A patient with second-degree burns is treated with silver sulfadiazine [Silvadene]. A nursing student asks the nurse about the differences between silver sulfadiazine and mafenide [Sulfamylon], because the two are similar products, and both contain sulfonamides. What does the nurse tell the student about silver sulfadiazine?
B.
Silver sulfadiazine has antibacterial effects primarily related to the release of free silver and not to
the sulfonamide portion of the molecule. Unlike mafenide, silver sulfadiazine reduces pain when
applied. Silver sulfadiazine and mafenide have similar antibacterial effects. Because silver
sulfadiazine does not suppress renal excretion of acid, it has fewer systemic effects.
A patient will be discharged from the hospital with a prescription for TMP/SMZ [Bactrim]. When providing teaching for this patient, the nurse will tell the patient that it will be important to:
D.
TMP/SMZ can injure the kidneys, because it causes deposition of sulfonamide crystals in the
kidneys. Patients should be advised to drink 8 to 10 glasses of water a day to maintain a urine flow
of 1200 mL in adults. Trimethoprim can cause hyperkalemia, so consuming extra potassium is unnecessary. The medication should be taken on an empty stomach.
A nurse is caring for an African-American patient who has been admitted to the unit for long-term antibiotic therapy with sulfonamides. The patient develops fever, pallor, and jaundice. The nurse would be correct to suspect that the patient has developed:
B.
Sulfonamides can cause hemolytic anemia in patients of African-American and Mediterranean
origin, usually because of a genetic deficiency. Red cell lysis can produce fever, pallor, and jaundice, and patients should be observed for these signs.
A pregnant patient is treated with trimethoprim/sulfamethoxazole (TMP/SMZ) [Bactrim] for a
urinary tract infection at 32 weeks’ gestation. A week later, the woman delivers her infant prematurely. The nurse will expect to monitor the infant for:
C.
Kernicterus is a disorder in newborns caused by deposition of bilirubin in the brain. Sulfonamides
promote kernicterus by displacing bilirubin from plasma proteins. Sulfonamides should not be
given to infants under 2 months of age or to pregnant women after 32 weeks’ gestation
A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely?
B.
Trimethoprim suppresses renal excretion of potassium, increasing the risk of hyperkalemia.
Patients at greatest risk are those taking high doses of trimethoprim and those taking other drugs
that elevate potassium, including ACE inhibitors and ARB medications. Trimethoprim does not
affect other serum electrolytes
A nurse is obtaining a drug history from a patient about to receive sulfadiazine. The nurse learns that the patient takes warfarin, glipizide, and a thiazide diuretic. Based on this assessment, the nurse will expect the provider to:
C.
Sulfonamides interact with several drugs and through metabolism-related interactions can
intensify the effects of warfarin. Patients taking both should be monitored closely for bleeding
tendencies.
A patient with bronchitis is taking TMP/SMZ, 160/800 mg orally, twice daily. Before administering the third dose, the nurse notes that the patient has a widespread rash, a temperature of 103° F, and a heart rate of 100 beats/minute. The patient looks ill and reports not feeling well. What will the nurse do?
B.
The most severe hypersensitivity reaction with TMP/SMZ is Stevens-Johnson syndrome, which
manifests with fever, malaise, and rash. The drug should be discontinued immediately if a rash
occurs.
A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders TMP/SMZ. What will the nurse tell the patient?
A.
Sulfonamides can intensify the effects of some drugs, including glipizide, which is a sulfonylurea-
type hypoglycemic medication. These drugs may require a reduction in dose to prevent toxicity.
Patients should monitor their blood glucose more closely.
A patient who is taking immunosuppressant medications develops a urinary tract infection. The
causative organism is sensitive to sulfonamides and to another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this patient asks the nurse why the more expensive antibiotic is being used. Which response by the nurse is
correct?
B.
A nurse is discussing microbial resistance among sulfonamides and trimethoprim with a nursing student. Which statement by the student indicates a need for further teaching?
A.
There is less microbial resistance to trimethoprim than there is to sulfonamides. Bacterial resistance
to trimethoprim is relatively uncommon.
