TB Nclex

The nurse cares for a patient with tuberculosis who is taking isoniazid and rifampin. About which data found in the patient's health history is the nurse most concerned? 1 Hepatitis B 2 Asthma attacks 3 Rheumatic fever 4 Allergy to penicillin

1 Hepatitis B Isoniazid (INH) and rifampin are tuberculosis medications that are metabolized in the liver and are extremely toxic. They are contraindicated in the patient with a history of liver disease, including any form of hepatitis. A history of asthma, rheumatic fever, or allergy to penicillin is not a contraindication to the administration of INH and rifampin.

The nurse is caring for the patient with a productive cough. The nurse collects a sputum specimen for an acid-fast bacillus (AFB) smear. What collection time by the nurse is most appropriate? 1 6 AM 2 12 noon 3 6 PM 4 9 PM

The correct answer is 6 AM because if the patient has a productive cough, early morning is the ideal time to collect sputum specimens for an AFB smear because secretions collect during the night. Twelve noon, 6 PM, and 9 PM are incorrect, because all of these times are afternoon or evening hours and the amount of secretions for the specimen may not be optimal.

The physician determines that a client has been exposed to someone with tuberculosis. The nurse expects the physician to order which of the following? a) Daily oral doses of isoniazid (Nydrazid) and rifampin (Rifadin) for 6 months to 2 years b) Isolation until 24 hours after antitubercular therapy begins c) Nothing, until signs of active disease arise d) Daily doses of isoniazid, 300 mg for 6 months to 1 year

d) Daily doses of isoniazid, 300 mg for 6 months to 1 year

A woman whose husband was recently diagnosed with active pulmonary tuberculosis (TB) is a tuberculin skin test converter. Management of her care would include: a) scheduling her for annual tuberculin skin testing. b) placing her in quarantine until sputum cultures are negative. c) gathering a list of persons with whom she has had recent contact. d) advising her to begin prophylactic therapy with isoniazid (INH).

d) advising her to begin prophylactic therapy with isoniazid (INH).

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's teenage daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? a) 3 to 5 days b) 1 to 3 weeks c) 2 to 4 months d) 6 to 12 months

d.

The nurse cares for an immunocompetent patient. Which clinical manifestation is most indicative of pulmonary tuberculosis? 1 Mucopurulent sputum 2 Diarrhea and fatigue 3 Lymph node enlargement 4 Hematuria and dehydration

1 Mucopurulent sputum A cough that progresses in frequency and produces mucoid or mucopurulent sputum is the most common symptom of pulmonary tuberculosis (TB). Diarrhea, hematuria, and dehydration are manifestations not directly associated with pulmonary TB. Fatigue and lymph node enlargement may be seen with TB but are not as indicative as is the production of mucopurulent sputum.

The nurse cares for a patient with a diagnosis of tuberculosis. Which assessment finding best indicates that the patient has been following the prescribed treatment plan? 1 Negative sputum cultures 2 Clear breath sounds bilaterally 3 Decrease in the number of coughing episodes 4 Conversion of the Mantoux test from positive to negative

1 Negative sputum cultures A patient's sputum is expected to convert to negative within three months of the beginning of treatment. If it does not, the patient is either not taking the medication or has drug-resistant organisms. Bilaterally clear breath sounds and a decrease in coughing are good indications that the patient is following the prescribed plan, but they are not as confirmatory as negative sputum cultures. Once a person has been exposed to the tuberculosis-causing organism, the Mantoux test will always elicit a positive result.

A 48-year-old patient with sudden onset of respiratory distress is scheduled for a stat ventilation-perfusion scan. What explanations should the nurse provide to the patient about the procedure? 1 Radioisotope is injected and inhaled to examine the lungs. 2 You will be sedated during the test to prevent you from moving. 3 We need to be sure there is no metal in your body before this test. 4 You will feel a sensation of chest pressure as the dye circulates through your body.

1 Radioisotope is injected and inhaled to examine the lungs. A ventilation perfusion scan has two parts. In the perfusion portion, a radioisotope is injected into the blood and the pulmonary vasculature is outlined. In the ventilation part, the patient inhales a radioactive gas that outlines the alveoli. Sedation is not required; magnetic imaging is not a component of the examination, so the patient can have the test even if there is metal in the body. Chest pressure may indicate an adverse reaction and is not normal.

