1. Mr. T.

has been treated for pulmonary tuberculosis (TB) and is being discharged home with his wife and two young children. Mr. T.¶s wife asks how TB is passed from one person to another so she can prevent any one else from catching it. The nurse responds, a. ³You should keep the windows and doors closed so as not to spread the droplets.´ b. ³He must be careful to cough into a handkerchief that is washed in hot water or discarded.´ c. ³Make sure to boil all milk before drinking or using it.´ d. ³You should wear gloves when handling his linen and bedding, because you can get TB by touching the germs.´ B. TB is spread through residue of evaporated droplets and may remain in the air for long periods of time. Thus care should be given when coughing or sneezing. 2. A client with tuberculosis is given the drug pyrazinamide (Pyrazinamide). Which one of the following diagnostic tests would be inaccurate if the client is receiving the drug? a. b. c. d. Liver function test Gall bladder studies Thyroid function studies Blood glucose A. Liver function tests can be elevated in clients taking pyrazinamide. This drug is used when primary and secondary antitubercular drugs are not effective. Urate levels may be increased and there is a chemical interference with urine ketone levels if these tests are done while the client is on the drug. 3. When a client asks the nurse why the physician says he "thinks" he has tuberculosis, the nurse explains to him that diagnosis of tuberculosis can take several weeks to confirm. Which of the following statements supports this answer? a. A positive reaction to a tuberculosis skin test indicates that the client has active tuberculosis, even if one negative sputum is obtained b. A positive sputum culture takes at least 3 weeks, due to the slow reproduction of the bacillus c. Because small lesions are hard to detect on chest x-rays, x-rays usually need to be repeated during several consecutive weeks d. A client with a positive smear will have to have a positive culture to confirm the diagnosis B. Because the culture takes 3 weeks to grow. Usually even very small lesions can be seen on x-rays due to the natural contrast of the air in the lungs; therefore, chest xrays do not need to be repeated frequently (c). Clients may have positive smears but negative cultures if they have been on medication (d). A positive skin test indicates the person only has been infected with tuberculosis but may not necessarily have active disease (a). 4. A female client must take streptomycin for tuberculosis. Before therapy begins, the nurse should instruct the client to notify the physician if which health concern occurs? a. b. c. d. Impaired color discrimination Increased urinary frequency Decreased hearing acuity Increased appetite

5. A male client is asking the nurse a question regarding the Mantoux test for tuberculosis. The nurse should base her response on the fact that the

Asking the client how he feels about the diagnosis allows the client to express his feelings about the diagnosis. b. While obtaining the client's history. the nurse notes that he refers to his diagnosis as "it. d. The nurse performs a PPD test on his right forearm today. When should he return to have the test read? 1. and does not help him to accept and deal with his disease. but if they¶re cleaned normally.a. Responding with "Let's not talk about it" ignores the client's feelings. The client's wife was recently diagnosed with pulmonary tuberculosis. laughing or singing. night sweats. d. 6. and the physician suspects that the client has now contracted the disease. b. c. If read too early or too late. reinforces the idea that there is something shameful about tuberculosis. 2. . and a productive cough. the results won¶t be accurate. Test stimulates a reddened response in some clients and requires a second test in 3 months. c. Telling the client he shouldn't be embarrassed is presumptive and judgmental. A client comes to the clinic because of low-grade afternoon fevers. it isn¶t necessary to dispose of eating utensils used by someone infected with TB. How long have you been having night sweats?" B. Tubercolusis is a communicable dse transmitted by which of the ff methods? a. Sexual contact and dirty needles don¶t spread the TB bacillus. Saying "it" won't kill the client if he takes his medications belittles the client and reinforces the idea that he may be at fault. Right after performing the test 24 hours after performing the test 48 hours after performing the test 1 week after performing the test 3. sneezing. b. Secual contact Using dirty needles Using an infected person¶s eating utensils Inhaling droplets exhaled from an infected person D. "It won't kill you if you take your medications. but may spread other communicable dses." "You shouldn't be embarrassed that you have tuberculosis.The TB bacillus is airborne and carried in droplets exhaled by an infected person who is coughing. it¶s never advisable to use dirty utensils." "Tell me how you feel about the diagnosis of tuberculosis. What is the nurse's best response? a. Area of redness is measured in 3 days and determines whether tuberculosis is present. A positive acid-fast bacillus sputum culture confirms the diagnosis. c. Skin test doesn¶t differentiate between active and dormant tuberculosis infection Presence of a wheal at the injection site in 2 days indicates active tuberculosis. 8. 7. 3." "Let's not talk about the tuberculosis. and avoids discussing the disease. d. An adult client is being screened in the clinic today for TB." never as tuberculosis. He reports having negative purified protein derivative (PPD) test results in the past. PPD test should be read in 48 to 72 hours. 4.

