Chapter 6 Flashcards
(16 cards)
A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin
(Rifadin). What would be an expected finding?
a. Crystalluria
b. Myopathy
c. Peripheral neuropathy
d. Red-orange–tinged urine
ANS: D
Urine tinged red-orange is a normal finding associated with rifampin’s adverse effects.
Peripheral neuropathy, myopathy, and crystalluria are not manifestations of adverse effects of
rifampin.
A nurse is teaching a group of nursing students about the problems associated with the long-
term therapy required to treat tuberculosis. Which statement by a student indicates a need for
further teaching?
a. “Long-term therapy increases the emergence of drug-resistant organisms.”
b. “Long-term therapy increases the incidence of drug toxicities.”
c. “Long-term therapy increases the likelihood of reactivation of latent infection.”
d. “Long-term therapy results in decreased patient adherence to drug regimens.”
ANS: C
Long-term drug therapy is used to prevent reactivation of latent infection that can occur if
drugs are withdrawn too soon. Long-term therapy can result in the emergence of drug-
resistant organisms, leads to more drug toxicities and side effects, and reduces adherence.
A nurse reads a tuberculin skin test on a patient and notes a 6 to 7 mm area of induration. The
patient is a young adult who has recently immigrated from a country with a high prevalence of tuberculosis. The patient has no other risk factors. The nurse will expect the provider to:
a. begin treating this patient with a two-drug regimen of isoniazid and rifampin.
b. order a chest radiograph and a sputum culture to assess for active tuberculosis.
c. order a nucleic acid amplification test of the patient’s sputum.
d. reassure the patient that this is not considered a positive test result.
ANS: D
This patient has a moderate risk of tuberculosis; the area of induration would have to be 10
mm or greater to be considered a positive skin test result. Without other clinical signs, there is
no indication to treat this patient or to perform diagnostic testing, so a chest x-ray or sputum
cultures are not recommended.
A patient is beginning treatment for active tuberculosis (TB) in a region with little drug-
resistant TB. Which treatment regimen will be used initially?
a. Isoniazid and pyrazinamide
b. Isoniazid, pyrazinamide, and ethambutol
c. Rifampin, pyrazinamide, and ethambutol
d. Isoniazid, rifampin, pyrazinamide, and ethambutol
ANS: D
The induction phase of treatment for patients in a region without drug resistance is the same
as for patients who are human immunodeficiency virus (HIV) negative or HIV positive and
includes isoniazid, rifampin, pyrazinamide, and ethambutol. It is not correct to begin with two
drugs. The three-drug regimen is used for inductions in areas with resistance to either
isoniazid or rifampin.
A patient with HIV who takes protease inhibitors develops tuberculosis and will begin
treatment. Which drug regimen will be used for this patient?
a. Isoniazid, pyrazinamide, ethambutol + rifabutin
b. Isoniazid, pyrazinamide, ethambutol
c. Isoniazid, rifampin, pyrazinamide, ethambutol
d. Isoniazid + rifabutin
ANS: A
Patients with HIV who take protease inhibitors are susceptible to drug interactions with
rifampin, which accelerates the metabolism of protease inhibitors. Rifabutin can be substituted
for rifampin in patients with HIV, because the degree of acceleration of this metabolism is
less. A three-drug regimen would increase drug resistance, as would a two-drug regimen.
A patient newly diagnosed with tuberculosis asks the nurse why oral medications must be
given in the clinic. The nurse will tell the patient that medications are given in the clinic so
that:
a. clinic staff can observe adherence to drug regimens.
b. nurses can monitor for drug toxicities.
c. providers can adjust doses as needed.
d. the staff can ensure that the U.S. Food and Drug Administration (FDA) regulations
are met.
ANS: A
Adherence to drug regimens is a serious problem in the treatment of TB. Directly observed
therapy (DOT) combined with intermittent dosing helps ensure adherence and increases the
chance of success. Patients report drug side effects to providers; it is not necessary to give
drugs in the clinic to monitor this. Doses are adjusted based on response to treatment and not
on DOT. The FDA regulations do not require DOT.
A patient comes to a clinic for tuberculosis medications 2 weeks after beginning treatment
with a four-drug induction phase. The patient’s sputum culture remains positive, and no drug
resistance is noted. At this point, the nurse will expect the provider to:
a. change the regimen to a two-drug continuation phase.
b. continue the four-drug regimen and recheck the sputum in 2 weeks.
c. obtain a chest radiograph and consider adding another drug to the regimen.
d. question the patient about adherence to the drug regimen.
ANS: B
In patients with positive pretreatment sputum test results, sputum should be evaluated every 2
to 4 weeks until cultures are negative and then monthly thereafter. In the absence of drug
resistance, treatment with the same regimen should continue. Sputum cultures should become
negative in over 90% of patients in 3 or more months. The induction phase should last 2
months, so this patient should remain on a four-drug regimen. It is not necessary to order a
chest radiograph or to add another drug at this stage of treatment. The patient is stable and has
not developed symptoms that cause concern, so the patient does not need to be questioned
about adherence.
Which patient should begin treatment for tuberculosis?
a. A patient with HIV and a tuberculin skin test result of a 4-mm region of induration
b. A recent immigrant from a country with a high prevalence of TB with a 10-mm
region of induration
c. A patient with no known risk factors who has a job-related tuberculin skin test
result of a 12-mm area of induration
d. An intravenous drug abuser with a tuberculin skin test result of a 5-mm region of
induration
ANS: B
The immigrant is considered to be at moderate risk, meaning that a 10-mm area of induration
on a tuberculin skin test (TST) is considered a positive result. After being evaluated for active
TB, this patient should be treated for latent TB. A patient with HIV is considered high risk, but
this patient has a negative TST result of less than 5 mm. For a low-risk patient receiving a
screening TST for a job, the area of induration must be 15 mm or greater to be considered a
positive result. An IV drug abuser is in the moderate-risk category; an area of induration of 10
mm or greater is needed to be considered a positive TST result.
