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

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 need to fan the area while the wound is open." "I must avoid cleaning the wound before I apply the drug." "If I feel some stinging, I should call the health care provider." "I will apply it in a very thin layer over the area."

"I will apply it in a very thin layer over the area." Explanation: When applying a topical sulfonamide, the client should apply it in a thin layer, about 1/16-in thick. Some stinging on application is normal and need not be reported. Air drafts worsen the pain and should be avoided. The wound should be cleaned and any debris removed before the drug is applied.

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? "Take this dose of medication and I'll notify your health care provider." "You have most likely developed these sores due to the stress of the infection." "I wouldn't worry about it. It should get better in the next day or two." "I'm going to contact your health care provider before I administer your medication."

"I'm going to contact your health care provider before I administer your medication." 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.

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." "This is a result of the urinary tract infection and will go away once you have completed your anti-infective." "Come immediately to the clinic to be checked for hepatitis." "Stop taking the nitrofurantoin and the health care provider will prescribe another medication."

"This is an expected side effect of this medication and is not alarming." Explanation: Phenazopyridine may cause a yellowish discoloration of the skin or sclera. It is not related to the nitrofurantoin, does not indicate the development of hepatitis, and is not a result of the urinary tract infection.

The nurse knows that the normal recommended time to administer a sulfonamide to a client is at which time? at bedtime to decrease stomach upset 1 hour before or 2 hours after meals during meals with a large glass of water anytime with a sip of water

1 hour before or 2 hours after meals Explanation: Unless the order reads otherwise, the nurse knows the normal recommended time to give sulfonamides to the client whose stomach is empty; that is, 1 hour before meals or 2 hours after meals. If gastric irritation occurs, then the nurse would notify the health care provider, who would likely allow that it may be given with food or immediately after meals.

Sulfonamides are often used to treat UTI in children older than what age? 2 months 4 months 6 months 12 months

2 months Explanation: Sulfonamides are often used to treat UTI in children older than 2 months of age.

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? 6 2 8 4

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

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. 4 6 8 2

8 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.

Your client has a deep wound that is draining large amounts of purulent material. You know that which of the following antibiotics should NOT be ordered for this client? Bactrim Tetracycline Vibramycin Penicillin

Bactrim Explanation: Sulfonamides halt multiplication of new bacteria but do not kill mature, fully formed bacteria. With the exception of the topical sulfonamides used in burn therapy, the presence of pus, serum, or necrotic tissue interferes with sulfonamide action because these materials contain PABA.

The pharmacology instructor is teaching about sulfonamides and informs the students that these drugs are used to control infections caused by which bacteria? Fungal growths Both gram positive and gram negative Gram positive Gram negative

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 in the treatment of fungal infections.

he nurse understands that some clients should not take sulfonamides. These include which clients? (Select all that apply.) Clients with a hypersensitivity to sulfonamides Teenagers Women who are lactating School-aged children Children younger than 2 months

Clients 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 clients 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.

24s 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. Explanation: The client is experiencing common adverse reactions related to the medication. Other adverse reactions include anorexia, nausea, vomiting, diarrhea, abdominal pain, or stomatitis. The client should be instructed to drink extra fluids and take the medication with food. Calling the prescriber for pain medication is not indicated. The client is not reporting an inability to stay alert.

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 Anuria Dehydration Proteinuria

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 treatmeent. 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.

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? Increased action of neuromuscular-blocking drugs Decreased absorption of tetracycline Increased profound respiratory depression Increased risk of bleeding

Decreased absorption of tetracycline Explanation: Interaction of antacids with a tetracycline drug causes decreased absorption of tetracycline. Increased action of neuromuscular-blocking drugs and increased profound respiratory depression are the result of interaction between neuromuscular-blocking drugs and tetracyclines. Increased risk of bleeding is a result of interaction between anticoagulants and tetracyclines.

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. Ensure care while moving client to avoid bruising. Change the client's diet to a soft diet or a liquid diet. Instruct client to drink cranberry juice regularly.

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

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 Liver function panel Renal function panal Complete blood count (CBC)

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.

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

Phenazopyridine Explanation: Phenazopyridine can change the urine color to reddish brown. There is no change in urine color with nofloxacin. oxybutynin, or solifenacin.

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? Cinoxacin Phenazopyridine Fosfomycin Methenamine

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.

