PTB (rn)

1. True or False: Tuberculosis is a contagious bacterial infection caused by

mycobacterium tuberculosis and it only affects the lungs.
 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.
2. 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?
 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).
3. Which statement is correct regarding mycobacterium tuberculosis?
 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.
4. Your patient with a diagnosis of latent tuberculosis infection needs a bronchoscopy.
During transport to endoscopy, the patient will need to wear?
 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.
5. 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:
 The answers are C, D, E, and F. 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.
6. Your patient is diagnosed with a latent tuberculosis infection. Select all the correct
statements that reflect this condition:
 The answers are B and C (“The patient is not contagious and will have no signs and
symptoms.” The patient will have a positive tuberculin skin test or IGRA test. 
 . 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.
7. 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?
 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.
8. 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?
 The answers are B, D, E, F, and G (night sweats, hemoptysis, chills, fever &
chest pain). cough should be present for 3 weeks or more (NOT 6 weeks). patient
will experience weight LOSS (not gain).
9. A patient has a positive PPD skin test that shows an 8 mm induration. As the nurse
you know that:
 The patient will need a chest x-ray and sputum culture to confirm the test results
before treatment is provided. 
10. 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?
 The patient should report back in 48-72 hours. If they fail to, the test must be
repeated.
11. 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?
 The answer is D (10). 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.
12. The physician orders an acid-fast bacilli sputum culture smear on a patient with
possible tuberculosis. How will you collect this?
 Collect 3 different sputum specimens on 3 different days
13. 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:
 She has 3 negative sputum cultures; her sign and symptom improve; she has been on tb
medication for about 3 weeks.
14. As the nurse you know that one of the reasons for an increase in multi-drug-resistant
tuberculosis is:
 Noncompliance due to duration of medication treatment needed.  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.
15. 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?
 Uric acid level. 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.
16. 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?
 Rifampin. This medication will cause body fluids to turn orange.
17. A patient with active tuberculosis is taking Ethambutol. As the nurse you make it
priority to assess the patient’s?
 Vision. 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.
18. A patient taking Isoniazid (INH) should be monitored for what deficiency?
  Vitamin B6. This medication can lead to low Vitamin B6 levels. Most patients will
take a supplement of B6 while taking this medication.
19. A patient is taking Streptomycin. Which finding below requires the nurse to notify the
physician?
 The patient has ringing in their ears. 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.