Chapter 88: Sulfonamides and Trimethoprim

Chapter 88: Sulfonamides and Trimethoprim

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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:

a.	birth defects.
b.	hypoglycemia.
c.	rash.
d.	kernicterus.

 

 

ANS:  D

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. Sulfonamides do not cause birth defects or hypoglycemia. Serious rashes may occur but are not the primary concern in the newborn.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   p. 1060

TOP:   Nursing Process: Evaluation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

2. 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?

a.	“Immunosuppressed patients are folate deficient.”
b.	“Patients who are immunosuppressed are more likely to develop resistance.”
c.	“Sulfonamides are bacteriostatic and depend on host immunity to work.”
d.	“Sulfonamides intensify the effects of immunosuppression.”

 

 

ANS:  C

Sulfonamides are usually bacteriostatic and require intact host defenses for complete elimination of infection. Immunosuppressed patients are not necessarily folate deficient. There is no increased likelihood of developing bacterial resistance in immunosuppressed patients. Sulfonamides do not affect immunosuppression.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   p. 1058

TOP:   Nursing Process: Assessment

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

3. 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:

a.	drink 8 to 10 glasses of water each day.
b.	eat foods that are high in potassium.
c.	take the medication with food.
d.	take folic acid supplements.

 

 

ANS:  A

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. It is not necessary to consume extra folic acid, because mammalian cells use dietary folate and do not have to synthesize it; it is the process of folic acid synthesis that is altered by sulfonamides.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 1063-1065

TOP:   Nursing Process: Planning

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

 

4. A nurse teaches a patient about sulfonamides. Which statement by the patient indicates a need for further teaching?

a.	“I need to drink extra fluids while taking this medication.”
b.	“I need to use sunscreen when taking this drug.”
c.	“I should call my provider if I develop a rash while taking this drug.”
d.	“I should stop taking this drug when my symptoms are gone.”

 

 

ANS:  D

Patients should always be advised to complete the prescribed course of the antibiotic even when symptoms subside. Patients should also understand the need to drink 8 to 10 glasses of water a day, to use sunscreen, and to notify the provider if they develop a rash.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   pp. 1063-1065

TOP:   Nursing Process: Implementation

MSC:  NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies