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Your patient is diagnosed with a latent tuberculosis infection. Select all the correct statements that reflect this condition:
- A. "The patient will not need treatment unless it progresses to an active tuberculosis infection."
- B. "The patient is not contagious and will have no signs and symptoms."
- C. "The patient will have a positive tuberculin skin test or IGRA test."
- D. "The patient will have an abnormal chest x-ray."
- E. "The patient's sputum will test positive for mycobacterium tuberculosis."
Correct Answer: B,C
Rationale: The patient WILL need medical treatment to prevent this case of LBTI from developing into an active TB infection later on. The patient will NOT have an abnormal chest x-ray or a positive sputum test. This is only in active TB.
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A 55-year old male patient is admitted with an active tuberculosis infection. The nurse will place the patient in precautions and will always wear when providing patient care?
- A. droplet, respirator
- B. airborne, respirator
- C. contact and airborne, surgical mask
- D. droplet, surgical mask
Correct Answer: B
Rationale: A patient with ACTIVE TB is contagious. The bacterium, mycobacterium tuberculosis which causes TB, is so small that it can stay suspended in the air for hours to days. Therefore, the nurse will place the patient in AIRBORNE precautions. In addition, a special mask must be worn called a respirator (as referred to as an N95 mask.....a surgical mask does NOT work with this condition).
When suctioning the airway of a client with a tracheostomy, the nurse applies suction for no longer than how many seconds?
- A. 5 to 7
- B. 10 to 12
- C. 15 to 20
- D. 25 to 30
Correct Answer: B
Rationale: Suctioning for 10 to 12 seconds minimizes the risk of hypoxia and mucosal trauma.
You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic breathing. This technique helps do the following:
- A. Increase the breathing rate to prevent hypoxemia
- B. Decrease the use of the abdominal muscles
- C. Encourages the use of accessory muscles to help with breathing
- D. Strengthen the diaphragm
Correct Answer: D
Rationale: Diaphragmatic breathing strengthens the diaphragm , improving breathing efficiency in COPD. It doesn't increase breathing rate , decrease abdominal muscle use , or encourage accessory muscle use .
The client has had a total laryngectomy. Which referral is specific for this surgery?
- A. CanSurmount.
- B. Dialogue.
- C. Lost Chord Club.
- D. SmokEnders.
Correct Answer: C
Rationale: Lost Chord Club (C) supports laryngectomy patients with communication and adjustment. CanSurmount (A), Dialogue (B), and SmokEnders (D) are for cancer, CLL, and smoking cessation.
Until the client can be examined later that morning, which advice by the nurse would be most helpful?
- A. Sucking on ice chips should help.
- B. Rest your voice.
- C. Massage your throat.
Correct Answer: B
Rationale: Resting the voice reduces strain on the vocal cords, which is beneficial for laryngitis and helps prevent further irritation.