Which patient should begin treatment for tuberculosis? a. A ...

[tingc95]

Which patient should begin treatment for tuberculosis?
 
  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 re-gion 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 tuber-culin skin test result of a 5-mm region of induration

Question 2

A patient who is receiving reperfusion therapy has a history of heparin-induced thrombosis (HIT). The patient has a creatinine clearance of 28 mL/min.
 
  In addition to the fibrinolytic agent, which medication will the nurse expect to administer to this patient? a. Aspirin
  b. Bivalirudin Angiomax
  c. Clopidogrel Plavix
  d. Fondaparinux Arixtra

[xoxo123]

Answer to Question 1

B
The immigrant is considered to be at moderate risk, meaning that a 10-mm area of induration on a tuberculin skin test (TST) is considered a positive result. After being evaluated for active TB, this patient should be treated for latent TB. A patient with HIV is considered high risk, but this patient has a negative TST result of less than 5 mm. For a low-risk patient receiving a screening TST for a job, the area of induration must be 15 mm or greater to be considered a positive result. An IV drug abuser is in the moderate-risk category; an area of induration of 10 mm or greater is needed to be considered a positive TST result.

Answer to Question 2

B
Patients receiving a fibrinolytic medication will also need an anticoagulant to reduce the risk of thrombosis. This patient cannot receive heparin because of the history of HIT, so he or she will need either bivalirudin or fondaparinux. Bivalirudin may be used at reduced doses in patients with a creatinine clearance less than 30 mL/min, but fondaparinux is contraindicated in such pa-tients. Antiplatelet drugs such as aspirin or clopidogrel are not used for this purpose.

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[xoxo123]

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