Prep U Chapter 22 Drugs
The health care provider is preparing to order rifampin and pyrazinamide for a female client with active tuberculosis. What question should the provider ask this client before confirming this order?
"Are you pregnant?"
A nurse works in a community setting and follows clients who have TB. Which clients would likely require the most follow-up from rifampin therapy?
An HIV-positive client
A patient with TB has been admitted to a health care facility. When providing instructions for the patient teaching related to antitubercular drugs, which instructions should the nurse provide in order to avoid complications in the patient's GI tract?
Avoid the consumption of alcohol.
Clients with tuberculosis that do not respond to the primary anti-TB drugs such as INH, may need to undergo therapy using second-line defense drugs. Which medication is a second-line drug?
Cycloserine
A nurse is caring for a 14-year-old with multidrug-resistant tuberculosis. The nurse's supervisor instructs the nurse to observe the client taking the anti-TB medication. Which abbreviation refers to this type of care?
DOT
Which of the following symptoms may indicate optic neuritis resulting from the use of ethambutol?
Difficulty differentiating between red and green
Which of the following are considered primary drugs to treat tuberculosis? Select all that apply:
Ethambutol (Myambutol) Isoniazid (Nydrazid) Rifampin (Rifadin)
An 80-year-old client is diagnosed with latent tuberculosis infection. What is a risk for the elderly population when being treated with INH?
Hepatotoxicity
A client is diagnosed with latent tuberculosis infection. The nurse expects that the treatment plan will include which drug?
INH
A client has just been diagnosed with tuberculosis (TB). The nurse can expect to start the client on which drug for the initial phase of treatment?
INH, rifampin, pyrazinamide, ethambutol
Which of the following antitubercular drugs are used during the continuation treatment phase of tuberculosis? Select all that apply:
Isoniazid Rifampin
The public health nurse is required to be present for each administered dose of antitubercular therapy administered to clients. What is the reason for this practice?
It prevents inadequate drug therapy.
A client taking isoniazid is worried about the side effects/adverse reactions. The nurse tells the client that a common adverse reaction of isoniazid is which of the following?
Jaundice
The nurse teaches the client on pyrazinamide that adverse reactions include which?
Painful joints
A female client is prescribed rifampin as part of her antitubercular regimen. She also takes oral contraceptives. The nurse is aware that this combination of medications can produce what effect?
Pregnancy
What therapeutic drug regimen will ensure client compliance?
Prescribe fixed-dose combinations of drugs.
A patient diagnosed with TB is undergoing treatment. The nurse knows that which of the following preventive therapies will avoid the spreading of TB?
Prophylactic therapy
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 need to be administered to the client?
Rifampin and isoniazid
A patient with TB is admitted to a health care facility. The nurse is required to administer an antitubercular drug through the parenteral route to this patient. Which of the following precautions should the nurse take when administering frequent parenteral injections?
Rotate injection sites for frequent parenteral injections.
A 43-year-old man has been diagnosed with active TB. He is prescribed a multiple drug therapy, including INH and rifampin. A priority assessment by the nurse will be to monitor which combination of laboratory test results?
Serum alanine transaminase, aspartate transaminase, and bilirubin
The nurse understands that which is the highest priority when teaching about antitubercular medications?
Taking medications as prescribed
While discussing tuberculosis, the nursing instructor explains that treatment is typically divided into two phases. What is the second phase called?
The continuation phase
Chest radiography and sputum sample microscopy have confirmed a diagnosis of TB in a 40-year-old man who has a history of type 1 diabetes and who currently has a diabetic foot ulcer. How should the nurse account for this patient's health status when planning care during INH treatment?
The patient will require vigilant monitoring of blood glucose levels.
What factors may prompt such a change in tuberculosis (TB) treatment to include second-line anti-TB drugs? Select all that apply.
There is resistance to the first-line drugs. The client is unable to tolerate first-line drugs.
The nurse is working with the family of a client who has just been diagnosed with active tuberculosis (TB). Which instructions would the nurse give this family?
You will have to take isoniazid for 6 to 12 months to protect you from TB.
A nurse is caring for a 61-year-old client whose health care provider has ordered 2200 mg of ethambutol daily. The recommended dose for ethambutol is 15-25 mg/kg/day. The client weighs 90 kg. Based on dosage calculation, the prescribed dose is:
at the high end of the recommended range.
A client is taking rifampin (Rifadin) for active TB. The nurse should stress that what may be caused by the use of this drug?
body fluids such as urine, saliva, tears, and sputum may become discolored.
A nurse teaching the client with tuberculosis (TB) should state that ethambutol can:
cause optic neuritis.
A nurse is caring for a 52-year-old client who has been diagnosed with a latent tuberculosis infection. The health care provider is considering ordering isoniazid (INH). The preexistence of what condition would require cautious use of INH in this client?
cirrhosis of the liver
After teaching a group of students about antitubercular therapy, the instructor determines that additional teaching is needed when the students identify which drug as an antitubercular agent?
dapsone
A nursing instructor is teaching about the tuberculosis (TB) drug pyrazinamide and informs students that the most severe adverse reaction to this drug is which of the following?
hepatotoxicity
What adverse effect would most likely necessitate discontinuing treatment with isoniazid?
jaundice
A nurse is caring for an older adult client with tuberculosis. The client has been prescribed ethambutol. Which adverse reactions of ethambutol should the nurse assess for?
optic neuritis
A client is admitted to hospice with the diagnosis of extensively drug-resistant tuberculosis (XDR-TB). Knowing some of the contributing factors to this disease, the nurse understands this disease is a major indication of what treatment failure?
to adequately diagnose, prevent, and treat MDR-TB
A 19-year-old Mexican American is about to start taking ethambutol (Myambutol). Before beginning drug therapy, it would be critical for the nurse to assess the patient's
visual acuity and establish a baseline.
