An adult exposed to tuberculosis is scheduled to begin prophylactic treatment with isoniazid. Which information is most important for the nurse to note before administering the initial dose?
Conversion of the client's PPD test from negative to positive
History of intravenous drug abuse
Current diagnosis of hepatitis B
Length of time of the exposure to tuberculosis
The Correct Answer is C
Choice A: Conversion of the client's PPD test from negative to positive is not the most important information for the nurse to note, as this is an expected finding for a client who has been exposed to tuberculosis and does not affect the administration of isoniazid. This is a distractor choice.
Choice B: History of intravenous drug abuse is not the most important information for the nurse to note, as this is not directly related to the use of isoniazid and does not contraindicate its administration. This is another distractor choice.
Choice C: Current diagnosis of hepatitis B is the most important information for the nurse to note, as this can increase the risk of hepatotoxicity and liver damage from isoniazid, which requires close monitoring and possible dose adjustment. Therefore, this is the correct choice.
Choice D: Length of time of the exposure to tuberculosis is not the most important information for the nurse to note, as this does not influence the dosage or frequency of isoniazid and does not indicate any complication or adverse reaction. This is another distractor choice.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Measuring abdominal girth is not a specific assessment for a client with a suprapubic catheter, which is a tube inserted through the lower abdomen into the bladder to drain urine. However, it may be useful for monitoring fluid status and abdominal distension.
Choice B reason: Assessing perineal area is not a specific assessment for a client with a suprapubic catheter, which is a tube inserted through the lower abdomen into the bladder to drain urine. However, it may be important for maintaining hygiene and preventing infection.
Choice D reason: Palpating flank area is not a specific assessment for a client with a suprapubic catheter, which is a tube inserted through the lower abdomen into the bladder to drain urine. However, it may be helpful for detecting kidney tenderness or enlargement.
Correct Answer is B
Explanation
Choice A: Remove the catheter and palpate the client’s bladder for residual distention. This is not the best action, as it may cause discomfort and trauma to the client. The catheter should not be removed until the bladder is fully emptied or up to 1,000 mL of urine is drained, as removing it too soon may cause urinary retention or infection.
Choice B: Allow the bladder to empty completely or up to 1,000 mL of urine. This is the best action, as it can prevent bladder spasms, overdistention, or rupture. The nurse should monitor the urine output and color, and document the amount and characteristics of urine drained.
Choice C: Clamp the catheter for thirty minutes and then resume draining. This is not the best action, as it may cause pain and discomfort to the client. The catheter should not be clamped unless ordered by the healthcare provider, as clamping it may increase the risk of infection or bladder damage.
Choice D: Remove the catheter and replace with an indwelling catheter. This is not the best action, as it may cause unnecessary exposure and trauma to the client. The catheter should not be replaced unless ordered by the healthcare provider, as replacing it may increase the risk of infection or urethral injury.
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