Room — An isolation room where air pressure is lower than surrounding areas, causing air to flow into the room when the door is open, preventing contaminated air from escaping.
Source Control — The practice of containing respiratory secretions at their source, e.g., by having a coughing patient wear a mask, to prevent transmission to others.
Mycobacterium tuberculosis — The slow-growing, acid-fast bacillus that causes tuberculosis, primarily affecting the lungs but can disseminate to other organs.
Directly Observed Therapy — A strategy where a healthcare worker or other designated person watches the patient swallow each dose of anti-TB medication to ensure adherence and completion.