Chapter 22: Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease

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.

A client, diagnosed with tuberculosis, will soon begin first-line drug treatment. How will rifampin most likely be administered to this client? A) orally, with food B) orally, on an empty stomach C) intramuscularly D) intravenously, as bolus

B) orally, on an empty stomach Rifampin should be taken on an empty stomach, either one hour before or two hours after a meal. IV administration is possible, but this takes place as a three-hour infusion, not as a bolus. Rifampin is not administered IM.

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

_______ risk increases after childbirth. a. active TB b. latent TB c. mortality

a. active TB

INH + Warfarin a. hepatoxicity b. anticoagulant activity increased c. back up contraceptive needed b. anticoagulant activity increased

b. anticoagulant activity increased

Contraindications of ethambutol: a. ages older 75 b. users of heroine c. ages less than 13

c. ages less than 13

A patient with HIV has been infected with Mycobacterium avium complex from an indoor pool. Which of the following medications is the recommended treatment for MAC? Choose all that apply. A) Clarithomycin B) Isoniazid (INH) C) Rifabutin D) Azithromycin

A) Clarithomycin D) Azithromycin The main drugs used in prevention of MAC disease in patients with HIV are the macrolides azithromycin and clarithromycin.

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? A. a new mother who is nursing B. an obese 45 year old man C. a cancer client D. an HIV positive client

An HIV-positive client

A patient who is receiving ethambutol comes into the clinic for a follow-up visit. Which finding on the assessment indicates a serious adverse reaction to the drug? A) a sputum culture that is negative for acid-fast bacilli B) changes in visual acuity C) poor appetite and GI upset D) dizziness and hearing loss

B) changes in visual acuity A serious adverse effect of ethambutol is optic neuritis.

A client, hospitalized with active tuberculosis, is receiving antitubercular drug therapy. When it becomes apparent that the client is not responding to the medications, what condition will the primary health care provider identify as a possible cause? A) human immunodeficiency virus (HIV) B) drug-resistant tuberculosis C) methicillin-resistant Staphylococcus aureus D) vancomycin-resistant Staphylococcus aureus

B) drug-resistant tuberculosis A patient who is being treated with antitubercular drug therapy and is not responding to the medication regimen is most likely experiencing drug-resistant tuberculosis. Human immunodeficiency virus causes tuberculosis to move more rapidly. This scenario does not provide any indication that the tuberculosis is related to the diminished patient response. The scenario does not identify methicillin- or vancomycin- resistant Staphylococcus aureus.

The nurse should teach patients taking isoniazid to avoid alcohol because of the increased risk of A) central nervous system depression B) liver damage C) drug-resistant tuberculous organisms D) rapid drug metabolism

B) liver damage Taking isoniazid and alcohol in combination increases the risk of liver damage.

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? A) 48 hours B) a week to 10 days C) 2 to 3 weeks D) 4 to 6 weeks

C) 2 to 3 weeks Therapeutic effects are usually apparent with the first 2 to 3 weeks of drug therapy for active TB.

The nurse questions an order for pyrazinamide for a patient with A nurse is assigned to care for a patient with TB in a health care facility. The patient has been prescribed Pyrazinamide. The nurse knows that in which of the following cases is the use of isoniazid contraindicated? A) active TB B) a recent heart attack C) an acute attack of gout D) a history of smoking

C) an acute attack of gout Pyrazinamide decreases the renal excretion of urates. This could worsen an attack of gout.

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 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? 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 Myalgia Joint pain Insomnia

Jaundice Jaundice is an adverse reaction related to isoniazid therapy. Insomnia, joint pain, and myalgia are not related to isoniazid therapy.

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? 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

Positive sputum culture after the completion of initial treatment 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 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? a) Thyroid-stimulating hormone, thyroxine, and triiodothyronine levels b) Red blood count, white blood count, and differential c) Fasting blood sugar and 2-hour postprandial blood sugar d) Serum alanine transaminase, aspartate transaminase, and bilirubin

Serum alanine transaminase, aspartate transaminase, and bilirubin

Like INH, rifampin-Rifadin may cause injury to the

b. liver. Rifampin-Rifadin may cause hepatic injury.

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? a. Pyrazinamide and dapsone b. Rifampin and Pyrazinamide c. Rifampin and isoniazid d. Dapsone and isoniazid

c. Rifampin and isoniazid 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.

INH treats a. latent TB b. active TB c. all of the above

c. all of the above

All of the following are signs of optic neuritis EXCEPT: a. eye pain b. vision loss in one eye c. eye redness d. inability to distinguish red and green

c. eye redness

Isoniazid is the drug of choice in the manage- ment of a. Hansen disease. b. Mycobacterium avium complex. c. tuberculosis. d. Both a and c.

c. tuberculosis.

A nurse teaching the client with tuberculosis (TB) should state that ethambutol can: a. cause urticaria. b. cause optic neuritis. c. cause paralysis. d. increase risk for bleeding.

cause optic neuritis Patients receiving ethambutol-Myambutol should have baseline and periodic eye exams because of the drug's ability to induce 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? a) Hypertension b) Glaucoma c) Folic acid deficiency d) Cirrhosis of the liver

cirrhosis of the liver

A client is prescribed isoniazid (INH) for the treatment of latent tuberculosis (TB). What assessment data identifies a significantly increased risk for the development of liver damage?

consumes alcohol daily

Rifampin works by a. inhibiting protein synthesis. b. inhibiting synthesis of the bacterial cell wall. c. disrupting the change of RNA to DNA. d. disrupting RNA synthesis

d. disrupting RNA synthesis Rifampin-Rifadin works by inhibiting bacterial and mycobacterial RNA synthesis.

The most common adverse effects associated with the use of INH are a. renal failure and increased seizure activity. b. CNS depression and peripheral neuropathy. c. memory impairment and renal failure. d. hepatitis and peripheral neuropathy.

d. hepatitis and peripheral neuropathy. Because of INH's ability to induce hepatitis, its use is limited in patients older than 35 years. To decrease the incidence of peripheral neuritis, INH is given with vitamin B6. Pyridoxine-vitamin B6 does not have any effect on TB; it only decreases the incidence of peripheral neuropathy.

