NURS 1250 EXAM 1 QUESTIONS WITH VERIFIED
ANSWERS
What is TB - Answers - chronic bacterial disease that is recurrent
What is TB cause by - Answers - mycobacterium tuberculosis
What does mycobacterium tuberculosis look like - Answers - -slender, rod-shaped
organism: bacilli
-waxy outer capsule resists destruction
How fast does TB grow and what type if bacilli - Answers - -slow growing: 2-12 weeks to
illicit an immune response
-Acid-fast bacilli (AFB)
Is Tb dangerous to the community - Answers - -reportable disease to the local health
department
-public health concern
Primary site of infection for TB - Answers - the lungs (it can seed into other organs)
What section does TB usually effect - Answers - the apices of the lunch (the upper
portion)
What are the three stages of TB - Answers - -primary active
-dormant (latent TB infection or LTBI)
-Reactivation TB
Primary active TB infection - Answers - have clinical manifestations and make you sick
Dormant (latent TB infection or LTBI) - Answers - -Bacteria temporarily inactive, but not
dead
-Individual infected, but not sick
Reactivation TB - Answers - Due to age, disease (HIV, immunosuppressive disease), or
use of immunosuppresive drugs
Risk factors for TB - Answers - -immigrants, foreign born (in the US) (12x more likely
than US)
-HIV/AIDS
-Individuals with altered immune function
-Homelessness, homeless shelters
-prison, detention facilities
,-areas of high IV drug abuse
-Overcrowded institutions, poor living conditions
Clinical manifestations - Answers - -Asymptomatic in early stages, initial infection
-Fever (typically low grade)
-Night sweats
-Dry cough, progressing to hemoptysis (bloody sputum)
-Weight loss
-Fatigue, arthralgias (joint pain)
-Cough, pleuritic chest pain
-Shortness of breath, dyspnea
What is pleuritic chest pain - Answers - -chest pain during inhalation and exhalation
-Has a regular patter and comes and goes
Types of diagnostic tests for TB - Answers - -PPD skin test, TST :mantoux test
-Sputum smear
-Sputum culture
PPD skin test, TST :mantoux test - Answers - -Intradermal- read 48-72 hours
-Measure INDURATION
- >15mm is positive in ALL people (less than 15 mm can be positive for
immunocomprimised patients)
-Redness NOT indicative of positive test
Sputum smear - Answers - -AFB positive (active TB)
-Rapid indicator of the tubercle bacillus
-At least 3 specimens needed, 8-24 hours apart
-One sputum should be an early morning specimen
-Acid Fast
Sputum Culture - Answers - -confirmatory diagnosis of infection with M. Tuberculosis -
Time consuming: 4-8 weeks for detection (slow growing)
Diagnostic tests for TB - Answers - -Chest X-Ray
-Interferon-gamma release assays (IGRA)
-Nucleic Acid Amplification (NAA)
Chest X-ray and TB - Answers - Dense lesions (apical, upper lobe), cavity formation
Interferon-gamma release assays (IGRA) - Answers - -"quantiferon-TB test" or "T-Spot
test"
-Can be used on those receiving the BCG vaccine
-Used for those unable to return to have TST read
,Nucleic Acid amplification (NAA) - Answers - -Amplifies DNA/RNA segments to rapidly
identify the microorganisms in a specimen
-Can detect M. Tuberculosis in hours
What is the gold standard for laboratory confirmation of TB - Answers - CULTURE
Prevention and precautions of TB - Answers - -Spread through the air- person to person
-Airborne isolation- "negative pressure"; HEPA filter
-N95 masks
-Keep patient door closed
-Place mask on patient if leaving room
-TB transmission reduced by direct sunlight/ ultraviolet light
How many air exchanges per hour is airborne isolation for TB - Answers - 6 fresh air
exchanges per hour
N95 masks- how is this different from "droplet precautions"? - Answers - Airborne
droplets: the size of the droplet is less than 5 microns, the particles are too small and
will go through a regular mask, and airborne stay suspended in the air for many hours
Pharmacologic therapy- Antitubercular agents - Answers - -New positive PPD:
Isoniazid (INH) for 6-9 months
-Rifampin
-Pyrazinamide
-Ethambutol
-Rifater- combination drug (increase compliance) -"DOTS" therapy
What is the action of Isoniazid (INH)? - Answers - inhibits cell wall synthesis and
metabolism as well as growth of dormant organisms-also actively kills growing bacteria
in the extracellular environment
What is the action of Rifampin? - Answers - inhibits RNA synthesis by blocking RNA
transcription in susceptible organisms
What is the action of Ethambutol? - Answers - the exact mechanism is unknown-
