Nokea
A female client receiving methotrexate for the treatment of rheumatoid arthritis is given a prescription for trimethoprim and sulfamethoxazole (Bactrim DS). The client returns to the physician's office feeling worse than before. She now has a cough and unusual bruising on the extremities. The physician orders a complete blood count and a complete metabolic profile. Which test results would the nurse expect to find? Select all that apply.
- A. Increased hemoglobin
- B. Decreased number of white blood cells
- C. Increased number of red blood cells
- D. Decreased number of platelets
Correct Answer: B,D
Rationale: The concomitant use of methotrexate and sulfonamides, like trimethoprim and sulfamethoxazole (Bactrim DS), can result in increased bone marrow suppression, leading to decreased amounts of white blood cells, red blood cells, and platelets in the blood.
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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.
A client is prescribed sulfadiazine one tablet twice daily for 10 days. When reviewing the client's history, the nurse notes that the client is also taking warfarin. The nurse would be alert for which of the following?
- A. Prolonged clotting times
- B. Increased risk of infection
- C. Decreased antibiotic effect
- D. Decreased white blood cell count
Correct Answer: A
Rationale: When warfarin and sulfonamides are given concomitantly, an increase in action of the anticoagulant is seen, leading to an increase in clotting time, such as PT/INR, and an increased risk of bleeding. An increased risk of infection and a decrease in the white blood cell count would occur when a sulfonamide is given with methotrexate. The combination of warfarin and sulfonamide does not impact the effect of the antibiotic.
A nurse is caring for a client who is being administered sulfasalazine. Which of the following instructions should the nurse include to ensure that the client gets the full benefits of the treatment?
- A. Take dosage while eating or immediately after eating.
- B. Increase food intake for the duration of sulfonamide therapy.
- C. Take the drug with a full glass of milk instead of water.
- D. Drink at least two to three 8-ounce glasses of fluid every day
Correct Answer: A
Rationale: The nurse should administer sulfasalazine with food or immediately afterward. Increasing the food intake during sulfonamide therapy is not necessary, as long as a proper diet is maintained and the physician's recommendations are followed. Two to three 8-ounce glasses of fluid is not enough; the client should drink at least eight to ten 8-ounce glasses of fluid every day. All drugs should be taken with water and not milk, juice, or any other liquid, unless specifically instructed by the physician.
When reviewing the medical records of several clients who are prescribed sulfonamide therapy, the nurse would expect laboratory findings related to which bacteria? Select all that apply.
- A. Pseudomonas aeruginosa
- B. Escherichia coli
- C. Klebsiella pneumoniae
- D. Streptococcus pyogenes
- E. Staphylococcus aureus
Correct Answer: B,C,E
Rationale: Sulfonamides are often used to control infections caused by both gram-negative and gram-positive bacteria, such as Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. Typically, sulfonamides are not used to treat infections caused by Pseudomonas aeruginosa or Streptococcus pyogenes.
After teaching a group of nursing students about sulfonamides, the instructor determines that the teaching was successful when the students identify which of the following as an example of a sulfonamide antibiotic? Select all that apply.
- A. Amoxicillin (Amoxil)
- B. Ciprofloxacin (Cipro)
- C. Sulfamethoxazole/trimethoprim (Bactrim)
- D. Clarithromycin (Biaxin)
- E. Silver sulfadiazine (Silvadene
Correct Answer: C,E
Rationale: Silver sulfadiazine(Silvadene) and sulfamethoxazole/trimethoprim(Bactrim) are sulfonamide antibiotics. Amoxicillin is an aminopenicillin. Ciprofloxacin is classified as a fluoroquinolone. Clarithromycin is a macrolide.