When educating a client who was recently prescribed inhaled corticosteroids, the nurse will discuss which potential adverse effects?

Choice A reason: The purpose of multiple drugs in tuberculosis treatment is not to hope one works but to ensure comprehensive bacterial eradication. Combination therapy targets different aspects of Mycobacterium tuberculosis, preventing resistance and ensuring efficacy, as single-drug therapy is ineffective and promotes resistant strains.

Choice B reason: Multiple drugs do not primarily reduce side effects; they increase the likelihood of adverse effects due to cumulative toxicity (e.g., hepatotoxicity from isoniazid and rifampin). The rationale for combination therapy is to enhance efficacy and prevent resistance, not to mitigate side effects, making this incorrect.

Choice C reason: Combination therapy (e.g., isoniazid, rifampin, ethambutol, pyrazinamide) enhances efficacy by targeting different bacterial populations and metabolic states of Mycobacterium tuberculosis. This synergistic approach ensures rapid bacterial killing, prevents resistance, and shortens treatment duration, making it the standard for effective tuberculosis management.

Choice D reason: The use of multiple drugs is not because drugs are becoming resistant but to prevent resistance development. Combination therapy overwhelms Mycobacterium tuberculosis with multiple mechanisms, reducing the chance of resistant mutants surviving. Resistance occurs with inadequate or monotherapy, not as a rationale for combination therapy.

Choice A reason: Reducing raw vegetables and fruit is not necessary with simvastatin. Dietary vitamin K may affect warfarin, but statins are unaffected by fruits or vegetables, except grapefruit, which inhibits CYP3A4, increasing simvastatin levels. A balanced diet supports cardiovascular health, making this instruction incorrect.

Choice B reason: Drug interactions are not rare with simvastatin, a statin metabolized by CYP3A4. Inhibitors like grapefruit juice or antifungals increase simvastatin levels, risking toxicity, while inducers reduce efficacy. Patients must be educated about potential interactions, making this statement incorrect and misleading for safe statin use.

Choice C reason: Reporting muscle pain immediately is critical with simvastatin, as it may indicate myopathy or rare rhabdomyolysis. Statins disrupt muscle cell membranes, causing pain or weakness. Early reporting allows monitoring of creatine kinase levels and prevents progression to severe muscle damage, ensuring patient safety.

Choice D reason: Reporting bleeding or yellow skin (jaundice) is essential, as simvastatin can cause hepatotoxicity, elevating liver enzymes, or rare bleeding due to drug interactions. Jaundice indicates liver dysfunction, and bleeding may result from interactions with anticoagulants, necessitating prompt reporting to adjust therapy or monitor liver function.

Choice E reason: Limiting fluid intake is not required with simvastatin. Fluid overload is unrelated to statins, which affect cholesterol synthesis, not fluid balance. Adequate hydration supports general health, and no evidence suggests fluid restriction is necessary, making this instruction irrelevant and potentially harmful.