Tuberculosis (TB)

29. A patient who has active TB has just been started on drug therapy for TB. The nurse informs the patient that the disease can be transmitted to others until: A. The chest x-ray shows resolution of the tuberculosis. B. Three sputum smears for acid-fast bacilli are negative. C. TB medications have been taken for 6 months. D. Sputum cultures on 3 consecutive days are negative.

29. B. The patient is considered infectious until three sputum smears are negative for acid-fast bacilli. Chest x-rays help to determine the presence of active TB but are not utilized to monitor the effectiveness of treatment. Taking the medications for 6 months is necessary, but the multidrug-resistant forms of the disease might not be eradicated after 6 months of therapy. Sputum cultures are used to diagnose the presence of active TB, but sputum smears are usually done to establish that treatment has been effective.

32. When teaching the patient who is receiving standard multidrug therapy for TB about possible toxic effects of the antitubercular medications, the nurse will give instructions to notify the health care provider if the patient develops: A. Yellow-tinged skin. B. Changes in hearing. C. Orange-colored urine. D. Thickening of the nails.

32. A. Noninfectious hepatitis is a toxic effect of INH, rifampin, and pyrazinamide, and patients who develop hepatotoxicity will need to use other medications. Changes in hearing and nail thickening are not expected with the four medications used for initial drug therapy. Orange discoloration of body fluids is an expected side effect of rifampin and not an indication to call the health care provider.

33. An alcoholic and homeless patient is diagnosed with active TB. Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen? A. Giving the patient written instructions about how to take the medications B. Teaching the patient about the high risk for infecting others unless treatment is followed C. Arranging for a daily noontime meal at a community center and give the medication then D. Educating the patient about the long-term impact of TB on health

33. C. Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help to ensure that the patient is available to receive the medication. The other nursing interventions may be appropriate for some patients, but are not likely to be as helpful with this patient.

34. After 2 months of TB treatment with a standard four-drug regimen, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). The nurse discusses the treatment regimen with the patient with the knowledge that: A. Directly observed therapy (DOT) will be necessary if the medications have not been taken correctly. B. The positive sputum smears indicate that the patient is experiencing toxic reactions to the medications. C. Twice-weekly administration may be used to improve compliance with the treatment regimen. D. A regimen using only INH and rifampin (Rifadin) will be used for the last 4 months of drug therapy.

34. A. After 2 months of therapy, negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. The nurse will need to initiate DOT if the patient has not been consistently taking the medications. Toxic reactions to the medications would not result in a positive sputum smear. Twice-weekly medication administration is not one of the options for therapy. INH and rifampin are used for the last 4 months of drug therapy only if the initial four-drug regimen has been effective as evidenced by negative sputum smears.

8. 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 isonaizid, 300mg daily, for how long? A. 10 to 14 days B. 2 to 4 weeks C. 3 to 6 months D. 9 to 12 months

8. 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. Isoaizid is the most common medication used for the treatment of TB, but other antibiotics are added to the regimen to obtain the best results.

9. 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, 300mg daily for 2 weeks, and send him home.

9. 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.

17. A nurse is teaching a client with TB about dietary elements that should be increased in the diet. The nurse suggests that the client increase intake of: A. Meats and citrus fruits B. Grains and broccoli C. Eggs and spinach D. Potatoes and fish

17. A. The nurse teaches the client with TB to increase intake of protein, iron, and vitamin C.

1. 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

1. C. This test would be classed as negative. A 5mm 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.

41. 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

41. D. 6 to 12 months

14. 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

14. C. Isoniazid and rafampin are contraindicated in clients with acute liver disease or a history of hepatic injury.

16. 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

16. 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.

18. Which of the following symptoms is common in clients with TB? A. Weight loss B. Increased appetite C. Dyspnea on exertion D. Mental status changes

18. A. TB typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low-grade fever, and night sweats.

19. 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. Agglunitnation testing D. Dark-field illumination

19. 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.

26. 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

26. D. INH and rifampin are hepatoxic 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.

2. 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

2. 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.

