Antibiotics Prep U

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 caused by the medication. It will go away when you finish taking the medication." Explanation: Sulfasalazine may cause the urine and skin to take on a orange-yellow color. This is a normal reaction and will go away once the medication therapy is over. The nurse should not recommend reducing fluid intake because this may lead to crystalluria. Neither citrus foods nor carrots have anything to do with the client's urine color.

A client who is taking phenazopyridine for urinary analgesia along with nitrofurantoin calls the clinic to report that her sclera appears yellowish. What is the nurse's best response to this client?

"This is an expected side effect of this medication and is not alarming."

The nurse is preparing to administer a sulfonamide to a client when the client states, "I woke up this morning with a lot of sores in my mouth." What is the nurse's next best action?

"I'm going to contact your health care provider before I administer your medication." Correct Explanation: The nurse should withhold the medication and notify the health care provider when a client develops an adverse reaction. In this case, the client developed numerous mouth sores overnight so it must be addressed before proceeding with medication administration. The other responses do not state that the medication should be withheld.

The clinic nurse is responsible for teaching a client about a new prescription for doxycycline. The nurse should increase which instruction in the teaching?

"Limit your exposure to the sun."

The nurse is caring for a client with ulcerative colitis who is taking sulfasalazine. What instruction will the nurse give this client?

"Expect your urine to turn yellow-orange."

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 instructs a patient 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 of the following complications associated with sulfonamide therapy?

Crystalluria 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 treatmeent. It is important to instruct the patient 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, this is not a side effect of this type of drug therapy nor is fluid volume disturbance. There is also no proof that sulfonamides cause hypokalemia.

Some patients stop taking their prescribed sulfonamide once symptoms disappear. What should the nurse tell the patient 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. Correct Explanation: When a sulfonamide is prescribed for an infection, some outpatients have a tendency to discontinue the drug once symptoms are gone. When teaching the patient the nurse emphasizes the importance of completing the prescribed course of therapy to ensure that all microorganisms causing the infection are erradicated. Failure to complete the course of therapy may result in a recurrence of the infection. The other options should be included in the teaching plan, but will not convince the patient to complete the full course of therapy.

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. Correct Explanation: The older adult may be hesitent to increase fluid intake because of fear of incontinence. Fear of diarrhea, fear of skin problems and fear of allergic reaction are not related to the instruction to increase fluid.

A patient 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. Which of the following should the nurse closely monitor for in this patient?

Hypoglycemic reaction Explanation: When patients with diabetes are prescribed sulfonamides, the nurse should assess for a possible hypoglycemic reaction. Sulfonamides may inhibit the hepatic metabolism of the oral hypoglycemic drugs (Orinase and Diabinese). The potassium level is not affected when a patient is taking a sulfonamide.

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

Inflammation is decreased because of interaction with intestinal bacteria. Explanation: Sulfonamides are bacteriostatic, which means they inhibit the growth of bacteria but do not destroy or kill off bacteria. They are used to treat ulcerative colitis because they interact with intestinal bacteria and help inhibit the inflammatory process.

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

Inhibit the activity of folic acid in bacterial cell metabolism Explanation: Sulfonamides work by inhibiting the activity of folic acid in bacterial cell metabolism. Penicillins work by inhibiting bacterial cell wall synthesis. Aminogycosides bind to ribosome 30S to prevent protein synsthesis. Quinolones work by altering DNA.

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

May cause the skin and urine to turn orange-yellow Explanation: One important adverse reaction the nurse should prepare the patient on sulfasalazine therapy about is that it can cause skin and urine to turn orange-yellow. It is not known to cause clay-colored stools nor to turn the eyes orange. Topical sulfonamide (sulfamylon) can sometimes cause facial edema.

The nurse informs a client of the most common adverse effect of sulfonamide therapy. What is it?

Nausea Explanation: Gastrointestinal effects (nausea, vomiting, anorexia, diarrhea, abdominal pain and stomatitis) are the most common adverse effects of sulfonamide therapy. Chills, fever, crystalluria (crystals in the urine) and photosensitivity are also adverse effects but are not considered common.

The nurse is assisting in the admission of a client with a suspected urinary tract infection. 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. 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.

Which drug would the nurse identify as turning a client's urine reddish brown?

Phenazopyridine

A nurse is caring for a client with irritation of the lower genitourinary tract. The client is administered phenazopyridine. Which condition in clients contraindicates the use of the drug?

Renal impairment

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

Renal insufficiency Explanation: Both tetracyclines and sulfonamides are contraindicated in patients with renal failure. These medications are not contraindicated in patients with asthma, hypertension, or diabetes mellitus

A 48-year-old female patient has acute pyelonephritis. Her urine pH is below 5.5, which indicates that it is acidic. Which of the following medications would serve to decrease the acidity of her urine?

Sodium bicarbonate

A client is given sulfasalazine to treat his/her ulcerative colitis. The client begins to complain of flu like symptoms (fever, cough, headache, and muscle aches and pains). The nurse notices red wheals on the client's face and neck. What type of reaction could the client be experiencing after taking sulfasalazine?

Stevens-Johnson syndrome Explanation: Clients with Stevens-Johnson syndrome (SJS) may complain of fever, cough, muscle aches and pains, and headache. These symptoms are accompanied by lesions on the skin and mucous membranes, eyes, and other organs. Lesions appear as red wheals or blisters, often starting on the face, in the mouth, or on the lips, neck, and extremities.

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

Topical Correct Explanation: Topical sulfonamides are used in prevention of burn wound infections. Sulfonamides are not administered intrathecally. Parenteral and oral administration are not recommended for the prevention of a burn infection

The nurse caring for a client taking sulfonamides will suspect what serious hypersensitivity reaction if the nurse observes sloughing of skin and mucous membranes?

Toxic epidermal necrolysis Explanation: Various types of hypersensitivity reactions may be seen during sulfonamide therapy. Symptoms include urticaria (hives) and pruritus (itching), but the presence of sloughing of skin and mucous membranes would indicate toxic epidermal necrolysis, which can cause death if internal organs are involved. Symptoms of Stevens-Johnson syndrome are red wheals or blisters that appear on the face, neck, mouth, lips, and extremities.

The use of sulfonamides has decreased because of the development of resistant strains.

True

When describing the actions of sulfonamides, which of the following would an instructor include?

inhibit folic acid synthesis Explanation: Sulfonamides inhibit the synthesis of folic acid, which is necessary for cells to grown and reproduce. Carbapenems inhibit cell membrane synthesis. Cephalosporins prevent bacteria from biosynthesizing the framework of their cell walls. Fluoroquinolones interfere with the action of DNA enzymes that are necessary for bacterial growth and reproduction.

A 32-year-old female client has a urinary tract infection. Her record reveals that she has recently been treated for anemia. The health care provider has indicated that drug therapy for the urinary tract infection will last more than 2 weeks. The most important nursing action will be to:

obtain a complete blood count to establish baseline values.

The nurse has learned that some patients should not take sulfonamides. These include which of the following patients?

• Patients with a hypersensitivity to sulfonamides • Women who are lactating • Children younger than 2 months Explanation: Studies have shown that sulfonamides are contraindicated for use in patients with a hypersensitivity to sulfonamides, during lactation, and in children younger than 2 months. No research shows that school-aged children and teenagers should not take sulfonamides.

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

Ability of bacteria to produce substances that inactivate or destroy the antibiotic Explanation: Bacterial resistance is the ability of bacteria to produce substances that inactivate or destroy the antibiotic. Bacteriostatic means they slow or retard the multiplication of bacteria. Bactericidal means they destroy the bacteria

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 ability of bacteria to produce substances that inactivate or destroy the antibiotic is known as which of the following?

Bacterial resistance Explanation: The ability of bacteria to produce substances that inactivate or destroy the antibiotic is known as bacterial resistance.

Anti-infectives are used to treat urinary tract infections which include which anatomical structures? (Select all that apply.)

Bladder Kidney Prostate gland Urethra Ureters

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 Correct Explanation: Before applying silver sulfadiazine, it is necessary to cleanse the wound completely and remove dead or burned skin and other debris. It would be inappropriate to perform wound care after the application of the drug and it should be applied in a thin layer no more than about 1/16 inch. Application of topical sulfonamides is a sterile, not clean, procedure.

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

A client is started on trimethoprim and sulfamethoxazole for a urinary tract infection. The client reports nausea, anorexia, and abdominal pain. What intervention does the nurse discuss with the client?

Consume the medication with food.

A patient has been prescribed a tetracycline drug for Rocky Mountain spotted fever. The patient also takes antacids. Which of the following effects is likely to occur due to an interaction between the two drugs?

Decreased absorption of tetracycline

A nurse is caring for a 6-year old child with a severe case of typhoid fever. The client was mistakenly administered tetracycline, which can cause adverse reactions. What could be a permanent effect in the child?

Discoloration of the teeth

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

Every 12 hours Explanation: Both mafenide and silver sulfadiazine are applied one to two times per day. It would not be applied more frequently on a regular basis, and it is not used to treat the pain of the burn.

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

Impaired skin integrity

Sulfonamides exert their effects by which of the following mechanism?

Inhibition of the activity of folic acid in bacterial cell metabolism Explanation: Sulfonamides exert their effects by inhibiting the activity of folic acid in bacterial cell metabolism.

A nurse is caring for a client with crystalluria. When caring for the client, which intervention would the nurse include in the plan of care to prevent more stones from forming?

Instruct the client to increase fluid intake to 2000 mL.

Tetracyclines must be used cautiously in the presence of what condition?

Liver impairment Kidney impairment

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

You are writing a plan of care for an 85-year-old male patient who has been prescribed sulfisoxazole for treatment of a severe urinary tract infection. Which of the following would be an appropriate nursing diagnosis for this patient?

Risk for Injury: Hypersensitivity reaction, kidney, liver, or blood disorders

Urinary anti-infectives are used only in urinary tract infections. What causes urinary anti-infectives to be so effective in treating UTIs?

They act specifically within the urinary tract

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 patient who has been on long-term sulfonamide therapy begins to bruise easily and have some bleeding from the mucous membranes. The nurse knows that these symptoms reflect which of the following complications attributed to sulfonamide therapy?

Thrombocytopenia Correct Explanation: Leukemia and hyperglycemia are not adverse effects of sulfonamide therapy. Leukopenia, although an adverse reaction, will cause signs of an infection such as fever, sore throat, and cough. Thrombocytopenia is manifested by easy bruising and unusual bleeding after trauma to the skin or mucous membranes.

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 +/-

When reviewing an older client's most recent laboratory values, which finding may contraindicate the use of tetracycline?

creatinine of 2.8 mg/dL (247.52 µmol/L) (high)

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)

Your client has been diagnosed with syphilis. He states that he is allergic to penicillin. You would anticipate which of the following drugs being prescribed for his treatment?

tetracycline

The client has completed a course of sulfonamide therapy and the nurse knows that continued inspection of the skin is required for how long after the end of treatment?

two weeks Explanation: The skin of a client undergoing sulfonamide therapy should be inspected regularly for signs of sores or blisters indicating the possibility of a severe allergic reaction. The skin and mucous membranes should be inspected for up to 14 days after the end of therapy, the period of time during which reactions can still occur.

A female client is prescribed fosfomycin for a urinary tract infection (UTI). Which reported condition suggests an adverse effect of the medication?

vaginal itching

The body is equipped with a natural defense system that includes which of the following?

• Saliva • Tears • Skin • Sweat • Mucous

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." Explanation: Clients taking sulfonamides should avoid any exposure to sunlight or ultraviolet light, such as tanning beds or sunlamps. Extra sunscreen would not protect the client from the photosensitivity effect of the medication. The client is correct in stating that he would complete the entire course of the medication, would drink a full glass of water with each pill, and would take the medication with meals.

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 of the following would be an appropriate response by the nurse? You selected:

"It would not be a good idea to be outside while taking this medication because of possible photosensitivity occurring." Explanation: A patient with chronic urethritis who is taking SMZ-TMP should avoid direct sunlight because it may cause cutaneous eruptions due to photosensitivity reaction. The risk that the patient's infection would be aggravated due to the cycling competition is low. Peripheral neuropathy is not an adverse effect of SMZ-TMP.

