Urinary Anti-infectives

Every question here, with the answer

1. A client taking nitrofurantoin calls, worried that their urine has turned brown. What should the nurse tell the client?

   1. Brown urine is an expected effect of the drug and does not harm you.
   2. Stop the drug and go to the emergency department.
   3. Drink less fluid so the urine clears.
   4. Brown urine means the infection has spread to the kidneys.

   Answer: Brown urine is an expected effect of the drug and does not harm you.

   Brown discoloration of the urine is a typical, harmless effect of nitrofurantoin. It does not mean worsening infection, and clients should increase, not decrease, fluid intake.

2. A client on nitrofurantoin develops a new cough, fever, chills and shortness of breath. What should the nurse do?

   1. Give the next dose early.
   2. Tell the client this is a sign the drug is working.
   3. Encourage more fluids and recheck tomorrow.
   4. Notify the health care provider because these may be pulmonary reactions.

   Answer: Notify the health care provider because these may be pulmonary reactions.

   Nitrofurantoin can cause acute, subacute or chronic pulmonary reactions, so the nurse monitors for dyspnea, chest pain, chills, fever and cough and notifies the provider. Waiting or giving more drug delays care.

3. A nurse is teaching a client who is starting TMP/SMX for a urinary tract infection. Which instructions are correct? Select all that apply.

   1. Avoid excessive sunlight.
   2. Increase your daily fluid intake unless told otherwise.
   3. Finish the whole course even if you feel better.
   4. Report a sore throat, fever or pale skin.
   5. Crush the tablets to make them easier to swallow.

   Answer: Avoid excessive sunlight., Increase your daily fluid intake unless told otherwise., Finish the whole course even if you feel better., Report a sore throat, fever or pale skin.

   TMP/SMX causes photosensitivity, fluids help prevent kidney stones, stopping early worsens infection and resistance, and sore throat, fever or pallor can signal blood dyscrasias. Tablets should not be crushed unless a pharmacist directs it.

4. Before giving the first dose of a urinary anti-infective, which action should the nurse confirm has been done?

   1. A urine culture and sensitivity was collected.
   2. The client has fasted for 12 hours.
   3. The client's urine has turned brown.
   4. A chest x-ray was taken.

   Answer: A urine culture and sensitivity was collected.

   Culture and susceptibility studies should be performed before starting urinary anti-infectives, and the nurse confirms baseline tests including urine culture and sensitivity. The other options are not required first steps.

5. For which clients should the nurse question an order for nitrofurantoin? Select all that apply.

   1. A client in labor at 39 weeks of pregnancy
   2. A client with a creatinine clearance below 60 mL
   3. A client with impaired hepatic function
   4. A breastfeeding client
   5. A healthy adult with an uncomplicated E. coli UTI

   Answer: A client in labor at 39 weeks of pregnancy, A client with a creatinine clearance below 60 mL, A client with impaired hepatic function, A breastfeeding client

   Nitrofurantoin is contraindicated after 37 weeks or during labor, with creatinine clearance under 60 mL, with impaired hepatic function, and during lactation. A healthy adult with a susceptible E. coli UTI fits its indication.

6. A client on antibiotics for a UTI develops white patches in the mouth and vaginal itching. What does the nurse suspect and do?

   1. Brown urine; increase fluids
   2. An expected effect; no action needed
   3. Photosensitivity; apply sunscreen
   4. A superinfection; report it to the health care provider

   Answer: A superinfection; report it to the health care provider

   Stomatitis, anogenital discharge or itching are signs of superinfection that the nurse reports to the provider. They are not expected effects or signs of photosensitivity.