Urinary Tract Infections and Pyelonephritis Practice Questions

25 multiple-choice questions on Urinary tract infections and pyelonephritis for paramedic and EMT students, from Chapter 22 (Genitourinary and Renal Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A resident with a long-term urinary catheter has cloudy urine in the bag but no fever and is at her baseline. How should you interpret this?

   1. A. She has urosepsis and needs fluids
   2. B. The catheter must be pulled at once
   3. C. She needs antibiotics before transport
   4. D. Cloudy urine alone is not infection
   Show answer

   Answer: D. Cloudy urine alone is not infection

   Bacteria colonize nearly all long-term catheters, so cloudy or smelly urine without fever, new confusion, or other signs is not enough to diagnose a catheter-associated UTI. Look for systemic signs before labeling it an infection.

2. A lower UTI (cystitis) typically causes:

   1. A. Fever, flank pain, and rigors
   2. B. Dysuria, frequency, urgency
   3. C. Hematemesis and black stools
   4. D. Testicular pain and swelling
   Show answer

   Answer: B. Dysuria, frequency, urgency

   Bladder infection causes burning, frequent small voids, and urgency, often without fever. Flank pain and fever suggest the kidney is involved.

3. A nursing home resident's catheter bag and tubing have turned purple. This usually indicates:

   1. A. Severe kidney bleeding
   2. B. A reaction to the bag plastic
   3. C. Bacteria in alkaline urine
   4. D. Very high blood glucose
   Show answer

   Answer: C. Bacteria in alkaline urine

   Purple urine bag syndrome occurs when certain bacteria break down dietary tryptophan products in alkaline urine, producing pigments that stain the bag. It signals colonization or infection, not bleeding.

4. A 28-year-old woman has 2 days of painful urination, now with fever of 39.2 °C (102.6 °F), right flank pain, and vomiting. This suggests:

   1. A. Simple cystitis
   2. B. Kidney stone without infection
   3. C. Appendicitis
   4. D. Pyelonephritis
   Show answer

   Answer: D. Pyelonephritis

   Fever, flank pain, and vomiting mean the infection has moved up to the kidney. Vomiting can prevent oral antibiotics, so she may need IV treatment.

5. A man with paraplegia has a fever and increased leg spasms but no burning on urination. A likely source of infection is:

   1. A. A muscle strain in his legs
   2. B. Normal changes in his paralysis
   3. C. A urinary infection he cannot feel
   4. D. Anxiety about his health condition
   Show answer

   Answer: C. A urinary infection he cannot feel

   Patients with spinal cord injury often cannot feel dysuria or bladder pain, so UTIs present with fever, increased spasticity, new incontinence, or autonomic dysreflexia. UTIs are a leading cause of sepsis in this group.

6. An older adult taking ciprofloxacin for a UTI felt a pop in the back of his heel and cannot push off when walking. You should suspect:

   1. A. Achilles tendon rupture
   2. B. A heel bone fracture
   3. C. Gout in the big toe
   4. D. A blood clot in the calf
   Show answer

   Answer: A. Achilles tendon rupture

   Fluoroquinolones carry an FDA boxed warning for tendinitis and tendon rupture, especially in older adults and those on steroids. A pop with weak push-off is classic for Achilles rupture.

7. Which patient is at highest risk for a catheter-associated UTI?

   1. A. A man with an external condom catheter
   2. B. A patient with a long-term catheter
   3. C. A woman whose catheter was removed last month
   4. D. A teen with an ankle sprain
   Show answer

   Answer: B. A patient with a long-term catheter

   Catheters give bacteria a direct route into the bladder. Risk rises the longer a catheter stays in. External catheters carry a much lower risk than an indwelling one, and the risk falls once a catheter is removed.

8. Which finding most suggests a UTI has progressed to sepsis?

   1. A. Burning when urinating
   2. B. Urinary frequency and urgency
   3. C. Cloudy urine
   4. D. Hypotension and tachycardia
   Show answer

   Answer: D. Hypotension and tachycardia

   Signs of systemic hypoperfusion indicate sepsis. Treat with fluids per protocol and transport to an appropriate facility.

9. Fluid management for a patient with urosepsis and a BP of 82/48 should be:

   1. A. Oral fluids only
   2. B. IV boluses with reassessment
   3. C. No fluids to avoid edema
   4. D. Fluids only if a fever is present
   Show answer

   Answer: B. IV boluses with reassessment

   Septic shock requires early volume replacement. Reassess lung sounds and perfusion after each bolus, especially in older patients.

10. Pregnant women with UTIs are at increased risk of:

    1. A. Kidney stones forming in the fetus
    2. B. Gestational diabetes only
    3. C. Pyelonephritis, preterm labor
    4. D. Bladder cancer
    Show answer

    Answer: C. Pyelonephritis, preterm labor

    Pregnancy slows urine flow, so infections can quickly reach the kidneys. Pyelonephritis increases the risk of preterm labor.

11. Which question is most useful for a patient with suspected UTI?

    1. A. Any fever, chills, or back pain?
    2. B. Is the pain worse after eating meals?
    3. C. Do you have heartburn?
    4. D. Have you had a recent cough?
    Show answer

    Answer: A. Any fever, chills, or back pain?

    Fever, chills, and flank pain help separate simple cystitis from pyelonephritis or sepsis. Questions about meals, heartburn, or cough point toward GI or respiratory causes and do not help stage a UTI.

12. Urethritis in a sexually active man with discharge is most often caused by:

    1. A. Kidney stones
    2. B. Benign prostatic hyperplasia
    3. C. Appendicitis
    4. D. Gonorrhea or chlamydia
    Show answer

    Answer: D. Gonorrhea or chlamydia

    Sexually transmitted infections are the most common cause of urethritis in young men. Partners also need treatment.

