TB drugs

An adult has active tuberculosis diagnosed by sputum examination and culture. In evaluating the patient's response to therapy, the nurse will want to see which finding? 1. An improved radiograph within 3 months 2. The absence of symptoms by 8 weeks 3. A return to a negative skin test by 4 weeks 4. A negative CT scan by 2 weeks

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When assessing a patient for adverse reactions to the combination of isoniazid and rifampin, the nurse would monitor which laboratory results? You may select more than one answer. 1. Liver function tests 2. CBC 3. Creatinine clearance 4. Uric acid levels 5. Calcium level

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The induction phase of active tuberculosis therapy: 1. begins after the continuation phase is completed. 2. comprises the first 2 months of drug treatment. 3. generally consists of a single active agent. 4. lasts 4 to 6 months

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A patient is taking pyrazinamide as a component of a multidrug regimen for tuberculosis. Which co-morbid condition in the patient's health history would most concern the nurse? a. Cirrhosis b. Migraine headaches c. Diabetes d. Osteoarthritis

ANS: A A history of cirrhosis would most concern the nurse, because liver injury is the principal adverse effect of pyrazinamide. Migraine headaches, diabetes, and osteoarthritis are not co-morbid conditions that would affect a patient taking pyrazinamide.

A patient who has been diagnosed with multidrug-resistant tuberculosis asks how long the treatment regimen will last. Select the nurse's best response. a. "After the sputum is converted to negative for TB organisms, the therapy continues for 12 to 24 months." b. "The entire course of therapy lasts 3 to 6 months or until the chest radiograph is normal." c. "Therapy is indefinite, because there is no method of determining responsiveness." d. "No therapy is completely effective in multidrug-resistant tuberculosis, so treatment is needed for several years."

ANS: A Multidrug resistance is defined as resistance to at least isoniazid and rifampin. Treatment requires at least three drugs to which the organism is sensitive and should continue for 12 to 24 months after sputum conversion. Initial therapy may consist of five, six, or even seven drugs. Three to 6 months is too short a drug regimen. Therapy is long but not indefinite Treatment is required for 1 to 2 years, not several years.

The nurse assesses a PPD on the forearm of a patient being screened for employment in an outpatient clinic. The induration is 4 mm. How should this finding be interpreted? a. Negative, insignificant b. Moderately significant, requiring chest radiograph c. Moderately significant, requiring sputum culture d. Significant, requiring treatment

ANS: A The finding should be interpreted as negative; induration of less than 5 mm is negative. The finding is neither moderately significant nor significant, and it does not require intervention.

When assessing a patient for adverse reactions to the combination of isoniazid and rifampin (Rifadin), the nurse would monitor which laboratory results? a. Liver function tests (LFTs) b. Complete blood cell count (CBC) c. Uric acid levels d. Calcium levels

ANS: A The nurse should monitor LFTs and creatinine clearance, because isoniazid and rifampin are hepatotoxic, and the chances of hepatotoxicity are increased when the two are given together. Nothing indicates a need to monitor a CBC, uric acid levels, or calcium levels.

An adult has active tuberculosis, as diagnosed by sputum examination and culture. In evaluating the patient's response to therapy, the nurse would want to see which finding? a. Improved x-ray report within 3 months b. Absence of symptoms by 8 weeks c. Return to a negative skin test by 4 weeks d. Negative computed tomography (CT) scan by 2 weeks

ANS: A The nurse would expect to see an improved x-ray report within 3 months. Therapy is evaluated in three ways: bacteriologic evaluation of the sputum, clinical evaluation, and chest radiographs. The nurse would not expect symptoms to be absent or a negative TB skin test. The patient will always have a positive test result, because antibodies are in the system. A CT scan is not indicated.

The nurse is caring for a patient who is taking rifabutin (Mycobutin). The patient begins to complain of a sudden onset of eye pain and blurred vision. The nurse suspects the patient is experiencing a. cataracts. b. uveitis. c. glaucoma-like syndrome. d. conjunctivitis.

ANS: B Rifabutin poses a risk of uveitis and should be discontinued if ocular pain or blurred vision develops. Cataracts, a glaucoma-like syndrome, and conjunctivitis are not effects associated with rifabutin.

The nurse is caring for a patient with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) who has taken protease inhibitors for 18 months. The patient has been diagnosed with active tuberculosis. The nurse would not expect the addition of which drug to the patient's medication regimen? a. Isoniazid (INH) b. Rifampin (Rifadin) c. Pyrazinamide (PZA) d. Kanamycin (Kantrex)

ANS: B Rifampin is contraindicated as part of the new antituberculosis regimen, because it would reduce the effects of the protease inhibitors. Isoniazid, pyrazinamide, and kanamycin could be included in the treatment of a patient with HIV/AIDS.

