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Difficulty: MediumStandard and Transmission-Based Precautions

A registered nurse is planning care and assigning tasks for a client who is admitted with active pulmonary tuberculosis and requires airborne precautions. Which of the following actions by the healthcare team indicate adherence to appropriate protocols? (Select all that apply.)

  1. The nurse places the client in a negative-pressure isolation room that exhausts air directly to the outside environment.Answer
  2. B
    The unlicensed assistive personnel wears a standard surgical mask when entering the room to deliver a meal tray.
  3. C
    The nurse delegates the task of educating the client's visitors on how to don respiratory protection to the unlicensed assistive personnel.
  4. The nurse places a standard surgical mask over the client's mouth and nose before transporting them to the radiology department.Answer
  5. E
    A healthcare team member removes their fit-tested N95 respirator inside the client's room immediately before exiting.
  6. The nurse maintains the client's room door securely closed at all times except during personnel entry and exit.Answer

Answer

The appropriate actions are placing the client in a negative-pressure isolation room, applying a standard surgical mask to the client during transport, and keeping the room door securely closed.
Appropriate management of a client with active pulmonary tuberculosis requires strict adherence to airborne precautions. This includes placing the client in an Airborne Infection Isolation Room (AIIR) that features negative air pressure and exhausts air directly to the outside environment. The door to this room must remain securely closed at all times to maintain the required pressure gradient. During essential transport, the client must wear a standard surgical mask to effectively contain infectious respiratory secretions at the source.

Step-by-Step Solution

1
Identify the transmission route for active pulmonary tuberculosis.
Tuberculosis is transmitted via airborne droplet nuclei.
Knowing the precise transmission route dictates the required tier of infection control precautions.
2
Determine the necessary environmental controls and personal protective equipment (PPE) for airborne precautions.
Requirements include a negative-pressure isolation room, keeping the door closed, and staff wearing fit-tested N95 respirators.
These specific measures prevent the escape of airborne pathogens and protect healthcare workers from inhaling suspended particles.
3
Evaluate the protocols for client transport and PPE doffing.
The client must wear a standard surgical mask during transport, and staff must remove their N95 respirators only after exiting the room.
A surgical mask on the client contains infectious secretions. Removing the N95 outside the room ensures the worker does not inhale suspended particles just before leaving.
4
Assess the delegation of tasks to unlicensed assistive personnel.
Educating visitors is identified as a task that cannot be delegated.
Initial and ongoing health education is strictly within the registered nurse's scope of practice.

Key Concept

Airborne precautions require placing the client in a negative-pressure room with the door closed, ensuring staff wear N95 respirators (which must be removed outside the room), and having the client wear a standard surgical mask during transport. Additionally, the registered nurse cannot delegate patient or visitor education to unlicensed personnel.
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Topics

Standard and Transmission-Based Precautions

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