Tuberculosis

Question 1

Tuberculosis is a bacterial or viral infection?

Answer 1

Bacterial caused by mycobacterium tuberculosis bacteria.

Question 2

Tuberculosis is acid-fast and it stains bright ???? with the acid-fast staining smear.

Answer 2

Red

Question 3

Tuberculosis is an AEROBIC bacteria (so it LOVES ???? and must have it to grow)

Answer 3

Oxygen

Question 4

Tuberculosis affects mainly the lungs BUT it can also affect the kidneys, brain, spine, joints, and liver.

True or False

Answer 4

True

Question 5

???? precautions are required when caring for a patient with an active TB infection….wear a ???? at all times when providing patient care and keep the patient located in a special ventilation/negative pressure air room.

Answer 5

Airborne, respirator

Question 6

The BCG (bacilli Calmette-Guerin) vaccine will give a ???? PPD skin test so a blood test and ???? X-ray is ordered instead.

Answer 6

False positive, chest x-ray

Question 7

In a Latent tuberculosis infection (LTBI), the mycobacterium tuberculosis bacteria is lying dormant and being controlled by the immune system.

True or a False

Answer 7

True

Question 8

True or False: Tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis and it only affects the lungs.
True
False

Answer 8

Answer: FALSE….tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis that affects the lungs AND other systems of the body like the joints, kidneys, brain, spine, liver etc.

Question 9

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

Answer 9

The answer is B. 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 (also referred to as an N95 mask…..a surgical mask does NOT work with this condition).

Question 10

Which statement is correct regarding mycobacterium tuberculosis?
A. This bacterium is an anaerobic type of bacteria.
B. It is an alkali bacterium that stains bright red during an acid-fast smear test.
C. It is known as being an aerobic type of bacteria.
D. It’s an acid-fact bacterium that stains bright green during an acid-fast smear test.

Answer 10

The answer is C. Mycobacterium tuberculosis is AEROBIC (it thrives in conditions that are high in oxygen), and it is an ACID-FAST bacterium, which means when it is stained during an acid-fast smear it will turn BRIGHT RED.

Question 11

Your patient with a diagnosis of latent tuberculosis infection needs a bronchoscopy. During transport to endoscopy, the patient will need to wear?
A. N95 mask
B. Surgical mask
C. No special PPE is needed 
D. Face mask with shield

Answer 11

The answer is C. Patients with a latent tuberculosis infection are NOT contagious. Therefore, no special PPE is needed for the patient during transport. HOWEVER, if the patient had ACTIVE tuberculosis they would need to wear a surgical mask during transport.

Question 12

You are assessing your newly admitted patients who are all presenting with atypical signs and symptoms of a possible lung infection. The physician suspects tuberculosis. So, therefore, the patients are being monitored and tested for the disease. Select all the risk factors below that increases a patient’s risk for developing tuberculosis:
A. Diabetes
B. Liver failure
C. Long-term care resident 
D. Inmate 
E. IV drug user 
F. HIV 
G. U.S. resident

Answer 12

The answers are C, D, E, and F. Remember from our lecture we discussed the risk factors for developing TB and to remember them I said remember the mnemonic “TB Risk”. It stands for tight living quarters (LTC resident, prison, homeless shelter etc.), below or at the poverty line (homeless), refugee (especially in high risk countries), immune system issue such as HIV, substance abusers (IV drugs or alcohol), Kids less than the age of 5….all these are risk factors.

Question 13

A 52-year old female patient is receiving medical treatment for a possible tuberculosis infection. The patient is a U.S. resident but grew-up in a foreign country. She reports that as a child she received the BCG vaccine (bacille Calmette-Guerin vaccine). Which physician’s order below would require the nurse to ask the doctor for an order clarification?
A. PPD (Mantoux test) 
B. Chest X-ray
C. QuantiFERON-TB Gold (QFT)
D. Sputum culture

Answer 13

The answer is A. Patients who have received the BCG vaccine will have a false positive on a PPD (Mantoux test), which is the tuberculin skin test. The BCG vaccine is a vaccine to prevent TB. It is given in foreign countries to children to prevent TB. Therefore, the person has already been exposed to the bacteria via vaccine and will have a false positive. A QuantiFERON-TB Gold test is a better option for this patient. It is a blood test.

Question 14

You’re teaching a group of long-term care health givers about the signs and symptoms of tuberculosis. What signs and symptoms will you include in your education?
A. Cough for a minimum of 6 weeks
B. Night sweats 
C. Weight gain
D. Hemoptysis 
E. Chills 
F. Fever 
G. Chest pain

Answer 14

The answers are B, D, E, F, and G. Option A is wrong because a cough should be present for 3 weeks or more (NOT 6 weeks). Option C is wrong because the patient will experience weight LOSS (not gain).

