NURS MED SURGE 11TH EDITION CH 27 EXAM:RESPIRATORY
PROBLEMS QUESTIONS WITH ANSWERS 2022/2023 UPDATE
A+
The health care provider writes an order for bacteriologic testing for a patient who has a
positive tuberculosis skin test. Which action should the nurse take?
A. Teach about the reason for the blood tests.
B. Schedule an appointment for a chest x-ray.
C. Teach the patient about providing specimens for 3 consecutive days.
D. Instruct the patient to collect several separate sputum specimens today.
ANS: C
Sputum specimens are obtained on 2 to 3 consecutive days for bacteriologic testing for Mycobacterium
tuberculosis. The patient should not provide all the specimens at once. Blood cultures are not used to test
for tuberculosis. A chest x-ray is not bacteriologic testing. Although the findings on chest x-ray
examination are important, it is not possible to make a diagnosis of TB solely based on chest x-ray
findings because other diseases can mimic the appearance of TB.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
A patient is hospitalized with active tuberculosis (TB). Which assessment finding indicates to the nurse
that prescribed airborne precautions are likely to be discontinued?
A. Chest x-ray shows no upper lobe infiltrates.
B. TB medications have been taken for 6 months.
C. Mantoux testing shows an induration of 10 mm.
D. Sputum smears for acid-fast bacilli are negative.
ANS: D
Repeated negative sputum smears indicate that M. tuberculosis is not present in the sputum, and the
patient cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine whether
treatment has been successful. Taking medications for 6 months is necessary, but the multidrug-resistant
forms of the disease might not be eradicated after 6 months of therapy. Repeat Mantoux testing would
not be done because the result will not change even with effective treatment.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement,
if made by the patient, indicates that teaching was effective?
A. “I will take the bus instead of driving.”
B. “I will stay indoors whenever possible.”
C. “My spouse will sleep in another room.”
D. “I will keep the windows closed at home.”
,NURS MED SURGE 11TH EDITION CH 27 EXAM:RESPIRATORY
PROBLEMS QUESTIONS WITH ANSWERS 2022/2023 UPDATE
A+
ANS: C
Teach the patient how to minimize exposure to close contacts and household members. Homes should be
well ventilated, especially the areas where the infected person spends a lot of time. While still infectious,
the patient should sleep alone, spend as much time as possible outdoors, and minimize time in congregate
settings or on public transportation.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation MSC: NCLEX: Health
Promotion and Maintenance
A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange
discolored urine and tears. Which response by the nurse reflects accurate knowledge about the
medication and the patient’s illness?
A. Ask the patient about any visual changes in red-green color discrimination.
B. Question the patient about experiencing shortness of breath, hives, or itching.
C. Explain that orange discolored urine and tears are normal while taking this medication.
D. Advise the patient to stop the drug and report the symptoms to the health care provider.
ANS: C
Orange-colored body secretions are a side effect of rifampin. The patient does not have to stop taking the
medication. The findings are not indicative of an allergic reaction. Alterations in red-green color
discrimination commonly occur when taking ethambutol, which is a different tuberculosis medication.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological
Integrity
An older adult is receiving standard multidrug therapy for tuberculosis (TB). Which finding should
the nurse report to the health care provider?
A. Yellow-tinged sclera
B. Orange-colored sputum
C. Thickening of the fingernails
D. Difficulty hearing high-pitched voices
ANS: A
Noninfectious hepatitis is a toxic effect of isoniazid, rifampin, and pyrazinamide, and patients who
develop hepatotoxicity will need to use other medications. Changes in hearing and nail thickening are not
expected with the four medications used for initial TB drug therapy. Presbycusis is an expected finding
in the older adult patient. Orange discoloration of body fluids is an expected side effect of rifampin and
not an indication to call the health care provider.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
A patient diagnosed with active tuberculosis (TB) is homeless and has a history of chronic
alcohol use. Which intervention by the nurse will be most effective in ensuring adherence with the
treatment regimen?
