# A client taking nitrofurantoin for cystitis develops fever, flank pain, vomiting, and costovertebral-angle tenderness. Which action is appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522886&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client taking nitrofurantoin for cystitis develops fever, flank pain, vomiting, and costovertebral-angle tenderness. Which action is appropriate?

## Option

1. Continue the same drug because it treats every urinary infection.
2. Notify the prescriber promptly because pyelonephritis is suspected and nitrofurantoin does not achieve appropriate renal-tissue levels. **✔ Correct answer**
3. Take the remaining doses only at bedtime.
4. Add an antacid containing magnesium trisilicate.

**Correct answer: 2**

## Explanation

The new systemic and flank findings suggest pyelonephritis. Nitrofurantoin is indicated for lower urinary infection, not pyelonephritis or perinephric abscess.

## In-depth explanation

Quick answer
Escalate upper-tract infection cues during nitrofurantoin therapy.

Why this is correct
Continuing a lower-tract agent can delay effective treatment of a renal infection.

Easy analogy or mental picture
Build a medication-safety chain: identify the new cue, connect it to the drug mechanism or labeled limitation, stop preventable exposure, stabilize the client, and verify a measurable response.

Memory hook
Drug, urgent cue, protective action, and reassessment endpoint.

NCLEX decision rule
Choose the action that prevents the most immediate medication-related harm while preserving indicated treatment and required monitoring.

Why the other choices are wrong
Options that continue a suspect exposure, normalize a labeled danger cue, substitute an unauthorized dose, or delay escalation leave the client at risk.References
1DailyMed: Nitrofurantoin CapsulesLower-tract indication and lack of pyelonephritis treatment

## Clinical scenario

Medication-safety review
Verify indication, current assessment, dose and route, organ function, interactions, urgent toxicity cues, authorized action, and measurable follow-up.

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