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? A. myalgia B. hepatotoxicity C. rashes D. diarrhea

hepatotoxicity

Select all of the signs of Hepatotoxicity: a. Weight gain b. Hypertension c. Anorexia d. Headache e. N/V f. pale stool g. hypotension h. dark urine i. anuria

c. Anorexia e. N/V f. pale stool h. dark urine

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 being treated for drug-resistant active tuberculosis reports experiencing dyspnea accompanied by headache, itching, and diaphoresis over the last 24 hours. Which assessment question asked by the nurse demonstrates an understanding of possible adverse reactions to this medication regimen?

"Did you eat any fish in the past few days?"

A nursing student asks the nurse which patients are more susceptible to tuberculosis infection. Which response by the nurse is correct? Select all that apply. 1Patients with cancer 2 Patients with diarrhea 3 Patients with malnutrition 4 Patients with gastric ulcer 5Patients with human immunodeficiency virus (HIV) infection

1 Patients with cancer 3 Patients with malnutrition 5 Patients with human immunodeficiency virus (HIV) infection Patients with cancer, malnutrition, and HIV infection are more susceptible to tuberculosis infections than other patients. Patients with these conditions have reduced immunity, which makes them more vulnerable to tuberculosis bacteria. Diarrhea and gastric ulcers do not decrease immunity and therefore do not increase the risk for infection.

The nurse is teaching a client taking isoniazid. The client also suffers from occasional acid reflux. What should the nurse teach this client about? a. Decreased effectiveness of the antacids b. Increased effectiveness of antacids c. Decreased absorption of isoniazid d. Increased absorption of isoniazid

c. Decreased absorption of isoniazid

The nurse would assess a patient taking isoniazid for A) elevated levels of serum aspartate aminotransferase B) symptoms of hyperkalemia C) decreased urine output D) hearing loss

A) elevated levels of serum aspartate aminotransferase Increased serum aspartate aminotransferase would indicate liver damage, an adverse effect of isoniazid.

A male patient is receiving pyrazinamide. The nurse assesses him for which of the following? A) elevated liver enzymes and jaundice B) elevated white blood cell count and fever C) elevated cardiac troponin levels and chest pain D) elevated creatinine kinase and muscle weakness

A) elevated liver enzymes and jaundice The most serious adverse effect of pyrazinamide is hepatotoxicity.

A client is hospitalized due to nonadherence to an antitubercular drug treatment for a diagnosis of tuberculosis (TB). Which intervention is most important for the nurse to implement? A) observing the client taking the medications B) administering the medications parenterally C) instructing the family on the medication regime D) counting the number of tablets in the bottle daily

A) observing the client taking the medications Directly observed therapy in which a healthcare provider observes the patient taking each dose of anti-TB drugs is recommended for all drug regimens and is considered mandatory in this case. The medications are not administered parenterally. The family should be instructed on the medication regimens, but this action is not imperative in maintaining compliance. Tablets missing from the bottle may not necessarily have been taken correctly by the patient.

A group of nursing students are reviewing information about the transmission of tuberculosis. The students demonstrate understanding when they state transmission occurs from person to person in which manner? The nursing student is studying how tuberculosis (TB) is contracted and identifies the mode of transmission to be which? A. droplets B. person-to-person C. dust D. blood-borne

A. droplets inhalation of infected aerosolized droplets

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.

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 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 nurse is caring for a client who has diabetes mellitus, pulmonary tuberculosis, and a new prescription for isoniazid. Which of the following supplements should the nurse expect to administer to prevent an adverse effect of INH? A) Ascorbic acid B) Pyridoxine C) Folic acid D) Cyanocobalamin

B) Pyridoxine

The nurse understands that which is the highest priority when teaching about antitubercular medications? a. Taking medications as prescribed b. Eating a well balanced diet c. Staying hydrated d. Monitoring sputum

Taking medications as prescribed

A health care provider has prescribed rifampin for a patient who is being discharged to home. The nurse should include which one of the following in the discharge teaching? A) "You will have to measure your urine output while taking rifampin." B) "Rifampin increases the risk of having seizures or convulsions." C) "Ask your eye care provider about wearing your contact lenses." D) "There is no necessary follow-up blood work."

C) "Ask your eye care provider about wearing your contact lenses." Rifampin causes a harmless red-orange discoloration of body fluids. This can permanently stain soft contact lenses. The client should consult an eye care provider before wearing contact lenses.

A client is prescribed rifampin. What information should the nurse include in the client's medication education? A) When taking it with warfarin, an increased anticoagulant effect occurs. B) It decreases hepatic enzymes and decreases metabolism of drugs. C) It has an increased serum half-life, so it is more effective than rifabutin. D) The urine, tears, sweat, and other body fluids will be a discolored red-orange.

D) The urine, tears, sweat, and other body fluids will be a discolored red-orange. The patient's urine, tears, sweat, and other body fluids will be a discolored red orange. This adverse effect is harmless, but the patient should be instructed on this adverse effect. The administration of this medication with warfarin will decrease the anticoagulant effect. The medication increases hepatic cytochrome P450 3A4 enzyme and decreases serum concentrations. The serum half-life of rifampin is shorter than that of the medication rifabutin.

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? A. hematuria B. adverse reaction of INH C. interaction between INH and rifampin D. adverse effect of rifampin

D. adverse effect of rifampin

_______ is the prototype of antitubercular agents. a. Isoniazid b. Rifampin c. ethambutol

a. Isoniazid

A patient receiving INH for TB prophylaxis reports anorexia, malaise, fatigue, jaundice, and nausea. The nurse should recognize these symptoms as an indicative of a. hepatitis. b. peripheral neuropathy. c. tyramine reaction. d. anemia.

a. hepatitis.

A patient on INH is experiencing tingling, numbness, and paresthesias of the extremities. What would the nurse suspect this is due to? a. increased excretion of pyridoxine b. increased excretion of thiamine c. increased excretion of tyramine

a. increased excretion of pyridoxine

The nurse is providing health education to a client prescribed isoniazid. What should the nurse instruct the client to avoid? A. alcohol B. direct sunlight C. foods containing purines D. unpasteurized dairy products

alcohol

What is the recommended treatment for a client younger than 18 years of age with LTBI?

