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Which of the following information about a patient who has a recent history of tuberculosis (TB) indicates that the nurse can discontinue airborne isolation precautions?
- A. Chest x-ray shows no upper lobe infiltrates.
- B. TB medications have been taken for 6 months.
- C. Mantoux testing shows an induration of 10 mm.
- D. Three sputum smears for acid-fast bacilli are negative.
Correct Answer: D
Rationale: Negative sputum smears indicate that M. tuberculosis is not present in the sputum, and the patient cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine whether treatment has been successful. Taking medications for 6 months is necessary, but the multidrug-resistant forms of the disease might not be eradicated after 6 months of therapy. Repeat Mantoux testing would not be done since it will not change even with effective treatment.
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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 teaching a patient who is receiving standard multidrug therapy for tuberculosis (TB) about possible toxic effects of the antitubercular medications. Which of the following findings should the nurse instruct the patient to report to the health care provider?
- A. Yellow-tinged skin
- B. Changes in hearing
- C. Orange-coloured sputum
- D. Thickening of the fingernails
Correct Answer: A
Rationale: Noninfectious hepatitis is a toxic effect of isoniazid (INH), rifampin, and pyrazinamide, and patients who develop hepatotoxicity will need to use other medications. Changes in hearing and nail thickening are not expected with the four medications used for initial TB drug therapy. Orange discoloration of body fluids is an expected adverse effect of rifampin and not an indication to call the health care provider.
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.
The nurse is assessing a patient who has just arrived after an automobile accident and the nurse notes that the breath sounds are absent on the right side. Which of the following actions should the nurse anticipate?
- A. Emergency pericardiocentesis
- B. Stabilization of the chest wall with tape
- C. Administration of an inhaled bronchodilator
- D. Insertion of a chest tube with a chest drainage system
Correct Answer: D
Rationale: The patient's history and absent breath sounds suggest a right-sided pneumothorax or hemothorax, which will require treatment with a chest tube and drainage. The other therapies would be appropriate for an acute asthma attack, flail chest, or cardiac tamponade, but the patient's clinical manifestations are not consistent with these problems.
The nurse is conducting a chest assessment on a patient with pneumococcal pneumonia. Which of the following findings should the nurse expect to assess?
- A. Vesicular breath sounds
- B. Increased tactile fremitus
- C. Dry, nonproductive cough
- D. Hyper-resonance to percussion
Correct Answer: B
Rationale: Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial pneumonias. Dullness to percussion would be expected. Pneumococcal pneumonia typically presents with a loose, productive cough. Adventitious breath sounds such as crackles and wheezes are typical.