A nurse is planning care for a client who has a new diagnosis of tuberculosis (TB).

Which intervention should the nurse include in the plan of care?

The client's fetal heart rate is 180 beats per minute.

Rationale: A fetal heart rate of 180 beats per minute is above the normal range of 110 to 160 beats per minute and indicates fetal distress. The nurse should report this finding to the provider immediately and prepare for interventions to improve fetal oxygenation, such as changing the client's position, administering oxygen, or initiating a fluid bolus.

Incorrect options:

A) The client's cervix is dilated to 4 cm. - This is a normal finding for the first stage of labor, which lasts until the cervix is fully dilated to 10 cm.

C) The client's contractions are 5 minutes apart. - This is a normal finding for the active phase of the first stage of labor, which occurs when the contractions are 3 to 5 minutes apart and last for 40 to 60 seconds.

D) The client's amniotic fluid is clear and odorless. - This is a normal finding that indicates the absence of infection or meconium staining in the amniotic fluid.

Place the client in a negative pressure isolation room.

Rationale: Placing the client in a negative pressure isolation room is an intervention that prevents the transmission of TB to other clients and staff. Negative pressure rooms have ventilation systems that create a lower pressure inside the room than outside, causing air to flow into the room and preventing air from escaping.

Incorrect options:

B) Administer a single antitubercular medication daily. - This is an incorrect intervention, as TB requires combination therapy with multiple antitubercular medications to prevent drug resistance and ensure effective treatment. The standard regimen for TB consists of four drugs: isoniazid, rifampin, ethambutol, and pyrazinamide.

C) Obtain three consecutive sputum cultures for acid-fast bacilli (AFB). - This is an intervention that is done before the diagnosis of TB is confirmed, not after. Sputum cultures for AFB are used to identify the presence of Mycobacterium tuberculosis, the causative agent of TB. Three consecutive negative sputum cultures are required to declare the client noninfectious.

D) Instruct the client to wear a surgical mask when outside the room. - This is an incorrect intervention, as surgical masks do not provide adequate protection against TB. The client should wear a high-efficiency particulate air (HEPA) respirator when outside the room, which filters out 99.97% of airborne particles.