After 2 months of tuberculosis (TB) treatment with isoniazid, rifampin (Rifadin), pyrazinamide, and ethambutol, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). Which action should the nurse take next?

Correct Answer: D

Rationale: The correct answer is D: Discuss the need for an injectable antibiotic with the health care provider. If a patient continues to have positive sputum smears for AFB after 2 months of standard TB treatment, it suggests drug resistance. The next step would be to consider adding an injectable antibiotic like amikacin or streptomycin to the treatment regimen. This decision should be made in consultation with the healthcare provider based on culture and sensitivity testing results. A: Teaching about drug-resistant TB is important, but the immediate action should be to adjust the treatment regimen. B: Scheduling directly observed therapy may help with medication adherence but does not address the need for a change in treatment. C: Asking about medication adherence is important, but if the patient has been compliant, a change in treatment is necessary.

Correct Answer: B

Rationale: The correct answer is B: Administer nitroglycerin. Nitroglycerin is the priority intervention because chest pain in a patient with a history of hypertension could indicate angina or a possible myocardial infarction. Nitroglycerin helps dilate blood vessels, reduce workload on the heart, and improve blood flow to the heart muscle, which can alleviate chest pain. Administering aspirin can also be beneficial to prevent clot formation, but nitroglycerin takes precedence in this situation. Providing reassurance and support is important but should not delay immediate treatment. Administering IV fluids is not indicated for chest pain in this scenario.

Correct Answer: C

Rationale: The most appropriate nursing diagnosis is "Ineffective coping related to unknown outcome of illness" (Choice C). This is because the patient's expression of feeling like a burden and wishing to be dead indicates difficulty coping with the uncertainties and challenges of their COPD. The patient's emotional distress and sense of hopelessness suggest ineffective coping mechanisms in dealing with their illness. Choice A (Complicated grieving) is incorrect because the patient's statement does not indicate grief over an actual loss, but rather a sense of burden and hopelessness. Choice B (Chronic low self-esteem) is incorrect as the patient's statement is more related to the impact of the illness on others rather than self-esteem issues. Choice D (Deficient knowledge) is not the most appropriate as the patient's statement reflects emotional distress rather than a lack of knowledge about COPD.

Correct Answer: B

Rationale: The correct answer is B: Administer a nebulized bronchodilator first. In COPD, bronchodilators help improve airflow by relaxing the muscles around the airways. This can help improve oxygenation levels. Before increasing oxygen flow rate or encouraging deep breathing, it is essential to address the underlying issue of airway constriction. Nebulized bronchodilators act quickly to provide relief and improve oxygen saturation. Administering a short-acting bronchodilator (choice C) could also be beneficial, but nebulized bronchodilators are typically more effective in severe cases. Encouraging deep breathing exercises (choice D) can be helpful in the long term but may not address the immediate need for improved oxygenation in this situation.

Correct Answer: B

Rationale: The correct answer is B: Administer corticosteroids. In the scenario described, the priority intervention is to administer corticosteroids to reduce airway inflammation and improve breathing in an acute asthma exacerbation. This treatment addresses the underlying cause of the symptoms and helps to prevent further complications. Nebulized bronchodilators (choice A) and inhalers (choice C) are important treatments for asthma but are typically used after corticosteroids to provide immediate relief of symptoms. Administering subcutaneous insulin (choice D) is not relevant to the management of asthma and would not address the patient's respiratory distress.