# A 25-year-old client with uncomplicated cystitis is being discharged on nitrofurantoin macrocrystals (Macrobid) 100 mg PO twice daily for 5 days. Which client teaching is most important? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=375251&lang=en > language: en > subject: Medical Emergencies > category: PA ## Question A 25-year-old client with uncomplicated cystitis is being discharged on nitrofurantoin macrocrystals (Macrobid) 100 mg PO twice daily for 5 days. Which client teaching is most important? ## Option 1. Take with a full glass of water on an empty stomach, at least 1 hour before or 2 hours after meals, to maximize absorption; expect harmless brown to dark yellow urine; it is effective for kidney infections (pyelonephritis) and can be used for that indication; complete the 5-day course; report any new cough, dyspnea, fever, chills, or tingling/numbness; avoid in patients with CrCl below about 60 mL/min, during the first trimester, and in those with G6PD deficiency. 2. Stop taking the medication if your urine turns brown or dark yellow, as this indicates liver toxicity; take on an empty stomach to avoid binding with food; it is safe to use in any stage of pregnancy and at any creatinine clearance level; a 3-day course is sufficient for cystitis; report any vaginal itching or discharge as this could indicate a superinfection. 3. Take with food or milk to improve absorption and reduce GI upset; expect harmless brown to dark yellow urine; complete the 5-day course; report new cough, dyspnea, fever, chills (possible acute pulmonary reaction), tingling/numbness (peripheral neuropathy), or unusual fatigue/jaundice; avoid in CrCl below about 30 mL/min, in late pregnancy at term, in G6PD deficiency, and in neonates because of hemolysis risk. **✔ Correct answer** 4. Take nitrofurantoin with a full glass of water on an empty stomach, 1 hour before or 2 hours after meals, as food decreases its effectiveness; the medication is safe to use in patients with kidney disease regardless of renal function; a 7-day course is standard for uncomplicated cystitis; you may stop the drug if you develop mild diarrhea, as this is a sign of allergy. **Correct answer: 3** ## Explanation Nitrofurantoin (Macrobid macrocrystals, Macrodantin microcrystals) is a urinary anti-infective that achieves therapeutic concentrations only in the urinary tract — making it useful for uncomplicated cystitis and prophylaxis but not for pyelonephritis or systemic urinary infections. Important teaching: (1) take with food or milk to improve absorption and reduce nausea; (2) expect harmless brown to dark yellow urine discoloration; (3) complete the prescribed course (5 days for Macrobid in uncomplicated cystitis); (4) acute pulmonary reaction can occur within hours to days — fever, chills, cough, dyspnea, eosinophilia, infiltrates — patient must stop the drug and seek care; chronic interstitial pneumonitis and pulmonary fibrosis are reported with prolonged use (months); (5) peripheral neuropathy especially in elderly, diabetics, B-deficient, anemic, or renally impaired — report tingling, numbness, weakness; (6) hepatotoxicity rare but possible — report jaundice, RUQ pain; (7) hemolytic anemia in G6PD deficiency; (8) avoid in CrCl less than about 30 mL/min because the drug cannot reach therapeutic urine concentrations and toxicity rises; (9) avoid at term (38 to 42 weeks gestation) and in neonates under 1 month because of hemolysis risk; (10) for pyelonephritis or febrile UTI, alternatives such as ceftriaxone, fluoroquinolones (when allowed), or amino-penicillin-based regimens are needed because nitrofurantoin does not achieve renal tissue levels. Empty stomach, stopping for dark urine, and using for pyelonephritis are wrong. ## In-depth explanation Nitrofurantoin is for uncomplicated cystitis only — with food, expect dark urine, watch lung and nerve adverse effects, avoid in renal failure, term pregnancy, and G6PD deficiency. ## Related questions - [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=en) - [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=en) - [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=en) - [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=en) - [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=en) - [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=en) - [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=en) - [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=375251&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=375251&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=375251&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=375251&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=375251&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. 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