The antitubercular drug isoniazid is prescribed for a client with active tuberculosis.
To evaluate the effectiveness of this medication, which outcome can the nurse expect this client to exhibit?

Decreased appetite and weight loss.

Decreased cough and sputum.

Vertigo and tinnitus.

A positive sputum smear and culture.

Answer and Explanation

The Correct Answer is B

Choice B rationale:

Isoniazid's Mechanism of Action:

It targets and inhibits the synthesis of mycolic acids, which are essential components of the cell wall of Mycobacterium tuberculosis, the bacteria that cause tuberculosis.

By disrupting cell wall formation, isoniazid prevents bacterial growth and multiplication, leading to the suppression and eventual eradication of the infection.

Clinical Manifestations of Active TB:

Persistent cough, often productive of sputum (phlegm), is a hallmark symptom of TB. The sputum may contain blood or have a rusty-colored appearance.

Other common symptoms include fever, night sweats, fatigue, weight loss, and chest pain. How Isoniazid Reduces Cough and Sputum:

As isoniazid effectively kills the TB bacteria, the inflammatory process within the lungs subsides.

This leads to a gradual decrease in the production of sputum, which is a direct result of the inflammatory response. Consequently, the frequency and severity of coughing episodes also diminish.

Monitoring Treatment Response:

Regular sputum smears and cultures are essential to assess the response to treatment.

A positive sputum smear indicates the presence of live TB bacteria, while a positive culture confirms their growth in the laboratory.

A gradual decrease in the number of bacteria seen on sputum smears, followed by negative cultures, signals a favorable response to treatment.

Timeframe for Improvement:

It's important to note that clinical improvement, including a reduction in cough and sputum, may not be immediately evident. It typically takes several weeks of consistent isoniazid therapy to achieve noticeable results.

Therefore, adherence to the prescribed treatment regimen is crucial for successful TB eradication. Addressing Other Choices:

Choice A: Decreased appetite and weight loss are often associated with active TB due to systemic inflammation and nutritional deficiencies. While isoniazid treatment may indirectly improve appetite and weight gain over time, these are not primary indicators of its effectiveness in suppressing the TB infection itself.

Choice C: Vertigo and tinnitus are potential side effects of isoniazid, but they do not reflect its efficacy in treating TB.

Choice D: A positive sputum smear and culture would indicate ongoing TB infection and a lack of response to treatment.

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Correct Answer is A

Explanation

Rationale for Choice A:

Direct (sliding) hiatal hernias: These are the most common type of hiatal hernia. They occur when the upper part of the stomach slides upward through the diaphragm into the chest cavity. This displacement disrupts the normal function of the lower esophageal sphincter (LES), which is a ring of muscle that acts as a valve between the esophagus and stomach. The LES is responsible for preventing stomach contents from refluxing back into the esophagus.

Esophageal reflux: When the LES is weakened or impaired, stomach acid, pepsin, and bile can flow back into the esophagus, causing a burning sensation known as heartburn, regurgitation of food or sour liquid, and irritation of the esophageal lining.

Prevention of esophageal reflux: Nursing actions aimed at preventing esophageal reflux are crucial in the management of hiatal hernias. These actions include:

Elevate the head of the bed: This helps to keep stomach contents below the level of the esophagus, reducing the risk of reflux. Avoid eating large meals: Large meals put more pressure on the stomach, which can increase the likelihood of reflux.

Avoid lying down after eating: Lying down can allow stomach contents to flow back into the esophagus more easily. Avoid foods that trigger reflux: Common triggers include fatty foods, spicy foods, acidic foods, caffeine, and alcohol.

Maintain a healthy weight: Excess weight can increase abdominal pressure and contribute to reflux.

Consider medications: If lifestyle changes are not enough to control reflux, medications such as antacids, H2 blockers, or proton pump inhibitors may be prescribed.

Rationale for Choice B:

Maintaining intact oral mucosa: This is not a primary goal in the care of a client with a hiatal hernia. While oral hygiene is important for overall health, it does not directly address the issue of esophageal reflux.

Rationale for Choice C:

Increasing intestinal peristalsis: This is not a relevant goal for a hiatal hernia. Hiatal hernias primarily affect the upper digestive tract, not the intestines.

Rationale for Choice D:

Promoting effective swallowing: This is not the most important goal in the care of a client with a hiatal hernia. While swallowing difficulties can occur in some cases, they are not the primary concern. The priority is to prevent esophageal reflux and its associated complications.

A. Provide suctioning so the patient does not have to cough. B. Position the patient with the head of the bed elevated. C. Encourage the patient to take breaks from the oxygen mask every few hours. D. Ask the patient to do quick, shallow breaths. E. Teach the patient to cough at least once an hour. F. Avoid treating fever with antipyretics. G. Assist the patient in ambulating safely.

Correct Answer is ["B","E","G"]

Explanation

B. Position the patient with the head of the bed elevated. Rationale:

Promotes lung expansion: Elevating the head of the bed by at least 30 degrees utilizes gravity to assist in diaphragmatic descent and lung expansion. This allows for greater intake of air, optimizing oxygen intake and facilitating better gas exchange.

Reduces work of breathing: When upright, the abdominal muscles can more effectively aid in breathing, reducing the workload on the diaphragm and accessory muscles. This conserves energy and decreases the patient's respiratory effort.

Enhances secretion drainage: Gravity also aids in the movement of secretions from the lower lobes of the lungs towards the upper airways, where they can be more easily coughed up or suctioned. This helps to clear the airways and improve ventilation.

E. Teach the patient to cough at least once an hour. Rationale:

Clears secretions: Coughing is a natural mechanism to clear secretions from the lungs and airways. It helps to prevent mucus buildup and potential obstruction, which can lead to atelectasis (collapse of lung tissue) and further compromise ventilation.

Improves gas exchange: By removing secretions, coughing allows for better airflow and gas exchange within the lungs. This enhances oxygenation and helps to prevent respiratory complications.

G. Assist the patient in ambulating safely. Rationale:

Mobilizes secretions: Ambulation encourages movement of secretions from the lower lobes of the lungs, promoting their clearance and preventing mucus buildup.

Prevents atelectasis: Walking and movement help to expand the lungs, reducing the risk of atelectasis and improving overall ventilation.

Enhances circulation: Ambulation also improves circulation, which can help to deliver oxygen to the tissues more effectively and aid in healing.

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The antitubercular drug isoniazid is prescribed for a client with active tuberculosis.To evaluate the effectiveness of this medication, which outcome can the nurse expect this client to exhibit?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is planning care for a client with a direct (sliding) hiatal hernia. Nursing actions should be planned to meet which goal?

Correct Answer is A

Explanation

A patient's data shows consolidation in the right middle and lower lobe, consistent with pneumonia. What actions can the nurse take to assist the patient in improving their ventilation and oxygenation? Select all that apply.

Correct Answer is ["B","E","G"]

Explanation

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The antitubercular drug isoniazid is prescribed for a client with active tuberculosis.
To evaluate the effectiveness of this medication, which outcome can the nurse expect this client to exhibit?