Unit1: Chapter 52- Drugs Affecting the Urinary Tract and the Bladder (Kach 7th Ed)

Question 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

Answer 1

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.

Question 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

Answer 2

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.

Question 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

Answer 3

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.

Question 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)

Answer 4

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.

Question 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.

Answer 5

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.

Question 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

Answer 6

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.

Question 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.

Answer 7

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.

Question 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

Answer 8

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).

Question 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

Answer 9

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.

Question 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

Answer 10

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.

Question 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

Answer 11

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

Question 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

Answer 12

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.

Question 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

Answer 13

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.

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

Answer 14

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.

Question 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

Answer 15

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.

Question 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

Answer 16

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.

Question 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.

Answer 17

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.

Question 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

Answer 18

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.

Question 19

Urinary anti-infectives are used only to treat urinary tract infections (UTIs). What causes urinary antiinfectives
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

Answer 19

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.

Question 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

Answer 20

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.

Question 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.

Answer 21

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.

Question 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

Answer 22

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.

Question 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.

Answer 23

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.

Question 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

Answer 24

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).

Question 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

Answer 25

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.

Question 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

Answer 26

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.

Question 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

Answer 27

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.

Question 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

Answer 28

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.

Question 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

Answer 29

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.

Question 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.

Answer 30

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.

Question 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

Answer 31

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.

Question 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

Answer 32

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.

Question 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

Answer 33

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.

Question 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.

Answer 34

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

Question 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)

Answer 35

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.