TB
A patient with newly diagnosed acquired immunodeficiency syndrome (AIDS) has a negative result on a skin test for tuberculosis (TB). Which action will you anticipate taking next? 1. Obtain a chest radiograph and sputum smear. 2. Tell the patient that the TB test results are negative. 3. Teach the patient about the anti-TB drug isoniazid. 4. Schedule TB testing again in 12 months.
4
A client admitted to the medical surgical unit with possible pulmonary tuberculosis (TB) asks the nurse why sputum specimens are needed if the skin test and chest x-ray indicate tuberculosis. The best response by the nurse is: a "Definitive diagnosis of the infection can only be made by the presence of the organism in sputum." b "The sputum culture helps to determine the presence of a viral infection." c "The sputum collection has nothing to do with the diagnosis of TB." d "Sputum collection gives information about the progression of the disease."
a
A client diagnosed with TB asks the nurse when he can return to work. The nurse should tell the client that: a. he can return to work when he has 3 negative sputum cultures b. he can return to work as soon as he feels well enough c. he can return to work after a week of being on the medication d. he should think about applying for disability because he will no longer be able to work
a
The nurse is assessing the result of a tuberculin skin test. Which area of induration always indicates a positive response to a tuberculin test? a >15 mm b 5-9 mm c <5 mm d 10-15 mm
a
The nurse is caring for a client who has been admitted to the unit with tuberculosis. The client is placed in isolation. To protect the caregivers and other clients on the unit, which type of isolation room is most appropriate? a Isolation room with an anteroom and negative air flow (Air flows into the room.) b Single-door room with positive air flow (Air flows out of the room.) c Isolation room with an anteroom and normal airflow d Single-door room with normal airflow
a
The nurse is conducting a community assessment because of the increased number of TB cases reported during the last year. Which population requires the most education regarding ways to The The nurse is conducting a community assessment because of the increased number of TB cases reported during the last year. Which population requires the most education regarding ways to decrease the risk of spreading TB? a Adult residents in nursing homes b Children who attend public school c Adolescents involved in sports d Infants in day care
a
Which clinical therapy is appropriate for a client with tuberculosis (TB) who experiences the complication of a pneumothorax? a Placement of chest tube to water-seal b CT to locate drainage c IV antibiotics d Intubation
a
A client's skin PPD test for tuberculosis is positive. Which of the following is the most appropriate nursing action? a Notify the health care provider. b Isolate the client immediately. c Place the client in a negative air-flow room. d Immediately begin antituberculosis medications.
a Rationale: A positive skin test (induration of at least 5 mm) does not necessarily mean that a client has tuberculosis. A positive finding suggests that a client has been exposed to the disease, and other tests such as a chest x-ray and, more importantly, a sputum culture, would be expected to aid in confirming the diagnosis of TB. However, a positive test may not necessarily mean that infection is present or that the client is contagious. Thus, the healthcare provider should be notified as soon as possible to begin further assessment. Using isolation, negative air-flow, and medications are not indicated prior to a definitive diagnosis.
Julianne Rolf, a nurse who works in your department, asks you to read her intradermal PPD (Mantoux) test, which was administered 50 hours ago. Examining the test site, you notice a 6-mm area that is slightly red and soft to the touch. Ms. Rolf denies any risk factors for TB such as diabetes, HIV infection, or organ transplantation. What do these findings represent? a Negative response b Indeterminate response c Positive response if she has an abnormal chest x-ray d Positive response
a RATIONALE: Although Ms. Rolf's PPD injection site is slightly red, it is not indurated or hard; therefore, this represents a negative PPD test result. A positive PPD test result manifests as a hard or indurated area between 5 and 9 mm for clients with an abnormal chest x-ray or greater than 15 mm for all clients. The reddened area does not represent an indeterminate response. Next Question
Which nursing intervention is appropriate to include in the plan of care for a client with TB to address the risk of infecting others? (Select all that apply.) a Providing verbal and written instructions about when to take the medications b Teaching the client how to avoid transmitting the disease to others c Teaching the client why it is important to comply with prescribed treatments for the whole course of therapy d Assessing self-care abilities and support systems e Informing all personnel who have contact with the client of the diagnosis
b,c,e
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
c
