Drugs Affecting the Urinary Tract and the Bladder

1.

The clinic nurse is admitting a 39-year-old woman who has come to the clinic complaining of left-sided tenderness, fever, chills, and flank pain. What does the nurse suspect the patient has?
A)
Cystitis
B)
Kidney stones
C)
Neurogenic bladder
D)
Pyelonephritis
Ans:
D

Feedback:

The fever and chills indicate an inflammatory process. Flank pain and left-sided tenderness indicate kidney swelling within the capsule. These symptoms indicate pyelonephritis. Kidney stones cause intense pain; fever and chills would not be present. Cystitis and neurogenic bladder present with bladder-related symptoms such as frequency, urgency, burning, and bloating.

2.

The nurse is caring for four patients. Which patient would flavoxate (Urispas), a urinary tract medication, be indicated for?
A)
A 1-year-old girl
B)
A 6-year-old boy
C)
A 10-year-old boy
D)
A 14-year-old girl
Ans:
D

Feedback:

Flavoxate prevents smooth muscle spasm in the urinary tract and can be given to children older than 12 years of age. Oxybutynin and phenazopyridine may be given to children 6 years old and older. Guidelines for use of an antispasmodic for a child younger than 6 have not been established.

3.

The nurse is discussing the effects of doxazosin (Cardura) with a 65-year-old man who has just been diagnosed with benign prostatic hyperplasia (BPH). The patient asks the nurse whether the drug will make him impotent. After the discussion with the patient, the nurse determines that a potential priority nursing diagnosis could be what?
A)
Sexual dysfunction related to adverse effects
B)
Deficient knowledge regarding drug therapy
C)
Noncompliance with drug therapy related to adverse effects
D)
Acute pain related to adverse effects
Ans:
C

Feedback:

The patient is concerned about his ability to perform sexually. Sexual dysfunction is a possible adverse effect and would be a concern for this patient. However, he has not started taking the drug. The nurse is concerned about noncompliance because of the possibility of this adverse effect. This is an important part of a man’s life and most men would not want to take medication that would cause sexual dysfunction. Headache is an adverse effect of drugs used for BPH, but it can be tolerated and treated with an analgesic. Deficient knowledge about the drug is a concern, but usually men who know that sexual dysfunction is a possible adverse effect of a drug will find out all they can about the drug. Acute pain is not related to this drug.

4.

A businesswoman who is leaving on a business trip the next day tells the nurse she knows she has cystitis and does not want to have to “mess” with medicine while she is gone. What drug would be a good choice for this patient?
A)
Fosfomycin (Monurol)
B)
Methenamine (Hiprex)
C)
Nitrofurantoin (Furadantin)
D)
Norfloxacin (Noroxin)
Ans:
A

Feedback:

Fosfomycin would be a good choice for this patient because it has the convenience of a single dose. Methenamine is taken either twice a day or up to four times a day. This drug could interfere with the patient’s busy schedule. Nitrofurantoin is also prescribed four times a day and would also be inconvenient for the patient. Norfloxacin is taken every 12 hours and could be inconvenient as well.

5.

The nurse is performing patient teaching about the urinary anti-infective methenamine (Hiprex). What information is most important for the nurse to share with this patient?
A)
Limit fluid intake.
B)
Drink orange juice once a day.
C)
Take the medication with food.
D)
Take the medication at night before going to bed.
Ans:
C

Feedback:

The patient should take the medication with food to decrease GI adverse effects. The nurse would encourage the patient to increase fluid intake to flush the bladder and urinary tract frequently and decrease the opportunity for bacteria growth. Orange juice would be contraindicated because it could cause an alkaline rash and produce alkaline urine, which encourages bacterial growth. This drug is taken two to three times a day and not in a single dose at night.

6.

