TB-Pearson

Negative response Although the 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.

A client has a​ 6-mm area that is slightly red and soft to the touch at the site of a PPD​ (Mantoux) test. Which finding should the nurse document for this​ client? Positive response Indeterminate response Negative response Positive response if the client had an abnormal chest​ x-ray

Rupture of tuberculosis lesion with contamination of the pleural space results in pneumothorax characterized by shortness of​ breath, hypoxia, dry​ cough, cyanosis, chest​ pain, and subcutaneous emphysema. These are not symptoms of miliary​ tuberculosis, reactivation​ tuberculosis, or encapsulation of the bacilli.

A client with tuberculosis experiences shortness of​ breath, hypoxia,​ cyanosis, and subcutaneous emphysema. Which pathophysiologic change should the nurse suspect as causing this​ client's symptoms? Rupture of tuberculosis lesion Miliary tuberculosis Encapsulation of the bacilli Reactivation tuberculosis

"As the treatment options are considered, the potential harm to your baby will be considered against the benefit for you." When treatment options are being considered, potential adverse effects of medications on the fetus are weighed against the benefit to the mother before they are prescribed during pregnancy. While none of the tuberculosis drugs have been found to be teratogenic, some are still being studied. Stating that tuberculosis will be more harmful than the potential treatment options is not always correct.

A patient at 26 weeks of gestation is diagnosed with tuberculosis and asks if any of the treatments will harm the baby. Which response should the nurse provide?'' "While some of the drugs used to treat tuberculosis can affect the fetus, none of the potential effects are serious." "As the treatment options are considered, the potential harm to your baby will be considered against the benefit for you." "The risk of allowing the tuberculosis to go untreated is far more harmful for your baby than the treatments will be." "Unfortunately, all of the drugs used to treat tuberculosis cross the placenta and are still being studied to determine the effects."

Sputum culture A sputum culture that is positive for M. tuberculosis provides the definitive diagnosis. A sputum smear provides a rapid indicator of the tubercle bacillus. A chest x-ray is used to diagnose and evaluate tuberculosis. Sensitivity testing is used to identify the appropriate drug therapy once the organism is detected.

A patient has a positive purified protein derivative (PPD) test for tuberculosis. Which test should the nurse expect to be prescribed to definitively diagnose tuberculosis? Sputum culture Sputum smear Sensitivity test Chest x-ray

QuantiFERON-TB test Tuberculin tests are used to screen for tuberculosis. For individuals who have previously received the tuberculosis vaccine, the QuantiFERON-TB test or the T-Spot test should be used instead of the Mantoux. A polymerase chain reaction test or sputum culture would not be indicated for this use.

A patient has previously received a tuberculosis vaccine. Which diagnostic test should the nurse expect to be prescribed for this patient to test for tuberculosis? Sputum culture Polymerase chain reaction test QuantiFERON-TB test Mantoux test

Refer to the public health department for management and follow-up. Nonadherence with the treatment regime is the greatest barrier to the control of tuberculosis. Referring the patient who may be noncompliant to the local public health department may help avoid this issue from occurring. The other interventions are important as well, but they are not barrier priority actions for the control of tuberculosis.

A patient is discharged on a treatment regimen for active tuberculosis. Which intervention should be a priority to enhance adherence to treatment? Instruct to avoid crowds and close physical contact. Refer to a support group for patients with active tuberculosis. Teach how to limit transmitting the disease to others. Refer to the public health department for management and follow-up.

Patient is an alcoholic. INH is a first-line drug for active tuberculosis but should not be prescribed for patients with a history of liver problems or heavy drinking. Diabetes, smoking, and nonadherence would not contraindicate the use of INH.

A patient is prescribed isoniazid (INH) as prophylactic treatment after close contact with an individual with active tuberculosis. For which information in the patient's history should the nurse question the use of this medication? Patient has been nonadherent with medications in the past. Patient is an alcoholic. Patient has diabetes. Patient smokes 40 packs per year.

