For which purpose is methenamine hippurate prescribed?
Long-term prevention of recurrent urinary infections
✓
Rapid cure of acute pyelonephritis
Relief of burning during urination
Treatment of urinary retention after surgery
Correct Answer
Long-term prevention of recurrent urinary infections
Methenamine hippurate is a urinary antiseptic used for long-term suppression of frequently recurring urinary infections, and it is started after an active infection has been cleared with another antimicrobial. Rapid cure of acute pyelonephritis requires an antibiotic that reaches kidney tissue. Relief of burning during urination is the job of a urinary analgesic such as phenazopyridine. Treatment of urinary retention after surgery calls for a cholinergic drug such as bethanechol or catheterization.
Category: Urinary Anti-infectives
Question 2
How should the nurse teach a patient to take fosfomycin granules?
Dissolve them in hot water and let it steep
Dissolve them in cool water and drink right away
✓
Swallow the dry granules followed by water
Sprinkle them on food and chew well
Correct Answer
Dissolve them in cool water and drink right away
Fosfomycin granules are stirred into cool water and the mixture is taken immediately after mixing. Dissolving them in hot water and letting it steep goes against the labeling, which says not to use hot water. Swallowing the dry granules followed by water is wrong because the drug must never be taken in its dry form. Sprinkling them on food and chewing is not a labeled way to take the drug.
Category: Urinary Anti-infectives
Question 3
A patient who takes warfarin is prescribed trimethoprim-sulfamethoxazole for a urinary infection. Which nursing action is needed?
Holding the antibiotic until warfarin is stopped
Increasing dietary vitamin K during the course
Closer INR monitoring for increased bleeding risk
✓
Checking serum digoxin levels daily
Correct Answer
Closer INR monitoring for increased bleeding risk
Trimethoprim-sulfamethoxazole can increase the anticoagulant effect of warfarin and prolong the prothrombin time, so the INR is followed more closely and the patient is watched for bleeding. Holding the antibiotic until warfarin is stopped is unnecessary when monitoring is in place. Increasing dietary vitamin K during the course is not how the interaction is managed and would make warfarin control unpredictable. Checking serum digoxin levels daily has no connection to this drug pair.
Category: Urinary Anti-infectives
Question 4
A patient taking trimethoprim-sulfamethoxazole develops a spreading red rash with blisters and mouth sores. What should the nurse do?
Give the next dose with food
Apply sunscreen and continue the drug
Encourage extra fluids and recheck later
Hold the drug and notify the provider
✓
Correct Answer
Hold the drug and notify the provider
A blistering rash with mucous membrane sores can signal a severe skin reaction such as Stevens-Johnson syndrome, and labeling directs stopping the drug at the first sign of rash. Giving the next dose with food does nothing for a hypersensitivity reaction. Applying sunscreen and continuing the drug would treat the problem as simple photosensitivity and risks progression. Encouraging extra fluids and rechecking later delays care for a possibly life-threatening reaction.
Category: Urinary Anti-infectives
Question 5
Fosfomycin kills susceptible bacteria by inhibiting which bacterial process?
Cell wall synthesis
✓
Folic acid synthesis
Protein synthesis at the ribosome
DNA gyrase activity
Correct Answer
Cell wall synthesis
Fosfomycin blocks an early enzyme step in building the bacterial cell wall, which makes it bactericidal. Folic acid synthesis is the target of trimethoprim and sulfamethoxazole. Protein synthesis at the ribosome is blocked by drugs such as aminoglycosides, tetracyclines and macrolides. DNA gyrase activity is inhibited by fluoroquinolones such as ciprofloxacin.
Category: Urinary Anti-infectives
Question 6
Nitrofurantoin is contraindicated in a patient with which condition?
Controlled essential hypertension
Significantly impaired kidney function
✓
Mild intermittent asthma
Iron deficiency anemia
Correct Answer
Significantly impaired kidney function
Poor kidney function keeps nitrofurantoin from reaching useful urine levels and lets the drug build up in the blood, raising the risk of toxicity such as neuropathy, so labeling lists significant renal impairment as a contraindication. Controlled essential hypertension does not affect nitrofurantoin use. Mild intermittent asthma is not a contraindication. Iron deficiency anemia is not a contraindication either.
Category: Urinary Anti-infectives
Question 7
Compared with oral oxybutynin, the transdermal form causes less dry mouth for which reason?
It blocks nicotinic rather than muscarinic receptors
It works by stimulating beta-3 receptors
It bypasses first-pass metabolism in the liver
✓
It is not absorbed into the bloodstream
Correct Answer
It bypasses first-pass metabolism in the liver
When oxybutynin is swallowed, first-pass liver metabolism forms an active metabolite that contributes heavily to dry mouth, and the skin route avoids much of that conversion. Blocking nicotinic rather than muscarinic receptors is incorrect, since every form of oxybutynin is antimuscarinic. Stimulating beta-3 receptors is how mirabegron works, not oxybutynin. Not being absorbed into the bloodstream is false, because the patch acts systemically.
