Chapter 41: Antitubercular Drugs Multiple Choice

During antitubercular therapy with isoniazid, a patient received another prescription for pyridoxine. Which statement by the nurse best explains the rationale for this second medication? A. "This vitamin will help to improve your energy levels." B. "This vitamin helps to prevent neurologic adverse effects." C. "This vitamin works to prtect your heart from toxic effects." D. " This vitamin helps to reduce gastrointestinal adverse effects."

b

The nurse should include which information in the teaching plan for a patient who is taking isoniazid (INH)? a. Urine and saliva may be reddish-orange. b. Pyridoxine (vitamin B6) should be added to the regimen. c. Injection sites should be rotated daily. d. The medication should be taken with an antacid to reduce gastric distress.

b

The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity include: (Select all that apply) A. Orange discoloration of sweat and tears B. Darkened urine C. Dizziness D. Fatigue E. Visual disturbances F. Jaundice

b d f

A patient newly diagnosed with tuberculosis asks the nurse how long he will need to take "all this medicine." The nurse replies that drug therapy for active tuberculosis may need to last how long? a. 6 months b. 12 months c. 24 months d. A lifetime

c

The nurse is teaching a patient who is staring antitubercular therapy with rifampin. Which adverse effects would the nurse expect to see? A. Headache and neck pain B. Gynecomastia C. Reddish brown urine D. Numbness or tingling of extremities

c

The nurse would correctly identify the method of action of isoniazid (INH) as which of the following? a. Inhibiting protein synthesis b. Inhibiting mycobacterial ATP synthase c. Altering cell wall synthesis d. Unknown method of action

c

When counseling a patient who has been newly diagnosed with TB, the nurse will make sure that the patient realizes that he or she is contagious: A. During all phases of the illness. B. Any time up to 18 months after therapy begins. C. During the postictal phase of TB. D. During the initial period of the illness and its diagnosis.

d

While monitoring a patient, the nurse knows that therapeutic response to antitubercular drugs would be? A. The patient states that he or she is feeling much better. B. The patient's laboratory rest resuls show a lower white blood cell count. C. the patient reports a decrease in cough and night sweats. D. There is decrease in symptoms, along with improved chest x-ray and sputum culture results.

d

The nurse is preparing to administer morning medications to a patient who has been newly diagnosed with tuberculosis. The patient asks, "Why do I have to take so many different drugs?" Which response by the nurse is correct? a. "Your prescriber hopes that at least one of these drugs will work to fight the tuberculosis." b. "Taking multiple drugs reduces the chance that the tuberculosis will become drug resistant." c. "Using more than one drug can help to reduce side effects." d. "Using multiple drugs enhances the effect of each drug."

ANS: B The use of multiple medications reduces the possibility that the organism will become drug resistant. The other options are incorrect.

The nurse is providing patient teaching for a patient who is starting antitubercular drug therapy. Which of these statements should be included? (Select all that apply.) a. "Take the medications until the symptoms disappear." b. "Take the medications at the same time every day." c. "You will be considered contagious during most of the illness and must take precautions to avoid spreading the disease." d. "Stop taking the medications if you have severe adverse effects." e. "Avoid alcoholic beverages while on this therapy." f. "If you notice reddish-brown or reddish-orange urine, stop taking the drug and contact your doctor right away." g. "If you experience a burning or tingling in your fingers or toes, report it to your prescriber immediately." h. "Oral contraceptives may not work while you are taking these drugs, so you will have to use another form of birth control."

ANS: B, E, G, H Medications for tuberculosis must be taken on a consistent schedule to maintain blood levels. Medication therapy for tuberculosis may last up to 24 months, long after symptoms disappear, and patients are infectious during the early part of the treatment. Compliance with antitubercular drug therapy is key, so if symptoms become severe, the prescriber should be contacted for an adjustment of the drug therapy. The medication must not be stopped. Because of potential liver toxicity, patients on this drug therapy must not drink alcohol. Discoloration of the urine is an expected adverse effect, and patients need to be warned about it beforehand. Burning or tingling in the fingers or toes may indicate that peripheral neuropathy is developing, and the prescriber needs to be notified immediately. A second form of birth control must be used because antitubercular drug therapy makes oral contraceptives ineffective.

A patient who has started drug therapy for tuberculosis wants to know how long he will be on the medications. Which response by the nurse is correct? a. "Drug therapy will last until the symptoms have stopped." b. "Drug therapy will continue until the tuberculosis develops resistance." c. "You should expect to take these drugs for as long as 24 months." d. "You will be on this drug therapy for the rest of your life."

ANS: C Drug therapy commonly lasts for 24 months if consistent drug therapy has been maintained. The other options are incorrect.

When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity? a. Rifampin (Rifadin) b. Isoniazid (INH) c. Ethambutol (Myambutol) d. Streptomycin

ANS: C Ethambutol may cause a decrease in visual acuity or even blindness resulting from retrobulbar neuritis. The other options are incorrect.

A patient who has been taking isoniazid (INH) has a new prescription for pyridoxine. She is wondering why she needs this medication. The nurse explains that pyridoxine is often given concurrently with the isoniazid to prevent which condition? a. Hair loss b. Renal failure c. Peripheral neuropathy d. Heart failure

ANS: C Pyridoxine (vitamin B6) may be beneficial for isoniazid-induced peripheral neuropathy. The other options are incorrect.

