The nurse is preparing to give a bed bath to an immobilized client with tuberculosis

Respiratory Disorders - Tuberculosis (Burke Textbook - Ch. 23)

Your client had a tuberculin skin test with a positive result. The husband is concerned that he may also have TB. You explain that positive skin test indicates that:

A. the client has active TB and the husband should immediately start prophylactic treatment.
B. the client has developed antibodies to TB; further testing is necessary to determine if the disease is active.
C. tuberculosis is a bloodborne disease and the husband does not have to worry.
D. the husband definitely has contracted the disease and should begin medications.

B. the client has developed antibodies to TB; further testing is necessary to determine if the disease is active.

Respiratory Disorders - Tuberculosis (Burke Textbook - Ch. 23)

The nurse is reading the TB skin test for a client. She measures the redness as 6 mm. This measurement is:

A. a negative response.
B. a negative response with no infection.
C. positive for a person with HIV.
D. invalid because the induration was not read.

D. invalid because the induration was not read.

Respiratory Disorders - Tuberculosis (Burke Textbook - Ch. 23)

Johnny, a 29-year-old HIV client has been taking INH for 2 months. He is now complaining of numbness in his feet. You explain that:

A. this is an unusual side effect.
B. he needs to be taking vitamin B6 along with the INH.
C. it is a minor problem and will resolve over time.
D. it is probably caused by his HIV status.

B. he needs to be taking vitamin B6 along with the INH.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 48)

589. A nurse is gathering data on a client with a diagnosis of tuberculosis (TB). The nurse reviews 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

Rationale:
A definitive diagnosis of TB is confirmed through culture and isolation of Mycobacterium tuberculosis. A presumptive diagnosis is made on the basis of a tuberculin skin test, a sputum smear that is positive for acid-fast bacteria, a chest x-ray, and histolic evidence of granulomatous disease on biopsy.

Test-Taking Strategy:
Use the process of elimination and note the word "confirm" in the question. Confirmation is made by identifying Mycobacterium tuberculosis.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 48)

598. A nurse is reading the results of a Mantoux skin test on a client with no documented health problems. The site has no induration and a 1-mm area of ecchymosis. The nurse interprets that the result is:

A. Positive
B. Negative
C. Uncertain
D. Borderline

B. Negative

Rationale:
A positive Mantoux reading has an induration measuring 5 mm or more in diameter in low- to high-risk individuals. A small area of ecchymosis is insignificant and is probably related to injection technique.

Test-Taking Strategy:
To answer this question accurately, it is necessary to know that induration is necessary for a positive response. Because the client in this question has no induration the result is negative.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 48)

599. A nurse is caring for a client who had a Mantoux skin test implantation 48 hours ago on admission to the nursing unit and reads the result of the skin test as positive. Which action by the nurse is the priority?

A. Report the findings.
B. Document the finding in the client's record.
C. Call the employee health service department.
D. Call the radiology department for a chest x-ray.

A. Report the findings.

Rationale:
The nurse who interprets a Mantoux test as positive notifies the physician immediately. The physician would order a chest x-ray to determine whether the client has clinically active TB or old, healed lesions. A sputum culture would be done to confirm the diagnosis of active TB. The client is placed on TB precautions prophylactically until a final diagnosis is made. The findings are documented in the client's record, but this action is not the highest priority. Calling the employee health service would be of no benefit to this client.

Test-Taking Strategy:
Because the nurse may not order diagnostic tests, eliminate option D first. Option C can be eliminated because this does not benefit the client. From the remaining option, notifying the physician should have a higher priority than documentation, even though both may be done in the same narrow time period.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 48)

600. A client being discharged from the hospital to home with a diagnosis of TB is worried abut the possibility of infecting the family and others. The nurse determines that the client would get the most reassurance from the knowledge that:

A. The family does not need therapy, and the client will not be contagious after 1 month of medication therapy.
B. The family does not need therapy, and the client will not be contagious after 6 consecutive weeks of medication therapy.
C. The family will receive prophylactic therapy, and the client will not be contagious after 1 continuous week of medication therapy.
D. The family will receive prophylactic therapy, and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy.

