Author Question: The health care practitioner is preparing to prescribe trimethoprim-sulfamethoxazole (Bactrim). For ... (Read 93 times)

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

The health care practitioner is preparing to prescribe trimethoprim-sulfamethoxazole (Bactrim). For which client should the nurse question an order for this medication?

1. The client who has a Shigella infection of the bowel
2. The client with P. jiroveci pneumonia
3. The client with iron-deficiency anemia
4. The client with pernicious anemia

Question 2

Which statement by a nursing student about the mechanism of action of sulfonamides indicates the need for further instruction?

1. Sulfonamides resemble the precursor molecule, PABA, so the enzymes needed for the synthesis of folic acid bind with sulfonamide instead of with PABA, stopping bacterial growth.
2. Sulfonamides slow the growth of bacteria because they only inhibit folic acid that is synthesized by bacteria.
3. Sulfonamides are effective against uropathogens by inhibiting the synthesis of bacterial folic acid.
4. Sulfonamides are most effective in clients who eat large amounts of foods rich in folic acid.

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

Answer to Question 1

Correct Answer: 4
Rationale 1: Trimethoprim-sulfamethoxazole is indicated for the treatment of Shigella infection of the small bowel.
Rationale 2: Trimethoprim-sulfamethoxazole is indicated for the treatment of P. jiroveci pneumonia.
Rationale 3: Trimethoprim-sulfamethoxazole should not be prescribed for clients with folate deficiency anemia. There is no reason to question the order if the client has iron deficiency anemia.
Rationale 4: Trimethoprim-sulfamethoxazole is contraindicated for clients with a folate-deficiency anemia because this drug is a folic acid inhibitor and would worsen the condition.
Global Rationale: Trimethoprim-sulfamethoxazole is contraindicated for clients with a folate-deficiency anemia because this drug is a folic acid inhibitor and would worsen the condition. There is no reason to question the order if the client has iron deficiency anemia. Trimethoprim-sulfamethoxazole is indicated for the treatment of Shigella infection of the small bowel and for treatment of P. jiroveci pneumonia.

Answer to Question 2

Correct Answer: 4
Rationale 1: Sulfonamides resemble PABA, which allows the enzyme necessary for bacterial growth to mistakenly bind with the sulfonamide instead of with PABA.
Rationale 2: Sulfonamides only inhibit folic acid synthesized by bacteria. It is ineffective against premade folic acid needed by humans.
Rationale 3: Sulfonamides are effective by inhibiting the synthesis of bacterial folic acid.
Rationale 4: This is an incorrect statement. Sulfonamides are ineffective against premade folic acid needed by humans.
Global Rationale: Sulfonamides resemble PABA, which allows the enzyme necessary for bacterial growth to mistakenly bind with the sulfonamide instead of with PABA. Sulfonamides only inhibit folic acid synthesized by bacteria. It is ineffective against premade folic acid needed by humans, thus level of ingestion of folic acid is not relevant.