# Situation: A 36-year-old woman comes to the Rural Health Unit (RHU), which provides free tuberculosis (TB) care under the National Tuberculosis Program (NTP), because of cough for 3 weeks, afternoon fevers, night sweats, and weight loss. She has type 2 diabetes controlled with metformin. She has no known liver disease and is not pregnant. The nurse identifies her as a presumptive TB case. According to Department of Health (DOH) guidelines under the NTP, which test is preferred as the initial diagnostic test?

> source: MyMerci (mymerci.kr)  
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> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 36-year-old woman comes to the Rural Health Unit (RHU), which provides free tuberculosis (TB) care under the National Tuberculosis Program (NTP), because of cough for 3 weeks, afternoon fevers, night sweats, and weight loss. She has type 2 diabetes controlled with metformin. She has no known liver disease and is not pregnant.

The nurse identifies her as a presumptive TB case. According to Department of Health (DOH) guidelines under the NTP, which test is preferred as the initial diagnostic test?

## 보기

1. Rapid molecular test on a sputum specimen **✔ 정답**
2. Direct sputum smear microscopy for acid-fast bacilli
3. Sputum culture with drug-susceptibility testing
4. Tuberculin skin test read after 48 to 72 hours

**정답: 1**

## 해설

Under the DOH National Tuberculosis Program, a rapid molecular test (a nucleic acid amplification test) on sputum is the preferred initial diagnostic test for presumptive TB; it detects the organism within hours and also shows rifampicin resistance. Sputum smear microscopy is now used mainly to monitor treatment, and culture is the reference standard but takes weeks.

## 심화 해설

The preferred initial test
Under the Department of Health (DOH) National Tuberculosis Program (NTP), the preferred initial diagnostic test for a presumptive TB case is a rapid molecular test on a sputum specimen. This is a nucleic acid amplification test that detects the genetic material of Mycobacterium tuberculosis. It gives results within hours and, importantly, also shows whether the organism is resistant to rifampicin. A rapid molecular test on sputum is the preferred first test for this woman with cough, fever, night sweats, and weight loss.

Why the molecular test is preferred
Compared with smear microscopy, a rapid molecular test is more sensitive, so it detects more cases, including some with fewer bacteria in the sputum. Detecting rifampicin resistance at the time of diagnosis means that drug-resistant TB can be treated correctly from the start rather than after months of ineffective therapy. Fast and accurate diagnosis shortens the time a person remains infectious in the community. Her diabetes makes TB more likely and can make the course more severe, which adds to the value of a quick, reliable test.

Where the other tests fit

| Test | Role in the NTP |
| --- | --- |
| Rapid molecular test | Preferred initial diagnostic test; also detects rifampicin resistance |
| Sputum smear microscopy | Mainly used to monitor treatment response |
| Sputum culture with drug-susceptibility testing | Reference standard; results take weeks |
| Tuberculin skin test | Shows infection, not disease; cannot separate latent from active TB |

Watch out! Older textbooks list direct sputum smear microscopy as the first test, and many review materials still do. Current DOH guidance under the NTP has moved to rapid molecular testing as the preferred initial test. Culture remains important as the reference standard and for full drug-susceptibility testing, but its slow turnaround makes it unsuitable as the first test. The tuberculin skin test is also affected by prior BCG vaccination, which is given at birth in the Philippines and can cause a false-positive result.

Nursing role
The nurse explains how to produce a good sputum specimen: rinse the mouth with water, take deep breaths, and cough deeply from the chest into the container, in an open or well-ventilated area away from others. The nurse checks that the container is labeled correctly and sent promptly, and advises her to cover her mouth when coughing while awaiting results.

Exam takeaway
For presumptive TB under the NTP, the preferred initial test is a rapid molecular test on sputum, which also detects rifampicin resistance. Key point! Smear microscopy is now used mainly for treatment monitoring.

## 임상 시나리오

Initial Test for Presumptive TBNTP diagnostic pathway at the RHU
The preferred initial test is a rapid molecular test on sputum. It gives results within hours and detects rifampicin resistance.

Smear microscopy is used mainly to monitor treatment; culture is the reference standard but takes weeks.

Teach deep coughing for a good sputum sample, collected in a well-ventilated area, and cough etiquette while awaiting results.

CautionThe tuberculin skin test does not diagnose active TB, and BCG at birth can cause a false-positive result.

## 핵심 개념

- **Presumptive TB** — A person with symptoms or signs suggestive of TB who needs diagnostic testing.
- **Rapid molecular test** — A nucleic acid amplification test that detects TB bacteria and rifampicin resistance within hours.
- **Rifampicin resistance** — Resistance of TB bacteria to rifampicin, a key first-line drug, which changes the treatment regimen.
- **Sputum smear microscopy** — Staining sputum to look for acid-fast bacilli, used in the NTP mainly to monitor treatment.

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