The nurse at a public health clinic is working with some students on rotation through the clinic. The nurse asks the students, "How is a definitive diagnosis of tuberculosis made?" The students would be correct to respond that a definitive diagnosis of tuberculosis is made by which of the following means? (Select all that apply.) a. Tuberculin skin testing b. Chest radiographs (x-ray films) c. Microscopic examination of sputum d. Chronic cough e. Night sweats

ANS: B, C Definitive diagnosis of TB is made by chest radiographs and microscopic examination of the sputum. TB skin testing, a chronic cough, and night sweats are not definitive and may not even be related to TB.

A patient being followed for latent tuberculosis has been on INH therapy for 2 months. While reviewing the laboratory test results, the nurse notes that the liver function test results have become grossly abnormal. The nurse should instruct the patient to a. continue the drug unless jaundice, nausea, or itching develops. b. continue the drug and have liver function tests repeated weekly. c. stop the medication immediately, and other drugs will be prescribed. d. stop the drug and restart it when liver function returns to normal.

ANS: C The nurse should instruct the patient to stop taking the medication immediately to prevent further damage to the liver, because INH therapy may cause hepatotoxicity. Liver function should be monitored closely. The drug should not be continued. The patient should not be instructed to restart the drug unless advised to do so by the prescriber. The patient would not know when liver function has returned to normal.

A patient is beginning therapy for active tuberculosis (TB). The patient asks, "Why do I have to take so many drugs?" What is the nurse's best response? a. "When a case is severe enough, multiple drugs are required." b. "The more agents used, the shorter the duration of the therapy." c. "Multiple agents prevent the emergence of resistant organisms." d. "It is assumed that patients take about 50% of the prescribed drug."

ANS: C The nurse's best response would be that multiple agents prevent the emergence of resistant organisms. Nothing indicates that the TB is severe. The use of multiple agents does not shorten the duration of therapy. It is not assumed that patients take about 50% of their medication.

The nurse is providing care to a patient with tuberculosis who is taking ethambutol (Myambutol). Which statement by the patient indicates a correct understanding of the effects of ethambutol? a. "Dizziness, drowsiness, and decreased urinary output are common with this drug, but they will subside over time." b. "Constipation will be a problem, so I will increase the fiber in my diet." c. "I will need to have my eyes checked periodically while I am taking this drug." d. "This medication may cause my bodily secretions to turn bluish green."

ANS: C The only significant adverse effect of ethambutol is optic neuritis. Patients should be advised to have their eyes checked periodically. Dizziness, drowsiness, and decreased urinary output are not listed as adverse effects. Gastrointestinal (GI) upset may occur, but constipation is not listed as an adverse effect. Ethambutol does not turn the urine bluish green.

The nurse is caring for a patient starting INH for latent tuberculosis. Which clinical manifestations would most concern the nurse? a. Cramps in the back when walking up steps b. Headaches and lightheadedness on awakening c. Dry mouth and difficulty swallowing solids d. Difficulty buttoning shirts

ANS: D Difficulty buttoning shirts would most concern the nurse, because this may indicate neuropathy. Dose-related peripheral neuropathy is the most common adverse effect of INH therapy. The patient may experience numbness, burning, or tingling in the hands and feet. Cramps in the back do not indicate neuropathy. Headaches and lightheadedness on awakening are not associated with INH administration even over longer periods of time. Dry mouth and difficulty swallow are not consistent with neuropathy

The nurse is caring for a patient who is being discharged home on rifampin (Rifadin) for the treatment of leprosy. What statement by the patient about the administration of this drug best indicates understanding? "I will take my medication a. twice daily." b. daily." c. twice weekly." d. monthly."

ANS: D The dosage currently recommended by the World Health Organization (WHO) is 600 mg once a month. Monthly dosing is just as effective as daily dosing and therefore is recommended. Twice daily, daily and twice weekly are not appropriate dosing regimens.

The nurse describes a typical course of therapy to a patient newly diagnosed with active tuberculosis. Which description is the most accurate? a. "The course of therapy generally lasts 1 year. Four drugs are required during that period." b. "Most patients require 4 full months of therapy, followed by 1 year of weekly tuberculin skin tests." c. "The four-drug regimen should last for 4 weeks. If the radiograph is normal, the medications are discontinued." d. "The entire course should take 6 months; the first 2 months with four drugs, and the last 4 months with two drugs."

ANS: D The most accurate description for the course of therapy for a newly diagnosed patient is that the entire course should take 6 months; the first 2 months with 4 drugs, and the last 4 months with 2 drugs. Therapy does not take a year or 4 full months. Therapy takes longer than 4 weeks.