Chapter 89: Drug Therapy of Urinary Tract Infections

Most cases (more than 80%) of uncomplicated, community-acquired urinary tract infection (UTI) are caused by which bacteria? Klebsiella pneumoniae Escherichia coli Enterobacter spp. Pseudomonas spp.

Escherichia coli

A nurse assesses the history of a patient who has had multiple complicated UTIs for which risk factors? (Select all that apply.) Female gender, child-bearing age Indwelling catheter Prostate hypertrophy Fair skin tone Urinary tract stones

Indwelling catheter Prostate hypertrophy Urinary tract stones

A patient who has acute cystitis is receiving treatment with trimethoprim/sulfamethoxazole. Which manifestation should indicate to a nurse that the patient's condition is worsening? Incontinence Flank pain 3+ pedal edema Hyperactive bowel sounds

Flank pain

The nurse is working with a patient who has a UTI. Because patient adherence to a medication regimen is a concern, the nurse anticipates use of which medication? Fosfomycin Amoxicillin Cephalexin Trimethoprim

Fosfomycin

Which outcomes should a nurse establish when planning care for a patient taking methenamine [Mandelamine]? (Select all that apply.) Maintains a urine pH of 5.5 or lower. Consumes 3000 mL of liquid daily. Uses an enteric-coated formulation. Avoids sulfonamide medications. No elevation in liver enzymes.

Maintains a urine pH of 5.5 or lower. Uses an enteric-coated formulation. Avoids sulfonamide medications.

A patient is to begin taking nitrofurantoin [Macrodantin]. The nurse should teach the patient that which manifestation should be the priority to report to the healthcare provider? Headache and drowsiness Brown-colored urine Nausea and vomiting Muscle weakness and tingling

Muscle weakness and tingling

With the exception of pyelonephritis, the nurse is aware that most urinary tract infections are treated by which method? IV antibiotics at the hospital IV antibiotics in the urgent care setting IM antibiotics at the primary physician's office Oral antibiotics in the home setting

Oral antibiotics in the home setting

The nurse identifies which statements about frequent urinary tract reinfections as true? (Select all that apply.) Reinfections are considered frequent if the individual has three or more a year. Prophylactic therapy should continue for at least 2 months. If reinfection is associated with sexual intercourse, the risk can be reduced by instructing the patient to void after intercourse. Single-dose nitrofurantoin 50 mg taken 1 hour before intercourse has been found to reduce the rate of reinfection. If a symptomatic episode occurs, the standard therapy for acute cystitis should be used.

Reinfections are considered frequent if the individual has three or more a year. If reinfection is associated with sexual intercourse, the risk can be reduced by instructing the patient to void after intercourse. If a symptomatic episode occurs, the standard therapy for acute cystitis should be used.

Before giving methenamine [Hiprex] to a patient, it is important for the nurse to review the patient's history for evidence of which problem? a. Elevated blood urea nitrogen and creatinine b. History of reactions to antibiotic agents c. Possibility of pregnancy d. Previous resistance to antiseptic agents

a. Elevated blood urea nitrogen and creatinine

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

a. begin antibiotic therapy after urine culture and sensitivity results are available.

A pregnant female patient with bacteriuria, suprapubic pain, urinary urgency and frequency, and a low-grade fever is allergic to sulfa, ciprofloxacin, and amoxicillin. The nurse knows that the best alternative for treating this urinary tract infection is with: a. cephalexin [Keflex]. b. fosfomycin [Monurol]. c. methenamine [Hiprex]. d. nitrofurantoin [Macrodantin].

c. methenamine [Hiprex].

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

c. pyelonephritis.

A young, nonpregnant female patient with a history of a previous urinary tract infection is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of 3 days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of urine. The nurse caring for this patient knows that which treatment is most effective? a. A 14-day course of amoxicillin with clavulanic acid [Augmentin] b. A 7-day course of ciprofloxacin [Cipro] c. A single dose of fosfomycin [Monurol] d. A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]

d. A 3-day course of trimethoprim/sulfamethoxazole [Bactrim]

The nurse is aware that acute cystitis occurs most often in which patient population? Older-adult male patients Children younger than 12 years Women of child-bearing age Women older than 50 years

Women of child-bearing age

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

a. "Make sure you tell your prescriber if you might be pregnant." b. "If you experience any tingling or numbness, stop taking the drug and call the clinic immediately." c. "Headaches and drowsiness can occur and are mild side effects." e. "Your urine may have a brown tinge while you are taking this drug."

A pregnant patient with fever, flank pain, and chills has a history of two previous bladder infections before getting pregnant. She is allergic to several antibiotics. She reports having taken methenamine successfully in the past. What will the nurse tell her? a. "This agent is not effective against infections of the upper urinary tract." b. "This antiseptic agent is safe for use during pregnancy and has no drug resistance." c. "This drug is linked to many serious birth defects and is not recommended during pregnancy." d. "You will need to take this medication with meals to avoid gastric upset."

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

The nurse is discussing upper and lower UTIs. Which of these conditions can be treated at home? (Select all that apply.) a. Acute cystitis b. Acute urethritis c. Recurrent UTI d. Severe pyelonephritis e. Acute bacterial prostatitis

a. Acute cystitis b. Acute urethritis c. Recurrent UTI

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

c. "You will need to take a low dose of medication for 6 months to prevent infections."

The parent of a 5-year-old child who has had four urinary tract infections in the past year asks the nurse why the provider doesn't just order an antibiotic for the child's current symptoms of low-grade fever, flank pain, and dysuria since these are similar symptoms as before. Which is the most important reason given by the nurse? a. "Your child may need to be hospitalized for treatment." b. "Your child may need a urine culture before and after treatment." c. "Your child may need tests to assess for urinary tract abnormalities." d. "Your child may need additional medications, such as urinary tract antiseptics."

c. "Your child may need tests to assess for urinary tract abnormalities."

An older male patient comes to the clinic with complaints of chills, malaise, myalgia, localized pain, dysuria, nocturia, and urinary retention. The nurse would most likely suspect that the patient has: a. acute cystitis. b. urinary tract infection. c. pyelonephritis. d. prostatitis.

d. prostatitis.

A patient is taking nitrofurantoin [Macrodantin]. Which finding should a nurse recognize as an indication that the treatment is having an undesired effect? Hyperpigmentation of the palms Dyspnea with chills Gum irritation with bleeding Scalp tenderness and thinning hair

Dyspnea with chills

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

a. Uncomplicated lower urinary tract infection treatable with short-course therapy

A patient has a positive urine culture 1 week after completion of a 3-day course of antibiotics. The nurse anticipates that the prescriber will: a. begin a 2-week course of antibiotics. b. evaluate for a structural abnormality of the urinary tract. c. initiate long-term prophylaxis with low-dose antibiotics. d. treat the patient with intravenous antibiotics.

a. begin a 2-week course of antibiotics.

Which patient with a urinary tract infection will require hospitalization and intravenous antibiotics? a. A 5-year-old child with a fever of 100.5°F, dysuria, and bacteriuria b. A pregnant woman with bacteriuria, suprapubic pain, and fever c. A young man with dysuria, flank pain, and a previous urinary tract infection d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter

d. An older adult man with a low-grade fever, flank pain, and an indwelling catheter

A patient who is taking nitrofurantoin calls the nurse to report several side effects. Which side effect of this drug causes the most concern and would require discontinuation of the medication? a. Anorexia, nausea, and vomiting b. Brown-colored urine c. Drowsiness d. Tingling of the fingers

d. Tingling of the fingers