Question 15

A patient has a positive PPD skin test that shows an 8 mm induration. As the nurse you know that:
A. The patient will need to immediately be placed in droplet precautions and started on a medication regime.
B. The patient will need a chest x-ray and sputum culture to confirm the test results before treatment is provided.
C. The patient will need an IGRA test to help differentiate between a latent tuberculosis infection versus an active tuberculosis infection.
D. The patient will need to repeat the skin test in 48-72 hours to confirm the results.

Answer 15

The answer is B. A positive PPD result does NOT necessarily mean the patient has an active infection of TB. The patient will need a chest x-ray and sputum culture to determine if mycobacterium tuberculosis is present and then treatment will be based on those results. The IGRA test does NOT differentiate between LTBI or an active TB infection. Patients are placed in airborne precautions (NOT droplet) if they have ACTIVE TB.

Question 16

A patient has a PPD skin test (Mantoux test). As the nurse you tell the patient to report back to the office in \_\_\_\_\_\_\_\_\_ so the results can be interpreted?
A. 24-48 hours
B. 12-24 hours
C. 48-72 hours 
D. 24-72 hours

Answer 16

The answer is C. The patient should report back in 48-72 hours. If they fail to, the test must be repeated.

Question 17

A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has arrived to the clinic to have his PPD skin test assessed. What is considered a positive result?
A. 5 mm induration
B. 15 mm induration
C. 9 mm induration
D. 10 mm induration

Answer 17

The answer is D. 15 mm induration is positive in ALL people regardless of health history or risk factors. However, for patients who are homeless (living in homeless shelter) and are IV drug users, a 10 mm or more is considered positive.

Question 18

The physician orders an acid-fast bacilli sputum culture smear on a patient with possible tuberculosis. How will you collect this?
A. Collect 2 different sputum specimens 12 hours apart
B. Collect 3 different sputum specimens (one in the morning, afternoon, and at night)
C. Collect 3 different sputum specimens on 3 different days
D. Collect 2 different sputum specimens on 2 different days

Answer 18

The answer is C. This is how an AFB sputum culture is collected.

Question 19

A patient receiving medical treatment for an active tuberculosis infection asks when she can starting going out in public again. You respond that she is no longer contagious when:
A. She has 3 negative sputum cultures
B. Her signs and symptoms improve
C. She has completed the full medication regime
D. Her chest x-ray is normal
E. She has been on tuberculosis medications for about 3 weeks

Answer 19

The answers are A, B, and E. These are all criteria for when a patient with active TB can return to public life (school, work, running errands). Until then they are still contagious and must stay home in isolation.

Question 20

As the nurse you know that one of the reasons for an increase in multi-drug-resistant tuberculosis is:
A. Incorrect medication ordered
B. Increase in tuberculosis cases nationwide
C. Incorrect route of drug ordered
D. Noncompliance due to duration of medication treatment needed

Answer 20

The answer is D. Patients must be on medication treatment for about 6-12 months (depending on the type of TB the patient has). This leads to noncompliant issues. DOT (directly observed therapy) is now being instituted so compliance is increased. This is where a public health nurse or a trained DOT worker will deliver the medication and watch the patient swallow the pill until treatment is complete.

Question 21

Your patient, who is receiving Pyrazinamide, report stiffness and extreme pain in the right big toe. The site is extremely red, swollen, and warm. You notify the physician and as the nurse you anticipated the doctor will order?
A. Calcium level
B. Vitamin B6 level
C. Uric acid level 
D. Amylase level

Answer 21

The answer is C. This medication can increase uric acid levels which can lead to gout. The patient’s signs and symptoms are classic findings in a gout attack.

Question 22

You note your patient’s sweat and urine is orange. You reassure the patient and educate him that which medication below is causing this finding?
A. Ethambutol
B. Streptomycin
C. Isoniazid
D. Rifampin

Answer 22

The answer is D. This medication will cause body fluids to turn orange.

Question 23

A patient with active tuberculosis is taking Ethambutol. As the nurse you make it priority to assess the patient’s?
A. hearing
B. mental status
C. vitamin B6 level
D. vision

Answer 23

The answer is D. This medication can cause inflammation of the optic nerve. Therefore, it is very important the nurse asks the patient about their vision. If the patient has blurred vision or reports a change in colors, the MD must be notified immediately.

Question 24

A patient taking Isoniazid (INH) should be monitored for what deficiency?
A. Vitamin C
B. Calcium
C. Vitamin B6 
D. Potassium

Answer 24

The answer is C. This medication can lead to low Vitamin B6 levels. Most patients will take a supplement of B6 while taking this medication.

Question 25

A patient is taking Streptomycin. Which finding below requires the nurse to notify the physician?
A. Patient reports a change in vision.
B. Patient reports a metallic taste in the mouth.
C. The patient has ringing in their ears.
D. The patient has a persistent dry cough.

Answer 25

The answer is C. This medication can be very toxic to the ears (cranial nerve 8). Therefore, it is alarming if the patient reports ringing in their ears, which could represent ototoxicity.