UNIT 4 CHAPTER 28 Rhinosinusitis, Influenza, Pneumonia, Pulmonary Tuberculosis

Question 1

What is Rihnosinusitis?

Answer 1

The inflammation leads to a build up of fluid and
pressure and can lead to infection

Pathophysiology Review
Rhinosinusitis is an inflammation of the mucous membranes of one or more of the sinuses and is usually seen with rhinitis, especially the common cold (coryza)

Question 2

What can cause Rhinosinuitis

Answer 2

Anything that interferes with sinus drainage (e.g., deviated nasal septum, nasal polyps or tumors, inhaled air pollutants or cocaine, allergies, facial trauma, and dental infection) can lead to rhinosinusitis.

Question 3

Signs and Symptoms of Rhinosinusitis?

Answer 3

Most episodes of rhinosinusitis are caused by viral infection and usually develop in the maxillary and frontal sinuses, although bacterial infection can also occur. Complications include cellulitis, abscess, and meningitis.

Assess for signs and symptoms of rhinosinusitis, which include pain over the cheek radiating to the teeth, tenderness to percussion over the sinuses, referred pain to the temple or back of the head, and general facial pain that is worse when bending forward.

In bacterial infection , purulent nasal drainage with postnasal drip, sore throat, fever, erythema, swelling, fatigue, dental pain, and ear pressure may be present.

Question 4

How many types of Rhinosinusitis is there? What is the difference between them?

Answer 4

2

viral and bacterial

viral
Assess for signs and symptoms of rhinosinusitis, which include pain over the cheek radiating to the teeth, tenderness to percussion over the sinuses, referred pain to the temple or back of the head, and general facial pain that is worse when bending forward.

bacterial
In bacterial infection , purulent nasal drainage with postnasal drip, sore throat, fever, erythema, swelling, fatigue, dental pain, and ear pressure may be present.

Question 5

How is Rhinosinusitis treated?

Answer 5

Management focuses on symptom relief and patient education. Teach him or her about correct use of the drug therapy prescribed. Also teach the patient to use the techniques described for reducing the transmission of influenza infection.

Drug therapy includes decongestants, antihistamines, and intranasal steroid spray to block or reduce the amount of chemical mediators in nasal and sinus tissues and relieve local inflammation . Antipyretics are given for fever, and analgesics may be given for pain.

First-generation antihistamines may not be appropriate drugs for older adults because these patients often have reduced drug clearance, higher risk for confusion, and anticholinergic effects such as dry mouth and constipation. Common drugs to avoid in this category include chlorpheniramine, diphenhydramine, and hydroxyzine. Teach older adults why they should not self-medicate with these drugs.

Question 6

A patient has been recently diagnosed with bacterial Rhinosinusitis. Which of the following statements require intervention?

A. Should blow my nose often and take decongestant medicinee to help reduce the fluid and pressure in my sinus’s.

B. I should take the antibiotic until I feel like I have been feeling better.

C. I should take a cough drop for my sore throat

D. I should take acetaminophen for my fever.

Answer 6

B. I should take the antibiotic until I feel like I have been feeling better.

Instruct patients with any bacterial infection to complete the entire antibiotic prescription, even when symptoms improve or subside. This action will help eradicate the organism and prevent development of resistant bacterial strains.

Question 7

Drug therapy for Rhinosinusitis

Answer 7

Drug therapy includes decongestants, antihistamines, and intranasal steroid spray to block or reduce the amount of chemical mediators in nasal and sinus tissues and relieve local inflammation . Antipyretics are given for fever, and analgesics may be given for pain.

Supportive therapy such as humidification, nasal irrigation, and applying hot wet packs over the sinus area can increase the patient’s comfort and help prevent spread of the infection . Instruct the patient about the importance of rest and increased fluid intake. Sleeping with the head of the bed elevated and avoiding cigare e smoke may reduce discomfort.

