Ch 10: antitubercular drugs
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? 1) "Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur." 2) "Take the medication with a full glass of water to prevent the mouth from becoming dry during therapy." 3) "Avoid excessive caffeine intake because this could increase the side effects of the medication." 4) "Make sure to limit your protein intake, as increased protein delays absorption of the medication."
"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur." Explanation: Because INH has some monoamine oxidase inhibitor activity, interactions may occur with tyramine-containing foods. INH may also interact with foods containing histamine. Clients should refrain from excessive intake of foods rich in tyramine, which include cheese and dairy products, beef or chicken liver, beer and ale, red wine, avocados, bananas, figs, raisins, caffeine, and chocolates. Because most people consume these food items, the diet is difficult to maintain.
A client diagnosed with tuberculosis (TB) has begun multidrug 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? 1) "Multiple drugs are used to speed up the course of treatment." 2) "Multiple drugs are used because health care providers aren't sure which drug will kill a particular TB strain." 3) "Multiple drugs are prescribed because the final testing results for TB can take up to 3 months." 4) "The use of multiple drugs prevents the development of drug-resistant TB."
"The use of multiple drugs prevents the development of drug-resistant TB." Explanation: 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 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? 1) "Oh, please don't worry. Your health care provider will explain everything to you." 2) "You will take one drug for 1 month." 3) "You will have multidrug therapy for 6 to 24 months." 4) "We will discuss this when you are calmer."
"You will have multidrug therapy for 6 to 24 months." Explanation: The nurse should tell the client that drug therapy for TB is based on the susceptibility of the infecting organism and the immunocompetence of the person affected. Usually clients with active or reactivated TB require multidrug therapy for 6 to 24 months. Telling the client not to worry and that the client needs to be calmer when discussing therapy are not therapeutic and minimize the client's concerns.
A client is to receive rifampin. Which would be most important for the nurse to include in the teaching plan for this client? 1) "The drug can cause an allergic reaction." 2) "Your urine or sweat may become orange in color." 3) "Call your health care provider if you experience headache or dizziness." 4) "You might experience some nausea or stomach upset."
"Your urine or sweat may become orange in color." Explanation: This drug causes body fluids to turn orange. The client needs to be informed of this to avoid being frightened when it occurs. Any drug can cause a hypersensitivity reaction. Although this information is important, it is not the priority. GI adverse effects are common. Although this instruction would be important, it would not be the priority. Headache and dizziness are common CNS effects of the drug that do not need to be reported.
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. 1) 2 2) 3 3) 4 4) 1
3 Explanation: Required dosage is 2 tablets of 150 mg, meaning that the client needs to take in 300 mg of isoniazid daily. Available tablet contains 100 mg of the drug. Therefore, 3 tablets (100*3) of isoniazid need to be administered daily.
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? 1) Adverse effect of rifampin 2) Interaction between INH and rifampin 3) Adverse effect of INH 4) Hematuria
Adverse effect of rifampin Explanation: Rifampin causes a harmless red-orange discoloration of urine, tears, saliva, and other body secretions.
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? 1) A cancer client 2) A new mother who is nursing 3) An HIV-positive client 4) An obese 45-year-old man
An HIV-positive client Explanation: The nurse should pay special attention to the HIV-positive client because this client will require rifampin therapy for a longer period of time than the other clients. An HIV-positive person is immunocompromised, and it will take longer to fight the infection. This could increase the difficulty of adherence to the drug regimen. In addition, many of the drugs used to treat HIV are contraindicated in clients who take rifampin. Rifampin can be safely administered to nursing mothers, those with cancer, and people over 65 given certain conditions. However, their therapy should not be longer than normally required unless complications occur.
A 20-year-old female is being treated with rifampin and INH. The nurse is teaching the client about birth control recommendations while on these medications. What method would the nurse recommend? 1) Depo-Provera injections 2) The use of condoms 3) Oral contraceptives and condoms concurrently 4) Any of the above
Any of the above Explanation: Since rifampin decreases the effectiveness of oral contraceptives, a different type of contraception should be used during therapy.