27. 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.

27. A. 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.

28. A hospitalized patient who may have tuberculosis (TB) has an order for a sputum specimen. When will be the best time for the nurse to collect the specimen? A. After the patient rinses the mouth with mouthwash B. As soon as the order is received from the health care provider C. Right after the patient gets up in the morning D. After the skin test is administered

28. C. Sputum specimens are ideally collected in the morning because mucus is likely to accumulate during the night. The patient should rinse the mouth with water; mouthwash may inhibit the growth of the bacilli. There is no need to wait until the tuberculin skin test is administered.

38. A patient with a chronic productive cough and weight loss is receiving a tuberculosis skin test and asks the nurse the reason for the test. Which response should the nurse give? A. The skin test will determine if you have a tuberculosis infection. B. The skin test will indicate whether you have active tuberculosis. C. The skin test is used to decide which antibiotic therapy will work best. D. The skin test is done prior to notification of the public health department.

38. A. A positive skin test will indicate whether the patient has been infected with tuberculosis. It does not indicate active infection, which will be established through chest x-ray and sputum culture. Initial drug treatment with 4 antibiotics uses a standardized protocol. Although the public health department should be notified if the patient has TB, the nurse should focus on the patient, rather than on the public health concerns.

39. 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).

39. D. Advising her to begin prophylactic therapy with isoniazid (INH).

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

4. 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.

12. A police officer brings in a homeless client to the ER. A chest x-ray suggests he has TB. The physician orders an intradermal injection of 5 tuberculin units/0.1 ml of tuberculin purified derivative. Which needle is appropriate for this injection? A. 5/8" to ½" 25G to 27G needle. B. 1" to 3" 20G to 25G needle. C. ½" to 3/8" 26 or 27G needle. D. 1" 20G needle.

12. C. Intradermal injections like those used in TN skin tests are administered in small volumes (usually 0.5 ml or less) into the outer skin layers to produce a local effect. A TB syringe with a ½" to 3/8" 26G or 27G needle should be inserted about 1/8" below the epidermis.

13. 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

13. B. One of the first pulmonary symptoms includes a slight cough with the expectoration of mucoid sputum

15. 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.

15. 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.

10. 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.

10. D. Continuing to have acid-fast bacilli in the sputum after 2 months indicated continued infection.

11. 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.

11. 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.

25. 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.

25. 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.

20. Which of the following antituberculus drugs can cause damage to the eighth cranial nerve? A. Streptomycin B. Isoniazid C. Para-aminosalicylic acid D. Ethambutol hydrochloride

20. A. Streptomycin is an aminoglycoside, and eight cranial nerve damage (ototoxicity) is a common side effect from amintoglycodsides.

21. The client experiencing eighth cranial nerve damage will most likely report which of the following symptoms? A. Vertigo B. Facial paralysis C. Impaired vision D. Difficulty swallowing

21. A. The eighth cranial nerve is the vestibulocochlear nerve, which is responsible for hearing and equilibrium. Streptomycin can damage this nerve.

22. 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

22. 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.

23. 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."

23. B, D, E.

24. 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.

24. B. A positive PPD test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists.

3. 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. Superinfection D. Tertiary infection

3. 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.

30. The nurse recognizes that the goals of teaching regarding the transmission of TB have been met when the patient with TB: A. Demonstrates correct use of a nebulizer. B. Reports daily to the public health department. C. Washes dishes and personal items after use. D. Covers the mouth and nose when coughing.

30. D. Covering the mouth and nose will help decrease airborne transmission of TB. The other actions will not be effective in decreasing the spread of TB.

31. A patient is receiving isoniazid (INH) after having a positive tuberculin skin test. Which information will the nurse include in the patient teaching plan? A. "Take vitamin B6 daily to prevent peripheral nerve damage." B. "Read a newspaper daily to check for changes in vision." C. "Schedule an audiometric examination to monitor for hearing loss." D. "Avoid wearing soft contact lenses to avoid orange staining."

