Chapter 34 - Pharmacology for the Primary Care Provider - Test Bank

Chapter 34: Drugs for Urinary Incontinence and Urinary Analgesia Test Bank MULTIPLE CHOICE 1. The primary care nurse practitioner (NP) sees a 50-year-old woman who reports frequent leakage of urine. The NP learns that this occurs when she laughs or sneezes. She also reports having an increased urge to void even when her bladder is not full. She is not taking any medications. The NP should: a. perform a dipstick urinalysis. b. prescribe desmopressin (DDAVP). c. prescribe oxybutynin chloride (Ditropan XL). d. teach exercises to strengthen the pelvic muscles. ANS: A A focused history with a careful physical examination is essential for determining the cause of incontinence. Urinalysis can rule out urinary tract infection (UTI), which can cause incontinence. Medications are prescribed after determining the cause, if any, and treating underlying conditions. Exercises to strengthen the pelvic muscles are part of treatment. DIF: Cognitive Level: Applying (Application) REF: 393 2. A patient who has diabetes reports intense discomfort when needing to void. A urinalysis is normal. To treat this, the primary care NP should consider prescribing: a. flavoxate (Urispas). b. bethanechol (Urecholine). c. phenazopyridine (Pyridium). d. oxybutynin chloride (Ditropan XL). ANS: D This patient is describing urge incontinence, or overactive bladder, which occurs when the detrusor muscle is hyperactive, causing an intense urge to void before the bladder is full. Urge incontinence is associated with many conditions, including diabetes. Oxybutynin chloride, which is an anticholinergic, acts to decrease detrusor overactivity and is indicated for treatment of urge incontinence. Flavoxate is used to treat dysuria associated with UTI. Bethanechol is indicated for urinary retention. Phenazopyridine is used to treat dysuria. DIF: Cognitive Level: Applying (Application) REF: 393 3. A patient reports having urinary frequency and discomfort associated with urination. After a careful physical examination and history to determine the cause, the NP should prescribe a medication from which drug class? a. Cholinergics b. Antispasmodics c. Anticholinergics d. Urinary tract analgesics ANS: B Antispasmodics are smooth muscle relaxants. Use of these drugs can produce increased bladder capacity and exhibit local anesthetic and analgesic actions. Cholinergic agents increase detrusor muscle tone to improve initiation of voiding and bladder emptying. Anticholinergics decrease detrusor tone to treat urge incontinence. Urinary tract analgesics are used to treat pain via a local analgesic effect on urinary tract mucosa and are used in conjunction with antibiotics to treat UTI. DIF: Cognitive Level: Applying (Application) REF: 393 - 394 4. A parent brings an 8-year-old child to the clinic because the child continues to wet the bed despite using cognitive-behavioral measures and a bed alarm system. The NP should prescribe: a. solifenacin (VESIcare). b. tolterodine (Detrol LA). c. desmopressin (DDAVP). d. phenazopyridine (Pyridium). ANS: C Desmopressin is used as an antidiuretic and decreases urine output for approximately 6 hours and is often used to treat nocturia in children. Solifenacin and tolterodine are anticholinergics. Phenazopyridine is a urinary tract analgesic. DIF: Cognitive Level: Understanding (Comprehension) REF: 394 5. A patient has a UTI and will begin treatment with an antibiotic. The patient reports moderate to severe suprapubic pain. The primary care NP should prescribe: a. ibuprofen as needed. b. bethanechol (Urecholine). c. phenazopyridine (Pyridium). d. increased oral fluid intake to dilute urine. ANS: C Phenazopyridine is a urinary tract analgesic used to treat pain via a local analgesic effect on urinary tract mucosa in conjunction with antibiotics to treat UTI. Ibuprofen may be used but does not have direct effects on the urinary tract mucosa. Bethanechol is used to treat voiding dysfunction and not pain. Increasing fluid intake should be used as adjunct therapy. DIF: Cognitive Level: Applying (Application) REF: 394 6. A primary care NP prescribes oxybutynin chloride for an 80-year-old patient to treat urinary incontinence. When teaching this patient about this medication, the NP should tell the patient: a. to increase intake of fluids and fiber. b. that alcohol may be consumed in moderation. c. that drowsiness may be a transient adverse effect. d. that hypertension may occur and to report headaches. ANS: A Oxybutynin chloride is an anticholinergic drug and can cause dry mouth and constipation. Patients should be taught to increase fluids and fiber. Patients should be cautioned to avoid alcoholic beverages. Drowsiness occurs but does not subside, and elderly patients are at increased risk for this side effect. Anticholinergics cause hypotension. DIF: Cognitive Level: Applying (Application) REF: 395 7. A patient reports dribbling small amounts of urine but also has difficulty initiating a urine stream. The primary care NP should prescribe: a. solifenacin (VESIcare). b. bethanechol (Urecholine). c. phenazopyridine (Pyridium). d. oxybutynin chloride (Ditropan XL). ANS: B Bethanechol is a cholinergic agonist and is used to treat voiding dysfunction by increasing the activity of the detrusor muscle. Solifenacin and oxybutynin chloride are anticholinergics. Phenazopyridine is a urinary tract analgesic. DIF: Cognitive Level: Applying (Application) REF: 397 8. A serious side effect associated with desmopressin is: a. dehydration. b. hypotension. c. hyponatremia. d. urinary retention. ANS: C Patients taking desmopressin should be cautioned to limit fluid intake because hyponatremia and water intoxication may occur. DIF: Cognitive Level: Remembering (Knowledge) REF: 394