NUR 212: Chapter 89 Drug Therapy for UTI's

When teaching a patient with genital herpes about treatment with valacyclovir, the nurse should include which statement?

"The intensity of infection episodes is reduced when the medication is taken daily." Rationale: Valacyclovir can reduce symptoms and shorten the duration of pain and viral shedding. Valacyclovir does not eliminate genital herpes entirely; therefore, patients must continue to use condoms and abstain from sex at times when the infection is active. Continuous daily administration of valacyclovir has been found to reduce the frequency and intensity of episodes, whereas episodic treatment simply reduces symptoms once an episode has begun.

Oral trimethoprim/sulfamethoxazole (TMP/SMZ) is prescribed for a patient and is being administered four times a day. Which intervention is appropriate?

Call the health care provider. Rationale: The nurse should call the health care provider to clarify this order. The half-life of this drug is 8 to 12 hours; the patient should receive the medication twice a day. The medication should not be scheduled four times a day. Oral TMP/SMZ is not expected to cause ototoxicity and should not have an interaction with milk.

When the nurse teaches high school students about sexually transmitted diseases (STDs), which infection will the nurse identify as the most common STD?

Chlamydia Rationale: Chlamydia trachomatis is the most frequently reported bacterial STD.

The primary health care provider has prescribed trimethoprim/sulfamethoxazole (TMP/SMZ) for a patient. The nurse recognizes that this may be prescribed to treat which condition?

Chronic urinary tract infection (UTI) Rationale: TMP/SMZ is a combination of trimethoprim and sulfonamide antibiotics and is used to treat chronic UTIs. Urinary antispasmodics, such as oxybutynin are used to treat urinary incontinence and urgency. Phenazopyridine hydrochloride is a urinary analgesic that is used for relieving pain and burning during urination. Antimuscarinic drugs, such as tolterodine tartrate are used for the treatment of overactive bladder disorder.

The nurse teaches the patient taking sulfamethoxazole the importance of which action to reduce crystalluria?

Increase fluid intake. Rationale: The nurse should teach the patient taking sulfamethoxazole the importance of increasing fluid intake to reduce crystalluria. The other answers do not affect crystalluria caused by sulfonamides.

The nurse should educate a patient with pelvic inflammatory disease (PID) about which potential long-term complication of PID?

Infertility Rationale: Acute pelvic inflammatory disease (PID) is a syndrome that includes endometritis, pelvic peritonitis, tubo-ovarian abscess, and inflammation of the fallopian tubes. Infertility can result from fallopian tube scarring. Bacterial endocarditis, cervical cancer, and renal tubular necrosis are not associated with complications of PID.

A patient reports flank pain and painful urination. On assessment, the nurse finds that the patient has a high fever. The nurse should notify the provider because the patient has symptoms of which condition?

Pyelonephritis Rationale: Pyelonephritis is an upper urinary tract infection (UTI). The symptoms of pyelonephritis include flank pain, painful urination, high fever, chills, and pus in the urine. Cystitis, urethritis, and prostatitis are lower UTIs. The symptoms of lower UTIs include painful urination, increased urinary frequency, and urgency.

Which of the following sulfonamides, applied topically, has the greatest therapeutic benefit for burns?

Silver sulfadiazine Rationale: Silver sulfadiazine is a topical antiinfective agent used to treat and prevent infection in second- and third-degree burns. Its effects are due primarily to the release of free silver and not to the sulfonamide portion of the molecule. Sulfadiazine and trimethoprim are sulfonamides used systemically, not topically. Sulfacetamide is used for superficial infections of the eye.

The nurse is caring for a patient who is on trimethoprim/sulfamethoxazole (TMP/SMZ) treatment. The laboratory reports show decreased platelet and white blood cell counts. What should the nurse interpret from these findings?

