NSG 554 Exam 3 – Wilkes
Questions with Answers| Latest Update
1. A 26-year-old nonpregnant woman has dysuria, frequency, and
urgency for 2 days with no fever, flank pain, or vaginal discharge.
Which is an appropriate first-line treatment?
A. Amoxicillin 500 mg once daily for 3 days
B. Nitrofurantoin 100 mg twice daily for 5 days
C. Ciprofloxacin 500 mg twice daily for 14 days
D. Cephalexin single dose
Answer: B. Nitrofurantoin 100 mg twice daily for 5 days
Rationale: Nitrofurantoin (5 days), TMP-SMX (3 days, if local resistance
<20%), or fosfomycin (single 3-g dose) are first-line for uncomplicated
cystitis. Fluoroquinolones are reserved for other options because of
adverse effects and resistance. Avoid nitrofurantoin with CrCl <30 mL/min.
2. Which urinalysis finding is MOST specific for a gram-negative
bacterial UTI?
A. Positive nitrite
B. Trace protein
C. Positive glucose
D. Elevated specific gravity
Answer: A. Positive nitrite
Rationale: Many gram-negative organisms (E. coli) convert urinary nitrate
to nitrite. A positive nitrite is specific, but a negative result does not rule out
UTI. Leukocyte esterase indicates pyuria.
NSG 554 Exam 3 Practice — Page 1
,3. Which patient with asymptomatic bacteriuria should be treated?
A. A 78-year-old nursing home resident
B. A woman with a chronic indwelling urinary catheter
C. A man with diabetes
D. A pregnant woman
Answer: D. A pregnant woman
Rationale: Asymptomatic bacteriuria is treated in pregnancy (risk of
pyelonephritis and preterm birth) and before invasive urologic procedures
with mucosal bleeding. Treating other groups promotes resistance without
benefit.
4. A pregnant patient at 12 weeks has a symptomatic UTI. Which
antibiotic should be AVOIDED?
A. Amoxicillin-clavulanate
B. Cephalexin
C. Fosfomycin
D. Fluoroquinolone
Answer: D. Fluoroquinolone
Rationale: Fluoroquinolones are avoided in pregnancy (cartilage concerns),
and TMP-SMX is avoided in the first trimester (folate antagonist). Obtain a
urine culture and confirm cure after treatment.
5. A 30-year-old woman has fever of 38.9°C, flank pain, nausea, and
costovertebral angle tenderness. Which is the MOST likely diagnosis?
A. Acute pyelonephritis
B. Uncomplicated cystitis
C. Urethritis
D. Renal cell carcinoma
Answer: A. Acute pyelonephritis
Rationale: Fever, flank pain, and CVA tenderness indicate upper tract
infection. Obtain UA and urine culture. Treatment: oral fluoroquinolone (if
local resistance <10%), TMP-SMX per susceptibilities, or a beta-lactam,
often with an initial IV dose of ceftriaxone.
NSG 554 Exam 3 Practice — Page 2
, 6. Which finding in a patient with pyelonephritis warrants hospital
admission?
A. Positive nitrite
B. Persistent vomiting with inability to tolerate oral medications
C. Low-grade fever
D. Mild flank discomfort
Answer: B. Persistent vomiting with inability to tolerate oral
medications
Rationale: Admission is indicated for sepsis, pregnancy, obstruction,
inability to take oral therapy, or lack of response at 48–72 hours. Consider
imaging if no improvement to rule out obstruction or abscess.
7. A postmenopausal woman has 4 UTIs in the past year. Which
prevention strategy is supported by evidence?
A. Vaginal estrogen therapy
B. Daily high-dose vitamin C
C. Douching after intercourse
D. Avoiding all fluids
Answer: A. Vaginal estrogen therapy
Rationale: Vaginal estrogen restores the flora and reduces recurrent UTIs.
Other options: postcoital or continuous antibiotic prophylaxis, increased
hydration, and cranberry products (modest evidence).
8. A 45-year-old man presents with dysuria and frequency and a
positive urine culture. How is his UTI classified and managed?
A. Treat only if febrile
B. No treatment required
C. Complicated; culture-guided treatment for at least 7 days and
evaluate for prostatic or structural cause
D. Uncomplicated; 3-day course
Answer: C. Complicated; culture-guided treatment for at least 7 days
and evaluate for prostatic or structural cause
Rationale: UTIs in men are generally considered complicated. Consider
prostatitis. Treat 7 days (longer if prostatitis) and evaluate for obstruction or
urologic abnormality if recurrent.
