Tuberculosis Questions
18. A patient taking Isoniazid (INH) should be monitored for what deficiency? A. Vitamin C B. Calcium C. Vitamin B6 D. Potassium
The answer is C. This medication can lead to low Vitamin B6 levels. Most patients will take a supplement of B6 while taking this medication.
A nurse must use a N95 respirator for protection against tuberculosis with a client. Which of the following considerations should be used while the nurse is utilizing this mask? The N95 respirator does not provide a seal around the sides of the mask The N95 respirator will not protect against influenza The mask must be fitted specifically for the nurse When a N95 respirator is not available, the nurse should use a surgical mask instead
The mask must be fitted specifically for the nurse An N95 respirator is a special type of mask worn by the nurse to filter out airborne particles of microorganisms. The respirator is designed to protect the wearer against pathogens of a specific size, such as tuberculosis. It must be fitted specifically for the nurse to ensure there is a tight seal against the face. The N95 respirator is not the same as a surgical mask and the two are not interchangeable.
A nurse is providing discharge education to a client who was diagnosed with tuberculosis 2 months ago. Which of the following client statements indicates more teaching is necessary? "I need to see the doctor one final time next month for follow up" "I'll finish my entire course of these drugs, even if I'm feeling better." "I'll make sure all of my family members that I've been around will get tested." "I'll have to wear a mask when I go out to public places."
"I need to see the doctor one final time next month for follow up" Follow up care for TB is essential, but a lengthy process. They will need to have continued follow-up care for up to 1 year. Multiple sputum samples over the year will need to be provided to evaluate the treatment's effectiveness. If the client only saw the doctor one more time next month, that would only be 3 months from diagnosis, which is not long enough. This statement requires further teaching by the nurse.
The nurse has provided a client with tuberculosis (TB) instructions on proper handling and disposal of respiratory secretions. The nurse determines that the client demonstrates understanding of the instructions when the client makes which statement? "I will discard used tissues in a plastic bag." "I need to wash my hands at least 4 times a day." "I will brush my teeth and rinse my mouth once a day." "I will turn my head to the side if I need to cough or sneeze."
"I will discard used tissues in a plastic bag." Rationale: Used tissues are discarded in a plastic bag. The client with TB should wash the hands carefully after each contact with respiratory secretions. Oral care should be done more frequently than once a day. The client should not only turn the head but also cover the mouth and nose when laughing, sneezing, or coughing.
The nurse is discharging a client with tuberculosis. The client asks if it is possible to stop taking the tuberculosis medication once she feels better. Which of the following is the most appropriate response? "Yes, this is the normal course of action for those with tuberculosis" "If you don't finish the entire treatment course, it can lead to drug resistance and complications in the future" "No, that would not be appropriate" "That would be appropriate if you save the extra medication for future occurrences"
"If you don't finish the entire treatment course, it can lead to drug resistance and complications in the future" Noncompliance with treatment may lead to drug resistance (MDR-TB), therefore strict adherence to the regimen is important. This statement by the nurse is most accurate, and offers the most amount of information for the client.
The nurse is caring for a client with tuberculosis and is giving report to the oncoming nurse. Which of the following statements is most appropriate? "The client is positive for TB and will require airborne precautions" "Since the client has started TB treatment, there are only 24 hours left for isolation precautions" "The client is positive for TB and will require enteric precautions" "The client screened positive for TB so I have stocked surgical masks outside the room"
"The client is positive for TB and will require airborne precautions" Tuberculosis requires airborne precautions.
A school is offering tuberculosis testing for all of its employees. The health nurse administers the injections to each of the employees using a tuberculin syringe. At which angle does the nurse administer the injections into the skin? 25 degree 60 degree 10 degree 90 degree
10 degree When a nurse administers an intradermal injection to test for tuberculosis, she should insert the needle at a 5 to 15-degree angle (or nearly flat against the skin). Inserting the needle at this angle will allow the nurse to inject the solution just under the skin to create a wheal for testing.
13. To what was the resurgence in tuberculosis (TB) resulting from the emergence of multidrug-resistant (MDR) strains of Mycobacterium tuberculosis related? a. A lack of effective means to diagnose TB b. Poor compliance with drug therapy in patients with TB c. Indiscriminate use of antitubercular drugs in treatment of other infections d. Increased population of immunosuppressed individuals with acquired immunodeficiency syndrome (AIDS)
13. b. Drug-resistant strains of TB have developed because TB patients' compliance with drug therapy has been poor, and there has been general decreased vigilance in monitoring and follow-up of TB treatment. TB can be diagnosed effectively with sputum cultures. Antitubercular drugs are almost exclusively used for TB infections. The incidence of TB is at epidemic proportions in patients with HIV, but this does not account for multidrug-resistant strains of T
14. Priority Decision: A patient diagnosed with class 3 TB 1 week ago is admitted to the hospital with symptoms of chest pain and coughing. What nursing action has the highest priority? a. Administering the patient's antitubercular drugs b. Admitting the patient to an airborne infection isolation room c. Preparing the patient's room with suction equipment and extra linens d. Placing the patient in an intensive care unit, where he can be closely monitored
14. b. patient with class 3 TB has clinically active disease, and airborne infection isolation is required for active disease until the patient is noninfectious, indicated by negative sputum smears. Cardiac monitoring and observation will be done with the patient in isolation. The nurse will administer the antitubercular drugs after the patient is in isolation. There should be no need for suction or extra linens after the TB patient is receiving drug therapy.
15. When obtaining a health history from a patient suspected of having early TB, the nurse should ask the patient about what manifestations? a. Chest pain, hemoptysis, and weight loss b. Fatigue, low-grade fever, and night sweats c. Cough with purulent mucus and fever with chills d. Pleuritic pain, nonproductive cough, and temperature elevation at night
15. b. TB usually develops insidiously with fatigue, malaise, anorexia, low-grade fevers, and night sweats, a dry cough, and unexplained weight loss. Pleuritic pain, flu-like symptoms, and a productive cough may occur with an acute sudden presentation; but dyspnea and hemoptysis are late symptoms.
16. Which medications would be used in four-drug treatment for the initial phase of TB (select all that apply)? a. Isoniazid b. Pyrazinamide c. Rifampin (Rifadin) d. Rifabutin (Mycobutin) e. Levofloxacin (Levaquin) f. Ethambutol (Myambutol)
16. a, b, c, f. For the first 2 months, a four-drug regimen consists of isoniazid, pyrazinamide, rifampin (Rifadin), and ethambutol (Myambutol). Rifabutin (Mycobutin) and levofloxacin (Levaquin) may be used if the patient develops toxicity to the primary drugs. Rifabutin may be used as first-line treatment for patients receiving medications that interact with rifampin (e.g., antiretrovirals, estradiol, warfarin).
17. Patient-Centered Care: A patient with active TB continues to have positive sputum cultures after 6 months of treatment. She says she cannot remember to take the medication all the time. What is the best action for the nurse to take? a. Arrange for directly observed therapy (DOT) by a public health nurse. b. Schedule the patient to come to the clinic every day to take the medication. c. Have a patient who has recovered from TB tell the patient about his successful treatment. d. Schedule more teaching sessions so that the patient will understand the risks of noncompliance
17. a. Notification of the public health department is required. If drug compliance is questionable, follow-up of patients can be made by directly observed therapy by a public health nurse. A patient who cannot remember to take the medication usually will not remember to come to the clinic daily or will find it too inconvenient. Additional teaching or support from others is not usually effective for this type of patient.
17. The 56-year-old client diagnosed with tuberculosis (Tb) is being discharged. Which statement made by the client indicates an understanding of the discharge instructions? 1. "I will take my medication for the full three (3) weeks prescribed." 2. "I must stay on the medication for months if I am to get well." 3. "I can be around my friends because I have started taking antibiotics." 4. "I should get a Tb skin test every three (3) months to determine if I am well."
2. "I must stay on the medication for months if I am to get well." / 2. Compliance with treatment plans for Tb includes multidrug therapy for six (6) months to one (1) year for the client to be free of the Tb bacteria. TEST-TAKING HINT: The test taker should determine if the time of three (3) weeks in option "1," months in option "2," or immediately in option "3" is the correct time interval.
18. The employee health nurse is administering tuberculin skin testing to employees who have possibly been exposed to a client with active tuberculosis (Tb). Which statement indicates the need for radiological evaluation instead of skin testing? 1. The client's first skin test indicates a purple flat area at the site of injection. 2. The client's second skin test indicates a red area measuring four (4) mm. 3. The client's previous skin test was read as positive. 4. The client has never shown a reaction to the tuberculin medication.
3. The client's previous skin test was read as positive. / 3. If the client has ever reacted positively, then the client should have a chest x-ray to look for causation and inflammation. TEST-TAKING HINT: The test taker should note descriptive terms such as "purple," "flat," or "4 mm" before determining the correct answer. Option "4" has the absolute word "never," and absolutes usually indicate incorrect answers.
