NRNP 6550 Final Exam Study Guide
Questions and Answers with Complete
Solutions | New update 2026\27
🔬 Urinalysis (UA) & Urine Cultures
Q: How do we interpret urine culture colony counts?
• Asymptomatic patients: > 100,000 colonies indicates bacteriuria.
• Symptomatic patients: 10 to 10,000 colonies is significant, provided there is
also pyuria.
• Pregnant women: Always repeat the culture to confirm.
Q: What defines pyuria and other key UA findings?
• Pyuria: > 10 leukocytes (WBCs) in the urine.
• Pyelonephritis indicators: Elevated erythrocytes (blood) and WBCs in the
urine.
• False positives: Can be caused by tumors, urethritis, or poor collection
techniques.
Q: What causes glucose or ketones to appear in a urinalysis?
• Glucose: Serum glucose must reach at least 180 mg/dL to spill into the urine.
Causes include Diabetes Mellitus (DM), Cushing's syndrome, or Fanconi
Syndrome (damage to tubule walls, e.g., from aminoglycosides). Note: Vitamin C
can cause false-negative glucose readings.
• Ketones: Typically caused by diabetic ketoacidosis, alcoholism, or starvation.
🚻 UTI Classifications & Anatomy
,Shutterstock
Explore
Classification Affected Anatomy Conditions
Lower UTI Bladder and Urethra Cystitis, Urethritis, Prostatitis
Upper UTI Kidneys and Ureters Pyelonephritis, Renal Abscess
Q: What is the difference between an Uncomplicated and Complicated UTI?
• Uncomplicated: Occurs in a normal, structurally functional urinary tract.
, • Complicated: Occurs in a urinary tract with structural defects or in a patient with
significant underlying health problems.
🦠 Pathogens & Risk Factors
Common UTI Pathogens:
• E. coli: Most common overall (especially elderly women).
• Proteus mirabilis: Common in elderly men.
• Providencia: Common in institutionalized patients.
• Others: Staphylococcus, Klebsiella, Enterococcus, Pseudomonas.
• Fungal: Candida.
Risk Factors:
• General: Female anatomy, advanced age, critical illness, catheters (due to
biofilm), diabetes, urinary calculi (stones), tumors, strictures, or neurogenic
bladder.
• Women: Sexual intercourse, new sexual partner, pregnancy, history of previous
UTIs.
• Men: Prostate enlargement (BPH), prostatitis, uncircumcised, men who have sex
with men (MSM), HIV positive.
🩺 Clinical Findings: Lower vs. Upper UTI
Finding Lower UTI Upper UTI (Pyelonephritis)
Urinary Dysuria, urgency,
Hematuria
Symptoms frequency, incontinence
Pain Location Suprapubic pain Flank pain
Fever, chills, malaise,
Systemic None (Fever/chills are
nausea/vomiting, tachycardia,
Symptoms uncommon)
tachypnea
Special Altered mental status (AMS) in the
-
Populations elderly
🧪 Diagnostics
Q: How is a UTI diagnosed?
, • Gold Standard: Urine culture and sensitivity (detects specific bacteria).
• Point of Care: Urinalysis (UA) looking for nitrites, leukocyte esterase, or blood.
• Bloodwork: A CBC showing leukocytosis with a "left shift" indicates
pyelonephritis.
Q: When is imaging required, and what types are used?
A: Imaging is required to rule out obstruction, calculi, or necrosis in cases of recurrent
UTIs in women or any UTI in men. Options include a voiding X-ray, abdominal CT,
pelvic ultrasound, or pelvic MRI.
💊 Pharmacological Management
1. Acute Cystitis (Lower UTI)
• First-Line: * Fosfomycin (Monurol): Single dose.
o Trimethoprim/sulfamethoxazole (Bactrim): 3 days. (Caution: Do not give
near delivery; use Cephalexin instead).
o Nitrofurantoin: 5 days. (Caution in the elderly).
• Second-Line:
o Fluoroquinolones (Ciprofloxacin or Levofloxacin): 3 days. (Contraindicated
in pregnancy).
o Beta-lactams (Amoxicillin-clavulanate, Cefdinir): 3 to 7 days.
2. Uncomplicated Upper UTI
• Outpatient: Ciprofloxacin (7 days), Levofloxacin (5 days), or Bactrim (14 days).
• Inpatient: Ceftriaxone, Cefotaxime, or Ampicillin.
• CAUTI (Catheter-Associated): Treat bacterial with antibiotics for 7 days; treat
candiduria with Fluconazole for 14 days.
• Symptom Relief: Pyridium can be given for urinary discomfort.
3. Acute Complicated Bacterial Pyelonephritis
• Action: Admit to hospital.
• Medications: * Aminoglycosides (Gentamicin/Tobramycin): Never use as
monotherapy. Dose based on renal function (trough < 2 mg/L, peak 5-10 mg/L).
Do not give to patients with Chronic Kidney Disease (CKD).
o Ampicillin or Cefazolin.
o Cefotaxime or Ceftriaxone (adjust based on obesity and pulmonary
disease).
📉 Acute Kidney Injury (AKI)
Q: What is AKI?
A: An acute loss of renal function resulting in the inability to excrete metabolic waste
products (urea nitrogen, creatinine) and maintain fluid/electrolyte balance. It typically
resolves within 3 months and is classified by etiology or the RIFLE criteria.
