NURS 620 Maryville Practice Exam 3
Urinary Tract Infections (UTIs)
1. What are potential causes of chronic infection/UTI?
• Obstructions
• Antibiotic-resistant bacteria (presence of multiple strains of bacteria)
Correct Answer: Obstructions and antibiotic-resistant bacteria
Rationale: Chronic UTIs often result from underlying structural or functional abnormalities that
prevent complete bladder emptying, allowing bacteria to persist. Additionally, the presence of
multiple bacterial strains that are resistant to antibiotics can lead to recurrent or chronic infection.
2. What additional HPI questions would you want to ask a patient with urinary complaints
(dysuria, urgency, etc.)?
• Fever
• N/V
• Pain (abdominal, pelvic, back)
• LMP
• Contraceptive use
• Sexual partners
• Hygiene habits
• Vaginal discharge/irritation
• History of UTIs
Correct Answer: All of the above
Rationale: A comprehensive history helps differentiate between UTI, STI, vaginitis, and other causes
of urinary symptoms. Key elements include associated systemic symptoms (fever, N/V), pain
characteristics, menstrual and contraceptive history, sexual history, hygiene practices, and previous
UTI history.
3. What are possible differential diagnoses of dysuria?
• Usually bladder problem
• UTI
• Pyelonephritis
• STI
• Inflammatory lesions of the prostate, bladder, & urethra
, • Bladder tumors
• Chronic renal failure
• Nephrolithiasis
• Vaginitis/prostatitis
• Prolapsed uterus
• Pelvic peritonitis
• Cancer of cervix or prostate
Correct Answer: All of the above
Rationale: Dysuria can result from infectious, inflammatory, structural, or neoplastic conditions
affecting the urinary tract or adjacent pelvic organs. A broad differential is essential to avoid missing
serious pathology.
4. What is the easiest, most noninvasive, and most economical way to identify UTI and/or other
renal problems?
Correct Answer: UA (Urinalysis)
Rationale: Urinalysis is the initial diagnostic test of choice for suspected UTI. It is inexpensive,
noninvasive, and rapidly provides information about infection, hematuria, proteinuria, and other
renal abnormalities.
5. Infection that occurs when the normal sterile condition of the urinary tract is invaded by
pathogenic bacteria is called:
Correct Answer: Lower urinary tract infection
Rationale: A lower UTI occurs when pathogenic bacteria invade the normally sterile urinary tract,
typically ascending from the perineal area.
6. Name the types of lower urinary tract infections.
Correct Answer:
• Urethra: Urethritis
• Bladder: Cystitis
• Bladder wall: Interstitial cystitis (IC)
• Prostate gland: Prostatitis
Rationale: Lower UTIs are classified by the anatomic site of infection. Urethritis affects the urethra,
cystitis affects the bladder, interstitial cystitis is a chronic inflammatory condition of the bladder wall,
and prostatitis affects the prostate gland.
,7. Acute lower urinary tract infections are characterized by what?
Correct Answer: Onset of UTI in a previously symptom-free individual.
Rationale: Acute lower UTI presents with sudden onset of symptoms in a patient who was previously
asymptomatic.
8. What tests would you order to diagnose lower UTI?
Correct Answer: UA C&S (Urinalysis with Culture and Sensitivity)
Rationale: Urinalysis identifies signs of infection (leukocyte esterase, nitrites, WBCs, bacteria), while
culture and sensitivity identify the specific organism and guide antibiotic selection.
9. What results would make you suspect UTI?
• Cloudy urine clarity
• Positive leukocytes esterase
• Positive nitrites (signals gram-negative organism, may have false negatives)
• Protein: 1+ to 4+ (kidney problems)
• Alkaline urine (pH 6.5-8)
• RBCs may be present
Correct Answer: All of the above
Rationale: These urinalysis findings are consistent with UTI. Leukocyte esterase indicates the
presence of WBCs, nitrites suggest gram-negative bacteria, and alkaline pH can be associated with
certain organisms.
