UTI and STD Drug Therapy (Exam Style)
______ End of Capillary Hydrostatic Pressure > Oncotic Pressure - Fluid moves into interstitial space - Filtration
Arterial
Fluid volume deficit stimulates volume-sensitive receptors - ______ - _______ _________
Atria Thoracic Vessels
Sulfonamides are often preferred drugs for acute urinary tract infections (UTIs). About 90% of UTIs are due to which bacteria? a) Escherichia coli b)Pneumocystis jiroveci c)Chlamydia trachomatis d)Plasmodium falciparum
Escherichia coli
D5LR D5 0.45NaCl 3% NaCl Draws fluid out of the cells and into the circulating blood volume Would help with ____ Fluid Replacement Therapy
Hypertonic
Osmolality of ECF is > 294 mOsm Etiology -Hypernatremia (serum sodium > 147 mEq/L) -Not usually caused by dietary intake of sodium -More likely caused by excess IV fluids -Water Deficit -Insufficient water intake (hypovolemia) -Fever, profuse sweating or severe diarrhea
Hypertonic contraction
When planning care for a patient receiving a sulfonamide antibiotic, which is the appropriate intervention? A) Force fluids to at least 2000 mL/day. b) Encourage liquids that produce acidic urine. C) Encourage a diet that causes an alkaline ash. d) Insert a Foley catheter for accurate input and output measurement.
a
With the exception of pyelonephritis, the nurse should be aware that most urinary tract infections are treated by which method? a)IV antibiotics at the hospital b)Oral antibiotics in the home setting c) IV antibiotics in the urgent care setting d) IM antibiotics at the primary physician's office
b
The nurse is caring for a patient who is on trimethoprim-sulfamethoxazole [Septra] treatment. The laboratory reports show decreased platelet and white blood cell counts. What should the nurse interpret from these findings? a) The patient has hyperkalemia. b) The patient has superinfection. c) The patient has blood dyscrasias. d) The patient has photosensitivity reaction
c
When teaching a patient with genital herpes about treatment with valacyclovir [Valtrex], the nurse should include which statement? a) "A condom needs to be worn only when symptoms of the virus are present." b) "Once the painful blisters heal, the infection has been cured and will not return." c) "The intensity of infection episodes is reduced when the medication is taken daily." d) "Although it is costly, continuous daily medication administration will eliminate the virus."
c
Which condition is referred to as pyelonephritis? a) Inflammation of the vagina b) Inflammation of the urethra c) Inflammation of the bladder d)Inflammation of the kidney(s)
d
Which medication would be most beneficial for a patient with acute pyelonephritis? a) Darifenacin [Enablex] b) Flavoxate HCl [Urispas] c) Phenazopyridine HCl [Pyridium] d) Trimethoprim-sulfamethoxazole [Septra]
d
Which of the following sulfonamides, applied topically, has the greatest therapeutic benefit for burns? a)Sulfadiazine b) Trimethoprim [Primsol] c)Sulfacetamide [Bleph-10] d)Silver sulfadiazine [Silvadene]
d
hen the nurse teaches high school students about sexually transmitted diseases (STDs), which infection will the nurse identify as the most common STD? a) Herpes b) Syphilis c) Gonorrhea d) Chlamydia
d
Which sulfonamide has bactericidal activity? a)Sulfasalazine [Azulfidine] b)Sulfadiazine [Microsulfon] c)Silver sulfadiazine [Silvadene] d) Trimethoprim-sulfamethoxazole [Bactrim]
4
Why are sulfonamides avoided, if possible, for infants younger than 2 months of age? a)It can cause ototoxicity. b) It can cause kernicterus. c) It can cause yeast infections. d) It can cause discoloration of teeth.
b
e nurse teaches the patient taking sulfamethoxazole the importance of which action to reduce crystalluria? a) Avoid red meat. b)Increase fluid intake. c) Increase intake of fruits and vegetables. d)Avoid milk and other foods high in calcium.
b
Normal Osmolality (mOsm/kg.)
280 - 295
Synthesized in the hypothalamus Acts on kidneys to increase reabsorption of water Hormone
ADH
This hormone is secreted from the posterior pituitary when: Plasma osmolality increases - Water deficit -Sodium excess Circulating Blood Volume decreases - Bleeding - Diuresis - Vomiting -Diarrhea
ADH
50 % of all PP - Maintains colloidal osmotic pressure (COP)
Albumin
Sodium balance is regulated by _____
Aldosterone
Water balance is regulated by _____ ______
Antidiuretic Hormone
All are reasons of Hydrostatic pressure increases due to: venous obstruction (socks, donating blood) sodium and water retention increased blood volume Sodium and water retention Congestive Heart Failure Renal Failure
Edema
10 % of all PP - Responsible for blood clotting
Fibrinogen
A patient who has acute cystitis is receiving treatment with trimethoprim/sulfamethoxazole (TMP/SMZ). Which manifestation should indicate to a nurse that the patient's condition is worsening? a)Flank pain b)Incontinence c)3+ pedal edema d)Hyperactive bowel sounds
Flank pain
40 % of all PP - responsible for immune functioning
Globulins
pushes water
Hydrostatic Pressure
Osmolality of the ECF < 280 mOsm ---- Intracellular overhydration (cell swelling) Etiology Hyponatremia (Na + < 135) --Water moves into the cell --Vomiting, diarrhea, severe burns --Hyperglycemia (elevated blood glucose) Water Excess --Water intoxication ---Renal failure; Congestive heart failure ---Syndrome of Inappropriate ADH (SIADH)
Hypotonic Contraction
0.9% Normal Saline (NS) Lactated Ringers Solution (LR) 5% Dextrose in Water (D5W) Would help with ____ Fluid Replacement Therapy
Isotonic
Sodium and Chloride Balance Regulated by: This which decreases NA+ and Water retention Atrial natriuretic peptide (heart) Brain-type natriuretic peptide (heart) Urodilantin (kidney)
Natriuretic peptidesc
Electrolyte Replacement Maintenance of Fluid Balance Replacement of Fluid Loss Adults require 1.5 to 2 ml/kg/hr Children require 2-4 ml/kg/hr Infants require 4-6 ml/kg/hr
Objective of Fluid Therapy
pulls water
Oncotic Pressure
The concentration of body fluids and electrolytes
Osmolality
The pressure or force that is created when two solutions are of different concentrations and are separated by a selectively permeable membrane
Osmotic forces
Sodium and Chloride Balance Regulated by: This which controls controls the effective circulating volume Increases Na and Water retention Aldosterone (steroid hormone)
Renin-Angiotensin-Aldosterone (RAA) system
______ is responsible for the extracellular fluid osmotic balance
Sodium
Net filtration = forces favoring filtration - force opposing filtration
Starling Hypothesis
_______ End of the Capillary Oncotic Pressure > Hydrostatic Pressure -Fluids move back into circulation -Reabsorption
Venous
A patient asks about a urinary tract infection (UTI) antibiotic that requires only one dose. Which first-line UTI antibiotic requires only one dose? a)Fosfomycin b) Ciprofloxacin c) Nitrofurantoin (monohydrate) d)Trimethoprim/sulfamethoxazole
a
A patient is diagnosed with syphilis. What is the treatment of choice for this condition? a) Penicillin G b)Cephalosporins c)Metronidazole [Flagyl] d) Ceftriaxone [Rocephin]
a
Released from adrenal cortex Increases blood volume Effects sodium reabsorption and therefore ECF volume Hormone
aldosterone
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 in order to prevent kernicterus. Which term should the nurse use to describe kernicterus to the mother? a) Hemolytic anemia b) Neurologic disorder c) Ophthalmic infection d)Hepatocellular failure
b
A patient has started on a medication regimen that includes trimethoprim-sulfamethoxazole [Bactrim, Septra]. The nurse notes that the source of the patient's infection has been determined to be viral in origin. What is the nurse's priority action? a) Ensure that the information is documented in the chart. b)Contact the healthcare provider to discuss the medication. c) Ask the patient if he knows how he contracted the infection. d) Administer the medication as ordered by the healthcare provider.
b
A patient suspected of having an acute upper urinary tract infection is admitted to the hospital. Which is the priority nursing action for this patient? a) Administer oral antibiotics. b) Assess the patient's symptoms. c) Administer intravenous antibiotics. d) Take the patient's urine sample for analysis.
b
The nurse is assessing a patient with acute cystitis. Which symptom would the nurse expect to find in the patient? a) Pus in the urine b)Painful urination c)High fever and chills d) Nausea and vomiting
b
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 best action? a) Tell the patient to be more careful. b)Administer vitamin K to the patient. c)Assess the patient's platelet counts. d)Ask the patient if someone is abusing her.
c
A patient is being treated for syphilis. Which drug would the nurse anticipate to be prescribed? a) Acyclovir [Zovirax] b) Metronidazole [Flagyl] c) Benzathine penicillin G d)Ceftriaxone [Rocephin]
c
During the assessment of a patient with acquired immunodeficiency syndrome (AIDS), the nurse finds that the primary healthcare provider has prescribed trimethoprim-sulfamethoxazole [Septra]. What is the reason for the prescription? a)To prevent viral infection b)To prevent corneal ulcers c) To prevent fungal infection d) To prevent Pneumocystis carinii infection
c
Which medication would be most beneficial for a patient with acute pyelonephritis? a) Darifenacin [Enablex] b) Flavoxate HCl [Urispas] c) Phenazopyridine HCl [Pyridium] d) Trimethoprim-sulfamethoxazole [Septra]
c
- Primary ECF anion (negatively charged) - Provides electro neutrality -Passively moves along with sodium
chloride
You need to watch for increase in sodium and decrease in bicarbonate, which lead to much ____
chloride
Fluid osmolality depends on ______ of dissolved particles
concentration
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? a) Cystitis b)Urethritis c) Prostatitis d)Pyelonephritis
d
An 18-year-old female patient presents to the clinic to obtain an oral contraceptive. The nurse knows she should also be screened for which bacterial sexually transmitted disease (STD)? a) Gonorrhea b)Bacterial vaginosis c) Trichomonas infection d)Chlamydia trachomatis infection
d
The nurse is assessing a patient who is receiving a sulfonamide for treatment of a urinary tract infection. To monitor the patient for the most severe response to sulfonamide therapy, the nurse should assess for which condition? a)Bleeding b) Diarrhea c) Hypertension d) Skin rash and lesions
d
The nurse is teaching a patient who is to begin taking nitrofurantoin [Macrodantin]. Which manifestation should be the priority to report to the healthcare provider? a)Brown-colored urine b)Nausea and vomiting c)Headache and drowsiness d)Muscle weakness and tingling
d
The primary healthcare provider has prescribed trimethoprim-sulfamethoxazole [Bactrim] for a patient. The nurse recognizes that this may be prescribed to treat which condition? a)Urinary incontinence b) Pain during urination c)Overactive bladder disorder d)Chronic urinary tract infection
d
Capillary hydrostatic pressure (Blood Pressure) - water pushing Interstitial oncotic pressure - water-pulling Are forces that favor _____
filtration
Movement between the arterial and venous end of the capillary controlled by:
hydrostatic, oncotic pressure
0.45% NaCl Lowers serum sodium levels decreases amount of fluid in circulatory system Would help with ____ Fluid Replacement Therapy
hypotonic
_____ is responsible for the intracellular fluid osmotic balance
potassium
Plasma oncotic pressure - water-pulling Interstitial hydrostatic pressure - water pushing Are forces that favor _____
reabsorption
Most abundant particle in ECF is _____, which determines movement of water into and out of cells
sodium