# Situation: A 34-year-old woman who sells vegetables at a public market has bacteriologically confirmed, drug-susceptible pulmonary tuberculosis (TB). She starts the standard 6-month regimen under the National Tuberculosis Program (NTP) at the Rural Health Unit (RHU), with a treatment supporter from the barangay. She lives with her husband and their two children, aged 3 and 8, and takes combined oral contraceptive pills. After 2 weeks, the nurse asks her to explain what she has learned. Which statement shows that she needs **FURTHER** teaching?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629948  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 34-year-old woman who sells vegetables at a public market has bacteriologically confirmed, drug-susceptible pulmonary tuberculosis (TB). She starts the standard 6-month regimen under the National Tuberculosis Program (NTP) at the Rural Health Unit (RHU), with a treatment supporter from the barangay. She lives with her husband and their two children, aged 3 and 8, and takes combined oral contraceptive pills.

After 2 weeks, the nurse asks her to explain what she has learned. Which statement shows that she needs **FURTHER** teaching?

## 보기

1. "If my eyes turn yellow, I will stop the tablets and go to the health center at once."
2. "My orange urine means the tablets are harming my kidneys, so I will stop them." **✔ 정답**
3. "My two children will be checked for TB even though they are not coughing."
4. "I will take my tablets each day with my treatment supporter watching."

**정답: 2**

## 해설

Orange-red urine, sweat, and tears are an expected, harmless effect of rifampicin; mistaking it for harm is a common reason for stopping treatment, which leads to relapse and drug resistance. The other statements are correct: jaundice calls for withholding the drugs and prompt referral, household contacts are screened, and supported daily dosing improves adherence.

## 심화 해설

Orange urine is expected, not harmful
Rifampicin (rifampin), one of the first-line drugs in the standard 6-month regimen, colors body fluids orange-red, including urine, sweat, tears, and saliva. This is a harmless and expected effect that does not mean the kidneys are damaged. A client who plans to stop her tablets because of orange urine needs further teaching, because stopping treatment leads to relapse and drug resistance. Mistaking this harmless color change for harm is a common and avoidable reason for interrupted therapy.

Why the other statements are correct
Yellowing of the eyes suggests drug-induced hepatitis, a serious adverse effect of isoniazid, rifampicin, and pyrazinamide. Withholding the tablets and going to the health center at once is the correct response so that liver function can be assessed. Screening household contacts, especially children under 5, even when they have no cough, is a core activity of the National Tuberculosis Program (NTP), because young children can develop severe TB and may be offered TB preventive treatment. Taking each dose with a treatment supporter watching improves adherence and is the standard of supported care.

| Statement | Assessment |
| --- | --- |
| Yellow eyes: stop the tablets and go to the health center | Correct: possible hepatitis |
| Orange urine means kidney harm, so stop the tablets | Needs further teaching |
| Children will be checked even without cough | Correct: contact screening |
| Tablets taken daily with the treatment supporter | Correct: supported adherence |

Another teaching point in this client
Rifampicin is a strong enzyme inducer in the liver. It speeds the breakdown of the hormones in combined oral contraceptive pills, so their contraceptive effect becomes unreliable. She should be counseled to use another reliable method, such as an intrauterine device or a barrier method, during treatment and for a period afterward as advised. This interaction is a frequent exam point when a woman on oral contraceptives starts TB treatment.

Watch out! Rifampicin also stains soft contact lenses permanently. Teach clients to expect the color change and to report jaundice, dark urine, nausea, or loss of appetite, which point to liver toxicity rather than the harmless discoloration.

Exam takeaway
Key point! Orange-red body fluids are an expected rifampicin effect; jaundice is a danger sign that calls for withholding the drugs and prompt assessment. Contact screening, supported daily dosing, and contraception counseling complete the teaching.

## 임상 시나리오

Rifampicin TeachingStandard 6-month TB treatment under the NTP
Orange-red urine, sweat, and tears are a harmless effect of rifampicin. Treatment continues; stopping it causes relapse and drug resistance.

Jaundice suggests drug-induced hepatitis: withhold the tablets and go to the health center at once.

Household contacts, especially young children, are screened even without symptoms. Rifampicin reduces the effect of combined oral contraceptives, so another method is advised.

CautionA client who stops treatment because of orange urine needs further teaching.

## 핵심 개념

- **Rifampicin** — A first-line antituberculosis drug that turns body fluids orange-red and induces liver enzymes.
- **Drug-induced hepatitis** — Liver injury from TB drugs, shown by jaundice, dark urine, nausea, or loss of appetite.
- **Treatment supporter** — A trained person who watches the client take each dose to support adherence.
- **Household contact** — A person living with a TB client who is screened for TB and may receive preventive treatment.
- **Enzyme inducer** — A drug that speeds the liver's breakdown of other drugs, such as oral contraceptive hormones.

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