Tuberculosis

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side and adverse effects of the medication should the nurse monitor? Select all that apply. A. Signs of hepatitis B. Flu-like syndrome C. Low neutrophil count D. Vitamin B6 deficiency E. Ocular pain or blurred vision F. Tingling and numbness of the fingers

A, B, C & E Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side and adverse effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange-colored body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid.

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. A. Fatigue B. Lethargy C. Chest pain D. Morning cough E. Low-grade fever F. Labored breathing

A, B, D & E The symptoms of tuberculosis include a slight morning cough, fatigue, lethargy, and low-grade fever. The other symptoms listed are advanced (not initial) signs and symptoms.

The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list? Select all that apply. A. Activities should be resumed gradually. B. Avoid contact with other individuals, except family members, for at least 6 months. C. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. D. Respiratory isolation is not necessary, because family members already have been exposed. E. Cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags. F. When 1 sputum culture is negative, the client is no longer considered infectious and usually can return to former employment.

A, C, D & E The nurse should provide the client and family with information about tuberculosis and allay concerns about the contagious aspect of the infection. The client needs to follow the medication regimen exactly as prescribed and always have a supply of the medication on hand. Side and adverse effects of the medication and ways of minimizing them to ensure compliance should be explained. After 2 to 3 weeks of medication therapy, it is unlikely that the client will infect anyone. Activities should be resumed gradually and a well-balanced diet that is rich in iron, protein, and vitamin C to promote healing and prevent recurrence of infection should be consumed. Respiratory isolation is not necessary, because family members already have been exposed. Instruct the client about thorough hand washing, to cover the mouth and nose when coughing or sneezing, and to put used tissues into plastic bags. A sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. When the results of 3 sputum cultures are negative, the client is no longer considered infectious and can usually return to former employment.

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? A. Hypercalcemia B. Peripheral neuritis C. Small blood vessel spasm D. Impaired peripheral circulation

B. 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. Options 1, 3, and 4 are not associated with the information in the question.

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? A. Five blood cultures are negative. B. Three sputum cultures are negative. C. A blood culture and a chest x-ray are negative. D. A sputum culture and a tuberculin skin test are negative.

B. Three sputum cultures are negative. The client with tuberculosis must have sputum cultures performed every 2 to 4 weeks after initiation of antituberculosis medication therapy. The client may return to work when the results of three sputum cultures are negative, because the client is considered noninfectious at that point. Options 1, 3, and 4 are not reliable determinants of a noninfectious status.

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? A. Systemic tuberculosis B. Pulmonary tuberculosis C. Exposure to tuberculosis D. No evidence of tuberculosis

C. Exposure to tuberculosis A client who tests positive on a tuberculin skin test either has been exposed to tuberculosis (TB) or has inactive (dormant) TB. The client must then undergo chest radiography and sputum culture to confirm the diagnosis. Options 1, 2, and 4 are incorrect interpretations of the data presented in the question.

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? A. Chest x-ray B. Bronchoscopy C. Sputum culture D. Tuberculin skin test

C. Sputum culture Tuberculosis is definitively diagnosed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made based on a tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histological evidence of granulomatous disease on biopsy.

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? A. Report any change in urine color. B. Take both medications with food. C. Take both medications together once a day. D. Expect to take the medications for 2 to 3 weeks.

C. 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.

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

C. Wearing glasses instead of soft contact lenses will be necessary. Soft contact lenses may be permanently damaged by the orange discoloration in body fluids caused by rifampin. Any sign of possible jaundice (yellow-colored skin) should always be reported. If rifampin is not tolerated on an empty stomach, it may be taken with food. The client may be on the medication for 12 months even if cultures give negative results.

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? A. 6 to 12 hours B. 12 to 24 hours C. 24 to 28 hours D. 48 to 72 hours

D. 48 to 72 hours The tuberculin skin test is an accurate and reliable test that will provide information to the primary health care provider about the client's possible exposure status to tuberculosis. Interpretation of the skin test result should be done 48 to 72 hours after the injection.

