A nurse is working on a surgical unit and is caring for a client who returned from the Post Anesthesia Care Unit (PACU) 90 minutes ago. Which interventions will decrease the client’s risk of developing a pulmonary embolism? (Select all that apply)

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.

A. Antiretroviral therapy (ART), including dolutegravir and lamivudine, inhibits HIV replication, reducing viral load to undetectable levels, which is a primary goal of treatment. This aligns with the patient’s regimen, as suppressing viral load prevents disease progression and reduces transmission risk.

B. Dolutegravir and lamivudine can cause side effects such as headache, nausea, vomiting, and anorexia, which are well-documented in clinical data. Educating the patient about these potential effects is crucial for adherence and managing expectations.

C. ART does not have zero side effects. Clinical evidence shows dolutegravir and lamivudine can cause adverse effects, including gastrointestinal issues and, rarely, liver problems, making this statement incorrect for patient education.

D. While dolutegravir may cause insomnia in some patients, it is not a universal effect requiring nighttime dosing. The prescribed morning dose of dolutegravir is standard to optimize adherence and efficacy, making this statement incorrect.

E. Doubling a missed dose is incorrect and potentially harmful. ART regimens require consistent dosing; patients should take the missed dose as soon as remembered unless it’s close to the next dose, to avoid toxicity and maintain efficacy.

F. Taking ART with antacids is not recommended, as antacids can reduce dolutegravir absorption, decreasing its effectiveness. Patients should be advised to avoid antacids or follow specific timing guidelines, making this statement incorrect.

G. CD4+T cell counts are a key measure of ART effectiveness, as they reflect immune system recovery. Monitoring CD4+T counts every 3 months, as ordered, assesses treatment success, making this statement correct for patient education.

H. ART, including dolutegravir and lamivudine, does not cause wasting syndrome. Wasting syndrome is associated with untreated HIV or older regimens, not modern ART, making this statement incorrect for patient education.