UTI Fitz and Leik

Question 1

23. Which of the following is most likely to be part
    of the clinical presentation of an otherwise healthy
    27-year-old woman with uncomplicated lower
    urinary tract infection (UTI)?
    A. urinary frequency
    B. fever
    C. suprapubic tenderness
    D. lower gastrointestinal (GI) upset

Answer 1

A. urinary frequency

Question 2

24. Compared with UTI in younger women, uncomplicated UTI in an elderly woman is more likely to be associated with each of the following signs and symptoms except:
A. new-onset urinary incontinence.
B. delirium.
C. weakness.
D. hematuria.

Answer 2

D. hematuria.

Question 3

25. A 36-year-old afebrile woman with no health problems presents with dysuria and frequency of urination. Her urinalysis findings include results positive for nitrites and leukocyte esterase. You evaluate these results and consider that she likely has:
    A. purulent vulvovaginitis.
    B. a gram-negative UTI.
    C. cystitis caused by Staphylococcus saprophyticus.
    D. urethral syndrome.

Answer 3

B. a gram-negative UTI.

Question 4

26. The most likely causative organism in community-acquired UTI in women during the reproductive years is:
A. Klebsiella species.
B. Proteus mirabilis.
C. Escherichia coli.
D. Staphylococcus saprophyticus.

Answer 4

C. Escherichia coli

Question 5

28. You see a 34-year-old woman with an uncomplicated UTI. She is otherwise healthy but reports having a sulfa allergy. Appropriate therapy would include:
A. TMP-SMX.
B. amoxicillin.
C. azithromycin.
D. nitrofurantoin.

Answer 5

D. nitrofurantoin.

Question 6

29. The notation of alkaline urine in a patient with a UTI may point to infection caused by:
A. Klebsiella species.
B. P. mirabilis.
C. E. coli.
D. S. saprophyticus.

Answer 6

D. S. saprophyticus.

Question 7

30. Which of the following is the most accurate information in caring for a 40-year-old man with cystitis?
    A. This is a common condition in men of this age.
    B. A gram-positive organism is the likely causative
    pathogen.
    C. A urological evaluation should be considered.
    D. Pyuria is rarely found.

Answer 7

B. A gram-positive organism is the likely causative

pathogen.

Question 8

31. Evidence-based factors that prevent or minimize the risk of UTIs include all of the following except:
    A. male gender.
    B. longer urethra-to-anus length in women.
    C. timed voiding schedule.
    D. zinc-rich prostatic secretions

Answer 8

C. timed voiding schedule.

Question 9

32. Hemorrhagic cystitis is characterized by:
A. irritative voiding symptoms.
B. persistent microscopic hematuria.
C. the presence of hypertension.
D. elevated creatinine and BUN levels

Answer 9

A. irritative voiding symptoms.

Question 10

33. A 44-year-old woman presents with pyelonephritis. The report of her urinalysis is least likely to include:
A. WBC casts.
B. positive nitrites.
C. 3+ protein.
D. rare RBCs

Answer 10

C. 3+ protein.

Question 11

34. An example of a first-line therapeutic agent for the
treatment of pyelonephritis is:
A. amoxicillin with clavulanate.
B. trimethoprim-sulfamethoxazole.
C. ciprofloxacin.
D. nitrofurantoin.

Answer 11

C. ciprofloxacin.

Question 12

36. Risk factors for UTI in women include:
    A. postvoid wiping back to front.
    B. low perivaginal lactobacilli colonization.
    C. hot tub use.
    D. wearing snug-fitting pantyhose.

Answer 12

B. low perivaginal lactobacilli colonization.

Question 13

37. All of the following can negatively impact perivaginal lactobacilli colonization except:
    A. recent antimicrobial use.
    B. exposure to the spermicide nonoxynol-9.
    C. estrogen deficiency.
    D. postcoital voiding

Answer 13

B. exposure to the spermicide nonoxynol-9.

Question 14

38. In children and the elderly, which of the following
    conditions can contribute to bladder instability and
    increase the risk of a UTI?
    A. constipation
    B. upper respiratory tract infection
    C. chronic diarrhea
    D. efficient bladder emptying

Answer 14

A. constipation

Question 15

39. Which of the following is not a gram-negative
organism?
A. E. coli
B. K. pneumoniae
C. P. mirabilis
D. S. saprophyticus

Answer 15

D. S. saprophyticus

Question 16

40. You see a 70-year-old woman in a walk-in center with a chief complaint of increased urinary frequency and dysuria. Urinalysis reveals pyuria and positive nitrites. She mentions she has a “bit of kidney trouble, not too bad.” Recent evaluation of renal status is unavailable. In considering antimicrobial therapy for this patient, you prescribe:
A. nitrofurantoin.
B. fosfomycin.
C. ciprofloxacin.
D. doxycycline.

Answer 16

C. ciprofloxacin.

Question 17

99. A 55-year-old woman who has had type 2 diabetes for 20 years is concerned about
    her kidneys. She has a history of three urinary tract infections (UTIs) within the past 8 months, but is currently asymptomatic. Which of the following is the best course to follow?