The nurse is assessing a patient who is taking oxybutynin (Ditropan). What would be the priority nursing assessment for this patient?
A)
Skin condition
B)
Cardiac arrhythmia
C)
Vision changes
D)
Mental status
Ans:
C

Feedback:

The nurse should assess for vision changes and recommend an ophthalmologic examination during treatment to evaluate drug effects on intraocular pressure so that the drug can be stopped if intraocular pressure increases. A rash and changes in cardiac rhythm and rate are possible adverse effects. Also, disorientation (mental status) could be a concern. However, these effects can be treated and may not necessitate stopping the medication.

7.

A patient is taking phenazopyridine (Azo-Standard) and ciprofloxacin (Cipro) for a urinary tract infection. What is the most important instruction the nurse needs to provide to the patient concerning this drug combination?
A)
“Do not be alarmed if your urine is a reddish-brown color.”
B)
“Be sure to take your medication with food if you have GI irritation.”
C)
“Increase your fluid intake. Drink lots of water.”
D)
“If you notice yellowing of your eyes or skin, contact your health care provider immediately.”
Ans:
D

Feedback:

Yellowing of the sclera and skin is a sign of drug accumulation in the body and a possible sign of hepatic (liver) toxicity. Phenazopyridine should not be used more than 2 days, especially if taken, as here, with an antibacterial agent (ciprofloxacin). The other suggested options are important and should be included in the instructions given the patient. However, the possibility of toxicity is the most important.

8.

A patient is taking pentosan polysulfate sodium (Elmiron) to decrease pain and discomfort associated with interstitial cystitis. What medication class may cause an adverse reaction when used with Elmiron?
A)
Anticoagulants
B)
Antihypertensives
C)
Diuretics
D)
Cardiac glycosides
Ans:
A

Feedback:

Anticoagulants may react with pentosan polysulfate sodium (Elmiron). This drug has anticoagulant and fibrinolytic effects, which could lead to potential or increased bleeding risks. Antihypertensives, diuretics, and cardiac glycosides do not cause drug–drug interactions with pentosan polysulfate sodium (Elmiron).

9.

A pregnant woman is helping her elderly father with taking his medications. He is taking dutasteride (Avodart). The nurse will instruct the daughter to do what?
A)
Crush the tablets to help facilitate swallowing.
B)
Avoid touching any crushed or broken tablets.
C)
Avoid direct contact with her father while he is on the medication.
D)
Use a barrier contraceptive while helping her father prepare the drug.
Ans:
B

Feedback:

Dutasteride contains androgenic hormone blockers that could be absorbed through the skin if the tablets are crushed and broken. These hormone blockers could have negative effects on a fetus. The woman should be cautioned not to touch any crushed or broken tablets. Her father will not pose a threat to her because of this drug therapy. She should not need barrier contraceptives if she is pregnant.

10.

A patient is being treated for benign prostatic hyperplasia (BPH). The patient asks the nurse how the medicine used to treat BPH is supposed to work. The nurse explains that the drug therapy is designed to relieve the symptoms associated with this condition by doing what?
A)
Shrinking the gland and/or relaxing the sphincter of the bladder
B)
Increasing testosterone levels to improve sexual functioning
C)
Increasing blood pressure, which will increase blood flow to the area
D)
Activate nitric acid, which will dilate blood vessels in the area to relieve pressure
Ans:
A

Feedback:

Drugs given to treat BPH will block sympathetic activity to allow relaxation of the sphincter of the bladder or will decrease testosterone effects to shrink the gland and relieve symptoms. They do not increase testosterone levels or blood pressure. Dilating blood vessels would further congest the gland and increase symptoms.

11.

The pharmacology students are learning about medications used to treat urinary tract problems. What symptoms does phenazopyridine treat?
A)
Urinary retention
B)
Hematuria
C)
Pain and urgency
D)
Hesitancy
Ans:
C

Feedback:

Phenazopyridine is an azo dye that acts as a urinary analgesic and relieves symptoms of dysuria, burning, and frequency and urgency of urination. Phenazopyridine does not treat urinary retention, hematuria, or hesitancy.

12.

