NSG 210 Antitubercular drugs, Cystic Fibrosis drugs - exam 2

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? A) Hypercalcemia B) Peripheral neuritis C) Small blood vessel spasm D) Impaired peripheral circulation

Answer - B Rationale:Isoniazid is an antitubercular medication. A common side effect of isoniazid is peripheral neuritis, manifested by numbness, tingling, and paresthesias in the extremities. This can be minimized with pyridoxine (vitamin B6) intake. Options 1, 3, and 4 are not associated with the information in the question.

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. The nurse should monitor for which side and adverse effects of rifabutin? Select all that apply. A) Signs of hepatitis B) Flu-like syndrome C) Low neutrophil count D) Vitamin B6 deficiency E) Ocular pain or blurred vision F) Tingling and numbness of the fingers

Answer- A, B, C, E Rationale: Rifabutin may be prescribed for a client with active MAC disease and tuberculosis. It inhibits mycobacterial DNA-dependent RNA polymerase and suppresses protein synthesis. Side and adverse effects include rash, gastrointestinal disturbances, neutropenia (low neutrophil count), red-orange-colored body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea, and flu-like syndrome. Vitamin B6 deficiency and numbness and tingling in the extremities are associated with the use of isoniazid.

The mother of a child with cystic fibrosis (CF) asks the clinic nurse about the disease. What should the nurse tell the mother about CF? A) Transmitted as an autosomal dominant trait B) A chronic multisystem disorder affecting the exocrine glands C) A disease that causes the formation of multiple cysts in the lungs D) A disease that causes dilation of the passageways of many organs

Answer- B Rationale:CF is a chronic multisystem disorder that affects the exocrine glands. The mucus produced by these glands (particularly those of the bronchioles, small intestine, and pancreatic and bile ducts) is abnormally thick, causing obstruction of the small passageways of these organs. It is transmitted as an autosomal recessive trait. It does not cause the formation of multiple cysts in the lungs. Options 1, 3, and 4 are incorrect.

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? A) Use alcohol in small amounts only. B) Report yellow eyes or skin immediately. C) Increase intake of Swiss or aged cheeses. D) Avoid vitamin supplements during therapy.

Answer- B Rationale:Isoniazid is hepatotoxic, and therefore the client is taught to report signs and symptoms of hepatitis immediately, which include yellow skin and 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 may cause a reaction characterized by redness and itching of the skin, flushing, sweating, tachycardia, headache, or lightheadedness. The client can avoid developing peripheral neuritis by increasing the intake of pyridoxine (vitamin B6) during the course of isoniazid therapy.

A sweat test is performed on an infant with a suspected diagnosis of cystic fibrosis (CF). The nurse reviews the results of the test and notes that the chloride level is 40 mEq/L (40 mmol/L). How should the nurse interpret this finding? A) A negative test B) A positive test C) Suggestive of CF D) An unrelated finding

Answer- C Rationale:In a sweat test, sweating on the infant's forearm is stimulated with pilocarpine, the sample is collected on absorbent material, and the amount of sweat chloride is measured. A chloride level higher than 60 mEq/L (60 mmol/L) is considered to be a positive test result. A sweat chloride level lower than 40 mEq/L (40 mmol/L) is considered normal. A sweat chloride level higher than or equal to 40 mEq/L (40 mmol/L) is suggestive of CF and requires a repeat test. Options 1, 2, and 4 are incorrect interpretations of the test results.

A client with tuberculosis is starting antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? A) Electrolyte levels B) Coagulation times C) Liver enzyme levels D) Serum creatinine level

Answer- C Rationale: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 monitored longer in the client who is older than 50 years or abuses alcohol. The laboratory tests in options 1, 2, and 4 are not necessary.

A client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? A) Weight loss B) Relief of heartburn C) Reduction of steatorrhea D) Absence of abdominal pain

Answer- C Rationale:Pancrelipase is a pancreatic enzyme used in clients with pancreatitis as a digestive aid. The medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. It is not used to treat abdominal pain or heartburn. Its use could result in weight gain but should not result in weight loss if it is aiding in digestion.

A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication? A) Should always be taken with food or antacids B) Should be double-dosed if 1 dose is forgotten C) Causes orange discoloration of sweat, tears, urine, and feces D) May be discontinued independently if symptoms are gone in 3 months

Answer- C Rationale:Rifampin causes orange-red discoloration of body secretions and will stain soft contact lenses 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 primary health care provider. It is best to administer the medication on an empty stomach unless it causes gastrointestinal upset, and then it may be taken with food. Antacids, if prescribed, should be taken at least 1 hour before the medication.

