A nurse is reviewing lab results on a patient to find urine cultures showing gram negative bacilli (E. coli). The nurse suspects transmission from which body system?
Genitourinary tract.
Gastrointestinal tract.
Integumentary tract.
Nasopharyngeal tract.
The Correct Answer is B
Choice A rationale
The genitourinary tract itself can be the site of infection, but E. coli, a common cause of UTIs, primarily originates from the gastrointestinal tract. While the genitourinary system is affected, it's typically a result of ascending bacterial migration rather than the primary source of the E. coli.
Choice B rationale
Gram-negative bacilli, specifically Escherichia coli (E. coli), are normal inhabitants of the human gastrointestinal tract. Due to anatomical proximity, E. coli can easily migrate from the perianal region to the urethra and ascend into the bladder, causing urinary tract infections.
Choice C rationale
The integumentary tract, or skin, primarily hosts a different microbial flora, predominantly gram-positive bacteria like Staphylococcus and Streptococcus species. While skin can be a source of infection, it is not the typical reservoir for E. coli causing urinary tract infections.
Choice D rationale
The nasopharyngeal tract primarily harbors respiratory pathogens such as Streptococcus pneumoniae or Haemophilus influenzae. It is not the source of gram-negative bacilli like E. coli that commonly cause urinary tract infections. Transmission routes for these pathogens are distinct.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
Choice A rationale
Measurement of post-void residual (PVR) urine volume is a valid indication for catheterization. This procedure assesses bladder emptying efficiency, particularly in patients experiencing urinary symptoms like hesitancy or incomplete voiding. Elevated PVR volumes (typically > 100 mL) can indicate outflow obstruction or bladder dysfunction, necessitating further investigation.
Choice B rationale
Relief of urinary retention is a primary indication for catheterization. Acute urinary retention, often caused by prostatic enlargement or neurologic dysfunction, results in painful bladder distention and potential renal compromise. Catheterization promptly drains the bladder, alleviating discomfort and preventing upper urinary tract damage by reducing intravesical pressure.
Choice C rationale
Routine acquisition of a urine specimen is generally not an indication for catheterization. Clean-catch midstream urine samples are typically sufficient for most diagnostic purposes, minimizing the risk of catheter-associated urinary tract infections (CAUTIs). Catheterization is invasive and should be reserved for situations where a clean voided specimen is unobtainable or specific sterile collection is required.
Choice D rationale
Convenience for nursing staff or the patient's family is not a legitimate medical indication for urinary catheterization. Catheterization is an invasive procedure associated with significant risks, including CAUTIs, urethral trauma, and patient discomfort. Its use should be medically justified and limited to situations where benefits clearly outweigh the potential harms, prioritizing patient safety.
Choice E rationale
An open perineal wound is a strong indication for urinary catheterization. Catheterization diverts urine away from the wound, preventing contamination and promoting optimal healing. Urine is inherently acidic and can introduce bacteria, impairing tissue repair and increasing infection risk in compromised perineal tissues, making diversion crucial for wound management.
Correct Answer is B
Explanation
Choice A rationale
Collecting the second voided specimen of the day is not the standard procedure for a clean-catch urine sample. A clean-catch specimen aims to collect urine mid-stream after initial flushing, regardless of the time of day, to minimize contamination from the urethra and external genitalia.
Choice B rationale
When obtaining a clean-catch urine specimen, the patient should void a small initial amount into the toilet. This initial stream helps to flush out microorganisms from the distal urethra and periurethral area, reducing contamination of the collected specimen and ensuring a more accurate representation of bladder urine.
Choice C rationale
Restricting fluids before specimen collection is generally contraindicated for a clean-catch urine. Adequate hydration ensures sufficient urine volume for collection and can help to dilute contaminants, making it easier to obtain a clean mid-stream sample. Fluid restriction may lead to a concentrated, insufficient sample.
Choice D rationale
Placing the specimen in a clean urinalysis container is insufficient; the container must be sterile. A non-sterile container can introduce external contaminants into the urine sample, leading to inaccurate laboratory results, potentially causing misdiagnosis or inappropriate treatment for a urinary tract infection.
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