A client is prescribed alprazolam for acute anxiety. What client history should cause a nurse to question this order?

Choice A Reason
A negative sputum culture is the most definitive indicator of the effectiveness of tuberculosis (TB) treatment. When a patient with active TB starts on medication, the goal is to eliminate the Mycobacterium tuberculosis bacteria from the body. A sputum culture that turns from positive to negative signifies that the bacteria have been eradicated from the respiratory secretions, indicating successful treatment.

Choice B Reason
While decreased hemoptysis (coughing up blood) is a positive sign and indicates an improvement in the patient's condition, it is not the most reliable parameter for determining the effectiveness of TB therapy. Hemoptysis may decrease as the patient's overall condition improves, but it does not confirm the eradication of the TB bacteria.

Choice C Reason
An improved chest x-ray can show a reduction in the lesions caused by TB, which is a good sign of recovery. However, chest x-rays cannot confirm whether the TB bacteria have been completely eliminated. They are more of a supportive indicator rather than a definitive one.

Choice D Reason
A decreased rate of coughing is another sign that the patient is responding to treatment, as coughing is a primary symptom of TB. However, similar to hemoptysis and chest x-ray improvements, a decrease in coughing does not necessarily mean that the TB bacteria have been fully cleared from the body.

Choice A Reason
While some medications for hypertension can cause visual side effects, it is not the most immediate concern when a patient reports blurred vision. Medication-related side effects are important to consider, but they typically present consistently rather than intermittently.

Choice B Reason
An ophthalmic examination is crucial for evaluating intermittent blurred vision in a client with hypertension. Hypertension can lead to hypertensive retinopathy, where high blood pressure causes damage to the blood vessels in the retina, potentially resulting in blurred vision or vision loss. An eye exam can help diagnose this condition and prevent further complications.

Choice C Reason
Blurred vision can indeed be associated with hypertension, particularly in severe cases or hypertensive crises. However, it is not considered a 'common' problem but rather a sign of potential end-organ damage, such as hypertensive retinopathy, which requires prompt medical evaluation.

Choice D Reason
The risk of brain tumors is not directly associated with hypertension. While hypertension is a risk factor for certain conditions like stroke, it is not typically linked with an increased risk of brain tumors. This choice might cause unnecessary alarm without a clinical basis.