# Stage 4 — Generate solutions. Select ALL actions appropriate during the first hour after suspected infectious pulmonary TB is recognized.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372910&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

Stage 4 — Generate solutions. Select ALL actions appropriate during the first hour after suspected infectious pulmonary TB is recognized.

1

Place a mask on the client, use a private room with the door closed while an AIIR is arranged, and limit movement outside the room to medically necessary transport.

2

Use a negative IGRA obtained today to exclude active pulmonary TB, discontinue respiratory isolation, and continue routine pneumonia care while cultures are pending.

3

Restrict entry to essential personnel wearing a fit-tested NIOSH-approved N95 or higher-level respirator and confirm appropriate respiratory protection before entry.

4

Classify every person who entered the building as a close contact and begin latent-TB medication before exposure intensity, symptoms, and medical risk are assessed.

5

Collect at least three sputum specimens 8 to 24 hours apart, including one early-morning specimen, and obtain smear, culture, NAA, and drug-susceptibility testing.

6

Notify the clinician and infection prevention, coordinate with the state or local TB program, and prioritize contacts using shared-air exposure and progression risk.

## Explanation

Appropriate actions: 1, 3, 5, and 6
Client masking, a closed private room pending AIIR placement, limited transport, fit-tested respirator use, complete respiratory sampling, and coordinated risk-based exposure assessment address source, environment, worker protection, diagnosis, and public health. A negative IGRA does not exclude active TB in a symptomatic client. Contact investigation does not label every person in the building identically or begin preventive medication without individual evaluation and TB-program guidance.

## In-depth explanation

Containment
Mask the client and close the door immediately. Use an AIIR as soon as possible and fit-tested N95 or higher respiratory protection for personnel entering.

Diagnosis
Collect the recommended sputum series and use NAA on at least one respiratory specimen when it affects management. Culture and susceptibility testing remain necessary.

Exposure response
Infection prevention and the TB program define and prioritize contacts. The chemotherapy recipient and young child warrant rapid assessment because progression can be especially consequential.

Avoid two shortcuts
An IGRA tests immune sensitization and cannot alone rule out active pulmonary disease. Exposure management is individualized rather than automatic treatment of an entire building.

## Clinical scenario

Scenario (Stage 4 — Generate solutions)
The client is masked and an AIIR is being prepared. The charge nurse coordinates containment, testing, and the first exposure-response steps.

## Key concepts

- **Client mask during transport** — Source control used when medically necessary movement outside the AIIR cannot be avoided.
- **AFB smear and culture** — Smear helps estimate infectiousness rapidly, while culture is the microbiologic standard and enables organism confirmation and further testing.
- **Contact prioritization** — Prompt evaluation of contacts with intense shared-air exposure or high risk of progression, followed by expansion according to investigation findings.

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