# A nurse is caring for a patient with active pulmonary tuberculosis who has been on anti-tuberculosis therapy for 2 weeks. Which nursing action is the MOST important priority to ensure safety in the healthcare environment?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=541854  
> 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 is the MOST important priority to ensure safety in the healthcare environment?

## 보기

1. Monitor the patient's sputum culture results daily to assess treatment effectiveness
2. Ensure the patient wears a surgical mask when being transported outside the negative pressure room **✔ 정답**
3. Administer medications at the same time each day to maintain therapeutic levels
4. Educate the patient about the importance of completing the full course of treatment

**정답: 2**

## 해설

The highest priority is preventing airborne transmission by ensuring the patient wears a surgical mask during transport outside the negative pressure room. Other options are important but do not directly address immediate safety from transmission.

## 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
Management of patients with active pulmonary tuberculosis: 1) Placement in a Negative Pressure Room. 2) Healthcare workers must wear an N95 Respirator. 3) If the patient leaves the isolation room (e.g., for radiography), they must wear a well-fitting surgical mask. This is a key component of source control. 4) Infectivity can generally be discontinued after 2-3 weeks of effective treatment and when 3 consecutive sputum smear tests are negative.
Caution:
A common pitfall in SATA (Select All That Apply) questions is placing 'patient education' or 'medication adherence monitoring' at the same priority level as infection control measures. While treatment completion is crucial from a public health perspective, **the immediate safety priority in an acute care ward setting is always preventing transmission**. Be careful with questions asking for the "MOST important" intervention.

## 핵심 개념

- **활동성 폐결핵 (Active Pulmonary Tuberculosis)** — Infection caused by Mycobacterium tuberculosis, presenting with clinical symptoms (cough, fever, weight loss, etc.) and being contagious. Distinguished from latent tuberculosis infection (LTBI).
- **공기매개 주의 (Airborne Precautions)** — Standard infection control guidelines for infections transmitted through droplet nuclei that can remain suspended in the air for long periods, such as tuberculosis, chickenpox, and measles. Includes negative pressure isolation rooms, N95 masks, and mask wearing during patient transport.
- **음압격리실 (Negative Pressure Room)** — Isolation room where indoor air pressure is kept lower than outside to prevent air from leaking into hallways or other spaces. Used when accommodating patients with airborne pathogens.
- **수술용 마스크 (Surgical Mask)** — Covers the wearer's mouth and nose, used to block large droplets and secretions exhaled by the wearer. During airborne precautions, it is worn during transport for source control of the patient's respiratory secretions.
- **객담 도말/배양 (Sputum Smear/Culture)** — Standard test for tuberculosis diagnosis and infectivity determination. AFB smear quickly detects acid-fast bacilli, while culture identifies the species and confirms drug susceptibility. Loss of infectivity is usually determined by three consecutive negative smears.

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