In assessing a homeless shelter client who is coughing severely, what question should be prioritized?

• A. Have you been having night sweats or hemoptysis
• B. Do you smoke
• C. Do you drink alcohol
• D. What is your daily routine

Answer: (A)

When a homeless shelter client presents with severe coughing, the immediate priority is to identify signs that suggest a contagious pulmonary infection, especially active tuberculosis. Night sweats or coughing up blood are red flags for TB and indicate potential systemic illness and contagiousness. If these symptoms are present, you can promptly initiate isolation precautions and TB testing (sputum analysis, chest X-ray, public health notification), which is crucial in a setting where transmission can spread quickly.

While questions about smoking, alcohol use, or daily routines provide useful context for overall health and risk factors, they do not signal the same urgent risk of contagious infection.