Pharmacology: Chapter 41: Drugs Used to Treat Disorders of the Urinary System

A patient has been taking an antimicrobial agent prescribed to treat a UTI for 2 days. She contacts the healthcare provider's office to report persistence of symptoms. In evaluating the medication effectiveness, which assessment(s) would be important? (Select all that apply.) a. Complete emptying of the bladder b. Amount of pain with urination as well as frequency c. Amount of daily fluid intake and output d. GI symptom complaints e. Bleeding with urination f. Persistence of nocturia

a. Complete emptying of the bladder b. Amount of pain with urination as well as frequency c. Amount of daily fluid intake and output d. GI symptom complaints e. Bleeding with urination Focused assessment of UTI symptoms includes assessing for urinary retention, pain and/or burning with urination, intake and output, GI symptoms, and bleeding with urination. Nocturia is common with OAB syndrome, not a UTI.

How often is fosfomycin (Monurol) usually administered when used in the treatment of UTIs? a. In a one-time dose b. Once per day c. Once per week d. Monthly

a. In a one-time dose Fosfomycin is the first antibiotic to be approved for administration in a single treatment dose for the treatment of UTIs. Fosfomycin is used to treat females with uncomplicated acute cystitis caused by susceptible strains of Escherichia coli and Enterococcus faecalis. Fosfomycin is not used in the treatment of kidney infections.

The nurse is assisting with postpartum care for a mother who has given birth to her fourth child. She reports a moderate amount of urinary incontinence since the birth of the third child and is concerned that this problem will worsen. Which instruction(s) may facilitate management of incontinence? (Select all that apply.) a. Instruction of proper wiping techniques to prevent bacterial infection b. Education on bladder training and Kegel exercises c. Information on personal hygiene measures to prevent perianal breakdown d. Information of incontinence products and appliances e. Importance of establishing a regular toileting schedule f. Importance of increasing fluid intake

a. Instruction of proper wiping techniques to prevent bacterial infection b. Education on bladder training and Kegel exercises c. Information on personal hygiene measures to prevent perianal breakdown d. Information of incontinence products and appliances e. Importance of establishing a regular toileting schedule Patient education for incontinence includes teaching about proper wiping technique to prevent infection, Kegel and bladder training exercises, personal hygiene measures to prevent perianal breakdown, incontinence products and appliances for personal use, and the importance of responding to the urge to void and maintaining a regular toilet schedule. Patient education for incontinence does not include increasing fluid intake.

The nurse is teaching a patient about the anticholinergic agent prescribed for urinary retention. Which statement by the patient indicates a need for further teaching? a. "I will chew gum to relieve dry mouth." b. "I will limit my fluid intake." c. "I will eat fresh fruits." d. "I will not drive if I develop blurred vision."

b. "I will limit my fluid intake." Adequate fluid intake will help prevent constipation, which is a common adverse effect of urinary retention. Dry mouth can be relieved by chewing gum. Fresh fruits will help prevent constipation. Caution patients not to drive until they have adjusted to blurred vision.

Which intervention(s) will help stimulate urination when a patient is experiencing postoperative urinary retention? (Select all that apply.) a. Reinforcing Kegel exercises b. Administration of bethanechol chloride (Urecholine) c. Pouring warm water over the perineum d. Increasing IV fluids e. Urinary catheterization

b. Administration of bethanechol chloride (Urecholine) c. Pouring warm water over the perineum Administration of bethanechol chloride stimulates the parasympathetic nerve, causing contraction of the detrusor urinae muscle in the bladder, usually resulting in urination. Placing the patient in the proper position to void, pouring warm water over the perineum, and running water in the sink are techniques used to assist with voiding. Although Kegel exercises may help patients with incontinence, it will not help in postoperative urinary retention. Increasing IV fluids and catheterization will not help stimulate urination.

