Nokea
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.
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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.
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.
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.
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 to administer mafenide to a client. The nurse would be alert for which of the following?
- A. Rash, itching, or other allergic reactions
- B. Crystals in the urine sample
- C. Inflammation of the mouth
- D. Loss of appetite
Correct Answer: A
Rationale: The nurse should assess for allergic reactions such as rash, itching, edema, and urticaria when administering mafenide. Topical sulfonamides like mafenide do not cause crystalluria, inflammation of the mouth, or loss of appetite.