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 Explanation: GI side effects with sulfonamide therapy may be mild, such as decreased appetite, inability to eat spicy foods (due to stomatitis), or loose stools for two days. But the drug may need to be discontinued for more serious problems such as pronounced weight loss.

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 a client who has developed leukopenia a result of long term sulfonamide therapy. What is the most important nursing intervention in light of this client's condition?

All individuals in contact with the client must perform frequent hand hygiene. Correct Explanation: Leukopenia is a decreased level of white blood cells, and the client is not protected adequately from infection. Therefore, frequent hand hygiene is vital to protect the client from infection. The other interventions are to protect the client who has thrombocytopenia, which is decreased platelets.

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. Explanation: Drugs used against bacteria are either bacteriostatic (slow or retard the multiplication of bacteria) or bactericidal (destroy the bacteria.) Broad-spectrum antibiotics can destroy several different types of bacteria.

Drugs that destroy the bacteria are known as which of the following?

Bacteriocidal Correct Explanation: Drugs that destroy the bacteria are known as bacteriocidal.

Drugs that slow or retard the multiplication of bacteria are known as which of the following?

Bacteriostatic

Sulfonamides are classified as which of the following?

Bacteriostatic Correct Explanation: Sulfonamides are primarily bacteriostatic.

The primary healthcare provider has prescribed mafenide for a patient with second-degree burns. Which of the following is the most frequent adverse reaction associated with the topical application of mafenide on the affected area?

Burning sensation during application Correct Explanation: The nurse should assess for a burning sensation or pain during application of mafenide. Skin turning yellow or urine taking on an orange hue is associated with sulfasalazine, not mafenide. The risk of Stevens-Johnson syndrome is present only for sulfonamides that are taken orally, not for topical sulfonamide preparations.

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 Explanation: The most frequent adverse reaction seen with topical application of a sulfonamide is a burning sensation or pain when the drug is applied to the skin. Other possible allergic reactions include skin rash, itching, edema, and urticaria.

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

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.

A client who takes digoxin for heart failure is also prescribed trospium. The nurse would monitor the client closely for:

Signs of digoxin toxicity

The nurse is caring for a 6-year-old child who has pyelonephritis. The use of what group of antibiotics would be contraindicated due to the client's age?

Tetracyclines

A nurse administers methenamine cautiously to a client with a history of which condition?

gout

Which statement is true in regards to the oral administration of tetracyclines?

Tetracyclines should be administered with a full glass of water.

The nurse working in the burn unit is preparing to change a patient's dressing for the first time. What should the nurse tell the patient before changing the dressing and applying the ordered mafenide (sulfamylon) ointment?

That stinging or burning may be felt during and after application of the ointment Correct Explanation: The nurse when instructed to do so will clean and remove debris present on the skin before each application of mafenide. The drug is applied in a layer no greater than 1/16 inch; thicker application is not recommended. It is important to warn the patient that stinging or burning may be felt during and for a short time after application. The nurse should never leave the dead tissue nor tell the patient that it will not hurt.

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). Explanation: It would be very important for the nurse to inform the health care provider that the client takes warfarin (Coumadin), which is an anticoagulant. Sulfadiazine will increase the action of the anticoagulant and increase the chances of bleeding. The health care provider does not need immediate notification of any of the other choices.

Urinary tract anti-infectives act directly to destroy the bacteria or through acidification of the urine.

true

A nurse is providing discharge teaching to a client who is being sent home on tetracycline (Sumycin) PO. What should the instructions include?

The need to take the drug on an empty stomach

Sulfonamides are classified as which type of medication?

antibacterial

The nurse is caring for a client who is taking a sulfonamide and notices that the client has developed itchy hives. After contacting the health care provider, what term will the nurse use to describe the client's symptoms?

urticaria

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." Correct Explanation: Cranberries are thought to prevent bacteria from attaching to the walls of the urinary tract, and are helpful in relieving symptoms. Cranberry capsules are not recommended because the fluid for hydration is as helpful as the berries. Drinking approximately 6 ounces of cranberry juice twice a day is the suggested dose but eating cranberries at each meal will be helpful.

