NRNP 6550 Final Exam 2022 - Questions And
Answers
Urine culture with UTI Ans - 100.000 colonies in asymptomatic: bacteruria
10 - 10.000 colonies in symptomatic patients but also pyuria
pyuria: more than 10 leukocytes
elevated erythrocytes with pyelonephritis
WBC in urine
false positive with tumor, urethritis and poor collection technique
Repeat in pregnant women
Lower urinary tract UTI and upper urinary tract UTI Ans - bladder and urethra:
cystitis/ urethritis/ prostatitis
kidney and ureters: pyelonephritis/ renal abcess
Uncomplicated and complicated uti Ans - Uncomplicated: in normal working
urinary tract
Complicated: defects in urinary tract or with other health problems
Common pathogens for UTI Ans - E.coli (elderly women)
Staphylococcus
proteus mirabilis (elderly men)
Klebsiella
enterecoccus
pseudomonas
Providencia (institutionalized)
Fungus: candida
Risk factors for UTI Ans - Female
critically ill
elderly
catheter (caused by biofilm)
DM
calculi, tumor, stricture
neurogenic bladder
Women:
sexual intercourse or new sex partner
pregnancy
previous UTI
Men:
prostate enlargement
prostatitis
lack of circumcision
gay
HIV
,Findings UTI Ans - Lower:
Dysuria/ urgency/ frequency/ incontinence
suprapubic pain
hematuria
fever/ chills uncommon
No flank pain
Upper:
flank pain
fever and chills
hematuria
n/v
ams (in elderly)
malaise
tachycardia/ tachypnea
Testing and results for UTI Ans - Gold standard: urine culture and sensitivity:
detection of bacteria. Start with POC: urine analysis.
UA: pos for nitrite or leukocyte or blood
CBC: leukocyte with left shift in pyelonephritis
For recurrent UTI in women or UTI in men rule out obstruction, calculi, or necrosis
with:
xr voiding
CT abdomen
US pelvis
MRI pelvis
Management acute cystitis Ans - First line:
- Single dose Fosfomycin (monurol)
- 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do not give near delivery of baby, give
cephalexin instead) or sulfa
- 5 days: nitrofurantoin, caution in elderly
Second line:
- qiunolones: ciprofloxain or levofloxacin for 3 days (not for pregnant women!)
- B-lactams: amoxi-clav, cefdinir for 3 - 7 days
Management uncomplicated upper UTI Ans - Outpt:
quinolone: ciprofloxacin for 7 days or levofloxacin for 5 days
Sulfa: trimethoprim/ sulfa (bactrim) for 14 days
Inpt:
Ceftriaxone or cefotaxime
Ampicillin
CAUTI:
bacterial: treat with AB for 7 days
Candiduria: fluconazole for 14 days
Discomfort: Pyridium
,Management acute complicated bacterial pyelonephritis Ans - - Admit
- Aminoglycosides: gentamicin/ tobramycin (not for monotherapy), based on renal
function (trough less than 2 and peak level 5-10mg/L) and do not give for CKD
- Ampicillin
- Cefazolin
- Cefotaxime and Ceftriaxon based on obesity and pulm disease
Urine analysis: glucose and ketones Ans - Serum glucose at least 180mg/dl for
glucose to appear in urine
Glucose in ua caused by:
- Fancone Syndrome (bad wall: caused by ahminoglycosides for example)
- DM
- Cushing's
- Vit C can give false negative
Ketones in urine:
- Alcohol
- Diabetic
- Starvation
Acute Kidney Injury Ans - -Acute renal function loss with inability to excrete
metabolic waste products (urea nitrogen and creatinine) to inability to maintain
fluid and electrolyte balance.