The nurse is providing health teaching to a 62-year-old female patient who has been started on norfloxacin (Noroxin). This patient should be taught to contact her physician if she experiences what adverse effect?
A)
Polydipsia
B)
Tachycardia
C)
Confusion
D)
Hypertension
Ans:
C

Feedback:

Urinary tract anti-infectives infrequently cause pruritus, urticaria, headache, dizziness, nervousness, and confusion. Norfloxacin is not known to cause polydipsia, tachycardia, or hypertension.

13.

A 50-year-old man calls the clinic nurse and complains of gastrointestinal upset after taking nitrofurantoin (Furadantin) on an empty stomach. What recommendation should the nurse make?
A)
Stopping the medication
B)
Taking vitamin C along with the medication
C)
Taking the medicine with or after meals
D)
Continuing to take the medicine on an empty stomach
Ans:
C

Feedback:

These adverse effects may result from GI irritation caused by the agent, which may be somewhat alleviated if the drug is taken with food, or from a systemic reaction to the urinary tract irritation. The nurse would not tell the patient to stop taking the medication without a physician’s order to do so nor would the nurse tell the patient to continue taking the medication on an empty stomach. Advising the patient to take the medication along with vitamin C would be of no benefit to the patient described in the question.

14.

A 72-year-old female clinic patient is started on cinoxacin (Cinobac) for a urinary tract infection. Before administering this drug, the nurse should assess the patient for what condition?
A)
Asthma
B)
Hypertension
C)
Diabetes mellitus
D)
Renal insufficiency
Ans:
D

Feedback:

Cinoxacin should be used with caution in the presence of renal dysfunction, which could interfere with the excretion and action of this drug. The patient’s having asthma, hypertension, or diabetes mellitus would not be a contraindication to the use of this drug.

15.

The nurse is caring for a 79-year-old male patient who was admitted through the emergency room for mental status changes determined to be caused by a urinary tract infection. The patient is started on norfloxacin (Noroxin) before his discharge home. What adverse effect should the nurse observe this patient for?
A)
Liver toxicity
B)
Photosensitivity
C)
Excess saliva
D)
Congestive heart failure
Ans:
B

Feedback:

Adverse effects include photosensitivity, headache, dizziness, nausea, vomiting, dry mouth, and fever. Generally, adverse effects of norfloxacin do not include liver toxicity, bone marrow depression, or congestive heart failure.

16.

A clinic patient has been prescribed phenazopyridine (Pyridium) for aid in treating a UTI. This patient should be informed that Pyridium will turn urine what color?
A)
Bluish-green
B)
Reddish-orange
C)
Brown
D)
Black
Ans:
B

Feedback:

Phenazopyridine turns urine reddish-orange, which may be mistaken for blood. It does not cause the urine to appear bluish-green, brown, or black.

17.

A small group of nursing students are giving an oral presentation to their classmates about urinary tract infections (UTIs). What is a measure that can be used to encourage patients to use to reduce the risk of recurrent urinary tract infections?
A)
Increase alkaline foods in your diet.
B)
Take tub baths, soaking 15 minutes daily.
C)
Use sterile gauze pads to cleanse after urinating.
D)
Drink 2,000 to 3,000 mL of fluid daily.
Ans:
D

Feedback:

Many activities are necessary to help decrease bacteria in the urinary tract (e.g., hygiene measures, proper diet, forcing fluids), to facilitate the treatment of UTIs, and help the urinary tract anti-infectives be more effective. Forcing fluids increases the amount of urine that is excreted and prevents urine from sitting in the bladder. It is helpful to keep the urine acidic, not alkaline and avoid sitting in water. The importance of cleansing is to cleanse from front to back. The use of sterile wipes is not necessary.

18.

What is the drug of choice in a patient with renal impairment who is being treated for a urinary tract infection (UTI)?
A)
Salazopyrin
B)
Silver sulfadiazine
C)
Declomycin
D)
Fosfomycin
Ans:
D

Feedback:

The dosage of fosfomycin, given orally, does not need to be changed in cases of renal impairment. It is the only medication listed here that is used in the treatment of urinary tract infections. Declomycin may be used to inhibit antidiuretic hormone in the treatment of chronic inappropriate antidiuretic hormone secretion. Salazopyrin is used in ulcerative colitis. Silver sulfadiazine is used topically to treat Pseudomonas infections.

19.

Urinary anti-infectives are used only to treat urinary tract infections (UTIs). What causes urinary anti-infectives to be so effective in treating UTIs?
A)
They sterilize feces.
B)
They act specifically within the urinary tract.
C)
They reach high plasma levels in a short period of time.
D)
They are excreted through the liver.
Ans:
B

Feedback:

Urinary tract anti-infectives act specifically within the urinary tract to destroy bacteria, either through a direct antibiotic effect or through acidification of the urine. They are not used in systemic infections because they do not attain therapeutic plasma levels. These drugs are usually excreted through the kidneys not through the liver, and they do not sterilize feces.

20.

The nurse is caring for a patient who is taking a urinary anti-infective. What would the nurse need to assess this patient for?
A)
Discolored urine
B)
Jaundice
C)
Signs and symptoms of continuing urinary tract infection (UTI)
D)
Flank pain
Ans:
C

Feedback:

Monitor patient response to the drug (i.e., resolution of UTI and relief of signs and symptoms) and repeat culture and sensitivity tests as recommended for evaluation of the effectiveness of all of these drugs. It would not be necessary to assess for discolored urine, jaundice, or flank pain.

21.

The nurse is writing a plan of care for an 85-year-old male patient admitted through the emergency room with a severe urinary tract infection. What intervention, if noted on the care plan, would be an inappropriate for this patient?
A)
Encourage the patient to drink cranberry juice as part of his daily fluid intake.
B)
Avoid urinary catheterization when possible.
C)
Force fluids unless contraindicated.
D)
Administer antacids to decrease GI irritation caused by the medication.
Ans:
D

Feedback:

It would not be appropriate to administer antacids because it will cause the urine to be alkaline and provide more opportunity for bacterial growth. The patients should be encouraged to force fluids and to include cranberry juice in those fluids to help acidify the urine. Avoiding urinary catheterization is an important nursing intervention in all patients because catheterization can allow introduction of bacteria in the bladder.

22.

A patient with benign prostatic hypertrophy (BPH) has been prescribed terazosin (Hytrin). How do alpha-adrenergic blockers, such as terazosin, assist in treating the symptoms of BPH?
A)
They increase gastric motility.
B)
They increase skeletal muscle contraction.
C)
They inhibit contraction of the urinary bladder.
D)
They decrease blood pressure.
Ans:
C

Feedback:

Alpha1-adrenergic blockers block postsynaptic alpha1-adrenergic receptors, which results in a dilation of arterioles and veins and a relaxation of sympathetic effects on the bladder and urinary tract. This action makes these drugs useful in the treatment of BPH. BPH is characterized by obstructed urine flow as the enlarged prostate gland presses on the urethra. Alpha1-blocking agents can decrease urinary retention and improve urine flow by relaxing muscles in the prostate and urinary bladder. Options A, B, and D are not correct.

23.

A 72-year-old man presents at a blood donor drive. The patient tells the nurse he donates blood on a regular basis. While reviewing the patient’s medication history, the nurse notes he is taking dutasteride (Avodart) for his benign prostatic hyperplasia (BPH). What would the nurse know is a contraindication to this patient giving blood?
A)
The testosterone blocking effects will be passed to those receiving the blood.
B)
Blood donation may cause malignant hyperthermia to occur during the donation.
C)
Severe hypotension may occur during blood donation.
D)
Malignant hypertension may occur during blood donation.
Ans:
A

Feedback:

Patients using either finasteride or dutasteride cannot donate blood for 6 months after the last dose to protect potential blood recipients from exposure to the testosterone blocking effects. The use of the drug dutasteride will not cause this patient to develop malignant hyperthermia, malignant hypertension, or severe hypotension during blood donation.

24.

