Catheter-Associated Urinary Tract Infections (CAUTIs) are one of the most common hospital-acquired infections and a major focus of patient safety and antimicrobial stewardship initiatives. The pharmacist’s role is pivotal, focusing on prevention by questioning the need for catheters and ensuring their prompt removal, as well as guiding appropriate treatment when infection does occur. As detailed in the Patient Care 4 curriculum’s module on infectious diseases of the kidney, understanding the principles of CAUTI management is a key competency. This quiz will test your knowledge on the crucial principles of CAUTI prevention, diagnosis, and evidence-based treatment.
1. What is the single most important risk factor for developing a catheter-associated UTI (CAUTI)?
- a. The duration of catheterization.
- b. The age of the patient.
- c. The patient’s gender.
- d. The type of antibiotic the patient is receiving.
Answer: a. The duration of catheterization.
2. A CAUTI is defined as a UTI that occurs in a patient with an indwelling urinary catheter that has been in place for:
- a. More than 12 hours.
- b. More than 24 hours.
- c. More than 2 calendar days.
- d. More than 1 week.
Answer: c. More than 2 calendar days.
3. The most critical and effective strategy for preventing CAUTI is:
- a. Prophylactic antibiotics for all catheterized patients.
- b. Daily irrigation of the catheter with sterile saline.
- c. Avoiding unnecessary catheterization and removing the catheter as soon as it is no longer indicated.
- d. Using a larger sized catheter.
Answer: c. Avoiding unnecessary catheterization and removing the catheter as soon as it is no longer indicated.
4. A patient with an indwelling catheter has a positive urine culture but no signs or symptoms of infection (e.g., no fever, no suprapubic tenderness). This condition is known as:
- a. Urosepsis
- b. Pyelonephritis
- c. Catheter-Associated Asymptomatic Bacteriuria (CA-ASB)
- d. A complicated UTI.
Answer: c. Catheter-Associated Asymptomatic Bacteriuria (CA-ASB)
5. What is the recommended management for Catheter-Associated Asymptomatic Bacteriuria (CA-ASB) in most patients?
- a. A 7-day course of ciprofloxacin.
- b. A 3-day course of trimethoprim/sulfamethoxazole.
- c. A single dose of fosfomycin.
- d. Antibiotic treatment is not recommended.
Answer: d. Antibiotic treatment is not recommended.
6. The “Management of… Catheter-associated UTI” is a specific lecture in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. How do indwelling catheters facilitate the development of UTIs?
- a. By providing a surface for bacterial biofilm formation.
- b. By allowing bacteria to ascend into the bladder from a contaminated drainage bag.
- c. By causing direct trauma to the urethral mucosa.
- d. All of the above.
Answer: d. All of the above.
8. Which of the following is a sign or symptom required for the diagnosis of a CAUTI?
- a. A positive urine culture alone.
- b. Cloudy or foul-smelling urine alone.
- c. Fever, suprapubic tenderness, or costovertebral angle (CVA) pain.
- d. The presence of the catheter for more than 24 hours.
Answer: c. Fever, suprapubic tenderness, or costovertebral angle (CVA) pain.
9. What is the most important first step in the treatment of a patient diagnosed with a symptomatic CAUTI?
- a. Starting a broad-spectrum antibiotic.
- b. Obtaining a blood culture.
- c. Removing or exchanging the urinary catheter, if possible.
- d. Administering an analgesic for pain.
Answer: c. Removing or exchange of the urinary catheter, if possible.
10. Compared to community-acquired UTIs, the pathogens causing CAUTIs are more likely to include:
- a. Only E. coli.
- b. A broader range of organisms including Pseudomonas, Enterococcus, and Candida.
- c. Only Gram-positive organisms.
- d. Viruses.
Answer: b. A broader range of organisms including Pseudomonas, Enterococcus, and Candida.
11. The management of UTIs is a specific topic within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. What is the recommended duration of antibiotic therapy for a patient with a CAUTI who has a prompt resolution of symptoms?
- a. 3 days
- b. 5 days
- c. 7 days
- d. 14 days
Answer: c. 7 days
13. A “biofilm” on a urinary catheter is problematic because:
- a. It physically obstructs the catheter.
- b. It protects the bacteria from host defenses and systemic antibiotics.
- c. It is easily removed with irrigation.
- d. It is not a clinical concern.
Answer: b. It protects the bacteria from host defenses and systemic antibiotics.
14. A pharmacist’s role in CAUTI prevention includes:
- a. Participating in “catheter rounds” to question the ongoing need for catheters.
- b. Promoting antimicrobial stewardship by preventing the treatment of asymptomatic bacteriuria.
- c. Developing institutional protocols for catheter care.
- d. All of the above.
Answer: d. All of the above.
