# A nurse is caring for a patient with active pulmonary tuberculosis who has been on anti-tuberculosis therapy for 2 weeks. Which nursing action demonstrates the highest priority for infection control and patient safety?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541361  
> language: ko  
> subject: Adult Health

## 문제

A nurse is caring for a patient with active pulmonary tuberculosis who has been on anti-tuberculosis therapy for 2 weeks. Which nursing action demonstrates the highest priority for infection control and patient safety?

## 보기

1. Placing the patient in a private room with standard precautions
2. Ensuring the patient wears a surgical mask when outside the room
3. Administering medications while wearing gloves and gown only
4. Implementing airborne precautions with negative pressure isolation **✔ 정답**

**정답: 4**

## 해설

Airborne precautions with negative pressure isolation are highest priority for active TB to prevent transmission via respiratory droplets. Other options (standard precautions, surgical mask, gloves/gown only) are insufficient for airborne pathogens.

## 심화 해설

Clinical Judgment
This question assesses the nurse's judgment in recognizing the serious adverse effect of drug-induced hepatotoxicity and prioritizing patient safety through immediate reporting and intervention. At week 6 of anti-tuberculosis treatment, the patient presents with clinical symptoms such as jaundice (yellowing of the eyes), fatigue, and nausea, along with markedly elevated liver enzyme levels of ALT 180 U/L, AST 165 U/L. These values exceed 3-5 times the upper limit of normal, posing a risk of progression to fulminant hepatic failure if the medication is continued. Therefore, the safest action is to **immediately hold** all potentially causative drugs and notify the physician to request a thorough evaluation and treatment plan adjustment.

Memory Tip
**H**epatotoxicity from **T**B drugs? **H**old all, **T**ell the doctor! Holding the medication is an important intervention within the **nurse's independent scope of judgment**.

KR vs US
In Korea, there may be more caution about discontinuing a medication without a physician's order change; however, in NGN/US nursing standards, when a clear life-threatening adverse effect occurs, the nurse has the authority and responsibility to hold the administration of that medication even before notifying the physician. 'Notify HCP' goes beyond simply informing; it must be accompanied by the necessary proactive measure (holding the drug).

## 임상 시나리오

Clinical Practice Guide: Airborne Infection Isolation

For a patient with confirmed or suspected active pulmonary tuberculosis, the immediate priority is to initiate **Airborne Precautions** with **negative pressure isolation**. M. tuberculosis is transmitted via droplet nuclei that can remain airborne for hours. Standard precautions and surgical masks are insufficient for source control within the patient's primary care environment.

Key Implementation Steps

- Place the patient in a private, monitored negative pressure room with 6-12 air exchanges per hour.

- Keep the door closed at all times. Verify negative pressure daily using visual indicators or smoke tests.

- All healthcare personnel must wear a fit-tested N95 respirator or powered air-purifying respirator (PAPR) before entering the room.

- Instruct the patient to wear a surgical mask only during necessary transport outside the isolation room.

- Limit patient transport to essential medical procedures; notify the receiving department of the patient's airborne isolation status.

Discontinuation of Precautions

Isolation can be discontinued only after clinical improvement, three consecutive negative acid-fast bacilli (AFB) sputum smears collected 8-24 hours apart, and effective anti-tuberculosis therapy for at least 2 weeks. Consult local infection prevention policy and public health guidelines.

## 핵심 개념

- **Airborne Precautions** — Infection control measures used for pathogens transmitted via droplet nuclei smaller than 5 microns, requiring negative pressure isolation and N95 respirators.
- **Negative Pressure Isolation** — A ventilation system that maintains lower air pressure inside a room, preventing contaminated air from escaping into hallways and other areas.
- **Droplet Nuclei** — Tiny particles 1-5 microns in size that remain suspended in the air for extended periods and can carry M. tuberculosis.
- **N95 Respirator** — A tight-fitting mask that filters at least 95% of airborne particles, required for staff entering a negative pressure room for airborne precautions.

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