2. Chest and lower back pain . However. This is known as which of the ff types of infection? 1. A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs. 11. This PPD would be read as having which of the following results? 1. 2. The active stage shows the classic symptoms of TB: fever. this test would be classed as negative. A client with primary TB infection can expect to develop which of the ff conditions? 1. 3. A 3mm raised area would be a positive result if a client had recent close contact with someone diagnosed with or suspected of having infectious TB. 4. it¶s considered positive according to the Centers for Disease Control and Prevention. 4. If the PPD test is reddened and raised 10 mm or more. Indeterminate Needs to be redone Negative Positive 3. Indeterminate isn¶t a term used to describe results of a PPD test. In addition. A client was infected with TB bacillus 10 years ago but never developed the dse. The general population has a 10% risk of developing active TB over their lifetime. 12. He¶s noe being treated for cancer. 3. The client begins to develop signs of TB. 3. Active TB within 2 weeks Active TB within 1 month A fever that requires hospitalization A positive skin test 4.9. and a chest X-ray should be ordered. in many cases because of a break in the body¶s immune defenses. primary sites of infection containing TB bacilli may remain latent for years and then activate when the client¶s resistance is lowered. Follow up should be done with this client. There¶s no such thing as tertiary infection and superinfection doesn¶t apply in this case. all but infants and immunosuppressed people will remain asymptomatic. A client has active TB. At this point. hemoptysis and night sweats. 2. Which of the ff sx will he exhibit? 1. as when a client is being treated for cancer. The test can be redone in 6 months to see if the client¶s test results change. 4. 10. Active infection Primary infection Superinfection Tertiary infection 1. The right forearm of a client who had a PPD test for TB is reddened and raised about 3 mm where the test was given. Some people carry dormant TB infections that may develop into active dse. the bacilli are walled off and skin test read positive.

4. it means it can be detected by a blood test. Chest pain may be present from coughing. Clients with TB typically have low-grade fevers.9 C). A client with a positive Mantoux test result will be sent for a chest X-ray. he should be monitored every 6 months to see if he develops changes in his chest x-ray or pulmonary examination. A chest x-ray can¶t determine if this is a primary or secondary infection 15.´ meaning the TB has gotten to his bloodstream He¶s a ::tuberculin Converter. Chest X-ray Mantoux test Sputum culture Tuberculin test 3. The sputum culture for Mycobacterium TB is the only method of confirming the dx. His Mantoux test is positive. Fever of more thatn 104 F (40 C) and nausea 4. Skin tests may be falsely positive or falsely negative. 2.2. 4. 3. Headache and photophobia 2. with 10mm of induration. Chills. Sputum culture confirms the dx. For which of the ff reasons is this done? 1. Which of the ff dx tests is definitive for TB? 1. Because his X-ray id negative. 2. The client¶s blood and X-ray results may stay negative. 3. There can be false positive and false-negative skin test results. the chest x-ray will show their presence in the lungs. These test result are possible because: 1. Typical s/sx are chills. but isn¶t usual. headache and photophobia aren¶t usual TB symptoms. 3. If the lesions are large enough. He had TB in the past and no longer has it He was successfully treated for TB. 4. fever. Lesions in the lung may not be big enough to be seen on X-ray.´ which means he has been infected with TB since his last skin test. not higher than 102 F (38. 13. 4. night sweats and hemoptysis. Being a seroconverter doesn¶t mean the TB has gotten into his bloodstream. 2. nausea. but skin tests always stay positive He¶s a ³seroconverter. . 14. night swears and hemoptysis 3. A tuberculin converter¶s skin test will be positive. His previous test was negative. A chest x-ray shows a client¶s lung to be clear. It doesn¶t mean the infection has advanced to the active stage. fever. meaning he has been exposed to and infected with TB and now has a cell-mediated immune response to the skin test. To confirm the dx To determine if a repeat skin test is needed To determine the extent of lesions To determine if this is a primary or secondary infection 3.

