Nokea
A client with a fever is ordered to receive sulfonamide therapy for an infection. The nurse needs to evaluate the client for which of the following during the course of therapy? Select all that apply.
- A. Response to drug therapy
- B. Elevated blood glucose levels
- C. Mental status changes
- D. Occurrence of adverse reactions
- E. Decrease in temperature
Correct Answer: A,D,E
Rationale: During the course of therapy, the nurse evaluates the client at periodic intervals for response to the drug, including relief of symptoms and decrease in temperature, as well as the occurrence of any adverse reactions.
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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.
The nurse suspects that a client who is taking a sulfonamide has leukopenia. Which assessment findings would support this suspicion? Select all that apply.
- A. Sore throat
- B. Cough
- C. Nausea
- D. Photosensitivity
- E. Bruising
Correct Answer: A,B
Rationale: Antibiotics including sulfonamides can lead to leukopenia, which would be manifested by fever, sore throat, or cough. Thrombocytopenia is also possible and would be manifested by easy bruising or unusual bleeding from minor to moderate trauma. Nausea and photosensitivity are adverse reactions to sulfonamides.
After administering sulfonamides to a client, the nurse observes that he has developed a fever, cough, and muscular aches. The nurse also observes that the client has developed lesions in the form of red wheals on the neck and the mouth. The nurse interprets these findings as indicating which of the following?
- A. Stevens-Johnson syndrome (SJS)
- B. Anaphylactic shock
- C. Thrombocytopenia
- D. Leukopenia
Correct Answer: A
Rationale: Clients with Stevens-Johnson syndrome (SJS) may complain of fever, cough, muscular aches and pains, and headache. Additional signs include lesions on the neck and mouth. Lesions are not symptoms of leukopenia or anaphylactic shock. A client with thrombocytopenia develops bruises on the skin but not lesions in the form of red wheals.
Which of the following represent contraindications to treatment with a sulfonamide? Select all that apply.
- A. Children younger than 6 years of age
- B. Adults older than 65 years of age
- C. Lactating females
- D. Clients with group A beta-hemolytic streptococci infections
- E. Women in the second trimester of pregnancy
Correct Answer: C,D
Rationale: The sulfonamides are contraindicated in clients with hypersensitivity to the sulfonamides, during lactation, in children younger than 2 years of age, near the end of pregnancy, and for infections caused by group A beta-hemolytic streptococci.
A nurse is reviewing the laboratory test results of a client receiving sulfasalazine therapy for ulcerative colitis. Which of the following would the nurse anticipate finding? Select all that apply.
- A. Pancytopenia
- B. Leukopenia
- C. Thrombocytopenia
- D. Aplastic anemia
- E. Iron deficiency anemia
Correct Answer: B,C,D
Rationale: Leukopenia, thrombocytopenia, and aplastic anemia are hematologic changes that may occur during prolonged sulfonamide therapy, such as during ulcerative colitis treatment with sulfasalazine.