Nokea
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.
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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.
The nurse suspects that a client who is taking a sulfonamide has leukopenia. Which assessment findings would support this suspicion? Select all that apply.
- A. Sore throat
- B. Cough
- C. Nausea
- D. Photosensitivity
- E. Bruising
Correct Answer: A,B
Rationale: Antibiotics including sulfonamides can lead to leukopenia, which would be manifested by fever, sore throat, or cough. Thrombocytopenia is also possible and would be manifested by easy bruising or unusual bleeding from minor to moderate trauma. Nausea and photosensitivity are adverse reactions to sulfonamides.
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.
A client is diagnosed with a urinary tract infection. When obtaining the client's drug history, the client reports using an herbal product in the past to prevent and relieve the symptoms. Which of the following would the client most likely identify?
- A. Ginger
- B. Feverfew
- C. Saw palmetto
- D. Cranberry
Correct Answer: D
Rationale: Cranberries and cranberry juice are commonly used remedies for preventing and relieving symptoms of UTIs. However, if an individual suspects a UTI, medical attention is necessary.
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.