31. A. Peripheral neurotoxicity associated can be prevented by taking vitamin B6 when being treated with INH. Visual changes, hearing problems, and orange staining are adverse effects of other TB medications.

37. When caring for a patient who is hospitalized with active TB, the nurse observes a family member who is visiting the patient. The nurse will need to intervene if the family member: A. Washes the hands before entering the patient's room. B. Puts on a surgical face mask before visiting the patient. C. Brings food from a "fast-food" restaurant to the patient. D. Hands the patient a tissue from the box at the bedside.

37. B. A high-efficiency particulate-absorbing (HEPA) mask, rather than a standard surgical mask, should be used when entering the patient's room because the HEPA mask can filter out 100% of small airborne particles. Handwashing before visiting the patient is not necessary, but there is no reason for the nurse to stop the family member from doing this. Because anorexia and weight loss are frequent problems in patients with TB, bringing food from outside the hospital is appropriate. The family member should wash the hands after handling a tissue that the patient has used, but no precautions are necessary when giving the patient an unused tissue.

40. 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

40. D. Daily doses of isoniazid, 300 mg for 6 months to 1 year

42. 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.

42. C. It's tuberculocidal, destroying the offending bacteria

43. 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."

43. C. "I will stay in isolation for at least 6 weeks."

44. A client with advanced acquired immunodeficiency syndrome (AIDS) is diagnosed with active tuberculosis. Which of the following regimens would the nurse expect the physician to prescribe? A. isoniazid (Laniazid) and rifampin (Rifadin) B. ethambutol (Myambutol), pyrazinamide, and isoniazid C. isoniazid, rifampin, ethambutol, and pyrazinamide D. ethambutol, ciprofloxacin (Cipro), pyrazinamide, and streptomycin

44. C. isoniazid, rifampin, ethambutol, and pyrazinamide

45. A recent immigrant from Vietnam is diagnosed with pulmonary tuberculosis (TB). Which intervention is most important for the nurse to implement with this client? A. Client teaching about the cause of TB B. Reviewing the risk factors for TB C. Developing a list of people with whom the client has had contact D. Client teaching about the importance of TB testing

45. C. Developing a list of people with whom the client has had contact

Which of the following diagnostic tests is definitive for TB? A. Chest x-ray B. Mantoux test C. Sputum culture D. Tuberculin test

5. C. The sputum culture for Myobacterium 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.

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

6. 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.

7. 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.

7. D. A tuberculin converter's skin test will be positive, meaning he has been exposed to an infected with TB and now has a cell-mediated immune response to the skin test. The client's blood and x-ray results may stay negative. It doesn't mean the infection has advanced to the active stage. Because his x-ray is negative, he should be monitored every 6 months to see if he develops changes in his x-ray or pulmonary examination. Being a seroconverter doesn't mean the TB has gotten into his bloodstream; it means it can be detected by a blood test.

35. A staff nurse has a TB skin test of 16-mm induration. A chest radiograph is negative, and the nurse has no symptoms of TB. The occupational health nurse will plan on teaching the staff nurse about the: A. Use and side effects of INH. B. Standard four-drug therapy for TB. C. Need for annual repeat TB skin testing. D. Recommendation guidelines for bacille Calmette-Guérin (BCG) vaccine.

35. A. The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9 months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not done for individuals who have already had a positive skin test. BCG vaccine is not used in the United States and would not be helpful for this individual, who already has a TB infection.

36. The nurse is performing TB screening in a clinic that has many patients who have immigrated to the United States. Before doing a TB skin test on a patient, which question is most important for the nurse to ask? A. "How long have you lived in the United States?" B. "Is there any family history of TB?" C. "Have you received the BCG vaccine for TB?" D. "Do you take any over-the-counter (OTC) medications?"

36. C. Patients who have received the BCG vaccine will have a positive Mantoux test; another method for screening (such as a chest x-ray) will be used in determining whether the patient has a TB infection. The other information may also be valuable but is not as pertinent to the decision about doing TB skin testing.