Tuberculosis

A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication? 1.Should always be taken with food or antacids 2.Should be double-dosed if 1 dose is forgotten 3.Causes orange discoloration of sweat, tears, urine, and feces 4.May be discontinued independently if symptoms are gone in 3 months

3.Causes orange discoloration of sweat, tears, urine, and feces

A client with tuberculosis (TB) has a prescription for rifampin. What instruction should the nurse include in the client's teaching plan? 1.Yellow-colored skin is common with this medication. 2.The medication must always be taken on an empty stomach. 3.Wearing glasses instead of soft contact lenses will be necessary. 4.As soon as the cultures come back negative, the medication may be stopped.

3.Wearing glasses instead of soft contact lenses will be necessary.

A client with active tuberculosis demonstrates less-than-expected interest in learning about the prescribed medication therapy. The nurse assesses that this client may ultimately need which intervention as a last resort? 1.Directly observed therapy 2.More medication instructions 3.Involvement of the family in teaching 4.Reinforcement by the primary health care provider

1.Directly observed therapy

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.Sputum culture

A client who has been taking the four first-line drugs for tuberculosis treatment for a month reports all of the following changes. Which changes would cause the nurse to collaborate quickly with the health care provider? Select all that apply. A. Blurry vision B. Constipation C. Difficulty sleeping D. Nausea when drinking beer E. Red-tinged urine F. Sunburn with minimal sun exposure G. Yellowing of the sclera

Answers: A, G Rationale: The drug ethambutol can cause optic neuritis that can lead to blindness. The drug should be stopped and the patient's vision evaluated immediately. Yellowing of the sclera is associated with jaundice from liver problems, which can be serious and life-threatening. The client's liver status must be evaluated immediately. Although nausea when drinking alcohol is an expected side effect of ethambutol, it is a priority to report this change to the health care provider at this time. The nurse needs to explain the side effect to the client and remind him or her that alcohol must be avoided during TB therapy to prevent liver problems. This change only needs to be reported to the health care provider if the client continues to consume alcohol. Difficulty sleeping may or may not be associated with the TB drug therapy. It does not require immediate attention. Red-tinged urine is an expected side effect of rifampin. The nurse reinforces this information to the client to relieve his or her anxiety. The drug pyrazinamide increases photosensitivity. Sunburn is a common side effect that the nurse needs to instruct the client to prevent but does not require immediate attention from the healthcare provider.

A client with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? A. Combination medication therapy is effective in eliminating cough and fever. B. Combination medication therapy improves adherence. C. Combination medication therapy has fewer side effects, particularly liver damage. D. The use of multiple medications destroys organisms quickly and reduces the development of drug-resistant organisms.

D. The use of multiple medications destroys organisms quickly and reduces the development of drug-resistant organisms.

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.Positive

The nurse is preparing to give a bed bath to an immobilized client with tuberculosis. 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.Particulate respirator, gown, and gloves

A client who has recently relocated to the United States from Vietnam comes to the emergency department with fatigue, lethargy, night sweats, and a low-grade fever. What is the nurse's first action? a. Contact the health care provider for tuberculosis (TB) medications. b. Perform a TB skin test. c. Place a respiratory mask on the client. d. Test all family members for TB.

c. Place a respiratory mask on the client.

The nurse has instructed a client diagnosed with tuberculosis about how to prevent the spread of infection after discharge from the hospital. The nurse determines that the client needs further reinforcement of information if the client makes which statement? 1."I should use disposable plates, forks, and knives." 2."I should cough into tissues and throw them away carefully." 3."It's important to cover my mouth if I laugh, sneeze, or cough." 4."It's very important to wash my hands after I touch my mask, tissues, or body fluids."

1."I should use disposable plates, forks, and knives." Because tuberculosis is transmitted by droplet, it cannot be carried on clothing, eating utensils, or other possessions. It is not necessary to discard any of these. The client should cover the mouth with a tissue when laughing, coughing, or sneezing and should dispose of tissues carefully. The client also may need to wear a mask as advised by the primary health care provider. It is important to perform proper hand washing after contact with body substances, tissues, or face masks.