Your client tells you that she is taking an antibiotic and a pain medication for a urinary tract infection. She cannot recall the name of the pain medication. You suspect the name of her pain medication is: Vibramycin. Pyridium. Penicillin. Bactrim.

Pyridium. Explanation: Pyridium is given to relieve pain associated with UTI. It has no antibacterial activity.

A clinic client has been prescribed phenazopyridine (Pyridium) for aid in treating a UTI. This client should be informed that Pyridium will change the urine to what color? Brown Reddish-orange Bluish-green Black

Reddish-orange Explanation: Phenazopyridine turns urine orange-red, which may be mistaken for blood.

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

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 pancreatic and splenic function.

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? Convulsive disorders Renal impairment Cerebral arteriosclerosis Diabetes

Renal impairment Explanation: Phenazopyridine, an anti-spasmodic drug, is contraindicated in clients with renal impairment and in undiagnosed urinary tract pain. The drug is not contraindicated in clients with cerebral arteriosclerosis, convulsive disorders, or hepatic impairment. Nalidixic acid, which is an anti-infective drug, and nitrofurantoin are used cautiously in clients with cerebral arteriosclerosis, convulsive disorders, and diabetes.

A client who takes digoxin for heart failure is also prescribed trospium. The nurse would monitor the client closely for: Increased central nervous system effects Changes in urine color Signs of digoxin toxicity Excess anticholinergic effects

Signs of digoxin toxicity Explanation: 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. Levels of trospium would not increase, so increased central nervous system effects or excess anticholinergic effects would most likely not occur. The combination of trospium and digoxin does not change the color of urine.

The drug's effect on what best reflects the major reason for avoiding the use of tetracyclines in children under 8 years of age? Hearing Kidneys Vision Teeth

Teeth Explanation: Tetracyclines should be used with caution in children younger than age 8 years because the drugs can potentially damage developing teeth and bones. They do not affect hearing or vision. They are excreted in the urine, so caution is necessary if the client has underlying renal dysfunction; however, this is not the main reason for avoiding use in children.

Which statement is true in regards to the oral administration of tetracyclines? Tetracyclines should be administered on a full stomach. Tetracyclines should only be administered in the morning. Tetracyclines should only be administered in the evening. Tetracyclines should be administered with a full glass of water.

Tetracyclines should be administered with a full glass of water. Explanation: Tetracyclines should always be administered with a full glass of water and on an empty stomach (except minocycline and tigecycline may be taken with food).

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 had a hip replacement less than six months ago. The client doesn't like cranberry juice. The client is allergic to cephalosporins.

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 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 They sterilize the feces They are excreted through the liver They reach high plasma levels in a short period of time

They act specifically within the urinary tract Explanation: Urinary tract anti-infectives act specifically within the urinary tract to destroy bacteria, either through a direct antibiotic effect or through acidification of the urine. They are not used in systemic infections because they do not attain therapeutic plasma levels. These drugs are not excreted through the liver, and they do not sterilize the feces.

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? Leukopenia Hyperglycemia Thrombocytopenia Hypokalemia

Thrombocytopenia Explanation: Leukopenia, hypokalemia and hyperglycemia are not adverse effects of sulfonamide therapy. Thrombocytopenia is a complication manifested by easy bruising and unusual bleeding after trauma to the skin or mucous membranes.

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? Avoid driving and performing tasks that require alertness. Call the prescriber for pain medication. Drink frequent sips of water. Consume the medication with food.

Urine culture and sentivity Explanation: Monitor the results of laboratory tests, such as urinalysis and urine culture and sensitivity, to evaluate the effectiveness if UTI is the problem,and renal and hepatic function tests to determine the need for possible dose adjustment and to evaluate for possible toxicity. CBC monitors for overall health.

A patient who is on sulfonamide therapy is about to be discharged. Which of the following precautions should the nurse instruct the patient to follow to reduce the effects of photosensitivity? Wear protective eyewear. Avoid lights while indoors. Increase fluid intake. Wear protective clothing and sunscreen when outside.

Wear protective clothing and sunscreen when outside. Explanation: The nurse should encourage a patient to wear protective clothing while going out in the sun to reduce the effect of photosensitivity. While increasing the fluid intake is recommended, it does not help combat the effects of photosensitivity. There is no need to avoid lights indoor; the skin becomes sensitive only to harsh sunlight during sulfonamide therapy. Wearing sunglasses may protect the eyes, but it will not protect the skin from the harmful effects of photosensitivity.

