A nurse reads a tuberculin skin test on a patient and notes a 6 ...

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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:
  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.

Question 2

A nurse is teaching a group of nursing students about the problems associated with the long-term therapy required to treat tuberculosis. Which statement by a student indicates a need for further teaching?
 
  a. Long-term therapy increases the emergence of drug-resistant organisms.
  b. Long-term therapy increases the incidence of drug toxicities.
  c. Long-term therapy increases the likelihood of reactivation of latent infection.
  d. Long-term therapy results in decreased patient adherence to drug regimens.

[macmac]

Answer to Question 1

ANS: D
This patient has a moderate risk of tuberculosis; the area of induration would have to be 10 mm or greater to be considered a positive skin test result. Without other clinical signs, there is no indication to treat this patient or to perform diagnostic testing, so a chest x-ray or sputum cultures are not recommended.

Answer to Question 2

ANS: C
Long-term drug therapy is used to prevent reactivation of latent infection that can occur if drugs are withdrawn too soon. Long-term therapy can result in the emergence of drug-resistant organisms, leads to more drug toxicities and side effects, and reduces adherence.

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TYSM

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Excellent