Chapter 88: Drug Therapy of Urinary Tract Infections

Chapter 88: Drug Therapy of Urinary Tract Infections

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A patient presents to the emergency department with complaints of chills, severe flank pain, dysuria, and urinary frequency. Vital signs reveal: temperature 102.9° F, pulse 92, respirations 24, and blood pressure 119/58. 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.

 

 

ANS:   C

The nurse should suspect pyelonephritis. Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, urinary urgency and frequency, as well as pyuria and bacteruria.

Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteruria.

Urinary tract infections (UTIs) are very general and are classified by their location. These symptoms are specific to pyelonephritis.

Prostatitis is manifested by high fever, chills, malaise, myalgia, localized pain, and various UTI symptoms, but not severe flank pain.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1033

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

2. 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.

 

 

ANS:   D

The nurse should suspect prostatitis, which is manifested by high fever, chills, malaise, myalgia, and localized pain and may also be manifested by dysuria, nocturia, and urinary urgency, frequency, and retention.

Clinical manifestations of acute cystitis include dysuria, urinary urgency and frequency, suprapubic discomfort, pyuria, and bacteruria.

Urinary tract infections are very general and are classified by their location.

Pyelonephritis is characterized by fever, chills, severe flank pain, dysuria, urinary frequency and urgency, as well as pyuria and bacteruria.

 

DIF:    Cognitive Level: Application             REF:    p. 1034

TOP:    Nursing Process: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity: Physiological Adaptation

 

3. For which of the following patients would nitrofurantoin (Macrodantin) be contraindicated?

a.	Patient with a urine phosphate of 0.9 gm/24 hr
b.	Patient with a urine specific gravity of 1.024
c.	Patient with bacteria in the urine
d.	Patient with a creatinine clearance of 38 mL/min

 

 

ANS:   D

Nitrofurantoin should not be administered to individuals with renal impairment, as indicated by a creatinine clearance of less than 40 mL/min. In the absence of good renal function, levels of nitrofurantoin in the urine are too low to be effective. Also, renal impairment reduces nitrofurantoin excretion, causing plasma levels of the drug to rise, posing a risk of systemic toxicity.

A urine phosphate of 0.9 is within acceptable limits as is a specific gravity of 1.024.

Macrodantin is indicated for cystitis and UTI, thus bacteria in the urine would be expected and not a contraindication.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 1035

TOP:    Nursing Process: Evaluation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

 

4. A patient who had surgery 6 days earlier has developed a urinary tract infection, for which the prescriber has ordered nitrofurantoin (Macrodantin). The nurse is providing patient education about the medication. What should the nurse include in the teaching? (Select all that apply.)

a.	“We will need to monitor your creatinine clearance levels.”
b.	“It would be best to take your meds on an empty stomach.”
c.	“Your urine may have a brown tint.”
d.	“You may experience constipation.”
e.	“You may experience a headache.”

 

 

ANS:   A, C, E

Creatinine clearance levels should be monitored, because if the levels are too low, toxicity may occur. Nitrofurantoin imparts a harmless brown color to the urine, and it can cause multiple neurologic effects, such as headache, vertigo, and drowsiness.

Nitrofurantoin should be taken with meals to minimize gastrointestinal (GI) upset (nausea, vomiting and diarrhea).

The patient will experience diarrhea, not constipation.

 

DIF:    Cognitive Level: Application             REF:    p. 1035

TOP:    Nursing Process: Implementation

MSC:   NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies