TB, Valley Fever, Sleep Apnea

Which is a clinical manifestation that can indicate TB infection in a client? A. Night sweats and bloody or rusty sputum B. Myalgia C. Pleuritic chest pain D. Hypoactive bowel sounds

** A. Night sweats and bloody or rusty sputum is highly suspicious for TB infection. B. Myalgia, or muscle aches and pain, are one of the common clinical manifestations of influenza. C. Pleuritic chest pain is a result of chronic coughing due to pneumonia. D. Hypoactive bowel sounds are a prominent clinical manifestation of pneumonia.

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. 1. Cough 2. Dyspnea 3. Weight gain 4. High-grade fever 5. Chills and night sweats

**1,2,5 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. 1. Dyspnea 2. Headache 3. Night sweats 4. A bloody, productive cough 5. A cough with the expectoration of mucoid sputum

**1,3,4,5 Rationale: TB 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 TB should also be assessed and correlated with the clinical manifestations. Saunders

The 56-year-old client diagnosed with 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 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 3 months to determine if I am well."

**2 1. Clients diagnosed with TB will need to take the medications for 6 months to a year. 2. CORRECT: Compliance with treatment plans for TB includes multi drug therapy for 6 months to 1 year for the client to be free of the TB bacteria. 3. Clients are no longer contagious when 3 morning sputum specimens are cultured negative, but this will not occur until after several weeks of therapy. 4. The TB skin test only determines possible exposure to the bacteria, not active disease. Davis Med Surg Success

A client has been taking isoniazid for 2 months. The client complains 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

**2 Rationale: Isoniazid is an anti tubercular 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. Saunders

The healthcare provider is assessing a patient with a new diagnosis of pulmonary tuberculosis (TB). Which of the following findings would the healthcare provider anticipate? Choose all answers that apply: A. Hemoptysis B. Palpitations C. Tinnitus D. Fatigue E. Night sweats

**A, D, E Patients who become infected with TB develop nonspecific systemic symptoms such as fatigue, night sweats, and fever. A cough also develops, which progresses to hemoptysis as pulmonary tissue is destroyed.

A patient has been diagnosed with latent tuberculosis infection (LTBI). Which of the following statements are true about the patient? Choose all answers that apply: A. Respiratory specimens for acid-fast bacteria will be positive. B. The patient will not be able to transmit TB to others. C. The patient may not report symptoms characteristic of TB. D. Interferon-gamma release assay (IGRA) results will be positive. E. The results of a chest radiograph will be negative.

**B, C, D The interferon-gamma release assay (IGRA) is usually positive in patients with LTBI, indicating they have been exposed to Mycobacterium tuberculosis. Respiratory specimens acid-fast bacteria will be negative in a patient with LTBI. This test will be positive in a patient with active TB disease, except if the patient has extrapulmonary disease. TST and IRGA results are usually positive in a patient with LTBI. There will be no symptoms or physical findings that suggest TB disease, but the patient may be treated in order to prevent the LTBI from progressing to TB disease. The chest X-ray will show evidence of TB lesions. Khan Academy

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

**C The patient should report back in 48-72 hours. If they fail to, the test must be repeated. RN.com

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.

**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. RN.com

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

**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. RN.com

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

**C, D, E, and F 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. RN.com

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

**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. RN.com

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

**D This medication will cause body fluids to turn orange. RN.com

True or False: Tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis and it only affects the lungs.

**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. RN.com

The nurse observes the unlicensed assistive personnel entering an airborne isolation room and leaving the door open. Which action is the nurse's best response? 1. Close the door and discuss the UAP's action after coming out of the room. 2. Make the UAP come back outside the room and then reenter, closing the door. 3. Say nothing to the UAP but report the incident to the nursing supervisor. 4. Enter the client's room and discuss the matter with the UAP immediately.