22. The client is admitted with a diagnosis of rule-out tuberculosis. Which type of isolation procedures should the nurse implement? 1. Standard Precautions. 2. Contact Precautions. 3. Droplet Precautions. 4. Airborne Precautions.
4. Airborne Precautions. / 4. Tuberculosis bacteria are capable of disseminating over long distances on air currents. Clients with tuberculosis are placed in negative air pressure rooms where the air in the room is not allowed to cross-contaminate the air in the hallway. TEST-TAKING HINT: Standard Precautions and Contact Precautions can be ruled out as the correct answer if the test taker is aware that Tb is usually a respiratory illness. This at least gives the reader a 1:2 chance of selecting the correct answer if the answer is not known.
4. A patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room. What should the patient be taught (select all that apply)? a. Expect routine TST to evaluate infection. b. Visitors will not be allowed while in airborne isolation. c. Take all medications for full length of time to prevent multidrug-resistant TB. d. Wear a standard isolation mask if leaving the airborne infection isolation room. e. Maintain precautions in airborne infection isolation room by coughing into a paper tissue.
4. Correct answers: c, d, e Rationale: To reduce antibiotic-resistant tuberculosis, patients must take multiple drugs for a minimum of 3 moths (or possibly longer). If patients need to be out of the negative-pressure room, they must wear a standard isolation mask to prevent exposure to others. Teach patients to cover the nose and mouth with paper tissue every time they cough, sneeze, or produce sputum. If a person has a positive reaction to the tuberculin skin test, he or she need not be tested again
568. The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply. 1. Activities should be resumed gradually. 2. Avoid contact with other individuals, except family members, for at least 6 months. 3. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. 4. Respiratory isolation is not necessary, because family members already have been exposed. 5. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags. 6. When 1 sputum culture is negative, the client is no longer considered infectious and usually can return to former employment.
568. Answer: 1, 3, 4, 5 Rationale: The nurse should provide the client and family with information about tuberculosis and allay concerns about the contagious aspect of the infection. The client needs to follow the medication regimen exactly as prescribed and always have a supply of the medication on hand. Side and adverse effects of the medication and ways of minimizing them to ensure compliance should be explained. After 2 to 3 weeks of medication therapy, it is unlikely that the client will infect anyone. Activities should be resumed gradually and a well-balanced diet that is rich in iron, protein, and vitamin C to promote healing and prevent recurrence of infection should be consumed. Respiratory isolation is not necessary, because family members already have been exposed. Instruct the client about thorough hand washing, to cover the mouth and nose when coughing or sneezing, and to put used tissues into plastic bags. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. When the results of 3 sputum cultures are negative, the client is no longer considered infectious and can usually return to former employment. Test-Taking Strategy: Focus on the subject, home care instructions for tuberculosis. Knowledge regarding the pathophysiology, transmission, and treatment of tuberculosis is needed to answer this question. Read each option carefully to answer correctly.
573. The nurse has conducted discharge teaching with a client diagnosed with tuberculosis who has been receiving medication for 2 weeks. The nurse determines that the client has understood the information if the client makes which statement? 1. "I need to continue medication therapy for 1 month." 2. "I can't shop at the mall for the next 6 months." 3. "I can return to work if a sputum culture comes back negative." 4. "I should not be contagious after 2 to 3 weeks of medication therapy."
573. Answer: 4 Rationale: The client is continued on medication therapy for up to 12 months, depending on the situation. The client generally is considered noncontagious after 2 to 3 weeks of medication therapy. The client is instructed to wear a mask if there will be exposure to crowds until the medication is effective in preventing transmission. The client is allowed to return to work when the results of 3 sputum cultures are negative. Test-Taking Strategy: Focus on the subject, client understanding of medication therapy. Knowing that the medication therapy lasts for up to 12 months helps you eliminate option 1 first. Knowing that 3 sputum cultures must be negative helps you eliminate option 3 next. From the remaining options, recalling that the client is not contagious after 2 to 3 weeks of therapy will direct you to the correct option.
574. The nurse is preparing to give a bed bath to an immobilized client with tuberculosis. The nurse should wear which items when performing this care? 1. Surgical mask and gloves 2. Particulate respirator, gown, and gloves 3. Particulate respirator and protective eyewear 4. Surgical mask, gown, and protective eyewear
574. Answer: 2 Rationale: The nurse who is in contact with a client with tuberculosis should wear an individually fitted particulate respirator. The nurse also would wear gloves as per standard precautions. The nurse wears a gown when the possibility exists that the clothing could become contaminated, such as when giving a bed bath. Test-Taking Strategy: Focus on the subject, precautions when caring for the client with tuberculosis. Think about the nurse's task, a bed bath. Knowing that the nurse should wear a particulate respirator eliminates options 1 and 4. Knowledge of basic standard precautions directs you to the correct option.
