A nurse is caring for a client who has asthma and developed viral pharyngitis and has a WBC of 16,000/mm.

Which of the following findings should the nurse expect?

Choice A rationale

Directly Observed Therapy is a specific strategy used during the treatment phase of tuberculosis and is not a diagnostic tool. Diagnosis of tuberculosis relies on sputum cultures, acid-fast bacilli smears, chest X-rays, and molecular tests like GeneXpert. Because DOT focuses on the administration of medication after a diagnosis has already been established, it does not improve the accuracy of the initial identification of the Mycobacterium tuberculosis pathogen in the clinical setting.

Choice B rationale

While public health programs often provide tuberculosis medications for free or at a subsidized cost to improve accessibility, the primary clinical objective of Directly Observed Therapy is not financial. The infrastructure required to have a trained healthcare worker or designated individual witness every dose actually increases the administrative and labor costs of the program. Therefore, reducing medication costs is a separate policy goal and not the functional purpose of the DOT protocol itself.

Choice C rationale

The primary goal of DOT is to ensure strict adherence to the complex and lengthy multi-drug regimen required to cure tuberculosis. Non-compliance is the leading cause of treatment failure, relapse, and the development of multidrug-resistant tuberculosis (MDR-TB). By having a healthcare provider watch the patient swallow their medication, the program guarantees that the full course is completed. This intervention protects both the individual patient and public health by reducing the transmission of the bacteria.

Choice D rationale

While the interaction between a patient and their DOT provider can offer some level of social interaction and emotional support, this is a secondary benefit rather than the primary medical purpose. The protocol is strictly designed as a public health intervention to manage medication compliance. Social support networks for TB patients are usually facilitated through counseling services, support groups, or community outreach programs rather than the structured, observation-based medication delivery system defined by DOT.

Choice A rationale

Monitoring skin color is a standard assessment for many medications but is not the primary focus for ethambutol. While liver toxicity can cause jaundice, which changes skin color, this is more commonly associated with other antituberculosis drugs like isoniazid or rifampin. Normal skin assessment involves checking for cyanosis or pallor, but ethambutol specifically lacks the high-frequency dermatologic side effects that would necessitate focused, prioritized skin monitoring over other specialized sensory tests.

Choice B rationale

Urine output monitoring is essential for evaluating renal function, especially since many drugs are cleared by the kidneys. However, ethambutol is not primarily known for causing acute renal failure or significant changes in urine volume. The normal range for adult urine output is 0.5 to 1.5 mL per kg per hour. While dosage adjustments are needed for patients with existing renal impairment, the drug itself does not typically require routine urine volume tracking for toxicity.

Choice C rationale

Cardiac rhythm monitoring is not a standard requirement for patients taking ethambutol. Unlike some antibiotics or specialized cardiac medications that can prolong the QT interval or cause arrhythmias, ethambutol lacks significant cardiotoxic properties. Normal sinus rhythm is the expected finding in healthy individuals. The primary physiological concerns with this medication remain focused on the central nervous system and sensory organs rather than the electrical conduction system of the heart or muscular contractility.

Choice D rationale

Ethambutol is known to cause optic neuritis, which is a common and serious side effect leading to decreased visual acuity and red-green color blindness. This occurs due to the inflammatory response in the optic nerve fibers. Regular monitoring of vision is crucial to detect early signs of toxicity, which can be reversible if the drug is stopped promptly. Assessing the ability to see clearly and distinguish colors ensures the patient does not suffer permanent vision loss.