Deck 51: Sulfonamides and the Pharmacotherapy of Urinary Tract Infections

Question 1

The health care practitioner is preparing to prescribe trimethoprim-sulfamethoxazole (Bactrim).For which client should the nurse question the order for this medication?
1)The client who has a Shigella infection of the bowel
2)The client with pernicious anemia
3)The client with P.carinii pneumonia
4)The client with iron-deficiency anemia

Answer 1

2

Question 2

A female client has been provided with a three-day course of therapy as prophylaxis against another urinary tract infection.Which of the following statements indicates that this client understands when to use this medication?
1)"I will take this medication on the first three days of the month."
2)"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."
3)"I will take this medication after my husband and I have sexual intercourse."
4)"When I first have symptoms, I will drink juice.If that is not effective, I will take the medication."

Answer 2

3

Question 3

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?
1)Cystitis with prostatitis
2)Acute pyelonephritis
3)Urethritis
4)Bladder infection

Answer 3

1

Question 4

A female client with acute uncomplicated cystitis has been treated with antibacterials, and now reports that all symptoms are resolved.What further instructions should be given to this client at this time?
1)"Come back to the clinic in two weeks for a urinalysis to check for signs of infection."
2)"You don't need to come back to the clinic unless your symptoms return."
3)"Don't try to figure out for yourself if you have an infection, it might be dangerous."
4)"Your health care practitioner would like to see you in two weeks to see how you are feeling."

Question 5

Prior to a pharmacology test, a group of nursing students are discussing uncomplicated versus complicated urinary tract infections.What is a significant difference in the treatments of these infections?
1)Clients with AUC receive a longer course of antibacterials than do clients with complicated urinary tract infections.
2)Clients with AUC receive a shorter course of antibacterials than do clients with complicated urinary tract infections.
3)Clients with AUC receive different antibacterials than do clients with complicated urinary tract infections.
4)The only difference between an AUC and a complicated urinary tract infection is the number of bacteria present in the urine at time of diagnosis.

Question 6

A school nurse is conducting a health class for fifth-grade girls.The nurse reinforces the idea that when toileting, the girls must remember to wipe from front to back.Which statement indicates a need for further education concerning this topic?
1)"Girls must be careful about the way they wipe to prevent infection from bacteria present near the rectum."
2)"Girls must be careful how they wipe because the connection from the outside to the bladder is very short."
3)"Girls need to wipe from front to back to avoid urinary tract infections."
4)"Girls only need to wipe front to back after having a bowel movement."

Question 7

A 19-year-old male comes to the clinic complaining of burning while voiding.The health care practitioner diagnoses urethritis, and explains to the client that it is caused by a pathogen that infects the urethra.The client asks the nurse to explain "how this could happen, because [his] girlfriend had the same problem last week." The nurse knows that in this case, the most likely cause of the urethritis in this client is:
1)Descending bladder infection.
2)A sexually transmitted disease.
3)Unrelated to his girlfriend's condition.
4)Poor hygiene.

Question 8

A 28-year-old female client presents to the Emergency Department with a temperature of 102.4°F.She complains of chills as well.She states that she began having some burning and frequency upon urination yesterday, and in the middle of the night woke up with the fever.She also states that her back is hurting.These symptoms describe what type of infection?
1)Irritative voiding symptoms
2)Cystitis
3)Acute pyelonephritis
4)Urethritis

Question 9

A 22-year-old female client has acute uncomplicated cystitis.Which antibacterial would not be an appropriate choice to treat this infection?
1)Trimethoprim-sulfamethoxazole (TMP-SMZ)
2)Norloxacin (Noroxin)
3)Fosfomycin (Monurol)
4)Metronidazole (Flagyl)

Question 10

Which of the following statements about the mechanism of action of sulfonamides by a nursing student studying pharmacology requires remediation by this student?
1)"Sulfonamides are effective against uropathogens by inhibiting the synthesis of bacterial folic acid."
2)"Sulfonamides are most effective in clients who eat large amounts of foods rich in folic acid."
3)"Sulfonamides slow the growth of bacteria because they only inhibit folic acid that is synthesized by bacteria."
4)"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."

Question 11

Which of the following statements indicates that a client understands the reason for the need to drink approximately three liters of fluid while taking trimethoprim-sulfamethoxazole (TMP-SMZ)?
1)"I need to drink a lot of fluids to prevent crystals from forming in my urine."
2)"I need to drink a lot of fluids to flush the bacteria out of my bladder."
3)"I need to drink a lot of fluids to prevent an allergy from developing."
4)"I need to drink a lot of fluids to keep my bladder full."