The clinic nurse is providing care for a patient with a urinary tract infection (UTI). Which drug would the nurse expect to administer to this patient?
A)
Solifenacin
B)
Pentosan polysulfate sodium
C)
Norfloxacin
D)
Alfuzosin
Ans:
C

Feedback:

Norfloxacin is a urinary anti-infective that is used in the treatment of adults with UTIs caused by susceptible strains of bacteria, uncomplicated urethral and cervical gonorrhea, and prostatitis caused by Escherichia coli. Solifenacin is an antispasmodic, pentosan polysulfate sodium is a bladder protectant, and alfuzosin is used in the treatment of benign prostatic hyperplasia (BPH).

25.

Urinary tract infections (UTIs) in children do occur. If a child has repeated UTIs, what would be important to assess for? (Select all that apply.)
A)
Obstruction
B)
Sexual abuse
C)
Drinking apple juice
D)
Bubble baths
E)
Drinking too much water
Ans:
A, B, D

Feedback:

Some children, because of congenital problems or in-dwelling catheters, require other urinary tract agents such as urinary tract analgesics or antispasmodics. A child with repeated UTIs should be evaluated for potential sexual abuse. Children need to be instructed in proper hygiene and should not be given bubble baths if UTIs occur. Repeated UTIs can be related to drinking alkaline juices such as orange or grapefruit, but not apple. Children should be encouraged to drink a lot of water. Drinking too much water would not cause repeated infections.

26.

A 77-year-old man has been placed on alfuzosin (Uroxatral) for his benign prostatic hyperplasia (BPH). The nurse explains to the patient that because of the medication he is taking, it will be necessary to monitor for what? (Select all that apply.)
A)
Pulse pressure
B)
Intraocular pressure
C)
Fluid intake
D)
Blood pressure
E)
Bladder emptying
Ans:
B, D, E

Feedback:

Special precautions to monitor cardiac function, intraocular pressure, blood pressure, and bladder emptying need to be taken when using alpha-adrenergic blockers with these patients. It would not be necessary to monitor pulse pressure or fluid intake in this patient.

27.

A 72-year-old man is being treated with doxazosin (Cardura) for his BPH. What nursing diagnosis would be important to include in this patient’s plan of care?
A)
Sexual dysfunction
B)
Chronic pain
C)
Disturbed sensory perception
D)
Risk of impaired urinary elimination
Ans:
A

Feedback:

Nursing diagnoses related to drug therapy might include sexual dysfunction related to drug effects, acute pain related to headache, central nervous system (CNS) effects, and GI effects of the drug, risk for injury related to blockage of alpha receptors, and deficient knowledge regarding drug therapy. The nursing diagnosis of risk of impaired urinary elimination would not be appropriate because the effect of the drug is to improve urinary elimination issues.

28.

You are preparing a plan of care for a 78-year-old female patient who has been hospitalized with a recurrent urinary tract infection (UTI). What would be important to assess for before administering a urinary tract antispasmodic? (Select all that apply.)
A)
Allergy to eggs
B)
Glaucoma
C)
Pyloric obstruction
D)
Dumping syndrome
E)
Duodenal obstruction
Ans:
B, C, E

Feedback:

Assess for contraindications or cautions: any history of allergy to these drugs to prevent hypersensitivity reactions; pyloric or duodenal obstruction; or other GI lesions or obstructions of the lower urinary tract, which could be dangerously exacerbated by these drugs; glaucoma, which could increase intraocular pressure due to blockage of the parasympathetic nervous system; and current status of pregnancy or lactation, which would require cautious use. It would not be necessary to assess this patient for an allergy to eggs or dumping syndrome.

29.

What would be an appropriate nursing intervention for a patient on a urinary tract antispasmodic?
A)
Monitor for patient use of hot showers.
B)
Advise patient about change in color of sclera.
C)
Offer sugarless hard candy.
D)
Teach proper personal hygiene.
Ans:
C

Feedback:

Offer frequent sips of water or use of sugarless hard candy to alleviate dry mouth because antispasmodics have anticholinergic effects that cause dry mouth. The use of hot water for showers will not cause the patient any danger. Urinary antispasmodics do not cause changes in the sclera. This patient has an issue with bladder spasms and not a urinary tract infection.