A) Recheck urine during the visit, send a urine specimen for culture and sensitivity,
and refer to a nephrologist
B) Order a urinalysis dipstick test to be repeated monthly
C) Order a CT scan of the kidneys
D) Provide empiric treatment for a UTI

Answer 17

A) Recheck urine during the visit, send a urine specimen for culture and sensitivity, and refer to a nephrologist

Although the patient is currently
asymptomatic, her history of three urinary tract infections (UTIs) in 8 months warrants testing while she is in the office.

A UTI is defined as the presence of
100,000 organisms per milliliter of urine in asymptomatic patients or greater than
100 organisms per milliliter of urine with pyuria (>7 WBCs/mL) in a symptomatic
patient.

Diabetic patients are at higher risk for UTIs and over time may develop bladder damage (cystopathy) and nephropathy.

A nephrology consult is prudent.

Question 18

129. The nurse practitioner is evaluating patients who are at high risk for complications due to urinary tract infections (UTIs). Which of the following patients does not belong in this category?

A) A 38-year-old diabetic patient with an A1C of 7.5%
B) A woman with rheumatoid arthritis who is being treated with methotrexate and
low-dose steroids
C) A 21-year-old woman who has a history of irritable bowel syndrome
D) A pregnant woman

Answer 18

C) A 21-year-old woman who has a history of irritable bowel syndrome

Irritable bowel syndrome is not associated with higher risk for urinary tract infection (UTI).

Risk factors for UTI are gender (female), pregnancy, spermicide use during the past year, having a mother with history of UTIs, having a new sex partner during
the past year, urinary incontinence, and cystocele.

Question 19

134. A 21-year-old woman complains to you of a 1-week episode of dysuria, frequency,
     and a strong odor to her urine. This is her second episode of the year. The previous
     urinary tract infection occurred 3 months ago. What is the most appropriate followup
     for this patient?
     A) Order a urinalysis and urine for culture and sensitivity (C&S), and treat the
     patient with antibiotics
     B) Order a urine C&S and hold treatment until you get the results from the lab
     C) Treat the patient with a 7-day course of antibiotics and order a urine C&S now
     and after she completes her antibiotics
     D) Treat the patient with a stronger drug, such as ofloxacin (Floxin), for 10 days

Answer 19

A) Order a urinalysis and urine for culture and sensitivity (C&S), and treat the patient with antibiotics Because this is the second urinary tract infection for the year and the last episode was 3 months ago, the best action is to order the urinalysis and urine C&S to identify the organism causing the infection.
Antimicrobial-resistant strains are increasing. Start empiric treatment with an antibiotic for 7-day duration (do not use 3-day regimen).

Question 20

385. A 16-year-old female patient is being treated for her first urinary tract infection.
     She had an allergic reaction with hives after taking sulfa as a child. Which of the
     following antibiotics would be contraindicated?
     A) Cephalexin (Keflex)
     B) Ampicillin (Amoxil)
     C) Trimethoprim–sulfamethoxazole (Bactrim)
     D) Nitrofurantoin crystals (Macrobid)

Answer 20

C) Trimethoprim–sulfamethoxazole (Bactrim) With the allergic history to a sulfa drug, it would be safest to avoid Bactrim.

Question 21

405. A 28-year-old male nurse tells the employee health nurse practitioner that he was
     treated for a urinary tract infection twice the previous year. The patient denies fever,
     flank pain, or urethral discharge during the visit. Which of the following is the best
     follow-up for this patient?
     A) Refer the patient to a urologist
     B) Prescribe the patient ofloxacin (Floxin) for 2 weeks instead of 1 week
     C) Advise the patient that he needs to void every 2 hours when awake
     D) Refer the patient to the local emergency department, because he has a very high
     risk of sepsis

Answer 21

A) Refer the patient to a urologist Urinary tract infections (UTIs) are relatively rare in young men with normal urinary tracts.

Urethritis can mimic a UTI; rule out gonorrhea and chlamydia.

A urine culture before initiating antibiotics
and a test of cure is recommended for this group.

Therefore, they should be referred to a urologist for evaluation and treatment. Additional tests that should be conducted may include intravenous pyelography, renal ultrasound, CT scan, or cystoscopy.

Question 22

430. All of the following are considered risk factors for urinary tract infections in
women except:
A) Diabetes mellitus
B) Diaphragms and spermicide use
C) Pregnancy
D) Intrauterine device

Answer 22

D) Intrauterine device An intrauterine device (IUD) is not a risk factor for urinary tract infections (UTIs).

In addition to causing increased urine glucose,
diabetes may increase the risk of UTIs through mechanisms that include impaired immune cell delivery, inefficient white blood cells, and inhibition of bladder contractions that allow urine to remain stagnant in the bladder.

Diaphragms are associated with an increased risk of UTIs. Urinating before inserting the diaphragm
and also after intercourse may reduce this risk.

Hormonal and mechanical changes
increase the risk of urinary stasis and vesicoureteral reflux. These changes, along with
an already short urethra (approximately 3–4 cm in females) and difficulty with hygiene due to a distended pregnant belly, increase the frequency of UTIs in
pregnant women. Indeed, UTIs are among the most common bacterial infections
during pregnancy.