NSG 550 Exam 1: (Latest 2026/2027 Update) Lab Values & Diagnostic
Interpretation | Q&A | Grade A | 100% Correct (Verified Answers) –
Nursing Program
Subject: NSG 550 – Advanced Pathophysiology / Diagnostic Interpretation
Source: NSG 550 Exam 1 Blueprint 2026/2027 Format: Q&A Guide with Rationale | Verified Grade A
1. What is the normal pH range for urine?
Correct Answer: 4.6 to 8.0
1. Urine pH varies based on diet, medications, and acid-base status. Acidic urine (<5.5) with metabolic acidosis; alkaline
urine (>7.0) with UTI (urease-producing bacteria) or metabolic alkalosis.
2. Normal range 4.6-8.0 reflects kidneys' ability to excrete acids/bases.
3. Prolonged highly acidic urine increases risk of uric acid stones; alkaline urine increases calcium phosphate stone risk.
2. What is the normal range for protein in urine?
Correct Answer: 0-8 mg/dL or 50-80 mg/24 hours (at rest)
1. Normal urine protein <150 mg/24h; transient proteinuria can occur with fever, exercise, or stress.
2. Persistent proteinuria indicates glomerular disease (e.g., glomerulonephritis, diabetes nephropathy).
3. Microalbuminuria (30-300 mg/24h) is earliest sign of diabetic nephropathy.
3. What is the normal specific gravity of urine in adults?
Correct Answer: 1.005 to 1.030
1. Specific gravity measures urine concentration ability. Low (<1.010) with water loading, DI, or renal failure. High
(>1.030) with dehydration, SIADH, glycosuria.
2. Fixed specific gravity (~1.010) indicates loss of concentrating ability (chronic kidney disease).
3. First morning specimen most concentrated (normally >1.020).
4. What is the normal specific gravity of urine in a newborn baby?
Correct Answer: 1.001 to 1.020
1. Newborns have limited concentrating ability due to immature renal tubules; specific gravity lower than adults.
2. By age 3-6 months, concentrating ability approaches adult levels.
3. Monitor for dehydration in infants (lowest concentration capacity).
5. What happens to urine specific gravity in SIADH?
Correct Answer: Elevated (concentrated urine, >1.030)
1. SIADH causes inappropriate ADH release → water retention → concentrated urine with low serum sodium.
2. Urine osmolality >100 mOsm/kg (inappropriately high) despite hyponatremia.
3. Treatment: fluid restriction, demeclocycline, vaptans.
6. What happens to urine specific gravity in diabetes insipidus?
Correct Answer: Decreased (dilute urine, <1.005)
1. Diabetes insipidus: ADH deficiency (central) or resistance (nephrogenic) → inability to concentrate urine.
2. Urine output 4-20 L/day with specific gravity <1.005, osmolality <300.
3. Water deprivation test confirms diagnosis; desmopressin (DDAVP) for central DI.
, 7. What urine leukocyte esterase level indicates a UTI?
Correct Answer: >100,000 CFU/mL (positive leukocyte esterase suggests pyuria)
1. Leukocyte esterase is an enzyme in WBCs; positive test indicates pyuria (>10 WBC/hpf).
2. Positive leukocyte esterase + nitrites (gram-negative bacteria) strongly suggests UTI.
3. Urine culture confirms diagnosis; >100,000 CFU/mL is diagnostic for significant bacteriuria.
8. What does the presence of ketones in urine indicate?
Correct Answer: Poorly controlled diabetes mellitus, hyperglycemia, infection, ketoacidosis related to alcoholism,
fasting, aspirin toxicity, or anesthesia
1. Ketones form when fatty acids are metabolized due to insufficient insulin (DKA) or starvation.
2. DKA: glucose >250, positive ketones, pH <7.35, anion gap >12.
3. Alcoholic ketoacidosis: history of heavy alcohol use, poor intake, vomiting; glucose normal or low.
9. What is the normal range for urine urobilinogen?
Correct Answer: 0.01 to 1.0 mg/dL
1. Urobilinogen is formed from bilirubin by gut bacteria. Alkaline urine: higher levels; acidic urine: lower levels.
2. Increased urobilinogen: hemolysis, hepatitis, cirrhosis. Decreased/absent: biliary obstruction (dark urine, light stools).