13. Prostatitis typically causes:

    1. A. Fever, perineal pain, dysuria
    2. B. Fever, flank pain, and rigors
    3. C. Sudden testicular pain, no fever
    4. D. Painless blood in the urine
    Show answer

    Answer: A. Fever, perineal pain, dysuria

    Acute bacterial prostatitis causes fever, chills, pain between the scrotum and anus, and painful urination. Flank pain with rigors suggests pyelonephritis, sudden testicular pain without fever suggests torsion, and painless hematuria raises concern for a bladder or kidney tumor.

14. A patient with diabetes is at increased risk of severe UTIs because:

    1. A. Glucose in urine kills bacteria
    2. B. High glucose impairs immunity
    3. C. Their fever response is stronger
    4. D. They empty the bladder fully
    Show answer

    Answer: B. High glucose impairs immunity

    Hyperglycemia weakens white blood cell function, and nerve damage can cause incomplete bladder emptying. Glucose in the urine feeds bacteria rather than killing them, the fever response is often blunted, and neuropathy leaves urine behind in the bladder.

15. Which patient with cystitis symptoms needs more urgent evaluation?

    1. A. A woman with mild burning only today
    2. B. A teen with urinary frequency
    3. C. A man with fever and flank pain
    4. D. A woman with cloudy urine
    Show answer

    Answer: C. A man with fever and flank pain

    UTIs in men are less common and more often complicated. Fever and flank pain suggest kidney involvement.

16. Emphysematous pyelonephritis, a severe gas-forming kidney infection, occurs mostly in patients with:

    1. A. Moderate persistent asthma
    2. B. Hypertension alone
    3. C. Poorly controlled diabetes
    4. D. Migraine headaches
    Show answer

    Answer: C. Poorly controlled diabetes

    This rare, life-threatening infection is strongly linked to diabetes and urinary obstruction.

17. Gross hematuria with dysuria in a young woman most often indicates:

    1. A. Hemorrhagic cystitis
    2. B. Renal cell kidney cancer
    3. C. Ruptured AAA
    4. D. Traumatic bladder rupture
    Show answer

    Answer: A. Hemorrhagic cystitis

    Bladder infection can cause visible blood in urine. Hematuria without infection, especially in older adults, needs cancer evaluation.

18. A woman with pyelonephritis has vomited every dose of her oral antibiotic. This matters because she:

    1. A. Can stop the medicine once fever falls
    2. B. May need IV antibiotics in the hospital
    3. C. Should double the next oral dose
    4. D. Will recover without any antibiotic therapy
    Show answer

    Answer: B. May need IV antibiotics in the hospital

    Persistent vomiting prevents absorption of oral antibiotics and adds dehydration, both reasons to admit for IV therapy. Doubling the dose or stopping early is not appropriate.

19. A patient with an indwelling catheter has no urine in the bag for 4 hours and lower abdominal pain. You should first:

    1. A. Remove the catheter immediately
    2. B. Give a large fluid bolus
    3. C. Assume the kidneys failed
    4. D. Check the tubing for kinks
    Show answer

    Answer: D. Check the tubing for kinks

    A kinked or blocked catheter is the most common cause. Check the tubing and bag position before considering other causes.

20. Two days after a prostate biopsy, a man has fever, chills, and HR 120. You should suspect:

    1. A. Normal soreness after a biopsy
    2. B. A side effect of anesthesia
    3. C. Anxiety about the biopsy results
    4. D. Sepsis from the procedure
    Show answer

    Answer: D. Sepsis from the procedure

    Transrectal prostate biopsy can introduce bowel bacteria and cause urosepsis within days. Fever with tachycardia after a urologic procedure should be managed as sepsis.

21. The most appropriate destination for a stable young adult with simple cystitis symptoms may be:

    1. A. Primary or urgent care per protocol
    2. B. The nearest Level I trauma center
    3. C. A cardiac catheterization lab nearby
    4. D. A regional burn center
    Show answer

    Answer: A. Primary or urgent care per protocol

    Uncomplicated cystitis without fever or sepsis can often be managed outside the ED. Follow local protocols for alternative destinations.

22. Which finding in a child with fever could suggest a UTI?

    1. A. Runny nose and a dry, barking cough
    2. B. Foul-smelling urine, irritability
    3. C. A blister rash on the hands and feet
    4. D. Pulling at one ear only
    Show answer

    Answer: B. Foul-smelling urine, irritability

    Young children often show only fever, irritability, poor feeding, or foul urine. UTI is a common cause of fever without a clear source.

23. Phenazopyridine (Pyridium), used for UTI discomfort, may cause:

    1. A. Black, tarry stools
    2. B. Green-colored urine
    3. C. Orange or red urine
    4. D. Milky white urine
    Show answer

    Answer: C. Orange or red urine

    This medication colors urine orange-red and can be mistaken for blood. Ask about medications. It does not darken the stool, and it colors urine orange-red rather than green or white.

24. Asymptomatic bacteria in the urine of an older adult without symptoms is:

    1. A. Always a sign of sepsis
    2. B. An emergency needing IV antibiotics
    3. C. Common and often not treated
    4. D. A cause of chest pain
    Show answer

    Answer: C. Common and often not treated

    Bacteriuria without symptoms is common in older adults and catheter users. Look for other causes of confusion before blaming the urine.

25. A woman with recurrent UTIs and fever develops a rash and hypotension after starting antibiotics. You should consider:

    1. A. An expected antibiotic side effect
    2. B. Antibiotic anaphylaxis
    3. C. Worsening cystitis only
    4. D. Kidney stone pain
    Show answer

    Answer: B. Antibiotic anaphylaxis

    Rash and hypotension soon after a new drug suggest an allergic reaction. Treat anaphylaxis with epinephrine per protocol.