Tuberculosis (11 Questions)

1. M. Jacques Tremblay, 45 years old, presents to the Emergency Department with a 3-week history of night sweats, weight loss, and coughing up blood (hemoptysis). The triage nurse suspects active pulmonary tuberculosis. M. Tremblay is currently sitting in the crowded waiting room wearing a surgical mask.

Medical Orders:
*Admit to medical unit.
*Chest X-ray.
*Sputum for Acid-Fast Bacilli (AFB).

Question:
What is the nurse’s priority action regarding room assignment? *

Place the patient in a standard private room with the door closed.

Cohort the patient in a room with another patient who has pneumonia.

Keep the patient in the hallway but ensure he keeps his mask on.

Place the patient in a negative-pressure airborne infection isolation room (AIIR).

2. Mme. Ginette Roy, 30 years old, is a nurse newly hired at the hospital. She receives a Mantoux (PPD) skin test as part of her pre-employment screening. She returns 48 hours later for the reading.

Assessment:
*There is a localized area of redness (erythema).
*There is a palpable, raised hard area (induration) measuring 12 mm.

Medical Orders:
*Employee Health Screening Protocol.

Question:
How should the occupational health nurse interpret this finding? *

Negative, because the redness is not significant.

Positive, because the induration is > 10 mm in a healthcare worker.

Negative, because induration must be > 15 mm to be positive.

Indeterminate, repeat the test in 1 week.

3. M. Pierre Gagnon, 50 years old, has a positive Mantoux test. He is asymptomatic. The physician orders a Chest X-ray to determine if the disease is active.

Assessment:
*No cough, no fever, no night sweats.
*Chest X-ray: Clear, no infiltrates or cavitations.

Medical Orders:
*Isoniazid (INH) 300 mg PO daily x 9 months.
*Vitamin B6 50 mg PO daily.

Question:
The patient asks, "If my chest X-ray is clear and I don't feel sick, why do I have to take pills for 9 months?" What is the correct nursing explanation? *

You are contagious, but the X-ray just didn't catch it yet."

"The medication is just a vitamin supplement to boost your immune system."

"You have active TB, but it is in your kidneys, not your lungs."

"You have Latent TB Infection; the bacteria are asleep in your body. You need treatment to prevent them from waking up and making you sick later."

4. Mme. Claire Bouchard, 28 years old, is starting treatment for active TB. She is prescribed the standard 4-drug regimen. Two days later, she calls the clinic in a panic: "My urine has turned bright orange! I think I'm bleeding internally!"

Medical Orders:
*Isoniazid (INH).
*Rifampin (Rifadin).
*Pyrazinamide.
*Ethambutol.

Question:
What is the nurse’s best response? *

"Stop all medications immediately and go to the Emergency Room."

"This indicates a liver injury; come in for a blood test."

"This is a harmless, expected side effect of Rifampin."

"This is a harmless, expected side effect of Isoniazide, drink more water to flush it."

5. M. Robert Fortin, 60 years old, is taking Ethambutol as part of his TB therapy. He visits the clinic for a monthly follow-up.

Medical Orders:
*Monthly follow-up.
*Monitor for adverse effects.

Question:
Which specific assessment is the priority for a patient taking Ethambutol? *

Visual acuity and color discrimination tests.

Hearing test (Audiometry).

Deep tendon reflexes.

Urea and Creatinine levels.

6. Mme. Sophie Lemieux, 44 years old, complains of tingling and numbness in her fingers and toes since starting TB treatment. The nurse notes she is prescribed Isoniazid (INH). The physician decides to add a supplement to her regimen.

Medical Orders:
*Continue Isoniazid.
*Add Pyridoxine (Vitamin B6).

Question:
What is the purpose of the Vitamin B6? *

To improve the absorption of the Isoniazid.

To prevent or treat peripheral neuropathy.

To prevent liver damage.

To boost the immune system against the bacteria.

7. M. Sylvain Cote, 55 years old, is admitted with suspected TB. The physician orders sputum specimens to confirm the diagnosis.

Medical Orders:
*Sputum for Acid-Fast Bacilli (AFB) smear and culture x 3.

Question:
What is the correct protocol for collecting these specimens? *

Collect three samples all at once after a respiratory treatment.

Collect one sample a day for three days, preferably in the evening.

Collect three consecutive morning specimens.

Swab the back of the throat three times.

8. M. Michel Desjardins, 38 years old, has been treated for active pulmonary TB for 3 weeks. He asks the nurse, "When can I go back to work and stop isolating myself from my family?"

Medical Orders:
*Continue RIPE therapy.
*Monitor sputum status.

Question:
What criteria must typically be met for the patient to be considered non-infectious? *

Once he has taken antibiotics for 5 days.

When he has three consecutive negative sputum smear results.

When his chest X-ray is completely clear.

When his fever is gone for 24 hours.

9. Mme. Valérie Turcotte, 52 years old, is taking Isoniazid, Rifampin, and Pyrazinamide. She comes to the clinic complaining of extreme fatigue, nausea, and stomach pain. The nurse observes that her sclera (whites of the eyes) are yellow.

Medical Orders:
*Liver Function Tests (ALT, AST, Bilirubin) STAT.
*Hold TB medications pending results.

Question:
What is the nurse’s clinical judgment? *

The patient is developing an allergy to the medication.

The TB has spread to the liver.

The patient has drug-induced hepatitis.

The patient has a blockage in the gallbladder.

10. M. André Lemieux, 40 years old, has a history of homelessness and substance abuse. He was discharged with active TB medication but has missed several appointments and refills. The public health nurse visits him at the shelter.

Medical Orders:
*Initiate Directly Observed Therapy (DOT).

Question:
What does this order entail? *

The patient must be hospitalized until the treatment is finished.

A designated responsible person must watch the patient swallow every dose of medication.

The patient must video call the doctor once a week.

The patient receives all his pills in a blister pack to manage himself.

11. M. Claude Gagnon, 45 years old, is hospitalized in a negative-pressure Airborne Infection Isolation Room (AIIR) with confirmed active pulmonary tuberculosis. The physician has ordered a Chest X-ray that requires him to be transported to the Radiology Department. M. Gagnon is coughing frequently.

Medical Orders:
*Chest X-ray (PA and Lateral) in Radiology Dept.
*Maintain Airborne Precautions.

Question:
What is the correct Personal Protective Equipment (PPE) protocol for the patient and the transporting nurse when leaving the isolation room? *

The patient wears an N95 respirator, and the nurse wears a surgical mask.

The patient wears a surgical mask, and the nurse wears a surgical mask.

The patient wears a surgical mask, and the nurse wears an N95 respirator.

The patient wears a N95 respirator, and the nurse wears an N95 respirator.