Pharm Ch 22
The nursing instructor is teaching students about drug regimens used for tuberculosis (TB). Who should receive instructions on the different prophylactic uses of isoniazid (INH)? Select all that apply.
Household members of those recently diagnosed with TB Those whose tuberculin skin test result has become positive in the last 2 years Those at risk for TB (such as those with Hodgkin's disease, leukemia, and other serious illnesses) All clients younger than 35 years with a positive skin test
A major concern among public health authorities is an increase in drug-resistant TB infections. Traditionally, this has been attributed to patient lack of adherence to medication regimen. New evidence indicates that:
Many drug-resistant infections are new infections, especially in those who are immunosuppressed. When infected people receive antitubercular drugs, drug-resistant mutants are not killed or weakened by the drugs. Eventually, the majority of the TB bacilli in the body are drug-resistant. Drug-resistant strains can be spread from one person to another, and there is increasing evidence that many drug-resistant infections are new infections, especially in people whose immune systems are suppressed. Not all TB infections are drug-resistant, nor are drug-resistant infections decreasing.
A 72-year-old patient with TB is undergoing standard treatment in a health care facility. Which of the following nursing interventions should the nurse perform during ongoing assessment of the treatment?
Monitor for appearance of adverse reactions. The nurse should monitor for the appearance of adverse reactions in the patient during ongoing assessment of the treatment. The nurse should monitor vital signs of the patient every four hours and not every 24 hours when the patient is hospitalized. The nurse should assess the patient's history of contacts as part of the pre-administration assessment and not as part of the ongoing assessment. DOT can only be used by the nurse to administer antitubercular drugs when the patient is at home, at his place of employment, or in school. DOT is not used when the patient is hospitalized.
When providing health education to a client prescribed isoniazid, the nurse should emphasize the need to avoid what element?
alcohol
Mr. Marks is a 35-year-old man who is being treated with isoniazid (INH) for exposure to TB. He has the following medical history: diabetes mellitus type 2, hypertension, hyperlipidemia, and coronary artery disease. He drinks one to two glasses of wine on the weekend and smokes two packs of cigarettes per day. Which adverse reaction should you as the nurse alert Mr. Marks to report to his physician right away?
Numbness and tingling in his feet INH should also be given with caution to patients with diabetes mellitus, malnutrition, or alcoholism because its effects (antagonism or increased excretion) on pyridoxine (vitamin B6) can cause peripheral neuropathy in these patients. Pyridoxine may be given concurrently with INH to decrease the risk for this adverse effect. Another frequent adverse effect is peripheral neuropathy. This effect may cause paresthesias in the hands and feet. As previously mentioned, malnourished patients and those with diabetes and alcoholism have a higher risk for this adverse effect.
A patient with TB is admitted to a health care facility. The nurse is required to administer an antitubercular drug through the parenteral route to this patient. Which of the following precautions should the nurse take when administering frequent parenteral injections?
Rotate injection sites for frequent parenteral injections.
A patient is hospitalized due to noncompliance with an antitubercular drug treatment. Which of the following is most important for the nurse to do? pg 108
Observe the patient taking the medications
After 3 weeks of drug therapy for TB, a patient is not showing reduction of symptoms. Repeated lab work shows positive cultures. What issues should the nurse consider? (Select all that apply.) pg 105
Patient noncompliance Drug resistance
A nurse works in a community setting and follows patients who have TB. Which of the following patients would likely require the most follow-up from rifampin therapy? pg 106
An HIV - positive patient
A 20-year-old female is being treated with rifampin and INH. What method of birth control would the nurse recommend for this patient?
Any of the above Since rifampin decreases the effectiveness of oral contraceptives, a different type of contraception should be used during therapy.
While discussing tuberculosis, the nursing instructor explains that treatment is typically divided into two phases. What is the second phase called? pg 103
The continuation phase
The nurse explains to the client that prophylactic antitubercular therapy is suggested for which of the following people? pg 103
Those who have been in close contact with a person with tuberculosis (TB)
A client asks the purpose for using three medications in combination to treat his tuberculosis. The nurse informs the client that multiple medications are given for which of the following reasons? pg 105
To prevent resistance
Which of the following is considered a secondary drug to treat tuberculosis? pg 103
Ciprofloxacin
The student nurse is trying to learn the differences in antitubercular drugs and correctly identifies which of the following to be completely bactericidal? pg 103
Isoniazid
A patient is taking rifampin (Rifadin) for active TB. When discussing this drug with the patient, the nurse should stress that pg 106
body fluids such as urine, saliva, tears, and sputum may become discolored.
