Chapter 48: Urinary Tract Anti-Infectives PrepU

11 See full question 28s The nurse advises the client who has been prescribed methenamine to avoid excessive consumption of which foods and beverages? Select all that apply.

Chocolate milk Orange juice Cottage cheese Explanation: Clients who take methenamine should avoid excessive intake of citrus products, milk, and milk products (e.g., chocolate milk), orange juice and cottage cheese. There are no contraindications to intake of shellfish or eggs. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 574. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 574 Add a Note

Question 3 See full question 16s The client asks the nurse how many cranberry capsules should be taken each day to help prevent urinary tract infection. What is the nurse's best response?

Correct response: 500 mg/day Explanation: The recommended dose of crnaberry capsules is nine to 15 capsules per day (400-500 mg/day).

Question 5 See full question 16s The nurse is aware that the health care provider will only prescribe nitrofurantoin with caution to clients with a history of which disorders? Select all that apply.

Correct response: Diabetes mellitus G6PD deficiency Cerebral arteriosclerosis Explanation: Nitrofurantoin is used cautiously in clients with cerebral arteriosclerosis, diabetes, and glucose-6-phosphate dehydrogenase (G6PD) deficiency. It is not contraindicated for clients with eczema or osteoporosis.

Question 3 See full question 14s The nurse is caring for a client with a urinary tract infection and a history of gout. Which anti-infective would be contraindicated for this client?

Correct response: Methanamine (Hiprex) Explanation: Clients who have a history of gout should use methenamine with great caution because it may cause crystals to form in the urine. The other urinary tract anti-infectives do not have this feature.

Question 3 See full question 27s The nurse is caring for a client who is vomiting and has a severe urinary tract infection. The nurse knows that which anti-infective can be given IV?

Correct response: Trimethoprim and sulfamethoxazole (TMP-SMZ) Explanation: Fosfomycin, nitrofurantoin and methenamine are all administered orally. TMP-SMZ can be administered both orally and IV.

Question 4 See full question 23s A female client is prescribed fosfomycin for a urinary tract infection (UTI). Which reported condition suggests an adverse effect of the medication?

Correct response: Vaginal itching Explanation: Adverse effects associated with urinary tract anti-infectives medications like fosfomycin include nausea, vomiting, diarrhea, anorexia, bladder irritation, dysuria, and vaginitis. The medication is not associated with any of the other conditions.

5 See full question 19s A client taking fosfomycin (Monurol) for chronic urinary tract infection notes symptoms of a bladder infection. Which other medication could be interfering with the anti-infective's effectiveness?

Metoclopramide (Reglan) Explanation: Drugs that increase gastric motility, such as metoclopramide and laxatives, will lower the plasma concentration of fosfomycin, so it will be less effective. Phenazopyridine, warfarin, and simvastatin may be taken with fosfomycin without significant interaction. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 572. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 572 Add a Note

12 See full question 27s The nurse is preparing to administer nitrofurantoin to a client. The nurse provides the client with which fluid when administering this medication?

Milk Explanation: Nitrofurantoin should be administered with food or milk to improve absorption. Neither water, vegetable juice, nor orange juice are appropriate to administer with nitrofurantoin.

7 See full question 14s The nurse is counseling a client who has been prescribed nitrofurantoin for treatment of a urinary tract infection. What should the nurse teach the client specific to timing of this medication?

Take it with food or milk. Explanation: Nitrofurantoin should be given with food, meals or milk because this drug is especially irritating to the stomach.

3 See full question 14s A nurse is caring for a client receiving nitrofurantoin drug therapy. What instruction should the nurse include in the teaching plan for the client and family? Select all that apply.

Take the drug with food or milk to improve absorption. Continue therapy for at least 1 week. Notify the PHCP in case of fever, chills, or cough. Explanation: The nurse should instruct the client to take the drug with food or milk to improve its absorption, to continue therapy for at least 1 week, and to notify the PHCP in case of fever, chills, or cough. The nurse should instruct the client receiving fosfomycin drug therapy to dissolve the drug in 90 to 120 mL of water. The nurse instructs the client undergoing methenamine drug therapy to avoid excessive intake of citrus products or milk products. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 574. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 574 Add a Note

11 See full question 11s The nurse counsels the client who has been prescribed nitrofurantoin to avoid the use of magnesium and aluminum salts while on the prescribed medication. Why?

