Nokea
The nurse is caring for patients with active tuberculosis (TB) who misuse alcohol and/or are homeless. Which of the following interventions by the nurse will be most effective in ensuring adherence with the treatment regimen?
- A. Educating the patient about the long-term impact of TB on health
- B. Giving the patient written instructions about how to take the medications
- C. Teaching the patient about the high risk for infecting others unless treatment is followed
- D. Arranging for a daily noontime meal at a community centre and giving the medication then
Correct Answer: D
Rationale: Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help to ensure that the patient is available to receive the medication. The other nursing interventions may be appropriate for some patients, but are not likely to be as helpful with this patient.
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The health care provider writes a prescription for bacteriological testing for a patient who has a positive tuberculosis skin test. Which of the following actions should the nurse take?
- A. Repeat the tuberculin skin testing.
- B. Teach about the reason for the blood tests.
- C. Obtain consecutive sputum specimens from the patient for 3 days.
- D. Instruct the patient to expectorate three specimens as soon as possible.
Correct Answer: C
Rationale: Three consecutive sputum specimens are obtained on different days for bacteriological testing for M. tuberculosis. The patient should not provide all the specimens at once. Blood cultures are not used for tuberculosis testing. Once skin testing is positive, it is not repeated.
The nurse is caring for a patient with primary pulmonary hypertension (PPH) who is receiving nifedipine. Which of the following findings indicate that the treatment is effective?
- A. BP is less than 140/90 mm Hg
- B. Patient reports decreased exertional dyspnea.
- C. Heart rate is between 60 and 100 beats/minute.
- D. Patient's chest x-ray indicates clear lung fields.
Correct Answer: B
Rationale: Since a major symptom of PPH is exertional dyspnea, an improvement in this symptom would indicate that the medication was effective. Nifedipine will affect BP and heart rate, but these parameters would not be used to monitor effectiveness of therapy for a patient with PPH. The chest x-ray will show clear lung fields even if the therapy is not effective.
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.
The nurse is caring for a patient who has just been admitted with pneumococcal pneumonia has a temperature of 38.7 C (101.7 F) with a frequent cough and symptoms of severe pleuritic chest pain. Which of the following prescribed medications should the nurse give first?
- A. Guaifenesin
- B. Acetaminophen
- C. Azithromycin
- D. Codeine phosphate
Correct Answer: C
Rationale: Early initiation of antibiotic therapy has been demonstrated to reduce mortality. The other medications also are appropriate and should be given as soon as possible, but the priority is to start antibiotic therapy.
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.