Nokea
After nitrofurantoin is administered to a client with an acute bacterial UTI, assessment reveals dyspnea, chest pain, cough, fever, and chills. Which of the following actions would be most appropriate?
- A. Monitor client for tightness of the chest.
- B. Offer fluids to the client at regular intervals.
- C. Provide oxygen support to the client.
- D. Withhold the drug and contact the primary health care provider.
Correct Answer: D
Rationale: The nurse should immediately notify the primary health care provider and withhold the next dose of the drug until the client is seen by the primary health care provider if acute pulmonary reactions are observed in the client. The nurse should monitor the client for signs of a nonproductive cough or malaise, which may indicate a chronic pulmonary reaction, which may occur during prolonged therapy. Tightness of the chest is not known to occur in the case of a chronic pulmonary reaction, so the nurse need not monitor the client for this. The nurse offers fluids at regular intervals to elderly clients who develop decreased thirst sensation as an adverse reaction to the urinary tract anti-infectives.
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A nurse is conducting an in-service presentation for a group of nurses about UTIs and hospitalized clients. When discussing preventive measures, the nurse would identify which of the following as the primary nursing intervention for prevention?
- A. Proper perineal hygiene
- B. Use of urinary acidifiers
- C. Hand hygiene
- D. Routine urinalysis
Correct Answer: C
Rationale: UTIs may affect the hospitalized client or nursing home resident with an indwelling catheter or a disorder such as a stone in the urinary tract. The primary nursing intervention to prevent UTIs in the hospitalized client is good hand hygiene or handwashing. Proper perineal hygiene may be helpful but not as effective as hand hygiene. The use of urinary acidifiers is appropriate to maintain pH of the urine but not prevent UTIs. Routine urinalysis would help identify potential infections but not prevent them.
The nurse is developing a plan of care for a client who is receiving an anti-infective drug for treatment of a UTI. The nurse has identified a nursing diagnosis of Impaired Urinary Elimination. Which of the following would the nurse include?
- A. Encouraging a fluid intake of at least 2000 mL/day
- B. Offering the client orange juice when administering the medication
- C. Monitoring urine output every 1 to 2 hours
- D. Checking the urine pH every 4 hours
Correct Answer: A
Rationale: Encouraging a fluid intake of at least 2000 mL/day would be appropriate. The nurse should offer fluids such as water, cranberry juice, or prune juice rather than orange juice or other citrus or vegetable juices. Intake and output are usually measured every 8 hours, not every 1 to 2 hours. Urine pH measurements would be appropriate if the client was receiving methenamine or nitrofurantoin.
A nurse is developing a teaching plan for a client diagnosed with a UTI and prescribed nitrofurantoin (Macrodantin). The nurse would warn the client about which of the following common gastrointestinal adverse reactions? Select all that apply.
- A. Anorexia
- B. Ileus
- C. Toxic megacolon
- D. Nausea
- E. Diarrhea
Correct Answer: A,D,E
Rationale: Common gastrointestinal adverse reactions seen with the use of nitrofurantoin (Macrodantin) include anorexia, nausea, vomiting, diarrhea, and abdominal pain.
A nurse is educating a client undergoing treatment for genitourinary tract bacterial infections on an outpatient basis. What instructions should the nurse offer the client as part of the client teaching plan?
- A. Notify the primary health care provider if abdominal pain occurs.
- B. Discontinue the therapy if symptoms vanish.
- C. Decrease fluid intake if symptoms subside.
- D. Increase fluid intake to at least 2000 mL/day.
Correct Answer: D
Rationale: The nurse should instruct the client to increase the fluid intake to at least 2000 mL/day to help remove bacteria from the genitourinary tract when caring for a client with a genitourinary tract bacterial infection. The nurse should stress the importance of continued therapy even if symptoms vanish or the client feels better after a few doses. The nurse should encourage continued increased fluid intake even if the symptoms subside. Abdominal pain is not commonly associated with genitourinary tract bacterial infections, so this instruction would not be necessary.
A client with a UTI is experiencing dysuria. The nurse would expect which of the following to be prescribed?
- A. Nitrofurantoin (Macrodantin)
- B. Oxybutynin (Ditropan)
- C. Sulfamethoxazole/trimethoprim (Bactrim)
- D. Phenazopyridine (Pyridium)
Correct Answer: D
Rationale: Phenazopyridine (Pyridium) is a urinary tract analgesic that is useful in treating dysuria caused by a UTI.