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A client is being discharged with a prescription for sulfasalazine. Which of the following would the nurse include in the discharge teaching plan? Select all that apply.
- A. Take the drug 1 hour before or 2 hours after meals.
- B. Use protective sunscreen or cover exposed areas when going outside.
- C. Finish the entire course of sulfonamide even if you begin feeling better.
- D. Decrease fluid intake to prevent increased excretion of the drug.
- E. Keep all follow-up appointments
Correct Answer: B,C,E
Rationale: The nurse should teach the client to take sulfasalazine with food or immediately after a meal, to use sunscreen or cover exposed areas to prevent severe sunburn, to increase fluid intake to prevent renal calculi, to finish the entire course of drug even if the symptoms go away, and to keep all follow-up appointments.
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A nurse is caring for a client with a urinary tract infection. After administering a sandwich and a large glass of cranberry juice to a client, the nurse observes that the client has developed diarrhea. Which of the following is the most likely cause of the client's condition?
- A. Extremely large dosage of cranberry juice
- B. Lack of activity or exercise
- C. Occurrence of crystalluria
- D. Minimized food and fluid intake
Correct Answer: A
Rationale: Clients may develop gastrointestinal distress such as diarrhea if they have consumed extremely large doses of cranberry juice. The recommended dose is 6 ounces of juice twice daily. Cranberry juice on an empty stomach or immediately after dosage will not lead to diarrhea if taken in the recommended amount. Minimized food and fluid intake or lack of exercise does not increase the chances of diarrhea. Crystalluria does not cause diarrhea.
When developing the plan of care for a client receiving sulfonamides for treatment of a urinary tract infection, the nurse identifies actions for encouraging fluid intake and monitoring intake and output based on which nursing diagnosis?
- A. Risk for Fluid Imbalance
- B. Impaired Urinary Elimination
- C. Risk for Ineffective Renal Perfusion
- D. Stress Incontinence
Correct Answer: B
Rationale: A client with a urinary tract infection already is experiencing an alteration in urinary elimination. Because one adverse effect of the sulfonamide drugs is altered elimination patterns, it is important to help the client maintain adequate fluid intake and output. The nurse would encourage clients to increase fluid intake to 2000 mL or more per day to prevent crystalluria and stones (calculi) forming in the genitourinary tract, as well as to aid in removing microorganisms from the urinary tract. It is important to measure and record the client's intake and output every 8 hours and notify the primary health care provider if the urinary output decreases or the client fails to increase his or her oral intake. If the client is unable to maintain adequate intake, then he or she would be at risk for fluid imbalance. If renal injury would occur, then the client would be at risk for ineffective renal perfusion. Bladder training would be an appropriate intervention to address stress incontinence.
A nurse is preparing a plan of care for an older adult client who is receiving sulfonamide therapy. Which of the following would the nurse include in the plan of care to reduce the likelihood of causing renal damage? Select all that apply.
- A. Administer sulfonamides once daily.
- B. Increase fluid intake up to 2000 mL if tolerated.
- C. Use sulfonamides cautiously in clients with renal impairment.
- D. Administer the dose intravenously instead of orally.
- E. Ask the prescriber to change the medication ordered
Correct Answer: B,C
Rationale: Older adults experience a decline in renal function with aging. Therefore, sulfonamides must be used cautiously in older clients. In addition, increasing fluid intake up to 2000 mL daily can decrease the likelihood of causing renal damage in older clients. The drug is administered throughout the day, not as a once-daily dose. Sulfonamides can affect renal function regardless of the route administered. Asking the prescriber to change the medication ordered may be appropriate but is not necessary as long as the drug is administered cautiously and the client is monitored closely.
A client who is on sulfonamide therapy is about to be discharged. Which of the following precautions should the nurse instruct the client to follow to reduce the effects of photosensitivity?
- A. Wear protective clothing and sunscreen when outside.
- B. Increase fluid intake.
- C. Avoid lights while indoors.
- D. Wear protective footwear
Correct Answer: A
Rationale: The nurse should encourage a client 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 while indoors; the skin becomes sensitive only to harsh sunlight during sulfonamide therapy. Wearing protective footwear may protect the feet from injury, but it will not protect the skin from the harmful effects of photosensitivity.
A 60-year-old client who is on sulfonamide therapy has impaired urinary elimination. She does not want to increase her oral fluid intake because of fear of incontinence. Which of the following nursing interventions would be most appropriate?
- A. Inform the client that there is no need to increase fluid intake.
- B. Inform the client that increasing fluid intake will not result in incontinence.
- C. Teach the client the times to take fluids to maintain continence.
- D. Increase fluid intake by 1000 mL instead of 2000 mL to avoid incontinence
Correct Answer: C
Rationale: The nurse's responsibility is to help the client overcome the fear of incontinence and to teach her when to take fluids to maintain continence. Instead of telling the client that increasing fluid intake has no effect on continence, the nurse should focus on helping the client with her problems of incontinence. The nurse should instruct the client to increase the fluid intake by at least 2000 mL, instead of only 1000 mL; however, this will not help control incontinence.