INH for 9 months

All of the following are signs of hyperuricemia EXCEPT: a. joint pain b. loose joints c. deformed joints d. joint stiffness

b. loose joints

New link

https://quizlet.com/200082962/tb-drugs-flash-cards/ https://quizlet.com/557227939/chapter-90-antimycobacterial-agents-drugs-for-tuberculosis-flash-cards/

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? first and second generation primary and secondary

primary and secondary

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

pyrazinamide

Is INH bactericidal or bacteriostatic? Is ethambutol bactericidal or bacteriostatic?

INH: bactericidal Ethambutol: bacteriostatic

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? a) "Oh, please don't worry. Your doctor will explain everything to you." b) "We will discuss this when you are calmer." c) "You will take one drug for 1 month." d) "You will have multidrug therapy for 6 to 24 months."

"You will have multidrug therapy for 6 to 24 months."

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? A. avoid excessive caffeine intake because this could increase the side effects of the medication B. do not drink beer or red wine while taking this medication because a serious adverse reaction can occur C. make sure to limit your protein intake, as increased protein delays absorption of the medication D. take the medication with a full glass of water to prevent the mouth from becoming dry during therapy

"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur."

What will the nurse teach a patient who is taking isoniazid? 1 "You will need to take vitamin C to potentiate the action of isoniazid." 2 "You should not be on that drug. I will check with the health care provider." 3 "Multidrug therapy is necessary to prevent the occurrence of resistant bacteria." 4"Pyridoxine (vitamin B6) will prevent numbness and tingling associated with taking isoniazid."

"Pyridoxine (vitamin B6) will prevent numbness and tingling associated with taking isoniazid." Isoniazid can cause peripheral neuropathy. Pyridoxine (vitamin B6) is the drug of choice to prevent this adverse reaction. It is not an antiinfective agent and thus will work to destroy the mycobacterium or prevent drug resistance. Vitamin C is not taken with this drug; the drug is appropriate for most patients, and isoniazid with pyridoxine is not multidrug therapy.

The nurse is assessing a patient with pulmonary tuberculosis who has been prescribed ethambutol, isoniazid, pyrazinamide, and rifampin. The patient says, "Can you tell me why four medications are prescribed and how I should administer all of them?" What response does the nurse give to the patient? 1 "You should take all these medications at a time before meals." 2 "You can stop administering pyrazinamide if you have nausea." 3 "You have to complete the course of any two prescribed medications." 4"You may have a more complete, more rapid response when four medications are given."

"You may have a more complete, more rapid response when four medications are given." The nurse should provide the patient instructions about drug administration and the need for medication. It helps the patient to adhere to the medication and effectively complete the treatment regimen. The nurse should inform the patient that multiple medications are prescribed for treating tuberculosis to increase the rate of cure and have effective treatment.

Your 33-year-old patient is taking multidrug therapy for TB. The patient has a history of hepatic dysfunction. Which combination of drugs would be contraindicated for this patient?

(a) Both INH and rifampin have the ability to induce hepatotoxicity.

Your patient has been taking triple antimicrobial therapy for active TB for the past 3 months. The patient comes to the clinic today and states, "My soft contact lenses have turned red." What medication may have caused this problem? a. INH b. Rifampin (Rifadin) c. Ethambutol (Myambutol) Spectinomycin

(b) Rifampin-Rifadin can turn all body fluids red, including tears.

Your patient about to get I.V. rifampin-Rifadin. To safely administer this medication you should

(c) You should administer IV rifampin-Rifadin by slow infusion over 3 hours.

Your patient has been diagnosed with active TB. This patient has multiple medical problems including HIV, steroid-dependent asthma, and type 2 diabetes. Which of the following drugs, given concurrently with the patient's previously prescribed medications, would be the most problematic?

(d) Rifampin-Rifadin is a potent inducer of the cytochrome P-450 hepatic enzyme system and its subsets. It interacts with many of the drugs used for these disorders.

Which is the first-line antitubercular drug? 1 Isoniazid 2 Amikacin 3 Cycloserine 4 Capreomycin

1 Isoniazid Isoniazid is a first-line and primary antitubercular drug. It is most widely used. It can be administered either as the sole drug in the prophylaxis of tuberculosis or in combination with other antitubercular drugs in the treatment of tuberculosis. Amikacin, cycloserine, and capreomycin are second-line antitubercular drugs.

A patient has a positive Mantoux test. Which test will the provider order next? 1 Sputum culture 2 Chest radiography 3 Tuberculin skin test 4 Stomach secretion culture

2 Chest radiography Tuberculosis is diagnosed by following three steps. In the first step the Mantoux test is conducted. If the results of the Mantoux test are positive, then the second step of diagnosis can be carried out. Sometimes the Mycobacterium becomes dormant and does not cause infection, but the patient still shows positive results to the Mantoux test. In the second step, chest radiography is conducted. If the results of chest radiography are positive, the third step is followed. In the third step, a culture of sputum and stomach secretions is done to detect the presence of Mycobacterium tuberculosis. The Mantoux test is also called a tuberculin skin test.

A patient is prescribed rifampin for the treatment of tuberculosis. While checking the patient's history, the nurse finds that the patient is on oral contraceptive therapy. What advice on the safe use of rifampin does the nurse give to the patient? 1 Take a lower dose of rifampin. 2Use other forms of birth control. 3 Take an initial half-dose of rifampin. 4 Use a double dose of the oral contraceptive.

2 Use other forms of birth control. Rifampin comes under the class of rifamycin antibiotics. It blocks the activity of oral contraceptives. As a result, contraception failure occurs. Therefore, the nurse should advise the patient to use other forms of birth control. A lower dose and initial half-dose of rifampin do not give the desired therapeutic effect; thus, avoid taking a lower dose or initial half-dose of rifampin. There is no need to take a double dose of the oral contraceptive, because that would be ineffective in this situation and might cause adverse effects for the patient.

