The nurse is reviewing the client's prescriptions.

The nurse is administering medications to the client and is monitoring potential adverse effects of medications. For each category below, click to specify the findings that indicate an adverse reaction. Each category may support more than 1 potential assessment finding. (Each category must have at least 1 response option selected)

 

Category	Findings
Head, Eyes, Ears, Nose, and Throat (HEENT)	Yellowing of the eyes Blurred vision Dry eyes
Gastrointestinal	Increased appetite Abdominal pain Hard stools
Laboratory Results	Increased liver enzymes Decreased prothrombin times Decreased platelet count

• Head, Eyes, Ears, Nose, and Throat (HEENT) — Blurred vision, Yellowing of the eyes: Ethambutol, one of the first-line antituberculosis medications, is known to cause optic neuritis as an adverse effect. Clients may report blurred vision, loss of color discrimination, or decreased visual acuity. Jaundice or yellowing of the eyes is a manifestation of significant hepatotoxicity as a result of isoniazid, rifampin and pyrazinamide, indicating liver injury.

• Gastrointestinal — Abdominal pain: Isoniazid, rifampin, and pyrazinamide are all hepatotoxic and may cause gastrointestinal discomfort such as abdominal pain, nausea, or anorexia. Abdominal pain in a client receiving these medications may indicate early hepatotoxicity or GI irritation. Reporting these findings promptly helps prevent serious liver injury.

• Laboratory Results — Increased liver enzymes: Hepatotoxicity is a common adverse effect of isoniazid, rifampin, and pyrazinamide. Elevations in AST, ALT, and bilirubin levels indicate liver inflammation or injury. Monitoring laboratory results allows for early detection of hepatotoxicity and timely adjustment of therapy.

Rationale for incorrect choices

• Head, Eyes, Ears, Nose, and Throat (HEENT) — Dry eyes: Dry eyes are not commonly associated with first-line antituberculosis medications. They do not indicate an adverse effect relevant to ethambutol, rifampin, isoniazid, or pyrazinamide.

• Gastrointestinal — Increased appetite: Increased appetite is not a recognized adverse effect of the tuberculosis medication regimen. Most commonly, these medications may cause anorexia or nausea rather than hyperphagia.

• Gastrointestinal — Hard stools: Constipation is not a typical adverse effect of first-line antituberculosis medications. Gastrointestinal symptoms usually involve nausea, vomiting, or abdominal discomfort, making hard stools an unlikely indicator.

• Laboratory Results — Decreased prothrombin times: While hepatotoxicity can affect clotting factors, the early expected lab finding is elevated liver enzymes rather than decreased prothrombin times. Decreased prothrombin times are not typical for this medication regimen.

• Laboratory Results — Decreased platelet count: Thrombocytopenia is a rare side effect and not commonly associated with first-line TB medications. Monitoring for liver enzymes is more critical for detecting early adverse reactions.