"Did you have a positive tuberculosis skin test after previous negative ones?" Patients with a recent skin test conversion from negative to positive are often started on prophylactic therapy, especially when other risk factors are present. Active tuberculosis (as diagnosed by sputum culture) or presence of tuberculosis symptoms would require active treatment (not prophylactic). Prophylaxis would not necessarily be indicated if someone traveled to a country where tuberculosis is prevalent, unless coming in close contact with an infected individual was indicated.

A patient reports starting prophylactic isoniazid therapy. Which question should the nurse ask to determine the reason for this treatment approach? "Have you recently traveled to a country where tuberculosis is prevalent?" "Have you been having a fever or night sweats? "Did you have a positive tuberculosis skin test after previous negative ones?" "Did you have a sputum culture that was positive for M. tuberculosis?"

"Begin single-drug prophylactic therapy." Patients with a recent skin test conversion from negative to positive are often started on single-drug (isoniazid) prophylactic therapy, particularly if other risk factors are present (recent immigrant, living in close quarters with other individuals). The BCG vaccine is used if isoniazid therapy is contraindicated. An initial regimen of 4 oral antituberculosis drugs and sensitivity testing to identify the appropriate drug therapy are appropriate once active disease has been confirmed.

A patient who recently immigrated to the United States and no known history has a positive PPD test. Which prescription should the nurse expect from the healthcare provider? "Administer Bacille Calmette-Guérin (BCG) vaccine." "Begin an initial regimen of 4 oral antituberculosis drugs." "Perform sensitivity testing to identify the appropriate drug therapy." "Begin single-drug prophylactic therapy."

Night sweats Patients with tuberculosis exhibit night sweats as well as weight loss, anorexia, and low-grade fever in the afternoon.

A patient with a history of chronic alcoholism is diagnosed with pulmonary tuberculosis. Which clinical manifestation should the nurse identify that supports this diagnosis? High fever in the morning Increased appetite Night sweats Weight gain

Negative airflow room A patient with active tuberculosis should be placed in a negative airflow room to dilute the concentration of droplet nuclei in the room and prevent spread to adjacent areas. The other room choices are not appropriate for this patient.

A patient with active tuberculosis is being admitted to an acute care facility. The nurse should request which type of room assignment for this patient? Room near nurse's station with respiratory isolation precautions Positive pressure isolation room Private room with double door entry Negative airflow room

Isoniazid (INH) INH is a first-line drug for active tuberculosis but should not be prescribed for patients with a history of liver problems or heavy drinking. Rifampin, pyrazinamide, and ethambutol hydrochloride are other pharmacologic therapies for treating tuberculosis, and the nurse need not question them for this patient.

A patient with tuberculosis has a history of liver damage caused by alcohol intake. Which medication prescription should the nurse question for this patient? Pyrazinamide (Tebrazid) Rifampin (Rifadin) Isoniazid (INH) Ethambutol hydrochloride (Myambutol)

"Monitor vision daily by reading newspapers and looking at the same blue object." Ethambutol is a first-line drug that can cause optic neuritis. The patient should be instructed to check visual acuity daily by reading a newspaper, and check for color perception by looking at the same blue object daily. The medication should be taken on a full stomach. Eye exams should be performed routinely while the patient is taking the medication. If visual changes are noted, the patient should notify the healthcare provider.

A patient with tuberculosis is prescribed ethambutol. Which instruction should the nurse provide to this patient? "If you have visual changes, immediately stop the drug." "Monitor vision daily by reading newspapers and looking at the same blue object." "Schedule an eye exam as soon as you finish therapy." "Always take this medication on an empty stomach."

"Repeating the skin test improves sensitivity to the test so that silent cases of tuberculosis are not missed." Yearly tuberculin skin testing with PPD is often required by state health departments for nursing home residents. If the initial test is negative, a repeat PPD in 1-2 weeks is recommended; repetition improves sensitivity to the test so that silent cases of tuberculosis are not missed.

A resident in a nursing home asks why a second test for tuberculosis has to be done if the first test was negative. Which response should the nurse make? "We test twice just in case the first tuberculosis skin test was not planted properly." "Repeating the skin test improves sensitivity to the test so that silent cases of tuberculosis are not missed." "Older adults are much harder to diagnose with tuberculosis; therefore, we always repeat the test." "You have several risk factors for tuberculosis and need to be tested twice to make sure the disease is not present."

