Deck 36: Urinary Tract Infection Prevention and Management in Pregnancy

Question 1

A 38 5/7 weeks pregnant woman presents to clinic and reports abrupt onset of dysuria, urinary frequency and hesitancy for the past 24 hours. What antibiotic do you anticipate prescribing?

A) Amoxicillin -clavulanate (Augmentin)
B) Ciprofloxacin (Cipro)
C) Nitrofurantoin (Macrobid)
D) Trimethoprim-sulfamethoxazole (Septra)

Answer 1

A

Question 2

A 29-week pregnant woman presents with urinary tract infection (UTI) symptoms. Upon exam you note a temperature of 101℉, costovertebral angle tenderness, and a urine dipstick with positive blood, nitrites, and leukocytes. Your exam findings will lead you to:

A) Prescribe nitrofurantoin 100 mg PO BID x 5 days
B) Order some additional blood work and follow up with her the next day
C) Prescribe amoxicillin-clavulanate 500 mg PO BID x 7 days and repeat culture and sensitivity of urine in 1 week
D) Refer to the birthing unit for further assessment and possible parenteral treatment

Answer 2

D

Question 3

Which patient would you be most concern about developing a UTI during pregnancy?

A) A 37-year-old, G2 P0010, with a healthy pregnancy
B) A 21-year-old, G1 P0000, with a history of type 1 diabetes
C) A 25-year-old, G2 P1001, with a history of UTIs during her childhood
D) A25-year-old, G1 P0000, currently pregnant with twins

Answer 3

C

Question 4

A healthy, 28-week pregnant woman presents to clinic for routine follow-up. Her clean catch urine dipstick reveals positive nitrites, moderate amount leukocytes, trace protein, and small amount of blood. She reports no subjective symptoms associated with a UTI. Which of the following is the most appropriate next step?

A) Ask patient for a midstream catch urine sample and send for culture/sensitivity testing and await results to determine further action.
B) Advise patient to increase fluid intake, educate her on signs of a UTI, and go to the hospital if she experiences any of them.
C) Hold off on ordering a urine culture and sensitivity, and immediately prescribe cefpodoxime 100mg BID x 3 days.
D) Advise patient to increase fluid intake and take cranberry pills and follow-up to the clinic in 1 week for repeat urine dipstick.

Question 5

For women presenting to prenatal care at 6-8 weeks gestation, when would be the ideal time to perform a routine urine culture for diagnosis of asymptomatic bacteriuria (ASB)?

A) 6-8 weeks pregnant
B) 12-15 weeks pregnant
C) 16-20 weeks pregnant
D) 28-30 weeks pregnant

Question 6

The presence of what sign or symptom, in addition to a pyelonephritis diagnosis, increases the risk of premature birth?

A) Costovertebral angle tenderness
B) An oral temperature of 99℉
C) Lab values of Hbg 8 g/dL and Hct 26%
D) Suprapubic pain

Question 7

A 25-week pregnant woman presents to the clinic for follow-up after antibiotic treatment of her third case of cystitis during pregnancy. What is the best course of action to prevent further infections?

A) Advise to increase fluid intake and perform monthly urine culture and sensitivity tests.
B) Prescribe nitrofurantoin 50 mg to be taken at bedtime for the remainder of pregnancy.
C) Prescribe another week of amoxicillin 500 mg BID.
D) Refer to birthing unit for further assessment.