10. Who should receive prophylaxis for recurrent UTI?
Correct Answer: 2 or more symptomatic UTIs within 6 months, or 3 or more within 12 months.
Rationale: Recurrent UTI is defined as at least 2 symptomatic episodes in 6 months or 3 in 12
months. These patients may benefit from antibiotic prophylaxis.
11. When should prophylaxis for recurrent UTI be initiated?
Correct Answer: After previous UTI resolution is confirmed.
Rationale: Prophylaxis should begin only after the acute infection has been treated and confirmed
resolved by negative urine culture.
, 12. Antibiotic regimen for recurrent UTI prophylaxis.
Correct Answer: Daily dosing for 6 months; post-coital prophylaxis; self-medication (3-4 days of
therapy when symptoms begin).
Rationale: Prophylaxis options include continuous daily low-dose antibiotics for 6 months, post-coital
dosing for sexually active women, or self-start therapy for reliable patients.
13. What is the clinical presentation of uncomplicated UTI?
• Dysuria
• Urinary frequency & urgency
• Hematuria
• Low back or suprapubic pain/tenderness
• Elderly = AMS (altered mental status)
Correct Answer: All of the above
Rationale: Uncomplicated UTI typically presents with dysuria, frequency, urgency, and suprapubic
pain. Hematuria may occur. In the elderly, confusion or altered mental status may be the only sign.
14. What is the oral treatment for acute uncomplicated UTI?
• Bactrim 1 DS BID x 3 days
• Cefdinir 500 mg BID x 5 days
• Nitrofurantoin 100 mg BID x 5 days
Correct Answer: All of the above are appropriate first-line options.
Rationale: First-line agents for uncomplicated UTI include trimethoprim-sulfamethoxazole (Bactrim),
cefdinir, and nitrofurantoin. Choice depends on local resistance patterns and patient allergies.
15. Patient education for uncomplicated UTI.
• Complete the antibiotic regimen
• Proper hygiene
• Drink plenty of water (8 - 8 oz glasses)
• Cotton undergarments
• Empty bladder after sexual intercourse
• Empty bladder frequently
• No tub baths or bubble baths
Urinary Tract Infections (UTIs)
1. What are potential causes of chronic infection/UTI?
• Obstructions
• Antibiotic-resistant bacteria (presence of multiple strains of bacteria)
Correct Answer: Obstructions and antibiotic-resistant bacteria
Rationale: Chronic UTIs often result from underlying structural or functional abnormalities that
prevent complete bladder emptying, allowing bacteria to persist. Additionally, the presence of
multiple bacterial strains that are resistant to antibiotics can lead to recurrent or chronic infection.
2. What additional HPI questions would you want to ask a patient with urinary complaints
(dysuria, urgency, etc.)?
• Fever
• N/V
• Pain (abdominal, pelvic, back)
• LMP
• Contraceptive use
• Sexual partners
• Hygiene habits
• Vaginal discharge/irritation
• History of UTIs
Correct Answer: All of the above
Rationale: A comprehensive history helps differentiate between UTI, STI, vaginitis, and other causes
of urinary symptoms. Key elements include associated systemic symptoms (fever, N/V), pain
characteristics, menstrual and contraceptive history, sexual history, hygiene practices, and previous
UTI history.
3. What are possible differential diagnoses of dysuria?
• Usually bladder problem
• UTI
• Pyelonephritis
• STI
• Inflammatory lesions of the prostate, bladder, & urethra
, • Bladder tumors
• Chronic renal failure
• Nephrolithiasis
• Vaginitis/prostatitis
• Prolapsed uterus
• Pelvic peritonitis
• Cancer of cervix or prostate
Correct Answer: All of the above
Rationale: Dysuria can result from infectious, inflammatory, structural, or neoplastic conditions
affecting the urinary tract or adjacent pelvic organs. A broad differential is essential to avoid missing
serious pathology.
4. What is the easiest, most noninvasive, and most economical way to identify UTI and/or other
renal problems?
Correct Answer: UA (Urinalysis)
Rationale: Urinalysis is the initial diagnostic test of choice for suspected UTI. It is inexpensive,
noninvasive, and rapidly provides information about infection, hematuria, proteinuria, and other
renal abnormalities.
