A nurse is caring for a client with diabetic ketoacidosis (DKA). Which of the following interventions is the priority?

Choice A reason: Providing sputum specimens every 2 weeks is not standard for tuberculosis treatment monitoring. Sputum cultures are typically collected monthly to assess treatment response until conversion to negative, usually within 2-3 months of effective therapy. Biweekly testing is excessive and not supported by guidelines, as it does not align with typical microbial clearance timelines.

Choice B reason: Expecting sputum cultures to be negative after 6 months of therapy is accurate for tuberculosis treatment with isoniazid, rifampin, and pyrazinamide. Effective multidrug therapy typically renders sputum cultures negative within 2-6 months, indicating reduced bacterial load and treatment success, assuming adherence and no drug resistance, aligning with standard TB treatment protocols.

Choice C reason: Drinking 8 ounces of water with pyrazinamide is not a specific requirement. While hydration is important, pyrazinamide does not require a specific fluid volume for administration. It is taken orally, and no evidence suggests water intake enhances efficacy or reduces side effects like hepatotoxicity or hyperuricemia, which are managed differently.

Choice D reason: Taking isoniazid with an antacid is incorrect. Antacids can reduce isoniazid absorption by altering gastric pH, decreasing bioavailability. Isoniazid should be taken on an empty stomach for optimal absorption, as food or antacids may interfere with its pharmacokinetics, potentially reducing its effectiveness against Mycobacterium tuberculosis.

Choice A reason: Frequent bowel movements are not typical in peritonitis. Inflammation of the peritoneal cavity causes ileus, reducing bowel motility and leading to constipation or obstipation. Peristalsis slows due to irritation, and the body diverts energy to combat infection, making diarrhea unlikely unless another condition, like gastroenteritis, is present, which is not indicated here.

Choice B reason: A rigid abdomen is a classic sign of peritonitis due to peritoneal inflammation causing muscle guarding and rigidity. The peritoneal irritation from infection or chemical irritants (e.g., bile, gastric contents) triggers involuntary abdominal wall contraction to protect inflamed tissues, resulting in a board-like abdomen, often with severe pain.

Choice C reason: Decreased urinary output occurs in peritonitis due to systemic inflammation and potential hypovolemia from fluid shifts into the peritoneal cavity (third-spacing). The kidneys receive reduced perfusion, activating the renin-angiotensin-aldosterone system, leading to oliguria. This reflects the body’s attempt to conserve fluid in response to systemic stress and inflammation.

Choice D reason: Inability to pass stools is expected in peritonitis due to paralytic ileus, where intestinal motility ceases from inflammation. Peritoneal irritation disrupts normal peristalsis, causing bowel obstruction symptoms like constipation or obstipation. This results from the body’s inflammatory response inhibiting gastrointestinal function, leading to stool retention.

Choice E reason: Hyperactive bowel sounds are not typical in peritonitis. The condition causes paralytic ileus, reducing or absent bowel sounds due to decreased peristalsis from peritoneal inflammation. Hyperactive sounds may occur in early mechanical obstruction but not in peritonitis, where inflammation halts bowel motility, leading to hypoactive or absent sounds.