Nokea
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.
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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.
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.
A client who is being discharged has been instructed to continue with sulfonamide therapy for a week. Which of the following points should the nurse include in the teaching plan to educate the client about the therapy?
- A. Discontinue dosage if symptoms of infection disappear.
- B. Take the drug a few minutes before a meal.
- C. Take any off-the-shelf medication if fever occurs.
- D. Ensure that all follow-up appointments are met
Correct Answer: D
Rationale: The nurse's plan should include educating the client about the importance of keeping the follow-up appointments. The nurse should instruct the client to adhere to the dosage schedule and not discontinue it even if the symptoms of the infection have gone. The client should inform the primary health care provider if fever, skin rash, or nausea occurs during the therapy. The client should be instructed to take the drug on an empty stomach (at least 2 hours before or after a meal) and not just before a meal.
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.
Sulfonamides are commonly used to treat which of the following types of infections? Select all that apply.
- A. Ulcerative colitis
- B. Urinary tract infection
- C. Acute otitis media
- D. Upper respiratory tract infection
- E. Osteomyelitis
Correct Answer: A,B,C
Rationale: Sulfonamides are often used to treat ulcerative colitis, urinary tract infection, and acute otitis media.