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. a. Dyspnea B. Headache C. Night sweats D. A bloody, productive cough E. A cough with the expectoration of mucoid sputum

A, C, D & E Tuberculosis should be considered for any clients with a persistent cough, weight loss, anorexia, night sweats, hemoptysis, shortness of breath, fever, or chills. The client's previous exposure to tuberculosis should also be assessed and correlated with the clinical manifestations.

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? A. "I should use disposable plates, forks, and knives." B. "I should cough into tissues and throw them away carefully." C. "It's important to cover my mouth if I laugh, sneeze, or cough." D. "It's very important to wash my hands after I touch my mask, tissues, or body fluids."

A. "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.

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? A. Directly observed therapy B. More medication instructions C. Involvement of the family in teaching D. Reinforcement by the primary health care provider

A. Directly observed therapy Tuberculosis is a highly communicable disease that is reportable to the local public health department. This agency has regulations that may be enforced to ensure compliance with tuberculosis therapy. Ultimately the client may be required to have directly observed therapy to reduce the risk to the public. This involves having a responsible person actually observe the client taking the medication each day.

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? A. Positive B. Negative C. Inconclusive D. Need for repeat testing

A. Positive The client with HIV infection is considered to have positive results on tuberculin skin testing with an area of induration larger than 5 mm. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client. It is possible for the client infected with HIV to have false-negative readings because of the immunosuppression factor. Options 2, 3, and 4 are incorrect interpretations.

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? A. "I need to continue medication therapy for 1 month." B. "I can't shop at the mall for the next 6 months." C. "I can return to work if a sputum culture comes back negative." D. "I should not be contagious after 2 to 3 weeks of medication therapy."

D. "I should not be contagious after 2 to 3 weeks of medication therapy." The client is continued on medication therapy for up to 12 months, depending on the situation. The client generally is considered noncontagious after 2 to 3 weeks of medication therapy. The client is instructed to wear a mask if there will be exposure to crowds until the medication is effective in preventing transmission. The client is allowed to return to work when the results of 3 sputum cultures are negative.

A client with pulmonary tuberculosis (TB) is on airborne isolation precautions. Which item(s) is essential for the nurse to wear? A. Gloves only B. Fluid shield mask C. gown, mask, gloves D. High-efficiency particulate air (HEPA) filter mask

D. High-efficiency particulate air (HEPA) filter mask The hospitalized client with TB is placed on airborne isolation. A HEPA filter mask must be worn whenever the nurse enters the client's room because these masks can remove almost 100% of the small TB particles. This mask must fit snugly around the nose and mouth. Option 1 is an incorrect option; although gloves may be needed, the nurse must wear a HEPA mask. Option 2 is incorrect. The mask must be a HEPA mask. Option 3 is an incorrect choice. The mask must be a HEPA mask, and there is no need for gown and gloves unless a wound, body fluid, or blood is involved.

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? A. The client has no risk of acquiring TB and needs no further workup. B. The client is at increased risk for acquiring TB and needs immediate medication therapy. C. The client's test result will be negative, and a sputum culture will be required for diagnosis. D. The client's test result will be positive, and a chest x-ray study will be required for evaluation.

D. The client's test result will be positive, and a chest x-ray study will be required for evaluation. The BCG vaccine is routinely given in many foreign countries to enhance resistance to TB. The vaccine uses attenuated tubercle bacilli, so the results of skin testing in persons who have received the vaccine will always be positive. This client needs to be evaluated for TB with a chest radiographic study. The remaining options are incorrect interpretations.

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? A. Venting to the outside and ultraviolet light B. Ultraviolet light and 3 air exchanges per hour C. Ten air exchanges per hour and venting to the outside D. Venting to the outside, 6 air exchanges per hour, and ultraviolet light

D. 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.