# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=361677&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

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?

## Option

1. Place the client in a private room with the door closed; use standard precautions without a respirator.
2. Place the client in a droplet-precautions room; wear a surgical mask within 1 m (3 ft).
3. Place the client in a negative-pressure AIIR; keep the door closed and wear a fit-tested N95 respirator. **✔ Correct answer**
4. Place the client in a contact-precautions room; wear gown and gloves without a respirator.

**Correct answer: 3**

## Explanation

Tuberculosis is transmitted via airborne droplet nuclei (

## In-depth explanation

Clinical Judgment
Apply NCJMM: Recognize cues (chronic cough, night sweats, weight loss, right upper lobe infiltrate = 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).

Memory Tip
My Chicken Hez TB — Measles, Chickenpox (Varicella), Herpes zoster (disseminated), Tuberculosis. These four require airborne isolation. Patient wears a surgical mask, staff wears an N95 — never confuse the two.

KR vs US
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 AIIR (negative pressure) + N95; any choice that puts a surgical mask on the nurse for TB care is wrong.

## Clinical scenario

Clinical Practice Guide
CDC 2005 TB guidelines: an AIIR maintains ≥6 air changes per hour (existing facilities) or ≥12 ACH (new construction), 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.

Caution
NCLEX frequently uses surgical-mask-vs-N95 confusion as a trap. Remember: patient wears a surgical mask; staff wears an N95. 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 (

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