Which of the ff instructions should the nurse give a client about his active tuberculosis? 1. To help prevent the development of active TB. A client with a productive cough. is highly contagious. chills and night sweats is suspected of having active TB. 4. After 7 to 10 days. 3. A client with positive skin test for TB isn¶t showing signs of active dse. for how long? 1. Isoniazid is the most common medication used for the tx of TB. 3. He would most likely be given isoniazid and two or three other antitubercular antibiotics until the dx is confirmed. 300 mg daily for 2 weeks and send him home 1. 2. The client is showing s/sx of active TB and because of the productive cough. ³it¶s OK to miss a dose every day or two´ ³If side effects occur. 3. but treatment typically lasts from 99 to 12 months. stop taking the medication´ ³Only take the medication until you feel better´ ³you must comply with the medication regimen to treat TB´ . placed in respiratory isolation and three sputum cultures should be obtained to confirm the diagnosis. Admit him to the hospital in respiratory isolation Prescribe isoniazid and tell him to go home and rest Give tuberculin test and tell him to come back in 48 hours to have it read Give prescription for isoniazid. 2. Decreased shortness of breath Improved chest x-ray Nonproductive cough Positive acid-fast bacilli in a putum sample after 2 months of tx 4. 4.16. 3. What s/sx would the client show if therapy is inadequate 1. If contagious and may be sent home. the dse must be treated for up to 24 months in some cases. but other antibiotics are added to the regimen to obtain the best results. although he¶ll continue to take the antitubercular drugs for 9 to 12 months. The other choices would all indicate improvement with therapy 19. 10 to 14 days 2 to 4 weeks 3 to 6 months 9 to 12 months 4. continuing to have acid-fast bacilli in the sputum after 2 months indicated continued infection. A client is dx with active tuberculosis and started on triple antibiotic therapy. He should be admitted to the hospital. 4. 17. three more consecutive sputum cultures will be obtained. and then isolation and tx would continue if the cultures were positive for TB. The physician should take which of the ff actions? 1. 4. 2. the client should be treated with isoniazid. because of the increasing incidence of resistant strains of TB. 18. 2. 300 mg daily.

1. 3. Other signs and symptoms may include fatigue. Which of the following symptoms is common in clients with active tuberculosis? 1.4. 2. Tuberculosis typically produces anorexia and weight loss. Dyspnea on exertion. dyspnea on exertion and change in mental status are not common symptoms of tuberculosis. Nephrotoxicity is a side effect that would be indicated with an increase in creatinine. oculomotor (III). Difficulty swallowing. 4. I. 3. At no time should he stop taking the mediation before his physician tells him to. 49. 48. Water. tinnitus. Droplet nuclei are the residue of evaporated droplets containing the bacilli. 3. 2. 50. Eating utensils. The nurse should teach clients that the most common route of transmitting tubercle bacilli from person to person is through contaminated: 1. It¶s essential that the client comply with therapy during that time or resistance will develop. Vertigo. which remain suspended and are . 4. and ataxia. Symptoms of ototoxicity include vertigo. A client is receiving streptomycin in the treatment regimen of tuberculosis. 2.V. balance. Facial paralysis would result from damage to the facial nerve (VII). Streptomycin is given via intramuscular injection. 3. and night sweats. Streptomycin can cause toxicity to the eighth cranial nerve. 4. Facial paralysis. Impaired vision would result from damage to the optic (II). and body position sense. which is responsible for hearing and equilibrium. Droplet nuclei. Hearing loss. Mental status changes. Tubercle bacilli are spread by airborne droplet nuclei. the regimen may last up to 24 months. Increased appetite is not a symptom of tuberculosis. 2. The nurse should assess for: 1. Increased appetite. 4. which is responsible for hearing. 3. hearing loss. Streptomycin can damage this nerve (ototoxicity). Diffi culty swallowing would result from damage to the glossopharyngeal (IX) or the vagus (X) 51. Weight loss. 2. A client is receiving streptomycin for the treatment of tuberculosis. low-grade fever. infi ltration. Diffi culty swallowing. Decreased serum creatinine. or the trochlear (IV) nerves. The eighth cranial nerve is the vestibulocochlear nerve. The nurse should assess the client for eighth cranial nerve damage by observing the client for: 1. 1. Dust particles. Impaired vision.

