Pulmonary Tuberculosis, NCLEX Licensure Exam Questions & Answers

1. A client with a suspected case of tuberculosis asks the nurse what test will confirm the diagnosis. What is the most appropriate response
by the nurse?
A) Chest X-ray
B) Sputum sample
C) Tuberculin Test
D) Urine Culture

Rationale: B) Sputum sample. Sputum Culture is the definitive test. X-rays usually appear normal in children with TB. The Tuberculin test
isn’t necessarily the most reliable test for TB in children. Stool Cultures and gastric washings will show positive results on acid- fast smears
but aren’t specific for Mycobacterium Tuberculosis. Sputum Samples are difficult to obtain from children, so gastric washings commonly
replace them.

2. A client with a productive cough, chills and night sweats is suspected of having active tuberculosis. The most important intervention by the
nurse would be?
A) Maintain the client on respiratory isolation
B) Prepare the client to be discharged on bed rest
C) Administer the tuberculin test ordered by the physician
D) Administer the isoniazid ordered by the physician immediately before discharge.

Rationale: A) Maintain the client on respiratory isolation This client is showing signs and symptoms of active TB and because of the
productive cough is highly contagious, He should be admitted to the hospital and placed in respiratory isolation, and three sputum cultures
should be obtained to confirm the diagnosis, He would most likely be given isoniazid and two or three other antitubercular antibiotics until
the diagnosis is confirmed and then isolation and treatment would continue if the cultures were positive for TB. After 7 to 10 days, three
more consecutive sputum cultures will be obtained. If they are negative, he would be considered noncontagious and may be sent home
although he’ll continue to take the antitubercular drugs 9 to 12 months.

3. (pg. 607) The nurse is assessing a child who has been admitted to the emergency department with a diagnosis of tuberculosis. Which
symptom would the nurse expect to observe?
A) Chills
B) Hyperactivity
C) Lymphadenitis
D) Weight Gain

Rationale: C) Lymphadenitis Children are usually asymptomatic and typically don’t manifest the usually pulmonary symptoms, but
lymphadenitis is more likely in infants and children than in adults, Weight loss, anorexia, night sweats, fatigue, and malaise are general
responses to the disease.

4. What is the priority instruction the nurse should give a client about his active tuberculosis?
A) “It’s OK to miss a dose every day or two”
B) “If side effects occur, stop taking the medication”
C) “Only take the medication until you feel better”
D) “You must comply with the medications regimen to treat TB”

Rationale: D) “You must comply with the medications regimen to treat TB” The regimen may last up to 24 months. Its essential that
the client comply with therapy during that time or resistance will develop. At no time should he stop taking the medications before his
physician tells him to.
5. A client has copious secretions. X-ray results indicate tuberculosis. The nurse anticipates that the client will most likely have which
procedure?
A) Repeat X-ray
B) Tracheostomy
C) Bronchoscopy
D) Arterial Blood Gas (ABG) analysis

Rationale: C) Bronchoscopy. Bronchoscopy can help diagnose TB and obtain specimens while clearing the bronchial tree of secretions.
X-rays may be repeated periodically to determine lung and endotracheal tube status. Tracheostomy may be done if the client remains on
the ventilator for a prolonged period. A change in condition or treatment may require an ABG analysis.

6. A client has just started treatment with rifampin for tuberculosis. What statement indicates the client has a good understanding of this
medication?
A) “I won’t go to family gatherings for 6 months.”
B) “My urine will look orange because of the medication”
C) “Now, I don’t need to cover my mouth of nose when I sneeze or cough”
D) “I told my wife to throw away all the spoons and forks before I come home.”

Rationale: B) “My urine will look orange because of the medication”. Rifampin discolors body fluids, such as urine and tears. The
client can go to family functions and eat with normal utensils the client should cover his mouth and nose when coughing and sneezing until
he has been on the medication at least 2 weeks.

7. A nurse assesses a newly admitted client with a diagnosis of pulmonary tuberculosis. Which clinical findings support this diagnosis? Select
all that apply.
A) Fatigue
B) Polyphagia
C) Hemoptysis
D) Night sweats
E) Black Tongue

Rationale: A) Fatigue, C) Hemoptysis, D) Night sweats. The general adaption syndrome is activated in response to Mycobacterium
tuberculosis a gram positive, acid-fast bacillus, causing an infectious response, which contributes to fatigue; the altered gas exchange also
contributes to fatigue because it deceases the available oxygen. Anorexia, not polyphagia is a common response to most infectious.
Hemoptysis is a response caused by damage to lung tissue; it is associated with more advanced tuberculosis. Night sweats are a common
symptom of infectious diseases; the infectious process influences the temperature- regulating center of the brain that promotes peripheral
vasodilation and increased permeability of the peripheral blood vessels, resulting in diaphoresis. Black , hairy tongue is associated with
fungal infection often seen with antibiotic therapy.

8. A client who is taking rifampin (Rifadin) tells the nurse, “My urine looks orange.” What action should the nurse take?
A) Explain this is expected
B) Check the liver enzymes
C) Strain the urine for stones
D) Ask what foods were eaten

Rationale: A) Explain this is expected. Rifampin (Rifadin) causes reddish orange discoloration of secretions such as urine, sweat and
tears. While liver enzymes should be monitored because od the risk of hepatitis, this action is not addressing the client’s statement. This
indicated for renal calculi, which are not related to rifampin. The medication, not food, is responsible for the urine color.
9. What must the nurse determine before discontinuing airborne precautions for a client with pulmonary tuberculosis?
A) Client no longer is infected
B) Tuberculin skin test is negative
C) Sputum is free of acid- fast bacteria
D) Client’s temperature has returned to normal

Rationale: C) Sputum is free of acid- fast bacteria. The absence of bacteria in the sputum indicates that the disease can no longer be
spread by the airborne route. Treatment is over an extended period; eventually the client may not have an active disease, but still remains
infected. Once an individual has been infected, the test will always be positive. This is not evidence that the disease cannot be transmitted.

10. A client is diagnosed with active tuberculosis and started on triple antibiotic therapy. The nurse would be concerned if the client
demonstrates which of the following?
A) Decreased Shortness of breath
B) Improved chest x-ray
C) Non-productive cough
D) Positive acid- fast bacilli in a sputum sample after 2 months of treatment.

Rationale: D) Positive acid- fast bacilli in a sputum sample after 2 months of treatment. Continuing to have acid-fast bacilli in the
sputum after 2 months indicates continued infection. The other choices would all indicate improvement with therapy.

References:

Hogan, M. A. (2017). Comprehensive review for NCLEX-RN. Upper Saddle River: Pearson.

Lisko, S. (2014). NCLEX-RN questions & answers made incredibly easy. Philadelphia: Wolters Kluwer Health / Lippincott Williams &
Wilkins.

Nugent, P. M., Green, J. S., & Ann, H. S. (2014). Mosbys comprehensive review of nursing for the NCLEX-RN examination. Singapore:
Elsevier (Singapore) Pte.

Rinehart, W., Hurd, C., & Sloan, D. (2013). NCLEX-RN Exam Prep, Third Edition. Pearson Certification.

SILVESTRI, L. A. (2008). Saunders comprehensive review for the nclex-rn exam. ST, LOUIS MO: SAUNDERS ELSEVIER.