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? 1) Red blood cells and white blood cells 2) BUN and creatinine 3) Sodium and potassium 4) Amylase and lipase
BUN and creatinine Explanation: Streptomycin can cause nephrotoxicity. The nurse would be monitoring the BUN and creatinine levels. Amylase and lipase are related to liver function. Streptomycin does not affect the electrolytes or blood cell counts.
A nurse is providing education to a client who is taking INH. The nurse is teaching the client to avoid which foods? 1) Potatoes and root vegetables 2) Cheese, dairy products, and bananas 3) Citrus fruits 4) Chicken and fish
Cheese, dairy products, and bananas Explanation: Clients who take INH should avoid eating tyramine, histamine-rich foods, and foods containing caffeine. Also, the client should be told to avoid consuming alcohol on a daily basis. Cheese, dairy products, chicken liver, beer, ale, bananas, and figs are rich in tyramine. Tuna, brine, and yeast extracts are rich in histamine. Clients need not refrain from eating potatoes, root vegetables, chicken, fish, or citrus fruits.
The nurse is teaching a client taking isoniazid. The client also suffers from occasional acid reflux. What should the nurse teach this client about? 1) Decreased effectiveness of the antacids 2) Increased effectiveness of antacids 3) Decreased absorption of isoniazid 4) Increased absorption of isoniazid
Decreased absorption of isoniazid Explanation: When isoniazid and antacids interact, there is reduced absorption of isoniazid. The effectiveness of the antacid is not affected.
The nurse is caring for a client receiving an antimycobacterial who reports dizziness, headache, and drowsiness. What nursing diagnosis is most likely to relate to this client's adverse drug effects? 1) Disturbed sensory perception (kinesthetic) related to central nervous system (CNS) effects of the drug 2) Deficient knowledge regarding drug therapy 3) Acute pain related to gastrointestinal (GI) effects of the drug 4) Imbalanced nutrition: less than body requirements
Disturbed sensory perception (kinesthetic) related to central nervous system (CNS) effects of the drug Explanation: The priority concern for this client right now is the disturbed sensory perception related to the CNS effects of the drug. Acute pain could also be used but it would be related to CNS effects, not GI effects. There is no indication of imbalanced nutrition or deficient knowledge in the question.
The nurse is caring for a client receiving an antimycobacterial who reports dizziness, headache, and drowsiness. What nursing diagnosis is most likely to relate to this client's adverse drug effects? 1) Imbalanced nutrition: less than body requirements 2) Disturbed sensory perception (kinesthetic) related to central nervous system (CNS) effects of the drug 3) Deficient knowledge regarding drug therapy 4) Acute pain related to gastrointestinal (GI) effects of the drug
Disturbed sensory perception (kinesthetic) related to central nervous system (CNS) effects of the drug Explanation: The priority concern for this client right now is the disturbed sensory perception related to the CNS effects of the drug. Acute pain could also be used but it would be related to CNS effects, not GI effects. There is no indication of imbalanced nutrition or deficient knowledge in the question.
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? 1) Human immunodeficiency virus 2) Methicillin-resistant Staphylococcus aureus 3) Vancomycin-resistant Staphylococcus aureus 4) Drug-resistant tuberculosis
Drug-resistant tuberculosis Explanation: A client who is being treated with antitubercular drug therapy and is not responding to the medication regime 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 client response. The scenario does not identify methicillin-resistant or vancomycin-resistant Staphylococcus aureus.
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? 1) Methicillin-resistant Staphylococcus aureus 2) Human immunodeficiency virus 3) Drug-resistant tuberculosis 4) Vancomycin-resistant Staphylococcus aureus
Drug-resistant tuberculosis Explanation: A client who is being treated with antitubercular drug therapy and is not responding to the medication regime 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 client response. The scenario does not identify methicillin-resistant or vancomycin-resistant Staphylococcus aureus.
