Pharm ch 48

A patient is complaining of urinary pain after being diagnosed with a urinary tract infection the previous day. What is the nurse's best action?

Administer ordered phenazopyridine hydrochloride. Phenazopyridine hydrochloride is a urinary analgesic prescribed to relieve the pain associated with urinary tract infections. The other drug options are antiinfective agents and antispasmodic drugs. Having the patient take a warm bath will not address the pain.

A patient diagnosed with an atonic bladder and a peptic ulcer is prescribed bethanechol. What is the nurse's best intervention?

Administer the medication only after meals. Bethanechol should not be taken if peptic ulcer is present. Bethanechol can cause epigastric distress, abdominal cramps, nausea, vomiting, diarrhea, and flatulence.

Nitrofurantoin

Antiseptic/ Antifective -Action: It stops the growth of bacteria -Can be used as a bacteriostatic- which means that it keeps bacteria from reproducing when the drug is given in a low dose or bactericidal and it depends on the drug dosage -Effective against E. Coli -Side effects: Anorexia, nausea, vomiting, abdominal pain, diarrhea, clostridium difficile, diarrhea, peripheral neuropathy, brown urine discoloration -Adverse Effects: fever, chills, cough (while on med = stop) -Facts about this drug: it is eliminated in the urine, binds to proteins -Contradictions: Do NOT take anti-acids with this medication because it will decrease the absorption

The nurse is preparing to administer bethanechol chloride (Urecholine) to a patient. The nurse understands that this drug acts to a. block parasympathetic nerve impulses. b. increase the tone of the urinary detrusor muscle. c. relax smooth muscles in the urinary tract. d. relieve urinary pain and burning.

B (Bethanechol is used to increase the tone of the detrusor muscle and increase the bladder tone to stimulate urination. It stimulates the parasympathetic nerves. It tones the smooth muscles of the urinary tract. It does not alleviate dysuria.)

A male patient reports urinary urgency and pain with burning on urination. The nurse understands that this patient will be treated for which condition? a. Cystitis b. Prostatitis c. Pyelonephritis d. Urethritis

B (In a male patient, a lower urinary tract infection is most likely prostatitis with symptoms similar to cystitis.)

The nurse is preparing to administer methenamine (Hiprex) to a patient who is diagnosed with a urinary tract infection. The nurse reviews the patient's chart and notes a urinary pH of 6.0. Which action will the nurse take? a. Administer the drug as ordered. b. Obtain an order for 8 ounces of cranberry juice three times daily. c. Request an order for an increased dose. d. Restrict fluids to concentrate the patient's urine.

B (Methenamine produces a bactericidal effect when the urine pH is less than 5.5. Cranberry juice will help to acidify the urine.)

Which side effects are common to most urinary antiseptics? a. Dyspnea and chest pain b. Nausea and vomiting c. Peripheral neuritis d. Visual disturbances

B (Nausea and vomiting are common side effects with most urinary antiseptics.)

The nurse is teaching a parent about administering nitrofurantoin suspension to a 5-year-old child. Which instruction will the nurse include in the patient teaching? a. "Give the medication on an empty stomach." b. "Have the child rinse the mouth after taking the drug." c. "Limit the child's fluid intake to concentrate the urine." d. "Report brownish-colored urine to the child's provider."

B Nitrofurantoin suspension can stain the teeth, so patients should rinse the mouth after taking it. Nitrofurantoin should be taken with food, and patients should increase fluids. A reddish-brown color is a harmless side effect.

The nurse provides teaching for a patient who will begin taking nitrofurantoin (Macrodantin) to treat a urinary tract infection. Which statement by the patient indicates understanding of the teaching? a. "If I experience gastrointestinal upset, I may take an antacid." b. "I should notify my provider immediately if my urine is brown." c. "I should take the drug with food and increase my fluid intake." d. "Tingling of my fingers is a harmless side effect of this drug."

C (Patients taking nitrofurantoin should take the drug with foods and increase fluid intake. The drug should not be taken with antacids. Brown urine is a harmless side effect. Tingling of extremities can indicate neuropathy.)