To maintain patient safety, the nurse would question the health care provider about the prescription for prednisone if the patient also had which condition? 1 Systemic fungal infection 2 Diabetes mellitus 3 Congestive heart failure 4 Renal insufficiency

1 Systemic fungal infection Systemic fungal infection would be a contraindication to the use of prednisone because the drug can interfere with the body's ability to fight infection. Although blood sugars may increase and fluid retention may occur, diabetes, congestive heart failure, and renal insufficiency are not absolute contraindications to the use of prednisone, although it should be used with caution.

A patient began taking antitubercular drugs a week ago. The nurse reviews the patient's medical record and learns that the patient has a 10-year history of consuming one standard drink of alcohol three times a week. The patient states, "In the last week, my urine turned orange and I am very worried about it." How should the nurse respond? 1 Inform the patient that it is one of the side effects of the antitubercular drug rifampin. 2 Recognize that the tuberculosis may have spread to the liver, and further medical consultation is required. 3 Recognize that the liver may be damaged due to alcohol, and so a liver function test should be performed. 4 Instruct the patient to stop taking antitubercular drugs immediately and consult the primary health care provider.

1. A nurse should be aware of some of the common side effects of antitubercular drugs like rifampin, one of which is orange discoloration of body fluids such as urine, sweat, tears, and sputum. It may also cause hepatitis. Liver damage can lead to jaundice, which usually presents as yellowish discoloration of urine and sclera. However it is highly unlikely that tuberculosis has spread to the liver. The alcohol intake of the patient is within normal limits, and so it is not correct to say that alcohol may have damaged the liver. It is also inappropriate to advise the patient to stop taking antitubercular drugs.

When can airborne infection isolation for a patient with pulmonary tuberculosis (TB) be discontinued? 1 Once isoniazid drug therapy has been initiated 2 After three consecutive acid-fast bacillus (AFB) smears are negative 3 After effective instruction on the use of a high-efficiency particulate air (HEPA) mask 4 When two consecutive negative x-ray results are confirmed

2 After three consecutive acid-fast bacillus (AFB) smears are negative Airborne infection isolation is indicated for the patient with pulmonary or laryngeal TB until the patient is noninfectious (defined as effective drug therapy, clinical improvement, and three negative AFB smears). Therapy must be deemed effective. Teaching the patient to properly use the HEPA mask isn't a criterion for terminating isolation. Chest x-rays are not criteria to terminate isolation.

The patient with human immunodeficiency virus (HIV) has been diagnosed with Candida albicans, an opportunistic infection. The nurse knows the patient needs more teaching when the patient says, 1 "I will be given amphotericin B to treat the fungus." 2 "I got this fungus because I am immunocompromised." 3 "I need to be isolated from my family and friends so they won't get it." 4 "The effectiveness of my therapy can be monitored with fungal serology titers."

3 "I need to be isolated from my family and friends so they won't get it." The patient with an opportunistic fungal infection does not need to be isolated because C. albicans is not transmitted from person to person. This immunocompromised patient will be likely to have a serious infection so it will be treated with intravenous amphotericin B. The effectiveness of the therapy can be monitored with fungal serology titers.

A patient who has tuberculosis (TB) is being treated with combination drug therapy. The nurse explains that combination drug therapy is essential because: Recommendations for the initial treatment of tuberculosis 1 It minimizes the required dosage of each of the medications. 2 It helps reduce the unpleasant side effects of the medications. 3 It shortens amount of time that the treatment regimen will be needed. 4 It discourages the development of resistant strains of the TB organism

4 It discourages the development of resistant strains of the TB organism Recommendations for the initial treatment of tuberculosis (TB) include a four-drug regimen until drug susceptibility tests are available. After susceptibility is established, the regimen can be altered, but patients should still receive at least two drugs to prevent emergence of drug-resistance organisms. Dosage, side effects, and duration of the regimen are not reasons for combination drug therapy in a patient with TB.

A client is prescribed rifampin (Rifadin), 600 mg P.O. daily. Which statement about rifampin is true? a) It's usually given alone. b) Its exact mechanism of action is unknown. c) It's tuberculocidal, destroying the offending bacteria. d) It acts primarily against resting bacteria.

c

A client admitted to the facility for treatment for tuberculosis receives instructions about the disease. Which statement made by the client indicates the need for further instruction? a) "I will have to take the medication for up to a year." b) "This disease may come back later if I am under stress." c) "I will stay in isolation for at least 6 weeks." d) "I will always have a positive test for tuberculosis."

c) "I will stay in isolation for at least 6 weeks."