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? 1) INH, rifampin, streptomycin, ethambutol 2) INH, rifampin, pyrazinamide, ethambutol 3) INH, streptomycin, pyrazinamide 4) INH, streptomycin, and rifampin
INH, rifampin, pyrazinamide, ethambutol Explanation: The initial phase of treatment for TB involves using the following drugs: isoniazid, rifampin, pyrazinamide, and ethambutol.
A client diagnosed with tuberculosis was prescribed antitubercular therapy but stopped after 1 month because of difficulty with the medication scheduling. As a result, secondary drugs are being prescribed. Which nursing diagnosis would the nurse identify? 1) Ineffective Self-Health Management 2) Impaired Comfort 3) Ineffective Coping 4) Imbalanced Nutrition: Less Than Body Requirements
Ineffective Self-Health Management Explanation: Difficulties with scheduling most likely led to the client not adhering to the treatment plan. As a result, the nursing diagnosis of Ineffective Self-Health Management would be most appropriate. Although nutrition can be affected, there is no indication that this is the problem. Although the client may have difficulty coping with the disease, there is no indication that this is a problem. The client may experience discomfort related to the adverse effects of the drug; however, there is no indication that this is an issue.
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? 1) Jaundice 2) Joint pain 3) Insomnia 4) Myalgia
Jaundice Explanation: Jaundice is an adverse reaction related to isoniazid therapy. Insomnia, joint pain, and myalgia are not related to isoniazid therapy.
The nurse knows that tuberculosis (TB) is an infectious disease seen around the world and in many cases due to overcrowding. The nurse would be aware of this condition if the lab reports showed which bacteria? 1) Escherichia coli 2) Mycobacterium tuberculosis 3) Staphylococcus aureus 4) Clostridium difficile
Mycobacterium tuberculosis Explanation: TB is an infectious disease caused by the Mycobacterium tuberculosis bacterium. The pathogen is also referred to as the tubercle bacillus.
The nurse knows that tuberculosis (TB) is an infectious disease seen around the world and in many cases due to overcrowding. The nurse would be aware of this condition if the lab reports showed which bacteria? 1) Mycobacterium tuberculosis 2) Clostridium difficile 3) Staphylococcus aureus 4) Escherichia coli
Mycobacterium tuberculosis Explanation: TB is an infectious disease caused by the Mycobacterium tuberculosis bacterium. The pathogen is also referred to as the tubercle bacillus.
The nurse understands that which is the highest priority when teaching about antitubercular medications? 1) Staying hydrated 2) Monitoring sputum 3) Eating a well balanced diet 4) Taking medications as prescribed
Taking medications as prescribed Explanation: For medications to be effective, it is most important that the nurse reinforce to the client that medications should be taken as prescribed and there should be no missed doses. Eating a well balanced diet, keeping hydrated and monitoring sputum are not medication priorities.
A nurse is assigned to care for a client with tuberculosis who has been prescribed rifampin. What should the nurse confirm to be sure that rifampin is not contraindicated in the client? 1) The client does not have diabetes mellitus. 2) The client does not have renal impairment. 3) The client does not have severe hepatic damage. 4) The client does not have acute gout.
The client does not have renal impairment. Explanation: The nurse should ensure that the client does not have renal impairment because rifampin is contraindicated in clients with this condition. Pyrazinamide and not rifampin is contraindicated in clients with severe hepatic damage, diabetes mellitus, and acute gout.
While discussing tuberculosis, the nursing instructor explains that treatment is typically divided into two phases. What is the second phase called? 1) The eradication phase 2) The intensive phase 3) The continuation phase 4) The management phase
The continuation phase Explanation: The most commonly used regimen for treatment of TB is divided into two phases: an initial 2-month phase consisting of daily administration of isoniazid (INH), rifampin, and pyrazinamide; and a 4-month continuation phase in which INH and rifampin are administered intermittently.
A client is prescribed rifampin. What information should the nurse include in the client's medication education? 1) It decreases hepatic enzymes and decreases metabolism of drugs. 2) When taking it with warfarin, an increased anticoagulant effect occurs. 3) The urine, tears, sweat, and other body fluids will be a discolored red-orange. 4) It has an increased serum half-life, so it is more effective than rifabutin.
The urine, tears, sweat, and other body fluids will be a discolored red-orange. Explanation: The client's urine, tears, sweat, and other body fluids will be a discolored red-orange. This adverse effect is harmless, but the client should be instructed on this adverse effect. The administration of this medication with warfarin will decrease the anticoagulant effect. The medication increases hepatic cytochrome P-450 3A4 enzyme and decreases serum concentrations. The serum half-life of rifampin is shorter than that of the medication rifabutin.
A client is prescribed rifampin. What information should the nurse include in the client's medication education? 1) When taking it with warfarin, an increased anticoagulant effect occurs. 2) The urine, tears, sweat, and other body fluids will be a discolored red-orange. 3) It has an increased serum half-life, so it is more effective than rifabutin. 4) It decreases hepatic enzymes and decreases metabolism of drugs.
The urine, tears, sweat, and other body fluids will be a discolored red-orange. Explanation: The client's urine, tears, sweat, and other body fluids will be a discolored red-orange. This adverse effect is harmless, but the client should be instructed on this adverse effect. The administration of this medication with warfarin will decrease the anticoagulant effect. The medication increases hepatic cytochrome P-450 3A4 enzyme and decreases serum concentrations. The serum half-life of rifampin is shorter than that of the medication rifabutin.
The nurse explains that prophylactic antitubercular therapy is suggested for which people? 1) Those who have been in close contact with a person with tuberculosis (TB) 2) Clients whose tuberculin skin test has become positive in the last three years 3) All clients older than 35 years of age with a positive skin test 4) Health care professionals employed in health institutions
Those who have been in close contact with a person with tuberculosis (TB) Explanation: Prophylactic antitubercular therapy is suggested for people who have been in close contact with a person with tuberculosis; clients whose tuberculin skin test has become positive in the last two years; and all clients younger than 35 years of age with a positive skin test.
The nurse is providing health education to a client prescribed isoniazid. What should the nurse instruct the client to avoid? 1) foods containing purine 2) dairy products 3) direct sunlight 4) alcohol
alcohol Explanation: Alcohol increases the risk of hepatotoxicity with isoniazid even if alcohol use is stopped during therapy. There is no therapeutic reason for clients taking isoniazid to avoid sunlight, dairy products, or purine.
After teaching a group of students about antitubercular therapy, the instructor determines that additional teaching is needed when the students identify which drug as an antitubercular agent? 1) isoniazid 2) rifampin 3) ethambutol 4) dapsone
dapsone Explanation: Dapsone is used to treat leprosy. Rifampin, isoniazid, and ethambutol are antitubercular drugs.
The nurse understands that tuberculosis (TB) can affect other organs of the body. The term used for TB outside the lungs called which? 1) interstitial. 2) extrapulmonary. 3) metastasized. 4) encapsulated.
extrapulmonary Explanation: The term used for TB outside the lungs is extrapulmonary. Interstitial means inside space between cells. Metastasized means that an initial tumor or growth has spread from another site such as in cancer but the cell type remains the same as the original organ upon biopsy. Encapsulated means that the cancer has not spread.
When administering a secondary drug to a person with tuberculosis (TB), the nurse is treating which type of TB? 1) TB with metastasis 2) TB of the lungs 3) extrapulmonary TB 4) TB in the interstitial spaces
extrapulmonary TB Explanation: TB is treated with a combination of drugs. Secondary drugs are used to treat extrapulmonary TB or drug-resistant microorganisms. TB does not metastasize as TB is caused by bacteria, not proliferation of cells. TB is not in the interstitial spaces as this is the space between cells.