A 25-year-old female patient reports urinary frequency with pain on urination, flank pain, fever, and chills. The nurse recognizes these symptoms as characteristic of which condition? a. Cystitis b. Dysuria c. Pyelonephritis d. Urethritis

C (These are symptoms of pyelonephritis, characterized by fever, dysuria, flank pain, and urinary frequency.)

The nurse assumes care for a patient who is experiencing urinary tract spasms and is ordered to receive flavoxate HCl (Urispas). When reviewing this patient's history, which condition would cause the nurse to notify the provider? a. Chronic obstructive pulmonary disorder b. Diabetes c. Glaucoma d. Hypotension

C (Urispas should not be used for patient who has gastrointestinal or urinary tract obstruction or if the patient has glaucoma.)

The nurse is caring for a hospitalized patient who has symptoms characteristic of pyelonephritis. Before administering the first dose of the intravenous antibiotic, the nurse will ensure that which action is performed? a. An antipyretic is administered. b. A dose of oral antibiotic is given. c. A urinary analgesic is given. d. A urine culture is obtained.

D (A urinalysis, as well as a culture and sensitivity, is usually performed before initiating drug therapy. An antipyretic is indicated for fever but does not need to be timed before the antibiotic. An oral antibiotic is not indicated. A urinary analgesic is given as needed.)

An older woman has urgent urinary incontinence related to an overactive bladder. Which medication does the nurse expect the provider to order? a. Dimethylsulfoxide (DMSO) b. Flavoxate (Urispas) c. Phenazopyridine HCl (Pyridium) d. Tolterodine tartrate (Detrol)

D (Detrol is used to treat an overactive bladder. Dimethylsulfoxide (DMSO) and flavoxate (Urispas) are used to relax uterine smooth muscle. Phenazopyridine HCl (Pyridium) is used to alleviate the pain and burning sensation during urination that is experienced with chronic cystitis.)

The nurse is preparing to administer a phenazopyridine HCl (Pyridium) dose to a patient who has diabetes. The nurse notes that the patient has a positive Clinitest. What will the nurse do next? a. Encourage the patient to increase oral fluid intake. b. Hold the dose until the patient's Clinitest is negative. c. Notify the provider of the patient's hyperglycemia. d. Request an order for serum blood glucose.

D (Phenazopyridine can alter the glucose urine test (Clinitest), so a blood test should be done to monitor glucose levels.)

A patient who has pain with urination associated with cystitis will be discharged home with a prescription for phenazopyridine (Pyridium). What instruction will the nurse include when teaching the patient about this drug? a. "Do not take this drug concurrently with an antibiotic." b. "Report reddish-brown urine to the provider immediately." c. "This drug has antiseptic and analgesic properties." d. "The drug provides symptomatic relief of pain."

D (Phenazopyridine is used to provide symptomatic pain relief. It may be taken with antibiotics. Reddish-brown urine is a harmless side effect. It does not have antiseptic properties.)

A patient will begin taking a urinary antimuscarinic medication. Which symptom should the patient report immediately? a. Dry mouth b. Fatigue c. Increased heart rate d. Urinary retention

D (Urinary retention should be reported to the provider. Dry mouth, fatigue, and increased heart rate are side effects, but they do not necessarily warrant reporting immediately. Urinary retention is more serious.)

The nurse is teaching a patient who has been prescribed nitrofurantoin. The teaching plan for this patient will include which interventions?

Do not take the medication with an antacid. Shake the suspension well before drinking. Increase fluids while on the medication. The medication should not be taken with an antacid, because they interfere with drug absorption. The medication should be shaken well before drinking, and the patient should increase fluids to help with nausea. This medication can stain the teeth, so swishing is not recommended. The medication can cause stomach upset and should be taken with food.

The nursing student would be correct in identifying which microbe as the most common etiology of pyelonephritis?

E. Coli Acute pyelonephritis, an upper UTI, is commonly seen in women of childbearing age, older women, and young girls. E. coli is the most common organism to cause pyelonephritis.

