210 - TB - Test 1

4 drugs: INH, rifampin, pyrazinamide, ethambutol

(SATA) Select the FIRST-LINE drug combo for initial phase of treatment for TB: -INH -streptomycin -rifampin -fluoroquinolones -pyrazinamide -capreomycin -ethambutol -aminoglycosides

collaborate with the social worker to investigate possible availability of funds.

A client admitted with tuberculosis reports concerns about paying for needed medications. The nurse should: collaborate with the social worker to investigate possible availability of funds. contact the community's free clinic for medications. call the public health nurse to research free medications. coordinate with the pharmaceutical company for free samples.

-Isoniazid and rifampin

A client being treated for tuberculosis is determined to be drug resistant. Which medications will no longer be effective in the treatment of the tuberculosis? -Isoniazid and rifampin -Carbamazepine and phenytoin -Dextroamphetamine and doxapram -Propranolol and sotalol

"You can take drug therapy for as long as 24 months or until all tubercle bacilli are eliminated." **The goal of treatment is to eliminate all tubercle bacilli from an infected person while avoiding emergence of significant drug resistance. Treatment of active tuberculosis requires the use of multiple drugs. Tuberculosis is an unusual disease in that drug therapy is required for a relatively long period.

A client diagnosed with tuberculosis asks the nurse how long the antitubercular medication will need to be taken. What is the best response? "Drug therapy will continue until all symptoms of tuberculosis have stopped." "Drug therapy will continue unless a drug resistance develops." "You can take drug therapy for as long as 24 months or until all tubercle bacilli are eliminated." "You will be on multiple drug therapy for the rest of your life."

false!!! Latent TB infection is not an active form of TB, and affected individuals are asymptomatic and cannot pass on the disease to others.

T/F: Latent TB infection is an active form of TB, and affected individuals are asymptomatic but can still pass on the disease to others.

true. redness AND induration must both be present

T/F: Redness at the test area doesn't indicate a positive test; an induration of greater than 10 mm indicates a positive test.

FALSE **Pyrazinamide and streptomycin are contraindicated in pregnancy. **A regimen of INH, rifampin, and ethambutol is usually used in the treatment of pregnant women.

T/F: Rifampin and pyrazinamide are NOT safe for use during pregnancy.

48-72 hours after injection

The PPD can be read ______________ hours after the injection.

extrapulmonary.

The nurse understands that tuberculosis (TB) can affect other organs of the body. The term used for TB outside the lungs called which? interstitial. extrapulmonary. metastasized. encapsulated.

Hepatotoxicity

An 80-year-old client is diagnosed with latent tuberculosis infection. What is a risk for the elderly population when being treated with INH? Hypovolemia Hypoxemia Hepatotoxicity Renal failure

initial infection usually occurs 2 to 10 weeks after exposure.

Initial TB infection takes place how long after exposure?

"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur."

A client has been prescribed INH for the treatment of tuberculosis. The nurse teaches the client about dietary restrictions while taking this medication. What is the most important instruction? "Make sure to limit your protein intake, as increased protein delays absorption of the medication." "Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur." "Avoid excessive caffeine intake because this could increase the side effects of the medication." "Take the medication with a full glass of water to prevent the mouth from becoming dry during therapy."

-INH, rifampin, pyrazinamide, ethambutol

A client has just been diagnosed with tuberculosis (TB). The nurse can expect to start the client on which drug for the initial phase of treatment? -INH, streptomycin, and rifampin -INH, streptomycin, pyrazinamide -INH, rifampin, pyrazinamide, ethambutol -INH, rifampin, streptomycin, ethambutol

-Wearing a disposable particulate respirator that fits snugly around the face

A client is admitted to the health care facility with active tuberculosis (TB). What intervention should the nurse include in the client's care plan? -Wearing a disposable particulate respirator that fits snugly around the face -Instructing the client to wear a mask at all times -Wearing a gown and gloves when providing direct care -Keeping the door to the client's room open to observe the client

Jaundice **Potentially serious adverse effects of INH include hepatotoxicity. Hepatotoxicity may be manifested by symptoms of hepatitis (e.g., anorexia, nausea, fatigue, malaise, jaundice) or elevated liver enzymes. The nurse reports their development to the health care provider promptly to prevent possible liver failure and death. Weight gain, fever, and arthralgia are not the most known adverse effects of INH.