**1 1. CORRECT: Closing the door reestablishes the negative air pressure, which prevents the air from entering the hall and contaminating the hospital environment. When correcting an individual, it is always best to do so in a private manner. 2. The employee is an adult and as such should be treated with respect and corrected accordingly. 3. Problems should be taken care of at the lowest level possible. The nurse is responsible for any task delegated, including the appropriate handling of the situation. 4. Correcting staff should never be done in the presence of the client. This undermines the UAP and creates doubt of the staff's competency in the client's mind. Davis

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

**1 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. Saunders

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. 1. Fatigue 2. Lethargy 3. Chest pain 4. Morning cough 5. Low-grade fever 6. Labored breathing

**1,2,4,5 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.

The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for TB. 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 have already 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 work.

**1,3,4,5 Rationale: The nurse should provide client and family with information about TB 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 he 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 have already 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 work. Saunders

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? 1. Surgical mask and gloves 2. Particulate respirator, gown, and gloves 3. Particulate respirator and protective eyewear 4. Surgical mask, gown, and protective eyewear

**2 Rationale: 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. Saunders

The employee health nurse is administering tuberculin skin testing to employees who have possibly been exposed to a client with active 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 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 1. A purple flat area indicates that the client became bruised when the intradermal injection was given, but it has no bearing on whether the test is positive. 2. A positive skin test is 10 mm or greater with induration, not redness. 3. CORRECT: If the client has ever reacted positively, then the client should have a chest x-ray to look for causation and inflammation. 4. These are negative findings and do not indicate the need to have x-ray determination of disease. Davis

The day shift charge nurse on a medical unit is making rounds after report. Which client should be seen first? 1. The 65-year-old client diagnosed with TB who has a sputum specimen to be sent to the laboratory. 2. the 76-year-old client diagnosed with aspiration pneumonia who has a clogged feeding tube. 3. The 45-year-old client diagnosed with pneumonia who has a pulse oximetry reading of 92%. 4. the 39-year-old client diagnosed with bronchitis who has an arterial oxygenation level of 89%.

**3 1. The specimen needs to be taken to the lab within a reasonable time frame, but a UAP can take specimens to the lab. 2. Clogged feeding tunes occur with some regularity. Delay in feeding a client will not result in permanent damage. 3. CORRECT: A pulse oximetry reading of 92% means that he arterial blood oxygen saturation is somewhere around 60% to 70%. 4. Arterial oxygenation normal values are 80% to 100%. Davis

A client with TB is being started on 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 levels

**3 Rationale: Isoniazid can be toxic to the liver. Isoniazid 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 or abuses alcohol. the lab tests in options 1, 2, and 4 are not necessary. Saunders

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

**3 Rationale: TB 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. Saunders

A client who is mouth breathing is receiving oxygen by face mask. The unlicensed assistive personnel (UAP) asks the registered nurse (RN) why a water bottle is attached to the oxygen tubing near the wall oxygen outlet. The RN responds that this feature facilitates which purpose? 1. Prevents the client from getting a nosebleed 2. Gives the client added fluid via the respiratory tree 3. Humidifies the oxygen that is bypassing the client's nose 4. Prevents fluid loss from the lungs during mouth breathing

**3. Rationale: The purpose of the water bottle is to humidify the oxygen that is bypassing the nose during mouth breathing. A client who is breathing through the mouth is not at risk for nosebleeds. The humidified oxygen may help keep mucous membranes moist, but it will not substantially alter fluid balance (options 2 and 4).

A client is scheduled to receive acetylcysteine 20% solution diluted in 0.9% normal saline by nebulizer. Which outcome would the nurse expect as a result of the administration of this medication? 1. Bronchodilation 2. Decreased coughing 3. Absence of wheezing 4. Thinning of respiratory secretions

**4 Rationale: Acetylcysteine is administered to thin bronchial secretions and is considered a mucolytic. The remaining options are the outcomes of respiratory medication therapy, but not of acetylcysteine.

A client has been taking pyrazinamide for 1 month. The client asks the nurse whether the therapy is due to be terminated soon. The nurse determines that the medication probably will be continued based on a positive finding in which report? 1. Blood culture 2. Urine culture 3. Wound culture 4. Sputum culture

**4 Rationale: Pyrazinamide is an antituberculosis medication given with other antituberculosis medications. Pyrazinamide might not be discontinued if sputum cultures continue to be positive. The remaining options are not related directly to the use of this medication.

