Chapter 87: Sulfonamides and Trimethoprim

Chapter 87: Sulfonamides and Trimethoprim

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A burn patient is admitted to a medical-surgical unit and acquires a urinary tract infection (UTI). The prescriber orders mafenide (Sulfamylon) to prevent bacterial colonization. The nurse should monitor the laboratory test results for the development of

a.	anemia.
b.	uremia.
c.	hepatitis.
d.	acidosis.

 

 

ANS:   D

Acid-base values should be monitored, because the drug is metabolized to a compound that can suppress renal excretion of acid, causing acidosis.

Nothing indicates that the nurse should monitor for anemia, uremia, or hepatitis.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1027

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

2. Eight hours after administering a sulfonamide, the nurse notes that a patient has a temperature of 104° F, pulse of 112, BP of 104/52, respirations of 20, malaise, and widespread lesions of the skin and mucous membranes. The nurse would be correct to suspect

a.	suprainfection.
b.	systemic mycoses.
c.	red man syndrome.
d.	Stevens-Johnson syndrome.

 

 

ANS:   D

Stevens-Johnson syndrome is manifested by symptoms such as widespread lesions of the skin and mucous membranes, together with fever, malaise, and toxemia.

A suprainfection would not manifest with lesions.

Systemic mycoses would not manifest with lesions.

Red man syndrome is manifested by flushing of the neck that extends sometimes to the trunk and body; it typically is seen in patients taking vancomycin.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1027

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

3. A patient with a history of transient ischemic attacks (TIAs) is being treated with warfarin (Coumadin) and begins therapy with trimethoprim/sulfamethoxazole (Bactrim). Which of the following findings would most concern the nurse?

a.	Thrombophlebitis
b.	Increased bleeding
c.	Decreased effect of the antibiotic
d.	Decreased effect of warfarin

 

 

ANS:   B

TMP/SMZ can intensify the effects of warfarin, therefore increased bleeding should most concern the nurse.

Thrombocytopenia is a concern, but thrombophlebitis is not.

Although the nurse would not like to see a decreased effect of the antibiotic, bleeding would be a greater concern.

A decreased effect of warfarin would need to be rectified, but the main concern is bleeding, especially in a patient with TIAs, who may fall and bleed even more.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1029

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. A patient is being treated with trimethoprim-sulfamethoxazole (Bactrim) for bronchitis. The patient has been taking captopril (Capoten) and spironolactone (Aldactone). The nurse would expect which of the following findings?

a.	Potassium level of 5.5 mEq/L
b.	Potassium level of 3.5 mEq/L
c.	Sodium level of 139 mEq/L
d.	Chloride level of 104 mEq/L

 

 

ANS:   A

The nurse would expect a potassium level of 5.5, because both captopril and spironolactone can cause hyperkalemia. Also, trimethoprim-sulfamethoxazole can cause hypersensitivity reactions in patients taking thiazide and loop diuretics and can affect the kidneys.

A potassium level of 3.5 is normal.

The sodium and chloride levels are normal.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1029

TOP:    Nursing Process: Planning

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies