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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.
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A client develops a cough and fever and laboratory test results reveal leukopenia after the client receives sulfonamide therapy. When developing the client's plan of care, the nurse would identify which nursing diagnosis?
- A. Impaired Urinary Elimination
- B. Impaired Skin Integrity
- C. Risk for Secondary Infection
- D. Deficient Knowledge
Correct Answer: C
Rationale: Fever and leukopenia suggest an infection, which can occur secondarily with sulfonamide therapy. Therefore, Risk for Infection would be the most appropriate nursing diagnosis. Impaired Urinary Elimination would be appropriate if the client was experiencing changes in urinary output. Impaired Skin Integrity would be appropriate if the client developed a rash or hypersensitivity reaction. Deficient Knowledge would be appropriate if the client lacked understanding of the drug therapy, which is not evident in this situation.
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 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.
After teaching the client about taking his prescribed sulfonamide therapy, the nurse determines that the client needs additional teaching when he states which of the following?
- A. I should take the drug with a large glass of water each time.
- B. I can take the drug at different times of the day each day.
- C. I have to finish the full prescription for the medication.
- D. I should call my doctor if my symptoms seem to get worse
Correct Answer: B
Rationale: It is important that the client takes the drug at the scheduled intervals consistently throughout the course of the therapy because a certain amount of the drug must be in the body at all times for the infection to be controlled. The client is correct in taking the drug with a large glass of water each time, finishing the full prescription, and calling the doctor if symptoms get worse.
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.