A client is admitted to the hospital with difficulty breathing. Which is the best approach for the nurse to use in obtaining the client's health history? 1. Focus only on the physical examination. 2. Obtain all information from family members. 3. Use the health care provider's medical history. 4. Plan short sessions with the client to obtain data.

**4 Rationale: The best source of information is the client. Option 1 is incorrect; the physical examination is not part of the health history. Option 2 is incorrect because it refers to all information. Option 3 is incorrect because the health care provider's medical history provides data that are different from the nurse's assessment. All efforts should be made to obtain as much information as possible from the client, using short sessions and closed-ended questions.

The nurse has conducted discharge teaching with a client diagnosed with TB who has been receiving medication for 2 weeks. The nurse determines that he 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."

**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. Saunders

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

**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. RN.com

During the screening process for tuberculosis (TB), the healthcare provider notes that the patient received the bacilli Calmette-Guérin (BCG) vaccination several years ago. Which of the following is the best method to determine this patient's TB status? A. Interferon-gamma release assay (IGRA) B. Bronchoscopy for acid-fast bacteria (AFB) smear and culture C. Computerized tomography (CT) D. Tuberculin skin test (TST)

**A The BCG vaccine may cause a positive TST even though the patient has not been infected with the TB bacteria. A CT scan may be indicated if the results of a chest radiograph suggest TB infection. Unlike the TST, IGRAs are not affected by the BCG vaccination and are not expected to give a false-positive result, so this is the preferred test for a patient with a history of BCG vaccination. A sputum sample is collected from patients when TB is suspected, but sputum collection can be done less invasively than bronchoscopy by deep sputum-producing coughing or sputum induction. Khan Academy

A woman in her first trimester of pregnancy is diagnosed with tuberculosis (TB) disease. Which of these interventions will the healthcare provider implement? Choose 1 answer: A. Begin treatment with antituberculous medications immediately. B. Delay treatment until after the results of an amniocentesis is available. C. Begin treatment with antituberculosis medications but decrease the daily dose. D. Wait until after the baby is born because antituberculous medications harm the fetus.

**A Treating a patient with a dose less than the recommended dose will not be effective and will encourage the development of drug resistant bacteria. Untreated TB disease represents a greater hazard to a pregnant woman and her fetus than does treatment with antituberculous medications. Pregnant women with TB are treated with isoniazid (INH), which is U.S. Food and Drug Administration (FDA) pregnancy risk category C. Medications in pregnancy risk category C have not shown any adverse fetal effects in animal studies, so treatment should begin. Khan Academy

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: (Select all that apply) 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

**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. RN.com

A nurse is providing information about tuberculosis to a group of clients at a local community center. Which of the following manifestations should the nurse include int he teaching? (Select all that apply) A. Persistent cough B. Weight gain C. Fatigue D. Night sweats E. Purulent sputum

**A, C, D, E A. CORRECT: The nurse should include in the teaching that a persistent cough is a manifestation of tuberculosis. B. Weight loss is a manifestation of TB. C. CORRECT: Fatigue is a manifestation of TB. D. CORRECT: Night sweats is a manifestation of TB. E. CORRECT: Purulent sputum is a manifestation of TB. ATI Med Surg

Which is true regarding primary progressive TB infection (PPTBI)? A.It may develop in individuals who are exposed to bacterium. B. It may mean that the first-line medications used for the treatment of TB will be ineffective. C. It is often asymptomatic and is only confirmed by positive sputum cultures and a positive skin test. D. It is only when the immune system becomes compromised that the disease can become reactivated

**A. Symptomatic TB infection is referred to as PPTBI, which may develop in a very small percentage of individuals who are exposed to bacterium. B. In clients who are suffering from multidrug-resistant TB, the first-line medications used for the treatment of the disease will be ineffective. C. Primary TB infection is only confirmed by positive sputum cultures and a positive skin test because it is often asymptomatic. D. In clients with latent TB infection (LTBI), the disease can become reactivated only when the immune system becomes compromised. It can be reactivated due to HIV infection, long-term diabetes, chronic renal disease, long-term steroid administration, sepsis, and malnutrition.