Sharon Atka, a 79-year-old woman, presents to the emergency department complaining of a cough, hemoptysis, night sweats, anorexia, and weakness. When asked about her medical history, she states that as a young woman, she was told she had TB but never really got sick from it. She also states that she was diagnosed with diabetes and heart failure 10 years ago. What should you suspect is responsible for her current symptoms? a Dormant TB b Skeletal TB c New-onset TB d Reactivation TB
d
The nurse is caring for a client who is receiving multiple drugs for treatment of tuberculosis. The nurse teaches the client the rationale for the multiple-drug treatment and evaluates learning as effective when the client makes which statement? a "Multiple drugs are necessary because I became infected from an immigrant." b "Multiple drugs will be required as long as I am contagious." c "Multiple drugs are necessary to develop immunity to tuberculosis." d "Multiple drugs are necessary because of the risk of resistance
d
The Mantoux test is used to determine whether a person has been exposed to TB. If the test is positive the nurse will find a: a. fluid-filled vesicle b. sharply demarcated erythema c. central area of induration d. circular or blanched area
c
The nurse working in an out-patient clinic would suspect which individual is most likely to contract tuberculosis? a Homemaker b Tobacco farmer c Homeless person d Day care worker
c
The nurse is preparing to assess a 90-year-old client admitted with tuberculosis. Which manifestation will the nurse most likely assess in this client? a Cough b Swollen lymph nodes c Night sweats d Hemoptysis
a Rationale: Presenting symptoms of tuberculosis in the older adult are often vague and include coughing, weight loss, diminished appetite, and periodic fevers. Night sweats, swollen lymph nodes, and hemoptysis are not considered presenting symptoms of tuberculosis in the older adult.
The nurse in a community clinic is asked to determine which clients require TB testing. Which individuals should the nurse recommend for this screening? (Select all that apply.) a Those who are infected with HIV or at high risk for HIV infection b Those with close contacts who have or are suspected to have TB c Those who are residents or staff of long term-residential facilities d Those who have had bacillus Calmette-Guerin (BCG) e Those who have had PPD
a,b,c
The nurse is providing care to a 4-month-old infant during a well-child checkup. The healthcare provider has ordered a PPD. Which data collected during the nursing assessment supports the need for this screening test?(Select all that apply.) a Persistent cough b No weight gain since last visit c Close contact with a person who has been diagnosed with TB d Higher risk for reactivation TB e Nursing home resident
a,b,c
The nurse is preparing a plan of care for a client diagnosed with TB. Which goals and outcomes are appropriate to include for this client? (Select all that apply.) a The client will articulate required treatment and follow-up care. b The client will demonstrate behaviors that reduce the risk of spreading the disease to others. c The client will have the resources necessary to obtain required supplies and medications. d The client with latent infection completes therapy and does not develop active TB. e The client with active TB complies with prescribed therapies, symptoms resolve, and chest x-rays improve.
a,b,c RATIONALE: Appropriate client goals and outcomes include the client will articulate required treatment and follow-up care, the client will demonstrate behaviors that reduce the risk of spreading the disease to others, and the client will have the resources necessary to obtain required supplies and medications. Examples of nursing observations during the evaluation phase include the client with active TB complies with prescribed therapies, symptoms resolve, and chest x-rays improve and the client with latent infection completes therapy and does not develop active TB.
The nurse caring for a homeless client at risk for tuberculosis will include which symptoms of the disease when educating the client? Select all that apply. a Fatigue b Weight loss c Night sweats d Productive cough that later turns to a dry, hacking cough e Low-grade morning fever
a,b,c Rationale: Manifestations of tuberculosis often develop insidiously and are initially nonspecific. Fatigue, weight loss, diminished appetite, low-grade afternoon fever, and night sweats are common. A dry cough develops, which later becomes productive of purulent and/or blood-tinged sputum. It is often at this stage that the client first seeks medical attention.
The public health nurse is training a novice nurse on tuberculin skin testing. Which information about the tine test should the public health nurse include in the training? (Select all that apply.) a "A multiple-puncture device is used to introduce tuberculin into the skin." b "Vesicular reaction is positive." c "The test is read within 48 to 72 hours and recorded as diameter of induration." d "PPD (0.1 mL) is injected intradermally into the dorsal aspect of the forearm." e "This test is less accurate than the PPD test."
a,b,e Rationale: In the tine test, a multiple-puncture device is used to introduce tuberculin into the skin. This test is less accurate than the PPD test. Vesicular reaction is positive. Intradermal injection of 0.1 mL of PPD into the dorsal aspect of the forearm, reading the test within 48 to 72 hours, and recording as diameter of induration are characteristics of the intradermal PPD (Mantoux) test.