A patient newly diagnosed with tuberculosis (TB) asks the nurse if medications will make him better. The nurse informs the patient that sometimes treatment fails and why this happens. Which of the following are reasons for treatment failure? (Select all that apply.) pg 105
inadequate initial drug treatment noncompliance with the therapeutic regimen
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? pg 103
primary and secondary
A student nurse needs further explanation about tuberculosis (TB) when making the following statement: pg 103
"TB can be cured by antitubercular drugs."
A middle-aged client with a complex history has begun multidrug treatment for TB. Which assessment question is most therapeutic?
"What kinds of routines would work for you to ensure that you don't miss doses of your rifampin?"
what does DOT stand for?
Directly Observed therapy
The nursing student read about a disease called Hansen's disease, which is caused by the bacterium Mycobacterium leprae and is treated with many of the same drugs as are used for TB. The student learned that another name for Hansen's disease is:
leprosy
A patient is hospitalized with active tuberculosis. The patient is receiving antitubercular drug therapy and is not responding to the medications. What do you suspect the patient is suffering from? pg 105
Drug-resistant tuberculosis
Gary is a construction worker who is diagnosed with leprosy and is prescribed rifampin. Gary is married, an alcoholic, and wears contact lenses. At the time of initiating the therapy, what should the nurse instruct the patient about the drug therapy? pg 106
Inform him that he should wear glasses during the therapy.
A 28-year-old client taking INH, rifampin, and ethambutol arrives at the clinic complaining of numbness in her feet. What adjustment to the client's drug regimen is most likely to remedy the issue?
Instructing the client to take the medications with vitamin B6 Vitamin B6 is usually given along with the INH to prevent peripheral neuritis.
A 28-year-old client taking INH, rifampin, and ethambutol arrives at the clinic complaining of numbness in her feet. What adjustment to the client's drug regimen is most likely to remedy the issue?
Instructing the client to take the medications with vitamin B6 Vitamin B6 is usually given along with the INH to prevent peripheral neuritis.
When a person is diagnosed with tuberculosis, family members may be treated prophylactically with which antitubercular drug? pg 103
Isoniazid (Nydrazid)
When a person is diagnosed with tuberculosis, family members may be treated prophylactically with which antitubercular drug? (Choose one)
Isoniazid (Nydrazid) When a person is diagnosed with tuberculosis, family members may be treated prophylactically with isoniazid (Nydrazid).
An HIV-positive patient is in a continuing phase of TB. The patient has completed the initial phase of the treatment program. In the continuing phase, the patient has shown no positive sputum results for six months. The nurse knows that under what circumstances does the treatment in the second phase last for four months or more?
Positive sputum culture after the completion of initial treatment
A homeless client presented at a street clinic with reports of hemoptysis and subsequently tested positive for TB. Which characteristics of the client's present circumstances would preclude treatment with INH? pg 105
an alcoholic who has hepatitis C (HCV)
When administering a secondary drug to a patient with tuberculosis (TB), the nurse is treating which type of TB? pg 103
extrapulmonary TB
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?
hepatotoxicity
A college student has a TB test prior to starting college. The tuberculin test site is noted with a reddened, raised area. What condition will the student be diagnosed with if the chest radioagraph is negative?
Latent tuberculosis People with inactive or latent TB have no symptoms and do not feel sick. The transmission of the infection occurs when an uninfected person inhales infected airborne particles that are exhaled by an infected person. Primary infection occurs 6-8 weeks after exposure. The patient has a mild, pneumonia-like illness that often is undiagnosed. Active tuberculosis is a result from reactivation of a latent infection.
A patient is hospitalized due to noncompliance with an antitubercular drug treatment. Which of the following is most important for the nurse to do?
Observe the patient taking the medications Directly observed therapy in which a health care provider observes the patient taking each dose of anti-TB drugs is recommended for all drug regimens and is considered mandatory in this case. The medications are not administered parenterally. The family should be instructed on the medication regime, but this action is not imperative in maintaining compliance. The patient should not be taking her/his own medications.