A healthcare worker who is asymptomatic has a screening TST result of 10 mm of induration
during a pre-employment physical. What will the nurse reading this test tell the patient?
a. “This is a negative test, so you are cleared for employment.”
b. “You have latent TB and will need to take isoniazid for 6 to 9 months.”
c. “You need to have a chest radiograph and a sputum culture.”
d. “You will begin taking a four-drug regimen to treat tuberculosis.”
ANS: C
This patient has a moderate risk and a positive skin test result. Before beginning treatment for
latent TB, active TB must be ruled out with chest X-rays and sputum cultures. This is not a
negative test result in a moderate-risk individual. Latent TB needs to be confirmed with
diagnostic testing. Treatment will not begin until tests have confirmed the diagnosis.
A patient is about to begin treatment for latent tuberculosis. The patient is an alcoholic, has
difficulty complying with drug regimens, and has mild liver damage. What will the nurse tell
this patient?
a. “You must stop drinking before adequate treatment can begin.”
b. “You must take isoniazid with close monitoring of hepatic function.”
c. “You must take rifampin daily for 4 months.”
d. “You will begin a regimen of isoniazid and rifampin.”
ANS: B
Isoniazid has an increased incidence of hepatotoxicity, especially when given with alcohol.
Patients who consume alcohol or who have liver damage should receive isoniazid with
caution and should have close monitoring of liver function. It is unrealistic to ask the
alcoholic to stop drinking to undergo treatment. Rifampin is toxic to the liver, especially in
alcoholics. Giving both drugs would only increase the risk of hepatotoxicity.
A patient has been taking isoniazid (Nydrazid) for 4 months for latent tuberculosis. The
patient reports bilateral tingling and numbness of the hands and feet, as well as feeling
clumsy. The nurse expects the provider to:
a. discontinue the isoniazid.
b. lower the isoniazid dose and add rifampin.
c. order pyridoxine 100 mg per day.
d. recheck the tuberculin skin test to see whether it worsens.
ANS: C
Patients sometimes develop peripheral neuropathy, characterized by paresthesias, clumsiness,
and muscle aches. If these occur, they may be reversed by administering pyridoxine (vitamin
B6). It is not necessary to discontinue the isoniazid. Lowering the isoniazid dose and adding
rifampin is not indicated. Rechecking the TST is not indicated.
A patient is about to begin treatment with isoniazid. The nurse learns that the patient also
takes phenytoin (Dilantin) for seizures. The nurse will contact the provider to discuss:
a. reducing the isoniazid dose.
b. reducing the phenytoin dose.
c. monitoring isoniazid levels.
d. monitoring phenytoin levels.
ANS: D
Isoniazid is a strong inhibitor of three cytochrome P450 enzymes, and inhibition of these
enzymes can raise the levels of other drugs, including phenytoin. Patients taking phenytoin
should have the levels of this drug monitored, and the dose should be reduced if appropriate.
Reducing the dose of isoniazid is not indicated. It is not necessary to monitor isoniazid levels.
A patient with high-risk factors for tuberculosis will begin therapy for latent TB with isoniazid
and rifampin. The nurse learns that this patient takes oral contraceptives. The nurse will
counsel this patient to discuss with ? her provider.
a. another birth control method
b. reducing the rifampin dose
c. reducing the isoniazid dose
d. increasing the oral contraceptive dose
ANS: A
Rifampin induces cytochrome P450 enzymes and can accelerate the metabolism of many
drugs, including oral contraceptive pills (OCPs). Women taking OCPs should consider a
nonhormonal form of birth control. Reducing the dose of rifampin or isoniazid is not
indicated. Increasing the OCP dose is not recommended.
A patient is about to begin treatment for latent tuberculosis with a short course of daily
rifampin. The patient asks why rifapentine (Priftin) cannot be used, because it can be given
twice weekly. What will the nurse tell this patient about rifapentine?
a. It is more toxic than rifampin.
b. It is not approved for treatment of latent TB.
c. It is not well absorbed and thus not as effective.
d. It will stain contact lenses orange.
ANS: B
Rifapentine is indicated only for pulmonary TB. Rifapentine’s toxicity is similar to that of
rifampin. Rifapentine is well absorbed. Both drugs stain contact lenses.
A patient who is being treated for HIV infection has a 5-mm area of induration after a routine
TST. The patient’s chest radiograph is normal, and there are no other physical findings. The
nurse will expect this patient to begin treatment with which drugs?
a. Isoniazid and rifabutin
b. Isoniazid and rifampin
c. Isoniazid and rifapentine
d. Isoniazid and pyrazinamide
ANS: A
Rifabutin is used off-label as an alternative to rifampin to treat TB in patients with HIV,
because it has less impact on the metabolism of protease inhibitors. The effects of rifapentine
on protease inhibitors is similar to those of rifampin. Pyrazinamide is not indicated.
A hospitalized patient is being treated for tuberculosis with a drug regimen that includes
pyrazinamide. The patient complains of pain in the knee and shoulder joints. The nurse will
contact the provider to request an order for:
a. ibuprofen.
b. renal function tests.
c. discontinuation of the pyrazinamide.
d. measurement of uric acid levels.
ANS: A
Polyarthralgias occur in 40% of patients during the initial phase of treatment with
pyrazinamide and can be managed with a nonsteroidal anti-inflammatory drug (NSAID).
Renal function tests and uric acid levels are not indicated. Unless the pain cannot be managed
with NSAIDs, there is no need to reduce the dose of pyrazinamide.