15. Which of the following is an appropriate indication for an indwelling urinary catheter?
- a. As a substitute for nursing care for an incontinent patient.
- b. To monitor urinary output in a critically ill patient.
- c. To obtain a urine sample from a patient who can void voluntarily.
- d. For patient convenience.
Answer: b. To monitor urinary output in a critically ill patient.
16. “Infectious Diseases of the Kidney” is a module within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
17. Why is routine screening for and treatment of CA-ASB not recommended?
- a. It does not improve patient outcomes (e.g., does not reduce symptomatic infections).
- b. It leads to the unnecessary use of antibiotics.
- c. It contributes to the development of antimicrobial resistance.
- d. All of the above.
Answer: d. All of the above.
18. A patient with a CAUTI and risk factors for multidrug-resistant organisms might require empiric therapy with an agent like:
- a. Trimethoprim/sulfamethoxazole
- b. Nitrofurantoin
- c. Piperacillin-tazobactam
- d. Amoxicillin
Answer: c. Piperacillin-tazobactam
19. A key practice to maintain a sterile, closed catheter drainage system is:
- a. Disconnecting the catheter from the drainage tube frequently.
- b. Keeping the collection bag elevated above the level of the bladder.
- c. Ensuring the catheter and collecting tube remain connected and sealed.
- d. Irrigating the catheter on a daily basis.
Answer: c. Ensuring the catheter and collecting tube remain connected and sealed.
20. An active learning session on infectious diseases of the kidney is part of the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
21. A patient develops a UTI 5 days after their urinary catheter was removed. Is this considered a CAUTI?
- a. No, because the catheter was already removed.
- b. Yes, if the catheter had been in place for >2 days before removal.
- c. Only if the patient is female.
- d. Only if the culture grows E. coli.
Answer: b. Yes, if the catheter had been in place for >2 days before removal.
22. Which of the following is NOT a sign or symptom of a UTI in a catheterized patient?
- a. New onset fever
- b. Costovertebral angle pain
- c. Foul-smelling urine in the absence of other symptoms.
- d. Suprapubic tenderness
Answer: c. Foul-smelling urine in the absence of other symptoms.
23. The microbiology of common UTI pathogens is covered in the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
24. The renal system module in Patient Care 4 covers the management of UTIs.
- a. True
- b. False
Answer: a. True
25. A patient has a CAUTI caused by Candida albicans (candiduria). What is the most appropriate initial management?
- a. Start IV amphotericin B.
- b. Start oral fluconazole immediately.
- c. Remove the catheter and see if the candiduria resolves.
- d. No treatment is ever needed for candiduria.
Answer: c. Remove the catheter and see if the candiduria resolves.
26. An external (“condom”) catheter in a male patient has a _____ risk of infection compared to an indwelling urethral catheter.
- a. higher
- b. lower
- c. identical
- d. unknown
Answer: b. lower
27. What is the role of a urine culture in managing CAUTI?
- a. It is not needed if the patient has a fever.
- b. It is essential for confirming the pathogen and guiding definitive antibiotic therapy.
- c. It is only performed after treatment is complete.
- d. To check the urine pH.
Answer: b. It is essential for confirming the pathogen and guiding definitive antibiotic therapy.
28. An active learning session on UTIs is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
29. Antimicrobial stewardship programs often focus heavily on CAUTI prevention because:
- a. It is a major driver of antibiotic overuse in hospitals.
- b. It is a common, yet highly preventable, hospital-acquired condition.
- c. It is linked to increased length of stay and healthcare costs.
- d. All of the above.
Answer: d. All of the above.
30. The management of UTIs is covered in the renal system module.
- a. True
- b. False
Answer: a. True
31. The term “biofilm” refers to a community of microorganisms encased in a self-produced matrix, attached to a surface.
- a. True
- b. False
Answer: a. True
32. The single most effective way to reduce the incidence of CAUTI in a hospital is to:
- a. Implement a protocol that restricts the use of and ensures prompt removal of urinary catheters.
- b. Use silver-coated catheters for all patients.
- c. Provide prophylactic antibiotics to every admitted patient.
- d. Use daily bladder irrigation.
Answer: a. Implement a protocol that restricts the use of and ensures prompt removal of urinary catheters.
33. A patient with a CAUTI has their catheter removed and is started on IV ceftriaxone. They are now afebrile and can tolerate oral intake. A reasonable next step is:
- a. Continue IV ceftriaxone for 14 days.
- b. Switch to an appropriate oral antibiotic to complete the course of therapy.
- c. Stop all antibiotics.
- d. Re-insert the catheter.
Answer: b. Switch to an appropriate oral antibiotic to complete the course of therapy.
34. A pharmacist reviewing a patient profile sees an order for an indwelling catheter without a clear indication. The most appropriate action is to:
- a. Ignore the order.
