ABIM IM Practice Test 4

A 76-year-old woman is seen in the preoperative clinic before an elective right total knee arthroplasty scheduled for next week. A urinalysis and urine culture ordered by the surgical office showed 10 to 20 leukocytes/hpf and more than 100,000 colony-forming units/mL of Escherichia coli susceptible to nitrofurantoin, cephalexin and fosfomycin. She has type 2 diabetes mellitus treated with metformin and long-standing mild stress urinary incontinence, which is unchanged. She says her urine sometimes looks cloudy and smells strong, but she has no fever, dysuria, urgency, increased frequency, suprapubic pain or flank pain. She has no urinary catheter and is not scheduled for a urologic procedure. Temperature is 36.8 °C (98.2 °F), blood pressure is 132/76 mm Hg, pulse rate is 76/min, and respiration rate is 14/min. There is no suprapubic or costovertebral angle tenderness. The leukocyte count is 7400/µL [4000–11,000], and hemoglobin A₁c is 7.1% (H) [4.0%–5.6%]. Which of the following is the most appropriate management?