The nurse has provided a client with tuberculosis (TB) instructions on proper handling and disposal of respiratory secretions. The nurse determines that the client demonstrates understanding of the instructions when the client makes which statement? 1."I will discard used tissues in a plastic bag." 2."I need to wash my hands at least 4 times a day." 3."I will brush my teeth and rinse my mouth once a day." 4."I will turn my head to the side if I need to cough or sneeze."

1."I will discard used tissues in a plastic bag."

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

1.Activities should be resumed gradually. 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 already have been exposed. 5.Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags.

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.Cough 2.Dyspnea 5.Chills and night sweats 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.Dyspnea 3.Night sweats 4.A bloody, productive cough 5.A cough with the expectoration of mucoid sputum

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.Fatigue 2.Lethargy 4.Morning cough 5.Low-grade fever 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.

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.Positive

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse should monitor for which side and adverse effects of rifabutin? Select all that apply. 1.Signs of hepatitis 2.Flu-like syndrome 3.Low neutrophil count 4.Vitamin B6 deficiency 5.Ocular pain or blurred vision 6.Tingling and numbness of the fingers

1.Signs of hepatitis 2.Flu-like syndrome 3.Low neutrophil count 5.Ocular pain or blurred vision

A client with tuberculosis (TB) asks the nurse about precautions to take after discharge to prevent infection of others. The nurse develops a response to the client's question based on which correct understanding of TB transmission? 1.The disease is transmitted by droplet nuclei. 2.Clothing and sheets should be bleached after each use to kill the TB nuclei. 3.Deep pile carpet collects TB bacteria and should be removed from the home. 4.The client should specifically maintain enteric precautions to prevent transmission.

1.The disease is transmitted by droplet nuclei. TB is spread by droplet nuclei or via the airborne route. The disease is not carried on objects such as clothing, eating utensils, linens, or furniture. It is unnecessary to remove carpeting from the home. Bleaching of clothing and linens is unnecessary, although the client and family members should use good hand-washing technique.

A client has been taking isoniazid for 2 months. The client complains to the nurse 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. peripheral neuritis Isoniazid is an antitubercular 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.

A nursing instructor asks a nursing student about a client admitted with tuberculosis (TB). What comment by the student indicates that there is a need for further teaching? 1."It is transmitted by the airborne route." 2."It is a fast-growing infectious disease." 3."People who have been in constant close contact with the infected person will need to be tested and treated if necessary." 4."The risk for transmission is reduced after the infectious person has received proper medication therapy for 2 to 3 weeks and clinical improvement occurs."

2."It is a fast-growing infectious disease." Mycobacterium tuberculosis is a nonmoving, slow-growing (not fast-growing), acid-fast rod transmitted via the airborne route. The other options are accurate statements.

The nurse is reading a tuberculin skin test for a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosis. How should the nurse interpret the result? 1.Positive 2.Negative 3.Uncertain 4.Borderline

2.Negative

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1.Use alcohol in small amounts only. 2.Report yellow eyes or skin immediately. 3.Increase intake of Swiss or aged cheeses. 4.Avoid vitamin supplements during therapy.

2.Report yellow eyes or skin immediately.

A client with tuberculosis receiving cycloserine orally twice daily must have blood drawn in 1 week to measure the serum concentration of the medication. The nurse prepares the client for this test by providing which information to the client? 1.Withhold the morning dose on the day of the scheduled blood test. 2.Take the morning dose, and have the blood drawn 2 hours after taking the dose. 3.Withhold the evening dose before the test and the dose scheduled for the morning of the test. 4.Double the dose the evening before the test, and withhold the morning dose on the day of the test.

2.Take the morning dose, and have the blood drawn 2 hours after taking the dose. Cycloserine is an antituberculosis medication that requires weekly serum medication level determinations to monitor for neurotoxicity and other adverse effects. Peak concentrations are measured 2 hours after dosing and should be between 25 and 35 mcg/mL.