A patient with a urinary tract infection is given a prescription for TMP/SMZ. When reviewing the drug with the patient, the nurse learns that the patient has type 1 diabetes mellitus and consumes alcohol heavily. What will the nurse do?
A.
Alcoholics are likely to be folate deficient and have an increased risk of megaloblastic anemia
when taking TMP/SMZ, so withholding this drug in this population is recommended.
A patient with a history of renal calculi has fever, flank pain, and bacteriuria. The nurse caring for this patient understands that it is important for the provider to:
D.
Patients with renal calculi are more likely to have complicated urinary tract infections that have
less predictable microbiologic etiologies.
Because the symptoms are mild, it is important first to obtain a culture and sensitivity to assist with antibiotic selection.
If symptoms worsen, a broad-
spectrum antibiotic may be started until sensitivity information is available.
Intravenous antibiotics
are indicated for severe pyelonephritis.
A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient?
C.
This patient has reinfection of his urinary tract at a rate of more than three per year, which is an indication for long-term prophylaxis.
A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will:
A.
Patients who develop a subsequent urinary tract infection after treatment are treated in a stepwise fashion, beginning with a longer course of antibiotics. The next steps would be to begin a 4- to 6-week course of therapy, followed by a 6-month course of therapy if that is unsuccessful.
A young, nonpregnant female patient with a history of a previous urinary tract infection is
experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days’ duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective?
B.
Short-course therapy is recommended for uncomplicated, community-acquired lower urinary tract infections.
The short course is more effective than a single dose, and compared with longer-course therapies, it is less costly, has fewer side effects, and is more likely to foster compliance.
Amoxicillin with clavulanic acid is a second-line drug used for pyelonephritis.
Fosfomycin is a second-line drug and can be useful in patients with drug allergies
A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication?
D.
Tingling of the fingers can indicate peripheral neuropathy, which can be an irreversible side effect
of nitrofurantoin.
Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient’s history for evidence of which problem?
B.
Methenamine should not be given to patients with renal impairment, because crystalluria can occur.
There is no cross-reactivity between methenamine and antibiotic agents.
Methenamine is
safe for use during pregnancy.
There is no organism drug resistance to methenamine
A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency,
and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that
the best alternative for treating this urinary tract infection is with:
A.
Methenamine is an excellent second-line drug for this patient and is indicated because of the
patient’s multiple drug sensitivities. It is safe in pregnancy, and there is no drug resistance.
Nitrofurantoin has potential harmful effects on the fetus and should not be used during pregnancy.
Single-dose regimens are not recommended in pregnant women.
Cephalexin can have cross-reactivity with amoxicillin
The parent of a 5-year-old child who has had four urinary tract infections in the past year asks
the nurse why the provider doesn’t just order an antibiotic for the child’s current symptoms of
low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is
the most important reason given by the nurse?
B.
Children with recurrent urinary tract infections should be assessed for underlying urinary tract abnormalities to help determine a possible cause for recurrence.
This child has mild fever and
therefore may not require hospitalization.
Urine cultures are important when treating patients with recurrent UTI prophylactically, but this is not the most important consideration.
Which patient with a urinary tract infection will require hospitalization and intravenous
antibiotics?
A.
The patient with an indwelling catheter and signs of pyelonephritis shows signs of a complicated UTI, which is best treated with intravenous antibiotics.
Three other patients show signs of
uncomplicated urinary tract infections that are not severe and can be treated with oral
antibiotics
A 20-year-old female patient has suprapubic discomfort, pyuria, dysuria, and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment?
B.
These are symptoms of uncomplicated cystitis, which is a lower urinary tract infection that can be treated with a short course of antibiotics.
Short-course therapy is more effective than single-dose
therapy and is preferred.
A complicated lower urinary tract infection would be associated with some predisposing factor, such as renal calculi, an obstruction to the flow of urine, or an indwelling catheter.
Upper urinary tract infections often include severe flank pain, fever, and chills
An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized
pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the
patient has:
C.
The nurse should suspect prostatitis, which is manifested by high fever, chills, malaise, myalgia, and localized pain, and may also be manifested by dysuria, nocturia, and urinary urgency,
frequency, and retention.
A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. The patient has a temperature of 102.9° F, a pulse of 92
beats/minute, respirations of 24 breaths/minute, and a blood pressure of 119/58 mm Hg. The
nurse would be correct to suspect that the patient shows signs and symptoms of:
D.
The nurse should suspect pyelonephritis. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, urinary urgency and frequency, and pyuria and bacteriuria.
Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteriuria.
Urinary tract infections (UTIs) are very general and are classified by their location
A pregnant patient with fever, flank pain, and chills has a history of two previous bladder
infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her?
D.
Methenamine is safe for use during pregnancy and would be an excellent choice for this patient if she had a lower urinary tract infection.
However, it is not an effective agent for upper urinary tract infection, because it is a prodrug that must break down into ammonia and formaldehyde to be
effective
A nurse is preparing to administer an antibiotic to a patient with methicillin-resistant
Staphylococcus aureus (MRSA). The nurse would expect the health care provider to order which antibiotic?
B.
A patient who is taking calcium supplements receives a prescription for ciprofloxacin [Cipro] for a urinary tract infection. The nurse will teach this patient to:
C.
Cationic compounds, including calcium supplements, can reduce the absorption of ciprofloxacin,
so proper interval dosing is necessary.
A nurse is preparing to administer oral ofloxacin to a patient. While taking the patient’s medication history, the nurse learns that the patient takes warfarin and theophylline. The
correct action by the nurse is to request an order to:
C.
Ofloxacin increases plasma levels of warfarin, so coagulation tests should be monitored.
The ofloxacin dose should not be reduced or increased.
Ofloxacin does not affect theophylline levels
A 65-year-old patient who receives glucocorticoids for arthritis is admitted to the hospital for treatment of a urinary tract infection. The prescriber has ordered intravenous ciprofloxacin
[Cipro]. Before administering the third dose of this drug, the nurse reviews the bacterial culture
report and notes that the causative organism is Escherichia coli. The bacterial sensitivity report is pending. The patient complains of right ankle pain. What will the nurse do?
C.
A rare but serious adverse effect associated with fluoroquinolones is tendon rupture, and those at
highest risk are children, patients older than 60 years, transplant patients, and any patients taking
glucocorticoids. Any pain in either heel should be reported and the drug should be discontinued.
A provider orders intravenous moxifloxacin [Avelox] for a patient who has sinusitis. Before administering the drug, the nurse will review this patient’s chart for:
A.
Moxifloxacin prolongs the QT interval and poses a risk of serious dysrhythmias. Patients with hypokalemia have an increased risk, so serum electrolyte levels should be monitored
A patient will receive oral ciprofloxacin [Cipro] to treat a urinary tract infection. The nurse
provides teaching for this patient. Which statement by the patient indicates a need for further
teaching?
D.
Dairy products inhibit the absorption of ciprofloxacin, so they should be avoided.
Abdominal pain and nausea and vomiting are common and usually mild.
Patients should stop taking the drug if heel pain occurs until tendonitis has been ruled out.
Photosensitivity can occur, so sunscreen should be
used
A patient who is receiving intravenous ciprofloxacin for pneumonia develops diarrhea. A
stool culture is positive for Clostridium difficile. The nurse will expect the provider to:
A.
C. difficile is resistant to fluoroquinolones; metronidazole is the drug of choice to treat this
infection. Metronidazole is lethal only to anaerobic organisms, so the ciprofloxacin should be
continued to treat the pneumonia
The nurse is caring for a patient who will begin receiving intravenous ciprofloxacin [Cipro] to treat pyelonephritis. The nurse learns that the patient has a history of myasthenia gravis. Which action by the nurse is correct?
D.
Ciprofloxacin and other fluoroquinolones can exacerbate muscle weakness in patients with myasthenia gravis and should not be given to these patients.
It is not correct to administer the drug and monitor for this effect.
Giving the drug by a different route will not alter this effect.
Metronidazole is given when C. difficile occurs.
Author
BodeS
ID
363879
Card Set
CH 75, 76, & 78
Description
Chapter 75, “Sulfonamides Antibiotics and Trimethoprim”
Chapter 76, “Drug Therapy of Urinary Tract Infections”
Chapter 78, “Miscellaneous Antibacterial Drugs”