Chapter 41: Antitubercular DrugsSamuel is an 18-year-old male who comes into the free health clinic periodically. Today, he is complaining of fatigue, joint pains, diarrhea, productive cough, and sores in his mouth. He has been living on and off the street for the past 6 months. Samuel has a history of intravenous (IV) drug use and has had unprotected sex with men and women in order to pay rent at a local hourly motel. He denies sharing needles while using IV drugs. His last vaccinations were while he was in middle school. He does not take any prescription medications. He uses illicit drugs andalcohol when he can get them. Samuel does not have a steady job and will pander for money. His current vital signs are blood pressure 110/63 mm Hg, heart rate 100 beats/min, respiratory rate 24 breaths/min, and temperature 101F. He has blood work taken along with an oral rapid human immunodeficiency virus (HIV) test in the clinic. The results are as follows:Laboratory Test Result Reference RangeHIV antibody Positive NegativeHCV antibody (hepatitis C virus)Positive NegativeHBsAg (hepatitis B surface antigen)Negative NegativeHBcAb (hepatitis B core antigen)Positive Negative Laboratory Test Result Reference RangeCD4+ lymphocytes 700/mm3800 to 2500/mm3HIV viral level Detected UndetectableRPR (rapid plasma regain) Negative NegativeHemoglobin 14.2 g/dL 13.5 to 16.5 g/dLHematocrit 42.5% 41% to 50%White Blood cells 11,000/mm314,400/mm34500 to 11,000/mm3Serum glucose (fasting) 90 mg/dL 60 to 110 mg/dLSerum triglycerides (fasting) 150 mg/dL 45 to 55 mg/dLTotal cholesterol Not tested <220 mg/dLAsparatate aminotransferase (AST)24 IU/L <35 IU/L1. As the CD4 cell count fails, what is Samuel at risk for developing?a. Slow HIV infection to other cellsb. Opportunistic infectionsc. Impending deathd. Impending renal and hepatic failure2. Samuel is referred to the HIV clinic at the local health department. He receives a Mantoux skin test and will be started on highly active antiretroviral therapy (HAART) with a combination of tenofovir 300 mg, emtricitabine 200 mg, and efavirenz 600 mg by mouth every day.As the nurse, you know that HAART will be beneficial for Samuel due to which therapeutic action?a. It destroys the HIV virus.b. It decreases plasma HIV levels.c. It boosts the immune system responsed. It prevents recurrent hepatitis infection. 3. Samuel asks you to describe HAART. How will you respond?a. “HAART is a single medication that increases your immunity to the virus.”b. “HAART is an antineoplastic medication that will prevent other infections.”c. “HAART is a vaccination that will stop the HIV virus from spreading in the body.”d. “HAARY is a combination of medications that will stop the HIV virus from spreading in the body.”4. In analyzing Samuel’s current medication regimen, you understand that the medications he is taking are classified asa. Nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI).b. Protease inhibitors and NRTI.c. Entry inhibitors and NNRTI.d. Integrase inhibitors and NRTI.5. Samuel asks you how these combinations of medications help control his HIV infection. Which response is correct?a. “These medications stop the HIV-infected cell from binding to your normal CD4 cells.”b. “These medications stop the HIV DNA from entering your normal CD4 cell DNA.”c. “These medications stop you from contracting other HIV-associated infectious diseases.”d. “These medications stop the HIV virus from duplicating.”6. Samuel returns to the HIV clinic 2 days later to have his Mantoux skin test read. In observing Samuel’s forearm, you note a 6-mm of induration where the Mantoux test wasadministered. What is your interpretation of this finding?a. Negative Mantoux skin test resultb. Normal finding for Mantoux skin testc. Positive Mantoux skin test resultd. Inconclusive Mantoux skin test result7. Samuel is sent across the street to the radiology department to have a chest radiograph taken. Soon after, the radiologist notifies the HIV clinic of abnormal findings on the radiograph. Samuel is admitted to the medical unit of the local hospital. Samuel is suspected of having pulmonary tuberculosis (TB). As the nurse, you know that which type of isolation precautions should be initiated?a. Droplet precautionsb. Airborne precautionsc. Contact precautionsd. Standard precautions8. Samuel is diagnosed with Mycobacterium tuberculosis. The physician order rifampin 10 mg/kg IV daily and isoniazid 5 mg/kg intramuscularly every day. Samuel’s current weight is 150 pounds. Which are the correct doses for rifampin and isoniazid?a. Give rifampin 680 mg and isoniazid 340 mg daily.b. Give rifampin 690 mg and isoniazid 350 mg daily. c. Give rifampin 650 mg and isoniazid 320 mg daily.d. Give rifampin 640 mg and isoniazid 300 mg daily.9. In analyzing Samuel’s previous blood work, which laboratory finding needs to be monitored while he is receiving isoniazid?a. Hemoglobinb. Glucosec. Creatinined. AST and ALT10. Samuel was discharged to a group home. His home medications include rifampin 10 mg/kg by mouth daily and isoniazid 5 mg/kg by mouth every day. He has lost 20 pounds in the past month. Given Samuel’s weight loss, what diet would you suggest?a. High calorie, high protein, and high fatb. High calorie, high carbohydrate, and low proteinc. High calorie, low carbohydrate, and high fatd. High calorie, high protein, and low fat11. In analyzing Samuel’s recent blood work, as the nurse, you know that his CD4 cell count and his current complications are used for which purposes (Select all that apply).a. To track and monitor HIV epidemic trendsb. To determine the severity of the diseasec. To determine the appropriate medication regimensd. To notify all potential persons who may have had contacte. To develop an accurate plan of caref. To prepare for participation in medication clinical trials12. In reviewing his health history, which behaviors placed Samuel at risk for HIV infection? (Select all that apply).a. Homeless living statusb. IV drug usec. Unprotected sex with mend. Unprotected sex with womene. Use of drugs and alcoholf. Unsteady employment13. What specific instructions will you include in the Samuel’s teaching plan regarding his newly prescribed medications? (Select all that apply).a. These medications can be taken with or without food.b. Avoid taking these medications with high-fat meals.c. Avoid drugs and alcohol while