# A nurse is caring for an adult client newly admitted with suspected active pulmonary tuberculosis. Sputum AFB smears are pending. Which actions are required components of CDC-recommended airborne precautions for this client? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=366306&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

A nurse is caring for an adult client newly admitted with suspected active pulmonary tuberculosis. Sputum AFB smears are pending. Which actions are required components of CDC-recommended airborne precautions for this client? Select all that apply.

1

Limit the client's hand washing because pulmonary tuberculosis is not transmitted through skin or hand contact

2

Place the client in a single negative-pressure airborne infection isolation room (AIIR) and keep the door closed except when entering or leaving

3

Have the client wear a surgical mask during essential transport outside the AIIR, such as for radiology procedures

4

Allow visitors free access to the room without respirators because TB is not transmissible to immunocompetent healthy adults

5

Wear a fit-tested, NIOSH-approved N95 or higher-level respirator before entering the room and during care

6

Wear a standard surgical mask when entering the room and providing direct client care

## Explanation

For suspected or confirmed infectious pulmonary TB, place the client in a negative-pressure AIIR and keep the door closed except for entry and exit (Choice 2). Health care personnel don a fit-tested, NIOSH-approved N95 or higher-level respirator before room entry (Choice 5). Limit transport to essential purposes and place a surgical mask on the client during transport (Choice 3). A standard surgical mask does not provide the respiratory protection required for staff entering the room (Choice 6). Hand hygiene remains part of Standard Precautions (Choice 1). Visitors do not receive unrestricted, unprotected access; the facility follows its TB visitor-respirator policy and provides instruction when respirators are used (Choice 4).

## In-depth explanation

Airborne Precautions — TB Bundle
1. Negative-pressure AIIR with ≥6 (preferably 12) air changes/hr, door closed, exhausted outside or HEPA-filtered
2. N95 or PAPR for ALL staff/visitors entering — surgical mask is NOT adequate
3. Client wears surgical mask during any necessary transport
4. Limit transport to medically essential only

Other Airborne Diseases
"My Chicken Hez TB": Measles, Chickenpox (varicella), Hez(Herpes zoster disseminated), TB.

Memory Tip
"N for N95" — Negative pressure room + N95 respirator. Surgical mask is only for the client during transport.

Caution
Discontinue airborne precautions only after 3 consecutive negative AFB sputum smears 8-24 hr apart with at least one early-morning specimen, and clinical improvement on therapy.

## Clinical scenario

Scenario
Adult, suspected active pulmonary TB: 6-week productive cough, hemoptysis, night sweats, 10 lb weight loss. Recent travel to high-prevalence region. Sputum AFB × 3 pending; CXR shows upper-lobe infiltrate.

Initial Isolation Setup
- AIIR assigned, door signage posted, door closed
- N95 fit-test verified for all team members
- Client educated: cover cough, mask during transport, importance of completing 4-drug RIPE therapy
- Public health notification (TB is reportable in all states)
- Contacts identified for screening

RIPE 4-Drug Therapy
Rifampin, Isoniazid (INH), Pyrazinamide, Ethambutol × 2 months → Rifampin + INH × 4 more months. Pyridoxine (B6) given with INH to prevent neuropathy.

When Precautions Continue
Maintain airborne until 3 negative AFB smears + clinical improvement.

## Key concepts

- **Airborne Infection Isolation Room (AIIR)** — Single-occupancy room with monitored negative pressure relative to surrounding areas, ≥6 air changes per hour (≥12 for new construction), with air exhausted directly outside or through HEPA filtration. Door kept closed except for entry/exit. Required for TB, measles, chickenpox, disseminated zoster, SARS, smallpox.
- **N95 respirator vs surgical mask** — N95 filters ≥95% of airborne particles ≥0.3 microns and requires fit-testing. Used to protect the WEARER from airborne pathogens. Surgical mask is for source control (worn by an infectious client) and droplet protection only — does NOT protect staff from airborne droplet nuclei such as TB.
- **TB precaution discontinuation criteria** — Three consecutive negative sputum AFB smears collected 8-24 hours apart, with at least one early-morning sample; clinical improvement on appropriate multi-drug therapy; and adherence to therapy demonstrated. Without all three, the client remains in airborne isolation.

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