Chapter 6 Pharm

Mr. Laird is a 49-year-old electrician who experienced severe burns on his trunk, arms, and hands in a workplace accident 2 weeks ago. Part of his current wound care regimen involves the daily application of silver sulfadiazine to his wounds. The nurses who are providing care for Mr. Laird in the burns and plastics unit of the hospital should perform what action when administering this medication?

Cleanse the wound of debris prior to applying the silver sulfadiazine

The nurse understands that some clients should not take sulfonamides. These include which clients? (Select all that apply.)

Clients with a hypersensitivity to sulfonamides Women who are lactating Children younger than 2 months

Some clients stop taking their prescribed sulfonamide once symptoms disappear. What should the nurse tell the client when first teaching about this medication to prevent the early discontinuation of the drug?

Failure to complete a course of therapy may result in a recurrence of the infection.

The nurse is giving instructions to a client age 77 years who has been prescribed a sulfonamide for treatment of a urinary tract infection. The nurse has instructed the client to increase fluids while taking this medication. What does the nurse anticipate will be the client's greatest fear related to this instruction?

Fear of incontinence.

The nurse is preparing to administer a sulfonamide to a client who is a Type 2 diabetic taking an oral hypoglycemic agent. The nurse will monitor the client for what reaction?

Hypoglycemia

Which nursing diagnoses would receive high priority for a burn client on sulfonamide therapy?

Impaired skin integrity

The nurse knows that sulfonamides are chosen to treat ulcerative colitis because of what action?

Inflammation is decreased because of interaction with intestinal bacteria.

The nursing student is studying about sulfonamides and learns that their which is their mode of action?

Inhibit the activity of folic acid in bacterial cell metabolism

The nurse is teaching the client who has just been placed on sulfasalazine about its potential adverse reactions. One common reaction the nurse should definitely include in teaching is which?

May cause the skin and urine to turn orange-yellow

The nurse is assisting in the admission of a client with a suspected urinary tract infection and an oral temperature of 100.9°F. The health care provider has written the following orders: acetaminophen 500 mg PO for elevated temperature; urinalysis for culture and sensitivity; sulfasalazine (Azulfidine) 500 mg PO four times daily; and force fluids to 3 L/day. Which order will the nurse complete first?

Obtain urine for culture and sensitivity.

A 55-year-old woman has recently begun treatment for a UTI with SMZ-TMP. When planning this client's care, what nursing diagnosis should the nurse prioritize?

Risk for Impaired Tissue Integrity related to drug-induced photosensitivity

A client is given sulfasalazine to treat ulcerative colitis. The client begins to report flu-like symptoms including fever, cough, headache, and muscle aches and pains. The nurse notices red wheals on the client's face and neck. The nurse suspects which adverse effect?

Stevens-Johnson syndrome (SJS)

Which category of antimicrobial agents is used chiefly because of low cost and effectiveness in treating common bacterial infections?

Sulfonamides

The nurse is admitting a client with a urinary tract infection who has been prescribed sulfadiazine. What information obtained in the admission process would cause the nurse to contact the health care provider immediately?

The client is currently taking warfarin (Coumadin).

The client who has been on long-term sulfonamide therapy begins to demonstrate symptoms associated with side affects of the therapy. The nurse knows that these symptoms are related to which complication associated with sulfonamide therapy?

Thrombocytopenia

The nurse is caring for a client with a urinary tract infection caused by Escherichia coli and expects the health care provider to order which sulfonamide?

Trimethoprim (TMP) and sulfamethoxazole (SMZ)

The nurse is caring for a client who has been prescribed a sulfonamide but does not have an infection. The nurse is aware that the medication has been prescribed to treat what condition?

Ulcerative Colitis

The nursing instructor is teaching about anti-infectives and informs students that viruses have been difficult to treat in the past. He indicates the reason for this to be which of the following?

Viruses have the ability to change because they use DNA and RNA of other cells.