Reactivation tuberculosis This client has signs and symptoms of reactivation​ tuberculosis, where a previous tuberculosis infection frequently becomes encapsulated and can lay dormant for years until reactivated by an immune system that is suppressed because of​ age, disease, or use of immunosuppressive medications.​ New-onset tuberculosis is​ unlikely, as the client is known to have a previous tuberculosis infection. The client is exhibiting signs and symptoms of an active tuberculosis​ infection; therefore, the tuberculosis is no longer dormant. Skeletal tuberculosis occurs when the bacteria spreads into the​ vertebrae, bones, and​ joints; the client is not exhibiting signs of this type of infection.

An older adult client experiencing a​ cough, hemoptysis, night​ sweats, anorexia, and weakness reports being told of having tuberculosis when younger. Which reason should the nurse suspect is responsible for the​ client's current​ symptoms? Dormant tuberculosis Skeletal tuberculosis Reactivation tuberculosis ​New-onset tuberculosis

The client will be allowed to breastfeed the infant. If maternal tuberculosis is inactive or the client has been on therapy long enough to prevent infection of the​ newborn, the client may breastfeed and care for her baby. It is not necessary with inactive tuberculosis to start pharmacologic therapy for the client or the infant. Since it is​ inactive, direct contact is not an issue.

As the nurse reviews the history of a client admitted in​ labor, the nurse notes that the client has inactive tuberculosis. Which should the nurse include in the plan of care for this​ client? Direct contact should be avoided until the client is noninfectious. Pharmacologic therapy for the client should be initiated immediately. Once​ delivered, the infant will be placed on prophylactic treatment. The client will be allowed to breastfeed the infant.

Use of airborne precautions Identification of infected individuals Treatment of clients with suspected or confirmed disease Infection control involves prompt identification of clients with active​ disease, use of airborne​ precautions, and treatment of clients with suspected or confirmed disease. It is impractical and unnecessary to screen everyone for tuberculosis. The BCG vaccine is recommended only for​ foreign-born individuals and for healthcare workers who are repeatedly exposed to those with active disease that is untreated or ineffectively treated.

The infection control nurse is teaching the staff at a​ long-term care facility after a recent outbreak of tuberculosis. Which element of infection control should the nurse include in the​ teaching? (Select all that​ apply.) Implementation of universal screening Use of airborne precautions Administration of the bacille ​Calmette-Guéérin ​(BCG) vaccine to residents Identification of infected individuals Treatment of clients with suspected or confirmed disease

An individual who is a resident or staff member of a​ long-term residential facility An individual with close contacts who already have or are suspected to have tuberculosis An individual infected with HIV or at high risk for HIV infection The Centers for Disease Control and Prevention​ (CDC) recommends screening those who are infected with HIV or at high risk for​ HIV, those with close contacts who have or are suspected to have​ tuberculosis, and those who are residents or staff of​ long-term residential facilities. BCG is a tuberculosis​ vaccine, not a risk factor for the disease. PPD is a tuberculosis​ test, not a risk factor for the disease.

The nurse in a community clinic is asked to determine which clients require tuberculosis testing. Which individual should the nurse recommend for this​ screening? (Select all that​ apply.) An individual who is a resident or staff member of a​ long-term residential facility An individual who had the bacille ​Calmette-Guéérin ​(BCG) vaccine An individual with close contacts who already have or are suspected to have tuberculosis An individual infected with HIV or at high risk for HIV infection An individual that has had PPD

Sudden weight gain Hemoptysis Chest pain Yellow tint to sclera Chest​ pain, hemoptysis, yellow tint to​ sclera, and sudden weight gain should all be reported. An orange tint to sweat is an expected side effect of rifampin.

