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Performance Exit Topic 10 Part 1: Antibacterials Due Jul 14, 2024 by 11:59 pm Final Score 53% 17 out of 32 questions answered correctly Co...

Performance Exit Topic 10 Part 1: Antibacterials Due Jul 14, 2024 by 11:59 pm Final Score 53% 17 out of 32 questions answered correctly Completed on Jul 7, 2024 8:52 pm Incorrect (15) Report content error Which statement describes how superinfection can occur? “It can occur when the serum level of an antibiotic is too high.”  “It can occur when the patient has a gram-positive bacterial infection.” “It can occur when the patient has a gram-negative bacterial infection.” “It can occur when the antibiotic eliminates the normal bacterial flora.” Rationale The normal bacterial flora consists of certain bacteria and fungi that are needed to maintain normal function in various organs. Superinfection can occur when antibiotics completely eliminate the normal bacterial flora. When these bacteria or fungi are killed by antibiotics, then other bacteria or fungi cause infection, which is known as superinfection. When the serum level of the antibiotic is too high, it causes a toxic reaction. Gram-positive and gram-negative bacterial infections do not cause superinfection. Test-Taking Tip: Eat breakfast or lunch before an exam. Avoid greasy, heavy foods and overeating. This will help keep you calm and give you energy. p. 318 Report content error Which assessment is most important before administering the first dose of ampicillin to an 80-year-old patient? Renal function Hepatic function Cross-sensitivity Total body fluid Rationale The most important assessment before administering ampicillin to an older adult is that of renal function because older adults are more sensitive to medications. Ampicillin formulations contain large amounts of sodium and/or potassium. Doses must be adjusted for patients with renal dysfunction. If the patient is hypervolemic, assessment of renal function is even more important; however, the nurse would monitor intake and output and edema with the administration of ampicillin. In addition, older adults are likely to have declining organ function, including hepatic function, which can lead to impaired elimination of any medication. However, assessing renal function is a priority over assessing hepatic function. Ampicillin can be administered by way of several routes; if the patient’s veins are too poor for an infusion, it can be administered by means of injection into the muscle or by mouth. Cross-sensitivity to other antibiotics is not important until ampicillin fails to eliminate the bacteria after one course of treatment. Total body fluid is a reasonable assessment before the administration of ampicillin; however, eradication of the infection is the priority. p. 318  Report content error Which occurrence(s) would the nurse mention as causative of bacterial resistance when explaining antibiotic therapy to a patient? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Antibiotics are stopped after the patient feels better. Antibiotics are prescribed according to culture and sensitivity reports. Antibiotics are prescribed to treat a viral infection. Antibiotics are taken with water or juice. Antibiotics are taken with ascorbic acid (vitamin C). Doses of antibiotics are skipped. Rationale Not completing a full course of antibiotic therapy or skipping doses can allow bacteria that have not been killed but have been exposed to the antibiotic to adapt their physiology to become resistant to that antibiotic. The same thing can occur when bacteria are exposed to antibiotics in the environment or when antibiotics are erroneously used to treat viral infections. Thus the nurse would mention that stopping antibiotics before the end of a course, skipping antibiotic doses, and using antibiotics to treat viral infections can lead to bacterial resistance. Antibiotics prescribed according to culture and sensitivity reports do not affect bacterial resistance. Bacterial resistance to antibiotics does not occur with the use of water, juice, or ascorbic acid. p. 315 Report content error Which occurrence would the nurse identify as the cause of reported oral candidiasis in a patient who has been taking an antimicrobial drug for 2 weeks? Superinfection Cross-resistance Antibiotic resistance Nosocomial infection Rationale Superinfection is a secondary infection that occurs when normal gut flora are destroyed by antibiotic use, leading to an overgrowth of fungus. Thus the nurse would identify superinfection as the cause of the patient’s oral candidiasis. Cross-resistance occurs between antibacterial drugs that have similar actions. Antibiotic resistance occurs when bacteria reduce or eliminate the effectiveness of the antibacterial drug. A nosocomial infection is a hospital-acquired infection. p. 315  Report content error Which organ can be damaged by