NUR 139 Review Questions: CH 41 Antitubercular Drugs
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. "It helps prevent the tuberculosis from becoming resistant to the drugs."
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. Beta blockers D. Oral Anticoagulants E. Oral antidiabetic drugs
The nurse would be correct in identifying which findings as posible side effects for bedaquiline? (Select all that apply) A. Headache B. Chest pain C. Nausea D. QT prolongation E. Paresthesias
A. Headache B. Chest pain C. Nausea
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. Inhibiting protein synthesis
A patient will be receiving long-term isoniazid (INH) therapy. What laboratory tests are more important for the nurse to monitor during therapy? A. liver enzyme levels B. Hematocrit and hemoglobin levels C. Creatinine levels D. Platelet Count
A. Liver Enzyme levels
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. Take medications as ordered and at the same time every day. B. Take medications on an empty stomach. C. Monitor blood glucose daily
A patient with TB has been taking antitubercular drugs. A sputum culture is ordered to test for acid-fast bacilli. When is the best time for the nurse to obtain the sputum culture? A.In the morning B.Noon C.1700 D.2200
ANS: A If the prescriber has ordered collection of a sputum specimen to test for acid-fast bacilli, it is best to obtain the sample early in the morning. The most common order is for three consecutive morning specimens, with a repeat specimen several weeks later.
A patient with a diagnosis of TB will be taking INH as part of the anti-TB therapy. When reviewing the patient's chart, the nurse finds documentation that the patient is a "slow acetylator." How should the nurse interpret this? A.The dosage of INH may need to be lower to prevent INH accumulation. B.The dosage of INH may need to be higher because of the slow acetylation process. C.He should not take INH. D.He will need to take a combination of anti-TB drugs for successful therapy.
ANS: A When INH is taken by slow acetylators, the INH accumulates because there are not enough liver enzymes to break down the INH. Therefore, the dosages of INH may need to be adjusted downward to prevent toxicity.
The patient's wife is taking rifampin to prevent her from developing a TB infection. Which statement by the wife indicates that further teaching is needed? A."Because my oral contraceptives will not work while I am taking rifampin, I will use another form of birth control." B."I will take the medication for 1 week and then stop." C."I will avoid prolonged exposure to the sun." D."My urine may turn a reddish color when taking rifampin."
ANS: B Antitubercular therapy is taken for long periods of time, often 24 months. Although this patient does not have an active infection at this time and is taking the rifampin to prevent an infection, the nurse should further investigate the length of time the medication is ordered. All other statements are true.
A patient has an extremely severe infection with a Mycobacterium that is resistant to all but one antitubercular drug; however, the patient has had an allergic reaction to that drug in the past. What does the nurse anticipate as being ordered for this patient? A.A combination of antitubercular drugs will be chosen to fight the infection. B.The patient will receive the drug and supportive care to help him tolerate the antitubercular therapy. C.The patient will remain on isolation precautions until his cough clears. D.There is nothing that can be done for this patient.
ANS: B It must be recognized that the urgency of treating a potentially fatal infection may have to be balanced against any prevailing contraindications. In extreme cases, patients are sometimes given a drug to which they have some degree of allergy with supportive care that enables them at least to tolerate the medication. Examples of such supportive care are treatment with antipyretics (e.g., acetaminophen), antihistamines (e.g., diphenhydramine), or even corticosteroids (e.g., prednisone, methylprednisolone).
A home care nurse is visiting a patient with a diagnosis of TB. The patient traveled abroad 2 months ago. He lives with his wife and 5-year-old son. The patient tells the nurse that he is concerned his son will also get TB, so he wants to share his pills with his son. What is the best response by the nurse? A."That is a good idea. Children should not be exposed to TB." B."You should give your son half of the dose you take." C."Do not share any of your medications with anyone. Contact your son's health care provider to discuss your concerns." D."Children have an immune system that makes them immune to TB."
ANS: C Medications of any kind should never be shared with any other person. In particular, antitubercular drugs are age specific. Assessment of age is also important because the likelihood of adverse reactions and toxicity is increased in older patients because of age-related liver and kidney dysfunction. Additionally, the safety of these drugs in children 13 years of age and younger has not been established.
