Nokea
A 52-year old female patient is receiving medical treatment for a possible tuberculosis infection. The patient is a U.S. resident but grew up in a foreign country. She reports that as a child she received the BCG vaccine (bacille Calmette-Guerin vaccine). Which physician's order below would require the nurse to ask the doctor for an order clarification?
- A. PPD (Mantoux test)
- B. Chest X-ray
- C. QuantiFERON-TB Gold (QFT)
- D. Sputum culture
Correct Answer: A
Rationale: The BCG vaccine can cause false-positive PPD (Mantoux) test results, making it unreliable in patients with a BCG history. The nurse should clarify this order, as an IGRA test (e.g., QuantiFERON-TB Gold) or other diagnostics are preferred.
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An adult is admitted with chronic obstructive pulmonary disease [COPD]. The nurse notes that he has neck vein distention and slight peripheral edema. The practical nurse notifies the registered nurse and continues frequent assessments because the nurse knows that these signs signal the onset of which of the following?
- A. Pneumothorax
- B. Cor pulmonale
- C. Cardiogenic shock
- D. Left-sided heart failure
Correct Answer: B
Rationale: Neck vein distention and peripheral edema indicate right-sided heart failure, or cor pulmonale, caused by pulmonary hypertension in COPD.
Before recommending the use of a nonprescription decongestant to a client with a cold, which aspect of the medical history should be assessed? Select all that apply.
- A. Arthritis
- B. Asthma
- C. Hypertension
- D. Diabetes
- E. Glaucoma
- F. Arrhythmias
Correct Answer: C, E, F
Rationale: Decongestants can exacerbate hypertension, glaucoma, and arrhythmias due to their vasoconstrictive effects. Asthma is also a concern as decongestants may worsen respiratory symptoms in some cases.
Which agents should the nurse suspect as being the cause of the victims' symptoms? Select all that apply.
- A. Anthrax
- B. Sarin gas
- C. Smallpox
- D. Radiation
- E. Cyanide
- F. Ebola virus
Correct Answer: B, E
Rationale: Sarin gas and cyanide are chemical agents that can cause rapid onset of dyspnea, weakness, and nausea, consistent with the symptoms described.
A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should the patient take this medication?
- A. The patient should use the medications every 2 hours for acute episodes of shortness of breath.
- B. The patient should use the Spiriva first and then 5 minutes later the Pulmicort.
- C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later.
- D. The patient should use the medications at the same exact time, regardless of the order.
Correct Answer: B
Rationale: Spiriva (anticholinergic) should be used first to open airways, followed by Pulmicort (corticosteroid) 5 minutes later to reduce inflammation. Every 2 hours is incorrect for maintenance drugs, and order matters (C, D).
A patient receiving medical treatment for an active tuberculosis infection asks when she can starting going out in public again. You respond that she is no longer contagious when:
- A. She has 3 negative sputum cultures
- B. Her signs and symptoms improve
- C. She has completed the full medication regime
- D. Her chest x-ray is normal
- E. She has been on tuberculosis medications for about 3 weeks
Correct Answer: A,B,E
Rationale: These are all criteria for when a patient with active TB can return to public life (school, work, running errands). Until then they are still contagious and must stay home in isolation.