probably inhibits bacterial RNA synthesis affecting protein metabolism, arresting cellular
multiplication and causing cell death
What is the indication for Isoniazid (INH)? - Answers - used for prophylaxis in patients
exposed to active disease and treatment of TB
What is the indication for Rifampin? - Answers - used in combination with other
antitubercular agents because resistance develops rapidly when used alone
What is the indication for Ethambutol? - Answers - used for treatment of active TB in
combination with other drugs
, What are the CNS side effects of Isoniazid (INH)? - Answers - -insomnia-muscle
twitching
-PERIPHERHERAL NEUROPATHY from vitamin B6 deficiency (this is the most
common side effect and is manifested as tingling and numbness in the extremities)
-convulsions
-psychotic episodes
What are the Derm side effects of Isoniazid (INH)? - Answers - skin rash
What are the GI side effects of Isoniazid (INH)? - Answers - -hepatitis
-GI distress
-transient delectation of liver enzymes
-nausea
-vomiting
What are the Heme side effects of Isoniazid (INH)? - Answers - Bloody dyscrasias
What are the other side effects of Isoniazid (INH)? - Answers - fever
Hat is the nursing management for Isoniazid (INH)? - Answers - be aware that
pyridoxine (B6) deficiency increases the risk of peripheral neuropathy.
-vitamin B6, 50 mg daily, may be prescribed to prevent neuropathy
What is the nursing management for Rifampin? - Answers - teach the patient that Red-
orange discoloration of body fluids (urine, saliva, sweat, tears) occurs with this drug and
note possible permanent staining of contact lenses
What are the side effects of Ethambutol? - Answers - EENT:-optic neuritis-decreased
visual acuity
What is the nursing management for Ethambutol? - Answers - instruct the patient
regarding the need to vital acuity testing and red-green color perception screening
before and during treatment.-report visual changes immediately
What is Pyrazinamide used? - Answers - used in combination with other antitbercular
agents-dose created to hepatotoxicity is the major adverse side effect
What is Rifater used? - Answers - a combination product used in the initial phase of
short-course treatment of pulmonary TB (increased compliance)
What drug make up Rifater? - Answers - -Rifampin
-Isoniazid
-Pyrazinamide
ANSWERS
What is TB - Answers - chronic bacterial disease that is recurrent
What is TB cause by - Answers - mycobacterium tuberculosis
What does mycobacterium tuberculosis look like - Answers - -slender, rod-shaped
organism: bacilli
-waxy outer capsule resists destruction
How fast does TB grow and what type if bacilli - Answers - -slow growing: 2-12 weeks to
illicit an immune response
-Acid-fast bacilli (AFB)
Is Tb dangerous to the community - Answers - -reportable disease to the local health
department
-public health concern
Primary site of infection for TB - Answers - the lungs (it can seed into other organs)
What section does TB usually effect - Answers - the apices of the lunch (the upper
portion)
What are the three stages of TB - Answers - -primary active
-dormant (latent TB infection or LTBI)
-Reactivation TB
Primary active TB infection - Answers - have clinical manifestations and make you sick
Dormant (latent TB infection or LTBI) - Answers - -Bacteria temporarily inactive, but not
dead
-Individual infected, but not sick
Reactivation TB - Answers - Due to age, disease (HIV, immunosuppressive disease), or
use of immunosuppresive drugs
Risk factors for TB - Answers - -immigrants, foreign born (in the US) (12x more likely
than US)
-HIV/AIDS
-Individuals with altered immune function
-Homelessness, homeless shelters
-prison, detention facilities
,-areas of high IV drug abuse
-Overcrowded institutions, poor living conditions
Clinical manifestations - Answers - -Asymptomatic in early stages, initial infection
-Fever (typically low grade)
-Night sweats
-Dry cough, progressing to hemoptysis (bloody sputum)
-Weight loss
-Fatigue, arthralgias (joint pain)
-Cough, pleuritic chest pain
-Shortness of breath, dyspnea
What is pleuritic chest pain - Answers - -chest pain during inhalation and exhalation
-Has a regular patter and comes and goes
Types of diagnostic tests for TB - Answers - -PPD skin test, TST :mantoux test
-Sputum smear
-Sputum culture
PPD skin test, TST :mantoux test - Answers - -Intradermal- read 48-72 hours
-Measure INDURATION
- >15mm is positive in ALL people (less than 15 mm can be positive for
immunocomprimised patients)
-Redness NOT indicative of positive test
Sputum smear - Answers - -AFB positive (active TB)
