Gas Exchange
A nurse is administering a purified protein derivative (PPD) test to a client. Which statement concerning PPD testing is true?
A positive reaction indicates that the client has been exposed to the disease. R: A positive reaction means the client has been exposed to TB; it isn't conclusive for the presence of active disease. A positive reaction consists of palpable swelling and induration of 5 to 15 mm. It can be read 48 to 72 hours after the injection
A client calls the health care provider's office and frantically tells the nurse his TB test is red, and he is afraid this means he has tuberculosis. The best response by the nurse would be
"A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques." R: A definitive diagnosis of active pulmonary tuberculosis requires identification of the organism from cultures or DNA amplification techniques. Culture remains the gold standard for laboratory confirmation of infection and is required for drug sensitivity testing.
A client calls the health care provider's office and frantically tells the nurse his TB test is red, and he is afraid this means he has tuberculosis. The best response by the nurse would be:
"A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques." R: A definitive diagnosis of active pulmonary tuberculosis requires identification of the organism from cultures or DNA amplification techniques. Culture remains the gold standard for laboratory confirmation of infection and is required for drug sensitivity testing.
The health care provider is preparing to order rifampin and pyrazinamide for a female client with active tuberculosis. What question should the provider ask this client before confirming this order?
"Are you pregnant?" R: Pyrazinamide and streptomycin are contraindicated in pregnancy. A regimen of INH, rifampin, and ethambutol is usually used in the treatment of pregnant women.
Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis?
"Because I had a previous reaction to the test, this time I need to get a chest X-ray." R: A client who previously had a positive PPD test (a reaction to the antigen) can't receive a repeat PPD test and must have a chest X-ray done instead.
A nurse recognizes that a client with tuberculosis needs further teaching when the client states:
"It will be necessary for the people I work with to take medication." R: The client requires additional teaching if he states that coworkers will need to take medication. If exposed and testing positive, medications would be required for coworkers.
A client diagnosed with tuberculosis (TB) has begun multidrug therapy. The client has asked the nurse why it is necessary to take several different drugs. How should the nurse respond to the client's question?
"The use of multiple drugs prevents the development of drug-resistant TB." R: Use of multiple drugs to treat TB is necessary to prevent the development of drug-resistant TB.
A client diagnosed with tuberculosis asks the nurse how long the antitubercular medication will need to be taken. What is the best response?
"You can take drug therapy for as long as 24 months or until all tubercle bacilli are eliminated." R: The goal of treatment is to eliminate all tubercle bacilli from an infected person while avoiding emergence of significant drug resistance. Treatment of active tuberculosis requires the use of multiple drugs. Tuberculosis is an unusual disease in that drug therapy is required for a relatively long period.
A 25-year-old pregnant client comes to the office for the first prenatal visit. During the history, the client tells the nurse she had tuberculosis 5 years ago. What is the nurse's best response?
"You will have to maintain an adequate level of calcium during your pregnancy." R: A client who had tuberculosis earlier in life must be especially careful to maintain an adequate level of calcium during pregnancy to ensure the calcium tuberculosis pockets in her lungs are not broken down and the disease is not reactivated. The tuberculosis may reoccur if the intra-abdominal pressure (from pushing) breaks the calcified pockets open
The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient?
6 to 12 months R: Pulmonary tuberculosis (TB) is treated primarily with anti-TB agents for 6 to 12 months. A prolonged treatment duration is necessary to ensure eradication of the organisms and to prevent relapse.
The nurse is preparing the room for a client admitted from the emergency department with suspected tuberculosis (TB). Which type of infection control precautions would the nurse anticipate?
Airborne precautions R: Airborne precautions should be initiated for any client with suspected tuberculosis. Clients with suspected TB are placed away from other hospitalized clients in a single-occupancy room.
Tuberculosis typically affects the lungs but can also involve other parts of the body. Which of the following can be affected by the disease?
All the above R: Tuberculosis is an infectious disease that usually affects the lungs but may involve most parts of the body, including lymph nodes, meninges, bones, joints, kidneys, and the gastrointestinal tract.
A client, hospitalized with active tuberculosis, is receiving antitubercular drug therapy. When it becomes apparent that the client is not responding to the medications, what condition will the primary health care provider identify as a possible cause?
Drug-resistant tuberculosis R: A client who is being treated with antitubercular drug therapy and is not responding to the medication regime is most likely experiencing drug-resistant tuberculosis. Human immunodeficiency virus causes tuberculosis to move more rapidly.
A client is diagnosed with latent tuberculosis infection. The nurse expects that the treatment plan will include which drug?
INH R: INH is the treatment of choice for LTBI. INH abbreviation: isonicotinic acid hydrazide.
A client being treated for tuberculosis is determined to be drug resistant. Which medications will no longer be effective in the treatment of the tuberculosis?
Isoniazid and rifampin R: Isoniazid and rifampin are used to treat tuberculosis. In multidrug resistance, the most effective drugs the client is resistant to are isoniazid and rifampin.
A client is prescribed isoniazid (INH) for a diagnosis of tuberculosis. Which adverse effect will result in discontinuation of the medication?