The absorption of the nitrofurantoin will be delayed. Explanation: If nitrofurantoin is given with magnesium trisilicate or magaldrate (used to relieve gastric upset), the nitrofurantoin absorption will be delayed. The client will not develop aluminum toxicity or severe diarrhea, and increased metabolism of nitrofurantoin will not occur. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 572. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 572 Add a Note

17 See full question 19s The nurse is caring for a client being treated for urosepsis. The client's medication regimen includes phenazopyridine. What outcome best indicates therapeutic effects of this medication?

The client reports an absence of urinary burning and pain Explanation: Phenazopyridine is an azo dye that acts as a urinary analgesic and relieves symptoms of dysuria, burning, and frequency and urgency of urination. Phenazopyridine does not treat infection, oliguria or hematuria. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 575. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 575 Add a Note

5 See full question 13s Which manifestations would indicate urinary tract infection? Select all that apply.

Urinary frequency Chills and fever Flank pain Explanation: Urinary frequency, urgency, burning on urination, chills, fever, and flank pain are all symptoms of urinary tract infection (UTI). Volume of urine does not increase with urinary frequency. The size of stream may be reduced from benign prostatic hypertrophy. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

6 See full question 15s What information is the top priority when educating a client who will be taking phenzopyridine?

Wear glasses instead of contact lenses while on medication. Explanation: It is most important to inform the client to wear glasses while on the medication because the fluid that lubricates the eyes may change color, causing permanent discoloration of contact lenses. Drinking extra fluids and taking the medication with food to avoid gastric upset are also teaching points the nurse should includes, however, the priority is related to the impact on eyes due to a permanent, irreversable change that can result from this medication if precaution is not taken. The client should not be told to take the medication for a minimum of three days, the maximum dosage time for this medication is two days, otherwise it can mask a serious disorder. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 574. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 574 Add a Note

20 See full question 18s After administering the prescribed trimethoprim/sulfamethoxazole to a client, the nurse would assess the client for which adverse reactions? Select all that apply.

anorexia glossitis allergic skin reaction Explanation: Adverse reactions associated with trimethoprim/sulfamethoxazole include GI disturbances, allergic skin reactions, headache, anorexia, glossitis, and hypersensitivity. Yellowish discoloration of the sclera and red-orange urine are associated with phenazopyridine.

19 See full question 15s A client who is hospitalized develops a UTI and is receiving anti-infective therapy. The nurse would expect to monitor the client's intake and output at which frequency?

every 8 hours Explanation: The nurse would monitor the client's intake and output every 8 hours. More frequent monitoring would not be necessary unless ordered by the health care provider in conditions such as renal failure. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

4 See full question 8s What should a nurse teach a client with a new prescription for methenamine?

"Don't take this drug if you are allergic to food dye." Explanation: Clients who are allergic to the food dye tartrazine should not take methenamine. Methenamine is used to treat chronic UTI and may cause nausea, vomiting, and bladder irritation. Pyridium is the drug that causes reddish orange urine. Dry mouth and drowsiness comes from antispasmodics. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 572. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 572 Add a Note

20 See full question 11s When describing the use of nitrofurantoin, a nurse explains that this drug has been known to cause acute and chronic reactions in which systems?

respiratory Explanation: The use of nitrofurantoin has been known to cause acute and chronic reactions in the respiratory system. Phenazopyridine adverse reactions are norexia, nausea, vomiting, and diarrhea, abdominal pain or stomatitis. Nitrofurantoin can cause peripheral neuropathy. Cardiovascular concerns are not known adverse reactions with the use of urinary medications.

12 See full question 9s The health care provider has ordered phenazopyridine to a client with a urinary tract infection as a urinary analgesic. The client has also been prescribed an anti-infective. The client may use the phenazopyridine for what duration?

two days Explanation: Phenazopyridine is not administered for more than two days when used in combination with an antibacterial drug to treat a UTI, because it may mask the symptoms of a more serious disorder. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

11 See full question 18s Which statement best indicates that a client knows how much fluid to drink each day to prevent urinary tract infections?

"I try to drink enough fluid so that my urine is pale yellow in color and clear." Explanation: The client is encouraged to drink at least 2,000 mL of fluid daily. The client should gauge the amount of fluid to drink by the color of the urine. It should be pale yellow during the day. The other statements don't indicate an understanding to base fluid intake on the appearance of the urine. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

6 See full question 2m 53s Which statement by a client taking phenazopyridine (Pyridium) and amoxicillin (Amoxil) for a bladder infection indicates a need for further instruction?

"I will call the doctor if my urine turns reddish orange." Explanation: Pyridium acts to relieve pain and spasms and may be stopped when symptoms resolve, but it causes urine to change to a harmless reddish-orange color that does not require medical intervention. The antibiotic should be continued for the full course of treatment and may be taken with food or milk if stomach upset occurs. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 574. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 574 Add a Note

19 See full question 20s The nurse is providing discharge instructions to a client who is taking pentosan polysulfate sodium. Which statement by the client indicates a need for further instruction?

"I will make sure to take this medication with my breakfast." Explanation: Pentosan polysulfate sodium should be taken on an empty stomach, either 1 hour before or 2 hours after meals. The client should call the health care provider at the first sign of bleeding. Alopecia and headache may occur with this medication.

4 See full question 24s A client is taking phenazopyridine (Azo-Standard) and nalidixic acid (Neg Gram) for a urinary tract infection. What is the most important instruction the nurse needs to provide to the client concerning this drug combination?

"If you notice yellowing of your eyes or skin contact your health care provider immediately." Explanation: Yellowing of the sclera and skin is a sign of drug accumulation in the body and a possible sign of hepatic toxicity. Phenazopyridine should not be used more than 2 days especially if taken with an antibacterial agent. The other options are important and should be told to the client. However, the possibility of toxicity is the most important. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

18 See full question 24s The nurse is providing care to an 84 year-old female client who is receiving nitrofurantoin for a urinary tract infection. The client has recently developed an infection to a venous ulcer on her lower leg. The nurse's colleague tells the nurse, "The nitrofurantoin should likely help with her leg ulcer as well as the UTI." What is the nurse's best response?

"Nitrofurantoin doesn't have any systemic effects, so she'll need another antibiotic." Explanation: Urinary tract anti-infectives do not generally have an antibiotic effect systemically, being activated or effective only in the urinary tract. Changing the dose would be of no benefit. Nitrofurantoin is not available intravenously. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 571. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 571 Add a Note

15 See full question 20s The nurse provides the female client what menstrual period information to assist in preventing urinary tract infections? Select all that apply.

"Use tampons instead of pads." "Void when changing the tampon." Explanation: Client teaching for preventing and treating UTIs includes using tampons during the menstrual periods instead of pads, and voiding every four hours and when changing the tampon. No matter what is wiped, it should be front to back, and the prolonged use of a tight garment should be avoided. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

1 See full question 1m 31s A client with a UTI is receiving a urinary tract anti-infective and phenazopyridine. The nurse understands that this drug would be used for no longer than which amount of time?

2 days Explanation: The risk of toxic effects of phenazopyridine increases if it is combined with antibacterial agents used for treating UTIs. When used, phenazopyridine should not be used for longer than 2 days. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

6 See full question 10s The nurse is providing a client with education regarding fluid requirements during a urinary tract infection. The nurse should remind the client to take in how much fluid each day?

2000 mL/day Explanation: The client should be encouraged to drink at least 2000 mL of fluid daily (if condition permits) to dilute urine and decrease pain on voiding. Drinking extra fluids aids in the physical removal of bacteria from the genitourinary tract and is an important part of UTI treatment Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 574. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 574 Add a Note

16 See full question 17s The nurse is admitting a 79 year-old male client whose current medication regimen includes tamsulosin 0.5 mg/day PO. The nurse should include what assessment in the client's plan of care?

Assessment for urgency or frequency Explanation: Tamsulosin is an alpha blocker used to treat benign prostatic hyperplasia. Consequently, the nurse should assess for any urgency or frequency that accompany the condition. It is not used to treat infections, so there is not normally a need for culture and sensitivity testing. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 570. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 570 Add a Note

12 See full question 15s The nurse is caring for a client who is receiving nitrofurantoin for treatment of a urinary tract infection. Which symptoms of adverse reactions reported by the client would cause the nurse to contact the health care provider immediately? Select all that apply.

Chest pain Dyspnea Explanation: If an adverse reaction occurs such as photosensitivity or diarrhea, the health care provider should be notified before the next dose is due. Discoloration of the urine can be expected with this medication. However, serious drug reactions, such as pulmonary reactions (chest pain, dyspnea) are reported immediately. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

Question 4 See full question 20s What foods and beverages that a client usually drinks should be limited, thus helping to reduce irritation to the bladder? Select all that apply.

Correct response: Coffee Diet cola Chocolate milk Explanation: The client should avoid eating foods or drinking liquids that irritate the bladder, such as coffee, tea, alcohol, artificial sweeteners, cholcoate and pepper. The client should be offered such fluids as water or cranberry or prune juice.

9 See full question 19s The nurse is counseling a client on prevention of urinary tract infections. What does the nurse advises the client to use to maintain an acid environment in the bladder? Select all that apply.

Cranberry juice Vitamin C supplements Explanation: Both Vitamin C supplements and cranberry juice help maintain an acid environment in the bladder. Water is helpful in diluting urine but it does not create an acid environment. Pepper and tea will irritate the bladder. Orange juice promotes an alkaline environment and can promote bacterial growth. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

8 See full question 20s The nurse is caring for a client with a urinary tract infection. This may mean the client has been diagnosed with which disorder? (Select all that apply.)

Cystitis Prostatitis Pyelonephritis Explanation: Cystitis is an inflammation of the bladder; prostatitis is an inflammation of the prostate gland; and pyelonephritis is an inflammation of the kidney nephron. All are parts of the urinary tract. Epididymitis is a inflammation in the male reproductive tract, and endometritis is an inflammation in the female reproductive tract. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 570. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 570 Add a Note

9 See full question 16s The nurse knows that the client who is prescribed sulfamethaxazole for treatment of a urinary tract infection is also taking an oral anticoagulant. What modification to this medication regimen will the client receive?

Decreased anticoagulant dose Explanation: Sulfamethaxazole, when taken with an oral anticoagulant, will cause the client to be at an increased risk for bleeding. Thus, the oral anticoagulant dose will be lowered if the client must take sulfamethaxazole. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 572. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 572 Add a Note

4 See full question 13s A small group of nursing students are giving an oral presentation to their classmates about urinary tract infections. What is a measure that can be used to encourage clients to use to reduce the risk of recurrent urinary tract infections?

Drink 2,000 mL to 3,000 mL of fluid daily Explanation: Many activities are necessary to help decrease the bacteria in the urinary tract (e.g., hygiene measures, proper diet, forcing fluids), to facilitate the treatment of UTIs and help the urinary tract anti-infectives be more effective. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

9 See full question 18s The nurse prepares to administer nitrofurantoin 100 mg PO every 12 hours to an adult client newly diagnosed with a urinary tract infection. Which measures would the nurse provide for safe and effective drug administration? Select all that apply.

Inform the client that the medication may cause the urine to turn a harmless brown coloration. Administer the drug with a meal or snack because food helps with drug absorption and decreases onset of GI distress. Explanation: The drug is an anti-infective agent used to treat or prevent urinary tract infections. Phenazopyridine is a urinary analgesic to relieve pain related to urinary burning, urgency, frequency, and irritation of the urinary tract mucosa. The medication may turn urine a harmless brown. The drug is absorbed better when administered with food, and there is a decrease in GI side effects when taken with food. Administering antacid with magnesium will decrease the absorption of the nitrofurantoin. The drug is contraindicated during pregnancy and during the first trimester, increases the risk for birth defects. During the end of pregnancy, the drug increases risk for hemolytic anemia. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

7 See full question 15s What signs or symptoms would alert the nurse caring for a client on long term nitrofurantoin therapy that the client is developing a chronic pulmonary reaction? Select all that apply.

Malaise Nonproductive cough Explanation: A nonproductive cough or malaise may indicate a chronic pulmonary reaction, which may occur during prolonged therapy. Dyspnea, chest pain, cough, fever and chills are indicative of an acute pulmonary reaction related to nitrofurantoin. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

14 See full question 20s The client has been prescribed fosfomycin (Monurol). The nurse is aware that clients who take which medication may not have an effective response to fosfomycin?

Metoclopramide Explanation: Fosfomycin (Monurol) if taken with metoclopramide will cause lowered plasma concentration and urinary tract excretion of the fosfomycin. Fosfomycin may have interactions with the other drugs, but not lowered concentration of the drug itself.

13 See full question 19s The health care provider has prescribed fosfomycin for a client with a urinary tract infection. What information should the nurse give to this client concerning administration requirements? Select all that apply.