A patient complains of abdominal discomfort while taking nitrofurantoin. What will the nurse teach the patient?

Eat when taking the medication. The drug is usually taken with food to decrease gastrointestinal distress. Antacids decrease the absorption of this medication. Taking the medication on an empty stomach will not help the gastric pain. Discontinuing the medication is not recommended for this side effect.

Urinary stimulants

Increases urinary muscle tone

The patient has been ordered treatment with darifenacin hydrobromide and is also undergoing treatment for glaucoma. What is the nurse's highest priority action?

Notify the health care provider of this information. The nurse should notify the health care provider of this information because glaucoma is a contraindication for usage of this medication.

The nurse is caring for a patient who is taking oxybutynin. The nurse recognizes that the patient is most likely experiencing which condition?

Overactive bladder

The patient has been ordered a regimen to treat a urinary tract infection and notifies the nurse that the patient's urine has turned an orange color. The nurse recognizes that the patient is most likely being treated with which drug?

Phenazopyridine HCl Of the drugs listed, phenazopyridine HCl (Pyridium) is known to turn the urine an orange color. It can cause staining of the underwear and should be included in the education of the patient.

urinary antiseptics/antiinfectives

Prevents bacterial growth in the kidneys and bladder, but is not effective for systemic infections. When giving these drugs in lower doses they can have a bacterial killing effect.

acute pyelonephritis

Upper UTI, is commonly seen in women of childbearing age, older woman, and young girls

Methenamine

Urinary Antiseptic/ Antiinfective-Action: it is used to prevent or control returning UTI -It is a bactericidal when the urine is acidic* -Urine pH has to be less than 5.5 for the drug to work* -Used for: Chronic UTIs -Effective against: E. Coli, and P. aeruginosa - Side Effects N&V, crystalluria*, elevated hepatic enzymes (should not be given to a patient with liver problems and should be stopped if the hepatic enzymes become elevated) -Contradictions: avoid taking this with sulfonamides because they can increase the risk of crystalluria occurring -patient needs to drink 8oz of cranberry juice a day with this medicine, eat acidic foods*

A patient with a history of burning upon urination is prescribed nitrofurantoin to treat a urinary tract infection. Which information will the nurse include in the patient's teaching plan?

Urine may turn brown. The nurse should instruct the patient that the urine may turn a harmless brown color. Fluids should be increased, not decreased, because this helps minimize gastrointestinal upset. Antacids should be avoided because they interfere with drug absorption. There is no indication suggesting fingerstick blood sugar measurement.

Rinse mouth after taking drug to prevent teeth staining.

What is an important teaching factor for the nurse to tell the patient in regards to oral care when taking nitrofurantoin.

Antacids

Which class of drugs interfere with the absorption of nitrofurantoin?

For which conditions would the nurse expect to see urinary analgesics prescribed? (select all that apply) a. Burning sensation b. Frequency c. Hesitation d. Retention e. Urgency

a b c

The pt is 68 years old, has a history of environmental allergies, narrow-angle glaucoma, depression, and overactive bladder. Which drug(s) will concern the nurse? a. Bethanechol b. Dunethyl sulfoxide c. Nitrofuration d. Oxybutynin e. Tolterodine tartrate

a c d e

Which urinary antiseptic druh-srug interactions is/are correct? (Select all that apply) a. Trimethoprin can be combined with sulfamethoxazole b. Antacids increase absorption of ciprofloxacin c. Sodium bicarbonate inhibits the action of methenamine d. Antacids can decrease the absorption of nitrofurantoin

a c d e

antimuscarinics

agents that block parasympathetic nerve impulses, parasympatholytics; and anticholinergics

