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A staff nurse has a tuberculosis (TB) skin test of 16-mm induration. A chest radiograph is negative, and the nurse has no symptoms of TB. Which of the following information should the occupational health nurse provide to the staff nurse?
- A. Use and adverse effects of isoniazid (INH)
- B. Standard four-drug therapy for TB
- C. Need for annual repeat TB skin testing
- D. Bacille Calmette-Guerin (BCG) vaccine
Correct Answer: A
Rationale: The nurse is considered to have a latent TB infection and should be treated with INH daily for 6-9 months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not done for individuals who have already had a positive skin test. BCG vaccine is used to prevent TB and is rarely used in Canada, it would not be helpful for this individual, who already has a TB infection.
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The nurse is performing tuberculosis (TB) screening in a clinic that has many patients who have immigrated to Canada. Before doing a TB skin test on a patient, which of the following questions is most important for the nurse to ask?
- A. Is there any family history of TB?
- B. Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?
- C. How long have you lived in the Canada?
- D. Do you take any over-the-counter (OTC) medications?
Correct Answer: B
Rationale: Patients who have received the BCG vaccine will have a positive Mantoux test. Another method for screening (such as a chest x-ray) will need to be used in determining whether the patient has a TB infection. The other information also may be valuable but is not as pertinent to the decision about doing TB skin testing.
The nurse is providing teaching to a patient with pneumonia. Which of the following patient statements indicate a good understanding of the discharge instructions given by the nurse?
- A. I will call the doctor if I still feel tired after a week.
- B. I will need to use home oxygen therapy for 3 months.
- C. I will continue to do the deep-breathing and coughing exercises at home.
- D. I will schedule two appointments for the pneumonia and influenza vaccines.
Correct Answer: C
Rationale: Patients should continue to cough and deep breathe after discharge for up to 6-8 weeks. Fatigue for several weeks is expected. Home oxygen therapy is not needed with successful treatment of pneumonia. The pneumonia and influenza vaccines can be given at the same time.
Which of the following information obtained by the nurse about a patient who has human immunodeficiency virus (HIV) and active tuberculosis (TB) disease is most important to communicate to the health care provider?
- A. The Mantoux test had an induration of only 8 mm.
- B. The chest x-ray showed infiltrates in the upper lobes.
- C. The patient is being treated with antiretrovirals for HIV infection.
- D. The patient has a cough that is productive of blood-tinged mucus.
Correct Answer: C
Rationale: Drug interactions can occur between the antiretrovirals used to treat HIV infection and the medications used to treat tuberculosis. The other data are expected in a patient with HIV and TB disease.
Which of the following information should the nurse include in the teaching plan for a patient who is receiving rifampin for treatment of tuberculosis?
- A. Your urine, sweat, and tears will be orange coloured.
- B. Read a newspaper daily to check for changes in vision.
- C. Take vitamin B6 daily to prevent peripheral nerve damage.
- D. Call the health care provider if you notice any hearing loss.
Correct Answer: A
Rationale: Orange-coloured body secretions are an adverse effect of rifampin. The other adverse effects are associated with other antituberculosis medications.
The nurse is caring for a patient with right lower-lobe pneumonia who has been treated with intravenous (IV) antibiotics for 2 days. Which of the following assessment data obtained by the nurse indicates that the treatment has been effective?
- A. Bronchial breath sounds are heard at the right base.
- B. The patient coughs up small amounts of green mucus.
- C. The patient's white blood cell (WBC) count is 9 x 10^9/L.
- D. Increased tactile fremitus is palpable over the right chest.
Correct Answer: C
Rationale: The normal WBC count indicates that the antibiotics have been effective. All the other data suggest that a change in treatment is needed.