- Resolves within 3mo
- classified with RIFLE or etiology
RIFLE Ans - Risk: creatinine up x 1.5 from baseline, GFR decrease more than
25% and UO less than 0.5ml/kg/hr for 6hr
Injury: creatinine up x 2 from baseline, GFR decrease more than 50% and UO less
than 0.5ml/kg/hr for 12hr
Failure: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO
less than 0.3ml/kg/hr for 12hr or anuria for 12hr
Loss: Complete loss of renal function for more than 4 weeks
End-stage Kidney Disease: RRT need for more than 3mo
Prerenal renal failure Ans - Most often the cause of RF
- Decreased blood supply; intravascular volume depletion, vasodilatory states
- Increased tubular sodium and water reabsorption, causing: oliguria, decreased
urine sodium, high urine osmolality, increased urine specific gravity
caused by:
1. Low CO
2. Hypovolemia
, 3. RAS (renal artery stenosis)
4. aminoglycosides, NSAIDS
Result:
- low urine volume
- increased urine creatinine with normal serum creatinine
- minimal proteinuria
- serum K moderately increased
- serum phos moderately increased
- serum calcium normal
- normal renal size on US
4. Low Na+
5. Low H2O
6. High osmolality (500 and up)
7. High uric acid
8. Specific gravity: greater than 1,010
9. Urinary sodium: less than 20
10. Sediment*: 0 (hyaline casts)
11. BUN/ creat ratio: greater than 10/1
Intrarenal Ans - Cause:
- Ischemia or nephrotixic injury (rhabdo, multiple myeloma, aminoglycosides,
chemo, contrast)
- Necrosis (acute tubular necrosis ATN) (prolonged hypotension, low CO, liver
disease)
- Acute tubulointerstitial nephritis from bacterial pyelonephritis, drug-induced,
immunologic disorders
- oliguric/ anuric
- decreased urine creatinine
- no proteinuria
- serum creatinine increased
- serum K increased
- serum phos increased
- serum Calcium decreased
Low Na+
High H2O
Low osmolality (350 and less)
Specific gravity: 1,010
Urinary sodium: greater than 20
Sediment: +
BUN/ creat ratio: less than 20/1
FEna: greater than 2%
Treat: stop offending drug.
Contrast: fluid administration, pre- and post. Hold metformin before contrast, for
48hrs.
Postrenal Ans - Cause:
Urinary flow obstruction: Enlarged prostate
Answers
Urine culture with UTI Ans - 100.000 colonies in asymptomatic: bacteruria
10 - 10.000 colonies in symptomatic patients but also pyuria
pyuria: more than 10 leukocytes
elevated erythrocytes with pyelonephritis
WBC in urine
false positive with tumor, urethritis and poor collection technique
Repeat in pregnant women
Lower urinary tract UTI and upper urinary tract UTI Ans - bladder and urethra:
cystitis/ urethritis/ prostatitis
kidney and ureters: pyelonephritis/ renal abcess
Uncomplicated and complicated uti Ans - Uncomplicated: in normal working
urinary tract
Complicated: defects in urinary tract or with other health problems
Common pathogens for UTI Ans - E.coli (elderly women)
Staphylococcus
proteus mirabilis (elderly men)
Klebsiella
enterecoccus
pseudomonas
Providencia (institutionalized)
Fungus: candida
Risk factors for UTI Ans - Female
critically ill
elderly
catheter (caused by biofilm)
DM
calculi, tumor, stricture
neurogenic bladder
Women:
sexual intercourse or new sex partner
pregnancy
previous UTI
Men:
prostate enlargement
prostatitis
lack of circumcision
gay
HIV
,Findings UTI Ans - Lower:
Dysuria/ urgency/ frequency/ incontinence
suprapubic pain
hematuria
fever/ chills uncommon
No flank pain
Upper:
flank pain
fever and chills
hematuria
n/v
ams (in elderly)
malaise
tachycardia/ tachypnea
Testing and results for UTI Ans - Gold standard: urine culture and sensitivity:
detection of bacteria. Start with POC: urine analysis.
UA: pos for nitrite or leukocyte or blood
CBC: leukocyte with left shift in pyelonephritis
For recurrent UTI in women or UTI in men rule out obstruction, calculi, or necrosis
with:
xr voiding
CT abdomen
US pelvis
MRI pelvis
Management acute cystitis Ans - First line:
- Single dose Fosfomycin (monurol)
- 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do not give near delivery of baby, give
cephalexin instead) or sulfa
- 5 days: nitrofurantoin, caution in elderly
Second line:
- qiunolones: ciprofloxain or levofloxacin for 3 days (not for pregnant women!)