576. A client who is human immunodeficiency virus (HIV)-positive has had a tuberculin skin test (TST). The nurse notes a 7-mm area of induration at the site of the skin test and interprets the result as which finding? 1. Positive 2. Negative 3. Inconclusive 4. Need for repeat testing
576. Answer: 1 Rationale: The client with HIV infection is considered to have positive results on tuberculin skin testing with an area of induration larger than 5 mm. The client without HIV is positive with an induration larger than 10 mm. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client. It is possible for the client infected with HIV to have false-negative readings because of the immunosuppression factor. Options 2, 3, and 4 are incorrect interpretations. Test-Taking Strategy: Eliminate options 3 and 4 first because they are comparable or alike. From the remaining options, recalling that the client with HIV infection is immunosuppressed will assist in determining the interpretation of the area of induration.
582. The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test that will confirm this diagnosis? 1. Chest x-ray 2. Bronchoscopy 3. Sputum culture 4. Tuberculin skin test
582. Answer: 3 Rationale: Tuberculosis is definitively diagnosed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made based on a tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histological evidence of granulomatous disease on biopsy. Test-Taking Strategy: Focus on the subject, confirming the diagnosis of tuberculosis. Confirmation is made by identifying the bacteria, M. tuberculosis.
589. A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? 1. Hypercalcemia 2. Peripheral neuritis 3. Small blood vessel spasm 4. Impaired peripheral circulation
589. Answer: 2 Rationale: Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are not associated with the information in the question. Test-Taking Strategy: Focus on the information in the question, numbness, paresthesias, and tingling in the extremities. Options 3 and 4 would not cause the symptoms presented in the question but instead would cause pallor and coolness. From the remaining options, you should know that peripheral neuritis is an adverse effect of isoniazid, and that these signs and symptoms do not correlate with hypercalcemia.
590. A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1. Use alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.
590. Answer: 2 Rationale: Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing tyramine, because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy. Test-Taking Strategy: Focus on the subject, client teaching for isoniazid. Because alcohol intake is prohibited with the use of many medications, eliminate option 1 first. Because the client receiving this medication typically is given supplements of vitamin B6, option 4 is incorrect and is eliminated next. Recalling that the medication is hepatotoxic will direct you to the correct option.
591. A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication? 1. Should always be taken with food or antacids 2. Should be double-dosed if 1 dose is forgotten 3. Causes orange discoloration of sweat, tears, urine, and feces 4. May be discontinued independently if symptoms are gone in 3 months
591. Answer: 3 Rationale: Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses permanently. Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a primary health care provider. It is best to administer the medication on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication. Test-Taking Strategy: Options 2 and 4 are comparable or alike and are inaccurate, based on general guidelines for medication administration; the client should not double-dose or discontinue medication independently. Eliminate option 1 next because of the closed-ended word "always."
592. The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that they will immediately report which finding? 1. Impaired sense of hearing 2. Gastrointestinal side effects 3. Orange-red discoloration of body secretions 4. Difficulty in discriminating the color red from green
592. Answer: 4 Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin. Test-Taking Strategy: Note the strategic word, immediately. Option 2 is the least likely symptom to report; instead, it should be managed by taking the medication with food. To select among the other options, you must know that this medication causes optic neuritis, resulting in difficulty with red-green discrimination.
593. A client with tuberculosis is starting antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level
593. Answer: 3 Rationale: Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years or abuses alcohol. The laboratory tests in options 1, 2, and 4 are not necessary. Test-Taking Strategy: Focus on the subject, the laboratory value to monitor. Recalling that this medication can be toxic to the liver will direct you to the correct option.
A nurse who works in a long-term care facility has learned that one of the residents has developed active tuberculosis. What should the nurse do to protect the other residents? Do not allow visitors to the center until the client has been adequately treated Administer masks to all residents and ask them to wear them around the infected client Isolate the client from everyone else except the client's roommate, who most likely has already been exposed Allow the client to remain in the nursing home but provide isolation precautions and treat the active disease
Allow the client to remain in the nursing home but provide isolation precautions and treat the active disease A client with active tuberculosis has the potential to transmit the infection to others and is considered contagious. In a long-term care facility, the client should receive treatment for the disease and should be isolated from other residents until the potential for the spread of the infection is past, which is one to two weeks after treatment is started. Other residents should be tested for exposure to tuberculosis using the Mantoux skin test.
