Chapter 93: Drug Therapy for Urinary Tract Infections

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? A. Fosfomycin B. Amoxicillin C. Cephalexin D. Trimethoprim

A. Fosfomycin 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.

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

A. Maintains a urine pH of 5.5 or lower. C. Uses an enteric-coated formulation. D. Avoids sulfonamide medications. Under acidic conditions, methenamine makes formaldehyde, which causes bacterial cell death. Formaldehyde requires an acid urine to be released. To prevent the dose from being converted to formaldehyde in an acidic stomach, an enteric-coated formula may be used. Ingestion of large volumes of fluid dilutes methenamine and raises the urinary pH. Hepatotoxicity is not associated with methenamine [Mandelamine].

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

A. Reinfections are considered frequent if the individual has three or more a year. C. If reinfection is associated with sexual intercourse, the risk can be reduced by instructing the patient to void after intercourse. E. If a symptomatic episode occurs, the standard therapy for acute cystitis should be used. Prophylactic therapy should continue for at least 6 months. Single-dose trimethoprim/sulfamethoxazole, taken after intercourse, has been found to reduce the risk of reinfection. The other three statements are true.

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

B. Dyspnea with chills 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.

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

B. Escherichia coli Most cases of uncomplicated, community-acquired UTIs are caused by E. coli. In rare cases, other gram-negative bacilli (e.g., K. pneumoniae, Enterobacter spp., and Pseudomonas spp.) are the cause.

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? A. Incontinence B. Flank pain C. 3+ pedal edema D. Hyperactive bowel sounds

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

B. Indwelling catheter C. Prostate hypertrophy E. Urinary tract stones Complicated UTIs occur in males and females and usually are associated with some predisposing factor, such as calculi, prostatic hypertrophy, or catheters. Uncomplicated UTIs occur primarily in women of child-bearing age and are not associated with any specific predisposing factor. Fair skin tone is unrelated to UTI occurrence.

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

C. Women of child-bearing age Acute cystitis is a lower urinary tract infection that occurs most often in women of child-bearing age.

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? A. Headache and drowsiness B. Brown-colored urine C. Nausea and vomiting D. Muscle weakness and tingling

D. Muscle weakness and tingling Nitrofurantoin is used in acute infections of the lower urinary tract only. Muscle weakness and tingling may indicate irreversible damage to sensory and motor nerves caused by demyelinization of nerves. Patients should be informed of these symptoms and taught to report them immediately. Gastrointestinal (GI) effects may be minimized by taking the drug with milk or food. Brown urine is a harmless effect of the urinary excretion of the medication. Headache and drowsiness are less common adverse effects that are readily reversible.

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

D. Oral antibiotics in the home setting Except for pyelonephritis, most UTIs can be treated with oral therapy at home.