After teaching a group of nursing students about the different classes of drugs, the instructor determines that the teaching was successful when the students identify drugs that slow or retard the multiplication of bacteria as which type of medication?

bacteriostatic

A client is diagnosed with an infection. What would the nurse anticipate being used to determine the best drug to treat the infection?

culture and sensitivity (C&S)

A client diagnosed with malaria has been prescribed treatment with sulfadiazine. The nurse should encourage the client to increase consumption of what dietary component?

fluids

The nurse is aware that sulfonamide therapy is used cautiously in older adults because of decreased function of what organ system?

renal

A client is started on sulfamethoxazole-trimethoprim for a urinary infection. What adverse effect should the nurse assess with this client?

renal damage

A client, who sustained a burn from a gas grill, has been prescribed a sulfonamide to prevent a burn infection. What route is preferred in the prevention of a burn infection?

topical

A client with a deep wound producing large amounts of purulent drainage is prescribed an antibiotic. The nurse should express concern about the potential effectiveness of the treatment if which medication is prescribed?

trimethoprim-sulfamethoxazole

Which action would the nurse suggest to a client to reduce the risk of photosensitivity from sulfonamide therapy? Select all that apply.

using sunscreen wearing sunglasses wearing protective clothing

A client with a urinary tract infection has been advised that cranberries, cranberry juice, and extra fluids may assist in relieving symptoms. What statement by the client would indicate a need for further instruction?

"I don't like cranberries so I will take a cranberry capsule."

A nurse is teaching a client how to apply a topical sulfonamide to a burn. Which statement by the client would indicate that the teaching was effective?

"I will apply it in a very thin layer over the area."

Which statement by a client taking a sulfonamide requires further instruction?

"I will make sure to use extra sunscreen when I go to the tanning booth."

The nurse is applying silver sulfadiazine (Silvadene) to a client's burn when the client states, "Every time you put that on me it burns." What is the nurse's best response?

"I'm sorry that it hurts, but many clients report a burning sensation when this medication is applied."

A professional female cyclist has been prescribed SMZ-TMP for chronic urethritis. She has informed the nurse that she has a cross-country race in 2 days. Which would be an appropriate response by the nurse?

"It would not be a good idea to be outside while taking this medication because of possible photosensitivity occurring."

The nurse receives a call from a client who is on sulfasalazine therapy. The client states, "My urine looks orange. What should I do?" What is the nurse's best response to this client?

"This is a normal reaction that will cease when the therapy is finished."

A client has been on sulfonamide therapy for the last six weeks. What client report may cause the health care provider to discontinue the sulfonamide?

10 lb weight loss

A client has been prescribed 4 g of sulfamethoxazole/trimethoprim tablets per day. The available drug is in the form of 500 mg. The nurse would administer how many tablets each day?

8

The nurse is caring for four clients on a medical floor. For which client would the nurse suspect the health care provider might order a sulfonamide?

A 35-year-old woman with a urinary tract infection and a history of ulcerative colitis

The nursing student learning about anti-infective therapy demonstrates understanding when she defines which as "bacterial resistance"?

Ability of bacteria to inactivate or destroy the antibiotic

What are sulfonamides classified as?

Antibacterial

A client is being treated for a urinary tract infection with trimethoprim-sulfamethoxazole. What assessment should the nurse make prior to the administration of the medication?

Assessing for renal insufficiency

The nursing instructor is teaching about anti-infectives and realizes further instruction is needed when a student makes which of the following statements?

Bactericidal means they slow or retard the multiplication of bacteria.

The pharmacology instructor is teaching about sulfonamides and informs the students that these drugs are used to control infections caused by which bacteria?

Both gram positive and gram negative

The nurse is caring for a client who has been on sulfonamide therapy for six months. What signs or symptoms would the nurse report to the health care provider immediately?

Bruises

The nurse understands that the most frequent adverse reaction seen with the topical application of a sulfonamide is which of the following?

Burning sensation or pain