Deck 50: Sulfonamides and the Pharmacotherapy of Urinary Tract Infections

Question 1

A client is admitted with a high fever accompanied by chills.The client complains of costovertebral pain but denies dysuria,urgency,or frequency.The diagnosis is pyelonephritis related to pathogens present in the blood.How would the nurse classify this urinary tract infection?

A)Ascending
B)Hematogenous
C)Retrograde
D)"Against the flow"

Answer 1

Hematogenous

Question 2

A client is in her 16th week of pregnancy.A routine urinalysis has revealed bacteriuria,and the midwife has given the client a prescription for an antibacterial.The client asks why she must take this medication when she has no symptoms of an infection.What is the nurse's best response?

A)"Even though you don't have any symptoms,the infection could keep your baby from gaining enough weight before birth."
B)"I know you don't want to take this medication,but it is safe and will not harm you or your baby."
C)"You are denying your symptoms because you don't want to take the medication."
D)"Taking this medication will prevent your baby from developing kidney damage in the future."

Answer 2

"Even though you don't have any symptoms,the infection could keep your baby from gaining enough weight before birth."

Question 3

A 22-year-old female client has acute uncomplicated cystitis.The nurse knows that which antibacterial would not be an appropriate choice to treat this infection?

A)Trimethoprim-sulfamethoxazole (TMP-SMZ)
B)Metronidazole (Flagyl)
C)Norfloxacin (Noroxin)
D)Fosfomycin (Monurol)

Answer 3

Metronidazole (Flagyl)

Question 4

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?

A)"Many clients have developed resistance to TMP-SMZ,so that drug isn't used as much."
B)"It is obvious that the TMP-SMZ didn't clear up your infection the first time,so you are being given another medication."
C)"I'm sure there is a good reason why you are being given this different medication."
D)"Cipro is less expensive than the drug you took the last time."

Question 5

A nurse is conducting a class for preschool parents concerning ways to prevent illness in children.A parent asks why little girls are at greater risk for urinary tract infections than little boys.Which response by the nurse is most accurate?

A)"Little boys have short urethras,but they also have testicles that block bacteria from the rectum."
B)"Most little girls don't wipe themselves as well as little boys do after using the bathroom."
C)"Little girls have short urethras,which makes it easier for bacteria to move into the bladder."
D)"Testosterone in boys helps prevent urinary tract infections."

Question 6

The nurse is caring for a client who has been diagnosed with AUC.The client lives in a community where drug resistance is an issue.Which antibiotics may be prescribed for this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Trimethoprim-sulfamethoxazole (TMP-SMZ)
B)Ciprofloxacin (Cipro)
C)Norfloxacin (Noroxin)
D)Nitrofurantoin (Furadantin)
E)Fosfomycin (Monurol)

Question 7

A 28-year-old female client presents to the emergency department with a temperature of 102.4°F.She states that she began experiencing frequency and burning upon urination yesterday and in the middle of the night woke up with the fever and chills.She also states that her back is hurting.These symptoms describe what type of infection?

A)Urethritis
B)Acute pyelonephritis
C)Acute renal failure
D)Cystitis

Question 8

The nurse in a urology clinic is asked by a parent why her son does not get urinary tract infections but her daughter does.How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)"Your son's urethra is longer than your daughter's,which makes it more difficult for bacteria to enter."
B)"Your son's scrotum is a physical barrier between the urethra and the anus,which provides added protection against UTIs."
C)"Your son's urethra is shorter than your daughter's,which protects him from UTIs."
D)"Your daughter may not be properly wiping after urination,which can increase the risk of developing a UTI."
E)"There are no anatomical differences between the male and female urinary tract.Some people are just more prone to UTIs than others."

Question 9

A school nurse is conducting a health class for fifth-grade girls.The nurse instructs the girls that when toileting,they must remember to wipe from front to back.Which statement by a student indicates the need for further education?

A)"Girls need to wipe from front to back to avoid urinary tract infections."
B)"Girls must be careful about the way they wipe to prevent infection from bacteria present near the rectum."
C)"Girls must be careful how they wipe because the connection from the outside to the bladder is very short."
D)"Girls need to wipe front to back only after a bowel movement."

Question 10

A female client has had repeated bouts of acute uncomplicated cystitis.The health care practitioner has recommended that she change the form of birth control she is using and see if she has fewer infections.What change would be most beneficial for this client?

A)The client should stop using spermicidal foam and begin using birth control pills.
B)The client should stop using a cervical cap and begin using a diaphragm.
C)The client should stop using the "sponge" and begin using a diaphragm.
D)The client should stop using a female condom and begin using a cervical cap.

Question 11

A female client with acute uncomplicated cystitis (AUC)has been treated with antibacterials,and now reports that all symptoms have resolved.What further instructions should be given to this client at this time?

A)"Don't try to figure out for yourself if you have an infection; it might be dangerous."
B)"Come back to the clinic in 2 weeks for a urinalysis to check for signs of infection."
C)"Your health care practitioner would like to see you in 2 weeks to see how you are feeling."
D)"You don't need to come back to the clinic unless your symptoms return."

Question 12

A client is being seen in the emergency department with a suspected urinary tract infection.The nurse believes the client has pyelonephritis based on which assessment findings? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Vomiting
B)Fever
C)Flank tenderness
D)Photophobia
E)Painful urination

Question 13

A 3-year-old female is being seen in the clinic with symptoms of a urinary tract infection.Which medication would be appropriate for a child this age?

