Question 1

Nitrofurantoin [Macrodantin] is prescribed for an adolescent female patient with acute cystitis. What should the nurse include in the teaching for this patient? (Select all that apply.)&#10;A) &#34;Make sure you tell your prescriber if you might be pregnant.&#34;&#10;B) &#34;If you experience any tingling or numbness, stop taking the drug and call the clinic immediately.&#34;&#10;C) &#34;Headaches and drowsiness can occur and are mild side effects.&#34;&#10;D) &#34;You should not take sulfonamides while taking this medication.&#34;&#10;E) &#34;Your urine may have a brown tinge while you are taking this drug.&#34;

Accepted Answer

Nitrofurantoin is linked to serious birth defects and is not recommended during pregnancy. Tingling and numbness indicate neuropathy,which is a serious and often irreversible side effect. Central nervous system (CNS)side effects usually are mild and reversible. Sulfonamides cannot be taken with methenamine,because they can cause crystalluria. Patients' urine may have a brown tinge while they are taking this drug.

Question 2

A young,nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria,urinary urgency and frequency,and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective?

A) A 14-day course of amoxicillin with clavulanic acid [Augmentin]
B) A 7-day course of ciprofloxacin [Cipro]
C) A single dose of fosfomycin [Monurol]
D) A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]

Accepted Answer

Short-course therapy is recommended for uncomplicated,community-acquired lower urinary tract infections. The short course is more effective than a single dose,and compared with longer-course therapies,it is less costly,has fewer side effects,and is more likely to foster compliance. Amoxicillin with clavulanic acid is a second-line drug used for pyelonephritis. Fosfomycin is a second-line drug and can be useful in patients with drug allergies.

Question 3

A pregnant patient with fever,flank pain,and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her?

A) "This agent is not effective against infections of the upper urinary tract."
B) "This antiseptic agent is safe for use during pregnancy and has no drug resistance."
C) "This drug is linked to many serious birth defects and is not recommended during pregnancy."
D) "You will need to take this medication with meals to avoid gastric upset."

"This agent is not effective against infections of the upper urinary tract."

Accepted Answer

Methenamine is safe for use during pregnancy and would be an excellent choice for this patient if she had a lower urinary tract infection. However,it is not an effective agent for upper urinary tract infection,because it is a prodrug that must break down into ammonia and formaldehyde to be effective. There is not enough time for formaldehyde to form in the kidneys,so it is not effective in the upper tract. Nitrofurantoin is linked to serious birth defects and also must be given with food to prevent gastrointestinal problems.

Question 4

A pregnant female patient with bacteriuria,suprapubic pain,urinary urgency and frequency,and a low-grade fever is allergic to sulfa,ciprofloxacin,and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with:

A) cephalexin [Keflex].
B) fosfomycin [Monurol].
C) methenamine [Hiprex].
D) nitrofurantoin [Macrodantin].

Accepted Answer

Methenamine is an excellent second-line drug for this patient and is indicated because of the patient's multiple drug sensitivities. It is safe in pregnancy,and there is no drug resistance. Nitrofurantoin has potential harmful effects on the fetus and should not be used during pregnancy. Single-dose regimens are not recommended in pregnant women. Cephalexin can have cross-reactivity with amoxicillin.

Question 5

A 30-year-old male patient reports having two to four urinary tract infections a year. What will the nurse expect to teach this patient?&#10;A) &#34;Make sure you void after intercourse and drink extra fluids to stay well hydrated.&#34;&#10;B) &#34;We will treat each infection as a separate infection and treat with short-course therapy.&#34;&#10;C) &#34;You will need to take a low dose of medication for 6 months to prevent infections.&#34;&#10;D) &#34;You will need to take antibiotics for 4 to 6 weeks each time you have an infection.&#34;

Accepted Answer

This patient has reinfection of his urinary tract at a rate of more than three per year,which is an indication for long-term prophylaxis. Voiding after intercourse is a good teaching point for sexually active women to prevent urinary infections,but it is not a sufficient preventive measure for recurrent infections in men. Short-course therapy may be used for each occurrence of infection if the reinfection rate is less than three per year. Long-term treatment for individual infections is recommended if relapse occurs or if infections do not clear with shorter-term therapy.

Question 6

The nurse is discussing upper and lower UTIs. Which of these conditions can be treated at home? (Select all that apply.)&#10;A) Acute cystitis&#10;B) Acute urethritis&#10;C) Recurrent UTI&#10;D) Severe pyelonephritis&#10;E) Acute bacterial prostatitis

Accepted Answer

Acute cystitis,urethritis,and recurrent UTIs can be treated on an outpatient basis. Severe pyelonephritis and acute bacterial prostatitis require hospitalization and IV antibiotics.

Question 7

A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication?&#10;A) Anorexia, nausea, and vomiting&#10;B) Brown-colored urine&#10;C) Drowsiness&#10;D) Tingling of the fingers

Accepted Answer

Tingling of the fingers can indicate peripheral neuropathy,which can be an irreversible side effect of nitrofurantoin. The other side effects are not serious and can be reversed.