D. The family will receive prophylactic therapy, and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy.

Rationale:
Family members or others who have been in close contact with a client diagnosed with TB are placed on prophylactic therapy with isoniazid (INH) for 6 to 12 months. The client is usually not contagious after taking medication for 2 to 3 consecutive weeks. However, the client must take the full course of therapy for (6 months or longer) to prevent reinfection or drug resistant TB.

Test-Taking Strategy:
Recalling that the family requires prophylactic therapy allows you to eliminate options A and B. From the remaining options, it is necessary to know that the client is not contagious after 2 to 3 weeks of consecutive medication therapy.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 48)

601. A nurse has reinforced discharge teaching with a client who was diagnosed with TB and has been on medication for 1 1/2 weeks. The nurse determines that the client has understood the information if the client makes which statement?

A. "I can't shop at the mall for the next 6 months."
B. "I need to continue medication therapy for 2 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."

Rationale:
The client is continued on medication therapy for 6 to 12 months, depending on the situation. The client is generally considered to be not contagious 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 employment when the results of three sputum cultures are negative.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 48)

602. A client with TB asks a nurse about precautions t take after discharge from the hospital to prevent infection of others. The nurse develops a response to the client's question based on the understanding that:

A. The disease is transmitted by droplet nuclei.
B. The client should maintain enteric precautions only.
C. Deep pile carpet should be removed from the home.
D. Clothing and sheets should be bleached after each use.

A. The disease is transmitted by droplet nuclei.

Rationale:
TB is spread by droplet nuclei or the airborne route. The disease is not carried on objects such as clothing, eating utensils, linens, or furniture. Bleaching of clothing and linens is uncessary, although the client and family members should use good hand washing technique. It is unnecessary to remove carpeting from the home.

Test-Taking Strategy:
TB is not carried on inanimate objects helps you to eliminate options C and D first. From the remaining options, recalling that the disease is transmitted by the airborne route, will direct you to option A.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 48)

603. The nurse is preparing to give a bed bath to an immobilized client with TB. The nurse should plan to wear which of the following items when performing this care?

A. Surgical mask and gloves.
B. Particulate respirator, gown, and gloves.
C. Particulate respiratory and protective eyewear.
D. Surgical mask gown, and protective eyewear.

B. Particulate respirator, gown, and gloves.

Rationale:
The nurse in contact with a client with TB should wear an individually fitted particulate respirator. The nurse would also wear gloves as per standard precautions. The nurse wears a gown whenever there is a possibility that the clothing could become contaminated, such as when giving a bed bath.

Test-Taking Strategy:
Knowing that the nurse should wear a particulate respirator mask helps you eliminate options A and D first. Recalling standard precautions helps you choose option B over option C.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 48)

604. A client with TB, whose status is being monitored in an ambulatory care clinic, asks the nurse when it is permissible to return to work. The nurse replies that the client may resume employment when:

A. Five sputum cultures are negative.
B. Three sputum cultures are negative.
C. A sputum culture and a chest x-ray are negative.
D. A sputum culture and a Mantoux test are negative.

B. Three sputum cultures are negative.

Rationale:
The client must have sputum cultures tested 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 noninfectous at this pont. The Mantoux test will not revert to negative once it is positive. The chest x-ray may or may not be negative.

Test-Taking Strategy:
Knowing that a positive Mantoux test result never reverts to negative helps you eliminate option D. To discriminate among the remaining options, it is necessary to know that three negative sputum cultures are required.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 49)

616. A client has been taking INH for 2 months. The client complains to a nurse about numbness, paresthesias, and tingling in the extremities. the nurse interprets that the client is experiencing:

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

B. Peripheral neuritis

Rationale:
A common side effect of INH is peripheral neuritis. This is manifested by numbness, tingling, and paresthesias in the extremities. This side effect can be minimized by pyridoxine (vitamin B6) intake. Options A, C, and D are incorrect.

Test-Taking Strategy:
Options C and D would not cause the symptoms presented in the question, but instead would cause pallor and coolness. From the remaining options, you should know either that these signs and symptoms do not correlate with hypercalcemia.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 49)

617. A client is to begin a 6-month course of therapy with INH. A nurse plans to teach the client to:

A. Drink alcohol in small amounts only.
B. Report yellow eyes or skin immediately.
C. Increase intake of Swiss or aged cheeses.
D. Avoid vitamin supplements during therapy.

