AH2 - Exam 1 - Lippincott 11ed - Test 4 - The Client with Tuberculosis

49. A client newly diagnosed with tuberculosis (TB) is being admitted with the prescription for "isolation precautions for tuberculosis." The nurse should assign the client to which type of room? 1. A room at the end of the hall for privacy. 2. A private room to implement airborne precautions. 3. A room near the nurses' station to ensure confdentiality. 4. A room with windows to allow sunlight.

1. A room at the end of the hall for privacy. Implementing airborne precautions for possible TB requires a private room assignment. In addition to isolating the client by using a private room, engineering controls can help prevent the spread of TB; a room at the end of the hall will aid in controlling airflow direction and can prevent contamination of air in adjacent areas. Confidentiality is provided for every client, regardless of the client's room location. Sunlight is not a component of isolation precautions.

53. A client is receiving streptomycin for the treatment of tuberculosis. The nurse should assess the client for eighth cranial nerve damage by observing the client for: 1. Vertigo. 2. Facial paralysis. 3. Impaired vision. 4. Diffculty swallowing.

1. Vertigo. The eighth cranial nerve is the vestibulocochlear nerve, which is responsible for hearing and equilibrium. Streptomycin can damage this nerve (ototoxicity). Symptoms of ototoxicity include vertigo, tinnitus, hearing loss, and ataxia. Facial paralysis would result from damage to the facial nerve (VII). Impaired vision would result from damage to the optic (II), oculomotor (III), or the trochlear (IV) nerves. Difculty swallowing would result from damage to the glossopharyngeal (IX) or the vagus (X) nerve.

50. Which of the following symptoms is common in clients with active tuberculosis? 1. Weight loss. 2. Increased appetite. 3. Dyspnea on exertion. 4. Mental status changes.

1. Weight loss. Tuberculosis typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low-grade fever, and night sweats. Increased appetite is not a symptom of tuberculosis; dyspnea on exertion and change in mental status are not common symptoms of tuberculosis.

55. The nurse should teach clients that the most common route of transmitting tubercle bacilli from person to person is through contaminated: 1. Dust particles. 2. Droplet nuclei. 3. Water. 4. Eating utensils.

2. Droplet nuclei. Tubercle bacilli are spread by airborne droplet nuclei. Droplet nuclei are the residue of evaporated droplets containing the bacilli, which remain suspended and are circulated in the air. Dust particles and water do not spread tubercle bacilli. Tuberculosis is not spread by eating utensils, dishes, or other fomites.

67. In which areas of the United States and Canada is the incidence of tuberculosis highest? 1. Rural farming areas. 2. Inner-city areas. 3. Areas where clean water standards are low. 4. Suburban areas with significant industrial pollution.

2. Inner-city areas. Statistics show that of the four geographic areas described, most cases of tuberculosis are found in inner-core residential areas of large cities, where health and sanitation standards tend to be low. Substandard housing, poverty, and crowded living conditions also generally characterize these city areas and contribute to the spread of the disease. Farming areas have a low incidence of tuberculosis. Variations in water standards and industrial pollution are not correlated to tuberculosis incidence.

65. The nurse should caution sexually active female clients taking isoniazid (INH) that the drug has which of the following effects? 1. Increases the risk of vaginal infection. 2. Has mutagenic effects on ova. 3. Decreases the effectiveness of hormonal contraceptives. 4. Inhibits ovulation.

3. Decreases the effectiveness of hormonal contraceptives. INH interferes with the effectiveness of hormonal contraceptives, and female clients of childbearing age should be counseled to use an alternative form of birth control while taking the drug. INH does not increase the risk of vaginal infection, nor does it affect the ova or ovulation.

52. A client is receiving streptomycin in the treatment regimen of tuberculosis. The nurse should assess for: 1. Decreased serum creatinine. 2. Diffculty swallowing. 3. Hearing loss. 4. IV infltration.

3. Hearing loss. Streptomycin can cause toxicity to the eighth cranial nerve, which is responsible for hearing, balance, and body position sense. Nephrotoxicity is a side effect that would be indicated with an increase in creatinine. Streptomycin is given via intramuscular injection

60. A client had a Mantoux test result of an 8-mm induration. The test is considered positive when the client: 1. Lives in a long-term care facility. 2. Has no known risk factors. 3. Is immunocompromised. 4. Works as a health care provider in a hospital.

