10 Antitubercular Drugs

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

Ans: A Feedback: 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 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? A) Rotate injection sites for frequent parenteral injections. B) Monitor patient's vital signs each morning. C) Monitor signs of liver dysfunction weekly. D) Administer streptomycin to promote nutrition.

Ans: A Feedback: The nurse should be careful to rotate injection sites when administering frequent parenteral injections. At the time of each injection, the nurse inspects previous injection sites for signs of swelling, redness, and tenderness. The nurse should monitor any signs of liver dysfunction monthly in patients who are being administered antitubercular drugs. The nurse should ensure that pyridoxine, and not streptomycin, is administered to the patient to promote nutrition, but this is only administered if the patient has been living in impoverished conditions and is malnourished. The nurse should monitor the patient's vital signs every 4 hours and not once every morning.

A nurse is assigned to care for a patient with TB in a health care facility. The patient has been prescribed pyrazinamide. Which of the following would the nurse identify as a contraindication to the prescribed therapy? A) Acute gout B) Age younger than 13 years C) Diabetic retinopathy D) Cataracts

Ans: A Feedback: The nurse should know that pyrazinamide is contraindicated among patients with acute gout. Pyrazinamide is also contraindicated in patients with acute hepatic or renal impairment and in patients with diabetes mellitus. Ethambutol is contraindicated in patients with diabetic retinopathy, patients with cataracts, and patients who are younger than 13 years of age.

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

Ans: A Feedback: 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 client is entering the continuation phase of treatment for tuberculosis. Which of the following would the nurse expect the client to receive? Select all that apply. A) Isoniazid B) Rifampin C) Ciprofloxacin D) Pyrazinamide E) Ethambutol

Ans: A, B Feedback: The continuation phase includes only the drugs isoniazid and rifampin.

Which of the following is true of secondary drugs to treat tuberculosis? Select all that apply. A) Secondary drugs are less effective than primary drugs. B) Secondary drugs are more toxic than primary drugs. C) Secondary drugs are used to treat extrapulmonary TB. D) Secondary drugs are used to treat drug-resistant TB. E) Secondary drugs are used as the first line to treat HIV patients with TB.

Ans: A, B, C, D Feedback: Secondary drugs are used to treat extrapulmonary and drug-resistant TB. Secondary drugs are less effective and more toxic than primary drugs used to treat TB.

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

Ans: A, B, C, D, E Feedback: 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.

When developing the plan of care for a client receiving antitubercular therapy, the nurse would identify which of the following as a goal? Select all that apply. A) Client will state adverse reactions to report. B) Client will maintain adequate nutritional status. C) Client and family demonstrate an understanding of the drug regimen. D) Client manages the therapeutic regimen effectively. E) Client exhibits a negative sputum culture.

Ans: A, B, C, D, E Feedback: The goals for a client taking antitubercular drugs can include identification and treatment of adverse reactions including ability to report adverse reaction, maintenance of adequate nutritional status, demonstration of understanding of the drug regimen by client and family, effective management of the therapeutic regimen by the client, and achievement of therapeutic response.

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

Ans: A, B, C, E Feedback: Pyrazinamide should be used cautiously in clients during pregnancy and lactation and in clients with hepatic or renal impairment, HIV infection, or diabetes.

A nursing student is reviewing information about tuberculosis therapy. The student demonstrates understanding of the information when identifying which of the following as true about the initial phase of tuberculosis therapy? Select all that apply. A) Drugs are used to kill the rapidly multiplying M. tuberculosis. B) Drugs are used to prevent drug resistance. C) The initial phase lasts approximately 6 to 9 months. D) The initial phase lasts approximately 2 months. E) The initial phase lasts approximately 4 months.

Ans: A, B, D Feedback: During the initial phase, which lasts approximately 2 months, drugs are used to kill the rapidly multiplying M. tuberculosis and to prevent drug resistance. The continuing phase lasts approximately 4 months and the entire treatment spans 6 to 9 months.

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

Ans: A, B, D, E Feedback: 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.

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

Ans: A, B, D, E Feedback: 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 is in the initial treatment phase for tuberculosis. Which of the following antitubercular drugs would the nurse expect the client to receive during this phase? Select all that apply. A) Isoniazid B) Rifampin C) Ciprofloxacin D) Pyrazinamide E) Ethambutol

Ans: A, B, D, E Feedback: The initial phase involves using the following drugs: isoniazid, rifampin, and pyrazinamide, along with ethambutol.

A client should be educated to limit consumption of which of the following foods to prevent an exaggerated sympathetic-type response when taking isoniazid (INH) for the treatment of tuberculosis? Select all that apply. A) Alcohol B) Grapes C) Bananas D) Meats E) Broccoli

Ans: A, C, D Feedback: When isoniazid is taken with foods containing tyramine, such as aged cheese and meats, bananas, yeast products, and alcohol, an exaggerated sympathetic-type response can occur.

A client with tuberculosis has failed treatment and requires retreatment. Which of the following drugs would the nurse anticipate being used? Select all that apply. A) Ethionamide (Trecator) B) Rifampin (Rifadin) C) Aminosalicylic acid (Paser) D) Cycloserine (Seromycin) E) Capreomycin (Capastat)

Ans: A, C, D, E Feedback: Retreatment drug regimens most often consist of the secondary drugs ethionamide (Trecator), aminosalicylic acid (Paser), cycloserine (Seromycin), and capreomycin (Capastat). Ofloxacin (Floxin) and ciprofloxacin (Cipro) may also be used in retreatment.