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? 1) hepatotoxicity 2) myalgia 3) rashes 4) diarrhea
hepatotoxicity Explanation: Some generalized reactions to pyrazinamide are nausea and vomiting, diarrhea, myalgia, and rashes. The most severe adverse reaction with pyrazinamide is hepatotoxicity.
When a person is diagnosed with tuberculosis, the nurse prepares the family members to be treated prophylactically with which drug? 1) pyrazinamide 2) isoniazid 3) ethambutol 4) rifampin
isoniazid Explanation: When a person is diagnosed with tuberculosis, family members may be treated prophylactically with isoniazid. Drugs used to treat the client with TB are ethambutol, pyrazinamide, and rifampin.
The nurse is assessing a client who has been prescribed treatment with isoniazid. What assessment finding would most likely necessitate contacting the health care provider to recommend discontinuing treatment? 1) jaundice 2) persistent nausea 3) alopecia 4) pruritus
jaundice Explanation: Jaundice is a clear indication of hepatotoxicity and would most likely warrant discontinuing treatment with isoniazid. Nausea would not likely prompt any change in treatment. Pruritus may be associated with liver damage but may also have other potential causes. Alopecia does not typically accompany isoniazid therapy.
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? 1) vertigo 2) epigastric distress 3) hypersensitivity 4) optic neuritis
optic neuritis Explanation: The nurse should assess for optic neuritis as it is one of the more severe reactions of ethambutol. Hypersensitivity and epigastric distress are adverse reactions associated with isoniazid. Vertigo is an adverse reaction of rifampin.
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? 1) antibacterial and antifungal 2) primary and tertiary 3) first and second generation 4) primary and secondary
primary and secondary Explanation: When classifying antitubercular drugs there are primary (first-line) and secondary (second-line) drugs. Primary drugs provide the foundation for treatment. Secondary drugs are less effective and more toxic than primary drugs. First- and second-generation drugs are two types of cephalosporins. Primary and tertiary refers to types of care. Antibacterial and antifungal also are not correct.
A male client who has been on a drug regimen for tuberculosis (TB) for the last 2 months says he has lost his appetite and 10 pounds. What should the nurse suggest to the health care provider for this client to help in the area of nutrition? 1) pyrazinamide 2) pyridium 3) rifampin 4) pyridoxine
pyridoxine Explanation: Frequently the inclusion of pyridoxine (Vitamin B6) is recommended for clients with TB to promote nutrition and prevent neuropathy. Rifampin and pyrazinamide are antitubercular drugs; pyridium is a drug used as a urinary tract analgesic.
A client with a diagnosis of rhinosinusitis has been prescribed ciprofloxacin 250 mg SC b.i.d. When contacting the prescriber, the nurse should question the: 1) choice of drug. 2) route. 3) dose. 4) frequency.
route. Explanation: Recommended parameters for ciprofloxacin are 100-500 mg b.i.d. PO for up to 6 weeks. As a result, the nurse should have the provider confirm the correct route.
The nurse is providing medication education to a client diagnosed with latent tuberculosis (TB). What reason should the nurse provide to stress the importance of receiving aggressive drug therapy? 1) to prevent progression of the disease to the active state 2) to prevent spread of the disease to uninfected persons 3) to minimize the disease's effect on the client's kidneys and liver 4) to lessen the chance of the client converting to a drug-resistant form of TB
to prevent progression of the disease to the active state Explanation: People with inactive or latent TB infection do not spread TB to others but active TB can develop years later if the latent infection is not effectively treated. By treating latent TB effectively, the disease will have no effect on liver and renal function. Inappropriate or ineffective drug treatment is the major cause of the development of drug-resistant TB; effective treatment will not eliminate the infection's health threat nor prevent development of the disease's drug-resistant form.