3. Is immunocompromised. An induration (palpable raised hardened area of skin) of more than 5 to 15 mm (depending upon the person's risk factors) to 10 Mantoux units is considered a positive result, indicating TB infection. An induration of greater than 5 mm is found in HIV-positive individuals, those with recent contacts with persons with TB, persons with nodular or fbrotic changes on chest x-ray consistent with old healed TB, or clients with organ transplants or immunosuppressed. An induration of greater than 10 mm is positive and the client may be a recent arrival (less than 5 years) from high-prevalent countries, injection drug user, resident or an employee of high-risk congregate settings (eg, prisons, long-term care facilities, hos-pitals, homeless shelters, etc.), or mycobacteriology lab personnel. Persons with clinical conditions that place them at high risk (eg, diabetes, prolonged corti-costeroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc.), a child less than 4 years of age, or a child or adolescents exposed to adults in high-risk categories.

61. Which of the following family members exposed to tuberculosis would be at highest risk for contracting the disease? 1. 45-year-old mother. 2. 17-year-old daughter. 3. 8-year-old son. 4. 76-year-old grandmother.

4. 76-year-old grandmother. Elderly persons are believed to be at higher risk for contracting tuberculosis because of decreased immunocompetence. Other high-risk populations in the United States and Canada include the urban poor, clients with acquired immunodefciency syndrome, and minority groups.

68. The nurse should include which of the following instructions when developing a teaching plan for a client who is receiving isoniazid and rifampin (Rifamate) for treatment of tuberculosis? 1. Take the medication with antacids. 2. Double the dosage if a drug dose is missed. 3. Increase intake of dairy products. 4. Limit alcohol intake.

4. Limit alcohol intake. Isoniazid and rifampin (Rifamate) is a hepatotoxic drug. The client should be warned to limit intake of alcohol during drug therapy. The drug should be taken on an empty stomach. If antacids are needed for gastrointestinal distress, they should be taken 1 hour before or 2 hours after the drug is administered. The client should not double the dose of the drug because of potential toxicity. The client taking the drug should avoid oods that are rich in tyramine, such as cheese and dairy products, or he may develop hypertension.

70. The nurse is providing follow-up care to a client with tuberculosis who does not regularly take the prescribed medication. Which nursing action would be most appropriate for this client? 1. Ask the client's spouse to supervise the daily administration of the medications. 2. Visit the client weekly to verify compliance with taking the medication. 3. Notify the physician of the client's noncompliance and request a different prescription. 4. Remind the client that tuberculosis can be fatal if it is not treated promptly.

1. Ask the client's spouse to supervise the daily administration of the medications. Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. In DOT, a responsible person, who may be a family member or a health care provider, observes the client taking the medication. Visiting the client, changing the prescription, or threatening the client will not ensure compliance if the client will not or cannot follow the prescribed treatment.

62. The nurse is teaching a client who has been diagnosed with tuberculosis how to avoid spreading the disease to family members. Which statement(s) indicate(s) that the client has understood the nurse's instructions? Select all that apply. 1. "I will need to dispose of my old clothing when I return home." 2. "I should always cover my mouth and nose when sneezing." 3. "It is important that I isolate myself from family when possible." 4. "I should use paper tissues to cough in and dispose of them promptly." 5. "I can use regular plates and utensils whenever I eat."

2, 4, 5 2. "I should always cover my mouth and nose when sneezing." 4. "I should use paper tissues to cough in and dispose of them promptly." 5. "I can use regular plates and utensils whenever I eat." When teaching the client how to avoid the transmission of tubercle bacilli, it is important for the client to understand that the organ-ism is transmitted by droplet infection. Therefore, covering the mouth and nose when sneezing, using paper tissues to cough in with prompt disposal, and using regular plates and utensils indicate that the client has understood the nurse's instructions about preventing the spread of airborne droplets. It is not essential to discard clothing, nor does the client need to be isolated from family members.

69. A client who has been diagnosed with tuberculosis has been placed on drug therapy. The medication regimen includes rifampin (Rifadin). Which of the following instructions should the nurse include in the client's teaching plan related to the potential adverse effects of rifampin? Select all that apply. 1. Having eye examinations every 6 months. 2. Maintaining follow-up monitoring of liver enzymes. 3. Decreasing protein intake in the diet. 4. Avoiding alcohol intake. 5. The urine may have an orange color.

