Question 1

A patient with HIV who takes protease inhibitors develops tuberculosis and will begin treatment. Which drug regimen will be used for this patient?

Accepted Answer

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.

Question 2

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:

Accepted Answer

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.

Question 3

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:

Accepted Answer

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.

Question 4

A patient is beginning treatment for active tuberculosis (TB) in a region with little drug-resistant TB. Which treatment regimen will be used initially?

Accepted Answer

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.

Question 5

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?

Accepted Answer

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.

Question 6

A patient is about to begin therapy with ethambutol. The nurse knows that, before initiating treatment with this drug, it is important to obtain which test(s)?

Accepted Answer

Optic neuritis is a dose-related adverse effect of ethambutol. Patients receiving this drug should have color vision and visual acuity testing before therapy starts and periodically thereafter. A CBC, hearing evaluations, and hepatic function testing are not recommended.

Question 7

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:

Accepted Answer

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.

Question 8

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:

Accepted Answer

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.

Question 9

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?

Accepted Answer

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.

Question 10

A nursing student asks a nurse why tuberculosis resistance is so high. Which reasons are correct?

Accepted Answer

There are many reasons for the emergence of drug-resistant organisms in the treatment of TB. They include erratic patient adherence, drug doses that are too low, and drug regimens with too few drugs. The immunocompetence of the host does not affect drug resistance, nor does the fact that some agents are bacteriostatic.

Question 11

A patient who is taking drugs to treat HIV has tuberculosis and has been on a four-drug regimen for 3 months without improvement in symptoms. Which drug will the nurse anticipate that the provider will add to this patient's regimen?

Accepted Answer

Bedaquiline is a newer, highly effective anti-TB drug that does not accelerate the metabolism of HIV drugs and is sued for multi-drug resistant TB. Capreomycin is a second-line drug used for drug-resistant TB, but is not as effective as bedaquiline. Ethionamide is a second-line drug that is less well tolerated of all anti-TB agents and is used only when there is no alternative. Pyridoxine is given to prevent peripheral neuritis in patients taking isoniazid.

Question 12

A patient who has drug-sensitive tuberculosis has completed 2 months of the standard four-drug therapy and asks the nurse how long he will have to take medication. Which response by the nurse is correct?

Accepted Answer

Patients with drug-sensitive tuberculosis take four drugs for 2 months during the induction phase, followed by two drugs for 4 months in the continuation phase. Drug therapy does not stop after the induction phase, even for asymptomatic patients. Although drug therapy is prolonged, it is not indefinite.

Question 13

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?

Accepted Answer

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.

Question 14

A nurse is performing a physical assessment on a patient with tuberculosis who takes rifampin [Rifadin]. What would be an expected finding?

Accepted Answer

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.

Question 15

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.

Accepted Answer

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.

Question 16

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?

Accepted Answer

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.

Question 17

A nurse is caring for a patient with HIV/acquired immunodeficiency syndrome (AIDS) who has taken protease inhibitors for 18 months. The patient has been diagnosed with active tuberculosis. Which drugs would the nurse expect to be added to the treatment plan of a patient with HIV/AIDS?

Accepted Answer

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

Question 18

Which patient should begin treatment for tuberculosis?

Accepted Answer

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.

Question 19

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:

Accepted Answer

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.

Question 20

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:

Accepted Answer

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.

Quiz 90: Antimycobacterial Agents: Drugs for Tuberculosis, Leprosy, and Mycobacterium Avium Complex Infection