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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.
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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.
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.
The health care professional has recommended sulfonamide therapy for a client. While obtaining the client's medical history, the nurse discovers that he is taking oral anticoagulants. Which of the following are the possible effects of combining sulfonamide therapy with oral anticoagulants?
- A. Increased action of the anticoagulant
- B. Increased risk of anaphylactic shock
- C. Rendering of sulfonamide therapy ineffective
- D. Development of leukopenia
Correct Answer: A
Rationale: Taking sulfonamide drugs when the client is already taking oral anticoagulants may result in increased action of the anticoagulants. Anaphylactic shock and leukopenia are some of the adverse reactions of sulfonamides but are not associated with mixing sulfonamides and anticoagulants. Oral anticoagulants do not decrease the effectiveness of sulfonamides.
A nurse is working in an ambulatory care setting that involves seeing clients with infections that require treatment. Which of the following would be important for the nurse to assess in these clients? Select all that apply.
- A. Client's use of self-remedies
- B. Review of lab results
- C. Vital signs
- D. Client's symptoms
- E. Client's general appearance
Correct Answer: A,B,C,D,E
Rationale: When assessing a client who may have an infection, the nurse should gather information about the client's general appearance; vital signs; symptoms, including the length of time the client has been experiencing them; and any self-remedies used. In addition, the nurse should review the results of any laboratory and diagnostic tests.
A client who is on sulfonamide therapy is about to be discharged. Which of the following precautions should the nurse instruct the client to follow to reduce the effects of photosensitivity?
- A. Wear protective clothing and sunscreen when outside.
- B. Increase fluid intake.
- C. Avoid lights while indoors.
- D. Wear protective footwear
Correct Answer: A
Rationale: The nurse should encourage a client to wear protective clothing while going out in the sun to reduce the effect of photosensitivity. While increasing the fluid intake is recommended, it does not help combat the effects of photosensitivity. There is no need to avoid lights while indoors; the skin becomes sensitive only to harsh sunlight during sulfonamide therapy. Wearing protective footwear may protect the feet from injury, but it will not protect the skin from the harmful effects of photosensitivity.