A client with tuberculosis has a prescription for Myambutol (ethambutol HCL). The nurse should tell the client to notify the doctor immediately if he notices?

Appeared in: DHS 2018 shift 1st

Explanation

Ethambutol (Myambutol) is a first-line bacteriostatic medication used in combination with other drugs to treat tuberculosis.
The most significant and serious adverse effect of Ethambutol is optic neuritis, which is inflammation of the optic nerve.
Symptoms of optic neuritis include decreased visual acuity (blurry vision) and a loss of red-green color discrimination.
This toxic effect is dose-dependent and requires immediate reporting to the physician. The drug must be discontinued to prevent permanent blindness.

Option A: Gastric distress is a common, non-specific side effect of many medications, including ethambutol, but it is not considered a medical emergency requiring immediate notification.
Option B: Changes in hearing (ototoxicity) and balance are characteristic adverse effects of Streptomycin, an aminoglycoside antibiotic that is also used to treat tuberculosis, not Ethambutol.
Option C: Red or orange discoloration of body fluids (urine, sweat, tears) is a harmless and expected side effect of Rifampin, another cornerstone antitubercular drug.

Clinical Relevance

Nursing practice connection: Use the key finding related to Adverse effects of antitubercular medications to guide bedside assessment, documentation, and the next nursing action.
Nurses have a crucial role in educating patients about the signs of serious drug toxicity. For Ethambutol, teaching the patient to self-monitor for any changes in vision is a key safety intervention.
A baseline visual acuity and color vision test (using Ishihara plates) should be performed before starting Ethambutol therapy, with monthly follow-up tests recommended.
What if? If the patient reported tingling and numbness in their hands and feet, the nurse should suspect peripheral neuropathy, a classic side effect of Isoniazid (INH), and inquire about pyridoxine (Vitamin B6) supplementation.

How to Approach the Question

First, identify the specific drug mentioned in the question: Myambutol (ethambutol HCL).
Next, recall the most serious or unique adverse effects associated with this drug. The question asks what requires 'immediate' notification, pointing towards a dangerous side effect.
Evaluate each option. 'Change in colour vision' is a hallmark sign of optic neuritis, the most critical toxicity of Ethambutol.
Rule out the other options by associating them with other drugs or classifying them as non-urgent. Hearing changes are linked to Streptomycin, red-orange fluids to Rifampin, and gastric distress is generally non-emergent.
Confirm that the chosen option represents a significant risk (potential for permanent blindness) that requires stopping the medication and immediate medical assessment.

Concept Tested & Keywords

Concept Tested: Adverse effects of antitubercular medications
Stem keywords: tuberculosis, Myambutol, ethambutol HCL, notify the doctor immediately
Lead-in keywords: notify immediately
Negative lead-in flag: false

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E6 Medicine Harrison 22e Part 1 pp. 1464-1466, 1461-1463

E6 Medicine Davidson Principles Practice 24e p. 613-615

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.