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."

The nurse knows that the recommended time to administer a sulfonamide to a patient is which of the following?

1 hour before or 2 hours after meals Explanation: Unless the order reads otherwise, the nurse should give sulfonamides to the patient whose stomach is empty--that is 1 hour before meals or 2 hours after meals. If gastric irritation occurs, then the nurse may give sulfonamides with food or immediately after meals.

The patient is ordered sulfasalazine 500 mg QID. The drug comes in 1000-mg tablets. How much should the nurse adminster to the patient at each dose?

1/2 tablet Explanation: The nurse should administer 1/2 tablet (500 mg) because the desired dose is half of the strength of the avaialable tablet. The ordered dose of 500 mg four times a day is the recommended dose.

A patient has been recommended 1500 mg of sulfasalazine oral suspension every 24 hours. The available drug is in the form of a 500 mg tablet. To meet the recommended dose, the nurse will administer _______ tablets each day.

3 Explanation: The required dosage is 1500 mg. Available tablet contains 500 mg of the drug. Therefore, 3 tablets (1500 mg/ 500 mg) need to be administered each day.

A patient 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 Correct Explanation: The required dosage is 4 gm per day. Available drug is in the form of 500 mg. Therefore, 8 (4000 mg/500 mg) tablets have to be administered every day.

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 nurse is caring for four patients on a medical floor. For which of the following patients would she suspect the physician might order a sulfonamide?

A 35-year-old woman with a urinary tract infection and a history of ulcerative colitis Explanation: The sulfonamides are used with caution in patients with renal impairment, hepatic impairment, or bronchial asthma. They are used to treat patients with ear infections, urinary tract infections, and ulcerative colitis. The topical sulfonamides are used to treat second- and third-degree burns.

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

Both gram positive and gram negative Explanation: The sulfonamides are used to treat both gram-negative and gram-positive bacteria such as Escherichia coli, Staphylococcus aureus, and Klebsiella and Enterobacter species. They are not used to treat infections caused by fungus.

The nurse is aware that which hospitalized clients are most at risk for urinary tract infections?

Clients with indwelling urethral catheter.

The nurse is caring for a neonate of a mother who took a sulfonamide during the last weeks of pregnancy. For which condition will the nurse monitor the neonate? Select all that apply.

Hemolytic anemia Jaundice

A client asks the nurse if it is safe to take Goldenseal (Hydrastis canadensis) as a treatment for a sinus infection. The nurse will counsel the client against taking this herb if the client has what condition?

Hypertension Correct Explanation: This herb is contraindicated in women who are pregnant and in individuals with hypertension. It may be useful in the treatment of diarrhea caused by bacteria, and has been used by American Indians tribes as a diuretic. It has historically been used in the treatment of sinus infections and digestive problems, such as peptic ulcers and gastritis.

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.

The health care professional has recommended sulfonamide therapy for a patient. While obtaining the patient's medical history, the nurse discovers that the patient is taking oral anticoagulants. Which of the following are the possible effects of combining sulfonamide therapy with oral anticoagulants?

Increased action of the anticoagulant

A nurse is caring for a patient with crystalluria. Which of the following interventions should the nurse perform to prevent more stones from forming?

Instruct the patient to increase fluid intake to 2000 mL Explanation: The nurse should instruct the patient to drink more fluids, so that the formation of crystals in urine (crystalluria) can be prevented. Unlike patients with thrombocytopenia, patients with crystalluria do not bruise easily so there is no need to exercise extra caution. Drinking cranberry juice is recommended for relieving symptoms of urinary tract infections, not for crystalluria. There is no need to shift the patient to a soft diet or a liquid diet.

The nurse is caring for a client who is on sulfonamide therapy and monitors the client for which common side effects? (Select all that apply.)

Nausea Diarrhea Photosensitivity

A nurse is helping with the discharge of a 92-year-old female patient who has been hospitalized for a serious upper urinary tract infection. The patient will continue taking SMZ-TMP at home. She is to be discharged into her daughter's care. The nurse will instruct the daughter to watch for which of the following most common adverse effects of the drug?

