You are caring for a patient with a positive TB skin test (15 mm), productive cough for two months, and unintentional weight loss. Which of the following orders will assist with the diagnosis of active tuberculosis? (Select all that apply)

Choice A reason: Collecting sputum specimens for acid-fast bacilli (AFB) testing over three consecutive mornings is critical for diagnosing active tuberculosis. AFB smear and culture detect Mycobacterium tuberculosis in sputum, confirming pulmonary TB. Morning samples yield higher bacterial loads, improving diagnostic sensitivity, as the bacteria accumulate overnight in the respiratory tract. Choice B reason: Monitoring vital signs every shift is important for assessing patient stability but does not directly aid in diagnosing active tuberculosis. Fever or tachycardia may suggest infection, but these are non-specific and not confirmatory. Diagnostic tests like AFB, imaging, or serology are needed to identify Mycobacterium tuberculosis as the cause of symptoms. Choice C reason: Ordering a complete blood count, basic metabolic panel, HIV viral load, and VDRL supports TB diagnosis. CBC may show anemia or leukocytosis, BMP assesses organ function, HIV testing identifies immunosuppression increasing TB risk, and VDRL rules out syphilis, which can mimic TB symptoms. These provide a comprehensive diagnostic workup. Choice D reason: A chest X-ray is essential for diagnosing active pulmonary tuberculosis. It reveals characteristic findings like cavitary lesions, infiltrates, or hilar lymphadenopathy in the lungs. These radiographic signs, combined with clinical symptoms and AFB testing, confirm the presence of active TB, particularly in patients with cough and weight loss. Choice E reason: Admitting the patient to a negative pressure room is crucial for diagnosing and managing suspected active TB. It prevents airborne transmission of Mycobacterium tuberculosis to others, ensuring safety while diagnostic tests like AFB and chest X-ray are conducted. This isolation is standard for suspected infectious TB cases.