The nurse instructs a client with tuberculosis on prescribed medication. Which finding should the nurse instruct the client to report to the healthcare​ provider? (Select all that​ apply.) Sudden weight gain Hemoptysis Orange tint to sweat Chest pain Yellow tint to sclera

​"I should take rifampin on an empty​ stomach." ​"I should not be frightened if my urine changes to an​ orange-red color; it is a normal side​ effect." ​"I should not take aspirin while I am taking​ rifampin." Rifampin should be taken on an empty​ stomach, and the client should not take aspirin while taking rifampin. An​ orange-red discoloration of​ urine, sweat,​ tears, and saliva is a normal side effect of rifampin. Vision should be monitored daily when taking​ ethambutol, not rifampin. Pyridoxine​ (vitamin B6) can be administered along with​ isoniazid, not rifampin.

The nurse instructs a client with tuberculosis on the medication rifampin. Which client statement indicates teaching has been​ effective? (Select all that​ apply.) ​"I should take rifampin on an empty​ stomach." ​"I should not be frightened if my urine changes to an​ orange-red color; it is a normal side​ effect." ​"I need to take pyridoxine​ (vitamin B6) along with the​ rifampin." ​"I need to monitor my vision daily by reading a​ newspaper." ​"I should not take aspirin while I am taking​ rifampin."

Presence of cough Difficulty breathing Skin color During the​ assessment, the nurse should observe for skin​ color, presence of​ cough, and difficulty breathing. Nasal congestion and carbon dioxide level can be affiliated with other respiratory​ disorders, but not necessarily tuberculosis.

The nurse is assessing a client with tuberculosis. Which should the nurse focus on during this​ assessment? (Select all that​ apply.) Presence of cough Difficulty breathing Nasal congestion Carbon dioxide level Skin color

52-year-old man complaining of fatigue, a dry cough, and night sweats Fatigue, night sweats, and a dry cough are all clinical manifestations of tuberculosis. Swollen lymph nodes, congestion, chills, muscle aches, and morning or high-grade fevers are not clinical manifestations of tuberculosis. The homeless population is at high risk for tuberculosis.

The nurse is assessing individuals who reside in a homeless shelter after learning of one resident being diagnosed with tuberculosis. Which individual should the nurse suspect as most likely to have tuberculosis? 20-year-old pregnant woman with swollen lymph nodes and a fever of 100°F (37.8°C) each morning 12-year-old man with a fever of 102.8°F (39.3°C), congestion, and runny nose 70-year-old woman with complaints of chills, muscle aches, and congestion 52-year-old man complaining of fatigue, a dry cough, and night sweats

Greater than 15 mm An induration of greater than 15 mm always indicates a positive response. An induration of between 5 and 15 mm indicates a positive response in certain settings and groups of patients. An induration of less than 5 mm always indicates a negative response.

The nurse is assessing the result of a tuberculin skin test. Which area of induration should the nurse identify that always indicates a positive response to a tuberculin test? Less than 5 mm Greater than 15 mm 10-15 mm 5-9 mm

Age less than 2 years Presence of HIV infection Age less than 2 years and presence of HIV infection greatly increase the risk for progression of tuberculosis infection to disease. Genetic​ factors, virulence of the​ organism, and magnitude of infection also increase risk but are not the greatest risk factors.

The nurse is caring for a child diagnosed with tuberculosis infection. Which risk factor should the nurse identify that would greatly increase the risk for progression to​ disease? (Select all that​ apply.) Genetic factors Age less than 2 years Presence of HIV infection Magnitude of the infection Virulence of the organism

Avoid injection drug use Injection drug use increases the risk for tuberculosis. High-fat foods, unprotected sex, and tobacco use will not necessarily increase the risk for tuberculosis.

The nurse is caring for individuals in a homeless shelter. Which behavior should the nurse emphasize to help reduce the risk of tuberculosis in this population? Avoid injection drug use Avoid unprotected sex Stop tobacco use Eat high-fat foods

"Have you recently traveled outside of the country?" Asking if the patient has recently traveled outside of the country can help assess risk for latent tuberculosis. Asking about the living situation and alcohol or recreational drug use are also important, but these do not assess risk for latent tuberculosis. Fevers related to tuberculosis usually occur in the afternoon and not in the morning.

The nurse is conducting a health history with a patient at risk for tuberculosis. Which question should the nurse ask to determine the patient's risk for latent tuberculosis? "Do you use alcohol or recreational drugs?" "Have you recently traveled outside of the country?" "Can you describe your living situation?" "Have you recently been experiencing fevers upon awakening?"