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? Decrease fluid intake while taking the medication. Use protection during sexual contact. Wipe from front to back after going to the bathroom. Take the entire medication and stop when you feel better.

Wipe from front to back after going to the bathroom. Explanation: Teaching points related to preventing UTIs include the following: Wiping front to back after going to the bathroom; avoid tight clothing, prolonged wearing of pantyhose, tight pants, or wet bathing suits; shower instead of taking a bath; after sexual contact, void and drink 2 to 8 ounces of water; increase fluid intake, gauging the amount your drink to the color of your urine; and avoid eating foods or drinking liquids that irritate the bladder, such as coffee, tea, alcohol, artificial sweeteners, chocolate, and pepper. The client should be instructed to take the entire medication until it is completed. Using protection during sexual contact does not prevent urinary tract infections but prevents sexually transmitted infections and pregnancy.

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. Provide oxygen support to the patient. Offer fluids to the patient at regular intervals. Monitor patient for a tightness of the chest.

Withhold the drug and contact primary health care provider. Explanation: 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. Tightness of the chest is not known to occur in case of a chronic pulmonary reaction, and so the nurse need not monitor the patient for the same. The nurse offers fluids at regular intervals to elderly patients who develop decreased thirst sensation as an adverse reaction to the urinary tract anti-infectives.

Sulfonamides are classified as which type of medication? antiviral antifungal antiprotozoal antibacterial

antibacterial Explanation: Sulfonamides treat bacterial infections and are considered antibacterial drugs. Antifungals are used to combat fungal infections such as yeast. Antivirals are used to combat viral infections such as the flu. Antiprotozoals combat microscopic organisms called protozoans that can inhabit water and food supplies.

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? orange coloration of urine skin turning yellow burning sensation during application Stevens-Johnson syndrome

burning sensation during application 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.

A client is diagnosed with an infection. What would the nurse anticipate being used to determine the best drug to treat the infection? tissue biopsy culture and sensitivity (C&S) white blood cell count x-ray

culture and sensitivity (C&S) Explanation: C&S testing helps to identify the best drug for eradicating the bacterial infection. The white blood cell count will indicate the presence of infection but not what drug to treat it with. A tissue biopsy will determine a tissue type. An x-ray will only give visual views of structures in the body.

A nurse administers methenamine cautiously to a client with a history of which condition? gout tendonitis rheumatoid arthritis osteoarthritis

gout Explanation: Methenamine should be used cautiously in clients with gout because it may cause crystals to form in the urine. There are no known adverse reactions with methanamine and rheumatoid arthritis, osteoarthritis, or tendinitis.

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. measure the urine pH and check if it is acidic. measure the client's blood pressure and heart rate. determine whether the client should be given medication orally or parenterally.

obtain a complete blood count to establish baseline values. Explanation: The two most important tasks that are applicable to all therapies for UTIs are assessing whether the client is hypersensitive to sulfonamides and taking a blood count before beginning therapy to establish a baseline. The nurse could also measure the urine pH, but that is essentially an ongoing check. The nurse does not determine the method of administration; that is part of the drug order, as well as the dose. Measuring the blood pressure and heart rate is important and should be done, but it is not related to the UTI or drug therapy.

A client has been prescribed oral tetracycline. The nurse will instruct the client to take the drug how? with milk or fruit juice. at bedtime only. take with a meal. on an empty stomach.

on an empty stomach. Explanation: Oral preparations of tetracycline should be administered on an empty stomach 1 hour before or 2 hours after taking a meal or other drugs to maximize absorption. Tetracycline is not absorbed effectively if taken with food or dairy products. The dosage must be distributed around the clock, and not just at bedtime, to increase effectiveness.

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

penicillins Explanation: Prescribers order tetracycline when penicillin is contraindicated to treat infections caused by Klebsiella, Neisseria gonorrhoeae, Treponema pallidum, Listeria monocytogenes, Clostridium, Bacillus anthracis, Fusobacterium fusiforme, and Actinomyces.

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? tachycardia skin rash or itching dizziness polydipsia

skin rash or itching Explanation: Clients taking sulfonamides should be instructed to contact the prescriber if they experience skin rash or itching. These symptoms may indicate a sulfonamide-induced allergic reaction and the need to change or stop the drug.

A nurse is monitoring a client on sulfonamide therapy. Which finding would lead the nurse to suspect that the client is developing thrombocytopenia? fever unusual bleeding sore throat cough

unusual bleeding 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.