A client is prescribed isoniazid (INH) for a diagnosis of tuberculosis. Which adverse effect will result in discontinuation of the medication? Weight gain Jaundice Fever Arthralgia

Liver function studies

A client is receiving rifampin and isoniazid in combination for treatment of tuberculosis. What would the nurse need to monitor closely? -Liver function studies -Urine culture -Audiometric studies -Pulmonary function studies

decreased hearing acuity

A client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs? -impaired color discrimination -increased urinary frequency -decreased hearing acuity -increased appetite

The need to consistently take the prescribed drugs in order to cure TB

A client, being treated for latent tuberculosis (TB) on an out-client basis, tells the nurse, "I've been feeling pretty good lately, so I haven't actually been all that consistent with taking my drugs." Subsequent health education by the nurse should focus on what subject? -The need to match drug dosages carefully to signs and symptoms -The need to consistently take the prescribed drugs in order to cure TB -The fact that nonadherence will necessitate the use of antiretrovirals -The fact that nonadherence to treatment exacerbates the risks of adverse effects

Orally, on an empty stomach

A client, diagnosed with tuberculosis, will soon begin first-line drug treatment. How will rifampin most likely be administered to this client? -Orally, with food -Orally, on an empty stomach -Intramuscularly -Intravenously, as bolus

-A positive reaction indicates that the client has been exposed to the disease.

A nurse is administering a purified protein derivative (PPD) test to a client. Which statement concerning PPD testing is true? -The PPD can be read within 12 hours after the injection. -A negative reaction always excludes the diagnosis of TB. -A positive reaction indicates that the client has been exposed to the disease. -A positive reaction indicates that the client has active tuberculosis (TB).

15-mm induration **A 10-mm induration strongly suggests a positive response in this tuberculosis screening test; a 15-mm induration clearly requires further evaluation.

A nurse is assessing the injection site of a client who has received a purified protein derivative test. Which finding indicates a need for further evaluation? 5-mm induration Reddened area 15-mm induration A blister

"The people I have contact with at work should be checked regularly." **Such casual contacts needn't be tested for tuberculosis. However, a person in close contact with a person who's infectious is at risk and should be checked. The client demonstrates effective teaching if he states that he'll take his medications for 9 to 12 months, that coworkers don't need medication, and that he requires laboratory tests while on medication.

A nurse recognizes that a client with tuberculosis needs further teaching when the client states: "I'll have to take these medications for 9 to 12 months." "It won't be necessary for the people I work with to take medication." "I'll need to have scheduled laboratory tests while I'm on the medication." "The people I have contact with at work should be checked regularly."

-The nurse is likely asymptomatic. *Latent TB infection is not an active form of TB, and affected individuals are asymptomatic and cannot pass on the disease to others. It does not confer immunity. However, small numbers of organisms may remain viable for years. Later, if immune mechanisms decline or fail, latent TB infection has the potential to develop into secondary TB.

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse? -The nurse is likely asymptomatic. -The nurse is now immune to more severe TB infection. -The nurse can spread TB to others. -The nurse has active TB infection.

"It is all right if I have a grilled cheese sandwich with American cheese." **Patients taking INH should avoid foods that contain tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts), because eating them while taking INH may result in headache, flushing, hypotension, lightheadedness, palpitations, and diaphoresis. Patients should also avoid alcohol because of the high potential for hepatotoxic effects.

A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement? "I am going to have a tuna fish sandwich for lunch." "It is all right if I drink a glass of red wine with my dinner." "It is all right if I have a grilled cheese sandwich with American cheese." "It is fine if I eat sushi with a little bit of soy sauce."