Rod

The nurse is discussing the organism that causes tuberculosis with colleagues. Which term should the nurse use to best describe the shape of this organism? Rod Corkscrew Spherical Spiral

Informing all personnel who have contact with the client of the diagnosis Teaching the client how to avoid transmitting the disease to others Teaching the client why it is important to comply with prescribed treatments for the whole course of therapy Informing all personnel who have contact with the client of the​ diagnosis, teaching the client how to avoid transmitting the disease to​ others, and teaching the client why it is important to comply with prescribed treatments for the whole course of therapy are appropriate interventions for infection control. Assessing​ self-care abilities and support systems and providing verbal and written instructions about when to take the medications address the problem of therapeutic regimen​ management, not risk of infection.

The nurse is identifying interventions for a client with tuberculosis. Which nursing intervention should the nurse identify to address the risk of infecting​ others? (Select all that​ apply.) Informing all personnel who have contact with the client of the diagnosis Assessing​ self-care abilities and support systems Teaching the client how to avoid transmitting the disease to others Teaching the client why it is important to comply with prescribed treatments for the whole course of therapy Providing verbal and written instructions about when to take the medications

Tailor teaching concerning the drugs to the needs of the client. Work collaboratively with other healthcare team members to identify barriers or challenges. Assess the​ client's understanding of the disease​ process, and identify misperceptions and emotional reactions. Working collaboratively with other healthcare team members to identify barriers or challenges can help provide insight to overcome identified barriers and would be the best approach in this situation. Tailoring teaching and determining client understanding can also be helpful. It would not be appropriate to hospitalize the client. It is important that the client take all the medication for the complete duration in order to effectively treat tuberculosis.

The nurse is planning care for a client who is homeless. The client is prescribed four drugs to treat tuberculosis. Which action should the nurse take to ensure compliance with this medication​ therapy? (Select all that​ apply.) Tailor teaching concerning the drugs to the needs of the client. Reduce the number of drugs and the duration of taking the medicine to accommodate the​ client's transient situation. Work collaboratively with other healthcare team members to identify barriers or challenges. Assess the​ client's understanding of the disease​ process, and identify misperceptions and emotional reactions. Ask the healthcare provider to consider hospitalizing the client for initial treatment to ensure compliance.

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. The client will have the resources necessary to obtain required supplies and medications. 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 tuberculosis complies with prescribed​ therapies, symptoms​ resolve, and chest​ x-rays improve; and the client with latent infection completes therapy and does not develop active tuberculosis.

The nurse is preparing a plan of care for a client diagnosed with tuberculosis. Which goal and outcome should the nurse identify for this​ client? (Select all that​ apply.) The client with active tuberculosis complies with prescribed​ therapies, symptoms​ resolve, and chest​ x-rays improve. The client will have the resources necessary to obtain required supplies and medications. The client will demonstrate behaviors that reduce the risk of spreading the disease to others. The client will articulate required treatment and​ follow-up care. The client with latent infection completes therapy and does not develop active tuberculosis.

Adult residents in nursing homes Those living in close quarters, such as adult residents in nursing homes, are most at risk for tuberculosis. Infants in daycare, children who attend public school, and adolescents involved in sports are at the same risk for tuberculosis as the general population.

The nurse is preparing teaching about the increased number of tuberculosis cases reported during the last year in the local community. For which population should the nurse focus to decrease the risk of spreading tuberculosis? Infants in daycare Children who attend public school Adult residents in nursing homes Adolescents involved in sports

Isoniazid Pyrazinamide Ethambutol Rifampin Rifampin,​ isoniazid, ethambutol, and pyrazinamide are used in initial treatment. Amikacin is a​ second-line agent.

The nurse is preparing teaching for a client newly diagnosed with tuberculosis. Which drug generally used in initial treatment should the nurse include in the​ session? (Select all that​ apply.) Isoniazid Pyrazinamide Ethambutol Amikacin Rifampin

Polymerase chain reaction​ (PCR) Sputum culture Sputum smear Sputum smear​ (detects acid-fast​ bacilli, which is a rapid indicator of the tubercular​ bacillus), PCR​ (permits rapid detection of DNA from the tubercular​ bacillus), and sputum culture​ (confirms the diagnosis of​ tuberculosis) are conducted before the initiation of antibiotic therapy. Intradermal PPD​ (Mantoux) and tine tests are performed to initiate a​ diagnosis, not after a diagnosis has been established.

