# A 32-year-old client is admitted with suspected pulmonary tuberculosis. Review the trend and answer the evaluation questions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=568340&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

A 32-year-old client is admitted with suspected pulmonary tuberculosis. Review the trend and answer the evaluation questions.

| Time | Data |
| --- | --- |
| Day 0 08:00 | event: Client placed in standard private room; airborne precautions not yet initiated. |
| Day 0 10:30 | event: Chest x-ray shows cavitary lesion; client transferred to AIIR. |
| Day 0 14:00 | event: NAAT positive for M. tuberculosis; RIPE started. |
| Day 14 | event: Three negative AFB smears, clinical improvement, 14 days of RIPE with adherence. |

Q1. Which phase of the client's care is most concerning regarding infection control?

Delay in starting RIPE until NAAT confirmation
Collection of AFB smears on consecutive days
Discharge planning with public health DOT
Initial placement in standard private room before AIIR transfer

Q2. On day 14, which finding is the strongest indicator that airborne precautions can be discontinued?

Completion of 14 days of RIPE with documented adherence
NAAT positive for M. tuberculosis complex
Client reports less cough and is afebrile for 24 hours
Three consecutive negative AFB smears on different days

Q3. What is the priority action before discontinuing airborne precautions?

Administer a tuberculin skin test to household contacts
Obtain a chest x-ray to confirm resolution of cavitary lesion
Verify that the client has had three negative AFB smears on different days
Ensure the client has a private room at home

## Explanation

The trend shows progression from initial placement in a standard private room to AIIR transfer, confirmation of M. tuberculosis, initiation of RIPE, and three consecutive negative AFB smears with clinical improvement. By day 14, the client meets CDC criteria for discontinuation of airborne precautions.

## In-depth explanation

Quick answer
On day 14, the client has three negative AFB smears, clinical improvement, and 14 days of effective therapy, meeting CDC criteria for discontinuing airborne precautions.

Why this is correct
The trend demonstrates that all three CDC criteria for discontinuation of airborne precautions are met by day 14: three consecutive negative AFB smears on different days, clinical improvement, and at least 2 weeks of effective therapy with documented adherence.

Clinical picture
Airborne precautions for pulmonary TB can be discontinued when the client has three negative AFB sputum smears collected on different days, clinical improvement, and at least 2 weeks of effective therapy with documented adherence.

Memory hook
Remember the '3-2-1' rule: 3 negative smears, 2 weeks of therapy, 1 clinical improvement.

NCLEX decision rule
CDC guidelines state that airborne precautions for TB can be discontinued when all three criteria are met.

Why the alternatives are wrong
Discontinuing precautions before all criteria are met risks transmission. Continuing precautions unnecessarily may delay discharge and increase costs, but is not unsafe.

Sources
1NCSBN 2026 NCLEX-RN Test Plan
2CDC Tuberculosis Screening and Testing of Health Care Personnel

## Clinical scenario

Day 0 08:00: Client placed in standard private room pending airborne infection isolation. Day 0 10:30: Chest x-ray shows right upper lobe cavitary lesion; client transferred to AIIR. Day 0 14:00: NAAT positive for M. tuberculosis complex; RIPE started. Day 1 08:00: First of three sputum AFB smears collected; result negative. Day 2 08:00: Second AFB smear negative; client reports less cough. Day 3 08:00: Third AFB smear negative; client afebrile for 24 hours. Day 14: Client has completed 14 days of RIPE with documented adherence; all three smears negative; clinical improvement noted. Discharge planning initiated with public health DOT.

## Key concepts

- **AIIR** — Airborne infection isolation room with negative pressure, used for clients with suspected or confirmed airborne infections such as tuberculosis.
- **AFB smear** — Acid-fast bacilli smear, a microscopic test used to detect mycobacteria in sputum; three negative smears on different days are required to discontinue airborne precautions for pulmonary TB.
- **RIPE** — Rifampin, isoniazid, pyrazinamide, and ethambutol; the standard four-drug regimen for initial treatment of active tuberculosis.

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