Question 1

A nurse reads a tuberculin skin test on a patient and notes a 6- to 7-mm area of induration. The patient is a young adult who has recently immigrated from a country with a high prevalence of tuberculosis. The patient has no other risk factors. The nurse will expect the provider to:

Accepted Answer

A)   begin treating this patient with a two-drug regimen of isoniazid and rifampin.
B)   order a chest radiograph and a sputum culture to assess for active tuberculosis.
C)   order a nucleic acid amplification test of the patient's sputum.
D)   reassure the patient that this is not considered a positive test result. D

Question 2

A patient who is taking drugs to treat HIV has tuberculosis and has been on a four-drug regimen for 3 months without improvement in symptoms. Which drug will the nurse anticipate that the provider will add to this patient's regimen?

Accepted Answer

A)   bedaquiline [Sirturo]
B)   capreomycin [Capastat Sulfate]
C)   ethionamide [Trecator]
D)   pyridoxine A

Question 3

A patient with HIV who takes protease inhibitors develops tuberculosis and will begin treatment. Which drug regimen will be used for this patient?

Accepted Answer

A)   Isoniazid, pyrazinamide, ethambutol + rifabutin
B)   Isoniazid, pyrazinamide, ethambutol
C)   Isoniazid, rifampin, pyrazinamide, ethambutol
D)   Isoniazid + rifabutin A

Question 4

A patient is about to begin treatment for latent tuberculosis with a short course of daily rifampin. The patient asks why rifapentine [Priftin] cannot be used, because it can be given twice weekly. What will the nurse tell this patient about rifapentine?

Accepted Answer

A)   It is more toxic than rifampin.
B)   It is not approved for treatment of latent TB.
C)   It is not well absorbed and thus not as effective.
D)   It will stain contact lenses orange.

Question 5

A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding?

Accepted Answer

A)   Crystalluria
B)   Myopathy
C)   Peripheral neuropathy
D)   Red-orange-tinged urine

Question 6

A patient is about to begin treatment for latent tuberculosis. The patient is an alcoholic, has difficulty complying with drug regimens, and has mild liver damage. What will the nurse tell this patient?

Accepted Answer

A)   "You must stop drinking before adequate treatment can begin."
B)   "You must take isoniazid with close monitoring of hepatic function."
C)   "You must take rifampin daily for 4 months."
D)   "You will begin a regimen of isoniazid and rifampin."

Question 7

A patient is beginning treatment for active tuberculosis (TB) in a region with little drug-resistant TB. Which treatment regimen will be used initially?

Accepted Answer

A)   Isoniazid and pyrazinamide
B)   Isoniazid, pyrazinamide, and ethambutol
C)   Rifampin, pyrazinamide, and ethambutol
D)   Isoniazid, rifampin, pyrazinamide, and ethambutol

Question 8

A patient has been taking isoniazid [Nydrazid] for 4 months for latent tuberculosis. The patient reports bilateral tingling and numbness of the hands and feet, as well as feeling clumsy. The nurse expects the provider to:

Accepted Answer

A)   discontinue the isoniazid.
B)   lower the isoniazid dose and add rifampin.
C)   order pyridoxine 100 mg per day.
D)   recheck the tuberculin skin test to see whether it worsens.

Question 9

A healthcare worker who is asymptomatic has a screening TST result of 10 mm of induration during a pre-employment physical. What will the nurse reading this test tell the patient?

Accepted Answer

A)   "This is a negative test, so you are cleared for employment."
B)   "You have latent TB and will need to take isoniazid for 6 to 9 months."
C)   "You need to have a chest radiograph and a sputum culture."
D)   "You will begin taking a four-drug regimen to treat tuberculosis."

Question 10

A hospitalized patient is being treated for tuberculosis with a drug regimen that includes pyrazinamide. The patient complains of pain in the knee and shoulder joints. The nurse will contact the provider to request an order for:

Accepted Answer

A)   ibuprofen.
B)   renal function tests.
C)   discontinuation of the pyrazinamide.
D)   measurement of uric acid levels.

