The nurse is caring for a client with known HIV who is newly admitted to the hospital with fever, night sweats, and severe cough. Laboratory results include a CD4+ cell count of 180/mm cubed and the client had a negative tuberculosis (TB) skin test 4 days ago. What action would the nurse take first.

Choice A rationale Droplet Precautions are used for diseases transmitted by large respiratory droplets, such as influenza or meningococcal disease, which generally travel about 3 to 6 feet before falling. While the client has a severe cough, tuberculosis is transmitted via smaller airborne particles, not larger droplets. Therefore, Droplet Precautions alone would not provide adequate protection against Mycobacterium tuberculosis. Choice B rationale The client presents with symptoms (fever, night sweats, severe cough) highly suggestive of active tuberculosis (TB). Although the TB skin test was negative, a client who is severely immunocompromised with a low CD4+ cell count (normal range for adults is 500 to 1,200 cells/mm³) may have an anergic response (inability to mount a reaction). Therefore, Airborne Precautions, which require a negative-pressure room and N95 mask, are the priority action to prevent the spread of potentially active pulmonary TB. Choice C rationale Standard Precautions are the minimum infection prevention practices that apply to all patient care and include hand hygiene and personal protective equipment (PPE) for contact with blood, body fluids, and non-intact skin. Given the signs and symptoms suggestive of an airborne disease like TB in an immunocompromised client, Standard Precautions are insufficient and would put staff and other clients at unnecessary risk of transmission. Choice D rationale Protective isolation (or neutropenic precautions) is designed to protect an immunocompromised client from microorganisms carried by others. The nurse's immediate priority, however, is to prevent transmission from the client to others, as the client presents with an infectious disease that poses a community health risk. Therefore, Airborne Precautions take precedence.