Tuberculosis (TB)
A client has a positive reaction to the PPD test. The nurse correctly interprets this reaction to mean that the client has: -Active TB -Had contact with Mycobacterium tuberculosis -Developed a resistance to tubercle bacilli -Developed passive immunity to TB
-Had contact with Mycobacterium tuberculosis A positive PPD test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists.
The nurse is preparing to give a bed bath to an immobilized client with TB. The nurse should wear which items when performing this care? -Surgical mask and gloves -Particulate respirator, gown, and gloves -Particulate respirator and protective eyewear -Surgical mask, gown, and protective eyewear
-Particulate respirator, gown, and gloves The nurse who is in contact with a client with TB 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.
A nurse is providing information to a group of clients at a local community center about tuberculosis. Which of the following clinical manifestations should the nurse include? (Select all that apply) -Persistent cough -Weight gain -Fatigue -Night sweats -Purulent sputum
-Persistent cough -Fatigue -Night sweats -Purulent sputum Manifestations of TB include persistent cough, weight loss, anorexia, fatigue, night sweats, hemoptysis, SOB, purulent sputum, fever, or chills.
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? -Adhere to a low cholesterol diet -Supplement the diet with pyridoxine (vitamin B6) -Get extra rest -Avoid excessive sun exposure
-Supplement the diet with pyridoxine (vitamin B6) 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.
The nurse understands the priority intervention with the patient with TB is which of the following? -Antibiotic administration -Initiation of isolation -TB test -Chest x-ray
-Initiation of isolation It is imperative that the TB patient be isolated as soon as possible to prevent the spread of the disease.
The nurse has conducted discharge teaching with a client diagnosed with TB who has been receiving medication for 2 weeks. The nurse determines that the client has understood the information if the client makes which statement? -"I need to continue medication therapy for 1 month." -"I can't shop at the mall for the next 6 months." -"I can return to work if a sputum culture comes back negative." -"I should not be contagious after 2 to 3 weeks of medication therapy."
-"I should not be contagious after 2 to 3 weeks of medication therapy." The client is continued on medication therapy for up to 12 months, depending on the situation. The client is generally considered non-contagious 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.
A home health nurse is teaching a client who has active tuberculosis and is following a medication regimen that includes a combination of isoniazid (Nydrazid) 250 mg PO daily, rifampin (Rifadin) 500 mg PO daily, pyrazinamide 750 mg PO daily, and ethambutol (Myambutol) 1 mg PO daily. Which of the following client statements indicate understanding? (Select all that apply) -"I can substitute one medication for another if I run out because they all fight infection." -"I will wash my hands each time I cough." -"I will wear a mask when I am in a public area." -"I am glad I don't have to have any more sputum specimens." -"I don't need to worry where I go once I start taking my medications."
-"I will wash my hands each time I cough." -"I will wear a mask when I am in a public area." The client should wash their hands each time they cough, and wear a mask while in public, to prevent spreading of the infection. The client has active TB, which is transmitted through the airborne route. Medications should not be replaced for one another; it is important that the client adhere to the multi-medication regimen prescribed to treat TB. The client will need to collect sputum cultures every 2 to 4 weeks until three consecutive sputum cultures have come back negative.
A nurse is caring for a client who has a new diagnosis of tuberculosis and has been placed on a multi-medication regimen. Which of the following instructions should the nurse give the client related to the medication ethambutol (Myambutol)? -"Your urine may turn a dark orange." -"Watch for a change in the sclera of your eyes." -"Watch for any changes in vision." -"Take vitamin B6 daily."
-"Watch for any changes in vision." The client who is receiving ethambutol will need to watch for visual changes due to optic neuritis. The client taking rifampin should expect to see their urine turn dark orange. Ethambutol does not have an adverse effect resulting in changes to the sclera of the eyes. The client taking isoniazid should take vitamin B6 daily and observe for signs of hepatotoxicity.
A nurse is preparing to administer a new prescription for isoniazid (INH) to a client who has tuberculosis. Which of the following is an appropriate statement by the nurse about this medication? -"You may notice yellowing of your skin." -"You may experience pain in your joints." -"You may notice tingling of your hands." -"You may experience a loss of appetite."
-"You may notice tingling of your hands." Tingling of the hands can be an adverse effect of isoniazid. Yellowing of the skin can be an adverse effect of rifampin or pyrazinamide. Experiencing pain in the joints and having a loos of appetite can be adverse effects of rifampin.
A nurse is teaching a client who has TB. Which of the following statements should the nurse include? -"You will need continue to take the multi-medication regimen for 4 months." -"You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication." -"You will need to remain hospitalized for treatment." -"You will need to wear a mask at all times."
