A patient taking ethambutol develops a sore throat and fever.
What is the appropriate nursing action?
Continue medication and monitor symptoms.
Discontinue medication and notify the healthcare provider immediately.
Increase dose to control symptoms.
Prescribe an antibiotic.
The Correct Answer is B
Choice A rationale
Ethambutol is an antituberculosis medication. The combination of a sore throat and fever can be indicative of a serious and potentially life-threatening adverse effect of the medication, such as hepatotoxicity or bone marrow suppression, which could manifest as agranulocytosis. Continuing the medication would be highly dangerous and could worsen the patient's condition.
Choice B rationale
Sore throat and fever can signal a severe systemic reaction to ethambutol, potentially indicating drug-induced agranulocytosis or hepatotoxicity. Agranulocytosis, characterized by a critically low white blood cell count (normal range for WBC is 4,500 to 11,000 cells/mm), leaves the body vulnerable to overwhelming infection. Immediate discontinuation of the drug and notifying the healthcare provider is the essential nursing action.
Choice C rationale
Increasing the dose of a medication when a patient is exhibiting signs of a potential adverse drug reaction is contraindicated. The symptoms of sore throat and fever suggest a systemic inflammatory or immune response to the drug. Increasing the dose would likely exacerbate the toxicity and further harm the patient, potentially leading to a more severe outcome.
Choice D rationale
A sore throat and fever in a patient on ethambutol could be a sign of a severe adverse drug reaction, not just a simple bacterial infection. While an infection may be present, the primary concern is the potential for bone marrow suppression. Prescribing an antibiotic without a proper diagnosis would be an inappropriate nursing action, as it is outside the scope of practice and would fail to address the underlying issue.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D"]
Explanation
Choice A rationale
A low therapeutic index indicates a small difference between the therapeutic dose and the toxic dose, not that low doses are ineffective. The therapeutic index is a ratio that compares the dose that produces a therapeutic effect to the dose that causes toxicity. Therefore, the low end of the dose range can still be therapeutic, but the therapeutic window itself is narrow.
Choice B rationale
Barbiturates have a low therapeutic index, which means there is a narrow margin between the therapeutic and toxic drug concentrations. A small increase in dosage beyond the therapeutic range can lead to significant toxicity. This narrow therapeutic window necessitates close monitoring of patients to avoid adverse effects.
Choice C rationale
While barbiturates are indeed habit-forming and have a high potential for physical and psychological dependence, this characteristic is not what is meant by a "low therapeutic index.”. The low therapeutic index refers to the relationship between the effective dose and the toxic dose, not the potential for addiction.
Choice D rationale
A low therapeutic index signifies that the range between the minimum effective concentration and the minimum toxic concentration is narrow. This means the drug dosage must be carefully controlled and monitored to ensure it is effective without causing harmful side effects. Small dosing errors can lead to toxicity, highlighting the drug's narrow safe dosage range.
Correct Answer is A
Explanation
Choice A rationale
Ranolazine (Ranexa) is an antianginal agent that works by inhibiting the late sodium current in cardiac myocytes. This inhibition leads to a reduction in intracellular calcium overload, improving myocardial relaxation and reducing ventricular wall tension. Unlike many other antianginal drugs, ranolazine does not significantly affect heart rate or blood pressure, making it useful in patients who cannot tolerate the hemodynamic effects of other agents.
Choice B rationale
Ranolazine is not a first-line therapy for angina. It is typically used as a second-line treatment in patients who have not achieved adequate symptom control with beta-blockers, calcium channel blockers, or nitrates. It is often prescribed in combination with other antianginal drugs.
Choice C rationale
Ranolazine is an oral medication available in an extended-release tablet formulation. It is not administered intravenously. The patient takes this medication by mouth, usually twice daily, for the long-term management of chronic angina.
Choice D rationale
Ranexa is metabolized by the liver, specifically via the cytochrome P450 3A (CYP3A) enzyme pathway. Therefore, it is contraindicated or requires significant dose adjustment in patients with moderate to severe hepatic impairment due to the risk of increased plasma concentrations and toxicity.
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