Which is a risk factor for tuberculosis (TB)? (Select all that apply.) a Living in a poorly ventilated environment b Sharing clothes with an infected individual c Using injection drugs d Being an immigrant to the United States e Having a compromised immune system
a,c,d,e
Which statement by a young adult recently diagnosed with active tuberculosis (TB) indicates the client's correct understanding of the planned treatment regimen and expected outcomes of this treatment? (Select all that apply.) a "I'll need to take the anti-TB medications for at least 6 months." b "I can return to school after I've been on the medicine for 2 days." c "Using four anti-TB drugs at the same time will help keep the bacteria from developing resistance to the drugs used to fight TB." d "If my sputum cultures are still positive after taking these drugs for 3 months, it might mean that I have drug-resistant TB." e "I can feel pretty confident that I'll be cured of TB if I take the prescribed medications as I am supposed to."
a,c,d,e Rationale: Newly diagnosed active tuberculosis is typically treated initially with a four oral anti-TB drug regimen using isoniazid, rifampin, pyrazinamide, and ethambutol for at least 2 months followed by at least 4 more months of just isoniazid and rifampin. The four-drug regimen helps to prevent drug-resistance, and clients can feel reasonably assured that their TB will be cured if they follow the treatment as prescribed. In most cases, sputum cultures will be negative within 3 months of starting therapy if the medications are taken faithfully. Positive cultures after this time may reflect treatment failure or drug resistance. The client should not return to school in 2 days, but should avoid crowds and close physical contact, especially during the first 3 weeks of treatment.
Which nursing diagnosis is appropriate to include in the plan of care for a client with TB? (Select all that apply.) a Deficient community health b Night sweats c Imbalanced nutrition d Injection drug use e Risk for infection
a,c,e
A patient's treatment regimen for tuberculosis (TB) includes rifampin (Rifadin). When teaching the patient about rifampin, which of the following information should be included? Select all that apply. a "You should switch from contact lenses to glasses during your treatment." b " If the medication causes stomach upset, you may take it with food." c "It's recommended that you abstain from alcohol during your treatment." d "You will need to take your medication for two full weeks." e "Call the clinic if you experience any unusual bruising or bleeding."
a,c,e Patients who are being treated for TB continue their therapy for several months. Rifampin concentrations may be decreased if taken with food so the patient should be advised to take the medication on an empty stomach (one hour before meals or two hours after meals) with a glass of water. Rifampin may cause orangish discoloration of body fluids like urine, saliva, sweat, and tears. The patient should be warned of this and reassured that the color change is harmless. But because it can stain contact lenses, wearing glasses during treatment is advised. Rifampin may cause thrombocytopenia and/or hepatotoxicity, which may cause unusual bruising or bleeding. Alcohol use during therapy may increase the potential for hepatotoxicity.
A nurse reading an elderly client's PPD tuberculosis skin test interprets it as positive. A student nurse later asks about the etiology and characteristics of TB in this age group. What is the best response to the student's question? a "Some older people acquire TB as a result of physiological stress from the shingles vaccine." b "A positive PPD test in an elderly person is almost always indicative of active TB." c "Most cases in the elderly are caused by a reactivation of a dormant TB bacterium." d "Infection with tuberculosis is confined to the respiratory tract, primarily the lungs."
c
A client is taking Rifadin(rifampin) 600mg PO daily for pulmonary tuberculosis. The nurse should tell the client to: ❍ A. Take the medication with juice ❍ B. Expect red discoloration of the urine ❍ C. Take the medication before going to bed at night ❍ D. Take the medication only if night sweats occur
b
At what phase of the nursing process does the nurse collect and document factors such as the client's complaints of fatigue, known exposure to TB, living circumstances, and substance abuse? a Implementation b Assessment c Evaluation d Diagnosis
b
The nurse in an inner city clinic is providing a health screening for a homeless man with a history of drug abuse. The client has a chronic non-productive cough. For what should the nurse expect to screen this client? a Sickle cell disease b Tuberculosis c Herpes zoster d Sick sinus syndrome
b
The public health nurse is completing a community assessment regarding the increased incidence of TB. Which population in the community should the nurse identify as having the greatest risk for contracting and developing TB? a Hispanics b Asian immigrants c Foreign-born residents d Blacks
b
Which has highest priority when teaching a client about antituberculosis medications? a Avoid exposure to crowds of people. b Take all the medications as prescribed. c Eat a well-balanced diet high in both protein and carbohydrate. d Get adequate rest when taking the medications.