The nurse is reviewing the medication administration record of a patient who is taking isoniazid (INH). Which drug or drug class has a significant drug interaction with isoniazid? a. Pyridoxine (vitamin B6) b. Penicillins c. Phenytoin (Dilantin) d. Benzodiazepines

ANS: C Taking INH with phenytoin will cause decreased metabolism of the phenytoin, leading to increased drug effects. Pyridoxine is often given with isoniazid to prevent peripheral neuropathy. The other options are incorrect.

The nurse is counseling a woman who will be starting rifampin (Rifadin) as part of antitubercular therapy. The patient is currently taking oral contraceptives. Which statement is true regarding rifampin therapy for this patient? a. Women have a high risk for thrombophlebitis while on this drug. b. A higher dose of rifampin will be necessary because of the contraceptive. c. Oral contraceptives are less effective while the patient is taking rifampin. d. The incidence of adverse effects is greater if the two drugs are taken together.

ANS: C Women taking oral contraceptives and rifampin need to be counseled about other forms of birth control because of the impaired effectiveness of the oral contraceptives during concurrent use of rifampin.

A patient has been taking antitubercular therapy for 3 months. The nurse will assess for what findings that indicate a therapeutic response to the drug therapy? a. The chronic cough is gone. b. There are two consecutive negative purified protein derivative (PPD) results over 2 months. c. There is increased tolerance to the medication therapy, and there are fewer reports of adverse effects. d. There is a decrease in symptoms of tuberculosis along with improved chest x-rays and sputum cultures.

ANS: D A therapeutic response to antitubercular therapy is manifested by a decrease in the symptoms of tuberculosis, such as cough and fever, and by weight gain. The results of laboratory studies (culture and sensitivity tests) and the chest radiographic findings will be used to confirm the clinical findings of resolution of the infection.

The nurse is discussing adverse effects of antitubercular drugs with a patient who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber? a. Gastrointestinal upset b. Headache and nervousness c. Reddish-orange urine and stool d. Numbness and tingling of extremities

ANS: D Patients on antitubercular therapy should report experiencing numbness and tingling of extremities, which may indicate peripheral neuropathy. Some drugs may color the urine, stool, and other body secretions reddish-orange, but this is not an effect that needs to be reported. Patients need to be informed of this expected effect. The other options are incorrect.

The nurse will assess the patient for which potential contraindication to antitubercular therapy? a. Glaucoma b. Anemia c. Heart failure d. Hepatic impairment

ANS: D Results of liver function studies (e.g., bilirubin level, liver enzyme levels) need to be assessed because isoniazid and rifampin may cause hepatic impairment; severe liver dysfunction is a contraindication to these drugs. In addition, the patient's history of alcohol use needs to be assessed.

A patient newly diagnosed with tuberculosis (TB) has been taking antitubercular drugs for 1 week calls the clinic and is very upset. He says, "My urine is dark orange! What's wrong with me?" Which response by the nurse is correct? a. "You will need to stop the medication, and it will go away." b. "It's possible that the TB is worse. Please come in to the clinic to be checked." c. "This is not what we usually see with these drugs. Please come in to the clinic to be checked." d. "This is an expected side effect of the medicine. Let's review what to expect."

ANS: D Rifampin, one of the first-line drugs for TB, causes a red-orange-brown discoloration of urine, tears, sweat, and sputum. Patients need to be warned about this side effect. The other options are incorrect.

The nurse is reviewing the medication list of a patient who has been newly diagnosed with tuberculosis and will be taking rifampin. Which classes of drugs, if taken with rifampin, may cause increased metabolism? (Select all that apply.) a. Beta blockers b. Proton pump inhibitors c. Selective serotonin reuptake inhibitors d. Oral anticoagulants e. Oral antidiabetic drugs

a d e

The nurse would be correct in identifying which findings as possible side effects of bedaquiline? (Select all that apply.) a. Headache b. Chest pain c. Nausea d. QT prolongation e. Paresthesias

a b c

Which teaching point is the priority when educating the patient beginning antitubercular therapy? (Select all that apply.) a. Take medications as ordered and at the same time every day. b. Take medications on an empty stomach. c. Monitor blood glucose daily. d. Increase intake of green leafy vegetables.

a b c

A patient will be receiving long-term isoniazid (INH) therapy. What laboratory tests are most important for the nurse to monitor during therapy? a. Liver enzyme levels b. Hematocrit and hemoglobin level c. Creatinine level d. Platelet count

a

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."

a

The nurse is explaining antitubercular therapy to a patient. The patient asks, "Why do I have to take so many different medications?" What is the nurse's best response? a. "It helps prevent the tuberculosis from becoming resistant to the drugs." b. "It makes sure that the disease is cured." c. "These medications will reduce symptoms immediately." d. "You will have fewer side effects."

a

The nurse would correctly identify the method of action of ethambutol as which of the following? a. Inhibiting protein synthesis b. Inhibiting mycobacterial ATP synthase c. Altering cell wall synthesis d. Unknown method of action

a