Nokea
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.
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The nurse is caring for a patient with primary pulmonary hypertension (PPH) who has been taking a calcium channel blocker with no effect. Which of the following medications should the nurse expect that the patient will receive next?
- A. Nifedipine
- B. Diltiazem
- C. Iloprost
- D. Bosentan
Correct Answer: C
Rationale: Iloprost has revolutionized care for PPH. It is now the treatment of choice for select patients unresponsive to calcium channel blockers. It is a long-acting chemically stable prostacyclin analogue, which is administered in an aerosolized form (100-150 mcg/day). Bosentan is an oral form of prostacyclin used to treat PPH. Nifedipine and diltiazem are calcium channel blockers.
The nurse is developing a teaching plan for a patient with a 12 pack-year history of cigarette smoking. Which of the following information should the nurse include in the plan of care?
- A. Computed tomography (CT) screening for lung cancer
- B. Options for smoking cessation
- C. Reasons for annual sputum cytology testing
- D. Erlotinib therapy to prevent tumour risk
Correct Answer: B
Rationale: Because smoking is the major cause of lung cancer, the most important role for the nurse is educating patients about the benefits of and means of smoking cessation. Early screening of at-risk patients using sputum cytology, chest x-ray, or CT scanning has not been effective in reducing mortality. Erlotinib may be used in patients who have lung cancer but not to reduce risk for developing tumours.
The nurse is caring for a patient with pneumonia who has symptoms of a sharp pain 'whenever I take a deep breath.' Which of the following actions should the nurse take next?
- A. Listen to the patient's lungs.
- B. Administer the PRN morphine.
- C. Have the patient cough forcefully.
- D. Notify the patient's health care provider.
Correct Answer: A
Rationale: The patient's statement indicates that pleurisy or a pleural effusion may have developed and the nurse will need to listen for a pleural friction rub or decreased breath sounds. Assessment should occur before administration of pain medications. The patient is unlikely to be able to cough forcefully until pain medication has been administered. The nurse will want to obtain more assessment data before calling the health care provider.
The nurse is providing teaching to a patient with pulmonary tuberculosis (TB) regarding the transmission of TB. Which of the following patient actions indicate that the teaching has been effective?
- A. Demonstrates correct use of a nebulizer
- B. Washes dishes and personal items after use.
- C. Covers the mouth and nose when coughing.
- D. Reports daily to the public health department.
Correct Answer: C
Rationale: Covering the mouth and nose will help decrease airborne transmission of TB. The other actions will not be effective in decreasing the spread of TB.
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.