b
The nurse evaluating a tuberculin test result 72 hours after it was administered to a client notes an area of induration that is 9 mm in diameter. What additional information would indicate that this should be interpreted as a positive finding? a Was born in Southeast Asia in Vietnam b Has HIV disease c Resides in a long-term care facility d Uses injected drugs
b Rationale: A 9 mm induration is considered a positive result in a client with HIV disease. Induration of 10-15 mm would be considered a positive test in clients with various other risk factors, including residing in a long-term care facility, birth in a high-incidence country, and injection drug use.
The nurse is providing care to a client who has been diagnosed with TB. Which diagnostic test is conducted before the The nurse is providing care to a client who has been diagnosed with TB. Which diagnostic test is conducted before the initiation of antibiotic treatment?(Select all that apply.) a Tine test b Sputum culture c Intradermal PPD (Mantoux) test d Sputum smear e Polymerase chain reaction (PCR)
b,d,e
A nurse is caring for a client with tuberculosis who is taking Rifampin for treatment of the disease. Of which nursing considerations should the nurse be aware regarding this medication? Select all that apply. a Record a baseline visual examination before therapy. b Monitor CBC, liver function studies, and renal function studies for evidence of toxicity. c Administer by deep intramuscular injection into a large muscle mass. d Administer with meals to reduce gastrointestinal side effects. e Administer on an empty stomach.
b,e Rationale: Rifampin is an oral antituberculosis medication that should be administered on an empty stomach. The nurse should monitor the CBC, liver function studies, and renal function studies. A baseline visual examination before therapy is necessary with ethambutol, another antituberculosis medication.
Clayton Laberge, a 47-year-old man with a history of chronic alcoholism, is admitted to the hospital complaining of dyspnea and hemoptysis and is diagnosed with pulmonary TB. Which assessment finding supports this diagnosis? a High fever in the morning b Increased appetite c Night sweats d Weight gain
c
a client with TB who has been on combined therapy with Rifadin (rifampin) and INH (isoniazid) asks the nurse how long he will have to take the medications? The nurse should tell the client that: a. medication is rarely needed after 2 weeks b. he will need the medication the rest of his life c. the course of combined therapy is usually 6 months d. he will be re-evaluated in one month to see if further medication is needed
c
The nurse is providing care to a client with TB. The client is a heavy drinker, and liver enzyme tests reveal damage. Which medication prescription should the nurse question for this client? a Pyrazinamide (Tebrazid) b Ethambutol hydrochloride (Myambutol) c Isoniazid (INH) d Rifampin (Rifadin)
c Rationale: INH is a first-line drug for active TB but should not be prescribed for clients with a history of liver problems or heavy drinking. Rifampin (Rifadin), pyrazinamide (Tebrazid), and ethambutol hydrochloride (Myambutol) are other pharmacologic therapies for treating TB that the nurse should not question for this client.
A client with tuberculosis who has been on combined therapy with Rifadin (rifampin) and INH (isoniazid) asks the nurse how long he will have to take medication. The nurse should tell the client that: ❍ A. Medication is rarely needed after two weeks. ❍ B. He will need to take medication the rest of his life. ❍ C. The course of combined therapy is usually six months. ❍ D. He will be re-evaluated in one month to see if further medication is needed.
c Rationale: The usual course of treatment using combined therapy with isoniazid and rifampin is six months. Two other medications, pyrazinamide and ethambutol, are usually given along with isoniazid and rifampin for 2 months. Answers A and D are incorrect because the treatment time is too brief. Answer B is incorrect because the medication is not needed for life
The charge nurse for a medical-surgical unit is notified that a client with tuberculosis (TB) is being transported to the unit. Which actions for infection prevention are the most appropriate in this circumstance? Select all that apply. a Perform hand hygiene only after leaving the room. b Test all staff members for TB immediately c Have the client wear a mask when coming from admissions. d Wear a mask and gown when caring for the client. e Stock the client's supply cart at the beginning of each shift.
c,d Rationale: Masks and gowns should be worn when caring for clients who do not reliably cover their mouths when coughing. When a client has an airborne disease and must go elsewhere in the hospital, the client must wear a mask. Supplies to prevent transmission of disease should be stocked at the end of the shift so that adequate supplies will be available for the next healthcare provider. Hand hygiene should be performed before and after client care. Clinical staff receive TB testing annually. There is no reason to test all staff members at this time.