Jaundice R: Potentially serious adverse effects of INH include hepatotoxicity. Hepatotoxicity may be manifested by symptoms of hepatitis (e.g., anorexia, nausea, fatigue, malaise, jaundice) or elevated liver enzymes. The nurse reports their development to the health care provider promptly to prevent possible liver failure and death.
The nurse is developing a community program since a recent increase in admissions to the acute care facility with tuberculosis infection. What is the most frequent form of tuberculosis that the nurse should focus on?
Mycobacterium tuberculosis R: Mycobacterium tuberculosis hominis is the most frequent form of tuberculosis that threatens humans.
A group of students are reviewing information about drugs used to treat tuberculosis. The students demonstrate understanding of the material when they identify which drug as a first-line treatment option?
Rifampin R: Rifampin, along with isoniazid, pyrazinamide, ethambutol, streptomycin, and rifapentine, are considered first-line agents for treating tuberculosis. Kanamycin, ciprofloxacin, and capreomycin are second-line agents.
A client had a tuberculin skin test (TST) performed as part of the immigration process and is surprised that the results are positive. How should the nurse best interpret this result?
The client was exposed to the tubercle bacillus at an indefinite point in the past. R: A positive reaction to the TST does not mean that a person has active tuberculosis, only that there has been exposure to the bacillus and that cell-mediated immunity to the organism has developed.
A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse?
The nurse is likely asymptomatic. R: Latent TB infection is not an active form of TB, and affected individuals are asymptomatic and cannot pass on the disease to others. Later, if immune mechanisms decline or fail, latent TB infection has the potential to develop into secondary TB.
What factors may prompt such a change in tuberculosis (TB) treatment to include second-line anti-TB drugs? Select all that apply.
There is resistance to the first-line drugs. The client is unable to tolerate first-line drugs R: Second-line anti-TB drugs are used in combination with other drugs when there is drug resistance to one of the first-line drugs or the client is unable to tolerate use of a first-line drug.
A client asks why three medications are prescribed to treat his tuberculosis. The nurse informs the client of which reasons?
To prevent resistance R: The CDC recommends multi-drug therapy to slow the development of bacterial resistance.
The nurse caring for a client with tuberculosis anticipates administering which vitamin with isoniazid (INH) to prevent INH-associated peripheral neuropathy?
Vitamin B6 R: Vitamin B6 (pyridoxine) is usually administered with INH to prevent INH-associated peripheral neuropathy.
A client is admitted to the health care facility with active tuberculosis (TB). What intervention should the nurse include in the client's care plan?
Wearing a disposable particulate respirator that fits snugly around the face R: Because TB is transmitted by droplet nuclei from the respiratory tract, the nurse should put on a disposable particulate respirators that fit snugly around the face when entering the client's room. Occupation Safety and Health Administration standards require an individually fitted mask.
A nurse is preparing an in-service presentation for a group of nurses about antitubercular drugs. The nurse would identify which drug as a secondary drug to treat tuberculosis?
ciprofloxacin R: Certain fluoroquinolones such as ciprofloxacin, ofloxacin, and levofloxacin have been proven effective against TB and are considered secondary drugs. Ethambutol, isoniazid, and pyrazinamide are primary antitubercular drugs.
Repeated lab work shows positive cultures for a client prescribed drug therapy for tuberculosis (TB) over 4 weeks ago. What are the likely reasons for this failure to achieve treatment goals? Select all that apply.
client has been nonadherent with medication therapy a delay in the initial diagnosis of the client infecting strain of TB is drug resistant R: The emergence of drug-resistant TB organisms has long been attributed mainly to poor client adherence to prescribed anti-TB drug therapy—that is, when previously infected clients do not take the drugs and doses prescribed for the length of time prescribed. However, drug-resistant strains can spread from one person to another, and there is increasing evidence that many drug-resistant infections are new infections, especially in people whose immune system is suppressed. Factors contributing to the development of drug-resistant disease include delayed diagnosis and delayed determination of drug susceptibility (which can take several weeks). Adequate drug therapy of clients with active disease usually produces improvement within 2 to 3 weeks.
A client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs?
decreased hearing acuity R: Decreased hearing acuity indicates ototoxicity, a serious adverse effect of streptomycin therapy. The client should notify the physician immediately if it occurs so that streptomycin can be discontinued and an alternative drug can be ordered.
A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client?
developing a list of people with whom the client has had contact R: To lessen the spread of TB, everyone who had contact with the client must undergo a chest X-ray and TB skin test. Testing will help determine if the client infected anyone else.
When a person is diagnosed with tuberculosis, it is most likely that the nurse prepares the family members to be treated prophylactically with which drug?
isoniazid R: When a person is diagnosed with tuberculosis, family members may be treated prophylactically with isoniazid.
What does a positive Mantoux test indicate?
production of an immune response R: The Mantoux test is based on the antigen/antibody response and will show a positive reaction after an individual has been exposed to tuberculosis and has formed antibodies to the tuberculosis bacteria. Thus, a positive Mantoux test indicates the production of an immune response.
The client reports cough, low-grade fever, anorexia, and night sweats. The client has also been coughing up blood at times. What disease does this client most likely have?
tuberculosis R: Symptoms of active TB include night sweats, cough, low-grade fever, fatigue, weight loss, and anorexia.
