Chapter 10: Antitubercular Drugs

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 assessing a client who has been prescribed treatment with isoniazid. What assessment finding would MOST likely necessitate contacting the health care provider to recommend discontinuing treatment?

jaundice

A nursing student studying pharmacology is focusing on drugs used to treat tuberculosis (TB). This student correctly identifies the classifications of anti-tubercular drugs as which of the following?

primary and secondary

A client being treated for active tuberculosis (TB) has received education from the home health nurse regarding how the medication will be administered. Which client statement identifies a need for further education?

"Directly observed therapy (DOT) means I will sign a contract stating I agree to take all my medications as they are prescribed."

A client has been prescribed INH for the treatment of TB. 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 of serious adverse reactions can occur."

A student nurse needs further explanation about tuberculosis (TB) when making the following statement:

"TB can be cured by anti-tubercular drugs."

A client has just been diagnosed with TB. The client is extremely upset and is asking questions concerning the medications. What is the appropriate response by the nurse?

"You will have multi-drug therapy for 6 to 24 months."

A client is to receive rifampin. Which would be the MOST important for the nurse to include in the teaching plan?

"Your urine or sweat may become orange in color."

After teaching a group of nursing students about extrapulmonary TB, the instructor determines that the teaching is successful when the students identify which organs as being commonly affects? Select all that apply.

1. adrenal glands 2. liver 3. bones 4. spleen

A client is prescribed isoniazid and rifampin for the treatment of active tuberculosis (TB). The client's medication education should stress that initial symptom improvement is likely to take how long?

2 to 3 weeks

The nurse is providing health education to a client prescribed isoniazid. What should the nurse instruct the client to avoid?

Alcohol

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 client with a positive sputum culture for TB has been started on streptomycin anti-tubercular therapy. Upon review of the laboratory results, the nurse notes that the client may be experiencing toxicity if which of the following results is abnormal?

BUN and creatinine

A nurse is providing education to a client who is taking INH. The nurse is teaching the client to avoid which foods?

Cheese, dairy products, and bananas.

The nurse is teaching a client about taking isoniazid. The client also suffers from occasional acid reflux. What should the nurse teach this client about?

Decreased absorption of isoniazid.

The client with a diagnosis of TB has a nursing diagnosis of ineffective self-health management. The nurse understands that the most effective method to ensure compliance to TB medications is which of the following?

Direct observed therapy

A client, being treated for active tuberculosis with ethambutol, states difficulty in identifying the red and green on the traffic lights when driving. Based on this finding, what intervention should the nurse consider initially?

Discontinue ethambutol

The nurse is caring for a client receiving an anti-mycobacterial who reports dizziness, headache, and drowsiness. What nursing diagnosis is MOST likely to relate to this client's adverse reaction?

Disturbed sensory perception (kinesthetic) related to CNS effects of the drug.

The nursing student is studying how TB is contracted and identifies the mode of transmission to be which?

Droplets

A client hospitalized with TB, is receiving anti-tubercular drug therapy. When it become apparent that the client is not responding to the medications, what condition will the PCP identify as a possible cause?

Drug-resistant TB

A nursing instructor is teaching about TB drug pyrazinamide and informs students that the most severe adverse reactions to this drug is which of the following?

Hepatotoxicity

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

A client diagnosed with tuberculosis was prescribed anti-tubercular 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 identify?

Ineffective Self-Health Management

The nurse is educating a client who has just been diagnosed with tuberculosis (TB). The nurse informs the client that the drug regimen is extensive. What should the nurse tell this client about the drug therapy related to duration?

It usually lasts 6 to 9 months.

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

A client who was frequently homeless over the past several years has begun a drug regimen consisting solely of isoniazid (INH). What is this client's most likely diagnosis?

Latent tuberculosis

The nurse knows that tuberculosis (TB) is an infectious disease seen around the world and in many cases due to overcrowding. The nurse would be aware of this condition if the lab reports showed which bacteria?

Mycobacterium tuberculosis

A client, diagnosed with tuberculosis, will soon begin first-line drug treatment. How will rifampin most likely be administered to this client?

Orally, on an empty stomach

When a client fails to improve appreciably after 4 weeks of treatment with first-line drugs, what adjuvant first-line anti-tubercular drug will be considered for inclusion in the existing medication regimen?