Treatment for bacterial rhinosinusitis includes broad-spectrum antibiotics, decongestants, and antipyretics. In some cases, nasal steroids or systemic steroids may be prescribed.

Question 8

What is Influenza?

Answer 8

Seasonal influenza, or “flu,” is a highly contagious acute viral respiratory infection that can occur at any age

Respiratory viral infections are common among humans and vary from mild colds to severe seasonal influenza that can lead to pneumonia, other complications, and death.

Influenza may be caused by different strains of one of several virus families, referred to as A, B, and C.

Question 9

The spouse of a 78-year-old client who was discharged to home 1 day ago after hospitalization for seasonal influenza calls to report the fever has returned and is now 103.4°F (39.7°C). What is the nurse’s primary concern for this client?
A. The client may not be taking the prescribed antiviral drug correctly
B. A second strain of influenza is likely
C. Pneumonia may be present
D. The client may be dehydrated

Answer 9

C. Pneumonia may be present

Question 10

What are the Signs and Symptoms of Influenza?

Answer 10

The patient with influenza often has a rapid onset of severe headache, muscle aches, fever, chills, fatigue, and weakness. Adults are contagious 24 hours before symptoms occur and up to 5 days after they begin. Sore throat, cough, and watery nasal discharge can also occur.

Infection with influenza strain B can lead to nausea, vomiting, and diarrhea. Most patients feel fatigued for 1 to 2 weeks after the acute episode has resolved.

Question 11

Can seasonal influenza be prevented?

Answer 11

Yes

Seasonal influenza can be prevented or its severity reduced when adults receive an annual influenza vaccination.

The recommended influenza vaccination for all adults is an IM injection.

This action not only helps practicing nurses avoid becoming infected, but it also reduces the risk for infection transmission from health care professional to patient.

Question 12

What groups or age group must receive the vaccine to avoid pneumonia?

Answer 12

Although annual vaccination is not 100% effective at preventing influenza, it is especially important for adults who:
* Are older than 50 years
* Have chronic illness or immune compromise
* Reside in institutions
* Live with or care for others with health problems that put them at risk for severe complications of influenza
* Are health care personnel providing direct care to patients (CDC,
2018a)

Question 13

2 BENEFITS OF Influenza Vaccine

Answer 13

1. This action not only helps practicing nurses avoid becoming infected, but it also reduces the risk for infection transmission from health care professional to patient.
2. Seasonal influenza can be prevented or its severity reduced when adults receive an annual influenza vaccination.

Question 14

What type of precaution is Influenza?

A. Airborne
B. Droplet
C. Contact
D. PPE

Answer 14

B. Droplet

Question 15

What are some Health Promotions for Influenza

Answer 15

• get the annual flu vaccine

-wash your hands especially after nose blowing, sneezing, coughing, rubbing the eyes, or touching the face.

-avoid large crowds

-cough or sneeze into upper sleeve than hand

-Other precautions include staying home from work, school, or crowded places; covering the mouth and nose with a tissue when sneezing or coughing; disposing properly of used tissues immediately; and avoiding close contact with other people (social distancing)

Question 16

Does Influenza respond to antibiotic drugs such as Ampicillin?

A. Yes
B. No

Answer 16

No

Viral infections do not respond to antibiotic therapy. Neuraminidase inhibitor (NAI) antiviral drugs such as oseltamivir, zanamivir, and peramivir have been effective in the prevention and treatment of some strains of influenza A and B

They can be given to adults at high risk for complications who have been exposed to influenza but have not yet been vaccinated. These drugs also shorten the duration of influenza. The drugs prevent viral spread in the respiratory tract by inhibiting a viral enzyme that allows the virus to penetrate respiratory cells.

Question 17

Drug therapy for Influenza. What is one antiviral drug.

Answer 17

Oseltamivir, Zanamivir, and Peramivir

To be most effective as treatment rather than for prevention, they must be taken within 24 to 48 hours after symptoms begin. Peramivir is only available as an IV drug.

Patients older than 65 years should be treated with antiviral drugs as soon as possible to reduce their risks for hospitalization, complications, and disability

Instruct the patient to rest for several days and increase fluid intake unless another problem requires fluid restriction

sore throat pain. Antihistamines may reduce the rhinorrhea. Other supportive measures are the same as those for rhinosinusitis.

Question 18

Can people be contagious before becoming symptomatic?

Answer 18

YES!

Labs – Which labs could be altered?
Assessment

Question 19

WHAT POPULATION IS AT RISK FOR PNEUMONIA

Answer 19

Vulnerable populations are at risk for
are the elderly developing pneumonia

Certain cultures are at greater risk for
developing pneumonia – American
Indians, Alaska Native

Question 20

What is Pneumonia?

Answer 20

Infection of the lung

Can be viral or bacterial

Question 21

What are the Signs/Symptoms of Pneumonia?

Answer 21

Observe the general appearance. Many patients with pneumonia have flushed cheeks and an anxious expression. The patient may have chest pain or discomfort, myalgia, headache, chills, fever, cough, tachycardia, dyspnea, tachypnea, hemoptysis (bloody sputum), and sputum production. Severe chest muscle weakness may also be present from sustained coughing.

Observe the patient’s breathing paern, position, and use of accessory muscles. The patient with hypoxia and reduced gas exchange may be uncomfortable in a lying position and will sit upright, balancing with the hands (“tripod position”). Assess the cough and the amount, color, consistency, and odor of sputum produced.

Crackles are heard on auscultation when fluid is in interstitial and alveolar areas, and breath sounds may be diminished. Wheezing may be heard if inflammation or exudate narrows the airways.

In evaluating vital signs, compare the results with baseline values. A patient with pneumonia, especially an older adult, is often hypotensive with orthostatic changes because of vasodilation and dehydration. A rapid, weak pulse may indicate hypoxemia, dehydration, or impending sepsis and shock. Dysrhythmias may occur from cardiac tissue hypoxia.

Question 22

How would a patient with hypoxia will present?

Answer 22

Observe the patient’s breathing pa ern, position, and use of accessory muscles. The patient with hypoxia and reduced gas exchange may be uncomfortable in a lying position and will sit upright, balancing with the hands (“tripod position”). Assess the cough and the amount, color, consistency, and odor of sputum produced.

Question 23

Common signs of Pneumonia

Answer 23

Pleuritic chest discomfort: Inflammation of the parietal pleura causes pain on inspiration

Purulent, blood- tinged, or rust- colored sputum: A result of the inflammatory process in which fluid from the pulmonary capillaries and red blood cells moves into the alveoli

Fever: Phagocytes release pyrogens that cause the hypothalamus to increase body temperature

Cough: Fluid accumulation in receptors of the trachea, bronchi, and bronchioles

Hypoxemia: Alveolar consolidation
Pulmonary capillary shunting

Increased respiratory rate/dyspnea

Question 24

What are the early signs of Pneumonia in a elderly patient?

Answer 24

CHANGE OF LOC
The older adult with pneumonia has weakness, fatigue (which can lead to falls), lethargy, confusion, and poor appetite. Fever and cough may be absent, but hypoxemia is often present. The most common symptom of pneumonia in the older-adult patient is a change in cognition with acute confusion from hypoxia.

Question 25

In which scenario would a start treating an elderly patient for Pneumonia?

A. WBC level 20,000
B. patient has a change of level of consciousness and is lethargic
C. complaining of congestion in chest
D. Has dyspnea

Answer 25

B. patient has a change of level of consciousness and is lethargic

The WBC count may not be elevated until the infection is severe. Waiting to treat the disease until more typical symptoms appear greatly increases the risk for sepsis and death.

Question 26

Would a patient with Pneumonia suffer with Anxiety?

