chapter 6 pharmacology

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

The client admitted to the hospital is ordered sulfasalazine 500 mg QID. The drug comes from the pharmacy in 1000-mg capsules. What is the best action by the nurse?

Contact the pharmacist

The nurse instructs a client on sulfonamide therapy to drink a full glass of water when taking the medication and to also drink at least 8 large glasses of water each day until therapy is finished. The nurse is trying to prevent which complication associated with sulfonamide therapy?

Crystalluria

The nurse expects to apply mafenide (Sulfamylon) to the skin of a client with a burn how many times each day?

Every 12 hours

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

A male client with diabetes who controls his disease with an oral agent and diet has been hospitalized with a urinary tract infection. The physician has ordered sulfasalazine 500 mg QID. What should the nurse closely monitor for in this client?

Hypoglycemic reaction

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

A client with a urinary tract infection is being treated with a sulfonamide antibiotic. The nurse should recognize that pathogens are being eradiated by what means?

Inhibition of folic acid synthesis

The nurse is assisting in the admission of a client with a suspected urinary tract infection and an oral temperature of 100.9 degrees ferenheit. 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.

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 (Bactrim) for a urinary infection. What adverse effect should the nurse assess with this client?

Renal damage

A client is given sulfasalazine to treat ulcerative colitis. The client begins to complain of 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)

The nursing student studying pharmacology identifies correctly which classes of drugs to be the first to effectively treat infections?

Sulfonamides

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 nurse is caring for the following clients and is aware that sulfonamides should be used cautiously in which client?

The client with asthma

The client who has been on long-term sulfonamide therapy begins 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

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

Drugs that destroy bacteria are known as which type of drug?

bacteriocidal

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 types of medication?

bacteriostatic

The action of sulfonamides is classified as which type of medication?

bacteriostatic

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?

burning sensation during application

The primary health care provider has prescribed mafenide for a client with second-degree burns. The nurse would be alert for which effect as the most frequent adverse reaction associated with the topical application of mafenide on the affected area?

burning sensation during application

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

When describing the action of sulfonamides to a client, the nurse integrates understanding of the drug's action with effects exerted due to which mechanism?

inhibition of the activity of folic acid in bacterial cell metabolism

A nurse is speaking to a 62-year-old female client who has been started on sulfisoxazole, a sulfonamide antibiotic. The nurse should teach this client to contact the health care provider if the client experiences what adverse effect associated with the drug?

skin rash or itching

A nurse is monitoring a client on sulfonamide therapy. Which finding would lead the nurse to suspect that the client is developing thrombocytopenia?

unusual bleeding

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 knows that the normal recommended time to administer a sulfonamide to a client is at which time?

1 hour before or 2 hours after meals

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

A client has been prescribed 4 gm of sulfamethoxazole-trimethoprim tablets per day. The available drug is in the form of 500 mg. To meet the recommended dose, the nurse will administer _______ 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

A client who has been on long-term sulfonamide therapy has developed low red blood cell counts and leukopenia. The nurse knows that this combination of problems is known as what disorder?

Aplastic anemia

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 nurse is caring for a client on sulfonamide who has developed a fever, cough, and headache. What signs/symptoms would alert the nurse to the possible development of Stevens-Johnson syndrome? Select all that apply.

Blister on the lip Red wheal on the neck