Mix in 90-120 mL of water. Medication is taken all at once. Explanation: Fosfomycin (Monurol) has special administration requirements; it comes in a 3-gram, one-dose packet that must be dissolved in 90-120 mL of water (not hot water). Administer the drug immediately after dissolving it in water. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

17 See full question 7s The nurse is caring for a pregnant client who has symptoms of a urinary tract infection. The nurse is aware that which urinary tract anti-infective is allowed to be used during pregnancy?

Nitrofurantoin Explanation: Nitrofurantoin is classified as pregnancy category B and may be used with caution during pregnancy. The other anti-infectives are contraindicated during pregnancy. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 572. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 572 Add a Note

16 See full question 31s A client with a urinary tract infection has been admitted to the unit with shortness of breath and a nursing diagnosis of Ineffective Breathing Pattern, related to adverse reaction to a drug. The nurse knows that the client has been taking which drug for treatment of the infection?

Nitrofurantoin Explanation: Pulmonary reactions have been reported with the use of nitrofurantoin and include dyspnea, chest pain, cough, fever, and chills. The other anti-infectives listed do not have pulmonary adverse reactions. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

1 See full question 22s Which would be most important prior to beginning therapy with a urinary anti-infective agent?

Obtaining a urine culture and sensitivity test Explanation: Although assessing urinary pattern, skin, and level of consciousness would be important to obtain a baseline, obtaining a urine culture and sensitivity test would be most important to ensure proper treatment. Inspecting the skin for rashes would also be helpful once the therapy starts to evaluate for possible hypersensitivity reactions and adverse effects. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 572. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 572 Add a Note

10 See full question 16s The nurse is caring for an older adult. What is the primary nursing intervention to increase fluid intake in older adults?

Offer a variety of fluids to the client every hour. Explanation: Offer fluid, preferably water, to the client at hourly intervals. The client's salt intake should not be increased. The water or fluid should be offered because the older adult often has a decreased thirst sensation, and must be encouraged to increase fluid intake. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

2 See full question 19s A cliient at a health care facility is receiving nitrofurantoin drug therapy for acute bacterial UTIs. What adverse reaction to the drug should the nurse monitor for in the client?

Peripheral neuropathy Explanation: The nurse should monitor for peripheral neuropathy as an adverse reaction in the client receiving nitrofurantoin drug therapy. The nurse need not monitor the client for urinary retention, blurred vision, or diarrhea. Urinary retention and blurred vision are the adverse reactions to flavoxate. Diarrhea is the adverse reaction to nalidixic acid. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 575. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 575 Add a Note

17 See full question 18s A client with interstitial cystitis has just begun to take pentosan polysulfate sodium. The nurse would notify the health care provider if the client exhibited which symptom(s). Select all that apply.

Petechiae Decreased blood pressure Blood in the urine Explanation: Adverse effects associated with pentosan use include bleeding that may progress to hemorrhage (related to the drug's heparin effects), headache, alopecia, and GI disturbances. It would be necessary to notify the health care provider if the client showed any signs of bleeding. Anorexia and headaches are not associated with this drug. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

8 See full question 19s The nurse knows that the health care provider chooses urinary tract anti-infective drugs because of what property?

Rapid excretion rate Explanation: Many of the anti-infective drugs used for treating UTIs are chosen because of the rapid excretion rate of the drugs, rather than the way they act inside the body. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 571. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 571 Add a Note

3 See full question 13s A clinic client has been prescribed phenazopyridine (Pyridium) for aid in treating a UTI. This client should be informed that Pyridium will change the urine to what color?

Reddish-orange Explanation: Phenazopyridine turns urine orange-red, which may be mistaken for blood. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 574. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 574 Add a Note

13 See full question 32s The nurse is aware that urinary tract anti-infectives must be used with caution for clients who have which disorders? Select all that apply.

Renal failure Cirrhosis of the liver Explanation: Urinary tract anti-infectives should be used with caution in clients with renal and hepatic disorders. It is not contraindicated with clients who have cardiac arrhythmias, Bell's palsy or psoriasis.

18 See full question 12s When considering the possible gastrointestinal side effects, what instruction should the nurse provide a client being prescribed a urinary tract antispasmodic?

Take medication with food Explanation: Administer the drug with food if GI upset occurs; encourage fluid intake to maintain urinary flow, flush the bladder, and prevent urinary stasis; use of sugarless hard candy to alleviate dry mouth; there is no restriction on food types while on this medication. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

2 See full question 15s A 50-year-old male calls the clinic nurse and reports gastrointestinal upset after taking nitrofurantoin (Furadantin) on an empty stomach. What recommendation should the nurse make?

