Page 1657 - Saunders Comprehensive Review For NCLEX-RN

592. Answer: 4

Rationale: Ethambutol causes optic neuritis, which decreases visual acuity and the
ability to discriminate between the colors red and green. This poses a potential safety
hazard when a client is driving a motor vehicle. The client is taught to report this
symptom immediately. The client also is taught to take the medication with food if
gastrointestinal upset occurs. Impaired hearing results from antitubercular therapy
with streptomycin. Orange-red discoloration of secretions occurs with rifampin.
Test-Taking Strategy: Note the strategic word, immediately. Option 2 is the least
likely symptom to report; instead, it should be managed by taking the medication
with food. To select among the other options, you must know that this medication
causes optic neuritis, resulting in difficulty with red-green discrimination.
Level of Cognitive Ability: Evaluating
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Evaluation
Content Area: Pharmacology: Respiratory Medications: Tuberculosis Medications
Health Problem: Adult Health: Respiratory: Tuberculosis
Priority Concepts: Client Education; Safety
Reference: Lewis et al. (2017), p. 509.

593. Answer: 3

Rationale: Isoniazid therapy can cause an elevation of hepatic enzyme levels and
hepatitis. Therefore, liver enzyme levels are monitored when therapy is initiated and
during the first 3 months of therapy. They may be monitored longer in the client
who is older than 50 years or abuses alcohol. The laboratory tests in options 1, 2, and
4 are not necessary.
Test-Taking Strategy: Focus on the subject, the laboratory value to monitor.
Recalling that this medication can be toxic to the liver will direct you to the correct
option.
Level of Cognitive Ability: Applying
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Implementation
Content Area: Pharmacology: Respiratory Medications: Tuberculosis Medications
Health Problem: Adult Health: Respiratory: Tuberculosis
Priority Concepts: Cellular Regulation; Safety
Reference: Hodgson, Kizior (2018), pp. 620-621.

594. Answer: 2

Rationale: Salmeterol is an adrenergic type of bronchodilator, and
beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always
administered before glucocorticoids when both are to be given on the same time
schedule. This allows for widening of the air passages by the bronchodilator, which
then makes the glucocorticoid more effective.
Test-Taking Strategy: Focus on the subject, the procedure for administering
inhaled medications. To answer this question correctly, you must know two

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