Chapter 65: Sulfonamides

Chapter 65: Sulfonamides

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient has been taking trimethoprim-sulfamethoxazole (TMP/SMX) for 14 days. The patient calls the primary care nurse practitioner (NP) to report fever, rash, and enlarged lymph nodes. The NP should suspect:

ANS:  A

Serum sickness reaction can occur days to weeks after administration of the drug and is characterized by fever, rash, and lymphadenopathy. Immediate sensitivity reaction includes anaphylaxis, urticaria, and angioedema and occurs within 30 minutes of drug administration. Cytotoxic hypersensitivity reaction causes hemolytic anemia, neutropenia, and thrombocytopenia and develops 7 to 14 days after drug administration. Cell-mediated hypersensitivity reaction causes maculopapular rash, Stevens-Johnson syndrome, and toxic epidermal necrolysis and takes 48 to 72 hours to develop.

DIF:    Cognitive Level: Applying (Application)                           REF:   702

2. An 80-year-old patient who has COPD takes TMP/SMX for acute exacerbations, which occur three or four times each year. To monitor this patient for adverse drug reactions, the primary care NP should order:

ANS:  D

The most frequently reported severe adverse reactions in elderly patients include bone marrow depression and decreased platelets. A CBC with differential is indicated to monitor for this. Evaluation of liver and renal function should be performed before beginning treatment because adverse effects are more common in patients with decreased renal and liver function.

DIF:    Cognitive Level: Applying (Application)                           REF:   703

3. The primary care NP teaches a patient about TMP/SMX before prescribing it to treat a urinary tract infection (UTI). Which statement by the patient indicates a need for further teaching?

ANS:  A

TMP/SMX should be taken on an empty stomach, so this statement is incorrect and indicates the need for further teaching. The other statements all are correct.

DIF:    Cognitive Level: Understanding (Comprehension)             REF:   703

4. A primary care NP prescribes TMP/SMX for a patient who is experiencing an exacerbation of COPD. The patient calls the NP 2 days later to report increased fever, cough, and shortness of breath. The NP should tell the patient:

ANS:  A

Fever, cough, and shortness of breath are included on a list of symptoms that may be early signs of serious reactions. Patients experiencing these symptoms should stop taking the medication immediately. Sore throat and arthralgia should also be reported but are not more worrisome than the symptoms this patient is experiencing. The patient should not continue the medication. Changing to another sulfonamide is incorrect because similar symptoms would occur.

DIF:    Cognitive Level: Applying (Application)                           REF:   703