The patient has blood dyscrasias. Rationale: TMP/SMZ may cause hematologic reactions in the patient. This may result in blood dyscrasias and life-threatening anemia in the patient. Sore throat, purpura, and decreased platelet and white blood cell count are symptoms of hematologic reactions. Hematologic reactions may lead to blood dyscrasias. Hyperkalemia does not affect platelet and white blood cell count. Muscle weakness and tiredness are the manifestations of hyperkalemia. Anal or genital discharge, furry black tongue, and stomatitis are manifestations of a superinfection. Reddened and burning skin is a manifestation of photosensitivity reaction.

During the assessment of a patient with acquired immunodeficiency syndrome (AIDS), the nurse finds that the primary health care provider has prescribed trimethoprim/sulfamethoxazole (TMP/SMZ). What is the reason for the prescription?

To prevent Pneumocystis jiroveci infection. Rationale: The patient with acquired immunodeficiency syndrome (AIDS) has a risk of developing Pneumocystis jiroveci infection as a result of reduced immunity. The antibacterial medication TMP/SMX has synergistic action and prevents P. jiroveci infection. Unlike sulfacetamide sodium, TMP/SMX is not available in ophthalmic dosage form and is not used to treat corneal ulcers. TMP/SMX has antibacterial action. It is not effective against viral and fungal infections because it does not inhibit the growth of viruses and fungi.

Before administering trimethoprim, it is most important for the nurse to assess the patient for a history of which condition?

Alcoholism Rationale: Trimethoprim inhibits bacterial synthesis of folic acid. It should be avoided in patients when folate deficiency is likely, such as in alcoholism, because bone marrow suppression may occur. Heart failure, diabetes, and emphysema are unrelated to adverse effects with trimethoprim.

A patient with type 2 diabetes mellitus is started on co-trimoxazole. Which nursing intervention is a priority for this patient?

Assess blood sugar. Rationale: The best answer would be to assess blood sugar. Co-trimoxazole increases the hypoglycemic response when taken with sulfonylureas (oral hypoglycemic agents). The nurse should assess blood sugar and determine which oral hypoglycemic agent the patient is taking. Trimethoprim/sulfamethoxazole is generally well tolerated; the most common side effects are nausea, vomiting, and rash. Blood dyscrasias (hemolytic anemia, agranulocytosis, leukopenia, thrombocytopenia, aplastic anemia) can happen. Blood pressure would not necessarily be assessed unless patient condition is determined.

A patient has been taking sulfonamides long term. The nurse assesses the patient and finds bruises on the legs and arms. What is the nurse's bestaction?

Assess the patient's platelet counts. Rationale: The nurse should assess the patient's platelet counts. Blood disorders such as hemolytic anemia, aplastic anemia, and low white blood cell and platelet counts could result from prolonged use and high dosages of sulfonamides. Asking the patient if someone is abusing him or her is not an appropriate response in this case, nor should the nurse tell the patient to "be more careful" without assessing what has caused the bruises. The nurse should not administer vitamin K without performing an assessment to determine the cause of the bruises. Vitamin K is only appropriate in certain bleeding instances and is not automatically ordered for patients with bruises.

Which outcome should a nurse establish for a patient with trichomoniasis who is receiving metronidazole?

Decrease in yellow-green, odorous vaginal discharge. Rationale: In women, trichomoniasis may be asymptomatic or may cause a diffuse, malodorous, yellow-green vaginal discharge, along with burning and itching sensations. Painful urination and watery discharge are associated with infection with herpes simplex virus type 2. Pain in the back of the testicles is the primary symptom of acute epididymitis, which is caused by gonorrhea or Chlamydia organisms. Genital and perianal warts are caused by human papillomaviruses.

A patient is taking nitrofurantoin. Which finding should a nurse recognize as an indication that the treatment is having an undesired effect?

Dyspnea with chills Rationale: Nitrofurantoin, a urinary tract antiseptic, may induce a pulmonary reaction that manifests with dyspnea, chest pain, and chills. These symptoms, which resolve 2 to 4 days after the drug is stopped, are thought to be hypersensitivity reactions. Hyperpigmentation of the palms, gum irritation with bleeding, and scalp tenderness and thinning hair are not side effects associated with nitrofurantoin.

