Question 1 of 7
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Which event occurs first in a patient after inhaling a droplet ejected from a host containing mycobacterium tuberculosis?
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- A lesion forms in the lungs.Directly after the bacterium is inhaled, it rapidly multiplies in the oxygen-rich lung tissue, and a lesion is formed that is inflamed and filled with bacteria.
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- The bacillus is encased in a granuloma.If the patient’s immune system is intact, the bacillus is encased in a granuloma, which is a collection of macrophages that walls off the bacteria to stop its growth, but this is not the first phase of the disease process.
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- Cavities open in the bronchi.Cavities open into the bronchi, allowing spread tuberculosis through coughing from a host with an active infection, but this is not the first phase of the disease process.
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- A secondary infection occurs.A secondary infection can develop after immunosuppression, HIV infection, or smoking, but this is not the first phase of the disease process.
Question 2 of 7
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A patient has been exposed to tuberculosis (TB) on an airplane. In which time frame would an immune response manifest?
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- 2 to 4 weeks2 to 4 weeks is not the amount of time for an immune response to develop for an accurate TB skin test after a patient is exposed to TB.
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- 2 to 6 weeks2 to 6 weeks is not the amount of time for an immune response to develop for an accurate TB skin test after a patient is exposed to TB.
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- 2 to 8 weeks2 to 8 weeks is not the amount of time for an immune response to develop for an accurate TB skin test after a patient is exposed to TB.
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- 2 to 10 weeksAn immune response after exposure takes between 2 and 10 weeks and is confirmed by an intradermal TB skin test that shows a 10-mm or larger induration.
Question 3 of 7
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A nurse suspects that a patient has been exposed to tuberculosis. Which symptom indicates an active tuberculosis infection? Select all that apply. One, some, or all responses may be correct.
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- Poor appetiteSymptoms of an active tuberculosis infection include a loss of appetite.
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- Productive coughSymptoms of an active tuberculosis infection include a productive cough.
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- Weight gainWeight loss is a common symptom of an active tuberculosis infection.
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- Bloody sputumSymptoms of an active tuberculosis infection include bloody sputum when coughing.
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- Night sweatsSymptoms of an active tuberculosis infection include night sweats, fever, and chills.
Question 4 of 7
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Which first-line antitubercular drug therapy is prescribed to kill actively growing mycobacteria outside cells and inhibit the growth of dormant bacteria inside cells?
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- EthambutolEthambutol is used daily for six months and inhibits bacterial RNA synthesis in the bacteria, so it suppresses bacterial growth, and it must be used in combination with other antitubercular drugs.
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- IsoniazidIsoniazid is used daily for two months, then three times per week for two to four months, and inhibits the enzymes of both actively growing mycobacteria outside the cell and dormant bacteria inside macrophages and granulomas.
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- RifampinRifampin is used daily for six months to kill slower-growing bacteria, such as those that reside inside macrophages and granulomas.
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- PyrazinamidePyrazinamide is used daily for six months to kill bacteria within the acidic environment of macrophages by lowering the pH of infected cells, and it is used in combination with other antitubercular drugs.
Question 5 of 7
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A nurse is reviewing the medical history of a patient diagnosed with tuberculosis (TB). Which documentation indicates the patient is at increased risk of liver toxicity while taking a first-line antitubercular drug? Select all that apply. One, some, or all responses may be correct.
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- Use of acetaminophenAcetaminophen is a liver-toxic drug that can increase the risk of toxicity in a patient taking a first-line tuberculosis drug.
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- Report of nauseaA side effect of most first-line drugs is nausea, vomiting, and diarrhea, but this does not indicate an increased risk for liver toxicity.
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- Loss of visionThe first-line drug ethambutol may cause optic neuritis that can lead to vision loss, but this does not indicate an increased risk for liver toxicity.
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- History of alcohol abuseThe risk of liver toxicities is increased if a patient drinks alcohol, which is toxic to the liver.
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- Deficiency in vitamin B6Isoniazid can cause a deficiency in vitamin B6, which may result in peripheral neuropathy with loss of sensation in the hands and feet, but this does not indicate an increased risk for liver toxicity.
Question 6 of 7
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A patient diagnosed with active tuberculosis (TB) has been prescribed rifampin. Which action would this drug take against the Mycobacterium tuberculosis cell?
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- Prevents cell wall synthesisIsoniazid and ethambutol inhibit cell wall synthesis of a TB cell.
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- Decreases cellular pHPyrazinamide decreases cellular pH of the TB cell.
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- Disrupts plasma membranesPyrazinamide disrupts plasma membranes of the TB cell.
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- Inhibits enzymes for RNA synthesisRifampin inhibits the enzymes needed for the TB cell’s RNA and protein synthesis.
Question 7 of 7
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Which instruction would the nurse provide to a patient taking the anti-tuberculosis drug rifampin?
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- “Do not wear soft contact lenses.”Rifampin can permanently stain contact lenses, as well as turn urine reddish orange.
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- “Take with food.”Food will delay the absorption of rifampin and may reduce its effects, but ethambutol should be taken with food to reduce stomach irritation.
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- “Combine with an antacid tablet.”Taking rifampin with an antacid tablet will delay the absorption of the drug and may reduce its effects.
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- “Set a regular time each day to take.”Setting a regular time each day to take antitubercular drugs will help prevent missing a dose.
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- “Avoid drinking alcohol.”Rifampin and other antitubercular drugs can damage the liver. This toxic overload is amplified when alcohol is consumed.