A client diagnosed with tuberculosis (TB) is distressed over fatigue and the loss of physical stamina. What should the nurse tell the client? 1.This is expected and will last for at least 1 year. 2.This is expected, and the client should gradually increase activity as tolerated. 3.This is an unexpected finding with TB, but it should resolve within 1 month or so. 4.This is a short-lived problem that should be gone within 1 week after beginning medication therapy.

2.This is expected, and the client should gradually increase activity as tolerated.

A client with tuberculosis whose status is being monitored in an ambulatory care clinic asks the nurse when it is permissible to return to work. What factor should the nurse include when responding to the client? 1.Five blood cultures are negative. 2.Three sputum cultures are negative. 3.A blood culture and a chest x-ray are negative. 4.A sputum culture and a tuberculin skin test are negative.

2.Three sputum cultures are negative.

A client with pulmonary tuberculosis (TB) is on airborne isolation precautions. Which item(s) is essential for the nurse to wear? 1.Gloves only 2.Fluid shield mask 3.Gown, mask, and gloves 4.High-efficiency particulate air (HEPA) filter mask

4.High-efficiency particulate air (HEPA) filter mask

The nurse working on a medical respiratory nursing unit is caring for several clients with respiratory disorders. The nurse should determine that which client on the nursing unit is at the lowest risk for infection with tuberculosis? 1.An uninsured man who is homeless 2.A newly immigrated woman from Korea 3.A man who is an inspector for the U.S. Postal Service 4.An older woman admitted from a long-term care facility

3.A man who is an inspector for the U.S. Postal Service

The nurse is caring for a client who had tuberculin skin testing 48 hours ago on admission to the nursing unit. The nurse reads the test result as positive. Which action by the nurse has the highest priority? 1.Document the finding in the client's record. 2.Call the employee health service department. 3.Contact the primary health care provider (PHCP). 4.Call the radiology department for a chest radiographic study to be done.

3.Contact the primary health care provider (PHCP).

The nurse reads that a client's tuberculin skin test is positive and notes that previous tests were negative. The client becomes upset and asks the nurse what this means. The nurse should base the response on which interpretation? 1.Systemic tuberculosis 2.Pulmonary tuberculosis 3.Exposure to tuberculosis 4.No evidence of tuberculosis

3.Exposure to tuberculosis

A client with tuberculosis is starting 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 level

3.Liver enzyme levels

A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin for treatment. The nurse teaches the client to perform which action? 1.Report any change in urine color. 2.Take both medications with food. 3.Take both medications together once a day. 4.Expect to take the medications for 2 to 3 weeks.

3.Take both medications together once a day. Rifampin in combination with isoniazid prevents the emergence of medication-resistant organisms. This combination, taken together daily, eliminates the tubercle bacilli from the sputum and improves clinical status. Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption. The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks.

The nurse places a hospitalized client with active tuberculosis in a private, well-ventilated isolation room. In addition, which action should the nurse take before entering the client's room? 1.Wash hands and don a surgical mask. 2.Wash hands and wear a gown and gloves. 3.Wash hands and place a high-efficiency particulate air (HEPA) respirator mask over the nose and mouth. 4.The nurse needs no precautions. The client is instructed to cover the mouth and nose when coughing.

3.Wash hands and place a high-efficiency particulate air (HEPA) respirator mask over the nose and mouth.

The nurse is teaching a client with tuberculosis about nutrition and foods that should be increased in the diet. The nurse should suggest that the client increase which food items? 1.Potatoes and fish 2.Eggs and spinach 3.Grains and broccoli 4.Meats and citrus fruits

4.Meats and citrus fruits The nurse teaches the client with tuberculosis to increase intake of protein, iron, and vitamin C. Foods rich in vitamin C include citrus fruits, berries, melons, pineapple, broccoli, cabbage, green peppers, tomatoes, potatoes, chard, kale, asparagus, and turnip greens. Food sources that are rich in iron include liver and other meats. Less than 10% of iron is absorbed from eggs, and less than 5% is absorbed from grains and vegetables.

