一位35歲男性最近剛從國外擁擠的庇護所移入。他來到急診室，表示過去三週有嚴重的夜間盜汗、體重減輕 5 公斤且咳血。他的生命徵象為體溫 38.5°C，呼吸 24次/分，血氧 94%，血壓 118/72 mmHg。醫師高度懷疑為活動性肺結核。護理師必須執行哪些特定的感染控制防護介入？（多選題）
A 35-year-old male recently arrived from a crowded shelter overseas. He presents to the ED reporting three weeks of severe night sweats, a 5-kg weight loss, and hemoptysis. His vitals are Temp 38.5°C (101.3°F), RR 24/min, SpO2 94%, and BP 118/72 mmHg. The provider highly suspects active pulmonary tuberculosis. Which specific infection control interventions must the nurse implement? (Select all that apply.)
- AAdmit the patient to a private room equipped with negative-pressure airflow venting directly to the outside.✓ 正解將病人安置在配備負壓氣流並直接向外排放的私人病房。
- BEnsure all healthcare personnel wear a fit-tested N95 respirator mask or higher when entering the room.✓ 正解確保所有醫護人員進入病房時佩戴經密合測試的 N95 呼吸器或更高防護等級的口罩。
- CPlace a specialized N95 particulate respirator on the patient when transporting him to the radiology department.在轉送病人至放射科時，為病人戴上專用的 N95 顆粒物呼吸器。
- DKeep the door to the patient's room open slightly to allow the nursing staff continuous visualization of the patient.將病人房門稍微打開，以便護理人員能持續觀察病人。
- ELimit patient transport out of the room to strictly essential medical purposes only.✓ 正解將病人帶出病房的運輸限制在嚴格必要的醫療目的範圍內。
本題測驗空氣傳染防護（Airborne Precautions）的具體規範。活動性肺結核 (TB) 主要透過小於 5 微米的微粒於空氣中飄浮傳播。依據 CDC 感染防護指引：病患必須被安置在擁有專屬對外排氣的負壓隔離病房（AII room）（選項A正確）；為避免病房內懸浮的含菌微粒飄出，病房房門必須隨時保持「緊閉（Closed）」（選項D錯誤）。所有醫護人員進入該區域必須配戴進行過密合度測試的 N95 等級口罩或 PAPR（選項B正確）。關於運送病患：應盡可能將檢查或治療安排在房內，唯有在醫療「絕對必要（Essential）」時才運出病房（選項E正確）；運送途中，應給予病患配戴「標準外科口罩（Surgical Mask）」來捕捉病患咳出的飛沫即可，病人本身「不需要」戴 N95，因為 N95 呼吸阻力極大且目的是過濾吸入空氣而非呼出空氣（選項C錯在給病患戴 N95）。
This question tests specific airborne precautions. Active pulmonary TB is spread by particles <5 microns that remain suspended in air. CDC guidelines require: (A) a private negative-pressure airborne infection isolation (AII) room vented to the outside; (B) all healthcare personnel must wear fit-tested N95 respirators or higher when entering; (E) limit transport out of the room to strictly essential medical purposes only. The door must remain CLOSED at all times (D is wrong). For transport, the patient wears a SURGICAL mask to capture droplets, NOT an N95 (C is wrong); N95 is designed to filter inhaled air and is unsuitable for source control on a patient.
TB的空氣隔離標準在台美完全一致。對於轉送過程中給病患戴普通外科口罩的觀念，這在 NCLEX 中是常見的高頻錯題陷阱，台灣感染科查核時也極度看重這一點（病患戴外科口罩、護理師戴 N95）。