A client has been prescribed INH for the treatment of tuberculosis. The nurse teaches the client about dietary restrictions while taking this medication. What is the most important instruction?
"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur."
A client is concerned because his drug regimen for drug-resistant TB is different from that of his friends. Which explanation by the nurse is accurate?
"Treatment is based on drug susceptibility reports."
A middle-aged client with a complex history has begun multidrug treatment for TB. Which assessment question is most therapeutic?
"What kinds of routines would work for you to ensure that you don't miss doses of your rifampin?"
A nurse is caring for a 39-year-old client who is taking INH, rifampin, and pyrazinamide. The client reports that her urine is red. What is the most likely cause of this discoloration?
Adverse effect of rifampin
The client is taking isoniazid (INH). The nurses is teaching the client the importance of understanding that INH can affect which vitamin?
B6
A client with TB is prescribed pyrazinamide. The nurse should assess and monitor for which of the following adverse reactions of pyrazinamide in the client?
Diarrhea
A client diagnosed with tuberculosis was prescribed antitubercular therapy but stopped after 1 month because of difficulty with the medication scheduling. As a result, secondary drugs are being prescribed. Which nursing diagnosis would the nurse most likely identify?
Ineffective Self-Health Management
The nurse is caring for a client who is taking INH for tuberculosis. What adverse effect is this client most at risk for?
Liver dysfunction
The nurse explains that prophylactic antitubercular therapy is suggested for which people?
Those who have been in close contact with a person with tuberculosis (TB)
When providing health education to a client prescribed isoniazid, the nurse should emphasize the need to avoid what element?
alcohol
A nursing student studying pharmacology is focusing on drugs used to treat tuberculosis (TB). This student correctly identifies the classifications of antitubercular drugs as which of the following?
primary and secondary
The client reports cough, low-grade fever, anorexia, and night sweats. The client has also been coughing up blood at times. What disease does this client most likely have?
tuberculosis
A major concern among public health authorities is an increase in drug-resistant TB infections. What is new evidence suggesting a possible cause for this resistant tendency?
Many drug-resistant infections are new infections, especially in those who are immunosuppressed.
A client asks why three medications are prescribed to treat his tuberculosis. The nurse informs the client of which reasons?
To prevent resistance
Tuberculosis typically affects the lungs but can also involve other parts of the body. Which of the following can be affected by the disease?
All the above
A client takes phenytoin for a seizure disorder. Before prescribing isoniazid for the client's tuberculosis, what would the nurse expect the health care provider to do?
Decrease the dose of phenytoin and monitor drug levels closely.
A client has just been diagnosed with TB. The client is extremely upset and is asking questions concerning the medications. What is an appropriate response by the nurse?
"You will have multidrug therapy for 6 to 24 months."
The nurse is teaching a client taking isoniazide. The client also suffers from occasional acid reflux. What should the nurse teach this client about?
Decreased absorption of isoniazid
A 72-year-old patient with TB is undergoing standard treatment in a health care facility. Which of the following nursing interventions should the nurse perform during ongoing assessment of the treatment?
Monitor for appearance of adverse reactions.
A male client newly diagnosed with tuberculosis (TB) asks the nurse if medications will make him better. The nurse informs the client that sometimes treatment fails and why this happens. What are some reasons for treatment failure? (Select all that apply.)
inadequate initial drug treatment noncompliance with the therapeutic regimen
On a medical trip to Africa, the nurse tours a tuberculosis clinic where the incidence of MDR-TB is at epidemic levels. Which factor is contributing to the development of multidrug-resistant tuberculosis (MDR-TB is) in developing countries?
delayed determination of drug susceptibility
A 35-year-old man being treated with isoniazid (INH) for exposure to TB has this medical history: diabetes mellitus type 2, hypertension, hyperlipidemia, and coronary artery disease. He drinks one to two glasses of wine on the weekend and smokes two packs of cigarettes per day. Which adverse reaction should the nurse alert the client to report to his health care provider right away?
numbness and tingling in his feet
Ms. Jones is admitted to the hospital with the diagnosis of rule-out tuberculosis. She is placed in isolation. The diagnosis is confirmed 72 hours after admission, based on sputum cultures and chest x-ray findings. She has been prescribed three different drugs for the treatment of TB. The nurse is completing discharge teaching with Ms. Jones. Which statement indicates that Ms. Jones understands the drug therapy?
"I will need to take the medication daily for up to 2 years."
The nurse is caring for a female client whose tests confirm she is 10 weeks pregnant and has contracted tuberculosis. The health care provider orders a combination of antimycobacterials. What combination of drugs should the nurse identify as safest for this pregnant client?
Isoniazid, ethambutol, and rifampin
A 49-year-old client is diagnosed with TB. The client has a history of alcoholism but has been sober for 3 months now. The client has been prescribed INH. What should the nurse ensure is obtained before initiating the therapy?
baseline liver function test values
