TB NCLEX Questions
The Causative agent of Tuberculosis is said to be: A Mycobacterium Tuberculosis B Hansen's Bacilli C Bacillus Anthracis D Group A Beta Hemolytic Streptococcus
A)
The public health nurse is providing follow-up care to a client with TB who does not regularly take his medication. Which nursing action would be most appropriate for this client? A Ask the client's spouse to supervise the daily administration of the medications. B Visit the clinic weekly to ask him whether he is taking his medications regularly. C Notify the physician of the client's non-compliance and request a different prescription. D Remind the client that TB can be fatal if not taken properly.
A) Question 59 Explanation: Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a responsible person, who may be a family member or a health care provider, observes the client taking the medication. Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or cannot follow the prescribed treatment.
A client with a productive cough, chills, and night sweats is suspected of having active TB. The physician should take which of the following actions? A Admit him to the hospital in respiratory isolation B Prescribe isoniazid and tell him to go home and rest C Give a tuberculin test and tell him to come back in 48 hours and have it read D Give a prescription for isoniazid, 300 mg daily for 2 weeks, and send him home
A) The client is showing s/s of active TB and, because of the productive cough, is highly contagious. He should be admitted to the hospital, placed in respiratory isolation, and three sputum cultures should be obtained to confirm the diagnosis. He would most likely be given isoniazid and two or three other antitubercular antibiotics until the diagnosis is confirmed, then isolation and treatment would continue if the cultures were positive for TB. After 7 to 10 days, three more consecutive sputum cultures will be obtained. If they're negative, he would be considered non-contagious and may be sent home, although he'll continue to take the antitubercular drugs for 9 to 12 months.
The nurse obtains a sputum specimen from a client with suspected TB for laboratory study. Which of the following laboratory techniques is most commonly used to identify tubercle bacilli in sputum? A Acid-fast staining B Sensitivity testing C Agglutination testing D Dark-field illumination
A) The most commonly used technique to identify tubercle bacilli is acid-fast staining. The bacilli have a waxy surface, which makes them difficult to stain in the lab. However, once they are stained, the stain is resistant to removal, even with acids. Therefore, tubercle bacilli are often called acid-fast bacilli.
A client who is HIV+ has had a PPD skin test. The nurse notes a 7-mm area of induration at the site of the skin test. The nurse interprets the results as: A Positive B Negative C Inconclusive D The need for repeat testing
A) The client with HIV+ status is considered to have positive results on PPD skin test with an area greater than 5-mm of induration. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client.
A client has a positive reaction to the PPD test. The nurse correctly interprets this reaction to mean that the client has: A Active TB B Had contact with Mycobacterium tuberculosis C Developed a resistance to tubercle bacilli D Developed passive immunity to TB
B) A positive PPD test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists.
INH treatment is associated with the development of peripheral neuropathies. Which of the following interventions would the nurse teach the client to help prevent this complication? A Adhere to a low cholesterol diet B Supplement the diet with pyridoxine (vitamin B6) C Get extra rest D Avoid excessive sun exposure
B) INH competes with the available vitamin B6 in the body and leaves the client at risk for development of neuropathies related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed.
A community health nurse is conducting an educational session with community members regarding TB. The nurse tells the group that one of the first symptoms associated with TB is: A A bloody, productive cough B A cough with the expectoration of mucoid sputum C Chest pain D Dyspnea
B) One of the first pulmonary symptoms includes a slight cough with the expectoration of mucoid sputum.
A client has active TB. Which of the following symptoms will he exhibit? A) Chest and lower back pain B) Chills, fever, night sweats, and hemoptysis C) Fever of more than 104*F and nausea D) Headache and photophobia
B) Typical signs and symptoms are chills, fever, night sweats, and hemoptysis. Chest pain may be present from coughing, but isn't usual. Clients with TB typically have low-grade fevers, not higher than 102*F. Nausea, headache, and photophobia aren't usual TB symptoms.
The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family members. Which statement(s) by the client indicate(s) that he has understood the nurses instructions? Select all that apply. A "I will need to dispose of my old clothing when I return home." B "I should always cover my mouth and nose when sneezing." C "It is important that I isolate myself from family when possible." D "I should use paper tissues to cough in and dispose of them properly." E "I can use regular plate and utensils whenever I eat."
B, D, and E
The right forearm of a client who had a purified protein derivative (PPD) test for tuberculosis is reddened and raised about 3mm where the test was given. This PPD would be read as having which of the following results? A) Indeterminate B) Needs to be redone C) Negative D) Positive
C This test would be classed as negative. A 5 mm raised area would be a positive result if a client was HIV+ or had recent close contact with someone diagnosed with TB. Indeterminate isn't a term used to describe results of a PPD test. If the PPD is reddened and raised 10mm or more, it's considered positive according to the CDC.