A patient presents to the clinic with a urinary tract infection (UTI). The nurse anticipates an antibacterial medication that is effective against which organism to be prescribed?

Escherichia coli Rationale: Most cases of uncomplicated, community-acquired UTI are caused by Escherichia coli. In rare cases, other gram-negative bacilli (eg, Klebsiella pneumoniae, Enterobacter, and Pseudomonas) are the cause.

Which organism most commonly causes cystitis?

Escherichia coli Rationale: The majority (more than 80%) of uncomplicated, community-associated urinary tract infections (UTIs) are caused by Escherichia coli. Rarely, other gram-negative bacilli— Klebsiella pneumoniae, Enterobacter, Proteus, Providencia, and Pseudomonas—are the cause. Gram-positive cocci, especially Staphylococcus saprophyticus, account for 10% to 15% of community-associated infections. Hospital-associated UTIs are frequently caused by Klebsiella, Proteus, Enterobacter, Pseudomonas, staphylococci, and enterococci; E. coli is responsible for less than 50% of these infections. Although most UTIs involve only one organism, infection with multiple organisms may occur, especially in patients with an indwelling catheter, renal stones, or chronic renal abscesses.

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?

Flank Pain Rationale: Flank pain may indicate continued infection or pyelonephritis. When acute cystitis is treated with a traditional agent of choice, such as trimethoprim/sulfamethoxazole, manifestations of dysuria, urinary urgency and frequency, suprapubic discomfort, and bacteriuria improve. Incontinence, 3+ pedal edema, and hyperactive bowel sounds are unrelated to acute cystitis.

A patient asks about a urinary tract infection (UTI) antibiotic that requires only one dose. Which first-line UTI antibiotic requires only one dose?

Fosfomycin Rationale: Fosfomycin is a first-line UTI antibiotic that requires just one dose. Ciprofloxacin is not a first-line UTI antibiotic and requires more than one dose. Nitrofurantoin (monohydrate) and TMP/SMZ are first-line UTI antibiotics but require more than one dose.

The nurse is working with a patient who has a urinary tract infection (UTI). Because patient adherence to the medication regimen is a concern, the nurse anticipates use of which medication?

Fosfomycin Rationale: When adherence is a concern, fosfomycin, which requires just one dose, is an attractive choice. As a rule, amoxicillin and cephalexin are avoided, because they are less effective than the alternatives and are less well tolerated. Trimethoprim requires a longer course of therapy than fosfomycin.

What is the mechanism of action for nitrofurantoin?

It injures bacteria by damaging DNA. Rationale: The mechanism of action for nitrofurantoin is that it injures bacteria by damaging the DNA of the bacteria. Methenamine is a prodrug that, under acidic conditions, breaks down into ammonia and formaldehyde. The formaldehyde denatures bacterial proteins, causing cell death. Other types of antibiotics have mechanisms of action that include inhibiting protein synthesis and weakening the bacterial cell wall.

What medication is most often associated with treatment of bacterial vaginosis?

Metronidazole Rationale: Metronidazole is the oral treatment used for bacterial vaginosis. The treatment of choice for syphilis is penicillin G. The current treatment of choice for gonorrhea is cephalosporins. Ceftriaxone is used for treatment of neurosyphilis.

A breast-feeding mother has been prescribed a sulfonamide. The nurse should recommend the patient either request a different antibiotic or discard expressed breast milk and provide the infant with formula to prevent kernicterus. Which term should the nurse use to describe kernicterus to the mother?

Neurologic disorder Rationale: Kernicterus is a disorder in newborns caused by deposition of bilirubin in the brain, which leads to severe neurologic disorder and death. Sulfonamides promote kernicterus by displacing protein-bound bilirubin from the proteins, leaving newly freed bilirubin access to brain sites. Sulfonamides are not administered to infants under 2 years old, nor are they given to pregnant patients near term or to nursing mothers. Hemolytic anemia, hepatocellular failure, and ophthalmic infection are not associated sulfonamide effects in infants.

