Nokea
Which of the following information should the nurse include in the teaching plan for a patient who is receiving rifampin for treatment of tuberculosis?
- A. Your urine, sweat, and tears will be orange coloured.
- B. Read a newspaper daily to check for changes in vision.
- C. Take vitamin B6 daily to prevent peripheral nerve damage.
- D. Call the health care provider if you notice any hearing loss.
Correct Answer: A
Rationale: Orange-coloured body secretions are an adverse effect of rifampin. The other adverse effects are associated with other antituberculosis medications.
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The nurse is caring for a patient with primary pulmonary hypertension (PPH) who has been taking a calcium channel blocker with no effect. Which of the following medications should the nurse expect that the patient will receive next?
- A. Nifedipine
- B. Diltiazem
- C. Iloprost
- D. Bosentan
Correct Answer: C
Rationale: Iloprost has revolutionized care for PPH. It is now the treatment of choice for select patients unresponsive to calcium channel blockers. It is a long-acting chemically stable prostacyclin analogue, which is administered in an aerosolized form (100-150 mcg/day). Bosentan is an oral form of prostacyclin used to treat PPH. Nifedipine and diltiazem are calcium channel blockers.
The nurse is caring for a patient with bacterial pneumonia who has pleurisy. Which of the following actions should the nurse implement to promote airway clearance?
- A. Assist the patient to splint the chest when coughing.
- B. Educate the patient about the need for fluid restrictions.
- C. Encourage the patient to wear the nasal oxygen cannula.
- D. Instruct the patient on the pursed lip breathing technique.
Correct Answer: A
Rationale: Coughing is less painful and more likely to be effective when the patient splints the chest during coughing. Fluids should be encouraged to help liquefy secretions. Nasal oxygen will improve gas exchange, but will not improve airway clearance. Pursed lip breathing is used to improve gas exchange in patients with COPD, but will not improve airway clearance.
The nurse is caring for patients with active tuberculosis (TB) who misuse alcohol and/or are homeless. Which of the following interventions by the nurse will be most effective in ensuring adherence with the treatment regimen?
- A. Educating the patient about the long-term impact of TB on health
- B. Giving the patient written instructions about how to take the medications
- C. Teaching the patient about the high risk for infecting others unless treatment is followed
- D. Arranging for a daily noontime meal at a community centre and giving the medication then
Correct Answer: D
Rationale: Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help to ensure that the patient is available to receive the medication. The other nursing interventions may be appropriate for some patients, but are not likely to be as helpful with this patient.
The nurse is caring for a patient who has just had a thoracentesis. Which of the following information is most important to communicate to the health care provider?
- A. BP is 150/90 mm Hg.
- B. Oxygen saturation is 89%.
- C. Pain level is 5/10 with a deep breath.
- D. Respiratory rate is 24 when lying flat.
Correct Answer: B
Rationale: Oxygen saturation would be expected to improve after a thoracentesis. A saturation of 89% indicates that a complication such as pneumothorax may be occurring. The other assessment data also indicate a need for ongoing assessment or intervention, but the low oxygen saturation is the priority.
Which of the following information obtained by the nurse about a patient who has human immunodeficiency virus (HIV) and active tuberculosis (TB) disease is most important to communicate to the health care provider?
- A. The Mantoux test had an induration of only 8 mm.
- B. The chest x-ray showed infiltrates in the upper lobes.
- C. The patient is being treated with antiretrovirals for HIV infection.
- D. The patient has a cough that is productive of blood-tinged mucus.
Correct Answer: C
Rationale: Drug interactions can occur between the antiretrovirals used to treat HIV infection and the medications used to treat tuberculosis. The other data are expected in a patient with HIV and TB disease.