30.

The nurse is providing health teaching to a patient who is taking methenamine (Hiprex). What instruction would be most important to include for the patient taking Hiprex?
A)
“Drink citrus juice with the medication to acidify the urine.”
B)
“Take sodium bicarbonate with the medication to make the urine alkaline.”
C)
“Limit your fluid intake to 8 ounce per day.”
D)
“While you are taking this drug, limit your intake of foods high in sodium.”
Ans:
A

Feedback:

Urinary tract anti-infectives act specifically within the urinary tract to destroy bacteria, either through a direct antibiotic effect or through acidification of the urine. Therefore, the nurse would not instruct the patient to take sodium bicarbonate, limit fluid intake, or limit their intake of foods high in sodium.

31.

The nurse is caring for a patient who is beginning treatment for benign prostatic hyperplasia and knows that this patient may be treated with which classification of drugs? (Select all that apply.)
A)
Urinary anti-infectives
B)
Urinary antispasmodics
C)
Alpha-adrenergic blockers
D)
Testosterone production blockers
E)
Urinary analgesics
Ans:
C, D

Feedback:

Alpha-adrenergic blockers and testosterone production blockers are drugs used in the treatment of benign prostatic hyperplasia. Urinary anti-infectives are used to treat urinary tract infections. Urinary antispasmodics are used to treat bladder spasms and urinary analgesics are used in the treatment of pain associated with urinary tract infections.

32.

The nurse is caring for a patient with a bladder infection. What symptoms are most common with this type of infection? (Select all that apply.)
A)
Frequency
B)
Urgency
C)
Dysuria
D)
Flank pain
E)
Temperature elevation over 102°F
Ans:
A, B, C

Feedback:

Patients with bladder infection most commonly experience urinary frequency, urgency, and burning on urination (dysuria). Patients with pyelonephritis also experience flank pain and temperature elevation.

33.

A patient with interstitial cystitis has just begun to take pentosan polysulfate sodium (Elmiron). The nurse would notify the physician if the patient exhibited which symptom(s). (Select all that apply.)
A)
Petechiae
B)
Anorexia
C)
Decreased blood pressure
D)
Blood in the urine
E)
Headache
Ans:
A, C, D

Feedback:

Adverse effects associated with pentosan use include bleeding that may progress to hemorrhage (related to the drug’s heparin effects), headache, alopecia, and GI disturbances. It would be necessary to notify the physician if the patient showed any signs of bleeding. Anorexia and headaches are not associated with this drug.

34.

The nurse is providing discharge instructions to a patient who is taking pentosan polysulfate sodium (Elmiron). Which statement by the patient indicates a need for further instruction?
A)
“I will make sure and take this medication with my breakfast.”
B)
“I will call the doctor if I start to have any unusual bruises.”
C)
“This drug I am taking may cause me to lose hair.”
D)
“I will take acetaminophen if I develop a headache.”
Ans:
A

Feedback:

Pentosan polysulfate sodium should be taken on an empty stomach, either 1 hour before or 2 hours after meals. The patient should call the physician at the first sign of bleeding. Alopecia and headache may occur with this medication.

35.

A patient with benign prostatic hyperplasia has been self-treating with an herbal called saw palmetto. The nurse would know which drug is contraindicated in this patient?
A)
Tamsulosin (Flomax)
B)
Finasteride (Proscar)
C)
Alfuzosin (Uroxatral)
D)
Terazosin (Hytrin)
Ans:
B

Feedback:

Saw palmetto is an herbal therapy that has been used very successfully for the relief of symptoms associated with benign prostatic hyperplasia (BPH). Patients with BPH should be cautioned not to combine saw palmetto with finasteride because serious toxicity can occur. There is no contraindication in the use of tamsulosin, alfuzosin, and terazosin, which are alpha-adrenergic blockers. Finasteride is a testosterone blocking agent.