A)Levofloxacin (Levaquin)
B)Trimethoprim-sulfamethoxazole (TMP-SMZ)
C)Fosfomycin (Monurol)
D)Ciprofloxacin (Cipro)

Question 14

A female client has been provided with a 3-day course of therapy as prophylaxis against another urinary tract infection.Which statement indicates that the client understands when to use this medication?

A)"I will take this medication on the first 3 days of the month."
B)"I will take this medication after my husband and I have sexual intercourse."
C)"When I first have symptoms,I will drink cranberry juice.If that is not effective,I will take the medication."
D)"If I develop symptoms of an infection,I will call the health care provider and make sure it is OK for me to go ahead and take the medication."

Question 15

A 19-year-old male client complains of burning while voiding.The health care practitioner diagnoses urethritis and explains that it is caused by a pathogen that infects the urethra.The client tells the nurse that his girlfriend had the same problem last week.The nurse knows that the most likely cause of the urethritis in this client is:

A)unrelated to his girlfriend's condition.
B)a descending bladder infection.
C)related to poor hygiene.
D)a sexually transmitted disease.

Question 16

A 45-year-old male client comes to the health care practitioner with symptoms of cystitis.The client also has a fever,and states that it is very hard for him to "pass much urine." The health care practitioner performs a rectal examination and finds tenderness.What is possibly causing this client's set of problems?

A)Bladder infection
B)Urethritis
C)Acute pyelonephritis
D)Cystitis with prostatitis

Question 17

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

A)"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."
B)"Sulfonamides slow the growth of bacteria because they only inhibit folic acid that is synthesized by bacteria."
C)"Sulfonamides are effective against uropathogens by inhibiting the synthesis of bacterial folic acid."
D)"Sulfonamides are most effective in clients who eat large amounts of foods rich in folic acid."

Question 18

A 19-year-old client with symptoms of recurrent urinary tract infection states that she generally does not finish the prescription given to her for the infection.What medication is the health care practitioner most likely to prescribe for this client?

A)Nitrofurantoin (Furadantin)
B)Trimethoprim-sulfamethoxazole (TMP-SMZ)
C)Fosfomycin (Monurol)
D)Ciprofloxacin (Cipro)

Question 19

An infant has been diagnosed with a urinary tract infection.The nurse anticipates the health care provider may prescribe which medications as part of the treatment regimen? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)Trimethoprim-sulfamethoxazole (TMP-SMZ)
B)Nitrofurantoin (Furadantin)
C)Fosfomycin (Monurol)
D)Norfloxacin (Noroxin)
E)Levofloxacin (Levaquin)

Question 20

A client has been diagnosed with a complicated urinary tract infection (C-UTI).The nurse knows that C-UTIs are often treated differently than acute uncomplicated cystitis (AUC).What is a significant difference in the treatment of these infections?

A)Clients with AUC are rarely treated with antibacterials while those with C-UTIs almost always receive this therapy.
B)Clients with AUC receive a shorter course of antibacterials than do clients with C-UTIs.
C)Clients with AUC receive a longer course of antibacterials than do clients with C-UTIs.
D)Clients with AUC receive more toxic antibacterials than do clients with C-UTIs.

Question 21

A client has been prescribed nitrofurantoin (Furadantin)for the treatment of a UTI.The nurse explains that this medication is effective against which causative organisms? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)E.coli
B)S.saprophyticus
C)Pseudomonas
D)Proteus
E)Serratia

Question 22

A client has received a prescription for a sulfonamide.Which statement by the client indicates a need for further instruction?

A)"If I develop a fever or severe diarrhea,I will call my health care provider."
B)"I will call the health care provider if my symptoms have not improved in the next few days."
C)"I will limit my fluid intake to about three glasses per day."
D)"I will return for my scheduled appointment for lab work."

Question 23

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

A)The client who has a Shigella infection of the bowel
B)The client with P.jiroveci pneumonia
C)The client with iron-deficiency anemia
D)The client with pernicious anemia

Question 24

For which client is the use of nitrofurantoin (Furadantin)contraindicated?

A)The client who needs a rescue inhaler for asthma three times a week
B)The client who has pernicious anemia
C)The client who developed nausea the last time she took the drug
D)The client who had hepatitis A 10 years ago

Question 25

Trimethoprim-sulfamethoxazole (Bactrim)has been prescribed for a client with a urinary tract infection.The nurse can administer this medication by which routes? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.

A)By mouth
B)By intravenous injection
C)By intramuscular injection
D)By subcutaneous injection
E)By the topical route

Question 26

Which statement indicates that a client understands the reason for the need to drink approximately 3 liters of fluid while taking trimethoprim-sulfamethoxazole (TMP-SMZ)?

A)"I need to drink a lot of fluids to keep my bladder full."
B)"I need to drink a lot of fluids to flush the bacteria out of my bladder."
C)"I need to drink a lot of fluids to prevent crystals from forming in my urine."
D)"I need to drink a lot of fluids to prevent an allergy from developing."

Question 27

A client is being treated with IV antibiotics for a complicated urinary tract infection.The nurse monitors the client for renal toxicity by monitoring for a weight gain of more than _____ kg in a 24-hour period.
(Record your answer rounding to the nearest whole number).

Question 28

The health care provider has ordered trimethoprim-sulfamethoxazole (Septra)to be administered IV to several hospitalized clients who have developed urinary tract infections.For which client should the nurse order?

A)The client with glaucoma
B)The client who has an indwelling urinary catheter inserted
C)The client who has AIDS
D)The client who had surgery yesterday