Which of the following patients is at greatest risk for developing a life-threatening system mycosis? 1. a patient who develops a sexually transmitted disease and is being treated with doxycycline 2. a patient with breast cancer being treated with the chemotherapeutic agent cyclophosphamide 3. a patient who is taking warfarin for the prevention of a thromboembolism 4. a patient with a strep throat who is being treated with cephalexin

2. a patient with breast cancer being treated with the chemotherapeutic agent cyclophosphamide A client with breast cancer who is being treated with cytotoxic chemotherapy agents is at greatest risk for developing a systemic fungal infection.

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

Which statement by the patient leads the nurse to believe that the patient has understood the teaching regarding ethambutol? 1 "This medication may cause my bodily secretions to turn red-orange." 2 "Constipation will be a problem, so I will increase the fiber in my diet." 3 "I will need to have my eyes checked periodically while I am taking this drug." 4 "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time."

3 "I will need to have my eyes checked periodically while I am taking this drug." Ethambutol can cause optic neuritis. Ophthalmologic examinations should be performed periodically to assess visual acuity. Rifabutin, rifampin, and rifapentine (not ethambutol) turn bodily secretions orange. Constipation is not an adverse effect of ethambutol. Dizziness, drowsiness, and decreased urinary output are not common with ethambutol.

What will the nurse teach patients taking rifampin and isoniazid prophylactically secondary to tuberculosis exposure? 1 These drugs will only need to be taken for 7 to 10 days. 2 Isoniazid may decrease serum glucose in susceptible people. 3Oral contraceptives become ineffective when given with rifampin. 4 Tanning beds may be used to counteract the pale skin tone caused by these medications.

3 Oral contraceptives become ineffective when given with rifampin. Women taking oral contraceptives who are prescribed rifampin must be switched to another form of birth control because oral contraceptives become ineffective when given with rifampin. These medications must be taken long term because the mycobacterium is slow growing. Isoniazid may increase, not decrease, serum glucose levels. They can cause photosensitivity, necessitating the use of sunscreen, not tanning beds.

A patient is hospitalized for the treatment of tuberculosis. How can the development of multidrug-resistant tuberculosis be prevented in the patient? 1 By performing regular blood tests 2 By performing regular chest x-rays 3 By performing regular sputum cultures 4 By performing drug susceptibility tests

4 By performing drug susceptibility tests Performing drug susceptibility tests will help prevent the development of multidrug-resistant tuberculosis in the patient. A drug susceptibility test is performed on the first Mycobacteriumspecies that is isolated from a patient specimen. Blood tests, chest x-rays, and sputum culture are done to diagnose tuberculosis and determine the prognosis; they are not preventive.

The nurse is caring for a patient with tuberculosis. The patient's drug susceptibility test reports are not known. What will the nurse expect the provider to order for this patient? 1 Cycloserine 2 Capreomycin 3 No drug therapy 4 Four-drug regimen therapy

4 Four-drug regimen therapy Four-drug regimen therapy is given to a patient when the drug susceptibility reports are unknown. The four-drug regimen consists of isoniazid, rifampin, ethambutol, and pyrazinamide. These drugs are 95% effective in combating the infection. Use of multiple medications reduces the possibility of the organisms' becoming drug resistant.

A 40-year-old man has been living with HIV for several years but experienced a significant decrease in his CD 4+ levels a few months ago. The patient has just been diagnosed with Mycobacterium avium complex disease. The nurse should anticipate administering which of the following medication? Select all that apply. A) Clarithromycin B) Pyrazinamide C) Rifapenrine (Priftin) D) Azithromycin E) Bactrim

A) Clarithromycin D) Azithromycin The main drugs used in prevention of M a C disease in patient with HIV or the macrolides azithromycin and claritomycin. Pyrazinamide, Bactrium, and Priftin are not used to treat MAC.

A client being treated for tuberculosis (TB) is determined to be drug resistant. Which medications no longer be effective in the treatment of the tuberculosis? A) isoniazid (INH) and rifampin (RIF) B) carbamazepine and phenytoin C) dextroamphetamine and doxapram D) propranolol and sotalol

A) isoniazid (INH) and rifampin (RIF) Isoniazid (INH) and rifampin Are used to treat tuberculosis. And multi drug resistance, the most effective drugs the patient is resistant to our isoniazid and rifampin. Carbamazepine and phenytoin are used to control seizures. Dextroamphetamine and doxapram are central nervous system stimulant. Propranolol and sotalol are beta-adrenergic blocking agents.

A patient is taking isoniazid. Which one of the following adverse effects does the nurse include in discharge teaching? A) numbness and tingling of extremities B) thirst and decreased urine output C) loose, watery bowel movements D) eye pain and visual disturbances

A) numbness and tingling of extremities Numbness and tingling of extremities would indicate peripheral neuropathy, an adverse effect of isoniazid.

A client with a positive sputum culture for TB has been started on streptomycin antitubercular 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? A. BUN and creatinine B. amylase and lipase C. red blood cells and white blood cells D. sodium and potassium

A. 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? A. cheese, dairy products, and bananas B. potatoes and root vegetables C. citrus fruits D. chicken and fish

A. cheese, dairy products, and bananas

A nurse is preparing a community teaching program about tuberculosis. When describing the individuals who are susceptible, who would the nurse include? Select all that apply. A. individuals living in crowded conditions B. individuals with HIV C. individuals less than 6 years of age D. individuals more than 30 years of age E. individuals with asthma

A. individuals living in crowded conditions B. individuals with HIV

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? A. optic neuritis B. hypersensitivity C. epigastric distress D. vertigo

A. optic neuritis

A patient has developed active tuberculosis and is prescribed isoniazid and rifampin. Which information will the nurse include in teaching the patient about taking this drug? (Select all that apply.) A.Isoniazid should be given 1 hour before or 2 hours after meals. B.Have periodic eye examinations as ordered by the health care provider. C.Compliance with drug regimen is essential. D.Report numbness, tingling, and burning of hands and feet. E.Warn patient that rifampin may turn body fluids a harmless green color.

A.Isoniazid should be given 1 hour before or 2 hours after meals. B.Have periodic eye examinations as ordered by the health care provider. C.Compliance with drug regimen is essential. D.Report numbness, tingling, and burning of hands and feet.

