# An adult with productive cough, night sweats, and weight loss is being evaluated for infectious pulmonary tuberculosis. Which actions are appropriate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=368584&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

An adult with productive cough, night sweats, and weight loss is being evaluated for infectious pulmonary tuberculosis. Which actions are appropriate? Select all that apply.

1

Limit transport to medically necessary purposes; during transport, have the client wear a surgical mask, follow cough etiquette, and notify the receiving department

2

Allow staff to substitute a surgical mask for a respirator when entering the airborne infection isolation room because both provide equivalent protection

3

Before entering the room, wear a fit-tested, NIOSH-approved N95 or higher-level respirator and perform a user seal check each time it is donned

4

Teach the client to cover coughs and sneezes, discard tissues without contaminating the hands, perform hand hygiene, and keep the room door closed

5

Discontinue airborne precautions after one negative acid-fast bacillus sputum smear because this result excludes infectious pulmonary tuberculosis

6

Place the client in a single-person airborne infection isolation room with monitored negative pressure and appropriate air handling

## Explanation

Suspected infectious pulmonary tuberculosis requires Airborne Precautions in an airborne infection isolation room with negative pressure and appropriate ventilation, with the door closed (Choice 6). Staff entering wear a fit-tested, NIOSH-approved N95 or higher-level respirator and perform a user seal check with each use (Choice 3); a surgical mask does not replace a respirator for room entry (Choice 2). Limit transport, use a surgical mask on the client for source control, reinforce cough etiquette, and alert the receiving department (Choices 1 and 4). One negative sputum smear does not exclude infectious tuberculosis. Discontinuation follows current public-health and facility criteria based on the clinical likelihood, diagnostic results, and response to treatment rather than a single result (Choice 5).

## In-depth explanation

Airborne Precautions for TB
1. AIIR: single-occupancy, negative pressure, 6-12 air changes/hr, exhaust outside or HEPA, door closed
2. N95 respirator (NIOSH-approved) or PAPR for staff — fit-tested annually, user seal check every donning
3. Surgical mask on the CLIENT (source control) for any necessary transport
4. Limit room entries; cohort care to limit exposed staff
5. Client education: cover cough, dispose tissues, hand hygiene, stay in room with door closed
6. Posted signage at door

N95 vs Surgical Mask
- N95: filters ≥95% of particles ≥0.3 µm; tight seal; protects WEARER from aerosols; required for staff entering AIIR
- Surgical mask: source control (captures wearer's droplets); does NOT provide aerosol protection; placed on the CLIENT during transport

Discontinuation Criteria for TB Airborne Precautions
Typically: three negative sputum AFB smears collected ≥8 hours apart with at least one early-morning specimen, AND clinical improvement on effective therapy, AND clinical judgment of the team. Some facilities require negative NAAT or molecular tests. ONE negative smear is NOT sufficient.

Active TB Treatment Reminder
RIPE: Rifampin, Isoniazid (with vitamin B6/pyridoxine to prevent peripheral neuropathy), Pyrazinamide, Ethambutol — initial 4-drug × 2 months, then 2-drug (RI) × 4 more months for drug-susceptible TB.

Memory Tip
"AIIR + N95 + Mask the CLIENT for transport; THREE negative smears to discontinue"

## Clinical scenario

Scenario
ED; adult with productive cough + night sweats + weight loss, evaluated for active pulmonary TB; 3 sputum AFB smears pending.

Action Map
1. AIIR: negative pressure, 6-12 ACH, HEPA/exhaust, door closed
2. N95 fit-tested + seal check for staff
3. Transport: surgical mask on the CLIENT (source control)
4. Client education: cover cough, hand hygiene, stay in room
5. Discontinue only after 3 negative AFB smears + clinical improvement

Avoid
- Surgical mask substitute for N95 (staff)
- Discontinuing isolation after one negative smear
- Leaving door open
- Group room placement

## Key concepts

- **Airborne Infection Isolation Room (AIIR)** — Single-occupancy room engineered for airborne isolation: negative pressure relative to surrounding areas (verified daily), at least 6-12 air changes per hour, air exhausted directly outside or through HEPA filtration before recirculation, door kept closed. Used for clients with confirmed or suspected airborne pathogens — TB, measles, varicella, suspected SARS-CoV-2 during aerosol-generating procedures, etc. Posted signage and limited entry; staff use N95 or PAPR.
- **N95 Respirator vs Surgical Mask** — N95 respirator: NIOSH-approved, filters at least 95% of airborne particles ≥0.3 micrometer; tight seal achieved by fit testing (annually) and user seal check at every donning; protects the WEARER from inhaling aerosols. Surgical mask: provides source control (captures the wearer's respiratory droplets) but does NOT seal tightly and does NOT protect against airborne aerosols. For TB: staff entering the AIIR wear N95; the client wears a surgical mask only during necessary transport to capture their droplet nuclei.
- **TB Airborne Precautions Discontinuation Criteria** — Active pulmonary TB airborne precautions are discontinued when active TB is ruled out OR the client is no longer infectious. Typical ruling-out criteria: three sputum AFB smears collected ≥8 hours apart (with at least one early-morning specimen) all negative, AND clinical improvement, AND clinical judgment of the infection prevention team. Many facilities also require negative molecular testing (NAAT). For confirmed TB on therapy: typical criteria include effective therapy ≥2 weeks, three negative AFB smears, and clinical improvement; specific criteria vary by facility/CDC guidance.

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