A. Repeat warnings about the high risk for infecting others several times.
B. Give the patient written instructions about how to take the medications.
, NURS MED SURGE 11TH EDITION CH 27 EXAM:RESPIRATORY
PROBLEMS QUESTIONS WITH ANSWERS 2022/2023 UPDATE
A+
C. Arrange for a daily meal and drug administration at a community center.
D. Arrange for the patient’s friend to administer the medication on schedule.
ANS: C
Directly observed therapy is the most effective means for ensuring compliance with the treatment
regimen. Arranging a daily meal will help ensure that the patient is available to receive the medication.
The other nursing interventions may be appropriate for some patients but are not likely to be as helpful
for this patient’s situation.
DIF: Cognitive Level: Analyze (analysis) TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
After 2 months of tuberculosis (TB) treatment with isoniazid, rifampin (Rifadin), pyrazinamide, and
ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which
action should the nurse take next?
A. Teach about drug-resistant TB.
B. Schedule directly observed therapy.
C. Ask the patient whether medications have been taken as directed.
D. Discuss the need for an injectable antibiotic with the health care provider.
ANS: C
The first action should be to determine whether the patient has been compliant with drug therapy because
negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the
medications have been taken correctly. Assessment is the first step in the nursing process. Depending on
whether the patient has been compliant or not, different medications or directly observed therapy may be
indicated. The other options are interventions based on assumptions until an assessment has been
completed.
DIF: Cognitive Level: Analyze (analysis) OBJ: Special Questions: Prioritization TOP: Nursing Process:
Implementation MSC: NCLEX: Physiological Integrity
Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative
chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB and has
never had a positive TB skin test before. Which information should the occupational health nurse plan
to teach the staff nurse?
A. Use and side effects of isoniazid
B. Standard four-drug therapy for TB
C. Need for annual repeat TB skin testing
D. Bacille Calmette-Guérin (BCG) vaccine
ANS: A
The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9
months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not
done for those who have already had a positive skin test result. BCG vaccine is not used in the United
States for TB and would not be helpful for this individual, who already has a TB infection.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Health
Promotion and Maintenance
PROBLEMS QUESTIONS WITH ANSWERS 2022/2023 UPDATE
A+
The health care provider writes an order for bacteriologic testing for a patient who has a
positive tuberculosis skin test. Which action should the nurse take?
A. Teach about the reason for the blood tests.
B. Schedule an appointment for a chest x-ray.
C. Teach the patient about providing specimens for 3 consecutive days.
D. Instruct the patient to collect several separate sputum specimens today.
ANS: C
Sputum specimens are obtained on 2 to 3 consecutive days for bacteriologic testing for Mycobacterium
tuberculosis. The patient should not provide all the specimens at once. Blood cultures are not used to test
for tuberculosis. A chest x-ray is not bacteriologic testing. Although the findings on chest x-ray
examination are important, it is not possible to make a diagnosis of TB solely based on chest x-ray
findings because other diseases can mimic the appearance of TB.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
A patient is hospitalized with active tuberculosis (TB). Which assessment finding indicates to the nurse
that prescribed airborne precautions are likely to be discontinued?
A. Chest x-ray shows no upper lobe infiltrates.
B. TB medications have been taken for 6 months.
C. Mantoux testing shows an induration of 10 mm.
D. Sputum smears for acid-fast bacilli are negative.
ANS: D
Repeated negative sputum smears indicate that M. tuberculosis is not present in the sputum, and the
patient cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine whether
treatment has been successful. Taking medications for 6 months is necessary, but the multidrug-resistant
forms of the disease might not be eradicated after 6 months of therapy. Repeat Mantoux testing would
not be done because the result will not change even with effective treatment.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB). Which statement,
if made by the patient, indicates that teaching was effective?
A. “I will take the bus instead of driving.”
B. “I will stay indoors whenever possible.”
C. “My spouse will sleep in another room.”
D. “I will keep the windows closed at home.”
,NURS MED SURGE 11TH EDITION CH 27 EXAM:RESPIRATORY
PROBLEMS QUESTIONS WITH ANSWERS 2022/2023 UPDATE
A+
ANS: C
Teach the patient how to minimize exposure to close contacts and household members. Homes should be
well ventilated, especially the areas where the infected person spends a lot of time. While still infectious,
the patient should sleep alone, spend as much time as possible outdoors, and minimize time in congregate
settings or on public transportation.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Evaluation MSC: NCLEX: Health
Promotion and Maintenance
A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange
discolored urine and tears. Which response by the nurse reflects accurate knowledge about the
medication and the patient’s illness?