- b. Dispense the catheter.
- c. Contact the provider to question the need for the catheter.
- d. Counsel the patient on how to insert the catheter.
Answer: c. Contact the provider to question the need for the catheter.
35. Which of the following is NOT an appropriate indication for an indwelling catheter?
- a. Management of acute urinary retention or obstruction.
- b. To obtain a urine specimen for convenience when the patient can void.
- c. Perioperative use for selected surgical procedures.
- d. To assist in healing of an open sacral or perineal wound in an incontinent patient.
Answer: b. To obtain a urine specimen for convenience when the patient can void.
36. A patient with a CAUTI is found to have VRE (Vancomycin-Resistant Enterococcus) in their urine. Which antibiotic might be required?
- a. Vancomycin
- b. Cefazolin
- c. Linezolid or Daptomycin
- d. Ceftriaxone
Answer: c. Linezolid or Daptomycin
37. The presence of pyuria (white blood cells in the urine) in a catheterized patient:
- a. Is diagnostic of a CAUTI.
- b. Is common and non-specific, and should not be used alone to diagnose a CAUTI.
- c. Indicates the patient needs immediate antibiotics.
- d. Is a sign of a fungal infection.
Answer: b. Is common and non-specific, and should not be used alone to diagnose a CAUTI.
38. The lecture “Management of UTIs, Part 1” covers CAUTI.
- a. True
- b. False
Answer: a. True
39. A “catheter bundle” is a set of:
- a. Different types of catheters.
- b. Evidence-based practices that, when implemented together, can significantly reduce CAUTI rates.
- c. Antibiotics used to treat CAUTI.
- d. Lab tests for diagnosing CAUTI.
Answer: b. Evidence-based practices that, when implemented together, can significantly reduce CAUTI rates.
40. An active learning session covering infectious diseases of the kidney is part of which course module?
- a. Module 9: Infectious Diseases of the Kidney
- b. Module 1: PUD and GERD
- c. Module 4: Gastrointestinal Infections
- d. Module 5: Nutrition & Weight Management
Answer: a. Module 9: Infectious Diseases of the Kidney
41. The risk of bacteriuria increases by approximately how much for each day a catheter is in place?
- a. 1-2%
- b. 3-7%
- c. 10-15%
- d. 25%
Answer: b. 3-7%
42. A key pharmacist role in stewardship is to discourage the practice of:
- a. Obtaining routine screening urine cultures from asymptomatic catheterized patients.
- b. Removing catheters when they are no longer needed.
- c. Using aseptic technique during insertion.
- d. Washing hands before and after handling a catheter.
Answer: a. Obtaining routine screening urine cultures from asymptomatic catheterized patients.
43. A patient with a CAUTI develops bacteremia. The duration of therapy should generally be:
- a. 3 days
- b. 5 days
- c. 7 days
- d. 10-14 days
Answer: d. 10-14 days
44. What is the best way to obtain a urine sample from a patient with an indwelling catheter?
- a. From the collection bag.
- b. By disconnecting the catheter from the drainage tube.
- c. By aspirating urine from the catheter’s sampling port using aseptic technique.
- d. By asking the patient to try and void around the catheter.
Answer: c. By aspirating urine from the catheter’s sampling port using aseptic technique.
45. Which of the following is true about CAUTI?
- a. It is the most common type of healthcare-associated infection.
- b. It is largely preventable.
- c. It leads to increased antibiotic use, cost, and length of stay.
- d. All of the above.
Answer: d. All of the above.
46. A “defend a therapeutic plan” exercise for a UTI is an objective in the Professional Skills Lab 3.
- a. True
- b. False
Answer: a. True
47. A patient with a CAUTI has their catheter removed. Their treatment should be based on:
- a. The same guidelines as for a complicated UTI.
- b. The same guidelines as for an uncomplicated UTI.
- c. A standard 3-day antibiotic course.
- d. No treatment is needed after catheter removal.
Answer: a. The same guidelines as for a complicated UTI.
48. An active learning session on CAUTI is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
49. A key aspect of CAUTI prevention that involves the entire healthcare team is:
- a. Regular communication and daily review of catheter necessity.
- b. Ensuring the pharmacy stocks all types of catheters.
- c. Blaming the nursing staff for all infections.
- d. Using prophylactic antibiotics in all patients.
Answer: a. Regular communication and daily review of catheter necessity.
50. The ultimate goal of learning about CAUTI management is to:
- a. Memorize antibiotic doses.
- b. Understand and implement strategies to prevent these common infections and to treat them appropriately when they occur.
- c. Pass the infectious disease exam.
- d. Be able to place a Foley catheter.
Answer: b. Understand and implement strategies to prevent these common infections and to treat them appropriately when they occur.