The nurse has conducted discharge teaching with a client diagnosed with tuberculosis who has been receiving medication for 2 weeks. The nurse determines that the 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."I should not be contagious after 2 to 3 weeks of medication therapy."

The clinic nurse administers a tuberculin skin test to a client. The nurse tells the client to return to the clinic for the results in how long? 1.6 to 12 hours 2.12 to 24 hours 3.24 to 28 hours 4.48 to 72 hours

4.48 to 72 hours

A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up? 1.Platelet count 325,000 mm3 (325 × 109/L) 2.Serum creatinine 1.0 mg/dL (88.3 mcmol/L) 3.Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) 4.Aspartate aminotransferase (AST) 55 U/L (55 U/L)

4.Aspartate aminotransferase (AST) 55 U/L (55 U/L) Because isoniazid therapy can cause elevated hepatic enzymes and hepatitis, liver enzymes 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 years of age or who abuses alcohol. The normal AST level is 0 to 35 U/L (0 to 30 U/L). The other options are not monitored routinely and are also normal.

The nurse is performing an admission assessment on a client with tuberculosis (TB) and is collecting subjective and objective data. Which finding would the nurse expect to note? 1.High fever 2.Flushed skin 3.Complaints of weight gain 4.Complaints of night sweats

4.Complaints of night sweats

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that they will immediately report which finding? 1.Impaired sense of hearing 2.Gastrointestinal side effects 3.Orange-red discoloration of body secretions 4.Difficulty in discriminating the color red from green

4.Difficulty in discriminating the color red from green

The nurse is caring for a client with tuberculosis (TB) who is fearful of the disease and anxious about the prognosis. In planning nursing care, the nurse should incorporate which intervention as the best strategy to assist the client in coping with the illness? 1.Allow the client to deal with the disease in an individual fashion. 2.Ask family members whether they wish a psychiatric consultation. 3.Encourage the client to visit with the pastoral care department's chaplain. 4.Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease.

4.Provide reassurance that continued compliance with medication therapy is the most proactive way to cope with the disease.

The nurse is assessing a client with the typical clinical manifestations of tuberculosis (TB). During history-taking the nurse anticipates that the client will report presence of cough and fatigue for what period of time? 1.1 or 2 days 2.1 to 2 weeks 3.Almost 1 week 4.Several weeks to months

4.Several weeks to months

The nurse in an ambulatory clinic is preparing to administer a tuberculin skin test to a client who may have been exposed to a person with tuberculosis (TB). The client reports having received the bacillus Calmette-Guérin (BCG) vaccine before moving to the United States from a foreign country. Which interpretation should the nurse make? 1.The client has no risk of acquiring TB and needs no further workup. 2.The client is at increased risk for acquiring TB and needs immediate medication therapy. 3.The client's test result will be negative, and a sputum culture will be required for diagnosis. 4.The client's test result will be positive, and a chest x-ray study will be required for evaluation.

4.The client's test result will be positive, and a chest x-ray study will be required for evaluation.

A client is being discharged to home after 2 weeks with a diagnosis of tuberculosis and is worried about the possibility of infecting family members and others. How should the nurse respond to provide reassurance? 1.The family does not need therapy, and the client will not be contagious after 1 month of medication therapy. 2.The family does not need therapy, and the client will not be contagious after 6 consecutive weeks of medication therapy. 3.The family will be treated prophylactically, and the client will not be contagious after 1 continuous week of medication therapy. 4.The family will be treated prophylactically, and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy.

4.The family will be treated prophylactically, and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy.

The nurse is admitting a client who is suspected of having tuberculosis (TB) to the nursing unit. The nurse should plan to admit the client to a room that has which properties? 1.Venting to the outside and ultraviolet light 2.Ultraviolet light and 3 air exchanges per hour 3.Ten air exchanges per hour and venting to the outside 4.Venting to the outside, 6 air exchanges per hour, and ultraviolet light

4.Venting to the outside, 6 air exchanges per hour, and ultraviolet light A client suspected of having TB is admitted to a private room that has at least 6 air exchanges per hour and negative pressure in relation to surrounding areas. The room should be vented to the outside and should have ultraviolet lights installed.

