A nurse is assessing a client who has Parkinson's disease.
Which of the following manifestations should the nurse expect?

Choice A rationale

While allergic reactions are a concern with many medications, rifampin's primary mechanism of action involves inhibiting bacterial RNA synthesis, leading to its characteristic orange discoloration of body fluids due to the drug's metabolic byproducts being excreted. Shortness of breath, hives, or itching are signs of a hypersensitivity reaction, which, while possible, are not the expected or normal physiological response to rifampin. This choice does not address the specific normal side effect reported.

Choice B rationale

Rifampin, an antibiotic used for tuberculosis, is known to induce an orange-red discoloration of body fluids, including urine, tears, sweat, and saliva. This phenomenon occurs because rifampin and its metabolites are highly pigmented and are excreted through these routes. It is a harmless, expected side effect due to the drug's inherent color and excretion pathway, and patients should be educated about this physiological change.

Choice C rationale

Ethambutol, another antitubercular drug, is specifically associated with optic neuritis, which can manifest as a decrease in visual acuity and red-green color discrimination. Rifampin, however, does not typically cause this ocular toxicity. Therefore, querying about visual changes related to red-green color discrimination would be inappropriate and misleading in the context of rifampin's known side effects.

Choice D rationale

Advising a patient to stop an antitubercular medication like rifampin without consulting the healthcare provider can have serious consequences. Tuberculosis treatment requires strict adherence to a multi-drug regimen to prevent drug resistance and ensure eradication of the infection. The orange discoloration is a benign, expected side effect and not an indication to discontinue therapy, making immediate cessation medically unsound.

Choice A rationale

The headache phase is the primary pain experience of a migraine, characterized by moderate to severe throbbing pain, often unilateral. This phase is associated with vasodilation of cerebral blood vessels and activation of trigeminal nerve pathways, leading to the debilitating pain and associated symptoms like photophobia and phonophobia.

Choice B rationale

The prodrome phase precedes the migraine headache by hours or days and involves subtle, non-specific symptoms such as fatigue, mood changes, neck stiffness, and food cravings. These symptoms reflect neurobiological changes in the brain that signal the impending migraine attack, providing an early warning to some individuals.

Choice C rationale

The postdrome phase, often called the "migraine hangover," occurs after the headache has resolved and can last for 24 to 48 hours. Symptoms include fatigue, difficulty concentrating, mood changes, and muscle soreness, indicating the brain's recovery process after the intense neuronal activity and inflammation of the headache phase.

Choice D rationale

The aura phase consists of focal neurological symptoms, typically visual (e.g., blind spots, flashing lights, zigzag lines), but can also include sensory (e.g., tingling, numbness) or motor disturbances. These transient symptoms precede or accompany the headache and are believed to be caused by cortical spreading depression, a wave of neuronal depolarization.