2, 4, 5 2. Maintaining follow-up monitoring of liver enzymes. 4. Avoiding alcohol intake. 5. The urine may have an orange color. A potential adverse effect of rifampin (Rifadin) is hepatotoxicity. Clients should be instructed to avoid alcohol intake while taking rifampin and keep follow-up appointments for periodic monitoring of liver enzyme levels to detect liver toxicity. Rifampin causes the urine to turn an orange color and the client should understand that this is normal. It is not necessary to restrict protein intake in the diet or have the eyes examined due to rifampin therapy.

63. A client has a positive reaction to the Mantoux test. The nurse interprets this reaction to mean that the client has: 1. Active tuberculosis. 2. Had contact with Mycobacterium tuberculosis. 3. Developed a resistance to tubercle bacilli. 4. Developed passive immunity to tuberculosis.

2. Had contact with Mycobacterium tuberculosis. A positive Mantoux skin test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active dis-ease exists. A positive Mantoux test does not mean that the client has developed resistance. Unless involved in treatment, the client may still develop active disease at any time. Immunity to tuberculosis is not possible.

57. The client with tuberculosis is to be dis-charged home with community health nursing follow-up. Of the following nursing interventions, which should have the highest priority? 1. Offering the client emotional support. 2. Teaching the client about the disease and its treatment. 3. Coordinating various agency services. 4. Assessing the client's environment for sanitation.

2. Teaching the client about the disease and its treatment. Ensuring that the client is well educated about tuberculosis is the highest priority. Education of the client and family is essential to help the client understand the need for completing the prescribed drug therapy to cure the disease. Offering the client emotional support, coordinating various agency services, and assessing the environment may be part of the care for the client with tuberculosis; however, these interventions are of less importance than education about the disease process and its treatment.

66. Clients who have had active tuberculosis are at risk for recurrence. Which of the following conditions increases that risk? 1. Cool and damp weather. 2. Active exercise and exertion. 3. Physical and emotional stress. 4. Rest and inactivity.

3. Physical and emotional stress. Tuberculosis can be controlled but never completely eradicated from the body. Periods of intense physical or emotional stress increase the likelihood of recurrence. Clients should be taught to recognize the signs and symptoms of a potential recurrence. Weather and activity levels are not related to recurrences of tuberculosis.

59. Which of the following techniques for admin-istering the Mantoux test is correct? 1. Hold the needle and syringe almost parallel to the client's skin. 2. Pinch the skin when inserting the needle. 3. Aspirate before injecting the medication. 4. Massage the site after injecting the medication.

1. Hold the needle and syringe almost parallel to the client's skin. The Mantoux test is administered via intradermal injection. The appropriate technique for an intradermal injection includes holding the needle and syringe almost parallel to the client's skin, keeping the skin slightly taut when the needle is inserted, and inserting the needle with the bevel side up. There is no need to aspirate, a technique that assesses for incorrect placement in a blood vessel, when giving an intradermal injection. The injection site is not massaged.

64. A client with tuberculosis is taking Isoniazid (INH). To help prevent development of peripheral neuropathies, the nurse should instruct the client to: 1. Adhere to a low-cholesterol diet. 2. Supplement the diet with pyridoxine (vitamin B6) 3. Get extra rest. 4. Avoid excessive sun exposure.

2. Supplement the diet with pyridoxine (vitamin B6) INH competes for the available vitamin B6 in the body and leaves the client at risk for development of neuropathies related to vitamin defciency. Supplemental vitamin B6 is routinely prescribed. Following a low-cholesterol diet, getting extra rest, and avoiding excessive sun exposure will not prevent the development of peripheral neuropathies.

56. What is the rationale that supports multidrug treatment for clients with tuberculosis? 1. Multiple drugs potentiate the drugs' actions. 2. Multiple drugs reduce undesirable drug adverse effects. 3. Multiple drugs allow reduced drug dosages to be given. 4. Multiple drugs reduce development of resistant strains of the bacteria.

4. Multiple drugs reduce development of resistant strains of the bacteria. Use of a combination of antituberculosis drugs slows the rate at which organisms develop drug resistance. Combination therapy also appears to be more effective than single-drug therapy. Many drugs potentiate (or inhibit) the actions of other drugs; however, this is not the rationale for using multiple drugs to treat tuberculosis. Treatment with multiple drugs does not reduce adverse effects and may expose the client to more adverse effects. Combination therapy may allow some medications (eg, antihypertensives) to be given in reduced dos-ages; however, reduced dosages are not prescribed for antibiotics and antituberculosis drugs.