MULTIPLE CHOICE
1. What part of the urinary tract is most susceptible to infection?
a. Urethral mucosa
b. Bladder
c. Ureters
d. Nephrons
A
Except for the urethral mucosa and the renal medulla, which appear
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MULTIPLE CHOICE
1. What part of the urinary tract is most susceptible to infection?
a. Urethral mucosa
b. Bladder
c. Ureters
d. Nephrons
A
Except for the urethral mucosa and the renal medulla, which appear to be relatively susceptible to infection, the normal urinary tract is resistant to colonization and subsequent infection by bacteria.
REF: 886 OBJ: Level 1: Recall
2. What characteristic of urine inhibits growth of many pathogens?
a. High glucose level
b. Low pH
c. High protein level
d. High pH
B
Although urine is frequently considered a good culture medium, the extremely high urine osmolarity (concentration) and low pH levels inhibit the growth of many uropathogens and almost all normal bacterial flora of the urethra.
REF: 886 OBJ: Level 1: Recall
3. All of the following can contribute to reduced leukocyte chemotaxis in the renal medulla except:
a. high ammonia concentration.
b. hyperosmolarity.
c. reduced water reabsorption.
d. sluggish blood flow.
C
Conditions such as high ammonia concentration, hyperosmolarity, lowered pH, and sluggish blood flow in the renal medulla can contribute to reduced leukocyte chemotaxis and bactericidal activity of white blood cells, resulting in lowered infection resistance.
REF: 886 OBJ: Level 1: Recall
4. Urinary tract infection (UTI) in children is associated with significant morbidity and long-term medical problems, including all the following except:
a. impaired renal function.
b. hypertension.
c. end-stage renal disease.
d. hemolytic-uremic syndrome.
D
UTI in children is associated with great morbidity and long-term medical problems, including impaired renal function, hypertension, end-stage renal disease, and complications of pregnancy as an adult.
REF: 886 OBJ: Level 1: Recall
5. The atypical clinical presentation of a geriatric patient with a urinary tract infection (UTI) includes all the following except:
a. burning upon urination.
b. delirium.
c. fever.
d. failure to thrive.
A
The diagnosis and management of UTI in the geriatric population can be challenging. These patients frequently have an atypical clinical presentation including delirium, fevers alone, or failure to thrive.
REF: 887 OBJ: Level 1: Recall
6. All of the following are reasons why institutionalized patients have more urinary tract infections (UTIs) than noninstitutionalized patients except:
a. general ill condition of institutionalized patients.
b. less frequent emptying of the bladder.
c. higher probability of urinary tract instrumentation.
d. higher incidence of urinary tract anatomic or functional abnormalities.
B
Hospitalized patients and those residing in long-term care facilities develop UTIs more often than outpatients. The generally ill condition of the institutionalized population, higher probability of urinary tract instrumentation, and higher incidence of genitourinary tract anatomic or functional abnormalities are major contributors to this difference.
REF: 888 OBJ: Level 1: Recall
7. A young woman goes to her physician complaining of dysuria, frequency, urgency, and suprapubic pain. A urinalysis shows hematuria, positive protein, positive leukocyte esterase, and a positive nitrite. What is a probable diagnosis?
a. Pyelonephritis
b. Bacteremia
c. Urinary tract infection (UTI)
d. Septicemia
C
Adults with uncomplicated lower UTIs limited to the urethra or bladder present primarily with dysuria, often in combination with frequency, urgency, suprapubic pain, and hematuria. Each episode of uncomplicated UTI in women is usually associated with 1 week of symptoms.
REF: 888 OBJ: Level 3: Synthesis
8. The symptoms of pyelonephritis include all the following except:
a. flank pain.
b. costovertebral angle tenderness.
c. fevers.
d. septicemia.
D
Patients with upper urinary tract infections (UTIs), such as pyelonephritis, have flank pain, nausea, vomiting, fevers, and costovertebral angle tenderness. These symptoms may occur in the presence or absence of symptoms of cystitis.
REF: 888 OBJ: Level 1: Recall
9. When a patient has an indwelling urinary catheter, what symptoms may be present indicating a urinary tract infection?
a. Flank pain and fever
b. Urgency and dysuria
c. Frequency and flank pain
d. Costovertebral angle tenderness and fever
A
Flank pain and fever without lower urinary tract symptoms, and bacteremia without any urinary tract symptoms, can be seen in patients with indwelling urinary catheters.