Tuberculosis typically affects the lungs but can also involve other parts of the body. Which of the following can be affected by the disease? Kidneys GI tract GU tract Meninges Bones Lymph nodes

ALL Kidneys GI tract GU tract Meninges Bones Lymph nodes

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.

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.

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

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.

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.

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.

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 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 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.

A nurse is teaching a client who has active tuberculosis about the treatment regimen. The client asks why four different medications are necessary. Which of the following responses should the nurse make? A) "Four medications decrease the risk for a severe allergic reaction." B) "Four medications reduce the chance that the bacteria will become resistant." C) "Four medications reduce the risk for adverse reactions." D) "Four medications decrease the chance of having a positive tuberculin skin test."

B) "Four medications reduce the chance that the bacteria will become resistant."

A female client has been diagnosed with tuberculosis (TB) and begun multi-drug therapy. The client has asked the nurse why it is necessary to take several different drugs. How should the nurse respond to the client's question? A) "Multiple drugs are used because doctors aren't sure which drug will kill a particular TB strain." B) "The use of multiple drugs prevents the development of drug-resistant TB." C) "Multiple drugs are prescribed because the final testing results for TB can take up to 3 months." D) "Multiple drugs are used in order to speed up the course of treatment."

B) "The use of multiple drugs prevents the development of drug-resistant TB." Use of multiple drugs to treat TB is necessary to prevent the development of drug-resistant TB. This approach to treatment is not necessitated by delays in testing, questionable diagnostic results, or the need to hasten the course of treatment.

A client receiving isoniazid (INH) and rifampin has a decreased urinary output and decreased sensation in his or her great toes. Which laboratory values should be assessed? A) hematocrit and hemoglobin B) ALT and AST C) urine culture and sensitivity D) complete blood count (CBC) with differential

B) ALT and AST Hepatotoxicity and peripheral neuropathy are important adverse effects of isoniazid and rifampin. The ALT/AST will assess liver function. The hematocrit and hemoglobin are not indicated with the described symptoms. Erythrocyte count and differential are not indicated with these symptoms.

A client, being treated for active tuberculosis (TB) 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? A) Assess for photosensitivity. B) Discontinue ethambutol. C) Decrease the ethambutol dose. D) Administer vitamin B12.

B) Discontinue ethambutol.(Myambutol). The administration of ethambutol should be discontinued if optic neuritis develops. Optic neuritis is an inflammatory, demyelinating disorder of the optic nerve that decreases visual acuity and ability to differentiate red and green. The inability to distinguish red and green is not indicative of photosensitivity. The ethambutol should not be decreased. There is no indication for the administration of vitamin B12.

A homeless individual was screened for tuberculosis (TB), and the results indicate latent TB. The community health nurse would anticipate inclusion of what intervention into the client's plan of care? A) undergoing conservative treatment for TB using adjuvant medications B) being treated for TB using first-line antitubercular drugs C) close monitoring to determine if treatment is necessary D) rescreening in 10 to 12 weeks to determine whether the TB has become active

B) being treated for TB using first-line antitubercular drugs Patients with latent TB cannot spread the disease to others, but treatment of the latent disease prevents progression of the disease to an active state. It is particularly important to treat latent TB in those patients who are at high risk for progression to activate TB. Homelessness is a major risk factor for active TB.

The nurse is reviewing a patient's medications and sees that the patient is receiving rifampin. The nurse's greatest concern about rifampin and its drug interactions is A) it decreases the metabolism of many other drugs B) it increases the metabolism of many other drugs C) it increases the risk for GI bleeding if given with warfarin D) it increases the risk of adverse effects from antiseizure drugs

B) it increases the metabolism of many other drugs Rifampin has many drug-drug interactions, and most are very significant Rifampin-Rifadin is a potent inducer of the cytochrome P-450 hepatic enzyme system and its subsets, so it has many potentially serious drug-drug interactions.

A client is prescribed isoniazid (INH) for a diagnosis of tuberculosis (TB). Which adverse effect will result in discontinuation of the medication? A) weight gain B) jaundice C) fever D) arthralgia

B) jaundice Potentially serious adverse effects of INH include hepatotoxicity and peripheral neuropathy. Hepatotoxicity may be manifested by symptoms of hepatitis (e.g.,, anorexia, nausea, fatigue, malaise, jaundice) or elevated liver enzymes. Weight gain, fever, and arthralgia are not the most known adverse effects of isoniazid (INH).

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? A) active tuberculosis B) latent tuberculosis C) Mycobacterium avium complex (MAC) D) human immunodeficiency virus (HIV)

B) latent tuberculosis Although use of INH by itself for treatment of latent TB is appropriate, use with other anti-TB drugs is essential for treatment of active TB. INH would not be used exclusively in the treatment of HIV or MAC.

The nurse is caring for a patient who is taking isoniazid and rifampin. Which one of the following groups of symptoms is indicative of an adverse effect that is worsened by the combination of the two drugs? A) numbness and tingling of the extremities B) nausea, abdominal pain, and jaundice C) decreased urine output and elevated blood urea nitrogen D) dizziness and loss of hearing

B) nausea, abdominal pain, and jaundice Both isoniazid and rifampin can be hepatotoxic. The use of the two drugs together increases the risk of liver damage, which would produce these symptoms.

A client, being treated for latent tuberculosis (TB) on an out-client basis, tells the nurse, "I've been feeling pretty good lately, so I haven't actually been all that consistent with taking my drugs." Subsequent health education by the nurse should focus on what subject? A) the fact that nonadherence to treatment exacerbates the risks of adverse effects B) the need to consistently take the prescribed drugs in order to cure TB C) the need to match drug dosages carefully to signs and symptoms D) the fact that nonadherence will necessitate the use of antiretrovirals

B) the need to consistently take the prescribed drugs in order to cure TB Consistent adherence to treatment is imperative to ensure successful treatment of TB. Nonadherence leads to resistance and unsuccessful treatment, not increased adverse effects. Antivirals are ineffective against TB.

The nurse who is giving isoniazid (INH) anticipates an order for which one of the following vitamins, usually given with INH? A) vitamin B3 (niacin) B) vitamin B6 (pyridoxine) C) folic acid (folate) D) vitamin D (calcitriol) To minimize the potential for peripheral neuropathy, INH may be given in combination with a. rifampin (Rifadin). b. pyridoxine (vitamin B6). c. spectinomycin. d. ethambutol (Myambutol).