A 14-year-old male is taking tolterodine (Detrol). What is the action of this drug? a. Restores bladder tone and function. b. Decreases the urge to void. c. Prevents urinary retention. d. Acidifies urine.

b. Decreases the urge to void. Tolterodine is used to reduce the urgency and frequency of bladder contractions and delay the initial desire to void in patients with an OAB. Tolterodine does not restore bladder tone and function, prevent urinary retention, or acidify urine.

The nurse is reviewing the urinalysis results of an older adult patient admitted with elevated temperature and incontinence. Which urinalysis properties are indicative of an infection? (Select all that apply.) a. Straw color b. Foul odor c. Trace glucose d. pH of 8.2 e. Specific gravity of 1.014

b. Foul odor d. pH of 8.2 Urinalysis properties indicating infection include a foul odor and pH greater than 8.0. Urine the color of straw, clear yellow, or amber is a normal finding. A trace amount of glucose in the urine is a normal finding. The normal range of specific gravity is 1.003 to 1.029.

What may become discolored by phenazopyridine (Pyridium) in addition to the urine? a. Feces b. Sclera c. Sputum d. Saliva

b. Sclera The urinary analgesic phenazopyridine hydrochloride will commonly turn the urine reddish orange. It may also affect the skin or sclera, in which case the healthcare provider should be contacted. Phenazopyridine does not discolor feces, sputum, or saliva.

Fluoxetine, erythromycin, clarithromycin, ketoconazole, itraconazole, miconazole, vinblastine, ritonavir, and nefazodone may inhibit the metabolism of which drugs? (Select all that apply.) a. Warfarin b. Tolterodine c. Phenytoin d. Darifenacin e. Heparin f. Solifenacin

b. Tolterodine d. Darifenacin f. Solifenacin These agents inhibit the metabolism of tolterodine, darifenacin, and solifenacin. Warfarin, phenytoin, and heparin are not influenced by these drugs.

The nurse is caring for a patient taking Pyridium for the diagnosis of UTI. What should the nurse report to the healthcare provider? (Select all that apply.) a. Orange-colored urine b. Yellow sclera c. Flushing of the skin d. Headache e. Increased pain and burning

b. Yellow sclera e. Increased pain and burning Yellow sclera and skin can indicate serious adverse effects of Pyridium. Pyridium should decrease pain and burning. Orange urine, flushing of the skin, and headache are expected adverse effects.

A 42-year-old woman is admitted with complaints of dysuria, frequency, and lower back pain. The urinalysis report is positive for red blood cells, and the blood work shows an elevated white blood cell count. Which medication will the nurse anticipate that the healthcare provider will order? a. Meperidine (Demerol) b. Bethanechol chloride (Urecholine) c. Ciprofloxacin (Cipro) d. Metronidazole (Flagyl)

c. Ciprofloxacin (Cipro) Dysuria, frequency, lower back pain, hematuria, and leukocytosis are indicators of a UTI. A variety of antimicrobial agents, including ciprofloxacin, are used to treat UTIs. Meperidine masks symptoms of pain that could lead to a more specific diagnosis and will not treat the underlying problem. Bethanechol is given for treatment of nonobstructive urinary retention. Metronidazole is given for treatment of vaginal infections.

Which organism causes most UTIs? a. Proteus mirabilis b. Klebsiella pneumoniae c. E. coli d. Pseudomonas aeruginosa

c. E. coli Gram-negative aerobic bacilli from the gastrointestinal (GI) tract cause most UTIs. Escherichia coli accounts for about 80% of non-institutionally acquired uncomplicated UTIs. Although common, P. mirabilis and K. pneumoniae are not responsible for most UTIs. Pseudomonas aeruginosa is not the most common cause of UTIs.

