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UWorld Pharmacology The community health nurse prepares a teaching plan for a client w ith 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 B 6) 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 Hepato xicity (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 fl uids (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 anta cids, 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 1. Client on IV heparin and the platelet count is 50,000/mm3 (50 x 109/L) 2. Client on newly prescribed lisinopril and is at 8 weeks gestation 3. Client on nitroglycerine patch for heart failure and blood pressure is 84/56 mm Hg 4. Client on phenytoin for epilepsy and the nurse notes gingival hyperplasia 5. Client on warfarin and prothrombin time/International Normalized 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 di scontinuing 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 in itiation 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 we ek 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, e ven 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 hypersensitivit y 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 attac ks. 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 in take 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. A client diagnosed with trichomonal vaginal infection (trichomoniasis) is prescribed metronidazole. Whic h of the following is essential for the nurse to teach? Select all that apply. Unordered Options Ordered Response 1. Avoid alcohol while taking this medication 2. Perform vaginal douche for 7 -10 days 3. Use birth control pills to prevent recurrence of infection 4. Your partner(s) must be treated simultaneously