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A nurse is preparing to teach a client about common adverse reactions associated with rifampin (Rifadin). Which of the following would the nurse include? Select all that apply.
- A. Discoloration of body fluids
- B. Vertigo
- C. Joint pain
- D. Nausea
- E. Rash
Correct Answer: A,B,D,E
Rationale: Common adverse reactions of rifampin include nausea, vomiting, epigastric distress, heartburn, fatigue, vertigo, rash, reddish-orange discoloration of body fluids, hematologic changes, and renal insufficiency.
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Which of the following circumstances would warrant a continuation treatment phase of 7 months? Select all that apply.
- A. Noninclusion of rifampin in the initial treatment phase
- B. Noninclusion of pyrazinamide in the initial treatment phase
- C. HIV positive clients
- D. Cavitary disease after completion of initial treatment
- E. Positive sputum culture after completion of initial treatment
Correct Answer: B,E
Rationale: Noninclusion of pyrazinamide in the initial treatment phase, positive sputum culture after completion of initial treatment, and positive sputum culture after initial treatment in a client with previously diagnosed HIV infections would warrant a continuation of the treatment phase.
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.
A client with diabetes who is taking an oral antidiabetic agent is diagnosed with tuberculosis and is prescribed rifampin. The nurse would instruct the client about which of the following?
- A. Increased risk for bleeding
- B. Greater risk for hepatotoxicity
- C. Increased blood glucose levels
- D. Risk for increased blood pressure
Correct Answer: C
Rationale: Rifampin interacts with oral hypoglycemic agents, leading to a decrease in the effectiveness of the oral hypoglycemic agent, thus increasing blood glucose levels. An increased risk for bleeding occurs when rifampin is given with oral anticoagulants. An increased risk of hepatotoxicity occurs when rifampin is given with isoniazid. When verapamil is given with rifampin, the effectiveness of verapamil is decreased, leading to increased blood pressure levels.
A 72-year-old patient with TB is undergoing standard treatment in a health care facility. Which ongoing assessment would the nurse complete?
- A. Monitoring for appearance of adverse reactions
- B. Monitoring patient's vital signs every 24 hours
- C. Assessing patient's history of contacts
- D. Use DOT to administer the drug to the patient
Correct Answer: A
Rationale: The nurse should monitor for the appearance of adverse reactions in the patient during ongoing assessment of the treatment. The nurse should monitor vital signs of the patient every 4 hours and not every 24 hours when the patient is hospitalized. The nurse should assess the patient's history of contacts as part of the preadministration assessment and not as part of the ongoing assessment. DOT can only be used by the nurse to administer antitubercular drugs when the patient is at home, at his place of employment, or in school. DOT is not used when the patient is hospitalized.
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.