Medical-Surgical Nursing
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| What continent has the most cases of tuberculosis? | Asia
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| What bacterium causes tuberculosis (TB)? | Mycobacterium tuberculosis
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| How is TB spread? | By airborne droplets expelled by a person with TB when cough, sneeze, talk, etc.
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| True or False: TB cannot be spread by physical contact. | True
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| What is the leading cause of mortality in HIV-infected patients? | Tuberculosis
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| Describe Mycobacterium tuberculosis. | A gram-positive, acid fast bacillus (AFB)
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| What is the focus of TB infection? | Ghon lesion
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| What is the hallmark of primary TB infection? | A calcified TB granuloma
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| How long after infection of TB does it take to develop a positive tuberculin skin test (TST)? | 2-10 weeks
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| True or False: Infants younger than 6 months can have a false negative to the TST. | True
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| What test is used to test for TB in vitro? | Quantiferon-TB Gold (QFT-G)
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| What are the 3 presentations of TB? | Primary, latent, and reactivated
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| Define primary TB. | When active disease develops within the first 2 years of infection
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| Can a person with latent TB infection (LTBI) transmit TB? | No
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| Does LTBI cause a positive TST? | Yes
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| Can LTBI develop into active TB disease? | Yes
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| Can a chest x-ray (CXR) diagnose pulmonary TB? | No
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| How do you diagnose active TB? | Obtain 3 sputum specimens, each on a different day, to smear and culture.
Positive for TB if: Smear contains acid fast bacilli and the culture is positive for M. tuberculosis.
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| What is the best time of day to collect sputum specimens for TB testing? | Early morning
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| What is the initial manifestation of pulmonary TB? | A dry cough that frequently becomes productive
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| True or False: TB can only infect the lungs. | False; TB can infect any organ as well as the bones
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| What are S/S of active TB? | Fatigue, malaise, anorexia, unexplained weight loss, low-grade fever, and night sweats
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| What 2 manifestations of TB indicate severe pulmonary disease? | Dyspnea and hemoptysis
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| True or False: Immunosuppressed patients and the elderly are less likely to have signs of infection with TB. | True
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| What is often the initial only manifestation of TB in the elderly? | A change in cognitive function
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| What is military TB? | The widespread dissemination of the mycobacterium
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| What are S/S of pleural TB? | Chest pain, fever, cough, and presence of unilateral pleural effusion
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| What is Pott's disease? | TB infection in the spine
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| What is the Mantoux test? | Tuberculin skin test (TST)
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| When should the Mantoux test be read? | 48-72 hours after injection
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| When an induration of specified size AND erythema are present
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| Is erythema without induration a significant result of the Mantoux test? | No
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| What size induration in the Mantoux test is considered positive in all people? | 15 or more millimeters
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| What are interferon-Y release assays (IGRAs)? | Blood testes that can detect interferon (INF) gamma release from T cells in response to M. tuberculosis
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| Is the Mantoux test affected by the BCG vaccine? | Yes, the BCG vaccine will cause a false positive TST
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| Are IGRAs affected by the BCG vaccine? | No
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| What are CXR findings suggestive of pulmonary TB? | Upper lobe infiltrates, cavity infiltrates, lymph node involvement, and pleural and/or pericardial effusion
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| What is the standard treatment for adults and children of TB? | Nine month regimen of daily isoniazid
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| What drug class should be administered to patients with TB who are HIV positive? | Rifamycins (e.g., Rifabutin)
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| What drugs are contraindicated with use of rifampin? | Protease inhibitors and nonnucleoside reverse transcriptase inhibitors (NNRTIs)
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| What 4 drugs are used in the first 2 months of treatment for active TB? | Isoniazid, rifampin, pyrazinamide, and ethambutol
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| What drug classes should be given to treat MDR-TB? | Aminoglycosides (e.g., Viomycin) and fluoroquinolones (e.g., ciprofloxacin)
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| Which TB drug causes optic neuritis? | Isoniazid
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| What foods should be avoided while taking isoniazid and why? | Foods containing tyramine (e.g., aged cheese, soy, tap beer) because it can cause hypertensive crisis
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| Which TB drug can cause body fluids to turn orange? | Rifampin
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| Which TB drug can cause seizures and psychosis? | Isoniazid
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| Which TB drug can cause DIC? | Rifampin
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| Which TB drug can cause pseudomembranous colitis? | Rifampin
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| Can rifampin affect hormonal contraceptives? | Yes; advise women to use another method of birth control
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| Which TB drug can cause irreversible blindness? | Ethambutol
Conduct baseline and monthly visual acuity and color discrimination tests
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| Which TB drug can cause gout? | Pyrazinamide
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| What interventions can be applied if TB drugs cause GI intolerance? | Give at bedtime with food; divide doses; consider PPIs
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