Combination therapy also appears to be more effective than single-drug therapy. Combination therapy may allow some medications (e. or other fomites. Offering the client emotional support. What is the rationale that supports multidrug treatment for clients with tuberculosis? 1. Multiple drugs reduce development of resistant strains of the bacteria. reduced dosages are not prescribed for antibiotics and antituberculosis drugs. . The test should be interpreted 2 to 3 days after administering the purifi ed protein derivative (PPD) by measuring the size of the fi rm. 4. 3. however. raised area (induration). 52. dishes. Dust particles and water do not spread tubercle bacilli. Positive. antihypertensives) to be given in reduced dosages. Since the test is positive. 2. Offering the client emotional support. The nurse is reading the results of a tuberculin skin test (see figure). 4. however. not false. 2. 3. however. 53. it is not necessary to redo the test. 3. 4. 2. Coordinating various agency services. 4. Positive responses indicate that the client may have been exposed to the tuberculosis bacteria. this is not the rationale for using multiple drugs to treat tuberculosis. Of the following nursing interventions. Multiple drugs reduce undesirable drug adverse effects. Treatment with multiple drugs does not reduce adverse effects and may expose the client to more adverse effects. these interventions are of less importance than education about the disease process and its treatment. Tuberculosis is not spread by eating utensils. 3. The tuberculin test is positive.circulated in the air.. Pinch the skin when inserting the needle. Assessing the client¶s environment for sanitation. Aspirate before injecting the medication. raised area. Hold the needle and syringe almost parallel to the client¶s skin.g. The client with tuberculosis is to be discharged home with community health nursing follow-up. The nurse should interpret the results as: 1. which should have the highest priority? 1. or an area that is less than 5 mm in diameter. Multiple drugs potentiate the drugs¶ actions. The test is positive. Teaching the client about the disease and its treatment. Ensuring that the client is well educated about tuberculosis is the highest priority. False. Massage the site after injecting the medication. Multiple drugs allow reduced drug dosages to be given. 3. 54. Which of the following techniques for administering the Mantoux test is correct? 1. Negative. A negative response is indicated by the absence of a fi rm. coordinating various agency services. Needing to be repeated. 2. Use of a combination of antituberculosis drugs slows the rate at which organisms develop drug resistance. 2. 4. and assessing the environment may be part of the care for the client with tuberculosis. Many drugs potentiate (or inhibit) the actions of other drugs. 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. 55.

4. 3. Other high-riskpopulations in the United States include the urban poor. Which statement(s) by the client indicate(s) that he has understood the nurse¶s instructions? Select all that apply. 8-year-old son. 2. the nurse should instruct the client to: 1. The Mantoux test is administered via intradermal injection. A positive Mantoux test does not mean that the client has developed resistance. Get extra rest.1. Developed passive immunity to tuberculosis. The nurse correctly interprets this reaction to mean that the client has: 1. 2. a technique that assesses for incorrect placement in a blood vessel. 76-year-old grandmother. A client has a positive reaction to the Mantoux test. 5. covering the mouth and nose when sneezing. 4. 57. . 17-year-old daughter. Adhere to a low-cholesterol diet. and using regular plates and utensils indicate that the client has understood the nurse¶s instructions about preventing the spread of airborne droplets. nor does the client need to isolate himself from family members. Immunity to tuberculosis is not possible.´ ³It is important that I isolate myself from family when possible. 5. Unless involved in treatment. 2. Which of the following family members exposed to tuberculosis would be at highest risk for contracting the disease? 1. and inserting the needle with the bevel side up. It is not essential to discard clothing. and minority groups. Exposure does not necessarily mean that active disease exists. the client may still develop active disease at any time. 3. ³I will need to dispose of my old clothing when I return home.´ ³I can use regular plates and utensils whenever I eat. Elderly persons are believed to be at higher risk for contracting tuberculosis because of decreased immunocompetence. keeping the skin slightly taut when the needle is inserted. clients with acquired immunodefi ciency syndrome. When teaching the client how to avoid the transmission of tubercle bacilli. 4. it is important for the client to understand that the organism is transmitted by droplet infection. 3.´ ³I should always cover my mouth and nose when sneezing. The nurse is teaching a client who has been diagnosed with tuberculosis how to avoid spreading the disease to family members. A client with tuberculosis is taking Isoniazid (INH). To help prevent development of peripheral neuropathies. when giving an intradermal injection. The appropriate technique for an intradermal injection includes holding the needle and syringe almost parallel to the client¶s skin. Had contact with Mycobacterium tuberculosis. There is no need to aspirate. 3. The injection site is not massaged. 1. 4. 4. A positive Mantoux skin test indicates that the client has been exposed to tubercle bacilli. Active tuberculosis. 2. 59.´ 2.´ ³I should use paper tissues to cough in and dispose of them promptly. using paper tissues to cough in with prompt disposal. 45-year-old mother. Developed a resistance to tubercle bacilli. Therefore. Supplement the diet with pyridoxine (vitamin B6). 58. 2. 56.