Answer 26

Yes

The patient with pneumonia often has pain, fatigue, and dyspnea, all of which promote anxiety. Assess anxiety by looking at his or her facial expression and general tenseness of facial and shoulder muscles. Listen to the patient carefully, and use a calm approach. Because of airway obstruction and muscle fatigue, the patient with dyspnea speaks in broken sentences. Keep the interview short if severe dyspnea or breathing discomfort is present.

Question 27

Lab Assessments for Pneumonia? Which labs and Diagnostic test are important?

Answer 27

A complete blood count (CBC) is obtained to assess for an elevated WBC count, which is a common finding except in older adults.

Pulse oximetry is used to assess for hypoxemia. Thoracentesis is used in patients who have an accompanying pleural effusion.

In severely ill patients, arterial blood gases (ABGs) may be assessed to determine baseline arterial oxygen and carbon dioxide levels and to help identify a need for supplemental oxygen.

Chest x-ray is the most common diagnostic test for pneumonia but may not show changes until 2 or more days after symptoms are present. Pneumonia usually appears on chest x-ray as an area of increased density. It may involve a lung segment, a lobe, one lung, or both lungs.

In the older adult, the chest x-ray is essential for early diagnosis because other pneumonia symptoms are often vague (Touhy & Je , 2020).

Question 28

A nurse assessing an older adult client with pneumonia notes the client is now confused and the oxygen saturation has dropped since the last assessment 1 hour ago from 90% to 84%. The nurse also notes the respiratory rate has increased from 26 to 32. What is the nurse’s best first action?
A. Encourage the client to use the incentive spirometer hourly.
B. Increase her O2 flow rate by 2 L and reassess in 5 minutes.
C. Increase the flow rate of the IV antibiotic.
D. Document the changes as the only action.

Answer 28

B. Increase her O2 flow rate by 2 L and reassess in 5 minutes.

Question 29

Nursing Intervention for Patients with Pneumonia

Answer 29

Help him or her cough and deep breathe at least every 2 hours.

The alert patient may use an incentive spirometer to facilitate deep breathing and stimulate coughing.

Encourage the alert patient to drink at least 2 L of fluid daily to prevent dehydration and to thin secretions unless another health problem requires fluid restriction.

Monitor intake and output, oral mucus membranes, and skin turgor to assess hydration status, especially when fever and tachypnea are present.

Oxygen therapy is usually delivered by nasal cannula or mask unless the hypoxemia does not improve with these devices. The patient who is confused may not tolerate a facemask.

Instruct him or her to get plenty of rest and increase activity gradually.

An important aspect of education for the patient and family is avoiding upper respiratory tract infection and viruses. Teach him or her to avoid crowds (especially in the fall and winter when viruses are prevalent), people who have a cold or flu, and exposure to irritants such as smoke. A balanced diet and adequate fluid intake are essential.

Question 30

What is the proper use of an Incentive Spirometer

Answer 30

Incentive spirometry is used to improve inspiratory muscle action and to prevent or reverse atelectasis (alveolar collapse).

Instruct the patient to sit up if possible, exhale fully, place the mouthpiece in his or her mouth; take a long, slow, deep breath, raising the piston as high as possible, and then hold the breath for 2 to 4 seconds before slowly exhaling.

Evaluate technique and record the volume of air inspired. Teach the patient to perform 5 to 10 breaths per session every hour while awake.

This intervention may not be helpful to patients who are very fatigued and/or have severe dyspnea.

Question 31

Signs and Symptoms of a patient recovering from Pneumonia

Answer 31

• New-onset confusion * Chills and fever
• Persistent cough
• Dyspnea
• Wheezing
• Hemoptysis
• Increased sputum production
• Chest discomfort
• Increasing fatigue
• Any other symptoms that have failed to resolve
  Assess the patient for:
• Fever
• Diaphoresis
• Cyanosis, especially around the mouth or conjunctiva * Dyspnea, tachypnea, or tachycardia
• Adventitious or abnormal breath sounds
• Weakness

Question 32

What is Emphysema?

Answer 32

When pulmonary empyema occurs as a result of pneumonia, further interventions are needed. Pulmonary empyema is a collection of pus in the pleural space most commonly caused by pulmonary infection . When empyema is present, gas exchange can be impaired by both reduced lung diffusion and reduced effective ventilation.

S/S OF EMPHYSEMA

Empyema is suspected when chest wall motion is reduced, fremitus is reduced or absent, percussion is flat, and breath sounds are decreased. Abnormal breath sounds, including bronchial breath sounds, egophony, and whispered pectoriloquy,may also be present. Diagnosis is made by chest x-ray or CT scan and a sample of the pleural fluid (obtained via thoracentesis). Empyema fluid is thick, opaque, exudative, and foul smelling.

TREATMENT OF EMPHYSEMA

Treatment includes draining the empyema cavity, re-expanding the lung, and controlling the infection . Appropriate antibiotics are prescribed. A chest tube(s) to closed-chest drainage is used to promote lung expansion and drainage.

Question 33

HEALTH PROMOTION FOR PNEUMONIA VACCINE

Answer 33

Vaccination can help prevent pneumonia. Currently, there are two pneumonia vaccines: pneumococcal polysaccharide vaccine (PPSV23) and pneumococcal conjugate vaccine (PCV13) for prevention of pneumonia (Phillips & Swanson, 2016). The CDC recommends that adults older than 65 years be vaccinated with both, first with PCV13 followed by PPSV23 about 12 months later. Adults who have already received the PPSV23 should have PCV13 about a year or more later. These recommendations also apply to adults between 19 and 64 years of age who have specific risk factors such as chronic illnesses (CDC, 2018b). Because pneumonia often follows influenza, especially among older adults, urge all adults to receive the seasonal vaccination annually.

Question 34

What is Pulmonary Tuberculosis?

Answer 34

Tuberculosis (TB) is a highly communicable disease caused by infection with Mycobacterium tuberculosis. It is one of the most common bacterial infections worldwide and one of the top 10 causes of death

M. tuberculosis is a slow-growing, acid-fast rod transmied via the airborne route. Adults most often infected are those having repeated close contact with an infectious person who has not yet been diagnosed with TB. The risk for infection transmission is reduced after an adult with active TB has received proper drug therapy for 2 to 3 weeks, clinical improvement occurs, and acid-fast bacilli (AFB) in the sputum are reduced.

Question 35

What transmission is Pulmonary Tuberculosis

Answer 35

The organism is transmi tted via aerosolization (i.e., an airborne route)

A contagious disease that primarily
affects the pulmonary system
*Caused by Mycobacterium Tuberculosis

When a person with active TB coughs, laughs, sneezes, whistles, or sings, infected respiratory droplets become airborne and may be inhaled by others.

M. tuberculosis is a slow-growing, acid-fast rod transmi ed via the airborne route. Adults most often infected are those having repeated close contact with an infectious person who has not yet been diagnosed with TB.

Question 36

At risk populations for contracting TB

Answer 36

In North America, the adults who are at greatest risk for development of TB are:
* Those in constant, frequent contact with an untreated infected person
* Those who have reduced immunity or HIV disease
* Adults who live in crowded areas such as long-term care facilities,
prisons, homeless shelters, and mental health facilities * Older homeless adults
* Users of injection drugs or alcohol
* Lower socioeconomic groups
* Foreign immigrants from less affluent countries

Many adults who acquire TB have risk factors such as homelessness, living in very crowded conditions, or substance use with malnutrition. These risk factors are best managed on a societal level.

Question 37

Health Promotion and maintenance of TB

Answer 37

Many adults who acquire TB have risk factors such as homelessness, living in very crowded conditions, or substance use with malnutrition. These risk factors are best managed on a societal level. Communities need to work toward providing adequate housing, substance-use programs that are accessible, and feeding centers or food banks for those in need. On a personal level, many health conditions make it more likely to contract TB if exposed. Adults with these health conditions should avoid people who are ill, stay well nourished, and practice good handwashing and social distancing.

