NRNP 6550 Final Questions and Answers (GradedA)

NRNP 6550 Final-
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Questions and Answers (Graded A)2022
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UrinebculturebwithbUTIb-bANSWERb100.000bcoloniesbinbasymptomatic:bbacteruria
10b-b10.000bcoloniesbinbsymptomaticbpatientsbbutbalsobpyuria
pyuria:bmorebthanb10bleukocytes
elevatedberythrocytesbwithbpyelonephritis
WBCbinburine

falsebpositivebwithbtumor,burethritisbandbpoorbcollectionbtechnique

Repeatbinbpregnantbwomen

LowerburinarybtractbUTIbandbupperburinarybtractbUTIb-
bANSWERbbladderbandburethra:bcystitis/burethritis/bprostatitis

kidneybandbureters:bpyelonephritis/brenalbabcess

Uncomplicatedbandbcomplicatedbutib-
bANSWERbUncomplicated:binbnormalbworkingburinarybtract

Complicated:bdefectsbinburinarybtractborbwithbotherbhealthbproblems

CommonbpathogensbforbUTIb-bANSWERbE.colib(elderlybwomen)
Staphylococcus
proteusbmirabilisb(elderlybmen)
Klebsiella
enterecoccus
pseudomonas
Providenciab(institutionalized)
Fungus:bcandida

RiskbfactorsbforbUTIb-bANSWERbFemale
criticallybill
elderly
catheterb(causedbbybbiofilm)
DM
calculi,btumor,bstricture
neurogenicbbladder
Women:
sexualbintercourseborbnewbsexbpartner
pregnancy
previousbUTI
Men:
prostatebenlargement
prostatitis
lackbofbcircumcision

,NRNP 6550 Final-
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Questions and Answers (Graded A)2022
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gay
HIV

FindingsbUTIb-bANSWERbLower:
Dysuria/burgency/bfrequency/bincontinence
suprapubicbpain
hematuria
fever/bchillsbuncommon
Nobflankbpain

Upper:
flankbpain
feverbandbchills
hematuria
n/v
amsb(inbelderly)
malaise
tachycardia/btachypnea

TestingbandbresultsbforbUTIb-
bANSWERbGoldbstandard:burinebculturebandbsensitivity:bdetectionbofbbacteria.bStartbwithbP

OC:burinebanalysis.
UA:bposbforbnitriteborbleukocyteborbblood
CBC:bleukocytebwithbleftbshiftbinbpyelonephritis
ForbrecurrentbUTIbinbwomenborbUTIbinbmenbruleboutbobstruction,bcalculi,borbnecrosisbwith:
xrbvoiding
CTbabdomen
USbpelvis
MRIbpelvis

Managementbacutebcystitisb-bANSWERbFirstbline:
-bSinglebdosebFosfomycinb(monurol)
-
b3bday:bsulfa:btrimethoprim/bsulfab(bactrim)b(dobnotbgivebnearbdeliverybofbbaby,bgivebcephale

xinbinstead)borbsulfa
-b5bdays:bnitrofurantoin,bcautionbinbelderly

Secondbline:
-bqiunolones:bciprofloxainborblevofloxacinbforb3bdaysb(notbforbpregnantbwomen!)
-bB-lactams:bamoxi-clav,bcefdinirbforb3b-b7bdays

ManagementbuncomplicatedbupperbUTIb-bANSWERbOutpt:
quinolone:bciprofloxacinbforb7bdaysborblevofloxacinbforb5bdays
Sulfa:btrimethoprim/bsulfab(bactrim)bforb14bdays

,NRNP 6550 Final-
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Questions and Answers (Graded A)2022
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Inpt:b
Ceftriaxoneborbcefotaximeb
Ampicillin

CAUTI:
bacterial:btreatbwithbABbforb7bdays
Candiduria:bfluconazolebforb14bdays

Discomfort:bPyridium

Managementbacutebcomplicatedbbacterialbpyelonephritisb-bANSWERb-bAdmit
-
bAminoglycosides:bgentamicin/btobramycinb(notbforbmonotherapy),bbasedbonbrenalbfunctio

nb(troughblessbthanb2bandbpeakblevelb5-10mg/L)bandbdobnotbgivebforbCKD
-bAmpicillin
-bCefazolin
-bCefotaximebandbCeftriaxonbbasedbonbobesitybandbpulmbdisease

Urinebanalysis:bglucosebandbketonesb-
bANSWERbSerumbglucosebatbleastb180mg/dlbforbglucosebtobappearbinburine




Glucosebinbuabcausedbby:
-bFanconebSyndromeb(badbwall:bcausedbbybahminoglycosidesbforbexample)
-bDMb
-bCushing's
-bVitbCbcanbgivebfalsebnegative

Ketonesbinburine:
-bAlcoholb
-bDiabetic
-bStarvation

AcutebKidneybInjuryb-bANSWERb-
Acutebrenalbfunctionblossbwithbinabilitybtobexcretebmetabolicbwastebproductsb(ureabnitrogenb
andbcreatinine)btobinabilitybtobmaintainbfluidbandbelectrolytebbalance.
-bResolvesbwithinb3mo
-bclassifiedbwithbRIFLEborbetiology

RIFLEb-
bANSWERbRisk:bcreatininebupbxb1.5bfrombbaseline,bGFRbdecreasebmorebthanb25%bandbU

Oblessbthanb0.5ml/kg/hrbforb6hr

, NRNP 6550 Final-
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Questions and Answers (Graded A)2022
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Injury:bcreatininebupbxb2bfrombbaseline,bGFRbdecreasebmorebthanb50%bandbUOblessbthanb0
.5ml/kg/hrbforb12hr

Failure:bcreatininebupbxb1.5bfrombbaseline,bGFRbdecreasebmorebthanb25%bandbUOblessbtha
nb0.3ml/kg/hrbforb12hrborbanuriabforb12hr

Loss:bCompleteblossbofbrenalbfunctionbforbmorebthanb4bweeks

End-stagebKidneybDisease:bRRTbneedbforbmorebthanb3mo

Prerenalbrenalbfailureb-bANSWERbMostboftenbthebcausebofbRF

-bDecreasedbbloodbsupply;bintravascularbvolumebdepletion,bvasodilatorybstates
-
bIncreasedbtubularbsodiumbandbwaterbreabsorption,bcausing:boliguria,bdecreasedburinebsod

ium,bhighburinebosmolality,bincreasedburinebspecificbgravity

causedbby:
1.bLowbCO
2.bHypovolemia
3.bRASb(renalbarterybstenosis)
4.baminoglycosides,bNSAIDS

Result:
-blowburinebvolume
-bincreasedburinebcreatininebwithbnormalbserumbcreatinine
-bminimalbproteinuria
-bserumbKbmoderatelybincreased
-bserumbphosbmoderatelybincreased
-bserumbcalciumbnormal
-bnormalbrenalbsizebonbUS
4.bLowbNa+
5.bLowbH2O
6.bHighbosmolalityb(500bandbup)
7.bHighburicbacid
8.bSpecificbgravity:bgreaterbthanb1,010
9.bUrinarybsodium:blessbthanb20
10.bSediment*:b0b(hyalinebcasts)
11.bBUN/bcreatbratio:bgreaterbthanb10/1

Intrarenalb-bANSWERbCause:
-
bIschemiaborbnephrotixicbinjuryb(rhabdo,bmultiplebmyeloma,baminoglycosides,bchemo,bcont

rast)