A nurse is caring for a client who is at 36 weeks of gestation and is undergoing a nonstress test (NST). The test is nonreactive. Which of the following interventions should the nurse suggest based on the findings?

A. Anterior fontanel closed. The anterior fontanel typically closes between 12 to 18 months of age. Closure at 4 months is premature and may indicate conditions such as craniosynostosis, which can affect skull and brain development. The provider should be notified for further evaluation.
B. Moves objects to mouth. This is an expected developmental milestone for a 4-month-old infant. At this age, infants begin to grasp objects and bring them to their mouths as part of their sensory exploration.
C. Rolls from back to abdomen. Most infants begin rolling from back to abdomen around 5 to 6 months. If a 4-month-old achieves this milestone early, it is not necessarily concerning but rather an indication of advanced motor development.
D. Posterior fontanel closed. The posterior fontanel typically closes between 6 to 8 weeks of age, so closure by 4 months is expected and does not require provider notification.

Rationale for Correct Choices:

• N95 respirator. The client’s presentation of a cough, fatigue, night sweats, weight loss, and positive sputum culture for M. tuberculosis strongly suggests active tuberculosis (TB). Tuberculosis is transmitted through airborne particles, and an N95 respirator is required to protect healthcare workers from inhaling these particles. The N95 mask is specifically designed to filter out small particles, including the Mycobacterium tuberculosis bacteria.
• Gloves. Gloves should be worn when caring for patients with suspected or confirmed TB to prevent contact transmission. While TB is primarily transmitted via airborne particles, gloves are still necessary to protect healthcare workers from coming into contact with bodily fluids such as sputum or any other potentially contaminated materials.

Rationale for Incorrect Options:

• Face shield. A face shield is not required as primary protection for TB. While face shields can protect against splashes and droplets, TB is primarily transmitted via airborne particles, for which an N95 respirator is more appropriate.
• Surgical mask. A surgical mask is not sufficient for protecting healthcare workers against tuberculosis because it does not filter out small airborne particles like the N95 respirator does. Surgical masks are primarily intended for droplet precautions, but tuberculosis is spread through airborne transmission, necessitating an N95 mask for adequate protection.

• Gown. A gown is not required in this situation unless the patient has other symptoms or conditions that increase the risk of contamination, such as excessive wound drainage or the potential for body fluid splashes. For TB transmission, the primary concern is airborne transmission, and appropriate PPE focuses on respiratory protection (N95) and gloves for contact precautions.