A patient is complaining of moderate bladder pain and spasms secondary to a UTI. Which drug would assist in relieving symptoms? a. Tolterodine (Detrol) b. Nitrofurantoin (Furadantin) c. Phenazopyridine hydrochloride (Pyridium) d. Oxybutynin chloride (Ditropan)

c. Phenazopyridine hydrochloride (Pyridium) Phenazopyridine relieves burning pain, urgency, and frequency associated with UTIs. Tolterodine is given for treatment of overactive bladder (OAB). Nitrofurantoin is given for treatment of UTIs but does not treat bladder pain or spasms. Oxybutynin is given for treatment of OAB.

Which condition will neostigmine be used to treat? a. OAB b. UTI c. Postoperative or postdelivery urinary retention d. Benign prostatic hypertrophy

c. Postoperative or postdelivery urinary retention Neostigmine is an anticholinesterase agent that binds to cholinesterase, preventing the destruction of acetylcholine. The acetylcholine accumulates at cholinergic synapses, and its effects become prolonged and exaggerated. This produces a general cholinergic response manifested by miosis; increased tone of intestinal, skeletal, and bladder muscles; bradycardia; stimulation of secretions of the salivary and sweat glands; and constriction of the bronchi and ureters. An OAB is treated with anticholinergic agents. Anticholinergic agents with more selective action on the bladder are darifenacin, oxybutynin, solifenacin, tolterodine, and trospium. UTIs are treated with antiinfectives. Benign prostatic hyperplasia-related urinary problems are treated with anticholinergic medications.

When obtaining urine for analysis on a patient in the labor and birth unit, the nurse assesses the urine to appear frothy. The nurse interprets this as a sign of possible: a. gestational diabetes. b. infection. c. preeclampsia (toxemia). d. dehydration.

c. preeclampsia (toxemia). Foamy or frothy urine may indicate protein; proteinuria is associated with kidney disease, toxemia of pregnancy (also found in leukemia), lupus erythematosus, and cardiac disease. Foamy or frothy urine does not indicate gestational diabetes, infection, or dehydration.

What is the action of urinary antimicrobial agents? a. Reduce pain associated with bladder spasms caused by the infection. b. Enhance output enough to flush out the infection from the urinary tract. c. Eliminate urinary retention. d. Have an antiseptic effect on the urine and the urinary tract.

d. Have an antiseptic effect on the urine and the urinary tract. Urinary antimicrobial agents have an antiseptic effect on the urine and the urinary tract. Pyridium reduces pain associated with bladder spasms related to urinary tract infection (UTI). Antimicrobial agents do not enhance output or eliminate urinary retention.

After undergoing prostate surgery, a patient is discharged on the medication phenazopyridine hydrochloride (Pyridium) to assist with urinary catheter discomfort. What information will the nurse include in the discharge teaching? a. Urine will have a foul smell while taking this medication. b. Diarrhea and abdominal cramping are expected adverse effects. c. The sclera of the eye is yellow while on therapy. d. Urine will appear reddish orange.

d. Urine will appear reddish orange. Phenazopyridine hydrochloride is used to produce a local anesthetic effect on the mucosa of the ureters and bladder. Patients should be instructed that phenazopyridine causes urine to become reddish orange, which is not a cause for alarm. Other secretions may also be reddish orange and contact lenses may become stained. Phenazopyridine does not cause a foul odor in the urine. Diarrhea is not a common adverse effect of phenazopyridine. Icterus is a sign of hepatic damage and should be reported to the healthcare provider.

The nurse is preparing to administer a single-dose packet of fosfomycin to a patient diagnosed with a UTI. When preparing this medication, the nurse will: a. pour contents into a soufflé cup and administer by mouth. b. mix with 3 mL of normal saline and inject subcutaneously. c. pour contents into 90 mL of juice, stir, and administer by mouth. d. mix contents with 120 mL of water and administer by mouth.

d. mix contents with 120 mL of water and administer by mouth. Fosfomycin is administered by pouring the entire contents of a single-dose packet into 90 to 120 mL of water. Fosfomycin is not injected. Hot water should not be used.