Your newest admission presents with persistent cough, weight loss, anorexia, and night sweats. What would you, as the nurse, expect for the physician to order? Select all that apply. pg 103-104
Skin test Chest radiograph
A nurse is caring for a patient with HIV who is suspected to also have tuberculosis (TB). Which of the following is true about patients with HIV and TB?
The skin test may not show a reaction even though the disease is present.
Tuberculosis caused by drug-resistant organisms should be considered in which of the following clients? Select all that apply:
• Clients who have no response to therapy • Clients who have been treated in the past
The nursing instructor is teaching students about drug regimens for tuberculosis (TB). He instructs them on the different prophylactic uses of isoniazid (INH), which include? (Select all that apply.)
• Those at risk for TB (such as those with Hodgkin's disease, leukemia, and other serious illnesses) • All patients younger than 35 years with a positive skin test • Those whose tuberculin skin test result has become positive in the last 2 years • Household members of those recently diagnosed with TB
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 to give the client about dietary restrictions? pg 105
"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur."
A patient is to receive rifampin. Which of the following would be most important for the nurse to include in the teaching plan for this patient? pg 106
"Your urine or sweat may become orange in color."
How many phases are involved in the standard treatment of tuberculosis (TB)? pg 103
2
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? pg 106
Adverse effet of rifampin
Mr. James, 49 years old, is diagnosed with TB. He has a history of alcoholism but has been sober for 3 months now. He has been prescribed INH. What should the nurse ensure is obtained before initiating the therapy?
Baseline liver function test values For a TB patient, you should obtain baseline liver function test values and schedule serial liver function tests throughout therapy. In addition, a nurse should ensure a baseline A1C evaluation for patients who are diabetics, because INH may cause hyperglycemia. Patients with preexisting anemias should have a baseline complete blood count (CBC), because they are at risk for hematologic disorders. For patients with a history of seizures, perform a baseline neurologic examination. Also assess baseline visual acuity. All other assessments such as height, weight, serum glucose level, and bone mass are not applicable to INH therapy.
The nursing instructor is teaching students about drug regimens for tuberculosis (TB). He instructs them on the different prophylactic uses of isoniazid (INH), which include? (Select all that apply.) pg 103
Household members of those recently diagnosed with TB Those whose tuberculin skin test result has become positive in the last 2 years Those at risk for TB (such as those with Hodgkin's disease, leukemia, and other serious illnesses) All patients younger than 35 years with a positive skin test
A patient has just been diagnosed with tuberculosis (TB). The nurse can expect to start the patient on which of the following drugs for the initial phase of treatment? pg 103
INH, rifampin, pyrazinamide, ethambutol
A patient with gout has just been diagnosed with active tuberculosis (TB). What is important for the nurse practitioner to consider when prescribing medication for this patient? pg 106
If pyrazinamide is administered with antigout medications, its effectiveness decreases.
The patient who has been on a drug regimen for tuberculosis (TB) for the last 2 months says he has lost his appetite and 10 pounds in the last 2 months. What drug should the nurse suggest to the physician for this patient to help in the area of nutrition? pg 107
pyridoxine
A patient is administered rifampin (Rifadin). Which of the following factors should the patient be taught? pg 106
The urine, tears, sweat, and other body fluids will be a discolored red-orange.
A patient receiving isoniazid (INH) and rifampin (Rifadin) has a decreased urinary output and peripheral neuropathy. Which laboratory values should be assessed?
ALT/AST and creatinine Hepatotoxicity and nephrotoxicity are important adverse effects of isoniazid and rifampin. The ALT/AST will assess liver function and creatinine will assess renal function. The hematocrit and hemoglobin are not indicated with the described symptoms. Erythrocyte count and differential are not indicated with these symptoms.
A patient seen in the clinic has symptoms of persistent cough, fever, and night sweats. He recently entered the United States from the Philippines. From what condition is the patient suffering?
Active tuberculosis Immigration from countries where the disease occurs, such as the Philippines, places patient at risk for tuberculosis. Active tuberculosis is characterized by symptoms of cough, fever, and night sweats. Patients with latent tuberculosis exhibit no symptoms and do not feel sick. Bacterial pneumonia is not commonly noted with night sweats. Emphysema is not noted with fever.
