A pregnant client reports to the health care clinic complaining ...

[saliriagwu]

A pregnant client reports to the health care clinic complaining of loss of appetite, weight loss, and fatigue. Following assessment, tuberculosis is suspected. A sputum culture is obtained, and Mycobacterium tuberculosis is identified in the sputum.
 
  The nurse provides instructions to the client regarding therapeutic management of tuberculosis. Which of the following instructions does the nurse provide to the client? 1. The need for therapeutic abortion is required.
  2. Medication will not be started until after delivery of the fetus.
  3. Isoniazid (INH) plus rifampin (Rifadin) will be required for a total of 9 months.
  4. The newborn must receive medication therapy immediately following birth.

Question 2

A client has been admitted with left-sided heart failure. When planning care for the client, interventions should be focused around reduction of which specific problem associated with this type of heart failure?
 
  1. Ascites
  2. Pedal edema
  3. Bilateral lung crackles
  4. Jugular vein distention

[babybsemail]

Answer to Question 1

3

Rationale: More than one medication may be used to prevent the growth of resistant organisms in the pregnant client with tuberculosis. Treatment must continue for a prolonged period. The preferred treatment for pregnant clients is isoniazid plus rifampin daily for a total of 9 months. Ethambutol is added initially if drug resistance is suspected. Pyridoxine (vitamin B6) is often administered with isoniazid to prevent fetal neurotoxicity. The infant will be tested at birth and may be started on preventive isoniazid therapy. Skin testing on the infant should be repeated at 3 months, and isoniazid may be stopped if the skin test result remains negative. If the skin test result converts to positive, a full course of isoniazid would be given.

Answer to Question 2

3

Rationale: The client with heart failure may present with different symptoms, depending on whether the right or the left side of the heart is failing. Adventitious breath sounds, such as crackles, are an indicator of decreased left-sided heart function. Peripheral edema, jugular vein distention, and ascites all can be present because of insufficiency of the pumping action of the right side of the heart.