Nokea
A nurse is caring for a client with burns. The client is prescribed topical silver sulfadiazine. The nurse would be alert for which of the following?
- A. Facial edema
- B. Skin necrosis
- C. Headache
- D. Rash
Correct Answer: B
Rationale: Skin necrosis is an adverse effect of silver sulfadiazine that the nurse should be alert for. Facial edema and rash are adverse effects of mafenide, used for second- and third-degree burns. Headache is an adverse effect of sulfadiazine, used for urinary tract infection.
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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.
The nurse is providing care to a client with diabetes who is receiving sulfonamides. The nurse counsels the client about the increased risk of hypoglycemia, especially if the client is taking which of the following medications? Select all that apply.
- A. Tolbutamide (Orinase)
- B. Lisinopril (Prinivil)
- C. Simvastatin (Zocor)
- D. Losartan (Cozaar)
- E. Chlorpropamide (Diabinese
Correct Answer: A,E
Rationale: Sulfonamides may inhibit the hepatic metabolism of the oral hypoglycemic drugs tolbutamide(Orinase) and chlorpropamide(Diabinese). Elderly clients may be especially sensitive to this reaction. Lisinopril, simvastatin, and losartan are used for cardiac conditions.
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.
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.