-Rapid indicator of the tubercle bacillus
-At least 3 specimens needed, 8-24 hours apart
-One sputum should be an early morning specimen
-Acid Fast
Sputum Culture - Answers - -confirmatory diagnosis of infection with M. Tuberculosis -
Time consuming: 4-8 weeks for detection (slow growing)
Diagnostic tests for TB - Answers - -Chest X-Ray
-Interferon-gamma release assays (IGRA)
-Nucleic Acid Amplification (NAA)
Chest X-ray and TB - Answers - Dense lesions (apical, upper lobe), cavity formation
Interferon-gamma release assays (IGRA) - Answers - -"quantiferon-TB test" or "T-Spot
test"
-Can be used on those receiving the BCG vaccine
-Used for those unable to return to have TST read
,Nucleic Acid amplification (NAA) - Answers - -Amplifies DNA/RNA segments to rapidly
identify the microorganisms in a specimen
-Can detect M. Tuberculosis in hours
What is the gold standard for laboratory confirmation of TB - Answers - CULTURE
Prevention and precautions of TB - Answers - -Spread through the air- person to person
-Airborne isolation- "negative pressure"; HEPA filter
-N95 masks
-Keep patient door closed
-Place mask on patient if leaving room
-TB transmission reduced by direct sunlight/ ultraviolet light
How many air exchanges per hour is airborne isolation for TB - Answers - 6 fresh air
exchanges per hour
N95 masks- how is this different from "droplet precautions"? - Answers - Airborne
droplets: the size of the droplet is less than 5 microns, the particles are too small and
will go through a regular mask, and airborne stay suspended in the air for many hours
Pharmacologic therapy- Antitubercular agents - Answers - -New positive PPD:
Isoniazid (INH) for 6-9 months
-Rifampin
-Pyrazinamide
-Ethambutol
-Rifater- combination drug (increase compliance) -"DOTS" therapy
What is the action of Isoniazid (INH)? - Answers - inhibits cell wall synthesis and
metabolism as well as growth of dormant organisms-also actively kills growing bacteria
in the extracellular environment
What is the action of Rifampin? - Answers - inhibits RNA synthesis by blocking RNA
transcription in susceptible organisms
What is the action of Ethambutol? - Answers - the exact mechanism is unknown-
probably inhibits bacterial RNA synthesis affecting protein metabolism, arresting cellular
multiplication and causing cell death
What is the indication for Isoniazid (INH)? - Answers - used for prophylaxis in patients
exposed to active disease and treatment of TB
What is the indication for Rifampin? - Answers - used in combination with other
antitubercular agents because resistance develops rapidly when used alone
What is the indication for Ethambutol? - Answers - used for treatment of active TB in
combination with other drugs
, What are the CNS side effects of Isoniazid (INH)? - Answers - -insomnia-muscle
twitching
-PERIPHERHERAL NEUROPATHY from vitamin B6 deficiency (this is the most
common side effect and is manifested as tingling and numbness in the extremities)
-convulsions
-psychotic episodes
What are the Derm side effects of Isoniazid (INH)? - Answers - skin rash
What are the GI side effects of Isoniazid (INH)? - Answers - -hepatitis
-GI distress
-transient delectation of liver enzymes
-nausea
-vomiting
What are the Heme side effects of Isoniazid (INH)? - Answers - Bloody dyscrasias
What are the other side effects of Isoniazid (INH)? - Answers - fever
Hat is the nursing management for Isoniazid (INH)? - Answers - be aware that
pyridoxine (B6) deficiency increases the risk of peripheral neuropathy.
-vitamin B6, 50 mg daily, may be prescribed to prevent neuropathy
What is the nursing management for Rifampin? - Answers - teach the patient that Red-
orange discoloration of body fluids (urine, saliva, sweat, tears) occurs with this drug and
note possible permanent staining of contact lenses
What are the side effects of Ethambutol? - Answers - EENT:-optic neuritis-decreased
visual acuity
What is the nursing management for Ethambutol? - Answers - instruct the patient
regarding the need to vital acuity testing and red-green color perception screening
before and during treatment.-report visual changes immediately
What is Pyrazinamide used? - Answers - used in combination with other antitbercular
agents-dose created to hepatotoxicity is the major adverse side effect
What is Rifater used? - Answers - a combination product used in the initial phase of
short-course treatment of pulmonary TB (increased compliance)
What drug make up Rifater? - Answers - -Rifampin
-Isoniazid
-Pyrazinamide