A nurse is developing a plan of care for a client receiving an antitubercular drug. Which nursing diagnosis would the nurse most likely include directly related to drug therapy? Select all that apply. A) Acute Pain B) Risk of Skin Integrity C) Imbalanced Nutrition D) Body Image Disturbances E) Risk for Ineffective Self Health Management

Ans: A, C, E Feedback: Drug administration-specific nursing diagnoses that may be made during treatment with antitubercular drugs include Acute Pain related to frequent injections, Imbalanced Nutrition due to gastric upset, and Risk for Ineffective Self Health Management related to indifference, lack of knowledge, and long-term treatment.

A nurse is preparing to administer ethambutol (Myambutol) to several clients. The nurse would expect to administer the drug cautiously to which clients? Select all that apply. A) Clients with hepatic impairment B) Clients with hypertension C) Clients with cataracts D) Clients with diabetic neuropathy E) Clients with renal impairment

Ans: A, C, E Feedback: Ethambutol (Myambutol) should be used cautiously in clients with hepatic or renal impairment and in clients with diabetic retinopathy or cataracts.

Tuberculosis responds well to long-term treatment with a combination of three or more antitubercular drugs. Which of the following is true regarding the duration of treatment for clients with tuberculosis? Select all that apply. A) The initial treatment phase should last for a minimum of 2 months. B) The initial treatment phase should last for a maximum of 2 months. C) The continuation treatment phase should last for 4 to 7 months. D) The continuation treatment phase should last for 6 to 12 months. E) Prophylactic treatment should be given for 6 to 9 months.

Ans: A, C, E Feedback: The Centers for Disease Control and Prevention recommends that treatment begin as soon as possible after diagnosis of TB and include the following: initial treatment phase lasting for a minimum of 2 months, continuation treatment phase lasting for 4 to 7 months, and prophylactic treatment given to family members of the infected individual for 6 to 7 months.

When providing care to a client taking isoniazid (INH), the nurse would monitor the client carefully for which of the following that indicate toxicity? Select all that apply. A) Peripheral neuropathy B) Visual changes C) Nausea D) Vomiting E) Hepatitis

Ans: A, E Feedback: Signs of isoniazid (INH) toxicity include peripheral neuropathy and hepatitis.

A patient diagnosed with TB is undergoing treatment. The nurse knows that which of the following would be used for household members and other close associates of the client to help prevent the spread of the disease? A) Long-term therapy B) Prophylactic therapy C) DOT therapy D) Short-term therapy

Ans: B Feedback: Prophylactic therapy will prevent or avoid the spreading of TB in household members and other close associates of the diagnosed client. Long-term treatment does not prevent the spreading of TB, though it may eventually cure or reduce the intensity of the disease. Directly observed therapy (DOT) is used to administer drugs two to three times weekly. Using DOT will not prevent the TB from spreading. Usually, short-term therapy is of no value in treating TB. Short-term therapy will also not prevent the disease from spreading.

A patient with TB is undergoing initial therapy in the treatment. The nurse has to administer three or more drugs in combination to the patient. The patient wishes to know the reason for administering a combination of drugs. Which of the following explanations does the nurse offer related to the combination of medications? A) Prevents the incidence of liver dysfunction B) Slows down bacterial resistance C) Slows body's resistance to medication D) Prevents further spreading of TB

Ans: B Feedback: The nurse should inform the patient that administering two to three drugs in combination slows down the development of bacterial resistance in the body. Administering a combination of drugs will not specifically prevent the incidence of liver dysfunction. Using drugs in combination does not slow down the body's resistance to medication, though it does reduce the development of bacterial resistance. Prophylactic treatment helps in preventing the TB from spreading further.

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 smoke

Ans: B, C Feedback: 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.

1. After teaching a group of nursing students about antitubercular therapy, the instructor determines that the teaching was successful when the students identify which of the following as a primary drug to treat tuberculosis? Select all that apply. A) Levofloxacin (Levaquin) B) Ethambutol (Myambutol) C) Isoniazid (Nydrazid) D) Rifampin (Rifadin) E) Ciprofloxacin (Cipro)

Ans: B, C, D Feedback: Ethambutol, isoniazid, pyrazinamide, and rifampin are considered primary drugs in the treatment of TB. Levofloxacin and ciprofloxacin are considered secondary drugs.

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

Ans: B, E Feedback: 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 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

Ans: C Feedback: Joint pain is an adverse reaction of ethambutol. Hypersensitivity and skin eruptions are adverse reactions of isoniazid. Myalgia is an adverse reaction of pyrazinamide.

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

Ans: C Feedback: 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 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

Ans: C Feedback: 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 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

Ans: C Feedback: 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.

A patient with TB has been admitted to a health care facility. When providing instructions related to antitubercular drugs, which of the following should the nurse include to minimize complications related to the GI tract? A) Double the dose if earlier dose is missed. B) Take prescribed pyrazinamide without regard to food. C) Take prescribed ethambutol with food. D) Avoid the consumption of alcohol.

Ans: D Feedback: The nurse should instruct the patient to avoid the consumption of alcohol since alcoholism compounds the patient's difficulties and complicates the general condition of the patient's gastrointestinal tract. The nurse should instruct the patient to take the prescribed dose of ethambutol without regard to food and to take the prescribed pyrazinamide along with food. The nurse should instruct the patient to avoid doubling the dose in case the earlier dose was missed.

A 45-year-old patient with TB is to receive rifampin. The nurse would monitor the patient for which of the following? A) Diarrhea B) Fever C) Dermatitis D) Vertigo

Ans: D Feedback: The nurse should monitor for vertigo as an adverse reaction of rifampin in the patient. Diarrhea, fever, and dermatitis are not adverse reactions of administering rifampin. Diarrhea is an adverse reaction of pyrazinamide. Fever is an adverse reaction of isoniazid. Dermatitis and pruritus are the adverse reactions of ethambutol.