A nurse is admitting a client who has tuberculosis and a productive cough. Which of the following types of isolation precautions should the nurse initiate for the client?

Choice A reason: "Use simple, childlike statements when speaking." This response is not appropriate because it can be demeaning and disrespectful to the client. The client is an adult who knows what they want to say, but they have difficulty saying it. Using simple statements is helpful, but they should not be childlike or patronizing.

Choice B reason: "Use a higher pitched tone of voice when speaking." This response is not appropriate because it can be irritating and confusing to the client. The client may have normal hearing, or they may have hearing loss due to age or stroke. Using a higher pitched tone of voice can make the speech harder to understand and may imply that the client is not intelligent.

Choice C reason: "Incorporate nonverbal cues in the conversation." This response is appropriate because nonverbal cues, such as gestures, facial expressions, and drawings, can help the client understand and express themselves better. Nonverbal cues can also reduce frustration and anxiety for both the client and the family member.

Choice D reason: "Ask multiple choice questions as part of the conversation." This response is not appropriate because it can be overwhelming and stressful for the client. Multiple choice questions can be hard to process and remember for someone with aphasia. It is better to ask yes or no questions, or to provide options with visual cues.

Choice A reason: Blood glucose levels are not a necessary laboratory test for a client who has tuberculosis and new prescriptions for rifampin and pyrazinamide. Blood glucose levels measure the amount of sugar in the blood and are used to diagnose and monitor diabetes. Rifampin and pyrazinamide do not affect blood glucose levels directly, but they may interact with some medications used to treat diabetes, such as sulfonylureas or metformin. The nurse should advise the client to monitor their blood glucose levels regularly and report any changes to the provider.

Choice B reason: Thyroid function studies are not a required laboratory test for a client who has tuberculosis and new prescriptions for rifampin and pyrazinamide. Thyroid function studies measure the levels of thyroid hormones and thyroid stimulating hormone in the blood and are used to diagnose and monitor thyroid disorders. Rifampin and pyrazinamide do not affect thyroid function directly, but they may interact with some medications used to treat thyroid disorders, such as levothyroxine or propylthiouracil. The nurse should advise the client to take their thyroid medication at least 4 hours before or after rifampin and pyrazinamide and report any symptoms of thyroid imbalance to the provider.

Choice C reason: Gallbladder studies are not a relevant laboratory test for a client who has tuberculosis and new prescriptions for rifampin and pyrazinamide. Gallbladder studies include ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) scans of the gallbladder and are used to diagnose and monitor gallstones or gallbladder inflammation. Rifampin and pyrazinamide do not affect the gallbladder directly, but they may cause side effects such as nausea, vomiting, or abdominal pain, which can mimic gallbladder problems. The nurse should assess the client for signs of hepatotoxicity, such as jaundice, dark urine, or clay colored stools, and report any findings to the provider.

Choice D reason: Liver function tests are a vital laboratory test for a client who has tuberculosis and new prescriptions for rifampin and pyrazinamide. Liver function tests measure the levels of enzymes, proteins, and bilirubin in the blood and are used to diagnose and monitor liver damage or disease. Rifampin and pyrazinamide are both hepatotoxic drugs, which means they can cause liver injury or failure. The nurse should instruct the client to have liver function tests done before starting the medication regimen and periodically during the treatment. The nurse should also educate the client about the signs and symptoms of hepatotoxicity, such as fatigue, loss of appetite, nausea, vomiting, or yellowing of the skin or eyes, and advise them to stop taking the medication and seek medical attention if they occur.