The community health nurse prepares a teaching plan for a client with latent
tuberculosis who is prescribed oral isoniazid (INH). Which instructions should the nurse
include? Select all that apply.
Unordered Options Ordered Response
1. Avoid drinking alcohol
2. Expect body fluids to change col...
the community health nurse prepares a teaching plan for a client with latent tuberculosis who is prescribed oral isoniazid inh which instructions should
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The community health nurse prepares a teaching plan for a client with latent
tuberculosis who is prescribed oral isoniazid (INH). Which instructions should the nurse
include? Select all that apply.
Unordered Options Ordered Response
1. Avoid drinking alcohol
2. Expect body fluids to change color to red
3. Report yellowing of skin or sclera
4. Report numbness and tingling of extremities
5. Take with aluminum hydroxide to prevent gastric irritation
You answered this question incorrectly. Correct answer is: 1,3,4
Time Spent: 46 Seconds
38% of people answered this question correctly.
Last Updated: 1/17/2016
Explanation
Isoniazid (INH) is a first-line antitubercular drug prescribed as monotherapy to treat
latent tuberculosis infection. Combined with other drugs, INH is also used for active
tuberculosis treatment. Two serious adverse effects of INH use are hepatotoxicity and
peripheral neuropathy.
A teaching plan for a client prescribed INH includes the following:
Avoid intake of alcohol and limit use of other hepatotoxic agents (eg,
acetaminophen) to reduce risk of hepatotoxicity (Option 1)
Take pyridoxine (vitamin B6) if prescribed to prevent neuropathy
Avoid aluminum-containing antacids (eg, aluminum hydroxide (Maalox))
within 1 hour of taking INH
Report changes in vision (eg, blurred vision, vision loss)
Report signs/symptoms of severe adverse effects such as:
, o Hepatoxicity (eg, scleral and skin jaundice, vomiting, dark urine, fatigue)
(Option 3)
o Peripheral neuropathy (eg, numbness, tingling of extremities) (Options 4)
(Option 2) Rifampin, another antitubercular drug, often causes a red-orange
discoloration of body fluids (ie, urine, sweat, saliva, tears). However, this effect is not
associated with INH use.
(Option 5) Concurrent use of antacids containing aluminum decreases INH
absorption. The medication may be taken with food if gastric irritation is a concern.
Educational objective:
Common potential side effects of INH include hepatotoxicity (eg, jaundice, vomiting,
dark urine, fatigue) and peripheral neuropathy (eg, numbness, tingling of extremities).
Clients should avoid alcohol use and aluminum-containing antacids, and report any
experienced side effects to the health care provider immediately.
In which scenarios should the nurse hold the prescribed medication and question its
administration? Select all that apply.
Unordered Options Ordered Response
Client on IV heparin and the platelet count is 50,000/mm3 (50 x
1.
109/L)
2. Client on newly prescribed lisinopril and is at 8 weeks gestation
Client on nitroglycerine patch for heart failure and blood pressure is
3.
84/56 mm Hg
Client on phenytoin for epilepsy and the nurse notes gingival
4.
hyperplasia
Client on warfarin and prothrombin time/International Normalized
5.
Ratio is 1.5 times control value
You answered this question incorrectly. Correct answer is: 1,2,3
Time Spent: 133 Seconds
30% of people answered this question correctly.
Last Updated: 2/2/2016
,Explanation
Heparin is a natural anticoagulant. Its risk is heparin-induced thrombocytopenia (HIT),
also known as heparin-associated thrombocytopenia. Normal platelet range is
150,000-400,000/mm3 (150-400 x 109/L). A mild lowering of platelets may occur and
resolve spontaneously around the 4th day of administration. The danger is type II HIT,
a more severe form in which there is an acute drop in the number of platelets (more
than 50% from baseline), which requires discontinuing heparin (Option 1).
Angiotensin-converting enzyme (ACE) inhibitors such as lisinopril are teratogenic.
Lisinopril can cause embryonic/fetal developmental abnormalities (cardiovascular and
central nervous system) if taken during pregnancy, especially during the first 13 weeks
of gestation. During the 2nd and 3rd trimesters, ACE inhibitors interfere with fetal renal
hemodynamics, resulting in low fetal urine output (oligohydramnios) and fetal growth
restriction (Option 2).
Nitroglycerine causes vasodilation and can lower blood pressure. Systolic blood
pressure should be >90 mm Hg to ensure renal perfusion (Option 3).
(Option 4) Gingival hyperplasia or hypertrophy is a known side effect of phenytoin
(Dilantin) and is not a reason to stop the drug. Vigorous dental hygiene beginning
within 10 days of initiation of phenytoin therapy can help control it. Signs and symptoms
that require discontinuation include toxic levels or phenytoin hypersensitivity syndrome
(fever, skin rash, and lymphadenopathy).
A client with gout who was started on allopurinol a week ago calls the health care
provider's (HCP's) office with several concerns. The nurse should recognize which
report by the client as being significant and requiring immediate follow-up?
Unordered Options Ordered Response
1. Also takes ibuprofen for pain
2. Frequency of urination has increased
3. Mild red rash has developed over torso
4. Nausea occurs after each dose
, You answered this question correctly.
Time Spent: 28 Seconds
64% of people answered this question correctly.
Last Updated: 12/15/2015
Explanation
Allopurinol is a medication frequently used in the prevention of gout. Gout is a
buildup of uric acid deposited in the joints that causes pain and inflammation. The
medication helps to prevent uric acid deposits in the joints and the formation of uric acid
kidney stones. Any rash in a client taking allopurinol, even if mild, should be reported
immediately to the HCP. The nurse should direct the client to stop taking the
medication immediately, schedule an appointment, and notify the HCP. A rash
caused by allopurinol may be followed by more severe hypersensitivity reactions that
can be fatal, including Stevens-Johnson syndrome and toxic epidermal necrolysis.
(Option 1) Allopurinol can take several months to become effective. Its primary use is
to prevent gout attacks; it is not effective in treating acute attacks. The client will need
to continue to take anti-inflammatory drugs (eg, nonsteroidal anti-inflammatory drugs or
colchicine) for acute attacks.
(Option 2) Clients are directed to take allopurinol with a full glass of water and to
increase daily fluid intake to prevent kidney stones. This will cause an increase in
urination and is an expected outcome.
(Option 4) Nausea can be prevented by instructing the client to take the medication
with food or following a meal.
Educational objective:
The nurse should direct the client taking allopurinol for gout to immediately discontinue
the medication and report to the HCP if any rash develops. Allopurinol-induced rashes
can develop into severe and sometimes fatal hypersensitivity reactions, such as
Stevens-Johnson syndrome. Similar instructions should be given to clients taking
anticonvulsants (eg, carbamazepine, phenytoin, lamotrigine) and sulfa antibiotics.
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