Nokea
A patient in the initial phase of TB is prescribed ethambutol. The nurse monitors the client for which of the following suggesting an adverse reaction?
- A. Hypersensitivity
- B. Skin eruptions
- C. Joint pain
- D. Myalgia
Correct Answer: C
Rationale: Joint pain is an adverse reaction of ethambutol. Hypersensitivity and skin eruptions are adverse reactions of isoniazid. Myalgia is an adverse reaction of pyrazinamide.
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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 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 is caring for a patient undergoing the second phase of standard TB treatment. The nurse knows that which of the following combinations of drugs needs to be administered to the client?
- A. Pyrazinamide and dapsone
- B. Rifampin and pyrazinamide
- C. Rifampin and isoniazid
- D. Dapsone and isoniazid
Correct Answer: C
Rationale: The nurse knows that a combination of rifampin and isoniazid drugs should be used during the second phase of standard treatment. Isoniazid, rifampin, and pyrazinamide are not used together as combination drugs in the second phase of standard treatment. Dapsone is used for leprosy and cannot be used in combination with isoniazid or any other drug for TB.
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.