B. Report yellow eyes or skin immediately.

Rationale:
INH is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately (which include yellow skin and sclera). For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, tuna fish, and foods containing tyramine because they may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, HA, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyroxine (vitamin B6) during the course of INH therapy.

Test-Taking Strategy:
Alochol intake is avoided when the client is taking a prescribed medication, so option A should be eliminated first. Because the client is receiving the medication typically is supplemented with vitamin B6, option D is incorrect and is eliminated next. From the remaining options, recalling that the medication is hepatotoxic will direct you to option B.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 49)

618. A client has been started on long-term therapy with rifampin (Rifadin). A nurse teaches the client that the medication:

A. Should always be taking with food or antacids.
B. Should be double-dosed if one does is forgotten.
C. Causes orange discoloration of sweat, tears, urine, and feces.
D. May be discontinued independently if symptoms are gone in 3 months.

C. Causes orange discoloration of sweat, tears, urine, and feces.

Test Taking Strategy:
Use of general medication administration principles will assist in eliminating options B and D. Eliminate option A next because of the close-ended word "always".

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 49)

619. A nurse had given a client taking ethambutol (Myambutol) information about the medication. The nurse determine that the client understands the instructions if the client states that he or she will immediately report:

A. impaired sense of hearing.
B. Problems with visual acuity
C. GI side effects.
D. Orange-red discoloration of body secretions.

B. Problems with visual acuity

Rationale:
Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if GI upset occurs. Impaired hearing results from antitubuecular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin (Rifadin).

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 49)

621. A client with TB is being started on antituberculosis therapy with INH. Before giving this client the first dose, a nurse ensures that which of the following baseline studies has been completed?

A. Electrolyte levels
B. Coagulation times
C. Liver enzyme levels
D. Serum creatinine level

C. Liver enzyme levels

Test-taking Strategy:
It is necessary to know that this medication can be toxic to the liver.

Respiratory Disorders - TB (Saunders NCLEX-PN Review Ch. 49)

620. Cycloserine (Seromycin) is added to the medication regimen for a client with TB. Which of the following would the nurse include in the client-teaching plan regarding this medication?

A. To take the medication before meals.
B. It is not necessary to call the physician if a skin rash occurs.
C. To return to the clinic weekly for serum drug level testing.
D. It is not necessary to restrict alcohol intake with this medication.

C. To return to the clinic weekly for serum drug level testing.

Respiratory Disorders - TB (ATI Med Surge - Ch. 22)

A home health nurse is caring for an older adult client who has active tuberculosis (TB). She lives at home with her husband who has tested negative for TB. She is prescribed the following medication regimen: Isoniazid (INH) 250 mg PO daily, Rifampin (RIF) 500 mg PO daily, Pyrazinaminde (PZA) 750 mg PO daily, Ethambutol 1 g PO daily. Which of the following statements indicates her understanding of appropriate home care measures. Select all that apply.

A. "I can substitute one medicaiton for another since they all fight the infection."
B. "I need to wash my hands each time I cough or sneeze."
C. "I will increase my intake of citrus fruits, red meat, and whole grains."
D. "I am glad I don't have to collect any more sputum specimens."
E. "I will remember to wear a mask when I am in a public place."

B. "I need to wash my hands each time I cough or sneeze."
C. "I will increase my intake of citrus fruits, red meat, and whole grains."
E. "I will remember to wear a mask when I am in a public place."

Respiratory Disorders - TB (ATI Med Surge - Ch. 22)

A client recently diagnosed with TB is prescribed the medication ethambutol (EMB). Which of the following instructions should the nurse reinforce to the client?

A. "Your urine may turn to a dark orange."
B. "The sclera's color may change to yellow."
C. "Watch for any changes in vision."
D. "Take a small daily dose of vitamin B6."

C. "Watch for any changes in vision."

Rationale:
Clients taking ethambutol will need to watch for changes in vision due to optic neuritis, such as blurred vision, altered color discrimination, and constriction of visual fields.

Respiratory Disorders - TB (ATI Med Surge - Ch. 22)

A client with possible TB is admitted to the unit. The client complains of night sweats, coughing up sputum that is streaked with blood, and weight loss. The priority nursing action is to

A. start airborne precautions.
B. obtain height and weight.
C. collect sputum for culturing.
D. encourage fluid intake.

A. start airborne precautions.

Rationale:
The greatest risk is the spread of the infection to others, airborne precaution should be initiated first.