Infection: Tuberculosis Exemplar

Question 1

What are the risk factors for tuberculosis?

Answer 1

1. immigrants
2. people in poor urban areas
3. HIV/AIDS infected individuals
4. Disadvantaged populations
5. Children under 15
6. Minorities
7. Overcrowded institutions (prisons, nursing homes, homeless shelters, drug treatment facilities, and healthcare facilities)
8. Close contacts of persons exposed to contagious cases of TB
9. Foreign-born, recently immigrated from high-risk areas
10. Healthcare workers who serve high-risk clients
11. Illicit drugs or high-risk substance users

Question 2

What are the typical symptoms of someone with TB?

Answer 2

1. Fatigue
2. weight loss
3. Diminished appetite
4. Low-grade afternoon fever
5. night sweats
6. dry cough, then hemoptysis (coughing up blood)
7. lethargy
8. nausea
9. irregular menses
10. pain in the chest

Question 3

What tests are done to determine if someone has TB?

Answer 3

1. Skin test
2. Sputum smear for acid-fast bacilli
3. Sputum culture
4. Sensitivity testing
5. Polymerase chain reaction
6. Chest x-ray
7. Medical history
8. Physical examination

Question 4

What education should be given to the community about TB?

Answer 4

1. how the disease is transmitted
2. How to avoid being infected
3. Signs and symptoms of the disease
4. Community awareness
5. How to possibly lower the incidence of TB
6. Prevention
7. Screenings at higher risk areas

Question 5

What is the PPD test?

Answer 5

Stand for Purified Protein Derivative test. It is used to screen for Tuberculosis

Question 6

How does the PPD test work?

Answer 6

Think about what we usually get to test for TB. they inject a small amount of the purified protein derivative to create a local inflammatory response.

Question 7

What does a PPD test that has an area of induration of less than 5 mm mean?

Answer 7

That it was a negative response

Question 8

What does a PPD test that has an area of induration of 5-9 mm mean?

Answer 8

It is positive for people who:

1. Are in close contact with someone who has TB
2. Have an abnormal chest x-ray
3. Have HIV infection or are immunocompromised
4. Have an organ transplant

Question 9

What does a PPD with an area of induration of 10-15 mm mean?

Answer 9

Positive for people who have other risk factors such as:

1. Birth in a high-prevalence country
2. Residents of high-risk congregate settings
3. injection drug use
4. Infants, children, and adolescents exposed to adults in high-risk categories
5. Medical risk factors (malnutrition, diabetes, etc.)

Question 10

What does a PPD with an area of induration of 15 mm or more mean?

Answer 10

It is positive for all people

Question 11

What is the most common type of PPD test?

Answer 11

A TB skin test also called a Mantoux test

Question 12

What are the clinical manifestations of a rupture of tuberculosis lesion with contamination of the pleural space resulting in pneumothorax?

Answer 12

Shortness of breath, hypoxia, dry cough, cyanosis, chest pain, and subcutaneous emphysema

Question 13

What should a nurse do for someone who has a rupture of tuberculosis lesion with contamination of the pleural space resulting in a pneumothorax?

Answer 13

1. place a chest tube to water seal
2. Provide analgesics
3. Provide continuous cardiorespiratory monitoring
4. Monitor drainage from the chest tube
5. Isolate the patient in a negative airflow room

Question 14

How long does prophylactic therapy last with isoniazid?

Answer 14

6-12 months for adults

Question 15

How long does initial treatment for oral antituberculosis drugs last?

Answer 15

2 months

Question 16

What are the four common oral antituberculosis drugs typically used?

Answer 16

1. Isoniazid
2. Rifampin
3. Pyrazinamide
4. Ethambutol

Question 17

What treatment is followed after initial treatment?

Answer 17

4 additional months of therapy with isoniazid and rifampin daily, twice per week, or weekly

Question 18

What would a nurse look for when assessing a patient that is suspected of tuberculosis?

Answer 18

1. look for difficulty breathing, presence of cough, and nature of the cough
2. Look for signs of fatigue, weight loss, night sweats
3. bloody sputum
4. chest pain
5. skin color

Question 19

What interventions should a nurse implement when educating a patient with TB?

