Which patient(s) should be tested for latent TB? (Select all that ...

[j.rubin]

Which patient(s) should be tested for latent TB? (Select all that apply.)
 
  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 2

A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin (Cipro).
 
  Before administering the third dose of this drug, the nurse reviews the bacterial culture report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do?
  a. Withhold the dose of ciprofloxacin and notify the provider of the patient's symptoms.
  b. Instruct the patient to exercise the right foot and ankle to minimize the pain.
  c. Question the patient about the consumption of milk and any other dairy products.
  d. Request an order to increase this patient's dose of glucocorticoids.

[mariahkathleeen]

Answer to Question 1

ANS: B, D, E
Testing should be limited to people who are at high risk of either having acquired TB recently or who might be progressing from latent to active TB. People who work in mycobacteriology laboratories work with TB and are at risk. Patients with some debilitating diseases, such as diabetes mellitus, are at risk. Immigrants from countries where TB is prevalent are at risk. Employees of day care centers and patients with cardiovascular disease are not at increased risk.

Answer to Question 2

ANS: A
A rare but serious adverse effect associated with fluoroquinolones is tendon rupture, and those at highest risk are children, patients older than 60 years, transplant patients, and any patients taking glucocorticoids. Any pain in either heel should be reported and the drug should be discontinued. Patients should be instructed not to exercise until tendonitis has been ruled out. Dairy products can reduce the absorption of ciprofloxacin, so this is not a concern with this patient. Because the pain may be caused by tendonitis associated with ciprofloxacin, it is not correct to request an increase in the glucocorticoid dosing.