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. You should keep the windows and doors closed so as not to spread the droplets. b. He must be careful to cough into a handkerchief that is washed in hot water or discarded. c. Make sure to boil all milk before drinking or using it. d. You 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

a. b. c. d.

Area of redness is measured in 3 days and determines whether tuberculosis is present. Skin test doesnt differentiate between active and dormant tuberculosis infection Presence of a wheal at the injection site in 2 days indicates active tuberculosis. Test stimulates a reddened response in some clients and requires a second test in 3 months.

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

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

2. Chills, fever, night swears and hemoptysis 3. Fever of more thatn 104 F (40 C) and nausea 4. Headache and photophobia 2. Typical s/sx are chills, fever, night sweats and hemoptysis. Chest pain may be present from coughing, but isnt usual. Clients with TB typically have low-grade fevers, not higher than 102 F (38.9 C). nausea, headache and photophobia arent usual TB symptoms. 13. Which of the ff dx tests is definitive for TB? 1. 2. 3. 4. Chest X-ray Mantoux test Sputum culture Tuberculin test 3. The sputum culture for Mycobacterium TB is the only method of confirming the dx. Lesions in the lung may not be big enough to be seen on X-ray. Skin tests may be falsely positive or falsely negative. 14. A client with a positive Mantoux test result will be sent for a chest X-ray. For which of the ff reasons is this done? 1. 2. 3. 4. 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. If the lesions are large enough, the chest x-ray will show their presence in the lungs. Sputum culture confirms the dx. There can be false positive and false-negative skin test results. A chest x-ray cant determine if this is a primary or secondary infection 15. A chest x-ray shows a clients lung to be clear. His Mantoux test is positive, with 10mm of induration. His previous test was negative. These test result are possible because: 1. 2. 3. 4. He had TB in the past and no longer has it He was successfully treated for TB, but skin tests always stay positive Hes a seroconverter, meaning the TB has gotten to his bloodstream Hes a ::tuberculin Converter, which means he has been infected with TB since his last skin test. 4. A tuberculin converters skin test will be positive, meaning he has been exposed to and infected with TB and now has a cell-mediated immune response to the skin test. The clients blood and X-ray results may stay negative. It doesnt mean the infection has advanced to the active stage. Because his X-ray id negative, he should be monitored every 6 months to see if he develops changes in his chest x-ray or pulmonary examination. Being a seroconverter doesnt mean the TB has gotten into his bloodstream; it means it can be detected by a blood test.

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

4. the regimen may last up to 24 months. Its essential that the client comply with therapy during that time or resistance will develop. At no time should he stop taking the mediation before his physician tells him to. 48. 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. 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. 49. A client is receiving streptomycin in the treatment regimen of tuberculosis. The nurse should assess for: 1. 2. 3. 4. Decreased serum creatinine. Diffi culty swallowing. Hearing loss. I.V. infi ltration. 3. 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. 50. 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. 2. 3. 4. Vertigo. Facial paralysis. Impaired vision. Difficulty swallowing. 1. 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. Diffi culty swallowing would result from damage to the glossopharyngeal (IX) or the vagus (X) 51. The nurse should teach clients that the most common route of transmitting tubercle bacilli from person to person is through contaminated: 1. 2. 3. 4. Dust particles. Droplet nuclei. Water. Eating utensils. 2. 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. 52. What is the rationale that supports multidrug treatment for clients with tuberculosis? 1. 2. 3. 4. Multiple drugs potentiate the drugs actions. Multiple drugs reduce undesirable drug adverse effects. Multiple drugs allow reduced drug dosages to be given. Multiple drugs reduce development of resistant strains of the bacteria. 4. 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 (e.g., antihypertensives) to be given in reduced dosages; however, reduced dosages are not prescribed for antibiotics and antituberculosis drugs. 53. The client with tuberculosis is to be discharged home with community health nursing follow-up. Of the following nursing interventions, which should have the highest priority? 1. 2. 3. 4. Offering the client emotional support. Teaching the client about the disease and its treatment. Coordinating various agency services. Assessing the clients environment for sanitation. 2. 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. 54. The nurse is reading the results of a tuberculin skin test (see figure). The nurse should interpret the results as: 1. 2. 3. 4. Negative. Needing to be repeated. Positive. False. 3. The tuberculin test is positive. 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, raised area (induration). Positive responses indicate that the client may have been exposed to the tuberculosis bacteria. A negative response is indicated by the absence of a fi rm, raised area, or an area that is less than 5 mm in diameter. Since the test is positive, it is not necessary to redo the test. The test is positive, not false. 55. Which of the following techniques for administering the Mantoux test is correct? 1. 2. 3. 4. Hold the needle and syringe almost parallel to the clients skin. Pinch the skin when inserting the needle. Aspirate before injecting the medication. Massage the site after injecting the medication.