A. Ask the patient about any visual changes in red-green color discrimination.
B. Question the patient about experiencing shortness of breath, hives, or itching.
C. Explain that orange discolored urine and tears are normal while taking this medication.
D. Advise the patient to stop the drug and report the symptoms to the health care provider.
ANS: C
Orange-colored body secretions are a side effect of rifampin. The patient does not have to stop taking the
medication. The findings are not indicative of an allergic reaction. Alterations in red-green color
discrimination commonly occur when taking ethambutol, which is a different tuberculosis medication.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Physiological
Integrity
An older adult is receiving standard multidrug therapy for tuberculosis (TB). Which finding should
the nurse report to the health care provider?
A. Yellow-tinged sclera
B. Orange-colored sputum
C. Thickening of the fingernails
D. Difficulty hearing high-pitched voices
ANS: A
Noninfectious hepatitis is a toxic effect of isoniazid, rifampin, and pyrazinamide, and patients who
develop hepatotoxicity will need to use other medications. Changes in hearing and nail thickening are not
expected with the four medications used for initial TB drug therapy. Presbycusis is an expected finding
in the older adult patient. Orange discoloration of body fluids is an expected side effect of rifampin and
not an indication to call the health care provider.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
A patient diagnosed with active tuberculosis (TB) is homeless and has a history of chronic
alcohol use. Which intervention by the nurse will be most effective in ensuring adherence with the
treatment regimen?
A. Repeat warnings about the high risk for infecting others several times.
B. Give the patient written instructions about how to take the medications.
, NURS MED SURGE 11TH EDITION CH 27 EXAM:RESPIRATORY
PROBLEMS QUESTIONS WITH ANSWERS 2022/2023 UPDATE
A+
C. Arrange for a daily meal and drug administration at a community center.
D. Arrange for the patient’s friend to administer the medication on schedule.
ANS: C
Directly observed therapy is the most effective means for ensuring compliance with the treatment
regimen. Arranging a daily meal will help ensure that the patient is available to receive the medication.
The other nursing interventions may be appropriate for some patients but are not likely to be as helpful
for this patient’s situation.
DIF: Cognitive Level: Analyze (analysis) TOP: Nursing Process: Implementation MSC: NCLEX:
Physiological Integrity
After 2 months of tuberculosis (TB) treatment with isoniazid, rifampin (Rifadin), pyrazinamide, and
ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which
action should the nurse take next?
A. Teach about drug-resistant TB.
B. Schedule directly observed therapy.
C. Ask the patient whether medications have been taken as directed.
D. Discuss the need for an injectable antibiotic with the health care provider.
ANS: C
The first action should be to determine whether the patient has been compliant with drug therapy because
negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the
medications have been taken correctly. Assessment is the first step in the nursing process. Depending on
whether the patient has been compliant or not, different medications or directly observed therapy may be
indicated. The other options are interventions based on assumptions until an assessment has been
completed.
DIF: Cognitive Level: Analyze (analysis) OBJ: Special Questions: Prioritization TOP: Nursing Process:
Implementation MSC: NCLEX: Physiological Integrity
Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative
chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB and has
never had a positive TB skin test before. Which information should the occupational health nurse plan
to teach the staff nurse?
A. Use and side effects of isoniazid
B. Standard four-drug therapy for TB
C. Need for annual repeat TB skin testing
D. Bacille Calmette-Guérin (BCG) vaccine
ANS: A
The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9
months. The four-drug therapy would be appropriate if the nurse had active TB. TB skin testing is not
done for those who have already had a positive skin test result. BCG vaccine is not used in the United
States for TB and would not be helpful for this individual, who already has a TB infection.
DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Planning MSC: NCLEX: Health
Promotion and Maintenance