B) vitamin B6 (pyridoxine) given while on INH therapy to prevent peripheral neuropathy

After 3 weeks of drug therapy for TB, a client is not showing reduction of symptoms. Repeated lab work shows positive cultures. What issues should the nurse consider? (Select all that apply.) A. defective medication B. client noncompliance C. intermittent administration D. drug resistance

B. client noncompliance D. drug resistance

The nurse understands that tuberculosis (TB) can affect other organs of the body. The term used for TB outside the lungs called which? A. interstitial B. extrapulmonary C. metastisized D. encapsulated

B. extrapulmonary

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? A. reduced absorption of isoniazid B. higher incidence of drug-related hepatitis C. increase blood levels of phenytoin D. increased risk for bleeding

B. higher incidence of drug-related hepatitis

A middle-aged adult is diagnosed with tuberculosis. Which is true of treatment for this diagnosis? A.Treatment may take about 10 days to 2 weeks. B.Usually two to three agents are needed. C.The bacteria is usually resistant to treatment therapy. D.Treatment for tuberculosis is usually without side effects.

B.Usually two to three agents are needed.

A nursing student is learning about the effects of bacteriocidal agents. How does rifampin achieve a therapeutic action against both intracellular and extracellular tuberculosis organisms? A) It is metabolized in the liver. B) It binds to acetylcholine. C) It inhibits synthesis of RNA. D) It causes phagocytosis.

C) It inhibits synthesis of RNA. Rifampin kills Mycobacterium by inhibiting synthesis of RNA. It is metabolized in the liver, but this characteristic does not represent its action. It does not mind to acetylcholine. It does not cause phagocytosis.

A client, seen in the clinic for symptoms of persistent cough, fever, and night sweats, has recently entered the United States from India/the Philippines. What is the most plausible explanation for the client's condition? A) latent tuberculosis B) bacterial pneumonia C) active tuberculosis D) emphysema

C) active tuberculosis Emigration from countries where disease occurs, such as the Philippines, places patients at risk for tuberculosis. Active tuberculosis is characterized by symptoms of cough, fever, and night sweats. Patients with latent tuberculosis exhibit no symptoms and do not feel sick. Bacterial pneumonia is not commonly noted with night sweats. Emphysema is not noted with fever.

The nurse taking care of a patient with tuberculosis (TB) receives an order for levofloxacin. This drug may be used to treat A) latent TB B) active TB C) drug-resistant TB D) adverse effects of isoniazid

C) drug-resistant TB A newer fluoroquinolone such as levofloxacin may be added to the drug regimen to treat drug-resistant tuberculosis.

A college student has a tuberculosis (TB) test prior to starting the semester. The test site is noted to have a reddened, raised area. What phase in the progression of TB is associated with the inability to spread the disease to others? A) transmission B) primary infection C) latent tuberculosis D) active tuberculosis

C) latent tuberculosis People with inactive or latent TB have no symptoms and do not feel sick. The transmission of the infection occurs when an uninfected person inhales infected airborne particles that are exhaled by an infected person. Primary infection occurs 6 to 8 weeks after exposure. The patient has a mild, pneumonia-like illness that often is undiagnosed. Active tuberculosis is a result from reactivation of a latent infection.

A female patient has not adhered to her drug regimen for tuberculosis. Which of the following is most effective to enhance adherence? A) explaining the importance of adherence B) having the patient's family administer the medication C) evaluating serum drug levels to determine adherence D) having nursing staff directly watch her take her medication

D) having nursing staff directly watch her take her medication The nursing staff should directly observe that the client successfully takes each dose of medication.

A client with a diagnosis of active TB has begun second-line therapy that includes the use of pyrazinamide. When monitoring this client, the nurse should suspect that adverse effects of this drug may account for which laboratory values? A) low hematocrit and mean corpuscular volume (MCV) B) increased INR and aPTT C) increased blood urea nitrogen and creatinine D) increased AST, ALT, and GGT

D) increased AST, ALT, and GGT The most severe adverse effect of pyrazinamide is hepatotoxicity. Consequently, liver enzymes such as GGT, ALT, and AST should be monitored. Changes in erythrocytes, coagulation, and renal function are less likely to result from pyrazinamide therapy.

A patient with HIV is taking rifampin and a protease inhibitor. The nurse should assess the patient for what condition? A) a worsened allergic reaction to rifampin B) elevated blood urea nitrogen and serum creatinine C) drowsiness, lethargy, and decreased responsiveness D) increased viral load and decreased CD4 count

D) increased viral load and decreased CD4 count In general, rifampin reduces the effectiveness of protease inhibitors. Increased viral load and decreased CD4 count are indications that the protease inhibitor is not effective and that the human immunodeficiency virus (HIV) disease has worsened.

A client, prescribed isoniazid (INH) for a diagnosis of tuberculosis (TB), has a yellow color in the sclera of the eye. What other finding would lead the nurse to suspect that hepatotoxicity has developed? A) diarrhea B) numbness C) diminished vision D) light-colored stools

D) light-colored stools The presence of light-colored stools is suggestive of hepatotoxicity. Diarrhea, numbness, and diminished vision are not related to hepatotoxicity of isoniazid (INH).

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. A. All clients older than 35 years of age with a positive skin test B. health care professionals emplyed in health insitutions C. clients whose tuberculin skin test has become positive in the last three years D. those who have been in close contact with a person with TB E. Household members of those recently diagnosed with TB F. Those whose tuberculin skin test result has become positive in the last 2 years G. Those at risk for TB (such as those with Hodgkin's disease, leukemia, and other serious illnesses) F. All clients younger than 35 years with a positive skin test

D. those who have been in close contact with a person with TB E. Household members of those recently diagnosed with TB F. Those whose tuberculin skin test result has become positive in the last 2 years G. Those at risk for TB (such as those with Hodgkin's disease, leukemia, and other serious illnesses) F. All clients younger than 35 years with a positive skin test

When teaching a patient about isoniazid (INH) and rifampin drug therapy, which statement will the nurse include? A."Take isoniazid with meals." B."Double the amount of vitamin C in your diet to prevent the peripheral neuropathy associated with isoniazid therapy." C."Notify the primary health care provider immediately if your urine turns a red-orange color." D."Avoid exposure to direct sunlight."

