Medications Pharm Midterm (TB, Burns)
A client with tuberculosis is being started on isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? 1. Electrolyte levels 2. Coagulation times 3. Liver enzyme levels 4. Serum creatinine level
Answer: 3 Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and during the first 3 months of therapy. They may be continuously monitored longer in the client who is older than fifty years or abuses alcohol. The other laboratory tests are not necessary.
A burn client is receiving treatments of topical mafenide acetate to the site of injury. The nurse monitors the client, knowing that which finding indicates that a systemic effect has occurred? 1. Hyperventilation 2. Elevated blood pressure 3. Local rash at the burn site 4. Local pain at the burn site
Answer: 1 Mafenide acetate is a carbonic anhydrase inhibitor which can suppress renal excretion of acid, therby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication will probably be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs from burn injury.
A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? 1. Hypercalcemia 2. Peripheral Nueritis 3. Small blood vessel spasm 4. Impaired peripheral circulation
Answer: 2 Isoniazid is an anti TB medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyrodoxine (Vitamin B6) intake.
A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1. Use alcohol in small amounts only. 2. Report yellow eyes or skin immediately. 3. Increase intake of Swiss or aged cheeses. 4. Avoid vitamin supplements during therapy.
Answer: 2 Isoniazid is hepatotoxic and therefore the client is taught to report any signs and symptoms of hepatitis immediately, which include yellow skin or sclera. For the same reason, alcohol should be avoided during therapy. The client should avoid intake of Swiss cheese, fish such as tuna, and foods containing TYRAMINE because they can cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid peripheral neuritis by supplementing with vitamin B6.
A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client regarding this medication? 1. Should always be taken with food or antacids. 2. Causes orange discoloration of sweat, tears, urine, and feces. 3. Should be double dosed if 1 dose is forgotten. 4. May be discontinued independently if symptoms are gone in 3 months.
Answer: 2 Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses and clothing permanently. Rifampin should be taken exactly as directed. Doses should not be doubled or skipped. The client should not stop therapy until directed to do so by a health care provider. It is best to administer the medication on an empty stomach unless it causes GI upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least one hour before rifampin.
Silver sulfadiazine is prescribed for a client with a partial-thickness burn and the nurse provides teaching about the medication. Which statement by the client indicates a need for further teaching? 1. The medication is an antibacterial. 2. The medication will help heal the burn. 3. The medication is likely to cause stinging every time it is applied. 4. The medication should be applied directly to the wound.
Answer: 3 Silver sulfadiazine is an antibacterial that has broad spectrum activity against gram positive and gram negative bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not cause stinging when applied.
The nurse has given a client taking ethambutol information about the medication. The nurse determines the client understands the instructions if the client states that he or she will immediately report which finding? 1. Impaired sense of hearing. 2. Gastrointestinal side effects. 3. Orange discoloration of body secretions. 4. Difficulty in discriminating the color red from green.
Answer: 4 Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. This poses a potential safety hazard when a client is driving a motor vehicle. The client is taught to report this symptom immediately. The client is also taught to take the medication with food if GI upset occurs. Impaired hearing results from anti TB therapy with streptomycin. Orange-red discoloration of secretions is caused by rifampin.
Silver sulfadiazine is prescribed for a client with a burn injury. Which laboratory finding requires the need for follow up by the nurse? 1. Glucose level of 99mg/dL 2. Magnesium level of 1.5meq/L 3. Platelet level of 300,000 mm3 4. White blood cell count of 3000 mm3
Answer: 4 Silver sulfadiazine is used for the treatment of burn injuries. Adverse effects of this medication include rash and itching, blue-green discoloration, leukopenia, and interstitial nephritis. The nurse should monitor a CBC, particularly the white blood cells, frequently for the client taking this medication. If leukopenia develops, the healthcare provider is notified and the medication is usually discontinued. The other laboratory values are not specific to this medication, and are also within normal limits.