3. Absent urobilinogen with bilirubinuria suggests obstructive jaundice.
10. What do hyaline or granular casts in urine indicate?
Correct Answer: Strenuous exercise (hyaline casts) or granular casts indicate nonspecific renal injury
1. Hyaline casts are normal in small numbers after exercise, fever, or dehydration.
2. Granular casts suggest chronic kidney disease or acute tubular necrosis (ATN).
3. Fine granular casts (dirty brown) seen in ATN; coarse granular casts in chronic renal disease.
11. What do fatty casts in urine indicate?
Correct Answer: Glomerular disease (nephrotic syndrome)
1. Fatty casts contain lipid droplets; associated with nephrotic syndrome (proteinuria >3.5 g/day, hypoalbuminemia,
edema).p>2. Oval fat bodies (lipid-laden tubular cells) often accompany fatty casts.
3. Causes: minimal change disease, FSGS, membranous nephropathy, diabetic nephropathy.
12. What do waxy casts in urine indicate?
Correct Answer: Chronic renal disease (chronic kidney disease, advanced renal failure)
1. Waxy casts are broad, brittle, with high refractive index; indicate tubular atrophy and fibrosis.
2. Associated with advanced chronic kidney disease (CKD stage 4-5).
3. Broad waxy casts indicate severe tubular damage; poor prognosis.
13. What do epithelial (renal tubular) casts indicate?
Correct Answer: Renal tubular disease or toxicity (acute tubular necrosis, interstitial nephritis)
1. Renal tubular epithelial cells (RTECs) slough into urine in ATN, drug toxicity (aminoglycosides, contrast), or heavy
metals.
2. Seen in ischemic or nephrotoxic ATN; often associated with granular casts and muddy brown granular casts.
3. Urine sediment finding helps differentiate prerenal azotemia (hyaline casts) from intrinsic renal failure (RTEC casts).
14. What is the normal glucose level in a 24-hour urine specimen?
Correct Answer: 50-300 mg/24 hours (0.3-1.7 mmol/24 hours)
1. Urine glucose normally negative; glycosuria occurs when blood glucose exceeds renal threshold (~180 mg/dL).
2. 24-hour urine glucose used to quantify glucose loss in renal glycosuria or monitor diabetic control (rare).p>3. False
positive: some medications (cephalosporins, salicylates).
Interpretation | Q&A | Grade A | 100% Correct (Verified Answers) –
Nursing Program
Subject: NSG 550 – Advanced Pathophysiology / Diagnostic Interpretation
Source: NSG 550 Exam 1 Blueprint 2026/2027 Format: Q&A Guide with Rationale | Verified Grade A
1. What is the normal pH range for urine?
Correct Answer: 4.6 to 8.0
1. Urine pH varies based on diet, medications, and acid-base status. Acidic urine (<5.5) with metabolic acidosis; alkaline
urine (>7.0) with UTI (urease-producing bacteria) or metabolic alkalosis.
2. Normal range 4.6-8.0 reflects kidneys' ability to excrete acids/bases.
3. Prolonged highly acidic urine increases risk of uric acid stones; alkaline urine increases calcium phosphate stone risk.
2. What is the normal range for protein in urine?
Correct Answer: 0-8 mg/dL or 50-80 mg/24 hours (at rest)
1. Normal urine protein <150 mg/24h; transient proteinuria can occur with fever, exercise, or stress.
2. Persistent proteinuria indicates glomerular disease (e.g., glomerulonephritis, diabetes nephropathy).
3. Microalbuminuria (30-300 mg/24h) is earliest sign of diabetic nephropathy.
3. What is the normal specific gravity of urine in adults?
Correct Answer: 1.005 to 1.030
1. Specific gravity measures urine concentration ability. Low (<1.010) with water loading, DI, or renal failure. High
(>1.030) with dehydration, SIADH, glycosuria.