The nurse is performing an admission assessment on a client with tuberculosis (TB) and is collecting subjective and objective data. Which finding would the nurse expect to note? High fever Flushed skin Complaints of weight gain Complaints of night sweats
Complaints of night sweats Rationale: The client with TB usually experiences a low-grade fever, weight loss, pallor, chills, and night sweats. The client also will complain of anorexia and fatigue. Pulmonary symptoms include a cough that is productive of a scant amount of mucoid sputum. Purulent, blood-stained sputum is present if cavitation occurs. Dyspnea and chest pain occur late in the disease.
The nurse is caring for a client who had tuberculin skin testing 48 hours ago on admission to the nursing unit. The nurse reads the test result as positive. Which action by the nurse has the highest priority? Document the finding in the client's record. Call the employee health service department. Contact the primary health care provider (PHCP). Call the radiology department for a chest radiographic study to be done.
Contact the primary health care provider (PHCP). Rationale: The nurse who obtains a positive test reading should call the PHCP immediately. The PHCP will prescribe a chest x-ray study to determine whether the client has clinically active tuberculosis (TB) or old, healed lesions. A sputum culture would be obtained to confirm the diagnosis of active TB. The client can be placed on prophylactic TB precautions until a final diagnosis is made. Although the results of the test would be documented and the employee health service department would be notified, these are not the actions of highest priority among the options provided.
The nurse is caring for a client diagnosed with tuberculosis (TB). Which assessments, if made by the nurse, are consistent with the usual clinical presentation of TB? Select all that apply. Cough Dyspnea Weight gain High-grade fever Chills and night sweats
Cough Dyspnea Chills and night sweats Rationale: The client with TB usually experiences cough (productive or nonproductive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever.
The community health nurse is conducting an educational session with community members regarding the signs and symptoms associated with tuberculosis. The nurse informs the participants that tuberculosis is considered as a diagnosis if which signs and symptoms are present? Select all that apply. Dyspnea Headache Night sweats A bloody, productive cough A cough with the expectoration of mucoid sputum
Dyspnea Night sweats A bloody, productive cough A cough with the expectoration of mucoid sputum Rationale: Tuberculosis should be considered for any clients with a persistent cough, weight loss, anorexia, night sweats, hemoptysis, shortness of breath, fever, or chills. The client's previous exposure to tuberculosis should also be assessed and correlated with the clinical manifestations.
Which of the following are considered anti-tubercular drugs? Select all that apply. Ethambutol Ceclor Isoniazid Rifampin Sulfamethoxazole and trimethoprim
Ethambutol Isoniazid Rifampin This is a first-line medication used to treat tuberculosis. This is a first-line medication used to treat tuberculosis. First-line agents provide the most effective antituberculosis treatment. If treatment with first-line agents fail, second-line drugs are added, but are more toxic to the client. Tuberculosis is difficult to treat because there is a waxy substance on the bacterium capsule that is difficult to penetrate and destroy.
The nurse reads that a client's tuberculin skin test is positive and notes that previous tests were negative. The client becomes upset and asks the nurse what this means. The nurse should base the response on which interpretation? Systemic tuberculosis Pulmonary tuberculosis Exposure to tuberculosis No evidence of tuberculosis
Exposure to tuberculosis Rationale: A client who tests positive on a tuberculin skin test either has been exposed to tuberculosis (TB) or has inactive (dormant) TB. The client must then undergo chest radiography and sputum culture to confirm the diagnosis. Options 1, 2, and 4 are incorrect interpretations of the data presented in the question.
1. True or False: Tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis and it only affects the lungs. True False
FALSE....tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis that affects the lungs AND other systems of the body like the joints, kidneys, brain, spine, liver etc.
The nurse is doing volunteer work in a homeless shelter. The nurse should monitor the individuals for which initial signs and symptoms of tuberculosis? Select all that apply. Fatigue Lethargy Chest pain Morning cough Low-grade fever Labored breathing
Fatigue Lethargy Morning cough Low-grade fever Rationale: The symptoms of tuberculosis include a slight morning cough, fatigue, lethargy, and low-grade fever. The other symptoms listed are advanced (not initial) signs and symptoms.
A nurse is caring for a client who has tuberculosis. The client is just completing a 9-month regimen of medication as part of treatment for the condition in which she responded well. Which of the following choices describes how follow-up is handled for the client who was treated successfully? The client needs a follow-up chest x-ray and sputum culture one time The client needs monthly AFB smears for a period of 2 years after treatment ends Follow-up is needed only if the client experiences symptoms of TB The client needs an annual follow-up chest x-ray
Follow-up is needed only if the client experiences symptoms of TB The standard form of treatment for tuberculosis is a 6 to 12 month regimen of medication, which is usually effective for most clients. After completing a therapeutic regimen, the client does not necessarily need routine follow-up unless he develops further symptoms of TB.