Question 11

A patient who is being treated for HIV infection has a 5-mm area of induration after a routine TST. The patient's chest radiograph is normal, and there are no other physical findings. The nurse will expect this patient to begin treatment with which drugs?

Accepted Answer

A)   Isoniazid and rifabutin
B)   Isoniazid and rifampin
C)   Isoniazid and rifapentine
D)   Isoniazid and pyrazinamide

Question 12

A patient newly diagnosed with tuberculosis asks the nurse why oral medications must be given in the clinic. The nurse will tell the patient that medications are given in the clinic so that:

Accepted Answer

A)   clinic staff can observe adherence to drug regimens.
B)   nurses can monitor for drug toxicities.
C)   providers can adjust doses as needed.
D)   the staff can ensure that the U.S. Food and Drug Administration (FD
A)   regulations are met.

Question 13

Which patient should begin treatment for tuberculosis?

Accepted Answer

A)   A patient with HIV and a tuberculin skin test result of a 4-mm region of induration
B)   A recent immigrant from a country with a high prevalence of TB with a 10-mm region of induration
C)   A patient with no known risk factors who has a job-related tuberculin skin test result of a 12-mm area of induration
D)   An intravenous drug abuser with a tuberculin skin test result of a 5-mm region of induration

Question 14

A patient who has drug-sensitive tuberculosis has completed 2 months of the standard four-drug therapy and asks the nurse how long he will have to take medication. Which response by the nurse is correct?

Accepted Answer

A)   "As long as you remain symptomatic, you will not have to take more medication."
B)   "The four-drug regimen will continue for 3 more months."
C)   "You will have to take maintenance drugs indefinitely."
D)   "You will need to take only two drugs for the next 4 months."

Question 15

A patient with high-risk factors for tuberculosis will begin therapy for latent TB with isoniazid and rifampin. The nurse learns that this patient takes oral contraceptives. The nurse will counsel this patient to discuss ____ with her provider.

Accepted Answer

A)   another birth control method
B)   reducing the rifampin dose
C)   reducing the isoniazid dose
D)   increasing the oral contraceptive dose

Question 16

A patient comes to a clinic for tuberculosis medications 2 weeks after beginning treatment with a four-drug induction phase. The patient's sputum culture remains positive, and no drug resistance is noted. At this point, the nurse will expect the provider to:

Accepted Answer

A)   change the regimen to a two-drug continuation phase.
B)   continue the four-drug regimen and recheck the sputum in 2 weeks.
C)   obtain a chest radiograph and consider adding another drug to the regimen.
D)   question the patient about adherence to the drug regimen.

Question 17

A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)?

Accepted Answer

A)   Color vision and visual acuity
B)   Complete blood cell (CB
C)   count
C)   Hearing testing and a tympanogram
D)   Hepatic function tests

Question 18

Which patients should be tested for latent TB?

Accepted Answer

A)   A day care employee
B)   A worker in a mycobacteriology laboratory
C)   A patient with cardiovascular disease
D)   A patient with diabetes mellitus
E)   An immigrant from a country where TB is prevalent

Question 19

A nursing student asks a nurse why tuberculosis resistance is so high. Which reasons are correct?

Accepted Answer

A)   Adherence to drug regimens is erratic.
B)   Drug doses are often too low.
C)   Many hosts are immunocompromised.
D)   Many regimens contain too few drugs.
E)   Some TB drugs are bacteriostatic.

Question 20

A patient is about to begin treatment with isoniazid. The nurse learns that the patient also takes phenytoin [Dilantin] for seizures. The nurse will contact the provider to discuss:

Accepted Answer

A)   increasing the phenytoin dose.
B)   reducing the isoniazid dose.
C)   monitoring isoniazid levels.
D)   monitoring phenytoin levels.

Exam 90: Antimycobacterial Agents: Drugs for Tuberculosis, Leprosy, and Mycobacterium Avium Complex Infection