Nokea
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.
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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.
An HIV-positive patient is in a continuing phase of TB. The patient has completed the initial phase of the treatment program. In the continuing phase, the patient has shown no positive sputum results for 6 months. The nurse knows that under what circumstances does the treatment in the second phase last for 4 months or more?
- A. Positive sputum culture after the completion of initial treatment
- B. Inclusion of pyrazinamide in the initial treatment
- C. Following the same eating habits in the continuing phase
- D. Nausea or vomiting after completing the initial treatment
Correct Answer: A
Rationale: Positive sputum culture after the completion of initial treatment leads to treatment in the second phase lasting for 4 to 7 months. Following the same eating habits (diet) will not cause treatment in the second phase to last for 4 months or more, nor will nausea or vomiting occurring after completing the initial treatment. Noninclusion of pyrazinamide in the initial treatment leads to the second phase lasting for 4 to 7 months or more.
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.
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.
A nurse would expect to administer pyrazinamide cautiously to which clients? Select all that apply.
- A. Clients with diabetes
- B. Clients with hepatic impairment
- C. Clients with renal impairment
- D. Clients with hypertension
- E. Clients with HIV infection
Correct Answer: A,B,C,E
Rationale: Pyrazinamide should be used cautiously in clients during pregnancy and lactation and in clients with hepatic or renal impairment, HIV infection, or diabetes.