Tetracyclines, Sulfonamides, and Urinary Antiseptics

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." Clients who take sulfasalazine should expect for their urine to turn yellow-orange while on the medication.

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." 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 making a reduction in dosage unnecessary.

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.

If a fetus or young infant receives a sulfonamide by placental transfer, in breast milk, or by direct administration, the drug displaces bilirubin from binding sites on albumin. As a result, what may the fetus experience?

- Hyperbilirubinemia - Kernicterus

Which of the following is an example of a sulfonamide antibiotic?

- Sulfamethoxazole/Trimethoprim (Bactrim) - Silver sulfadiazine (Silvadene)

The nurse understands that some clients should not take sulfonamides. These include which clients?

- clients with a hypersensitivity to sulfonamides - women who are lactating - children younger than 2 months

The nurse should advise clients that which of the following are adverse reactions that may occur with the administration of tetracyclines?

- nausea - vomiting - diarrhea - epigastric distress - stomatitis - sore throat - skin rashes - photosensitivity

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. - assessing whether the client is hypersensitive to sulfonamides

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 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 sulfonamides are used with caution in clients with renal impairment, hepatic impairment, or bronchial asthma. They are used to treat clients with ear infections, urinary tract infections, and ulcerative colitis. The topical sulfonamides are used to treat second- and third-degree burns.

A nurse is caring for a hospitalized client with a urinary tract infection (UTI). The nurse is preparing to administer nitrofurantoin, which is a bacteriostatic antibiotic. Which statement best differentiates bacteriostatic and bactericidal medications?

Bacteriostatic medications slow or retard the multiplication of bacteria.

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

Clients with indwelling urethral catheter

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.

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

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 Interaction of antacids with a tetracycline drug causes decreased absorption of tetracycline.

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 patient is being prescribed tetracycline for the treatment of rickettsiae. The nurse learns that the patient is also taking an anticoagulant for a circulatory disorder. What is the effect of oral anticoagulant drugs interacting with tetracycline?

Increased risk of bleeding

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

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 newly diagnosed with syphilis is allergic to penicillin. What medication should this client be prescribed?

Pencillin

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 Phenazopyridine is an azo dye, which will discolor the urine orange or red.

A nurse has administered demeclocycline to a patient. Which of the following adverse reactions should the nurse closely monitor the patient for?

Photosensitivity

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

Signs of digoxin toxicity Trospium interacts with digoxin, leading to increased serum levels of digoxin. Therefore, the nurse would need to monitor the client for signs and symptoms of digoxin toxicity

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 Giving sodium bicarbonate to a patient who has acidic urine may help reduce its acidity. The nurse could also advise the patient to drink at least 1.5 L of water daily

A patient has been prescribed oral tetracycline for the treatment of acne. Which of the following must the nurse include in the patient teaching plan?

Take the drug on an empty stomach. Oral preparations of tetracycline should be administered on an empty stomach with a full glass of water to maximize absorption

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 Tetracycline may be effective in treating syphilis when penicillin cannot be given

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

Tetracycline should be taken on an empty stomach 1 hour before or 2 hours after meals with a full 8 ounces of water to ensure full absorption.

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 Tetracyclines can potentially damage developing teeth and bones and thus should be used cautiously or avoided in children under the age of 8 years.

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). 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.

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 sentivity Monitor the results of laboratory tests, such as urinalysis and urine culture and sensitivity, to evaluate the effectiveness if UTI is the problem

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?

When applying a topical sulfonamide, the client should apply it in a thin layer, about 1/16-in thick.

A nurse is caring for a patient receiving nitrofurantoin for acute bacterial UTI. The drug is known to cause acute pulmonary reactions such as dyspnea, chest pain, cough, fever, and chills. What interventions should the nurse perform if these reactions are observed in the patient?

Withhold the drug and contact primary health care provider. The nurse should immediately notify the primary health care provider and withhold the next dose of the drug until the patient is seen by a primary health care provider if acute pulmonary reactions are observed in the patient. The nurse should monitor the patient for signs of a nonproductive cough or malaise, which may indicate a chronic pulmonary reaction, which may occur during prolonged therapy

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 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

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) An elevated creatinine level is associated with renal dysfunction, which may contraindicate the use of tetracycline in an older adult due to the risk of further kidney damage

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

every 12 hours

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 this medication is used, it is imperative that the client maintain a fluid intake that allows for an output of 1500 mL of urine in 24 hours.

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

gout Methenamine should be used cautiously in clients with gout because it may cause crystals to form in the urine.

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

pencillins

The nurse is administering a urinary tract drug that exerts a topical analgesic effect on the lining of the urinary tract. Which drug would the nurse be most likely to administer?

phenazopyridine Phenazopyridine is a dye that exerts a topical analgesic effect on the lining of the urinary tract.

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

renal

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 Monitor client response to the drug (resolution of UTI and relief of signs and symptoms) and repeat culture and sensitivity tests as recommended for evaluation of the effectiveness of all of these drugs.

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 These symptoms may indicate a sulfonamide-induced allergic reaction and the need to change or stop the drug.

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

tetracyclines should be administered with a full glass of water

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 person with thrombocytopenia shows visible signs of easy bruising and unusual bleeding after moderate to slight trauma to the skin

A nurse is reviewing the medical record of a client who is prescribed tetracycline. Which drug, if found being used by the client, would alert the nurse to the need for a decreased dosage of that drug?

warfarin The concomitant use of tetracycline with warfarin, an anticoagulant, increases the risk of bleeding, necessitating a reduction in the dosage of warfarin.