antibacterial drugs? Select all that apply. One, some, or all responses may be correct. Eyes Liver Brain Spleen Kidneys Rationale Organs that can develop toxicities from antibacterial medications include the liver and kidneys. The eyes, brain, and spleen are not damaged by antibiotics. p. 315 Report content error The nurse is reviewing a patient’s medical history before administering azithromycin. Which patient factor would most likely contribute to hepatotoxicity? Drinks fruit juice with the medication Takes acetaminophen at maximum dosing Uses antacids after taking the medication Prescribed theophylline twice a day Rationale Hepatotoxicity (liver toxicity) can occur if azithromycin is taken with other hepatotoxic drugs, such as high doses of acetaminophen. Fruit juice taken with azithromycin can alter the absorption of the medication. Antacids can alter the absorption of azithromycin. Theophylline levels are increased if taken with azithromycin. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have improved the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. p. 326  Report content error The nurse reviews the medication list for a patient who is receiving treatment for Clostridium difficile. Which drug interaction is most likely to contribute to vancomycin nephrotoxicity? Current Medications Vancomycin 125 mg orally 4 times a day Furosemide 40 mg orally daily Metoprolol 25 mg extended-release tablets twice a day Atorvastatin 10 mg orally daily Acetaminophen 650 mg orally every 4 hours as needed for pain, up to 4 doses a day Furosemide Metoprolol Atorvastatin Acetaminophen Rationale Nephrotoxicity is potentiated when vancomycin is taken with furosemide. Metoprolol does not pose a drug interaction that increases the risk for nephrotoxicity. Atorvastatin may contribute to rhabdomyolysis with lipopeptides. Acetaminophen may increase the risk for liver toxicity; however, the patient’s dose is low and as-needed. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet). p. 328 Report content error Which action by the nurse is inappropriate in caring for a patient receiving levofloxacin for a urinary tract infection (UTI)? Encouraging the patient to have caffeinated products Instructing the patient to take the drug along with food Instructing the patient to drink 8 glasses of water per day Informing the primary health care provider if the pH of the urine is 5 Rationale Levofloxacin can increase the effects of caffeine. This can lead to adverse effects from too much caffeine. Thus encouraging the patient to have caffeinated products is inappropriate. Levofloxacin may cause gastrointestinal distress, so it should be taken along with food. Drinking 6 to 8 glasses of water per day may reduce the burning sensation associated with a UTI. The pH of urine should be less than 6.7 to prevent crystalluria. Because the pH is 5, informing the primary health care provider is not necessary. Test-Taking Tip:A burning sensation while passing urine is the clinical sign of a UTI. Identify the option that may aggravate the condition of the patient. p. 337 Report content error Which complication would the nurse monitor for in a patient who is on nonsteroidal antiinflammatory drug (NSAID) therapy and has been prescribed levofloxacin to treat a lower respiratory tract infection? Seizures Ototoxicity Nephrotoxicity Encephalopathy Rationale Levofloxacin is the drug of choice for severe lower respiratory tract infections. Levofloxacin should not be administered with NSAIDs because it may cause central nervous system reactions, such as seizures. Thus the nurse would monitor this patient for seizures. Ototoxicity is an adverse effect of vancomycin. Nephrotoxicity may be seen with high doses of amphotericin B. Encephalopathy is an adverse effect of streptomycin and is not seen when levofloxacin is administered along with NSAIDs. Test-Taking Tip:You have at least a 25% chance of selecting the correct response in a multiple-choice item with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong, then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 337 Report content error Which assessment will the nurse include when planning care for a patient who is receiving daily gentamicin infusions? Deep tendon reflexes Range of motion Vision Hearing Rationale Aminoglycosides can cause ototoxicity. The nurse should plan to assess for hearing loss and report the findings to the health care provider. Assessing deep tendon reflexes, range of motion, and vision are not priorities for the nurse when caring for patients taking aminoglycosides. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. p. 335 Report content error Which laboratory test is used to monitor for antibiotic toxicity? Trough Aspartate aminotransferase (AST) Peak Alanine aminotransferase (ALT) Rationale A peak measures the highest concentration of antibiotic levels in the blood. The test is used to monitor for antibiotic toxicity. The lowest concentration of antibiotic blood levels is measured with the trough; the test is important to maintain a therapeutic drug level but is not helpful for monitoring for toxicity. AST and ALT measure liver enzymes, which can be used to monitor for liver damage. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer. pp. 334,336 Report content error Which statement correctly describes fluoroquinolones? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Prescribed for gram-positive organisms Treat gram-negative organisms Are the first choice antibiotic for common infections Can be taken with all other medications Require increased fluid intake to 6 to 8 glasses a day while taking Rationale Fluoroquinolones are a broad spectrum antibiotic class that treat gram- negative and gram-positive organisms. The patient should be well hydrated to prevent crystalluria. Fluoroquinolones should be reserved for patients with uncomplicated infections who have no other options. The patient should not take antacids or iron products at the same time as fluoroquinolones, as it can affect absorption. p. 337 Report content error Which cue in a patient’s medical record would cause concern for a patient receiving gentamicin? A trough drawn 10 minutes before the next scheduled gentamicin dose A white blood cell count of 8.2 x 109/L Urinary output of 400 mL in the last 24 hours Culture results with sensitivity to gentamicin Rationale A patient’s urine output for a 24 hour day should be at least 600 mL. A urine output of 400 mL would alert the nurse to possible renal insufficiency. A white blood cell count of 8.2 x 109/L is within normal range. A trough should be drawn 10 minutes before a dose of gentamicin is received. A culture result with a sensitivity to gentamicin is appropriate because it would indicate that gentamicin will treat the particular cause of infection. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to possibly choose more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response. p. 335 Report content error Which action would the nurse suspect as the cause of shortness of breath, facial flushing, severe headache, vomiting, and confusion in a patient receiving metronidazole treatment? Drinking alcohol Taking vitamin B6 Taking echinacea Swishing the medication Rationale A patient receiving metronidazole treatment should avoid drinking alcohol to prevent a drug interaction that results in a disulfiram reaction. Disulfiram reactions are manifested by shortness of breath, facial flushing, severe headache, vomiting, and confusion. Thus the nurse would suspect that the patient has been drinking alcohol while taking metronidazole. Taking vitamin B6helps prevent peripheral neuropathy in patients who are receiving antitubercular treatment. Taking echinacea along with ketoconazole may lead to hepatotoxicity. Swishing the medication is advised for patients receiving any suspensions, such as nystatin, and this would not be a possible reason for the patient’s condition. p. 343 Report content error Which explanation will the nurse provide if a patient asks the nurse why a combination medication, trimethoprim- sulfamethoxazole (TMP-SMZ), is prescribed for a urinary tract infection? “The risk of allergic reaction is reduced with low doses of two medications.” “Combination medication reduces bacterial resistance to treatment.” “Sulfamethoxazole is faster acting when combined with trimethoprim.”  “Trimethoprim increases the absorption of sulfamethoxazole.” Rationale Trimethoprim is combined with sulfamethoxazole to prevent bacterial resistance to sulfonamide drugs used alone and to obtain a better bactericidal response. Allergic reactions may still occur with these medications. Sulfamethoxazole has intermediate action. Trimethoprim provides additional treatment of gram-negative bacteria. Trimethoprim does not change the absorption of sulfamethoxazole. p. 340 Correct (17) Report content error Which intervention(s) would be appropriate when caring for a patient who has been prescribed penicillin G potassium? Select all that apply. One, some, or all responses may be correct. Monitoring for superinfection Monitoring the patient for respiratory distress Obtaining a culture and sensitivity test after starting the therapy  Having availability of epinephrine to treat severe allergic reaction Advising the patient to take the medication on an empty stomach Rationale Taking penicillin for a prolonged period may cause superinfections. Therefore monitoring for stomatitis, which is a type of superinfection, would be appropriate and required. Respiratory distress is a severe allergic reaction that can occur after a first or second dose of penicillin. Thus monitoring the patient for signs of respiratory distress would also be appropriate. Epinephrine is used to treat a severe allergic reaction that may occur with the use of penicillin, so the nurse would have epinephrine on hand to treat a severe allergic reaction. For effective treatment, a culture and sensitivity test would be obtained before starting the therapy. Penicillins should be taken with food to avoid gastric irritation. Test-Taking Tip: Be alert for details. Details provided in the question stem, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses. p. 318 Report content error Which nursing action would be most important before administering an intravenous dose of penicillin? Locating the intravenous (IV) site Recording the daily urine output Obtaining serum creatinine levels Assessing the patient for any allergies Rationale The most important nursing action would be asking the patient whether the patient is allergic to penicillin before administering it. This would prevent allergic or hypersensitivity reactions caused by penicillin. Locating the intravenous site would be done if the patient has no known allergies to penicillin. After injecting the penicillin, the nurse would record the urine output and obtain the serum creatinine levels. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action. p. 318 Report content error Which intervention is the most important when caring for a 22-year-old woman who has been prescribed amoxicillin? Obtain a baseline complete blood count (CBC). Assess if the patient is on oral contraceptives. Inform the patient about possible superinfections. Instruct the patient not to take the medication before meals. Rationale This medication may decrease the effectiveness of oral contraceptives. Thus the most important intervention is assessing whether the patient is on oral contraceptives and whether the patient is sexually active. Long-term use of antibiotics can cause blood dyscrasias, but a baseline assessment is not indicated. Obtaining a baseline CBC, informing the patient about possible superinfections, and instructing the patient not to take the medication before meals are not priorities. Test-Taking Tip: When using this program, be sure to note if you guess at an answer. This will permit you to identify areas that need further review. Also, it will help you to see how correct your guessing can be. p. 318 Report content error The nurse is assessing a patient who received the first dose of amoxicillin an hour ago. Which sign or symptom would require immediate intervention by the nurse? Nausea Candidiasis Angioedema Tongue discoloration Rationale Angioedema is a life-threatening reaction to a medication. The reaction can happen when a patient with an allergy is exposed to the first dose of a medication. Angioedema is a sign the airway may become compromised and requires immediate intervention. Nausea, candidiasis, and tongue discoloration are side effects of amoxicillin, but they are not life-threatening. Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose one or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response. p. 316 Report content error The nurse is reviewing the medication administration record of a patient who was newly prescribed ceftriaxone. Which patient parameter would lead the nurse to hold the dose and contact the health care provider (HCP)? Cefazolin allergy Diabetes mellitus White blood cell (WBC) count 8.2 cells/mm3 Creatinine 1.1 mg/dL Rationale A patient who has an allergy to one type of cephalosporin will most likely have an allergy to others. The allergy would necessitate the nurse holding the dose and contacting the HCP. The medication is not contraindicated in patients with diabetes mellitus. The patient has normal WBC and creatinine levels. p. 322 Report content error Which term is used to describe when an antibacterial drug is no longer effective due to repeated use? Potentiative effect  Antagonistic effect Inherent resistance Acquired resistance Rationale Acquired resistance occurs with repeated use of antibiotics. The bacteria mutate and become resistant to the drug. The potentiative effect occurs when one antibiotic increases the effectiveness of a second antibiotic. The antagonistic effect is when two antibiotics are used and the second antibiotic reduces the effectiveness of the first. Inherent resistance occurs without exposure to any antibiotic. An example is Pseudomonas aeruginosa, which will always naturally be resistant to penicillin G. p. 314 Report content error Which laboratory value would the nurse assess to ensure safe administration of vancomycin to a patient? Vitamin B12 Renal function Red blood cell count Blood glucose concentration Rationale Vancomycin is a tricyclic glycopeptide, which causes nephrotoxicity. Therefore the nurse would check the patient’s renal function before administering vancomycin. Renal impairment may lead to severe toxicity. The dosing frequency of vancomycin is dependent on renal function. Therefore it is important to check the patient’s renal function. Vancomycin does not affect vitamin