The nurse is providing education to a patient prescribed oral sulfonamide therapy. The nurse should instruct the patient to take the sulfonamide under which circumstance?

On an empty stomach, with a full glass of water. Rationale: Oral sulfonamides should be taken on an empty stomach and with a full glass of water. To minimize the risk of renal damage, adults should maintain a daily urine output of 1200 mL. Sulfonamides should not be taken with soy or nonmilk products or food or before breakfast without liquids.

With the exception of pyelonephritis, the nurse should be aware that mosturinary tract infections (UTIs) are treated by which method?

Oral antibiotics in the home setting. Rationale: Except for pyelonephritis, most UTIs can be treated with oral therapy at home. Complicated UTIs and pyelonephritis require IV antibiotics in the hospital. IM antibiotics are infrequently used in the treatment of UTIs.

The nurse is assessing a patient with acute cystitis. Which symptom would the nurse expect to find in the patient?

Painful urination. Rationale: Acute cystitis is a lower urinary tract infection. Symptoms of acute cystitis include pain and burning sensation during urination. Pus in the urine, high fever, and chills are signs and symptoms of an upper urinary tract infection, such as pyelonephritis. Nausea and vomiting are not symptoms of acute cystitis; these are nonspecific symptoms and can be caused by many conditions.

A patient who has syphilis is to start treatment. It is most important for the nurse to ask the patient about allergies to which antibiotic?

Penicillin G Rationale: Penicillin G is the drug of choice for all stages of syphilis. Tetracycline and azithromycin may be used in patients with a penicillin allergy. Cefoxitin is not used in the treatment of syphilis.

A patient is diagnosed with syphilis. What is the treatment of choice for this condition?

Penicillin G Rationale: The treatment of choice for syphilis is penicillin G. The current treatment of choice for gonorrhea is cephalosporins. Ceftriaxone is used for treatment of neurosyphilis. Metronidazole is used for bacterial vaginosis.

A patient who has acquired immunodeficiency syndrome (AIDS) is receiving trimethoprim/sulfamethoxazole (TMP/SMZ). Which response should a nurse expect if the medication is achieving the desired effect?

Resolution of pneumonia Rationale: TMP/SMZ is the treatment of choice for Pneumocystis pneumonia (PCP), an infection caused by Pneumocystis jiroveci (formerly thought to be Pneumocystis carinii). PCP is an opportunistic pneumonia caused by a fungus that thrives in immunocompromised hosts. It does not increase the number of CD4 T cells, the targeted cells of the human immunodeficiency virus (HIV), nor does it affect joint pain. Increased appetite and weight gain are not therapeutic actions of TMP/SMZ.

Which finding should the nurse expect when assessing a male patient with secondary syphilis?

Skin lesions and flu-like symptoms Rationale: Secondary syphilis develops 2 to 6 weeks after emergence of the primary lesion (a chancre , which is a hard, red, protruding, painless sore at the urethra of the penis). Symptoms of secondary syphilis result from the spread of Treponema pallidum by way of the bloodstream and manifest as skin lesions, along with flu-like symptoms and enlarged lymph nodes. Heart valve and aortic damage may develop with tertiary syphilis. A thin, watery urethral discharge is unrelated to syphilis.

Which medication is combined with sulfamethoxazole as a powerful antimicrobial preparation whose components act in concert to inhibit sequential steps in tetrahydrofolic acid synthesis?

Trimethoprim Rationale: Trimethoprim is combined with sulfamethoxazole as a powerful antimicrobial preparation whose components act in concert to inhibit sequential steps in tetrahydrofolic acid synthesis. This combination is called TMP/SMZ, Bactrim, or Septra. Penicillin, tetracycline, or erythromycin are not combined with sulfamethoxazole.

Which sulfonamide has bactericidal activity?

Trimethoprim/sulfamethoxazole (TMP/SMZ) Rationale: TMP/SMZ has a bactericidal action. It inhibits folic acid synthesis and protein synthesis of nucleic acids, which are essential for the formation of genetic material. As a result of impaired formation of the genetic material and proteins, bacteria are destroyed. The other sulfonamides such as sulfasalazine sulfadiazine and silver sulfadiazine are bacteriostatic because they only inhibit the growth of the bacteria but do not destroy it.

The nurse is aware that acute cystitis occurs most often in which patient population?

Women of child-bearing age Rationale: Acute cystitis is a lower urinary tract infection that occurs most often in women of child-bearing age. It is less likely to occur in other patient populations, including older adult patients (both male and female) and children younger than 12 years.

While teaching a patient about urinary tract infections (UTIs), the nurse is aware that which statements are true about UTIs? Select all that apply.

-Most UTIs are associated with Escherichia coli. -Urethritis, cystitis, and pyelonephritis are types of UTIs. -Complicated UTIs are often associated with a predisposing factor such as renal calculi. Rationale: True statements about UTIs are that most UTIs are associated with Escherichia coli. In addition, urethritis, cystitis, and pyelonephritis are types of UTIs. Furthermore, complicated UTIs are associated with a predisposing factor such as renal calculi. On the other hand, UTIs are more common in women than men mostly because of the length of the urethra. UTIs are the second most common infection encountered today in the United States.

A patient suspected of having an acute upper urinary tract infection (UTI) is admitted to the hospital. Which is the priority nursing action for this patient?

Assess the patient's symptoms. Rationale: The first priority is to assess the patient's symptoms related to UTI. The nurse should also assess the patient for signs and symptoms of urinary incontinence, pain during urination, and frequency and urgency of urination. The next step is to monitor urine culture and sensitivity results to find the causative organism of the infection. Based on the culture results, specific antibiotics can be administered to the patient as prescribed by the primary health care provider. If the test results reveal that the patient has a severe infection, specific antibiotics would be given intravenously to ensure an effective recovery.

A patient is being treated for syphilis. Which drug would the nurse anticipate to be prescribed?

Benzathine penicillin G Rationale: The drug of choice for all stages of syphilis is benzathine penicillin G. Acyclovir is used in the treatment of genital herpes. Metronidazole is often used to treat infections caused by Trichomonas vaginalis. Ceftriaxone is effective in the treatment of gonorrhea.

Which condition is referred to as pyelonephritis?

Inflammation of the kidney(s) Rationale: Pyelonephritis is inflammation of the kidney(s). Vaginitis is inflammation of the vagina. Urethritis is inflammation of the urethra. Cystitis is inflammation of the bladder.

A patient has been prescribed trimethoprim/sulfamethoxazole (TMP/SMZ). Which intervention is appropriate?

Instruct the patient to increase fluids in the diet. Rationale: When taking TMP/SMZ, increased fluid intake is highly recommended to avoid complications such as crystallization in the urine. The course of therapy is not always 14 days; the patient does not have to take the drug on a full stomach, and the drug is not prescribed only for urinary tract infections.

During the assessment of a pregnant patient in labor, the nurse finds that the patient has active genital herpes lesions. What is the best strategy to prevent the spread of infection to the newborn?

Performing a cesarean section Rationale: Genital herpes is caused by herpes simplex virus type 2. It is characterized by genital warts and spreads by physical contact and sexual transmission. Because the patient is in labor, there is no time to treat the lesions. Neonatal herpes infection is often considered life threatening. The best treatment strategy to prevent the spread of the infection to the newborn is delivery via cesarean section. This helps prevent contact between the newborn and the site of infection. Folic acid supplements help to prevent spina bifida. They do not help to prevent the spread of infection. Delivering the child by vaginal delivery exposes the newborn to herpes. Administering antiviral medication by the IV route during pregnancy may cause congenital abnormalities in the fetus.