The nurse understands that when a client is taking isoniazid and antacids together which of the following may occur? pg 105
Decreased absorption of isoniazid
A patient being treated for tuberculosis is determined to be drug resistant. Which of the following medications will the patient be resistant to in the treatment of the tuberculosis?
Isoniazid (INH) and rifampin Isoniazid (INH) and rifampin are used to treat tuberculosis. In multidrug resistance, the most effective drugs the patient is resistant to are isoniazid and rifampin. Carbamazepine and phenytoin are used to control seizures. Dextroamphetamine and doxapram are central nervous system stimulants. Propranolol and sotalol are beta-adrenergic blocking agents.
Active tuberculosis (TB) may be difficult to diagnose in patients infected with HIV because of their immune system deficiency. Which of the following can be used to determine if an HIV patient with a negative skin test has active TB? (Select all that apply) pg 106
X-ray studies Sputum analyses Physical examinations
A patient seen in the clinic has symptoms of persistent cough, fever, and night sweats. He recently entered the United States from the Philippines. From what condition is the patient suffering?
Active tuberculosis Immigration from countries where the disease occurs, such as the Philippines, places patient at risk for tuberculosis. Active tuberculosis is characterized by symptoms of cough, fever, and night sweats. Patients with latent tuberculosis exhibit no symptoms and do not feel sick. Bacterial pneumonia is not commonly noted with night sweats. Emphysema is not noted with fever.
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? pg 106
Adverse effect of rifampin
You are caring for a 39-year-old client who is taking INH, rifampin, and pyrazinamide. The client calls you to report that her urine is red. What is the most likely cause of this discoloration?
Adverse effect of rifampin Rifampin causes a harmless red-orange discoloration of urine, tears, saliva, and other body secretions.
You are caring for a 39-year-old client who is taking INH, rifampin, and pyrazinamide. The client calls you to report that her urine is red. What is the most likely cause of this discoloration?
Adverse effect of rifampin Rifampin causes a harmless red-orange discoloration of urine, tears, saliva, and other body secretions.
A patient with TB has been admitted to a health care facility. When providing instructions for the patient teaching related to antitubercular drugs, which of the following instructions should the nurse provide in order to avoid complications in the patient's GI tract?
Avoid the consumption of alcohol. The nurse should instruct the patient to avoid the consumption of alcohol since alcoholism compounds patient's difficulties and complicates the general condition of the patient's gastrointestinal tract. The nurse should instruct the patient to take the prescribed dose of Ethambutol without regard to food and to take the prescribed Pyrazinamide along with food. The nurse should instruct the patient to avoid doubling the dose in case the earlier dose was missed.
The client is taking isoniazid (INH). It is important that the client understand INH can affect which vitamin? pg 109
B6
A nurse is providing education to a patient who is taking INH. The nurse will advise the patient to avoid which of the following foods? pg 105
Cheese, dairy products, and bananas
After 3 weeks of drug therapy for TB, a client is not showing reduction of symptoms. Repeated lab work shows positive cultures. What issues should the nurse consider? (Select all that apply.)
Client noncompliance Drug resistance
A patient is hospitalized due to noncompliance with an antitubercular drug treatment. Which of the following is most important for the nurse to do?
Observe the patient taking the medications Directly observed therapy in which a health care provider observes the patient taking each dose of anti-TB drugs is recommended for all drug regimens and is considered mandatory in this case. The medications are not administered parenterally. The family should be instructed on the medication regime, but this action is not imperative in maintaining compliance. The patient should not be taking her/his own medications.
A nurse is assigned to care for a patient with TB who has been prescribed rifampin. Which of the following should the nurse ensure to confirm that rifampin is not contraindicated in the patient? pg 106
Patient does not have renal impairment
The nurse understands that which of the following is the highest priority when teaching about antitubercular medications? pg 108
Taking medications as prescribed
A patient is admitted to hospice with the diagnosis of XDR-TB. Knowing some of the contributing factors to this disease, the nurse understands this disease is a major indication of:
The failure to adequately diagnose, prevent, and treat MDR-TB. The development of XDR-TB indicates failure to adequately diagnose, prevent, and treat MDR-TB. The failure to adequately treat immunosuppressive diseases is not a direct corollary to developing TB. Additionally, patients receive treatment without notifying health authorities with their diagnosis. As with all treatment regimens, personal (not healthcare system) responsibility is the significant consideration in treatment adherence.