Urinary Stimulant

agents that increase the tone of urinary muscles

A 72-year-old pt has been prescribed flavoxate for urinary spasms. Which diagnosis in the pt's med hx would be of the highest concern to the nurse? a. Dementia b. Glaucoma c. Hypoglycemia d. Migraines

b

The pt has a UTI and has been advised to increase her fluid intake and decrease her urine pH. What information would the nurse include in discharge teaching to help the pt meet this goal? a. "Drinking whole milk will hell" b. "Cranberry juice will help acidify the urine" c. "Be sure to drink 12-14 8 oz glasses of water per day" d. "Drink prune juice four times per day to make urine alkaline"

b

What drug is commonly used to treat urinary tract spasms? a. Bethanechol b. Oxybutyin c. Phenazopyridine d. Trimethiprim

b

Which pt is more likely to benefit from bethanechol chloride? a. A 44-year-old patient with prostatitis b. A 53-year-old patient with paraplegia c. A 65-year-old patient with pylonephritis d. A 70-year-old patient with overactive bladder

b

What may occur when methenamine is given with sulfonamide? a. Bleeding b. Chest pain c. Crystalluria d. Intestinal distention

c

Which drug is commonly prescribed as a urinary analgesic? a. Bethanechol b. Flavoxate c. Phenazopyridine hydrochloride d. trimethoprim

c

The pt will be receiving ertapenem to prevent recurring UTIs. Which side effects will the nurse include in the pt teaching? (Select all that apply) a. Visual disturbances b. Back pain c. Diarrhea d. Headache e. Nausea

c d e

The patient has been prescribed an antiinfective and phenazopyridine for a UTI. She calls the clinic and is very concerned that her urine has turned reddish orange. After reviewing the pt's chart and her medications, what will the nurse tell her? a. "If you do not take the antibiotic with food in your stomach, your urine will turn orange" b. "Inadequate liquid intake will cause your urine to turn bright orange." c. "This is an indication of an allergic reaction. You need to come back to the clinic." d. "Bright reddish-orange urine is to be expected when taking phenazopyridine."

d

The pt is being discharged from the emergency department after being diagnosed with a UTI. She has been prescribed nitrofurantoin 100 mg qid with meals and at bedtime. The nurse will advise the pt to contact her health care provider immediately if she experiences which side effect? a. Brown urine b. Frequency in urination c. Diarrhea d. Tingling or numbness of the extremities

d

antispasmodics

decrease spasms in the urethra and bladder by relaxing the smooth muscles lining their walls, thus allowing normal emptying of the bladder

Anticholinergics

decreases urgency and urinary incontinence

antispasmodic

decreases urgency and urinary incontinence

Nitrofurantoin

effective against many gram-positive and gram-negative bacteria, especially E. coli, when treating UTIs adverse reactions: Anorexia, abdominal pain, nausea and vomiting, dyspnea, chest pain, cough

benign prostatic hyperplasia (BPH)

enlargement of the prostate gland Universal in older males Avoid meds that causes urinary retention-anticholinergic, antihistamine, decongestant

Bacteriostatic

inhibits bacterial growth

Bactericidal

kills bacteria

Cystitis

lower urinary tract infection frequent in females Caused by E. Coli Sx: pain and burning on urination, frequency and urgency

Urinary tract infection

microbial infection of any part of the urinary tract

The nurse is instructing the patient on the proper way to take tolterodine tartrate. The nurse instructs the patient to take the medication

once a day at the same time every day, with or without food. The medication is designed to be taken once over a 24-h period, but it should be taken at the same time every day for maximum effectiveness.

Antiinfectives

prevents bacterial growth

Urinary antispetics

prevents bacterial growth

Methenamine

produces a bacteriocidal effect when urine pH is less than 5.5

Antimuscurinic

relieves pain and burning

Urinary analgesicis

relieves pain and burning

pyelonephritis

upper urinary tract infection Caused by: E. Coli Sx: chills, high fever, flank pain, painful urination, frequency, urgency, and pyuria

micturition

urination

Fluoroquinolones

used for lower UTI infections. They should not be used unless the patient has no other choice beause of harsh adverse reactions. side effects: tendon rupture, peripheral neuropathy, central nervous system effects, exacerbation of myasthenia gravis

Oxybutynin (Ditropan)