The nurse is providing care to a client who has been diagnosed with tuberculosis. Which diagnostic test should the nurse expect to be prescribed prior to initiating antibiotic​ treatment? (Select all that​ apply.) Polymerase chain reaction​ (PCR) Sputum culture Tine test Sputum smear Intradermal PPD​ (Mantoux) test

​Infection, Risk for Fatigue ​Nutrition, Imbalanced: Less than Body Requirements ​Health: Community, Deficient Nursing diagnoses that may be appropriate for inclusion in the plan of care for the client with tuberculosis include ​Fatigue; Infection, Risk​ for; Nutrition,​ Imbalanced: Less than Body​ Requirements; and ​Health: Community, Deficient.​ Resilience, Impaired is not a risk factor for tuberculosis

The nurse is reviewing data collected during the assessment of a client with tuberculosis. Which nursing diagnosis should the nurse select for this​ client? (Select all that​ apply.) ​Resilience, Impaired ​Infection, Risk for Fatigue ​Nutrition, Imbalanced: Less than Body Requirements ​Health: Community, Deficient

"I need to try and quit smoking; I will look for a support group to help me do so." A patient receiving treatment for active tuberculosis should stop smoking. The patient should eat a high-protein, high-carbohydrate diet, not a high-fat diet. Alcohol should be avoided altogether if possible. Fluid intake should be 2000-3000 mL per day.

The nurse is teaching a patient receiving treatment for active tuberculosis. Which patient statement should indicate to the nurse that teaching has been effective? "I will reduce my alcohol intake to less than 3-4 drinks per week." "I need to try and quit smoking; I will look for a support group to help me do so." "I will keep my fluid intake to 1000-1800 mL per day to reduce strain on my kidneys." "I will try to include more fats in my diet to prevent weight loss due to tuberculosis."

"Eat a high-protein, high-carbohydrate diet." Individuals with tuberculosis should ingest a well-balanced high-protein, high-carbohydrate diet to help maintain adequate nutritional status. Individuals with tuberculosis should drink 2-3 liters of fluid a day. An increase in unsaturated fats is not recommended. Alcohol intake should be avoided.

The nurse is teaching a patient recently diagnosed with tuberculosis about measures to cope with the disease. Which instruction should the nurse include to minimize nutritional problems that are secondary to tuberculosis? "Eat a high-protein, high-carbohydrate diet." "Keep fluid intake between 1-1.5 liters per day." "Increase intake of unsaturated fats." "Ensure moderate alcohol intake, to a maximum of two drinks per day."

Tuberculosis Asian immigrants are at the greatest risk for contracting and developing tuberculosis. These individuals are not any particular risk for heart, lung, or metastatic diseases.

The nurse notes a large number of Asian immigrants in a community. For which potential health problem should these community members be assessed? Heart disease Metastatic illnesses Lung disease Tuberculosis

e. Mycobacterium tuberculosis in droplet nuclei enter the air c. Droplet nuclei enter the lungs and the bacteria multiply a. WBCs surround bacteria b. Tubercle forms and caseous necrosis occurs d. Scar tissue forms around tubercle and the lesion calcifies

The nurse prepares educational material on the development of tuberculosis for a group of new nurses. In which order should the nurse explain the disease process​ develops? a. WBCs surround bacteria b. Tubercle forms and caseous necrosis occurs c. Droplet nuclei enter the lungs and the bacteria multiply d. Scar tissue forms around tubercle and the lesion calcifies e. Mycobacterium tuberculosis in droplet nuclei enter the air

"Once surrounded by phagocytic cells, M. tuberculosis organisms continue to multiple slowly within the macrophage." The inflammatory response brings neutrophils and macrophages to the site. These phagocytic cells surround and engulf the bacilli, isolating them and preventing their spread. However, M. tuberculosis organisms continue to multiply slowly within the macrophage, and some of these bacilli enter the lymphatic system to stimulate a cell-mediated immune response. The spread to the lymphatic system is not caused by the tubercle. The organism does not initially implant in the immune system, nor is it caused by erosion of granulomatous tissue.

The nurse prepares teaching material on tuberculosis for a group of new nurses. Which pathophysiological process should the nurse explain that allows M. tuberculosis organisms to enter the lymphatic system and stimulate a cell-mediated immune response? "Granulomatous tissue erodes into the blood vessels and lymphatic system, causing an immune response." "A granulomatous lesion called a tubercle is formed, allowing the disease to spread to the lymphatic system." "Once surrounded by phagocytic cells, M. tuberculosis organisms continue to multiple slowly within the macrophage." "M. tuberculosis bacilli elude upper airway defenses and implant in an alveolus and the lymphatic system."

Having a compromised immune system Using injection drugs Being an immigrant to the United States Living in a poorly ventilated environment Risk factors for tuberculosis include being an immigrant to the United​ States, prolonged contact with others in tight living quarters that are poorly​ ventilated, a compromised immune​ system, and injection drug use. Sharing clothes with a person who has tuberculosis is not a risk factor for developing the disease.

The nurse suspects that a client is at risk for tuberculosis. Which risk factor should the nurse assess in this​ client? (Select all that​ apply.) Having a compromised immune system Sharing clothes with an infected individual Using injection drugs Being an immigrant to the United States Living in a poorly ventilated environment

Leukemia diagnosis Only children who have one or more risk factors, such as close contact with an individual diagnosed with tuberculosis, a compromised immune system, or recent immigration, should have an intradermal tuberculin skin test with purified protein derivative (PPD), also known as the Mantoux test. In this case, leukemia would cause a compromised immune status. History of asthma, presence of Down syndrome, and recent treatment for otitis media will not necessarily increase the risk.

The nurse suspects that a preschool patient may need an intradermal tuberculosis test. Which data should indicate to the nurse that this type of skin test is required? Down syndrome History of asthma Leukemia diagnosis Recent antibiotic treatment for otitis media

Use disposable tissues to contain respiratory secretions. To prevent​ transmission, especially during the first 2​ weeks, the client should use disposable tissues to contain respiratory secretions. Being compliant with the medication​ regimen, maintaining good general health through diet and​ exercise, and testing of housemates of the client do not prevent the spread of tuberculosis to the family members.

The nurse visits the home of a client with tuberculosis. Which action should the nurse teach family members to take during the first 2 weeks of treatment to prevent the spread of the infection to other family​ members? Ensure that housemates of the client are tested and receive prophylactic treatment if indicated. Be compliant with the medication regimen. Use disposable tissues to contain respiratory secretions. Emphasize the importance of maintaining good general health through diet and exercise.

Infants and young children Infants and young children are at a greater risk of more life-threatening forms of tuberculosis such as disseminated tuberculosis or tuberculosis meningitis. Pregnant women, older adults, and newest immigrants are not at greater risk for disseminated tuberculosis or tuberculosis meningitis.

The public health nurse is assessing a group of immigrants living in a small area. On which subgroup should the nurse focus for disseminated tuberculosis or tuberculosis meningitis? Older adults Infants and young children Pregnant women Newest immigrants

​"The test is read within 48 to 72​ hours." ​"Diameter of induration is recorded in​ millimeters." In the Mantoux​ test, 5, not​ 10, tuberculin units are injected intradermally​ (0.1 mL of​ PPD, or 5​ units) into the ventral aspect of the forearm. The test is read within 48 to 72​ hours, and the response is recorded as diameter of induration. Research is inconclusive regarding​ T-SPOT versus Mantoux test.

The public health nurse is training a nurse on tuberculin skin testing. Which information about the Mantoux test should the public health nurse include in the​ training? (Select all that​ apply.) ​"This test is less accurate than the​ T-SPOT test." ​"The test is read within 48 to 72​ hours." ​"Diameter of induration is recorded in​ millimeters." ​"PPD (0.1​ mL) is injected intradermally into the dorsal aspect of the​ forearm." ​"Ten tuberculin units are​ injected."