The nurse is reading a tuberculin skin test for a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosis. How should the nurse interpret the result? Positive Negative Uncertain Borderline
Negative Rationale: A positive reading has an induration measuring 10 mm or larger and is considered abnormal. A small area of ecchymosis is insignificant and probably is related to injection technique. The remaining options are incorrect interpretations.
The nurse is caring for a client with tuberculosis (TB) who is fearful of the disease and anxious about the prognosis. In planning nursing care, the nurse should incorporate which intervention as the best strategy to assist the client in coping with the illness? Allow the client to deal with the disease in an individual fashion. Ask family members whether they wish a psychiatric consultation. Encourage the client to visit with the pastoral care department's chaplain. Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease.
Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease. Rationale: A primary role of the nurse working with a client with TB is to teach the client about medication therapy. An anxious client may not absorb information optimally. The nurse continues to reinforce teaching using a variety of methods (repetition, teaching aids), and teaches the family about the medications as well. The most effective way of coping with the disease is to learn about the therapy that will eradicate it. This gives the client a measure of power over the situation and outcome. Allowing the client to deal with the disease in an individual fashion gives no active assistance to the client. Asking family members whether they wish a psychiatric consultation does not involve the client. Although visiting with the pastoral care department's chaplain may be helpful, it is not the best strategy among the options provided.
The nurse is assessing a client with the typical clinical manifestations of tuberculosis (TB). During history-taking the nurse anticipates that the client will report presence of cough and fatigue for what period of time? 1 or 2 days 1 to 2 weeks Almost 1 week Several weeks to months
Several weeks to months Rationale: The client with TB may report signs and symptoms that have been present for weeks or even months. These may include fatigue, lethargy, chest pain, anorexia and weight loss, night sweats, low-grade fever, and cough with mucoid or blood-streaked sputum. It may be the production of blood-tinged sputum that finally forces some clients to seek care.
The nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnostic test that will confirm this diagnosis? Chest x-ray Bronchoscopy Sputum culture Tuberculin skin test
Sputum culture Rationale: Tuberculosis is definitively diagnosed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made based on a tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histological evidence of granulomatous disease on biopsy.
Which of the following is a true statement regarding tuberculosis? TB is caused by an infection with a bacterium called Mycobacterium The only organ affected by TB is the lungs TB is typically transmitted through the droplet route Most people exposed to TB develop an active infection
TB is caused by an infection with a bacterium called Mycobacterium Tuberculosis is an infectious disease caused by mycobacterium tuberculosis that can spread easily between people who do not take appropriate precautions. M. tuberculosis is an aerobic bacterium, so it primarily affects the lungs, but can affect other organs including the brain, kidneys, joints and liver.
7. A 52-year old female patient is receiving medical treatment for a possible tuberculosis infection. The patient is a U.S. resident but grew-up in a foreign country. She reports that as a child she received the BCG vaccine (bacille Calmette-Guerin vaccine). Which physician's order below would require the nurse to ask the doctor for an order clarification? A. PPD (Mantoux test) B. Chest X-ray C. QuantiFERON-TB Gold (QFT) D. Sputum culture
The answer is A. Patients who have received the BCG vaccine will have a false positive on a PPD (Mantoux test), which is the tuberculin skin test. The BCG vaccine is a vaccine to prevent TB. It is given in foreign countries to children to prevent TB. Therefore, the person has already been exposed to the bacteria via vaccine and will have a false positive. A QuantiFERON-TB Gold test is a better option for this patient. It is a blood test.
2. A 55-year old male patient is admitted with an active tuberculosis infection. The nurse will place the patient in ___________________ precautions and will always wear _____________________ when providing patient care? A. droplet, respirator B. airborne, respirator C. contact and airborne, surgical mask D. droplet, surgical mask
The answer is B. A patient with ACTIVE TB is contagious. The bacterium, mycobacterium tuberculosis which causes TB, is so small that it can stay suspended in the air for hours to days. Therefore, the nurse will place the patient in AIRBORNE precautions. In addition, a special mask must be worn called a respirator (also referred to as an N95 mask.....a surgical mask does NOT work with this condition).