1. 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 clients 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. 56. Which of the following family members exposed to tuberculosis would be at highest risk for contracting the disease? 1. 2. 3. 4. 45-year-old mother. 17-year-old daughter. 8-year-old son. 76-year-old grandmother. 4. Elderly persons are believed to be at higher risk for contracting tuberculosis because of decreased immunocompetence. Other high-riskpopulations in the United States include the urban poor, clients with acquired immunodefi ciency syndrome, and minority groups. 57. The nurse is teaching a client who has been diagnosed with tuberculosis how to avoid spreading the disease to family members. Which statement(s) by the client indicate(s) that he has understood the nurses instructions? Select all that apply. 1. 2. 3. 4. 5. I will need to dispose of my old clothing when I return home. I should always cover my mouth and nose when sneezing. It is important that I isolate myself from family when possible. I should use paper tissues to cough in and dispose of them promptly. I can use regular plates and utensils whenever I eat. 2, 4, 5. When teaching the client how to avoid the transmission of tubercle bacilli, it is important for the client to understand that the organism 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 nurses instructions about preventing the spread of airborne droplets. It is not essential to discard clothing, nor does the client need to isolate himself from family members. 58. A client has a positive reaction to the Mantoux test. The nurse correctly interprets this reaction to mean that the client has: 1. 2. 3. 4. Active tuberculosis. Had contact with Mycobacterium tuberculosis. Developed a resistance to tubercle bacilli. Developed passive immunity to tuberculosis. 2. A positive Mantoux skin test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease 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. 59. 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. INH competes for the available vitamin B6 in the body and leaves the client at risk for development of neuropathies related to vitamin deficiency. 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. 60. The nurse should caution sexually active female clients taking isoniazid (INH) that the drug has which of the following effects? 1. 2. 3. 4. Increases the risk of vaginal infection. Has mutagenic effects on ova. Decreases the effectiveness of hormonal contraceptives. Inhibits ovulation. 3. INH interferes with the effectiveness ofhormonal 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. 61. Clients who have had active tuberculosis are at risk for recurrence. Which of the following conditions increases that risk? 1. 2. 3. 4. Cool and damp weather. Active exercise and exertion. Physical and emotional stress. Rest and inactivity. 3. 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 potentialrecurrence. Weather and activity levels are not related to recurrences of tuberculosis. 62. In which areas of the United States is the incidence of tuberculosis highest? 1. 2. 3. 4. Rural farming areas. Inner-city areas. Areas where clean water standards are low. Suburban areas with signifi cant industrial pollution. 2. 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. 63. 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. 2. 3. 4. Take the medication with antacids. Double the dosage if a drug dose is missed. Increase intake of dairy products. Limit alcohol intake.

4. 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 foods that are rich in tyramine, such as cheese and dairy products, or he may develop hypertension. 64. 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 clients teaching plan related to the potential adverse effects of rifampin? Select all that apply. 1. 2. 3. 4. 5. Having eye examinations every 6 months. Maintaining follow-up monitoring of liver enzymes. Decreasing protein intake in the diet. Avoiding alcohol intake. The urine may have an orange color. 2, 4, 5. 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. 65. The nurse is providing follow-up care to a client with tuberculosis who does not regularly take his medication. Which nursing action would be most appropriate for this client? 1. 2. 3. 4. Ask the clients spouse to supervise the daily administration of the medications. Visit the client weekly to ask him whether he is taking his medications regularly. Notify the physician of the clients noncompliance and request a different prescription. Remind the client that tuberculosis can be fatal if it is not treated promptly. 1. 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