Question 8

An older male patient comes to the clinic with complaints of chills,malaise,myalgia,localized pain,dysuria,nocturia,and urinary retention. The nurse would most likely suspect that the patient has:&#10;A) acute cystitis.&#10;B) urinary tract infection.&#10;C) pyelonephritis.&#10;D) prostatitis.

Accepted Answer

The nurse should suspect prostatitis,which is manifested by high fever,chills,malaise,myalgia,and localized pain and may also be manifested by dysuria,nocturia,and urinary urgency,frequency,and retention. Clinical manifestations of acute cystitis include dysuria,urinary urgency and frequency,suprapubic discomfort,pyuria,and bacteriuria. Urinary tract infections are very general and are classified by their location. Pyelonephritis is characterized by fever,chills,severe flank pain,dysuria,and urinary frequency and urgency,as well as by pyuria and bacteriuria.

Question 9

A 20-year-old female patient has suprapubic discomfort,pyuria,dysuria,and bacteriuria greater than 100,000/mL of urine. Which are the most likely diagnosis and treatment?&#10;A) Uncomplicated lower urinary tract infection treatable with short-course therapy&#10;B) Complicated lower urinary tract infection treatable with single-dose therapy&#10;C) Uncomplicated upper urinary tract infection requiring 14 days of oral antibiotics&#10;D) Complicated upper urinary tract infection requiring parenteral antibiotics

Accepted Answer

These are symptoms of uncomplicated cystitis,which is a lower urinary tract infection that can be treated with a short course of antibiotics. Short-course therapy is more effective than single-dose therapy and is preferred. A complicated lower urinary tract infection would be associated with some predisposing factor,such as renal calculi,an obstruction to the flow of urine,or an indwelling catheter. Upper urinary tract infections often include severe flank pain,fever,and chills.

Question 10

A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will:&#10;A) begin a 2-week course of antibiotics.&#10;B) evaluate for a structural abnormality of the urinary tract.&#10;C) initiate long-term prophylaxis with low-dose antibiotics.&#10;D) treat the patient with intravenous antibiotics.

Accepted Answer

Patients who develop a subsequent urinary tract infection after treatment are treated in a stepwise fashion,beginning with a longer course of antibiotics. The next steps would be to begin a 4- to 6-week course of therapy,followed by a 6-month course of therapy if that is unsuccessful. If urinary tract infections are thought to be caused by other complicating factors,an evaluation for structural abnormalities may be warranted. Unless the infections are severe or are complicated,intravenous antibiotics are not indicated.

Question 11

A patient with a history of renal calculi has fever,flank pain,and bacteriuria. The nurse caring for this patient understands that it is important for the provider to:&#10;A) begin antibiotic therapy after urine culture and sensitivity results are available.&#10;B) give prophylactic antibiotics for 6 weeks after the acute infection has cleared.&#10;C) initiate immediate treatment with broad-spectrum antibiotics.&#10;D) refer the patient for intravenous antibiotics and hospitalization.

Accepted Answer

The answer of A patient with a history of renal...

Question 12

Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics?&#10;A) A 5-year-old child with a fever of 100.5&#176;F, dysuria, and bacteriuria&#10;B) A pregnant woman with bacteriuria, suprapubic pain, and fever&#10;C) A young man with dysuria, flank pain, and a previous urinary tract infection&#10;D) An older adult man with a low-grade fever, flank pain, and an indwelling catheter

Accepted Answer

The answer of Which patient with a urinary tract infection...

Question 13

Before giving methenamine [Hiprex] to a patient,it is important for the nurse to review the patient's history for evidence of which problem?&#10;A) Elevated blood urea nitrogen and creatinine&#10;B) History of reactions to antibiotic agents&#10;C) Possibility of pregnancy&#10;D) Previous resistance to antiseptic agents

Accepted Answer

The answer of Before giving methenamine [Hiprex] to a patient,it...

Question 14

A patient presents to the emergency department with complaints of chills,severe flank pain,dysuria,and urinary frequency. The patient has a temperature of 102.9°F,a pulse of 92 beats per minute,respirations of 24 breaths per minute,and a blood pressure of 119/58 mm Hg. The nurse would be correct to suspect that the patient shows signs and symptoms of:

A) acute cystitis.
B) urinary tract infection.
C) pyelonephritis.
D) prostatitis.

Accepted Answer

The answer of A patient presents to the emergency department...

Question 15

The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever,flank pain,and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse?

A) "Your child may need to be hospitalized for treatment."
B) "Your child may need a urine culture before and after treatment."
C) "Your child may need tests to assess for urinary tract abnormalities."
D) "Your child may need additional medications, such as urinary tract antiseptics."

Accepted Answer

The answer of The parent of a 5-year-old child who...

Deck 89: Drug Therapy of Urinary Tract Infections