B12, blood glucose concentration, or red blood cell counts; therefore the nurse need not check these in the patient. p. 328 Report content error Which action would the nurse take if the patient develops excessive sweating and reports itching of the face and neck while vancomycin is being administered intravenously? Assess the patient’s blood pressure. Increase the rate of infusion. Decrease the rate of infusion. Stop the vancomycin infusion. Rationale Rapid infusion of vancomycin results in red man syndrome. This syndrome is characterized by flushing and itching of the head, face, neck, and upper trunk. It is most common when the drug is infused too rapidly. Thus the nurse would stop the vancomycin infusion in this situation. Checking the blood pressure is a secondary intervention and would be done once the patient is stabilized. Rapid infusion of vancomycin may also cause hypotension; this leads to excessive sweating. Rapid administration of the vancomycin infusion worsens the itching and hypotension. The symptoms of red man syndrome can usually be alleviated by slowing the rate of infusion of the dose to at least 1 hour, but in this situation, the syndrome is already underway, so it is best to stop the infusion. p. 328 Report content error Which teaching will the nurse provide to a patient who has been prescribed azithromycin for otitis media? “You can stop taking the medication once your symptoms improve.” “Take this medication on an empty stomach.” “Come back to have culture and sensitivity done when you finish the medication.” “You must complete the full course of the medication.” Rationale Completion of the full course of the medication is the most important patient teaching point for all antibacterial medications. Taking the full course is necessary to effectively kill the bacteria and prevent the growth of more bacteria. Patients should be informed that their symptoms might get better before they finish the full course of medication, but that they must continue to take the medication as prescribed until the full course is complete. The medication should be taken 1 hour before or 2 hours after eating. However, if gastrointestinal upset occurs, patients may take it with food. A culture and sensitivity specimen will be collected before the antibiotic is started. A repeat test might not be necessary after completion of the treatment. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, and give your brain time to reflect; recall may occur. p. 327 Report content error Which cue indicates cranial nerve VIII toxicity in a patient receiving vancomycin?  Facial pain Vision blurring Hearing loss Facial asymmetry Rationale Vancomycin may cause ototoxicity. Ototoxicity results in damage to the auditory branch of cranial nerve VIII. A patient may report tinnitus and hearing loss. Cranial nerve V is related to facial sensation and movement. Cranial nerve VI is related to eye movement. Cranial nerve VII is related to facial movement. Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks “why,” be sure that the response you have chosen is a reason. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer. pp. 325,328 Report content error Which information would the nurse include when teaching a patient about the administration of an antacid and ciprofloxacin? “Take both drugs simultaneously.” “Take the antacid every alternate day.” “Take the drug on an empty stomach.” “Take ciprofloxacin 2 hours before or after the antacid.” Rationale The nurse would instruct the patient to take ciprofloxacin 2 hours before or after the antacid for the best absorption. The antacids should not be taken on alternate days because this may not help prevent gastrointestinal problems. Ciprofloxacin interacts with antacids, and this decreases the absorption of the ciprofloxacin. Ciprofloxacin causes gastric irritation when administered on an empty stomach. p. 337 Report content error For which patient would the nurse question the prescription of tetracycline? A 6-year-old patient with a Haemophilus influenzae infection A 45-year-old patient with a history of diabetes mellitus  A 60-year-old patient with a history of hypertension A 40-year-old patient diagnosed with rickettsiae Rationale Tetracycline is contraindicated in children younger than 8 years old because it can cause permanent discoloration of the teeth. Thus the nurse would question the prescription of tetracycline for a6-year-old patient with aHaemophilus influenzae infection.Tetracycline is not contraindicated for patients diagnosed with diabetes mellitus or hypertension. Tetracycline is used to treat rickettsiae. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors. pp. 332-333 Report content error Which instruction would the nurse include in the discharge teaching for a patient receiving tetracycline? “Take the medication until you feel better.” “Use sunscreen and protective clothing when outdoors.” “Keep the remainder of the medication in case of recurrence.” “Take the medication with food or milk to minimize gastrointestinal upset.” Rationale Photosensitivity is a common side effect of tetracycline. Exposure to the sun can cause severe burns; therefore the nurse would instruct the patient to use sunscreen and wear protective clothing when outdoors. The medication should not be taken with milk and should be completely finished, not taken only up until the patient feels better and retained in case of recurrence. Test-Taking Tip: Pace yourself during the testing period and work as accurately as possible. Do not be pressured into finishing early. Do not rush! Students who achieve higher scores on examinations are typically those who use their time judiciously. pp. 332-333 Report content error After teaching a patient prescribed doxycycline for the treatment of a skin infection, which patient response reflects an understanding of doxycycline administration? Select all that apply. One, some, or all responses may be correct. “I will take this medication on an empty stomach.” “I will take all the doses that have been prescribed for me.” “I will let my health care provider know if my infection gets worse.”  “I will get medical attention if I have serious side effects.” “If I start to feel better, I can stop taking the medication.” Rationale The patient would be advised to take doxycycline with food to prevent gastrointestinal side effects. Patients should always take the complete course of antibiotics as prescribed. Worsening signs of infection indicate that the antibiotic therapy is not working; the patient should be advised to notify their health care provider if the infection does not improve. Patients should be made aware that adverse reactions such as hearing loss, nephrotoxicity, neurotoxicity, or anaphylaxis require medical attention. Doxycycline can cause gastrointestinal side effects such as nausea and vomiting and should not be taken on an empty stomach. Just because the patient feels better, does not mean the infection has been fully treated. The patient should never stop taking the medication until it is completed. pp. 331-333 Report content error Following education from the nurse for a new prescription of tetracycline, which patient statement reflects a need for clarification? “I should use sunblock and wear sunglasses when going outside.” “My oral contraceptive will be effective if I continue to take it daily as directed.” “I will avoid taking my medication with a glass of milk.” “I will complete my entire course of tetracycline, even if I start to feel better.” Rationale Tetracycline may decrease the effectiveness of oral contraceptives. The patient should plan to use an additional (back-up) method of birth control to prevent unwanted pregnancy while on the antibiotic. Tetracycline causes photosensitivity, and patients should be educated on wearing protective clothing, sunglasses, and sunblock when outdoors. Calcium-rich foods, like milk, may inhibit absorption of tetracycline and should not be taken with medication. The patient should complete the entire antibiotic regimen to ensure proper treatment, regardless of symptomology. p. 331 Report content error A patient is prescribed trimethoprim-sulfamethoxazole (TMP-SMZ) TMP 160 mg/SMZ 800 mg tablet orally every 12 hour for 10 days. Which statement indicates the patient requires further instruction? “I drink water frequently during the day.” “I avoid direct sunlight.” “I take the medication an hour before meals or snacks.” “I will take the medication until I feel better.” Rationale Trimethoprim-sulfamethoxazole (TMP-SMZ) is prescribed for 5 to 14 days. The prescription should be completed even if symptoms improve to avoid resistant bacteria growth. The patient requires more education about completing the full prescription. Drinking water is appropriate to prompt excretion through the kidneys. Avoiding direct sunlight reduces the risk for photosensitivity that is a side effect of the medication. Taking the medication on an empty stomach is preferred to support absorption of the medications. pp. 340,341 Report content error A patient prescribed trimethoprim-sulfamethoxazole (TMP- SMZ) reports feeling tired along with a painful and blistering rash. Which complication is likely occurring? Superinfection Hemolytic anemia Photosensitivity Stevens-Johnson syndrome Rationale Stevens-Johnson syndrome is a reaction to medications that results in flulike symptoms that include fatigue (tired feeling) and a painful rash that spreads and blisters. Superinfections include stomatitis, furry black tongue, itching, and anal or genital discharge. Hemolytic anemia is a disorder in which red blood cells are destroyed and the skin may be jaundiced. Photosensitivity is a redness from sunlight exposure, but it is less likely because the patient additionally reports feeling tired. pp. 340,341,342