A client diagnosed with active tuberculosis has been prescribed a combination of isoniazid and rifampin for treatment. The nurse teaches the client to perform which action? A) Report any change in urine color. B) Take both medications with food. C) Take both medications together once a day. D) Expect to take the medications for 2 to 3 weeks.

Answer- C Rationale:Rifampin in combination with isoniazid prevents the emergence of medication-resistant organisms. This combination, taken together daily, eliminates the tubercle bacilli from the sputum and improves clinical status. Rifampin produces a harmless red-orange color in all body fluids and should be taken along with the isoniazid 1 hour before or 2 hours after eating to maximize absorption. The treatment regimen is maintained for at least 6 months for effectiveness, and the therapeutic effect may be evident in 2 to 3 weeks.

Breathing exercises and postural drainage are prescribed for a hospitalized child with cystic fibrosis. What instruction should the nurse include in the client's teaching plan? A) Schedule the procedures so they are 4 hours apart. B) Perform the breathing exercises and then the postural drainage. C) Perform the postural drainage first and then the breathing exercises. D) Perform postural drainage in the morning and breathing exercises in the evening.

Answer- C Rationale:Breathing exercises are recommended for a majority of children with cystic fibrosis (CF), even those with minimal pulmonary involvement. The exercises usually are performed twice daily, and they are preceded by postural drainage. The postural drainage will mobilize secretions, and the breathing exercises will then assist with expectoration. Exercises to assist in assuming correct postures and in maximizing thoracic mobility, such as swinging the arms and bending and twisting the trunk, are included. The ultimate aim of these exercises is to establish a good habitual breathing pattern.

A client with a documented exposure to tuberculosis is on medication therapy with isoniazid. The nurse is monitoring laboratory results and determines that which laboratory value indicates the need for follow-up? A) Platelet count 325,000 mm3 (325 × 109/L) B) Serum creatinine 1.0 mg/dL (88.3 mcmol/L) C) Blood urea nitrogen (BUN) 20 mg/dL (7.1 mmol/L) D) Aspartate aminotransferase (AST) 55 U/L (55 U/L)

Answer- D Rationale: Because isoniazid therapy can cause elevated hepatic enzymes and hepatitis, liver enzymes are monitored when therapy is initiated and during the first 3 months of therapy. They may be monitored longer in the client who is older than 50 years of age or who abuses alcohol. The normal AST level is 0 to 35 U/L (0 to 30 U/L). The other options are not monitored routinely and are also normal.

The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the parent? A) "The immunization schedule will need to be altered." B) "The child should not receive any hepatitis vaccines." C) "The child will receive all of the immunizations except for the polio series." D) "The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination."

Answer- D Rationale: Cystic fibrosis is a chronic multisystem disorder (autosomal recessive trait disorder) characterized by exocrine gland dysfunction. The mucus produced by the exocrine glands is abnormally thick, tenacious, and copious, causing obstruction of the small passageways of the affected organs, particularly in the respiratory, gastrointestinal, and reproductive systems. Adequately protecting children with cystic fibrosis from communicable diseases by immunization is essential. In addition to the basic series of immunizations, a yearly influenza immunization is recommended for children with cystic fibrosis. Options 1, 2, and 3 are incorrect.

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that they will immediately report which finding? A) Impaired sense of hearing B) Gastrointestinal side effects C) Orange-red discoloration of body secretions D) Difficulty in discriminating the color red from green

Answer- D Rationale: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 also is taught to take the medication with food if gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs with rifampin.

A client has been taking pyrazinamide for 6 months. The nurse determines that the medication is effective if which cultures yield a negative result? A) Urine B) Blood C) Wound D) Sputum

Answer- D Rationale:Pyrazinamide is an antituberculosis medication that is given in conjunction with other antituberculosis medications. Its use may be discontinued by the prescriber if sputum cultures become negative. The remaining options are incorrect.

Isoniazid is prescribed for a child with human immunodeficiency virus (HIV) infection who has a positive tuberculin skin test result. The mother of the child asks the nurse how long the child will need to take the medication. For how long should the nurse tell the mother the medication will need to be taken? A) 4 months B) 6 months C) 9 months D) 12 months

Answer- D Rationale:For children with HIV infection who demonstrate a positive tuberculin skin test result, a minimum of 12 months of treatment with isoniazid is recommended.

A clinic nurse is assessing a client who has been on isoniazid for 6 months. Which client complaint should most concern the nurse? A) Dry mouth B) Cramping diarrhea C) Frequent headaches D) Difficulty tying shoes

Answer- D Rationale:The client complaint that should most concern the nurse is difficulty tying shoes because this may indicate neuropathy. Dose-related peripheral neuropathy is one of the more common adverse effects of isoniazid. Dry mouth, cramping diarrhea, and frequent headaches are not concerns with administration of this medication.