-Action: direct action on smooth muscles to relieve spasms -This drug is a urinary antispasmodic -Side effects: drowsiness, dizziness, blurred vision, tachycardia, dry mouth, GI distress, constipation -Contradiction: avoid in glaucoma patients, GI and urinary obstructions, and GERD

Bethanechol (urecholine)

-Action: increase bladder tone of detrusor muscle -This drug is a urinary stimulant -Use: neurogenic bladder, urinary retention -Side effects: GI distress, headache, dizziness -Adverse Effects: nephrotoxicity, hepatotoxicity -Contradictions: Peptic ulcer patients

Phenazopyridine (Pyridium)

-Action: relive pain, burning sensation, frequency, urgency in the urinary tract -This drug is a urinary analgesic -Side effects: GI distress, Red orange urine that is normal to get because of the drug -Adverse reactions: hemolytic anemia, nephrotoxicity, hepatotoxicity (this is preventable if you do not take the drug for more than 7 days) -pyridium can alter diabetic blood glucose results which means that this drug causes the test strips not to get an accurate reading*

Nursing process for Nitrofurantoin

-Assess the patient for UTI by urine culture and sensitivity results -Goal: to have the patient free of signs and symptoms in 10 days - monitor urine output and specific gravity -Advise patient to AVOID anti-acids -Teach the patient to increase their fluids and take this medication with food to keep the GI tract from getting upset

Trimethoprim and Trimethoprim sulfamethoxazole

-Use: acute and chronic UTI systemically - This drug is a urinary antibiotic -The patient can not have this if they are allergic to sulfa drugs* - Side effects: headache, dizziness, nervousness, insomnia, photosensitivity, GI distress, crystalluria, clostridium difficile diarrhea, elevated hepatic enzymes, seizures, hyperkalemia* - watch renal activity with renal patients

Tolterodine tartrate (Detrol LA)

-Use: control of an overactive bladder and decrease urge and urinary incontinence -This drug is a urinary anti-muscarinic/ Anticholinergic drug -Side effects: headache, dizziness, confusion, blurred vision, dysphonia, peripheral edema, elevated hepatic enzymes, dry mouth, diarrhea, constipation, abdominal pain -Contradictions: narrow angle glaucoma patients and hepatic impairment patients

Fluroquinolones

-Use: treats lower UTIs -This drug is a urinary antibiotic - Side effects: headache, dizziness, photosensitivity, visual impairment, peripheral neuropathy, GI distress, tendinitis, tendon rupture, seizures, clostridium difficile diarrhea -Cautions with this drug: use in uncomplicated UTI only if no other drug treatments are available

Antibacterials to know for these urinary problems are?

1) Trimethoprim-sulfamethoxazole 2) Fluoroquinolone-ciprofloxzcin 3) ofloxacin 4) levofloxacin

Drugs to know that are antiseptics/ antiinfectives for urinary problems are?

1) nitrofurantoin 2) Methenamine

The nurse is caring for a patient who is diagnosed with a urinary tract infection. The patient reports always having difficulty remembering to take medications. Which drug will the nurse expect the provider to select when treating this patient? a. Fosfomycin tromethamine (Monurol) b. Ciprofloxacin (Cipro) c. Nitrofurantoin (Macrodantin) d. Trimethoprim-sulfamethoxazole (Bactrim)

A (Fosfomycin is given as a one-time, single dose. Ciprofloxacin is given daily or twice a day. Nitrofurantoin is given four times daily. Trimethoprim-sulfamethoxazole is given twice daily.)

The nurse is preparing to administer methenamine (Hiprex) to a patient who has pyelonephritis. Which action will the nurse perform? a. Increase fluid intake to 2000 mL/day. b. Monitor the patient's urine for dark brown color. c. Order alkaline foods three times daily. d. Request an order for a sulfonamide antibiotic.

A (Patients who take methenamine can develop crystalluria and should increase fluid intake to prevent this effect. A reddish-brown color is a harmless side effect. Patients should have acidic urine, not alkaline urine. Methenamine taken with sulfonamides increases the risk of crystalluria.)

acute cystitis

A lower UTI, frequently occurs in female patients because of their shorter urethra.