The RIFLE Criteria
Questions and Answers with Complete
Solutions | New update 2026\27
🔬 Urinalysis (UA) & Urine Cultures
Q: How do we interpret urine culture colony counts?
• Asymptomatic patients: > 100,000 colonies indicates bacteriuria.
• Symptomatic patients: 10 to 10,000 colonies is significant, provided there is
also pyuria.
• Pregnant women: Always repeat the culture to confirm.
Q: What defines pyuria and other key UA findings?
• Pyuria: > 10 leukocytes (WBCs) in the urine.
• Pyelonephritis indicators: Elevated erythrocytes (blood) and WBCs in the
urine.
• False positives: Can be caused by tumors, urethritis, or poor collection
techniques.
Q: What causes glucose or ketones to appear in a urinalysis?
• Glucose: Serum glucose must reach at least 180 mg/dL to spill into the urine.
Causes include Diabetes Mellitus (DM), Cushing's syndrome, or Fanconi
Syndrome (damage to tubule walls, e.g., from aminoglycosides). Note: Vitamin C
can cause false-negative glucose readings.
• Ketones: Typically caused by diabetic ketoacidosis, alcoholism, or starvation.
🚻 UTI Classifications & Anatomy
,Shutterstock
Explore
Classification Affected Anatomy Conditions
Lower UTI Bladder and Urethra Cystitis, Urethritis, Prostatitis
Upper UTI Kidneys and Ureters Pyelonephritis, Renal Abscess
Q: What is the difference between an Uncomplicated and Complicated UTI?
• Uncomplicated: Occurs in a normal, structurally functional urinary tract.
, • Complicated: Occurs in a urinary tract with structural defects or in a patient with
significant underlying health problems.
🦠 Pathogens & Risk Factors
Common UTI Pathogens:
• E. coli: Most common overall (especially elderly women).
• Proteus mirabilis: Common in elderly men.
• Providencia: Common in institutionalized patients.
• Others: Staphylococcus, Klebsiella, Enterococcus, Pseudomonas.
• Fungal: Candida.
Risk Factors:
• General: Female anatomy, advanced age, critical illness, catheters (due to
biofilm), diabetes, urinary calculi (stones), tumors, strictures, or neurogenic
bladder.
• Women: Sexual intercourse, new sexual partner, pregnancy, history of previous
UTIs.
• Men: Prostate enlargement (BPH), prostatitis, uncircumcised, men who have sex
with men (MSM), HIV positive.
🩺 Clinical Findings: Lower vs. Upper UTI
Finding Lower UTI Upper UTI (Pyelonephritis)
Urinary Dysuria, urgency,
Hematuria
Symptoms frequency, incontinence
Pain Location Suprapubic pain Flank pain
Fever, chills, malaise,
Systemic None (Fever/chills are
nausea/vomiting, tachycardia,
Symptoms uncommon)
tachypnea
Special Altered mental status (AMS) in the
-
Populations elderly
🧪 Diagnostics
Q: How is a UTI diagnosed?
, • Gold Standard: Urine culture and sensitivity (detects specific bacteria).
• Point of Care: Urinalysis (UA) looking for nitrites, leukocyte esterase, or blood.
• Bloodwork: A CBC showing leukocytosis with a "left shift" indicates
pyelonephritis.
Q: When is imaging required, and what types are used?
A: Imaging is required to rule out obstruction, calculi, or necrosis in cases of recurrent
UTIs in women or any UTI in men. Options include a voiding X-ray, abdominal CT,
pelvic ultrasound, or pelvic MRI.
💊 Pharmacological Management
1. Acute Cystitis (Lower UTI)
• First-Line: * Fosfomycin (Monurol): Single dose.
o Trimethoprim/sulfamethoxazole (Bactrim): 3 days. (Caution: Do not give
near delivery; use Cephalexin instead).
o Nitrofurantoin: 5 days. (Caution in the elderly).
• Second-Line:
o Fluoroquinolones (Ciprofloxacin or Levofloxacin): 3 days. (Contraindicated
in pregnancy).
o Beta-lactams (Amoxicillin-clavulanate, Cefdinir): 3 to 7 days.
2. Uncomplicated Upper UTI
• Outpatient: Ciprofloxacin (7 days), Levofloxacin (5 days), or Bactrim (14 days).
• Inpatient: Ceftriaxone, Cefotaxime, or Ampicillin.
• CAUTI (Catheter-Associated): Treat bacterial with antibiotics for 7 days; treat
candiduria with Fluconazole for 14 days.
• Symptom Relief: Pyridium can be given for urinary discomfort.
3. Acute Complicated Bacterial Pyelonephritis
• Action: Admit to hospital.
• Medications: * Aminoglycosides (Gentamicin/Tobramycin): Never use as
monotherapy. Dose based on renal function (trough < 2 mg/L, peak 5-10 mg/L).
Do not give to patients with Chronic Kidney Disease (CKD).
o Ampicillin or Cefazolin.
o Cefotaxime or Ceftriaxone (adjust based on obesity and pulmonary
disease).
📉 Acute Kidney Injury (AKI)
Q: What is AKI?
A: An acute loss of renal function resulting in the inability to excrete metabolic waste
products (urea nitrogen, creatinine) and maintain fluid/electrolyte balance. It typically
resolves within 3 months and is classified by etiology or the RIFLE criteria.
The RIFLE Criteria
