Author Question: A patient with bronchitis is taking TMP/SMZ, 106/80 mg orally, twice daily. Before administering ... (Read 78 times)

urbanoutfitters · **on:** Jul 23, 2018

A patient with bronchitis is taking TMP/SMZ, 106/80 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 per minute. The patient looks ill and reports not feeling well. What will the nurse do?
a. Administer the dose and request an order for an antipyretic medication.
b. Withhold the dose and request an order for an antihistamine to treat the rash.
c. Withhold the dose and notify the provider of the symptoms.
d. Request an order for intravenous TMP/SMZ, because the patient is getting worse.

Question 2

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.

ankilker · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: C
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. Requesting an antipyretic while giving the drug is incorrect. Giving antihistamines is not indicated. Giving TMP/SMZ intravenously would make the reaction worse.

Answer to Question 2

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.