Nausea and vomiting Correct Explanation: The nurse should instruct the daughter to watch for nausea and vomiting, which are two common adverse effects SMZ-TMP, along with diarrhea. Urticaria, photosensitivity reactions, and jaundice are not identified adverse effects of SMZ-TMP

A client with a urinary tract infection has been admitted to the unit with shortness of breath and a nursing diagnosis of Ineffective Breathing Pattern, related to adverse reaction to a drug. The nurse knows that the client has been taking which drug for treatment of the infection?

Nitrofurantoin

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

Renal Explanation: Sulfonamides should be administered with great caution in the older adult because of age-related, decreased renal function. Though hepatic function may diminish related to age, it is not a caution to sulfonamide therapy. The same is true for neurological and integumentary function.

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

Renal damage Correct Explanation: Renal damage is a contraindication to the administration of SMZ-TMP; thus, the medication will produce liver damage. It does not cause liver toxicity, bone marrow depression, or congestive heart failure.

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

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) Explanation: TMP and SMZ (Bactrim) are used to treat acute bacterial UTI, otitis media, and traveler's diarrhea that are due to Escherichia coli. The other medications are most effective against Haemophilus influenzae.

A nurse is monitoring a patient on sulfonamide therapy. Which of the following symptoms should the nurse assess to find out if the patient has thrombocytopenia?

Unusual bleeding Correct Explanation: A person with thrombocytopenia shows visible signs of easy bruising and unusual bleeding after moderate to slight trauma to the skin. Fever, cough, and sore throat are common symptoms associated with many other conditions; they do not specifically indicate thrombocytopenia.

Which laboratory test should the nurse monitor to evaluate treatment effectiveness, when a client has been prescribed a medication to manage bladder spasms associated with a urinary tract infection?

Urine culture and sensitivity

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. Explanation: When teaching about viruses, the instructor should inform the students that viruses do not have a typical cell structure and use host cells to grow and divide. Because viruses use the DNA and RNA of other cells, their ability to change has posed a problem in making drugs to treat viral infections.

The nursing student is caring for a patient with ulcerative colitis. The student asks the instructor why the patient is taking a sulfonamide. What should the instructor tell the student?

When sulfonamides interact with intestinal bacteria, they help to inhibit the inflammatory process. Explanation: When sulfasalazine interacts with intestinal bacteria, it helps to inhibit the inflammatory process, which is how the drug treats ulcerative colitis. How sulfonamides work to inhibit the activity of folic acid to treat gram-negative and gram-positive bacteria does not help in the inflammatory process that is seen in ulcerative colitis. That the kidneys excrete sulfonamides has no bearing on how sulfanomides work for ulcerative colitis.

A client diagnosed with a urinary tract infection (UTI) asks the nurse about how to prevent another infection. Which statement by the client indicates effective teaching by the nurse?

Wipe from front to back after going to the bathroom.

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

The nurse is caring for a patient with a urinary tract infection (UTI) being treated with a sulfonamide. The patient asks for something to drink. Which of the following options should the nurse give to the patient?

cranberry juice Explanation: Cranberries and cranberry juice are commonly used remedies for preventing and relieving symptoms of UTIs. The use of cranberries in conjunction with antibiotics has been recommended by physicians for the long-term suppression of UTIs. Although cranberies may relieve symptoms or prevent a UTI, their use will not cure a UTI. The other options are not thought to have any effect on a UTI.

A client is seeking treatment for bladder spasms causing dysuria and urgency. Which clinical condition identified in the client's medical history will serve to contraindicate treatment with a urinary tract antispasmodic medication?

glaucoma

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

Which of the following nursing diagnoses would receive high priority for a burn patient on sulfonamide therapy?

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

A client with a UTI also has a history of glucose-6-phosphate dehydrogenase (G6PD) deficiency. Based on the nurse's understanding of urinary drugs, the nurse would expect to administer which drug with caution if prescribed?

nitrofurantoin

A client has been prescribed oral tetracycline. The nurse will instruct the client to take the drug how?

on an empty stomach

Tetracycline is often a viable treatment option when a client has an allergy to what antibiotics?

penicillins

A nurse is caring for a client who is taking a urinary anti-infectives. The nurse would need to assess this client for:

signs and symptoms of continuing UTI.