NSG 554 Exam 3 Practice — Page 3
Questions with Answers| Latest Update
1. A 26-year-old nonpregnant woman has dysuria, frequency, and
urgency for 2 days with no fever, flank pain, or vaginal discharge.
Which is an appropriate first-line treatment?
A. Amoxicillin 500 mg once daily for 3 days
B. Nitrofurantoin 100 mg twice daily for 5 days
C. Ciprofloxacin 500 mg twice daily for 14 days
D. Cephalexin single dose
Answer: B. Nitrofurantoin 100 mg twice daily for 5 days
Rationale: Nitrofurantoin (5 days), TMP-SMX (3 days, if local resistance
<20%), or fosfomycin (single 3-g dose) are first-line for uncomplicated
cystitis. Fluoroquinolones are reserved for other options because of
adverse effects and resistance. Avoid nitrofurantoin with CrCl <30 mL/min.
2. Which urinalysis finding is MOST specific for a gram-negative
bacterial UTI?
A. Positive nitrite
B. Trace protein
C. Positive glucose
D. Elevated specific gravity
Answer: A. Positive nitrite
Rationale: Many gram-negative organisms (E. coli) convert urinary nitrate
to nitrite. A positive nitrite is specific, but a negative result does not rule out
UTI. Leukocyte esterase indicates pyuria.
NSG 554 Exam 3 Practice — Page 1
,3. Which patient with asymptomatic bacteriuria should be treated?
A. A 78-year-old nursing home resident
B. A woman with a chronic indwelling urinary catheter
C. A man with diabetes
D. A pregnant woman
Answer: D. A pregnant woman
Rationale: Asymptomatic bacteriuria is treated in pregnancy (risk of
pyelonephritis and preterm birth) and before invasive urologic procedures
with mucosal bleeding. Treating other groups promotes resistance without
benefit.
4. A pregnant patient at 12 weeks has a symptomatic UTI. Which
antibiotic should be AVOIDED?
A. Amoxicillin-clavulanate
B. Cephalexin
C. Fosfomycin
D. Fluoroquinolone
Answer: D. Fluoroquinolone
Rationale: Fluoroquinolones are avoided in pregnancy (cartilage concerns),
and TMP-SMX is avoided in the first trimester (folate antagonist). Obtain a
urine culture and confirm cure after treatment.
5. A 30-year-old woman has fever of 38.9°C, flank pain, nausea, and
costovertebral angle tenderness. Which is the MOST likely diagnosis?
A. Acute pyelonephritis
B. Uncomplicated cystitis
C. Urethritis
D. Renal cell carcinoma
Answer: A. Acute pyelonephritis
Rationale: Fever, flank pain, and CVA tenderness indicate upper tract
infection. Obtain UA and urine culture. Treatment: oral fluoroquinolone (if
local resistance <10%), TMP-SMX per susceptibilities, or a beta-lactam,
often with an initial IV dose of ceftriaxone.
NSG 554 Exam 3 Practice — Page 2
, 6. Which finding in a patient with pyelonephritis warrants hospital
admission?
A. Positive nitrite
B. Persistent vomiting with inability to tolerate oral medications
C. Low-grade fever
D. Mild flank discomfort
Answer: B. Persistent vomiting with inability to tolerate oral
medications
Rationale: Admission is indicated for sepsis, pregnancy, obstruction,
inability to take oral therapy, or lack of response at 48–72 hours. Consider
imaging if no improvement to rule out obstruction or abscess.
7. A postmenopausal woman has 4 UTIs in the past year. Which
prevention strategy is supported by evidence?
A. Vaginal estrogen therapy
B. Daily high-dose vitamin C
C. Douching after intercourse
D. Avoiding all fluids
Answer: A. Vaginal estrogen therapy
Rationale: Vaginal estrogen restores the flora and reduces recurrent UTIs.
Other options: postcoital or continuous antibiotic prophylaxis, increased
hydration, and cranberry products (modest evidence).
8. A 45-year-old man presents with dysuria and frequency and a
positive urine culture. How is his UTI classified and managed?
A. Treat only if febrile
B. No treatment required
C. Complicated; culture-guided treatment for at least 7 days and
evaluate for prostatic or structural cause
D. Uncomplicated; 3-day course
Answer: C. Complicated; culture-guided treatment for at least 7 days
and evaluate for prostatic or structural cause
Rationale: UTIs in men are generally considered complicated. Consider
prostatitis. Treat 7 days (longer if prostatitis) and evaluate for obstruction or
urologic abnormality if recurrent.
NSG 554 Exam 3 Practice — Page 3