Category: Overactive Bladder Drugs
Question 8
A patient taking oxybutynin plans to do yard work on a very hot day. Which risk should the nurse teach about?
Low blood sugar from heavy activity
Bleeding from fragile capillaries
Bladder spasm from heavy sweating
Heat illness from decreased sweating
✓
Correct Answer
Heat illness from decreased sweating
Antimuscarinic drugs reduce sweating, so heat cannot be released normally and heat prostration or heat stroke can occur in hot conditions. Low blood sugar from heavy activity is not an effect of oxybutynin. Bleeding from fragile capillaries is not linked to this drug. Bladder spasm from heavy sweating is not a recognized effect, and the drug relaxes the bladder.
Category: Overactive Bladder Drugs
Question 9
An older adult who started oxybutynin last week develops new confusion and agitation. What should the nurse suspect?
Central anticholinergic effects of the drug
✓
An expected sign that the bladder is healing
Excess stimulation of beta-3 receptors
Serotonin syndrome from the drug
Correct Answer
Central anticholinergic effects of the drug
Oxybutynin crosses into the brain and can cause confusion, agitation, hallucinations and drowsiness, especially in older adults, so new mental status changes are reported to the provider. An expected sign that the bladder is healing is not a real effect, and confusion is never an expected finding. Excess stimulation of beta-3 receptors relates to mirabegron. Serotonin syndrome is caused by serotonergic drugs, not antimuscarinics.
Category: Overactive Bladder Drugs
Question 10
Mirabegron is started in a patient who takes digoxin. What should the nurse anticipate?
Holding digoxin while on mirabegron
Monitoring of serum digoxin levels
✓
Daily serum magnesium levels
A switch to an IV form of digoxin
Correct Answer
Monitoring of serum digoxin levels
Mirabegron raises digoxin concentrations, so labeling advises using the lowest digoxin dose and monitoring serum digoxin levels when the two are combined. Holding digoxin while on mirabegron is not required. Daily serum magnesium levels are not part of managing this interaction. A switch to an IV form of digoxin would not prevent the interaction and is not indicated.
Category: Overactive Bladder Drugs
Question 11
A patient is taking nitrofurantoin oral suspension at home. What should the nurse teach the patient to do after each dose?
Lie flat for a short time
Skip the next dose if the urine darkens
Rinse the mouth to keep the teeth from staining
✓
Stop the drug once the burning eases
Correct Answer
Rinse the mouth to keep the teeth from staining
Nitrofurantoin can stain the teeth, so patients rinse the mouth thoroughly after a dose of the liquid. Lying flat after a dose is not needed. Darker, brownish urine is an expected and harmless effect, so it is no reason to skip a dose. The full course is finished even after symptoms ease, so the infection is cleared and resistance is less likely.
Category: Urinary Anti-infectives
Question 12
Which overactive bladder drug class is an alternative for a patient who cannot tolerate antimuscarinic adverse effects?
Alpha-1 adrenergic agonists
Direct cholinergic agonists
Loop diuretics
Beta-3 adrenergic agonists
✓
Correct Answer
Beta-3 adrenergic agonists
Beta-3 adrenergic agonists such as mirabegron relax the detrusor during bladder filling without blocking muscarinic receptors, so they avoid typical effects such as dry mouth. Alpha-1 adrenergic agonists tighten the bladder neck and are not used for overactive bladder. Direct cholinergic agonists such as bethanechol contract the bladder and would worsen urgency. Loop diuretics increase urine output and would make symptoms worse.
Category: Overactive Bladder Drugs
Question 13
A patient taking phenazopyridine needs a urine dipstick test. Why should the nurse note the drug on the request?
Its dye can interfere with color-based urine tests
✓
It makes the urine too dilute to test
It kills bacteria and gives a false negative culture
It raises urine glucose to a high level
Correct Answer
Its dye can interfere with color-based urine tests
Phenazopyridine is an azo dye that colors the urine reddish orange, and that color can interfere with urinalysis methods based on color reactions or spectrometry. Making the urine too dilute to test is not an effect of the drug. Killing bacteria to cause a false negative culture is wrong because the drug has no antibacterial action. Raising urine glucose to a high level is not something the drug does.
Category: Urinary Analgesics
Question 14
A patient taking phenazopyridine develops a yellowish tinge to the sclera. What does this finding suggest?