Increases the risk of vaginal infection. . 2. Rural farming areas. 3. Increase intake of dairy products. Variations in water standards and industrial pollution are not correlated to tuberculosis incidence. Limit alcohol intake. Periods of intense physical or emotional stress increase the likelihood of recurrence. 2. 2. Take the medication with antacids. INH does not increase the risk of vaginal infection. 3. and crowded living conditions also generally characterize these city areas and contribute to the spread of the disease. getting extra rest. Statistics show that of the four geographic areas described. Weather and activity levels are not related to recurrences of tuberculosis. Following a low-cholesterol diet. Rest and inactivity. 2. Tuberculosis can be controlled but never completely eradicated from the body. Inner-city areas. Areas where clean water standards are low. where health and sanitation standards tend to be low. 4. Clients who have had active tuberculosis are at risk for recurrence. Cool and damp weather. INH competes for the available vitamin B6 in the body and leaves the client at risk for development of neuropathies related to vitamin deficiency. 3. Physical and emotional stress. 61.4. In which areas of the United States is the incidence of tuberculosis highest? 1. and female clients of childbearing age should be counseled to use an alternative form of birth control while taking the drug. nor does it affect the ova or ovulation. Substandard housing. 4. The nurse should caution sexually active female clients taking isoniazid (INH) that the drug has which of the following effects? 1. 62. 3. 4. 2. INH interferes with the effectiveness ofhormonal contraceptives. 2. 60. Double the dosage if a drug dose is missed. 3. Farming areas have a low incidence of tuberculosis. 63. 3. Active exercise and exertion. and avoiding excessive sun exposure will not prevent the development of peripheral neuropathies. Suburban areas with signifi cant industrial pollution. Clients should be taught to recognize the signs and symptoms of a potentialrecurrence. Has mutagenic effects on ova. 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. Avoid excessive sun exposure. most cases of tuberculosis are found in inner-core residential areas of large cities. Which of the following conditions increases that risk? 1. Inhibits ovulation. Decreases the effectiveness of hormonal contraceptives. 4. Supplemental vitamin B6 is routinely prescribed. poverty.

The client should be warned to limit intake of alcohol during drug therapy. Ask the client¶s spouse to supervise the daily administration of the medications. The client should not double the dose of the drug because of potential toxicity.4. 4. 2. Visiting the client. The medication regimen includes rifampin (Rifadin). observes the client taking the medication. or threatening the client will not ensure compliance if the client will not or cannot follow the prescribed treatment . The drug should be taken on an empty stomach. or he may develop hypertension. Maintaining follow-up monitoring of liver enzymes. The client taking the drug should avoid foods that are rich in tyramine. 5. Rifampin causes the urine to turn an orange color and the client should understand that this is normal. 2. Visit the client weekly to ask him whether he is taking his medications regularly. 64. 3. 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. The nurse is providing follow-up care to a client with tuberculosis who does not regularly take his medication. 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. The urine may have an orange color. Which nursing action would be most appropriate for this client? 1. they should be taken 1 hour before or 2 hours after the drug is administered. Isoniazid and rifampin (Rifamate) is a hepatotoxic drug. 1. 65. Decreasing protein intake in the diet. Having eye examinations every 6 months. 5. Directly observed therapy (DOT) can be implemented with clients who are not compliant with drug therapy. 1. If antacids are needed for gastrointestinal distress. A client who has been diagnosed with tuberculosis has been placed on drug therapy. 3. who may be a family member or a health care provider. changing the prescription. 2. 4. Notify the physician of the client¶s noncompliance and request a different prescription. In DOT. Remind the client that tuberculosis can be fatal if it is not treated promptly. 4. It is not necessary to restrict protein intake in the diet or have the eyes examined due to rifampin therapy. Avoiding alcohol intake. such as cheese and dairy products. A potential adverse effect of rifampin (Rifadin) is hepatotoxicity. a responsible person.