9. A patient has a positive PPD skin test that shows an 8 mm induration. As the nurse you know that: A. The patient will need to immediately be placed in droplet precautions and started on a medication regime. B. The patient will need a chest x-ray and sputum culture to confirm the test results before treatment is provided. C. The patient will need an IGRA test to help differentiate between a latent tuberculosis infection versus an active tuberculosis infection. D. The patient will need to repeat the skin test in 48-72 hours to confirm the results.
The answer is B. A positive PPD result does NOT necessarily mean the patient has an active infection of TB. The patient will need a chest x-ray and sputum culture to determine if mycobacterium tuberculosis is present and then treatment will be based on those results. The IGRA test does NOT differentiate between LTBI or an active TB infection. Patients are placed in airborne precautions (NOT droplet) if they have ACTIVE TB.
3. Which statement is correct regarding mycobacterium tuberculosis? A. This bacterium is an anaerobic type of bacteria. B. It is an alkali bacterium that stains bright red during an acid-fast smear test. C. It is known as being an aerobic type of bacteria. D. It's an acid-fact bacterium that stains bright green during an acid-fast smear test.
The answer is C. Mycobacterium tuberculosis is AEROBIC (it thrives in conditions that are high in oxygen), and it is an ACID-FAST bacterium, which means when it is stained during an acid-fast smear it will turn BRIGHT RED.
4. Your patient with a diagnosis of latent tuberculosis infection needs a bronchoscopy. During transport to endoscopy, the patient will need to wear? A. N95 mask B. Surgical mask C. No special PPE is needed D. Face mask with shield
The answer is C. Patients with a latent tuberculosis infection are NOT contagious. Therefore, no special PPE is needed for the patient during transport. HOWEVER, if the patient had ACTIVE tuberculosis they would need to wear a surgical mask during transport.
10. A patient has a PPD skin test (Mantoux test). As the nurse you tell the patient to report back to the office in _________ so the results can be interpreted? A. 24-48 hours B. 12-24 hours C. 48-72 hours D. 24-72 hours
The answer is C. The patient should report back in 48-72 hours. If they fail to, the test must be repeated.
12. The physician orders an acid-fast bacilli sputum culture smear on a patient with possible tuberculosis. How will you collect this? A. Collect 2 different sputum specimens 12 hours apart B. Collect 3 different sputum specimens (one in the morning, afternoon, and at night) C. Collect 3 different sputum specimens on 3 different days D. Collect 2 different sputum specimens on 2 different days
The answer is C. This is how an AFB sputum culture is collected.
19. A patient is taking Streptomycin. Which finding below requires the nurse to notify the physician? A. Patient reports a change in vision. B. Patient reports a metallic taste in the mouth. C. The patient has ringing in their ears. D. The patient has a persistent dry cough.
The answer is C. This medication can be very toxic to the ears (cranial nerve 8). Therefore, it is alarming if the patient reports ringing in their ears, which could represent ototoxicity.
15. Your patient, who is receiving Pyrazinamide, report stiffness and extreme pain in the right big toe. The site is extremely red, swollen, and warm. You notify the physician and as the nurse you anticipated the doctor will order? A. Calcium level B. Vitamin B6 level C. Uric acid level D. Amylase level
The answer is C. This medication can increase uric acid levels which can lead to gout. The patient's signs and symptoms are classic findings in a gout attack.
11. A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has arrived to the clinic to have his PPD skin test assessed. What is considered a positive result? A. 5 mm induration B. 15 mm induration C. 9 mm induration D. 10 mm induration
The answer is D. 15 mm induration is positive in ALL people regardless of health history or risk factors. However, for patients who are homeless (living in homeless shelter) and are IV drug users, a 10 mm or more is considered positive.
14. As the nurse you know that one of the reasons for an increase in multi-drug-resistant tuberculosis is: A. Incorrect medication ordered B. Increase in tuberculosis cases nationwide C. Incorrect route of drug ordered D. Noncompliance due to duration of medication treatment needed
The answer is D. Patients must be on medication treatment for about 6-12 months (depending on the type of TB the patient has). This leads to noncompliant issues. DOT (directly observed therapy) is now being instituted so compliance is increased. This is where a public health nurse or a trained DOT worker will deliver the medication and watch the patient swallow the pill until treatment is complete.
17. A patient with active tuberculosis is taking Ethambutol. As the nurse you make it priority to assess the patient's? A. hearing B. mental status C. vitamin B6 level D. vision
The answer is D. This medication can cause inflammation of the optic nerve. Therefore, it is very important the nurse asks the patient about their vision. If the patient has blurred vision or reports a change in colors, the MD must be notified immediately.
16. You note your patient's sweat and urine is orange. You reassure the patient and educate him that which medication below is causing this finding? A. Ethambutol B. Streptomycin C. Isoniazid D. Rifampin
The answer is D. This medication will cause body fluids to turn orange.
