A client is diagnosed with a urinary tract infection (UTI). The health care practitioner elects to treat the client with ciprofloxacin (Cipro)
The client asks the nurse why she isn't receiving trimethoprim-sulfamethoxazole (TMP-SMZ), the drug she was given 8 months ago for a UTI. What would be the most accurate response?
1. "Many clients have developed resistance to TMP-SMZ, so that drug isn't used as much."
2. "It is obvious that the TMP-SMZ didn't clear up your infection the first time, so you are being given another medication."
3. "I'm sure there is a good reason why you are being given this different medication."
4. "Cipro is less expensive than the drug you took the last time."
Correct Answer: 1
Rationale 1: Many strains are resistant to TMP-SMZ, so its use as a first-line agent has been limited. Cipro is equally effective and has not developed as much resistance.
Rationale 2: The client had the other infection 8 months ago, so this response is not correct.
Rationale 3: The client has asked for an explanation. The nurse did not answer the client's question.
Rationale 4: Medications might be prescribed according to cost, but in this case, Cipro is newer and more expensive than TMP-SMZ, which has been used for a long time.
Global Rationale: The nurse should be prepared to answer the client's questions. Many strains of bacteria are resistant to TMP-SMZ, so its use as a first-line agent has been limited. Cipro is equally effective and has not developed as much resistance. Since the previous infection was 8 months ago, this is not a reinfection. Cipro is typically more expensive than TMP-SMZ.
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