Developing a list of people with whom the client has had contact

A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client? -Client teaching about the cause of TB -Reviewing the risk factors for TB -Developing a list of people with whom the client has had contact -Client teaching about the importance of TB testing

6 to 12 months

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy? 3 to 5 days 1 to 3 weeks 2 to 4 months 6 to 12 months

-Tuberculous empyema due to primary progressive tuberculosis

An older adult client admitted to the hospital with tuberculosis becomes cyanotic, tachycardic, and develops a fever and cough. Chest x-ray reveals pus in the pleural space. What is the most likely diagnosis? -Tuberculous empyema due to primary progressive tuberculosis -Pneumococcal pneumonia with pulmonary edema -Legionnaire disease -Fungal infection

Primary drug resistance

Resistance to one of the first-line anti-TB agents in people who have not had previous treatment -Primary drug resistance -Secondary or acquired drug resistance -Multidrug resistance

-Secondary or acquired drug resistance

Resistance to one or more anti-TB agents in patients undergoing therapy -Primary drug resistance -Secondary or acquired drug resistance -Multidrug resistance

-Multidrug resistance

Resistance to two agents, isoniazid (INH) and rifampin. The populations at greatest risk for multidrug resistance are those who are HIV positive, institutionalized, or homeless. -Primary drug resistance -Secondary or acquired drug resistance -Multidrug resistance

tuberculosis

The client reports cough, low-grade fever, anorexia, and night sweats. The client has also been coughing up blood at times. What disease does this client most likely have? Kaposi sarcoma pneumonia caused by influenza Pneumonitis interstitial infection tuberculosis

"Are you pregnant?" **Pyrazinamide and streptomycin are contraindicated in pregnancy. A regimen of INH, rifampin, and ethambutol is usually used in the treatment of pregnant women.

The health care provider is preparing to order rifampin and pyrazinamide for a female client with active tuberculosis. What question should the provider ask this client before confirming this order? "Are you pregnant?" "Have you ever experienced a miscarriage?" "Do you have a family history of diabetes?" "Are you allergic to penicillin?"

Liver dysfunction

The nurse is caring for a client who is taking INH for tuberculosis. What adverse effect is this client most at risk for? Renal dysfunction Central nervous system dysfunction Liver dysfunction Gastric dysfunction

Mycobacterium tuberculosis

The nurse is developing a community program since a recent increase in admissions to the acute care facility with tuberculosis infection. What is the most frequent form of tuberculosis that the nurse should focus on? P-neumocystis jirovecii tuberculosis -Mycobacterium avium-intracellulare complex -Mycobacterium tuberculosis -Ghon tuberculosis

-6 to 12 months

The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient? -3 months -3 to 5 months -6 to 12 months -13 to 18 months

-Caseating necrosis and cavitation

What does the destructive nature of tuberculosis cause in a previously unexposed immunocompetent person? -Cavitation and rapidly progressing pulmonary lesions -Caseating necrosis and cavitation -Rapidly progressing lesions and purulent necrosis -Caseating necrosis and purulent pulmonary lesions

Maintain adequate hydration **The nurse should instruct the pregnant client with tuberculosis to maintain adequate hydration as a health-promoting activity. The client need not avoid direct sunlight or red meat, or wear light clothes; these have no impact on the client's condition.

What important instruction should the nurse give a pregnant client with tuberculosis? -Maintain adequate hydration. -Avoid direct sunlight. -Avoid red meat. -Wear light, cotton clothes.

Sputum or bronchial cultures

When talking to a group of homeless women living in a shelter, the nurse should educate about risk for developing tuberculosis. The nurse should emphasize which lab/diagnostic test as considered to be the "gold" standard for diagnosing tuberculosis? -Computed tomography (CT) of the chest -Sputum or bronchial cultures -Complete blood count (CBC) -CD4+ T-cell serum levels

"Because I had a previous reaction to the test, this time I need to get a chest X-ray." **A client who previously had a positive PPD test (a reaction to the antigen) can't receive a repeat PPD test and must have a chest X-ray done instead.

Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis? "I will come back in 1 week to have the test read." "If the test area turns red that means I have tuberculosis." "I will avoid contact with my family until I am done with the test." "Because I had a previous reaction to the test, this time I need to get a chest X-ray."