13. A patient receiving medical treatment for an active tuberculosis infection asks when she can starting going out in public again. You respond that she is no longer contagious when: (SATA) A. She has 3 negative sputum cultures B. Her signs and symptoms improve C. She has completed the full medication regime D. Her chest x-ray is normal E. She has been on tuberculosis medications for about 3 weeks
The answers are A, B, and E. These are all criteria for when a patient with active TB can return to public life (school, work, running errands). Until then they are still contagious and must stay home in isolation.
6. Your patient is diagnosed with a latent tuberculosis infection. Select all the correct statements that reflect this condition: A. "The patient will not need treatment unless it progresses to an active tuberculosis infection." B. "The patient is not contagious and will have no signs and symptoms." C. "The patient will have a positive tuberculin skin test or IGRA test. D. "The patient will have an abnormal chest x-ray." E. "The patient's sputum will test positive for mycobacterium tuberculosis."
The answers are B and C. The patient WILL need medical treatment to prevent this case of LBTI from developing into an active TB infection later on. The patient will NOT have an abnormal chest x-ray or a positive sputum test. This is only in active TB.
8. You're teaching a group of long-term care health givers about the signs and symptoms of tuberculosis. What signs and symptoms will you include in your education? A. Cough for a minimum of 6 weeks B. Night sweats C. Weight gain D. Hemoptysis E. Chills F. Fever G. Chest pain
The answers are B, D, E, F, and G. Option A is wrong because a cough should be present for 3 weeks or more (NOT 6 weeks). Option C is wrong because the patient will experience weight LOSS (not gain).
5. You are assessing your newly admitted patients who are all presenting with atypical signs and symptoms of a possible lung infection. The physician suspects tuberculosis. So, therefore, the patients are being monitored and tested for the disease. Select all the risk factors below that increases a patient's risk for developing tuberculosis: A. Diabetes B. Liver failure C. Long-term care resident D. Inmate E. IV drug user F. HIV G. U.S. resident
The answers are C, D, E, and F. Remember from our lecture we discussed the risk factors for developing TB and to remember them I said remember the mnemonic "TB Risk". It stands for tight living quarters (LTC resident, prison, homeless shelter etc.), below or at the poverty line (homeless), refugee (especially in high risk countries), immune system issue such as HIV, substance abusers (IV drugs or alcohol), Kids less than the age of 5....all these are risk factors.
The nurse in an ambulatory clinic is preparing to administer a tuberculin skin test to a client who may have been exposed to a person with tuberculosis (TB). The client reports having received the bacillus Calmette-Guérin (BCG) vaccine before moving to the United States from a foreign country. Which interpretation should the nurse make? The client has no risk of acquiring TB and needs no further workup. The client is at increased risk for acquiring TB and needs immediate medication therapy. The client's test result will be negative, and a sputum culture will be required for diagnosis. The client's test result will be positive, and a chest x-ray study will be required for evaluation.
The client's test result will be positive, and a chest x-ray study will be required for evaluation. Rationale: The BCG vaccine is routinely given in many foreign countries to enhance resistance to TB. The vaccine uses attenuated tubercle bacilli, so the results of skin testing in persons who have received the vaccine will always be positive. This client needs to be evaluated for TB with a chest radiographic study. The remaining options are incorrect interpretations.
A client is being admitted to the hospital from home with complications of tuberculosis. When making a room assignment, the nurse would most likely consider which of the following factors? The hospital's isolation procedures Whether the client will have someone staying with him Whether a nursing assistant is available to help the client The nurses assigned to work during the shift
The hospital's isolation procedures Most client room assignments are made based on the client's condition and the availability of staff. In this situation, the client has an infectious condition and needs a specific room that has a negative pressure air system. Therefore in this case, the client's assignment is based on the hospital's isolation procedures for a client with an airborne illness.
A client diagnosed with tuberculosis (TB) is distressed over fatigue and the loss of physical stamina. What should the nurse tell the client? This is expected and will last for at least 1 year. This is expected, and the client should gradually increase activity as tolerated. This is an unexpected finding with TB, but it should resolve within 1 month or so. This is a short-lived problem that should be gone within 1 week after beginning medication therapy.
This is expected, and the client should gradually increase activity as tolerated. Rationale: The client with TB has significant fatigue and loss of physical stamina. This can be very frightening for the client. The nurse teaches the client that this symptom will resolve as the therapy progresses and that the client should gradually increase activity as energy levels permit. Options 1, 3, and 4 are incorrect information.
