# An older adult with diabetes and chronic renal failure is starting an isoniazid-containing tuberculosis regimen. Which prescription should the nurse expect to reduce a predictable neurologic adverse effect?

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

An older adult with diabetes and chronic renal failure is starting an isoniazid-containing tuberculosis regimen. Which prescription should the nurse expect to reduce a predictable neurologic adverse effect?

## Option

1. Vitamin K to prevent ototoxicity.
2. Calcium carbonate to prevent optic neuritis.
3. Folic acid to prevent red-man syndrome.
4. Pyridoxine to reduce the risk of peripheral neuropathy. **✔ Correct answer**

**Correct answer: 4**

## Explanation

Older age, diabetes, and chronic renal failure increase susceptibility to isoniazid-associated peripheral neuropathy; pyridoxine is recommended for clients with neuropathy risk factors.

## In-depth explanation

Quick answer
Expect pyridoxine with isoniazid for this high-risk client.

Why this is correct
Isoniazid can cause dose-related peripheral neuropathy. CDC materials identify diabetes, renal failure, advanced age, HIV, pregnancy, alcoholism, and malnutrition among risk states where vitamin B6 support is used.

Easy analogy or mental picture
Add the vitamin guardrail before the tingling pathway becomes damaged.

Memory hook
INH plus neuropathy risk: think B6.

NCLEX decision rule
Assess baseline sensation, hepatic symptoms, adherence, interactions, and the full tuberculosis regimen rather than teaching one adverse effect in isolation.

Why the other choices are wrong
Vitamin K, calcium, and folate do not prevent the characteristic isoniazid neuropathy mechanism described here.References
1CDC: Treatment of Latent TB Infection and TB Disease ModuleIsoniazid neuropathy risk and pyridoxine for clients with risk factors

## Clinical scenario

Isoniazid teaching
Review neuropathy risks, pyridoxine, hepatic warning symptoms, alcohol avoidance, adherence, drug interactions, and tuberculosis follow-up.

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