Chapter 20: Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics

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? Anuria Crystalluria Proteinuria Dehydration

Crystalluria Explanation: Sulfonamides may cause the urine and skin to take on an orange-yellow color. Crystalluria may occur during administration of a sulfonamide. Often this problem can be prevented by increasing fluid intake during treatment. It is important to instruct the client to drink a full glass of water when taking an oral sulfonamide and to drink at least 8 large glasses of water each day until therapy is finished. Although drinking water will prevent dehydration if anuria occurs this must be investigated further as it can lead to an emergency and not a complication of sulfonamide therapy. There is also no proof that sulfonamides cause proteinuria.

Which nursing diagnoses would receive high priority for a burn client on sulfonamide therapy? Risk for body image alteration Impaired skin integrity Risk for ineffective regimen management Potential for altered nutrition

Impaired skin integrity Explanation: The skin can become more sensitive to sunlight during sulfonamide therapy. The nurse should inspect the client's skin each shift for signs of sores or blisters, indicating a possible allergic reaction. Risk for impaired skin integrity is the diagnosis of highest priority. Furthermore, a real diagnosis should always take priority over a risk for diagnosis or potential diagnosis.

A nurse is educating a patient undergoing treatment for genitourinary tract bacterial infections on an outpatient basis. What instructions should the nurse offer the patient as part of the patient teaching plan? Increase fluid intake to at least 2000 ml/d. Decrease fluid intake if symptoms subside. Notify the PHCP if abdominal pain occurs. Discontinue the therapy if symptoms vanish.

Increase fluid intake to at least 2000 ml/d. Explanation: The nurse should instruct the patient to increase the fluid intake to at least 2000 ml/d to help remove bacteria from the genitourinary tract when caring for a patient with a genitourinary tract bacterial infection. The nurse need not instruct the patient to notify the PHCP if abdominal pain occurs, discontinue the therapy if symptoms vanish, or decrease fluid intake if symptoms subside. The nurse should stress the importance of continued therapy even if symptoms vanish or the patient feels better after a few doses. The nurse should encourage continued increased fluid intake even if the symptoms subside. Abdominal pain is not known in patients with genitourinary tract bacterial infections, and so the nurse need not educate the patient to monitor for the same.

The nurse learns that a 7-year-old child has been prescribed tetracyclines several times in recent years. What assessment should the nurse prioritize? Assess the client's deep tendon reflexes. Inspect the client's teeth. Inspect the client's skin and sclerae for jaundice. Assess the client for signs of ototoxicity.

Inspect the client's teeth. Explanation: Use tetracyclines with caution in children younger than 8 years of age because they can potentially damage developing bones and teeth. Tetracyclines are not closely linked to ototoxicity or hepatic damage. CNS effects such as decreased deep tendon reflexes are unlikely.

A 3-year-old has a history of recurrent urinary tract infections (UTI). Which practice implemented by the parents for the child indicates an understanding of preventive measures regarding these infections? Provides acrylic underwear 3 ounces of orange juice daily Cleans the perineal area from back to front No use of bubble bath liquids or salts

No use of bubble bath liquids or salts Explanation: Cystitis is very difficult to treat in young girls and can become a chronic problem. To decrease the number of bacteria introduced into the bladder, patient education should cover the following hygiene measures: Always wipe from front to back and never from back to front to avoid the introduction of intestinal bacteria into the urethra; avoid baths, particularly bubble baths, which facilitate the entry of bacteria into the urethra on the bubbles; and wear dry cotton underwear to discourage bacterial growth. Patient education also should stress the importance of avoiding alkaline ash foods (e.g., citrus fruits, certain vegetables) and antacids and encouraging foods that acidify the urine.

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? Provide client with eight ounces of fluid. Obtain urine for culture and sensitivity. Administer sulfasalazine (Azulfidine). Administer acetaminophen for temperature.

Obtain urine for culture and sensitivity. Explanation: A culture and sensitivity is obtained to determine which bacteria is growing in the urine, and which antibiotic the bacteria is sensitive to. It must be performed prior to any antibiotic being given to the client so that the test will be accurate. Most acetaminophen orders are for elevated temperature at or above 101.

Robert Shue, age 62, is an athletic, tall man. He suffers from dysuria and frequency. He has been diagnosed with a urinary tract infection. He has been prescribed an antibiotic and urinary analgesic. Today he contacts the office reporting that his urine color has changed to orange. What drug was most likely prescribed to him? Phenazopyridine Methenamine Cinoxacin Fosfomycin

Phenazopyridine Explanation: Phenazopyridine is an azo dye, which will discolor the urine orange or red. It is important to inform the client to expect this change in urine color. Other drugs that cure UTIs are not known to change the normal color of urine.

A male client presents to the emergency department in pain. He is diagnosed with mild to moderate burns on his forearms secondary to exposure to hot pipes in his home. The nurse expects the health care provider to order what topical medication? Sulfadiazine Penicillin Tetracycline Amoxicillin

Sulfadiazine Explanation: Sulfonamides are rarely used in critical care settings, except that topical silver sulfadiazine (Silvadene) is used to treat burn wounds.

A client who has been diagnosed with syphilis reports an allergy to penicillin. The nurse would anticipate that which drug will be prescribed for the treatment? Phenazopyridine hydrochloride Tetracycline Amoxicillin Trimethoprim-sulfamethoxazole

Tetracycline Explanation: Tetracycline may be effective in treating syphilis when penicillin cannot be given. If the client is allergic to penicillin, it is likely they are also allergic to amoxicillin. Trimethoprim-sulfamethoxazole is prescribed to treat urinary tract infections (UTIs), while phenazopyridine hydrochloride is used to manage the pain associated with UTIs.

Sulfonamides are commonly used to treat which of the following types of infections? Select all that apply. Ulcerative colitis Acute otitis media Urinary tract infection Upper respiratory tract infection Osteomyelitis

Ulcerative colitis Urinary tract infection Acute otitis media Explanation: Sulfonamides are often used to treat ulcerative colitis, urinary tract infection, and acute otitis media.