Which is the main cause of blood tinged, rust-colored sputum in a client suffering from TB? A. The destruction of lung parenchyma tissue B. The inflammatory process of the lungs C. Decreased pH and increased CO2 D. Tachypnea and tachycardia

**A. The destruction of lung parenchyma tissue is the main cause of blood tinged, rust-colored sputum in the client. B. The inflammatory process of the lungs causes homeostasis in a client with influenza. C. Respiratory acidosis is indicated by decreased pH and increased CO2 in the client. D. Tachypnea and tachycardia result from the inflammatory response to bacterial infection.

A nurse is. teaching a client who has tuberculosis. Which of the following statements should the nurse include in the teaching? A. "You will need to continue to take the multimedication regimen for 4 months." B. "You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication." C. "You will need to remain hospitalized for treatment." D. "You will need to wear a mask at all times."

**B A. the client who has tuberculosis needs to continue taking the multi medication regimen for 6 to 12 months. B. CORRECT: The client who has tuberculosis needs to provide sputum samples every 2 to 4 weeks to monitor the effectiveness of the medication. C. the client who has tuberculosis is often treated in the home setting. D. The client who has TB needs to wear a mask in public areas. ATI Med Surg

The tuberculin skin test (TST) results for a patient who has been diagnosed with human immunodeficiency virus (HIV) is negative. How should the healthcare provider interpret this test result? Choose 1 answer: A. Poor technique was used when administering the TST. B. The patient is unable to mount an immune response to the test. C. The examiner failed to palpate the patient's arm thoroughly. D. The patient has not been exposed to the tuberculosis bacteria.

**B An immunocompetent person who has been exposed to TB will mount an immune response to the PPD, causing a positive result. A false-negative test in an immunocompromised person (e.g. HIV patients or patients receiving immunosuppressive therapy) is the result of anergy, where the person is not able to mount an immune response to the test

The healthcare provider is evaluating the tuberculin skin test (TST) for a patient who has a diagnosis of human immunodeficiency virus (HIV). The skin test is positive if the area of induration is at least __ mm? A. 1 B. 5 C. 10 D. 15

**B Khan Academy

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."

**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. RN.com

A home health nurse is teaching a client who has active tuberculosis. The provider has prescribed the following medication regimen: isoniazid 250 mg PO daily, rifampin 500 mg PO daily, Pyrazinamide 750 mg PO daily, and ethambutol 1 mg PO daily. Which of the following client statements indicate the client understands the teaching? (Select all that apply) A. "I can substitute one medication for another if I run out because they all fight infection." B. "I will wash my hands each time I cough." C. "I will wear a mask when I am in a public area." D. " I am glad I idon'thave to have any more sputum specimens." E. "I don't need to worry where I go once I start taking my medications."

**B, C A. Medications should not be replaced for one another. It is important that the client adhere to the multimedication regimen prescribed to treat tuberculosis. B. Correct: The client should wash her hands each time she coughs to prevent spreading the infection. C. Correct: The client should wear a mask while in public areas to prevent spreading theinfecjion. The client has active TB, which is transmitted through the airborne route. D. The client will need to collect sputum cultures every 2 to 4 weeks until three consecutive sputum cultures have come back negative. E. The client should continue to avoid crowded areas if possible and take preventative measures, such as wearing a mask when going out. *ATI Med Surg

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? Choose all answers that apply: A. "You will need to take your medication for two full weeks." B. "It's recommended that you abstain from alcohol during your treatment." C. "You should switch from contact lenses to glasses during your treatment." D. " If the medication causes stomach upset, you may take it with food." E. "Call the clinic if you experience any unusual bruising or bleeding."

**B, 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.

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

**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). RN.com

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

**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). RN.com

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.

**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. RN.com

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

**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. RN.com

A nurse is preparing to administer a new prescription for isoniazid (INH) to a client who has TB. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication? A. "You might notice yellowing of your skin." B. "You might experience pain in your joints." C. "You might notice tingling of your hands." D. "You might experience a loss of appetite."

