A patient newly diagnosed with tuberculosis (TB) has been taking antitubercular drugs for 1 week and calls the clinic, saying, "My urine is dark orange! What’s wrong with me?" Which response by the nurse is correct?
You will need to stop the medication, and it will go away.
It’s possible that the TB is worse. Please come in to the clinic to be checked.
This is not what we usually see with these drugs. Please come in to the clinic to be checked.
This is an expected side effect of the medicine. Let’s review what to expect.
The Correct Answer is D
Choice A reason: Stopping antitubercular medication due to dark orange urine is incorrect, as this is an expected effect of rifampin. Discontinuing therapy prematurely risks treatment failure and resistance development. Patient education about harmless discoloration is needed, not cessation, unless serious adverse effects like hepatotoxicity occur.
Choice B reason: Dark orange urine does not indicate worsening tuberculosis. It is a benign effect of rifampin’s red-orange metabolite excreted in urine. Worsening tuberculosis would present with increased symptoms like cough or fever, not urine discoloration, making this response inaccurate and alarming to the patient.
Choice C reason: Dark orange urine is a common, expected effect of rifampin, not an unusual finding requiring clinic evaluation. Rifampin’s metabolites cause harmless discoloration of bodily fluids. Only symptoms like jaundice or abdominal pain would warrant further investigation, not this benign side effect.
Choice D reason: Dark orange urine is an expected side effect of rifampin, a first-line antitubercular drug. Its red-orange metabolite discolors urine, sweat, and tears, which is harmless. Educating the patient about this effect reassures them, ensures adherence, and prevents unnecessary concern, focusing on other potential serious side effects.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Orange-tinged urine is an expected effect of rifampin, not a therapeutic response. It results from the drug’s red-orange metabolite excreted in urine, not an indicator of tuberculosis resolution. Clinical improvement, like reduced symptoms and negative cultures, better reflects the effectiveness of antitubercular therapy.
Choice B reason: A therapeutic response to antitubercular therapy is indicated by decreased symptoms (e.g., cough, fever), improved chest radiographs (reduced infiltrates), and negative sputum cultures, showing reduced Mycobacterium tuberculosis burden. These objective measures confirm the drugs, like isoniazid and rifampin, are effectively killing the bacteria and resolving the infection.
Choice C reason: Increased tolerance to antitubercular therapy or fewer adverse effects does not indicate a therapeutic response. Tolerance reflects patient adaptation to side effects, not bacterial clearance. Objective measures like symptom reduction and negative cultures are needed to confirm the therapy’s effectiveness against tuberculosis.
Choice D reason: Negative PPD results are not used to monitor active tuberculosis treatment. PPD tests detect latent tuberculosis or prior exposure, not active disease. Therapeutic response is assessed through symptom improvement, chest imaging, and sputum cultures, which directly indicate the reduction of active Mycobacterium tuberculosis infection.
Correct Answer is A
Explanation
Choice A reason: Theophylline, a methylxanthine, causes palpitations by increasing cyclic AMP through phosphodiesterase inhibition, stimulating cardiac beta-1 receptors. This can lead to tachycardia or arrhythmias, especially at high levels. Monitoring heart rate is critical due to theophylline’s narrow therapeutic index and potential for cardiovascular toxicity.
Choice B reason: Diarrhea is not a primary adverse effect of theophylline. Gastrointestinal upset, like nausea or vomiting, may occur due to gastric irritation, but diarrhea is less common. Theophylline’s main toxicities involve the cardiovascular and nervous systems, making palpitations a more significant concern.
Choice C reason: Drowsiness is not associated with theophylline, which acts as a CNS stimulant, potentially causing nervousness or insomnia. Its phosphodiesterase inhibition increases cyclic AMP, enhancing alertness, not sedation. Drowsiness is more linked to antihistamines, making this incorrect for theophylline monitoring.
Choice D reason: Bradycardia is not a typical theophylline effect. Theophylline stimulates the heart via beta-1 receptor activation, causing tachycardia or palpitations. Bradycardia may occur with other drugs, like beta-blockers, but theophylline’s sympathomimetic effects make palpitations a more relevant adverse effect to monitor.
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