• Any adult who works with people are at high risk of having TB should be screened yearly

Question 38

Signs and Symptoms of Tuberculosis

Answer 38

Early detection of TB depends on patient reports rather than observable indicators. TB has a slow onset, and patients are often not aware of problems until the disease is advanced. TB is considered for any patient with a persistent cough and other symptoms, such as

unintended weight loss,
anorexia,
drenched night sweats,
hemoptysis,
shortness of breath,
fever,
chills

Question 39

S/S of Tuberculosis

Answer 39

The patient with TB has progressive fatigue, lethargy, nausea, anorexia, weight loss, irregular menses, and a low-grade fever. Symptoms may have been present for weeks or months. Night sweats may occur with the fever. A cough with mucopurulent sputum, often streaked with blood, is present. Chest tightness and a dull, aching chest pain occur with the cough. Ask about, assess for, and document the presence of any of these symptoms to help with diagnosis, establish a baseline, and plan nursing interventions.

When assessing the patient, you may note dullness with percussion over the involved lung fields, bronchial breath sounds, crackles, and increased transmission of spoken or whispered sounds. Partial obstruction of a bronchus from the disease or compression by lymph nodes may produce localized wheezing.

Question 40

Testing and Diagnosis for TB

Answer 40

Tuberculin skin testing (TST), also known as the Mantoux test, is the most commonly used reliable screening test for TB. A small amount (0.1 mL) of purified protein derivative (PPD) is placed intradermally in the forearm.

TB infection can be tested by methods. In addition to chest x-ray, sputum cultures of blood or respiratory secretions can be tested. Many fully automated nucleic acid amplification tests (NAATs) for TB are used on respiratory secretions. Results of these tests are available in less than 2 hours; however, they have limitation

Blood analysis can be done with interferon-gamma release assays, or IGRAs. The first IGRA was the QuantiFERON-TB Gold In-Tube test. IGRAs show how the patient’s immune system responds to the TB bacterium.

Once a person’s skin test is positive for TB, a chest x-ray is used to detect active TB or old, healed lesions. Calcifications usually indicate old, healed lesions.

Caseation and inflammation may be seen on the x-ray if the disease is active (McCance et al., 2019). The chest x-rays of HIV-infected patients may be normal or may show infiltrates in any lung zone and lymph node enlargement.

Question 41

A client who has been taking the four first-line drugs for tuberculosis treatment for a month reports all of the following changes. Which changes would cause the nurse to collaborate quickly with the health care provider? Select all that apply.
A. Blurry vision
B. Constipation
C. Difficulty sleeping
D. Nausea when drinking beer
E. Red-tinged urine
F. Sunburn with minimal sun exposure
G. Yellowing of the sclera

Answer 41

A. Blurry vision
G. Yellowing of the sclera

Question 42

Drug Therapy for Pulmonary Tuberculosis
What are the First-Line drugs used to treat Tuberculosis?
Name 1

Answer 42

. First-line therapy for non–drug- resistant (drug-susceptible) TB is listed in the Common Examples of Drug Therapy: First-Line Treatment for Tuberculosis box and uses
isoniazid,
rifampin,
pyrazinamide, and
ethambutol for the first 8 weeks (initial treatment phase).

Question 43

Rifampin pt teaching/ side effects

Answer 43

side effect
Warn patients to expect an orange-reddish staining of the skin and urine and all other secretions to have a reddish-orange tinge; also, soft contact lenses will become permanently stained because knowing the expected side effects decreases anxiety when they appear.

adverse effect
Remind patients to avoid alcoholic beverages while on this drug because the liver-damaging effects of this drug are potentiated by alcohol.
Tell patients to report darkening of the urine, a yellow appearance to the skin or whites of the eyes, and an increased tendency to bruise or bleed, which are signs and symptoms of liver toxicity or failure.

reduces affect of oral contraceptives

Question 44

Isoniazid pt teaching/ side effects

Answer 44

Instruct patients to avoid antacids and to take the drug on an empty stomach (1 hour before or 2 hours after meals) to prevent slowing of drug absorption in the GI tract.

side effect
Teach patients to take a daily multiple vitamin that contains the B-complex vitamins while on this drug because the drug can deplete the body of this vitamin.