D."Avoid exposure to direct sunlight."

The nurse is teaching a client taking isoniazid. The client also suffers from occasional acid reflux. What should the nurse teach this client about? A. decreased effectiveness of the antacids B. increased effectiveness of the antacids C. decreased absorption of isoniazid D. increased absorption of isoniazid

Decreased absorption of isoniazid

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? a. INH, streptomycin, and rifampin b. INH, streptomycin, pyrazinamide c. INH, rifampin, pyrazinamide, ethambutol d. INH, rifampin, streptomycin, ethambutol

INH, rifampin, pyrazinamide, ethambutol

Which of the following represents the mechanism of action of fluoroquinolones? (Choose one) a) Interference with the synthesis of bacterial DNA. b) Blockage of attachment of bacteria to host cell c) Interference of glucose metabolism inside the bacteria d) Interference with bacterial cell wall synthesis

Interference with the synthesis of bacterial DNA

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? 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

Monitor for appearance of adverse reactions. 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 four 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 pre-administration 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.

Which circumstances would warrant a continuation treatment phase of seven 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

Non-inclusion of pyrazinamide in the initial treatment phase Positive sputum culture after completion of initial treatment 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 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? _____ The nurse is counseling a woman who is beginning antitubercular therapy with rifampin. The patient also takes an oral contraceptive. Which statement by the nurse is most accurate regarding potential drug interactions? a "You will need to switch to another form of birth control while you are taking the rifampin." b "Your birth control pills will remain effective while you are taking the rifampin." c "You will need to take a stronger dose of birth control pills while you are on the rifampin." d "You will need to abstain from sexual intercourse while on the rifampin to avoid pregnancy."

Pregnancy d "You will need to abstain from sexual intercourse while on the rifampin to avoid pregnancy."

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

Rotate injection sites for frequent parenteral injections. 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 patient's vital signs every four hours and not once every morning.

While discussing tuberculosis, the nursing instructor explains that treatment is typically divided into two phases. What is the second phase called? The management phase The continuation phase

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.

A client asks why three medications are prescribed to treat his tuberculosis. The nurse informs the client of which reasons? A. to prevent adverse reactions B. to prevent resistance C. to decrease length of drug therapy D. to decrease allergic response of medications

To prevent resistance

When educating a college student who lives in a crowded apartment and was recently diagnosed with tuberculosis, the school nurse will emphasize which treatment plan? a. "To destroy this bacterium, you must strictly adhere to a long-term drug regimen of several medications." b."You will have to wear a N95 mask while on campus at all times." c. "If isoniazid makes you nauseous, we can substitute something milder." d. "Once your fever goes away you can stop taking the streptomycin injection."

a. "To destroy this bacterium, you must strictly adhere to a long-term drug regimen of several medications." Success of chemotherapy for prophylaxis and treatment of tuberculosis depends on strict adherence to a lengthy drug regimen which includes isoniazid, rifampin, ethambutol, pyrazinamide, and streptomycin (or some combination of these).

A client is to receive rifampin. Which would be most important for the nurse to include in the teaching plan for this client? a. "Your urine or sweat may become orange in color." b. "The drug can cause an allergic reaction." c. "You might experience some nausea or stomach upset." d. "Call your health care provider if you experience headache or dizziness."

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

To minimize adverse effects from isoniazid, the nurse should monitor a. AST and ALT levels. b. creatinine clearance. c. BUN. d. vital capacity.

a. AST and ALT levels. AST and ALT are liver enzymes and indi- cate liver functioning. Because hepatitis and other liver problems frequently are adverse effects of INH, these enzymes should be monitored closely. Creatinine clearance and BUN indicate renal func- tion and are not a major concern with INH. Vital capacity is not altered by INH.

INH crosses (select all that apply): a. BBB b. Renal function c. Liver metabolism d. Placenta e. Breast milk

a. BBB c. Liver metabolism d. Placenta e. Breast milk

Select all of the adverse effects of ethambutol: a. Hepatotoxicity b. Decreased urine output c. Muscle weakness d. Blood dyscrasias e. Tachypnea

a. Hepatotoxicity d. Blood dyscrasias

When talking to a group of homeless women living in a shelter, the nurse should educate about risk for developing tuberculosis. The nurse should emphasize which lab/diagnostic test as considered to be the "gold" standard for diagnosing tuberculosis? a. Sputum or bronchial cultures b. CD4+ T-cell serum levels c. Computed tomography (CT) of the chest d. Complete blood count (CBC)

a. Sputum or bronchial cultures A definitive diagnosis of active pulmonary tuberculosis requires identification of the organism from cultures or DNA amplification techniques. CT scans help determine the extent of lung involvement. CBC and CD4+ T-cell testing will show extent of body's response to the infection and if antigens are activate

Ethambutol a. impairs cell membrane b. inhibits protein synthesis c. inhibits DNA replication

a. impairs cell membrane

A middle-aged woman with a complex social and medical history has begun multidrug treatment for TB. Which of the nurse's following assessment questions is most therapeutic? a) "Have you given any thought to the choices you made that resulted in your getting tuberculosis?" b) "What kinds of routines would work best for you to make sure that you don't miss any doses of your rifampin?" c) "What can we do to help you stop smoking?" d) "What do your friends and family think about the fact that you're getting treated for TB?"

b) "What kinds of routines would work best for you to make sure that you don't miss any doses of your rifampin?"

Older adults are very susceptible to pneumonia in all its varieties. The symptoms that older adults exhibit can be very different than those of other age groups who have pneumonia. What signs and symptoms are older adults with pneumonia less likely to experience than people with pneumonia in other age groups? a. Deterioration in mental status b. Marked elevation in temperature c. Pleuritic pain d. Loss of appetite

b. Marked elevation in temperature Pleuritic pain, a sharp pain that is more severe with respiratory movements, is common. With antibiotic therapy, fever usually subsides in approximately 48 to 72 hours, and recovery is uneventful. Older adults are less likely to experience marked elevations in temperature; in these persons, the only sign of pneumonia may be a loss of appetite and deterioration in mental status.

