A client presents to the medical surgical unit.

Which of the following findings requires further action by the nurse? Select all that apply.

Airborne precautions (Anticipated): Tuberculosis is an airborne disease, requiring negative pressure isolation, N95 respirators, and airborne precautions to prevent transmission.

Rifampin (Anticipated): A key first-line TB medication that inhibits bacterial RNA synthesis. It is part of the standard RIPE (Rifampin, Isoniazid, Pyrazinamide, Ethambutol) regimen.

Contact precautions (Contraindicated): TB does not spread via direct contact, so contact precautions (gloves, gowns) are unnecessary unless the client has open wounds with drainage.

Isoniazid (Anticipated): A primary anti-TB drug that inhibits mycolic acid synthesis, crucial for treating active and latent TB infections.

Monthly TB skin test for 1 year (Contraindicated): Once TB is diagnosed, routine Mantoux tests are unnecessary, as they will likely remain positive due to prior exposure.

Pyrazinamide (Anticipated): A bactericidal TB medication used in the intensive phase of treatment to shorten therapy duration.

Ethambutol (Anticipated): Used to prevent drug resistance in TB treatment. Regular eye exams are needed due to the risk of optic neuritis.

A) Withhold the medication if pulse rate is less than 60/min: Enalapril, an ACE inhibitor, primarily affects blood pressure and does not typically require withholding based on pulse rate alone. Withholding enalapril is not recommended unless instructed by the healthcare provider for other reasons, such as a significant drop in blood pressure. The issue at hand is likely related to orthostatic hypotension rather than pulse rate.

B) Increase dietary potassium: Enalapril can increase potassium levels in the blood due to its effect on the renin-angiotensin system, potentially leading to hyperkalemia. Clients should avoid excessive potassium intake, especially through supplements or potassium-rich foods, unless advised by their healthcare provider. Increasing potassium may exacerbate any existing risks.

C) Decrease daily fluid intake: Decreasing fluid intake is not a recommended intervention for managing syncope related to enalapril. In fact, reducing fluid intake can exacerbate dehydration or low blood pressure, potentially worsening symptoms. Adequate hydration is typically important for managing blood pressure and syncope risk.

D) Rise slowly from a sitting position to a standing position: This is the most appropriate
advice. Enalapril can cause orthostatic hypotension, a condition in which blood pressure drops when changing positions (such as from sitting to standing). This can lead to dizziness or syncope. Rising slowly from a sitting position helps prevent a sudden drop in blood pressure and reduces the risk of fainting. Clients should be instructed to take this precaution until the body adjusts to the medication’s effects.