Please help me understand this question

twozer0, NP · Jan 29, 2016

What do you think is the right answer and why?
A 55-year-old woman who has type 2 diabetes is concerned about her kidneys. She has a history of 3 urinary tract infections within the past 8 months. She denies dysuria and frequency at this visit. Which of the following is the best initial course to follow?
A) Recheck the patient's urine and order a urine for culture and sensitivity
B) Order an IVP (intravenous pyelogram)
C) Advise the patient to follow up with a urologist
D) Evaluate the patient for a possible kidney infection

I would choose C. Advise patient to follow up with a urologist. A makes no sense, she has had 3 infections over the past 8 months, so what is rechecking going to do? Intravenous Pyelograms are outdated and hardly used since CT became the gold standard, they are still used but barely. Also the patient is type 2 diabetic and probably uses metformin, no contrast for those people! D. Just like A. which at this point is pointless to evaluate for recurring UTI, refer.

the patient needs evaluation by a urologist for several things, such as an infected stone, renal mass, ureteral stricture, etc. I would chose C.

Helenegusa · Jan 29, 2016

I would go with D first, complete CMP, CBC, creatinine and BUN. But checking for hematuria and WBC would be excellent also. I might order a culture to compare with the previous infections...

amysiuk · Jan 29, 2016

The urology answer is prob CORRECT....... In REAL LIFE!

NCLEX-prob not.

So, pt c/c is just dismissed then sent to urology?? What would the NCLEX lady say?

Overall, this is a poor question. Vague/ambiguous and doesnt attempt to assess critical thinking, just if a person can correctly guess the BEST answer, even if incorrect

nurselove757 · Feb 1, 2016

This question came from the Leik Certification book at Family Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions, Second Edition: 9780826134240: Medicine & Health Science Books @ Amazon.com.

Thank you for providing me with your input. Now I know that it's a poorly written question. Here is the answer and the rationale that the book gave:

A: Recheck the patient's urine and order a urine for culture and sensitivity A urinary tract infection is defined as the presence of 100,000 organisms per mL of urine in asymptomatic patients or greater than 100 organisms per mL or urine with pyuria (more than 7 WBCs/mL) in a symptomatic patient.

(question 89)

nurselove757 · Feb 1, 2016

This question came from the Leik Certification book at Family Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions, Second Edition: 9780826134240: Medicine & Health Science Books @ Amazon.com.

Thank you for providing me with your input. Now I know that it's a poorly written question. Here is the answer and the rationale that the book gave:

A: Recheck the patient's urine and order a urine for culture and sensitivity A urinary tract infection is defined as the presence of 100,000 organisms per mL of urine in asymptomatic patients or greater than 100 organisms per mL or urine with pyuria (more than 7 WBCs/mL) in a symptomatic patient.

(question 89)

nurselove757 · Feb 1, 2016

This question came from the Leik Certification book at Family Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions, Second Edition: 9780826134240: Medicine & Health Science Books @ Amazon.com.

Thank you for providing me with your input. Now I know that it's a poorly written question. Here is the answer and the rationale that the book gave:

A: Recheck the patient's urine and order a urine for culture and sensitivity A urinary tract infection is defined as the presence of 100,000 organisms per mL of urine in asymptomatic patients or greater than 100 organisms per mL or urine with pyuria (more than 7 WBCs/mL) in a symptomatic patient.

(question 89)