Taking the medicine with or after meals Explanation: These effects may result from GI irritation caused by the agent, which may be somewhat alleviated if the drug is taken with food, or from a systemic reaction to the urinary tract irritation. The nurse would not tell the client to stop taking the medication without an order to do so, nor would the nurse tell the client to continue taking the medication on an empty stomach. Advising the client to take the medication along with vitamin C would be of no benefit in the scenario. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 574. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 574 Add a Note

1 See full question 2m 53s When teaching a client who is to receive fosfomycin, the nurse would include what as possible adverse effects? (Select all that apply.)

Vomiting Dysuria Anorexia Explanation: Vomiting is a common adverse effect of fosfomycin. Dysuria is a common adverse effect of fosfomycin. Anorexia is a common adverse effect of fosfomycin. Fatigue is not associated with the use of fosfomycin. Diaphoresis is not associated with the use of fosfomycin. Skin staining is an adverse effect associated with methylene blue. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 571. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 571 Add a Note

19 See full question 24s The hospital nurse is caring for a client who is 24 hours post-operative. The nurse can best prevent the development of a urinary tract infection by:

ensuring the client's urinary catheter is discontinued as soon as possible, as prescribed. Explanation: Indwelling catheters are one of the most significant risk factors for UTI's. Consequently, removing them as soon as they are no longer absolutely necessary reduces the likelihood of UTI's. Adequate fluid intake and consumption of acidic beverages are also beneficial, but to a lesser degree. Early ambulation has many benefits, but prevention of UTI's is not among the main benefits. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 572. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 572 Add a Note

2 See full question 7m 34s It is important for the nurse to obtain an allergy history before administering an anti-infective because clients who are allergic to tartrazine should not take which anti-infectives?

methenamine Explanation: Clients who are allergic to tartrazine should not be administered methenamine because it contains tartrazine dye and an allergic reaction may result. Clients with a history of allergy to penicillin should not take amoxicillin. Ciprofloxacin is a quinolone antibiotic and should not be taken if hypersensitive to the drug. Nitrofurantoin is a nitrofuran antibacterial and is used prophylactically and should be given with food to avoid GI upset. The nurse should administer nitrofurantoin cautiously to clients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 572. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 572 Add a Note

6 See full question 32s The nurse is seeing a pregnant client who has a confirmed urinary tract infection that requires treatment. Which anti-infective medication should the nurse anticipate will be prescribed for this client?

nitrofurantoin Explanation: Anti-infectives are contraindicated in patients with a hypersensitivity to the drugs and during pregnancy (pregnancy category C) and lactation. One exception is nitrofurantoin, which is classified as a pregnancy category B drug and is used with caution during pregnancy. Tartrazine is not an anti-infective but a food dye that is added to the anti-infective medication methenamine.

1 See full question 22s A client with a UTI also has a history of glucose-6-phosphate dehydrogenase (G6PD) deficiency. Based on the nurse's understanding of urinary drugs, the nurse would expect to administer which drug with caution if prescribed?

nitrofurantoin Explanation: The nurse should administer nitrofurantoin cautiously to clients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Methenamine should be used cautiously in clients with gout because it may cause crystals to form in the urine. Clients with a history of allergy to penicillin should not take amoxicillin. Ciprofloxacin is a quinolone antibiotic and should not be taken if hypersensitive to the drug.

3 See full question 8s A client with a urinary tract infection (UTI) has a new prescription for nitrofurantoin. The nurse would question this order if the client has a history of:

renal dysfunction. Explanation: The urinary tract antiseptic nitrofurantoin is commonly prescribed for chronic UTI, because it is concentrated in the urine with minimal systemic effect. It does not affect blood pressure or glaucoma. Because it is concentrated in the urine, it should be used cautiously with clients experiencing renal dysfunction. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 572. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 572 Add a Note

10 See full question 16s A client receiving anti-infective therapy asks the nurse about the best fluids to drink to help eliminate the infection. Which would the nurse suggest as most appropriate? Select all that apply.

water cranberry juice prune juice Explanation: The nurse should suggest water, cranberry juice, and prune juice as fluids to drink, rather than orange juice or other citrus or vegetable juices. With the use of methenamine the client should avoid citrus and milk products.

