Question 1

A patient receives a Mantoux tuberculin skin test as part of screening for a new job.The test is administered on a Friday,and the patient returns to the clinic the following Wednesday.The primary care nurse practitioner (NP)notes a 3-mm area of induration.The patient has no risk factors for tuberculosis (TB).The NP should:

A) repeat the test.
B) record the test as positive.
C) record the test as negative.
D) ask about previous TB exposure.

repeat the test.

Accepted Answer

If the patient returns after more than 3 days and the results appear negative,the test should be repeated.

Question 2

A patient has a Mantoux tuberculin skin test with a 12-mm area of induration.The patient has a cough,and a chest radiograph is positive.The primary care NP should refer this patient to an infectious disease specialist and should plan to monitor a regimen of:

A) isoniazid for 6 months.
B) isoniazid and rifapentine.
C) isoniazid, rifapentine, and ethambutol.
D) isoniazid, rifampin, pyrazinamide, and ethambutol.

Accepted Answer

Newly diagnosed patients with active disease should be started on a four-drug regimen.

Question 3

A patient who takes isoniazid and rifampin for latent TB comes to the clinic with a new-onset cough and night sweats.The primary care NP should evaluate these findings by ordering:&#10;A) a sputum culture.&#10;B) LFTs.&#10;C) renal function tests.&#10;D) tuberculin skin test.

Accepted Answer

Patients with latent TB who develop symptoms while being treated should have a sputum culture.

Question 4

A patient comes to the clinic to have a Mantoux tuberculin skin test read after 48 hours.The primary care NP notes a 6-mm area of induration.The patient is a young adult with no known contacts and has never traveled abroad.The NP should:

A) repeat the test.
B) order a chest radiograph.
C) tell the patient the test is negative.
D) refer to an infectious disease specialist.

Accepted Answer

A chest x-ray should be obtained on all patients who have a positive purified protein derivative tuberculin test (PPD).The test was read in the appropriate time frame,so repeating the test is not necessary.This patient has a positive PPD.Referral to an infectious disease specialist should be made when the diagnosis is confirmed.

Question 5

A patient who is taking isoniazid and rifampin for latent TB is seen by the primary care NP for a routine follow-up visit.The patient reports having nausea,vomiting,and a decreased appetite.The NP should:

A) ask about alcohol intake.
B) suggest taking the medications with food.
C) reassure the patient that these side effects are common.
D) order liver and renal function tests and serum glucose.

Accepted Answer

Concomitant use of alcohol with isoniazid increases the risk of hepatitis.This patient shows signs of hepatitis,so the NP should ask about alcohol consumption.Isoniazid should be taken on an empty stomach.

Question 6

A patient is taking isoniazid,pyrazinamide,rifampin,and streptomycin to treat TB.The primary care NP should routinely perform:&#10;A) serum glucose and liver function tests (LFTs).&#10;B) bone marrow density and ophthalmologic tests.&#10;C) ophthalmologic, hearing, and serum glucose tests.&#10;D) color vision, serum glucose, and LFTs.

Accepted Answer

For patients taking isoniazid,obtain periodic ophthalmologic examinations; for patients taking pyrazinamide,perform blood glucose tests.

Question 7

A primary care NP sees a 5-year-old child for a tuberculin skin test.The child lives in a high-risk community,and a grandparent who babysits has active TB.The PPD shows a 6-mm area of induration.A chest radiograph is normal.The NP will refer this patient to an infectious disease specialist and should expect the patient to be on _____ for _____ months.

A) isoniazid; 6
B) ethambutol; 3
C) isoniazid and rifapentine; 3
D) ethambutol and amikacin; 6

Accepted Answer

This child has a positive PPD with no pulmonary signs,so a 3-month course of isoniazid and rifapentine is indicated.Ethambutol is not recommended in children younger than 13 years.

Question 8

A patient who has been taking medications to treat TB tells the primary care NP that the infectious disease specialist has added ethambutol to the drug regimen.The patient asks the NP for information about this drug.The NP should explain that this drug:

A) should be taken 1 hour before or 2 hours after a meal.
B) should not be taken by patients who have renal impairment.
C) requires more frequent monitoring of LFTs.
D) means the patient will need regular vision examinations and evaluation of color vision.

Accepted Answer

Ethambutol can cause changes in vision,including red-green color blindness.It should be taken with food.It may be taken by patients with renal impairment with adjustment of doses.

Deck 66: Antitubercular Agents