An expected and harmless dye effect
Drug accumulation from reduced kidney excretion
✓
An allergic reaction to sulfonamides
Dehydration from urinary frequency
Correct Answer
Drug accumulation from reduced kidney excretion
A yellow tinge of the skin or sclera may mean phenazopyridine is accumulating because the kidneys are not excreting it well, and the drug should be stopped and the provider notified. An expected and harmless dye effect describes orange urine, not yellow eyes. An allergic reaction to sulfonamides is not what this sign represents. Dehydration from urinary frequency does not cause scleral discoloration.
Category: Urinary Analgesics
Question 15
Which finding in a patient receiving bethanechol should the nurse report right away?
An urge to urinate soon after a dose
Mild sweating after a dose
Wheezing and shortness of breath
✓
Increased saliva production
Correct Answer
Wheezing and shortness of breath
Bethanechol stimulates muscarinic receptors, which can constrict the airways and cause bronchospasm, so wheezing and breathing difficulty need prompt attention. An urge to urinate soon after a dose is the intended effect. Mild sweating after a dose is a common, expected cholinergic effect. Increased saliva production is also an expected cholinergic effect rather than an emergency.
Category: Urinary Stimulants
Question 16
A patient taking tamsulosin is scheduled for cataract surgery. Why should the nurse make sure the eye surgeon knows about the drug?
It raises pressure inside the eye
It causes severe dry eye after surgery
It increases bleeding from the eye
It can cause a floppy iris during surgery
✓
Correct Answer
It can cause a floppy iris during surgery
Alpha-1 blockers, tamsulosin in particular, are linked to intraoperative floppy iris syndrome, which can complicate cataract surgery, so the surgeon needs to know in advance. Raising pressure inside the eye is a concern with anticholinergics in narrow-angle glaucoma, not with tamsulosin. Severe dry eye after surgery is not the warning tied to this drug. Increased bleeding from the eye is not a recognized effect of tamsulosin.
Category: BPH Drugs
Question 17
Tamsulosin causes less blood pressure lowering than doxazosin for which reason?
It selectively blocks alpha-1A receptors in the prostate
✓
It blocks beta-1 receptors in the heart
It inhibits the enzyme that activates testosterone
It inhibits phosphodiesterase in the bladder
Correct Answer
It selectively blocks alpha-1A receptors in the prostate
Tamsulosin is relatively selective for the alpha-1A receptors that predominate in prostate and bladder neck smooth muscle, so it relaxes them with less effect on blood vessels than nonselective alpha-1 blockers such as doxazosin. Blocking beta-1 receptors in the heart describes cardioselective beta blockers. Inhibiting the enzyme that activates testosterone describes 5-alpha-reductase inhibitors such as finasteride. Inhibiting phosphodiesterase describes tadalafil.
Category: BPH Drugs
Question 18
A baseline prostate-specific antigen (PSA) level is drawn before a patient starts finasteride for which reason?
The drug raises PSA, which can mimic cancer
The drug lowers PSA, which can hide a rising value
✓
The drug is unsafe when PSA is normal
The drug works only when PSA is elevated
Correct Answer
The drug lowers PSA, which can hide a rising value
Finasteride lowers serum PSA, so a baseline value is needed and later results are interpreted with the drug in mind; any confirmed rise while on therapy is evaluated because it may signal prostate cancer. The drug raising PSA to mimic cancer is the opposite of its effect. The drug being unsafe when PSA is normal is not true. The drug working only when PSA is elevated is also not true, since its benefit comes from shrinking the prostate.
Category: BPH Drugs
Question 19
A patient taking dutasteride asks about donating blood. What should the nurse explain?
He may donate as long as he skips the dose that day
He may donate because the drug does not enter the blood
He should not donate during therapy or for a period after stopping
✓
He should donate often to lower his drug levels
Correct Answer
He should not donate during therapy or for a period after stopping
Dutasteride can reach a pregnant person through donated blood and harm a male fetus, so labeling says men taking it should not donate blood until a waiting period has passed after the last dose. Donating as long as he skips the dose that day ignores the drug's long persistence in the body. Saying the drug does not enter the blood is false, since it is absorbed systemically. Donating often to lower drug levels is not a valid or safe practice.
Category: BPH Drugs
Question 20
Which phosphodiesterase inhibitor is approved to treat the signs and symptoms of benign prostatic hyperplasia?
Sildenafil
Vardenafil
Avanafil
Tadalafil
✓
Correct Answer
Tadalafil
Tadalafil is approved both for erectile dysfunction and for urinary symptoms of benign prostatic hyperplasia, which it eases by relaxing smooth muscle in the prostate and bladder neck. Sildenafil is approved for erectile dysfunction and pulmonary arterial hypertension, not BPH. Vardenafil is approved only for erectile dysfunction. Avanafil is also approved only for erectile dysfunction.
Category: BPH Drugs