2. Fixed specific gravity (~1.010) indicates loss of concentrating ability (chronic kidney disease).
3. First morning specimen most concentrated (normally >1.020).
4. What is the normal specific gravity of urine in a newborn baby?
Correct Answer: 1.001 to 1.020
1. Newborns have limited concentrating ability due to immature renal tubules; specific gravity lower than adults.
2. By age 3-6 months, concentrating ability approaches adult levels.
3. Monitor for dehydration in infants (lowest concentration capacity).
5. What happens to urine specific gravity in SIADH?
Correct Answer: Elevated (concentrated urine, >1.030)
1. SIADH causes inappropriate ADH release → water retention → concentrated urine with low serum sodium.
2. Urine osmolality >100 mOsm/kg (inappropriately high) despite hyponatremia.
3. Treatment: fluid restriction, demeclocycline, vaptans.
6. What happens to urine specific gravity in diabetes insipidus?
Correct Answer: Decreased (dilute urine, <1.005)
1. Diabetes insipidus: ADH deficiency (central) or resistance (nephrogenic) → inability to concentrate urine.
2. Urine output 4-20 L/day with specific gravity <1.005, osmolality <300.
3. Water deprivation test confirms diagnosis; desmopressin (DDAVP) for central DI.
, 7. What urine leukocyte esterase level indicates a UTI?
Correct Answer: >100,000 CFU/mL (positive leukocyte esterase suggests pyuria)
1. Leukocyte esterase is an enzyme in WBCs; positive test indicates pyuria (>10 WBC/hpf).
2. Positive leukocyte esterase + nitrites (gram-negative bacteria) strongly suggests UTI.
3. Urine culture confirms diagnosis; >100,000 CFU/mL is diagnostic for significant bacteriuria.
8. What does the presence of ketones in urine indicate?
Correct Answer: Poorly controlled diabetes mellitus, hyperglycemia, infection, ketoacidosis related to alcoholism,
fasting, aspirin toxicity, or anesthesia
1. Ketones form when fatty acids are metabolized due to insufficient insulin (DKA) or starvation.
2. DKA: glucose >250, positive ketones, pH <7.35, anion gap >12.
3. Alcoholic ketoacidosis: history of heavy alcohol use, poor intake, vomiting; glucose normal or low.
9. What is the normal range for urine urobilinogen?
Correct Answer: 0.01 to 1.0 mg/dL
1. Urobilinogen is formed from bilirubin by gut bacteria. Alkaline urine: higher levels; acidic urine: lower levels.
2. Increased urobilinogen: hemolysis, hepatitis, cirrhosis. Decreased/absent: biliary obstruction (dark urine, light stools).
3. Absent urobilinogen with bilirubinuria suggests obstructive jaundice.
10. What do hyaline or granular casts in urine indicate?
Correct Answer: Strenuous exercise (hyaline casts) or granular casts indicate nonspecific renal injury
1. Hyaline casts are normal in small numbers after exercise, fever, or dehydration.
2. Granular casts suggest chronic kidney disease or acute tubular necrosis (ATN).
3. Fine granular casts (dirty brown) seen in ATN; coarse granular casts in chronic renal disease.
11. What do fatty casts in urine indicate?
Correct Answer: Glomerular disease (nephrotic syndrome)
1. Fatty casts contain lipid droplets; associated with nephrotic syndrome (proteinuria >3.5 g/day, hypoalbuminemia,
edema).p>2. Oval fat bodies (lipid-laden tubular cells) often accompany fatty casts.
3. Causes: minimal change disease, FSGS, membranous nephropathy, diabetic nephropathy.
12. What do waxy casts in urine indicate?
Correct Answer: Chronic renal disease (chronic kidney disease, advanced renal failure)
1. Waxy casts are broad, brittle, with high refractive index; indicate tubular atrophy and fibrosis.
2. Associated with advanced chronic kidney disease (CKD stage 4-5).
3. Broad waxy casts indicate severe tubular damage; poor prognosis.
13. What do epithelial (renal tubular) casts indicate?
Correct Answer: Renal tubular disease or toxicity (acute tubular necrosis, interstitial nephritis)
1. Renal tubular epithelial cells (RTECs) slough into urine in ATN, drug toxicity (aminoglycosides, contrast), or heavy
metals.
2. Seen in ischemic or nephrotoxic ATN; often associated with granular casts and muddy brown granular casts.
3. Urine sediment finding helps differentiate prerenal azotemia (hyaline casts) from intrinsic renal failure (RTEC casts).
14. What is the normal glucose level in a 24-hour urine specimen?
Correct Answer: 50-300 mg/24 hours (0.3-1.7 mmol/24 hours)
1. Urine glucose normally negative; glycosuria occurs when blood glucose exceeds renal threshold (~180 mg/dL).
2. 24-hour urine glucose used to quantify glucose loss in renal glycosuria or monitor diabetic control (rare).p>3. False
positive: some medications (cephalosporins, salicylates).