-"You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication." The client who has TB needs to provide sputum samples every 2 to 4 weeks to monitor the effectiveness of the medication. The client who has TB needs to continue taking the multi-medication regimen for 6 to 12 months. The client who has TB is often treated in the home setting. The client who has TB needs to wear a mask when in public areas.
A nurse is reading a client's TST at 48 hours and notes that the client has 6 mm of redness and 3 mm of induration. The client is HIV+. Which of the following is the correct reading of the client's test? -9 mm and negative -6 mm and positive -3 mm and positive -3 mm and negative
-3 mm and negative The size necessary for the test to be read as positive will depend on the individual's risk factors. In immunocompromised clients, an induration of 5 mm is a positive test. A larger area of induration is required for a positive test in clients who are not immunocompromised or at risk for TB (10 mm or more). Although erythema may occur, the size of the area of redness does not matter when determining whether a test is positive.
A nurse administers a TST for a client at high risk of TB infection. When should the test result be evaluated? -12-24 hours after the test -24-36 hours after the test -48-72 hours after the test -Immediately after the test
-48-72 hours after the test TSTs rely on a delayed sensitivity reaction to a derivative of the bacteria M. tuberculosis. The test should be evaluated at 48-72 hours after administration. A positive reaction is indicated by induration (not erythema) at the site of the test. The size of the indurated area required for a positive test varies with the individual's risk factors and immune status.
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? -Acid-fast staining -Sensitivity testing -Agglutination testing -Dark-field illumination
-Acid-fast staining 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 with productive cough, chills, and night sweats is suspected of having active TB. The physician should take which of the following actions? -Admit him to the hospital in respiratory isolation -Prescribe isoniazid and tell him to go home and rest -Give a tuberculin test and tell him to come back in 48 hours and have it read -Give a prescription for isoniazid, 300 mg daily for 2 weeks, and send him home
-Admit them to the hospital in respiratory isolation 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 anti-tubercular 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 anti-tubercular drugs for 9 to 12 months.
The nurse is assessing a client with extra-pulmonary TB. Which of the following is true about this type of condition? (Select all that apply) -Genitourinary system is affected -Depression occurs -Weight gain occurs -It is associated with macular degeneration -Osteomyelitis occurs
-Genitourinary system is affected -Osteomyelitis occurs Extra-pulmonary TB affects various systems such as the genitourinary, musculoskeletal, and central nervous systems. The immunocompromised client is the usual victim of this type of condition. Osteomyelitis occurs when bones are affected while meningitis occurs if the brain is affected.
A nurse is changing a wound dressing for a client with TB who is on airborne precautions. When removing PPE after completing this task, which of the following should the nurse remove first? -Mask -Gown -Gloves -Eye protection
-Gloves By removing the gloves first, the nurse can prevent contamination of other items, including non-contaminated materials. With airborne precautions, the order of removal of PPE is gloves, eye protection, gown, and lastly mask; the mask is removed last to prevent inhalation of airborne pathogens that may have contaminated other PPE.
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? -Heart disease -Allergy to penicillin -Hepatitis B -Rheumatic fever
-Hepatitis B Isoniazid and rifampin are contraindicated in clients with acute liver disease or a history of hepatic injury.
The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB? -Take the medication with antacids -Double the dosage if a drug dose is forgotten -Increase intake of dairy products -Limit alcohol intake
-Limit alcohol intake 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 preparing a plan of care on the admission for a client who has active TB. Which of the following interventions should the nurse include in the plan? -Instruct individuals living with the client to implement airborne precautions when the client returns home -Place the client in a private room with a negative-pressure airflow ventilation system -Start antibiotic therapy on admission before a sputum culture is obtained -Apply a surgical mask before entering the clients room
-Place the client in a private room with a negative-pressure airflow ventilation system The nurse should place the client who has active TB in a private room with negative-pressure airflow via a HEPA filtration system. In these rooms the air is not returned to the inside ventilation system but is filtered and exhausted directly to the outside. Airborne precautions are not needed in the home; however, all exposed family members should receive TB testing. A sputum culture should be obtained before antibiotic therapy is implemented. The procedure for airborne precautions included donning with a disposable particulate respirator, not a surgical mask
The nurse performs an admission assessment on a client with a diagnosis of TB. The nurse should check the results of which diagnostic test that will confirm this diagnosis? -Chest x-ray -Bronchoscopy -Sputum culture -Tuberculin skin test (TST)
-Sputum culture TB is definitively diagnosed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made based on a TST, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histological evidence of granulomatous disease on biopsy. Confirmation is made by identifying the bacteria, M. tuberculosis.
