Ch 22 prep U
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 client is to receive rifampin. Which would be most important for the nurse to include in the teaching plan for this client?
"Your urine or sweat may become orange in color."This drug causes body fluids to turn orange. The client needs to be informed of this to avoid being frightened when it occurs.
A client has been prescribed 2 tablets of 150 mg isoniazid every day. The available drug is in the form of a 100-mg tablet. To meet the recommended dose, the nurse will administer _______ tablets each time.
3
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 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
If treatment fails, retreatment is necessary. Which of the following drugs are used in retreatment of tuberculosis? Select all that apply:
Ethionamide (Trecator) Aminosalicylic acid (Paser) Cycloserine (Seromycin) Capreomycin (Capastat)
A nurse is discussing targeted testing for latent tuberculosis infection (LTBI) with a group of nursing students. The nurse mentions that testing should be focused on groups considered to be at high risk for infection. Which group is considered high risk?
Factors associated with high risk for LTBI include homelessness, HIV infection, immigrating from areas with high TB rates, previous exposure to an infected individual, use of injectable drugs, pre-existing diabetes mellitus, advanced or younger age, low body weight, and use of high doses of corticosteroids.
The nursing instructor is teaching students about drug regimens used for tuberculosis (TB). Who should receive instructions on the different prophylactic uses of isoniazid (INH)? Select all that apply.
Household members of those recently diagnosed with TB Those whose tuberculin skin test result has become positive in the last 2 years Those at risk for TB (such as those with Hodgkin's disease, leukemia, and other serious illnesses) All clients younger than 35 years with a positive skin test
What is the recommended treatment for a client younger than 18 years of age with LTBI?
INH for 9 months
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. The most commonly used regimen for treatment of TB is divided into two phases: an initial 2-month phase consisting of daily administration of isoniazid (INH), rifampin, and pyrazinamide; and a 4-month continuation phase in which INH and rifampin are administered intermittently.
When instructing the client with tuberculosis (TB) about the drug Isoniazid, the nurse advises that the most common symptom of toxicity is:
peripheral neuropathy.
The client is taking isoniazid (INH). The nurses is teaching the client the importance of understanding that INH can affect which vitamin?
B6. Isoniazid can cause a pyridoxine deficiency which leads to peripheral neuropathy. Vitamin B6 is pyridoxine.
The nurse teaches the client on pyrazinamide that adverse reactions include which?
Painful joints. An adverse reaction of pyrazinamide includes myalgia or painful joints. Optic neuritis is associated with ethambutol. Vertigo is associated with rifampin. Isoniazid can result in peripheral neuropathy.
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 six months. The nurse knows that under what circumstances does the treatment in the second phase last for four months or more?
Positive sputum culture after the completion of initial treatment.
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 new client presents with persistent cough, weight loss, anorexia, and night sweats. What would the nurse expect for the health care provider to order? Select all that apply.
Skin test Chest radiograph
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 explains that prophylactic antitubercular therapy is suggested for which people?
Those who have been in close contact with a person with tuberculosis (TB)
A nurse teaching the client with tuberculosis (TB) should state that ethambutol can:
cause optic neuritis.One of the most severe adverse reactions to ethambutol is optic neuritis, which is a decrease in visual acuity and changes in color perception.
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
What adverse effect would most likely necessitate discontinuing treatment with isoniazid?
jaundice
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
There are projected state budget cuts to the public health department in the coming fiscal year. Because TB is rarely diagnosed, the fiscal cutbacks will include elimination of the team responsible for diagnosing and treating tuberculosis. The nurse can:
suggest that the program be supported without change.
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
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 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
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
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. Some generalized reactions to pyrazinamide are nausea and vomiting, diarrhea, myalgia, and rashes. The most severe adverse reaction with pyrazinamide is hepatotoxicity.
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."Because INH has some monoamine oxidase inhibitor activity, interactions may occur with tyramine-containing foods. INH may also interact with foods containing histamine. Clients should refrain from excessive intake of foods rich in tyramine, which include cheese and dairy products, beef or chicken liver, beer and ale, red wine, avocados, bananas, figs, raisins, caffeine, and chocolates. Because most people consume these food items, the diet is difficult to maintain.
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 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. INH should also be given with caution to clients with diabetes mellitus, malnutrition, or alcoholism because its effects (antagonism or increased excretion) on pyridoxine (vitamin B6) can cause peripheral neuropathy in these clients. Pyridoxine may be given concurrently with INH to decrease the risk for this adverse effect. Another frequent adverse effect is peripheral neuropathy. This effect may cause paresthesias in the hands and feet. As previously mentioned, malnourished people and those with diabetes and alcoholism have a higher risk for this adverse effect.
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. The nurse should pay special attention to the HIV-positive client because this client will require rifampin therapy for a longer period of time than the other clients. An HIV-positive person is immunocompromised, and it will take longer to fight the infection. This could increase the difficulty of adherence to the drug regimen. In addition, many of the drugs used to treat HIV are contraindicated in clients who take rifampin. Rifampin can be safely administered to nursing mothers, those with cancer, and people over 65 given certain conditions. However, their therapy should not be longer than normally required unless complications occur.
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. The nurse should instruct the patient to avoid the consumption of alcohol since alcoholism compounds 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.
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.
When providing health education to a client prescribed isoniazid, the nurse should emphasize the need to avoid what element?
alcohol
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. For a TB client, the nurse should obtain baseline liver function test values and schedule serial liver function tests throughout therapy. In addition, a nurse should ensure a baseline A1C evaluation for clients who are diabetics, because INH may cause hyperglycemia. Clients with preexisting anemias should have a baseline complete blood count (CBC), because they are at risk for hematologic disorders. For clients with a history of seizures, perform a baseline neurologic examination. Also assess baseline visual acuity.
Tuberculosis typically affects the lungs but can also involve other parts of the body. Which of the following can be affected by the disease?
tuberculosis is an infectious disease that usually affects the lungs but may involve most parts of the body, including lymph nodes, meninges, bones, joints, kidneys, and the gastrointestinal tract.