Adverse effect
Remind patients to avoid alcoholic beverages while on this drug because the liver-damaging effects of this drug are potentiated by alcohol.
Tell patients to report darkening of the urine, a yellow appearance to the skin or whites of the eyes, and an increased tendency to bruise or bleed, which are signs and symptoms of liver toxicity or failure.

Question 45

Pyrazinamide pt teaching/ side effects

Answer 45

Ask patients if they have ever had gout because the drug increases uric acid formation and will make gout worse.

side effect
Instruct patients to drink at least 8 ounces of water when taking this tablet and to increase fluid intake to prevent uric acid from precipitating, making gout or kidney problems worse.

Teach patients to wear protective clothing, a hat, and sunscreen when going outdoors in the sunlight because the drug causes photosensitivity and greatly increases the risk for sunburn.

Adverse effect

Remind patients to avoid alcoholic beverages while on this drug because the liver-damaging effects of this drug are potentiated by alcohol.

Tell patients to report darkening of the urine, a yellow appearance to the skin or whites of the eyes, and an increased tendency to bruise or bleed, which are signs and symptoms of liver toxicity or failure.

Question 46

Ethambutol pt teaching/ side effects

Answer 46

Adverse Effect pt/teaching
Instruct patients to report any changes in vision, such as reduced color vision, blurred vision, or reduced visual fields, immediately to his or her primary health care provider because the drug can cause optic neuritis, especially at high doses, and can lead to blindness.

Remind patients to avoid alcoholic beverages while on this drug because the drug induces severe nausea and vomiting when alcohol is ingested.

Ask patients if they have ever had gout because the drug increases uric acid formation and will make gout worse.
Instruct patients to drink at least 8 ounces of water when taking this drug and to increase fluid intake to prevent uric acid from precipitating, making gout or kidney problems worse.

Question 47

18. The employee health nurse is administering tuberculin skin testing to employees who have possibly been exposed to a client with active tuberculosis (Tb). Which statement indicates the need for radiological evaluation instead of skin testing?
19. The client’s first skin test indicates a purple flat area at the site of injection.
20. The client’s second skin test indicates a red area measuring four (4) mm.
21. The client’s previous skin test was read as positive.
22. The client has never shown a reaction to the tuberculin medication.

Answer 47

3. The client’s previous skin test was read as positive.

If the client has ever reacted positively, then the client should have a chest x-ray to look for causation and inflammation.

Question 48

22. The client is admitted with a diagnosis of rule-out tuberculosis. Which type of isolation procedures should the nurse implement?
23. Standard Precautions.
24. Contact Precautions.
25. Droplet Precautions.
26. Airborne Precautions.

Answer 48

4. Airborne Precautions.

. Tuberculosis bacteria are capable of dis- seminating over long distances on air cur- rents. Clients with tuberculosis are placed in negative air pressure rooms where the air in the room is not allowed to cross- contaminate the air in the hallway.

Question 49

17. The 56-year-old client diagnosed with tuberculosis (Tb) is being discharged. Which statement made by the client indicates an understanding of the discharge instructions?
    A. “I will take my medication for the full three (3) weeks prescribed.”
    B. “I must stay on the medication for months if I am to get well.”
    C. “I can be around my friends because I have
    started taking antibiotics.”
    D. “I should get a Tb skin test every three (3) months to determine if I am well.”

Answer 49

B. “I must stay on the medication for months if I am to get well.”

Compliance with treatment plans for
Tb includes multidrug therapy for six (6) months to one (1) year for the client to be free of the Tb bacteria.