UTI + pyelonephritis

Question 1

What is a Urinary Tract Infection (UTI)?

Answer 1

An infection of the urinary tract — the most common outpatient infection.

Question 2

What is the most common pathogen causing UTIs?

Answer 2

Escherichia coli (E. coli)

Question 3

What other pathogen can cause urine to turn green?

Answer 3

Pseudomonas

Question 4

What other organisms can sometimes cause UTIs?

Answer 4

Fungal and parasitic infections (especially in immunosuppressed, diabetic, or kidney-problem patients, or those on multiple antibiotics).

Question 5

How can frequent antibiotic use increase infection risk?

Answer 5

It disrupts normal flora, increasing risk for infections like C. diff.

Question 6

What are the normal defense mechanisms of the urinary tract?

Answer 6

Complete bladder emptying, competent ureterovesical junction, ureteral peristalsis, slightly acidic pH (6–7.5), and antimicrobial proteins/peptides.

Question 7

What is the most common route of bacterial entry in UTIs?

Answer 7

Ascending route — bacteria travel up the urethra → bladder (cystitis) → ureters → kidneys (pyelonephritis).

Question 8

What is hematogenous transmission in UTI pathophysiology?

Answer 8

Blood-borne pathogens invade the kidneys, ureters, or bladder from another site in the body.

Question 9

What conditions can cause hematogenous UTI spread?

Answer 9

Ureteral obstruction, renal stones (cause trauma), renal scarring.

Question 10

What are the classifications of UTIs based on location?

Answer 10

Upper (Pyelonephritis – kidney) and Lower (Cystitis – bladder, Urethritis – urethra).

Question 11

What is urosepsis?

Answer 11

UTI that progresses to systemic infection causing sepsis.

Question 12

What defines a complicated UTI?

Answer 12

Occurs in a patient with structural/functional urinary tract problems or underlying disease.

Question 13

What defines an uncomplicated UTI?

Answer 13

Occurs in an otherwise normal urinary tract.

Question 14

What are the classic lower UTI (cystitis) symptoms?

Answer 14

Dysuria, frequency, urgency, suprapubic discomfort, hematuria, sediment, and cloudy urine.

Question 15

What are the upper UTI (pyelonephritis) symptoms?

Answer 15

Fever, chills, flank pain (CVA tenderness), fatigue, anorexia, confusion (especially in older adults).

Question 16

What is the gold standard diagnostic test for UTI?

Answer 16

Urinalysis (UA)

Question 17

What urinalysis findings indicate a UTI?

Answer 17

Positive nitrites, ↑ WBCs, leukocyte esterase, bacteria.

Question 18

What is the proper clean-catch technique for urine culture?

Answer 18

Wipe front to back → start urinating → stop → continue midstream → close container.

Question 19

What does the presence of squamous cells in a urine culture mean?

Answer 19

Contamination due to improper cleaning.

Question 20

How is a urine specimen collected from a Foley catheter?

Answer 20

From the sampling port after sterilizing it and clamping the tubing for 20 minutes.

Question 21

When should a urine specimen from a Foley be sent to lab?

Answer 21

Immediately after insertion (to rule out preexisting UTI).

Question 22

What imaging test is gold standard for suspected pyelonephritis?

Answer 22

Ultrasound.

Question 23

What imaging is used if obstruction is suspected?

Answer 23

CT scan.

Question 24

What are common antibiotics for UTI treatment?

Answer 24

Trimethoprim/sulfamethoxazole (Bactrim), Nitrofurantoin (Macrobid), Cephalexin, Fosfomycin.

Question 25

What antibiotic is safe during pregnancy?

Answer 25

Nitrofurantoin (Macrobid).

Question 26

What antifungal may be used for fungal UTIs?

Answer 26

Fluconazole.

Question 27

What urinary analgesic is used to relieve dysuria?

Answer 27

Phenazopyridine (AZO).

Question 28

What side effects should be taught with Phenazopyridine (AZO)?

Answer 28

Turns urine, tears, and contacts orange/red; stains fluids.

Question 29

What key patient education prevents UTI recurrence?

Answer 29

Empty bladder often, void before/after intercourse, drink adequate fluids, wipe front to back, evacuate bowels regularly, proper perineal hygiene.

Question 30

How do antibiotics affect birth control?

Answer 30

They reduce its effectiveness → increases risk for unplanned pregnancy.

Question 31

What are CAUTI prevention measures?

Answer 31

Daily perineal care (once per shift), keep bag below bladder level, remove catheter early when appropriate.

Question 32

Who needs reminders for hygiene?

Answer 32

Pediatrics (don’t want to shower) and elderly (may need help).

Question 33

What is acute pyelonephritis?

Answer 33

Inflammation of renal parenchyma and collecting system, often due to bacterial infection from the lower urinary tract.

Question 34

What are the most common organisms causing pyelonephritis?

Answer 34

E. coli, Klebsiella, Enterobacter species.

Question 35

What are common predisposing factors for pyelonephritis?

Answer 35

Vesicoureteral reflux, lower urinary tract dysfunction, obstruction (BPH, stricture, stones), pregnancy.

Question 36

Where does pyelonephritis infection usually begin?

Answer 36

In the renal medulla and spreads to the cortex.

Question 37

What are classic symptoms of acute pyelonephritis?

Answer 37

Fever/chills, nausea/vomiting, malaise, flank pain, dysuria, urgency, frequency, CVA tenderness.

Question 38

What serious complication can result from pyelonephritis?

Answer 38

Urosepsis.

Question 39

What lab findings are seen in pyelonephritis?

Answer 39

Elevated WBC count, bacteriuria, hematuria, WBC casts.

Question 40

What additional test is needed in severe pyelonephritis?

Answer 40

Blood culture (to check for sepsis).

Question 41

What is the gold standard imaging for pyelonephritis?

Answer 41

Ultrasound.

Question 42

What imaging is preferred if obstruction or stones suspected?

Answer 42

CT scan (faster, shows stones).

Question 43

How is mild pyelonephritis managed (outpatient)?

Answer 43

Fluids, NSAIDs/antipyretics, antibiotics (5–14 days), follow-up cultures, rest.

Question 44

How quickly should symptoms improve with treatment?

Answer 44

Within 24–72 hours.

Question 45

What is key in antibiotic teaching for UTI/pyelonephritis?

Answer 45

Complete the entire antibiotic course, even if feeling better.

Question 46

How is severe pyelonephritis managed (inpatient)?

Answer 46

Hospitalization, IV antibiotics → switch to PO when tolerated, fluids, NSAIDs, monitor for sepsis.

Question 47

What nursing implications are important for pyelonephritis?

Answer 47

Stress completing antibiotics, follow-up cultures, report recurrence, maintain hydration, get rest.

Question 48

What is the key difference between mild and severe pyelonephritis treatment?

Answer 48

Mild = outpatient oral therapy; Severe = hospitalization and IV antibiotics.

Question 49

What might long-term or recurrent infections require?

Answer 49

Long-term, low-dose prophylactic antibiotics.