What information is most important for a nurse to include when teaching a client with tuberculosis about the prescribed first-line drug therapy? a. "Report darkening or reddening of the urine while taking Rifampin." b. "Do not drink alcohol in any quantity while taking Isoniazid." c. "Restrict fluid intake to 2 quarts of liquid a day on pyrazinamide." d. "Temporary visual changes while taking ethambutol are not serious."

ANS: B All the drugs for tuberculosis are liver toxic and can cause liver damage. Drinking alcohol compounds this damage and should be ingested only in small quantities, if at all. The reddened urine is an expected side effect of Rifampin therapy and, while the patient should be taught about this side effect, it does not need to be reported. Fluids should be increased, not decreased for a patient taking pyrazinamide to prevent gout or hyperuricemia. The visual changes associated with ethambutol are serious and not temporary. If the drug is not stopped when changes occur, it can cause optic neuritis and lead to blindness.

The community health nurse is planning treatment for multi-drug resistant tuberculosis for a client who is addicted to heroin. Which action will be most effective in ensuring that the client completes treatment? a. Arrange for a health care worker to observe the client take the medication. b. Give the client written instructions about how to take prescribed medications. c. Have the client repeat medication names and side effects. d. Instruct the client about the possible consequences of nonadherence.

a. Arrange for a health care worker to observe the client take the medication.

The nurse is providing education for a client who is taking isoniazid, rifampin, and ethambutol for tuberculosis. Which of these points does the nurse include in the plan of care? Select all that apply. a. Take a supplement containing B vitamins. b. Avoid alcohol containing beverages. c. Have kidney function tests monthly. d. Report changes in vision to the health care provider. e. Notify the health care provider for red-orange urine.

a. Take a supplement containing B vitamins. b. Avoid alcohol containing beverages. d. Report changes in vision to the health care provider.

A client is being discharged home with active tuberculosis. Which information does the nurse include in the discharge teaching plan? a. "You will not spread the disease unless you stop taking your medication." b. "You will not pose an increased risk of disease to the people you have been living with." c. "You will have to take these medications for at least 1 year." d. "Your sputum may turn a rust color as your condition gets better."

b. "You will not pose an increased risk of disease to the people you have been living with."

The nurse in the community health clinic is planning education related to tuberculosis (TB). Which of these groups will the nurse target? Select all that apply. a. Breast cancer survivors b. Those in the local prison c. Homeless adults d. Recent immigrants to the United States e. Those who have received bacille Calmette-Guérin (BCG) vaccine

b. Those in the local prison c. Homeless adults d. Recent immigrants to the United States

The medical-surgical unit has one negative-airflow room. Which of these four clients who have just arrived on the unit should the charge nurse admit to this room? a. Client with bacterial pneumonia and a cough productive of green sputum b. Client with neutropenia and pneumonia caused by Candida albicans c. Client with possible H5N1 influenza who currently has epistaxis d. Client with right empyema who has a chest tube and a fever of 103.2° F (39.6°C)

c. Client with possible H5N1 influenza who currently has epistaxis A client with possible tuberculosis or H5N1 avian influenza would be admitted to the negative-airflow room to prevent airborne transmission of organisms from the client room to other clients/staff and areas of the hospital.A client with bacterial pneumonia does not require a negative-airflow room but should have airborne or Droplet Precautions in place. A client with neutropenia may be in a regular room with an emphasis on handwashing. The client with a right empyema who also has a chest tube and a fever would have Contact Precautions in place but does not require a negative-airflow room.

The nurse notices a visitor walking into the room of a client on airborne isolation with no protective gear. What does the nurse do? a. Ensures that the client is wearing a mask b. Informs the visitor that the client cannot receive visitors at this time c. Provides a particulate air respirator to the visitor d. Provides the visitor with a surgical mask

d. Provides the visitor with a surgical mask