- B-lactams: amoxi-clav, cefdinir for 3 - 7 days
Management uncomplicated upper UTI Ans - Outpt:
quinolone: ciprofloxacin for 7 days or levofloxacin for 5 days
Sulfa: trimethoprim/ sulfa (bactrim) for 14 days
Inpt:
Ceftriaxone or cefotaxime
Ampicillin
CAUTI:
bacterial: treat with AB for 7 days
Candiduria: fluconazole for 14 days
Discomfort: Pyridium
,Management acute complicated bacterial pyelonephritis Ans - - Admit
- Aminoglycosides: gentamicin/ tobramycin (not for monotherapy), based on renal
function (trough less than 2 and peak level 5-10mg/L) and do not give for CKD
- Ampicillin
- Cefazolin
- Cefotaxime and Ceftriaxon based on obesity and pulm disease
Urine analysis: glucose and ketones Ans - Serum glucose at least 180mg/dl for
glucose to appear in urine
Glucose in ua caused by:
- Fancone Syndrome (bad wall: caused by ahminoglycosides for example)
- DM
- Cushing's
- Vit C can give false negative
Ketones in urine:
- Alcohol
- Diabetic
- Starvation
Acute Kidney Injury Ans - -Acute renal function loss with inability to excrete
metabolic waste products (urea nitrogen and creatinine) to inability to maintain
fluid and electrolyte balance.
- Resolves within 3mo
- classified with RIFLE or etiology
RIFLE Ans - Risk: creatinine up x 1.5 from baseline, GFR decrease more than
25% and UO less than 0.5ml/kg/hr for 6hr
Injury: creatinine up x 2 from baseline, GFR decrease more than 50% and UO less
than 0.5ml/kg/hr for 12hr
Failure: creatinine up x 1.5 from baseline, GFR decrease more than 25% and UO
less than 0.3ml/kg/hr for 12hr or anuria for 12hr
Loss: Complete loss of renal function for more than 4 weeks
End-stage Kidney Disease: RRT need for more than 3mo
Prerenal renal failure Ans - Most often the cause of RF
- Decreased blood supply; intravascular volume depletion, vasodilatory states
- Increased tubular sodium and water reabsorption, causing: oliguria, decreased
urine sodium, high urine osmolality, increased urine specific gravity
caused by:
1. Low CO
2. Hypovolemia
, 3. RAS (renal artery stenosis)
4. aminoglycosides, NSAIDS
Result:
- low urine volume
- increased urine creatinine with normal serum creatinine
- minimal proteinuria
- serum K moderately increased
- serum phos moderately increased
- serum calcium normal
- normal renal size on US
4. Low Na+
5. Low H2O
6. High osmolality (500 and up)
7. High uric acid
8. Specific gravity: greater than 1,010
9. Urinary sodium: less than 20
10. Sediment*: 0 (hyaline casts)
11. BUN/ creat ratio: greater than 10/1
Intrarenal Ans - Cause:
- Ischemia or nephrotixic injury (rhabdo, multiple myeloma, aminoglycosides,
chemo, contrast)
- Necrosis (acute tubular necrosis ATN) (prolonged hypotension, low CO, liver
disease)
- Acute tubulointerstitial nephritis from bacterial pyelonephritis, drug-induced,
immunologic disorders
- oliguric/ anuric
- decreased urine creatinine
- no proteinuria
- serum creatinine increased
- serum K increased
- serum phos increased
- serum Calcium decreased
Low Na+
High H2O
Low osmolality (350 and less)
Specific gravity: 1,010
Urinary sodium: greater than 20
Sediment: +
BUN/ creat ratio: less than 20/1
FEna: greater than 2%
Treat: stop offending drug.
Contrast: fluid administration, pre- and post. Hold metformin before contrast, for
48hrs.
Postrenal Ans - Cause:
Urinary flow obstruction: Enlarged prostate
