A patient admitted with chronic obstructive pulmonary disease 4 days ago was placed on a nasal cannula at 2 liters per minute.

Upon assessment of the patient, his nares are crusted with secretions of dried blood and mucus.

What intervention is priority by the nurse?

Choice A rationale

Active laryngeal tuberculosis is highly contagious and is spread through small airborne droplets when the patient coughs, speaks, or sneezes. Because these particles can remain suspended in the air for long periods, the patient must be placed in an Airborne Infection Isolation Room. These rooms have a special ventilation system that maintains negative pressure, ensuring that air flows into the room from the hallway and is exhausted directly to the outside through a high-efficiency particulate air filter.

Choice B rationale

While gowns may be used during specific procedures where splashing is expected, the primary mode of transmission for tuberculosis is airborne, not contact. The most critical piece of personal protective equipment for staff is a fit-tested N95 respirator or a higher-level respirator, which filters out the tiny tubercle bacilli. Relying on gowns for staff and visitors without emphasizing respiratory protection would be an insufficient and unsafe practice for managing a patient with active, infectious laryngeal tuberculosis.

Choice C rationale

Removing personal protective equipment inside the hallway is incorrect for airborne precautions. The nurse should remove most PPE inside the room or in an anteroom to prevent the spread of contaminants. However, the N95 respirator must remain on until the nurse has completely exited the room and closed the door. Removing the respirator while still in the presence of potentially contaminated air, or handling PPE inappropriately in the public hallway, increases the risk of environmental contamination and exposure.

Choice D rationale

A semi-private room is entirely inappropriate for a patient with suspected active tuberculosis. Tuberculosis requires airborne precautions, not just droplet precautions. Droplet precautions are for larger particles that do not remain suspended in the air and only travel short distances. Airborne pathogens like Mycobacterium tuberculosis can travel much further and require negative pressure and specialized filtration. Placing such a patient in a semi-private room would expose other patients and staff to a high risk of infection. .

Choice A rationale

Antibiotics are pharmacological agents designed to inhibit the growth of or destroy bacteria, not to serve as a public health barrier for viral transmission. Acute rhinitis is almost exclusively caused by viruses such as rhinovirus or coronavirus. Since these medications have no effect on viral replication or shedding, they do not prevent the spread of a cold to other people. Education must focus on hand hygiene and respiratory etiquette to reduce transmission of viral pathogens.

Choice B rationale

The timing of antibiotic administration is irrelevant to the treatment of a viral cold. Antibiotics do not become ineffective simply because symptoms have already developed; rather, they are fundamentally ineffective against viruses at any stage of the illness. Using antibiotics "just in case" or after symptoms start contributes significantly to the global crisis of antibiotic resistance. The nurse must clarify that the nature of the pathogen, not the timing of the dose, dictates the treatment.

Choice C rationale

Antibiotics target specific bacterial structures or metabolic pathways, such as cell wall synthesis or 30S ribosomal subunits, which are absent in viruses. Viral infections like acute rhinitis involve intracellular replication that antibiotics cannot interrupt. Giving antibiotics for a virus is clinically inappropriate and exposes the patient to unnecessary side effects, such as Clidostridioides difficile infections or allergic reactions. Normal white blood cell counts are 5,000 to 10,000 cells/mcL, and viral infections often do not elevate these like bacterial ones.

Choice D rationale

Immunosuppressed individuals are at a higher risk for secondary bacterial infections, but antibiotics are still not used to treat primary viral rhinitis in this population. While a provider might be more vigilant for complications, the fundamental rule remains that viral triggers do not respond to antibacterial therapy. Prophylactic use is generally discouraged unless there is clear evidence of a concurrent bacterial process. Treatment for viruses focuses on supportive care regardless of the patient's underlying immune status.