Answer 19

1. Assess the patient’s knowledge about the disease process, and identify misperceptions and emotional reactions
2. Assess the patient’s ability and interest in learning, developmental level, and obstacles to learning
3. Identify the patient’s support systems, and include significant others in teaching
4. Establish a relationship of mutual trust with the patient and significant others
5. develop mutually acceptable learning goals with the patient and significant other
6. Select appropriate teaching strategies, use learning aids such as literature and visual materials that are appropriate for age, level of education, and intellect
7. Document your teaching

Question 20

What interventions should a nurse implement to reduce the risk for infection?

Answer 20

1. Negative airflow room
2. Standard precautions and tuberculosis isolation techniques (N95 respiratory and gown)
3. Tell the patient to avoid crowds and close contact with others
4. Place a mask on the patient during transport to other parts of the facility for diagnostic or treatment procedures
5. Inform all personnel having contact with the patient of the diagnosis
6. Assist visitors to mask before entering the room

Question 21

What teaching should a nurse give to help the patient limit transmitting the disease to others?

Answer 21

1. Always cough and expectorate into tissues
2. Dispose of tissues properly, placing them in a closed bag
3. Wear a mask if sneezing or unable to control respiratory secretions
   4 The disease is not spread by touching inanimate objects so no special precautions are required for eating utensils, clothing, books, or other objects used
4. how to collect sputum specimens
5. The importance of complying with the prescribed treatment for the entire course of therapy

Question 22

What referrals are appropriate for TB patients?

Answer 22

1. Smoking cessation clinics or support groups
2. Alcohol treatment facilities, AA group, and other treatment programs
3. Drug treatment facilities
4. Low-cost community clinics and incentive programs for people with TB
5. Counseling, support groups, and other community resources that provide additional assistance and support

Question 23

A nurse is caring for a client on a four-medication regimen to treat tuberculosis. The nurse discovers that the client isn’t taking all medications. What is appropriate for the nurse to say to the client?

1. Don’t you realize that resistance can develop if you don’t take your meds properly?
2. You must take your meds as instructed. Do you need supervision?
3. Why aren’t you taking your meds? Don’t you want to get better?
4. Taking several medications can be difficult. Tell me about the difficulties you are having

Answer 23

The correct answer is: “Taking several medications can be difficult. Tell me about the difficulties you’re having

Acknowledging that a multidrug regimen can be difficult conveys empathy. Asking the client to discuss difficulties promotes active participation. The nurse may then provide more education and help remove such potential obstacles to compliance as lack of finances.

The other responses are closed questions that require only a yes-or-no answer.
They also have an adversarial tone and are judgmental, blocking further therapeutic communication.
“Why” questions should be avoided because clients may interpret such questions as accusations and become defensive.

Question 24

A client is placed in isolation for suspected tuberculosis. Which action should the nurse take when entering the client’s room?

1. Leave the door open when in the room
2. Wear an N95 respirator
3. Apply a face mask with an eye shield
4. Minimize verbal interactions

Answer 24

The correct answer is: Wear an N95 respirator.

Tuberculosis is acquired via airborne transmission. With airborne precautions, the door of a negative-pressure room must remain shut to ensure effectiveness. All personnel entering the room should wear an N-95 respirator or similarly approved respirator.

A simple face mask with an eye shield is not an effective barrier to stop transmission.
There is no need to minimize verbal interactions with a client with tuberculosis.

Question 25

The nurse is admitting four clients with infections to the medical-surgical unit, but only one negative pressure room is available. Which client is it most appropriate to assign to the negative pressure room?

1. A client with toxic shock syndrome with a temperature of 102.4
2. A client with a wound infected with vancomycin-related enterococci
3. A client with a cough who may have TB
4. A client admitted with diarrhea and has C. difficile

Answer 25

The correct answer is: a client with a cough who may have tuberculosis (TB)

The client with suspected TB needs to have airborne precautions and a negative pressure room.

Clients with C. difficile and VRE require contact precautions and should ideally be placed in private rooms, but could be placed in rooms with other clients with the same diagnosis.
Standard precautions are required for the client with toxic shock syndrome (TSS).