Nokea
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.
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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 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 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.
The nurse is preparing to administer a prescribed sulfonamide. Which of the following would the nurse do? Select all that apply.
- A. Have the client sit up to take the drug
- B. Give the prescribed drug on an empty stomach
- C. Be sure to administer the drug immediately after a meal
- D. Have the client decrease his fluid intake
- E. Encourage the client to drink additional fluids
Correct Answer: A,B,E
Rationale: Oral medication should be administered to clients only when they are in an upright or sitting position. Sulfonamides should be administered on an empty stomach if tolerated with 8 ounces of water. Increased fluid intake is encouraged to prevent crystalluria.
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.