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Which of the following represent contraindications to treatment with a sulfonamide? Select all that apply.
- A. Children younger than 6 years of age
- B. Adults older than 65 years of age
- C. Lactating females
- D. Clients with group A beta-hemolytic streptococci infections
- E. Women in the second trimester of pregnancy
Correct Answer: C,D
Rationale: The sulfonamides are contraindicated in clients with hypersensitivity to the sulfonamides, during lactation, in children younger than 2 years of age, near the end of pregnancy, and for infections caused by group A beta-hemolytic streptococci.
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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.
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.
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.
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 a group of nursing students about the action of sulfonamides, the instructor determines that the teaching was successful when the students state that the action of this class of drugs is primarily which of the following?
- A. Bacteriostatic
- B. Bactericidal
- C. Promotor of folic acid activity
- D. Bacterial cell metabolizer
Correct Answer: A
Rationale: The sulfonamides are primarily bacteriostatic because of their ability to inhibit the activity of folic acid in bacterial cell metabolism. They are not bactericidal.