Question 12

The health care provider has ordered trimethoprim-sulfamethoxazole (Septra)to be administered IV to a hospitalized client who has developed a urinary tract infection.For which client should the nurse question the order?
1)The client who has a Foley catheter inserted
2)The client who has a history of asthma
3)The client who had surgery yesterday
4)The client with glaucoma

Question 13

For which of the following clients is the use of nitrofurantoin (Furadantin)contraindicated?
1)The client who has pernicious anemia
2)The client who had hepatitis A 10 years ago
3)The client who needs a rescue inhaler for asthma three times a week
4)The client who developed nausea the last time she took the drug

Question 14

A nurse is conducting a class for preschool parents concerning ways to prevent illness in children.One of the parents asks why little girls are at greater risk for urinary tract infections than are little boys.Which of the following is the best response by the nurse?
1)"Little boys have short urethras, but they also have testicles that block bacteria from the rectum."
2)"Testosterone in boys helps prevent urinary tract infections."
3)"Little girls have short urethras, which make it easier for bacteria to move into the bladder."
4)"Most little girls don't wipe themselves as well as little boys do after using the bathroom."

Question 15

A female client is in her 16^th week of pregnancy.A routine urinalysis has revealed bacteriuria, and the midwife has given the client a prescription for an antibacterial.The client questions the nurse as to why she must take this medication when she doesn't have any symptoms of an infection.What is the nurse's best response to this client?
1)"Taking this medication will prevent your baby from developing kidney damage in the future."
2)"Even though you don't have any symptoms, the infection could keep your baby from gaining enough weight before birth."
3)"You are denying your symptoms because you don't want to take the medication."
4)"I know you don't want to take this medication, but it is safe, and will not harm you or your baby."

Question 16

A client is diagnosed with a urinary tract infection.The health care practitioner elects to treat this client with ciprofloxacin (Cipro).The client asks the nurse why she isn't receiving trimethoprim-sulfamethoxazole (TMP-SMZ), the drug she was given eight months ago when she had a urinary tract infection.What is the best response by the nurse to this client?
1)"Cipro is less expensive than the drug you took the last time."
2)"Many clients have developed resistance to TMP-SMZ, so that drug isn't used as much."
3)"It is obvious that the TMP-SMZ didn't clear up your infection the first time, so you are being given another medication."
4)"I'm sure there is a good reason why you are being given this different medication."

Question 17

A female client has had repeated bouts of acute uncomplicated cystitis.The health care practitioner has recommended that this client change the form of birth control that she is using and see if she has fewer infections.What change would be most beneficial in assisting this client?
1)The client should stop using the "sponge" and begin using a diaphragm.
2)The client should stop using a female condom and begin using a cervical cap.
3)The client should stop using spermicidal foam and begin using birth control pills.
4)The client should stop using a cervical cap and begin using a diaphragm.

Question 18

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?
1)Ascending
2)Retrograde
3)"Against the flow"
4)Hematogenous

Question 19

A 3-year-old female is being seen in the clinic with symptoms of a urinary tract infection.Which of the following medications would be appropriate for use in a child of this age?
1)Trimethoprim-sulfamethoxazole (TMP-SMZ)
2)Ciprofloxacin (Cipro)
3)Levofloxacin (Levaquin)
4)Fosfomycin (Monurol)

Question 20

A 19-year-old client is being seen in the clinic with symptoms of another urinary tract infection.The client states that most of the time, she doesn't finish the prescription given to her for the infection.What medication is the health care practitioner most likely to prescribe for this client?
1)Nitrofurantoin (Furadantin)
2)Ciprofloxacin (Cipro)
3)Fosfomycin (Monurol)
4)Trimethoprim-sulfamethoxazole (TMP-SMZ)

Question 21

A client has been taking nitrofurantoin (Furadantin)for treatment of a urinary tract infection.The client calls and reports that her urine has turned brown.What is the best response by the nurse to the concerns of this client?
1)"Please come to the office immediately so you can be examined for a possible allergic reaction to the medication."
2)"Please go to the Emergency Department immediately.The brown color indicates that you are experiencing a severe adverse reaction to the medication."
3)"Are you running a fever?"
4)"This is a normal finding.Don't be concerned."

Question 22

Which of the following statements by a client who has received a prescription for a sulfonamide indicates a need for further instruction?
1)"If I develop a fever or severe diarrhea, I will call my health care provider."
2)"I will return for my scheduled appointment for lab work."
3)"I will limit my fluid intake to about three glasses per day."
4)"I will call the health care provider if my symptoms have not improved in the next few days."