The infection control nurse is educating the staff at a long-term care facility after a recent outbreak of TB. Which elements of infection control should the nurse include in the teaching? (Select all that apply.) a Administration of the bacillus Calmette-Guerin (BCG) vaccine to residents b Implementation of universal screening c Treatment of clients with suspected or confirmed disease d Use of airborne precautions e Identification of infected individuals
c,d,e
An occupational health nurse is screening a new employee in a long-term care facility for tuberculosis. The employee questions why purified protein derivative (PPD) testing is done twice. Which is the most appropriate response by the nurse? a "The first PPD was not interpreted in the correct time frame of 48-72 hours." b "The treatment for TB is 6 months of medication, and we want to make sure the first results of the first PPD were accurate." c "Different medication is used in the second PPD." d "There is an increased risk for a false-negative response for people who work in long-term care facilities. The two-step is recommended to accurately screen for TB.
d
The nurse is providing care for a client diagnosed with TB. After learning that a chest x-ray has been ordered, the client asks, "Why do I need another test? They already know what is wrong with me." Which rationale is the nurse's best response? a "An x-ray permits rapid detection of DNA from the tubercular bacillus." b "An x-ray identifies the appropriate drug therapy." c "An x-ray establishes liver function before initiation of medication therapy because drugs may be hepatotoxic." d "An x-ray evaluates the diagnosis and effectiveness of treatment."
d
The nurse teaching a client taking prophylactic daily Isoniazid (INH) in order to prevent active TB following tuberculin test conversion should include which instruction? a "This drug turns your urine red-orange. This is a harmless side-effect of this medication." b "You will need to have periodic eye examinations during your treatment." c "Do not use aspirin while taking this drug because abnormal bleeding may occur." d "Be sure to report any numbness and tingling of your extremities to your health care provider."
d
a client with TB has a prescription for Myambutol, (ethambutol HCI) The nurse should tell the client to notify the dr. immediately if he notices: a. gastric distress b. changes in hearing c. red discoloration of body fluids d. changes in color vision
d
A client with tuberculosis has a prescription for Myambutol (ethambutol HCl). The nurse should tell the client to notify the doctor immediately if he notices: ❍ A. Gastric distress ❍ B. Changes in hearing ❍ C. Red discoloration of body fluids ❍ D. Changes in color vision
d Rationale: An adverse reaction to Myambutol is changes in visual acuity or color vision. Answer A is incorrect because it does not relate to the medication. Answer B is incorrect because it is an adverse reaction to Streptomycin. Answer C is incorrect because it is a side effect of Rifampin.
The nurse is planning care for a 90-year-old client who was recently diagnosed with tuberculosis. The client lives alone in an apartment and will continue treatment at home. Which nursing diagnosis is a priority for this client? a Risk for Injury b Deficient Knowledge c Ineffective Breathing Pattern d Ineffective Therapeutic Regimen Management
d Rationale: The treatment regimen for tuberculosis requires that the client take many medications, maintain nutrition, and be aware of potential side effects. Due to increased age and normal forgetfulness, this client is at risk for ineffective treatment in the home. The client may have a knowledge deficit but the priority is the treatment regimen. Since the client is being treated in the home, there is not much risk for ineffective breathing. The client is at risk for injury because of age, not TB.
An adolescent client is brought to the emergency department (ED) with fatigue, weight loss, a dry cough, and night sweats. The family just recently immigrated to the United States. Based on this data, for which potential risk should the nurse include when planning care for this client? a Pneumonia b Renal failure c Septicemia d Pneumothorax
d Rationale: This client was foreign-born, a risk factor for tuberculosis (TB), and has the classic symptoms of tuberculosis. The nurse plans frequent respiratory assessments, as this child is at risk for pneumothorax. Patients with TB are not at particular risk for pneumonia, renal failure, or septicemia