**C A. Yellowing of the skin is an adverse effect of rifampin or Pyrazinamide. B. Experiencing pain in the joints is an adverse effect of rifampin. C. CORRECT: Tingling of the hands is an adverse effect of isoniazid. D. Loss of appetite is an adverse effect of rifampin. ATI Med Surg

A nurse is caring for a client who has a new diagnosis of tuberculosis and has been placed on a multimedication regimen. Which of the following instructions should the nurse give the client related to ethambutol? A. "Your urine can turn a dark orange." B. "Watch for a change in the sclera of your eyes." C. "Watch for any changes in vision." D. "Take vitamin B6 daily."

**C A. the client who is receiving rifampin should expect to see his urine turn a dark orange. B. The client who is taking ethambutol does not have an adverse effect resulting in changes to the sclera of the eyes. C. CORRECT: The client who is receiving ethambutol will need to watch for visual changes due to optic neuritis, which can result from taking this medication. D. The client who is taking isoniazid should take vitamin B6 daily and observe for signs of hepatotoxicity. ATI Med Surg

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.

**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. RN.com

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

**C This is how an AFB sputum culture is collected. RN.com

A patient taking Isoniazid (INH) should be monitored for what deficiency?* A. Vitamin C B. Calcium C. Vitamin B6 D. Potassium

**C This medication can lead to low Vitamin B6 levels. Most patients will take a supplement of B6 while taking this medication. RN.com

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

**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. RN.com

The healthcare provider administers a tuberculin skin test (TST) to a patient and gives instructions to return in 48 to 72 hours so the results can be interpreted. These instructions are based on the knowledge that a positive TST is the result of a ___ hypersensitivity reaction. Choose 1 answer: A. Type I B. Type II C. Type III D. Type IV

**D A. Examples of type I hypersensitivity reactions are hay fever, asthma, and anaphylaxis. B. A blood transfusion is an example of a type II hypersensitivity reaction. D. CORRECT: A positive TST and reactions to poison ivy are examples of type IV hypersensitivity reactions. These reactions are referred to as delayed hypersensitivity reactions, which explains why the tuberculosis skin test is read 48 - 72 hours after injection. Khan Academy

A patient is receiving the antitubercular medication streptomycin. Which of these statements made by the patient would alert the healthcare provider that the patient is experiencing a common adverse effect from the medication? Choose 1 answer: A. "It burns when I urinate." B. "I sometimes see flashing lights." C. "I feel bloated and full of gas." D. "I feel dizzy and my ears are ringing."

**D Khan Academy

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

**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. RN.com

A patient is being treated for tuberculosis (TB) with isoniazid (INH). Which of these assessment findings would indicate that the patient is experiencing an adverse reaction to the medication? Choose all answers that apply: A. Gouty attacks in the toes B. Fever and loss of appetite C. Painful urination and flank pain D. Dark urine and yellowish skin E. Peripheral neuropathy

**D, E Signs of INH-induced hepatotoxicity include dark urine and yellowing of the skin (jaundice). Peripheral neuropathies may develop because INH can cause pyridoxine (vitamin B6) deficiency (vitamin B6 has a role in neurotransmitter synthesis). Peripheral neuropathy can be avoided if the patient supplements the diet with vitamin B6. Fever and loss of appetite are signs of TB, not of an adverse reaction to INH. Hyperuricemia and resulting gouty attacks may be caused by pyrazinamide, which is another antitubercular medication. Khan Academy

What is the correct dosage of isoniazid prescribed to treat a client with TB? A. 10 mg/kg 600 mg max daily B. 20 to 25 mg/kg 2 g max daily C. 5 mg/kg 300 mg max daily D. 15 to 20 mg/kg daily

A. Rifampin should be administered at doses of 10 mg/kg, up to 600 mg daily. B. Pyrazinamide should be administered at dose of 20 to 25 mg/kg, up to 2 g daily. **C. Isoniazid should be administered 5 mg/kg, up to 300 mg daily. D. Ethambutol should be administered 15 to 20 mg/kg daily.