A patient is administered rifampin (Rifadin). Which of the following factors should the patient be taught?
The urine, tears, sweat, and other body fluids will be a discolored red-orange. The urine, tears, sweat, and other body fluids will be a discolored red-orange. This adverse effect is harmless, but the patient 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.
Ms. Ellis has been prescribed INH for the treatment of tuberculosis. You are teaching her about dietary restrictions while taking this medication. What is the most important instruction to give her about dietary restrictions?
"Do not drink beer or red wine while taking this medication because a serious adverse reaction can occur." Because INH has some monoamine oxidase inhibitor activity, interactions may occur with tyramine-containing foods. INH may also interact with foods containing histamine. Patients 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 patient is to receive rifampin. Which of the following would be most important for the nurse to include in the teaching plan for this patient?
"Your urine or sweat may become orange in color." This drug causes body fluids to turn orange. The patient 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 patient 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. pg 105
3
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? pg 110
BUN and creatinine
The nursing student is studying how tuberculosis (TB) is contracted. The nurse correclty identifies the mode of transmission to be which of the following? pg 103
Droplets
Tuberculosis (TB) affects only the lungs. True or false? pg 104
False
Gary is a construction worker who is diagnosed with leprosy and is prescribed rifampin. Gary is married, an alcoholic, and wears contact lenses. At the time of initiating the therapy, what should the nurse instruct the patient about the drug therapy?
Inform him that he should wear glasses during the therapy. People going through rifampin therapy are prone to skin discoloration and discoloration of contact lenses. This is because rifampin can discolor bodily fluids, such as urine, saliva, tears, and sputum. People taking rifampin are not known to have decreased sexual urge or have blood pressure elevation. The patient should continue the rifampin therapy for the period suggested by the physician, which may or may not be a year.
A nurse teaching the patient with tuberculosis (TB) should include the following information about ethambutol: pg 105
It can cause optic neuritis
A 35-year-old man is being treated with isoniazid (INH) for exposure to TB. He has the following medical history: diabetes mellitus type 2, hypertension, hyperlipidemia, and coronary artery disease. He drinks one to two glasses of wine on the weekend and smokes two packs of cigarettes per day. Which adverse reaction should the nurse alert the client to report to his physician right away? pg 105
Numbness and tingling in his feet
A client has been prescribed INH therapy for the treatment of latent tuberculosis. The client has a history of hypertension. The nurse informs the client not to eat cheese, dairy products, or bananas, or consume any foods or drinks containing caffeine. What is the best explanation the nurse can give the client about the effects of eating these foods while on INH? pg 105
These foods can cause an unsafe increase in blood pressure.
The nurse explains that prophylactic antitubercular therapy is suggested for which people?
Those who have been in close contact with a person with tuberculosis (TB)
Tuberculosis typically affects the lungs but can also involve other parts of the body. Which of the following can be affected by the disease?
Tuberculosis is an infectious disease that usually affects the lungs but may involve most parts of the body, including lymph nodes, meninges, bones, joints, kidneys, and the gastrointestinal tract.
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?
optic neuritis
Gary is a construction worker who is diagnosed with leprosy and is prescribed rifampin. Gary is married, an alcoholic, and wears contact lenses. At the time of initiating the therapy, what should the nurse instruct the patient about the drug therapy?
Inform him that he should wear glasses during the therapy. People going through rifampin therapy are prone to skin discoloration and discoloration of contact lenses. This is because rifampin can discolor bodily fluids, such as urine, saliva, tears, and sputum. People taking rifampin are not known to have decreased sexual urge or have blood pressure elevation. The patient should continue the rifampin therapy for the period suggested by the physician, which may or may not be a year.
A patient is administered isoniazid (INH) for latent tuberculosis. Which of the following factors will result in discontinuation of the medication?
Jaundice Potentially serious adverse effects include hepatotoxicity and peripheral neuropathy. Hepatotoxicity may be manifested by symptoms of hepatitis (e.g., anorexia, nausea, fatigue, malaise, jaundice) or elevated liver enzymes. Cachexia, fever, and thrombus are not the most known adverse effects of isoniazid (INH).
