# Stage 2 — Analyze cues. Complete the four statements that convert suspected pulmonary TB into immediate isolation, respiratory protection, and diagnostic actions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372903&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

Stage 2 — Analyze cues. Complete the four statements that convert suspected pulmonary TB into immediate isolation, respiratory protection, and diagnostic actions.

Airborne precautions begin when pulmonary TB is ::선택::suspected from the clinical patternconfirmed by three culturesproven by a positive IGRA, not only after laboratory confirmation. While awaiting AIIR transfer, the client should ::선택::wear a fit-tested N95 continuously in bedwear a mask for source control while the door remains closedremain unmasked so sputum production can be observed. Personnel entering the room should use ::선택::a fit-tested NIOSH-approved N95 or higher-level respiratora surgical mask only if the client is coughingstandard precautions until the NAAT result returns. Respiratory testing should include ::선택::one IGRA followed by no respiratory specimensone smear only if fever persistsat least three sputum specimens 8 to 24 hours apart including one early-morning specimen, with NAA testing on at least one respiratory specimen when indicated.

## Explanation

Four governing rules
Airborne precautions begin when pulmonary TB is suspected. The client wears a mask for source control while the door is closed and AIIR transfer is arranged. Personnel entering use a fit-tested NIOSH-approved N95 or higher-level respirator. Diagnostic evaluation includes at least three sputum specimens 8 to 24 hours apart, with one early-morning specimen, plus NAA testing on at least one respiratory specimen when indicated.

## In-depth explanation

Suspicion is the trigger
Infection-control action precedes confirmation. An infection test such as IGRA cannot rule out active pulmonary disease in a symptomatic client.

Source control and worker protection differ
The client wears a mask and remains behind a closed door while awaiting AIIR placement. Personnel entering use a fit-tested N95 or higher level of respiratory protection.

Build the diagnostic set
At least three sputum specimens are examined at 8-to-24-hour intervals, including one early-morning specimen. NAA testing rapidly detects M. tuberculosis complex but does not replace smear, culture, susceptibility testing, or genotyping.

NCLEX rule
Isolate on suspicion; confirm in parallel.

## Clinical scenario

Scenario (Stage 2 — Analyze cues)
The nurse translates the symptom, imaging, and exposure pattern into four operational infection-control rules.

## Key concepts

- **Source control** — Masking the client to reduce release of infectious material while isolation placement and necessary transport are managed.
- **Respiratory protection** — A fit-tested NIOSH-approved N95 or higher-level respirator used by personnel entering the care space of a client with suspected pulmonary TB.
- **Nucleic acid amplification test** — A rapid test for M. tuberculosis complex on a respiratory specimen that informs management but does not replace smear, culture, and susceptibility testing.

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