Pyrazinamide

A client has been infected with Mycobacterium avium complex from an indoor pool. Which medication is recommended anti-tubercular used to treat MAC?

Rifabutin (Mycobutin)

The nurse understands that which is the highest priority when teaching about anti-tubercular 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

A nurse is teaching a client about the standard treatment for tuberculosis, which is divided into two phases. Which statement best explains the difference in the two phases?

The continuation phase includes the drugs rifampin and isoniazid.

A client is prescribed Rifampin. What information should the nurse include in the client's medication education?

The urine, tears, sweat, and other body fluids will be discolored red-orange.

A client diagnosed with tuberculosis (TB) has begun multi-drug therapy. The client has asked the nurse why it is necessary to take several different drugs. How should the nurse respond?

The use of multiple drugs prevents the development of drug-resistant TB.

The nurse explains the prophylactic anti-tubercular therapy is suggested for which people?

Those who have been in close contact with a person with TB.

The nurse is providing medication education to a client diagnosed with latent TB. What reason should the nurse provide to stress the importance of receiving aggressive drug therapy?

To prevent progression of the disease to the active state.

After several rounds of treatment for TB over past several years, a male client continues to test positive for active TB, a fact that the care team attributes to the client's nonadherence to treatment. The client's most recent diagnostic workup reveals that he now has multidrug resistant TB. The nurse should anticipate that the client may require treatment with:

a fluoroquinolone.

A homeless client presented at a street clinic with reports of hemoptysis and subsequently tested positive for TB. Which characteristics of the client's present circumstances would preclude treatment with INH?

an alcoholic who has hepatitis C (HCV)

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 nurse teaching the client with TB should state that ethambutol can:

cause optic neuritis.

After teaching a group of students about anti-tubercular therapy, the instructor determines that additional teaching is needed when the students identify which drug as an anti-tubercular agent?

dapsone

A client in the initial phase of tuberculosis treatment comes to the clinic with reports of a decrease in visual acuity and changes in color perception. The nurse expects to find which drug as being the cause of this reaction?

ethambutol

Gary is a construction worker who is diagnosed with leprosy and is prescribed rifampin. Gary is married, an alcoholic, and wears contact lenses. At the time of initiating the therapy, the nurse should inform the client:

he should wear glasses during the therapy.

A nursing student is learning about the tuberculosis (TB) drug isoniazid. The student has learned to instruct clients taking this drug to refrain from drinking alcohol while taking isoniazid, for which reason?

higher incidence of drug-related hepatitis

What is isoniazid's mechanism of action?

inhibits cell wall formation.

A nurse is administering an anti-tubercular drug that exhibits bactericidal activity. Which drug will the nurse administer?

isoniazid

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 healthcare provider right away?

numbness and tingling in his feet.

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

The nurse is caring for an older adult client with TB. The client has been prescribed ethambutol. Which adverse reactions of ethambutol should the nurse assess for?

optic neuritis

A client with a diagnosis of rhinosinusitis has been prescribed ciprofloxacin 250 mg SC b.i.d. When contacting the prescriber, the nurse should question the:

route

The nurse is providing medication education to a client prescribed ethambutol. What information provided by the nurse accurately describes the visual acuity problem associated with this medication? Select all that apply.

1. "a condition called optic neuritis may occur while you are taking this medication." 2. "let your PCP know immediately if your vision starts to lose sharpness." 3. "you may have problems distinguishing between colors, especially red from green."

A group of nursing students are reviewing information about anti-tubercular drugs. The students demonstrate understanding when they identify which as true about this therapy? Select all that apply.

1. It treats active cases of TB 2. It provides prophylaxis to prevent the spread of TB 3. It renders the client noninfectious to others

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.)

1. inadequate initial drug treatment 2. noncompliance with the therapeutic regimen

Active TB may be difficult to diagnose in clients infected with HIV because of their immune system deficiency. A nurse understands that which can be used to determine if an HIV client with a negative skin test has active TB? Select all that apply.

1. x-ray studies 2. sputum analysis 3. physical examination

A client has been prescribed a daily dosage of Rifampin 600 mg. The available drug is in the form of a 300 mg capsule. To meet the recommended daily dose, the client will need ___ capsules.

2

A nurse is explaining standard treatment for tuberculosis to a client. The nurse would describe the treatment as occurring in how many phases?

2

When a person is diagnosed with TB, the nurse prepares the family to be treated prophylactically with which drug?

isoniazid