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A client is taking trimethoprim and sulfamethoxazole (Bactrim DS) one tablet twice daily for 14 days. Which of the following would the nurse include when teaching the client about possible adverse reactions? Select all that apply.
- A. Muscle pain
- B. Blurred vision
- C. Anorexia
- D. Crystalluria
- E. Photosensitivity
Correct Answer: C,D,E
Rationale: Teaching should address potential adverse reactions that can occur while taking a sulfonamide. These adverse reactions include nausea, vomiting, anorexia, stomatitis, chills, fever, crystalluria, and photosensitivity.
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A group of nursing students are reviewing information about sulfonamides. Which of the following if stated by the students indicate understanding of this drug class? Select all that apply.
- A. Sulfonamides are well absorbed when given orally.
- B. Sulfonamides are poorly absorbed when given orally.
- C. Sulfonamides treat only gram-positive infections.
- D. Sulfonamides treat only gram-negative infections.
- E. Sulfonamides are excreted by the kidneys
Correct Answer: A,E
Rationale: Sulfonamides are well absorbed by the GI tract and are excreted by the kidneys. Sulfonamides treat both gram-positive and gram-negative infections.
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 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.
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.
A nurse is working in an ambulatory care setting that involves seeing clients with infections that require treatment. Which of the following would be important for the nurse to assess in these clients? Select all that apply.
- A. Client's use of self-remedies
- B. Review of lab results
- C. Vital signs
- D. Client's symptoms
- E. Client's general appearance
Correct Answer: A,B,C,D,E
Rationale: When assessing a client who may have an infection, the nurse should gather information about the client's general appearance; vital signs; symptoms, including the length of time the client has been experiencing them; and any self-remedies used. In addition, the nurse should review the results of any laboratory and diagnostic tests.