Isoniazid (INH) works by a. inhibiting protein synthesis. b. inhibiting synthesis of the bacterial cell wall. c. disrupting the change of RNA to DNA. d. interfering with folic acid synthesis.

b. inhibiting synthesis of the bacterial cell wall.

A client diagnosis with tuberculosis asks the nurse how long the antitubercular medication will need to be taken. What is the best response? a. "You will be on multiple drug therapy for the rest of your life." b. "Drug therapy will continue unless a drug resistance develops." c. "You can expect to take multiple drugs possibly for as long as 24 months or until all tubercle bacilli are eliminated." d. "Drug therapy will continue until all symptoms of tuberculosis have stopped."

c. "You can expect to take multiple drugs possibly for as long as 24 months or until all tubercle bacilli are eliminated." The goal of treatment is to eliminate all tubercle bacilli from an infected person while avoiding emergence of significant drug resistance. Treatment of active tuberculosis requires the use of multiple drugs. Tuberculosis is an unusual disease in that drug therapy is required for a relatively long period.

Your 51-year-old patient has recently been exposed to TB. The patient had a negative TB skin test 6 months ago; however, the current test is positive. Which of the following inter- ventions should be done while this patient receives INH prophylaxis? a. Baseline CBC and repeat CBC every 6 months b. Baseline renal function tests and repeat test every 3 months c. Baseline hepatic function test and repeat test every month d. Baseline pyridoxine level and repeat test every 6 months

c. Baseline hepatic function test and repeat test every month INH is the drug used for TB exposure pro- phylaxis. This drug requires monitoring liver function tests, especially in patients over the age of 35.

Which of the following statements concerning INH is correct? a. INH has very few drug-drug interactions, but the few are very significant. b. INH has very few drug-drug interactions, and they are very insignificant. c. INH has many drug-drug interactions, and most are very significant. d. I NH has many drug-drug interactions, but they are very insignificant.

c. INH has many drug-drug interactions, and most are very significant. INH interacts with a variety of drugs, including anti-seizure drugs, aluminum based antacids, benzodiazepines, disulfiram, enflurane, ketoconazole, meperidine, oral anticoagulants, and rifampin.

A major concern among public health authorities is an increase in drug-resistant tuberculosis (TB) infections. What new evidence suggests a possible cause for this resistant tendency? a. Client adherence is the primary cause of drug-resistant TB infections. b. The clear majority of TB infections are now drug-resistant. c. Many drug-resistant infections are new infections, especially in those who are immunosuppressed. d. Only drug-resistant strains are actively infecting clients.

c. Many drug-resistant infections are new infections, especially in those who are immunosuppressed.

A 32-year-old client has had a positive reaction to a tuberculin skin test and the duration of exposure is unknown. What education about medications will the nurse provide to the client? a. The client will be required to take antibiotics for a minimum of 10 days. b. The client will be instructed to take ethambutol and pyrazinamide and be informed of the side effects. c. The client will need education about the administration of isoniazid and the importance of taking it as prescribed. d. The client should be instructed that the urine will turn orange, as well as the tears.

c. The client will need education about the administration of isoniazid and the importance of taking it as prescribed. People who are 35 years of age or younger with a positive reaction of unknown duration are considered to harbor a small number of microorganisms and usually are treated with isoniazid. It is important to inform the client that they should take the medication as directed and not skip doses or stop the medication without discussing it with the physician. The client will not be required to take a short course (10 days) of antibiotics. The urine and tears turn orange when taking rifampin. This does not occur when taking isoniazid.

A client calls the health care provider's office and frantically tells the nurse his TB test is red, and he is afraid this means he has tuberculosis. The best response by the nurse would be: a. "This result definitely confirms the diagnosis; we will begin treatment now." b. "Have you eaten anything unusual to cause this reaction?" c. "Wait until tomorrow to see if things change." d. "A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques."

d. A definitive diagnosis of active pulmonary tuberculosis requires cultures or DNA amplification techniques." A definitive diagnosis of active pulmonary tuberculosis requires identification of the organism from cultures or DNA amplification techniques. Culture remains the gold standard for laboratory confirmation of infection and is required for drug sensitivity testing. The local reaction is not influenced by food consumption.

Patient education about INH should include limiting the intake of which of the following? a. Avocados b. Chocolate c. Tuna fish d. All of the above e. None of the above

d. All of the above Avocados and chocolate are high in tyramine and may cause hypertension. Tuna fish is high in histamine and may cause headache, palpitations, hypotension, or other reactions.

INH administration a. oral b. IM c. IV d. a and b only

d. a and b only

1. You are caring for a patient who has active TB. He is prescribed isoniazid, rifampin, and ethambutol. He protests at taking so many medicines. Your best action would be to a. rotate the drugs, offering one each day. b. administer only the isoniazid and mark the others as "refused." c. force him to take all three drugs. d. explain the rationale for triple-drug therapy.

d. explain the rationale for triple-drug therapy. Triple-drug therapy is the standard for TB treatment, because the TB bacillus can easily become resistant to one drug. Thus, using multiple drugs helps to eradicate the disease and prevent relapse with strains of bacteria that are resistant to common antitubercular drugs. Infor- mation about the reason behind therapy and the importance of multidrug therapy should help to gain patient acceptance toward therapy. Because of the concerns about multidrug-resistant TB, you should never administer the drugs sporadically or give only one of the ordered drugs. You cannot force the patient to take ordered drug therapy because patients have the right to refuse therapy.

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? 1 Absence of fever 2 Increased urine output 3Tingling of extremities / numbness and tingling in his feet 4 Decreased sputum production

numbness and tingling in his feet The nurse should immediately report to the primary health care provider any adverse changes in the patient's health status during drug therapy. These changes include numbness or a tingling sensation in the extremities, which indicates a potential central nervous system complication such as peripheral neuropathy. Absence of fever indicates the patient's adherence to drug therapy. It is not mandatory to report to the primary health care provider.

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