The nurse would question the use of sulfonamide therapy in which client? Select all that apply.

• 18-month-old female client • breastfeeding client 32 years of age Explanation: Sulfonamides are contraindicated in clients who are younger than 2 years of age and women who are lactating. Sulfonamides would not be contraindicated in the other clients as long as there is no indication of a previous hypersensitivity reaction

Which of the following are ways in which microbes enter the body? (Select all that apply)

• Break in the skin • Ingestion • Breathing • Mucous membrane contact Explanation: Microbes enter the body in different ways, such as through a break in the ski, or by ingestion, breathing, or contact with the mucous membranes of the body.

The nursing instructor is teaching the nursing students about serious hematologic adverse reactions that can occur with prolonged sulfonamide therapy. Which of the following should be included?

• Leukopenia • Thrombocytopenia • Aplastic anemia Explanation: Some serious hematologic adverse reactions can occur during prolonged sulfonamide therapy. These include leukopenia, thrombocytopenia, and aplastic anemia. Sulfonamides are not known to cause leukemia or pernicious anemia.

A client has been admitted for treatment of a burn on the left arm. Which sulfonamides are most likely to be prescribed to treat the damaged skin?

• Mafenide (Sulfamylon) • Silver sulfadiazine (Silvadene) Explanation: Mafenide and silver sulfadiazine are topical medications used in the treatment of burns. Trimethoprim and sulfamethoxazole are used in the treatment of acute bacterial UTI cased by E. coli. Sulfasalazine and sulfisoxazole are both used in the treatment of UTI and otitis media.

The nurse is caring for a client who is on sulfonamide therapy and monitors the client for which common side effects?

• Nausea • Diarrhea • Photosensitivity Explanation: Common side/adverse effects related to the use of sulfonamides include nausea, vomiting, diarrhea, anorexia, abdominal pain, stomatitis, chills, fever, crystalluria, and photosensitivity. Anemia, low white count, and low platelet count are much less common reactions and are related to the long-term use of sulfonamides.

A nursing instructor is teaching students that sulfonamides work on both gram-negative and gram-positive bacteria. Some infections that this class of drugs treats include which of the following?

• Urinary tract infections • Ulcerative colitis • Acute otitis media • Second- and third-degree burns Explanation: The sulfonamides often are used in the treatment of infections such as urinary tract infections, ulcerative colitis, and acute otitis media. Topical preparations are used in the treatment of second- and third-degree burns. This class of drugs is not used to treat pneumonia but is known to treat types of meningitis.

Mr. Martin has been prescribed SMZ-TMP for a urinary tract infection. Mr. Martin has a history of hypertension, allergic reactions to furosemide, and smoking (1 pack of cigarettes per day). Two days after starting therapy, Mr. Martin develops an itchy rash on the trunk of his body. How would you explain to Mr. Martin what has occurred?

"You are having an allergic reaction to the medication and need to stop taking it immediately." A rash and itching indicate signs of an allergic reaction. Cross-sensitivity may also occur with chemically related drugs, such as the thiazide or loop diuretics and the oral sulfonylureas.

The nurse is applying mafenide (Sulfamylon) to a client's burned skin and knows that which adverse reactions may occur with this medication?

• Burning sensation • Itching • Rash Explanation: The most common adverse reactions seen in the use of mafenide (Sulfamylon) are pain or burning sensation, rash, itching, and facial edema. Leukopenia and skin discoloration are seen with the use of silver sulfadiazine.

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?

No use of bubble bath liquids or salts

The nurse understands the risk of patients developing a "superinfection" when taking an anti-infective. A superinfection can best be defined as which of the following?

Secondary infection caused by a disruption of normal flora Explanation: Antibiotics can disrupt the normal flora, causing a secondary infection or "superinfection." This new infection is superimposed on the original infection. The destruction of large numbers of nonpathogenic bacteria (normal flora) by the antibiotic alters the chemical enviornment. This allows for uncontrolled growth of bacteria not affected by the antibiotic being administered

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