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A nurse is developing a plan of care for a client receiving an antitubercular drug. Which nursing diagnosis would the nurse most likely include directly related to drug therapy? Select all that apply.
- A. Acute Pain
- B. Risk of Skin Integrity
- C. Imbalanced Nutrition
- D. Body Image Disturbances
- E. Risk for Ineffective Self Health Management
Correct Answer: A,C,E
Rationale: Drug administration-specific nursing diagnoses that may be made during treatment with antitubercular drugs include Acute Pain related to frequent injections, Imbalanced Nutrition due to gastric upset, and Risk for Ineffective Self Health Management related to indifference, lack of knowledge, and long-term treatment.
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When completing the preadministration assessment for any antitubercular drug, which of the following would the nurse include? Select all that apply.
- A. Culture and sensitivity testing
- B. Complete blood count
- C. Family and contacts history
- D. Radiographic studies
- E. Medication history
Correct Answer: A,B,C,D,E
Rationale: Preadministration assessment for any antitubercular drug should include culture and sensitivity testing, complete blood count, radiographic studies, medication history, and a family and contacts history for those with active TB.
A nurse is preparing to administer ethambutol (Myambutol) to several clients. The nurse would expect to administer the drug cautiously to which clients? Select all that apply.
- A. Clients with hepatic impairment
- B. Clients with hypertension
- C. Clients with cataracts
- D. Clients with diabetic neuropathy
- E. Clients with renal impairment
Correct Answer: A,C,E
Rationale: Ethambutol (Myambutol) should be used cautiously in clients with hepatic or renal impairment and in clients with diabetic retinopathy or cataracts.
A nurse would suspect tuberculosis caused by drug-resistant organisms in which of the following clients? Select all that apply.
- A. Clients who are HIV positive
- B. Clients who have no response to therapy
- C. Clients who have been treated in the past
- D. Clients who have asthma
- E. Clients who have smoke
Correct Answer: B,C
Rationale: Tuberculosis caused by drug-resistant organisms should be considered in clients who have no response to therapy and in patients who have been treated in the past.
A nursing instructor is describing a situation in which a client with tuberculosis periodically visits his primary health care provider and demonstrates taking his medication in front of the nurse. The instructor is describing which of the following?
- A. Initial phase of treatment
- B. Continuation phase of treatment
- C. Directly observed therapy
- D. Adherence evaluation
Correct Answer: C
Rationale: With directly observed therapy (DOT), the patient makes periodic visits to the office of the primary health care provider or the health clinic and takes the drug in the presence of the nurse. Nurses watch the patient swallow each dose of the medication treatment. In some cases, the nurse may travel to the patient's home, place of employment, or school to observe or administer medication. DOT can be used during the initial and/or continuation phase of treatment.
The nurse is preparing a teaching plan to foster client adherence to the tubercular drug treatment programs. Which of the following would the nurse include? Select all that apply.
- A. Reinforcing that short-term treatment is ineffective
- B. Reviewing the prescribed drug, doses, and frequency of administration
- C. Using a calendar to designate the days the drug is to be taken for alternate-dosage schedule
- D. Arranging for direct observation therapy with the client and family
- E. Instructing the client about possible adverse reactions and the need to notify prescriber should any occur
Correct Answer: A,B,D,E
Rationale: Teaching points that can be used by the nurse to increase the likelihood for effective therapeutic outcomes include reinforcing that short-term treatment is ineffective; reviewing the drug therapy regimen, including the prescribed drug-doses, and frequency of administration; arranging for direct observation therapy with the client and family; and instructing the client about possible adverse reactions and the need to notify the prescriber should any occur.