REF: 889 OBJ: Level 1: Recall
10. Bacteria gain access to the urinary tract by all of the following routes except the:
a. ascending route.
b. neurologic route.
c. hematogenous route.
d. lymphatic pathways.
B
Bacteria gain access to the urinary tract by three different routes, the ascending route, the hematogenous route, and the lymphatic pathways.
REF: 889 OBJ: Level 1: Recall
11. Because the urethra is shorter in women, bacteria are easily introduced into the bladder by:
a. fecal contamination.
b. vaginal contamination.
c. sexual intercourse.
d. poor personal hygiene.
C
Because of the shorter urethra in women, bacteria are easily introduced into the bladder by sexual intercourse.
REF: 890 OBJ: Level 1: Recall
12. What is the most common way for the renal parenchyma to become infected with gram-positive bacteria?
a. Ascending route
b. Descending route
c. Hematogenous route
d. Poor personal hygiene
C
Infection of the renal parenchyma by many species of gram-positive bacteria (particularly in patients with staphylococcal bacteremia or endocarditis, mycobacterial infection, Candida infection, and other fungal infections) clearly occurs by the hematogenous route. Gram-negative infections rarely occur by the hematogenous route.
REF: 890 OBJ: Level 2: Interpretation
13. What is the cause of most uncomplicated urinary tract infections (UTIs)?
a. Pseudomonas aeruginosa
b. Staphylococcus epidermidis
c. Streptococcus agalactiae
d. Escherichia coli
D
Of the Enterobacteriaceae, antibiotic-susceptible strains of E. coli that emanate from the patient’s own fecal flora cause most uncomplicated UTIs.
REF: 890 OBJ: Level 1: Recall
14. What organisms usually cause urinary tract infections (UTIs) in older men in conjunction with prostatic hypertrophy?
a. Enterococcus spp.
b. Staphylococcus epidermidis
c. Streptococcus agalactiae
d. Escherichia coli
A
Enterococcal UTIs occur primarily in older men, particularly in association with urinary tract manipulation or instrumentation or prostatic hypertrophy.
REF: 890 OBJ: Level 1: Recall
15. What group has more urinary tract infections (UTIs) caused by Staphylococcus saprophyticus?
a. Asymptomatic elderly men
b. Symptomatic sexually active young women
c. Symptomatic middle-age men
d. Elderly women
B
S. saprophyticus is found predominantly in symptomatic sexually active women younger than age 40.
REF: 890 OBJ: Level 1: Recall
16. What organisms growing in a urine culture can be considered contaminants?
a. Enterobacteriaceae
b. Streptococcus spp.
c. Fungus
d. Bacillus spp.
D
Isolation of Bacillus spp. can almost be considered contamination. Urinary tract infections (UTIs) truly caused by the organism are exceedingly rare.
REF: 891 OBJ: Level 1: Recall
17. What is one factor that may contribute to the incidence of candiduria in hospitalized patients?
a. Poor personal hygiene
b. Contaminated instruments
c. Increased use of broad-spectrum antibiotics
d. Increased use of multidrug regimens in hospitalized patients
C
Candiduria is rare in healthy adults. However, it is commonly seen in hospitalized patients. As many as 10% of patients in tertiary care facilities have Candida in their urine. This is because of several factors, including sicker patients, increasing incidence of urinary instrumentation, and increasing use of broad-spectrum antibiotics.
REF: 891 OBJ: Level 1: Recall
18. What may candiduria signify?
a. Bladder or renal parenchymal infection
b. Urinary tract fungus ball
c. Disseminated candidiasis
d. All of the above
D
Candiduria may be an indication of bladder or renal parenchymal infection, a urinary tract fungus ball, or disseminated candidiasis. Predisposing factors include diabetes mellitus, antibiotic and corticosteroid therapy, female gender, instrumentations, and disturbance of urine flow.
REF: 891 OBJ: Level 1: Recall
19. Urine cultures are performed for all the following reasons except to:
a. test for Chlamydia.
b. confirm a cure.
c. detect asymptomatic bacteriuria in pregnant women.
d. evaluate for bacteremia.