A client with a positive Mantoux test result will be sent for a chest x-ray. For which of the following reasons is this done? A To confirm the diagnosis B To determine if a repeat skin test is needed C To determine the extent of the lesions D To determine if this is a primary or secondary infection
C) If the lesions are large enough, the chest x-ray will show their presence in the lungs. Sputum culture confirms the diagnosis. There can be false-positive and false-negative skin test results. A chest x-ray can't determine if this is a primary or secondary infection.
A client diagnosed with active TB would be hospitalized primarily for which of the following reasons? A To evaluate his condition B To determine his compliance C To prevent spread of the disease D To determine the need for antibiotic therapy
C) The client with active TB is highly contagious until three consecutive sputum cultures are negative, so he's put in respiratory isolation in the hospital.
Which of the following diagnostic tests is definitive for TB? A Chest x-ray B Mantoux test C Sputum culture D Tuberculin test
C) The sputum culture for Mycobacterium tuberculosis is the only method of confirming the diagnosis. Lesions in the lung may not be big enough to be seen on x-ray. Skin tests may be falsely positive or falsely negative.
Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a client with TB. A nurse reviews the medical record of the client. Which of the following, if noted in the client's history, would require physician notification? A Heart disease B Allergy to penicillin C Hepatitis B D Rheumatic fever
C) Isoniazid and rafampin are contraindicated in clients with acute liver disease or a history of hepatic injury.
A chest x-ray should a client's lungs to be clear. His Mantoux test is positive, with a 10mm if induration. His previous test was negative. These test results are possible because: A He had TB in the past and no longer has it. B He was successfully treated for TB, but skin tests always stay positive C He's a "seroconverter", meaning the TB has gotten to his bloodstream D He's a "tuberculin converter," which means he has been infected with TB since his last skin test
D)
A client is diagnosed with active TB and started on triple antibiotic therapy. What signs and symptoms would the client show if therapy is inadequate? A Decreased shortness of breath B Improved chest x-ray C Nonproductive cough D Positive acid-fast bacilli in a sputum sample after 2 months of treatment
D) Continuing to have acid-fast bacilli in the sputum after 2 months indicated continued infection.
The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB? A Take the medication with antacids B Double the dosage if a drug dose is forgotten C Increase intake of dairy products D Limit alcohol intake
D) INH and rifampin are hepatotoxic drugs. Clients should be warned to limit intake of alcohol during drug therapy. Both drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after these drugs are administered. Clients should not double the dosage of these drugs because of their potential toxicity. Clients taking INH should avoid foods that are rich in tyramine, such as cheese and dairy products, or they may develop hypertension.
A nurse is caring for a client diagnosed with TB. Which assessment, if made by the nurse, would not be consistent with the usual clinical presentation of TB and may indicate the development of a concurrent problem? A Nonproductive or productive cough B Anorexia and weight loss C Chills and night sweats D High-grade fever
D) The client with TB usually experiences cough (non-productive or productive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever.
A client with a positive skin test for TB isn't showing signs of active disease. To help prevent the development of active TB, the client should be treated with isoniazid, 300 mg daily, for how long? A 10 to 14 days B 2 to 4 weeks C 3 to 6 months D 9 to 12 months
D) Because of the increased incidence of resistant strains of TB, the disease must be treated for up to 24 months in some cases, but treatment typically lasts for 9-12 months. Isoniazid is the most common medication used for the treatment of TB, but other antibiotics are added to the regimen to obtain the best results.
Which of the following family members exposed to TB would be at highest risk for contracting the disease? A 45-year-old mother B 17-year-old daughter C 8-year-old son D 76-year-old grandmother
D) Elderly persons are believed to be at higher risk for contracting TB because of decreased immunocompetence. Other high-risk populations in the US include the urban poor, AIDS, and minority groups.
A client was infected with TB 10 years ago but never developed the disease. He's now being treated for cancer. The client begins to develop signs of TB. This is known as which of the following types of infection? a) active infection b) primary infection c) super infection d) tertiary infection
a) Some people carry dormant TB infections that may develop into active disease. In addition, primary sites of infection containing TB bacilli may remain inactive for years and then activate when the client's resistance is lowered, as when a client is being treated for cancer. There's no such thing as tertiary infection, and superinfection doesn't apply in this case.
A client with primary TB infection can expect to develop which of the following conditions? a) Active TB within 2 weeks b) Active TB within 1 month c) A fever that requires hospitalization d) A positive skin test
d) A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs. At this point, the bacilli are walled off and skin tests read positive. However, all but infants and immunosuppressed people will remain asymptomatic. The general population has a 10% risk of developing active TB over their lifetime, in many cases because of a break in the body's immune defenses. The active stage shows the classic symptoms of TB: fever, hemoptysis, and night sweats.
