A patient has been compliant with drug therapy for tuberculosis (TB) and has returned as instructed for follow-up. Which result indicates that the patient is no longer infectious or communicable?
Negative chest x-ray.
No clinical symptoms.
Three negative sputum cultures.
Negative skin test.
The Correct Answer is C
Choice A rationale
A negative chest x-ray, while indicative of resolving lung pathology, does not definitively confirm the absence of viable Mycobacterium tuberculosis. Radiographic resolution can lag behind bacteriologic clearance, meaning granulomas might still be present even if the active infection has been eliminated, and thus transmissibility cannot be excluded solely based on imaging.
Choice B rationale
The absence of clinical symptoms, such as cough, fever, or weight loss, suggests clinical improvement but does not guarantee bacteriologic cure or non-infectiousness. A patient can be asymptomatic yet still shed viable mycobacteria, posing a risk of transmission to others. Bacteriological confirmation is essential.
Choice C rationale
Three negative sputum cultures, typically collected on separate days, are the gold standard for confirming that a patient with tuberculosis is no longer infectious. This indicates the absence of viable Mycobacterium tuberculosis in respiratory secretions, significantly reducing the risk of transmission to others due to the inability to aerosolize infectious particles.
Choice D rationale
A negative skin test, or tuberculin skin test (TST), indicates the absence of a delayed-type hypersensitivity reaction to M. tuberculosis antigens. It primarily reflects exposure and immune response, not active infection or infectiousness. A previously positive TST usually remains positive even after successful treatment, so a negative result in a treated patient is not a measure of non-infectiousness.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
A sputum culture for acid-fast bacillus (AFB) is considered the gold standard for confirming the diagnosis of active pulmonary tuberculosis. This test directly identifies the presence of Mycobacterium tuberculosis in respiratory secretions, providing definitive evidence of infection and allowing for drug susceptibility testing, which is crucial for guiding treatment.
Choice B rationale
A chest X-ray can show abnormalities suggestive of pulmonary tuberculosis, such as infiltrates, cavitations, or effusions, but it is not definitive. Other respiratory conditions can present similarly, and a chest X-ray alone cannot confirm the presence of active Mycobacterium tuberculosis. It serves as a supportive diagnostic tool.
Choice C rationale
A sputum smear for acid-fast bacilli provides rapid presumptive evidence of active tuberculosis by visualizing AFB under a microscope. While helpful for early detection and isolation precautions, it does not confirm the species of mycobacteria and has lower sensitivity than culture. A positive smear needs confirmation with culture.
Choice D rationale
The Mantoux test, or tuberculin skin test, indicates exposure to Mycobacterium tuberculosis and the development of a cell-mediated immune response. A positive test signifies either latent TB infection or active disease but cannot differentiate between the two. It does not confirm active pulmonary tuberculosis and is not reliable for confirming active disease.
Correct Answer is ["50"]
Explanation
Step 1: Calculate the total puffs per day. 2 puffs/dose × 2 doses/day = 4 puffs/day.
Step 2: Calculate the number of days the inhaler will last. 200 puffs ÷ 4 puffs/day = 50 days. The inhaler will last 50 days.
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