A
Urine cultures are requested not only in connection with the symptoms of acute urinary tract infection (UTI) but also in the absence of specific symptoms, as a test of cure, to evaluate the effectiveness of antimicrobial therapy, to detect asymptomatic bacteriuria in pregnant women, and to evaluate for bacteremia, fever, or both, to name but a few instances.
REF: 893 OBJ: Level 1: Recall
20. The criteria used to determine the presence of a urinary tract infection (UTI) include all the following except:
a. presence or absence of symptoms.
b. patient history.
c. predisposing factors.
d. the type of organism or organisms isolated.
B
The criteria that determine if a UTI is present must include the presence or absence of symptoms, predisposing factors, the patient population, and the type of organism or organisms isolated.
REF: 893 OBJ: Level 1: Recall
21. In what patient population is a colony count on a urine culture significant?
a. Young, sexually active women with cystitis
b. Elderly men with prostatitis
c. Asymptomatic individuals with pyelonephritis
d. Elderly women with candiduria
C
The outcome of a urine culture must be evaluated together with other laboratory and clinical data; attempts to attach significance to the colony count should be restricted to the original patient population in which that significance was established.
REF: 893 OBJ: Level 2: Interpretation
22. What is the most commonly used method to collect urine samples?
a. Catheterized specimen
b. Suprapubic aspirate
c. First morning specimen
d. Voided midstream specimen
D
The voided midstream collection, in which the patient collects the urine specimen, is the most commonly used method in clinical practice.
REF: 893 OBJ: Level 1: Recall
23. What specimen reduces the risk of contamination with urethral flora?
a. Catheterized specimen
b. Suprapubic aspirate
c. First morning specimen
d. Voided midstream specimen
A
Catheterized specimen collection, which is an invasive technique, reduces the risk of contamination of urine with the urethral flora; however, because the catheter is passed through the urethra, some contamination may occur.
REF: 893 OBJ: Level 1: Recall
24. What is the definitive method for collecting uncontaminated urine specimens?
a. Catheterized specimen
b. Suprapubic aspirate
c. First morning specimen
d. Voided midstream specimen
B
Suprapubic aspiration is the definitive method for collecting uncontaminated urine specimens.
REF: 893 OBJ: Level 1: Recall
25. What additive can maintain urine sample integrity for up to 48 hours at room temperature?
a. Sodium citrate
b. Calcium citrate
c. Sodium borate
d. Ethylenediamine tetraacetic acid (EDTA)
C
An example of a urine sample additive is sodium borate, which maintains sample integrity for up to 48 hours at room temperature. Sodium borate also helps prevent overgrowth without causing toxicity to existing pathogens.
REF: 894 OBJ: Level 1: Recall
26. Because urine is an excellent supportive medium for bacteria growth, how must urine specimens be handled after collection?
a. Store at room temperature for up to 24 hours.
b. Process the refrigerated specimen within 24 hours.
c. Store in the refrigerator for 48 hours.
d. Immediately refrigerate.
Urine is an excellent supportive medium for growth of most uropathogens and therefore must be immediately refrigerated or preserved. Generally, urine should be refrigerated, received, and processed in the laboratory within 2 hours.
REF: 894 OBJ: Level 1: Recall
27. Screening methods for urinary tract infections are appropriate for which of the following?
a. Urine specimens with significant pyuria and bacteriuria
b. Straight catheterization
c. Suprapubic aspiration
d. Cystoscopy
Screening methods are not appropriate for urine collected by straight catheterization, cystoscopy, suprapubic aspiration, and bladder washout or for test of infection cure and specimens collected from ileoconduits.
28. What size calibrated loops should be used to inoculate a urine sample that was collected by suprapubic aspiration?
a. 0.001 mL
b. 0.01 mL
c. 0.1 mL
d. 1.0 mL
29. In what type of specimen is the etiologic agent of acute prostatitis usually recovered?
a. Voided midstream urine
b. Suprapubic aspirate
c. Straight catheterization
d. All of the above
30. All of the following features should be considered in a urinary tract infection (UTI) workup except:
a. colony count of a pure or predominant organism.
b. measurement of pyuria.
c. presence or absence of symptoms.
d. nitrite positive.
31. What do specimens with multiple uropathogens (i.e., three or more) indicate?
a. Probable contamination
b. Polymicrobial infection
c. Bacteremia
d. Septicemia
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