5. Infection that occurs when the normal sterile condition of the urinary tract is invaded by
pathogenic bacteria is called:
Correct Answer: Lower urinary tract infection
Rationale: A lower UTI occurs when pathogenic bacteria invade the normally sterile urinary tract,
typically ascending from the perineal area.
6. Name the types of lower urinary tract infections.
Correct Answer:
• Urethra: Urethritis
• Bladder: Cystitis
• Bladder wall: Interstitial cystitis (IC)
• Prostate gland: Prostatitis
Rationale: Lower UTIs are classified by the anatomic site of infection. Urethritis affects the urethra,
cystitis affects the bladder, interstitial cystitis is a chronic inflammatory condition of the bladder wall,
and prostatitis affects the prostate gland.
,7. Acute lower urinary tract infections are characterized by what?
Correct Answer: Onset of UTI in a previously symptom-free individual.
Rationale: Acute lower UTI presents with sudden onset of symptoms in a patient who was previously
asymptomatic.
8. What tests would you order to diagnose lower UTI?
Correct Answer: UA C&S (Urinalysis with Culture and Sensitivity)
Rationale: Urinalysis identifies signs of infection (leukocyte esterase, nitrites, WBCs, bacteria), while
culture and sensitivity identify the specific organism and guide antibiotic selection.
9. What results would make you suspect UTI?
• Cloudy urine clarity
• Positive leukocytes esterase
• Positive nitrites (signals gram-negative organism, may have false negatives)
• Protein: 1+ to 4+ (kidney problems)
• Alkaline urine (pH 6.5-8)
• RBCs may be present
Correct Answer: All of the above
Rationale: These urinalysis findings are consistent with UTI. Leukocyte esterase indicates the
presence of WBCs, nitrites suggest gram-negative bacteria, and alkaline pH can be associated with
certain organisms.
10. Who should receive prophylaxis for recurrent UTI?
Correct Answer: 2 or more symptomatic UTIs within 6 months, or 3 or more within 12 months.
Rationale: Recurrent UTI is defined as at least 2 symptomatic episodes in 6 months or 3 in 12
months. These patients may benefit from antibiotic prophylaxis.
11. When should prophylaxis for recurrent UTI be initiated?
Correct Answer: After previous UTI resolution is confirmed.
Rationale: Prophylaxis should begin only after the acute infection has been treated and confirmed
resolved by negative urine culture.
, 12. Antibiotic regimen for recurrent UTI prophylaxis.
Correct Answer: Daily dosing for 6 months; post-coital prophylaxis; self-medication (3-4 days of
therapy when symptoms begin).
Rationale: Prophylaxis options include continuous daily low-dose antibiotics for 6 months, post-coital
dosing for sexually active women, or self-start therapy for reliable patients.
13. What is the clinical presentation of uncomplicated UTI?
• Dysuria
• Urinary frequency & urgency
• Hematuria
• Low back or suprapubic pain/tenderness
• Elderly = AMS (altered mental status)
Correct Answer: All of the above
Rationale: Uncomplicated UTI typically presents with dysuria, frequency, urgency, and suprapubic
pain. Hematuria may occur. In the elderly, confusion or altered mental status may be the only sign.
14. What is the oral treatment for acute uncomplicated UTI?
• Bactrim 1 DS BID x 3 days
• Cefdinir 500 mg BID x 5 days
• Nitrofurantoin 100 mg BID x 5 days
Correct Answer: All of the above are appropriate first-line options.
Rationale: First-line agents for uncomplicated UTI include trimethoprim-sulfamethoxazole (Bactrim),
cefdinir, and nitrofurantoin. Choice depends on local resistance patterns and patient allergies.
15. Patient education for uncomplicated UTI.
• Complete the antibiotic regimen
• Proper hygiene
• Drink plenty of water (8 - 8 oz glasses)
• Cotton undergarments
• Empty bladder after sexual intercourse
• Empty bladder frequently
• No tub baths or bubble baths