15 See full question 1m 9s A 7 year-old client who weighs 73.5 lbs. has been diagnosed with a urinary tract infection and prescribed nitrofurantoin 6 mg/kg/day PO in four divided doses. How many 50-mg tablets should the nurse administer for each dose? Your Response: 1

1 Explanation: First, convert the client's weight from pounds to kilograms: 73.5 ÷ 2.2 = 33.4 mg. The ordered dose is 6 mg/kg, and 6 x 33.4 = 200.4 mg. The drug is ordered in divided doses, four times daily, and 200.4 ÷ 4 = 50.1 mg. It would not be possible to administer 0.1 mg using 50 mg tablets, so the nurse should administer one 50-mg tablet. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 575. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 575 Add a Note

14 See full question 17s The nurse is aware that which urinary tract anti-infectives can cause a client to develop a swollen, inflammed tongue (glossitis)? Select all that apply.

Amoxicillin (Amoxil) Trimethoprim and sulfamethoxazole (TMP-SMZ) Explanation: Both amoxicillin and TMP-SMZ can cause glossitis. All of these medications can cause nausea and vomiting. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 575. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 575 Add a Note

7 See full question 17s The nurse caring for a client who takes warfarin (Coumadin) for recurrent deep vein thrombosis (DVT) and recently started taking sulfamethoxazole (Bactrim) for a urinary tract infection notes petechiae in the client's eyes and on the chest. What nursing action is appropriate?

Hold the next Bactrim dose. Explanation: The oral anticoagulants interact with nalidixic acid and sufamethoxazole to increase the risk of bleeding. The antibiotic should be held until the primary health provider can evaluate the client. Blood cultures are not needed unless symptoms of the infection worsen. Fluid intake will help treat the UTI, but will not resolve the drug interaction. Petechiae indicate bleeding, not clotting that might cause a DVT. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 575. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 575 Add a Note

16 See full question 7s The nurse is aware that fosfomycin may be prescribed by the health care provider because of what feature that is unique among the urinary tract anti-infectives?

It is given one time only to treat urinary tract infections. Explanation: Fosfomycin is unique because it is administered as a 3 gram/one-time only dose. All of the other urinary tract anti-infectives can be administered orally, and nausea and vomiting are the most common adverse effects for urinary tract anti-infectives. Most of the other urinary tract anti-infectives are used to treat acute, bacterial urinary tract infections. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 573. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 573 Add a Note

5 See full question 2m 13s A client taking fosfomycin (Monurol) for chronic urinary tract infection notes symptoms of a bladder infection. Which other medication could be interfering with the anti-infective's effectiveness?

Metoclopramide (Reglan) Explanation: Drugs that increase gastric motility, such as metoclopramide and laxatives, will lower the plasma concentration of fosfomycin, so it will be less effective. Phenazopyridine, warfarin, and simvastatin may be taken with fosfomycin without significant interaction. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 572. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 572 Add a Note

10 See full question 11s The acute care nurse abides by what policy to best prevent the occurence of urinary tract infections in hospitalized clients?

Performing good hand hygiene Explanation: The primary nursing intervention to prevent UTIs in the hospitalized client is good hand hygiene. Though it is important that the client's perineum be washed back to front, and that the undergarments are changed in a timely manner and that the client voids frequently, hand washing remains the best way to prevent all infections. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 572. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 572 Add a Note

5 See full question 14s A male client 69 years of age comes to the clinic reporting various urinary symptoms, including reduced flow and blood in the urine. The nurse knows that the health care provider must rule out what condition in this client before treatment is started for benign prostatic hypertrophy?

Prostate cancer Explanation: Prostate cancer should always be ruled out before treatment is started for BPH, because early stage prostate cancer has few signs or symptoms. Ruling out prostate infection, cystitis, and kidney infection is less important than ruling out prostate cancer before BPH treatment begins. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 570. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 570 Add a Note

18 See full question 19s A client at a health care facility is receiving nitrofurantoin drug therapy for acute bacterial UTIs. The nurse would be alert to which as a possible adverse reaction? Select all that apply.

peripheral neuropathy bacterial superinfection Explanation: Adverse reactions associated with nitrofurantoin include nausea, anorexia, headache, peripheral neuropathy, and bacterial superinfection. Diarrhea and glossitis are associated with amoxicillin. Urinary retention is not an associated adverse reaction with nitrofurantoin. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs, p. 571. Chapter 48: Urinary Tract Anti-Infectives and Other Urinary Drugs - Page 571 Add a Note