# Stage 1 — Recognize cues. Review the 0700 handoff. Highlight the findings that require the nurse's immediate follow-up. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617302&lang=en > language: en > subject: Standard/Transmission-Based Precautions/Surgical Asepsis > category: SIPC ## Question Stage 1 — Recognize cues. Review the 0700 handoff. Highlight the findings that require the nurse's immediate follow-up. 0700 handoff. Mr. R, a 38-year-old man who moved from the Philippines 14 months ago, was admitted six hours ago to a general medical room for presumed community-acquired pneumonia. He reports a three-week productive cough with intermittent blood-streaked sputum, a 12-pound weight loss over six weeks, drenching night sweats, and fatigue. During the morning interview he adds that a coworker has pulmonary TB, diagnosed last month. Overnight, ceftriaxone and azithromycin were started and blood cultures were collected; his wife and two children visited. He shares the room and bathroom with Mr. S, age 72, a roommate on chemotherapy. At 0630: temperature 38.1 C (100.6 F), heart rate 102 beats/min, respirations 22 breaths/min, BP 118/72, and SpO2 93 percent on 2 L/min; these values are unchanged from admission. His WBC count of 12.4 x 10^9/L is noted. The 0500 chest radiograph, read at 0640, shows a right-upper-lobe cavity with surrounding infiltrate. No airborne order is active, and staff wore surgical masks overnight. ## Explanation The findings that change the plan are the recent contact with a coworker who has TB, the cavitary right-upper-lobe lesion, a roommate who is immunocompromised by chemotherapy, and staff who used surgical masks rather than respirators. Together they make pulmonary TB a working concern that needs airborne controls and an exposure assessment now. The fever, tachycardia, tachypnea, oxygen need, and leukocytosis overlap with bacterial pneumonia, are unchanged since admission, and are already being treated, so they do not by themselves change the isolation decision. ## In-depth explanation Quick answer Highlight **a coworker has pulmonary TB**, **right-upper-lobe cavity**, **a roommate on chemotherapy**, and **staff wore surgical masks**. Why this is correct A subacute cough with hemoptysis and weight loss becomes an infection-control problem when two findings are added: known infectious contact and an upper-lobe cavity. The other two correct findings show who is currently exposed and unprotected: an immunocompromised roommate sharing the air and bathroom, and staff wearing surgical masks, which do not protect the wearer from droplet nuclei. Each requires action (source control, AIIR, respirators, notification, exposure reconstruction) without waiting for smear or NAAT results. Easy analogy or mental picture Think of a smoke alarm: the fever and fast heart rate tell you something is burning, but the cavity and the TB contact tell you the fire can spread through the air vents, and the roommate and unprotected staff are the people standing in the smoke. Memory hook Cavity + contact = airborne; then ask who breathed the air and what they wore. NCLEX decision rule When findings could fit either a common and a transmissible diagnosis, prioritize the cues that change infection-control action and identify who is exposed, rather than the shared nonspecific signs already being treated. Why the other choices are wrong **Temperature 38.1 C (100.6 F)**, **heart rate 102 beats/min**, **respirations 22 breaths/min**, **SpO2 93 percent on 2 L/min**, and **WBC count of 12.4 x 10^9/L** are tempting because they look abnormal, but they are shared by bacterial pneumonia and TB, have not changed since admission, and are being managed; they do not distinguish the diagnosis or trigger isolation. **Ceftriaxone and azithromycin were started** and **blood cultures were collected** are appropriate pneumonia care that can falsely reassure; empiric pneumonia therapy does not treat TB or reduce the need for airborne precautions. References 1CDC — Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings (MMWR)Airborne precautions begin when TB is suspected; surgical masks are not respiratory protection for staff; exposure assessment of contacts ## Clinical scenario Scenario (Stage 1 — Recognize cues) A client admitted overnight for presumed pneumonia has a newly read chest radiograph and discloses a recent TB contact while sharing a non-isolation room. ## Key concepts - **Airborne infection isolation room (AIIR)** — A single-patient negative-pressure room used for clients with suspected or confirmed airborne infections such as pulmonary TB. - **Cavitary lesion** — A gas-filled space within a lung infiltrate; in the upper lobes it is a classic imaging feature of reactivation pulmonary TB with high infectiousness. - **N95 respirator** — A fit-tested NIOSH-approved respirator that protects the wearer from airborne particles, unlike a surgical mask, which provides source control. ## Related questions - [A nurse is caring for a client newly admitted with suspected methicillin-resistant Staphyl…](https://mymerci.kr/pages/nclex_q.php?qn_id=360517&lang=en) - [A nurse is about to enter the room of a client with Clostridioides difficile infection dur…](https://mymerci.kr/pages/nclex_q.php?qn_id=361226&lang=en) - [A 22-year-old female client presents to the emergency department with a 4-week history of …](https://mymerci.kr/pages/nclex_q.php?qn_id=361677&lang=en) - [A 65-year-old client admitted to the medical ICU with sepsis and acute delirium has just p…](https://mymerci.kr/pages/nclex_q.php?qn_id=361679&lang=en) - [A new graduate registered nurse (RN) on a medical unit just hung an intravenous antibiotic…](https://mymerci.kr/pages/nclex_q.php?qn_id=361710&lang=en) - [A nurse is caring for a client newly admitted with active Clostridioides difficile infecti…](https://mymerci.kr/pages/nclex_q.php?qn_id=363996&lang=en) - [A nurse is caring for an adult client newly admitted with suspected active pulmonary tuber…](https://mymerci.kr/pages/nclex_q.php?qn_id=366306&lang=en) - [A nurse cares for a client newly admitted with a positive surveillance culture for vancomy…](https://mymerci.kr/pages/nclex_q.php?qn_id=366709&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=617302&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=617302&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=617302&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=617302&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=617302&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._