The patient tells the nurse, "I had a shot after I returned from my trip overseas. I thought that was supposed to stop me from getting a TB infection." What information regarding TB-related injections does the nurse identify as being true? A.BCG is used to prevent infection with TB for women of childbearing age. B.A positive result for a PPD test is indicated by redness at the site of injection. C.PPD is a diagnostic injection given intradermally to detect exposure to the TB organism. D.BCG is a vaccine injection derived from an activated strain of Mycobacterium bovis.
ANS: C PPD is a diagnostic injection given intradermally in doses of 5 tuberculin units (0.1 mL) to detect exposure to the TB organism. A positive result is indicated by induration (not erythema) at the site of injection and is known as the Mantoux reaction, named for the physician who described it. BCG is used in much of the world to vaccinate young children against TB. Although it does not prevent infection, evidence indicates that it reduces active TB by 60% to 80% and is even more effective at preventing more severe cases involving dissemination of infection throughout the body.
Four weeks after beginning antitubercular drug therapy on an outpatient basis, the patient reports that he still experiences night sweats. What does the nurse identify as the main concern at this time? A.He is not taking his medication properly. B.More time is needed to see a therapeutic response. C.His infection may be resistant to the drug therapy ordered. D.He may have contracted a different strain of TB.
ANS: C The nurse should not jump to conclusions that the patient is not taking his medication properly. An improvement should start to occur within 2 weeks of starting drug therapy, but this may not occur if the patient's TB is not sensitive to the prescribed drugs. An evaluation of the drug therapy will be needed.
A patient is receiving INH for the treatment of TB. Which vitamin does the nurse anticipate administering with the INH to prevent INH-precipitated peripheral neuropathies? A.Vitamin C B.Vitamin B12 C.Vitamin D D.Vitamin B6
ANS: D Pyridoxine (vitamin B6) may be indicated to prevent INH-precipitated peripheral neuropathies and numbness, tingling, or burning of the extremities.
The nurse 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. Pyridoxine (Vitamin B6) should be added to the regimen
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. 24 months
The nurse would correctly identify the method 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. Altering cell wall synthesis
Bedaquiline (Sirturo) is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which statement by the patient indicates a correct understand-ing of the instructions? a. "I will take this with food." b. "I need to take this 1 hour before breakfast." c. "I can stop this drug if the side effects bother me." d. "It's okay to have a glass of wine while taking this drug."
a. "I will take this with food."
The nurse is counseling a woman who is beginning antitu-bercular 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. "You will need to switch to another form of birth control while you are taking the rifampin."
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 protect your heart from toxic effects." d. "This vitamin helps to reduce gastrointestinal adverse effects."
b. "This vitamin helps to prevent neurologic adverse effects."
The nurse is monitoring for liver toxicity in a patient who has been receiving long-term isoniazid therapy. Manifestations of liver toxicity which of these? (Select all that apply.) a. Orange discoloration of sweat and tears. b. Darkened urine. c. Dizziness. d. Fatigue. e. Visual disturbances. f. Jaundice.
b. Darkened urine. d. Fatigue. f. Jaundice.
The nurse is teaching a patient who is starting antitubercular therapy with rifabutin. Which adverse effects would the nurse expect to see? (Select all that apply.) a. Headache and neck pain b. GI tract disturbances c. Reddish brown urine d. Numbness or tingling of extremities e. Gynecomastia f. Neutropenia
b. GI tract disturbances c. Reddish brown urine f. Neutropenia
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 during which time? 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. During the initial period of the illness and its diagnosis.
While monitoring a patient, the nurse knows that a thera-peutic response to antitubercular drugs would be which of these? a. The patient states that he or she is feeling much better. b. The patient's laboratory test results show a lower white blood cell count. c. The patient reports a decrease in cough and night sweats. d. There is a decrease in symptoms, along with improved chest x-ray and sputum culture results.
d. There is a decrease in symptoms, along with improved chest x-ray and sputum culture results.
